Fla. Admin. Code tit. 65 | Fla. Admin. Code Title 65 — Department of Children and Families

Division 65K Adult Human Trafficking

Chapter 65K-1 ADULT SAFE HOUSE CERTIFICATION

Fla. Admin. Code R. 65K-1.001 Definitions

(1) “Administrator” means the full-time employee who is responsible for the overall operation and day-to-day management of a certified adult safe house.

(2) “Adult Safe House” as defined in Section 402.881, F.S.

(3) “Case Management” means the process of coordinating, managing, supporting, and implementing services and tasks in accordance with the care plan.

(4) “Certification” means the Department’s formal recognition that an adult safe house meets the minimum standards set forth in Section 402.881, F.S., and these rules.

(5) “Change of Ownership” means when the licensee sells or otherwise transfers majority of ownership interest of the adult safe house to a different individual or entity. A change in governing body is not a change of ownership.

(6) “Emergency Housing” means an adult safe house that provides immediate safety in a temporary shelter to individuals seeking refuge from human trafficking.

(7) “Governing Body” also known as the “Governing Board” means the board of trustees, the partnership, the corporation, the association, or the person or group of persons who maintain and control the adult safe house organization and which is responsible for the operation of the certified adult safe house.

(8) “Human Trafficking” as defined in Section 787.06, F.S.

(9) “Human Trafficking Advocate” means a designated individual working on behalf of, and at the direction of, a certified adult safe house whose primary purpose is to provide advice, counseling, or services to human trafficking residents and who has been identified by the adult safe house as an individual who may assert a claim to privileged communications with residents in an adult safe house under Section 402.881, F.S.

(10) “Owner” means an individual or corporation who has the legal or rightful ownership of the adult safe house.

(11) “Residential Housing” means an adult safe house that provides programming to support residents with services and shelter in an adult safe house on a long-term basis. Residential Housing does not include private residences of victims who reside with known relatives, friends, or through formal lease agreements or property ownership.

(12) “Transitional Housing” means an adult safe house that provides temporary housing to support residents in living independently in an adult safe house as they transition to permanent housing. Transitional housing does not include private residences of victims who reside with known relatives, friends, or through formal lease agreements or property ownership.

(13) “Trauma-informed” means creating a safe and therapeutic environment for residents in the adult safe house, recognizing and acknowledging the impact of trauma, using survivor-centered services that avoid re-traumatization, and integrating trauma awareness.

(14) “Volunteer” means unpaid staff members or individuals who provide direct and indirect services to those seeking and receiving services from an adult safe house.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.002 Application and Certification Process

(1) Application.

(a) Application for certification must be made on form “Application for Adult Safe House Certification” CF 1956, (June 2025), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18186. The application must be signed by the owner.

(b) The applicant may be a for-profit or not-for-profit.

(2) Certification.

(a) Certification is valid for two years from the date it was issued.

(b) Certification is non-transferable and valid only for the adult safe house listed on the certificate issued by the Department for each individual site.

(d) Prior to the issuance of a certification and annually thereafter, the adult safe house must be inspected by a representative from the Department. The inspection includes an assessment of the adult safe house’s ability to implement and maintain the certification standards. The Department must complete an on-site inspection when a complaint or concern rises to the level for potential violation of certification standards. The adult safe house must cooperate with the Department during all inspections.

(3) The adult safe house may not retain a person as a board member, director, or officer if that person served as a board member, director, or officer of an agency subject to licensure or certification by the Department and failed to secure a license or certification to operate and continued to operate after the revocation or suspension of the agency’s license or certification or if the reason for non-certification is directly related to their responsibilities. An exemption from this prohibition may be requested from the Department after two years from the most recent disqualifying event.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.003 Administration and Organization

(1) Statement of Purpose and Program Description. The adult safe house must have a written statement of purpose describing the core values, mission, services the adult safe house provides, methods of service delivery, and a description of the program that outlines if serving females or males, and if minors are allowed to accompany their caregiver in the adult safe house.

(2) Business Registration. The owner of the adult safe house must be registered to conduct business under the Division of Corporations in Florida.

(3) Geographic Coverage. The adult safe house must provide a description of the geographic area the adult safe house intends to serve, to include if admitting residents from a specific county, region, statewide or national level.

(4) Governing Body.

(a) Each adult safe house shall have a governing body.

(b) The adult safe house must maintain a list of the members of its governing body and must not be fewer than three members. This list must be available to the Department and must:

Include the name and term of each member; and
Identify each office and the term of that office.

(d) Responsibilities of the governing body must include the following:

Review matters affecting the care and services to residents.
Evaluate in writing the administrator’s performance annually.
Approve the annual budget of anticipated income and expenditures necessary to provide the services described in its statement of purpose. The governing body must also approve the annual financial audit report.
Maintain written minutes of all meetings, which must be available to the Department upon request.

(e) Members of the governing body may review and recommend changes to the operational policies and procedures.

(f) Members of the governing body must not have a proprietary interest in the adult safe house program and shall not be the owner or a family member of the owner of the adult safe house.

(g) Undergo level 2 background screenings pursuant to Chapter 435, F.S., and training pursuant to paragraph 65K-1.008(4)(e), F.A.C., as a condition of membership on the governing board.

(h) Confidentiality.

Adhere to the confidentiality policies of the adult safe house. The governing body shall not have access to resident names or files maintained by the adult safe house.
In the event there are legal or financial implications on the organization, the governing body can access resident files that have unique identification numbers for the resident’s name.

(5) Organizational Chart.

(a) The adult safe house must maintain a current organizational chart showing the administrative structure including the lines of authority.

(b) The adult safe house must maintain an employee roster that must be provided to the Department annually and upon request.

(c) The adult safe house must provide written notification to the Department 30 days prior to changing the administrator. The adult safe house must notify the Department within 24 hours after the administrator is terminated in circumstances that require immediate action.

(d) A change in ownership requires the submission of a new application for certification within five business days of the individual or entity aquiring ownership.

(6) Accreditation. If the adult safe house is accredited, a copy must be provided to the Department.

(7) Financial Ability. The adult safe house must provide written documentation of financial ability to operate at the time of application submission and when requested by the Department.

(a) Initial Operational Expenses. Adult safe houses seeking an initial certification must provide evidence of sufficient funding to operate for at least six months. The six months of funding is calculated based on the projected expenditures in the annual budget submitted at the time of initial certification.

(b) Annual budget. The adult safe house must provide the Department with an annual budget of anticipated income and expenditures necessary to provide the services described in its statement of purpose.

Financial audits are required for adult safe houses that expend equal to or in excess of $750,000 of state financial assistance, as outlined in Section 215.97, F.S. Annual audits must be conducted by an independent certified public accountant (CPA) licensed pursuant to Chapter 473, F.S.
Adult safe houses that do not meet the audit threshold must provide proof a financial review was conducted by an external auditor or by an independent certified public accountant (CPA) licensed pursuant to Chapter 473, F.S. The external auditor shall not have a proprietary interest in the adult safe house agency or program and must sign and attest that there is no conflict of interest.

(d) If fees for services are charged, the adult safe house shall have a fee schedule.

The schedule shall clearly list the specific services covered by each fee.
The fee schedule shall be given to each resident.
A copy of the fee schedule shall be filed with the Department. The adult safe house must submit a copy of any updates made to the fee schedule during the certification year within 30 days of the changes.

(e) If funding is obtained through public solicitation, a charitable permit for such solicitation must be obtained as required by Chapter 496, F.S.

(8) Insurance Coverage. The adult safe house must obtain liability insurance, and assess the potential risks associated with the delivery of services to determine the amount of coverage necessary.

(9) Community Support.

(a) The adult safe house shall establish partnerships with local service providers, legal organizations, and healthcare providers to provide a comprehensive range of support services and ensure ongoing collaboration with community agencies to support and expand the service array available to residents.

(b) If there is a local human trafficking task force or human trafficking coalition, the adults safe house must participate, and provide documentation to the Department through attendance records from meetings.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.004 Operating Policies and Procedures

(1) Policies and procedures set forth in this rule must be available for qualitative review by the Department prior to initial certification. Any policies or procedures that are updated during the certification year must be submitted during recertification or 30 days prior to implementation of the new policy if proposed change results in substantial changes that alters the original direction or intent to the programming of the adult safe house.

(2) Written policies and procedures must be available to all employees and volunteers upon their beginning date of employment or service, and thereafter as revised. Employees and volunteers must indicate in writing prior to unsupervised contact with residents that they have read and understand the policies and procedures relevant to their position or volunteer duties, which must be documented in their personnel file.

(3) The adult safe house must provide residents with a copy of the policies and procedures.

(4) The adult safe house must develop and implement written policies and procedures that ensure compliance with provisions of this rule chapter, and Section 402.881, F.S., and requires the adult safe house and governing body to provide a therapeutic environment that is trauma-informed.

(5) Written policies and procedures must be developed and complied with to address the following:

(a) Admission. Must identify who is eligible for services and how those services are accessed. Prospective residents must be informed of the admission criteria, and if ineligible, referred to other organizations that can aid the resident.

(b) Communicable Disease Prevention and Preparedness. Outline measures to prevent the spread of a disease to include accommodations for visitation at the adult safe house, capacity restrictions and emergency staffing plans to support ratio through the recruitment of volunteers, and safety measures for residents and staff.

(c) Grievance. Guidance on the grievance process that is clear and developmentally appropriate for all residents. The adult safe house must indicate timeframes for responding to the grievance, escalation process for residents, and steps to take when the grievance involves an employee or volunteer. The policy must also include grievance procedures for staff.

(d) Emergency Management Plan. A comprehensive and effective plan to ensure the safety and well-being of employees, volunteers, and residents in the event of an emergency. The adult safe house must annually review and update the plan. A current plan must be maintained by the adult safe house and made available for inspection upon request. The emergency management plan must address the following:

Emergencies that may be reasonably expected in the adult safe house. Examples include natural or manmade disasters such as hurricanes or tornados; contamination of the air, ground, water, or food; fire; public health hazards such as outbreak of communicable diseases; significant incidents such as resident death or injury; security incidents such as intruders, hostage situations, kidnapping, or workplace violence; human acts that may jeopardize the health, safety, or welfare of employees, volunteers, or participants; or shelter-in-place that requires the house to lockdown.
Procedures for reporting emergencies or incidents.
Procedures to implement the plan and personnel notification; delegations of authority and lines of succession.
Identification of alternative facilities; procedures for evacuation, including type of evacuation and exit route assignments.
Procedures to account for all staff members and participants; and identification and protection of records and databases.

(e) Confidentiality. Maintaining the confidentiality and privacy of residents, personnel, and resident records.

The adult safe house must also ensure that residents, employees and volunteers receive written information on the restrictions relating to the disclosure of information about residents and the location of the adult safe house. Residents shall be provided with written documentation prior to or at the time of admission. Employees and volunteers must be provided with the restrictions prior to or at the time of hire.
Residents shall not participate in fundraising and sharing their stories if they are residing at the adult safe house or receiving services from the program.
The policy must outline the requirement for a signed consent form to allow for sharing of images, personal stories, and participation in fundraising efforts for former residents that are no longer in the program.
Data and information shared must be accurate, validated and align with confidentially laws and procedures.

(f) Abuse and Neglect Reporting. The requirement of any employee or volunteer who knows or has reason to suspect that a vulnerable child or adult is abused or neglected, must report such knowledge or suspicion to the Department’s Abuse Hotline. Policy should outline training requirements and acknowledgement forms.

(g) Personnel Policies. Must include the following:

Provisions for newly hired staff members to accompany trained staff until new staff members complete pre-service training requirements;
Annual evaluation of the work and performance of each staff member, which includes provisions for employee participation in the evaluation process;
Background screening, ratio and use of volunteers; and
When staff are named in an active abuse and neglect investigation with the Department.

(h) Service Delivery. Requirement to provide services with a trauma-informed, survivor-centered, culturally sensitive approach to ensure each resident’s unique needs are met in a safe and therapeutic environment. The policy must outline the trauma-informed model used by the adult safe house. If providing a 24-hour hotline, the adult safe house must develop procedures on responding to calls, linking individuals to services, assessing for immediate danger, and ensuring confidentiality pursuant to paragraph (e) of this subsection.

(i) Serving Families. If serving families with minor children, procedures must detail room sharing, child-care, child assessments, service delivery, and schooling requirements.

(j) Case Management. Documentation for case management staffing’s, facilitation, and development of a care plan that is created with input from the resident.

(k) Interpreters, Translators and Language Options. Identify and assess the language needs of each resident and provide the following, as needed:

A range of oral and written language assistance options, including American Sign Language;
Written materials in languages other than English; and
Oral language interpretation for residents with limited English proficiency.

(l) Discharge and Aftercare. Discharge planning and aftercare services must be offered, specify the availability of services, and identify the staff member or agency responsible for follow-up and implementation of the plan. Policy must also specify that there is no requirement for residents to participate.

(m) Fee for Service. Description of the relationships between fees and services provided and the conditions under which fees are charged and waived. The policy must outline the agency’s requirement to provide referrals for individuals when fees for service are not waived.

(n) Employee and Resident Code of Conduct. Maintaining boundaries, refraining from personal relationships with residents, and corrective action to address misconduct.

(o) Quality Control. Outline a critical review process to review continuous quality improvement outcomes and implementing a plan for changes, as needed, to staffing, policies, and services, which include improving quality and timeliness of service delivery.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.005 Housing Standards

(1) Compliance with Local Codes. Adult safe houses must comply with all local codes and provide written proof of compliance to the Department.

(a) Safety and Sanitation Inspection. Prior to the issuance of a certification or to recertify, the adult safe house must be inspected by a representative from the Department using the “Adult Safe House Health Inspection Checklist” form CF 1958, (June 2025), which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18187. Written approval of satisfactory safety and sanitation conditions must be on file.

(b) Fire Inspection. Adult safe houses must ensure that a fire safety inspection, which conforms to fire safety standards as determined by each municipality, county, and special district with fire safety responsibilities, is conducted annually.

(d) Local Zoning. Adult safe houses must notify local zoning office at time of initial certification of the intent to provide residential services to adults experiencing trauma.

(2) Buildings, Grounds, and Interior Accommodations.

(a) Design, Construction, and Accessibility. The design and construction of new adult safe houses or renovations to an existing adult safe house must meet the minimum requirements of the applicable state and local governing agencies.

(b) Adult safe houses must have proper illumination and ventilation. All interior areas occupied by residents must be temperature-controlled in a manner conducive to comfort, safety, and privacy.

If serving children, adult safe houses with swimming pools, spas or near open water hazards must have lifesaving equipment available and accessible in case of an emergency.
If an outside play area is made available for children, the area must be free of debris and broken or dangerous materials and must be routinely checked for safety. Play areas must be fenced in accordance with local ordinances to prevent access by children to all water hazards within or adjacent to outdoor play areas, such as pools, ditches, retention, and fishponds.

(d) Interior Accommodations.

The adult safe house must be furnished to create a homelike environment.
A common area should be available for the informal use of the residents, to include an area large enough to accommodate the number of residents who reside in the adult safe house.
If offices for administrative functions are co-located in the house, they must be separate from the living and sleeping area.
There must be adequate space to allow human trafficking advocates and residents to talk privately and without interruption.
Bathrooms must be in working condition with water and electricity and include locking mechanism on the entry door for privacy.
Bedrooms.

a. The adult safe house must provide each resident with storage for clothing and personal belongings, which must be reserved solely for the individual to use. Residents shall have access to their personal belongings at all times unless otherwise considered contraband or unsafe to residents.

b. Adult safe houses must provide each resident with a safe, permanent, and comfortable bed and mattress in good repair. Clean sheets, pillows, pillowcases, and blankets must be provided to each resident upon arrival.

c. Children accompanying their caregiver to the adult safe house must be provided with their own bed or crib that is appropriate for the child’s age.

d. The adult safe house must arrange for the residents and their children to have their own room, separate from other residents. The adult safe house may allow for multiple families to share a room when an assessment deems it appropriate, and the families agree to sharing a room. Families that share rooms shall be responsible for the supervision and care of their own children.

e. Residents shall have the right to keep their bedroom door closed. The adult safe house may inspect the bedroom when there are concerns of safety or suspected contraband. If the adult safe house allows for locks on doors, staff must have a key to enter when there is an emergency. Adult safe houses that do not allow for locks, must have signs on the bedroom door that allow residents to use for privacy.

Laundry. Laundry rooms must be available to residents and located in an area separate from areas occupied by residents.

(3) Safety, Security, and Food Service Requirements. The adult safe house must take precautionary measures to provide for the safety and well-being of residents.

(a) Safety.

A route of evacuation must be posted in conspicuous places in the event of a fire and other emergency situations. The route must be reviewed with staff and residents according to the adult safe house’s policy. The evacuation map must include the following:

a. Clearly identify all exits of the house, i.e. doors, windows;

b. Identify the location of any emergency equipment, such as fire extinguishers or first aid kits; and

c. Identify safe assembly points in the event of an evacuation.

Transportation. Vehicles used to transport residents must be maintained in a safe operating condition. The number of persons in a vehicle used to transport residents must not exceed the number of available seats; appropriate restraining devices must be used when transporting residents in vehicles. All vehicles shall be fully insured to transport residents and all staff operating vehicles must have a valid divers license.
Methods of Communication. The adult safe house must have communication access available for use in the house at all times by staff and residents. The adult safe house may limit access to communication in accordance with the resident’s care plan, when applicable.

a. Methods of communication may include mobile or landline telephones, computers for video communication or conferencing, or mobile devices equipped to make phone calls.

b. Emergency numbers, such as 911, poison control, Florida Abuse Hotline, Florida Human Trafficking Hotline, and local law enforcement agencies must be posted in a clear and conspicuous location in the adult safe house.

Communicable Disease Prevention and Preparedness. In the event of a pandemic, epidemic or outbreak, the adult safe house must utilize resources issued by the Florida Department of Health (DOH).
Adult safe house must follow the emergency management plan developed to address the safety of staff and residents and the directives of its local emergency management center.
The adult safe house must maintain ongoing communication with the Department throughout an evacuation until their safe return.
The adult safe house must notify the Department within 24 hours upon learning of any structural damages to the property or building that effect the safety of residents. The adult safe house must submit a written plan to the Department within 48 hours of notification outlining their plan for resident safety, including when the damages will be corrected.
Grievance. The adult safe house must post the grievance procedure, which allows the residents and staff to make complaints anonymously without fear of retaliation. The information should be prominently posted in areas frequented by the residents and where it can be read without scrutiny. The procedure must be explained to the residents at the time of admission and staff at time of hire. Copies of grievances must be provided to the Department upon request.
Incident Reporting. The adult safe house must submit the “Incident Reporting” form CF 1959, (June 2025), which is herein incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18188, to the Department as soon as practical, and in no event more than 24 hours after an incident outlined in the form has occurred.
Resident’s Rights. The adult safe house must post any laws and policies that protect the rights of residents in a common area.

(b) Food and Nutrition. If the adult safe house serves meals, three well-balanced meals a day must be offered in the morning, noon, and evening. The adult safe house must prepare meals according to an individual’s special dietary requirements.

Coordination with Law Enforcement. The adult safe house must inform the local law enforcement agency within the county or city of its intent to establish a secure house for residents and provide the law enforcement agency with a method for making referrals for admission and services. The adult safe house may only disclose the location when in accordance with Section 787.06(10) F.S.
Narcotics, alcohol, or other impairing drugs are prohibited on the premises. This does not include prescription medications.
Smoking and vaping is prohibited within the adult safe house, all outdoor play areas, and in vehicles. The adult safe house may designate specific areas for smoking and vaping.
To protect the privacy of residents, electronic surveillance systems may not be installed in bedrooms, bathrooms, and hallways adjacent to bedrooms or bathrooms in the adult safe houses. Electronic surveillance systems may be installed in the common areas, by entrance and exit doors, in parking areas, and other outside areas of the adult safe house. If there is electronic surveillance, all residents must be notified of such surveillance in writing, at the time of admission in the adult safe house and when new surveillance is installed. Exterior doors must have working and secured locks to ensure the safety of residents; windows must have working locking mechanisms; and safe houses may include additional safety measures such as alarm systems, for added security measures.
The adult safe house shall allow the Department to review the surveillance upon request.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.006 Admission and Services

(1) Admission.

(a) The adult safe house must provide an orientation to residents prior to or at time of admission to the home. The orientation must include the following:

Rules of the adult safe house;
Expectations for the resident;
Assessment and services offered;
Written policies and procedures outlined in Rule 65K-1.004, F.A.C.; and
Statement of purpose and program description.

(b) Children must be accompanied by their legal guardian who is receiving human trafficking services. The legal guardian is responsible for the care and supervision of the minor child.

(2) Services. Adult safe houses must use a trauma-informed, survivor-centered approach to assess individuals and children accompanying their legal guardian to determine appropriate services and supports.

(a) Resident Services. The adult safe house must provide trauma-informed and responsive, comprehensive, short term or long-term services according to the individual’s care plan. The adult safe house must make appropriate referrals for services when not provided directly by the program. Services must include:

Counseling options, which incorporate crisis intervention, safety planning, and assessment of risk;
Treatment and intervention for sexual assault;
Substance abuse and mental health screening;
Case management; and
Advocacy.

(b) Referrals. The adult safe house must maintain a comprehensive and current database of information and referral resources, which must be made available for use by all staff.

The adult safe house must provide one-on-one case management to individuals who reside in the emergency shelter for 72 hours or more, and to residential housing participants. This provision does not preclude adult safe houses from providing case management to residents housed less than 72 hours or to residents in transitional housing.
A case management staffing must be held bi-weekly for the purposes of ensuring effective communication among human trafficking advocates about the progress of residents toward meeting their goals and objectives, and addressing individual resident issues.

(d) Coordination of Medical Services.

(e) Reporting. The adult safe house, upon request, must provide the Department with information using a unique identifier to maintain confidentiality for the purpose of evaluation of adult human trafficking service trends.

(f) Care Plans.

The adult safe house must initiate a written care plan with the resident within 7 business days of admission and must be completed within 30 days of admission.
Care plans must outline details of the supports, activities, and resources required for the resident to achieve individual goals.
The care plan must include the following:

a. An assessment of the individual’s needs, strengths, challenges, and concerns;

b. Recommended services; and,

c. Document the resident’s long-term goals and supports requested to achieve goals.

The adult safe house must update the care plan in coordination with the resident as needed or at least every six months.

(g) Hotline or Warm Line Services. If the adult safe house provides hotline or warm line services, the adult safe house must have a telephone operated to provide crisis intervention, safety planning, information, and referrals to or on behalf of individuals involved in human trafficking. Adult safe houses that provide hotline or warm line services must have a recorded message that guides the caller on who to call when the telephone is not operated 24 hours a day, seven days a week. The adult safe house must respond within an hour of receiving the recorded message. The telephone must have a TTY or telephone relay service.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.007 Resident Files and Confidentiality Requirements

(1) Record Keeping. The adult safe house must provide for the maintenance of records, including electronic storage media, regarding the administrative, fiscal, and programmatic operation of the adult safe house. Records must be current, complete, accurate, and maintained in such form as to permit Department evaluation. All records and files, including electronic storage media, must be kept for a minimum of seven years after termination of certification.

(2) The adult safe house must maintain an individual file for each resident admitted into the house. Individual records must be current and must include, at a minimum;

(a) Demographic information including name, date of birth, and family composition;

(b) Social history, strengths, needs of the individual, and services required;

(d) Signed informed consent by the individual;

(e) Summary of dates of contact and progress toward goals; and

(f) Discharge summary and aftercare plan.

(3) The case files of HIV-infected residents shall not be segregated or flagged in any way that would permit their identification as case files of a HIV-infected resident, or in any way different from the files of non-HIV-infected residents.

(4) The file on each resident must be maintained in a secure place and must not be disclosed in whole or in part without the written consent of the resident.

(5) Access to any resident’s identifying information must be limited to staff members who have a legitimate interest in the case and need to know to carry out their job duties.

(6) The adult safe house must provide the Department with access to all files upon request to ensure compliance with the delivery of services provided to residents.

(a) During the certification process, the adult safe house must maintain the confidentiality of residents using a unique identifier for each resident. The unique identifier must accompany the resident’s file instead of the resident’s name.

(b) At any time, the Department receives a complaint that involves the resident’s safety, discrimination, retaliation, or service delivery, the resident’s file must be submitted with the resident’s name and identifying information.

(7) Destruction of Records. Adult safe houses shall ensure that all destruction of records is conducted in a manner that safeguards the interests of the residents and staff. In destroying records containing information that is confidential or exempt from disclosure, the adult safe house shall employ destruction methods that prevent unauthorized access to or use of the information and ensure that the information cannot be read, reconstructed, or recovered. Appropriate destruction methods for paper, electronic records, and non-paper media, i.e. audio tapes, video tapes, or photographic films; include burning and shredding records that are confidential or exempt from disclosure.

(8) Confidentiality.

(a) Adult safe houses are confidential as provided in Section 787.06(10), F.S.

(b) Information may not be disclosed to the public or on social media.

(c) The adult safe house must ensure that employees and volunteers receive written information on the restrictions relating to the disclosure of information about residents and the location of adult safe houses.

(d) The adult safe house shall protect the identity of residents when a showcase or tour of the facility is conducted and require the individuals touring and showcasing the safe house to sign a confidentiality agreement. Residents must be made aware of the upcoming tours and showcases.

History

Rulemaking Authority 402.881, 787.06(10) FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.008 Personnel and Staffing Requirements

(1) The adult safe house must have a personnel file for each employee, which includes:

(a) Identification confirming the staff’s age. Human trafficking advocates who work directly with residents in an adult safe house must be at least 18 years of age.

(b) Application for employment.

(d) A minimum of two character reference letters or reference checks from an employer or individual unrelated to the applicant verifying that the applicant is suitable to work with individuals impacted by trauma.

(e) Verification of background screen completion prior to hire, to include:

A signed “Attestation of Good Moral Character,” form CF 1649, (June 2025), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18189;
Level 2 background screening pursuant to Section 435, F.S. A person who is disqualified because of the background screen may request an exemption from disqualification pursuant to Section 435.07, F.S.

(f) Employee’s start and end dates for employment and reason for departing the program.

(g) Annual performance evaluations and any disciplinary actions taken.

(h) Training record and conferences attended.

(i) A signed “Abuse and Neglect Reporting” form CF 1957, (June 2025), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18190, acknowledgement forms of abuse and neglect laws, reporting requirements, and confidentiality.

(2) Personnel File Retention. The adult safe house must maintain personnel files for a period of five years from termination of employment.

(3) Qualifications. Each certified adult safe house must have at a minimum, the following positions filled by qualified staff:

(a) A full-time administrator responsible for the management of the adult safe house. Qualifications include a bachelor’s degree from an accredited college or university and two years’ experience working in the human trafficking or social services field, or four years minimum experience in an administrative/management capacity and two years’ experience working in the human trafficking or social services field. The administrator must successfully complete 30 hours of human trafficking training within 90 days of their date of employment. In the event the administrator position becomes vacant, an interim administrator must be appointed until the position can be filled permanently.

(b) The adult safe house must have at least one full time manager on site that supervises staff and manages all advocacy, counseling, and volunteer services. The adult safe house may determine the manager’s qualifications. The manager must successfully complete 30 hours of human trafficking training within 90 days of their date of employment.

(4) Training. The adult safe house must develop, implement, and review annually and revise as necessary a staff training and development plan to ensure that all new employees, current employees, and volunteers meet training requirements pursuant to this rule. The adult safe house may use the Department’s curriculum or submit a training curriculum for approval by the Department. Adult safe houses may use trainings approved through the accrediting body that meet the required training topics.

(a) The training of each employee and volunteer must be documented in the staff member’s personnel file and must include activities or course titles, number of hours, names of instructors and title or position, and dates of completion.

(b) The adult safe house must provide an orientation for all new employees during the first two weeks of their employment. This orientation must include a review of job responsibilities, adult safe house administrative procedures, confidentiality, Health Insurance Portability and Accountability Act (HIPAA), program goals, adult safe house purpose and objectives, resources and services, and identification and reporting child abuse and neglect. The training hours for orientation do not count towards the 40 hours for pre-service.

(c) All human trafficking advocates working with residents must receive a minimum of 40 hours of preparation training in human trafficking prior to unsupervised contact with residents, in addition to six hours of the following training:

Trauma-informed care, including recognizing the signs, symptoms, and triggers of trauma and the impact of trauma;
Secondary trauma and self care;
Essential service delivery and collaboration;
Motivational interviewing
De-escalation; and
First aid and cardiopulmonary resuscitation.

(d) In-service Training. The adult safe house must ensure that human trafficking advocates receive at least 10 hours of training activities during each full year of employment.

The adult safe house must identify trainings to address deficiencies of the staff for opportunities to improve.
Activities related to supervision of the advocate’s routine tasks must not be considered training for the purposes of this requirement.
The training requirement is effective after the first anniversary of their employment or service.

(e) Members of the governing body must complete the adult safe house orientation outlined in paragraph (b) of this subsection and the Department approved, one hour training on human trafficking within 30 days of appointment.

(5) Volunteers.

(a) Adult safe houses that utilize volunteers to work directly with residents must develop a description of duties and specific responsibilities.

(b) Each volunteer must receive the same orientation and training outlined in paragraph (4)(b) of this rule.

(d) Volunteers that perform the same or substantially similar services for residents as a paid employee must have the same qualifications, training, supervision and evaluation as the paid employee.

(e) Volunteers that have unsupervised contact with residents will be required to meet the same background screening requirements as employees and may assert a claim to priviliged communications with residents in an adult safe house under Section 402.881, F.S.

(f) Volunteers that have supervised contact with residents for more than 10 hours per month will be required to meet the same background screening requirements as employees.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.009 Corrective Action Plan

(1) A corrective action plan (CAP) may be imposed on the adult safe house when a violation of certification standards has occurred and the adult safe house has the ability to understand and correct the infraction.

(2) The adult safe house must submit a written CAP to the Department within seven calendar days from the date of receipt of the inspection. The CAP must be signed by the administrator or designee of the adult safe house.

(a) The CAP must include the following:

Identify the violation;
The actions the adult safe house will take to correct each of the violations identified;
The date by which the violation must be corrected; and
The actions the adult safe house will take to ensure the violation identified does not occur again.

(b) The Department will reject any proposed CAP that fails to identify all the information described in paragraph (a) of this rule or reflects a plan of action that does not address the violation(s). If the Department rejects a proposed CAP, the Department must notify the adult safe house in writing of the reasons for rejection and require the submission of an amended CAP addressing the deficiency or deficiencies within five calendar days of receipt of the Department’s notice rejecting the CAP. Failure to submit a CAP that is sufficient for Department approval within 30 days of the inspection completion date may be considered non-compliant and be subject to administrative action .

(3) Once the CAP is approved by the Department, the date to resolve all violations in the corrective action plan must not exceed 30 days from the inspection completion date, unless a date is directed or extended by the Department.

(4) The Department may deny, suspend, or revoke a certification pursuant to Section 402.881, F.S. when the adult safe house does not complete the CAP successfully.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.010 Administrative Actions and Closures

(1) The Department is the certifying authority for all adult safe houses and has final authority for approval, denial, revocation, or suspension of any certification under Section 120, F.S.

(2) Adult Safe House Closures.

(a) If an adult safe house closes voluntarily, it must notify the Department in writing at least 30 calendar days prior to closing.

(b) The adult safe house must submit a transition plan to the Department. The transition plan must;

Outline the process for assisting each resident with relocating to a new adult safe house for ongoing service delivery.
Identify the expected date of closure.
Plan for storing resident files and location where files will be stored.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.011 Standards for Emergency Housing

(1) Adult safe houses that provide services as emergency housing must comply with the certification requirements set forth in Rules 65K-1.001 through 65K-1.010, F.A.C., in addition to the program standards outlined in this rule.

(2) All emergency housing must be available for service delivery on a 24-hour basis, 7 days a week.

(3) An initial screening must be completed within the first 24 hours of admittance into the emergency housing.

(4) The initial screening must include an assessment of immediate emergency needs, including food, housing, and clothing, and relevant family, social, emotional, educational, health, and employment history.

(5) All emergency housing must provide an integrated program of crisis counseling with a range of counseling services, which includes immediate crisis intervention, short-term counseling, and referrals to, or arrangements for, long-term treatment when appropriate.

(6) Emergency housing may provide temporary or short-term housing to residents as identified by the adult safe house policies and procedures. The adult safe houses certified as an emergency shelter shall provide for a 35 day maximum stay for residents, and shall document in writing any exceptions. All exceptions shall be consistent with the adult safe house’s policies.

(7) Staffing Ratio. There must always be at least one awake staff for every 10 residents. Children must be counted as part of the ratio. Staff coverage shall be available at all times to provide for the services identified in the agency’s statement of purpose.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.012 Standards for Residential Housing

(1) Adult safe houses that provide services in a residential house must comply with the certification requirements set forth in Rules 65K-1.001 through 65K-1.010, F.A.C., in addition to the program standards outlined in this rule.

(2) A staff ratio is not required for residential housing. Human trafficking advocates must be available on-site for a minimum set of hours as outlined in the adult safe house’s policy for service delivery and be available 24-hours a day, seven days a week for response when not on site.

(3) Residential housing may provide long-term housing for a period of time identified by the adult safe house.

(4) In addition to the services outlined in Rule 65K-1.006, F.A.C., residents should be provided with comprehensive, integrated services as recommended by the assessment and input from the resident, which may include:

(a) Life skills;

(b) Substance abuse treatment;

(d) Support in securing employment;

(e) Job training;

(f) Schooling or educational support;

(g) Securing housing and means of transportation;

(h) Financial management and,

(i) Healthcare (medical, dental, vision).

(5) Discharge and Aftercare. The adult safe house must prepare a written discharge summary at least 45 calendar days prior to the projected date for exiting the program, unless the release is unplanned and unforeseen.

(a) Discharge planning must be created with input from the resident and any supportive individuals identified by the resident.

(b) The discharge summary must include the following:

An outline of the plan for discharge;
A summary of services;
An assessment of goal achievement;
Identification of the needs which remain to be met;
Recommendations for the resident following discharge, including provisions for support and referrals;
Identify who is responsible for validating the resident engaged in the services referred by the adult safe house;
The date and reasons for discharge; and
The name, address, and telephone number of the resident.

(6) Aftercare plans must, at minimum, reflect recommendations for services, where appropriate, and document any referrals generated. The plan must include the frequency of contact between the adult safe house and the discharged resident. The aftercare plan must identify if the resident declines the aftercare services.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Fla. Admin. Code R. 65K-1.013 Standards for Transitional Housing

(1) Adult safe houses that provide services as transitional housing must comply with the certification requirements set forth in Rules 65K-1.001 through 65K-1.010, F.A.C., in addition to the program standards outlined in this rule.

(2) Transitional housing provides housing to independent residents that require minimal support from the adult safe house program.

(3) All transitional housing must provide services to residents based on an assessment or request of the resident. The adult safe house is responsible for making appropriate referrals when appropriate.

(4) Transitional housing may provide temporary or long term housing to residents as identified by the adult safe house policies and procedures.

(5) A staff ratio is not required for transitional housing. Human trafficking advocates must be available on-call 24-hours a day, seven days a week to provide support as needed.

History

Rulemaking Authority 402.881 FS. Law Implemented 402.881 FS. History-New 7-16-25.

Division 65G Agency for Persons with Disabilities

Chapter 65G-1 WAIVER ENROLLMENT FOR CHILDREN IN THE CHILD WELFARE SYSTEM

Fla. Admin. Code R. 65G-1.010 Definitions

In this chapter, terms and phrases shall have the meanings defined in Chapter 393, F.S., or this section.

(1) “Area Office” is the local office responsible for managing one of the Agency’s 14 service areas.

(2) “Central Office” is the Agency’s headquarters located at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main phone number (850)488-4257.

(3) “Crisis enrollment” is expedited enrollment on an Agency-operated Medicaid waiver regardless of an applicant’s date of application for the waiver or placement on the Agency’s preenrollment categories.

(4) “Handbook” is the Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, October 2003, incorporated by reference in Agency for Health Care Administration (AHCA) subsection 59G-13.080(12), F.A.C. The Handbook is available at: http://floridamedicaid.acs-inc.com/index.jsp.

(5) “Protective Services” means the program in the Department of Children and Family Services that responds to reports made to the department’s central abuse hotline alleging abuse, abandonment, neglect, or exploitation, pursuant to Chapter 39 or 415, F.S.

(6) “Preenrollment Category” is the list maintained by the Central Office of persons requesting and waiting for waiver services.

(7) “Waiver” is a Home and Community-Based Services (HCBS) waiver authorized by 42 U.S.C. 1396n(c) of the federal Social Security Act and Section 409.906, F.S., that provides a package of Medicaid-funded home and community-based supports and services to eligible persons with developmental disabilities who live at home or in a home-like setting. The Agency currently operates two HCBS waivers:

(a) The Developmental Disabilities Home and Community-Based Services (DD) waiver that provides home and community-based supports and services without a dollar cap to eligible persons with developmental disabilities who are able to live at home or in a home-like setting; and,

(b) The Family and Supported Living (FSL) waiver that provides limited home and community-based supports and services with an annual dollar cap to eligible persons with developmental disabilities who are able to live in their own home or family home.

History

Specific Authority 393.501(1), 393.065 FS. Law Implemented 393.065 FS. History–New 9-19-07.

Fla. Admin. Code R. 65G-1.046 Crisis Determination Procedure

History

Rulemaking Authority 393.501(1), 393.065 FS. Law Implemented 393.065. History–New 9-19-07, Transferred to 65G-11.004.

Fla. Admin. Code R. 65G-1.047 Crisis Status Criteria

(1) Individuals determined to be in crisis will be prioritized for available waiver placements in order of the severity of crisis, with the severity determined by risk to the health, safety, and welfare of each applicant relative to that of the other applicants, as indicated by the applicable criteria for each crisis category met by the applicant.

(2) If several crises status applicants fall within the same crisis category, they will be prioritized within that category by consideration of the intensity of services needed.

“Intensity of services needed” prioritizes the following service needs in intensity from greatest to least:

(a) Residential placement with need of residential habilitation, nursing, or behavioral services, including supported living with required supports;

(b) Residential placement without need of residential habilitation, nursing, or behavioral services, including supported living with some supports;

(d) Other therapies to avoid or reduce disability;

(e) Meaningful day activity needs;

(f) Durable medical equipment needs;

(g) Environmental accessibility adaptations;

(h) Consumable medical supplies.

(3) If an applicant falls within more than one category of crises, the applicant will be considered within the higher priority of crisis category. After prioritization based on crisis category and intensity of services, applicants will be further prioritized if necessary based on the chronological order of crisis determination, with the earlier dates of determination having higher priority.

(4) “First priority” crisis category: The applicant is currently homeless, living in a homeless shelter, or living with relatives in an unsafe environment. In such cases, the following indicia, supported by credible evidence, are relevant to a crisis determination in this category:

(a) Without immediate provision of waiver services, the health and safety of the applicant are at risk;

(b) The applicant has no shelter available and needs emergency placement by the Agency or another state agency;

(d) The applicant temporarily is staying with friends or relatives but residence is not expected to last more than several weeks;

(e) The applicant’s caregiver has no legal obligation to provide shelter to the applicant and the caregiver’s commitment to shelter the applicant is low;

(f) Factors affecting the applicant’s safety in the current setting include risk of physical abuse of the applicant or risk of insufficient supervision and support;

(g) The home has insufficient room to shelter the applicant, or the applicant must share a room in an inappropriate living arrangement, based on the ages, genders, and conditions of the persons sharing the room;

(h) The applicant’s desire for placement creates a reasonable expectation that the applicant will be cooperative with placement;

(i) Violence or illegal activities within the applicant’s current living environment by the applicant or others has required the intervention of local or state law enforcement authorities;

(j) Complaints of neglect, exploitation, or abuse of the applicant to Protective Services, or other adverse environmental conditions affecting the applicant, have been investigated and confirmed pursuant to chapter 39, part II, or section 415.104, F.S.;

(k) The applicant requires services of greater intensity.

(5) “Second priority” crisis category: The applicant exhibits behaviors that, without provision of immediate waiver services, may create a life-threatening situation for the applicant or others, or that may result in bodily harm to the applicant or others requiring emergency medical care from a physician. In such cases, the following indicia supported by credible evidence are relevant to a determination of crisis under this category:

(a) Without immediate waiver services, the health and safety of the applicant or others in the household is at risk;

(b) The applicant’s injury to self or others is frequent or intense;

(d) There is documentation of medical treatment for the applicant’s injury to self or others;

(e) No other supports are available to address the applicant’s behaviors;

(f) Other attempted behavioral assessments and interventions have proven ineffective;

(g) The relative ages, sexes, and sizes of the aggressor and the subjects of aggression place the subjects of aggression at risk of injury;

(h) The caregiver has insufficient ability to control the applicant;

(i) The ages or disabilities of the applicant or caregiver exacerbate the problems;

(j) Violence or illegal activity within the applicant’s current living environment by the applicant or others has required the intervention of local or state law enforcement authorities;

(k) Complaints of neglect, exploitation, or abuse of the applicant, or other adverse environmental conditions affecting the applicant have been investigated by Protective Services and confirmed pursuant to Chapter 39, Part II, or Section 415.104, F.S.;

(l) The applicant requires services of greater intensity.

(6) “Third priority” crisis category: The applicant’s current caregiver is in extreme duress and is no longer able to provide for the applicant’s health and safety because of illness, injury, or advanced age. The applicant needs immediate waiver services to remain living with the caregiver or to relocate to an alternative living arrangement. In such cases, the following indicia, supported by credible evidence, are relevant to a determination of crisis in this category:

(a) Without immediate provision of waiver services, the applicant’s health and safety are at imminent risk;

(b) Other potential caregivers, such as another parent, stepparent, brother, sister or other relative or person, are unavailable or are unwilling or unable to provide care;

(d) The caregiver is deceased, about to expire, or permanently disabled;

(e) The caregiver’s age impairs the caregiver’s ability to provide sufficient care to the applicant;

(f) The caregiver cannot provide sufficient care because of the age or size of the applicant, or the physical, functional, or behavioral demands of the applicant;

(g) The services provided by the caregiver are limited in amount, duration, or frequency, rendering the applicant semi-dependent or totally dependent;

(h) The caregiver’s economic situation is unstable and unlikely to improve as a result of the care-giving demands of the applicant;

(i) The caregiver’s obligations to the needs of other dependents prevent the caregiver from providing the applicant with adequate care, or the caregiver’s obligation of care to the applicant places other dependents at risk of insufficient care;

(j) Violence or illegal activities within the applicant’s current living environment by the applicant or others has required intervention by local or state law enforcement authorities;

(l) The individual requires services of greater intensity.

History

Rulemaking Authority 393.501(1), 393.065 FS. Law Implemented 393.065 FS. History–New 9-19-07.

Chapter 65G-2 LICENSURE OF RESIDENTIAL FACILITIES AND ADULT DAY TRAINING PROGRAMS

Fla. Admin. Code R. 65G-2.001 Definitions

For the purposes of this chapter, the term:

(1) “Adult Day Training Program” means the same as in section 393.063, F.S.

(2) “Agency” means the Agency for Persons with Disabilities.

(3) “Applicant” means a person or entity that has submitted a written application to the Agency for the purposes of obtaining an initial license or renewing an existing license in accordance with section 393.067, F.S.

(4) “Behavior Analyst” means a person certified under Chapter 65G-4, F.A.C.

(5) “Benefit payments” has the same meaning as set forth in section 402.33, F.S.

(6) “Change of ownership” means the process set forth in Rule 65G-2.0021, F.A.C., further defined as an event in which the controlling interest changes to a different person or entity through sale, lease, contract, gift, etc., or in which 45 percent or more of the ownership, controlling interest, or voting shares, or controlling interest in a corporation whose shares are not publicly traded on a recognized stock exchange are transferred or assigned, including the final transfer or assignment of multiple transfers or assignments taking place over a 2-year period that cumulatively total 45 percent or greater. A change solely in the management company or board of directors is not a change of ownership.

(7) “Client” has the same meaning as in Section 393.063, F.S.

(8) “Controlling interest” means:

(a) The applicant or licensee;

(b) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the applicant or licensee; or

(c) A person or entity that serves as an officer of, is on the board of directors of, or has a 5-percent or greater ownership interest in the management company or other entity, related or unrelated, with which the applicant or licensee contracts to manage the facility.

(d) This term does not include a voluntary board member or the ownership or legal authority of the property on which the facility is located.

(9) “Corrective Action Plan” is a mutually agreed upon plan prepared by the licensee and approved by the Agency by which the corrective action will be accomplished. Corrective Action Plans may be issued as a part of a Notice of Noncompliance.

(10) “Covered person” is as defined in section 393.135, F.S.

(11) “Direct Care Core Competency Training” means the training described and mandated by the Florida Medicaid Developmental Disabilities Individual Budget Waiver Services Coverage and Limitations Handbook (“iBudget Handbook”), which is incorporated by reference in Rule 59G-13.070, F.A.C.

(12) “Direct service provider” is as defined in Section 393.063, F.S.

(13) “Entity” means a partnership, association, joint venture, company, sole proprietorship, corporation, limited liability corporation, professional limited liability corporation, or any other form of business.

(14) “Essential care” means care and follow-up measures that are medically necessary and directed by the resident’s treating physician, health care practitioner, behavior analyst, or mental health professional for the purpose of continuing an ongoing course of treatment or therapy for an illness, injury, medical condition, or diagnosis until such time as such care and follow-up measures are no longer directed or recommended by the treating practitioner.

(15) “Federal benefit rate” means the amount of money the Federal government provides to recipients of the Supplemental Security Income (“SSI”) program for a particular calendar year.

(16) “Governing Authority” shall mean the organization, person, or persons designated to assume full legal responsibility for the determination of policy, management, operation, and financial viability of the ADT program. This includes the licensee.

(17) “Household members” means residents, live-in staff, family members of live-in staff, and any other person residing in the facility.

(18) “Legal representative” means:

(a) for a resident or participant under the age of 18 years, to include the parents of a minor child whose rights have not been terminated, health care surrogate appointed by a Florida court to represent the child or anyone designated by the parent(s) of the child to act on the parent(s)’ behalf (e.g., due to military absence), or anyone appointed by a Florida court as a guardian or guardian advocate under Chapter 393 or 744, F.S.

(b) for resident or participant age 18 years or older, anyone designated by the resident or participant through a Power of Attorney or Durable Power of Attorney, a medical proxy under Chapter 765, F.S., health care surrogate, or anyone appointed by a Florida court as a guardian or guardian advocate under Chapter 393 or 744, F.S.

(19) “Licensee” means a person or entity which has been issued and currently holds a valid license from the Agency.

(20) “Live-in staff” means direct service provider(s) whose primary residence is the same as that of the residents for whom they are providing supports and services.

(21) “Local Review Committee (LRC)” means the committee established pursuant to Rule 65G-4.008, F.A.C., to provide oversight of behavioral services to Agency clients in a service region.

(22) “Monitor” or “monitoring” means an on-site inspection conducted by Agency staff for the purpose of determining compliance with chapter 393 and rules adopted thereunder.

(23) “Notice of Noncompliance” means a notification issued by the Agency to a licensee in response to a minor violation of a rule and prior to imposing an administrative disciplinary action, as described in section 120.695, F.S.

(24) “Operator” means the person and/or entity responsible for the management and administration of a facility.

(25) “Other Location” means for purposes of the incident reporting requirements under Section 393.067, F.S., any location within the community where the resident or client may be located while not under the supervision of a covered person.

(26) “Parcel” means the same as a “lot” as that term is defined in Section 177.031, F.S.

(27) “Participant” means any person, regardless of whether such person is a client of the Agency, who participates in services provided by the Adult Day Training Program.

(28) “Personal needs allowance” means funds set aside from benefit payments and third-party payments to provide for the client's current maintenance and incidental personal expenses.

(29) “Physical harm” means a bodily injury or illness requiring first aid or any other medical procedures.

(30) “Plan of Remediation” means the plan established by the Agency to be followed by the licensee in order to correct a violation of rule as part of an administrative complaint. Failure to timely complete a Plan of Remediation will constitute an additional rule violation.

(31) “Provider” means any program or facility for the care, treatment, training, residence or habilitation of persons with developmental disabilities that is licensed by the Agency or receives funds from the Agency through a contract. A provider does not include a spouse, family member or guardian with whom a person with developmental disabilities resides or a provider covered under the provisions of Part VIII of Chapter 400, F.S.

(32) “Regional Office” means the primary office for a service region of the Agency for Persons with Disabilities.

(33) “Resident” means any person with a developmental disability whose primary place of residence is a facility, , as defined in subsection 65G-2.001(14), F.A.C., and section 393.063, F.S., whether or not such person is a client of the Agency.

(34) “Residential facility” or “Facility” is as defined in section 393.063, F.S. A facility includes all buildings and grounds included in the physical address of the license. The following are facilities: foster care facility, group home facility, or residential habilitation center as defined in section 393.063, F.S.

(35) “Representative payee” has the same meaning as set forth in section 402.33, F.S.

(36) “Residential habilitation” has the same meaning as set forth in section 393.063, F.S.

(37) “Room and board payment” means a limited reimbursement by the Agency to a residential facility providing residential habilitation and room and board to a client, to cover the cost of providing food and shelter to a client in accordance with chapter 393, F.S., and chapter 65G-2, F.A.C.

(38) “Routine or preventive” means physical or mental health care other than essential care, such as routine examinations, annual check-ups, or preventive screenings and dental care and cleanings.

(39) “School” is as defined in Section 1003.01, F.S., for purposes of the incident reporting requirements under Section 393.067, F.S.

(40) “Self-determination” is as defined in Section 393.063, F.S.

(41) “Sexual activity” is as defined in Section 393.135, F.S.

(42) “Sexually aggressive resident” means a minor who is an alleged juvenile sexual offender, as defined in Section 985.475, F.S., or an adult who is documented to have committed an act of sexual abuse as that term is defined in Section 415.102, F.S.

(43) “Third-party benefits” has the same meaning as set forth in section 402.33, F.S.

(44) “Voluntary board member” means a board member of a not-for-profit corporation or organization who serves solely in a voluntary capacity, does not receive any remuneration for their service to the corporation or organization, and has no financial interest in the corporation or organization.

(45) “Welfare” means care which promotes those rights enumerated in Sections 393.13(3) and (4), F.S.

(46) “Zero Tolerance” means Agency initiated activities, such as education and training, which are intended to prevent occurrences of abuse, neglect, exploitation, and abandonment involving persons with developmental disabilities and to facilitate quicker identification and reporting of potentially harmful situations and environments in which abuse, neglect, exploitation, or abandonment may arise.

(47) This Rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0662, 393.067, 393.501, 402.33 FS. Law Implemented 393.066, 393.0662, 393.067, 393.13, 402.33 FS. History‒New 7-1-14, Amended 7-1-18, 8-17-23, 2-27-25.

Fla. Admin. Code R. 65G-2.002 License Application and Renewal Procedures

(1) Providers required to be licensed under section 393.067, F.S., to provide services must maintain a valid current license issued by the Agency.

(2) Application. All applications for initial licensure as well licensure renewal must be submitted using License Application Form 65G-2.002-A (December 2025), which is incorporated herein by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-18971. A copy of this form may also be obtained by contacting the Agency. The Agency shall review license applications in compliance with the requirements of section 120.60, F.S.

(3) Conditional license. The Agency may issue a conditional license to a facility or program if, at the time of license renewal, the facility or program is found to have uncorrected violations that the facility or program has had an opportunity to correct. The issuance of a conditional license does not change the license expiration date.

(4) License renewals. An application for the renewal of the license must be submitted to the Agency at least 45 days prior to the expiration of the current license.

(a) A license which has not been renewed prior to the expiration date is terminated and invalid and the facility or program shall be considered unlicensed except as otherwise provided under section 120.60(4), F.S. If a timely and sufficient application for renewal has been received by the Agency, the original license shall remain in effect until the Agency acts upon the application for renewal.

(b) If the Agency receives an application to renew a license after its expiration date, the Agency shall consider it to be an application for an initial license rather than an application for license renewal.

(c) If an application for renewal has been submitted to the Agency but has not been completed prior to the date of expiration, the Agency may issue a conditional license until the renewal process is completed.

(5) The Agency shall consider the following factors when reviewing an application for an initial license or license renewal.

(a) Prior disciplinary action against an applicant or controlling interest including:

the nature and seriousness of any violation for which a sanction was imposed;
the type of disciplinary action imposed, including the amount of any applicable fine imposed;
the number of prior disciplinary actions;
compliance with any conditions or requirements of any disciplinary action;
the length of time the applicant operated a facility or program without any violation since the most recent violation for which a disciplinary action was imposed; and
any failure by the applicant or controlling interest to comply with any settlement agreement with the Agency.

(b) If a licensee, applicant, owner, manager, or controlling entity has previously been determined to have operated a facility or program without a license or with an expired license, when a license was required by Florida Statutes or by rule, the length of time the facility or program operated without a license or with an expired license. Operating a facility or program with an expired license constitutes operating a facility or program without a license.

(c) If a licensee or controlling entity has had a license to operate a facility or program revoked by a state agency, including the:

license revocation; and
length of time that has passed since license revocation.

(d) Whether a licensee or controlling entity has received a bankruptcy order of discharge.

(e) Whether the Department of Children and Families has verified that the applicant or employee of the applicant is responsible for abuse, neglect, exploitation, or abandonment of a child or the abuse, neglect, or exploitation of a vulnerable adult in any health care setting.

(f) Whether the Agency has determined that there is clear and convincing evidence that the applicant is unqualified for a license because of a lack of good moral character. For purposes of this paragraph, “good moral character” means a personal history of honesty, fairness, and respect for the rights of others and for state and federal law.

(g) Any failure by the licensee to notify the Agency about a change of ownership in accordance with Rule 65G-2.0021, F.A.C.

(h) Whether there has been any prior disciplinary action under the license being renewed. This includes any prior disciplinary actions and verified findings against either the licensee or the licensee’s employees. This also includes disciplinary action taken in accordance with section 393.0673(2), F.S.

(i) Whether a prior license was relinquished after notification to the licensee of:

an investigation for disciplinary action, or
disciplinary action that has been initiated or pending.

(6) If the applicant has not provided sufficient supporting information with the application, the Agency shall require the applicant to provide additional information regarding the applicant’s qualifications for the types of residents or participants or the level of services the applicant wishes to serve.

(7) A license shall be valid for the dates specified on the license. A license which has not been renewed prior to the expiration date is invalid and the facility or program shall be considered unlicensed except as otherwise provided under section 120.60(4), F.S.

(8) Each facility or program, regardless of whether it is owned or managed under a single individual, partnership, association, joint venture, company, sole proprietorship, corporation, limited liability corporation, or professional limited liability corporation, must operate under a separate and distinct license.

(9) Prior to issuing an initial license or renewing an existing license, the facility or program must be inspected by the Agency in accordance with Rule 65G-2.0032, F.A.C., to ensure that the facility or program meets the physical and safety standards of this chapter. Unless otherwise set forth in a conditional license, any deficiencies identified during the site inspection must be remediated by the applicant and the Agency must have confirmed the successful remediation prior to the issuance of a license or license renewal.

(10) Non-responsive applicant. If certified mail sent to the provider’s address of record, or mailing address if applicable, is returned as unclaimed or undeliverable, the Agency will send a copy of the letter by regular mail to the provider’s address of record, or mailing address if applicable, with a copy to the applicant’s address if different from the provider. The applicant must respond to the request within 21 days of the date of the letter sent by regular mail. If timely response is not received, the applicant will be considered non-responsive, and the application will be subject to withdrawal or denial.

(11) An application is considered complete upon receipt of:

(a) All required documents, information and required fees;

(b) All required background screening results; and

(c) Completion of a satisfactory inspection if required by authorizing statutes or rules. Satisfactory inspection means no regulatory violations exist, or all prior violations found have been determined by the Agency to be corrected.

(12) A licensure inspection will not be authorized until paragraphs (11)(a) and (b) of this rule have been satisfied.

(13) The licensee must give at least 30 days written notice to the Agency prior to the licensee’s intent to close a licensed facility or program.

(14) If the applicant fails to submit a complete application prior to the expiration of the facility’s or program’s existing license, the application shall be considered an initial application rather than a renewal application.

(15) No facility or program licensed under this chapter shall provide services to non-citizens without a legal residency status.

History

Rulemaking Authority 393.066(8), 393.0662(15), 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.0655, 393.067, 393.0673, 393.13 FS. History–New 7-23-14, Amended 2-27-25, 3-26-26, Technical Change 9-4-26.

Fla. Admin. Code R. 65G-2.0021 Change of Ownership

(1) Application Required. A license to operate a facility or program is not assignable or transferable and is valid only for the individual, entity, premises, and purposes specified on the license.

(2) The transferring facility or program is the licensee, and the receiving or transferee facility or program is the applicant.

(3) A change of ownership of a facility or program is not a transfer of the license itself consistent with Rule 65G-2.002, F.A.C.

(4) The licensee and applicant are jointly responsible for providing written notice to the Agency 90 days prior to the intended change of ownership. Failure to notify the Agency will result in disciplinary action. The notice shall be in writing and shall include:

(a) intended effective date of closure, transfer, or purchase;

(b) name of the licensee;

(d) signature of the licensee; and

(e) copy of any business agreement(s), purchasing agreement(s), or other changes of ownership agreement(s) between the licensee and the applicant.

(5) Copies of the notice must be provided to the licensee, the applicant, and the Agency.

(6)(a) The applicant’s failure to provide adequate and timely notice of a facility’s or program’s intent to take over operation of the facility or program shall be considered during the review of the applicant’s initial application by the receiving facility or program or controlling interest, including whether there are any residents or participants remaining in the facility or program.

(b) The licensee’s failure to provide adequate and timely notice of a facility’s or program’s intent to complete a change of ownership under this rule shall be considered during the review of any future applications of the transferring facility or program or controlling interest, including whether there are any residents or participants remaining in the facility or program.

(7) A person or entity that has received the business ownership of a facility or program by way of a transfer must still submit an application for licensure and receive a license before it may operate as a facility or program under section 393.067, F.S.

(8) The applicant, or receiving facility or program, must submit a license application using License Application Form 65G-2.002-A (December 2025), which is incorporated by reference in Rule 65G-2.002, F.A.C., to the Agency 60 days prior to the intended effective date of the change of ownership.

(a) A license application must include the intended effective date of the change of ownership.

(b) The change of ownership intended effective date cannot be prior to the date the application is received and approved by the Agency.

(c) Failure to submit an application for licensure prior to the intended effective date of a change of ownership to a different legal entity constitutes unlicensed activity.

(d) Both the licensee and applicant facility or program are jointly and severally liable under this rule chapter for any lapse in the continuity of care due to an improper change in ownership as outlined in this rule.

(e) All required application documents and information must be received with the application or within 21 days of the request by the Agency with the exception of the transferee’s proof of a written right to occupy, which includes and is not limited to, a lease, contract for sale of the property, or other written record of the right to occupy.

(9) When the licensee’s license application is submitted for renewal, the pending renewal will be administratively withdrawn from review if the applicant’s initial application is approved with an effective date prior to the expiration of the licensee’s license.

(10) Expiration of the licensee’s license prior to the approval of the applicant’s initial license application, when no renewal application has been submitted, may result in the denial of an applicant’s initial license application.

(11) If the applicant has not been issued the license on the effective date of the change of ownership, documentation must be submitted by the licensee that provides for continuation of operation of the licensee for those days between the date of the change of ownership and the date the applicant is licensed by the Agency.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Law Implemented 393.067, 393.0673 FS. History–New 3-26-26.

Fla. Admin. Code R. 65G-2.003 Length of Licenses

The Agency shall determine the length of a program or facility’s license based on the following:

(1) A one year license shall be issued to residential facilities and a three-year license shall be issued to adult day training programs which meet all applicable licensing criteria.

(2) A license which has been renewed shall be issued for a period specified therein with an effective date being the date of the expiration of the previous license.

(3) The issuance of a license does not constitute a waiver of any statutory or rule violations by the licensee and does not prevent the Agency from seeking administrative disciplinary action against the licensee for violations committed by the licensee.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Law Implemented 393.067, 393.0673 FS. History–New 8-13-78, Formerly 10F-6.05, 10F-6.005, 65B-6.005, Amended 7-1-14, 2-27-25, 3-26-26.

Fla. Admin. Code R. 65G-2.0031 Other Licenses

History

Rulemaking Authority 393.067 FS. Law Implemented 393.067 FS. History–New 8-13-78, Amended 4-17-80, Formerly 10F-6.07, 10F-6.007, 65B-6.007, Repealed 1-19-16.

Fla. Admin. Code R. 65G-2.0032 Agency Monitoring and Oversight

(1) The Agency shall conduct ongoing monitoring of each facility or program, either unannounced or announced, in order to ensure the facility or program is in full compliance with the applicable requirements of chapter 393, F.S., and Agency rules. Each monitoring checklist shall be verified by the signature of the most senior facility or program staff member present during the monitoring.

(2) Each licensee shall be monitored prior to initial licensure, renewal licensure, and on an ongoing basis thereafter.

(3) Follow-up monitoring may be conducted to verify correction of deficiencies at any time on an unannounced basis.

(4) Licensees and employees of the licensee must permit any Agency staff or designated agent of the State of Florida, who presents proper State of Florida-issued identification, to enter and inspect any part of any facility or program building or to inspect records relating to the operation of the facility or program or the provision of client care at any time.

(a) Agency staff or its designee shall be permitted to obtain any documents related to the operation of the facility or program for those residents or participants.

(b) Agency staff or its designee shall be permitted to obtain photographs, video recordings or other methods of memorialization, of the residence or program site, the condition therein, and the condition of the residents or participants.

(5) Upon the Agency’s request, the licensee must make available documentation relating to the licensee’s financial ability to continue operations of the facility or program in accordance with the requirements of Chapter 65G-2, F.A.C., for up to 60 days without dependence upon payment from the state or other third-party fees from residents or participants. Such documentation shall include bank account statements, pay stubs, documentation of a line of credit, or any other documents which would demonstrate the current ability of the licensee to continue operations.

(6) Licensees and employees shall afford Agency staff the opportunity to observe any safety drills or protocols to verify the effectiveness and efficiency of evacuations.

(7) The Agency may temporarily suspend monitoring for a specific time or location if the Agency determines that a recent, impending, or ongoing disaster, or emergency situation has rendered monitoring unsafe or impossible.

(8) Licensees shall have an on-site licensure review by the Agency within 30 days following the admission of their first resident or participant to ensure that they are in compliance with the requirements of chapter 393, F.S., and Chapter 65G-2, F.A.C.

(9) Any records or documents that a licensee is required to provide or maintain shall be accurate and shall not include any false or misleading information.

(10) A licensee or applicant shall not make willful or intentional misstatements, orally or in writing, to intentionally mislead Agency staff, the Department of Children and Families, or law enforcement in the performance of their duties.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Laws Implemented 393.067, 393.0673 FS. History–New 7-1-14, Amended 2-27-25, 3-26-26.

Fla. Admin. Code R. 65G-2.004 License Violations – Non-Disciplinary Actions

(1) Notice of Noncompliance.

(a) The Agency shall issue a Notice of Noncompliance as provided under section 120.695, F.S., in response to the first occurrence of a minor violation unless corrected before the completion of the on-site monitoring which identified the minor violation.

(b) The Agency shall include at a minimum the following with a Notice of Noncompliance:

The specific rule that is being violated;
Information on how to comply with the rule, which may include directions for the licensee to formulate a Corrective Action Plan as set forth in subsection (2); and
A specific time frame within which the licensee must take corrective action to come into compliance with the rule.

(2) Corrective Action Plan.

(a) Within 15 calendar days following the receipt of a Notice of Noncompliance, the licensee must submit a proposed written Corrective Action Plan to the designated regional office. Corrective Action Plan within the required timeframe or repeat occurrences of same or similar violations shall result in the imposition of disciplinary action as described in paragraph 65G-2.0041(4)(b) or (c), F.A.C. For the purposes of this subsection, a first occurrence of a violation refers to those violations which have not been previously observed and cited by Agency staff within the past 12 months.

(b) The Corrective Action Plan shall specify in writing all the following:

The specific actions the facility will take to correct each of the violations identified and to comply with the applicable licensing requirements;
The name(s) of the staff person(s) responsible for completing each action; and
A timeframe for accomplishing each action.

(c) The Agency shall reject any proposed Corrective Action Plan that fails to identify all of the information defined in paragraph (2)(b) of this rule.

(d) If the Agency rejects a Corrective Action Plan, the Agency shall notify the licensee in writing of the reasons for rejection and shall state that the licensee has 10 days from receipt of the notification to submit an amended Corrective Action Plan. If the licensee fails to timely submit an amended Corrective Action Plan that addressed the deficiencies defined in the 10-day notice sent by the Agency, the Agency shall consider this to be an additional violation(s).

(e) All action taken to correct a violation shall be documented in writing by the licensee.

(f) Failure to fully come into compliance with the rule specified in the Notice of Noncompliance or comply with the terms of a Corrective Action Plan shall result in the imposition of disciplinary action as defined in Rule 65G-2.0041, F.A.C. This includes imposing disciplinary action based on both the underlying violation and on the failure to timely correct the underlying violation after receipt of a Notice of Noncompliance or Corrective Action Plan that was approved or provided by the Agency.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Law Implemented 393.067, 393.0673 FS. History–New 7-1-14, Amended 1-23-25, 3-26-26.

Fla. Admin. Code R. 65G-2.0041 License Violations – Disciplinary Actions

(1) Under a final order of the Agency, the Agency shall impose disciplinary action against a licensee for the violation of any facility or program standard as provided in chapter 393, F.S., or the Agency’s rules. First offenses of minor violations will be issued a Notice of Noncompliance, as set forth within this rule chapter, prior to disciplinary action.

(a) Each day a violation occurs, or continues to occur, constitutes a separate violation and is subject to a separate and additional disciplinary action.

(b) Failure to comply with the terms of a Corrective Action Plan or settlement agreement shall constitute a separate violation subject to a separate and additional administrative proceeding and additional disciplinary action from the underlying violation.

(c) A Plan of Remediation shall be in response to a violation of these rules and shall be included as part of a disciplinary action imposed as a result of the violations. Failure to timely complete a Plan of Remediation shall constitute an additional and separate violation beyond the violation for which it was implemented.

(2) The Agency shall consider any aggravating and mitigating factors when determining appropriate disciplinary action, which include the following:

(a) the severity of the violation;

(b) whether the incident involved the abuse, neglect, exploitation, abandonment, death, or serious physical or mental injury of a resident or participant;

(d) any remedial actions taken to correct the violation and the timeliness of such actions;

(e) whether the licensee willfully committed the violation, was aware of the violation, was willfully ignorant of the violation, or attempted to conceal the violation;

(f) the number of individuals impacted;

(g) whether the licensee reported the violation within the timeframes described in this chapter;

(h) whether the licensee has cooperated with the Agency, or any other investigating regulatory or law enforcement agency regarding the violation;

(i) whether there have been repeat instances of the same or similar violation or any other violation by the licensee, with consideration of the amount of time that has passed between violations;

(j) whether a violation involved more than one employee of the licensee; and

(k) any other relevant mitigating or aggravating factors.

(3) The Agency may take disciplinary action against licensees in accordance with sections 393.067 and 393.0673, F.S., as follows:

(a) a moratorium on admissions;

(b) the suspension, denial, or revocation of the license, including nonrenewal of the license; and

each fine shall not exceed $1,000 per violation;
each day a violation occurs constitutions a new violation; and
no fine issued under this rule chapter may exceed the limitation in section 393.0673, F.S.

(4) The agency may impose more than one type of disciplinary action for a single violation.

(5) Failure to pay any fine or adhere to a moratorium, suspension, or any other disciplinary measure implemented in accordance with this chapter shall constitue a separate violation.

(6) The expiration or relinquishment of a license that is pending administrative disciplinary action does not render the administrative proceeding moot and the licensee may still be subject to administrative disciplinary action. The Agency may continue to seek administrative disciplinary action against a licensee for violations that occurred during a licensee’s management or oversight of a facility or program even if the licensee ceases to own, lease, operate, or provide services in the facility or program after the violations have occurred.

(7) For purposes of disciplinary action under these rules and chapter 393, F.S., for verified findings of abuse, neglect, abandonment, or exploitation of a child or vulnerable adult, the licensee is responsible not only for administration of the facilities in compliance with the standards provided by statute and administrative rule, but is ultimately responsible for the care and supervision of the clients in the facility or the participants of the program.

(a) A licensee may not delegate to others the ultimate responsibility for the safety of the clients in its care.

(b) A licensee is subject to disciplinary action for an employee’s lapse in care or supervision of the clients at the facility or the participants of the program in which a verified finding of abuse, neglect, abandonment, or exploitation occurred at the licensee’s facility or program.

(8) Disciplinary guidelines applicable to disciplinary actions taken under these rules and chapter 393, F.S., are set forth within the APD Licensing Disciplinary Chart Form 0041 (December 2025), which is incorporated herein by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18973. A copy may also be obtained by request to the Agency.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Law Implemented 393.067, 393.0673 FS. History–New 7-1-14, Amended 1-23-25, 3-26-26.

Fla. Admin. Code R. 65G-2.005 License Denial, Suspension or Revocation

(1) The Agency shall deny an application for licensure if:

(a) the applicant fails to provide the Agency with a complete application for licensure and has failed to respond to the Agency’s request for the missing information by the deadline set by the Agency;

(b) the applicant or a controlling entity has an arrest awaiting final disposition for, has been found guilty of (regardless of adjudication), entered a plea of nolo contendere or guilty to, or has been adjudicated delinquent and the record has not been sealed or expunged for, any offense identified in sections 393.0655 or 435.04, F.S.;

(c) the applicant or a controlling entity has had a license to operate a residential facility revoked by the Agency, the Agency for Health Care Administration (AHCA), the Department of Children and Families (DCF), Department of Juvenile Justice (DJJ), or the Department of Health (DOH);

(d) the applicant or a controlling entity has had a previous disciplinary action taken against them by Medicaid or Medicare;

(e) the applicant or a controlling entity has voluntarily relinquished a license to operate a residential facility in lieu of the Agency, AHCA, DCF, DJJ, or DOH pursuing an investigation or an administrative complaint against the applicant or a controlling entity;

(f) the applicant fails to provide the Agency with satisfactory proof of financial ability to operate for up to 60 days without dependence upon payment from the state or other third-party fees;

(g) the Agency’s monitoring of the applicant’s facility reveals violations of chapter 393, F.S., or this rule chapter that the applicant does not correct within the timeframe set by the Agency;

(h) DCF has verified or substantiated that the applicant or a controlling entity, is responsible for the abuse, neglect, or abandonment of a child or the abuse, neglect, or exploitation of a vulnerable adult;

(i) the applicant or the applicant’s agent or employee falsely represented or omitted a material fact in its license application submitted under section 393.067, F.S.;

(j) the applicant or a controlling entity has had a professional license revoked by a state licensing entity; or

(k) the Agency, AHCA, DOH, DJJ, or DCF have taken or are in the process of taking disciplinary action against the applicant’s or a controlling entity’s other licensed facility or facilities.

(2) In evaluating an application for licensure or renewal, the Agency shall consider whether DCF has verified or substantiated that the applicant’s employee is responsible for the abuse, neglect, or abandonment of a child or the abuse, neglect, or exploitation of a vulnerable adult. In conducting the evaluation, the Agency shall consider the following factors:

(a) the severity of the nature of the incident;

(b) whether the incident involved the abuse, neglect, exploitation, abandonment, death, or serious physical or mental injury of a resident or participant;

(d) whether the applicant was aware of the incident, was willfully ignorant of the incident, or attempted to conceal the incident;

(e) the number of individuals impacted by the incident;

(f) whether the applicant reported the incident within the timeframes described in this rule chapter;

(g) whether the applicant has cooperated with the Agency or any other investigating regulatory or law enforcement agency regarding the incident(s);

(h) whether there have been repeat instances of the same or similar incident(s), with consideration of the amount of time that has passed between incidents;

(i) whether an incident(s) involved more than one employee of the applicant; and

(j) any other relevant mitigating or aggravating factors.

(3) This rule is in addition to any disciplinary action listed in Rule 65G-2.0041, F.A.C.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Law Implemented 393.067, 393.0673 FS. History–New 8-13-78, Formerly 10F-6.03, 10F-6.003, 65B-6.003, Amended 7-1-14, 2-27-25, 3-26-26.

Fla. Admin. Code R. 65G-2.006 Licensed Residential Facility Capacity

(1) Maximum number of residents in each facility.

(a) A facility shall not serve more clients than the maximum capacity, as stated on the license.

(b) The licensed capacity shall be determined by the Agency after consideration of the following, as described in Rule 65G-2.007, F.A.C., General Residential Facility Standards:

the individual needs of each resident;
the number of staff members and direct service providers, and each staff member’s or direct service provider’s qualifications;
the experience, education, and qualifications of the facility operator or owner;
the type of services provided; and
any limitations imposed by the Fire Marshal and other relevant federal, state, and local authorities.

(c) The Agency shall reassess the maximum number of residents that may be served by a facility at any time the licensee requests a change of the facility’s capacity determination. This shall be reviewed using the criteria listed under paragraph (1)(b) of this rule and:

the level of active and appropriate supervision as evidenced by the staffing pattern and the number of staffing hours provided;
the frequency and severity of incident reports and violations that occurred or were identified during the current or preceding licensure year, which could be reasonably attributable to the number of residents served by the facility; and
the licensee’s response and cooperation with the Agency and whether the licensee has completed all Corrective Action Plans.

(d) If a licensee requests to increase the capacity of the facility, the licensee must submit a request to the Regional Office in writing at least 30 days prior to the proposed change. The request must:

include documentation showing that the licensee has successfully passed a fire inspection; and
demonstrate that the facility is in compliance with any local governmental or municipal zoning requirements as defined in section 419.001, F.S., and Rule 65G-2.015, F.A.C.

(e) The Agency shall monitor the facility and reassess the staffing pattern and the number of staff whenever it receives a request for capacity increase.

(f) If the request is approved, the Agency shall issue an amended license setting forth the new maximum capacity for the remainder of the previously existing license.

(g) The Agency may waive the 30-day prior notice requirement in paragraph (1)(d) of this rule due to an emergency or natural disaster wherein the licensee, after consultation and approval by the Agency, may increase the capacity of the facility.

(2) Census – the Licensee shall maintain one census, for each license issued, of residents living at the facility, regardless of whether they are clients of the Agency. The census information shall include the names, dates of birth, and if the resident is a client, the level of waiver services reimbursement, and client eligibility diagnosis. For changes to the census the licensee shall inform the Agency in writing prior to any change in the census to include an updated census. The updated census shall be sent to the Agency within five calendar days.

(3) Needs and characteristics of residents in each facility.

(a) Each facility licensed under this rule chapter shall serve only those residents whose characteristics, level of care, age, and sex are included on its license application.

(b) The Agency shall determine the needs and characteristics of residents who may be served by a facility based on a review of the following:

the layout, accessibility, and use of the facility;
the number of staff and direct care providers employed by the facility;
qualifications of staff; and
the level of care and services needed by the residents.

(c) The Agency shall reassess the characteristics of residents that may be served by a facility at any time the licensee requests a change of the facility’s capacity. This shall be reviewed using the criteria listed under paragraph (3)(b) of this rule and:

the level of active and appropriate supervision as evidenced by the staffing pattern and the number of staffing hours provided;
the frequency and severity of incident reports and violations that occurred or were identified during the current or preceding licensure year, which could be reasonably attributable to the characteristics of residents served by the facility; and
the licensee’s response and cooperation with the Agency and whether the licensee has completed all Corrective Action Plans.

(d) If a licensee wishes to change the level of care, age, or sex of residents that may be served in the facility from what was specified within the licensee’s most recent application for licensure, the licensee shall notify the Regional Office in writing 30 days prior to the proposed change. The Agency shall reinspect the facility if changes in the needs and characteristics of services provided or the level of care, age, or sex of residents served require additional modification to the home or staffing requirements. Upon approval the Agency shall inform the licensee and update the appropriate electronic systems to reflect the new needs and characteristics of residents served.

(4) The Agency’s evaluation of the characteristics, level of care and demographics of the facility’s residents or maximum number of residents served by a facility does not constitute a determination that the licensed facility is being operated in a safe or effective manner, a determination that the facility is acting in full compliance with the licensing requirements of this chapter, or a determination that any individual staff member employed by the facility is qualified or properly trained to serve the facility’s residents.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.02, 10F-6.002, 65B-6.002, Amended 7-1-14, 3-26-26.

Fla. Admin. Code R. 65G-2.007 General Residential Facility Standards

(1) Facility name and identification.

(a) No facility may be referred to or use names such as “nursing facility” or “rest facility” unless it is a nursing facility licensed under chapter 400, F.S.

(b) No facility may use the word “school” in its name unless there is a state or county certified educational program operated within the facility.

(c) No facility may erect any exterior sign which would label the residents or functions of the facility by indicating that the facility serves persons with developmental disabilities.

(2) Leasing of property by licensees. If the licensee is not the owner of the property, the licensee must have a fully executed lease.

(a) The lease must be current at the time of initial licensure and renewal.

(b) The lease must not lapse during the term of the license.

(c) The terms of the lease must not preclude the facility from being able to operate as a group home or foster home in accordance with Chapter 65G-2, F.A.C.

(3) General physical facility and site requirements. The facility is responsible for providing a healthy, safe, and caring residential environment that is clean, hygienic, and sanitary. For the facility to create such an environment, it must have and maintain the minimum standards as established by paragraphs (a) through (h) of this subsection, except in the event of impossibility such as a natural disaster or loss of power outside of the control of licensee.

(a) The facility must be free of any dangerous physical conditions and hazards. Interior and exterior building surfaces must be free of:

cracks, holes, tears, uneven projections, protruding nail, splinters;
broken, warped, or loose boards, tile, linoleum, handrails, railings, plaster, lath, window panes, hanging fixtures;
exposed pipes or electric wiring;
water spillage or damage; and
tripping hazards.

(b) All areas of the facility occupied by residents, including bedrooms, common areas, hallways, bathrooms, and dining areas shall have natural or mechanical ventilation.

(c) Ramps, doors, corridors, toileting and bathing facilities, furnishings, and equipment shall be designed to accommodate resident needs and disabilities.

(d) Those facilities serving residents with physical impairments may not have architectural barriers that prevent the resident’s participation in everyday facility activities.

(e) Each facility that requires medically essential service is solely responsible for any backup equipment or power supply and a planned course of action in the event of a power outage or interruption of service in accordance with section 366.15, F.S.

(f) The facility shall provide safe and sanitary housing. Floors, walls, ceilings, windows, doors, and all parts of the structures shall be of sound construction, properly maintained or in working order, and kept clean, hygienic, and sanitary as necessary to ensure the health and safety of the facility’s residents.

(g) All interior doors with locks shall be readily opened from the inside of the room.

(h) Exterior doors must not prevent individuals from exiting the building, but may utilize delayed egress systems provided such systems meet all of the following conditions:

egress is prevented for a maximum of 30 seconds;
the delayed egress system has been approved by the local authority having jurisdiction over fire safety or the State Fire Marshall; and
locks are automatically disengaged in the event of a fire, power outage, or activation of the fire alarm.

(4) Common living and dining areas.

(a) A minimum of 35 square feet of combined living and dining area shall be provided per household member, excluding bedrooms, bathrooms, hallways, kitchens, utility rooms, garage, and laundry rooms.

(b) The living area shall be provided with an adequate number of appropriate furnishings for the usual functions of daily living. These furnishings shall be sturdily constructed, in working condition, and designed to meet the daily needs of household members.

(c) The dining area furnishings shall be adequate in number, in working condition, and designed to meet the daily needs of household members.

(d) Facilities shall not charge residents an additional fee for television or internet services provided in a common area.

(5) Kitchen.

(a) The kitchen shall be large enough to accommodate the equipment and personnel needed to prepare and properly serve the required number of meals.

(b) The kitchen shall have equipment, utensils, and supplies in good condition and working order to properly store, prepare, and serve the required number of meals.

(c) Multi-use utensils, tableware, and equipment shall be thoroughly cleaned with hot water and disinfected after each meal.

(d) Cleaned and disinfected utensils, equipment, and all single-use articles shall be stored at least six inches above the floor in a clean, dry location and in a way that protects them from contamination by splashing, dust, and other contaminants.

(e) The food-contact surfaces of fixed equipment shall be protected from contamination. Such surfaces must be cleaned and disinfected, including equipment, counter tops, storage shelves, and similar areas. Food contact surfaces must be maintained in a clean, hygienic, and sanitary condition.

(f) All sinks shall be of sufficient size and depth to accommodate the utensils being washed.

(g) After cleaning, all equipment and utensils shall be dried. Cleaned equipment and utensils and all single-use articles shall be handled in a way that protects them from contamination.

(h) Dishwashers shall be properly installed and maintained in good repair and shall be operated in accordance with the manufacturer’s instructions and specifications.

(6) Bedrooms.

(a) Bedrooms shall be arranged to provide for resident privacy.

Bedroom doors shall not have vision panels except as may be necessary for residents who require visual supervision due to documented behavioral or medical issues.
Direct access to a resident’s bedroom from a common area is required. Sole access to a resident’s bedroom shall not be through a bathroom or other bedroom.
In determining licensed capacity, only bedrooms that are fully accessible and available for resident use may be considered. Bedrooms that are utilized exclusively by direct care staff, live-in caregivers, or the family members of live-in caregivers shall not be considered as available for resident use and will not be considered in determining the licensed capacity of the facility.

(b) Facilities initially licensed before July 1, 2014, with no lapse in licensure or change in licensee, can have a maximum of four residents sharing a bedroom. Facilities initially licensed on or after July 1, 2014, can have a maximum of two residents sharing a bedroom.

(d) Multi-occupancy bedrooms used by residents shall provide at least 60 square feet per person of usable floor space.

(e) Usable floor space shall include only those areas with vertical wall heights of five feet or more and does not include closet areas.

(f) Bedroom arrangements shall be compatible with the physical needs of the residents. Beds for residents shall be located so as to avoid drafts from windows and excessive heat from heat sources.

(g) No portable heaters shall be used in bedrooms in facilities serving six or fewer residents.

(h) Dresser drawers and either a wardrobe or an enclosed closet space adequate to store the appropriate belongings of each resident shall be provided commensurate with any physical or behavioral limitations of the resident and the physical limitations of the facility. Captain-style beds with drawers installed as part of the bed frame may be substituted or used as dresser drawers.

(i) Each resident shall have an individual bed.

Futons, cots, inflatable mattresses, hammocks, and sleeper sofas shall not be used as permanent bedding.
Each resident’s bed shall have a clean, firm, comfortable mattress which is clean and in good condition, and free from fabric tears, holes, odors, loose springs, and noticeable sagging.
Beds shall be of suitable dimensions to accommodate residents who are using them. The bedding must consider and accommodate the physical needs and requirements of the individual resident.
Bunk beds shall not be permitted.
Enclosure bed system shall not be permitted unless it is required within a resident’s approved behavioral plan under Chapter 65G-8, F.A.C., and is used in conformity therewith.

(j) The facility shall offer bedding and linens for each resident.

These shall include a suitable pillow, pillowcase, sheets, blanket, and a bedspread or comforter which shall all be clean and in good condition.
All bedding and linens shall be clean and in good condition.
Bed linens shall be replaced with clean linens at least once each week, or more frequently as required.
Residents shall not be permitted to sleep or rest on soiled beds and bed pillows.
A resident may choose to purchase their own bedding and linens in order to personalize his or her bedroom or when it is determined by a licensed physician to be medically necessary to address a diagnosed medical condition.
Bedding and linens purchased by the licensee must be available to accommodate the licensed capacity of the home.
A mattress cover or waterproof sheet shall be provided if needed by the resident due to allergies, incontinence, or other medical or physical reasons.
Bedding shall be appropriate to the season.

(k) Bedroom furnishings for residents shall include adequate shelf space, individual chest or dresser space, draperies or shades commensurate with any physical or behavioral limitations of the resident. Window coverings, including draperies or shades, are not required for skylight windows.

(l) Additional storage space shall be available elsewhere in the facility to accommodate residents’ luggage and large or seldom used personal belongings commensurate with the physical limitations of the facility. The storage space must be able to be secured or locked and free from insects or pests.

(m) Each resident shall be allowed to decorate his or her private quarters in an individual style that will respect the care of the property and other residents who may share the bedroom commensurate with the physical limitations of the facility.

(7) Bathrooms.

(a) There shall be at least one toilet, lavatory, and tub or shower, accessible and available for resident use for every three residents in facilities initially licensed on or after July 1, 2014. Facilities initially licensed before July 1, 2014, and continuously thereafter shall have no less than one toilet and lavatory for every six residents, and one shower for every eight residents.

(b) Only bathrooms that are functional and that meet the needs of the individual residents shall be considered when determining the licensed capacity of a facility. Bathrooms used solely by staff, live-in staff, or family members of live-in staff are not available to residents and shall not be considered in the calculation of licensed capacity.

(d) Bathrooms shall be clean, hygienic, sanitary and well-ventilated.

(e) Bathrooms must be indoors.

(f) Bathrooms shall provide individual privacy. When multiple residents share a bathroom, the licensee and direct care staff are responsible for ensuring that the rights, preferences, and privacy of other residents are taken into consideration and respected.

(g) Each resident shall be provided a separate and appropriate place for his/her own toothbrush, towel, and other personal care items.

(h) Toilet and bathing area fixtures shall be in good working condition and approximate normal patterns found in residential construction, except for special requirements applicable for residents with physical impairments or for special needs.

(i) Bathrooms shall have sufficient supplies of toiletry items such as shampoo, toothpaste, soap, and toilet paper to accommodate resident needs. A resident may choose to purchase his or her own toiletry items based on his or her personal preference. A resident may discontinue his or her choice at any time and request to use facility-supplied toiletry items.

(8) Water temperature. The facility must have an adequate supply of hot water for bathing and dishwashing, sufficient to meet the needs of all household members. Hot water accessible to residents must not exceed 120 degrees Fahrenheit (48.9 degrees Celsius) at the outlet.

(9) Laundry.

(a) Laundry services, including clothes washing and drying, shall be provided by or available within the facility or accessible to residents through commercial laundry services. If the laundry appliances become inoperable, outside laundry services shall be provided until such time as repairs are made or the appliances are replaced. The facility shall be responsible for the cost of such services.

(b) Laundry soap, fabric softener, bleach, and stain remover shall be supplied for resident use and paid for by the facility.

(c) If laundry services are provided within the facility, the facilities and appliances shall kept free of excessive lint build-up.

(10) Heating and cooling.

(a) Indoor temperature shall be maintained within a range of 68 to 80 degrees Fahrenheit, as appropriate for the climate.

(b) Any heating equipment or apparatus employed shall not constitute a burn hazard to the residents.

(c) There shall be no discernible differences between the temperature and humidity of areas within the facility that are used by staff and those areas used by the residents, unless such differences are based on documented resident need or preference.

(d) Temperature variances due to a natural disaster, power outages outside of the licensee’s control, or equipment failures that are being repaired in a timely manner that will not endanger the facility’s residents shall not be considered violations of this subsection. The licensee must notify the Agency when repairs or replacement to the heating and air conditioning system are needed to maintain the required temperature range in accordance with paragraph (10)(a). The licensee must keep the Agency updated with respect to any repairs or replacement.

(e) Portable heaters, such as space heaters, must utilize an automatic safety switch that turns the unit off if it is tipped over, and a thermostatic control or timer which ensures that the unit will turn itself off and prevent overheating or creating an electrical hazard.

(11) Lighting. All areas of the facility shall be adequately lighted in accordance with area usage and to ensure the health and safety of residents.

(12) Housekeeping and maintenance. The interior and exterior of the facility shall be maintained by the licensee to ensure the health and safety of residents. The licensee must:

(a) keep the buildings in a clean, safe and orderly condition. This includes all rooms, corridors, attics, basements, and storage areas;

(b) keep attics, basements, stairways and similar areas free of accumulations of refuse, discarded furniture, discarded equipment, newspapers, magazines, boxes, and other similar items;

(d) supply and pay for necessary cleaning supplies;

(e) keep the facility free of unpleasant or noxious odors;

(f) ensure that the grounds and any additional buildings on the grounds are kept free of unkempt vegetation and debris and maintained in a safe and sanitary condition;

(g) ensure that all outdoor garbage and other waste materials are kept in covered containers until removed. Containers shall be emptied as often as necessary to prevent public nuisance and health hazards in accordance with municipal and county requirements of the jurisdiction within which the facility is located;

(h) ensure that all indoor garbage and other waste materials are stored in a manner that maintains a sanitary condition. Trash cans or other such waste containers must be emptied as often as necessary to prevent attracting pest or vermin and unpleasant and noxious odors;

(i) provide mitigation of risk or assurances of safety to prevent harm or injury from hazardous areas. Such mitigating risk or assurances of safety methods include door chimes, alarms, fencing or a wall of at least four feet in height. A hazardous area is that area designated as such by Agency staff at the time of initial licensure, or in the case of a significant change in the needs and characteristics of the residents of the facility, or a significant change to the facility, property or land adjacent, which may include, but is not limited to, water hazards such as, canals, creeks, holding ponds, rivers, lakes, swamps. In determining the hazardous area, Agency staff shall consult with the licensee and any determination about the hazardous area designation must be related to and consider the needs and characteristics of the residents of the facility; and

(j) except when restitution is a component of a client’s LRC-approved behavior plan, licensees are solely responsible for any costs associated with the repair or replacement of any facility equipment or property which is owned or leased by the licensee when such equipment or property is lost, damaged or destroyed by a resident. Unless the licensee agrees to cover replacement or repair costs, a resident who damages or destroys equipment or property which is owned or leased by himself/herself or other residents of the facility shall be responsible for any costs associated with the repair or replacement of such equipment or property.

(13) Meal services. Unless contraindicated by documented medical, behavioral, or dietary requirements for individual residents, the following meal service standards shall apply to all facilities:

(a) Food and beverages shall be of adequate quantity and variety, served at appropriate temperatures, prepared by methods which conserve nutritional value, and served in a form easy for residents to manage and, within reason, in keeping with resident preferences.

(b) Within reason, dietary practices in keeping with the religious requirements of the resident’s faith group shall be observed at the request of the resident, or the resident’s authorized representative.

(c) Residents who are not routinely absent from the facility for work or other purposes must be prepared at least three meals at regular times during each 24-hour period. If a resident is absent from the facility for work or for an approved program during a regular meal time, the resident must be provided a meal at no charge to the resident. Snacks shall be available and provided by the facility at appropriate times during the day or evening.

(d) Dining and serving arrangements shall provide for a variety of eating experiences and the opportunity for residents to make food selections with guidance.

(e) Meals are developed in accordance with residents’ individual medical, behavioral, and dietary requirements.

(f) Menus shall be planned, written, and dated at least two days in advance of consumption. Resident participation in meal planning is recommended but not required.

(g) In accordance with the menu, a minimum of two days of fresh food supplies and five days of staple food and drinking water supplies sufficient for all household members shall be available at the facility at all times.

(14) Food preparation, storage, and service.

(a) All food preparation surfaces, preparation equipment, utensils, cutlery, and dishes must be maintained in a clean and disinfected manner, free of any damage, and safe for intended use.

(b) Food must be free from cross-contamination.

(d) Hotplates, grills, propane stoves, and similar equipment must be operated in a well-ventilated area and free from hazard(s).

(e) All food received or used in a licensed facility shall be clean, hygienic and sanitary, and safe for human consumption, and free from spoilage, adulteration, and misbranding.

(f) Food, while being transported, stored, prepared, displayed, or served within the facility, shall be protected from dust, flies, rodents or other vermin, toxic materials, unclean equipment and utensils, flooding, sewage, overhead leakage, and any other source of contamination.

(g) Food shall be stored a minimum of six inches above the floor, on clean shelves, racks, or other clean surfaces in such a manner as to be protected from splashing and other contamination. Food must be stored in a manner which permits free air circulation in and around food. Metal pressurized beverage containers, food packaged in cans, glass, or other waterproof containers need not be elevated when the floor is clean, and the food container is not exposed to moisture.

(h) Food not subject to further washing or cooking (ready-to-eat food) before being served shall be stored in a manner that protects it from cross-contamination with food requiring washing or cooking. Packaged food shall not be stored in contact with water or undrained ice.

(i) Food, whether raw or prepared, if removed from the container or package in which it was obtained, shall be stored in a clean, covered, and labeled container, except during necessary periods of preparation or service. Container covers shall be impervious and nonabsorbent.

(j) Prior to the food being placed into the freezer, the container must be clearly marked to indicate the date of freezing. Food must be dated if not consumed upon initial preparation.

(k) Hot food shall be cooled within four hours to 41 degrees Fahrenheit or below.

(l) Potentially hazardous food. For purposes of this rule, “potentially hazardous food” means food that requires refrigeration or freezing to prevent spoilage while it is in storage. The following requirements apply to potentially hazardous food:

Different types of raw animal products such as beef, fish, lamb, pork, or poultry shall be separated during storage and processing by use of different containers, partitions, shelves, or by cleaning and sanitizing the equipment between product use. Raw food products shall be physically separated from ready-to-eat food products during display or storage by storing the raw products below all ready-to-eat food products.
Upon receipt, potentially hazardous food shall be stored in a refrigerator or freezer, as appropriate, at temperatures that will protect it from spoilage. All potentially hazardous food shall be kept at safe temperatures, either below 41 degrees Fahrenheit or above 135 degrees Fahrenheit after cooking.
Potentially hazardous foods that are to be served without further cooking (ready-to-eat foods) and that will require refrigeration shall not be allowed to remain between 41 and 135 degrees Fahrenheit for a period in excess of four hours.
Frozen potentially hazardous food shall be thawed in refrigerated units at a temperature not to exceed 41 degrees Fahrenheit, under cold potable running water, or in a microwave. Frozen potentially hazardous food shall be cooked immediately after thawing.
Potentially hazardous foods shall be kept for no more than seven days after its initial cooking.

(15) Firearms and weapons.

(a) Firearms, ammunition, and all other weapons shall be prohibited in licensed facilities unless the facility also serves as the primary residence of the licensee.

(b) All firearms must be stored unloaded. Firearms and ammunition shall be stored separately from each other within locked storage areas. Weapons normally associated with hunting, fishing, hiking, or recreational target sports, such as bows and arrows, spear guns or slingshot type devices, shall be stored unloaded within locked storage areas not accessible to facility residents. Other weapons associated with personal protection such as stun guns or chemical aversive sprays such as Mace or pepper spray shall also be kept in locked storage areas not accessible to facility residents.

(16) Hazardous and toxic chemicals or compounds.

(a) All poisonous and toxic chemicals or compounds and potentially hazardous instruments shall be used with extreme caution. Chemicals or compounds harmless to humans shall be used whenever reasonably appropriate.

(b) Poisonous and toxic compounds shall be kept in a locked storage space.

(d) In all cases, such products shall be stored in their original containers or, if transferred to other containers for dispensing purposes, clearly labeled as to the contents and locked in a storage area.

(e) Facilities constructed before 1978 may have lead-based paint hazards. For facilities built before 1978, the licensee must provide written disclosure of the presence of lead-based paint or lead-based paint hazards to current and prospective residents of the facility.

(17) Swimming pools and other bodies of water hazards.

(a) Residents who are not proficient swimmers:

Must be supervised by sight and sound at all times when they are within 50 feet of any body of water or water hazard such as pools, hot tubs, canals, creeks, holding ponds, rivers, lakes, swamps or areas subject to flooding. Access to bodies of water or other water hazards must be restricted when supervision is not available. Supervision must be provided by an adult employee of the facility who is responsible for the resident and who is also certified in first aid and CPR.
Must not be allowed in pools or other bodies of water without wearing a life jacket or other U.S. Coast Guard approved flotation device unless engaged in swimming lessons or while under the direct supervision of an on-shift employee capable of assisting with swimming-related emergencies who is also certified in first aid and CPR.

(b) All water-related recreational activities in which residents are participating, such as boating or water sports, must be directly supervised by an adult employee of the facility.

(c) Pools without filters, such as wading or kiddy pools, are permitted for use by facilities and shall be assembled and used in accordance with manufacturer’s instructions. Such pools must be emptied and stored away when not in use and filled with clean water before the next use.

(d) All entry points and safety covers must be locked when the pool or spa is not in use.

(e) Swimming pools must be equipped with one of the following life saving devices: ring buoy, rescue tube, flotation device with a rope, or a pole of sufficient length to cover the area of the pool.

(f) While the pool or spa is in use, accessible ingress and egress must be provided.

(g) All stairs and ladders in and around the pool or spa must be in good working condition.

(h) Any pool or spa located on the facility property shall be maintained in a clean, hygienic, and sanitary condition.

(18) Smoking.

(a) Facilities that do not prohibit residents or staff from smoking indoors, either through admission criteria, house rules or self-government, may permit smoking only in areas that are designated by the residents, except that the designated smoking area shall not include indoor common areas shared or accessed by non-smoking residents.

(b) Residents shall not be permitted to smoke in bed, except that those confined to bed by infirmity may be permitted to do so only under the visual supervision of staff.

(c) Smoking shall not be permitted indoors if any of the residents of the facility are children or possess a medical condition, such as asthma, which would be aggravated by indoor smoking.

(19) Alarms. Alarms that are activated when an exterior door or window is opened are permitted for use within residential facilities.

(20) Smoke and carbon monoxide detectors. Facilities shall be equipped with smoke and carbon monoxide detectors in good working condition.

(21) Insect, rodent, and vermin control.

(a) Effective measures shall be utilized to minimize the presence of rodents, flies, cockroaches, bedbugs, and other insects on the premises, which includes maintaining a clean environment in the facility.

(b) All buildings shall be effectively maintained rodent-proofed and rodent free.

(d) For persistent pest control problems, a licensed pest control operator must be utilized to eliminate the threat.

(22) Animal health and safety.

(a) Animals must be kept free from disease or under treatment by a licensed veterinarian.

(b) Animals being kept indoors or having access to the indoors must be treated for flea and tick control in accordance with the recommendations of a licensed veterinarian to prevent infestations.

(c) Animals requiring rabies vaccination must be vaccinated for rabies and their vaccinations must be current at the time of inspection. Proof of rabies vaccination or veterinary certification of vaccination exemption shall be kept on the premises at all times.

(d) Facility property must be kept reasonably free from animal waste.

(23) Response to resident sickness.

(a) Facility staff must carefully clean any areas contaminated with vomit, stool, or bodily fluids.

(b) Vomit, stool, and bodily fluids shall be cleaned up before disinfecting. Responsible staff shall wear disposable gloves to clean and disinfect whenever possible. Cleaning shall be done with disposable towels, and used towels shall be disposed of in a non-absorbent plastic bag.

(c) Facility staff must disinfect the affected area after it is completely cleaned. Staff shall allow the area to air-dry, and discard all materials used to clean the area, including placing used towels and gloves in a non-absorbent plastic bag. Staff must wash their hands with soap and water immediately after removing gloves.

(d) Soiled linens, soiled clothes, or other soiled items shall be carefully removed and kept separated from uncontaminated items. Soiled linens, soiled clothes, or other soiled items that are contaminated shall be washed separately from uncontaminated items using a regular wash cycle at high temperature with detergent, or regular wash cycle with detergent and bleach or other sanitizer.

(24) Foreclosures, evictions, and bankruptcies.

(a) Licensees must notify the Agency within 24 hours upon the receipt of a notice of eviction or foreclosure involving the property at which the license is maintained.

(b) Licensees who file for bankruptcy protection must notify the Agency within 24 hours of filing for bankruptcy.

(25) Mobile homes or manufactured homes, as defined in section 320.01(2), F.S., may not be used for foster care facilities, group home facilities, or residential habilitation centers. This does not include modular homes. For the purposes of this rule, a mobile or manufactured home is a home that is transported on a non-removable chassis which remains a structural part of the home and considered relocatable.

(26) Optional in-service training. The licensee may develop in-service training for family members, guardians or guardian advocates of residents. This training may address topics such as appropriate behavioral interventions, guardianship, social security benefit issues, or other topics of relevance. Under no circumstances may the licensee, or its contracted trainer or presenter, charge a fee for the provision of such training.

(27) Willful or intentional misstatements. A licensee or applicant shall not make willful or intentional misstatements, orally or in writing, to intentionally mislead Agency staff, the Department of Children and Families, or law enforcement in the performance of their duties.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.08, 10F-6.008, 65B-6.008, Amended 7-1-14, 5-5-15, 3-26-26.

Fla. Admin. Code R. 65G-2.0071 Foster Care Facility Standards

(1) Each foster care facility shall be located in an area which complies with local zoning restrictions.

(2) Each foster care facility shall designate a person as responsible for the ongoing operation of the foster care facility and for ensuring compliance with Chapter 65G-2, F.A.C., and section 393.067, F.S.

(3) In addition to the staffing requirements delineated under Rule 65G-2.008, F.A.C., foster care facilities which utilize live-in caregivers must provide for at least one back-up direct care staff who has undergone a successful background screening in accordance with section 393.0655, F.S., and chapter 435, F.S. This back up direct care staff must be willing and able to render services to residents in the event that neither of the live-in caregivers are able to do so.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.09, 10F-6.009, 65B-6.009, Amended 7-1-14, Formerly 65G-2.011, Amended 3-26-26.

Fla. Admin. Code R. 65G-2.0072 Group Home Facility Standards

(1) Each group home facility shall be located in an area which complies with local zoning restrictions.

(2) Each group home facility shall have a designated facility operator on-site or on call at all times. The facility operator is responsible for the ongoing operation of the group home facility and for ensuring compliance with Chapter 65G-2, F.A.C., and section 393.067, F.S. whenever the facility operator is onsite or on call and one or more residents are present in the facility.

(3) The facility operator shall be a person of responsible character and integrity, qualified by education, training, and experience to effectively manage the facility. The operator shall have successfully completed at least 90 credit hours of accredited college level coursework applicable to the functions of the facility, such as education, special education, social work, sociology, health, psychology or child development, or have at least a high school diploma and three years relevant experience in working with children, adolescents or adults with disabilities. The licensee shall designate a capable person who shall perform all the necessary duties of the operator during the temporary absence of the operator. Direct service providers hired by the licensee prior to the adoption date of this rule shall be exempt from this requirement.

(4) An area of the facility shall be designated as office space where files, desk, telephone and other administrative tools and equipment are located. Adequate provisions shall be made for ensuring the security of confidential files and other types of records, such as account books, inventories, audits, resident records, and resident funds. These records may be kept electronically.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.10, 10F-6.010, 65B-6.010, Amended 7-1-14, Formerly 65G-2.012, Amended 3-26-26.

Fla. Admin. Code R. 65G-2.0073 Residential Habilitation Center Standards

(1) Organization and administration.

(a) A residential habilitation center need not be a fully self-contained program unit. Residential habilitation center activities may be coordinated with habilitative educational and recreational activities in which the residents engage outside of the facility.

(b) Each facility shall designate a facility operator who is onsite or on call at all times. The facility operator is responsible for the ongoing operation of the residential habilitation facility and for ensuring compliance with Chapter 65G-2, F.A.C., and chapter 393, F.S.

(c) The operator shall be a person of responsible character and integrity, qualified by education, training, and/or experience to effectively manage the facility. The operator should have successfully completed accredited college level course work applicable to the functions of the facility, such as education, special education, social work, sociology, health, psychology or child development, or have at least a high school diploma and three years relevant experience in working with children, adolescents or adults with developmental disabilities. The operator shall designate a capable person who, in his or her absence but under his or her supervision, will perform all the necessary duties of the position.

(d) An area of the facility shall be designated as office space where files, desk, telephone and other administrative tools and equipment are installed. Provisions shall be made for locking and protecting confidential files and other types of records, e.g., account books, inventories, audits, resident records, and resident funds

(2) Resident training.

(a) The residential habilitation center shall ensure that all residents receive habilitative services to meet their individualized needs.

(b) The residential habilitation center will assist the resident in exercising maximum independence in the following:

Self-care skills, such as eating, dressing, toileting, bathing, and grooming;
Daily living skills, such as community living skills, housekeeping skills, first aid, and use of a telephone;
Communication skills, verbal or nonverbal, such as receptive language, expressive language, functional reading, and functional writing;
Social skills, such as adaptive behaviors for appropriately interacting with others in all settings;
Motor skills, such as fine and gross motor skills;
Recreational skills or interests;
Human growth and development;
Basic knowledge or cognitive development, including both pre-academic and academic skills; and
Job related skills.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.11, 10F-6.011, 65B-6.011, Amended 7-1-14, Formerly 65G-2.013, Amended 3-26-26.

Fla. Admin. Code R. 65G-2.0074 Adult Day Training Program Standards

(1) Right to use and occupy.

(a) The licensee must have the legal right to use and occupy the property.

(b) If the licensee is not the owner of the property, they must have a fully executed lease.

The lease must be current at the time of initial licensure and renewal.
The lease must not lapse during the term of the license.
The terms of the lease must not preclude the program from being able to operate as an Adult Day Training Program (“ADT”) in accordance with Chapter 65G-2, F.A.C.

(2) Physical site standards.

(a) The program is responsible for providing a healthy, safe, and caring environment. The program must have and maintain the minimum physical site standards as established by this Rule. The only exception to the physical site standards is in the event of an emergency, such as a natural disaster or loss of power outside of the control of licensee.

(b) An occupied dwelling, storage units, or garage may not be used for ADT services.

(c) The physical site must be free of dangerous conditions and hazards. Interior and exterior building surfaces must be free of hazardous conditions including:

cracks, holes, tears, uneven projections, protruding nails, splinters;
broken, warped, or loose: boards, tile, linoleum, handrails, railings, plaster, lath, windowpanes, hanging fixtures;
exposed pipes, ducts, or electrical wiring within human reach;
water leaks or damage;
tripping hazards; and
hazardous chemicals or materials that are not safely stored.

(d) All areas of the physical site occupied by participants, including rooms, common areas, hallways, bathrooms, and dining areas shall have natural or mechanical ventilation.

(e) Each program must have documentation showing that the licensee has successfully passed and maintains compliance with fire safety inspections.

(f) Ramps, doors, corridors, bathrooms, changing areas, furnishings, and equipment shall be accessible and designed to accommodate participants’ needs and disabilities.

(g) The physical site must not have architectural barriers that prevent participation in everyday program activities or limits care.

(h) Each program that serves participants who require medically essential services requiring a power source or equipment that requires electricity is solely responsible for ensuring there is backup equipment or power supply and a planned course of action in the event of a power outage or interruption of service in accordance with section 366.15, F.S.

(i) The program shall provide a safe, clean, hygienic and sanitary setting. Floors, walls, ceilings, windows, doors, and all parts of the structures shall be of sound construction, properly maintained, in working order, and kept clean as necessary to ensure the health and safety of the facility’s/program’s participants.

(j) All interior doors with locks must be openable from the inside of the room.

(k) Exterior doors must not prevent individuals from exiting the building.

(l) Each physical site must have a designated drop off and pick up area that is free from hazards and roadway traffic.

(3) Activity area and dining area.

(a) The number of occupants in the building shall not exceed the maximum occupancy indicated on the license.

(b) The classroom and activity area shall be provided with an adequate number of appropriate furnishings for the usual functions. These furnishings shall be sturdily constructed, in working condition, and be designed to meet the daily needs of participants.

(c) The dining area furnishings shall be adequate in number, sturdily constructed and be designed to meet the daily needs of participants.

(4) Food preparation, storage, and service.

(a) All surfaces, preparation equipment, utensils, cutlery, and dishes must be maintained in a clean and sanitized manner, free of any damage, and safe for intended use.

(b) All participant’s food plans must be maintained in participant file and followed, if applicable.

(d) All food must be stored at appropriate temperature and location to maintain safety.

(e) Hotplates, grills, propane stoves, and similar equipment must be operated in a well-ventilated area and free from hazard(s).

(f) All food received or used in a licensed program shall be clean, hygienic and sanitary, and safe for human consumption, and free from spoilage, adulteration, and misbranding.

(g) Food, while being transported, stored, prepared, displayed, or served within licensed program, shall be protected from dust, flies, rodents or other vermin, toxic materials, unclean equipment and utensils, flooding, sewage, overhead leakage, and any other source of contamination.

(h) Food shall be stored a minimum of six inches above the floor, on clean shelves, racks, or other clean surfaces in such a manner as to be protected from splashing and other contamination. Food must be stored in a manner which permits free air circulation in and around food. Metal pressurized beverage containers, food packaged in cans, glass, or other waterproof containers need not be elevated when the floor is clean, and the food container is not exposed to moisture.

(i) Food not subject to further washing or cooking (ready to eat) before being served shall be stored in a manner that protects it from cross-contamination with food requiring washing or cooking. Packaged food shall not be stored in contact with water or undrained ice.

(j) Food, whether raw or prepared, if removed from the container or package in which it was obtained, shall be stored in a clean, covered, and labeled container except during necessary periods of preparation or service. Container covers shall be impervious and nonabsorbent.

(k) Prior to the food being placed into the freezer, the container must be clearly marked to indicate the date of freezing. Food must be dated if not consumed upon initial preparation.

(l) Hot food shall be cooled within 4 hours to 41 degrees Fahrenheit or below.

(m) Potentially hazardous food. For purposes of this rule, “potentially hazardous food” means food that requires refrigeration or freezing to prevent spoilage while it is in storage. The following requirements apply to potentially hazardous food:

Different types of raw animal products such as beef, fish, lamb, pork, or poultry shall be separated during storage and processing by use of different containers, partitions, shelves, or by cleaning and sanitizing the equipment between product use. Raw food products shall be physically separated from ready-to-eat food products during display or storage by storing the raw products below all ready-to-eat food products.
Upon receipt, potentially hazardous food shall be stored in a refrigerator or freezer, as appropriate, at temperatures that will protect it from spoilage. All potentially hazardous food shall be kept at safe temperatures, either below 41 degrees Fahrenheit or above 135 degrees Fahrenheit after cooking.
Potentially hazardous foods that are to be served without further cooking (ready to eat foods) and will require refrigeration shall not be allowed to remain between 41 degrees and 135 degrees Fahrenheit for a period in excess of four hours.
Frozen potentially hazardous food shall be thawed in refrigerated units at a temperature not to exceed 41 degrees Fahrenheit, or under cold potable running water, or in a microwave. Frozen potentially hazardous food shall be cooked immediately after thawing.
Potentially hazardous foods shall be kept for no more than seven days after its initial cooking.

(n) When meal services are served or prepared by the program, the following standards shall apply:

The program shall identify each participants’ nutritional needs and dietary orders at the time of admission. A copy of current dietary plans, if applicable, shall be maintained on file.
Food and beverages shall be of adequate quantity and variety, served at appropriate temperatures, prepared by methods which conserve nutritional value, and served in a form easy for participants to manage and, within reason, in keeping with participant preferences. Within reason, dietary practices in keeping with the religious requirements of the participant's faith group shall be observed at the request of the participant or the participant’s legal representative.
Menus shall be planned and written and dated at least two days in advance of consumption.
Meals shall be prepared and served in accordance with the facility or program’s menu.
Meals shall be served in accordance with participants’ applicable dietary plan.

(o) If the program is required to be inspected for food preparation or handling by another state or local governmental agency, such program will be in compliance with this subsection upon a showing of a current, valid, satisfactory inspection from that other state or local governmental agency. Failure to have such an inspection, or evidence thereof, shall be grounds for discipline in accordance with Rule 65G-2.0041, F.A.C. Any stop sale or emergency action taken by the inspecting entity regarding the inspection may be grounds for discipline in accordance with Rule 65G-2.0041, F.A.C., unless such stop sale or emergency action is later found to be invalid.

(5) Bathrooms and changing areas.

(a) The physical site shall have bathrooms, equipped with functioning toilets and sinks, accessible and available for participant use, follow ADA Standards and be in a good working condition that is clean, hygienic and sanitary.

(b) Bathrooms and changing areas used by participants shall provide individual privacy.

(d) Bathrooms and changing areas shall have sufficient supplies of toiletry items such as soap and toilet paper to accommodate participants’ needs.

(e) Bathrooms and changing areas must be indoors.

(f) For all ADTs, the physical site shall have at minimum two toilets and two sinks for every 50 individuals, including participants and staff.

(6) Water temperature. The program must have an adequate supply of clean water. Hot water, if available in changing facilities or sinks, used by participants must not exceed 120 degrees Fahrenheit (48.9 degrees Celsius) at the outlet.

(7) Heating and cooling.

(a) Indoor temperature shall be maintained within a range of 62 degrees to 80 degrees, as appropriate for the climate. The facility or program shall not provide services to participants when temperatures fall outside of this range. An alternative location meeting these temperature ranges, commensurate with the facility’s emergency operation plan, must be immediately utilized until the temperature in the original licensed location falls within the ranges outlined herein.

(b) All heating equipment shall be maintained to ensure that there is no burn hazard to the participants.

(c) Portable heaters, such as space heaters, must utilize an automatic safety switch that turns the unit off if it is tipped over, and a thermostatic control which ensures that the unit will turn itself off and prevent overheating or creating an electrical hazard.

(d) There shall be no discernible differences between the temperature and humidity of areas within the physical site that are used by staff and those areas used by the participants unless such differences are based on documented participant need or preference.

(e) The physical site must maintain a thermometer which accurately identifies the temperature.

(f) The licensee must notify the Agency when repairs to the heating or cooling systems are needed, when it is reasonably expected to cause the temperature to fail to meet the requirements of this section, the timeline for those repairs, and must keep the Agency updated as repairs are made.

(g) Programs that operate outdoors must have alternate settings in place in the event of inclement weather, including extreme heat, humidity, or cold, and respite for participants when needed.

(8) Lighting. All areas of the physical site shall be suitably lit in accordance with area usage.

(9) Housekeeping and maintenance.

(a) The interior and exterior of the physical site shall be maintained by the licensee to ensure the health and safety of participants. The physical site must have a written plan for housekeeping, including staff, equipment, and supplies. As part of the licensee's housekeeping plan, the licensee must:

(b) Keep the buildings in a clean, safe, and orderly condition. This includes all rooms, bathrooms, corridors, storage areas, entry ways and ramps;

(d) Keep stairways and similar areas free of accumulations of refuse, discarded furniture, discarded equipment, newspapers, magazines, boxes, and other similar items;

(e) The physical site shall be free of unpleasant or noxious odors.

(f) To ensure the health and safety of participants, the grounds and any additional buildings on the grounds, under the control and custody of the ADT, shall be free of unkempt vegetation and debris and maintained in a safe, clean, and sanitary condition.

(g) All outdoor garbage and other waste materials shall be kept in covered containers until removed. Containers shall be emptied as often as necessary to prevent public nuisance and health hazards in accordance with municipal and county requirements of the jurisdiction within which the facility or program is located.

(h) All indoor garbage and other waste materials shall be stored in a manner that would maintain a sanitary condition. Trash cans or other such waste containers must be emptied as often as necessary to prevent attracting pest or vermin and prevent unpleasant or noxious odors.

(i) Except when restitution is a component of a client’s Local Review Committee-approved or participant’s behavior plan, licensees are solely responsible for any costs associated with the repair or replacement of any facility or program equipment or property which is owned or leased by the licensee when such equipment or property is lost, damaged, or destroyed by a participant. Any necessary repairs must be made in a timely fashion to keep all requirements described in this rule in good working condition.

(10) Firearms and weapons.

(a) Only certified security guards or law enforcement may be permitted to carry firearms, ammunition, and any other weapon in the course of their duty.

(b) If an armed security guard is used, the program must maintain policies to ensure participants remain safe and do not have access to weapons.

(11) Hazardous and toxic compounds.

(a) All poisonous and toxic compounds and potentially hazardous instruments shall be used with extreme caution. Compounds harmless to human consumption shall be used whenever reasonably appropriate.

(b) All poisonous, toxic, and hazardous compounds and materials shall be stored in an appropriate container which identifies the material it contains, and locked in a storage space to restrict participant access.

(12) Swimming pools and other bodies of water.

(a) Access to bodies of water or other water hazards must be restricted when supervision is not available. Supervision must be provided by an adult staff member of the program who is responsible for the participant who is certified in first aid and CPR.

(b) All water-related recreational activities in which participants are partaking, such as boating or water sports, must be directly supervised by an adult staff member of the facility or program who is certified in first aid and CPR with the means to contact Emergency Response Services.

Must be supervised by sight and sound at all times when they are within 50 feet of any body of water or water hazard such as pools, hot tubs, canals, creeks, holding ponds, rivers, lakes, swamps or areas subject to flooding.
Must not be allowed in pools or other bodies of water without wearing a life jacket or other U.S. Coast Guard approved flotation device, unless engaged in swimming lessons or while under the direct supervision of staff capable of assisting with swimming-related emergencies and who is certified in first aid and CPR.

(d) Any swimming pool maintained by the facility must be kept in a clean, hygienic and sanitary condition.

(13) Smoking. Smoking, vaping, or use of other tobacco products shall not be permitted indoors.

(14) Alarms. Alarms that are activated when an exterior door or window is opened are permitted for use within licensed facilities/programs.

(15) Smoke and carbon monoxide detectors.

(a) Facilities shall be equipped with smoke and carbon monoxide detectors in good working condition. Battery activated detectors must be tested at least every six months.

(b) Battery activated detectors testing must be documented and maintained by the physical site. Documentation must include:

First and last name of staff completing the test;
Date of the test;
Time of the test; and
Result of the test.

(16) Insect, rodent, and vermin control.

(a) Measures shall be utilized to minimize the presence of rodents, flies, cockroaches, bedbugs, lice, and other insects on the premises, which include maintaining a clean environment in the physical site. This shall include, but not be limited to the use of a licensed pest control operator.

(b) All buildings shall be maintained rodent-proof and free from rodents.

(d) For persistent pest control problems, a licensed pest control operator must be used to address the persistent pest control problem.

(e) In the event of an infestation, all measures taken must be documented by the licensee and provided to the Agency.

(17) Animal health and safety.

(a) Animals must be kept free from disease or under treatment by a licensed veterinarian.

(b) Animals kept indoors or having access to the indoors must be treated for flea and tick control in accordance with the recommendations of a licensed veterinarian to prevent infestations.

(18) Response to participant sickness.

(a) Program staff must carefully clean any areas contaminated with vomit, stool, or other bodily fluid.

(b) Vomit, stool, and bodily fluid shall be cleaned up before disinfecting. Responsible staff shall wear disposable gloves to clean and disinfect whenever possible. Cleaning shall be done with disposable towels and used towels shall be disposed of in a non-absorbent plastic bag.

(c) Program staff must disinfect the affected area after cleaning. Staff shall allow the area to air-dry and discard all materials used to clean the area, including placing used towels and gloves in a non-absorbent plastic bag. Staff must wash their hands with soap and water immediately after removing gloves.

(d) Soiled linens, soiled clothes, or other soiled items shall be carefully removed and kept separate from uncontaminated items.

(e) Participants who become ill while receiving services must be separated from other participants to prevent possible spread of infectious diseases.

(f) Program staff and direct service providers must seek and obtain emergency medical treatment when necessary.

(g) Program staff must maintain and adhere to policies and procedures outlining the program’s response to participants becoming sick while receiving services.

(19) Foreclosures, evictions and bankruptcies.

(a) Licensees must notify the Agency within 24 hours upon the receipt of a notice of eviction or foreclosure involving the property at which the license is maintained.

(b) Licensees who file for bankruptcy protection must notify the Agency within 24 hours of filing for bankruptcy.

(20) Optional in-service training. The licensee may develop optional in-service training for family members, guardians, or guardian advocates of participants This training may include but is not limited to parent and caregiver training. The program shall not require such training as a condition upon the provision of adult day training services.

(21) Emergency management plans.

(a) Emergency Plan Components. Under section 393.067(8), F.S., each physical site shall prepare and maintain a written comprehensive emergency management plan. The emergency management plan must address the following:

Provisions for all hazards. Each plan shall describe the potential hazards to which the physical site is vulnerable such as hurricanes, tornadoes, flooding, fires, hazardous materials, transportation accidents, physical site damage, and power outages during severe cold or hot weather.
Provisions and plans for the care of participants remaining in the physical site during an emergency, including pre-disaster or emergency preparation, protecting the physical site program, ensuring participants and staff have adequate supplies, medications, emergency power, ensuring participants have adequate food and water, maintaining adequate staffing, and emergency equipment.
Identification of participants with mobility limitations who may need specialized assistance while at the physical site.
Identification of, coordination with, and compliance with the local emergency management agency orders.
Arrangement and coordination of post-disaster activities including responding to family inquiries, obtaining medical intervention for participants, transportation, etc.
The identification of staff responsible for implementing each part of the plan.

(b) Emergency management plans shall be reviewed and updated at least annually and may be developed with the assistance of appropriate resource persons from the local fire marshal, Regional Office, or local emergency management agency.

(c) Emergency Management Plan Implementation. In the event of an internal or external disaster, the program shall implement the emergency management plan in accordance with sections 252.355 and 252.356, F.S.

All staff must be knowledgeable of physical site procedures for handling emergencies and implementing the emergency management plan. All staff must be trained in the physical site emergency management plan within 30 days of hire. Staff shall be trained in the emergency management plan annually, after the plan’s annual update. Documentation of staff training must be maintained in the staff’s personnel file.
All staff are responsible for implementing the emergency management plan and must be able to implement the emergency management plan.
If telephone service is not available during an emergency, the program shall notify the Agency, and also request assistance, by appropriate means, for restoration of communications from local law enforcement or emergency management personnel.

(d) Evacuation. The physical site must evacuate the premises during or after an emergency if so directed by the local emergency management agency.

The licensee shall report the evacuation to the designated Agency regional office contact within six hours of the evacuation order.
The physical site shall not be reoccupied until (1) the area is cleared for reentry by the local emergency management agency, local fire marshal, or any other agency or entity having authority and (2) the physical site meets the immediate needs of the participants.

(e) In the event a state of emergency has been declared and the physical site is not required to evacuate the premises, the physical site may provide emergency shelter above the physical site’s licensed capacity provided the following conditions are met:

No one’s life, health, well-being and overall safety would be put at risk;
The immediate needs of all participants and other individuals sheltered at the physical site can be met by the program;
Within forty-eight (48) hours following the physical site exceeding its capacity, the licensee must report to the Agency that the physical site is overcapacity and describe the conditions that have caused it to be overcapacity. If the physical site continues to be overcapacity after the declared emergency ends, the Agency shall review such ongoing requests on a case-by-case basis; and
The program maintains a log of the additional persons housed in the physical site. The log shall include each additional individual’s name, address, and the dates of arrival and departure. The log shall be available for review by representatives of the Agency and the local emergency management agency or its designee. The admissions and discharge log maintained by the physical site may not be used to satisfy this requirement.

(f) Emergency management plans, documents regarding staff training, and any logs must be made available to the Agency within three days of the request.

(22) Program standards.

(a) Programs of Adult Day Training services must support full access and integration into the outside community.

(b) The program must provide a variety of physically and mentally stimulating activities.

(d) Participants should be able to choose the activities in which they participate.

(e) All program services shall be provided in a person-centered approach, in accordance with a participant’s goals and choices and ensure the participant’s rights to privacy, dignity, and respect.

(f) All program services shall include training and assistance with skill acquisition and retention in activities of daily living, personal care, social skills, self-help, socialization, adaptive skills, recreation, and encourage independence as outlined in the Florida Medicaid Developmental Disabilities Individual Budget Waiver Services Coverage and Limitations Handbook (“iBudget Handbook”), which is incorporated by reference in Rule 59G-13.070, F.A.C.

(g) Provisions of services shall be maintained in accordance with all applicable rules, including but not limited to the iBudget Handbook, Rule 59G-13.070, F.A.C.

(h) Documentation storage must be maintained in accordance with HIPAA to prevent any unauthorized access or disclosures.

(23) Transportation.

(a) When the ADT is providing transportation for participants during the course of program’s activities, a record must be maintained for each participant transported in a vehicle. The licensee must maintain the record for a minimum of 12 months.

(b) All transportation records must be available for review by the Agency during monitoring visits and upon request.

Name of each participant;
The date of transportation was provided;
Mode of Transportation;
Destination; and
Name of all staff involved in the transportation and the staff member responsible for keeping the record to verify that all participants have arrived safely at the destination.

(d) Prior to each departure, the transportation record must be recorded with each participant’s name, date and time of departure, and initialed by the direct service provider verifying each participant is accounted for.

(e) Upon arrival at the destination, the driver must complete the transportation record and mark each participant off the record as the participant departs the vehicle.

(f) The driver must complete a physical inspection and visual sweep of the vehicle at the arrival of the destination to ensure that no participant is left inside the vehicle. A participant shall not be left unattended in a vehicle.

(g) If the licensee contracts with an outside entity to provide transportation, the licensee must assign a direct care staff to perform the duties described in paragraphs (a) through (f).

(h) The maximum number of individuals transported must not exceed the manufacturer’s designated seating capacity or the number of factory installed seatbelts.

(i) When transporting participants, the staff to participant ratio must be maintained.

(j) Participants must use seatbelts or other safety restraints during transportation.

(k) Staff providing transportation must meet all training requirements set forth in this rule.

(l) All vehicles used to transport participants must be maintained in a clean condition and pursuant to the vehicle or manufacturers’ requirements or instructions to ensure that they are in proper working order. Documentation of the maintenance must be maintained on file for a minimum of 12 months, and available to Agency staff during monitoring visits and upon request.

(m) Smoking and vaping shall be prohibited in vehicles.

(n) The interior of the vehicle, when being used to transport participants must be maintained at a temperature between 65 to 78 degrees Fahrenheit. The vehicle can be ventilated either by mechanical or natural means to maintain the temperature. This is only during the operational transportation of the vehicle and does not include the loading or unloading of the vehicle.

(24) Administration.

(a) The program shall have a Governing Authority which shall establish policies in compliance with this rule and all other applicable rules.

(b) The Governing Authority shall establish that the owner, operator, or a designated Program director is on-site during the program’s hours of operation and is responsible for the daily and ongoing operation of the program and for ensuring compliance with all rules and regulations, including Chapter 65G-2, F.A.C., the iBudget Handbook, and chapter 393, F.S., whenever one or more participants are present.

(c) The Program director shall possess at a minimum an associate’s degree from an accredited college or university, and two years verifiable experience working directly with individuals receiving services or related experience. Related experience will substitute on a year-for-year basis for the required college education.

(d) The licensee must designate a staff member to serve as the back-up Program director when the Program director is unavailable. The designee shall meet the same qualifications as the Program director.

(e) The licensee shall ensure that each staff member:

Maintains personal cleanliness and hygiene;
Refrains from abusive, neglectful, exploitative, and other unacceptable conduct such as the use of alcohol, illegal use of narcotics or other impairing drugs, and behavior or language which may be injurious to participants; and
Who is diagnosed as having a communicable disease, infection, or infestation after beginning work in the physical site shall be excluded from working until deemed non-infectious in the work setting.

(f) An area of the physical site shall be designated as office space where files, desk(s), telephone(s), and other administrative tools and equipment are located. Provisions shall be made for ensuring the security of confidential files and other types of records, such as account books, inventories, audits, and client/participant records. These records may be kept electronically.

(g) All documentation must be completed in English.

(25) Financial standards.

(a) The licensee shall maintain fiscal records pertaining to the cost of providing care to the Agency’s clients in accordance with generally accepted accounting principles.

(b) Upon request by the Agency, the licensee shall provide to the Agency evidence of financial ability to operate the program in accordance with the requirements of Chapter 65G-2, F.A.C., for up to 60 days without dependence upon payment from the state or other third-party fees from clients. Such evidence shall include bank account statements, pay stubs, documentation of a line of credit, or any other documents which would demonstrate the expected ability of the licensee to continue operations for that period and under those conditions.

(c) If a program receives funds for developmental training programs, sufficient documentation evidencing a 12.5% match of the Individual and Family Supports and iBudget Waiver funds from the General Appropriations Act from local sources must be provided upon request by the Agency. In-kind match is acceptable provided there are no reductions in the number of persons served or the level of services provided.

(d) The Agency may audit the records of a program to ensure compliance with Chapter 65G-2, F.A.C., and chapter 393, F.S., provided that financial audits shall be limited to the records of the Agency’s clients.

(e) Upon request by the Agency, the program shall make available copies of any internal or external audit reports pertaining to funding received on behalf of the Agency’s clients.

(f) The licensee, the program staff, direct service providers, and any family members thereof are prohibited from:

Being the named beneficiary of a client’s life insurance policy unless related to the client by blood or marriage;
Receiving any indirect financial benefit from a client’s life insurance policy unless related to the client or client by blood or marriage; or
Borrowing or otherwise using a client’s personal funds for any purpose other than the client’s or client’s benefit.

(26) Staffing ratios.

(a) The licensee shall employ and schedule adequate staff to maintain the program in a manner that promotes and ensures the health, safety, and welfare of all participants, and protects participants and the public from any known dangerous behaviors. At a minimum, the licensee shall maintain the staffing pattern delineated and described on the participants’ support plan(s), approved service authorizations, or agreed contract of care. Every participant, regardless of the funding source, must be included in the staffing ratio calculations.

(b) If the Agency determines that the program does not have adequate staff, the Agency will send the program a Notice of Noncompliance for the first occurrence. Such notice will provide a timeline and a Corrective Action Plan to ensure that the program has an adequate number of qualified personnel. Additional occurrences shall be addressed in accordance with the disciplinary chart in Rule 65G-2.0041, F.A.C.

(27) Required skills for all direct service providers.

(a) A direct service provider must be capable of effective communication with the participants of the program as well as other individuals, such as support coordinators, Agency staff, family members of participants, and others who routinely interact with facility or program staff.

(b) A direct service provider must demonstrate the ability to comprehend, comply with, and implement all requirements provided by law and Agency rules and statutes for the provision of services rendered to participants of their facilities or programs.

(d) A direct service provider responsible for transporting participants shall not possess driving violations, committed within the past three years, which relate to driving under the influence of alcohol or drugs or any other moving violation(s) that resulted in the suspension or revocation of his or her license.

Licensees must update their staff’s driving history on an annual basis.
A direct service provider must obey all traffic laws while transporting participants.
There must be a current and appropriate auto insurance policy that covers the vehicle and staff.

(28) Safety standards.

(a) A direct service provider shall not be under the influence of alcoholic beverages, medicine, or other substances to the extent their normal faculties are impaired. For the purpose of this paragraph “normal faculties” include but are not limited to the ability to see, hear, walk, talk, judge distances, drive an automobile, make judgements, act in emergencies and, in general, to perform the ordinary mental and physical acts of daily life and employment duties.

(b) Licensees are responsible for ensuring that a direct service provider who transports participants has a valid driver’s license.

(c) Licensees are required to ensure that all direct service providers continue to meet all staffing requirements in accordance with all applicable rules and Florida Statutes.

(d) On at least an annual basis, all licensees must access the Florida Department of Law Enforcement’s Sex Offender and Predator System database for the purposes of identifying database registrants who reside within a one-mile radius of the physical site. The licensee shall notify all direct service providers of the location of sexual offenders or predators who live within one mile of the physical site and document such notification.

(e) The physical site shall have on the premises a first aid kit. The first aid kit shall be maintained in places known and readily available to all direct service providers.

The first aid kit must be adequately stocked with no expired items.
Potentially toxic materials contained within first aid kits shall be stored in a manner that does not pose a risk to participants.

(f) The program staff must call 911 immediately upon any emergency, injury, or illness that cannot be addressed effectively on site or any event that can be considered life threatening.

(g) The physical site shall conduct at minimum quarterly fire drills or more frequently if required by the fire authority having jurisdiction when participants are on site. Subject to fire authority having jurisdiction approval, evacuation of the premises shall not be required; however, the physical site shall ensure that the participants are taken at least to the point of exit. A current attendance record must accompany program staff during a drill or actual evacuation and be used to account for all participants.

Dates and results of each fire drill shall be recorded and maintained for three years following the date of the drill.
The record must include the time of drill, point(s) of exit(s) used, evacuation time, number of participants at the time of the drill, the length of time taken to evacuate the premises, and the signature of the person conducting the drill.

(h) The program shall provide supervision to each participant during an evacuation between the physical site and the transportation.

(i) The program shall ensure the use of the designated drop off and pick up areas during transitions from the physical site and transportation.

(j) The program will ensure that all participants are accounted for at all times during and upon completion of any program activity, whether on-site or in the outside community.

(29) Behavioral interventions and responses to behavioral issues.

(a) The program shall have a written statement of policies and procedures describing actions that may be taken by a direct service provider to help prevent or respond to behavioral problems exhibited by participants, including emergency procedures and reporting requirements. Such policies and procedures, as well as any actions taken by a direct service provider involving participants of the program, shall be consistent with the provisions of section 393.13, F.S., as well as Chapters 65G-4 and 65G-8, F.A.C.

(b) A direct service provider must be trained to appropriately respond to serious and spontaneous behavioral incidents requiring emergency intervention procedures.

(c) A direct service provider shall not implement emergency intervention procedures that use restraint or seclusion, or cause physical discomfort, unless they have been certified through an Agency-approved emergency procedure curriculum in accordance with Chapter 65G-8, F.A.C.

(d) The following responses are strictly forbidden:

Physical or corporal punishment that includes, but is not limited to hitting, slapping, smacking, pinching, paddling, pulling hair, pushing, or shoving participants;
The use of noxious substances or devices which induce pain or other adverse stimulus to control behavior, including but not limited to pepper on tongue, squirt of lemon juice, ammonia inhalants, or electric shock;
Verbal abuse, including but not limited to cursing at participants, using slurs or derogatory names, or screaming;
Humiliation or psychological abuse, including but not limited to keeping a participant in wet or soiled clothing or diapers, making a participant stand in front of others to be ridiculed, preventing the client from wearing clothing, making a resident wear a sign, or placing a participant in a dark or locked time-out room.

(30) Investigations.

(a) The licensee and program staff must cooperate and comply with any investigation conducted by the Agency or a law enforcement agency or any other agency authorized by law.

(b) Paragraphs (c) and (d) are only applicable in situations where the licensee has been made aware of a verified DCF Abuse investigation.

(c) If a licensee, direct service provider, volunteer, or any other person working in the program has been identified as an alleged perpetrator in an active protective investigation of abuse, neglect, or exploitation of a vulnerable adult under chapter 415, F.S., or abuse, abandonment, or neglect of a child under part II of chapter 39, F.S., and the protective services investigator has reasonable suspicion that the abuse, neglect, exploitation, or abandonment has occurred, the alleged perpetrator shall be prohibited from being alone with participants unless he or she is under the constant visual supervision of another staff member who is not under such investigation.

(d) If the protective investigation concludes with a verified finding of abuse, neglect, exploitation, or abandonment against the alleged perpetrator, the perpetrator shall be prohibited from being alone with participants unless he or she is under the constant visual supervision of another person working in the facility or program who has not, to the knowledge of the licensee, been named as the alleged perpetrator in an ongoing protective investigation or has a verified finding, until the Corrective Action Plan, below, is accepted. If the perpetrator remains employed by the licensee, the licensee must submit a Corrective Action Plan that contains the following documentation to the Agency within 15 days of notification of the verified finding:

Explanation of why the licensee is not terminating the perpetrator;
What disciplinary action was taken against the perpetrator;
Any training, including dates, that the program staff member or direct service provider received; and
How the licensee will protect participants from abuse, neglect, or exploitation by this perpetrator.

(e) If the protective investigation concludes with no verified finding of abuse, neglect, exploitation, or abandonment against the alleged perpetrator, the licensee, direct service provider, volunteer, or other person working in the facility or program may be permitted to resume unsupervised contact with participants of the facility or program.

(31) Medication and specialized equipment.

(a) Any program that administers medication must comply with Chapter 65G-7, F.A.C.

(b) All medications must be adequately labeled and stored in a locked location outside of participant access.

(32) Requirements for personnel policies, procedures, and records.

(a) All licensees with staff shall develop and maintain the following:

Job descriptions for paid staff;
Documentation of all program staff training, including a record of training dates, training content, trainers, and staff in attendance;
Separate personnel records for each full and part-time staff member that contain written documentation of each staff member’s name, home address, phone number, job assignment, education, qualifications, experience, references, background screening, staff training participation, performance evaluations, emergency management plan training, any disciplinary action taken against the staff member, and dates of employment and termination; and
A weekly written schedule indicating staff coverage posted at least one week in advance. Weekly schedules of actual staff coverage shall be maintained for a six-month period.

(b) The licensee shall provide a copy of any or all items discussed in this section to the Agency upon request, within three calendar days.

(33) Direct service provider training requirements.

(a) All direct service providers must comply with all training requirements and training documentation retention requirements set out in the iBudget Handbook.

(b) For those participants with behavior plans, staff must be trained in the participant’s current behavioral plans before working with the participant, by a behavioral analyst or behavioral assistant.

(c) For those participants with nutrition plans, staff assisting with meals must be trained in the participant's current plan.

(d) Documentation of the training in paragraphs (b) and (c) must be maintained in the staff member’s personnel record.

(34) Sexual activity and physical contact.

(a) The licensee shall develop and enforce a written policy regarding sexual activity involving participants of the program. Such policy shall:

explicitly prohibit sexual activity between a participant and a covered person;
explicitly prohibit sexual activity that involves participants who are under the age of eighteen;
require staff to report sexual activity involving participants under the age of eighteen to Department of Children and Families, and law enforcement;
not, in any way, abridge or restrict the civil and legal rights of persons with developmental disabilities, including those specified within section 393.13, F.S.; and
address appropriate physical boundaries and standards between a direct service provider and participants, including the following elements:

a. physical contact between a direct service provider and participants should be brief, age appropriate, and shall not include sexual activity;

b. a dress code for both participants and direct service providers shall be established that outlines the type of clothing that is acceptable as well as where and under what circumstances it is acceptable;

c. direct service providers and participants must respect personal space, except as may be necessary for participants who require visual supervision due to documented behavioral or medical issues;

d. a provision which permits direct service providers to assist or supervise a participant while he or she bathes, showers, or toilets, if the participant requires assistance or supervision, but staff shall never be permitted to bathe, shower, or toilet simultaneously with any participant under any circumstances;

e. guidelines concerning the level and type of supervision required for participants, with which all direct service providers shall be familiar; and

f. open communication among participants and direct service providers about events occurring in the facility in order to encourage reporting of incidents of abuse or inappropriate sexual behavior.

(b) The licensee shall provide direct service providers with training regarding the licensee’s policy regarding sexual activity, involving participants prior to providing direct care services.

(c) The following safeguards shall be implemented in any program that serves one or more sexually aggressive participants, or those who require a Safety Plan under the iBudget Handbook, Chapter 65G-2, F.A.C., or any other similar requirement:

All direct service providers shall review all relevant records and complete history related to sexually aggressive participants in order to prevent the occurrence of sexual abuse incidents. When available to the licensee, such information provided to staff must include, but is not limited to, the date of the sexual abuse incident, type of abuse, brief narrative outlining the event, type of treatment the resident received, all remedial measures taken, and the outcome of the treatment. If the participant is currently in treatment, the licensee shall maintain contact information for the treatment provider;
Prior to attendance, the program must review the Safety Plan of any participant. The program is responsible for complying with any requirements of the Safety Plan and implementing its provisions, as applicable to the program. All staff must be trained on the Safety Plan prior to working with the participant;
The program must maintain a signed copy of the most current safety plan, when applicable;
A sexually aggressive participant shall be provided visual supervision at all times the participant is awake in the program;
Known sexually aggressive participants shall never be left alone with other participants;
Only one participant may use the bathroom at any time that the bathroom door is closed; and
Participants who are minors are not permitted to possess obscene materials as defined in section 847.001, F.S., on the premises.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.0673(8), 393.501(1) FS. Law Implemented 393.067, 393.0673, 393.13 FS. History–New 1-23-25, Amended 3-26-26.

Fla. Admin. Code R. 65G-2.008 Staffing Requirements for Residential Facilities

(1) The licensee shall employ adequate staff to maintain the facility in a manner that promotes and ensures the health, safety, and welfare of residents, and protects nonresidents from any known dangerous behaviors that the residents exhibit. At a minimum, the licensee shall maintain the staffing pattern sufficient to accommodate the number and characteristics of the residents it offers to serve in its most recent application for licensure and as approved by the Agency.

(a) The Agency shall consider the following when deciding whether a facility has adequate staff to maintain the facility:

the documented level of need for each resident;
state and/or federal requirements;
behavior plan;
support plan;
safety plan;
medically ordered care;
additional staffing needs identified by licensee for residents funded through other means;
court orders, if applicable;
the number of residents and their unique service requirements;
the competency, training, and education of staff; and
the range of services offered.

(b) It is the licensee’s responsibility to provide adequate staffing levels to meet the health and safety needs of each resident, even if the staffing levels exceed the minimum identified for the facility. All staffing patterns must meet the minimum requirements set forth in this rule and other applicable rules as residents move in or out of the facility or when the identified level of need changes.

(2) Direct Service Provider Qualifications.

(a) A direct service provider shall be at least 18 years of age.

(b) A direct service provider must undergo employment screening as required by section 393.0655, F.S., and chapter 435, F.S. The licensee shall be responsible for ensuring that every direct service provider in the facility has complied with section 393.0655, F.S., and chapter 435, F.S. Any staff or volunteers, including direct service providers, managers, supervisors, and licensees that do not meet eligibility under section 393.0655, F.S. and chapter 435, F.S., must not provide direct care services or have access to any resident, resident funds, or resident living setting.

(c) A direct service provider must have at least a high school diploma or the equivalent. When determining the equivalency of high school diplomas, providers may accept official transcripts, affidavits from educational institutions, and other formal or legal documents that can be reasonably used to determine educational background. A direct service provider hired using the licensee’s best judgment prior to July 1, 2014, and who has remained continuously employed by the licensee is exempt from this screening requirement.

(d) Prior to beginning employment, a direct service provider must have:

At least one year of experience in a medical, psychiatric, nursing or childcare setting, or other environment where he or she worked directly with persons with a developmental disability.
Successfully completed college, vocational or technical training equal to 30 semester hours, 45 quarter hours, or 720 classroom hours in special education, mental health, counseling, guidance, social work or health and rehabilitative services can substitute for the required experience.

(e) A direct service provider hired by the licensee prior to July 1, 2014, and who has remained continuously employed by the licensee, shall be exempt from this subsection.

(f) The requirements in paragraph (2)(d) of this rule may be waived if the facility meets the following conditions with respect to its staff and provides the written notification discussed in paragraph (2)(g) of this rule:

A direct service provider who does not meet the experience requirements must spend his or her first 90 days of employment working directly under the supervision or oversight of another direct service provider who meets the requirements. For purposes of this section, “direct supervision or oversight” means a direct service provider who meets the experience requirements and is physically present and immediately available to provide assistance to the new direct service provider who does not meet the experience requirement. For purposes of this section, “physically present” means under the same contiguous roof line.
With respect to transporting residents, the direct service provider who does not meet the experience requirement may take residents out of the facility only if accompanied by another direct service provider who meets the one-year experience requirement. In those instances, the experienced direct service provider must remain, at all times, within 100 feet of the direct service provider who does not meet the one-year experience requirement.

(g) If the licensee makes an arrangement as described in paragraph (2)(f) of this rule the licensee shall provide written notification to the Regional Office no later than five days after the direct service provider starts employment with the licensee. This notification must include the name of the direct service provider and the facility in which he or she will be working.

(h) If the licensee makes an arrangement described in paragraph (2)(f) of this rule, the licensee shall also conduct a performance evaluation of any direct service provider employed under subparagraphs (2)(f)1. or 2. of this rule no later than 120 days after the direct service provider began his or her employment with the licensee. This performance evaluation shall, at a minimum, include an assessment of the direct service provider’s ability to perform the prescribed duties of his or her position. Documentation of this performance evaluation shall be maintained within the personnel file of the direct service provider and made available to the Agency upon request.

(3) Required Skills for All Direct Service Providers.

(a) A direct service provider must be capable of effective communication with the residents of the homes as well as other individuals such as support coordinators, Agency staff, family members of residents, and others who routinely interact with residential staff.

(b) A direct service provider must be mentally competent to comprehend, comply with, and implement all requirements provided by law and Agency rule for the provision of services rendered to residents of their facilities.

(4) Safety Standards.

(a) A direct service provider shall not be under the influence of alcoholic beverages, medications, or other substances to the extent his or her normal faculties are impaired. For the purposes of this paragraph “normal faculties” include but are not limited to the ability to see, hear, walk, talk, judge distances, drive an automobile, make judgments, act in emergencies and, in general, to perform the mental and physical acts of daily life and employment duties.

(b) Licensees are responsible for ensuring that a direct service provider who transports clients has a valid driver’s license.

A direct service provider responsible for transporting clients shall not possess driving violations, committed within the past three years, which relate to driving under the influence of alcohol or drugs or any other moving violation(s) which resulted in the suspension or revocation of that direct service provider’s license.
Licensees must update their staff’s driving history on an annual basis.
A direct service provider must obey all traffic laws while transporting residents.

(c) On at least an annual basis, all licensees must access the Florida Department of Law Enforcement’s Sex Offender/Predator Database for the purposes of identifying database registrants who reside within a one-mile radius of the facility. The licensee shall notify facility staff of the location of sexual offenders or predators who live within one mile of the facility and document such notification.

(5) Investigations.

(a) If a licensee, direct services provider, volunteer, or any other person working in the facility receives a verified finding of abuse, neglect, abandonment, or exploitation under chapter 415, F.S. and chapter 39, F.S., in the course of their position with the facility, the licensee is subject to disciplinary action outlined in this rule chapter pursuant to section 393.0673, F.S.

(b) If a licensee, direct service provider, volunteer, or any other person working in the facility has been identified as an alleged perpetrator in an active protective investigation of abuse, neglect, or exploitation of a vulnerable adult under chapter 415, F.S., or abuse, abandonment, or neglect of a child under Part II of chapter 39, F.S., the alleged perpetrator shall be prohibited from being alone with facility residents or having access to resident funds, unless he or she is under the constant visual supervision of another person working in the facility who has not been named as the alleged perpetrator in an ongoing protective investigation.

(c) If the protective investigation concludes with a verified finding of abuse, neglect, exploitation, or abandonment against the alleged perpetrator, the perpetrator shall be prohibited from being alone with facility residents unless he or she is under the constant visual supervision of another person working in the facility who has not, to the knowledge of the licensee, been named as the alleged perpetrator in an ongoing protective investigation, or has a verified finding, until a Corrective Action Plan is accepted and completed. If the perpetrator remains employed by the licensee, the licensee must submit a Corrective Action Plan that contains the following documentation to the Regional Office within 15 days of notification of the verified finding:

explanation of why the licensee is not terminating the employment of the perpetrator;
what disciplinary action was taken against the perpetrator;
any training, including dates, that the direct service provider received; and
how the licensee will protect facility residents from abuse, neglect, or exploitation by the perpetrator.

(d) If the protective investigation concludes with no verified finding of abuse, neglect, exploitation, or abandonment against the alleged perpetrator, the licensee, direct service provider, volunteer, or other person working in the facility may be permitted to resume unsupervised contact with residents of the facility.

(e) The licensee shall cooperate with DCF during an abuse, neglect, or exploitation investigation and request and obtain documentation of the conclusion of the investigation.

(6) Requirements for Personnel Policies, Procedures, and Records.

(a) All licensees with employees shall develop and maintain the following:

Job descriptions for paid staff;
Documentation of all facility staff training, including a record of training dates, training content and trainers, and staff in attendance;
Separate personnel records for each full and part-time employee that contain written documentation of the employees’ education, qualifications experience, references, background screening, staff training participation, and any disciplinary action taken against the employee; and,
A weekly written schedule indicating staff coverage for at least one week in advance. Weekly schedules of actual staff coverage shall be maintained for a six-month period.

(b) The licensee shall provide a copy of any or all items discussed in paragraph (6)(a) of this rule to the Agency or Regional Office upon request, within three calendar days.

(7) Staff Training Requirements.

(a) All direct service providers must complete the Agency’s Direct Care Core Competency training within 90 days of first providing services or supports to residents.

(b) Written documentation of all required staff training must be maintained by the licensee for at least three years following the receipt of such training and be made available to the Agency upon request.

(c) All direct service providers hired to work in a licensed residential facility must complete the Agency’s Zero Tolerance training curriculum on the detection, prevention, and reporting of abuse, neglect, and exploitation prior to providing direct services. In addition, all direct service providers must complete a refresher Zero Tolerance training course every three years. Staff must be able to successfully demonstrate their knowledge of required abuse reporting procedures both in theory and in practice.

(d) A direct service provider must complete a basic first aid course, including instruction in the abdominal thrust maneuver and cardio-pulmonary resuscitation (CPR), and shall maintain a current certification in CPR within 90 days of providing direct services. Online or computer-based courses are not acceptable to meet this requirement; such training must be provided in a classroom setting by a certified trainer. Facilities shall ensure there is always at least one direct service provider with current CPR certification onsite when residents are present.

(e) All staff must complete an educational course on HIV/AIDS, within 90 days of providing direct services.

(f) For those residents with behavior plans, staff must be trained on the residents’ current behavioral plans by a certified behavioral analyst. Documentation of the training must be maintained in the staffs’ personnel record.

(g) Facilities shall comply with the requirements of Chapter 65G-8, F.A.C.

History

Rulemaking Authority 383.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.0655, 393.067 FS. History–New 7-1-14, Amended 8-6-17, 3-26-26.

Fla. Admin. Code R. 65G-2.009 Resident Care and Supervision Standards

(1) Resident Care Standards.

(a) To ensure the health and safety of the facility’s residents, which includes providing appropriate physical care and supervision, each facility shall:

facilitate the implementation of resident support plans, behavior plans, and any other directions from medical or health care professionals as applicable;
correctly and appropriately implement reactive strategy as necessary in accordance with the resident’s behavior plan, the staff’s training in reactive strategies, Florida Statutes, and the Florida Administrative Code;
contact the resident’s support coordinator, as necessary, to ensure the timely provision of needed medical and dental care; and
contact the resident’s legal representative, if no support coordinator is assigned, to ensure the timely provision of needed medical and dental care;
provide care and treatment for each resident that is individualized and appropriate to reflect the differences in each individual resident’s personal goals, abilities, sex, age, and special needs;
participate in staff training and meetings as required by the Agency, and
employ sufficient staff so that it is not dependent upon the use of volunteers or residents. However, residents shall be encouraged, but not required, to perform personal housekeeping chores and independent activities of daily living that are appropriate to their age, behavioral considerations, and ability such as:

a. maintaining his or her own quarters; and

b. participating in ordinary household tasks such as meal preparation, grocery shopping, dishwashing, laundering, cleaning common areas of the residence or site, lawn care, gardening, and other tasks generally performed by a typical family.

(b) The facility shall adhere to and protect resident rights and freedoms in accordance with the Bill of Rights of Persons with Developmental Disabilities, as provided in section 393.13, F.S. This includes, but is not limited to, honoring and protecting each resident’s right to:

Dignity, privacy, and humane care, including the right to be free from abuse, including sexual abuse, neglect, and exploitation, as set forth in section 393.13(3)(a), F.S.;
Be free from harm, including unnecessary physical, chemical, or mechanical restraint, isolation, excessive medication, abuse, or neglect;
Religious freedom and practice;
Receive services, within available sources, which protect his or her personal liberty and which are provided in the least restrictive conditions necessary to achieve the purpose of treatment;
Participate in an appropriate program of quality education and training services, within available resources, regardless of chronological age or degree of disability;
Social interaction and participation in community activities;
Physical exercise and recreational opportunities;
Consent to or refuse treatment, subject to the powers of a legal representative, natural guardian, or guardian advocate appointed under section 393.12, F.S., or a guardian appointed under chapter 744, F.S.;
When otherwise qualified, not be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity which receives public funds by reason of having a developmental disability; and
When otherwise qualified, not be denied the right to vote in public elections on the basis of having a developmental disability.

(c) The placement of a resident within a facility shall not be construed as a termination or restriction of the rights and responsibilities of the parents or guardians. Although not required, it is recommended that parents, guardians, and other responsible persons organize as volunteers for the purpose of promoting the welfare of the residents.

(d) Each facility shall establish, maintain, and make available to residents and employees written house rules and regulations in consultation with residents, for the orderly operation of the group home facility.

(e) Each facility shall, when appropriate, help establish resident government within the meaning of section 393.13, F.S.

(f) Within the scope of the licensee’s responsibility for care and supervision of residents, the licensee shall ensure that there is appropriate action taken for a resident’s essential, routine, or preventative care following a resident’s medical, dental, therapy or other health care-related appointments. The licensee’s responsibility includes, but is not limited to:

scheduling additional appointments for residents or assisting residents in scheduling their own appointments; and
providing staff with appropriate training on changes in medication or dietary regimens, positioning of residents, utilization of specialized equipment, or any other area which has changed after any such appointments that would be within the licensee’s purview and authority to supervise.

(2) Facilities shall provide opportunities for residents to participate in community activities.

(3) Transfer and Placement of Residents.

(a) The licensee shall have written criteria and procedures in place for the admission or termination of residential services for clients; termination procedures must be consistent with Chapter 65G-3, F.A.C.

(b) The facility shall only accept and serve persons with developmental disabilities, whether or not such persons are clients of the Agency.

(d) The facility shall not accept or serve a resident unless it can meet his or her specific programmatic and physical accessibility needs. The facility must be capable of effectively and safely meeting the needs of all facility residents accepted for placement.

(e) When determining whether to accept a person as a resident of the facility, the facility shall:

Ensure that the placement of new residents within the facility does not adversely affect the health, safety, or welfare of current facility residents;
Obtain the Agency’s approval prior to any proposed placement that would deviate from the criteria specified on the facility’s application for licensure; and
Provide descriptive information to the Agency on the prospective resident if the proposed placement involves an individual who is not a client of the Agency. This information must include:

a. documentation showing that the individual has an intellectual or developmental disability as defined in Chapter 65G-4, F.A.C.;

b. documentation showing whether the individual has any medical needs or limitations;

c. documentation showing whether the individual has any behavioral issues; and

d. a statement regarding any known criminal history of the individual and, if the individual does have a criminal history, an explanation and documentation of his or her involvement with the legal system.

(f) Prior to a proposed transfer of a client from one licensed facility to another, the licensee shall discuss the transfer and reasons for transfer with the client, the client’s authorized representative (if one has been appointed), support coordinator (if available), the Agency, and other involved service providers, as appropriate.

(g) The licensee shall notify the Agency, in writing, of changes in the census of the home within five calendar days.

(h) A licensee who operates, administers, or manages more than one foster care facility, group home facility or residential habilitation center facility must receive approval from the Agency prior to transferring a client from one of its licensed facilities to another of its licensed facilities. Prior approval shall not be required in the event of an emergency in which there is a substantial probability that the health or safety of the client would be jeopardized in the absence of immediate relocation.

(i) When a resident is moving from a licensee’s facility to a new residential setting, the licensee releasing the resident shall provide any personal belongings of the resident to the resident or the resident’s legal representative. The property inventory list completed in accordance with subparagraph (j)4. below, shall be referenced in order to account for all items.

(j) To ensure the smooth, safe and most effective transition of a new resident to the licensee’s facility, the licensee receiving the resident shall:

prior to placement, provide an opportunity for the referred resident and his or her legal representative to visit the facility;
prior to placement, cooperate with and assist the Agency, the resident’s support coordinator, and the resident’s legal representative with the new resident’s discharge from the former residential setting;
make needed preparations for the new resident, including ensuring that all staff are made aware of the resident’s needs, and are properly trained and equipped to meet those needs;
upon receiving the resident for care, complete an itemized property inventory list accounting for the resident’s records, personal funds, serviceable clothing, and any other personal belongings. This inventory shall be signed by the licensee and the resident or the resident’s legal representative; and
update the inventory list within 30 days to reflect the acquisition of new items and reflect items that have been discarded, except that new and discarded articles of clothing are not required to be continually inventoried.

(4) Resident Funds.

(a) Neither the licensee nor staff employed by the licensee may receive any financial benefit by charging a fee against, borrowing, or otherwise using the personal funds of a resident for their personal benefit.

(b) The licensee must develop policies and procedures which detail the methods for management and accounting of any personal funds or benefits of facility residents. The policies and procedures must comply with generally accepted accounting principles. Each staff member having access to resident funds and account information must be trained in the proper implementation of these policies and procedures.

(c) The licensee must obtain written authorization, signed by the resident or the resident’s legal representative annually, if the licensee will be responsible for the management of any personal funds of the resident.

(d) With respect to the clients of the Agency, the licensee shall maintain:

Written receipts for purchases made with client funds, valued at $25.00 or more for at least one year following the date of purchase; and
An accounting of income and expenditures from each client’s personal funds, which includes any benefits received by a client. Each client’s individual accounting must include, but is not limited to:

a. The group home facility’s name and address;

b. The client’s name;

c. The client’s ending balance for the previous month;

d. The month and year for the accounting form;

e. The date and amount of all deposits and withdrawals;

f. An accounting of the client’s personal needs allowance, as defined in Rule 65G-2.018, F.A.C., and any increase in the personal needs allowance based on the annual posting of the maximum federal benefit rate;

g. The account balance following each deposit or withdrawal;

h. A brief statement of the purpose or reason for each deposit and withdrawal;

i. The name and signature of the staff member that completed each deposit or withdrawal;

j. The client’s signature, in any instance where money has been withdrawn for the client to use at his or her own discretion; and

k. The ending balance for the month.

(e) The available amount of each client’s personal funds must reconcile with the most recent ending balance which is recorded within the licensee’s record of client income and expenditures.

(f) Accounting information for financial accounts and for cash must be made on separate forms.

(g) Licensees who received benefits on behalf of clients shall maintain a checking or savings account for the personal funds of clients.

If a single account is maintained for multiple clients, a separate accounting must be maintained for each individual client that reconciles monthly with the account’s total, as noted on the bank statement, and shall be retained by the provider for review by the Agency. This accounting shall include, but is not limited to, an accounting of the client’s personal needs allowance, as defined in Rule 65G-2.018, F.A.C., and any increase in the personal needs allowance based on the annual posting of the maximum federal benefit rate.
With the exception of the facility’s other residents or clients, the personal funds of residents or clients must not be co-mingled with the funds of any other person or entity, including those of the licensee or staff.

(h) Client accounting records shall be kept on the premises or maintained electronically and in a central location. Relevant current financial information, such as the account balance and a supply of funds, shall be maintained and secured in each facility to allow for purchases and other client or guardian-authorized uses of resident funds. Any cash shall be kept in a secure location within the facility.

(i) All client records shall be made available upon request by Agency staff for inspection and monitoring purposes.

(j) The licensee, the licensee’s employees, and any family members thereof are prohibited from:

Being the named beneficiary of a client or resident’s life insurance policy unless related to the client or resident by blood or marriage;
Receiving any indirect financial benefit from a client or resident’s life insurance policy unless related to the client or resident by blood or marriage; or
Borrowing or otherwise using a client or resident’s personal funds for any purpose other than the client or resident’s benefit.

(k) Any records required under this subsection shall be produced, maintained, and contain information required under generally accepted accounting principles.

(5) Resident Records.

(a) The facility shall establish and maintain an individual record for each resident on the premises. The record shall contain information pertinent to the resident’s health, supervision, and care. The records may be maintained electronically.

(b) All documentation must be in legible English.

the resident’s name and date of birth;
the name, addresses and telephone number of the resident’s physician and dentist;
contact information for the resident’s legal representative and support coordinator;
written authorization signed by the resident or resident’s legal representative for routine medical or dental care;
medical and dental reports, including any examination results and laboratory findings, if received by the facility, and the resident’s medication history and any special instructions for carrying, lifting, positioning, bathing, assisting with meals or other aspects of personal care;
the resident’s legal competency, guardianship status, and the identification of any authorized representatives;
a property inventory list;
incident reports directly involving the resident;
a color photograph of the resident taken within the past five years; and
if applicable, a copy of the resident’s current support plan, as supplied by the resident’s support coordinator, and any other applicable plans such as an implementation plan or behavior plan.

(d) The records shall be current to the greatest extent possible and updated at least 30 days following receipt of new information.

The property inventory list must be updated:

a. every twelve months; and

b. 30 days prior to a resident being discharged.

If any of the required information is not available, the licensee shall include written documentation in the record that a diligent effort was made to obtain the missing information.

(e) Resident and client records shall be kept confidential in accordance with section 393.13, F.S.

(f) Resident records shall be accessible for inspection and duplication by any Agency staff or designated agent of the State of Florida who presents proper State of Florida-issued identification. If Agency staff or a designated agent requests a copy of the records, the facility shall provide a complete copy to the Agency, as soon as possible given the volume of records requested, but in any instance no later than two calendar days.

(g) Client records in the possession of the facility shall be the property of the client and shall remain with the client in the event that he or she moves to a different facility or the facility has a change in providers. However, in accordance with HIPAA, the licensee shall retain a copy of the records for six years, which shall be made available to the Agency for surveying, monitoring, and inspection purposes. For the purposes of this subsection, the licensee is solely responsible for the costs of reproducing client records.

(6) Resident Supervision.

(a) Each facility must provide the level of supervision necessary to ensure that residents are protected from harm and that a safe and healthy living environment is created and maintained. Direct service providers must be given specific information and strategies to provide such an environment for all of residents of the facility. To the maximum extent possible, however, the facility shall respect the rights of residents to privacy and self-determination.

(b) At least one staff person must be present at all times while residents are in the facility. The only exception would be if the licensee prepares a written plan proposing that a specified client be left alone for limited periods of time during the day or night. Such plans must be approved by the Regional Office prior to implementation. In granting plan approval, the Agency shall consider the needs, characteristics, and abilities of the resident and the proposed circumstances under which the resident will be left alone. Non-compliance with the approved plans may result in the imposition of administrative fines, the suspension or revocation of such plans, or other administrative actions as appropriate.

(7) Video Monitoring.

(a) The use of video cameras for the purposes of visually monitoring residents is permitted. Video footage must not be used in any way that may humiliate, punish, demean, or violate the privacy rights of any resident. Video monitoring may also be required by the Agency as a component of any settlement agreement with a licensee.

(b) A licensee who uses video monitoring, shall:

Develop written criteria for determining which residents will be monitored by video camera;
Develop written protocols for implementing video monitoring, including but not limited to:

a. who may access video footage;

b. the purpose and use of video recordings; and

c. how, when, and where such footage will be stored, and for how long, to include a minimum thirty-day retention period;

Receive the written consent of the resident, if competent, or the resident’s guardian or legal representative prior to using video monitoring;
Explain to the Agency, the facility’s residents, or, if applicable, a resident’s legal representative when and where monitoring will occur and the purpose of the monitoring system;
Provide to the Agency the titles and positions of all persons authorized to access video feeds at off-site locations. Such remote access must be accompanied by safeguards, such as firewalls and other security measures, sufficient to ensure resident privacy; and
Preserve video footage as follows:

a. for a minimum of thirty days from the recording;

b. upon the occurrence of a critical incident, as defined in paragraph 65G-2.010(6)(f), F.A.C., captured by video monitoring;

c. upon notice of any law enforcement or Department of Children and Families’ investigation of any incident captured by video monitoring; and

d. at the request of the Agency and in accordance with paragraph (7)(f) of this rule.

(c) The use of remote interactive video monitoring, where the licensee or its designee can watch live video from another location in the facility or from an offsite location, shall be limited to vocational and educational settings, medical and special treatment spaces, administrative offices, or common areas. Remote interactive video monitoring may not be used in bedrooms or bathrooms.

(d) The Agency reserves the right to preclude, restrict, or suspend a facility’s authority to conduct video monitoring under this subsection at any time if the Agency determines that any provision of this subsection or section 393.13, F.S., has been violated.

(e) The videos obtained by the facility through video monitoring shall be considered records of the facility and made available for viewing and duplication by any Agency staff or designated agent of the State of Florida who presents proper State of Florida-issued identification. Such videos must be maintained in a format that permits access and duplication.

(f) Storage – if a facility or licensee elects to install a video monitoring system, it must have (1) a method for saving any video of violations of Florida law and (2) a method to release the saved video to the Agency. Video shall be stored in accordance with the licensee’s written protocols and preserved as required in paragraph (7)(b) of this rule.

It is the licensee’s responsibility to have an adequate storage system capable of saving and releasing the video to the Agency for review.
The responsibility to save and release a video to the Agency is the licensee’s responsibility. Failure to comply with this section shall be a violation under this chapter.
Defenses – Limited storage capacity, technical errors, or design limitations in the video licensee’s technology, system, or equipment shall not be defenses to a violation of this subsection.

(8) Behavioral Interventions and Responses to Behavioral Issues Involving Residents.

(a) The facility shall have a written statement of policies and procedures governing actions that may be taken by direct service providers to help prevent or respond to problematic behaviors exhibited by residents, including emergency procedures and reporting requirements. Such policies and procedures, as well as any actions taken by direct service providers involving residents of the facility, shall be consistent with the provisions of section 393.13, F.S., as well as Chapters 65G-4 and 65G-8, F.A.C.

(b) A direct service provider must be trained to appropriately respond to serious and spontaneous behavioral incidents requiring emergency intervention procedures.

(c) A direct service provider must not implement emergency intervention procedures that use restraint or seclusion, or cause physical discomfort, unless he or she has been certified through an Agency-approved emergency procedure curriculum under Chapter 65G-8, F.A.C.

(d) The following responses are strictly forbidden:

Physical or corporal punishment that includes, but is not limited to, hitting, slapping, smacking, pinching, paddling, pulling hair, pushing or shoving residents;
The use of noxious substances, which include painful or aversive stimuli used to control behavior such as pepper on tongue, squirt of lemon juice, ammonia inhalants, or electric shock;
Verbal abuse such as cursing at residents, using slurs or derogatory names, or screaming;
Humiliation, such as keeping a resident in wet or soiled clothing or diapers, making the resident stand in front of others to be ridiculed, or making the resident wear a sign or dunce cap, placing residents in dark or locked time-out rooms; and
Any reactive strategy prohibited under Rule 65G-8.009, F.A.C.

(9) Sexual Activity and Physical Contact.

(a) The licensee shall develop and enforce a written policy regarding sexual activity involving residents of the facility. Such policy shall:

explicitly prohibit sexual activity between a resident and a covered person;
explicitly prohibit sexual activity that involves residents who are under the age of eighteen;
not in any way abridge nor restrict the civil and legal rights of persons with developmental disabilities, including those specified within section 393.13, F.S.; and
address appropriate physical boundaries and standards among direct service providers and residents and must include the following elements:

a. a dress code for direct service providers that outlines the type of clothing that is acceptable as well as where and under what circumstances it is acceptable;

b. a provision for mutual respect by direct service providers and residents for personal space, such as knocking before entering a bedroom, except as may be necessary for residents who require visual supervision due to documented behavioral or medical issues;

c. parameters establishing who is allowed to visit whose bedroom and under what conditions;

d. a provision that all residents and direct service providers shall sleep in separate beds;

e. a provision that permits direct service providers to assist or supervise residents while the resident bathes, showers, or toilets, if the resident requires assistance or supervision, and that prohibits staff from bathing, showering, or toileting simultaneously with the resident under any circumstances;

f. guidelines concerning the level and type of supervision required for residents and all direct service providers shall be familiar with such guidelines; and

g. open communication among residents and direct service providers about events occurring in the facility in order to encourage reporting of incidents of inappropriate sexual behavior.

(b) The licensee shall provide direct service providers with training regarding the licensee’s policy regarding sexual activity involving residents of the facility.

(c) The following safeguards shall be implemented in any facility which serves one or more sexually aggressive residents or residents who require a Safety Plan under this rule chapter, under the iBudget Handbook incorporated by reference in Rule 59G-13.070, F.A.C., or under any other similar requirement:

All direct service providers shall review all available written, detailed and complete history related to sexually aggressive residents in order to prevent the occurrence of sexual abuse incidents. When available to the licensee, such information provided to staff must include, but is not limited to, the date of the sexual abuse incident, type of abuse, brief narrative outlining the event, type of treatment the resident received and the outcome of the treatment. If the resident is currently in treatment, the licensee shall maintain contact information for the treatment provider;
Prior to admission, the facility must review the Safety Plan of any resident. The facility is responsible for complying with any requirements of the Safety Plan and implementing its provisions, as applicable to the facility. All staff must be trained on the Safety Plan prior to working with the resident;
The prospective resident, if legally competent, or his or her legal representative must sign and agree to the Safety Plan. The Safety Plan shall be reviewed and updated as needed, at least once a year;
Newly placed sexually aggressive residents shall be provided visual supervision at all times the resident is awake during the resident’s first twenty-four (24) hours in the facility;
A sexually aggressive resident is not allowed to share a bedroom with another resident without Agency approval. Such approval shall take into consideration the licensee’s plan to ensure supervision sufficient to ensure the safety of residents;
Known sexually aggressive residents shall never be left alone with other residents in a bedroom, bathroom, or behind closed doors without prior Agency approval. Only one resident may use the bathroom at any time that the bathroom door is closed; and
Residents who are minors are not permitted to possess obscene materials as defined in section 847.001, F.S., on the premises.

(10) Solicitation Activities. The licensee must have the written permission of the resident, if competent, or the resident’s legal representative prior to using the resident’s image, voice, name, picture, personal information, or disability for the purpose of securing donations.

(11) First Aid.

(a) The facility shall have on the premises an American Red Cross-approved or equivalent first aid kit that meets essential safety standards with unexpired contents. The first aid kit shall be maintained in places known to and readily available to all direct service providers.

(b) Potentially toxic materials contained within first aid kits should be stored in a manner which does not pose a risk to residents.

(12) Medication.

(a) Medication shall be administered to a resident in accordance with the written order or prescription issued by the resident’s health care practitioner. Ongoing staff re-training and competency-based verification of skills shall be provided when there is evidence of medication errors to correct staff practices and prevent future occurrences.

(b) All prescription medication shall be kept in its original container bearing the original dated label with legible information stating the prescription number, direction for use, resident’s name, physician’s name, and address of the issuing pharmacy.

(d) A resident whose physician has deemed the resident capable of handling his or her own medications should be encouraged to do so. Staff shall assist the resident by making the medication available and reminding the resident to take medication at appropriate times.

(e) The licensee must maintain a current and accurate daily record of prescription and non-prescription medication administered to residents in accordance with the provisions of Chapter 65G-7, F.A.C.

(f) The administration of medication to residents, as well as the documentation of administration of such medication, medication storage, and error reporting shall be performed in accordance with sections 393.13 and 393.506, F.S., Chapter 65G-7, F.A.C., and this rule chapter.

(g) If the licensee or a direct service provider observes or receives reports from other individuals that a resident may have experienced an adverse reaction to an administered medication, such information must be conveyed immediately to either the prescribing physician or the licensed medical professional employed by the licensee who has been charged with the responsibility of securing appropriate medical treatment for residents. If either the prescribing physician or medical professional employed by the licensee is unable to be reached, facility staff shall immediately seek medical attention for the resident.

(13) Specialized Equipment.

(a) The licensee shall ensure that all direct service providers have been trained and are competent in the proper application, monitoring, and removal of specialized equipment worn by residents, including but not limited to Ankle-Foot Orthoses (AFOs), leg braces, arm splints, neck collars, helmets, and safety belts.

(b) The licensee shall ensure that all direct service providers are knowledgeable in the proper operation of other specialized equipment required by residents such as wheelchairs, lifts, and positioning devices.

(c) The licensee shall contact the appropriate support coordinator(s) as soon as significant signs of wear and tear are noticed on specialized equipment used by a resident.

(14) Transportation.

(a) The facility shall provide or arrange for the incidental transportation of residents within the community as a typical household would provide for its members.

(b) A record must be maintained that lists each participant being transported in a vehicle. The record must be maintained on file at the facility for a minimum of 12 months.

All transportation records must be available for review by the Agency during monitoring visits and upon request.
The transportation record must include, at minimum:

a. Name of each resident;

b. Date and time of departure;

c. Date and time of the arrival; and

d. Name and signature of the driver.

Prior to each departure, the transportation record must be recorded with each resident’s name, date and time of departure, and initialed by the direct service provider verifying each resident is accounted for.
Upon arrival at the destination, the driver of the vehicle must complete the transportation record and mark each resident off the record as the resident departs the vehicle.

(c) The driver must complete a physical inspection and visual sweep of the vehicle at the arrival of the destination to ensure that no resident is left in the vehicle.

(d) If the licensee contracts with an outside entity to provide transportation, the licensee must assign a direct care personnel to perform the duties described in this rule.

(e) The maximum number of individuals transported must not exceed the manufacturer’s designated seating capacity or the number of factory installed seatbelts.

(f) When transporting residents, the staff to resident ratio must be maintained.

(g) Residents must use seatbelts or other safety restraints during transportation.

(h) Direct care staff must meet all training requirements set forth in this rule.

(i) All vehicles used to transport participants must be maintained in a clean condition and pursuant to the vehicle or manufacturers’ requirements or instructions to ensure that they are in proper working order. Documentation of the maintenance must be maintained on file for a minimum of 12 months, and available to Agency staff during monitoring visits and upon request.

(j) Smoking and vaping shall be prohibited in vehicles.

(k) The interior of the vehicle, when being used to transport residents must be maintained at a temperature between 65 to 78 degrees Fahrenheit. The vehicle can be ventilated either by mechanical or natural means to maintain the temperature. This is only during operational transportation of the vehicle and does not include the loading or unloading of the vehicle.

(l) Transportation shall be provided by the facility at no cost to the residents unless such trips involve destinations which are more than 25 miles from the facility. If the trip is more than 25 miles, the facility may charge the residents for the excess.

(m) Any vehicle in which residents are transported shall:

have a current license plate;
carry at least the minimum insurance coverage required by state law;
contain a working and tagged fire extinguisher;
be operated by a driver holding an appropriate valid driver’s license;
have working seatbelts and wheelchair tie-downs when applicable;
have working heat and air conditioning; and
be maintained in a manner to ensure safe transport.

(n) The number of transported residents not seated in wheelchairs during the trip shall not exceed the number of available seats in the vehicle.

(o) Residents shall be encouraged to use public transportation in areas where it is available and appropriate to the residents’ ability.

(p) Residents shall not be left unattended in any vehicle operated by the facility.

(q) Facilities that plan to use facility staff to take clients outside of Florida shall provide prior notification to the Agency.

(15) Communication Among Staff.

(a) Each facility shall have a system in place to communicate recent incidents and resident information to staff working on subsequent shifts. The system shall include:

a mechanism for documenting in writing any and all information, such as medical or behavioral incidents or physician or therapist orders or recommendations, of which staff should be made aware and which could potentially affect the residents’ health or safety if staff were unaware of such information; and
a procedure or mechanism to ensure that the information described in this subsection is reviewed across all shifts.

(b) Such communication-related documentation shall be maintained within the facility for a least one year following each entry and may be maintained electronically. The information shall be made available to the Agency during inspections.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1), 393.506(6) FS. Law Implemented 393.067, 393.13, 393.135, 393.506 FS. History–New 7-1-14, Amended 3-26-26.

Fla. Admin. Code R. 65G-2.010 Fire and Emergency Procedures

(1) Emergency Standards.

(a) Direct service providers shall be knowledgeable in facility procedures for handling emergencies.

(b) There shall be at least one telephone which is accessible to direct service providers and residents for emergency use at all times. The facility must have the following telephone numbers readily accessible at each telephone extension in the facility:

Local law enforcement;
Fire Department;
Each resident’s doctors;
Ambulance;
Support Coordinator for each resident;
Regional Office;
Emergency Agency on-call number, as assigned by the Regional Office;
Florida Abuse Hotline; and,
Poison Control Hotline.

(2) Fire Safety Standards. The licensee shall annually request that the local authority having jurisdiction over fire safety or the State Fire Marshall inspect the facility for compliance with Chapter 69A-38, F.A.C., as applicable. The facility must have an approved fire inspection prior to receiving an initial license or the renewal of a license.

(3) Emergency Preparedness Drills.

(a) Dates and results of required monthly fire drills (i.e., time of day, points of exit used, evacuation time, and signature of person conducting the drill) shall be recorded and maintained for one year following the date of the drills.

(b) Required monthly fire drills shall not be conducted between the hours of midnight and 5:00 a.m.

(c) Regional Office employees shall be afforded the opportunity to observe monthly fire drills in order to verify the effectiveness and efficiency of evacuations.

(4) Emergency Management Plans.

(a) Under section 393.067(8), F.S., each facility shall prepare and maintain a written comprehensive emergency management plan which shall be updated as needed and on an annual basis. The emergency management plan must address the following:

Provisions for all hazards. Each plan shall describe the potential hazards to which the facility is vulnerable such as hurricanes, tornadoes, flooding, fires, hazardous materials, incidents from fixed facilities or transportation accidents, and power outages during severe cold or hot weather.
Provisions for the care of residents remaining in the facility during an emergency, including pre-disaster or emergency preparation, protecting the facility, ensuring residents and staff have adequate supplies, medications, emergency power, food and water, maintaining adequate staffing, and emergency equipment.
Provisions for the care of residents who are evacuated from the facility during an emergency, including identification of such residents and transfer of resident records, evacuation transportation, sheltering arrangements, supplies, staffing, emergency equipment, and medications.
Identification of residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation.
Identification of and coordination with the local emergency management agency.
Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for residents, transportation, and reporting to the county office of emergency management the number of residents who have been relocated and the place of relocation.
The identification of staff responsible for implementing each part of the plan.

(b) Emergency Management Plan Development.

Emergency management plans shall be updated at least annually and may be developed with the assistance of appropriate resource persons from the local fire marshal, Regional Office, or local emergency management agency.
The facility shall review its emergency management plan on an annual basis.

(c) Emergency Management Plan Implementation. In the event of an internal or external disaster, the facility shall implement the facility’s emergency management plan in accordance with Sections 252.355 and 252.356, F.S.

All staff must be knowledgeable of facility procedures for handling emergencies, trained in their duties and are responsible for implementing the emergency management plan. All staff must be trained on the facility’s emergency management plan within 30 days of hire. Staff shall be trained on the emergency management plan annually, after the plan’s annual update.
All staff are responsible for implementing the emergency management plan and must be able to implement the emergency management plan.
If telephone service is not available during an emergency, the facility shall request assistance from local law enforcement or emergency management personnel in maintaining communication.

(d) Facility Evacuation. The facility must evacuate the premises during or after an emergency if so directed by the local emergency management agency.

The facility shall report the evacuation to the designated Agency Regional office within six hours of the evacuation order and at every six hour interval until the evacuation is complete.
The facility shall not be reoccupied until the area is cleared for reentry by the local emergency management agency, local fire marshall, or any other agency or entity having authority or its designee and the facility can meet the immediate needs of the residents.
In cases where the facility experiences significant structual damage, the licensee or facility staff must relocate residents until the facility can be safely reoccupied.
The licensee or designated facility staff is responsible for knowing the location of all relocated residents and for ensuring that those residents return to the facility safely.
The licensee or designated facility staff shall provide the Agency with the name of a contact person who shall be available by telephone 24 hours a day, seven days a week, until the facility is reoccupied.
The licensee or designated facility staff shall assist in the relocation of residents and shall cooperate with outreach teams established by the Agency or emergency management officials to assist in relocation efforts. The needs and preferences of each resident shall be considered to the greatest extent possible in any relocation decision.

(e) Emergency shelter. In the event a state of emergency has been declared and the facility is not required to evacuate the premises, the facility may provide emergency shelter above the facility’s licensed capacity provided the following conditions are met:

No person’s life, health, and overall safety will be jeopardized;
The immediate needs of all residents and other individuals sheltered at the facility can be met by the facility;
Within forty-eight (48) hours following the facility exceeding its capacity, the facility must report to the Agency that the facility is over capacity and describes the conditions which have caused it to be over capacity. If the facility will continue to be over capacity after the declared emergency ends, the Agency shall review such ongoing requests on a case-by-case basis;
The facility must ensure that those individuals who are not residents of the facility are returned to their place of residence or other suitable placement as soon as possible; and
The facility maintains a log of the additional persons being housed in the facility. The log shall include the individual’s name, usual address, and the dates of arrival and departure. The log shall be available for review by representatives of the Agency and the local emergency management agency or its designee. The admissions and discharge log maintained by the facility may be used for this purpose provided the information is maintained in a manner that is easily accessible.

(5) Missing Residents. After determining that a resident is missing, staff shall immediately call local law enforcement and ask the officer to:

(a) Take a report of the missing resident;

(b) Assign a case number and provide the number to the staff reporting the resident as missing; and

(d) If the responding law enforcement officer refuses to take a missing person report for any reason, the staff making the report will document the name of the officer and call the responding local law enforcement agency and request to speak to the appropriate Watch Commander about the refusal to take a missing person report.

(e) The facility shall make a critical incident report in accordance with paragraph (6)(f) of this rule.

(6) Incident Reporting.

(a) In all cases involving a known or suspected abuse, neglect or exploitation, the incident shall be reported immediately to the Florida Abuse Hotline as required under sections 39.201 and 415.1034, F.S.

(b) The licensee shall report all incidents and follow up measures to incidents to the Agency in the following manner and according to the specified timeframes using APD Incident Reporting Form OP 3-0006 (December 2025), incorporated herein by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-18972. A copy of this form may also be obtained from the Agency.

(c) The reporting provider or covered person shall also immediately notify the resident’s legal representative and support coordinator, as appropriate and, for children in the custody of the Department of Children and Families, the designated caseworker.

(d) The provider or covered person must take immediate action in the situation to resolve the emergency and ensure the individual’s health and safety. This action may include, but is not limited to, calling 911, performing Cardiopulmonary Resuscitation (CPR) for recipients without a pulse who are not breathing, and back blows and abdominal thrust maneuvers for choking.

(e) The APD Incident Reporting Form shall be electronically submitted to the appropriate Regional Office in the agency approved method within the required timeframes outlined in this rule. The report must be completed as accurately as possible, based on firsthand knowledge when available.

(f) Providers or covered persons must provide initial notice of the occurrence of a critical incident within four hours after the provider or covered person becomes aware of the incident. Initial notice may be made via electronic submission through the Agency’s designated incident reporting system, e-mail, or phone call to the appropriate Regional Office. A complete APD Incident Reporting Form must be submitted electronically within one calendar day after the initial notification. Telephonic contact does not include the sending of text messages over the phone.

A supervisor may be the one to make the initial notice of the critical incident.
The APD Incident Reporting Form must be completely filled out and electronically submitted via the Agency’s designated incident reporting system and must include, at minimum:

a. Individuals involved in the incident, including staff and any witnesses;

b. When the incident occurred;

c. Location of incident;

d. Incident category and type;

e. Detailed description of the incident, including circumstances prior, during, and after the incident;

f. Causes or contributing factors to the incident;

g. Provider responsible for care during the incident, when applicable;

h. Any and all actions taken by a provider or covered person to protect a resident, participant, or client, gain control, remedy or manage the situation;

i. Any information identified within the providers investigation into the incident, if applicable;

j. Law enforcement information, when applicable; and

k. Department of Children and Families investigation information, when applicable.

Critical incidents include the following:

a. The unexpected death of a resident or a client;

b. Any sexual activity, as defined in section 393.135, F.S., between a covered person and a resident or client regardless of the consent of the resident or client, incidents of nonconsensual sexual activity between residents or clients, sexual activity involving any resident or client who is a minor; and nonconsensual sexual activity between a resident or client and any person in the community;

c. The unexpected absence or unknown whereabouts, beyond one hour, of a resident or client who is a minor or an adult resident or client who has been adjudicated incompetent;

d. A resident or client has sustained a life-threatening injury or illness;

e. A hospital admission as a result of a medication error;

f. Negative news media reports regarding the operation of the facility or the care of residents or clients;

g. The arrest of a resident or client for a violent criminal offense;

h. The arrest of a covered person for a potentially disqualifying offense specified in section 393.0655, F.S.;

i. The Department of Children and Families has made a finding of verified abuse, neglect, exploitation, or abandonment by the provider or the provider’s employees;

j. Suspected or confirmed human trafficking of a resident, participant, or client; or

k. Resident, participant, or client left in vehicle unattended.

(g) Reportable incidents must be reported to the Regional Office within one calendar day following the incident by submitting a completed APD Incident Reporting Form which must be electronically mailed to the designated Regional Office email address for the region in which the resident resides. Reportable incidents include:

The death of a resident or client that does not constitute an unexpected death;
Physical altercations occurring between a resident or client and a member of the community, a resident or client and direct service providers, or two or more residents or clients, that results in law enforcement contact;
Any injury to a resident or client due to an accident, act of abuse, neglect or other incident that occurs or allegedly occurs while the resident or client is receiving services from a covered person that requires the resident or client to receive medical treatment in an urgent care center, emergency room or physician office setting due to injury that is being reported currently or requires admission to a hospital;
The arrest of a resident or client for a non-violent offense while that resident or client is under the care of a provider or covered person;
The unexpected absence or unknown whereabouts of a legally competent adult resident or client beyond eight hours;
Any act which clearly reflects the physical attempt by a resident or client to cause his or her own death;
The commitment of a resident or client to mental health services pursuant to chapter 394, F.S., also known as the “Baker Act;”
The commitment of a resident, participant, or client to mental health services through voluntary commitment;
Injury of a covered person caused by a resident, participant, or client; or
Any sudden onset of illness to a resident or client while receiving services from a covered person that requires the resident or client to receive medical treatment in an urgent care center, emergency room or physician office setting due to sudden onset of illness or requires admission to a hospital.

(h) Any and all follow-up measures taken by a provider or covered person to protect a resident, participant, or client, gain control, remedy or manage the situation must be noted on APD Incident Reporting Form, which must be completed and submitted to the Regional Office no later than five days following the date the incident was reported. Ongoing follow-up information must be submitted to the Regional Office until the incident is resolved. If the initial incident report contains all necessary information for the initial and follow-up reporting, an additional follow-up is not necessary. Follow-up documentation includes:

All follow-up actions implemented by the provider.
Preventative measures taken or initiated by the provider to prevent the recurrence of the same type of incident, when applicable.
Any follow-up activities related to medical, behavioral, additional support, etc. to ensure ongoing health and safety of the client.

History

Rulemaking Authority 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.067 FS. History–New 7-1-14, Amended 7-1-18, 3-26-26.

Fla. Admin. Code R. 65G-2.011 Foster Care Facility Standards

History

Rulemaking Authority 393.501(1), 393.067 FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.09, 10F-6.009, 65B-6.009, Amended 7-1-14, Transferred to 65G-2.0071.

Fla. Admin. Code R. 65G-2.012 Group Home Facility Standards

History

Rulemaking Authority 393.501(1), 393.067 FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.10, 10F-6.010, 65B-6.010, Amended 7-1-14, Transferred to 65G-2.0072.

Fla. Admin. Code R. 65G-2.013 Residential Habilitation Center Standards

History

Rulemaking Authority 393.501(1), 393.067 FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.11, 10F-6.011, 65B-6.011, Amended 7-1-14, Transferred to 65G-2.0073.

Fla. Admin. Code R. 65G-2.014 Comprehensive Transitional Education Program Standards

History

Rulemaking Authority 393.501(1), 393.067 FS. Law Implemented 393.067, 393.18 FS. History–New 7-31-91, Formerly 10F-6.013, 65B-6.013, Amended 7-1-14, Repealed 3-26-26.

Fla. Admin. Code R. 65G-2.015 Siting

(1) This rule applies to facilities licensed by the Agency under section 393.067, F.S., and this rule chapter. It does not apply to those facilities licensed as foster care facilities that also use live-in caregivers.

(2) Definitions.

(a) “Dwelling unit” means a structure or part of a structure that is rented for use as a home, residence, or sleeping place by one person or by two or more persons who maintain a common household.

(b) “Facility” means a home licensed by the Agency as defined within section 393.067, F.S., and this chapter.

(c) “Foster care facility” means a residential facility licensed by the Agency as defined within chapter 393, F.S., which provides a family living environment including supervision and care necessary to meet the physical, emotional and social needs of its residents. The capacity of such a facility shall not be more than three residents.

(d) “Live-in caregivers” means those individuals who are responsible for rendering paid services and supports within a residential facility to an individual with a developmental disability and whose primary residence is the same as that of the individual to whom they are rendering the aforementioned services and supports.

(e) “Lot” means a parcel or tract of land defined by reference to recorded plats or by metes and bounds, or the least fractional part of subdivided lands having limited fixed boundaries or an assigned number, letter, or any other legal description by which it can be identified.

(3) All facilities seeking initial licensure, or licensure in a different licensing category, on or after July 1, 2014 must fully comply with the requirements of section 419.001, F.S., to the extent applicable.

(4) There shall be not more than three facilities within a radius of 1,000 feet. In addition, licensure of any facility located within 1,000 feet of another facility can only occur if a variance is first granted by the appropriate local government unit in accordance with the provisions of section 419.001, F.S.

(5) All distance requirements in this section shall be measured from the nearest point of the existing home or area of single-family zoning to the nearest point of the proposed home. The facility seeking initial licensure or a change in an existing license shall be included in the computation of numbers of facilities within a 1,000 foot radius.

(6) The requirements of subsections (4) and (5) of this rule do not apply to a “community residential home” located within a “planned residential community” as those terms are defined in section 419.001, F.S. A facility has the burden of establishing that it is a “community residential home” within a “planned residential community.” To satisfy this burden, a facility must provide the following documents with its initial license application and each subsequent license renewal application:

(a) A copy of all local ordinances approving the planned residential community as a planned unit development; and,

(b) Documents which verify that the facility:

Is a community residential home located within a planned residential community;
Is under unified control;
Was planned and developed as a whole;
Has a gross lot area of 8 acres or more; and
Provides choices with regard to housing arrangements, support providers, and activities.

History

Rulemaking Authority 393.066(8), 393.067(1), 393.067(7), 393.501(1) FS. Law Implemented 393.066, 393.067, 393.501 FS. History–New 8-1-05, Formerly 65B-6.014, Amended 7-1-14, 3-26-26.

Fla. Admin. Code R. 65G-2.017 Health Safety Standards for Licensed Facilities

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.067 FS. History–New 2-26-15, Repealed 3-26-26.

Fla. Admin. Code R. 65G-2.018 Personal Needs Allowance

(1) A residential facility, that serves as the representative payee for a client, must set aside a personal needs allowance from the benefit payments or third-party benefits, or both, of the client, The facility is responsible for maintaining and administering the personal needs allowance, in accordance with the wishes of the client or the client’s legal representative. The client's personal needs allowance is for the benefit of only that client.

(2) The personal needs allowance shall be at least eighteen (18) percent of the maximum federal benefit rate for Social Security Income payments to an individual.

(3) This Rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0662, 393.067, 393.501, 402.33, FS. Law Implemented 393.066, 393.0662, 393.067, 402.33, FS. History–New 8-17-23.

Chapter 65G-3 TERMINATION, SUSPENSION OR REDUCTION OF CLIENT SERVICES BY SERVICE PROVIDERS

Fla. Admin. Code R. 65G-3.001 Definitions

(1) “Contract” means a formal written agreement between the provider and Agency and includes Medicaid Waiver Services Agreement.

(2) “Discrimination” means the unjust or prejudicial treatment of different categories of people.

(3) “Fading” is the planned reduction in a client’s level of service over a specified period of time, which is determined by the client’s identified progress and needs identified based on medical necessity. This planned reduction must be documented in the client’s records which may include but is not limited to the client’s plans of care, support plan, cost plan, provider documentation, or Agency determinations.

(4) “Individual Representative” is defined in subsection 65G-4.0213(13), F.A.C.

(5) “Provider” means any individual, program, or facility that receives payment for the care, treatment, training, residence or habilitation of persons with developmental disabilities. A provider does not include:

(a) A spouse, family member or guardian with whom a person with developmental disabilities resides;

(b) A provider covered under the provisions of part VIII of chapter 400, F.S.; or

(c) Individuals or entities providing services to clients through the Consumer Directed Care Plus program pursuant to sections 393.066, and 409.221, F.S., and the rules of the Agency.

(6) “Reduction” means a decrease in the frequency, duration or intensity in the level of services, initiated by a non-residential provider that is not a result of faded or prescribed reductions that are part of service planning.

(7) “Retaliatory Conduct” means negative action against a client or client’s individual representative motivated by the desire to punish the client or the client’s individual representative.

(8) “Suspension” means an involuntary and temporary break in services in a non-residential program initiated by the provider. Suspension does not mean a break of services to a client by a service provider due to the unavailability of funds to the provider by the Agency.

(9) “Termination” means the involuntary, permanent discharge or discontinuation of services in a program by the provider when such action is not included as part of the service planning process. Termination does not mean a discontinuation of services to a client by a service provider due to the unavailability of funds to the provider by the Agency.

(10) “Regional Office” means the Agency local office responsible for managing a specific geographical region.

History

Rulemaking Authority 393.125(2), 393.501(2) FS. Law Implemented 393.125(2) FS. History–New 12-10-91, Formerly 10F-8.026, 65B-8.026, Amended 6-4-19.

Fla. Admin. Code R. 65G-3.002 Criteria for Admissions and Services

History

Rulemaking Authority 393.125(2) FS. Law Implemented 393.125(2) FS. History–New 12-10-91, Formerly 10F-8.028, 65B-8.028, Repealed 5-13-19.

Fla. Admin. Code R. 65G-3.003 Rules for Reduction of Services by the Provider

History

Rulemaking Authority 393.125(2) FS. Law Implemented 393.125(2) FS. History–New 12-10-91, Formerly 10F-8.029, 65B-8.029, Repealed 5-13-19.

Fla. Admin. Code R. 65G-3.004 Rules for Suspension of Services by the Provider

History

Rulemaking Authority 393.125(2) FS. Law Implemented 393.125(2), 120 FS. History–New 12-10-91, Amended 5-19-93, Formerly 10F-8.030, 65B-8.030, Repealed 5-13-19.

Fla. Admin. Code R. 65G-3.005 Rules for Termination, Reduction, or Suspension of Services by the Provider

(1) TERMINATIONS AND REDUCTIONS

(a) If a provider determines that he or she must terminate or reduce services the provider gives to a client, the provider shall send written notice of intent to terminate or reduce services to the client and their individual representative by certified mail or electronic mail. The provider shall send the required notice to the Regional Office and Support Coordinator via electronic mail.

The provider may not terminate or reduce services until at least thirty calendar days after the receipt of the notification by the client, individual representative, Regional Office, and Support Coordinator.
If the client is not on the iBudget Waiver pursuant to section 393.0662, F.S., notification is only required to be given by the provider to the Regional Office, the client and the client’s individual’s representative.

(b) Upon receipt of the notice from the provider, the Support Coordinator shall:

Evaluate the circumstances that led to the proposed termination or reduction,
Determine what actions, if any, should be taken to resolve the situation,
Immediately assist the client or the client’s individual representative in locating an alternate provider if resolution is not acceptable to the client or provider or otherwise not possible, and
Update the client’s support plan, cost plan and relevant service authorizations accordingly.

(c) At the request of the client or the client’s individual representative, the Support Coordinator shall arrange a meeting with the provider and the client or the client’s individual representative, to offer any recommendations to the client and the provider in an effort to resolve the concerns that led to the issuance of the notice of intent to terminate or reduce service. The meeting must be arranged within five (5) calendar days of the client’s or the individual representative’s request for the meeting.

(d) The Support Coordinator shall contact the Regional Office immediately if the client and the client’s individual representative need assistance in locating an alternate provider at least 25 days prior to the effective date of termination or reduction in services. The Regional Office will assist the client and the client’s individual representative in meeting the client’s needs.

(e) If the termination is for services provided in a licensed residential facility, the Regional Office shall immediately work with the client’s Support Coordinator to assist the client or the client’s individual representative in choosing an alternate place to live before the date of termination.

(f) If the client or the client’s individual representative selects an individual or entity to render the services who is not qualified to be that client’s provider, the Regional Office shall issue a notice to deny the client’s selection of provider choice within 30 calendar days of the client’s notification to the Regional Office. The notice shall identify:

Any alternate providers or service options for the client that the Agency has determined are readily available;
The reason the Agency is denying the client’s selection of provider choice;
The specific statute or rule supporting the denial; and
An explanation of the client’s administrative hearing rights pursuant to sections 393.125, 120.569, and 120.57, F.S.

(2) SUSPENSIONS

(a) Emergency Suspension: A service provider may suspend services provided to a client in a non-residential program when the behavior of the client constitutes an immediate danger to health, safety, or welfare of the client, another recipient of the provider’s services, the provider, or a third party. If a service provider suspends a client’s services for this reason, the provider shall give written notice of suspension to the client, the client’s individual representative, the client’s Support Coordinator, and Regional Office at the time of the suspension or thereafter, detailing reasons for the suspension.

(b) Other Suspension: A service provider may suspend services provided to a client in a non-residential program when the client’s behavior interferes with services provided to other recipients of the provider’s services. If a service provider initiates a suspension for this reason, the service provider shall provide written notice of suspension from a non-residential program to the client, the client’s individual representative, the client’s Support Coordinator, and the Regional Office at the time of the suspension or thereafter, detailing reasons for the suspension.

This type of suspension shall not exceed 3 service days.
If the client is not on the iBudget Waiver pursuant to section 393.0662, F.S., notification is only required to be given by the provider to the Regional Office, the client and the client’s individual’s representative.

(c) The Support Coordinator shall ensure that appropriate service coverage is available during the time of suspension and update the support plan, cost plan, and relevant service authorizations accordingly. The Support Coordinator shall contact the Regional office the day the Support Coordinator receives notice of the suspension if assistance is needed in securing alternate services or providers. The Regional Office will assist the client and the client’s individual representative in meeting the client’s needs.

(3) This rule does not apply to fading or other reduction of care set forth in the client’s plan of care.

History

Rulemaking Authority 393.125(2), 393.501(1) FS. Law Implemented 393.125(2) FS. History–New 12-10-91, Amended 5-19-93, Formerly 10F-8.031, 65B-8.031, Amended 6-4-19.

Fla. Admin. Code R. 65G-3.006 Discrimination and Retaliatory Conduct

(1) Service providers are prohibited from:

(a) Taking any action that qualifies as illegal discrimination against any client receiving services in the receipt of those services.

(b) Prejudicing the future provision of appropriate services when the client or the client’s individual representative attempts to advocate with the Agency, a government entity, or advocacy organization for desired services. Providing factual information regarding a client that is pertinent to ensure the safety, health, and welfare of the client and third parties shall not be considered “prejudicing the future provision of appropriate services.”

(c) Taking any action that qualifies as retaliatory conduct againt a client or the client’s individual representative if either has complained about the service provider to the Agency, a governmental entity or advocacy organization, or any other individual or entity.

(2) In cases where the Agency has determined the provider has engaged in retaliatory conduct, illegal discriminatory conduct, or withheld factual information, as described within this section, the Agency may initiate action against the service provider’s license, pursuant to chapter 65G-32, F.A.C., or any contract with the Agency, including the Medicaid Waiver Services Agreement, in accordance with the provisions of applicable state law and administrative rules.

History

Rulemaking Authority 393.125(2), 393.501(1) FS. Law Implemented 393.125(2) FS. History–New 12-10-91, Amended 5-19-93, Formerly 10F-8.033, 65B-8.033, Amended 6-4-19.

Chapter 65G-4 SERVICE DELIVERY PRACTICE AND PROCEDURE

Fla. Admin. Code R. 65G-4.001 Definitions for Behavioral Services: Practice and Procedure

(1) Area Behavior Analyst means a behavior analyst employed by, or under contract with an area office of the Agency who holds a doctorate from an accredited university program with behavior analysis as a primary focus, is a board certified behavior analyst, has completed a dissertation that had behavior analysis as its central focus and has at least one year of experience in the provision of behavior analysis services for persons with developmental disabilities. However, if no one with these qualifications is available, then the individual must be a certified behavior analyst with at least the education and experience requirements for taking the board’s behavior analyst examination.

(2) Behavior analysis refers to the use of scientific methods to produce socially significant improvements in behavior. This process entails gathering information to analyze or describe the link between behavior and environment. It includes assessment of the environment and consequences that are maintaining the behavior targeted for change. It also encompasses changing the situations in the environment that trigger problem behavior and arranging situations that will provide the opportunity for desirable behaviors to occur. Behavior Analysis interventions teach or increase occurrence of skills to replace the behavior targeted for change and arrange delivery of consequences for desirable and undesirable behavior. A behavior analytic intervention also includes strategies and approaches to maintain the gains of the intervention over time and in varied settings. Behavior change interventions are based on the principles and laws of behavior. Behavior analytic interventions require monitoring and evaluation for effectiveness through direct observation and quantification of the behavior targeted for change. Caregivers and family members are actively involved in the behavior analysis process and are taught how to implement specific techniques or changes in the environment. Behavior analysis does not rely on cognitive therapies and expressly excludes psychological testing, neuropsychology, psychotherapy, sex therapy, physchoanalysis, hypnotherapy and long term counseling as treatment modalities.

(3) Behavior analysis services – The use of behavior analysis to assist a person or persons to learn new behavior, to increase existing behavior, to reduce existing behavior, and to emit behavior under precise environmental conditions. The term “behavior analysis services” includes the terms “behavior analysis service plan,” “behavioral programming,” “behavioral supports,” “behavior modification programs,” “behavior intervention plans,” “behavior plans,” and “behavioral programs,” as well as those interventions designed to ameliorate dangerous behavior as described in subsection 65G-4.010(3), F.A.C., below. These services are supported in documentation showing that they are applied, behavioral, analytic, technological, conceptually systematic, and effective relative to the definitions of these terms found in “Some Current Dimensions of Applied Behavior Analysis” by D. M. Baer, M. M. Wolf, and T. R. Risley and available in the Journal of Applied Behavior Analysis, Volume 1, 1968. This article is incorporated by reference and may be found online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1310980/pdf/jaba00083-0089.pdf.

(4) Certification Body – A nonprofit corporation whose standards for certification of behavior analysts and assistant behavior analysts adheres to the national standards of boards that determine professional credentials to meet the needs of behavior analysts, state governments and consumers of behavior analysis services. The certification procedure of the nonprofit corporation must undergo regular psychometric review and validation pursuant to a job analysis survey of the profession and standards established by content experts in the field.

(5) Certified Behavior Analyst – A behavior analyst certified by a certification body, including a Board Certified Behavior Analyst – Doctoral level, a Board Certified Behavior Analyst, a Board Certified Assistant Behavior Analyst and a Florida Certified Behavior Analyst.

(6) Consultation – Monthly contacts between a Board Certified Assistant Behavior Analyst (BCaBA) and a consulting Board Certified Behavior Analyst (BCBA), during which the behavior analysis services provided by the BCaBA are evaluated. At the time consultation is provided, the consulting BCBA shall not be the BCaBA’s subordinate, employee, spouse or family member. The consulting BCBA shall not be considered an employee of the BCaBA if the only compensation received by the consulting BCBA consists of payment for consultation. Monthly contacts may include the BCaBA’s presentation of behavior analysis services designed by the BCaBA, with a focus on graphic displays of data, at local review committee meetings, established in Rule 65G-4.008, F.A.C.

(7) Contingent exercise – Bodily exertion or effort that is not topographically related to the misbehavior, involving a repeated series of physical movements required as a consequence for inappropriate behavior.

(8) Desensitization – A method for teaching an individual to exhibit calm or incompatible behavior during the gradual and systematic presentation of increasing levels of an aversive or feared stimulus resulting in the ability to tolerate the formerly feared stimulus.

(9) Dietary manipulations – Procedures involving the alteration of dietary variables including the quantity or type of food eaten and liquids consumed, the caloric density of the diet, the oral stimulation involved in eating, and the temporal distribution of the daily diet.

(10) Extinction – A procedure in which reinforcement of a previously reinforced behavior is discontinued.

(11) Facility – Can be a publicly or privately established residential operation serving individuals with behavioral service needs.

(12) Functional Communication Training (FCT) – a procedure in which a functional form of communication is taught and reinforcement is provided contingent upon communication, while withholding reinforcement for other behavior.

(13) Positive practice overcorrection – Activities that involve repeated performance of a desirable alternative behavior related to a targeted inappropriate behavior.

(14) Provider – An enrolled professional authorized to provide behavior analysis services. Only individuals who are board certified behavior analysts – doctoral level, board certified behavior analysts (BCBA), board certified assistant behavior analysts (BCaBA), Florida certified behavior analysts or persons licensed in accordance with Chapter 490 or 491, F.S., on active status, and demonstrating supervision as required, may be providers of behavior analysis services. Only those providers holding a certificate on active status from a recognized certification organization for behavior analysis shall use the title, “certified behavior analyst.” Individuals performing behavior analysis services shall limit their practice to areas of documented expertise and in accordance with their education, training, and certification or licensure, unless otherwise demonstrating evidence of supervision by an individual meeting the requisite education, training, and certification.

(15) Regular psychometric review and validation – A certification process which complies with recognized national standards in the testing and certification industry to ensure the certification examinations are fair, valid and reliable and in conformance with recognized standards such as those of the International Organization for Standardization (ISO) or the National Commission for Certifying Agencies (NCCA).

(16) Response blocking – The use of physical intervention upon occurrence of an undesirable behavior in such a way as to interrupt the normal form of responding.

(17) Response cost – A procedure in which a specified amount of available reinforcers are removed from the individual’s reserve upon occurrence of a specified behavior.

(18) Restitutional overcorrection – Activities that involve correcting the effects of a specified behavior to a better condition than present prior to the occurrence of the specified behavior.

(19) Time-out – These procedures include the withdrawal of the opportunity to earn positive reinforcement or the loss of access to positive reinforcers for a specified period of time.

(20) Token Economy – A behavior change system in which identified behaviors are reinforced by a symbolic medium of exchange, or token, which is later used by a participant in the “purchase” of backup reinforcers, including objects or activities.

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13(4)(g)3., 393.17 FS. History–New 9-23-96, Formerly 10F-4.023, 65B-4.023, Amended 4-4-12.

Fla. Admin. Code R. 65G-4.0011 Recognized Certification Organizations for Certified Behavior Analysts

All providers of behavior analysis services must either be licensed to practice in accordance with Chapter 490 or 491, F.S., or certified under a nonprofit corporation meeting the qualifications under Section 393.17(2), F.S. All providers of behavior analysis services must submit to the Agency for Persons with Disabilities proof of their active licensure or certification in order to provide behavior analysis services. Pursuant to Rule 65G-4.001, F.A.C., and as required by Section 393.17(2), F.S., the Agency recognizes the certification for behavior analysts awarded by the following organizations: Behavior Analyst Certification Board, Inc.

History

Rulemaking Authority 393.17(2) FS. Law Implemented 393.17(2) FS. History–New 4-4-12.

Fla. Admin. Code R. 65G-4.002 Service Delivery

(1) The Agency shall provide all clients with appropriate supports and services in accordance with their support plan. Implementation of this policy, however, is subject to availability of funds.

(2) Clients of the Agency shall be integrated within local communities to the greatest extent possible. To this end, generic and specialized community services rather than Agency services shall be used whenever this will serve the best interest of the client. For referral purposes, each area office shall have a current descriptive directory of community resources.

(3) Programs and services provided by or for the Agency shall adhere to the policies, standards and procedures specified and made reference to in this chapter. The Agency shall make every effort to ensure that services provided are of good quality and at least comparable to those provided to persons in the community without disabilities.

(4) Medicaid providers should be reminded that all contracts for programs and services provided to the Agency shall include any terms and requirements established in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook as required by Rules 59G-13.083, and 65G-4.008, 65G-4.009, 65G-4.010, F.A.C.

History

Rulemaking Authority 373.13(4)(g)3., 393.501(1) FS. Law Implemented 373.13(4)(g)3., 393.17 FS. History–New 1-1-77, Formerly 10F-4.08, 10F-4.008, 65B-4.008, Amended 4-4-12.

Fla. Admin. Code R. 65G-4.0021 Tier Waivers

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 10-20-08, Repealed 11-21-10.

Fla. Admin. Code R. 65G-4.0022 Tier One Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 10-20-08, Repealed 11-21-10.

Fla. Admin. Code R. 65G-4.0023 Tier Two Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 10-20-08, Amended 7-15-09, Repealed 11-21-10.

Fla. Admin. Code R. 65G-4.0024 Tier Three Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 10-20-08, Repealed 11-21-10.

Fla. Admin. Code R. 65G-4.0025 Tier Four Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 10-20-08, Repealed 11-21-10.

Fla. Admin. Code R. 65G-4.0026 Tier Waivers

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 3-7-10, Amended 9-28-11, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.0027 Tier One Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 3-7-10, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.0028 Tier Two Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 3-7-10, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.0029 Tier Three Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 3-7-10, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.00291 Tier Four Waiver

History

Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 3-7-10, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.003 Certification as a Behavior Analyst

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.024, 65B-4.024, Repealed 4-4-12.

Fla. Admin. Code R. 65G-4.004 Certification as an Associate Behavior Analyst

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.025, 65B-4.025, Repealed 4-4-12.

Fla. Admin. Code R. 65G-4.005 Renewal of Behavior Analysis Certification

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.026, 65B-4.026, Repealed 4-4-12.

Fla. Admin. Code R. 65G-4.006 Approved Continuing Education

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.027, 65B-4.028, Repealed 4-4-12.

Fla. Admin. Code R. 65G-4.007 Behavior Analysis Certification Fees

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.17 FS. History–New 9-23-96, Formerly 10F-4.028, 65B-4.027, Repealed 4-4-12.

Fla. Admin. Code R. 65G-4.008 Behavior Analysis Services Oversight System Organization

(1) The Agency will establish and maintain a behavioral services program including a senior clinician, the Agency Senior Behavior Analyst (ASBA), to assume direction for standards of behavioral practice as provided in this chapter, develop and manage systems of quality, utilization and cost containment for statewide behavioral practice. The ASBA holds a doctorate from an accredited university program with behavior analysis as a primary focus, is a board certified behavior analyst, has completed a dissertation that had behavior analysis as its central focus and has at least one year of experience in the provision of behavior analysis services for persons with developmental disabilities. However, if no one with these qualifications is available, then the ASBA must be a certified behavior analyst with at least the education and experience established by the designated certification board. The behavioral services program will also include the support of at least one master’s level board certified behavior analyst. The ASBA will direct:

(a) Area Behavior Analysts, who will be recruited, appointed, given clinical supervision and annually evaluated in conjunction with their functional supervisor in the area to which they are assigned.

(b) Committees.

The Local Review Committees (LRC) working in conjunction with the ASBA shall adopt the model LRC bylaws to establish guidelines for committee function, including the establishment of time frames for scheduling, reviewing, and approving, as well as tracking for efficient program review and approval, charter content, committee membership, meeting participants, confidentiality requirements and development of a process to resolve provider and LRC disputes.
The Peer Review Committee (PRC) working in conjunction with the ASBA shall adopt the model PRC bylaws to establish membership, as well as annual projects including, at minimum, review of behavioral practices in at least one Developmental Disability Center, at least one state operated forensic facility, at least one area community residential behavioral provider, at least one Local Review Committee, and other services as identified by the Agency.
Behavior Analysis Practices Committee (BAPC) shall be established to meet at least annually with membership from Area and Developmental Disabilities Centers Behavior Analysts, the PRC, providers of behavior analysis and behavior assistant solo service providers and agency providers, as well as behavioral residential services providers to assure that common operational requirements established in Rules 65G-4.008, 65G-4.009, and 65G-4.10, F.A.C., are implemented consistently statewide, including the qualifications and processes for establishing individuals and agencies as behavior analysis providers, behavior analysis agencies and residential behavioral providers, establishing consensus standards for LRC operation, standards for behavioral assessment content and behavior analysis support plan program content, standards for graphic display of data, documentation, billing, as well as behavioral services practice and service sanctions to ensure service quality to meet the changing needs of service recipients and provider requirements.

(2) A statewide peer review committee (PRC) and local review committees (LRCs) shall be appointed by the Agency to provide oversight of behavior analysis services.

(a) The Agency will establish the composition, function and procedures to be followed by the committees in the form of Model bylaws incorporated by reference in subsection (5) of this rule.

(b) Each committee shall be chaired by a person who holds a doctorate from an accredited university program with behavior analysis as a primary focus, is a board certified behavior analyst, has completed a dissertation that had behavior analysis as its central focus and has at least one year of experience in the provision of behavior analysis services for persons with developmental disabilities. However, if no one with these qualifications is available, then the chairperson must be a certified behavior analyst with at least the education and experience requirements for taking the board’s behavior analyst examination.

(c) Local review committees may establish subcommittees within varied locations outside the area office or within large facilities, upon mutual agreement between an area office and a provider, or between a primary facility campus and remote locations, and operate under the rules governing local review committees. Subcommittees shall ensure that at least two participating members are certified behavior analysts who are not employed or contracted by the facility, and who have no interest in the behavior programs produced by it. Members whose programs are reviewed in the course of the LRC meeting must abstain from decisions regarding their programs. The LRC shall remain responsible for the decisions of the subcommittees.

A sufficient number of LRCs shall be established to allow for the timely and thorough review of behavior analysis services.
Programs developed, implemented and submitted by a BCBA to the LRC chairperson following implementation may proceed forward until a decision is rendered by the LRC chairperson.
A provider submitting a behavior analysis services plan will be notified by the LRC chairperson within 21 days that the plan has been received with preliminary review completed.
Within 30 days of receipt of a behavior analysis services plan the LRC chairperson will notify the provider of the date the plan will be reviewed by the committee, if needed.
Behavior analysis services plans must be reviewed and a decision rendered within 90 days of receipt by the LRC chairperson.
At the time of review by the LRC, a decision will be rendered:

a. To “approve,” and a review date established, or

b. To “approve with modifications” and a review date established. Behavior analysis services plans developed, implemented and submitted by a BCBA may proceed forward and modifications submitted by the provider to the LRC chairperson within 30 days without further LRC review, until the next established review date, or

c. To “not approve” Behavior analysis services plans that are not approved must be revised by the provider, and resubmitted within 14 working days. Based upon the modifications the LRC chairperson must render a decision orally and in writing within seven working days of receipt, in the language of the provider, and in English.

Each LRC will be chaired by an individual meeting the qualifications set forth in paragraph (2)(b), above, who is either an employee of the Agency or under contract to provide this service. Under no circumstances may the chair participate in the LRC review of his or her own services, services provided by or to a family member, or related services.

(3) The PRC shall conduct onsite reviews of behavior analysis services including the operations of local review committees; provide training and technical assistance related to client and systemic behavior analysis services issues; and provide recommendations regarding laws and regulations that affect behavior analysis services.

(4) Each area office, and each developmental disabilities center, hereafter referred to as “facility,” shall have a local review committee that shall oversee behavior analysis services provided to clients in their area or facility as specified in paragraphs (a)-(c), below:

(a) The committee shall review behavior analysis services programs as required in Rule 65G-4.010, F.A.C., to ensure that behavioral programs are implemented as required and with the intended improvement in target behaviors.

The person who designed the services or a certified or licensed designee, who has sufficient knowledge of the plan and its implementation, shall be present during the initial committee review. A person with primary responsibility for the ongoing implementation and monitoring of the services shall be present at all future meetings at which the services are reviewed by the committee.
Any person can request that a behavior analysis services plan be brought before the committee for its review to ensure compliance with Chapter 393, F.S., and Chapter 65G-4 or 65G-8, F.A.C. Providers should also be aware of the requirements in the Developmental Disabilities Waiver Services Coverage and Limitations Handbook (in Rule 59G-13.083, F.A.C.)

(b) The committee shall monitor behavior analysis services in accordance with a monitoring schedule approved by the committee. Approval of services includes the determination by the LRC chairperson that the individual designing and implementing the behavior analysis services is in compliance with subsection 65G-4.001(14), F.A.C., above, or is appropriately supervised.

(c) If reactive strategies (as that term is defined in subsection 65G-8.001(15), F.A.C., continue without the implementation of required behavioral programs or behavior analysis services requiring review are not presented to the LRC or are not found to be in accordance with Florida law, the committee chairperson shall request that the Agency notify the behavior analyst, and when appropriate, the residential provider and behavior analyst’s supervisor, of the services, orally at the time of review and in writing within ten days of review in the language of the provider or supervisor, and in English, of each area of non-compliance.

Absent emergency circumstances that threaten public health, safety or welfare, the provider shall have twenty (20) days within which to demonstrate compliance or present to the committee chairperson in writing evidence showing that the services being provided are in compliance with Florida Statutes and the Agency rules. The provider may present whatever evidence appropriate to demonstrate that the provider is in compliance with Chapter 393, F.S., Chapter 65G-4 or 65G-8, F.A.C. Providers should also be aware of the requirements of the Developmental Disabilities Waiver Services Coverage and Limitations Handbook in Rule 59G-13.083, F.A.C.
If emergency circumstances exist for the recipient of behavioral services the committee chairperson may give instruction to the provider on how to proceed with services or to cease and desist from continued behavior analysis services, with other recommendations for necessary safeguards and supports.
If, however, the committee determines that the behavior analyst, and when appropriate, the residential provider, is not in compliance with Chapter 393, F.S., or Chapter 65G-4 or 65G-8, F.A.C. the committee chairperson shall report all facts and circumstances to the Agency in writing within five (5) days of the provider’s response and request a final decision be made by the Agency. Providers should also be aware of the requirements of the Developmental Disabilities Waiver Services and Limitations Handbook in Rule 59G-13.083, F.A.C.
Within twenty (20) days of such report, the Agency shall notify the committee, in writing, and the provider, in writing and orally in the language of the provider and in English, of its decision. In the event the Agency finds the provider is not in compliance with Florida Statutes or the Agency rules, the Agency shall allow the provider an additional ten (10) days to modify services to meet requirements. If modifications are not made within the time allotted, the Agency shall consider whether a recoupment action should be initiated, provider status should be revoked, supervision be required, complaint be submitted to the designated certification or licensing board, or the requirement that the services being provided be discontinued.
If modifications are not made within the time allotted in subparagraph 4., and the agency must take one of the actions in subparagraph 4., the agency shall consider whether any of the following occurred:

a. Falsification of Documentation.

b. Absence of documentation, such as graphs, behavioral assessments, behavior plans and required summaries.

c. Lack of program monitoring as approved by the LRC.

d. Failing to maintain a current behavior plan for an individual served.

e. Failure to present behavior plan/s requiring LRC review.

f. Failure to revise behavior plans based upon LRC recommendations or upon analysis of data and consistent with Chapter 65G-4, F.A.C.

g. Failure to address behaviors related to health and safety.

h. Failure to provide adequate supervision to behavior analysts and behavior assistants working under such service delivery arrangement.

i. Failure to resubmit behavior plan revisions within time constraints established by the LRC.

j. Repeated deficiencies that display lack of competence.

k. Repeated use of restricted measures for problem behavior as itemized in subsection 65G-8.006(9), F.A.C., or use of reactive strategies without an LRC approved behavior analysis services plan as set forth in Rule 65G-8.006, F.A.C.

l. Consistent pattern of failure to return phone calls or email, reply to any correspondence or show up for scheduled service visits and cannot be located.

m. Failure to report abuse of a minor, or adult with disabilities as mandated by Florida Law.

n. Failure to report immediately to law enforcement of potentially life threatening situations such as possession of explosives, fire arms, weapons, toxic material or illegal substances by individuals with impaired judgment and behavioral issues.

o. Felony or misdemeanor related to the practice of behavior analysis or the health and safety of an individual.

p. Failure to abide by ethical guidelines of their professional certification or licensing body.

q. Assessment Report past due 30 day limit.

r. Behavior plan past due 90 day limit.

s. Documentation not submitted to the waiver support coordinator.

t. Non-Compliance with standards of Behavior Focused and Intensive Behavior homes, including a current behavior plan developed or revised within the year and reporting of reactive strategies.

u. Falsifying billing or billing at a higher rate than the analyst’s qualifications warrant.

v. Billing for services in school settings.

w. Failure to comply with Rules 65G-4.008, 4.009, 4.010, F.A.C., or Chapter 393, F.S.

x. Providers should also be aware of the requirements of the Developmental Disabilities Waiver Services and Limitations Handbook in Rule 59G-13.083, F.A.C.

Following a committee report set forth above, the Agency, after consideration of the factors set forth in subparagraph 5., above, may require additional supervision of the provider’s services. The requirement for additional supervision may be a prerequisite for allowing the provider to continue to serve as an authorized behavior analysis services provider. Such required supervision shall include the following conditions:

a. Supervision must be provided by a Board Certified Behavior Analyst – Doctoral level, or a Board Certified Behavior Analyst, or a person licensed under Chapter 490 or 491, F.S., (Psychologist, School Psychologist, Clinical Social Worker, Marriage and Family Therapist or Mental Health Counselor), with evidence (e.g. work samples) of at least three years of experience in the application of Applied Behavior Analysis procedures approved by a local review committee, to persons with exceptional needs post certification or licensure,

b. Face-to-face meetings for up to two hours every two weeks or two hours per 40 hours of the provider’s contact with clients. These meetings shall be between the provider and a board certified behavior analyst or a person licensed under Chapter 490 or 491, F.S., during which the supervisor directs and evaluates the behavior analysis services,

c. The supervisor shall not be, at the time supervision is provided, the provider’s subordinate or employee, spouse or family member. The supervisor shall not be considered an employee of the provider if the only compensation received by the supervising behavior analyst consists of payment for supervision; and,

d. The provider’s presentation of behavior analysis services designed and implemented by the provider, with a focus on graphic displays of data, at local review committee meetings, established in Rule 65G-4.008, F.A.C., may be substituted for up to 25 percent of the total supervision time required.

(5) Forms incorporated by Reference.

(a) Model LRC Bylaws are hereby incorporated by reference as Form APD-CBA – 1 (10/10).

(b) Model PRC Bylaws are hereby incorporated by reference as Form APD-CBA – 2 (10/10).

Anyone may acquire a copy of the model bylaws by contacting the ASBA at the APD Central Office, 4030 Esplanade Way, Tallahassee, Florida 32399, email: apd_info@apd.state.fl.us, phone: (850)488-4257.

History

Rulemaking Authority 393.125, 393.13(4)(g)3., 393.17 FS. Law Implemented 393.066, 393.13(4)(g)3. FS. History–New 9-23-96, Formerly 10F-4.029, 65B-4.029, Amended 4-4-12.

Fla. Admin. Code R. 65G-4.009 Design, Implementation and Monitoring of Behavior Analysis Services

(1) Providers of behavior analysis services shall provide services only as certified and as provided by law.

(2) All aspects of behavior analysis services shall be integrated with other relevant services and supports being provided to the client by the provider within the scope of authorized behavioral services.

(3) The selection of behavior analysis procedures and decisions by the provider to make environmental changes that obviate the need for the use of behavior change procedures shall be based upon information obtained through direct and indirect functional assessment or functional analysis designed to identify patterns of behavior and the functional relationships between the behavior or behaviors targeted for change and the environment. The assessment shall contain at minimum:

(a) Operational definitions of all behaviors targeted for change;

(b) Description of conditions under which the behavior is most likely and least likely to occur;

(d) Other relevant personal, social, medical, pharmacological or historical information that may impact on behavior targeted for change, if any;

(e) Putative functional relationships between targeted behavior and environment; and,

(f) Recommendations for procedures to decrease maladaptive behavior and increase relevant appropriate alternative behavior.

(4) Behavior analysis services designed by the provider to decrease behavior shall include procedures for increasing functional replacement behavior, or acquisition of adaptive skills to serve as a functional alternative to the behaviors targeted for change.

(5) Behavior analysis procedures that are the least intrusive to the client and the most likely to be effective shall be used by the provider.

(6) Medical treatment to address purely medical etiologies or physical or occupational therapies to address behaviors that are related to physical limitations shall be provided concurrent with, or prior to, the implementation of behavior analysis services by the provider.

(7) Behavior analysis services shall not be provided continuously without appropriate considerations for maintenance and generalization of behavior change in relevant settings or a designation of criteria for termination of the interventions or services.

(8) The provider shall ensure that persons responsible for implementing, monitoring and providing behavior analysis services receive performance-based training that prepares them to properly implement the behavior analysis procedures involved, within the circumstances under which the services will be provided.

(9) The provider shall take reasonable steps to ensure data collection for behaviors targeted for increase and decrease during the entire period services are in effect. Graphic displays of weekly data for behaviors targeted for change shall be maintained and up-dated by the provider.

(10) The LRC shall approve the provider’s behavior analysis services plan and specify the requirements for reporting of findings and data to the committee for behavior analysis services approved by the committee.

(a) Behavior analysis services plans are to be written as succinctly as is possible to effectively serve as a guide to those who will be implementing the plan.

(b) The behavior analysis services plan shall include, either in text or by reference to appropriate documents:

Identifying information for the individual affected by the plan.
The name, signature and certification or licensure information of the individual who developed, supervises or approves the implementation of the procedures described in the plan.
Objective statements of goals relative to behavior reduction and behavior acquisition resulting in program termination.
Rationale for intervention being warranted, and selection of proposed interventions, consistent with assessment results.
Medical, social and historical information including previous treatment programs relevant to the current problems being addressed.
How and where behavioral services will be integrated with daily routines and other relevant services.
Identification of behaviors targeted for reduction.
Identification of behaviors targeted for acquisition or as replacement.
Data collection methods for behaviors targeted for reduction and acquisition.
Intervention procedures for behaviors targeted for reduction and acquisition.
Description of performance-based training for persons implementing procedures.
Techniques for maintaining and generalizing behavioral improvements, as well as criteria for the reduction and fading of behavioral services.
When employed, rationale for use of ancillary support staff, such as behavior assistants; a description of training, their routine or duties, performance monitoring and fading of services.
Methods of monitoring for programmatic fidelity and effectiveness, including but not limited to:

a. Data analysis and interpretation.

b. Direct observation in the setting(s) where the plan is implemented, including the observation of the implementation of procedures or simulated implementation.

c. Discussions with supervisors, and observations of individuals who implement the behavior analysis procedures involved.

d. Schedule or frequency of monitoring, and who, by function or assignment, will conduct monitoring.

e. Determination that the services are in accordance with Florida Statutes and the Agency rules.

Signatures of informed participants as may be required by law and individuals authorized to approve the procedures.

(c) Modifications to the behavior analysis service plan which include procedures listed in Rule 65G-4.010, F.A.C., approved by the LRC shall be documented and submitted by the provider to the committee chairperson within one week after the changes are made, for determination of need for committee review. A summary of the effects of and modifications to behavior analysis services plan shall be written by the provider at least annually. This summary will include a graphical display of data collected over the year with appropriate annotation of program modifications.

History

Rulemaking Authority 393.13(4) FS. Law Implemented 393.13(4)(g)3. FS. History–New 9-23-96, Formerly 10F-4.030, 65B-4.030, Amended 4-4-12.

Fla. Admin. Code R. 65G-4.010 Behavior Analysis Services Approval

(1) All written plans describing behavior analysis services consistent with subsection 65G-4.009(10), F.A.C., shall be submitted to the local review committee chairperson within five working days following implementation.

(2) All behavior analysis services designed to include restricted procedures or those services designed to address those actions of the individual which, without behavioral, physical, or chemical intervention can be expected to result in outcomes identified in subsection 65G-4.010(3), F.A.C., below and will be provided or supervised by a Certified Behavior Analyst as defined in subsection 65G-4.001(5), F.A.C., or a person licensed pursuant to Chapter 490 or 491, F.S.: In those cases where it is unclear whether behavior analysis services meet either criteria, the provider must contact the LRC chairperson to determine the need for LRC review.

(3) Written plans describing behavior analysis services must be submitted to the LRC chairperson, when:

(a) Behavior analysis services include restricted procedures such as:

The contingent delivery or removal of events to reduce the probability of occurrence of a problem behavior, including but not limited to: extinction or withholding of reinforcement for those behaviors referenced in paragraph 65G-4.010(3)(b), F.A.C., response blocking for more than 15 seconds, contingent exercise, restitutional overcorrection, positive practice overcorrection, time-out and response cost.
The removal of an aversive event contingent upon the display of a behavior targeted for increase, including but not limited to, Functional Communication Training using removal of demands or noise as a reinforcer, and desensitization programs.
Access to abundant amounts of an event or stimulus so that it loses potency as a reinforcer, and severely restricted access to an event or stimulus to increase its potency as a reinforce.
Behavioral protective devices, as defined in subsection 65G-8.001(4), F.A.C., and electronic devices for monitoring and signaling.
Dietary manipulations.

(b) Behavior analysis services address behaviors that:

Have resulted in self-inflicted, detectable damage, or resulted in external or internal damage requiring medical attention or are expected to increase in frequency, duration, or intensity resulting in self-inflicted, external or internal damage requiring medical attention.
Have occurred or are expected to occur with sufficient frequency, duration or magnitude that a life-threatening situation might result, including excessive eating or drinking, vomiting, ruminating, eating non-nutritive substances, refusing to eat, holding one’s breath, or swallowing excessive amounts of air.
Have resulted in detectable damage, or external or internal damage to other persons that requires medical attention or are expected to increase in frequency, duration or intensity resulting in external or internal damage to other persons that requires medical attention.
Have resulted or are expected to result in major property damage or destruction.
Have resulted or are expected to result in arrest and confinement by law enforcement personnel.
Have resulted in the need or meet the characteristics for behavioral services in a Behavior Focused or Intensive Behavior Residential Habilitation program.
Have resulted in the need for additional staffing or Behavior Assistant Services in one or more settings.
Have resulted in the repeated use of reactive strategies without a formal approved behavior plan.

(c) Behavioral programs or manuals implemented as group contingencies or behavior change systems, including behavioral program manuals, level systems and token economies, are implemented.

History

Rulemaking Authority 393.13(4)(g)3. FS. Law Implemented 393.13(4)(g)3. FS. History–New 9-23-96, Formerly 10F-4.031, 65B-4.030, Amended 4-4-12.

Fla. Admin. Code R. 65G-4.011 Determination of Intellectual Disability in Capital Felony Cases: Intelligence; Tests to be Administered

(1) When a defendant convicted of a capital felony is suspected of having or determined to have intellectual disability, intelligence tests to determine intellectual functioning as specified below shall be administered by a qualified professional who is authorized in accordance with Florida Statutes to perform evaluations in Florida. The test shall consist of an individually administered evaluation, which is valid and reliable for the purpose of determining intelligence. The tests specified below shall be used.

(a) The Stanford-Binet Intelligence Scale.

(b) Wechsler Intelligence Scale.

(2) Notwithstanding this rule, the court, pursuant to Section 921.137, F.S., is authorized to consider the findings of the court appointed experts or any other expert utilizing individually administered evaluation procedures which provide for the use of valid tests and evaluation materials, administered and interpreted by trained personnel, in conformance with instructions provided by the producer of the tests or evaluation materials. The results of the evaluations submitted to the court shall be accompanied by the published validity and reliability data for the examination.

History

Rulemaking Authority 921.137(1) FS. Law Implemented 921.137(1) FS. History–New 1-13-04, Formerly 65B-4.032.

Fla. Admin. Code R. 65G-4.012 Determination of Intellectual Disability: Intelligence Tests to Be Administered

(1) For the purposes of Chapters 393 and 916, F.S., the Stanford-Binet Intelligence Scale or the Wechsler Adult & Infant Intelligence Scale, administered by or under the direct supervision of a psychologist or school psychologist licensed under Chapter 490, F.S., shall be used to determine intellectual disability and the level of intellectual functioning.

(2) Notwithstanding subsection (1), if, given the condition of the individual to be tested, the Stanford-Binet Intelligence Scale or the Wechsler Adult & Infant Intelligence Scale are not valid and reliable as determined by the person authorized to administer such tests as specified in subsection (1), an alternative test or evaluation procedure, administered and interpreted in conformance with instructions provided by the producer of the tests or evaluation materials, may be used. The results of the testing or evaluation must include reference to published validity and reliability data for the specified test or evaluation procedure.

History

Rulemaking Authority 393.063(38), 916.106, 393.501(1) FS. Law Implemented 393.063(38), 916.106 FS. History–New 6-13-06, Formerly 65B-4.033.

Fla. Admin. Code R. 65G-4.014 Eligibility for Agency Services – Definitions

(1) Autism means a condition which meets the requirements of Section 393.063, F.S., that the condition is:

(a) Pervasive, meaning always present and without interruption;

(b) Neurologically based, meaning that the condition is not the result of physical impairment;

(d) With extended duration, meaning that the condition reasonably can be expected to continue indefinitely into the future;

(e) Causes severe learning disorders resulting in both severe communication disorders affecting both verbal and nonverbal skills, and severe behavior disorders. Autism is characterized by an individual evidencing at least six of the following twelve features from the following subparts 1 and 2, with at least one feature from subpart 2:

Severe communication disorders, which may include:

a. A delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime),

b. Stereotyped and repetitive use of language or idiosyncratic language,

c. For those applicants with speech, marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction,

d. Failure to develop peer relationships appropriate to developmental level,

e. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, pointing out objects of interest, or achievements to others),

f. Lack of social or emotional reciprocity,

g. Marked impairment in the ability to initiate or sustain a conversation with others in individuals with adequate speech, or

h. Impaired imaginative ability evidenced by a lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

Severe behavior disorders, which are restricted, repetitive and stereotyped patterns of behavior, interests, and activities which may include:

a. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus,

b. Apparently inflexible adherence to specific, nonfunctional routines or rituals,

c. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements), or

d. Persistent preoccupation with parts of objects.

(2) Cerebral Palsy – means a group of disabling symptoms of extended duration that result from damage to the developing brain during the prenatal period and characterized by paralysis, spasticity, or abnormal control of movement or posture, such as poor coordination or lack of balance, which is manifest prior to three years of age. For purposes of the rule, cerebral palsy also means the presence of other significant motor dysfunction appearing prior to age 18 due to perinatal or external events such as anoxia, oxygen deprivation, or traumatic brain injury. Excluded from this definition is motor dysfunction caused by medical events, including stroke or progressive diseases such as muscular dystrophy. The impairment from cerebral palsy must constitute a substantial handicap which is reasonably expected to continue indefinitely.

(3) Down syndrome – means a condition caused by the presence of extra chromosomal material on chromosome 21. This disorder is often associated with impairment in cognitive ability, characteristic physical growth and features, and congenital medical conditions.

(4) Intellectual Disability – is evidenced by the concurrent existence of:

(a) Significantly sub-average general intellectual functioning evidenced by an Intelligence Quotient (IQ) two or more standard deviations below the mean on an individually administered standardized intelligence test; and,

(b) Significant deficits in adaptive functioning in one or more of the following areas:

Communication skills,
Self-care, home living,
Social and interpersonal skills,
Use of community resources and self-direction,
Functional academic skills,
Work, leisure, health and safety awareness and skills,

(d) Constitute a substantial handicap which is reasonably expected to continue indefinitely.

(5) Phelan-McDermid syndrome – means a disorder caused by the loss of the terminal segment of the long arm of chromosome 22, which occurs near the end of the chromosome at a location designated q13.3, typically leading to developmental delay, intellectual disability, dolicocephaly, hypotonia, or absent or delayed speech.

(6) Prader-Willi Syndrome – means a genetic disorder which is most often associated with a random deletion of chromosome 15. Commonly associated characteristics include insatiable appetite, chronic overeating, hypotonia, short stature, obesity, and behavioral issues. Individuals diagnosed with Prader-Willi syndrome generally have intellectual disability; however, an individual with Prader-Willi syndrome can be determined as eligible for services without an accompanying diagnosis of intellectual disability.

(7) Spina Bifida – For the purposes of agency eligibility, spina bifida refers to a confirmed diagnosis of spina bifida cystica or myelomeningocele.

(8) Tatton-Brown-Rahman syndrome – means a disorder caused by a mutation in the DNMT3A gene typified by mild to severe intellectual disability, macrocephaly, stature and weight that is greater than or equal to two or more standard deviations above the mean for the person’s age and sex, and any of the following features presenting in infancy, childhood, or adolescence:

(a) Mild facial dysmorphism.

(b) Joint hypermobility.

(d) Kyphoscoliosis.

(e) Seizures.

(f) Cryptorchidism.

(g) Deficits in behavior.

(h) Hematologic malignancies.

(9) Eligibility Rules – Rules 65G-4.014 through 65G-4.017, F.A.C., inclusive, which apply to eligibility determinations for services provided through the Agency for Persons with Disabilities for individuals with developmental disabilities.

(10) DD Waiver – Home and Community-Based Services (HCBS) waiver authorized by 42 U.S.C. 1396n(c)(1) of the Social Security Act and Section 409.906, F.S., that provides a package of Medicaid-funded home and community-based supports and services to eligible persons with developmental disabilities who live at home or in a home-like setting.

(11) Agency Services – home and community-based supports and services to eligible persons funded through general revenue allocations or sources other than the DD Waiver.

History

Rulemaking Authority 393.065(13), 393.066(8), 393.501(1) FS. Law Implemented 393.065, 393.066 FS. History–New 5-16-12, Technical Change 11-3-25, Amended 8-30-26.

Fla. Admin. Code R. 65G-4.015 Eligibility for Agency Services Criteria

In order to be determined eligible for agency services the applicant must:

(1) Be at least three years of age.

(2) Be a resident of and domiciled in the state of Florida in accordance with Sections 222.17(1) and (2), F.S. Domicile may not be established in Florida by a minor who has no parent domiciled in Florida, or by a minor who has no legal guardian domiciled in Florida, or by any alien not classified as a resident alien. Dependents of active duty military personnel stationed in the state of Florida are exempt from residency and domicile requirements.

(3) Have a confirmed diagnosis of one of the following developmental disabilities as defined in this these Eligibility Rules:

(a) Autism;

(b) Cerebral palsy;

(d) Intellectual disability;

(e) Phelan-McDermid syndrome;

(f) Prader-Willi syndrome;

(g) Spina Bifida;

(h) Tatton-Brown-Rahman syndrome; or

(i) Children between 3 and 5 years of age who are at high risk of later diagnosis of one of the disabilities listed above. Such high-risk children shall not be placed on a preenrollment category for waiver services until a confirmed diagnosis of a qualifying disability is given.

(4) DD Waiver services are only available (conditioned upon the preenrollment category) to persons who meet the requirements of 42 CFR §435.217(b)(1) for receiving home and community-based services. It is mandatory that the determination is made that without DD Waiver services these individuals would otherwise require the level of care furnished in a hospital, nursing home, or an Intermediate Care Facility for People with Intellectual Disabilities (referred to in the CFR as an “ICF/MR”).

History

Rulemaking Authority 393.065(13), 393.066(8), 393.501(1) FS. Law Implemented 393.065, 393.066 FS. History–New 5-16-12, Amended 6-3-20, Technical Change 11-3-25, Amended 8-30-26.

Fla. Admin. Code R. 65G-4.016 Application Process

(1) Application for Services from the Agency may be made by submitting an application by hand delivery, U.S. Postal Service, or facsimile to the Agency. The Application for Services may also be submitted through the Agency’s online portal which can be found on the Agency’s website, www.APD.myflorida.com. The Application for Services Form 65G-4.016A, Rev. 2026, a printable paper application, is available on the Agency website at https://apd.myflorida.com/services/apply.htm or upon request by contacting the Agency. The application is available in English, Spanish, and Haitian Creole and is incorporated by reference herein, https://flrules.org/Gateway/reference.asp?No=Ref-19720. The Agency shall acknowledge receipt of all applications it receives, regardless of the manner of submission, with an immediate receipt confirmation provided in the same manner in which the application was received, unless the applicant has designated an alternative preferred method of communication on the submitted application.

(2) Upon receipt of a completed, signed, and dated Application for Services, as described in section 393.065(1)(d), F.S., the Agency shall review the application and supporting documentation and make a final determination regarding the applicant’s eligibility for Agency services within time frames established in section 393.065(1), F.S. If the Agency requires additional documentation, information or if additional evaluations are necessary to determine eligibility, the timeframe for the determination process may be tolled until any necessary documentation or information is received by the Agency or assessments are completed.

(3) If an applicant is unable to produce an existing evaluation that establishes eligibility or if there is concern that the information provided is inaccurate, incorrect, or incomplete, the Agency will be responsible for obtaining an evaluation to establish eligibility. Professional diagnoses under Rule 65G-4.017, F.A.C., must document all criteria for eligibility as set forth in Eligibility Rules. The evaluation process includes only those assessments necessary to determine eligibility that were administered by a person qualified to administer the instrument(s).

(4) When the eligibility determination is complete, the Agency shall notify the applicant in writing within five (5) business days of the decision. If the applicant is determined ineligible for Agency services, the Agency shall notify the applicant of the right to appeal the decision in accordance with Chapter 120, F.S.

(5) If the applicant is determined to be ineligible to receive services from the Agency, the Agency shall offer suggestions regarding other programs, agencies, or services for which the applicant may be eligible.

(6) If a category of covered conditions in this rule is not also covered by the state’s Medicaid developmental disabilities waiver (DD waiver) at the time an individual is determined to be eligible, those individuals will be placed on a preenrollment category and may be provided services funded through general revenue allocations or sources other than the DD Waiver.

History

Rulemaking Authority 393.065(13), 393.066(8), 393.501(1) FS. Law Implemented 393.065, 393.066 FS. History–New 5-16-12, Amended 11-21-24, 7-6-25, 8-30-26.

Fla. Admin. Code R. 65G-4.017 Establishing Eligibility

(1) Establishing Eligibility – Autism. A diagnosis of autism, as defined by Rule 65G-4.014, F.A.C., may only be made by one or more of the following who has specific training and experience in making such diagnosis:

(a) A Florida-licensed psychiatrist;

(b) A Florida-licensed psychologist;

(d) A board-certified developmental pediatrician, or

(e) Collateral information received from another state may be accepted if the evaluator is licensed through the same credentials required for licensure in Florida for the professions listed in paragraph (1)(a), above.

(2) Establishing Eligibility – Cerebral Palsy. Diagnosis is confirmed by written documentation from one or more of the following:

(a) A medical doctor;

(b) A doctor of osteopathy, or

(3) Establishing Eligibility – Down Syndrome. Evidence under this category requires medical records documenting a chromosome analysis (also referred to as a karyotype) finding the individual has an extra genetic material on their number 21 chromosome. In the absence of a chromosome analysis, a diagnosis of Down syndrome can be accepted by written documentation from one or more of the following:

(a) A medical doctor; or

(b) A doctor of osteopathy.

(4) Establishing Eligibility –Intellectual Disability. To establish that an individual has intellectual disability the following criteria shall be applied:

(a) A single test or subtest should not be used alone to determine eligibility. If a person has significantly different (statistically defined) scores on different scales of a test or tests, or a great deal of variability on subtest scores of an IQ test, the full-scale score may not indicate intellectual disability and should not be relied on as a valid score. In that instance, closer scrutiny is required to make an appropriate differential diagnosis. This may include review of school records, school placement, achievement scores, medical records, medication history, behavior during testing and the psychosocial situation at the time of testing. Closer scrutiny must also be required when there is a great deal of variability between IQ scores on different IQ tests or different administrations of the same IQ test. Nothing here is intended to preclude clinical judgment from appropriately determining that a single full-scale IQ score of 70 or below, or two or more standard deviations below the mean, on an individually administered intelligence test is sufficient to establish eligibility.

(b) The performance measures for this category of adaptive functioning deficits must be validated by the professional judgment of a psychologist who is experienced in working with people who have intellectual disability, who has specific training and validation in the assessment instrument that is used, and who is one of the following:

A Florida-licensed psychologist,
A Florida-licensed school psychologist,
A certified school psychologist.

(c) Any standardized test may be submitted as proof. However, the applicant must demonstrate that any test not presumptively accepted by the agency is valid. The following are presumptively accepted standardized tests of intelligence to establish eligibility for intellectual disability:

Stanford-Binet Intelligence Test (all ages),
Wechsler Preschool and Primary Scale of Intelligence (under six years of age),
Differential Ability Scales – Preschool Edition (under six years of age),
Wechsler Intelligence Scale for Children (WISC) (children up to 15 years, 11 months),
Differential Ability Scales (children up to 15 years, 11 months),
Wechsler Adult Intelligence Scale (WAIS),
Test of Nonverbal Intelligence-3 (TONI-3),
Comprehensive Test of Nonverbal Intelligence-2 (C-TONI 2),
Universal Nonverbal Intelligence Test (UNIT),
Leiter International Performance Scale-Revised (Leiter-R).

(d) The following tests of adaptive functioning are presumptively accepted in the determination:

Vineland Adaptive Behavior Scales,
AAMR Adaptive Behavior Scale,
Adaptive Behavior Assessment System (ABAS),
Adaptive Behavior Evaluation Scale (ABES).
Scales of Independent Behavior-Revised

(e) In all cases, assessments or evaluations for eligibility should be obtained from appropriately licensed professionals with experience and training in the instruments and population for whom eligibility is to be determined.

(5) Establishing Eligibility – Phelan-McDermid syndrome. The diagnosis of Phelan-McDermid Syndrome must be confirmed utilizing genetic testing, with written documentation from:

(a) A medical doctor; or

(b) A doctor of osteopathy.

(6) Establishing Eligibility – Prader-Willi syndrome. Diagnosis is confirmed by written documentation from one or more of the following:

(a) A medical doctor;

(b) A doctor of osteopathy, or

(7) Establishing Eligibility – Spina Bifida. Diagnosis is confirmed by written documentation from one or more of the following:

(a) A medical doctor;

(b) A doctor of osteopathy, or

(8) Establishing Eligibility – Tatton-Brown-Rahman syndrome. The diagnosis of Tatton-Brown-Rahman syndrome must be confirmed utilizing genetic testing, with written documentation from:

(a) A medical doctor; or

(b) A doctor of osteopathy.

(9) Establishing Eligibility – High-Risk Children, 3 to 5 years of age. Evidence under this category requires a determination by an APD area office that a medical diagnosis of developmental delay evidenced by the child indicates a high probability that the child is likely to have an eventual diagnosis of a qualifying condition under Rule 65G-4.014, F.A.C., if early intervention services are not provided, or the child has one or more physical or genetic anomalies associated with a developmental disability, such as:

(a) Genetic or chromosomal disorders (such as Down syndrome or Rett syndrome);

(b) Metabolic disorders (such as phenylketonuria);

(d) Neurological abnormalities and insults;

(e) Congenital and acquired infectious diseases;

(f) Chronic or catastrophic illnesses or injuries;

(g) A parent or guardian with developmental disabilities who requires assistance in meeting the child’s developmental needs, or

(h) Other conditions or genetic disorders generally associated with developmental disabilities, such as tuberous sclerosis, congenital syphilis, fetal alcohol syndrome, or maternal rubella, as documented by a physician.

(i) If a child between three and five years of age already has been determined to have a developmental disability in one of the five categories identified in Chapter 393, F.S., that child shall be eligible for services from the agency under the appropriate diagnosis and shall be added to a preenrollment category.

(j) If a child served under the category of high risk does not have a confirmed diagnosis by his or her fifth birthday, they shall be given a notice of case closure and the case will be closed at the agency. The agency shall make the child’s parent or guardian aware of appropriate agencies, programs or school programs which the agency is aware of which might be able to assist the child.

History

Rulemaking Authority 393.065(13), 393.066(8), 393.501(1) FS. Law Implemented 393.065, 393.066 FS. History–New 5-16-12, Amended 6-3-20, Technical Change 11-3-25, Amended 8-30-26.

Fla. Admin. Code R. 65G-4.0210 Definitions

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.0662 FS. History–New 10-2-13, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.0211 General Provisions

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.0662 FS. History–New 10-2-13, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.0212 Establishing the Final iBudget Allocation Amount

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.0662 FS. History–New 10-2-13, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.0213 Definitions

For the purposes of this chapter, the term:

(1) “Agency” means the Agency for Persons with Disabilities.

(2) “Allocation Algorithm” means the mathematical formula based upon statistically validated relationships between client characteristics (variables) and the client’s level of need for services provided through the Waiver as set forth in Rule 65G-4.0214, F.A.C., and as provided in Section 393.0662(1)(a), F.S.

(3) “Allocation Algorithm Amount” means the result of the Allocation Algorithm apportioned according to available funding.

(4) “Amount Implementation Meeting Worksheet” or “AIM Worksheet” means a form used by the Agency for new Waiver enrollees, and upon recalculation of a client’s algorithm, to:

(a) Communicate a client’s Allocation Algorithm Amount;

(b) Identify proposed services based upon the Allocation Algorithm Amount; and

(c) Identify additional services, if any, should the client or their legal representative feel that any Significant Additional Needs of the client cannot be met within the Allocation Algorithm Amount. The Amount Implementation Meeting Worksheet – APD Form 65G-4.0213 A, effective 7-1-21, is hereby adopted and incorporated by reference, and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12459.

(5) “Approved Cost Plan” means the document that lists all Waiver services that have been authorized by the Agency for the client, including the anticipated cost of each approved Waiver service, the provider of the approved service, and information regarding the provision of the approved service.

(6) “Available Service” means a support that is covered, authorized, or provided by a government program not operated by the agency, a community program, a third party such as a private health insurance company, or provided by a natural support.

(7) “Client” has the same meaning as provided in Section 393.063(7), F.S.

(8) “Client Advocate” has the same meaning as provided in Section 393.063(8), F.S, and includes legal counsel if designated by the client or the client’s legal representative.

(9) “Client Review” means the Agency’s review of information submitted by a WSC to determine if the request meets significant additional needs criteria.

(10) “Community Supports” means resources or services accessible to a client as a member of the community. This includes, but not limited to, resources available through organizations such as faith-based, cultural, geographic, non-profit, for-profit, and community groups.

(11) “Handbook” means the Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, as adopted by Rule 59G-13.070, F.A.C. (effective October 2020) and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-12102.

(12) “Health and Safety” includes emotional, behavioral, mental, and physical health and safety.

(13) “iBudget” means the Home and Community-Based Services Medicaid Waiver program under Section 409.906, F.S., that consists of the Waiver service delivery system utilizing individual budgets required pursuant to Section 393.0662, F.S., and under which the Agency for Persons with Disabilities operates the Home and Community-Based Services Waiver.

(14) “iBudget Amount” means the total amount of funds that have been approved by the Agency, pursuant to the iBudget Rules, for a client to spend for Waiver services during a fiscal year.

(15) “iBudget Rules” means Rules 65G-4.0213 through 65G-4.0218, F.A.C., and are the rules which implement and interpret iBudget Amounts.

(16) “Legal Representative” means:

(a) For clients under the age of 18 years, the legal representative or health care surrogate appointed by the Florida court to represent the child or anyone designated by the parent(s) of the child to act on the parent(s)’ behalf (e.g., due to military absence).

(b) For clients age 18 years or older, the legal representative could be the client, anyone designated by the client through a Power of Attorney or Durable Power of Attorney, a medical proxy under Chapter 765, F.S., or anyone appointed by a Florida court as a guardian or guardian advocate under Chapter 393 or 744, F.S.

(17)(a) “Medically necessary” or “medical necessity,” as defined in the Handbook, means that the medical or allied care, goods, or services furnished or ordered must meet the following conditions:

Be necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain,
Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient’s needs,
Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational,
Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide; and
Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider.

(b) The fact that a provider has prescribed, recommended, or approved medical or allied care, goods, or services does not, in itself, make such care, goods or services medically necessary or a medical necessity or a covered service.

(18) “Natural Support” means unpaid supports that are or may be provided voluntarily to the client in lieu of Waiver services and supports. Any determination of the availability of natural supports includes, but is not limited to consideration of the client’s caregiver(s) age, physical and mental health, travel and work or school schedule, responsibility for other dependents, sleep, and ancillary tasks necessary to the health and well-being of the client.

(19) “Person-centered planning” ‒ means a planning approach directed by a client with long term care needs, intended to identify the strengths, capacities, preferences, needs, and desired outcomes of the client. The client or legal representative determines the other participants in this process for the purposes of assisting the client to identify and access a personalized mix of paid and non-paid services and supports that will assist him/her to achieve personally-defined outcomes in the most inclusive community setting and to facilitate health, safety, and well-being.

(20) “Qualified Organization” means an organization which employs support coordinators who serve clients that receive Agency services and is determined by the Agency to have met all of the requirements of Section 393.0663(2), F.S., the Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook, and Chapter 65G-14, F.A.C.

(21) “Questionnaire for Situational Information” or “QSI” effective 5-21-15 means an assessment instrument used by the Agency to determine a client’s needs in the areas of functional, behavioral, and physical status. The QSI is adopted by the Agency as the current valid and reliable assessment instrument and is hereby incorporated by reference. The QSI is available at: http://www.flrules.org/Gateway/reference.asp?No=Ref-07075.

(22) “QSI Assessor” – means an Agency employee who has been certified by the Agency in the administration of the QSI.

(23) “Service Authorization” – means an Agency notification that authorizes the provision of specific Waiver services to a client and includes, at a minimum, the provider’s name and the specific amount, duration, scope, frequency, and intensity of the approved service.

(24) “Service Families” means eight categories that group services related to: Life Skills Development, Supplies and Equipment, Personal Supports, Residential Services, Support Coordination, Therapeutic Supports and Wellness, Transportation and Dental Services. The Service Families include the following services:

(a) Life Skills Development, which includes:

Life Skills Development Level 1 (companion services),
Life Skills Development Level 2 (supported employment); and
Life Skills Development Level 3 (adult day training).
Life Skills Development Level 4 (prevocational services).

(b) Supplies and Equipment which includes:

Consumable Medical Supplies,
Durable Medical Equipment and Supplies,
Environmental Accessibility Adaptations; and
Personal Emergency Response Systems (unit and services).

Services formerly known as in-home supports, respite, personal care and companion for clients age 21 or older, living in their own home or family home and also for those at least 18 but under 21 living in their own home; and
Respite Care (for clients under 21 living in their family home).

(d) Residential Services, which includes:

Standard Residential Habilitation,
Behavior- Focused Residential Habilitation,
Intensive- Behavior Residential Habilitation,
Enhanced Intensive Behavior Residential Habilitation,
Medical Enhanced Intensive Behavior Residential Habilitation,
Live-In Residential Habilitation,
Special Medical Home Care; and
Supported Living Coaching.

(e) Waiver Support Coordination.

(f) Therapeutic Supports and Wellness, which includes:

Private Duty Nursing,
Residential Nursing,
Skilled Nursing,
Dietician Services,
Respiratory Therapy,
Speech Therapy,
Occupational Therapy,
Physical Therapy,
Specialized Mental Health Counseling,
Behavior Analysis Services; and
Behavior Assistant Services.

(g) Transportation; and

(h) Dental Services, which consists of Adult Dental Services.

(25) “Significant” means of considerable magnitude or considerable effect.

(26) “Significant Additional Needs” or “SANs” means, as provided in Section 393.063(39), F.S., an additional need for medically necessary services which would place the health and safety of the client, the client’s caregiver, or the public in serious jeopardy if it is not met. The term also includes services to meet an additional need that the client requires in order to remain in the least restrictive setting, including, but not limited to, employment services and transportation services. The Agency may provide additional funding only after the determination of a client’s initial allocation amount and after the WSC has documented the availability of non-Waiver resources on the Verification of Available Services form. Examples of SANs that may require long-term support include, but are not limited to, any of the following:

(a) A documented history of significant, potentially life-threatening behaviors, such as recent attempts at suicide, arson, nonconsensual sexual behavior, self-injurious behavior requiring medical attention, dementia, or age-related behaviors that present significant health and safety risks,

(b) A complex medical condition that requires active intervention by a licensed nurse on an ongoing basis that cannot be taught or delegated to a non-licensed person,

(c) A need for total physical assistance with activities of daily living such as eating, bathing, toileting, grooming, dressing, personal hygiene, lifting, transferring or ambulation;

(d) Permanent or long-term loss or incapacity of a caregiver;

(e) Loss of services authorized under the state Medicaid plan or through the school system due to a change in age;

(f) Significant decline in medical, behavioral or functional status;

(g) Lack of a meaningful day activity needed to foster mental health, prevent regression or engage in meaningful community life and activities;

(h) One or more of the situations described in Rule 65G-1.047, F.A.C., Crisis Status Criteria; and

(i) Risk of abuse, neglect, exploitation, or abandonment that can be mitigated with Waiver services.

(27) “Significant change in condition or circumstance” means a significant change or deterioration in a client’s health status, an actual or anticipated change in the client’s living situation, a change in the caregiver relationship or the caregiver’s ability to provide supports, loss of or deterioration of his or her home environment, or loss of the client’s spouse or caregiver. Examples of a significant change include:

(a) A deterioration in health status that requires that the client receive services at a greater intensity or in a different setting to ensure that client’s health or safety;

(b) Onset of a health, environmental, behavioral, or medical condition that requires that the client receive services at a greater intensity or in a different setting to ensure the client’s health or safety; or

(c) A change in age or living setting resulting in a loss of services funded or otherwise provided from sources other than the Waiver. This may include a change in living setting which requires a different service array or a change in the availability or health status of a primary caregiver that prevents that caregiver from continuing to provide support.

(28) “Support plan” means an individualized and person-centered plan of supports and services designed to meet the needs of a client enrolled in the iBudget. The plan is based on the preferences, interests, talents, attributes and needs of a client, including the availability of natural supports.

(29) “Temporary basis” means a time period of less than 12 months.

(30) “Verification of Available Services” means a form completed by the WSC to enable the Agency to certify and document that the client has utilized all available services through the Medicaid State Plan, school-based services, private insurance, other benefits, and any other resources, such as local, state, and federal government and non-government programs or services and natural or community supports, that might be available prior to requesting Waiver funds. The Verification of Available Services documents and verifies that the iBudget Waiver is the payer of last resort. A valid and accurate Verification of Available Services is a condition precedent to the authorization of services. The Verification of Available Services – APD Form 65G-4.0213 B, effective 7-1-21, is hereby adopted and incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12445.

(31) “Waiver” means the iBudget operated by the Agency.

(32) “Waiver Support Coordinator” or “WSC” means an employee of a qualified organization as defined in Section 393.0663, F.S., who is selected by the client or the client’s legal representative to assist the client and family in identifying their capacities, needs, and resources; finding and gaining access to necessary supports and services; coordinating the delivery of supports and services; advocating on behalf of the client and family; maintaining relevant records; and monitoring and evaluating the delivery of supports and services to determine the extent to which they meet the needs and expectations identified by the client, family, and others who participated in the development of the support plan with person-centered planning.

(33) “WSC Job Aid for Cost Plans and Significant Additional Needs Documentation” means a form that identifies the documentation required for each service requested in the cost plan. The documentation identified by this form is a material part of each request. The WSC Job Aid for Cost Plans and Significant Additional Needs Documentation – APD Form 65G-4.0213 D, effective 7-1-21, is hereby adopted and incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12447.

(34) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.063, 393.0662, 409.906 FS. History–New 7-7-16, Amended 7-1-21, 1-3-23.

Fla. Admin. Code R. 65G-4.0214 Allocation Algorithm

(1) To establish the Allocation Algorithm Amount for any client who has not previously had a QSI assessment, a QSI assessment must be completed prior to calculating the Allocation Algorithm Amount under subsection (2).

(a) The QSI assessor shall arrange for a face to face meeting with the client and, if available, the client’s legal representative. The WSC shall attend the face to face meeting with consent of the client or the client’s legal representative. If the client or the client’s legal representative is not capable of fully responding to all of the assessment questions, at least one participant with day-to-day knowledge of the client’s care should participate.

(b) A copy of the completed QSI evaluation and scores shall be provided to the client and WSC.

(c) Upon receiving QSI results if the client or his or her legal representative identifies an error in the QSI results the WSC shall notify the Agency in writing setting forth the details of the error. At any time, the client or WSC can prepare a statement to be maintained in client’s Central File identifying any concerns with the QSI assessment score or responses. If any error is identified in the QSI assessment the Agency shall review the error to determine if any adjustments are needed. The Agency shall inform the WSC of the result of the review and provide a revised Allocation Algorithm Amount, if appropriate, within 15 working days of notification of the error. The WSC shall in turn notify the client or the client’s representative.

(d) The client or WSC may request a reassessment any time there has been a significant change in circumstance or condition that would impact any of the questions used as variables in the algorithm determination. The Agency shall arrange for a reassessment at the earliest possible time in accordance with the circumstances, complete the reassessment, and notify the client and WSC of the results within 60 days of the request for reassessment. This section shall not be construed to require the Agency to wait for the completion of a QSI in order to address an emergency situation of the client.

(2) To calculate the Allocation Algorithm for each client, the following weighted values, as applicable, shall be summed, and the resulting total then squared:

(a) The base value for all clients, 27.5720;

(b) If the client is age 21 to 30, 47.8473;

(d) If the client resides in supported or independent living, or the client resides in a licensed facility and does not receive residential habilitation services, 35.8220;

(e) If the client resides in a licensed residential facility that is designated to provide Standard or Live-In residential habilitation services, 90.6294;

(f) If the client resides in a licensed residential facility with a Behavior Focus designation, 131.7576;

(g) If the client resides in a licensed residential facility with an Intensive Behavior designation, 209.4558;

(h) If the client resides in a licensed residential facility that is a Comprehensive Transitional Education Program or provides Special Medical Home Care, 267.0995;

(i) The sum of the scores on the client questions in the QSI Behavioral Status Subscale (Questions 25-30), multiplied by 0.4954;

(j) If the client resides in the family home, the sum of the scores on the client questions in the QSI Functional Status Subscale (Questions 14-24), multiplied by 0.6349;

(k) If the client resides in supported or independent living, the sum of the scores on the client questions in the QSI Functional Status Subscale (Questions 14-24), multiplied by 2.0529;

(l) If the client resides in supported or independent living, the sum of the scores on the client questions in the QSI Behavioral Status Subscale (Questions 25-30), multiplied by 1.4501;

(m) The client’s score on QSI Question 16, multiplied by 2.4984;

(n) The client’s score on QSI Question 18, multiplied by 5.8537;

(o) The client’s score on QSI Question 20, multiplied by 2.6772;

(p) The client’s score on QSI Question 21, multiplied by 2.7878;

(q) The client’s score on QSI Question 23, multiplied by 6.3555;

(r) The client’s score on QSI Question 28, multiplied by 2.2803;

(s) The client’s score on QSI Question 33, multiplied by 1.2233;

(t) The client’s score on QSI Question 34, multiplied by 2.1764;

(u) The client’s score on QSI Question 36, multiplied by 2.6734; and

(v) The client’s score on QSI Question 43, multiplied by 1.9304.

(3) The squared result of the sum of the applicable values of paragraphs (2)(a) through (v), above, then apportioned according to available funding, is the client’s Allocation Algorithm Amount.

(4) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.063, 393.0662 FS. History–New 7-7-16, Amended 7-1-21.

Fla. Admin. Code R. 65G-4.0215 General Provisions

(1) Medical necessity alone is not sufficient to authorize a service under the Waiver; in addition:

(a) With the assistance of the WSC, the client must utilize all available State Plan Medicaid services, school-based services, private insurance, natural supports, and any other resources that may be available to the client before expending funds from the client’s iBudget Amount for support or services. As an example, State Plan Medicaid services for children under the age of 21 typically include personal care assistance, therapies, consumable medical supplies, medical services, and nursing;

(b) The services must be within Waiver coverages and limitations; and

(c) The cost of the services must be within the Allocation Algorithm Amount unless there is a significant additional need demonstrated.

Failure to meet the above criteria shall result in a denial of a request for additional funding.

(2) WSCs shall coordinate with the clients they serve to ensure that services are selected from all available resources to keep the annual cost of services within the client’s iBudget Amount while maintaining the client’s health and safety.

(3) Prior to authorizing new or increased services or at the time of a medical necessity review, the Agency must certify and document within the client’s cost plan that the client has used all available services authorized under the Medicaid State Plan; school-based services; private insurance; local, state, and federal government and non-government programs or services; natural or community supports; and any other benefit or resource that may be available to the client before using funds from the iBudget to pay for supports and services.

(a) The iBudget Waiver is the payor of last resort.

(b) A valid and accurate Verification of Available Services form is a condition precedent to the authorization of services. To enable the Agency to certify and document that the client has utilized all available services pursuant to Section 393.0662(3), F.S., the WSC must complete and submit the Verification of Available Services to the Agency:

At the time of any requests to add or increase services, or
Upon request from the Agency when it is making determinations of medical necessity for Waiver services.

(4) Cost Plan Flexibility.

(a) After the client’s proposed cost plan is approved, he or she may change the services in his or her Approved Cost Plan provided that such change does not jeopardize the health and safety of the client and meets medical necessity.

(b) When changing the services within the Approved Cost Plan, the client and his or her WSC shall ensure that sufficient funding remains allocated for unpaid services that were authorized and rendered prior to the effective date of the change.

(c) Clients enrolled in iBudget will have flexibility and choice to budget or adjust funding among the following services without requiring additional authorizations from the Agency, provided the client’s overall iBudget Amount is not exceeded and all health and safety needs are met:

Life Skills Development 1,
Life Skills Development 2,
Life Skills Development 3, within the approved ratio,
Life Skills Development 4, within the approved ratio,
Durable Medical Equipment,
Adult Dental,
Personal Emergency Response Systems,
Environmental accessibility adaptations,
Consumable Medical Supplies,

10 Transportation,

Personal Supports up to $16,000,
Respite up to $10,000.

(d) Medically necessary services will be authorized by the Agency for covered services not listed above if the cost of such services are within the client’s iBudget Amount and in accordance with subsection 65G-4.0215(1), F.A.C. The Agency shall authorize services in accordance with criteria identified in Section 393.0662(1)(b), F.S., medical necessity requirements of Section 409.906, F.S., subsection 59G-1.010(166), F.A.C., Handbook limitations, and the authority under Title 42 of the Code of Federal Regulations, Part 440, Section 230(d).

(e) Service authorization and any modifications to it must be received by the provider prior to service delivery. This includes changes to the authorization as a result of clients redistributing funds within their existing cost plan.

(5) Consumer Directed Care Plus (CDC+): clients enrolled in the CDC+ program are subject to iBudget Rule 65G-4.0214, subsections 65G-4.0215(1), (2) and (7), and Rules 65G-4.0216, 65G-4.0217, 65G-4.0218, F.A.C.

(6) Approval, Denial, or Closure of Applications.

(a) iBudget Waiver providers must have applied through the Agency for Persons with Disabilities to ensure that they meet the minimum qualifications to provide iBudget Waiver services. iBudget Waiver providers must also be enrolled as a Medicaid provider through the Agency for Health Care Administration. However, providers do not have to provide Medicaid State Plan services in order to provide Waiver services.

(b) To enroll as a provider for iBudget Waiver services, the provider must first submit an application to the Agency or Persons with Disabilities using the Regional iBudget Provider Enrollment Application – WSC – APD Form 65G-4.0215 A, effective date 01-2023, for Waiver Support Coordinator applications, which is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12444, or the Regional iBudget Provider Enrollment Application – Non-WSC – APD Form 65G-4.0215 B, effective date 7-1-2021, for all other provider applications, which is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-14984. These forms are hereby incorporated by reference. The qualifications to provide services are identified in the Handbook.

(c) The Agency will review the application and approve or deny complete applications within 90 days of receipt; the Agency will close incomplete applications.

The Agency will only consider complete applications that include all required information and meet the requirements delineated in this chapter, the iBudget Handbook, and Section 393.0663, F.S. An application is complete upon the Agency’s receipt of all requested information and correction of any error or omission for which the applicant was notified.
If the Agency receives an incomplete application, the Agency will notify the applicant. The applicant will have 45 calendar days from the date of the notice to submit the documentation, information, or make any corrections designated in the notice. If the applicant does not complete the application within 45 days of the notice, the application must be closed by the Agency. After an application is closed, all documentation and information submitted will no longer be considered, and a new complete application must be submitted for consideration by the Agency. The closure of an application is not Agency action and will not be considered substantively by the Agency in any subsequent application.

(d) If a Waiver provider wishes to, expand by providing additional services, expand services geographically, or expand from solo to agency, the provider must notify the Agency regional office by submitting a Provider Expansion Request form – APD Form 65G-4.0215 C, effective date 01-2023, which is hereby incorporated by reference and is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14985. The Agency regional office must approve any expansion prior to the provision of expanded services. The qualifications to provide or expand services are identified in the Handbook.

(7)(a) When a client is enrolled in the iBudget, that client remains enrolled in the Waiver position allocated unless the client becomes disenrolled due to one of the following conditions:

The client or client’s legal representative chooses to terminate participation in the Waiver.
The client moves out-of-state.
The client loses eligibility for Medicaid benefits and this loss is expected to extend for a lengthy period.
The client no longer needs Waiver services.
The client no longer meets level of care for admission to an ICF/IID.
The client no longer resides in a community-based setting but moves to a correctional facility, detention facility, defendant program, or nursing home or resides in a setting not otherwise permissible under Waiver requirements.
The client is no longer able to be maintained safely in the community.

If a client is disenrolled from the Waiver and becomes eligible for reenrollment within 365 days that client can return to the Waiver and resume receiving Waiver services. If Waiver eligibility cannot be re-established or if the client who has chosen to disenroll has exceeded this time period, the client cannot return to the Waiver until a new Waiver vacancy occurs and funding is available. In this instance, the client is added to the preenrollment category of clients requesting Waiver participation. The new effective date is the date eligibility is re-established or the client requests re-enrollment for Waiver participation.

(b) Providers are responsible for notifying the client’s WSC and the Agency if the provider becomes aware that any of the conditions of paragraph (a) or (c), exists.

(c) If a client or legal representative refuses to cooperate with the provision of Waiver services in any of the following ways: develop a cost plan or support plan, participate in a required QSI assessment or other approved Agency needs assessment tool, or refuse to annually sign the Waiver eligibility worksheet that establishes a level of care, then the Agency will review the circumstances to determine if the client should be removed from the Waiver for failing to comply with specific eligibility requirements. Any such decision by the Agency shall provide written notice to the client, the client’s legal representative and the WSC, at least 30 days before terminating services.

(d) Clients denied services shall have the right to a fair hearing. Clients are exempted from this provision if they do not have the ability to give informed consent and do not have a legal representative. The Agency shall not remove a client from the Waiver due to non-compliance if it directly impacts the client’s health, safety, and welfare.

(8) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.063, 393.0662, 409.906 FS. History–New 7-7-16, Amended 9-12-18, 7-1-21, 1-3-23.

Fla. Admin. Code R. 65G-4.0216 Establishment of the iBudget Amount

(1) The iBudget Amount for a client shall be the Allocation Algorithm Amount, as provided in Rule 65G-4.0214, F.A.C., plus any approved Significant Additional Needs funding as provided in Rule 65G-4.0218, F.A.C.

(2) The Agency will determine the iBudget Amount consistent with the criteria and limitations contained in the following provisions: Sections 409.906 and 393.0662, F.S.; and Rules 59G-13.080, 59G-13.081, and 59G-13.070, F.A.C.

(3) Significant Additional Needs Review:

(a) The first time the Allocation Algorithm Amount is calculated, the WSC will discuss the Allocation Algorithm Amount with the client, and, if available, the client’s legal representative and, if available and applicable, the client advocate, in order to determine if the client has any Significant Additional Needs.

(b) The WSC shall discuss the services requested with the client or the client’s legal representative, and, if available and applicable, the client advocate.

(c) The Agency will conduct a Client Review to determine whether services requested meet health and safety needs and waiver coverage and limitations. The AIM Worksheet must be completed as part of the Client Review and submitted to the Agency within 30 days of receipt of the new Allocation Algorithm Amount.

(d) The Agency will issue a decision of the iBudget Amount within 30 days of receipt of the AIM Worksheet. The client and his or her legal representative will be advised of the Agency’s decision for the amount of the client’s final iBudget Amount within 30 days.

If additional documentation is requested, the deadline for the Agency’s response shall be extended to 60 days following the receipt of the original request.
The Verification of Available Services form is a material part of the request form. Failure to include the Verification of Available Services form is a basis for denial.

(e) The Agency shall approve an increase to the iBudget Amount if additional funding is required to meet the Significant Additional Needs subject to the provisions of the iBudget Rules. The Agency, upon completion of its review shall notify in writing the client, the WSC and the client advocate, if any, of its decision.

(4) After the iBudget Amount is established, if a client remains in the same living setting and experiences a significant change in condition or circumstances where the proposed needs cannot be met within the current iBudget Amount, the WSC shall request services through the significant additional needs process without the calculation of a new algorithm or the completion of the AIM Worksheet.

(5) iBudget Amounts are pro-rated as appropriate based on the length of time remaining in the fiscal year.

(6) The Agency shall ensure that the sum of all clients’ projected expenditures do not exceed the Agency’s annual appropriation.

(7) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.063, 393.0662, 409.906 FS. History–New 7-7-16, Amended 7-1-21.

Fla. Admin. Code R. 65G-4.0217 iBudget Cost Plan

(1) When a client’s iBudget Amount is determined, the WSC must submit a cost plan proposal, which includes a completed Verification of Available Services form, that reflects the specific Waiver services and supports (paid and unpaid) that will assist the client to achieve identified goals, and the provider of those services and supports, including natural supports. The cost plan proposal is derived from person-centered planning. The Verification of Available Services form is a material part of the cost plan proposal. Failure to include the Verification of Available Services form will result in a denial of the cost plan.

(2) The WSC shall provide documentation for requested services as specified in Section C of the WSC Cost Plan and Significant Additional Needs Job Aid to document medical necessity and compliance with Handbook coverage and limitations.

(3) Each client’s proposed iBudget cost plan shall be reviewed and approved by the Agency in conformance with the iBudget Rules and the Handbook. Any conflict between the Handbook and these iBudget Rules shall be resolved in favor of these rules.

(4) For a client to begin receiving a specific Waiver service, that service must have been listed in an Approved Cost Plan and the service authorization must have been issued to the provider prior to the delivery of service.

(5) Clients must budget their funds so that their needs are met throughout the plan year. All clients shall allocate iBudget funding each month for Waiver support coordination services, which is a required service under the Waiver.

(6) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.063, 393.0662, 409.906 FS. History–New 7-7-16, Amended 7-1-21.

Fla. Admin. Code R. 65G-4.0218 Significant Additional Need Funding

(1) Supplemental funding for Significant Additional Needs (SANs) may be of a one-time, temporary, or long-term in nature.

(2) The presence of a significant additional need or significant change in condition or circumstance alone does not warrant an increase in the amount of funds allocated to a client’s iBudget as determined by the algorithm.

(3) A client’s annual expenditures for home and community-based services Medicaid Waiver services may not exceed the limits of his or her iBudget. The total of all clients’ projected annual iBudget expenditures may not exceed the Agency’s appropriation for Waiver services.

(4) SANs can only be approved after the determination of a client’s initial allocation amount and after the WSC has documented the availability of non-Waiver resources on the Verification of Available Services form. Nothing in this section prohibits the authorization of emergency services on a temporary basis through the Agency. Requests for SANs require:

(a) The client to have a significant additional need as defined in this chapter; and

(b) A significant additional need cannot be created by failing to maintain sufficient funds to cover services previously authorized in accordance with subsections 65G-4.0215(2) and (5), F.A.C.

(5) The WSC shall submit a SANs request that reflects the specific Waiver services and supports that will assist the client to meet identified needs, with all required supporting documentation as specified in the WSC Job Aid for Cost Plans and Significant Additional Needs Documentation. The documentation identified in the WSC Job Aid is material to the SANs requests. The Agency must close or deny the SANs request without such documentation.

(a) The SANs request shall be submitted indicating how the current budget allocation and requested SANs funds would be used. The request should also include an explanation of why additional funding is needed, and any additional documentation appropriate to support the request.

(b) The SANs request shall be submitted with an updated support plan, which must include an explanation of why additional funding is needed and indicate how the current budget allocation and requested SANs funds would be used. The request must include documentation appropriate to support the request in accordance with the WSC Job Aid for Cost Plans and Significant Additional Needs Documentation form.

(c) Documentation of attempts within the last 30 days prior to submitting the SANs request to locate natural or community supports, third-party payers, or other sources of support to meet the client’s health and safety needs must also be documented and verified by the WSC on the Verification of Available Services form.

(d) If there are any concerns about the accuracy of the QSI results, the WSC shall submit this as well.

(6) If a client’s iBudget Amount includes Significant Additional Needs beyond what was determined by the Allocation Algorithm, and the Agency determines that the intensity, frequency or duration of the service(s) is no longer medically necessary, the Agency will adjust the client’s services to match the current need.

(7)(a) The Agency will not consider incomplete SANs requests due to lacking material information to determine whether SANs criteria are met. A SANs request is incomplete if it does not:

Provide detail the client’s current approved services, including the number and type of units and dollar amount for each service. The client to staff ratio, if applicable, must also be included;
Clearly indicate whether the current approved services are requested to continue on an annualized basis;
Clearly identify any new or increased services being requested in the current fiscal year and on an annualized basis, if applicable to that service type;
Include a complete Verification of Available Services form;
Include documentation to support the information provided in the Verification of Available Services Form, or identify the location of the currently valid documentation in the designated data management system;
Place the request in the proper status for submission in the designated data management system; or
Include certification that the request meets the criteria for SANs.

(b) The Agency shall close incomplete SANs requests upon receipt.

(8) The Agency will request the documentation and information necessary to evaluate a client’s increased funding requests based on the client’s needs and circumstances. The documentation will vary according to the funding request and may include the following as applicable: support plans, results from the Questionnaire for Situational Information, cost plans, expenditure history, current living situation, interviews with the client and his or her providers and caregivers, prescriptions, data regarding the results of previous therapies and interventions, assessments, and provider documentation.

(9) Within 30 days of receipt of a request for SANs funding, and adjustments in the client’s service array, the Agency shall approve, deny (in whole or in part), or request additional documentation concerning the request.

(a) If the request does not include all necessary documentation, the Agency shall provide the client and WSC with a written notice of what additional documentation is required. The client or WSC shall provide the documentation within 10 days, or notify the Agency in writing that the client wishes the Agency to render its decision based upon the documentation provided.

(b) If additional documentation is requested, the deadline for the Agency’s response shall be extended to 60 days following the receipt of the original request. If the client has not received a notice from the Agency approving, denying or requesting additional information within 60 days, the client or WSC may notify the Agency in writing of such failure to issue a timely notice and the Agency shall have 20 days from receipt of the Notice to approve or deny the request.

(c) Failure of the Agency to issue this Notice within 20 days shall mean the requested funding for services are authorized as of the 21st day, and the client and service providers may treat the authorization as an approval.

(10) Individual and Family Supports (IFS) funding may cover temporary emergency services pursuant to Chapter 65G-13, F.A.C., while requests for Significant Additional Needs are being processed.

(11) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.063, 393.0662, 409.906 FS. History–New 7-7-16, Amended 7-1-21.

Fla. Admin. Code R. 65G-4.022 The iBudget Florida Cost Plan

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.0662 FS. History–New 10-2-13, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.024 Cost Plan Changes

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.0662 FS. History–New 10-2-13, Repealed 1-19-16.

Fla. Admin. Code R. 65G-4.027 Supplemental Cost Plan Funding

History

Rulemaking Authority 393.501(1), 393.0662 FS. Law Implemented 393.0662 FS. History–New 10-2-13, Repealed 1-19-16.

Chapter 65G-5 SUPPORTED LIVING SERVICES

Fla. Admin. Code R. 65G-5.001 Definitions

(1) “Community supported living arrangements (CSLA)” means a Medicaid state plan optional service. The following services are available through CSLA funding:

(a) Supported living coaching;

(b) Personal assistance; and,

(2) “CLSA provider” means a provider that is certified by the Agency and is also enrolled with Medicaid as a provider of Community Supported Living Arrangements services.

(3) “Environmental modification” means minor additions or changes to the homes of eligible individuals to allow access, including ramps, grab rails in the bathroom, shower or kitchen, raised toilet seats, transfer devices or other minor physical modifications.

(4) “Immediate family” means spouse, children, parents and siblings, including stepchildren, stepparents, stepsiblings and in-laws.

(5) “Individual” means an adult who has developmental disabilities, who is a client of the Agency as defined in Chapter 393, F.S., and who is receiving supported living services.

(6) “Personal assistance services” means personal services for assistance in activities of daily living, including assistance in bathing, grooming, dressing, transferring, food preparation, eating and routine household maintenance.

(7) “Provider” means an individual vendor, agency or direct service staff of an agency certified by the Agency to provide supported living services.

(8) “Support plan” means a plan of supports and services for the individual developed in such a manner whereby the individual controls and directs the process. The support plan identifies the preferences and needs of the individual and authorizes the supports, resources and services necessary to meet those preferences and needs.

(9) “Supported living coaching” means:

(a) Assistance with tasks;

(b) Training of skills;

(d) Coordination of natural supports and generic community resources.

(10) “Support coordinator” means a person who is designated by the Agency to assist individuals in identifying their desires, capacities, needs and resources; find and gain access to necessary supports and services; coordinate the delivery of supports and services; advocate on behalf of the individual, and provide other assistance and support as defined in Section 393.063, F.S.

(11) “Supported living services” means the provision of supports necessary for an adult who has a developmental disability to establish, live in and maintain his or her own household in the community. For purposes of this rule, supported living services include supported living coaching provided through state general revenue funds, the CSLA Medicaid state plan option and the Developmental Disabilities Home and Community-Based Services Waiver.

History

Rulemaking Authority 393.501 FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.002, 65B-11.002.

Fla. Admin. Code R. 65G-5.002 Eligibility for Services

(1) All persons eighteen years of age or older who have developmental disabilities, reside within the state of Florida and are clients of the Agency shall be eligible for supported living services.

(2) Individuals must be Medicaid recipients in order to receive supported living services through the CSLA Medicaid state plan option. Services shall not be provided simultaneously to an individual through CSLA and the Developmental Disabilities Home and Community-Based Services Waiver.

(3) Persons who are clients of the Agency and who wish to receive supported living services shall make a request for such services through their support coordinator.

(4) Persons who are not clients of the Agency must first make application for determination of eligibility for developmental disability services. They may concurrently request supported living services.

(5) Supported living services must be authorized by an individual’s support plan. A preliminary determination of the individual’s support requirements to reside in supported living shall be made as part of the individual support plan process.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.003, 65B-5.003.

Fla. Admin. Code R. 65G-5.003 Planning for Supported Living Services

(1) An individual’s desire and willingness to participate in supported living shall be considered as part of the support planning process, and supported living services shall be authorized by the support plan when requested by the individual or the individual’s guardian.

(2) The support plans of individuals in supported living are facilitated by the support coordinator and shall address the following with regard to supported living services:

(a) Frequency of supported living coaching services and specific areas of support required by the individual to live in his or her own home and participate in the local community;

(b) An explanation of the individual’s need for the services;

(d) When services will be provided;

(e) The methodology that will be used to provide the services;

(f) How the individual can access supported living coaching services 24 hours a day for emergency assistance;

(g) How natural and generic supports available through family, friends, neighbors, and the community at large will be included in the support process;

(h) What supports are in place to meet the home and community safety needs of the individual;

(i) A financial profile that includes an accountable strategy for assisting the individual in money management, when requested by the individual or the individual’s guardian; and,

(j) The outcomes the individual wishes to achieve during the next year.

(3) Supported living services are authorized and provided in any of the following support areas based on functional assessment of the individual’s capacities in the community and the individual’s preferences.

(a) Housing procurement;

(b) Household maintenance and management;

(d) 24-hour emergency assistance;

(e) Meal planning and preparation;

(f) Shopping and consumer skills;

(g) Clothing care;

(h) Self-care, manners and sexuality;

(i) Money management and banking;

(j) Utilizing third party benefits;

(k) Time management;

(l) Recreation and leisure;

(m) Mobility and travel skills;

(n) Civic responsibilities;

(o) Advocacy;

(p) Interpersonal communication;

(q) Facilitation of one-to-one relationships;

(r) Support counseling;

(s) Self-medication;

(t) Individual specific documentation;

(u) Meetings with the individual present;

(v) Quality assurance activities.

(4) The information required by Rule 65G-5.004, F.A.C., shall be identified on the individual support plan form or included in a separate implementation plan which is made part of the individual support plan by reference.

(5) The supported living coaching provider and the individual have authority to adjust the areas and level of coaching support in response to emerging needs and life changes of the individual. All such adjustments must be reviewed with the support coordinator at the time of the quarterly visit provided for in Rule 65G-5.006, F.A.C.

(6) Adjustments to the areas or levels of coaching support that affect the provider’s rate agreement must be authorized prior to implementation by an update to the individual support plan. The support coordinator is responsible for updating the support plan and obtaining area office review and approval of funding.

(7) At least ten working days prior to the annual support plan review, the supported living coaching provider shall send the support coordinator a written summary regarding the supports and services provided during the past year and recommendations for the coming year.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45) FS. History–New 1-18-95, Formerly 10F-11.006, 65B-11.006.

Fla. Admin. Code R. 65G-5.004 Selection of Housing

(1) The individual shall select a home available for lease or sale to any member of the community based on the individual’s own choice and personal financial resources with assistance from the supported living coaching provider as needed.

(2) The following criteria identify an eligible supported living setting:

(a) The name of the individual appears on the lease or mortgage either singularly, with a roommate, or with a guarantor;

(b) Neither the supported living provider nor the immediate family of the supported living provider shall serve as landlord or have any interest in the ownership of the housing unit; and,

(3) As part of the housing search, the supported living coaching provider shall assist the individual to complete a survey of the housing being considered. This survey shall be based on the Housing and Urban Development housing quality standards found in 24 C.F.R. §887.251. The supported living coaching provider shall also assist the individual in a quarterly update of the housing survey based upon the same standards as the initial survey.

(4) The supported living coaching provider shall forward a copy of the completed survey for the housing that was selected by the individual to the individual’s support coordinator within ten (10) working days of the selection, and shall make a copy of the quarterly housing survey update available to the support coordinator at the time of the support coordinator’s quarterly home visit provided for in Rule 65G-5.006, F.A.C.

(5) If the housing selected by the individual does not meet the housing quality standards identified in Rule 65G-5.004, F.A.C., a waiver shall be granted by the Area Administrator when the selection is based on the individual’s choice and the standard waived does not compromise the client’s health and safety.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.065(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.005, Amended 10-28-03, Formerly 65B-11.005.

Fla. Admin. Code R. 65G-5.005 Selection of Providers by Participants

(1) Individuals may choose from among the available providers within the area. Every effort shall be made to ensure that the individual receives services from the provider of his or her choice. Eligible individuals who wish to receive services through the Medicaid CSLA state plan option must choose from among the available CSLA providers.

(2) The individual’s support coordinator shall provide information to the individual verbally and in writing concerning the philosophy and scope of services available from each supported living provider and shall assist the individual as needed in the screening and selection of a provider.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.004, 65B-11.004.

Fla. Admin. Code R. 65G-5.006 Ongoing Monitoring by Support Coordinator

(1) The individual’s support coordinator shall have at least monthly telephone contact with the individual to monitor the individual’s health and well-being. This call may be initiated by the support coordinator or the individual.

(2) When telephone contact is not possible, a face-to-face visit shall be made.

(3) The individual’s support coordinator shall conduct a quarterly home visit to ensure that supported living services are being carried out in accordance with the support plan. This visit shall be scheduled at a mutually convenient time and shall not be unannounced. The supported living coach shall also attend unless the individual requests otherwise.

(4) In addition to reviewing supported living services, the support coordinator shall review the updated housing survey and the individual’s need for a financial subsidy or adjustment of current subsidy at the time of the quarterly home visit. If the supported living coaching provider is acting as fiscal agent for the individual, bank statements and any other financial records shall be reviewed by the support coordinator at the time of the quarterly home visit.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.009, 65B-11.009.

Fla. Admin. Code R. 65G-5.007 Individual Survey Activities

(1) The individual shall be asked at least annually to complete a survey that addresses his or her satisfaction with service delivery and the extent to which the individual’s desired outcomes identified in Rule 65G-5.003, F.A.C., have been achieved.

(2) If the individual desires or needs assistance to complete the survey, he or she shall be asked to identify a person or persons to assist on a volunteer basis in reviewing the supports and services that the individual has received.

(3) The survey process shall be distinct from the support planning process; however, the individual may choose to include some or all of the persons who assist the individual in support planning.

(4) Persons who are selected by the individual to assist in the survey process may be family members, friends, or neighbors of the individual; however, paid staff providing direct supported living services to an individual may not assist in survey activities for that individual.

(5) The results of the survey shall be reported to the staff person designated by the area office who will follow up on any concerns raised.

(6) The area office shall forward results of individual survey activities to the Agency’s central office for submission to the state supported living services monitoring board.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.008, 65B-5.008.

Fla. Admin. Code R. 65G-5.008 Certification of Providers

(1) Providers of supported living coaching services shall meet the minimum qualifications of a behavioral program specialist, State of Florida Career Service Class Specification #5751. These are an associate’s degree with a major in nursing, education, or a social, behavioral or rehabilitative science and two years of experience; or a bachelor’s degree with a major in nursing, education, or a social, behavioral or rehabilitative science. Experience can be substituted for the required college on a year-for-year basis.

(2) Providers of personal care assistance through the CSLA Medicaid state plan option shall meet the minimum requirements of a Human Services Worker II, State of Florida Career Service Class Specification #5709. These are one year of experience working in medical, psychiatric, nursing or child care setting, or working with developmentally disabled persons. College or vocational or technical training can substitute at the rate of 30 semester, 45 quarter or 720 classroom hours for the required experience.

(3) Providers of environmental modifications through the CSLA Medicaid state plan option must be licensed as contractors pursuant to Chapter 489, F.S., when the modifications to be performed require a permit.

(4) Agencies or individuals who wish to be certified as providers of supported living coaching services, CSLA personal assistance services or CSLA environmental modification services, shall submit a completed provider application, which is hereby incorporated by reference and is available at area offices. This application shall be submitted to the area office in the area where the applicant wishes to provide services. Providers must comply with all assurances specified in the application.

(5) Each area office program shall develop operating procedures to respond to requests for blank applications and requests for information or assistance from prospective applicants. This shall include timely procedures for notifying applicants of errors or omissions in the application.

(6) Within fifteen working days of receipt of a complete application, the area office shall approve or deny the application.

(7) On denial of an application, the area office shall inform the applicant of any right to a hearing pursuant to Section 120.57, F.S.

(8) On approval of an application for supported living coaching or CSLA personal assistance certification, the area office shall issue a certification to provide services that shall be valid for no more than one year.

(9) On acceptance of an application for CSLA environmental modifications certification, the area office shall issue a certification to provide services that shall remain valid unless terminated under the provisions of Rule 65G-5.011, F.A.C.

(10) Supported living certification is valid statewide. Providers who wish to expand services to a new area shall submit a copy of their application and certificate from the certifying area to the area office in the new district.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.010, 65B-11.010.

Fla. Admin. Code R. 65G-5.009 Annual Survey and Renewal of Certification

(1) The area office shall conduct an annual unannounced survey of each supported living coaching and personal assistance provider to monitor compliance with the requirements of this rule, including all items covered in the provider’s application for certification.

(2) A survey report shall be completed within 30 calendar days after the survey and a copy shall be forwarded to the provider within three working days of the report’s completion.

(3) When the survey determines that the provider is in compliance with the requirements of this rule, the area office shall issue a certification that will be valid for no more than one year.

(4) When it is determined through the survey, or otherwise comes to the attention of the area office, that a provider is out of compliance with the requirements of this rule, the provider shall be required to develop a plan of correction, which must be accepted by the area office before its implementation. This corrective action plan must be submitted to the area office within ten working days after the provider is notified of the unsatisfactory rating by means of the survey monitoring report.

(5) Within 60 calendar days after acceptance of the corrective action plan, area office staff shall revisit the provider to determine if the plan has been successfully implemented to bring the provider into compliance with the requirements of this rule. If the provider is determined to be in compliance at the time of this visit, the area office shall issue a certification to provide services that will be valid for no more than one year.

(6) If the provider is still found to be out of compliance with the requirements of this rule, a moratorium shall be imposed on referrals of individuals to the provider and the provider shall be notified of the moratorium in writing within ten working days after completion of the monitoring visit. This notification shall also inform the provider of the need to develop a second corrective action plan to address continuing deficits.

(7) The second corrective action plan must be submitted to the area office within ten working days after the provider receives notification. The plan must be implemented within 30 calendar days of its acceptance by the area office, which shall conduct follow-up monitoring as necessary to verify the provider’s compliance. If monitoring determines that deficiencies have been corrected, the provider shall be issued a certification to provide services that shall be valid for no more than one year.

History

Rulemaking Authority 393.510(1) FS. Law Implemented 393.065(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.011, 65B-11.011.

Fla. Admin. Code R. 65G-5.010 Suspension of Provider Certification

(1) The area office shall suspend a provider’s certification when there is good faith reason to believe that the provider has engaged in any of the following:

(a) Submitted false information on the application for certification;

(b) Submitted a fraudulent invoice for services;

(c) Abused, neglected, or exploited a person as defined by Chapter 415, F.S., or committed any action that violates the minimum standards for good moral character set forth in Section 393.0655, F.S.;

(d) Failed, if an agency provider, to terminate or reassign a direct service staff person who has abused, neglected, or exploited a person as defined by Chapter 415, F.S., or committed any action that violates the minimum standards for good moral character set forth in Section 393.0655, F.S.;

(e) Lost a required professional certification, licensure or registration;

(f) Financially benefited by borrowing or otherwise using an individual’s personal funds, or

(g) Engaged in conduct, whether while directly performing the services to be provided under the terms of the certification or not, that adversely affects the provider’s ability to continue to perform his or her work thereunder or adversely affects the Agency’s ability to carry out its assigned mission. This includes any act or acts rendering the provider ineffective in his or her role under the terms of the certification, or affecting the provider’s ability for acceptance or trust by the Agency, citizens of the state, clients or individuals. Providers are required to conduct themselves in a manner that reflects favorably upon the state, the Agency, and themselves.

(2) The area office shall notify the provider of the suspension of certification in writing by certified mail. The written notice shall include the reason for suspension and a statement of the provider’s right to respond within twenty calendar days.

(3) In the event that a provider’s timely response provides the area office with evidence that the reasons for the suspension were not valid, the suspension shall be lifted.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066, 393.0655 FS. History–New 1-18-95, Formerly 10F-11.012, 65B-11.012.

Fla. Admin. Code R. 65G-5.011 Termination of Provider Certification

(1) If a provider fails to fully correct continuing deficits as identified in Rule 65G-5.013, F.A.C., within 30 calendar days after notice, the area office shall terminate the provider’s certification.

(2) If a provider fails to respond to a notice of suspension issued according to Rule 65G-5.010, F.A.C., the provider’s certification shall be terminated.

(3) If, following a provider’s timely response to a notice of suspension issued according to Rule 65G-5.010, F.A.C., the area office continues to believe in good faith that the reason for the provider’s suspension is valid, the provider’s certification shall be terminated.

(4) The area office shall notify the provider of the proposed termination of the provider’s certification in writing by certified mail and shall provide a copy to the Agency’s central office. The written notice shall include the reason for termination and a statement of the provider’s right to an administrative hearing in accordance with Chapter 120, F.S., provided the hearing is requested within twenty calendar days. The termination shall be effective on the 21st day after issuance of the notice unless a hearing is requested.

(5) Any provider who voluntarily wishes to terminate certification shall notify the area office in writing at least 30 calendar days prior to the anticipated termination date. Within three working days of receipt, the area office shall send a copy of the provider’s termination notice to the Agency’s central office.

(6) Individuals receiving supported living services from a provider whose certification is suspended or pending termination shall be notified of the pending change. They shall be advised of their right to continue receiving services from another certified provider and shall be assisted in the selection of a new provider.

(7) The agency shall maintain a list of providers willing to temporarily provide services to the individuals of providers whose certifications are suspended or terminated.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066, 393.0655 FS. History–New 1-18-95, Formerly 10F-11.013, 65B-11.013.

Fla. Admin. Code R. 65G-5.012 Documentation of Services

The provider shall maintain documentation that the supports and services for which billings or invoices are submitted have been provided. For providers of supported living coaching and personal assistance this shall include written documentation of the dates, times and summary of support provided during contact with the individual.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.014, 65B-11.014.

Fla. Admin. Code R. 65G-5.013 Rates and Payments

(1) The area office shall establish a rate agreement with each provider based on reasonable and necessary costs. Rates for services provided through the CSLA Medicaid state plan option or the DS/HCBS waiver shall not exceed the maximum rates established by Medicaid.

(2) Payments for services provided through CSLA or the Developmental Disabilities Home and Community-Based Services Waiver will be made to the provider by Medicaid’s fiscal agent. Payments for services provided solely through state general revenue funds will be made to the provider by the Florida state comptroller.

History

Rulemaking Authority 393.501(1) FS. Law Implemented 393.063(45), 393.066 FS. History–New 1-18-95, Formerly 10F-11.015, 65B-11.015.

Chapter 65G-6 FOSTER CARE, GROUP HOME, DEVELOPMENTAL TRAINING, AND SUPPORTED EMPLOYMENT PROGRAMS TRUST FUND

Fla. Admin. Code R. 65G-6.001 Authority to Loan; Provisions and Determination of Eligibility

(1) Eligible Expenses – Trust Funds under this chapter are for the purpose of granting loans to eligible programs. Initial costs of development are those permissible costs for establishment of new programs and those permissible costs necessary for an already established program to initiate the accommodation of hard to place clients. Cost of development may include structural modification, purchase of equipment and fire and other safety devices, and the purchase of insurance. Cost of structural modification shall include only those changes required for compliance with building, fire safety and health codes and those changes necessary for the implementation of the intended program. Purchase of equipment shall include only those basic furnishings, equipment, and appliances necessary to furnish, equip, and maintain the premises and considered essential to the operation of the intended program. Such cost shall not include the actual construction, lease or any other costs of acquisition of the program.

(2) Amounts of Loans – An eligible program may receive a lump sum loan in one payment, not to exceed the approved rate for providing two months of residential or non-residential service to each Agency client to be placed in the program by the Agency. Loans granted to programs shall not be in lieu of payment for residential or non-residential service and care provided, but shall stand separate and distinct. The amount of the monthly care and maintenance payment shall be determined by the appropriate rate or rate formula for the category of client.

(3) Terms of the Loan – Any loan granted through the Trust Fund shall be repaid in five equal annual installments without interest.

(4) A program receiving a loan under the act and operating as a nonprofit corporation meeting the requirements of Section 501(c)3., of the Internal Revenue Code, shall submit to the Agency a report setting forth the service it has provided during the year and upon approval of each such annual statement, the Agency shall forgive 20 per cent of the principal of such loan. The report shall include:

(a) A brief narrative description of the facility and programs;

(b) The age, functioning level and handicapping conditions of the client served;

(d) The average number of clients served per month for the previous 12 months;

(e) A list of actual loan expenditures;

(f) A report by Agency staff who have surveyed the operation of the facility;

(g) Proof of compliance with health, fire, building and zoning regulations;

(h) Proof of compliance with Section 501(c)3. of the Internal Revenue Code; and,

(i) A recommendation from the Area Administrator that the loan be forgiven.

(5) In the event the borrower ceases to accept and provide care and maintenance to persons placed in the program by the Agency, or the borrower files papers of bankruptcy, at that point, the loan shall become an interest bearing loan at the rate of 5% per annum on the entire amount of the initial loan which shall be repaid within a one year period from the date at which the home ceases to provide care or files papers in bankruptcy and the amount of the loan due plus interest shall constitute a lien in favor of the State of Florida against all real and personal property of the borrower.

History

Rulemaking Authority 393.15 FS. Law Implemented 393.15 FS. History–New 3-31-76, Amended 1-1-77, Formerly 10F-5.03, 10F-5.003, Amended 9-28-99, Formerly 65B-5.003.

Chapter 65G-7 MEDICATION ADMINISTRATION

Fla. Admin. Code R. 65G-7.001 Definitions

The terms and phrases used in this chapter shall have the meanings defined below:

(1) “Administration of medication” means the obtaining and giving of one or more doses of medicinal substances by an authorized person to an Agency client for his or her consumption.

(2) “Administration route” means the path through which medication or prescribed formula is delivered to a client. For purposes of this chapter, administration routes include the following:

(a) “Enteral,” which means medication or prescribed enteral formula is delivered by gastrostomy jejunostomy tube, or gastrostomy-jejunostomy tube, via the body’s gastrointestinal system.

(b) “Inhaled,” which means medication is administered as nose drops or nose spray, or medication is inhaled by mouth, such as an inhaler or nebulizer.

(c) “Ophthalmic,” which means solution or ointment medication is instilled into the eye or applied on or around the eyelid.

(d) “Oral,” which means medication including, but not limited to, tablet, capsule, liquid, or powder form is introduced into the gastrointestinal tract by mouth.

(e) “Otic,” which means solutions or ointment medication is placed in the outer ear canal or applied around the outer ear.

(f) “Parenteral,” which means medication is injected into the body through some route other than the digestive tract, such as subcutaneous, intra-dermal, intra-muscular, or intravenous administration.

(g) “Rectal,” which means any medication including, but not limited to, capsule, enema, gel, or suppository is administered via the rectum.

(h) “Topical,” which means medication including, but not limited to, salve, lotion, ointment, cream, spray, shampoo, or solution is applied locally to a body part.

(i) “Transdermal,” which means a patch containing a pre-measured or measured amount of topical medication that is absorbed into the body via the epidermis (outer layer of skin).

(j) “Vaginal,” which means any medication including, but not limited to, capsule, cream, or ointment that is administered via the internal vagina. This route does not include medications applied to the epidermis external to the vagina.

(3) “Advanced Practice Registered Nurse” or “APRN” means any person licensed or authorized by the State of Florida to practice professional nursing and certified in advanced or specialized nursing practice, including certified registered nurse anesthetists, certified nurse midwives, and nurse practitioners, pursuant to chapter 464, F.S.

(4) “Client’s record” means a file maintained by the Waiver Support Coordinator for each client that contains the client’s name and date of birth, written authorization for routine medical/dental care from the client or legal representative medical summary, the name address and telephone number of the client’s physician(s) and dentist(s), a record of the client’s illnesses and accidents, the legal status of the client, current services and support plan, and client financial documentation. This shall be taken to include any central client record as maintained under the Agency data management system, whether paper or electronic in format.

(5) “Controlled medication” means any substance enumerated in Schedules I, II, III, IV, and V, in section 893.03, F.S.

(6) “Corrective Action Plan” means a written plan of action developed by the provider in cooperation with the Agency for correcting cited deficiencies in compliance with this chapter.

(7) “Current prescriber order” means a prescription or order that has not been discontinued by the prescriber and may be dispensed until the prescribed number of refills has been fulfilled and administered, or until the medication has expired.

(8) “Direct-support professional” means the same as defined in section 393.063(13), F.S.

(9) “Dispense” means the same as defined in section 465.003(6), F.S.

(10) “Drug monograph” means the informational documents that are provided every time a new medication is ordered for a patient that contains specific drug-related uses, warnings, side effects and other information, depending on the medication dispensed.

(11) “Expiration date of a prescription” is the date after which the prescription may not be dispensed by the pharmacy, or one year after the written date of the prescription, except in the case of a controlled medication, which, depending on class, could expire at any time, from immediately after the first fill to twelve months from the written date of the prescription.

(12) “Expired medication” is a medication that shall not be administered because the expiration date of the medication has passed. The expiration date of a medication is the date after which the medication expires per the pharmacist’s label or the label provided by the manufacturer on over-the-counter medications.

(13) “Facility” means a residential facility licensed under chapter 393, F.S., or other facility staffed by direct service providers where Agency clients receive training, respite care, or other services on a regularly scheduled basis.

(14) “Informed Consent for Medication Administration” means the specific consent a client or client’s legal representative gives to a provider that allows that provider to assist the client with medication administration, and on which the client or the client’s legal representative acknowledges that the provider is not professionally licensed to provide medication administration assistance.

(15) “Legal Representative” means:

(a) For clients under the age of 18 years, the legal representative or health care surrogate appointed by the Florida court to represent the child or anyone designated by the parent(s) of the child to act in the parent(s)’ behalf (e.g., due to military absence).

(b) For clients age 18 years or older, the legal representative could be the client, anyone designated by the client through a Power of Attorney or Durable Power of Attorney, a medical proxy under chapter 765, F.S., or anyone appointed by a Florida court as a guardian or guardian advocate under chapter 393 or 744, F.S.

(16) “Licensed Practical Nurse” or “LPN” means any person licensed or authorized by the State of Florida to practice practical nursing pursuant to chapter 464, F.S.

(17) “Medical Case Manager” or “MCM” means a health care practitioner employed by the Agency to provide consultation and technical assistance regarding the health and safety of Agency clients.

(18) “Medication” means over-the-counter medications and prescribed medications.

(19) “Medication Administration Record” or “MAR” means the chart maintained for each client that records the medication administration information required by this chapter. Other information or documents pertinent to medication administration may be attached to the MAR.

(20) “Medication Administration Trainer” or “Trainer” means an individual who is licensed or authorized to practice nursing by the State of Florida pursuant to chapter 464, F.S., and who obtains Agency approval to train MAP applicants in Basic Medication Administration, Prescribed Enteral Formula Administration, or Insulin Administration pursuant to Rule 65G-7.003, F.A.C.

(21) “Medication Assistance Provider” or “MAP” means a direct service provider not otherwise licensed to administer medication who has successfully completed an Agency-provided training course taught by an Agency-approved Trainer and has current validation to provide clients with medication administration or supervise clients with self-administration of medication.

(22) “Nebulizer” means an electrically-powered (including battery-powered) machine that turns liquid medication into a mist so that it can be breathed directly into the lungs through a mouthpiece or face mask.

(23) “Over-the-counter or “OTC” medication” means a medication for general distribution that is available to the general public for use in the treatment of human illnesses, ailments, or injuries.

(24) “Pharmacist” means any person licensed pursuant to chapter 465, F.S., to practice the profession of pharmacy.

(25) “Pharmacy profile” means the electronic file kept by the client’s pharmacy that maintains client-specific information and prescription history, such as date of birth, diagnoses, allergies, insurance information, and medication history.

(26) “Physician” means a Doctor of Medicine or Osteopathy who holds a valid and active license in full force and effect pursuant to the provisions of chapter 458 or 459, F.S.

(27) “Physician Assistant” or “PA” means a person who is a graduate of an approved program or its equivalent or who meets standards approved by the Board of Medicine and is licensed to perform medical services delegated by the supervising physician or osteopathic physician pursuant to chapters 458 and 459, F.S.

(28) “Prescribed medication” means simple or compound substances, mixtures of substances, or prescribed enteral formulas that are prescribed for the care, mitigation, or prevention of disease or for health maintenance by a licensed practitioner authorized by the laws of the State of Florida to prescribe or order such substances.

(29) “Prescription” means prescription as defined in section 465.003(23), F.S.

(30) “Primary route of medication administration” or “primary route” means the oral route, or in the case of a MAP who primarily administers medication via the enteral route, this term means the enteral route. The primary route refers to the route of medication administration that is used to determine the annual validation date of a specific MAP for the purpose of requiring retraining and validation if a lapse in validation occurs.

(31) “Provider” means either a single person providing services to a client of the Agency, including a CDC+ provider, or a business entity such as a Group Home or Adult Day Training Center providing services to clients of the Agency.

(32) “PRN” or “pro re nata” means the administration of medication on an as-needed basis rather than per a prescribed schedule.

(33) “Regional Office” is one of the local offices responsible for managing one of the Agency’s six service areas.

(34) “Registered Nurse” or “RN” means any person licensed or authorized by the State of Florida to practice professional nursing, pursuant to chapter 464, F.S.

(35) “Self-administration of medication without supervision” means that the client is capable of self-administering his or her own medications without any supervision, monitoring, verbal prompting, physical assistance, or cuing from staff.

(36) “State Office” is the Agency’s headquarters, situated at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0959; main telephone number (850)488-4257.

(37) “Subcutaneous” means beneath or under all layers of the skin.

(38) “Supervised self-administered medication” means direct, face-to-face observation of a client during the client’s self-administration of medication and includes instruction or other assistance necessary to ensure correct self-administration of the medication.

(39) “Supported living” means the provision of supports necessary for an adult who has a developmental disability to establish, live in, and maintain his or her own household in the community.

(40) “Unlicensed” means, for purposes of this rule, any direct service provider not licensed, authorized, certified, or otherwise permitted by Florida law to administer medication or to supervise a client’s self-administration of medication.

(41) “Validation” means a MAP or MAP applicant’s on-site demonstration of competency in administering or supervising self-administration of medication(s) to a client, certified by a Validation Trainer following the direct service provider’s successful completion of an Agency-provided medication administration training course, or successful annual completion of an Agency provided in-service on medication error prevention and medication administration.

(42) “Validation Trainer” means a practitioner who is licensed or authorized to practice nursing by the State of Florida pursuant to chapter 464, F.S., or who is licensed or authorized to practice medicine by the State of Florida pursuant to chapter 458 or 459, F.S., and who obtains Agency approval to validate MAPs or MAP applicants in Medication Administration, Prescribed Enteral Formula Administration, or Insulin Administration pursuant to Rule 65G-7.0035, F.A.C.

(43) “Validation by simulation” means the in-person, one-on-one imitation by a MAP or MAP applicant of the actual process used when administering medication or supervising the self-administration of medication by a particular route, which must occur as part of the required Medication Administration Training Course.

(44) “Waiver Support Coordinator” or “WSC” means a Support Coordinator as defined in section 393.063(43), F.S.

Rulemaking authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, 3-26-26.

Fla. Admin. Code R. 65G-7.002 Authorization for Medication Administration and Informed Consent Requirement

(1) An Agency client’s need for assistance with medication administration or ability to self-administer medication without supervision must be documented by the client’s physician, PA, or APRN on an “Authorization for Medication Administration,” APD Form 65G-7.002 A, effective April 2019, incorporated here by reference, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10587.

(a) The client’s current Authorization Form must be maintained in the client’s current place of residence, with a copy of the form in the client’s record. The WSC is responsible for assuring that all providers that assist a client with medications have an up-to-date copy of the Authorization.

(b) The Authorization Form must be reviewed and updated by the client’s physician, PA, or APRN at least annually and upon any change in the client’s medical condition or self-sufficiency that would affect the client’s ability to self-administer medication or tolerate particular administration routes. Any provider who accompanies a client to a medical professional when a change to the Authorization Form is made is responsible for notifying the WSC of any new Authorization Form.

(2) In addition to an executed Authorization for Medication Administration Form and before providing a client with medication assistance, an unlicensed provider must also obtain from the client or the client’s legal representative a signed “Informed Consent for Medication Administration” APD Form 65G-7.002 B, effective December 2018, incorporated herein by reference, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10588.

(a) The Informed Consent for Medication Administration must be updated annually or at any point when there is any change in the client’s residential facility provider or other provider agency.

(b) The current Informed Consent for Medication Administration must be maintained in each location or facility in which the client is receiving supervision of self-administration of medication or administration of medication. A copy of each provider’s Informed Consent for Medication Administration must also be in the client’s record.

(c) The MAP may not act as the client’s health care surrogate or proxy or sign the Informed Consent for Medication Administration referenced above. Providers or other facility staff may witness the execution of the form by the client.

(3) A MAP shall limit his or her assistance to the minimum necessary to ensure proper administration or supervised self-administration of the medication while preserving the client’s independence.

(4) The requirements of this chapter do not apply to the following:

(a) Health care practitioners whose professional licenses include administration of medication, except all health care practitioners who provide medication assistance to Agency clients must ensure the medication administration related documentation requirements attached to Agency clients are maintained pursuant to this chapter to ensure the safety and welfare of the clients. This includes the use of the following forms in cases where the client is served by both MAPs and licensed health care practitioners:

The Authorization for Medication Administration, pursuant to subsection (1);
A medication administration record to document any medications given as instructed in Rule 65G-7.008, F.A.C. The health care practitioner may use the Medication Administration Record Form, APD Form 65G-7.008 A, adopted and incorporated by reference in Rule 65G-7.008, F.A.C.;
The Insulin Administration Log, APD Form 65G-7.008, adopted and incorporated by reference in Rule 65G-7.008, F.A.C.;
The Off-Site Medication Form, APD Form 65G-7.009 A, adopted and incorporated by reference in Rule 65G-7.009, F.A.C.;
The Medication Destruction Record, APD Form 65G-7.007 A, adopted and incorporated by reference in Rule 65G-7.007, F.A.C.;
The Medication Error Report, APD Form 65G-7.006 A, adopted and incorporated by reference in Rule 65G-7.006, F.A.C.;
The Controlled Medication Count Form, APD Form 65G-7.007 B, adopted and incorporated by reference in Rule 65G-7.007, F.A.C.;

(b) Client family members or friends who provide medication assistance without compensation, as permitted by section 464.022(1), F.S.;

(c) Providers employed by or under contract with State Medicaid intermediate care facilities for the developmentally disabled, regulated through chapter 400, part VIII, F.S., providers employed by or under contract with licensed home health agencies regulated (except as referenced in paragraph (a), above) under chapter 400, Part III, hospices (except as referenced in paragraph (a), above) regulated under chapter 400, part IV, health care service pools (except as referenced in paragraph (a), above) regulated through chapter 400, part IX, F.S., or providers employed by or under contract with assisted living facilities regulated through chapter 429, part I, F.S.; and

(d) Clients authorized to self-administer medication without assistance or supervision as described in rule 65G-7.0025, F.A.C., except as pertains to storage of medications as outlined in Rule 65G-7.007, F.A.C.

(e) Direct-support professionals and client relatives when administering insulin in group homes in compliance with section 393.504, F.S.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, 3-26-26.

Fla. Admin. Code R. 65G-7.0025 Self-Administration of Medication Without Supervision

A client who is authorized by his or her health care practitioner to self-administer medication without the supervision of a MAP or a licensed or authorized nurse, as set forth in the Authorization for Medication Administration Form, APD Form 65G-7.002 A, adopted and incorporated by reference in Rule 65G-7.002, F.A.C., may do so. Any provider who helps the client may do so by making the medication available and reminding the client to take his or her own medication at appropriate times. This does not negate the requirement that the client be capable of self-administering his or her own medications without any supervision, monitoring, verbal prompting, physical assistance, or cuing from staff. Medications for the self-administering client may be stored pursuant to Rule 65G-7.007, F.A.C., and the entire container of medications provided to the client at the appropriate time(s), without further assistance. A pill organizer (also known as “pill minder” or “pill box”) may be used by a client who self-administers without supervision, however the client must fill the pill organizer without any supervision, monitoring, verbal prompting, physical assistance, or cuing from staff. MAPs may not transfer the medications from the original container to any other container.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 7-1-19, Technical Change 2-5-26.

Fla. Admin. Code R. 65G-7.003 Medication Administration Trainer Requirements

(1) Proposed Trainers must receive Agency approval before providing or offering to provide any of the following three medication administration courses to MAP applicants:

(a) Basic Medication Administration Training;

(b) Prescribed Enteral Formula Administration Training; or

(2) Trainer Eligibility: To be eligible for approval to provide medication administration courses, individuals must:

(a) Be licensed or authorized to practice:

Nursing by the State of Florida pursuant to chapter 464, F.S.; or
Medicine as a physician in the State of Florida pursuant to chapter 458 or 459, F.S.
To be eligible for approval to provide Insulin Administration Training, individuals must be a licensed Registered Nurse or Advanced Practice Registered Nurse pursuant to chapter 464, F.S., or be authorized to practice medicine as a physician pursuant to chapter 458 or 459, F.S.

(b) Apply on Medication Administration Trainer Application Form, APD Form 65G-7.003 A, effective March 2026, adopted and incorporated herein, which may be obtained at http://flrules.org/Gateway/reference.asp?No=Ref-19162. The application must include the full address, email address, and telephone number of the applicant, and his or her name, nursing license number and license expiration date. Applicants that wish to provide the prescribed enteral formula administration course or the insulin administration course must clearly indicate so on the Medication Administration Trainer Application Form.

(c) Complete the training required in subsection (5). The application for training is not considered complete until the Medication Administration Trainer Application Form indicates that the training has been successfully completed by the MCM providing the overview course.

(3) If the Agency denies an application to offer training, it will identify the reasons for the denial in writing in a notice to the applicant. This notice shall include a statement of the applicant’s due process rights to a hearing pursuant to sections 120.569 and 120.57, F.S.

(4) Approved Trainers shall:

(a) Only provide training for courses which they have been approved to train;

(b) Use standard course curriculum provided by the Agency for all medication administration training, prescribed enteral formula administration training, and insulin administration training, with the exception of providers using previously approved web-based curriculums as of July 1, 2018. Such web-based providers may continue to use those web-based courses, so long as the curriculum continues to meet curriculum standards as set forth in Rule 65G-7.0033, F.A.C. Otherwise, the Agency-provided curriculums are the only course curriculums that may be used for training MAP applicants. Failure to teach the curriculum to the Agency standards and requirements as set forth in Rule 65G-7.0033, F.A.C., shall subject the trainer’s approval to disciplinary action, including revocation of approval;

(c) Submit proof of nursing license renewal to their Regional Office MCM within 30 days of renewal in order to maintain approval for training. The proof of nursing license renewal may be submitted via email, by mail or other delivery, or in person;

(d) Inform the Regional Office within 30 days of occurrence when the Trainer’s nursing license is revoked, or the Trainer otherwise loses the authority to practice nursing in the State of Florida. If the Trainer’s nursing license is revoked or if the Trainer otherwise loses the authority to practice nursing in the State of Florida, the approved Trainer shall immediately be removed from any training he or she may be scheduled to provide;

(e) Notify the Regional Office within 30 days of any changes to the Trainer’s contact information, including telephone number, email address, or mailing address;

(f) Provide a schedule of training courses to the local Regional Office MCMs and any other Regional Office MCMs in whose areas their course may be provided. This schedule must include all courses, including place, date, and time. If a course is scheduled or changed after the training dates have been provided, an email including the updated place, date, and time of the course to any Agency Office previously notified as soon as the course is scheduled is sufficient. If a Trainer works for an entity that employs Trainers for the purpose of providing this training, the entity may submit the course dates to the Regional Office for the Trainer. The Trainer is responsible for ensuring the course schedule is provided to the Regional Office;

(g) Make provision for Agency employees to observe their training upon request. This requirement includes Trainers providing web-based distance learning courses. The Agency shall randomly attend training to ensure that Trainers are meeting the requirements of the provided Agency curriculum. In addition, the Agency shall attend trainings if specific complaints have been received regarding the training to ensure that Trainers are meeting the requirements of the provided Agency curriculum.

(h) Maintain a copy of a training roster for each course provided, including a list of attendees, and a list of attendees who successfully completed the course, beginning on July 1, 2019. These documents must be maintained for at least two years.

(5) All Trainers must attend:

(a) An Initial Training providing an overview of Chapter 65G-7, F.A.C., provided by a Regional Office MCM before the application to provide medication administration training is approved. Locations and information on how to attend this training can be obtained from the Regional Office. Contact information for each Regional Office may be found at www.apdcares.org/locations;

(b) An Annual Update Training course provided by a Regional Office MCM, which is due no later than December 31st of each year. Trainers approved within 6 months prior to December 31st may forego taking the annual update until the year following the year the Trainer is initially approved.

(6) The Agency shall assign a Trainer Number to each Approved Trainer that the Trainer must display on all materials used in connection with the courses taught. The individual who has obtained a Trainer Number is authorized to teach medication administration courses, prescribed enteral formula administration courses, insulin administration courses, or all such courses throughout the State of Florida.

(7) Any Approved Trainer who has received a Trainer Number prior to January 1, 2019, may continue to provide training using the most current curriculum provided by the Agency. The Trainer shall not be required to attend the initial Chapter 65G-7, F.A.C., overview mentioned in paragraph (5)(a). The Trainer shall be required to attend the Annual Update Training described in paragraph (5)(b).

(8) The Agency shall deny a Trainer’s application for failure to comply with the application or eligibility requirements or for any of the following:

(a) Obtaining or attempting to obtain approval through fraud, deceit, false statements, or misrepresentation of material facts, whether such statements are made knowingly or negligently;

(b) Failing to provide complete and accurate information in the initial application for approval or in any request for information from the Agency during the application process;

(c) Failing to notify the Agency within 30 days of a change in the information required for approval, including contact and address information;

(d) Failing to provide information regarding the applicant’s eligibility requirements or providing information indicating that the applicant does not meet eligibility requirements. Nursing licenses or authorizations in current but inactive status must be updated to active status before an approval may be provided.

(9) Failure to comply with section 393.506, F.S., or any provision of Chapter 65G-7, F.A.C., shall subject the Trainer’s approval to disciplinary action, including use of a corrective action plan, suspension, or revocation of the Trainer’s approval. If revoked, the Trainer shall not subsequently be approved to provide medication administration training, prescribed enteral formula administration training, or insulin administration training. The Agency may take action against a Trainer’s approval if the Trainer fails to comply with section 393.506, F.S., or Chapter 65G-7, F.A.C., including any of the following actions or omissions:

(a) Obtaining or attempting to obtain approval through fraud, deceit, false statements, or misrepresentation of material facts, whether such statements are made knowingly or negligently;

(b) Failing to provide complete and accurate information in the initial application for approval or in any notification of change in information, including contact information;

(d) Falsifying any records regarding the course;

(e) Failing to attend the required annual review through a Regional Office;

(f) Failing to maintain any required records regarding the course, including attendance, hours of training, date of course, name of course, and any other persons assisting the Trainer;

(g) Failing to maintain the course curriculum in the format and content provided by the Agency, with the exception that a Trainer may make minor alterations to the format when developing a web-based curriculum;

(h) Permitting Trainers who are not currently actively licensed or authorized to practice nursing by the State of Florida to provide training;

(i) Permitting individuals who have not been approved by the Agency to provide training;

(j) Failing to notify the Agency of individuals who are providing training that the Trainer knows are not approved by the Agency;

(k) Permitting individuals who have had their approval revoked to provide training;

(l) Providing training while not currently licensed or authorized to practice nursing by the State of Florida or providing training after the nursing license or authorization has been revoked or otherwise acted upon by the State of Florida;

(m) Failing to notify the local Regional Office in a region in which their course may be provided of all scheduled medication administration training courses, including place, date, and time;

(n) Sharing the course exam with persons not participating in the course in any form, including on the internet, or to a student prior to the student taking the exam;

(o) Providing training that the Agency determines does not meet the standards set forth pursuant to Rule 65G-7.0033, F.A.C.;

(p) Failing to provide simulation of all approved routes of medication administration during a medication administration course, unless the course is web-based and the simulation will be provided by the Validating Trainer under the supervision or direction of the Medication Administration Trainer.

(10) Training Certificates:

(a) Certificate Requirements for Trainer: Upon successful completion of the Initial Training and the Annual Update Training, the Agency shall issue the Trainer a completed Certificate of Completion. The Certification shall include the Trainer Number issued by the Agency. Trainers who have successfully completed the Initial Training or the Annual Update Training must maintain the original Certificate indicating successful completion of training and provide it to the Agency upon request.

(b) Certificate Requirements for MAP Applicants:

Upon successful completion of the Basic Medication Administration examination, the Trainer shall issue the examinee a completed Certificate of Completion for Basic Medication Administration Training, APD Form 65G-7.003 B, effective December 2018, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10590. Upon successful completion of the validation by simulation and the course exam, the Trainer shall issue the examinee a partially completed Basic Medication Administration Validation Certificate, APD Form 65G-7.003 C, effective April 2019, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10591. This Validation Certificate Form shall reflect the examinee’s successful completion of the validation by simulation only and may not be issued prior to the successful completion of the exam.
Upon successful completion of the Prescribed Enteral Formula Medication Administration examination, the Trainers shall issue the examinee a completed Prescribed Enteral Formula Administration Certificate of Completion, APD Form 65G-7.003 D, effective April 2019, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10592.
Upon successful completion of the Insulin Administration examination, the Trainer shall issue the examinee a completed Insulin Administration Certificate of Completion, APD Form 65G-7.003 E, effective March 2026, adopted and incorporated herein, which may be obtained at https://flrules.org/Gateway/reference.asp?No=Ref-19174.
The Certificate(s) shall contain the following:

a. Trainer’s name and Trainer Number;

b. Trainer’s nursing license number and date of expiration;

c. Date(s) of course;

d. Name of the student; and

e. Signature of Trainer.

Trainers shall not substitute a different form for the certificate forms listed in paragraph (10)(b).

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, 3-26-26.

Fla. Admin. Code R. 65G-7.0033 Medication Administration Training Course Curriculum Requirements

(1) The Agency shall provide Medication Administration Training curriculum for the following courses:

(a) Basic Medication Administration course;

(b) Prescribed Enteral Formula Administration course; and

(2) Basic Medication Administration course curriculum requirements:

(a) Basic Medication Administration Courses shall:

Not be less than 6-hours in length;
Be limited to no more than 20 participants in each class; and
Use the test provided by the Agency.

(b) The Basic Medication Administration Course Curriculum, as provided by the Agency covers:

Safe storage, handling, and disposal of medications;
Understanding medication instructions;
Medical indications and purposes of commonly used medications;
Common side effects;
Symptoms of adverse reactions;
Proper administration of medications, including the following routes:

a. Oral;

b. Enteral;

c. Transdermal, including validation by simulation;

d. Ophthalmic;

e. Otic, including validation by simulation;

f. Rectal;

g. Inhaled; and

h. Topical, including validation by simulation.

Safety and sanitation while administering medication;
Medication administration documentation and recordkeeping;
Medication errors and error reporting;
Administrative documentation requirements including, but not limited to:

a. Authorizations; and

b. Consents.

Offsite medication procedures; and
Validation requirements.

(c) Web-Based course curriculum requirements: Basic Medication Administration Trainers may provide the Agency course via web-based distance learning if the course complies with the following curriculum requirements in addition to the requirements provided for in paragraphs (2)(a) and (2)(b):

The course taught must:

a. Demonstrate:

(I) Interactivity between the student and course provider within 24 hours;

(II) How interactivity promotes student involvement, and

(III) That the course measures learning and addresses comprehension of content at regular intervals;

b. Monitor student enrollment, participation, and course completion;

c. Provide for in-person simulation of routes as indicated in Rule 65G-7.004, F.A.C.;

d. Be able to satisfactorily demonstrate that stated course hours (minimum of 6) are consistent with the actual course hours spent by the student to complete the course;

e. Assure qualified instructors will be available to answer questions and provide students with necessary support during the course; and

f. Require that the student complete a statement at the end of the course indicating that he or she personally completed each module/session of instruction.

A Trainer may make changes to the format but not the content of the Agency-provided curriculum or exams that are provided with the Agency curriculum when developing a web-based course, so long as the changes have been approved by the Agency;
To meet the requirements for competency in otic, transdermal, and topical medication simulation set forth in section 393.506(2)(a), F.S., the Validation Trainer may supervise the simulation for the completion of the initial training under written instruction from the Medication Administration Course Trainer for web-based courses only.

(3) Prescribed Enteral Formula Administration Course Requirements:

(a) Prescribed Enteral Formula Administration Training shall:

Not be less than two hours in length and include didactic, demonstration, and return demonstration elements;
Be limited to no more than 6 participants for each class;
Use the test provided by the Agency.

(b) The Prescribed Enteral Formula Administration Course Curriculum, as provided by the Agency covers:

Safe storage, handling, and disposal of prescribed enteral formulas;
Understanding administration instructions;
Symptoms of adverse reactions;
Proper administration of prescribed enteral formulas; and
Validation requirements.

(4) Insulin Administration Course Requirements:

(a) Insulin Administration courses shall:

Not be less than four hours in length and include didactic, demonstration, and return demonstration elements;
Be limited to no more than six participants for each class; and
Use the test provided by the Agency.

(b) The Insulin Administration course curriculum, as provided by the Agency, covers:

Safe storage and handling of insulin, including proper disposal of administration equipment;
Understanding administration instructions;
Proper administration of insulin;
Symptoms of hypoglycemia and hyperglycemia;
Potential adverse reactions, including reactions at administration sites; and
Validation requirements.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 7-1-19, Amended 3-26-26.

Fla. Admin. Code R. 65G-7.0035 Validation Trainer Requirements

(1) Individuals must first receive Agency approval as a Validation Trainer before validating or offering to validate the competency of a MAP or MAP applicant to provide either:

(a) Basic medication administration assistance;

(b) Prescribed enteral formula administration; or

(2) Validation Trainer Eligibility: To be eligible for approval as a Validation Trainer, individuals must:

(a) Be licensed or authorized to practice:

Nursing in the State of Florida pursuant to chapter 464, F.S. Validation Trainers for Insulin Administration must be a licensed Registered Nurse or Advanced Practice Registered Nurse pursuant to chapter 464, F.S.; or
Medicine as a physician in the State of Florida pursuant to chapter 458 or 459, F.S.

(b) Apply on Validation Trainer Application Form, APD Form 65G-7.0035 A, effective March 2026, adopted and incorporated herein, which may be obtained at http://flrules.org/Gateway/reference.asp?No=Ref-19163. The application must include the full address, email address, and telephone number of the applicant, and his or her name, professional license number, and expiration date. Applicants who wish to validate the competency of MAPs or MAP applicants to provide prescribed enteral formula administration or insulin administration must clearly indicate so on the Validation Trainer Application Form.

(c) Complete the validation requirements overview required in subsection (5). The application for training is not considered complete until the Validation Trainer Application Form indicates that the validation requirements overview has been successfully completed by the MCM providing the overview course.

(3) If the Agency denies an application to offer Validation training, it will identify the reasons for the denial in writing in a notice to the applicant. This notice shall include a statement of the applicant’s due process rights to a hearing pursuant to sections 120.569 and 120.57, F.S.

(4) All Validation Trainers must:

(a) Submit proof of professional license renewal to their Regional Office within 30 days of renewal to maintain approval for training. The proof of professional license renewal may be submitted via email, by mail or other delivery, or in person;

(b) Inform the Regional Office within 30 days of occurrence when a Validation Trainer’s professional license is revoked or loses the authority to practice nursing or medicine in the State of Florida. If the Validation Trainer’s professional license is revoked or the Trainer otherwise loses the authority to practice medicine or nursing in the State of Florida, the Validation Trainer shall immediately be removed from any training he or she may be scheduled to provide;

(c) Notify the Regional Office within 30 days of any changes to contact information, including telephone number, email address, or mailing address;

(d) Make provision for Agency MCMs or other Agency employees to observe the Validation Trainer’s validation training upon request.

(5) All Validation Trainers must attend:

(a) An initial validation requirements overview provided by a Regional Office MCM before their application to provide validation is approved. Information on how to contact the Regional office can be found at http://apdcares.org/region/. Medication Administration Trainers who have been approved by the Agency to provide Basic Medication Administration Training may provide Validation Training without attending an initial validation requirements overview, but must comply with all other requirements of this rule;

(b) A for-cause follow-up review of validation requirements upon notification by a Regional office MCM. A for-cause follow-up review may be requested by an MCM in the case of a complaint submitted to or discovered by the Agency, or a statutory or regulatory amendment.

(6) The Agency shall assign a Validation Trainer Number to each Approved Validation Trainer that the Validation Trainer must display on all materials used in connection with the validations completed. The individual who has obtained a Validation Trainer Number is authorized to validate medication administration, prescribed enteral formula administration, insulin administration, or all validations throughout the State of Florida.

(7) The Agency shall deny a Validation Trainer’s application for failure to comply with application or qualification requirements or for any of the following:

(a) Obtaining or attempting to obtain approval through fraud, deceit, false statements, or misrepresentation of material facts, whether such statements are made knowingly or negligently;

(b) Failing to provide complete and accurate information in the initial application for approval or in any request for information from the Agency during the application process;

(c) Failing to notify the Agency within 30 days of a change in the information required for provider approval, including contact and address information;

(d) Failing to provide information regarding the applicant’s eligibility requirements or providing information indicating that the applicant does not meet eligibility requirements. Professional licenses in current but inactive status must be updated to active status before an approval may be provided.

(8) Failure to comply with section 393.506, F.S., or any provision of Chapter 65G-7, F.A.C., shall subject the Validation Trainer’s approval to disciplinary action, including use of a corrective action plan, suspension, or revocation of the Validation Trainer’s approval. If revoked, the Validation Trainer shall not subsequently be approved to provide validation training. The Agency shall take action against a Validation Trainer’s approval for any of the following actions or omissions:

(a) Obtaining or attempting to obtain approval through fraud, deceit, false statements, or misrepresentation of material facts, whether such statements are made knowingly or negligently;

(b) Failing to provide complete and accurate information in the initial application for approval or in any notification of change in information, including contact information and address;

(d) Falsifying any records;

(e) Failing to attend any required overview or review through a Regional Office;

(f) Failing to maintain any required records regarding the validation of competency;

(g) Permitting Validation Trainers who are not currently actively licensed or authorized to practice nursing or medicine by the State of Florida to validate competency for MAPs or MAP applicants;

(h) Permitting individuals who have not been approved by the Agency to validate competency for MAPs or MAP applicants;

(i) Permitting individuals to provide validation training after their approval has been revoked;

(j) Providing validation while not currently licensed or authorized to practice nursing or medicine by the State of Florida or providing validation after the professional license or authorization has been revoked or otherwise acted upon by the State of Florida.

(9) Training Certifications:

(a) Certificate Requirements for Validation Trainers: Upon successful completion of the initial overview, the Agency shall issue the Validation Trainer a completed Certificate of Completion. Validation Trainers who have successfully completed the initial overview must maintain the original Certificate indicating successful completion and provide it to the Agency upon request.

(b) Certificate Requirements for MAP Applicants:

Upon successful completion of the on-site validation, the Validation Trainers shall complete the Basic Medication Administration Validation Certificate, APD Form 65G-7.003 C, effective April 2019, adopted in Rule 65G-7.003, F.A.C.
Upon successful completion of the on-site validation completed during the Prescribed Enteral Formula Administration validation, the Validation Trainers shall issue the examinee a completed Prescribed Enteral Formula Administration Validation Certificate, APD Form 65G-7.0035 B, effective December 2018, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10594.
Upon successful completion of the on-site validation completed during the Insulin Administration validation, the Validation Trainers shall issue the examinee a completed Insulin Administration Validation Certificate, APD Form 65G-7.0035 C, effective March 2026, adopted and incorporated herein, which may be obtained at https://flrules.org/Gateway/reference.asp?No=Ref-19175.
The Certificate(s) shall contain the following:

a. Medication Administration Trainer’s name and Trainer Number;

b. Validation Trainer’s name, Trainer Number, and signature;

c. Validation Trainer’s nursing or physician licensing number and date of expiration;

d. Date(s) of validation(s);

e. Name of the student; and

f. All routes validated.

Validation Trainers shall not substitute a different form for the certificate forms listed in paragraph (9)(b).
If the Validation Trainer provides subsequent validations for a MAP who has previously been validated on other routes, the Validation Trainer shall document the subsequent successful validations on the MAP’s original Validation Certificate, in the space provided.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 7-1-19, Amended 3-26-26.

Fla. Admin. Code R. 65G-7.004 Medication Assistance Provider Training and Validation Requirements

(1)(a) Unless otherwise authorized by law in the State of Florida, an individual shall not administer medication or supervise the self-administration of medication to Agency clients unless he or she has successfully completed an Agency-provided medication administration training course and obtained a current validation for the route by which the medication is administered. These requirements are necessary in order for an individual to become or remain a MAP.

(b) Unless otherwise authorized by law in the State of Florida, individuals who are not currently recognized by the Agency as a MAP permitted to administer prescribed enteral formulas or supervise the self-administration of prescribed enteral formulas to Agency clients are prohibited from doing so. MAPs or other unlicensed direct service providers administering prescribed enteral formulas who have previous training in the administration of prescribed enteral formula at the time this rule becomes effective shall have until December 31, 2019 to obtain the training and validation required to continue administering prescribed enteral formulas to clients, during which time they may continue to administer prescribed enteral formulas.

(c) Unless otherwise authorized by law in the State of Florida, individuals who are not recognized by the Agency as a MAP permitted to administer insulin or supervise the self-administration of insulin to Agency clients are prohibited from doing so.

(2) An individual who wishes to obtain authorization as a MAP to administer medication or supervise the self-administration of medication to Agency clients must:

(a) Complete the Agency-approved Basic Medication Administration Training, including validation by simulation for the otic, transdermal, and topical routes as part of the training course. If the individual is not given the opportunity by the Trainer to obtain the required validation by simulation, he or she may obtain on-site validation from the Validation Trainer by either simulation or with an actual client using the client’s medication. A list of available Trainers may be obtained from the Regional Office MCM;

(b) Complete a two-part, Agency-provided exam within three calendar days of completing the Medication Administration Training, achieving a score of at least 85% on the Course Content section of the exam and 100% on the MAR section of the exam. If the individual fails to obtain a passing score, he or she may be permitted by the Trainer to retake the examination once to attempt to obtain a passing score. If the individual fails to obtain a passing score the second time, he or she must retake the Medication Administration Training prior to being permitted to attempt to obtain a passing score. If the individual fails to take the exam within three calendar days, he or she must take the course again in order to sit for the exam; and

(c) Obtain validation pursuant to subsections (5) and (6), prior to being permitted to assist in medication administration.

(3) A MAP or MAP applicant who wishes to administer or supervise self-administration of prescribed enteral formulas must:

(a) Be authorized as a MAP for the administration or supervision of self-administration of medication, pursuant to subsection (2);

(b) Complete the Agency-provided Prescribed Enteral Formula Administration Training. A list of available Trainers may be obtained from the Regional Office MCM;

(c) Complete a two-part, Agency-provided exam following the Prescribed Enteral Formula Administration training, achieving a score of at least 85% on the course content section of the exam and 100% on the simulated return demonstration. If the individual fails to obtain a passing score, he or she may be permitted by the Trainer to retake the examination once to attempt to obtain a passing score. If the individual fails to obtain a passing score the second time, he or she must retake the Prescribed Enteral Formula Administration Training prior to being permitted to attempt to obtain a passing score;

(d) Obtain validation focused on prescribed enteral formula administration pursuant to subsections (5) and (6), in addition to the Agency-provided medication administration training course and validation; and

(e) MAPs or other unlicensed direct service providers administering prescribed enteral formulas who have previous training in the administration of prescribed enteral formula at the time this rule becomes effective shall have 180 days from the effective date of the rule to obtain the training and validation required to continue administering prescribed enteral formulas to clients, during which time they may continue to administer prescribed enteral formulas.

(4) An individual who wishes to obtain authorization as a MAP to administer insulin or supervise the self-administration of insulin to Agency clients must:

(a) Be authorized as a MAP for the administration or supervision of self-administration of insulin pursuant to subsection (2);

(b) Complete Insulin Administration Course training. A list of available Trainers may be obtained from the Regional Office MCM;

(c) Complete a two-part, Agency-provided exam following the Insulin Administration Course training, achieving a score of at least 90% on the course content section of the exam and 100% on the APD Insulin Administration Log section of the exam. If the individual fails to obtain a passing score, he or she may be permitted by the Trainer to retake the examination, once, to attempt to obtain a passing score. If the individual fails to obtain a passing score the second time, he or she must retake the Insulin Administration Course training prior to being permitted to attempt to obtain a passing score; and

(d) Obtain validation focused on insulin administration pursuant to subsections (5) and (6), in addition to the Agency-provided medication administration training course and validation.

(5) Validation Requirements:

(a) Any MAP who is validated for otic, transdermal, or topical routes is not required to become revalidated for those three routes, unless the validation for the MAP’s primary route lapses. Any MAP who is validated for administration routes other than otic, transdermal, or topical routes, may obtain validation for these three routes via on-site validation from the Validation Trainer by either simulation or with an actual client using the client’s medication.

(b) MAP applicants must be assessed and validated as competent to administer medication or to supervise the self-administration of medication by an approved Validation Trainer after obtaining a passing score on the training examination. A list of available Validation Trainers may be obtained from the Regional Office MCM.

(c) MAP applicants who wish to administer prescribed enteral formula medication or to supervise the self-administration of prescribed enteral formula medication shall obtain a separate validation specific to prescribed enteral formula administration in addition to the validation required for Basic Medication Administration pursuant to paragraph (5)(a). A list of available Validation Trainers may be obtained from the Regional Office MCM.

(d) MAP applicants who wish to administer insulin shall obtain a separate validation specific to insulin administration in addition to the validation required for Basic Medication Administration pursuant to paragraph (5)(a). A list of available Validation Trainers may be obtained from the Regional Office MCM.

(e) The MAP must achieve a score of 100% proficiency in the validation prior to being approved to provide medication administration assistance, prescribed enteral formula administration, or insulin administration.

(f) MAP applicants must successfully complete their initial validation for their primary non-simulated medication administration routes within 180 days of completion of the Medication Administration Training, including Basic Medication Administration Training, Prescribed Enteral Formula Training, and Insulin Administration Training.

(6) Successful assessment and validation require that the applicant demonstrate his or her capability to correctly administer medication and supervise the self-administration of medications in a safe and sanitary manner in an on-site client-setting using the client’s prescribed medications, except for the simulated routes, which include otic, transdermal, and topical administration routes.

(a) Validation for Basic Medication Administration includes a demonstration of the following proficiencies:

The ability to comprehend and follow medication instructions on a prescription label, physician’s order, and properly complete a MAR form;
The ability to administer medication by oral, transdermal, ophthalmic, otic, rectal, enteral, inhaled, or topical administration routes;
The ability to obtain pertinent medication information, including the purpose of the medication, its common side effects, and symptoms of adverse reactions to the medication, either from the package insert that comes from the pharmacy, or other professionally recognized medication resource, and to maintain this information for easy access and future reference;
The ability to write legibly, convey accurate information, and communicate with Agency staff and other health care providers through the applicant’s writings in a manner that ensures the health, safety, and well-being of the clients;
The ability to comply with medication administration record-keeping requirements;
The ability to communicate in a manner that permits health care providers and emergency responders to adequately and quickly respond to emergencies,
Knowledge of the proper storage and handling of medications;
Knowledge of proper disposal of expired or unused medications;
Knowledge of special requirements relating to storage and disposal of controlled medications;
Knowledge of requirements for obtaining authorizations for medication administration assistance, authorization for self-administration of medication without supervision, and informed consent for medication administration assistance; and
Training on the correct positioning and use of any adaptive equipment or use of special techniques required for the proper administration of medication.

(b) Validation for Prescribed Enteral Formula Administration includes a demonstration of the following proficiencies:

The ability to comprehend and follow prescribed enteral formula instructions on a physician’s order and properly complete a MAR form;
The ability to administer prescribed enteral formula by the enteral administration route;
The ability to write legibly, convey accurate information, and comply with medication administration record-keeping requirements;
The ability to communicate in a manner that permits health care providers and emergency responders to adequately and quickly respond to emergencies;
Knowledge of the proper storage and handling of prescribed enteral formulas;
Adequate training on the correct positioning and use of any adaptive equipment or use of special techniques required for the proper administration of prescribed enteral formulas.

The ability to comprehend and follow insulin administration instructions on a physician’s order and properly complete a MAR form and the APD Insulin Administration Log form;
The ability to administer prescribed insulin by the subcutaneous administration route;
The ability to write legibly, convey accurate information, and comply with medication administration record-keeping requirements;
The ability to communicate in a manner that permits health care providers and emergency responders to adequately and quickly respond to emergencies;
Knowledge of the proper storage and handling of insulin; and
Demonstrates adequate training on the preparation of an insulin dose, identification and preparation of appropriate administration sites, and proper disposal of insulin administration equipment to ensure safe administration of insulin.

(d) Subsequent validations for additional routes may be completed by the MAP following his or her initial validation(s). If the MAP obtains a subsequent validation, he or she must ensure that the Validation Trainer documents the subsequent validation(s) on the MAP’s original Validation Certificate, in the space provided.

(7) To maintain his or her ability to administer or supervise the self-administration of medication, a MAP must attend an Update Training Course and be revalidated annually, subject to the following qualifications:

(a) Update Training Course (referred to as Annual Inservice Training in section 393.506, F.S.):

MAPs that administer or supervise self-administration of medications must attend an annual update training course in Basic Medication Administration provided by the Agency, prior to the expiration of their current validation. Upon successful completion of the Basic Medication Administration annual update, the MAP shall receive a Certificate of Completion for Basic Medication Administration Annual Update, APD Form 65G-7.004 A, effective December 2018, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10595.
MAPs that administer or supervise self-administration of prescribed enteral formulas must attend an annual update training course in Prescribed Enteral Formula Administration provided by the Agency prior to their re-validation. This course is required in addition to the Basic Medication Administration annual update training course. Upon successful completion of the Prescribed Enteral Formula Administration annual update, the MAP shall receive a Certificate of Completion for Prescribed Enteral Formula Administration Annual Update, APD Form 65G-7.004 B, effective December 2018, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10596.
MAPS that administer or supervise the self-administration of insulin must attend an annual update training course in Insulin Administration provided by the Agency prior to their revalidation. This course is required in addition to the Basic Medication Administration annual update training course. Upon successful completion of the Insulin Administration annual update, the MAP shall receive a Certificate of Completion for Insulin Administration Annual Update, APD Form 65G-7.004 C, effective March 2026, adopted and incorporated herein, which may be obtained at http://flrules.org/Gateway/reference.asp?No=Ref-19165.
MAPs who are required to re-validate on or before October 15, 2019 are permitted to complete the re-validation without completing the Update Training Course prior to re-validation.

(b) Re-Validation Requirements:

Effective and Expiration Dates:

a. Primary Routes.

(I) The effective date of a MAP’s primary route validation is the date that the MAP successfully completed the initial validation for that route.

(II) The expiration date for his or her primary route validation is based on the date of his or her initial validation received for a primary route of medication administration. The validation for the primary route of medication administration expires annually on the anniversary date of his or her initial effective date.

b. All Other Routes, Except Otic, Transdermal, and Topical Routes.

(I) The effective date of a MAP’s non-primary route(s), except otic, transdermal, and topical routes, is the date of the most recent validation for that specific route, regardless of when the MAP successfully completed the initial validation for that specific route.

(II) The expiration date for a MAP’s non-primary route(s), except otic, transdermal, and topical routes, is one year from the date of the most recent validation.

c. Otic, Transdermal, and Topical Routes.

(I) The effective date of a MAP’s otic, transdermal, and topical routes is the date that the MAP successfully completed the initial validation by simulation or with an actual client.

(II) Otic, transdermal, and topical routes do not expire.

2.a. If the MAP’s validation for the all administration routes other than the primary route expire, the MAP is not required to complete the required courses provided for in subsection (2). In this case, the MAP may continue to administer medications or supervise the administration of medications for routes for which the MAP maintains a current validation.

b. If the MAP’s validation for the primary routes expires, the MAP must complete the required courses provided for in subsection (2) and be revalidated for the primary route and all other routes, regardless of whether the non-primary route validations have expired, prior to being permitted to continue administering medications or supervising administration of medications.

MAPs shall, at least annually, through demonstration, be assessed and revalidated as competent to:

a. Administer medication or supervise the self-administration of medication;

b. Administer prescribed enteral formulas, if previously validated for prescribed enteral formula administration. This revalidation is in addition to the required revalidation for Basic Medication Administration; and

c. Administer insulin, if previously validated for administering insulin. This revalidation is in addition to the required revalidation for Basic Medication Administration.

A MAP must be re-validated annually within the 60 days preceding the expiration of his or her current validation.
MAPs who fail to acquire revalidation for the primary route of administration before the expiration of their validation for the primary route must retake the Basic Medication Administration Course and obtain current validation for their primary route within 180 days of completion of the Basic Medication Administration Course, prior to continuing to administer or supervise self-administration of medication;
MAPs who fail to acquire revalidation for prescribed enteral formula administration before the expiration of their validation must retake the prescribed enteral formula administration course and successfully revalidate within 180 days of completion of the Prescribed Enteral Formula Administration Course, prior to continuing to administer prescribed enteral formulas.
MAPS who fail to acquire revalidation for insulin administration before the expiration of their validation must retake the Insulin Administration Course and successfully revalidate within 180 days of completion of the Insulin Administration Course, prior to continuing to administer insulin.
MAPs must successfully complete their re-validation for their primary non-simulated medication administration routes within 60 days of completion of the Update Training Course, including the Update for Basic Medication Administration and Prescribed Enteral Formula.

(8) A MAP may only assist in the administration of medication through an administration route for which the MAP holds a current, active validation.

(a) When a client is prescribed a medication requiring an administration route for which the MAP has not yet been validated or for which his or her validation has expired, the MAP must obtain a validation for that specific administration route before administering the medication to the client via that route.

(b) Temporary Validation.

When a client is prescribed a medication requiring an administration route for which the MAP has not been validated, the MAP may obtain a temporary validation for only that specific administration route and only that specific client from any individual licensed or authorized to practice nursing in the State of Florida pursuant to chapter 464, F.S., or licensed to practice medicine as a physician in the State of Florida pursuant to chapter 458 or 459, F.S., if:

a. The prescribed medication is necessary to ensure the health and safety of the client;

b. The MAP or the MAP’s supervisor attempts and is unable to contact a MAP who is able to administer the medication at the appropriate dosage times and who is validated for the specific administrative route;

c. The MAP obtains a validation in that administration route from an Agency-approved Validation Trainer as soon as possible within 30 days of the date the temporary validation was signed by the medical professional;

d. The nurse or physician documents the validation using either Temporary Validation Form, Form 65G-7.004 C, effective March 2026, adopted and incorporated herein, which may be obtained at http://flrules.org/Gateway/reference.asp?No=Ref-19166, or using a document with the nurse or physician’s letterhead on it indicating:

(I) That the nurse or physician validated the MAP;

(II) The date of validation;

(III) The route of administration validated;

(IV) The length of time the validation is necessary in order to ensure the client obtains the medication as prescribed and to provide time for the MAP to either obtain a validation from an Agency-approved Validation Trainer or locate a MAP who is validated in the appropriate administration route to provide the medication. Under no circumstances shall a Temporary Validation last longer than 30 days from the date of validation.

If the physician or nurse uses a form with the nurse or physician’s letterhead on it rather than the Temporary Validation Form, the document used to record the Temporary Validation must be attached to the Temporary Validation Form. Completed Temporary Validation forms must be maintained by the MAP and his or her employer and be available to the Agency for review upon request.
A Temporary Validation can only be obtained for the following routes:

a. Oral;

b. Enteral, except for prescribed enteral formulas;

c. Transdermal;

d. Ophthalmic;

e. Otic;

f. Rectal;

g. Inhaled; and

h. Topical.

(c) If the client is prescribed an enteral formula, the MAP must obtain the required training and validation specific to prescribed enteral formula administration before administering prescribed enteral formula.

(d) Temporary validation cannot be issued for insulin administration. If the client is prescribed insulin, the MAP must obtain the required training and validation specific to insulin administration before administering insulin or supervising the self-administration of insulin.

(9) Once trained and validated on one nebulizer or intermittent positive pressure breathing machine, a MAP is not required to train on subsequent machines of the same type to qualify as validated for nebulizers or intermittent positive pressure breathing machines.

(10) Trained and validated MAPs must maintain the original certificates indicating successful completion of training and validation. Employers of MAPs must maintain a copy of the training certificate and proof of current validation of each employee providing medication administration assistance at the site where the medication administration assistance is being provided.

(11) Any employer or contractor who offers MAP services is responsible for maintaining a record of the MAP’s training certification and annual validation and for making such records available for Agency review upon request.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, 3-26-26.

Fla. Admin. Code R. 65G-7.005 Medication Administration Procedures

(1) Upon receipt of the Basic Medication Administration training certification and validation certification, MAPs are authorized to administer medications or to supervise the self-administration of medications via the following medication routes for which the MAP has been validated:

(a) Oral;

(b) Enteral, with the exception of prescribed enteral formulas;

(d) Otic;

(e) Ophthalmic;

(f) Rectal;

(g) Inhaled; and

(h) Topical.

(2) MAPs that have not completed the Prescribed Enteral Formula Administration Training and received the corresponding training certification and validation certification shall not administer Prescribed Enteral Formula.

(3) MAPs that have not completed the Insulin Administration training and received the corresponding training certification and validation certification shall not administer insulin or supervise the self-administration of insulin under this chapter.

(4) Licensed health care practitioners shall administer or supervise the self-administration of medications within their scope of practice.

(5) MAPs and licensed health care practitioners shall:

(a) Only provide administration of medication or supervision with self-administration of medications as prescribed or ordered by the client’s health care practitioner and which are properly labeled and dispensed in accordance with chapters 465 and 499, F.S. If multiple clients are prescribed identical OTC medications, the facilities may use a single stock container to provide the medications to multiple clients;

(b) Comply with new or changed orders for a specific medication, which override the previous orders for that medication. No order to discontinue the previous order is necessary;

(c) Comply with the time limit as provided for in time-limited orders (i.e. those that are ordered for a specific number of doses or days). Such orders do not require an order to discontinue at the completion of the time allotted in the time limit;

(d) Before administering medication or supervising the self-administration of medication, become familiar with the client’s medical history and medication background and locate the name and contact numbers of the client’s prescribing practitioner for consultation regarding the prescribed medications;

(e) Perform appropriate hand sanitation measures before administering medication or supervising the self-administration of medication, with repeated sanitization as needed during medication administration;

(f) Assist only one client at a time with medication administration in a quiet location free from distraction;

(g) Only prepare medications for one client, at the time the medication is given;

(h) Following the administration of medication or supervision of self-administration of medication, return each client’s medication to its portable or permanent medication storage location before assisting another client;

(i) Call the client’s primary care provider within 24 hours to reconcile the client’s medications with those ordered upon the client’s discharge from any inpatient, emergency, or urgent care facility. This call must be documented, along with the primary care provider’s response, including any instructions for medication administration and follow up. The primary care provider’s failure to respond should also be documented, along with continued attempts to contact him or her. If no licensed person is present to take the instructions from the primary care provider, the MAP must also ask for faxed or electronically supplied instructions;

(j) Immediately report torn, damaged, illegible, or mislabeled prescription labels to the dispensing pharmacist and, if a client is residing in a residential facility, notify the facility supervisor;

(k) Check the directions and expiration date of each medication to ensure that expired medications (those which are no longer current) or those no longer prescribed are not administered;

(l) Continue to provide medications for which there is a current prescriber order and the medication is not expired, but the prescription itself is expired, until the current supply is exhausted, or, in the case of a PRN medication, for no longer than 6 months after the date the prescription expired;

(m) Verify that the correct medication is administered to the correct client, at the correct time, with the correct dosage, by the correct route, and for the correct reason, as prescribed by the health care practitioner;

(n) Observe complete ingestion of oral medication before leaving the client and before recording or documenting the administration of the medication on the MAR;

(o) Record the date, time, dosage, and name of each regularly scheduled medication or PRN medication on the MAR immediately following administration or supervision of self-administration and sign or initial the entries. For PRN medications, the MAP or licensed health care practitioner must also enter the reason for the medication on the back of the MAR (if using the APD MAR form adopted and incorporated by reference in Rule 65G-7.008, F.A.C.) or in a place provided for such an entry on a pharmacy-provided or electronic MAR;

(p) Following the first three doses of a new medication, including PRN medications, observe the client directly for a minimum of 20 minutes and document observations to detect and respond immediately to potential side effects, unless ordered differently by the prescribing health care practitioner, and review the MAR for any special instructions by the prescribing practitioner regarding required observations. This documentation shall include both adverse reactions or a lack of adverse reactions to the new medication;

(q) Enter the response to the medication on the back of the MAR for PRN medications (state whether the medication alleviated the symptom for which it was given, e.g. “headache is better”) or in the place provided for such an entry on a pharmacy provided or electronic MAR. This entry should indicate date and time of entry, and be initialed or signed by the MAP or licensed health care practitioner;

(r) Ensure that the prescription for a medication is promptly refilled so that a client does not miss a prescribed dosage of medication. If the MAP or licensed health care practitioner is not responsible for routine refills of a medication, he or she shall notify the individual responsible for refilling the client’s prescriptions that the client needs a medication refill and document this notification;

(s) Keep on-site a copy of the prescription, order, or pharmacy profile with the client’s MAR or medical record, written or printed legibly and displaying the following information:

The client’s name;
The name of the medication;
The prescribed dosage;
The time intervals or specific times the medication must be given;
The administration route by which the medication must be given;
Specific directions for use;
The medical reason or diagnosis for which the medication was ordered or prescribed; and
For PRN medications, the complaint for which the medication is ordered, the maximum number of days that the medication should be given, the maximum number of doses per day, and conditions under which the health care practitioner should be notified.

(6) Licensed health care practitioners and MAPs who are validated to administer or supervise self-administration of whole (not crushed) oral medication may give the medication in any substance that facilitates swallowing and is tolerated by the client.

(6) A MAP who has been validated to administer or supervise self-administration of prescribed enteral formulas may administer prescribed enteral formulas through gastrostomy tubes, including percutaneous endoscopic gastrostomy (“PEG”), button-style gastrostomy, and jejunal (“JT”).

(7) In emergency situations, MAPs are permitted to administer prescribed rescue (emergency) medications via routes outlined by this rule chapter, if they have not been previously validated for that particular route. However, MAPs must have first received training by an individual licensed or authorized to practice nursing pursuant to chapter 464, F.S., or medicine as a physician pursuant to chapters 458 or 459, F.S., demonstrating the proper administration of the medication, in any route outlined in this rule chapter, that is being used in the emergency. Documentation of this training must be readily available to verify in-service training was provided.

(8) A MAP who has been validated to administer or supervise self-administration of insulin may administer prescribed insulin through an insulin pen or similar device designed for self-administration.

(9) In the administration of medications, a MAP shall not:

(a) Assist with the administration or supervise the self-administration of any OTC medication or medication samples without a written order by the client’s physician, PA, or APRN;

(b) Crush, dilute, or mix crushed medications without instructions from the prescribing health care practitioner or licensed pharmacist that have been transcribed to the MAR;

(c) Administer medications or supervise the self-administration of medications, including PRN and OTC medications, unless a health care practitioner has provided directions for the medication;

(d) Prepare syringes for a client’s use during the self-administration of medication via a subcutaneous, intra-dermal, intra-muscular or intravenous route;

(e) Administer medications or supervise the self-administration of medication route for which the MAP has not been validated, with the exception of a rectal gel prescribed for seizures and administered in an emergency situation;

(f) Administer medications or supervise the self-administration of medication via a parenteral, subcutaneous, intra-dermal, intra-muscular or intravenous route, with the exception of an epi-pen administered in an emergency situation, or the subcutaneous administration of insulin through an insulin pen, or similar device designed for self-administration, as authorized under this section;

(g) Administer or supervise self-administration of medications that are inserted vaginally, or administered via a tracheostomy;

(h) Perform irrigation of partial or full thickness wounds (such as vascular ulcers, diabetic ulcers, pressure ulcers, surgical wounds) or apply agents used in the debridement of necrotic tissues in wounds of any type;

(i) Supervise, monitor, prompt, assist or cue a client to correctly fill a pill organizer (also known as a “pill minder” and “pill box”); and

(j) Assist a client with medications for which the health care provider’s prescription or order does not specify the medication schedule, medication amount, dosage, route of administration, purpose for the medication, or with medication that would require professional medical judgment by the MAP.

(k) Administer medications or supervise the self-administration of medications from a pill organizer.

(10) A MAP who has been validated to administer or supervise self-administration of prescribed enteral formulas shall not:

(a) Administer prescribed enteral formulas through a Gastrojejunal (“GJ”) tube or any tube that requires venting or suction;

(b) Administer prescribed enteral formulas using any procedures that require clinical judgement, which is the process by which a licensed health care professional decides on data to be collected about a client, makes an interpretation of the data, arrives at a diagnosis, and identifies appropriate medical intervention; this involves problem solving, decision making, and critical thinking;

(d) Replace or attempt to replace a dislodged tube;

(e) Administer prescribed enteral formulas through nasal tubes of any type. These are commonly known as, but not limited, to nasogastric (“NG”), nasoduodenal (“ND”), and nasojejunal (“NJ”) tubes.

(11) MAPs shall comply with section 393.506, F.S., and this chapter.

(12) MAPs shall not:

(a) Obtain or attempt to obtain a passing grade on either the training course exam or validation through fraud, deceit, false statements, or misrepresentation of material facts, whether such statements are made knowingly or negligently;

(b) Falsify any records regarding medication administration;

(c) Continue to provide services as a MAP if he or she fails to successfully pass required re-validation on his or her primary route(s);

(d) Continue to provide medication administration or supervision of medication administration via any of the non-primary routes if he or she fails to successfully maintain his or her validation for the non-primary route.

(d) Provide services as a MAP while not currently authorized to do so by the State of Florida;

(e) Provide services as a MAP after the Agency has determined the MAP shall not continue to provide medication administration assistance.

(13) If a MAP violates any provision of section 393.506, F.S., or this chapter, the Agency shall:

(a) Prohibit the MAP from providing medication administration services to clients of the Agency;

(b) Request the MAP:

Successfully complete the Basic Medication Administration Course and corresponding validation;
Successfully complete the Prescribed Enteral Formula Administration Course and corresponding validation;
Participate in and successfully complete a corrective action plan; and
Comply with remediation requests.

(14) If a MAP or licensed health care practitioner violates any provision of section 393.506, F.S., or this chapter within an Agency-licensed residential facility, the Agency shall take such actions as set forth in Chapter 65G-2, F.A.C., against the residential facility where the MAP or licensed health care practitioner is providing services as is necessary to ensure the health, safety, and welfare of the Agency’s clients and third parties.

(15) Any person, including licensed health care practitioners, who in good faith renders emergency care or treatment in violation of this chapter, either in direct response to emergency situations related to and arising out of a public health emergency declared pursuant to section 381.00315, F.S., a state of emergency which has been declared pursuant to section 252.36, F.S., or at the scene of an emergency outside of a hospital, physician’s office, or other place having proper medical equipment, without objection of the injured victim or victims, shall not be held responsible for the administrative violation as a result of such care or treatment where the person acts as an ordinary reasonably prudent person would have acted under the same or similar circumstances.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, 3-26-26.

Fla. Admin. Code R. 65G-7.006 Medication Errors

(1) A “medication error” is any of the following:

(a) Administration or supervision of self-administration of a wrong medication, including:

Administration or supervision of self-administration of medication for any symptom, illness, or reason other than the one for which the medication was prescribed;
Administration or supervision of self-administration of medication for which there is no current prescriber order;

(b) Administration or supervision of self-administration of a wrong dose, including;

Administration or supervision of self-administration of an incorrect dose of medication;
Administration or supervision of self-administration of more than one dose of the same medication in a scheduled time period;

(c) Administration or supervision of self-administration of a medication to the wrong client, which means the administration or supervision of self-administration of medication to a client that is prescribed or ordered for someone else;

(d) Administration or supervision of self-administration of medication via the wrong route;

(e) Failure to administer or supervise the self-administration of medication within 60 minutes of the prescribed dosage time;

(f) Failure to immediately and accurately document administration or supervision of self-administration of medication on the MAR;

(g) Administration or supervision of self-administration of a medication which has expired or is improperly labeled;

(h) Failure to conduct an accurate medication count for controlled medications;

(i) Failure to administer or supervise the self-administration of a medication, for any of the following reasons:

Client refused the medication;
MAP or licensed health care practitioner did not administer or supervise the self-administration of the medication;
Medication was not available;
New order not initiated within 24 hours;
Refill not ordered timely;
Insurance issue;
Pharmacy issue;
Family error;
Other not given;

(j) Administration or the supervision of self-administration of medication by a MAP not validated as required by Rule 65G-7.004, F.A.C.

(2) Immediately following an error as listed in subsection (1), the MAP, licensed health care practitioner, or facility administrator must take the following steps:

(a) Notify supervisory personnel;

(b) In the case of administration of a wrong medication, a wrong dosage, or the provision of medication to the wrong client, immediately notify the client’s health care practitioner, observe the client closely for a minimum period of 60 minutes after the medication was administered or self-administration was supervised, or for as long as directed by the health care practitioner, and immediately report any observed changes in the client’s condition to the prescribing health care practitioner, and call 911 to request emergency services if the client exhibits respiratory difficulty or other potentially life-threatening symptoms;

(c) For all errors listed in subsection (1), with the exception of paragraphs e., f., g., h., and j., notify the client’s prescribing health care practitioner of the error, and if there is no licensed health care professional present, request that the practitioner prepare and electronically transmit via fax or secure email a medication directive addressing the error to the client’s home, facility, or pharmacy, and document the client’s health care practitioner’s response or lack of response; and

(d) Fully document all observations and contacts made regarding a medication error in a “Medication Error Report,” APD Form 65G-7.006 A, effective April 2019, incorporated herein by reference, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10598. The MAP or licensed health care practitioner shall place a copy of the Report in the client’s file. It is permissible to use an alternate Medication Error Report form generated by an electronic system, provided that the alternate electronic form collects all the information required and collected on the Agency form.

(3) If a medication error occurs in a facility, the MAP or licensed health care practitioner must:

(a) Submit the Medication Error Report to the facility administrator and to the Regional Office within 24 hours of discovering the error; and

(b) Maintain a copy of the report in the client’s record and also with the MAR for review.

(4) If a medication error occurs in a client’s home, the MAP or licensed health care practitioner who committed the error must:

(a) Submit a Medication Error Report to the Regional Office within 24 hours of discovering the error;

(b) Maintain a copy of the report in the client’s record and with the MAR for review.

(5) If a discrepancy in the accounting of a controlled substance occurs following a medication count, the MAP or licensed health care practitioner must report the discrepancy within 24 hours following discovery of the error to:

(a) The Regional Office; and

(b) The MAP’s or licensed health care practitioner’s supervisor, if applicable.

(6) If an Agency MCM determines that the medication error justifies corrective action, the Regional Office will notify the MAP, licensed health care practitioner, or his or her supervisor in writing of the necessary corrective action plan, including a specific and reasonable timeframe for completion of the corrective action plan. If the MAP or licensed health care practitioner fails to comply with the corrective action plan, the Agency may take action against:

(a) The MAP’s validation, including prohibiting the MAP from providing medication administration services; or

(b) The provider’s residential facility license, and

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, Technical Change 2-5-26.

Fla. Admin. Code R. 65G-7.007 Storage Requirements

(1) MAPs and licensed health care practitioners must observe the following medication storage requirements:

(a) Store each medication at the temperature appropriate for that medication, including refrigeration if required;

(b) Destroy any prescription medication that has expired per the pharmacist’s label or the label provided by the manufacturer on OTC medications, or is no longer prescribed and document the medication disposal on a “Medication Destruction Record,” APD Form 65G-7.007 A, effective April 2019, incorporated herein by reference, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10756. The MAP or licensed health care practitioner must sign the Record before a third-party witness;

(c) Maintain medication samples in their original containers labeled by the dispensing health care practitioner with the client’s name, the practitioner’s name, and the directions for administering the medication. The MAP or licensed health care practitioner must initial and add to the label the date the medication is opened;

(d) Maintain OTC medications in their original stock containers. OTC medications in original stock containers are not required to have individual client’s names provided on the container;

(e) Store the medications centrally in a locked container in a secured enclosure if the client requiring the medication assistance is residing or receiving services in a facility setting;

(f) Organize and maintain stored medications in a manner that ensures their safe retrieval and minimizes medication errors;

(g) Store all medications that require refrigeration in a refrigerator, in their original containers either within a locked storage container that is clearly labeled as containing medications, or in a medication dedicated refrigerator located in a locked, secured medication storage room;

(h) Return each medication to its portable or permanent storage unit immediately following medication administration assistance.

(2) A residential facility or supported living client who does not require medication administration assistance or supervised self-administration may store his or her medication in a secure, locked place within his or her room. However, a client’s medications must be centrally stored and retrieved by the MAP or licensed health care practitioner if:

(a) The client’s physician documents in the client’s file that leaving the medication in the personal possession of the client would constitute a threat to the health, safety, or welfare of the client or others;

(b) The client fails to securely maintain the medication in a locked place;

(c) The MAP, licensed health care practitioner, facility administrator, or Agency determines that, based on the home’s physical arrangements or the habits of other residents, the client’s personal possession of medication poses a threat to the safety of others, or

(d) The client or the client’s authorized representative requests in writing that the client’s medication be centrally stored.

(3) Either a licensed health care practitioner or MAP must securely maintain keys to the locked containers and storage enclosures containing medications and provide written procedural provisions for accessibility to medications in cases of emergency.

(4) If multiple clients are prescribed identical OTC medications, the facility may use a single stock container to provide the medications to multiple clients;

(5) Controlled medication storage requires the following additional safeguards:

(a) The controlled medications must be stored separately from other prescription and OTC medications in a locked container within a locked enclosure.

(b) For facilities operating in shifts, a MAP or licensed health care practitioner must perform controlled medication counts for each incoming and outgoing personnel shift, as follows:

The medication count must be performed by a MAP or licensed health care practitioner and witnessed by another MAP or licensed health care practitioner,
Both providers must verify count accuracy by documenting the amount of medication present and comparing that amount to both the previous count and number of doses administered between counts,
The providers must record the medication count on a “Controlled Medication Form.” The Controlled Medication Count Form, APD Form 65G-7.007 B, effective April 2019, incorporated herein, may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10600. The MAP or licensed health care practitioner must sign and date the form verifying the count; and
Immediately document and report any medication discrepancies to the facility supervisor.

(c) For facilities with only one MAP or licensed health care practitioner per shift, the MAP or licensed health care practitioner must conduct, document, and sign a daily medication count on the Controlled Medication Form; and

(d) For facilities with no shifts, the MAP or licensed health care practitioner who is responsible for medication administration must conduct, document, and sign a controlled medication count at least once each day on the Controlled Medication Form, using the same counting and documentation technique described in paragraph (5)(c).

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, Technical Change 2-5-26.

Fla. Admin. Code R. 65G-7.008 Documentation and Record Keeping

(1) The MAP and licensed health care practitioner shall maintain an up-to-date MAR for each client requiring assistance with medication administration, except when the client is off-site. The MAP and licensed health care practitioner must document the administration of medication or supervision of self-administered medication immediately on the MAR. The MAP and licensed health care practitioner may use the Agency’s Medication Administration Record Form, APD Form 65G-7.008 A, effective April 2019, adopted and incorporated herein, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10601, or on an alternative MAR form that includes the following information:

(a) The client’s name;

(b) Any client food or medication allergies;

(d) The medication strength (e.g., 5mg/ tsp);

(e) The prescribing health care practitioner for each medication;

(f) The date that the medication was ordered and any date the medication was changed (including D/C date);

(g) Prescribed dosage for each medication;

(h) Scheduled time of administration for each medication;

(i) Prescribed route of administration for each medication;

(j) Prescribed instructions for crushing, mixing or diluting of specific medications, if applicable;

(k) The dates each medication was administered;

(l) The initials and signature of the MAP or licensed health care practitioner who administered or supervised the self-administration of medications;

(m) A record of any medication dosage refused or missed, documented by the MAP or licensed health care practitioner responsible for administering the scheduled dosage, by drawing a circle around the appropriate space on the MAR form and initialing it; and,

(n) The reasons for not administering a medication, annotated and initialed by the MAP or licensed health care practitioner in the comments section on the MAR form.

(2) If necessary, it is acceptable for more than one “back” of the MAR to be attached to any MAR to allow for more entries and explanations.

(3) It is permissible for MAPs or licensed health care practitioners to use a MAR provided by a pharmacy or from an electronic system if that MAR collects and records the same information as the Agency MAR.

(4) Each client’s record must contain the following medication documentation, recorded in a manner that effectively communicates to the Agency Staff and other health care providers, and which must be readily available to the MAP or licensed health care practitioner and for Agency review upon request:

(a) Completed MAR forms;

(b) A list of potential side effects, adverse reactions, and drug interactions for each medication. The drug monograph provided by the pharmacy or an electronic health program is sufficient to meet this requirement;

(d) Written determination by the client’s physician that the client requires assistance with the administration of his or her medications, using Authorization for Medication Administration, adopted and incorporated by reference in Rule 65G-7.002, F.A.C.; and

(e) The current Informed Consent form adopted and incorporated by reference in Rule 65G-7.002, F.A.C., permitting a MAP to assist with the administration of medication.

(5) MAPs validated for insulin administration and the supervision of self-administration of insulin, and licensed health care practitioners, shall maintain an up-to-date insulin administration log using Insulin Administration Log, APD Form 65G-7.008, effective March 2026, adopted and incorporated herein, which may be obtained at https://flrules.org/Gateway/reference.asp?No=Ref-19172, for each client requiring assistance with insulin administration, except when the client is off-site. The MAP and licensed health care practitioner must immediately document the administration of insulin or supervision of self-administered insulin on Insulin Administration Log, APD Form 65G-7.008.

(6) If an electronic Medication Administration Record (eMAR) is being used to capture insulin administration, the eMAR must include all of the elements of the Insulin Administration Log, APD Form 65G-7.008:

(a) Insulin order information:

Name of insulin prescribed (as printed on medication label);
Dose;
Frequency;
Whether or not blood glucose level checks are required for administration of insulin to the client; and
Insulin order expiration date.

(b) Insulin administration:

Date and time of insulin administration;
Name of insulin administered;
Blood glucose level at the time of insulin administration, if required for the client;
Number of units given; and
Administration site.

(7) The MAP or his or her employer must maintain documentation that the MAP has completed an approved medication administration course and is currently validated as competent to assist with the administration of medication.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, 3-26-26.

Fla. Admin. Code R. 65G-7.009 Off-site Medication Administration

(1) If a client who has his or her medications administered to him or her or who is supervised with self-administration of medication will be away from a licensed residential facility or supported living home and requires assistance with medications during that time by persons other than the MAP or licensed health care practitioner, the MAP or licensed health care practitioner must comply with the following requirements to assure that the client has appropriate medications during his or her absence:

(a) Provide an adequate amount of medication for administration of all dosages the client will require while away;

(b) Perform a count of the medication amounts provided to the client for administration during the absence and a second count of the medication amounts received upon the client’s return;

(c) Record both medication counts in an “Off-site Medication Form,” APD Form 65G-7.009 A, effective April 2019, incorporated herein by reference, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-10602. The MAP or licensed health care practitioner shall not use an alternative Off-Site Medication Form. The MAP or licensed health care practitioner must retain a copy of the original form and send a copy with the client and the responsible person.

(2) Medication may not be transferred from its original container to a pill organizer or be otherwise co-mingled outside of its original container unless the client’s primary care provider determines that the client is able to self-administer medication without supervision; in that case, only the client, the client’s family member or family member surrogate, a natural support, or a legal representative may transfer the medications from the original container. The MAP may not supervise, monitor, prompt, assist or cue any client to correctly fill a pill organizer (also known as a “pill minder” or “pill box”).

(3) The MAP or licensed health care practitioner must provide the name and telephone number of a contact person and the name and telephone number of the client’s prescribing practitioner to the person who will assist the client with medication administration while the client is off-site, for use in the event that there are questions or adverse reactions.

History

Rulemaking Authority 393.501(1), 393.506(6) FS. Law Implemented 393.506 FS. History–New 3-30-08, Amended 7-1-19, Technical Change 2-5-26.

Chapter 65G-8 REACTIVE STRATEGIES

Fla. Admin. Code R. 65G-8.001 Definitions

(1) “Approved emergency procedure curriculum” means a course of instruction in procedures and techniques for intervening in behavioral emergency situations, approved by the Agency for Persons with Disabilities (“Agency”), and incorporated into a facility’s or program’s policy for utilizing reactive strategies.

(2) “Authorized staff person” means an employee of a facility or program that has completed training in the approved emergency procedure curriculum and is approved by the authorizing agent to use restraint and seclusion procedures.

(3) “Authorizing agent” means an individual authorized by the facility or program manager to approve use of a reactive strategy.

(4) “Behavioral protective device” means a device used as a means of interfering with or preventing specific results of a targeted behavior as part of a behavior program approved by the Local Review Committee.

(5) “Chemical restraint” means the use of medication to effect immediate control of an individual’s behavior. It does not include the medication administered as treatment for a medical or psychiatric condition.

(6) “Client” means any person with a developmental disability receiving services in the State of Florida.

(7) “Containment” means immobilizing an individual with any technique for the purpose of behavioral control.

(8) “Facility” means a residential operation serving Agency clients funded or licensed under Chapter 393, F.S., and includes separate and secure facilities serving forensics clients pursuant to Chapter. 916, Part III, F.S.

(9) “Implementation plan” means an individualized plan utilizing services to assist a client with developmental disabilities in acquiring skills that enable the client to improve his or her physical, mental, and social functioning.

(10) “Licensed medical professional” means a physician licensed under Chapter 458 or 459, F.S.; or registered nurse, licensed practical nurse, or Advanced Registered Nurse Practitioner licensed under Chapter 464, F.S.

(11) “Local Review Committee” means the committee required by subsection 65G-4.008(3), F.A.C., to oversee and review all behavior analysis services provided to clients to ensure that the services are designed and approved in accordance with Florida Statutes and agency rules.

(12) “Manual restraint” means the use of hands or body to immobilize a person’s freedom of movement or normal access to his or her body for more than fifteen continuous seconds. It does not include physically guiding a client during transport or skill training for up to two minutes. Repeated applications and releases of manual restraint in order to circumvent the fifteen-second and two-minute criteria are prohibited.

(13) “Mechanical restraint” means a physical device used to restrict an individual’s movement or restrict the normal function of the individual’s body. The definition does not include the following:

(a) Medical protective equipment as defined by this rule;

(b) Physical equipment or orthopedic appliances, surgical dressings or bandages, or supportive body bands or other restraints necessary for medical treatment, routine physical examinations, or medical tests;

(c) Devices used to support functional body position or proper balance, or to prevent a person from falling out of bed, falling out of a wheelchair, or

(d) Equipment used for safety during transportation, such as seatbelts or wheelchair tie-downs.

(14) “Medical protective equipment” means health-related protective devices prescribed by a physician or dentist for use during specific medical or surgical procedures, or for use as client protection in response to an existing medical condition.

(15) “Reactive strategies” means the procedures or physical crisis management techniques of seclusion or manual, mechanical, or chemical restraint utilized for control of behaviors that create an emergency or crisis situation.

(16) “Seclusion” means enforced isolation or confinement of an individual in a room or area. It does not mean “time out” or “time out from positive reinforcement” procedures as defined by this rule, or isolation resulting from medical conditions or symptoms of illness.

(17) “Time out” or “time out from positive reinforcement” means a procedure designed to interrupt a specific behavior of an individual by temporarily removing that individual to a separate area or room, or by screening him or her from others, or by signaling that the individual is in “time out.” “Time out” is not a reactive strategy regulated by these rules. “Time out” procedures differ from the reactive strategy of seclusion through the following characteristics:

(a) A “time out” is of short duration, as brief as one minute and never longer than twenty consecutive minutes;

(b) It is implemented only in response to a specified behavior;

(c) It is part of a written program that includes a functional assessment and is approved by a Local Review Committee; and,

(d) The program is implemented either by a Certified Behavior Analyst certified by the Behavior Analyst Certification Board®, Inc.; a behavior analyst certified by the Agency pursuant to Section 393.17, F.S., and Rule 65G-4.003, F.A.C.; a psychologist licensed under Chapter 490, F.S.; or a clinical social worker, mental health counselor, or therapist licensed under Chapter 491, F.S.

(e) “Time out” data is collected for assessment, evaluation, and analysis;

(f) It is not used as a disciplinary act, threat, or as a tool for staff’s convenience;

(g) A termination criterion (e.g., “one minute of calm”) ends the time out period, ensuring that termination of the time out is under the control of the person in time out; and,

(h) After termination, the individual returns to his or her previous activity.

NOTE: Use of time-out for a period exceeding twenty minutes constitutes the reactive strategy of seclusion.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.002 Approved Emergency Procedure Curriculum

(1) All providers and facilities that use reactive strategies must utilize an emergency procedure training curriculum approved by the Agency, and require all staff utilizing reactive strategies to be trained in that curriculum.

(2) The training curriculum must meet the following minimum requirements for approval:

(a) It has a history of applied use to persons with developmental disabilities;

(b) It includes an ongoing training program;

(d) It provides for periodic review of both trainer and participant competency;

(e) It does not include reactive strategy procedures prohibited by this rule chapter or any other Florida law or rule;

(f) It requires at least twelve direct training hours;

(g) It includes non-physical crisis intervention techniques;

(h) The curriculum incorporates training in the provisions of this rule chapter;

(i) It provides for supervised practice and performance-based competency evaluation, including a written test with a minimum passing achievement score of 80%;

(j) It includes training in criteria for use of reactive strategies, and methods for reducing physical interventions;

(k) It incorporates quality assurance and safety measures as well as incident data collection and review;

(l) It provides participants with a certificate displaying the name of the curriculum, the name of the trainer, the date(s) of training; and the date of certificate expiration;

(m) The curriculum includes instruction in reactive strategy precautions and potential hazards; and,

(n) It includes a “release” criterion (e.g., a stated period of calm behavior) that is of short duration and that is client-driven or initiated.

(3) Staff must be certified through an Agency-approved emergency procedure curriculum before being authorized or permitted to administer a reactive strategy technique. Providers and facilities must maintain copies of all staff training certificates and make the certificates available to the Agency upon request.

(4) Training certification is valid for one year. Before the certificate expires, staff must undertake a full training curriculum to obtain new certification.

(5) In order to obtain Agency approval for a proposed curriculum, the provider must submit a copy of the curriculum materials and an “Emergency Procedure Training Curriculum Application,” APD Form 65G8-001 (August 2008), incorporated herein by reference. A copy of the form may be obtained by writing or calling the Agency for Persons with Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main telephone number (850)488-4527.

(6) The Agency’s Senior Behavior Analyst will refer the proposed curriculum to a multidisciplinary committee or a Peer Review Committee as defined in Rule 65G-4.008, F.A.C., for additional review and comment.

(7) The Senior Behavior Analyst’s review of a proposed emergency procedure curriculum must include:

(a) Verification of the curriculum’s compliance with the minimum criteria established in this rule chapter;

(b) Direct observation of the reactive strategy techniques incorporated in the curriculum;

(d) Committee recommendations to the Senior Behavior Analyst for either accepting or rejecting the proposed curriculum.

(8) Following review, the Senior Behavior Analyst will make a final determination to either accept or reject the proposed curriculum and provide notification of the determination in writing, stating the reasons for rejection. If the proposed curriculum is rejected, it may be resubmitted with appropriate modifications to meet minimum requirements provided by this rule chapter.

(9) No changes to approved curriculum materials or procedures may be incorporated until the curriculum, along with the proposed changes, is resubmitted to the Agency and approved.

(10) The Agency may deny or withdraw approval for any of the following acts or omissions:

(a) Obtaining or attempting to obtain course approval through fraud, false statements, deceit, or misrepresentation of material facts, whether those representations or statements are made knowingly or negligently;

(b) Failure to provide complete and accurate information in the initial application for approval or in any notification for a change in information;

(d) Failure to maintain the curriculum format and content as approved by the Agency.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.003 Reactive Strategy Policy and Procedures

(1) All facilities or providers subject to this rule shall develop and implement policies and procedures consistent with the provisions of this rule chapter, including adoption of an approved emergency procedure curriculum, appropriate staff training, record maintenance, reporting and recording the use of any reactive strategy, training in the provisions of this rule chapter, data collection, and maintenance of reactive strategy consent information in client records, and any other requirements established in this rule chapter.

(2) Facility or provider policies and procedures may include only the reactive strategies provided in the Agency-approved curriculum. No change to the approved curriculum or variation of a specific reactive strategy may be employed without an Agency-approved variance or waiver obtained in advance through Section 120.542, F.S. A proposed variance to a reactive strategy must demonstrate that it is designed for a specific client and the variance request must include documented evidence of need and benefit. Variance requests will be evaluated by the Local Review Committee and the Agency’s Senior Behavior Analyst.

(3) Providers and facilities that employ reactive strategies are required to implement procedures to ensure the safety of staff and clients during the use of reactive strategies and to ensure that Agency clients are not placed at risk because of existing medical conditions.

(4) All staff implementing reactive strategies must be certified in advance for all reactive strategy techniques used or approved for use by the facility or provider.

(5) A variation of a specific reactive strategy may be employed only if it is designed for a specific client with documented evidence of need and benefit, and only if evaluated and approved in advance of implementation by the Local Review Committee and the Agency’s Senior Behavior Analyst.

(6) The provider or facility must conduct an internal review of its emergency procedures at least annually with a written evaluation that addresses the following issues:

(a) Proposed methods of reducing the use of reactive strategies;

(b) Policy evaluations and proposals to ensure that all applications of reactive strategies are being conducted in accordance with the Agency-approved emergency procedure curriculum and administered in a safe manner; and,

The facility or provider must maintain this written evaluation for a minimum of five years and make it available to the Agency upon request.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.004 Initial Assessments

(1) Upon an individual’s admission to a facility or program and at least annually thereafter, the facility or provider must obtain information and documents relevant to the use of reactive strategies from a variety of sources for the individual’s records. Appropriate sources include the individual, his or her family members, treating medical professionals, and other informants familiar with the individual. The individual’s records must include the following documentation:

(a) A physician’s report of medical conditions or physical limitations that would place him or her at risk of physical injury during restraint or seclusion, or otherwise preclude the use of one or more reactive strategies; and,

(b) Documentation of any history of trauma, such as a history of sexual or physical abuse, that the informants, individual, facility, or providers believe to be relevant to the use of reactive strategies.

(2) Medical conditions or physical limitations that might create a risk to the individual include, but are not limited to, the following:

(a) Obesity;

(b) Cardiac conditions;

(d) Asthma or other respiratory conditions;

(e) Impaired gag reflex;

(f) Back conditions or spinal problems;

(g) Seizure disorders;

(h) Deafness;

(i) Blindness;

(j) Limitations on range of motion;

(k) Osteoporosis;

(l) Osteopenia; and,

(m) Hemophilia.

(3) In addition to the annual review, the individual’s file information must be updated whenever there is a change in the individual’s physical or psychological condition that might affect his or her tolerance of one or more reactive strategies, or updated in compliance with any reassessments required by State or Federal law.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.005 Authorizations for Specific Reactive Strategies

(1) Upon initiating any reactive strategy, staff must immediately notify the highest-level direct care supervisor.

(2) Each use of a reactive strategy requires continuous staff supervision.

(3) The following reactive strategies can be approved only by the following authorizing agents:

(a) The authorizing agent for medical protective equipment or chemical restraint must be a physician licensed under Chapter 458 or 459, F.S;

(b) The authorizing agent for behavioral protective devices must be either a Certified Behavior Analyst certified by the Behavior Analyst Certification Board®, Inc.; a behavior analyst certified by the Agency pursuant to Section 393.17, F.S., and by Rule 65G-4.003, F.A.C.; a psychologist licensed under Chapter 490, F.S.; or a clinical social worker, marriage and family therapist, or mental health counselor licensed under Chapter 491, F.S.

(c) The authorizing agent for mechanical restraint must be a Certified Behavior Analyst certified by the Behavior Analyst Certification Board®, Inc.; a behavior analyst certified by the Agency pursuant to Section 393.17, F.S., and by Rule 65G-4.003, F.A.C.; a physician licensed under Chapter 458 or 459, F.S.; a psychologist licensed under Chapter 490, F.S.; or a clinical social worker, marriage and family therapist, or mental health counselor licensed under Chapter 491, F.S.

(d) The authorizing agent or staff person with approval authority for seclusion must have at least a bachelor’s degree, two years of experience serving individuals with developmental disabilities, and be certified in reactive strategies through an Agency-approved emergency procedure curriculum; and,

(e) The authorizing agent or staff person with approval authority for manual restraint must be certified in reactive strategies through an Agency-approved emergency procedure curriculum.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.006 Limitations on Use and Duration of Reactive Strategies

(1) All authorizations for a reactive strategy must include a clear rationale for its use.

(2) Reactive strategies must not be implemented automatically or as part of a deceleration plan for undesirable behaviors, as punishment, as a substitute for an implementation plan, or for the convenience of staff.

(3) At the onset of seclusion or restraint implementation, staff will notify the appropriate authorizing agent of the conditions leading up to the use of the reactive strategy. The authorizing agent is responsible for terminating any procedure not in compliance with this rule.

(4) Each use of a reactive strategy requires continuous staff monitoring.

(5) A reactive strategy must provide for the least possible restriction consistent with its purpose.

(6) A reactive strategy must be terminated immediately when the emergency ends.

(7) Reactive strategies must be implemented in a manner that permits the greatest possible amount of comfort and protection from injury to the individual.

(8) The Agency may disapprove the use of any emergency procedure, system, strategy, or program that does not meet the above requirements or that contains procedures the Agency determines to be unsafe.

(9) If an individual exhibits behavior requiring a reactive strategy at a frequency of more than two times in any thirty-day period, or six times in any twelve-month period, then the facility or provider should submit a request for behavior analysis services for that individual, including documentation of the frequency of reactive strategy use.

(10) The facility or provider must provide written behavioral criteria for termination of a reactive strategy, conforming to the Agency-approved emergency procedure curriculum, to all staff trained in those techniques.

(11) Reactive strategies must be terminated within five minutes after predetermined behavioral criteria have been met. Providers and facilities may seek an exemption from this requirement through the variance and waiver process authorized by Section 120.542, F.S.

(12) Reactive strategies must be limited to one hour in duration; additional time for a reactive strategy requires reauthorization.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.007 Seclusion and Restraint

(1) Every effort should be made to avoid unnecessary use of seclusion and restraint; therefore, staff should try to redirect and diffuse problem behavior before employing the reactive strategy of seclusion and restraint.

(2) Seclusion and restraint as a reactive strategy may be utilized only if certified staff persons are available in sufficient number to ensure its safe implementation.

(3) Staff must continuously observe the client during restraint procedures, monitor respiration rate, and determine when release criteria have been met.

(4) Seclusion and restraint procedures exceeding one hour require approval by an authorizing agent.

(5) Seclusion and restraint may not exceed two hours without visual review and approval of the procedure by an authorizing agent or the agent’s on-site designee.

(6) Staff must obtain additional authorization for use of seclusion and restraint for a behavioral episode occurring more than fifteen minutes after termination of a prior procedure, and document the additional use in the individual’s record.

(7) Before initiating a seclusion or restraint procedure, staff must inspect the environment and the individual in order to ensure that any foreign objects that might present a hazard to the individual’s safety are removed.

(8) Any room in which the individual is held must have sufficient lighting and ventilation to permit the individual to see and breathe normally, and must have enough space to permit him or her to lie down comfortably.

(9) The door to any room in which an individual is secluded without an attending staff person must not be locked; however, the door can be held shut by a staff person using a spring bolt, magnetic hold, or other mechanism that permits the individual in seclusion to leave the room if the caregiver leaves the vicinity. Forensic facilities may seek a waiver or variance from this requirement through Section 120.542, F.S.

(10) An individual mechanically restrained for more than one hour must be permitted an opportunity for motion and exercise for at least ten minutes of each hour that the individual is restrained.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.008 Chemical Restraint

(1) Chemical restraint is used for behavioral control; it is not standard treatment for medical or psychiatric conditions.

(2) An individual may be given a chemical restraint only on the written order of an authorized physician who has determined that the chemical is the least restrictive, most appropriate alternative available.

(3) The authorizing physician either must be present at the onset of the emergency requiring restraint, or must provide telephone consultation with an authorized staff person who is present and has personally examined the individual.

(4) If the authorizing physician is not present to write the order, he or she must dictate the order’s contents to another on-site licensed medical professional.

(5) An order for chemical restraint must be recorded in the individual’s record on the same date it is issued, along with the expected results of the medication and a detailed description of the behaviors that justified the use of chemical restraint.

(6) A licensed medical professional must conduct a face-to-face evaluation of the individual within one hour of administration of a chemical restraint, if the restraint was ordered by telephone. The medical professional must record the results of this evaluation in the individual’s record and document whether the administration of medication achieved the expected results.

(7) Staff must monitor an individual who has been chemically restrained at least once every half-hour and record the effects of the restraint in the individual’s record.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.009 Prohibited Procedures

The following reactive strategies are prohibited:

(1) Reactive strategies involving noxious or painful stimuli, as prohibited by Section 393.13(4)(g), F.S.;

(2) Untested or experimental procedures;

(3) Any physical crisis management technique that might restrict or obstruct an individual’s airway or impair breathing, including techniques whereby staff persons use their hands or body to place pressure on the client’s head, neck, back, chest, abdomen, or joints;

(4) Restraint of an individual’s hands, with or without a mechanical device, behind his or her back;

(5) Physical holds relying on the inducement of pain for behavioral control;

(6) Movement, hyperextension, or twisting of body parts;

(7) Any maneuver that causes a loss of balance without physical support (such as tripping or pushing) for the purpose of containment;

(8) Any reactive strategy in which a pillow, blanket, or other item is used to cover the individual’s face as part of the restraint process;

(9) Any reactive strategy that may exacerbate a known medical or physical condition, or endanger the individual’s life;

(10) Use of any containment technique medically contraindicated for an individual;

(11) Containment without continuous monitoring and documentation of vital signs and status with respect to release criteria; and,

(12) Use of any reactive strategy on a “PRN” or “as required” basis.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.010 Documentation and Notification

(1) Staff must document the following information in the individual’s record as soon as possible, but no later than the end of the work shift following the use of a reactive strategy:

(a) The behavior that necessitated a reactive strategy;

(b) The reactive strategy used;

(d) The person(s) who initiated, applied, authorized, and terminated the reactive strategy;

(2) The authorizing agent must review and sign the reactive strategy documentation within twenty-four hours or by the end of the next business day.

(3) The service provider or facility must also document every use of a reactive strategy on the “Reactive Strategy Report,” APD Form 65G8-002 (August 2008), incorporated herein by reference. A copy of the form may be obtained by writing or calling the Agency for Persons with Disabilities, at 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399-0950; main telephone number (850)488-4527. These Reports must be submitted within thirty days to the Local Review Committee chairperson, or the chairperson’s designee, and copies of the Report made a part of the individual’s record.

(4) Agency Area Offices and Developmental Services Institutions must submit copies of these Reports electronically to the Central Office Senior Behavior Analyst on a monthly basis.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.011 Access to Rules

(1) The provider or facility employing reactive strategies must maintain on-site a copy of Rule Chapter 65G-8, F.A.C, accessible by staff, clients, parents, guardians, and guardian advocates.

(2) The requirements established in this rule chapter are to be incorporated into all staff pre-service training programs related to the use of reactive strategies.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Fla. Admin. Code R. 65G-8.012 Enforcement

(1) Use of a reactive strategy not authorized by or in violation of this rule chapter or any other provision of law is a violation of Section 393.13, F.S., “The Bill of Rights of Persons with Disabilities,” or Section 916.107, F.S., and is subject to the enforcement proceedings, penalties, and private rights of action provided therein.

(2) A residential facility licensed under Section 393.067, F.S., that violates any reactive strategy provision or requirement of this rule chapter through the action of either facility management or staff, is subject to administrative disciplinary action authorized by Section 393.0673, F.S.

History

Rulemaking Authority 393.501, 393.13(4)(h)2., 916.1093(2) FS. Law Implemented 393.13(4)(h), 916.1093(2) FS. History–New 8-7-08.

Chapter 65G-9 FORENSIC CLIENT SERVICES

Fla. Admin. Code R. 65G-9.002 Right to Vote in Public Elections

(1) Any forensic client not adjudicated incompetent under the provisions of Chapter 744, F.S., or otherwise disqualified by law, and meeting the legal age and residency requirements of the state shall, if he or she requests, be assisted in registering to vote and in voting in public elections.

(2) A client who is properly registered to vote in a county other than the county of placement, shall be assisted in making application for a vote-by-mail ballot in that county if he or she so requests. A client who is not registered to vote shall be assisted in registering in the county of his permanent residence, if he or she so requests.

(3) If a client requests assistance in voting, registering, or in getting information about voting requirements, staff at the facility shall assist the client in obtaining the information.

History

Rulemaking Authority 916.1093(2), 916.107(7) FS. Law Implemented 916.107(7) FS. History–New 9-12-17.

Chapter 65G-10 PROVIDER TRAINING

Fla. Admin. Code R. 65G-10.001 Definitions

(1) “Agency” or “APD” means the Agency for Persons with Disabilities.

(2) “Basic Training” includes courses that any person who intends to become a Direct Service Provider for clients of the Agency must successfully complete before becoming a Direct Service Provider.

(3) “Competency-Based Assessment” is a test administered at the conclusion of a training course to determine if the trainee obtained the necessary knowledge, skill sets, and/or competencies to qualify as having successfully completed the participant’s required training.

(4) “Consultant” shall have the same meaning as in the Consumer-Directed Care Plus Program Coverage, Limitations, and Reimbursement Handbook (CDC+ Handbook), as adopted by Rule 59G-13.088, Florida Administrative Code (F.A.C.). A Consultant is included within the meaning of Support Coordinator.

(5) “Consumer-Directed Care Plus Program” or “CDC+ Program” means a consumer-directed program that provides an alternative to the Medicaid State Plan and the Home and Community-Based Services Medicaid Waiver (also known as the iBudget Waiver). The CDC+ Program operates under the authority of section 1915(j) of the Medicaid State Plan Amendment of the Social Security Act and is governed by Title 42 of the Code of Federal Regulations, Part 441, and Sections 409.221 and 393.0662(2) and (7), F.S.

(6) “Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook” or “iBudget Handbook” refers to the handbook incorporated by reference in Rule 59G-13.070, F.A.C.

(7) “Direct Service Provider” means a person 18 years of age or older who has direct face-to-face contact with a client while providing services to the client or has access to a client’s living areas or to a client’s funds or personal property.

(8) “Home and Community Based Services Waiver” or “Waiver” means the Medicaid waiver authorized by 42 U.S.C. 1396n(c) of the federal Social Security Act and Section 409.906, F.S., that provides Medicaid funding for home and community-based services to eligible persons with developmental disabilities who are eligible for Agency services and who live at home or in a home-like setting.

(9) “In-Service Training” also known as Continuing Education in certain professions, includes courses provided or approved by the Agency that must be taken on an annual or biannual basis in order to maintain the provider’s status as a HCBS Waiver Direct Service Provider.

(10) “In-Service Training Credits” or “Credits” refer to the standard unit of measurement of coursework used for training and credential purposes.

(11) “Learning Management System” or “LMS” refers to an automated system used by the Agency to administer the learning process within an organization.

(12) “Medicaid Waiver Services Agreement” or “MWSA” means the contract between the Agency and providers of Medicaid Waiver services to Agency clients, as defined in Section 393.063(7), F.S.

(13) “Pre-Service Training” includes service-specific courses that must be taken prior to becoming a support coordinator and after completion of the required Basic Training.

(14) “Qualified Organization” shall have the same meaning as in Section 393.0663(2), F.S.

(15) “Quality Improvement Organization” or “QIO” means a group of health quality experts, clinicians, and consumers contracted with the Agency for Health Care Administration and organized to improve the quality of care delivered to Agency clients.

(16) “Regional Office” means one of the Agency’s offices serving a Region. The contact information for each Regional Office is designated on the Agency’s website.

(17) “Service Specific Training” includes courses that must be taken prior to or within a short specific time period of becoming a HCBS Waiver Direct Service Provider and is specific to the service one is authorized to provide, as designated in these rules and the Handbook.

(18) “Support Coordinator” which is also known as “waiver support coordinator” or “WSC”, shall have the same meaning as defined in Section 393.063(42), F.S. For the purposes of this rule, this definition includes consultant as defined in the CDC+ Handbook as incorporated in Rule 59G-13.088, F.A.C.

(19) “Trainee” means a person who receives training from Agency Staff.

(20) This rule is in effect for five years from its effective date.

History

Rulemaking Authority 393.0663(5), 393.501(1), 393.066(8) FS. Law Implemented 393.066(2), 393.0663, 393.063 FS. History–New 7-1-21.

Fla. Admin. Code R. 65G-10.004 Support Coordinator Basic, WSC Pre-Service Level 1 Training, and WSC In-Person Level 2 Training

(1) Any person who wishes to provide support coordination services must have the requisite knowledge and experience as set forth in the Florida Medicaid Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook (“Handbook”), adopted in Rule 59G-13.070, F.A.C., prior to taking the Basic Training.

(2) The requirements for Basic Training are identified in the iBudget Handbook and must be completed prior to taking the WSC In-Person Level 2 competency-based assessment.

(3) Any Basic Training that must to be taken on a periodic basis does not count toward in-service training requirements.

(4) Persons interested in providing support coordination services who enrolled after the effective date of this rule, July 1, 2021, must complete both the Pre-Service Level 1 (“Level” 1) training and the In-Person Level 2 (“Level 2”) training which include the Level 1 and Level 2 competency-based assessments, as provided by the Agency.

(5) The WSC Pre-Service Level 1 training consists of self-paced, online training modules in the LMS that describe foundational concepts and requirements related to Waiver support coordination services. The Pre-Service Level 1 training curriculum can be found on the Agency’s website at www.apdcares.org.

(a) At the end of the Level 1 training, the trainee must complete the Level 1 competency-based assessment with a score of 85% or higher to receive credit.

(b) Trainees must pass the assessment within 30 days of completing the Level 1 training. Trainees who do not pass the Level 1 assessment within 30 days of the Level 1 training must retake the Level 1 training before they may retake the Level 1 competency-based assessment.

(d) Trainees must successfully pass the Level 1 competency-based assessment before taking the In-Person Level 2 training and signing a Medicaid Waiver Service Agreement with the Agency.

(6) The WSC In-Person Level 2 training will be provided by the Agency at the regional offices to provide hands on experience to practice key tasks related to Waiver Support Coordination and provides practical scenarios and experiences related to foundations learned in online training. The curriculum for the Level 2 training can be found on the Agency’s website at www.apdcares.org.

(a) Trainees must bring their own laptop or other electronic device that is compatible with APD data management systems to the Level 2 training.

(b) Trainees who were unable to complete any portion of the Level 2 training must complete the missed portion(s) at the next available Level 2 training session.

(c) Trainees must attend all Level 2 training sessions before they may take the Level 2 competency-based assessment, which is documented by the trainee’s signature on a daily attendance sheet, maintained by the Agency during the Level 2 training, as proof of attendance.

(d) The Level 2 competency-based assessment, which is administered at the end of the Level 2 training, must be passed with a score of 85% or higher in order to receive credit.

(e) Trainees will receive a Certificate of Completion upon passing the Level 2 competency-based assessment. Each trainee is responsible for uploading his or her Certificate of Completion into the LMS system.

(f) Trainees must successfully pass the Level 2 assessment within 120 days of passing the Level 1 assessment.

(7) Individuals providing support coordination services who were enrolled before, July 1, 2021, must complete the Level 1 training and pass the Agency’s Level 1 competency-based assessment.

(a) These support coordinators must successfully complete the Agency’s Level 1 competency-based assessment within 120 days after the effective date of this rule.

(b) Support coordinators who fail the Level 1 competency-based assessment, under this section, will be allowed to retake the Level 1 training and the Level 1 competency-based assessment. Upon failing to successfully pass the assessment after a third attempt, the Agency will terminate the support coordinator’s MWSA.

(c) The Level 1 training, taken pursuant to section (4) of this rule, may be counted toward meeting the annual in-service training requirements, once.

(8) The Agency may require a support coordinator to retake any portion of the Pre-Service Training or any required Basic Training as a result of a QIO review of 86% or lower, as designated by the Agency.

(9) If a support coordinator discontinues providing support coordination services for more than 12 months and wants to return as a provider of support coordination services, all Basic Training and the Per-Service Level 1 and the Level 2 In-Person Training must be completed again.

This rule is in effect for five years from its effective date.

History

Rulemaking Authority 393.0663(5), 393.501(1), 393.066(8) FS. Law Implemented 393.066(2), 393.0663, 393.063 FS. History–New 7-1-21.

Fla. Admin. Code R. 65G-10.005 Support Coordinator In-Service Training

(1) All support coordinators must attend a minimum of 18 hours of job-related in-service training annually.

(2) Any and all training that is received by a support coordinator, in order to meet the annual 18-hour in-service requirement, must relate to services provided to individuals served by the support coordinator as referenced in Chapter 393, F.S.; Division 65G, F.A.C.; the iBudget Handbook, and, if applicable, the CDC+ Handbook. Such topics may include, but are not limited to:

(a) Employment related services and benefits;

(b) School transition planning process;

(d) Case management;

(e) Person-centered planning;

(f) Service options for Agency clients;

(g) Affordable housing;

(h) Characteristics of Agency clients;

(i) Community and natural supports;

(j) The abuse, neglect, and exploitation of Agency clients;

(k) Behavioral and emotional health;

(l) Crisis management;

(m) Physical health and wellbeing;

(n) Emergency preparedness, response, and recovery;

(o) Characteristics and needs related to aging;

(p) Technology components of Agency data management systems; and

(q) Adaptive resources.

(3) Support coordinators may take up to 12 hours per year toward their annual in-service training requirement by attending webinars, training offered during monthly meetings, or other trainings conducted or organized by APD.

(4) Support coordinators must maintain documentation verifying successful completion for each in-service training in order to receive in-service training credit, as follows:

(a) Support coordinators will receive documentation from the Agency regarding his or her successful completion of any APD provided in-service training; and

(b) For any in-service training provided by non-APD sources, support coordinators must complete the Support Coordinator In-Service Training Verification, APD Form 65G-10.005 A, effective July 1, 2021, incorporated here by reference, which may be obtained at http://www.flrules.org/Gateway/reference.asp?No=Ref-12745. The Support coordinator must maintain this form for their records for review by a QIO or by the Agency.

(5) Support coordinators may receive in-service training credits by attending seminars, workshops, home study courses, and webinars presented by other government agencies, certification organizations that specialize in case management, or professional organizations designated by the Agency. A listing of such organizations may be found on the Agency website at https://apd.myflorida.com/providers/training/in-service-training.htm.

(6) Any support coordinator who has received and maintains a certification from the Commission on Rehabilitation Counselor Certification may satisfy the 18-hour annual in-service training requirement. The support coordinator is responsible for maintaining proof of this certification in their records.

(7) This rule is in effect for five years from its effective date.

History

Rulemaking Authority 393.0663(5), 393.501(1), 393.066(8) FS. Law Implemented 393.066(2), 393.0663, 393.063 FS. History–New 7-1-21.

Chapter 65G-11 DD PREENROLLMENT CATEGORIES

Fla. Admin. Code R. 65G-11.001 Definitions

In addition to the terms defined in Section 393.064, F.S., and for the purpose of this rule chapter, the following terms and phrases shall have the following meanings:

(1) “Agency” is the Agency for Persons with Disabilities (“APD”).

(2) “Caregiver” is defined as the person who provides personal care, supervision, training or housing to an individual.

(3) “State Office” is the Agency’s headquarters located at 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399-0950, main telephone number (850)488-4257.

(4) “Crisis Enrollment” is the waiver enrollment of an eligible individual to a Home and Community Based Services Waiver, in accordance with Rule 65G-11.004, F.A.C.

(5) “Questionnaire for Situational Information (QSI)” is the agency approved assessment that assesses a person’s need for level of support in areas of community living, functional, behavioral and physical health. The assessment is completed every three years and is updated as the needs and life circumstances of the individual changes. The QSI is administered by trained and certified agency staff.

(6) “Preenrollment Category” is the prioritized list of clients maintained by the APD State Office of Persons with Disabilities that have been determined eligible for APD services and eligible to receive waiver services when funding is available.

(7) “Waiver” is a Home and Community Based Services (HCBS) waiver authorized by 42 U.S.C. 1396n(c) of the federal Social Security Act and Section 409.906, F.S., that provides Medicaid funding for home and community based services to eligible persons with developmental disabilities who are eligible for Agency services.

(8) “Short term services” are not duplicative of any services required by other state agencies or departments and shall only be provided when other community resources are not available. The Agency shall provide short term services to individuals on a preenrollement category through the use of Social Services Block Grant funding as allocated by the legislature.

History

Rulemaking Authority 393.065(12), 393.501(1) FS. Law Implemented 393.065 FS. History–New 10-24-10, Amended 6-5-25.

Fla. Admin. Code R. 65G-11.002 Preenrollment Category Criteria

(1) In accordance with Chapter 393, F.S., beginning July 1, 2010, the Agency will assign a category of priority for a preenrollement category by collecting information about the individual’s needs and the status of the individual’s caregiver if applicable. If an individual meets the criteria for more than one category, the highest-ranking category will be assigned. If funding is available, the Agency shall offer waiver enrollment to individuals on a preenrollement category in the order of the categories, category 1 being the top category. Within categories 3 through 7, the date the individual was determined eligible for a preenrollement category shall determine the order for receiving waiver services.

(2) If a backup caregiver is available, the name, relationship and age of the backup caregiver must be provided.

(3) Category 1 includes individuals determined to meet the crisis criteria specified in Rule 65G-1.047, F.A.C. The process for crisis determination will follow the requirements outlined in Rule 65G-11.004, F.A.C.

(a) Individuals whose situation has reached a crisis may request a crisis application be completed by the Agency. In addition to the requirements of Chapter 65G-1, F.A.C., the following shall apply:

(b) A temporary placement in jail is not considered a form of housing and therefore will not exclude the individual from the definition of homeless. Additionally an individual that is within 90 days of discharge from an institutional setting and does not have an acceptable home or residential situation in place shall be considered in Category 1.

(4)(a) Category 2 includes children who are jointly served by the Agency and the Department of Children and Family Services (“DCF,” also known as the Department of Children and Families) in the Child Welfare program. A monthly data match between the two agencies identifies these individuals. DCF may bring to the attention of APD any child in need of critical services with an open case with the Department of Children and Families in the Child Welfare program, rather than wait for the data match. If the youth is still on a preenrollement category for APD services at the age of 18 when they age-out of foster care, the youth will remain under Category 2 until they begin receiving services, unless they are deemed homeless and qualify under Category 1.

(b) For individuals who are at least 18 years but not yet 22 years of age and who are eligible under section 393.065(5)(b)1.b., F.S., the Agency must provide waiver services, including residential habilitation, and the community-based care lead agency must fund room and board at the rate established in s. 409.145(3) and provide case management and related services as defined in s. 409.986(3)(e). Individuals may receive both waiver services and services under s. 39.6251. Services may not duplicate services available through the Medicaid state plan.

(5) Category 3 includes the following individuals:

(a) Individuals for whom the caregiver has a condition or circumstance that is expected to render the caregiver unable to provide care within the next twelve months and other caregivers are unable, unwilling or unavailable to provide care. The evaluation of the caregiver’s condition or circumstance should consider the level of care necessitated by the client’s needs and the caregiver’s ability to provide that level of care. The condition or circumstance that renders the caregiver unable must be documented by a physician’s statement if it is a medical condition and must explain the reason the current caregiver can no longer provide the individual’s care. If the caregiver is paid by any source for their services to the individual there is a rebuttable presumption that another paid provider could be substituted and therefore that another caregiver is available to provide care. The client may present evidence to show that this presumption is not correct under their particular circumstances. Circumstances that are not medical in nature must be described and signed by the caregiver. This documentation will be provided to the Agency for a determination of eligibility for Category 3.

(b) Individuals who are at substantial risk of incarceration or court commitment which is defined as unlawful activity by the individual that has required the intervention of local or state law enforcement even if the unlawful activity did not result in an arrest or criminal charges. Documentation is required to include a summary of incidents in which the individual has engaged in dangerous behavior, has past history of involvement with the court system or law enforcement, is currently involved with the court system or law enforcement, multiple arrests, incarceration in jail, prison or admission to the Developmental Disabilities Defendant Program.

(c) This category includes individuals who are currently incarcerated and are expected to be released within 12 months. Documentation for placing an individual in the priority category includes copies of any past court commitments, documentation from law enforcement, and court ordered competency evaluations. Documentation must include: 1) a summary of incidents in which the individual has engaged in dangerous behavior, has past history of involvement with the court system or law enforcement, is currently involved with the court system or law enforcement, multiple arrests, incarceration in jail, prison or admission to the Developmental Disabilities Defendant Program, and 2) copies of any past court commitments, documentation from law enforcement, and court ordered competent evaluations.

(d) Individuals whose behaviors or physical needs place them or their caregiver at risk or harm within the next 12 months, and for whom no other supports are currently available to meet their needs. Documentation of behaviors or physical needs that are casing the risk or potential harm and the medical treatment provided to the individual or to others because of the individual’s behaviors or physical needs must be provided. Documentation of the frequency, intensity and duration of behavioral incidents and an explanation of behavioral interventions that have used must also be provided.

(e) Individuals who are identified by the facility as ready for discharge from a state mental health hospital, intermediate care facility for the developmentally disabled, a skilled nursing facility, correctional facility, or a secure forensic facility within the next 12 months. There must be evidence that without the provision of waiver-funded services, these individuals will be at risk of readmission to an institution due to a lack of available caregiver or a lack of appropriate or available services. Documentation for this category must include a discharge summary from the facility that indicates the individual is ready for discharge or no longer meets the criteria for the level of care required by the facility and the status of available caregivers for the individual. Documentation that there are no other resources or services available other than waiver services to meet the individuals needs must be provided.

(f) Individuals receiving Voluntary Protective Services (VPS) or requesting DCF assistance to prevent their child from entering foster care. The parents or caregivers shall provide documentation from the applicable agencies or departments confirming this information.

(g) In reviewing the caregiver’s ability to provide, care the Agency shall consider the reliability and long-term commitment of the caregiver in order to ensure continuity of care. Additionally, the caregiver’s responsibility for other minors under their care shall be considered.

(6) Category 4 includes individuals whose primary caregiver is age 60 years of age or older and for whom no alternate caregiver is available. Documentation of the caregiver’s date of birth and verification that no alternate caregiver is available must be provided.

(7) Category 5 includes individuals who are expected to graduate from secondary school within the next 12 months, individuals who have received a special diploma and need the support available through waiver funded services to obtain or maintain competitive employment, or individuals who have applied for and been accepted to an accredited institution for postsecondary education. Documentation of the individual’s graduation is required as well as documentation that there are no other resources available, other than waiver funded services to provide the individual with the support to obtain or maintain a job.

(8) Category 6 includes individuals who are age 21 years of age older and do not meet the criteria for any other category. Documentation of this category is obtained through verification of the individual’s date of birth and verification that documentation does not qualify the individual for any other category.

(9) Category 7 includes those individuals who are younger than 21 years of age and who do not meet the criteria for any other category. Documentation of this category is obtained through verification of the individual’s date of birth and absence of any documentation that places an individual into another category. Prevention and early intervention services that are critical to the child’s developmental growth shall be a high priority for services from the Agency as well as support to the parents or caregivers to maintain the child in the family home.

History

Rulemaking Authority 393.065(12), 393.501(1) FS. Law Implemented 393.065 FS. History–New 10-24-10, Amended 6-30-25.

Fla. Admin. Code R. 65G-11.003 Preenrollment Category Placement Procedure

(1) The Agency shall assign a preenrollement category to each individual on a preenrollement category upon adoption of this rule by using information from the current needs assessment and the Questionnaire for Situational Information (QSI), version 4.0, and the Wait list Prioritization Checklist. Additionally, the Agency will also request information about: 1) identification of the current caregiver, 2) demographic information of the caregiver, 3) medical circumstances or other circumstances of the caregiver that prevent the caregiver from providing care, and 4) the availability of other caregiver.

(2) The Agency will notify each individual/guardian on a preenrollement category in writing of the individual’s assigned preenrollment category and eligibility determination date. The individual/guardian may submit documentation to the Agency if there is a need for the category assignment to be reconsidered. Upon review of the information provided, the Agency will notify the individual in writing within 15 working days, of the reconsideration decision.

(3) At any time during the year, the individual can request a reevaluation to move to another category by submitting to the Agency a written request with the required documentation as specified for each category.

(4) The individual, family or guardian must ensure that accurate address and phone contact information is provided to the area staff and must notify the Agency at any time this information changes.

(5) Individuals will be removed from the preenrollement category and the individual’s Agency record will be closed if the individual:

(a) Becomes domiciled in another state;

(b) Becomes ineligible for APD and the waiver, or

(c) Cannot be contacted or located over a 60 calendar day period using the information provided to the Agency staff. The individual can reapply for APD services at any time.

(6) The Agency shall provide regular communication to the individuals on a preenrollement category and their parents/guardians/family members regarding possible resources in the community or other government programs, and the ongoing activities of the Agency.

History

Rulemaking Authority 393.065(12), 393.501(1) FS. Law Implemented 393.065 FS. History–New 10-24-10, Amended 6-5-25.

Fla. Admin. Code R. 65G-11.004 Crisis Determination Procedure

(1) Subject to funding availability, the Agency will accept oral or written requests for crisis enrollment in a HCBS waiver by the applicant or the applicant’s family, guardian, guardian advocate, or support coordinator.

(2) The applicant or applicant’s representative shall request crisis enrollment through the Agency. The Agency may not enroll an applicant on the waiver unless the Agency has determined that the applicant has a developmental disability, as defined in Section 393.063, F.S., meets the level of care requirements set forth in section 393.065(5), F.S., the eligibility requirements of Chapter 65G-4, F.A.C. and:

(a) The recipient’s intelligence quotient (IQ) is 59 or less, or

(b) The recipient’s IQ is 60-70 inclusive and the recipient has a secondary handicapping condition that includes:

Autism, Cerebral palsy, Down syndrome, epilepsy, Phelan-McDermid syndrome, Prader-Willi syndrome, spina bifida, Tatton-Brown-Rahman syndrome; or
Ambulation, sensory, chronic health, and behavioral problems.

(c) The recipient’s IQ is 60-70 inclusive and the recipient has severe functional limitations in at least three of the following major life activities:

Self-care,
Learning,
Mobility,
Self-direction,
Understanding and use of language,
Capacity for independent living, or

(d) The recipient is eligible under a primary disability of autism, Cerebral palsy, spina bifida, Prader-Willi syndrome, Down syndrome, Phelan-McDermid syndrome, Prader-Willi syndrome, spina bifida, or Tatton-Brown-Rahman syndrome, and the condition results in substantial functional limitations in three or more major life activities listed in paragraph (c), above.

(3) The Agency will collect pertinent information and supporting documentation relevant to a crisis determination and conduct a preliminary assessment based on the crisis status criteria specified in Rule 65G-1.047, F.A.C.

(a) If the Agency concludes that the applicant does not meet crisis status or that the services needed are available from other agencies or programs or covered by other third-party payors, the Agency will deny the crisis enrollment request and provide written notification of the denial to the applicant or applicant’s representative.

(b) The applicant or the applicant’s representative may, upon request, review the initial assessment and supporting documentation to ensure that all necessary information is included.

(4) APPROVAL.

(a) If funding is available and the applicant is approved for crisis enrollment, the applicant will be offered placement on the waiver. In determining the appropriate waiver placement, the Agency will consider the availability of services necessary to resolve the crisis situation, including the need for residential habilitation services, nursing services beyond the coverage provided through the Medicaid State Plan, or placement in a residential facility.

(b) After the Agency determines the appropriate waiver placement, the Agency will provide written notice of placement to the applicant or applicant’s representative. If the applicant is not already a client of the Agency or is not already on a preenrollement category, the Agency will provide a full determination of the applicant’s eligibility for services within the timeframe provided in s. 393.065(1), F.S. Eligibility for Medicaid waiver services is contingent upon eligibility for the state Medicaid services. If the applicant is not enrolled in a state Medicaid program, the Agency will refer the applicant to the local Department of Children and Families for submission of a Request for Assistance (RFA). If the applicant is deemed eligible for state Medicaid, the Agency will complete the waiver enrollment. If the applicant is not Medicaid-eligible, the Agency will rescind the approval for crisis enrollment on the Medicaid waiver.

(5) DENIAL. The Agency will notify the applicant or applicant’s representative in writing of a denial of crisis enrollment. If the Agency denied the application based on lack of documentation and additional documentation becomes available, or a change in the applicant’s situation may affect the applicant’s status for crisis determination, the applicant may reapply to the Agency for crisis consideration.

History

Rulemaking Authority 393.065(13), 393.501(1) FS. Law Implemented 393.065 History–New 9-19-07, Formerly 65G-1.046, Amended 6-5-25, 8-30-26.

Chapter 65G-12 AGENCY DATA MANAGEMENT SYSTEMS

Fla. Admin. Code R. 65G-12.001 Definitions

(1) “Agency” means the Agency for Persons with Disabilities.

(2) “Client” means a person determined eligible by the Agency for Persons with Disabilities (“Agency”) for services under Chapter 393, Florida Statutes.

(3) “Consumer-Directed Care Plus Program” or “CDC+ Program” means a consumer-directed program that provides an alternative to the Medicaid State Plan and the Home and Community-Based Services Medicaid Waiver (also known as the iBudget Waiver). The CDC+ Program operates under the authority of section 1915(j) of the Medicaid State Plan Amendment of the Social Security Act and is governed by Title 42 of the Code of Federal Regulations, Part 441, and Sections 409.221, 393.0661(3)(e), and 393.0662(2), F.S.

(4) “Electronic Visit Verification” or “EVV” means a system under which visits conducted as part of personal care services or home health care services are electronically verified.

(5) “Home and Community-Based Services Waiver” or “HCBS Waiver” means services authorized by 42 U.S.C. 1396n(c) of the federal Social Security Act and Section 409.906, F.S., that provides a package of Medicaid-funded home and community-based supports and services to eligible persons with developmental disabilities who live at home or in a home-like setting.

(6) “Home Health Services” are medically necessary services that are provided in the home of the eligible client and include such activities as private duty nursing, skilled nursing, physical therapy, occupational therapy, speech-language pathology services, and medical supplies that require an in-home visit for set-up. This does not include any service or supply provided in a licensed facility.

(7) “Personal Care Services” means individual assistance with or supervision of essential activities of daily living for self-care, including ambulation, bathing, dressing, eating, grooming, and toileting, and other similar services that are incidental to the care furnished and essential to the health, safety, and welfare of the client if no one else is available to perform those services. For purposes of this rule chapter, “personal care services” include personal supports, personal care assistance, and respite services, as defined in Rules 59G-13.070 and 13.088, Florida Administrative Code. This does not include any service provided in a licensed facility.

(8) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501, 393.066(8) FS. Law Implemented 42 U.S.C. 1396b(l), 393.066(2) FS. History–New 6-17-20.

Fla. Admin. Code R. 65G-12.002 Electronic Visit Verification

(1) Pursuant to the 21st Century Cures Act of 2016, 42 U.S.C. 1396b(l), as a condition for payment from the Agency, providers of personal care services and home health services that require an in-home visit pursuant to the HCBS Waiver or the CDC+ program shall use the Agency-designated Electronic Visit Verification (“EVV”) system to verify the following:

(a) The type of service performed;

(b) The individual receiving the service;

(d) The location of service delivery;

(e) The individual providing the service; and

(f) The time the service begins and ends.

(2) Providers of personal care services shall use the Agency-designated EVV system by November 1, 2020.

(3) Providers of home health services shall use the Agency-designated EVV system by December 31, 2022.

(4) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.501, 393.066(8), 120.54(6) FS. Law Implemented 42 U.S.C. 1396b(l), 393.066(2) FS. History–New 6-17-20.

Chapter 65G-13 INDIVIDUAL AND FAMILY SUPPORTS

Fla. Admin. Code R. 65G-13.001 Definitions

(1) “APD iConnect” or “iConnect” means the Agency for Persons with Disabilities’ (“Agency”) designated data management system as described in Section 393.066(2), Florida Statutes (F.S.), Chapter 65G-12, Florida Administrative Code (“F.A.C.”), and the Florida Medicaid Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook (“iBudget Handbook”), which is incorporated by reference in Rule 59G-13.070, F.A.C.

(2) “Benefit payments” has the same meaning as set forth in section 402.33, Florida Statutes (F.S.).

(3) “Central record” means, as described in Section 393.13(4)(i), F.S., a collection of paper or electronic files established by the Agency that pertains to each client. Each client central record is maintained by his or her support coordinator and contains the client’s updated demographic information; contact information for the client’s legal representative(s); releases of information; legal documents (such as a designation of power of attorney, healthcare surrogate, or guardianship, as well as guardian advocate papers and court orders); medical and medication information; results of assessments, eligibility determinations, and evaluations; and service delivery information, including cost plans, written service authorizations, and implementation plans, as required.

(4) “Client” has the same meaning as provided in Section 393.063, F.S.

(5) “Family care services” means direct supports provided through the IFS program to clients in the family home.

(6) “Family home” means the primary residence occupied by the client and any of the client’s family member(s).

(7) “Family member” means a spouse, child, parent, grandparent, sibling, aunt, uncle, niece, nephew, stepchild, stepparent, stepsibling, in-law, and adoptive relationships, who is not a client of the Agency.

(8) “Fiscal agent” means a person who serves as the designated payee of a disability benefit payment, is a co-signer on bank accounts, maintains physical possession of banking records, or otherwise controls the client’s finances.

(9) “Guardian advocate referrals” mean referrals or recommendations to organizations in order to obtain a guardian advocate, as defined in Section 393.063, F.S., to represent a client of the Agency pursuant to Section 393.12, F.S.

(10) “Habilitative services” means specific training activities that help a client to acquire, maintain, or improve self-help, socialization, and adaptive skills to enable a client to reside in the community.

(11) “Home and Community-Based Services (“HCBS”) Waiver” or “Waiver” means the Medicaid waiver program authorized by 42 U.S.C. 1396n(c)(1) of the Federal Social Security Act and Section 409.906, F.S., the administration of which the Agency for Health Care Administration (“AHCA”) is responsible, and which consists of the Waiver service delivery system and utilizes individual budgets that are required pursuant to Section 393.0662, F.S., under which the Agency, in consultation with AHCA, operates the Developmental Disabilities Individual Budgeting (“iBudget”) Waiver.

(12) “Imminent serious jeopardy” means a situation in which a client or other individual(s) are likely to encounter substantial harm within the immediate future without the provision of Individual and Family Supports to the client, or the client would require institutionalization without Individual and Family Supports within the immediate future.

(13) “Individual and Family Supports” or “IFS” means temporary assistance the Agency provides to meet critical service needs of a client, funded by Social Services Block Grant funds and General Revenue funds.

(14) “Individual Financial Profile” or “IFP” means a profile developed by a client of the Agency or a client’s legal representative and the client’s support coordinator or, if applicable, supported living coach, which accurately reflects the client’s finances and is required to determine the client’s need for an in-home subsidy.

(15) “In-home subsidy” or “HIS” means a type of financial assistance the Agency may provide to a client living in his or her own home, based on the client’s needs identified in his or her Individual Financial Profile, with supporting documentation, that is either provided monthly or as a one-time basis. The subsidy includes the following:

(a) “Monthly in-home subsidy” means financial assistance the Agency may provide on a monthly basis for a set amount of time to a client who has demonstrated an ongoing need for financial assistance in order to live in his or her own home.

(b) “Start-up in-home subsidy” means financial assistance the Agency may provide, which is approved on a one-time basis as a single supplement to the client’s income to cover start-up costs based on the client’s individual needs.

(16) “Legal representative” means a person with designated authority by law to act on behalf of an applicant or client to obtain Agency services. A legal representative may include:

(a) For an applicant or client under the age of 18 years:

The parents of a minor child whose rights have not been terminated;
Health care surrogate appointed by a Florida court to represent the child; or
Anyone appointed by a Florida court as a guardian or guardian advocate under Chapter 393 or 744, F.S.

(b) For an applicant or client age 18 years or older:

Anyone designated by the client through a Power of Attorney or Durable Power of Attorney;
A medical proxy under Chapter 765, F.S.;
Health care surrogate; or
Anyone appointed by a Florida court as a guardian or guardian advocate under Chapter 393 or 744, F.S.

(17) “Licensed residential facility” means any residential facility licensed under section 393.067, F.S.

(18) “Medicaid State Plan” means a comprehensive written statement established by the AHCA, as the single state agency, describing the scope and nature of the Medicaid program. The Plan outlines current Medicaid eligibility standards, policies and reimbursement methodologies to ensure the state program receives matching federal funds under Title XIX of the Social Security Act.

(19) “Medical/dental services” means the same as defined in Section 393.063, F.S.

(20) “Medically Necessary” shall have the same meaning as the iBudget Handbook.

(21) “Natural support” means unpaid supports that are or may be provided voluntarily to the client in lieu of Waiver or IFS. Any determination of the availability of natural supports includes but is not limited to consideration of the client’s caregiver(s) age, physical and mental health, travel and work or school schedule, responsibility for other dependents, sleep, and ancillary tasks necessary to the health and well-being of the client.

(22) “Own home” means a house, apartment, or comparable living space that:

(a) The client chooses, rents or owns, controls, and occupies as a primary place of residence;

(b) Meets the HUD housing quality standard found in 24 C.F.R. 982.401;

(d) Is not a licensed residential facility.

(23) “Parent training” means training for parents and caregivers as part of the implementation of a formal behavior analysis services plan that is designed, implemented or monitored and approved as required by Rules 65G-4.009 and 65G-4.010, F.A.C., or self-advocacy training. This includes classes in the community and individualized training in the home for parents/caregivers of clients which is designed to increase his or her knowledge of developmental disabilities, child development, parenting skills, advocacy skills, or accessing and organizing services for the client. This includes parent and caregiver training as part of Behavior Analysis and Behavior Assistant services.

(24) “Personal needs allowance” means funds set aside from benefit payments and third-party payments to provide for the client's current maintenance and incidental personal expenses.

(25) “Provider” means an individual vendor, agency, or direct service staff of an agency certified or approved by the Agency to provide services to Agency clients.

(26) “Quarterly meeting” means a meeting initiated by the support coordinator to assess a client’s progress in achieving goals, to determine if services are sufficient and satisfactory, to ensure that housing continues to meet the requirements, and to review the client's overall health, safety, and wellbeing.

(27) “Recreation” therapeutic activities utilized to provide temporary relief for a brief planned absence of the caregiver in a community setting.

(28) “Regional office” means one of the Agency’s offices serving a designated geographic area of the State.

(29) “Rehabilitative services” mean specific training activities that help a client to restore or regain self-help, socialization, and adaptive skills to enable a client to reside in the community.

(30) “Residential facility services” means room and board, supervision, training activities, and other habilitative and rehabilitative services provided to persons with developmental disabilities in a residential facility as defined in Section 393.063, F.S.

(31) “Respite services” means short-term, temporary care provided due to a primary caregiver’s brief planned or emergency absence, or when the primary caregiver is available but temporarily physically unable to care for or supervise the client for a brief period of time.

(32) “Roommate” means an individual who resides with a client and pays a share of the housing’s expenses.

(33) “Room and board payment” means a limited reimbursement by the Agency to a licensed residential facility providing residential habilitation and room and board to a client, to cover the cost of providing food and shelter to a client in accordance with chapter 393, F.S., and chapter 65G-2, F.A.C.

(34) “Significant” means of considerable magnitude or considerable effect.

(35) “Social services” mean services provided by a support coordinator, support planning, psychological evaluations, interpreter services, and court-ordered competency training.

(36) “Specialized therapies” mean treatments or activities prescribed and provided by an appropriately trained, licensed, or certified professional or staff person, including but not limited to physical therapy, speech therapy, occupational therapy, respiratory therapy, specialized mental health counseling, behavior analysis, behavior assistant services, dietician, and physical management services.

(37) “Support coordinator” means the same as defined in Section 393.063, F.S. For clients enrolled in the CDC+ Program, this term includes the CDC+ Consultant.

(38) “Supported Living” means a category of individually determined services that are medically necessary to prevent institutionalization and designed and coordinated in such a manner as to provide assistance to adult clients who require ongoing supports to live as independently as possible in their own homes, to be integrated into the community, and to participate in community life to the fullest extent possible.

(39) “Supported living coach” means a provider who assists a client in locating appropriate housing; and who assists a client in the acquisition, retention, or improvement of skills related to the activities of daily living, household chores, meal preparation, shopping, personal finances, and any social and adaptive skills necessary to enable the client to reside in his or her own home.

(40) “Supported living services” means a category of individually determined services designed and coordinated in such a manner as to provide assistance to adult clients who require ongoing supports to live as independently as possible in his or her own homes, to be integrated into the community, and to participate in community life to the fullest extent possible as stated in Section 393.063, F.S., which meets the requirements described in Chapter 65G-5, F.A.C.

(41) “Support plan” means an individualized and person-centered plan of supports and services designed to meet the daily needs of a client and to help the client live as independently as possible.

(42) “Third-party benefits” has the same meaning as set forth in section 402.33, F.S.

(43) “Transportation” means provision of rides to and from services or employment to enable a client to receive the supports and services identified on the support plan and authorized by the Agency.

(44) “Unavailability of funds” means the Agency has obligated all of the available budgeted funds for IFS expenditures.

(45) “Waiting List” means the prioritized list of clients, maintained by the Agency, that have been determined eligible for Agency services and are waiting to receive Waiver services when funding becomes available pursuant to Section 393.065(5), F.S.

(46) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066(8), 393.0663, 393.0695, 393.501(1), 402.33 FS. Law Implemented 393.063, 393.066, 393.0663, 393.0695, 402.33 FS. History–New 8-28-16, Amended 12-25-22, 8-17-23.

Fla. Admin. Code R. 65G-13.002 Individual and Family Supports (IFS) Procedure

(1) Requesting IFS.

(a) A request for IFS can be made orally or in writing to the appropriate Agency regional office by a client, client’s legal representative, or client’s support coordinator. IFS can also be initiated by the Agency.

(b) A request for IFS must include:

The name and address of the client for whom IFS is being requested;
If the requester is different than the client, the name, contact information, and relationship with the client of the individual submitting the IFS request;
A description of the specific need to be addressed by the requested IFS service(s);
Documentation that demonstrates the specific need to be addressed by the requested IFS service(s); and
An explanation of the efforts taken to address those needs through other funding sources and natural supports.

(2) Within 30 calendar days of receipt of a request for IFS, the Agency will approve, partially approve, deny, reduce, terminate, or request additional documentation to supplement the request. If additional documentation or information is requested, the deadline for the Agency’s response shall be extended to 60 calendar days following the receipt of the original request for IFS.

(a) If the Agency requests additional documentation:

The requester shall either:

a. Provide the requested documentation or information within 10 calendar days of the date of the written notice; or

b. notify the Agency in writing that the individual requesting IFS wishes the Agency to render its decision based upon the documentation and information provided with the initial request.

If the Agency does not receive the requested additional information, the Agency will make a determination of the request for IFS based on the information available.

(3) Prior to authorizing the use of IFS, the support coordinator or, if the client is not enrolled on the Waiver, the Agency, shall assist the client with exploring alternative funding and service(s) options for which the individual may be eligible to receive in accordance with subsection 65G-13.003(3), F.A.C.

(a) If alternative funding and/or service(s) options are available or become available, the Agency shall partially approve, deny, reduce, or terminate the request for IFS to the extent not covered from the alternative funding and/or service(s).

(b) The support coordinator shall document in iConnect the alternative options that were explored.

(4) Approval for IFS.

(a) IFS funds can only be encumbered for the current fiscal year.

(b) IFS will not be approved retroactively, except in limited circumstances:

To correct an administrative error; or
On a case-by-case basis to consider a health and safety risk to the client or emergency situations.

(c) The regional office shall only approve IFS for clients who meet the IFS eligibility criteria described in Rule 65G-13.003, F.A.C., and the Agency has available funds.

(5) IFS shall not be approved for goods or services if the client:

(a) Requested and was denied the same goods or services provided under the Medicaid State Plan and/or the Waiver under the same or substantially similar circumstances; and/or

(b) Is in the process of disputing a denial or termination pertaining to the same goods or services under the Medicaid State Plan and/or the Waiver.

(6) Denial or Partial Approval of IFS.

(a) If the regional office concludes that the client’s request does not meet or only partially meets the IFS criteria described in Rule 65G-13.003, F.A.C., the regional office shall deny, reduce, partially approve, or terminate the IFS request and provide written notification of the denial to the client or client’s legal representative within the timeframe established in subsection (2) of this rule.

(b) If the Agency denies or partially approves a request for IFS based on lack of documentation and additional documentation subsequently becomes available, or there is a change in the client’s situation, client may submit a new request for IFS, at any time, to the regional office.

(c) The Agency shall not authorize the use of IFS that exceed the appropriation amount. Unavailability of funds is sufficient reason to deny a request for IFS.

(7) Reduction or Termination of IFS. If any time after an approval of IFS the agency determines that a client does not meet all the eligibility requirements, the Agency may reduce or terminate the benefit by providing written notification to the client or client’s legal representative.

(8) Anytime IFS are denied, partially approved, reduced, or terminated, the client shall have the right to request an administrative hearing pursuant to Sections 393.125(1)(b), 120.569 and 120.57, F.S., within 30 calendar days of receipt of notification.

(9) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066(8), 393.0663, 393.501(1) FS. Law Implemented 393.063, 393.066, 393.0663 FS. History–New 8-28-16, Amended 12-25-22.

Fla. Admin. Code R. 65G-13.003 Individual and Family Supports Criteria

(1) IFS may only be approved for clients when community-based services are medically necessary to prevent institutionalization under Section 393.066(3), F.S., which may include the use of IFS to avert a crisis as described in Section 393.065(5)(a), F.S. and Division 65G, F.A.C.

(2) Clients enrolled on the Waiver must not receive IFS services that are the same or substantially the same as the services offered on the Waiver, except for:

(a) A client approved for and actively enrolling onto the Waiver, the client shall demonstrate imminent serious jeopardy prior to Waiver enrollment. The provision of IFS shall only be approved to directly address the imminent serious jeopardy and must end on the effective date upon commencement of Waiver services that addresses the imminent serious jeopardy. The utilization of IFS will be reviewed on the 90th day from the date the client applied for enrollment onto the Waiver for clients who have not yet enrolled onto the Waiver by the 90th day.

(b) A client with a pending Significant Additional Need (“SAN”) request, as described in Rule 65G-4.0218, F.A.C., that is in imminent serious jeopardy and the IFS directly addresses the need for which the SAN has been requested. For IFS approved under this paragraph, the IFS must terminate:

Upon denial of the SAN request; or
After approval of the SAN request and upon commencement of the waiver service(s) for which the SAN has been requested.

(3) In order for a client to receive a specific IFS service, the service must not be offered or available by any other resource. Other resources include, but are not limited to:

(a) Medicaid State Plan;

(b) The Waiver, except as provided for in subsection (2) of this rule;

(d) Other agencies or programs; and

(e) Other paid supports, such as Medicare or private insurance.

(4) The following services are allowable under IFS:

(a) Adult day training, as defined in Section 393.063, F.S.;

(b) Employment and pre-vocational services;

(d) Guardian advocate referrals, as described in Section 393.12, F.S.;

(e) Medical and dental services, which include but are not limited to nursing services, consumable medical supplies, durable medical equipment, medical evaluations, and dental services;

(f) Parent training;

(g) Personal care services, as defined in Section 393.063, F.S.;

(h) Recreation;

(i) Residential facility services;

(j) Respite services, as defined in Section 393.063, F.S.;

(k) Social services;

(l) Specialized therapies;

(m) Supporting living services;

(n) Transportation; and

(o) Other habilitative and rehabilitative services.

(5) Non-allowable IFS services include but are not limited to the following:

(a) Home repairs;

(b) Installation or maintenance of spas or swimming pools;

(d) Restraint devices;

(e) Satellite or cable television services or the purchase of a television;

(f) Vacation travel or accommodations;

(g) Aesthetic home improvements;

(h) Contractor services;

(i) Any portion of the principal or interest of a mortgage payment;

(j) Property taxes;

(k) Premiums for life, auto, medical/health, renter’s, or homeowner’s insurance;

(l) Loans, debts, or credit card payments;

(m) Personal spending funds or savings accounts;

(n) Alcohol or nicotine products or supplies;

(o) Alimony payments, child support payments, or any payments that are not for the direct benefit of the client;

(p) Purchase or replacement of major appliances such as refrigerators, stoves, dishwasher, or washer/dryer;

(q) General repair and maintenance of property, such as repair of major appliances and heating, ventilation, and air conditioning systems;

(r) Computing devices, such as computers and tablet personal computers;

(s) Telephones for persons in the family home or a licensed facility;

(t) Second telephone line in person’s own home;

(u) Court costs, lawyer fees, traffic tickets, or fines;

(v) Recreational items or expenses related to events and activities that a client attends that do not address an assessed need of the client;

(w) Capital improvements to property;

(x) Fees related to legal guardianship and legal guardianship reports;

(y) Supporting or subsidizing any other person living in the client’s household; and

(z) Covering or replacing supports or services that are allowable under the Medicaid State Plan, the Waiver, or any other governmental program after the client has been determined eligible for the Medicaid State Plan, the Waiver, or other governmental program.

(6) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.065, 393.066(8), 393.0663, 393.501(1) FS. Law Implemented 393.063, 393.065, 393.066, 393.0663 FS. History–New 8-28-16, Amended 12-25-22.

Fla. Admin. Code R. 65G-13.004 In-Home Subsidy Procedure

(1) A request for an in-home subsidy must be made by submitting a complete and accurate Individual Financial Profile, Form 65G-13.004 A, effective 12-2022, adopted and incorporated herein, which may be found at https://apd.myflorida.com/customers/supported-living/docs/Individual%20Financial%20Profile%20Form%20-%20FINAL%20221222.pdf and http://www.flrules.org/Gateway/reference.asp?No=Ref-14949, with the required supporting documentation, by either:

(a) For a client enrolled on the Waiver, the client’s support coordinator; or

(b) For a client not enrolled on the Waiver, the client’s supported living coach, if one is assigned, otherwise the client or the client’s legal representative.

(2) A request to renew a monthly in-home subsidy shall meet the requirements of subsection (1) of this rule and be submitted to the Agency by the earliest of the following:

(a) 30 calendar days prior to the end of the approval period designated in the Agency’s notice approving the monthly in-home subsidy;

(b) 30 calendar days prior to the new fiscal year, or June 1 of each year; or

(3) If a client is assigned a supported living coach, the supported living coach shall comply with all the requirements described in the iBudget Handbook. The assigned supported living coach shall also:

(a) Assist the client and/or legal representative in drafting, gathering documentation for, and timely submitting the client’s Individual Financial Profile;

(b) Assist the client in obtaining additional funding sources and document all such efforts in the request for the in-home subsidy. Analysis of other funding sources for the client, may include, but is not limited to:

Seeking employment;
Obtaining potential roommates to share costs with the client;
Seeking any subsidized housing options for the client;
Applying for supplemental nutrition assistance program (“SNAP”); and
Seeking any other resources available to the client;

(c) If the client is enrolled on the Waiver, coordinating with the client’s support coordinator in completing the client’s Individual Financial Profile; and

(d) If the client is enrolled on the Waiver, sending the client’s completed Individual Financial Profile to the support coordinator no more than 10 calendar days following the selection of housing by the client and prior to signing the lease.

(4) If the client enrolled on the Waiver is not assigned a supported living coach, then the client’s support coordinator shall perform the role of the supported living coach under this chapter.

(5) If the client is enrolled on the Waiver, then the support coordinator shall review the Individual Financial Profile to verify that it accurately reflects all sources of income and monthly expenses of the client. The support coordinator shall submit the client’s Individual Financial Profile to the regional office within 7 calendar days of receipt.

(6) Within 30 calendar days of receipt of a request for an in-home subsidy, the Agency will approve, partially approve, deny, terminate, reduce, or request additional documentation to supplement the request.

(a) If additional documentation is requested, the deadline for the Agency’s response shall be extended to 60 calendar days following the receipt of the original request.

If the Agency requests additional documentation from the client, the client shall either:

a. Provide the requested documentation within 10 calendar days of the date of the written notice; or

b. Notify the Agency in writing that the client wishes the Agency to render its decision based upon the documentation provided with the initial request.

If the client fails to timely respond to the Agency’s notice requesting additional documentation, the Agency will deny, terminate, reduce, or partially approve the request based on the documentation available.

(b) The Agency will issue a notice of its determination to the client, and if applicable, the client’s legal representative.

Should a request for in-home subsidy be approved or partially approved, the notice will indicate amount, the period, and the specifically approved use(s) of such funds.
In-home subsidy funds shall be used to purchase the less costly version of the items listed in the notice.
Anytime an in-home subsidy is denied, partially approved, reduced, or terminated, the client shall have the right to request an administrative hearing pursuant to Sections 393.125(1)(b), 120.569 and 120.57, F.S., within 30 calendar days of receipt of notification.

(7) The Agency shall deny an in-home subsidy request if the client, his or her support coordinator or, if applicable, supported living coach, does not provide an accurate and up-to-date Individual Financial Profile to substantiate the request.

(8) If an in-home subsidy is approved, the client shall provide a copy of the signed lease to his or her support coordinator. The support coordinator shall place the copy of the signed lease in the client’s central record.

(9) A client who requests an in-home subsidy from the Agency shall not commit to a living situation that is beyond his or her financial means prior to having the Agency review and approve his or her Individual Financial Profile for an in-home subsidy. The Agency is not responsible for the costs of the living arrangement that the client agrees to in a lease or mortgage without Agency approval.

(10) The Agency will deny payment for an in-home subsidy requested by a client or legal representative who did not request prior authorization. In limited circumstances, an exception may be made on a case-by-case basis by the Agency’s regional office to:

(a) Correct an administrative error; or

(b) Consider a health and safety risk or emergency.

(11) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0663, 393.0695, 393.501 FS. Law Implemented, 393.063, 393.066, 393.0663, 393.0695 FS. History–New 12-25-22, Technical Change 5-14-26.

Fla. Admin. Code R. 65G-13.005 In-Home Subsidy Criteria

(1) All in-home subsidy funding is limited to basic living necessities that enable a client, in supported living, to live in his or her own home.

(2) In addition to the other requirements of this section, to be eligible for an in-home subsidy, a client must establish:

(a) He or she is eighteen years of age or older;

(b) He or she either:

Requires the assistance of an in-home subsidy to move into one’s own home; or
Is unable to remain in his or her own home without an in-home subsidy;

Is in the client’s best interest;
Does not jeopardize the health, safety, or welfare of themselves or others; and
Is more cost-effective than other options;

(d) For a client who leases their own home, a current written lease, signed by the client and landlord that is not prohibited.

Prohibited leases for in-home subsidy purposes include:

a. A month-to-month lease unless the client’s circumstances meet any of the criteria listed in sub-sub-subparagraphs (I)-(III) of this paragraph and may not be used for more than three consecutive months per fiscal year.

I. All available housing options that meet a client’s identified needs require a month-to-month lease. For purposes of this paragraph, “available housing options” means the options that are reasonable relative to the client’s financial means, as identified in the Individual Financial Profile;

II. Alternative living arrangements that offer long-term leases, such as annual leases, cannot reasonably meet the client’s identified needs as described in his or her support plan; or

III. The client’s health, safety, and welfare require he or she sign a month-to-month lease. The client may request an extension to the three-month period if the client’s health, safety, and welfare are at risk.

b. Any fixed term that is less than one month.

(3) In-home subsidies are funds of last resort and will only be granted when all other available resources are exhausted, including those described in subsection 65G-13.003(3), F.A.C. The client shall utilize all resources or options, other than moving into the family home, to reduce the cost of living, including the requirements in paragraphs (a)-(e) below, before an in-home subsidy may be authorized.

(a) A client requesting an in-home subsidy for rental assistance shall show proof that he or she has applied for and been denied or is on the waiting list for rental assistance through the U.S. Department of Housing and Urban Development or other local governmental organization (e.g., the local public housing authority).

(b) A client is expected to participate in utility/telephone company budget plans, if available, or other low-income cellular phone assistance programs. In-home subsidy funds may be used to pay the cost of cellular phone service instead of a landline telephone service only if it would not cost more than a landline telephone service. A cost comparison of cellular phone services and landline telephone service shall be included with the client’s Individual Financial Profile.

(c) A client who intends to use the in-home subsidy funds for food shall show proof that he or she has been approved or denied supplemental nutrition assistance program (“SNAP”) benefits within the last twelve (12) months.

(d) A client is expected to live within his or her means, which may include living with a roommate or roommates.

(e) Costs related to the in-home subsidy request shall be reasonable for the geographical area where the client lives.

(4) An in-home subsidy will not be approved if the need for which it is being requested is the result of the mismanagement of client funds by either the client or the client’s legal representative.

(5) The Agency will not reimburse start-up expenses that the client incurred prior to receiving approval for a start-up in-home subsidy.

(6) Unavailability of funds is sufficient reason to deny an in-home subsidy.

(7) Amount of in-home subsidy. The Agency determines an eligible client’s in-home subsidy amount by calculating an individual determination of need, based on the client’s Individual Financial Profile and supporting documentation.

(8) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0663, 393.0695, 393.501 FS. Law Implemented, 393.063, 393.066, 393.0663, 393.0695 FS. History–New 12-25-22.

Fla. Admin. Code R. 65G-13.006 In-Home Subsidy Restrictions

(1) In-home subsidy funds are limited to an individual determination of need and shall not be used to purchase restricted items, which include:

(a) Satellite or cable television services or the purchase of a television;

(b) Maintenance of a swimming pool;

(d) Aesthetic home improvements;

(e) Contractor services;

(f) Medical or dental services;

(g) Medicines, medical supplies, or adaptive equipment or aids;

(h) Any portion of the principal or interest of a mortgage payment;

(i) Insurance premium(s), which include but are not limited to life, auto, medical/health, renter’s, and homeowner’s;

(j) Loans, debts, or credit card payments;

(k) Personal spending funds or savings accounts;

(l) Alcohol or nicotine products or supplies;

(m) Alimony payments or child support payments, alimony payments, child support payments, or any payments that are not for the direct benefit of the client;

(n) Major appliances, which includes but is not limited to an air conditioner, heater, refrigerator, stove, dishwasher, or washer/dryer;

(o) Computer, tablet personal computer, or cell phone;

(p) Second telephone line;

(q) Court costs, lawyer fees, traffic tickets, or fines;

(r) Recreational items or expenses related to events and activities that a client attends;

(s) Reimbursement of money owed for cost of expenses related to events and activities that a client attends;

(t) Capital improvements to property;

(u) General repair and maintenance of property, which includes but is not limited to repair and maintenance of major appliances;

(v) Fees related to legal guardianship and legal guardianship reports;

(w) Property taxes;

(x) Supporting or subsidizing any other person living in the client’s household;

(y) Paying a contractor for the provision of services and supports to a client who is the recipient of the in-home subsidy;

(z) Internet;

(aa) Transportation;

(bb) Services and supports otherwise covered under Rules 65G-13.002 and 13.003, F.A.C.; and

(cc) Covering or replacing supports or services which are allowable under the U.S. Department of Housing and Urban Development, the Medicaid State Plan, the Medicaid Home and Community-Based Services Waiver, or any other governmental agency.

(2) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0663, 393.0695, 393.501 FS. Law Implemented, 393.063, 393.066, 393.0663, 393.0695 FS. History–New 12-25-22.

Fla. Admin. Code R. 65G-13.007 In-Home Subsidy Review

(1) The Agency can review any in-home subsidy for compliance with this chapter and Florida statutes.

(2) An in-home subsidy shall be used in a manner that is approved by the Agency, as described in the approval notice issued by the Agency. Should in-home subsidy funds not be used in a manner approved by the Agency, the Agency shall take action to ensure that the use of in-home subsidy funds complies with this chapter and Florida Statutes, including:

(a) Terminating or decreasing the amount of the subsidy; or

(b) Disbursing direct payment to the vendor (such as a landlord or utility company) instead of disbursing an in-home subsidy payment to the client or the legal representative.

(3) An in-home subsidy may be reduced or terminated if funds are not available.

(4) Upon request by the Agency, the recipient of any in-home subsidy shall provide an updated Individual Financial Profile within 10 calendar days of the Agency’s request. Failure to submit an updated and accurate Individual Financial Profile may result in denial, partial approval, reduction, or termination of the in-home subsidy.

(5) Verification of start-up and monthly in-home subsidy expenditures. If a client has a supported living coach, the supported living coach shall verify that the in-home subsidy funds have been spent appropriately, as described in the approval notice sent by the Agency. If a client does not have a supported living coach but has support coordinator, then the client’s support coordinator shall perform this verification.

(a) This verification includes reviewing receipts to verify that designated items were purchased as approved by the Agency on at least a quarterly basis.

(b) The provider conducting the verification shall notify the Agency in writing upon discovering any use of in-home subsidy funds that were not approved by the Agency. Additionally, the provider shall take appropriate action to address any unapproved use of such funds, which may include:

Providing additional supports to the client who is the recipient of the in-home subsidy, such as training and advising with money management; and/or
Assisting in locating someone to provide financial management for the client who is the recipient of the in-home subsidy.

(c) This verification shall be documented by the provider conducting the verification in the client’s progress/case notes within iConnect.

(6) Review of the monthly in-home subsidy. If a client has a supported living coach, the supported living coach shall reassess a client’s need for the in-home subsidy on a quarterly basis, or more frequently if necessary, to determine the client’s ongoing need for the subsidy. If a client does not have a supported living coach but has support coordinator, then the client’s support coordinator shall perform this reassessment.

(7) A client shall submit a new Individual Financial Profile to the regional office when circumstances affecting the client’s need for an in-home subsidy change substantially. Circumstances that substantially affect a client’s need for an in-home subsidy, which may include:

(a) A change in Social Security payments;

(b) The client receives any back payment for Social Security income or other benefits;

(d) A change in employment status;

(e) A change in availability of subsidized housing;

(f) A change in the client’s income;

(g) A change in housing or rent expenses;

(h) Eviction due to non-payment of rent requiring the client to secure an alternative living arrangement;

(i) Pest infestation not covered in rental agreement;

(j) Loss of child support payments for any client who has children; and/or

(k) A change in expenditures that results in financial hardship not attributable to mismanagement of the client’s funds.

(8) If a family member, fiscal agent, or any other person who controls the finances of a client who is the recipient of an in-home subsidy uses the funds in a way that is not for the sole benefit of the client or inconsistent with the notice of approval sent by the Agency, the Agency will make appropriate referrals to the State Attorney, law enforcement, or other appropriate authorities.

(9) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0663, 393.0695, 393.501 FS. Law Implemented, 393.063 393.066, 393.0663, 393.0695 FS. History–New 12-25-22.

Fla. Admin. Code R. 65G-13.008 Room and Board Payments

(1) For the Agency to authorize a room and board payment to a licensed residential facility in accordance with legislative appropriation for room and board services received by a client, the client must:

(a) reside in a licensed residential facility;

(b) have sought and obtained all available third-party benefits and benefit payments, for which the client is entitled;

(c) have utilized all third-party benefits and benefit payments towards the payment of room and board services, except for a personal needs allowance as set forth in Rule 65G-2.018, F.A.C.; and

(d) provide all records relating to receipt of third-party benefits and benefit payments to the residential facility in which the client resides.

(2) The licensed residential facility must request a room and board payment in accordance with this subsection.

(a) The licensed residential facility must submit the Room and Board Reimbursement Form, APD Form 65G-13.008 A, adopted and incorporated herein, which may be found at: http://www.flrules.org/Gateway/reference.asp?No=Ref-15472, in accordance with the instructions contained therein.

(b) The licensed residential facility must submit for its adult clients, at least annually or upon any change in the client’s Social Security eligibility, a copy of the most recent Supplemental Security Income (“SSI”) program award or denial letter, which demonstrates a good faith attempt to secure a benefit payment for the client to the regional office in which the facility is located. The contact information for each regional office can be found at https://apd.myflorida.com/.

(3) The room and board reimbursement payment for an adult must be calculated as follows:

(a) add together all benefit payments and third-party benefits; then

(b) subtract the personal need allowance, described in Rule 65G-2.018, F.A.C.; then

(4) The room and board payment for a client under the age of 22 is $583.42, regardless of that client’s benefit payments and third-party benefits.

(5) This Rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.066, 393.0662, 393.067, 393.501, 402.33, FS. Law Implemented 393.066, 393.0662, 393.067, 402.33, FS. History–New 8-17-23.

Chapter 65G-14 QUALIFIED ORGANIZATIONS AND WAIVER SUPPORT COORDINATION

Fla. Admin. Code R. 65G-14.001 Definitions

(1) “Agency” means the Agency for Persons with Disabilities.

(2) “Clearinghouse” means a database created and maintained by the Agency for Health Care Administration that allows the results of criminal history checks to be shared among specified agencies according to Section 435.12, Florida Statutes (F.S.).

(3) “Code of Ethics” means a set of values, standards, and principles to guide decision-making and everyday professional conduct of Support Coordinators employed by a Qualified Organization.

(4) “Consultant” shall have the same meaning as in the Consumer-Directed Care Plus Program Coverage, Limitations, and Reimbursement Handbook (“CDC+ Handbook”), as adopted by Rule 59G-13.088, Florida Administrative Code (F.A.C.).

(6) “Corrective Action” means any act of remediation that the Qualified Organization is required to complete in response to any state or federal regulatory agency’s or its representative’s findings of unacceptable performance, nonperformance, or noncompliance with the terms and conditions of this chapter, Rules 65G-4.0213 through 4.0218, F.A.C. (“iBudget Rules”), Chapter 65G-10, F.A.C., Section 393.0663, F.S., or the Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook.

(7) “Corrective Action Plan” means a plan prepared by the Qualified Organization and approved by the Agency by which the corrective action will be accomplished. A Corrective Action Plan has the same meaning as a Plan of Remediation.

(8) “Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook” or “iBudget Handbook” refers to the handbook incorporated by reference in Rule 59G-13.070, F.A.C.

(9) “Employee” means a person who works in the service of an employer, the Qualified Organization, in a relationship in which the employer has the right to control the details of his or her job performance, as opposed to an independent contractor.

(10) “Home and Community Based Services Waiver” or “Waiver” means the Medicaid waiver authorized by 42 U.S.C. 1396n(c) of the federal Social Security Act and Section 409.906, F.S., that provides Medicaid funding for home and community based services to eligible persons with developmental disabilities who are eligible for Agency services and who live at home or in a home-like setting.

(11) “Home Region” means the Region in which the applicant submitted its application to become a Qualified Organization and where services will be rendered by the Qualified Organization, if approved. If the applicant wishes to render services in multiple Regions, only one application must be submitted to the Home Region as described in Rule 65G-14.002, F.A.C.

(12) “iConnect” means the Agency’s designated data management system as described in Section 393.066(2), F.S.

(13) “Legal Representative” means:

(14) “Medicaid Waiver Services Agreement” or “MWSA” means the voluntary contract as described in Section 409.907, F.S., between the Agency and providers of Medicaid Waiver services to Agency clients, as defined in Section 393.063(7), F.S.

(15) “Mentee” means a person employed by a Qualified Organization who is guided, advised, or trained by a mentor.

(16) “Mentor” means a Support Coordinator employed and designated by a Qualified Organization who uses his or her knowledge, skills, and experience to guide, advise, or train a mentee employed by the same Qualified Organization.

(17) “Ombudsman” means the Agency’s primary point of contact for addressing issues of concern or unresolved issues expressed by clients, legal representatives, providers, and other external stakeholders.

(18) “Qualified Organization” shall have the same meaning as in Section 393.0663(2), F.S.

(19) “Quality Improvement Organization” or “QIO” means a group of health quality experts, clinicians, and consumers contracted with the Agency for Health Care Administration and organized to improve the quality of care delivered to Agency clients.

(20) “Region” means one of six designated local geographical areas served by the Agency. There are six regions across the state of Florida: Northwest, Northeast, Central, Suncoast, Southeast, and Southern.

(21) “Regional Office” means one of the Agency’s offices serving a Region. The contact information for each Regional Office is designated on the Agency’s website.

(22) “Sexual Misconduct” shall have the same meaning as in Section 393.135, F.S.

(23) “Support Coordinator” shall have the same meaning as in Section 393.063, F.S. and the CDC+ Handbook.

(24) “Waiver Support Coordinator” refers to a Support Coordinator who assists clients enrolled on the Medicaid Home and Community-Based Services Waiver.

(25) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662, 393.0663, 393.501 FS. Law Implemented 393.063, 393.0662, 393.0663 FS. History–New 7-1-21, Amended 10-25-22.

Fla. Admin. Code R. 65G-14.002 Qualifications

(1) Each Qualified Organization must meet the requirements of Section 393.0663, F.S., this rule chapter, and the iBudget Handbook, and be approved by the Agency. A provider agency, as described in the iBudget Handbook, which provides support coordination services prior to the effective date of this rule must apply to and be approved by the Agency before it can be designated as a Qualified Organization.

(2) Application for Approval. Any business entity that wishes to become a Qualified Organization must submit the following to the appropriate Regional Office, which will be known as the applicant’s Home Region:

(a) A completed Qualified Organization Application, APD Form 65G-14.002 A, effective July 1, 2021, incorporated here by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12650;

(b) A copy of the proposed code of ethics described in Rule 65G-14.0041, F.A.C.;

(d) A copy of the proposed mentoring program described in Rule 65G-14.0043, F.A.C.;

(e) A copy of the proposed policies and procedures required by the iBudget Handbook for provider agencies;

(f) A copy of each prospective Support Coordinator’s provider application as described in Rule 65G-4.0215, F.A.C., or Medicaid Waiver Services Agreement (“MWSA”) for existing Support Coordinators; and

(g) A table of organization, including at minimum: the first and last name, position title, contact information including phone number and email address, Medicaid provider number (if applicable), and indicate full or part-time employment for all directors, supervisors, owners, operators, managers, or any other position that directly oversees the operations of any Qualified Organization in the State of Florida or who provides support coordination services regardless of contractual relationship, including a designated mentor(s). The table must indicate in which region each individual operates. If the Qualified Organization operates in multiple regions, the table of organization must be organized by region and a point of contact must be designated for each region.

(3) Qualified Organization Leadership.

(a) Any directors, supervisors, owners, operators, and managers who directly oversee the operations of any Qualified Organization in the State of Florida must have at least a bachelor’s degree from an accredited college or university and two years of experience providing services to persons with developmental disabilities, regardless of whether that individual is an active Support Coordinator.

(b) Any directors, supervisors, owners, operators, and managers who directly oversee the operations of any Qualified Organization in the State of Florida must complete the Level 1 Training described in Rule 65G-10.004, F.A.C., regardless of whether they are Support Coordinators.

(c) Any directors, supervisors, operators, and managers who directly oversee Support Coordinators in the State of Florida must attend a minimum of six (6) monthly support coordinator meetings with Agency staff each year. These meetings can be attended in any region, although directors, supervisors, operators, and managers who directly oversee Support Coordinators in particular regions must attend at least one meeting in that region or regions each year.

(4) Approval, Denial, or Closure of Applications.

(a) The Agency will review the application and approve or deny complete applications within 90 days of receipt. The Agency will close incomplete applications and notify the applicant that it was closed because it was incomplete.

(b) The Agency will only consider complete applications that include all required information and meet the requirements delineated in this chapter, the iBudget Handbook, and Section 393.0663, F.S. An application is complete upon the Agency’s receipt of all requested information and correction of any error or omission for which the applicant was notified.

(c) If the Agency receives an incomplete application, the Agency will notify the applicant within 30 days of receipt. The applicant will have up to 45 calendar days from the date of the notice to submit the documentation, information, or make any corrections designated in the notice. If the applicant does not complete the application within 45 days of the notice, the application must be closed by the Agency. After an application is closed, all documentation and information submitted will no longer be considered, and a new complete application must be submitted for consideration by the Agency. The closure of an application is not Agency action. The closure of an application will not be considered substantively by the Agency in any subsequent application.

(5) If the Qualified Organization intends to operate in multiple Regions, the applicant must indicate such in the application. The region in which the applicant submits the application will be considered the applicant’s Home Region, which must be a region in which it provides services.

(6) A Qualified Organization that wishes to expand service provision geographically must comply with Rule 65G-4.0215, F.A.C.

(7)(a) Each Qualified Organization may only hire a Support Coordinator as an employee pursuant to this paragraph and Section 393.0663(1) and (2), F.S., and not as an independent contractor.

(b) Each Qualified Organization must employ a minimum of four Support Coordinators at all times except as described in paragraph (c) of this rule.

(c) If a Qualified Organization should be reduced to employing less than four Support Coordinators, the Qualified Organization has a maximum of 90 days to re-establish a minimum employment of four. For purposes of this rule, mentees count towards the minimum of four Support Coordinators.

(8) Failure to demonstrate compliance with Section 393.0663, F.S., this rule chapter, and the iBudget Handbook shall result in disciplinary action as described in Rule 65G-14.005, F.A.C.

(9) If a Qualified Organization does not provide any Agency approved support coordinator or consultant services under the Waiver for 180 consecutive days, then it shall no longer be recognized as a Qualified Organization under Section 393.0663, F.S.

(10) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662, 393.0663, 393.501 FS. Law Implemented 393.063, 393.0662, 393.0663 FS. History–New 7-1-21, Amended 10-25-22.

Fla. Admin. Code R. 65G-14.003 Agency Monitoring and Oversight

(1) To enable the Agency to comply with Section 393.0663(3), F.S., each Qualified Organization must report to the Agency any violation of ethical or professional conduct by Support Coordinators employed by that organization within seven (7) calendar days of discovering the violation, unless the violation threatens the health and safety of a client(s). Any violation that could cause a client’s physical, mental, or emotional health to be significantly impaired must be reported to the Agency within 24 hours of discovering the violation. Violations shall be treated as discovered by a Qualified Organization as of the first day on which such violation is known or by exercising reasonable diligence should have been known to the Qualified Organization. Each Qualified Organization is responsible for reporting violations that occur from the time of hiring each Support Coordinator. For the purposes of this section, a “violation of ethical or professional conduct” shall include any of the following actions on the part of a Support Coordinator:

(a) Unprofessional interactions with a client, legal representative, service provider, or Agency staff member as evidenced by documented or observed instances of screaming, yelling, cursing, or physical altercations as well as engaging or attempting to engage in verifiable romantic or sexual behavior with a client;

(b) Arrest for a disqualifying criminal offense as described in Sections 393.0655(5) and 435.04(2), F.S.;

(d) Falsification of documentation;

(e) Accidental or incidental unauthorized disclosure of a client’s confidential or private information;

(f) Reckless or intentional unauthorized disclosure of a client’s confidential or private information;

(g) Failure to perform support coordination duties necessary to comply with legal notices regarding client services, such as updating cost plans based on service determinations;

(h) Failure to perform support coordination duties, as required by statutes and administrative rules, including the iBudget Handbook, which jeopardize or are likely to jeopardize the health, safety, or welfare of a client;

(i) Borrowing, attempting to borrow, or accepting funds from a client or, if applicable, client’s legal representative or family;

(j) Diverting clients to specific providers and not facilitating provider choice;

(k) Not maintaining updated and accurate contact and demographic information for clients and legal representatives in iConnect;

(l) Material or repeated occurrences of Support Coordinators making errors inputting data in iConnect; and

(m) Any violation of the Qualified Organization’s code of ethics.

(2) To report a violation(s), the Qualified Organization must send an e-mail message to the Regional Office in the Region where the violation(s) occurred. Any violation involving abuse, neglect, exploitation, or abandonment of a client must also be immediately reported to the Florida Abuse Hotline in compliance with Sections 415.1034 and 39.201, F.S. The e-mail to the Agency must include the following information:

(a) Name of the Qualified Organization;

(b) Name and Medicaid provider identification number of the Support Coordinator(s) with reported ethical or legal violation;

(c) A detailed description of the violation(s), including the date of the violation(s); how and when the Qualified Organization discovered the violation(s); and, if applicable, client(s) impacted and how they are impacted or affected as well as any individual(s) who witnessed or were involved with the violation(s);

(d) Action(s) taken by the Qualified Organization against the Support Coordinator(s); and

(e) Any action(s) taken by the Qualified Organization intended to reduce the likelihood of recurrence of the violation.

(3) All Qualified Organizations must maintain an active and accurate roster within the Clearinghouse to ensure all Support Coordinators have active and eligible level II background screenings. All Support Coordinators must complete level II background screening upon hire and maintain an eligible status within the Clearinghouse in accordance with Section 393.0655 and Chapter 435, F.S.

(4) If any client or, if applicable, his or her legal representative has a concern or complaint that the Qualified Organization has failed to resolve using their complaint and grievance procedure, then the client or legal representative may submit the complaint or grievance to the State Ombudsman at https://apd.myflorida.com/contacts/.

(5) The Qualified Organization shall provide each client or, if applicable, his or her legal representative, with an Invitation to Take a Client Satisfaction Survey, APD Form 65G-14.003 A, effective July 1, 2021 and incorporated here by reference, during each client’s annual support plan meeting in compliance with the iBudget Handbook. The Invitation to Take a Client Satisfaction Survey is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12652.

(6) A Qualified Organization’s failure to properly report a known violation described in this rule constitutes a separate and additional violation.

(7) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662(7), (15), 393.0663(5), 393.501(1) FS. Law Implemented 393.0662, 393.0663(3), 393.063 FS. History–New 7-1-21.

Fla. Admin. Code R. 65G-14.004 Qualified Organization Duties and Responsibilities – Oversight of Support Coordinators

(1) Each Qualified Organization must comply with all requirements identified in Section 393.0663, F.S., which includes ensuring that all Support Coordinator staff have the knowledge, skills, and abilities necessary to competently provide services to individuals with developmental disabilities. Each Qualified Organization must maintain and enforce standards and procedures to ensure that its Support Coordinators are complying with their duties and responsibilities as described in Chapter 393, F.S.; Division 65G, F.A.C.; the iBudget Handbook, and, if applicable, the CDC+ Handbook, including ensuring its Support Coordinators timely request renewal of their MWSA. Qualified Organizations are responsible for promptly addressing complaints/compliance issues regarding its Support Coordinators’ performance.

(2) Upon request by the Agency or making any material change, the Qualified Organization must submit the following documentation to any Regional Office(s) in which it provides services to demonstrate compliance with Chapter 393, F.S., the iBudget Handbook, and this rule chapter:

(a) A copy of the code of ethics described in Rule 14.0041, F.A.C.;

(b) A copy of the disciplinary process described in Rule 14.0042, F.A.C.;

(d) A copy of the policies and procedures required by the iBudget Handbook for provider agencies; and

(e) Table of organization, including at minimum: the first and last name, position title, contact information including phone number and email address, Medicaid provider number (if applicable), and indicate full or part-time employment for all directors, supervisors, owners, operators, managers, or any other position that directly oversees the operations of any Qualified Organization in the State of Florida or who provides support coordination services regardless of contractual relationship, including a designated mentor(s). If the Qualified Organization operates in multiple regions, the table of organization must be organized by region and a point of contact must be designated for each region.

(3) Upon hiring a prospective Support Coordinator who does not have an active MWSA as a Support Coordinator, the Qualified Organization must submit the provider application as described in Rule 65G-4.0215, F.A.C. to the Regional Office and, if applicable, the dual employment plan as described in the iBudget Handbook.

(4) Upon hiring a Support Coordinator with a Medicaid provider number or upon request by the Agency, the Qualified Organization must submit the following information regarding that Support Coordinator to the appropriate Regional Office that includes:

(a) The Support Coordinator’s first and last name;

(b) The Support Coordinator’s Medicaid provider number;

(c) Validation that the Support Coordinator is compliant with training required by Section 393.0663(2)(b)11., F.S.; the iBudget Handbook; and Chapter 65G-10, F.A.C.; and

(d) Any disclosures regarding dual employment of the Support Coordinator.

(5) The Qualified Organization must ensure that any Support Coordinator who pursues dual employment complies with the iBudget Handbook requirements pertaining to dual employment, including ensuring the Support Coordinator remains in compliance with the approved dual employment plan and timely addressing any performance and availability issues.

(6) Each Support Coordinator is prohibited from simultaneously working for more than one Qualified Organization.

(7) Upon request by the Agency or within five (5) calendar days of any Support Coordinator vacancy, which means absence or unavailability in excess of 30 calendar days, the Qualified Organization must submit the following information regarding that Support Coordinator to the appropriate Regional Office that includes:

(a) A list of the clients affected by the absence;

(b) The beginning and end dates of the vacancy;

(d) Whether the Support Coordinator left the Qualified Organization voluntarily or involuntarily.

(8) Support Coordinator Training.

(a) Each Qualified Organization must ensure that its Support Coordinators timely complete all required training in accordance with the iBudget Handbook and Chapter 65G-10, F.A.C.

(b) The Qualified Organization must maintain documentation to validate that each Support Coordinator employed by the Qualified Organization timely completed required training as described in the iBudget Handbook and Chapter 65G-10, F.A.C.

(9) Incident Reporting. The Qualified Organization must ensure Support Coordinators comply with all incident reporting requirements articulated in Sections 415 and 39, F.S., and subsection 65G-2.010(5), F.A.C.

(10) Falsification of documents. The Agency will take disciplinary action in accordance with Rule 65G-14.005, F.A.C., against a Qualified Organization that misrepresents or omits any material fact in any documentation submitted to the Agency.

(11) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662, 393.0663, 393.501 FS. Law Implemented 393.063, 393.0662, 393.0663 FS. History–New 7-1-21, Amended 10-25-22.

Fla. Admin. Code R. 65G-14.0041 Qualified Organization Duties and Responsibilities – Code of Ethics

(1) Each Qualified Organization must develop, maintain, and enforce a professional code of ethics applicable to all Support Coordinators within the organization. Failure to develop, maintain, or enforce a professional code of ethics shall constitute grounds for the Agency to deny approval of or take disciplinary action against the Qualified Organization.

(2) The code of ethics must include:

(a) Provisions addressing how the Qualified Organization will prevent and avoid actual and perceived conflicts of interest among its Support Coordinators, which must prohibit each Support Coordinator from:

Being the legal representative, applying to be the legal representative, or being affiliated with an organization or person who is the legal representative of a client served by the Qualified Organization;
Being the legal representative or representative payee for any benefits received by a client served by the Qualified Organization nor assume control of a client’s finances or assume possession of a client’s checkbook, investments, or cash;
Rendering support coordination services to a client who is a family member;
Unduly influencing paid services on behalf of a client from a service provider who is a family member of the Support Coordinator or any employee of the Qualified Organization;
Providing any waiver service other than support coordination and CDC+ consultant services;
Being a subsidiary of or being directly or indirectly controlled by persons or organizations providing waiver services within the state of Florida, other than support coordination and related administrative activities to clients who receive services from the Agency;
Requesting or receiving financial compensation from family members of clients; and
Providing assistance to a client on completion of the Support Coordinator Client Satisfaction Survey.

(b) Provisions mandating every Support Coordinator to promote client choice as described in the iBudget Handbook, including freedom to direct service planning and choose a provider from all available providers;

(c) Provisions addressing how the Qualified Organization will ensure that clients’ rights under Section 393.13, F.S., are protected, including reporting known or suspected abuse, neglect, exploitation, and sexual misconduct;

(d) Provisions encouraging fairness, integrity, and civility, including providing honest and accurate information verbally and in writing, being available for clients, timely responding to communications from clients and Agency staff, and cooperating and collaborating with others involved in client care;

(e) Provisions requiring Support Coordinators to counsel clients and, if applicable, the client’s legal representative regarding covered services and that covered services will only be approved if they are individualized, specific, consistent with the client’s needs, and not in excess of the client’s needs;

(f) Provisions requiring Support Coordinators to explore all services available through local, state, and federal government and non-government programs or services, including the Medicaid State Plan; school-based services; private insurance; natural supports; and community supports, prior to requesting Waiver funds on behalf of the client, which may be evidenced by denial letters, coverage policies, case notes, and other documentation;

(g) Provisions requiring Support Coordinators to only pursue Waiver services for clients that the Support Coordinator believes address the capacities, needs, and resources of their clients and are not available through other resources or funding sources, which the Support Coordinator must indicate on the Verification of Available Services Form incorporated by reference in Rule 65G-4.0213, F.A.C.;

(h) Provisions requiring confidentiality and privacy of client information;

(i) Provisions prohibiting Support Coordinators from misrepresenting their affiliation with the Agency; and

(j) Provisions addressing Support Coordinator duties and responsibilities described in Chapter 393, F.S., and the iBudget Handbook, including:

Ensuring Significant Additional Needs requests are complete and accurate when submitted;
Assisting clients and, if applicable, legal representatives obtain services through the Medicaid state plan;
Participating in meetings required by the Agency;
Participating in meetings coordinating services on behalf of the client;
Assisting clients and, if applicable, their legal representative with the process for addressing client complaints and grievances regarding possible service delivery issues;
Coordinating in the preparation and planning for natural disasters, including ensuring each client has a personal disaster plan and monitoring the status of each client, including providing information on available resources during and after a natural disaster; and
Updating service authorizations in iConnect to reflect the current, approved level of service(s) and providing the updated service authorizations to providers.

(3) The Qualified Organization must make the approved code of ethics available to all its employed Support Coordinators and must review the code of ethics to each client or, if applicable, client’s legal representative on an annual basis or immediately upon request.

(4) Upon discovering that a Support Coordinator has violated the code of ethics, the Qualified Organization must send a report to the Agency as described in Rule 65G-14.003, F.A.C.

(5) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662(7), (15), 393.0663(5), 393.501(1) FS. Law Implemented 393.0662, 393.0663(2)-(3), 393.063 FS. History–New 7-1-21.

Fla. Admin. Code R. 65G-14.0042 Qualified Organization Duties and Responsibilities – Disciplinary Process

(1) Each Qualified Organization must develop, maintain, and enforce a disciplinary process applicable to all Support Coordinators within the organization. Failure to develop, maintain, or enforce a disciplinary process shall constitute grounds for the Agency to deny the application of or take disciplinary action against the Qualified Organization.

(2) The disciplinary process must, at a minimum, include:

(a) Comprehensive review of the violation(s) to determine its impact within the Organization, including its impact on service delivery to clients;

(b) Any Support Coordinator who is responsible for a violation will meet with his or her supervisor to review and address the violation(s), which may include:

Discussing factors that led to the violation(s);
Discussing whether this is a repeat violation for the Support Coordinator; and
Discussing how the violation will be avoided or prevented from recurring, which may include requiring additional training for the Support Coordinator or the development of additional job aides to help the Support Coordinator improve his or her job performance.

(c) Disciplinary action commensurate with the Support Coordinator’s violation(s), including consideration of whether it is a repeat violation and its gravity; and

(d) Appropriate follow-up.

(3) The Qualified Organization must make the approved disciplinary process available to all its employed Support Coordinators and must review the disciplinary process to each client or, if applicable, client’s legal representative on an annual basis or immediately upon request.

(4) A Qualified Organization’s failure to enforce its disciplinary process against a Support Coordinator responsible for a violation(s) constitutes a violation by the Qualified Organization.

(5) Agency Oversight.

(a) Within 10 days of receiving notice from the Regional Office that the Qualified Organization or any of its Support Coordinators violated rules or statutes designated in Rule 65G-14.005, F.A.C., the Qualified Organization must submit to the Agency’s Regional Office a proposed Corrective Action Plan that contains all of the following:

The actions the Qualified Organization and, if applicable, individual Support Coordinators will take to correct each of the violations identified and to comply with the applicable requirements;
The name of the staff person(s) responsible for completing each action; and
A timeframe for accomplishing each action.

(b) The Agency will reject any proposed Corrective Action Plan that fails to identify all of the information described in paragraph (5)(a) of this rule or reflects a plan of action that does not address the violation(s). If the Agency rejects a proposed Corrective Action Plan, the Agency shall notify the Qualified Organization in writing of the reasons for rejection and require the Qualified Organization to submit an amended Corrective Action Plan addressing the deficiency or deficiencies within five business days of receipt of the Agency’s notice rejecting the Corrective Action Plan.

(c) The Qualified Organization is responsible for ensuring that the Corrective Action Plan is fully implemented within the timeframes designated in the Corrective Action Plan, which includes documenting in writing all action taken to correct a violation.

(d) If the Qualified Organization fails to remediate a violation pertaining to the Qualified Organization or any of its Support Coordinators within the timeframes established in the Corrective Action Plan or the violation reoccurs within the same 12-month period, the Agency may take action against the Qualified Organization as described in Rule 14.005, F.A.C.

(e) Where the violation presents a danger to the health, safety, or welfare of a client(s), the Agency may take immediate action as described in Rule 14.005, F.A.C.

(6) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662(7), (15), 393.0663(5), 393.501(1) FS. Law Implemented 393.0662, 393.0663(2), 393.063 FS. History–New 7-1-21.

Fla. Admin. Code R. 65G-14.0043 Qualified Organization Duties and Responsibilities – Mentoring Program

(1) In addition to completing required training as provided in the iBudget Handbook and Rule 65G-10.004, F.A.C., any person or Support Coordinator who has less than 12 months’ experience working as a Support Coordinator as of July 1, 2021 must complete an Agency-approved mentoring program offered by his or her Qualified Organization. Mentees will only receive credit for participating in a mentoring program approved by the Agency. The following qualifications and restrictions apply:

(a) Any existing Waiver Support Coordinator who has an active Medicaid Waiver Services Agreement but less than 12 months’ experience working as a Waiver Support Coordinator within the past 12 months of July 1, 2021 may receive credit for completing activities described in subsection (4) of this rule prior to joining the Qualified Organization.

(b) Mentees may serve clients during the mentoring program as long as their mentor supervises each activity described in paragraphs (4)(a) and (b) of this rule.

(2) As described in paragraph (1)(a) of this rule, mentees do not need to repeat activities described in subsection (4) of this rule that they have already performed within the past 12 months of July 1, 2021 and documented in case notes in iConnect. To receive credit, activities completed and documented during said period should be listed on APD Form 65G-14.0043 B, as described in subsection (10) of this rule. The mentee must participate in the mentoring program for no less than 30 days. Nothing in this section prohibits the Qualified Organization from electing to place or keep a Support Coordinator in mentee status due to concerns about competency or performance.

(3) Mentees who did not have an active MWSA upon joining a Qualified Organization must shadow or observe a mentor over the course of no less than 90 days. All mentees must complete all activities described in subsection (4) of this rule.

(4) The Qualified Organization must request approval from the Agency Regional Office prior to implementing a new mentoring program at the time of the prospective Qualified Organization’s application or changing an approved mentoring program. The request must include, in writing, a copy of the Qualified Organization’s policies or procedures concerning the mentoring program. These policies or procedures must require:

(a) A mentee to shadow or observe a mentor and participate in the following:

A minimum of five (5) support plan meetings involving the mentor or mentee’s clients;
At least nine (9) face-to-face visits in a variety of settings, including meetings with the mentor or mentee’s clients in family homes, supported living arrangements, and licensed facilities. At least six (6) of these visits must detail the coordination of providers’ supports;
Meetings with the Agency, including the Regional Office and State Office meetings, which occur while the mentee is participating in the mentoring program;
Discussions to educate clients and families regarding identifying and preventing abuse, neglect, and exploitation;
Instructions to clients and families on mandatory reporting requirements for abuse, neglect, and exploitation;
Use of iConnect for case management activities; and
Supported Living Quarterly Meeting.

(b) A mentee to shadow or observe a mentor or, if applicable, other Support Coordinator employed by the Qualified Organization, participate in the following if they occur while the mentee is participating in the mentoring program:

Submission of a Significant Additional Needs (“SAN”) request;
Medicaid eligibility redetermination process;
Discussion with the assessor regarding the completion of the comprehensive needs assessment; and
Updating of a minimum of five (5) client cost plans and service authorizations in iConnect.

(c) If the events discussed in subparagraph (4)(b) of this Rule do not occur while the mentee is participating in the mentoring program, the Qualified Organization must review these processes, including the documentation in the client’s central record, with the mentee.

(d) Mentors to:

Have at least two (2) years of experience working as a Waiver Support Coordinator immediately prior to being hired;
Have an active caseload;
Have no ethical violations within the past three (3) years;
Have no unresolved QIO background screening alerts for the past three years;
Remain in compliance with required training as specified in the iBudget Handbook and Chapter 65G-10, F.A.C.;
Pass the Level 1 competency-based assessment described in Section 393.0663, F.S., and Rule 65G-10.004, F.A.C., with a score of 90% or better;
Have no delinquent Corrective Action Plan per QIO review or Agency audit, or timely resolve any Corrective Action Plan required while the Support Coordinator is a mentor;
Have no more than three mentees assigned to him or her at any given time; and
Ensure that, if the mentor and mentee’s clients do not require any of the items listed in subsection (4) but another Support Coordinator employed by the Qualified Organization has a client(s) who does, the mentee can acquire the necessary experience with the other Support Coordinator.

(e) If the Qualified Organization operates in multiple regions, a statement regarding how the mentor will meet the mentoring program requirements.

(5) Agency staff will provide a written certificate to mentees who attend the meetings discussed in subparagraph (4)(a)3. of this rule. The mentee must maintain this documentation to validate successful completion.

(6) Any Qualified Organization that intends to provide consultation services for clients enrolled in the CDC+ program must include guidance and instructions with respect to the CDC+ Handbook in its mentoring program, including observing or shadowing a consultant:

(a) Review draft, denied, or updated purchasing plans, if applicable, or review the current purchasing plans; and

(b) Submit a SAN request, if applicable, or review the most recent SAN request that was submitted.

(7) The Agency must only approve mentoring programs that address the requirements identified in section (4) and, if applicable, section (6) of this rule.

(8) The Agency must send the applicant written notice indicating approval or denial of the proposed mentoring program within the timeframes established in Rule 65G-14.002(4), F.A.C., as well as the reasons for a denial, if applicable.

(9) The prospective Support Coordinator must successfully complete the Level 1 Training before completing the mentoring program.

(10) Support Coordinator Mentoring Program Completion.

(a) For a mentee described in subsection (3) of this rule to receive credit for completing a mentoring program, the mentor must issue a letter indicating the mentee’s successful completion of the mentoring program to the mentee and the Agency’s Regional Office. This letter is titled Certification of Mentoring Program Completion, on APD Form 65G-14.0043 A, effective July 1, 2021 and incorporated here by reference. The Certification of Mentoring Program Completion form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12654.

(b) For a mentee described in subsection (2) of this rule to receive credit for completing a mentoring program, the mentor must issue a Certification of Mentoring Program Completion for Existing WSCs, APD Form 65G-14.0043 B, effective July 1, 2021 and incorporated here by reference, to the mentee and Agency’s Regional Office. The Certification of Mentoring Program Completion for Existing WSCs form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12655.

(c) The Qualified Organization must maintain a copy of the Support Coordinator Mentoring Program Completion Certification form for six (6) years. The mentor may only issue this letter after the mentee successfully completes all tasks and duties required by the mentoring program.

(11) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662(7), (15), 393.0663(5), 393.501(1) FS. Law Implemented 393.0662, 393.0663(2), 393.063 FS. History–New 7-1-21.

Fla. Admin. Code R. 65G-14.005 Disciplinary Action

(1) The purpose of this rule is to notify Qualified Organizations of the ranges of penalties that will routinely be imposed in response to a Qualified Organization’s violation(s) of applicable Agency rule(s) or statute(s) and, if applicable, failure to timely correct the violation(s). The Agency will also consider any aggravating and mitigating factors as discussed in this rule when determining the appropriate penalty.

(2) The ranges of penalties are based upon a single count violation of each provision listed. Multiple counts of the violated provisions or a combination of violations may result in a higher penalty than that for a single, isolated violation.

(3) If a Qualified Organization wishes to voluntarily relinquish its authorization to provide support coordination services, then the Qualified Organization may do so only with the approval of the Agency. If the voluntary relinquishment is accepted by the Agency at the time an investigation is underway, or is anticipated, or when a disciplinary action is in progress, the Agency shall continue to follow through with any determination that a violation has occurred or that the disciplinary action in progress has not been completed, and shall consider such information with any future application to operate as a Qualified Organization.

(4) The Agency may impose more than one type of disciplinary action if it appears necessary to achieve compliance or protect the health, safety, and welfare of Agency clients. The ranges of penalties are as follows:

Violation

First Offense

Additional Offense(s)

(a) Failure to employ four or more support coordinators.

(Section 393.0663(2)(b)1., F.S., and subsection 65G-14.002(7), F.A.C.)

Moratorium on new client assignments until minimum requirements are met. If the QO does not meet the minimum WSC requirements within 90 days.

Moratorium on new client assignments, fine up to $100 per day.

(b) Failure of any directors, supervisors, owners, operators, and managers who directly oversee the operations of any Qualified Organization in the State of Florida to have at least a bachelor’s degree from an accredited college or university and two years of experience providing services to persons with developmental disabilities.

(Paragraph 65G-14.002(3)(a), F.A.C.)

Corrective Action Plan and/or fine per occurrence up to $500.

Corrective Action Plan, fine per occurrence up to $1,000.

(c) Failure of any directors, supervisors, operators, and managers who directly oversee Support Coordinators in the State of Florida to complete Level 1 Training as described in Rule 65G-10.004, F.A.C., regardless of whether they are Support Coordinators.

(Paragraph 65G-14.002(3)(b), F.A.C.)

Fine per occurrence up to $500.

Fine per occurrence up to $1,000.

(d) Failure of any director, supervisor, operator, or manager who directly oversees Support Coordinators in the State of Florida to attend a minimum of six (6) monthly support coordinator meetings with Agency staff each year, including at least one meeting in each region served by that particular director, supervisor, operator, or manager.

(Paragraph 65G-14.002(3)(c), F.A.C.)

Fine per occurrence up to $500.

Fine per occurrence up to $1,000.

(e) Failure to report to the Agency a violation of ethical or professional conduct by Support Coordinators employed by that organization within seven (7) calendar days.

(Section 393.0663(3)(a), F.S., and subsections 65G-14.003(1), (2), and 65G-14.0041(4), F.A.C.)

Corrective Action Plan and/or fine up to $250 per violation.

Fine up to $1,000 per violation.

(f) Failure to report any violation that could cause a client’s physical, mental, or emotional health to be significantly impaired to the Agency within 24 hours of discovering the violation.

(Subsection 65G-14.003(1), F.A.C.)

Corrective Action Plan that includes re-training on zero tolerance and reporting requirements and/or fine up to $1,000 per violation.

Corrective Action Plan that includes re-training on zero tolerance and reporting requirements, fine up to $2,000 per violation.

(g) Failure to immediately report abuse, neglect, exploitation, or abandonment of a client to the Florida Abuse Hotline in compliance with Sections 415.1034 and 39.201, F.S.

(Subsection 65G-14.003(2), F.A.C.)

Corrective Action Plan that includes re-training on zero tolerance and reporting requirements and/or a fine up to $1,000 per violation.

Corrective Action Plan that includes re-training on zero tolerance and reporting requirements, a fine up to $2,000 per violation.

(h) Failure to include all required information in any report to the Agency as required by subsection 14.003(2), F.A.C.

(Rule 65G-14.003(2), F.A.C.)

Corrective Action Plan.

Corrective Action Plan and fine up to $100 per occurrence.

(i) Failure to maintain an active and accurate roster within the Clearinghouse to ensure all Support Coordinators have active and eligible level II background screenings.

(Subsection 65G-14.003(3), F.A.C.)

Corrective Action Plan, and/or fine up to $250.

Corrective Action Plan, fine of up to $500 per person, per day.

(j) Failure to ensure that all Support Coordinators complete level II background screening upon hire and maintain eligible status within the Clearinghouse in accordance with Section 393.0655 and Chapter 435, F.S.

(Subsection 65G-14.003(3), F.A.C.)

Corrective Action Plan that includes retraining on Background Screening requirements, and/or fine up to $500 per person, per day.

Corrective Action Plan, fine up to $1,000 per person, per day.

(k) Failure to provide each client or, if applicable, his or her legal representative, with an invitation to take a client satisfaction survey during each client’s annual support plan meeting.

(Section 393.0663(3)(b), F.S., and subsection 65G-14.003(5), F.A.C.)

Fine up to $100 per occurrence.

Fine up to $250 per occurrence.

(l) Failure to maintain and enforce standards and procedures to ensure that its Support Coordinators are complying with their duties and responsibilities as described in Chapter 393, F.S.; Division 65G, F.A.C.; the iBudget Handbook, and, if applicable, the CDC+ Handbook.

(Sections 393.0663(2)(b)2.-9., F.S., and subsection 65G-14.004(1), F.A.C.)

Corrective Action Plan, fine up to $500 per occurrence, and/or moratorium on new client assignments.

Corrective Action Plan, fine up to $1,000 per occurrence, moratorium on new client assignments.

(m) Failure to promptly address complaints/compliance issues regarding Support Coordinators’ performance.

(Subsection 65G-14.004(1), F.A.C.)

Corrective Action Plan and/or fine up to $500.

Corrective Action Plan with a moratorium on new client assignments for the specified Support Coordinator until complaint(s) is remediated, fine up to $2,000.

(n) Failure to submit documentation to the appropriate Regional Office(s) upon the Agency’s request or making a material change to any of the documents described in subsection 65G-14.004(2), F.A.C.

(Paragraphs 65G-14.004(2)(a)-(e), F.A.C.)

Corrective Action Plan and/or fine up to $100.

Corrective Action Plan and/or fine up to $500.

(o) Failure to submit and maintain initial and/or updated dual employment forms for a Support Coordinator.

(Paragraphs 65G-14.004(5)(b)-(c), F.A.C.)

Corrective Action Plan.

Corrective Action Plan and/or fine up to $100 per day until plan is submitted.

(p) Failure to ensure that any Support Coordinator who is dually employed complies with the approved dual employment plan.

(Paragraph 65G-14.004(5)(a), F.A.C.)

Corrective Action Plan, potential moratorium on new client assignments, and/or fine up to $500 per occurrence.

Moratorium on new client assignments, fine up to $1,000 per occurrence.

(q) Failure to timely submit information relating to a Support Coordinator’s vacancy in excess of 30 calendar days to the appropriate Regional Office.

(Subsection 65G-14.004(7), F.A.C.)

Corrective Action Plan and potential moratorium on new client assignments.

Fine up to $1,000 per occurrence and potential moratorium on new client assignments.

(r) Failure to ensure that its Support Coordinators timely complete all required training in accordance with the iBudget Handbook and Chapter 65G-10, F.A.C., including maintaining documentation to validate successful completion.

(Sections 393.0663(2)(b)10.-11., F.S., and paragraphs 65G-14.004(8)(a)-(b), F.A.C.)

Corrective Action Plan.

Corrective Action Plan and a fine up to $500 per occurrence.

(s) Failure to ensure all Support Coordinators comply with all incident reporting requirements articulated in Chapters 415 and 39, F.S., and subsection 65G-2.010(5), F.A.C.

(Subsection 65G-14.004(9), F.A.C.)

Corrective Action Plan, and/or fine up to $100.

Corrective Action Plan and fine up to $500 per occurrence.

(t) The Qualified Organization misrepresented or omitted any material fact in any documentation submitted to the Agency.

(Subsection 65G-14.004(10), F.A.C.)

Fine up to $1,000 per occurrence.

Fine up to $5,000 per occurrence.

(u) Failure to maintain and enforce an approved professional code of ethics applicable to all its Support Coordinators.

(Subsection 65G-14.0041(1), F.A.C.)

Corrective Action Plan, a fine per violation up to $1,000, and/or a moratorium on new client assignments.

Corrective Action Plan with a fine per violation up to $5,000, a moratorium on new client assignments.

(v) Failure to report to the Agency a violation of the code of ethics by any Support Coordinator(s) employed by that organization.

(Subsection 65G-14.0041(2), F.A.C.)

Corrective Action Plan, a fine per violation up to $500, and/or a moratorium on new client assignments.

Corrective Action Plan with a fine per violation up to $1,000, a moratorium on new client assignments.

(w) Failure to include all required provisions articulated in paragraphs 65G-14.0041(2)(a)-(i), F.A.C., in a code of ethics that was modified after it was approved.

(Subsection 65G-14.0041(2), F.A.C.)

Corrective Action Plan.

Corrective Action Plan and/or moratorium on new client assignments.

(x) Failure to comply with any requirement articulated in subsection 65G-14.0041(3), F.A.C., regarding making available and reviewing the approved code of ethics with the client or, if applicable, legal representative on an annual basis or immediately upon request.

(Subsection 65G-14.0041(3), F.A.C.)

Corrective Action Plan, and/or a fine per violation up to $500.

Corrective Action Plan with a fine per violation up to $2,500, a moratorium on new client assignments.

(y) Failure to maintain or enforce an approved disciplinary process in accordance with Rule 65G-14.0042, F.A.C.

(Subsections 65G-14.0042(1)-(4), F.A.C.)

Corrective Action Plan, a fine per violation up to $1,000 and/or a moratorium on new client assignments.

Corrective Action Plan with a fine per violation up to $5,000, a moratorium on new client assignments.

(z) Failure to fully implement an approved Corrective Action Plan within the timeframes described therein.

(Subsection 65G-14.0042(5), F.A.C.)

Fine up to $1,000 per day.

Fine up to $2,000 per day, moratorium on new client assignments.

(aa) Failure to implement an Agency-approved mentoring program.

(Section 393.0663(2)(b)12., F.S., and subsections 65G-14.0043(1) and (3), F.A.C.)

Corrective Action Plan and/or fine up to $1,000 per occurrence.

Corrective Action Plan, fine up to $5,000 per occurrence.

(bb) Allowing a mentee to perform WSC duties without a mentor.

(Paragraph 65G-14.0043(1)(c), F.A.C.)

Corrective Action Plan and/or fine up to $500.

Corrective Action Plan, Fine up to $2,500.

(cc) Designating a mentor who does not meet the minimum qualifications.

(Paragraph 65G-14.0043(4)(d), F.A.C.)

Corrective Action Plan and/or fine up to $750 per occurrence.

Corrective Action Plan, fine up to $4,000 per occurrence.

(dd) Failure to comply with requirements pertaining to completion of the mentoring program.

(Paragraphs 65G-14.0043(10)(a)-(c), F.A.C.)

Corrective Action Plan and/or fine up to $500.

Corrective Action Plan, fine up to $2,000.

(ee) Failure to comply with any other applicable laws or rules.

(Section 393.0663(3)(c), F.S.)

Corrective Action Plan, a fine per violation up to $1,000 and/or a moratorium on new client assignments.

Corrective Action Plan, fine up to $5,000.

(5) The Agency shall consider whether any of the following mitigating factors are present, which indicate that less severe disciplinary action is warranted:

(a) The gravity of the violation(s) is not severe, meaning it did not involve the abuse, neglect, exploitation, abandonment, death, or serious physical or mental injury of a client or other individual; death or serious physical or mental injury could not reasonably have resulted from the violation; and the violation has not resulted in permanent or irrevocable injuries, damage to property, or loss of property or client funds;

(b) The Qualified Organization has already taken or is taking remedial action to correct the violation(s) and the corrective action was taken promptly;

(c) The violation has not occurred previously or, if it has occurred, the length of time since the last violation was substantial;

(d) The violation(s) affects only one client, as opposed to several clients under the care of Support Coordinators employed by the Qualified Organization;

(e) The Qualified Organization reported the violation(s) within the timeframes described in this chapter;

(f) The Qualified Organization has cooperated with the Agency, AHCA, DCF, and/or the QIO regarding the violation(s); and

(g) Any other relevant mitigating factors.

(6) In addition to mitigating factors, the Agency shall also consider whether any of the following aggravating factors are present, which indicate that more severe disciplinary action is warranted:

(a) The gravity of the violation(s) is severe, meaning it either involved the abuse, neglect, exploitation, abandonment, death, or serious physical or mental injury of a client or other individual; death or serious physical or mental injury could reasonably have resulted from the violation(s); or the violation has resulted in permanent or irrevocable injuries, damage to property, or loss of property or client funds;

(b) There have been repeat instances of the same or similar violation by the Qualified Organization or its Support Coordinator(s), with consideration of the amount of time that has passed;

(d) For violations identified by the Agency or the QIO, the Qualified Organization did not rectify the violations identified in the Corrective Action Plan within the timeframe identified in the Corrective Action Plan;

(e) For violations identified by the Qualified Organization, the Qualified Organization did not rectify the violation(s) within a reasonable timeframe;

(f) The violation(s) negatively affects multiple clients under the care of a Support Coordinator employed by the Qualified Organization;

(g) The violation(s) involves more than one Support Coordinator employed by the Qualified Organization;

(h) The Qualified Organization has been aware of the violation(s) for more than seven (7) working days and has failed to report the violation to the Agency;

(i) The Qualified Organization has been aware of the violation(s) for more than seven (7) working days and has not initiated action to rectify the violation;

(j) The Qualified Organization has failed to cooperate with the Agency, AHCA, DCF, and/or the QIO regarding the violation(s); and

(k) Any other relevant aggravating factors.

(7) The Agency considers any violation that only results in a Corrective Action Plan as described in subsection (5) of this rule to be a minor violation as described in Section 120.695, F.S.

(8) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 393.0662, 393.0663, 393.501 FS. Law Implemented 393.063, 393.0662, 393.0663 FS. History–New 7-1-21, Amended 10-25-22.

Chapter 65G-15 STATE INSTITUTION CLAIMS PROGRAM

Fla. Admin. Code R. 65G-15.001 Definitions

(1) “Agency” means the Agency for Persons with Disabilities.

(2) “Claimant” means any person who submits a restitution claim alleging property damage and/or direct medical expenses for his or her injuries under Section 402.181, F.S.

(3) “Health care” means services, supplies, and equipment that are necessary for the treatment of an injury to a person’s body.

(4) “Incident” means the same or similar event or occurrence in time.

(5) “Resident” means any individual of any developmental disability center or state institution under the supervision of the Agency, while such individual is living and receiving services at the center or institution. This includes Tacachale, Sunland Center, the Developmental Disabilities Defendant Program (“DDDP”), and Pathways.

(6) “Preponderance of the evidence” means the party bearing the burden of proof must present evidence which shows that the fact to be proven is more probable than not.

(7) “Repair cost” means the cost of services to restore a damaged asset to a condition that is as useful or productive as the asset was before the damage.

(8) “Replacement cost” means the cost of acquiring an asset that is of comparable value as the asset previously held.

(9) “Restitution” means recompense for injury or loss. Restitution includes any taxes, shipping, or other related costs necessary to be made whole.

(10) “Restitution claim” means any reimbursement claim resulting from property damages and/or direct medical expenses for injuries caused by a resident(s) that has not been restored or recompensed by any other source including but not limited to workers’ compensation, casualty and liability insurance, and health insurance.

History

Rulemaking Authority 402.181(3), 393.501(1) FS. Law Implemented 402.181 FS. History–New 5-2-22.

Fla. Admin. Code R. 65G-15.002 Restitution Claims

(1) A claimant filing a restitution claim under Section 402.181, F.S., has the burden to prove by a preponderance of the evidence:

(a) That the action(s) of a resident(s) is the direct cause of claimant’s property damages and/or direct medical expenses for injuries; and

(b) The monetary amounts of the claimant’s damages and/or expenses.

(2) Only one restitution claim can be submitted per claimant per incident.

(3) The maximum restitution amount per restitution claim may not exceed $1,000.00.

(4) Restitution claims must be submitted to the Agency using the State Institution Claims Program Form (“Claims Form”), APD Form 65G-15.002 A, effective 5-2-22, incorporated here by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14194

(a) A complete Claims Form must be received by the Agency, in accordance with the instructions on the form, within 90 calendar days from the date of the incident that caused the property damage and/or medical injury.

(b) Any restitution claim received after 90 days of the incident must be denied.

For 21 calendar days from the date the Agency issues a request for additional information to the claimant or claimant’s legal representative. If the Agency has not received the additional information within the 21 calendar days, the Agency will make a determination on the claim based solely upon the information available at that time.
Whenever a claimant makes a claim for restitution or compensation for the same incident which is not pursuant to Section 402.181, F.S., for the period of time until such claim is resolved; the time for appeal, if any, has expired; and the Agency receives notice thereof from the claimant or the legal representative.

History

Rulemaking Authority 402.181(3), 393.501(1) FS. Law Implemented 402.181 FS. History–New 5-2-22.

Chapter 65G-16 Unique Abilities Partnership Program

Fla. Admin. Code R. 65G-16.002 Unique Abilities Partnership Program

(1) A business may apply to the Agency for designation as a Florida Unique Abilities Partner by submitting a completed Florida Unique Abilities Partner Program Application Form, UAP-1, http://www.flrules.org/Gateway/reference.asp?No=Ref-07593, effective date: December 2016, which is hereby adopted and incorporated by reference.

(2) An individual may nominate a business for designation as a Florida Unique Abilities Partner by submitting a completed Florida Unique Abilities Partner Program Nomination Form, UAP-2, http://www.flrules.org/Gateway/reference.asp?No=Ref-07592, effective date: December 2016, which is hereby adopted and incorporated by reference.

(3) The Florida Unique Abilities Partner Program Application and Nomination Forms are available at https://adp.myflorida.com/unique/, and may be submitted online at https://adp.myflorida.com/unique/, by electronic mail to: Unique.Abilities@apdcares.org, or by U.S. mail to: Unique Abilities Partner Program, Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380, Tallahassee, FL 32399.

History

Rulemaking Authority 413.801(10) FS. Law Implemented 413.801 FS. History–New 12-11-16, Formerly 73B-4.001, Technical Change 4-7-26.

Division 65 Departmental

Chapter 65-2 RULES OF PRACTICE AND PROCEDURE

Fla. Admin. Code R. 65-2.042 Applicant/Recipient Fair Hearings

The Department of Children and Families, hereinafter referred to as Department, is required to provide notice and an opportunity of a hearing to any applicant or recipient when the Department’s action, intended action or failure to act would adversely affect the individual’s or family’s eligibility for an amount or type of financial assistance, medical assistance, social services, Temporary Assistance of Needy Families (TANF), or Supplemental Nutrition Assistance Program (SNAP) benefits, or where action on a claim for such assistance or services is unreasonably delayed.

(1) The hearings covered by Rule 65-2.042, F.A.C., et seq., are those within the Department of Children and Families in the execution of those social and economic programs administered by the former Division of Family Services of the Department of Health and Rehabilitative Services prior to the reorganization effected by Chapter 75-48, Laws of Florida.

(2) Parties in any Section 120.569, F.S., proceedings are agencies and appellants. Party includes the Agency.

(3) Hearing officer shall mean the individual presiding over the hearing. The hearings will be conducted by a hearing officer from the Office of Appeal Hearings, which is within the Office of Inspector General.

(4) All parties shall be entitled to receive notice of hearings, conferences and decisions of the Department and those other rights afforded by Chapter 120, F.S.

(5) When staff personnel and others appear as witnesses, the staff and others shall be sworn and subject to examination and cross-examination.

(6) These hearings are conducted in accordance with Rule 65-2.042, F.A.C., et seq., and the Uniform Rules of Procedure, Chapter 28-106, F.A.C. The Department has been granted exceptions to complying with certain Uniform Rules by the Administration Commission.

(a) An exception was granted for Rule 28-106.104, F.A.C., Filing. The Department relies upon Rule 65-2.045, F.A.C., Hearings Request.

(b) An exception was granted for Rule 28-106.105, F.A.C., Appearances. The Department relies upon Rule 65-2.058, F.A.C., Appearances.

(c) An exception was granted for Rule 28-106.106, F.A.C., Who May Appear; Criteria for Qualified Representatives. The Department relies upon Rule 65-2.058, F.A.C., Appearances.

(d) An exception was granted for Rule 28-106.107, F.A.C., Standards of Conduct for Qualified Representatives. The Department relies upon Rule 65-2.058, F.A.C., Appearances.

(e) An exception was granted to Rule 28-106.109, F.A.C., Notice to Interested Parties. There is no substitute for this rule.

(f) An exception was granted to Rule 28-106.111, F.A.C., Point of Entry into Proceedings and Mediation. The Department relies upon Rule 65-2.043, F.A.C., Hearing Request and Notification of Right to Hearings.

(g) An exception was granted for Rule 28-106.201, F.A.C., Initiation of Proceeding. The Department relies upon Rule 65-2.043, F.A.C., Hearing Request and Notification of Right to Hearings.

(h) An exception was granted to Rule 28-106.210, F.A.C., Continuances. The Department relies upon Rule 65-2.059, F.A.C., Continuances.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.42, 10-2.042, Amended 10-30-00, 4-2-18.

Fla. Admin. Code R. 65-2.043 Hearings Request and Notification of Right to Hearings

(1) Every applicant or recipient shall be informed in writing at the time of application and at the time of any action on his/her claim, of the right to a hearing, the method of obtaining this hearing, and that he/she may present his/her case or have legal counsel or an authorized representative present it.

(2) In cases of intended action to discontinue, terminate, or reduce assistance, the Department shall give timely and adequate notice.

(3) In Supplemental Nutrition Assistance Program (SNAP) cases:

(a) The notice of adverse action shall be considered timely if the advance notice period provides at least 10 days from the date the notice is mailed to the date upon which it becomes effective. Also, if the advance notice period ends on a weekend or holiday, and a request for a fair hearing is received the day after the weekend or holiday, the Department shall consider the request timely.

(b) The notice shall be considered adequate if it explains in easily understandable language: the proposed action; the reason for the proposed action; the household right to request a fair hearing; the telephone number and if possible name of the person to contact for additional information; the availability of continued benefits; and the liability of the household for any overissuance received while awaiting a fair hearing if the decision is adverse to the household. If there is an organization that provides free legal representation, the notice shall also advise the household of the availability of the service.

The Department initiates a mass change based on the following: Federal adjustments to eligibility standards, allotments, and deductions, state adjustments to utility standards; mass changes in public assistance; and mass changes in Federal benefits.
The Department receives a written statement from the household or the authorized representative which either states that SNAP benefits are no longer desired or which acknowledges that information the household has provided will result in a reduction of benefits and waives the right to notice of adverse action.
The Department determines that all of the members of the household have died.
The household has been receiving an increased allotment to restore benefits, the restoration is complete, and the household was previously notified in writing of when the increased allotment would terminate.
The household’s allotment varies from month to month with the certification period to take into account changes which were anticipated at the time of certification and the household was so notified at the time of certification.
The household applied jointly for public assistance and SNAP benefits pending approval of the public assistance grant and was notified at the time of certification that SNAP benefits would be reduced upon approval of the public assistance grant.
A household member is disqualified for fraud in accordance with Federal Regulation, or the benefits of the remaining household members are reduced or terminated to reflect the disqualification of that household member.
The household contains a member subject to a lockout or strike and, for purposes of receiving a longer certification period than is otherwise allowed for such households, signs a waiver of his/her right to notice of adverse action to enable the Department to reduce or terminate benefits when the lockout or strike is settled and the household has begun receiving income from employment again.
The Department determines that the household has moved from the project area.

(4) In all other cases, “timely” means that the notice is mailed at least 10 days before the date of action, that is, the date upon which the action would become effective. “Adequate” means a written notice that includes a statement of what action the agency intends to take, the reasons for the intended agency action, explanation of the individual’s right to request an evidentiary hearing (if provided) and a state agency hearing, and the circumstances under which assistance is continued if a hearing is requested. The specific regulations supporting the action must be included for Medicaid actions.

(5) The Department shall dispense with timely notice but shall send adequate notice to be received no later than the effective date of the action when:

(a) The Department has factual information confirming the death of a recipient or of the Temporary Assistance of Needy Families (TANF) payee when there is no relative available to serve as new payee;

(b) The Department receives a clear written statement signed by a recipient that he or she no longer wishes to receive assistance, or that gives information which requires termination or reduction of assistance, and the recipient has indicated, in writing, that he understands that this must be the consequence of supplying such information;

(c) The recipient has been admitted or committed to an institution, and further payments to that individual do not qualify for Federal financial participation under the State plan;

(d) The recipient has been placed in skilled nursing care, intermediate care or long-term hospitalization;

(e) The claimant’s whereabouts are unknown and Department mail directed to him has been returned by the post office indicating no known forwarding address. The claimant’s check must, however, be made available to him/her if his/her whereabouts become known during the payment period covered by a returned check;

(f) A recipient has been accepted for assistance in a new jurisdiction and that fact has been established by the jurisdiction previously providing assistance;

(g) A TANF child is removed from the home as a result of a judicial determination, or voluntarily placed in foster care by his/her legal guardian;

(h) A change in level of medical care is prescribed by the recipient patient’s physician;

(i) A special allowance granted for a specific period is terminated and the recipient has been informed in writing at the time of initiation that the allowance shall automatically terminate at the end of the specified period.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.43, Amended 4-28-86, Formerly 10-2.043, Amended 10-30-00, 4-2-18.

Fla. Admin. Code R. 65-2.044 Right to Request a Hearing

Any applicant/recipient dissatisfied with the Department’s action or failure to act has a right to request a hearing. He/she may do so when it is believed that:

(1) Opportunity to make application has been denied.

(2) The application has been rejected.

(3) The application has not been acted upon within a reasonable length of time.

(4) The benefits have been modified or discontinued.

(5) Reconsideration of the assistance/service benefits is refused or delayed.

(6) Opportunity has not been given to make a choice of service.

(7) Any other Department action or inaction relating to public assistance eligibility is incorrect.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.44, 10-2.044, Amended 4-2-18.

Fla. Admin. Code R. 65-2.045 Hearings Request

(1) A request for hearing is defined as any clear written or oral statement to the Department that the applicant/recipient or his/her authorized representative wants an opportunity to present the case to a higher authority. The freedom to make such a request shall not be limited or interfered with in any way.

(2) The date of the request is the date it is received by the Department.

(3) A request for hearing may be made by the applicant/recipient or someone on his/her behalf. However, if the appeal is filed by someone other than the applicant/recipient, attorney, legal guardian, spouse, next of kin, the grantee relative in cash assistance, or a person allowed by the Department as an authorized representative to participate in the eligibility determination, the person making the appeal must have written authorization of the applicant/recipient. Such written authorization must accompany the hearing request. Should the request be filed without the written authorization, the authorization must be provided in response to a request from the Department or hearing officer, prior to the appeal going forward. Without prior proper written authorization, the Department will treat a request for hearing as being made by someone not authorized to do so. Therefore, the appeal will be dismissed.

(4) The request shall be in written form when made by someone other than the applicant/recipient.

(5) In appeals related to the Supplemental Nutrition Assistance Program (SNAP) program the Department upon request shall make available without charge the specific materials necessary for a household, or its representative, to determine whether a hearing should be requested or to prepare for a hearing. Upon request, the Department shall also help the household with its hearing request. If there is an individual or organization available that provides free legal representation, the household shall also be informed of the availability of that service.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.45, 10-2.045, Amended 1-8-07, 4-2-18.

Fla. Admin. Code R. 65-2.046 Time Limits in Which to Request a Hearing

(1) The appellant or authorized representative must exercise the right to appeal within 90 calendar days in all programs except the Road to Independence (RTI) Program under Section 409.1451(4), F.S., and the Adoption Subsidy Program under Sections 120.569 and 120.57, F.S. The right to appeal under the RTI Program must be exercised within 30 calendar days from the date of receipt of the notice of adverse action pursuant to paragraph 65C-42.004(3)(a), F.A.C. The right to appeal under the Adoption Subsidy Program must be exercised within 21 calendar days from the receipt of the notice of adverse action pursuant to subsection 65C-16.013(2), F.A.C. Additionally, in the Supplemental Nutrition Assistance Program (SNAP), a household may request a fair hearing at any time within a certification period to dispute its current level of benefits. The 30-day time period under the RTI Program begins on the date the written notification is received. The 90-day time period for all other programs begins with the date following:

(a) The date on the written notification of the decision on an application.

(b) The date on the written notification of reduction or termination of program benefits.

(c) The date of the Department’s written notification of denial or a request or other action which aggrieves the petitioner when that denial or action is other than an application decision or a decision to reduce or terminate program benefits.

(2) The time limitation does not apply when the Department fails to send a required notification, fails to take action of a specific request or denies a request without informing the appellant. If the notice is not mailed on the day it is dated, the time period commences on the date it is mailed.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.46, 10-2.046, Amended 4-2-18.

Fla. Admin. Code R. 65-2.047 Preliminary or Procedural Matters

Only the hearing officer may rule on preliminary or procedural matters relevant to the hearing.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.47, Amended 4-28-86, Formerly 10-2.047, Amended 10-30-00, 4-2-18.

Fla. Admin. Code R. 65-2.048 Action to Reduce or Discontinue Assistance or Service

(1) In all programs other than the Supplemental Nutrition Assistance Program (SNAP), a hearing request filed within ten (10) days after the date of mailing or hand delivery of the notice either orally or written, requires that assistance be continued at the current level until the final written decision of the hearings officer is rendered; unless, a change affecting the appellant’s grant occurs while the hearing decision is pending and the recipient fails to request a hearing after notice of the change.

(2) In the SNAP program if a household requests a fair hearing, a continuation of benefits within the period provided by the notice of Adverse Action, as set forth in subsection 65-2.043(3), F.A.C., and if certification period has not expired, the household’s participation in the program shall be continued on the basis authorized immediately prior to the Adverse Action, unless the household specifically waives continuation of benefits. A form for requesting a fair hearing shall contain space for the household to indicate whether or not continued benefits are requested. If the form does not positively indicate that the household has waived continuation of benefits, the Department shall assume that continuation of benefits is desired and the benefits shall be issued accordingly. If the Department’s action is upheld by the hearing decision, a claim against the household shall be established for all over issuances. If a hearing request is not made within the period provided by the notice of Adverse Action, benefits shall be reduced or terminated as provided in the notice. However, if the household establishes that its failure to make the request within the advance notice period was for good cause, the Department shall reinstate the benefits to the prior basis. When benefits are reduced or terminated due to a mass change, participation on the prior basis shall be reinstated only if the issue being contested is that SNAP eligibility or benefits were improperly completed or that federal law or policy is being misapplied or misinterpreted by the Department.

Once reinstated or continued, benefits shall not be reduced or terminated prior to the receipt of the hearing decision unless:

(a) The certification period expires. The household may reapply and may be determined eligible for a new certification period with benefit amount as determined by the Department.

(b) The hearing officer makes a preliminary determination, in writing and at the hearing that the sole issue is one of federal law, regulation, or policy and that the household’s claim that the Department improperly computed the benefits or misapplied or misinterpreted such law, regulation or policy is invalid.

(c) A change affecting the household’s eligibility or basis of issuance occurs while the hearing decision is pending and the household fails to request a hearing after the subsequent notice of adverse action.

(d) A mass change affecting the household’s eligibility or basis of issuance occurs while the hearing is pending.

The Department shall promptly notify the household in writing if benefits are reduced or terminated pending the hearing decision.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.48, 10-2.048, Amended 4-2-18.

Fla. Admin. Code R. 65-2.049 Hearing Request Procedures

(1) Any hearing request, submitted to the Department, written or oral, must be sent by the Department to the Office of Appeal Hearings within three (3) working days, excluding holidays and weekends, along with a statement of the matters asserted by the Department and a copy of the Notice of Case Action when such Notice exists. This must include a reference to the particular section of the statutes or rules involved and be submitted with the hearing request. If it is an oral request, the Request for Hearing Form must be completed by Department staff, omitting the signature of the appellant.

(2) Upon receipt of the Request for Hearing, a supervisory review is mandated. The supervisory review or interview may satisfy the appellant regarding his/her case so that a request for hearing is withdrawn. Should an error be discovered during this process, immediate action shall be taken to rectify it, and the appellant shall be so advised.

(3) The Office of Appeal Hearings shall also be notified immediately when the review results in a change of status of the case. If the appellant is satisfied with the adjustment and/or explanation made by the Department representative, the appellant will be given the opportunity to withdraw the request. If the appellant chooses to withdraw the appeal, he/she will be requested to make a written statement to this effect, stating the reason for withdrawal. However, if the appellant declines to make a written statement, the Department representative shall immediately notify the Office of Appeal Hearings, in writing, of the appellant’s decision.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.49, 10-2.049, Amended 4-2-18.

Fla. Admin. Code R. 65-2.050 Transportation

The Department has the responsibility of assuring that the appellant has transportation to the hearing if requested. This rule applies only to Department public assistance cases.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.50, 10-2.050, Amended 4-2-18.

Fla. Admin. Code R. 65-2.056 Basis of Hearings

The hearing shall include consideration of:

(1) Any Department action, or failure to act with reasonable promptness, on a claim of financial assistance, social services, medical assistance, Temporary Assistance of Needy Families (TANF), or Supplemental Nutrition Assistance Program (SNAP) benefits, which includes delay in reaching a decision on eligibility in both initial and subsequent determination, or in making a payment, the amount of payment, change in payments, refusal to consider a request for or undue delay in making an adjustment in payment, and discontinuance, termination or reduction of such assistance.

(2) The hearing officer must determine whether the Department’s decision on eligibility or procedural compliance was correct at the time the decision was made. The hearings are de novo hearings, in that, either party may present new or additional evidence not previously considered by the Department in making its decision.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-18-78, Formerly 10-2.56, 10-2.056, Amended 12-11-06, 4-2-18.

Fla. Admin. Code R. 65-2.057 Conduct of Hearing

The hearing is a formal proceeding and shall be conducted pursuant to these rules. At the request of the petitioner, the hearing may be conducted as an informal proceeding pursuant to Section 120.57(2), F.S.

(1) For programs other than Supplemental Nutrition Assistance Program (SNAP) the appellant, or his/her representative, shall have adequate opportunity to examine the contents of the case file and all documents and records to be used by the Department at the hearing at a reasonable time before the date of the hearing, as well as during the hearing. In the SNAP program, the household must be given the opportunity to examine all documents and records to be used at the hearing at a reasonable time before the date of the hearing as well as during the hearing pursuant to 7 C.F.R. 273.15(p). The contents of the case file including the application form and documents of verification used by the Department to establish the household’s ineligibility or eligibility and benefit amount shall be made available, provided that confidential information is protected from release. If requested, the Department shall provide free copies of the relevant portions of the case file to the household or its representative. Confidential information that is protected from release and other documents or records which the household will not otherwise have an opportunity to contest or challenge shall not be introduced at the hearing or affect the hearing official’s decision.

(2) The appellant, or his/her representative, shall have adequate opportunity to bring witnesses.

(3) Each party shall have the right: to present evidence relevant to the issue; to cross-examine opposing witnesses on any matter relevant to the issue; to impeach any witness, regardless of which party first called him to testify; and to rebut the evidence presented against him/her, through the introduction of rebuttal evidence.

(4) Oral evidence shall be taken only on oath or affirmation.

(5) Opening and closing statements may be presented.

(6) To the extent that the rules of discovery in the Florida Rules of Civil Procedure are not inconsistent with Chapter 120 F.S., the rules of discovery of the Florida Rules of Civil Procedure shall be applicable. The hearings officer may issue appropriate orders to effectuate the purposes of discovery and to prevent delay.

(7) All motions shall be in writing unless made on the record during the hearing and shall fully state the action requested and the grounds relied on. The original written motion shall be filed with the hearings officer. The hearings officer shall conduct such proceedings and make such orders as it deems necessary to dispose of issues raised by the motion. All motions shall be accompanied by a written memorandum stating the grounds upon which such motion is based unless the party is not represented by counsel. All other parties to the action may, within seven (7) days of service, file written memorandum in opposition to such motion. Motions shall be decided on the basis of the pleadings, unless the hearings officer orders a hearing to resolve the issues.

(8) Oral and written communications from the general public may be received by the hearings officer, provided that such communication shall be subject to cross-examination, challenge and rebuttal.

(9) Federal regulations require that public assistance records shall be confidential as set forth in subsections 65A-1.204(2) and (3), F.A.C. Hearings conducted pursuant to these rules are only open to a party or witness, except as provided in federal regulation.

(10) A hearings officer shall not grant a motion for rehearing or reconsideration.

(11) The hearing officer shall insure that all relevant issues are considered.

(12) The hearing officer shall request, receive and make part of the record information determined necessary to decide the issues being raised.

(13) Hearing requests from households, such as migrant farm workers, shall be processed faster than others if necessary to enable them to receive a decision before they leave the area.

(14) Federal regulations require that public assistance records shall be confidential as set forth in subsections 65A-1.204(2) and (3), F.A.C. Hearings conducted pursuant to these rules are only open to a party or witness, except as provided in federal regulation.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.57, 10-2.057, Amended 1-8-07, 4-2-18.

Fla. Admin. Code R. 65-2.058 Appearances

(1) A person may be represented by an attorney, or other qualified representative or may appear on their own behalf.

(2) The hearing shall be attended by a representative of the Department.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.58, 10-2.058, Amended 12-11-06.

Fla. Admin. Code R. 65-2.059 Continuances

(1) The hearings officer may grant a continuance of the hearing pursuant to Rule 28-106.210, F.A.C., or upon stipulation of all parties of record and the consent of the hearings officer.

(2) In appeals related to the Supplemental Nutrition Assistance Program (SNAP), the household may request and is entitled to receive a postponement of the scheduled hearing. The postponement shall not exceed 30 days and the time limit for action on the decision may be extended for as many days as the hearing is postponed.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Amended 3-1-79, Formerly 10-2.59, 10-2.059, Amended 4-2-18.

Fla. Admin. Code R. 65-2.060 Evidence

(1) The burden of proof, except where otherwise required by statutes, is on the party asserting the affirmative of an issue. The burden is upon the Department when the Department takes action which would reduce or terminate the benefits or payments being received by the recipient. The burden is upon the petitioner if an application for benefits or payments is denied. The party having the burden shall establish his/her position, by a preponderance of evidence, to the satisfaction of the hearing officer.

(2) When the hearing involves medical issues such as those concerning a diagnosis, an examining physician’s report, or a Medical Review Team’s decision, if the hearing officer considers it necessary, a medical assessment other than that of the person or persons involved in making the original decision shall be obtained at agency expense and made a part of the record.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.60, 10-2.060, Amended 10-30-00.

Fla. Admin. Code R. 65-2.061 Failure to Appear

Abandonment may be deemed to have occurred if the appellant, without good cause therefor, fails to appear by himself/herself or an authorized representative at the hearing scheduled for such appellant. If good cause is shown, the appeal will no longer be considered abandoned and the hearing will be reset. The hearing officer shall determine whether or not good cause existed for the non-appearance of the appellant or authorized representative upon receipt of written or oral explanation from the appellant, the appellant’s authorized representative or Department representative. Written explanation for failure to appear must be received by the Office of Appeal Hearings within 60 calendar days from the date of the hearing when the appellant alleges nonreceipt of the notice of hearing or 30 calendar days from the date of the hearing for all other reasons.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.61, 10-2.061, Amended 4-2-18.

Fla. Admin. Code R. 65-2.066 Final Orders

(1) Orders issued by the hearings officers of the Office of Appeal Hearings of the Department of Children and Families are final orders and shall be implemented immediately.

(2) The Final Order shall be based exclusively on evidence and other materials introduced at the hearing or material submitted after the hearing upon agreement of all parties.

(3) The Final Order shall be in writing and include a caption, time and place of the hearing, statement of issues, findings of fact and conclusions of law. These orders will adhere to the requirements of the Florida Administrative Procedures Act, Chapter 120, F.S.

(4) The Final Order issued by the hearings officer shall be dated and mailed at the time it is signed and the period allowed for judicial review will run from this date.

(5) The Final Order shall be rendered within 90 days of request for all programs except Supplemental Nutrition Assistance Program (SNAP), in which case it shall be rendered in 60 days.

(6) The Final Order shall authorize corrective action retroactively to the date the incorrect action was taken.

(7) The Final Order shall include notice of a right to a judicial review.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 5-17-78, Formerly 10-2.66, 10-2.066, Amended 4-2-18.

Fla. Admin. Code R. 65-2.068 TANF Overpayment Hearings

(1) Federal Regulation 45 C.F.R. 233.20(a)(13) requires the Department to recover overpayments of the Temporary Assistance of Needy Families (TANF) Program. Rule 65A-1.900, F.A.C., provides the method and procedures to be used by the Department to implement 45 C.F.R. 233.20(a)(13).

(2) The Department must notify a person who has been paid benefits to which he/she was not entitled. The notice shall include the amount of overpayment, the dates of overpayment, the reason overpayment occurred, and a statement that action will be taken to recover this overpayment by a reduction in the TANF grant, or through court action. The notice shall include the person’s right to request a hearing if he/she disagrees with the Department’s determination that an overpayment occurred or if he/she disagrees with the amount of overpayment.

(3) The hearings will meet the requirements of 45 C.F.R. 205.10 and Section 120.569, F.S. The hearing will be conducted in accordance with Rule 65-2.042, F.A.C., et seq.

(4) The hearing officer shall enter an Order upon completion of the hearing process. This Order shall be final and binding upon the Department and appealable by the person to the appropriate District Court of Appeal.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 4-5-83, Formerly 10-2.68, Amended 4-28-86, Formerly 10-2.068, Amended 4-2-18.

Fla. Admin. Code R. 65-2.069 Intentional Program Violation Disqualification Hearings

(1) The hearings officer of the Office of Appeal Hearings shall conduct intentional program violation disqualification hearings. These hearings shall be conducted in accordance with regulations published by the United States Department of Agriculture, Food and Nutrition Service in 7 C.F.R. 273.16.

(2) The provision for an individual to waive an intentional program violation disqualification hearing is an option of the Food Stamp Act of 1977, 7 U.S.C. 2011 et seq., as amended, and included in 7 C.F.R. 273.16.

History

Rulemaking Authority 409.285 FS. Law Implemented 409.285 FS. History–New 7-16-80, Formerly 10-2.69, Amended 4-28-86, 1-5-93, Formerly 10-2.069, Amended 4-2-18.

Chapter 65-6 STATE RESIDENTIAL FACILITIES - FEE COLLECTION SYSTEM

Fla. Admin. Code R. 65-6.010 Definitions

(1) Client Trust Fund. An account established by the department for the purpose of accepting and administering in trust any money or other property received for personal use or benefit of a client; such as parent contributions, benefit payments, and interest.

(2) Cost of Service. The average cost of providing a service to a client. This includes direct costs and indirect costs.

(3) Department. The Department of Children and Families.

(4) Direct Costs. Those costs which are traceable to the unit providing service.

(5) Direct Service Worker. The counselor who has primary responsibility for providing social or case management services to the client.

(6) Fee Formula. The methodology used to determine the client’s ability to pay fees for services based on the client’s income and expenses.

(7) Fee Schedule. The methodology used to determine the client’s or responsible party’s ability to pay fees based on family size and income.

(8) Gross Income. Income before any deductions. This includes income from salaries, wages, commissions, tips, net rental and royalty income, net income from self-employment, alimony, pensions, annuities, gain from the sale of assets, in the years recognized for income tax purposes, capital gain distributions, public assistance or welfare payments, retirement or disability insurance payments, unemployment or workers’ compensation, Social Security and Veterans’ Administration payments, interest, and dividends from stocks, bonds and other securities, estates or trusts, including interest on client trust funds. The benefit payments, for example SSA, SSI, VA, mentioned here are those received for members of the family other than the client. Benefit payments received for the client are not considered part of gross income.

(9) Indirect Costs. Those costs which benefit a unit providing service, but are not traceable to that unit.

(10) Net Income. Gross income less federal, state or local payroll taxes, and social security deductions. Deductions for payroll savings plans, bond purchases or contributions to retirement systems may not be used to determine net income.

(11) Payor. A person or entity responsible for the payment of fees or reimbursement for the cost of services. A first party payor is the client. A second party payor is the client’s responsible party. A third party payor is an individual or entity other than first or second party payors who is or may be liable to pay all or part of the cost of service. This may be an individual, institution, corporation, or public or private agency, but does not include any program sponsored or supervised by the department.

(12) Personal Allowance. Funds set aside from benefit payments to provide for the client’s incidental personal expenses as described in rule 65-6.018, F.A.C.

(13) Residential Facilities. These include hospitals, institutions, foster homes, group homes, child care facilities or other establishments which provide 24-hour care and are either operated by the department or under contract with the department for the provision of residential services to clients of the department.

(14) Residential Services. Those services for maintenance, supervision and care provided, contracted or purchased by the department for clients in residential facilities; also called residential care.

(15) Service. Aid, assistance or goods provided or purchased by the department, either directly or through its agencies or contractors, including, but not limited to treatment, counseling, therapy, training or residential care.

(16) Service Fee. An amount charged to the client or the client’s responsible party as partial or total reimbursement to the department for the cost of services provided directly by the department or through its agencies or contractors.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.10, Amended 1-27-86, 3-29-89, 4-27-93, Formerly 10-6.010, Amended 11-26-18.

Fla. Admin. Code R. 65-6.011 Authority for Charging Fees

History

Rulemaking Authority 402.33(2), (9)(a), (10) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.11, Amended 3-29-89, Formerly 10-6.011, Repealed 9-30-18.

Fla. Admin. Code R. 65-6.012 Liability for Fees

Liability for fees begins on the first day that services are provided and terminates at the end of the next to the last day that services are provided to the client.

(1) The following shall be liable for the payment of fees for services or reimbursement for the cost of services:

(a) Clients;

(b) Parents of a minor client;

(d) Guardians, representative payees and trustees, not as individuals, but in their fiduciary capacity.

(2) Third party payors are liable to the extent that they may be required by contract or law to provide or to participate in the cost of providing services to the client.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.12, Amended 4-27-93, Formerly 10-6.012.

Fla. Admin. Code R. 65-6.013 Exclusions from Liability

The following parties shall not be liable for the payment of fees:

(1) Indigents whose only sources of income are from state and federal aid. For purposes of this rule, income from state or federal aid shall be defined as cash assistance or cash equivalent benefits based on an individual’s proof of financial need, such as Temporary Cash Assistance and the Supplemental Nutrition Assistance Program.

(2) Recipients of Supplemental Security Income shall not be assessed fees other than for residential services, in accordance with subsection 65-6.016(2), F.A.C.

(3) Parents of minor clients, when the client has been permanently committed to the department and parental rights have been permanently severed.

(4) Parents of a minor child, when the child has requested and is receiving services without parental consent. However, the court may order fees to be paid to the department in accordance with chapter 39, F.S., when parental consent has not been obtained before providing services under this statute.

(5) Clients in residential care, receiving wages from employment as part of discharge plans or plans to prepare the client for independent living, who have requested and been granted a fee waiver or reduction in accordance with subsection 65-6.022(6), F.A.C.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.13, Amended 3-29-89, Formerly 10-6.013.

Fla. Admin. Code R. 65-6.014 Determining Cost of Services and Criteria for Ability to Pay

History

Rulemaking Authority 402.33(4) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.14, 10-6.014, Repealed 9-30-18.

Fla. Admin. Code R. 65-6.015 Financial Information and Verification

(1) The client or responsible party will complete and return to the department the Financial Information form (CF Form 280, effective September 2018), which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10017, will be completed by the direct service worker for parents of children placed in the custody of the department under chapter 39, F.S. The form will be provided by the direct service worker, or may be obtained from the fee collection unit. This form will specify all gross income, benefit payments, third party benefits available to the client and responsible party, the number of persons dependent on that income, and other related information required to determine and verify the ability to pay for the cost of services provided. In addition, the client or responsible party must identify the assets that may be available to assure payment of the fees. The form, and instructions for its completion, will be provided at the time a person applies for services, becomes a client or is admitted to a residential facility.

(2) The direct service worker, or a person designated by the Regional Managing Director or Facility Administrator, shall assist the client or responsible party in completing the form.

(3) The client or responsible party must complete, sign and return the form to the department within 30 days of its receipt. If the responsible party is not present at the time the client is admitted for services or the client is unable to complete the form, a blank form will be delivered or mailed to the client or responsible party within 10 days of the client’s admission for services. A completed and signed form must be returned to the department within 30 days of receipt of the form.

(4) The Financial Information form must include a signed statement specifying that:

(a) The information is true and correct;

(b) Changes in gross income or expenses in excess of $50 a month, in the number of individuals dependent on that income, or in the availability of third party benefits or benefit payments shall be reported to the department within 15 days of the change;

(5) Except as provided in subsection (8) of this rule, the client or responsible party is required to submit a new Financial Information form annually, unless notification pursuant to paragraph (4)(b) of this rule was provided during the year. It must be submitted within 15 days after the proper blank form is provided by the department. If the form is not returned within that time frame, the department will effect delivery of another blank form by hand or certified mail and request a return within 15 days.

(6) If the client or responsible party fails to complete or sign the initial form within the required time frame, the department shall:

(a) Bill the client or responsible party for the cost of services less reimbursements from third party payors; and,

(b) Enter suit to enforce the financial information requirement, if the bill is not paid and the department determines that suit is likely to identify revenue sources.

(7) The department shall verify any of the information reported on the financial information form in accordance with the most economical uniform procedures.

(8) In the case of an adult unmarried client or a client in foster care, if there is knowledge that the client’s financial condition has not changed, the fee collection unit will continue collection of the client’s or responsible party’s current fee. The direct service worker may sign a Financial Information – Short Form (CF Form 280A, effective September 2018) which is incorporated by reference and available at available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10016, certifying that the information on file has not changed except as noted on the form.

History

Rulemaking Authority 402.33(6)(b) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.15, Amended 1-27-86, 3-29-89, 4-27-93, Formerly 10-6.015, Amended 11-26-18.

Fla. Admin. Code R. 65-6.016 Income and Benefits Subject to Fee Assessment

The cost of services, as defined in subsection 65-6.010(4), F.A.C., is the maximum amount which a payor shall be charged, unless ordered by a court. Payment of fees shall not be a prerequisite to receiving services.

(1) First and second party payors shall be charged a fee not in excess of their ability to pay, according to the procedures described in rule 65-6.019, F.A.C. The maximum amount which may be charged is the cost of service, unless otherwise ordered by a court, less:

(a) Third party reimbursements received by the department for services provided to the client; and,

(b) In the case of residential care services, benefit payments applied to the cost of residential care.

(2) Benefit payments designated for the care and maintenance of clients, less a personal allowance, shall be applied to the cost of residential care.

(a) Representative payees, other than the department, shall be billed for benefit payments, and for any retroactive benefits received applicable to periods during which the client was in residential care.

(b) A responsible party who is liable for fees based on his income, and who is also a representative payee, shall be billed for the fee based on income, and for the amount of the benefit payment to be applied to the cost of service.

(c) If a client or representative payee receiving the benefit payments fails to pay the amount billed, the department shall request the payor of benefits to have the department designated as representative payee of the benefits.

(3) If a responsible party remarries, a step-parent’s income shall not be subject to fee assessment. However, the number of dependents used in determining ability to pay shall be in proportion to the responsible party’s contribution to total family income.

(4) If a client is receiving residential and non-residential services, the primary fee shall be the fee for residential services. A fee for non-residential services shall be charged only if the ability to pay for residential services exceeds the residential service fee. In this instance, the fee for non-residential services is the lower of the service fees or the difference between ability to pay for residential services less the residential service fee.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.16, Amended 1-27-86, 3-29-89, 4-27-93, Formerly 10-6.016.

Fla. Admin. Code R. 65-6.017 Client Earnings

(1) Fees shall not be assessed on wages which are below the minimum hourly wage under the Federal Fair Labor Standards Act.

(2) Clients who are employed while in residential care may keep monthly earnings of up to $100. Of the remaining amount of earnings, the client may keep one third of the earnings. Two thirds of the earnings shall be subject to fee assessment in accordance with rule 65-6.019, F.A.C.

(3) Clients, whose cost of service is being paid by the Medicaid Program, shall pay fees from client earnings in accordance with Medicaid regulations 42 C.F.R. Parts 430-436.

(4) A client who was employed prior to admission, and who has earnings as a result of that employment, such as from self-employment, or sick or annual leave, shall be assessed on such earnings in accordance with rule 65-6.019, F.A.C.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.17, Amended 4-27-93, Formerly 10-6.017.

Fla. Admin. Code R. 65-6.018 Personal Allowance

For clients in residential care, a personal allowance shall be set aside from benefit payments for the personal needs of the client. The representative payee is responsible for maintaining and administering the client’s personal allowance for the benefit of the client. This allowance shall be used to purchase clothing, recreational needs or activities, therapeutic equipment, transportation, and other personal and comfort items for the client. The amount of the allowance shall be determined annually by the client, the direct service worker, the appropriate program office and the provider of services. The allowance shall not exceed $100 per month. This amount may be adjusted annually to reflect changes in the cost of living.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.18, Amended 4-27-93, Formerly 10-6.018.

Fla. Admin. Code R. 65-6.019 Methodology for Assessing Fees

(1) Upon submission of the financial information required by this chapter, or the court order for clients in short term placement, the department shall compute the fee according to the fee formula as found in rule 65-6.020, F.A.C., or fee schedule as found in subsection (3), or assess the Court ordered payment.

(2) Fees for residential services charged to clients with no dependents shall be based on the fee formula in rule 65-6.020, F.A.C.

(3) For families of two or more, fees for residential services except for those services listed in subsection 65-6.019(7), F.A.C., shall be charged according to a sliding fee schedule based on gross income and family size. The “Sliding Fee Schedule for Residential Services,” CF-FSP 5435, July, 2018 is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10018.

(4) Fees for non-residential services shall be assessed according to sliding fee schedules based on gross income and family size, unless the fee, or the criteria for determining the fee, is set by statute.

(5) If the department makes any retroactive adjustment on the basis of additional financial information the department may:

(a) Refund payors for overpayment of fees;

(b) At the payor’s option, offset overpayments against future billings, or

(6) Clients or responsible parties, who are not assessed a fee, shall be encouraged to make voluntary payments for services.

(7) Fees for services in short term residential facilities such as detention centers, emergency shelter or crisis homes shall be assessed in accordance with the court order.

History

Rulemaking Authority 402.33(3) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.19, Amended 1-27-86, 3-29-89, Formerly 10-6.019, Amended 11-26-18.

Fla. Admin. Code R. 65-6.020 Fee Formula for Residential Services for Adult Clients with No Dependents

(1) For purposes of this rule, the following definitions shall apply:

(a) Disposable Income. Net income less fixed domestic expenses and other allowable deductions.

(b) Fixed Domestic Expenses. Basic household expenses which are deducted from net income in the fee formula:

Rent on domicile,
Homestead payments,
Real estate taxes on homestead,
Utility payments,
Life insurance,
Automobile insurance,
Home insurance,
Health insurance,
Transportation costs. Mileage is allowed at the rate approved under state travel regulations.

Uninsured medical expenses or casualty losses of such assets as housing or tools of a trade.
Legal fees and court costs which are incurred for the benefit of the client for such purposes as: restoration of competency, filing of reports by relatives, parents or guardians of estates or property, adoption, and other legal fees for which a client could normally be responsible.
Maintenance or major repairs on a home, major appliances, or automobile which is a primary vehicle.
Elective surgery which would permit the client to maintain or improve health conditions.

(2) Contingent upon the satisfactory completion and submittal of the Financial Information form, the client will be assessed a fee based on ability to pay, determined according to the following formula:

(a) Gross income less normal payroll deductions for social security and income tax equals net income.

(b) Net income less fixed and other allowable expenses equals disposable income.

(3) The residential fee is the lower of:

(a) The client’s disposable income after providing for a personal allowance in accordance with rule 65-6.018, F.A.C.

(b) The cost of care less reimbursements from other sources.

History

Rulemaking Authority 402.33(6) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.20, Amended 1-27-86, Formerly 10-6.020, Amended 11-26-18.

Fla. Admin. Code R. 65-6.021 Notification of Fees

(1) When a client applies for services, the client or responsible party shall be informed of the department’s fee collection policy.

(2) The department shall determine the fee assessment based on the client’s or responsible party’s ability to pay and on the availability of benefit payments and third party benefits. The fee assessed shall be billed to the client or responsible party retroactive to the first day that services were provided to the client.

(3) The department shall notify the client or responsible party of the amount of the fee, the billing procedure, and the right to request a review of the assessed fee.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.21, 10-6.021.

Fla. Admin. Code R. 65-6.022 Fee Review Procedures

(1) A client or responsible party may request a review of the fee if they do not agree with the assessment.

(2) The Regional Managing Director or Facility Administrator shall appoint, at a minimum, three members to a review committee. The Regional Managing Director or Facility Administrator may appoint a designee to approve the decisions of the committee.

(3) The client or responsible party must notify the department, in writing, of his request for review of the fee assessed, and must submit any receipts, tax records, bills, certified statements or other documentation needed to substantiate the request for a review of the fee.

(a) If the request, with the required documentation, is submitted to the department within three months of the date shown on the Notice of Maintenance Fee to be Charged, depending upon the committee’s recommendation, the fee may be changed retroactive to the first month for which fees were assessed.

(b) If the request, with the required documentation, is submitted later than three months after the date shown on the Notice of Maintenance Fee to be Charged, depending upon the committee’s recommendation, the fee may be adjusted retroactively to the month in which the request was received.

(4) The department shall inform persons requesting a review of the fee assessed of the criteria used to evaluate such requests, as follows:

(a) Each member of a family unit, including the client, is entitled to receive the benefits of an equitable share of the family’s income.

(b) The fee assessed shall not cause the family to be unable to purchase directly medical or dental treatment or other services prescribed in the client’s habilitation, rehabilitation, or treatment plan.

(c) The department shall not be expected to accept payment for residential services which is less than the cost of caring for the client at home, except for a family with insufficient income to meet basic needs.

(d) A client or responsible party shall not expect to increase his net worth by diverting income to savings or investment in preference to reimbursing the department for the fee assessed.

(e) The payment of the assessed fee shall not force the family members remaining at home to live on an income which would qualify them for public assistance.

(f) Resources available for payment of the assessed fee for residential services shall not be diverted for expenditures which would not be possible if the client lived at home.

(g) The fee assessed shall not cause the family to be unable to visit or otherwise be actively involved in the rehabilitation of the client.

(5) The review committee shall notify the client or responsible party of the date and time his request will be reviewed.

(6) Fee waivers or reductions may be granted to allow a client in residential care to accumulate funds from benefit payments or other sources in accordance with discharge plans, or plans to prepare for independent living. The client, or the client’s direct service worker shall submit the request in writing and provide a justification for the request.

(7) The review committee, by majority vote, shall recommend to the Regional Managing Director or designee, or Facility Administrator or designee, whether a fee reduction or waiver shall be granted. This recommendation shall be made within 30 days of receipt of the request, with the required documentation.

(8) If the committee recommends that a fee waiver or reduction is justified, the committee shall recommend an effective date in accordance with paragraph 65-6.022(3)(a) or (b), F.A.C. The committee may also recommend that the fee waiver or reduction be granted for a specified, limited period of time.

(9) If the Regional Managing Director or designee, or Facility Administrator or designee, denies the request for a fee waiver or reduction, the client or responsible party shall be informed of his right to appeal the decision pursuant to the provisions of chapter 120, F.S.

(10) The Regional Managing Director or designee, or Facility Administrator or designee, shall notify the requesting party, in writing, within ten days of the decision.

History

Rulemaking Authority 402.33(7) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.22, 10-6.022, Amended 11-26-18.

Fla. Admin. Code R. 65-6.023 Enforcement of Delinquent Accounts

(1) An account is considered delinquent when a charge for fees remains unpaid for 61 days from the date the charge was made to the account.

(2) The department shall charge interest on amounts which remain unpaid for over 6 months from the date the amount was charged to the account.

(a) The interest rate charged shall be equal to the average rate of interest earned by the Chief Financial Officer on state funds deposited in commercial banks as reported by the Treasurer for the previous year.

(b) Payments received on accounts which have been charged interest shall first be applied to interest charges. Any remaining amounts shall be applied to the oldest charges.

(3) Any negotiation or settlement of accounts must occur within 120 days of the date the account becomes delinquent. The Regional Managing Director or Facility Administrator shall designate the persons authorized to negotiate and settle accounts on behalf of the department.

(4) The department may write-off an account which has been determined as uncollectible. If subsequent to writing-off an account the department determines that collection potential exists, enforcement of collection may be made in accordance with the provisions of this rule, unless the assessed fee has been negotiated or the account settled.

(5) Unpaid fees for services provided by the department to a client constitute a lien on any property owned by the client or the client’s responsible party which property is not exempt by Section 4, Article X of the State Constitution.

(6) Upon the death of a person against whom the department has a claim, the department shall file such caveats as are in the best interest of the state. If the department effects recovery, the fund from which the filing fee for the caveat was paid shall be reimbursed.

History

Rulemaking Authority 402.33(8) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.23, Amended 1-27-86, Formerly 10-6.023, Amended 11-26-18.

Fla. Admin. Code R. 65-6.024 Out-of-State Fees

(1) A responsible party whose residence is out of state shall be requested by the department to apply for interstate transfer of the client. This requirement does not apply to a foster care client’s responsible party.

(2) If the responsible party applies for interstate transfer of the client within 90 days of the department’s request, fees will be assessed as described in this rule.

(3) A responsible party who does not apply for interstate transfer of the client within 90 days of the department’s request shall be assessed the cost of service.

History

Rulemaking Authority 402.33(2) FS. Law Implemented 402.33 FS. History–New 1-23-85, Formerly 10-6.24, Amended 1-27-86, Formerly 10-6.024.

Fla. Admin. Code R. 65-6.025 Administration of Client Trust Funds

History

Rulemaking Authority 402.17 FS. Law Implemented 402.17 FS. History–New 1-27-86, Amended 4-27-93, Formerly 10-6.025, Repealed 9-30-18.

Fla. Admin. Code R. 65-6.026 Payments from the Client Trust Fund

History

Rulemaking Authority 402.17 FS. Law Implemented 402.17 FS. History–New 1-27-86, Amended 4-27-93, Formerly 10-6.026, Repealed 9-30-18.

Fla. Admin. Code R. 65-6.027 Use of Client Resources for Financial Eligibility

(1) When the department determines that a client should be placed in a program which requires financial eligibility and the client is income eligible, but exceeds the program’s resource limitation, the department may apply excess resources in the Client Trust Fund to the cost of care in accordance with rule 65-6.016, F.A.C., after providing for personal need and comfort items for the client. A monthly charge, up to the full cost of care less third party reimbursements, shall be made until the amount of the client’s resources are below the program’s resource limitation.

(2) Subsequent charges may be made to ensure that the client’s resources do not exceed the resource limitation.

(3) If the client’s resources are deposited in a client trust fund, the department shall transfer the amounts charged to the state treasury. The client, guardian, or responsible party shall be notified of charges made for the cost of care in accordance with rule 65-6.021, F.A.C.

History

Rulemaking Authority 402.17(1)(a)9. FS. Law Implemented 402.17 FS. History–New 1-27-86, Amended 4-27-93, Formerly 10-6.027.

Chapter 65-25 CLIENT TRUST FUNDS INTEREST EARNED AND FEES CHARGED DISTRIBUTION

Fla. Admin. Code R. 65-25.001 Definitions

The following terms and phrases when used in this rule and in the interpretation thereof, shall have the meaning ascribed to them as follows:

(1) “Client” – means any person receiving services, or who is determined eligible to receive services, provided by the department.

(2) “Department” – refers to the Department of Children and Families.

(3) “Fees charged” – means any assessments made against the fund amount on deposit by the applicable bank, by the United States Government, or by the department for maintenance of the fund or other charges to the fund as prescribed by law.

(4) “Earning balance” – is derived by calculating the average of the ending monthly balance for each month for which interest or fees are being distributed. A client’s fund should reflect a minimum earning balance of two hundred dollars ($200.00) in order to receive a pro-rata share of the distributed interest or fees charged. The department’s Assistant Secretary for Administration, or designee, shall approve the distribution of interest or fees on an earning balance less than the above minimum balance if it is so requested by the departmental custodian of the applicable fund. The approval shall be granted for the requesting fund only to avoid the necessity of: re-programming micro-computer systems originally designed with a lesser earning balance computation, changing earning balances on existing accounts, or other circumstances warranting a lesser computational earning balance.

History

Rulemaking Authority 402.17(6) FS. Law Implemented 402.17(6)(b) FS. History–New 3-19-92, 9-23-92, Formerly 10-25.001.

Fla. Admin. Code R. 65-25.002 Distribution Methodology

(1) The interest accruing on client funds is the property of the individual client and must be used or conserved for the personal use or benefit of that client. Similarly, when service charges or other fees are charged to the fund, the individual clients whose monies comprise the fund must bear those charges and fees. The department, in order to offset administrative cost of maintaining the client’s individual accounts, shall assess, upon approval by the department’s Assistant Secretary for Administration, or designee, a service charge against the fund ranging from zero (0%) to a maximum not to exceed ten per cent (10%) per period on the net interest earned/fees charged for that particular period.

(2) Interest earned or fees charged will be prorated quarterly, or a more frequent proration if in the best interest of the department and approved by the department’s Assistant Secretary for Administration, or designee, and distributed to the individual client’s accounts who have had a positive balance throughout the period and meets the minimum balance criteria.

(3) The methodology for proration is as follows:

(a) Compute the earning balance for each client.

(b) List all clients with an earning balance.

(d) Divide the net amount for distribution, interest earned minus service charges or fees, by the total earning balance obtained in paragraph (c), above. This yields an interest/fee factor.

(e) Multiply each individual client’s earning balance by the interest/fee factor. The resulting figure is the interest to be credited or the fees to be charged to the individual client’s account. The sum of all clients’ interest or fees posted must equal the total net interest earned/fees charged for distribution. Service charges or fees charged to a client’s account cannot result in a negative balance within the account.

History

Rulemaking Authority 402.17(6) FS. Law Implemented 402.17(6)(b) FS. History–New 3-19-92, Amended 9-23-92, Formerly 10-25.002.

Chapter 65-29 PENALTIES ON SERVICE PROVIDERS

Fla. Admin. Code R. 65-29.001 Financial Penalties for a Provider’s Failure to Comply With a Requirement for Corrective Action

(1) Purpose. The purpose of this rule is to implement the provisions of section 402.73(1), F.S., and to provide procedures for the imposition of financial penalties upon providers that fail to comply with a department request for corrective action.

(2) Definitions. For the purpose of this rule, the following definitions shall apply:

(a) “Corrective Action” means acts of remediation the provider is required to make in response to department findings of unacceptable performance, nonperformance, or noncompliance to the terms and conditions of a contract.

(b) “Corrective Action Plan” means the mutually agreed upon plan prepared by the provider and approved by the department by which corrective action will be accomplished.

(d) “Extenuating Circumstances” means conditions beyond the control of either party that may form a basis for reasonable forgiveness of certain contract requirements. By their nature such conditions are unique necessitating the determination of their existence on a case by case basis and precluding the application of such a determination to more than a single instance during the term of any contract.

(e) “Findings of Fact” means the conclusions reached by the department on factual issues.

(f) “Notice of Intent to Impose a Financial Penalty” means a written notice issued by the department to the provider making the provider aware that a financial penalty is pending if the provider does not successfully complete the required corrective action plan within the time specified in the corrective action plan.

(g) “Provider” means an organization or individual providing services to or on behalf of the department or its clients.

(h) “Unacceptable Performance” means provider action(s), or lack thereof, that fails to satisfy the requirements of the contract.

(3) Penalty Provision. All contracts entered into by the department for services shall contain a notice that penalties shall be imposed for failure to implement or to make acceptable progress on corrective action plans developed as a result of noncompliance, non-performance, or unacceptable performance with the terms and conditions of a contract. Such provisions shall also contain the following:

(a) A statement that corrective action plans shall be required for noncompliance, nonperformance, or unacceptable performance and penalties shall be imposed for failure to comply with a department approved corrective action plan, unless the Department determines that extenuating circumstances exist.

(b) The increments of penalty imposition that shall apply, unless the department determines that extenuating circumstances exist, shall be based upon the severity of the noncompliance, nonperformance, or unacceptable performance that generated the need for corrective action plan. The penalty, if imposed, shall not exceed ten percent (10%) of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance that is determined to have a direct effect on client health and safety shall result in the imposition of a ten percent (10%) penalty of the total contract payments during the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. Noncompliance involving the provision of service not having a direct effect on client health and safety shall result in the imposition of a five percent (5%) penalty. Noncompliance as a result of unacceptable performance of administrative tasks shall result in the imposition of a two percent (2%) penalty.

(d) The potential deduction of a financial penalty from the department’s payments to a provider.

(4) Process. If at any time(s) during the effective contract period, the department gives notice to the provider that its delivery of services is unacceptable or is not in compliance with the terms and conditions of the contract, the department shall request corrective action, in accordance with section 120.695, F.S. The department’s request for corrective action shall identify the incident(s) of noncompliance or unacceptable performance, and be submitted to the provider in writing. The provider, in turn, must submit a corrective action plan upon receipt of the department’s request. The provider’s failure to submit a corrective action plan that is determined acceptable to the department shall be grounds for termination of the contract.

(5) Source of Funds Available for Payment of Financial Penalty. A provider shall not pay a financial penalty with funds intended to be used, or which are budgeted, to provide services to clients. The provider shall not reduce the amount or quality of services being delivered to clients as a result of the imposition of a financial penalty pursuant to this rule.

(6) Notice of Intent to Impose a Penalty and Notice of Preliminary Findings of Fact. The department shall give the provider a written notice of its intent to impose a financial penalty, which shall include the following information:

(a) The factual basis upon which the department determined that a corrective action plan was needed; and,

(b) A description of the corrective action which was agreed upon between the provider and the department and which was not implemented or satisfactorily accomplished; and,

(7) Contesting a Penalty. Within twenty-one (21) calendar days of receipt of written notice described in subsection (6), the provider may file written exceptions to the Preliminary Findings of Fact. If no exceptions are timely filed, the department shall adopt such Preliminary Findings of Fact in its Final Order Imposing a Financial Penalty.

(8) The District Administrator or Regional Director will, in consultation with the Office of the General Counsel, resolve any issues raised by exceptions, if filed, after which the Department may issue a Final Order. The Final Order, if issued, shall require that the penalty be imposed prospectively and be applied to the next invoice submitted. The final order shall require the application of the penalty on all subsequent invoices until the required corrective actions have been implemented. Said Final Order shall be reviewable pursuant to chapter 120, F.S.

(9) Failure to Pay a Financial Penalty. The department shall deduct the amount of financial penalty from funds that would otherwise be due a provider. This deduction shall not exceed ten percent (10%) of the invoice amount that would otherwise be due such provider for the period in which the corrective action plan has not been implemented or in which acceptable progress toward implementation has not been made. A provider’s failure to include such deductions in a request for payment shall constitute grounds for the department to reject the provider’s request for payment.

(10) The remedies identified in this rule do not limit or restrict the department’s application of any other remedy available to it in the contract or under law. Furthermore, the remedies described in this rule may be cumulative and may be assessed upon each separate failure in order to enforce provider compliance.

History

Rulemaking Authority 402.73(1) FS. Law Implemented 402.73(1) FS. History–New 4-14-02, Amended 10-3-17, 2-5-18.

Division 65B Developmental Services Program

Chapter 65B-4 SERVICE DELIVERY PRACTICE AND PROCEDURE

Fla. Admin. Code R. 65B-4.008 Service Delivery

History

Rulemaking Authority 20.19, 393.02(2) FS. Law Implemented 20.19, 393.01, 393.0111, 393.015, 393.08, 402.13 FS. History–New 1-1-77, Formerly 10F-4.08, 10F-4.008, Transferred to 65G-4.002.

Fla. Admin. Code R. 65B-4.023 Definitions for Behavior Analysis Certification and Services Rules

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.023, Transferred to 65G-4.001.

Fla. Admin. Code R. 65B-4.024 Certification as a Behavior Analyst

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.024, Transferred to 65G-4.0.

Fla. Admin. Code R. 65B-4.025 Certification as an Associate Behavior Analyst

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.025, Transferred to 65G-4.004.

Fla. Admin. Code R. 65B-4.026 Renewal of Behavior Analysis Certification

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.026, Transferred to 65G-4.005.

Fla. Admin. Code R. 65B-4.027 Approved Continuing Education

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.027, Transferred to 65G-4.007.

Fla. Admin. Code R. 65B-4.028 Behavior Analysis Certification Fees

History

Rulemaking Authority 393.13(4)(g)3., 393.17 FS. Law Implemented 393.17 FS. History–New 9-23-96, Formerly 10F-4.028, Transferred to 65G-4.006.

Fla. Admin. Code R. 65B-4.029 Behavior Analysis Services Oversight System Organization

History

Rulemaking Authority 393.125, 393.13(4)(g)3., 393.17 FS. Law Implemented 393.066, 393.067(14), 393.125, 393.13, 393.17, 402.165, 402.166, 402.167(1) FS. History–New 9 23 96, Formerly 10F 4.029, Transferred to 65G 4.008.

Fla. Admin. Code R. 65B-4.030 Design, Implementation and Monitoring of Behavior Analysis Services

History

Rulemaking Authority 393.13(4) FS. Law Implemented 393.0651, 393.066, 393.067(14), 393.068, 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.030, Transferred to 65G-4.009.

Fla. Admin. Code R. 65B-4.031 Behavior Analysis Services Approval

History

Rulemaking Authority 393.13(4)(g)3. FS. Law Implemented 393.066, 393.067(14), 393.068, 393.13, 393.17 FS. History–New 9-23-96, Formerly 10F-4.031, Transferred to 65G-4.010.

Fla. Admin. Code R. 65B-4.032 Determination of Mental Retardation in Capital Felony Cases: Intelligence; Tests to be Administered

History

Rulemaking Authority 921.137(1) FS. Law Implemented 921.137(1) FS. History–New 1-13-04, Transferred to 65G-4.011.

Fla. Admin. Code R. 65B-4.033 Determination of Mental Retardation: Intelligence Tests to be Administered

History

Rulemaking Authority 393.063(38), 393.501(1), 916.106 FS. Law Implemented 393.063(38), 916.106 FS. History–New 6-13-06, Transferred to 65G-4.012.

Chapter 65B-5 FOSTER CARE, GROUP HOME, DEVELOPMENTAL TRAING, AND SUPPORTED EMPLOYMENT PROGRAMS TRUST FUND

Fla. Admin. Code R. 65B-5.003 Authority to Loan; Provisions and Determination of Eligibility

History

Rulemaking Authority 393.15 FS., as amended by Ch. 76-128, Laws of Florida. Law Implemented 393.15 FS., as amended by Ch. 76-128, Laws of Florida. History–New 3-31-76, Amended 1-1-77, Formerly 10F-5.03, 10F-5.003, Amended 9-28-99, Transferred to 65G-6.001.

Chapter 65B-6 LICENSURE OF RESIDENTIAL FACILITIES

Fla. Admin. Code R. 65B-6.002 Licensed Capacity (Transferred to 65G-2.006)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.02, 10F-6.002, Transferred to 65G-2.006.

Fla. Admin. Code R. 65B-6.003 Denial or Revocation (Transferred to 65G-2.005)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.03, 10F-6.003, Transferred to 65G-2.005.

Fla. Admin. Code R. 65B-6.005 Types of Licenses (Transferred to 65G-2.003)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.05, 10F-6.005, Transferred to 65G-2.003.

Fla. Admin. Code R. 65B-6.007 Other Licenses (Transferred to 65G-2.0031)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Amended 4-17-80, Formerly 10F-6.07, 10F-6.007, Transferred to 65G-2.0031.

Fla. Admin. Code R. 65B-6.008 General Standards (Transferred to 65G-2.007)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.08, 10F-6.008, Transferred to 65G-2.007.

Fla. Admin. Code R. 65B-6.009 Foster Care Facility Standards (Transferred to 65G-2.011)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.09, 10F-6.009, Transferred to 65G-2.011.

Fla. Admin. Code R. 65B-6.010 Group Home Facility Standards (Transferred to 65G-2.012)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.10, 10F-6.010, Transferred to 65G-2.012.

Fla. Admin. Code R. 65B-6.011 Residential Habilitation Center Standards (Transferred to 65G-2.013)

History

Rulemaking Authority 393.067(5) FS. Law Implemented 393.067 FS. History–New 8-13-78, Formerly 10F-6.11, 10F-6.011, Transferred to 65G-2.013.

Fla. Admin. Code R. 65B-6.013 Comprehensive Transitional Education Program (Transferred to 65G-2.014)

History

Rulemaking Authority 393.067(7), (10), 393.13, 393.0655, 415 FS. Law Implemented 393.067(7), (10), 393.13, 393.0655, 415 FS. History–New 7-31-91, Formerly 10F-6.013, Transferred to 65G-2.014.

Fla. Admin. Code R. 65B-6.014 Siting (Transferred to 65G-2.015)

History

Rulemaking Authority 393.067, 393.501(2) FS. Law Implemented 393.063, 393.066, 393.13, 393.501 FS. History–New 8 1 05, Transferred to 65G-2.015.

Chapter 65B-38 INTERMEDIATE CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED (ICF/DD)

Fla. Admin. Code R. 65B-38.001 Purpose and Intent

History

Rulemaking Authority 393.067(7), 393.501(1), (2) FS. Law Implemented 393.067, 393.13, 393.501, 633.01, 633.022, 633.05 FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.01, Amended 9-3-89, 12-7-92, Formerly 10D-38.001, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.002 Definitions

History

Rulemaking Authority 393.067(7), 393.501(1), (2) FS. Law Implemented 393.063, 393.065(2), 393.067, 393.17 FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.02, Amended 7-16-86, 9-3-89, 12-7-92, Formerly 10D-38.002, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.003 General Standards

History

Rulemaking Authority 393.067(7), 393.501(1) FS. Law Implemented 393.063(10), (29), 419 FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.03, Amended 9-3-89, 12-7-92, Formerly 10D-38.003, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.004 Responsibilities for Operation

History

Rulemaking Authority 393.067(7), 393.501(1) FS. Law Implemented 393.067(7), 393.13(2), 393.501(2), 393.062 FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.04, Amended 9-3-89, 12-7-92, Formerly 10D-38.004, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.005 License Required

History

Rulemaking Authority 393.067(7), 393.501(1) FS. Law Implemented 393.067(7), 393.501(2) FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.05, Amended 9-3-89, 12-7-92. Formerly 10D-38.005, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.006 Licensure Procedure

History

Rulemaking Authority 393.067(7), 393.501(1) FS. Law Implemented 393.0655, 393.067(4), (13), 393.501(2) FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, 5-13-86, Formerly 10D-38.06, Amended 7-16-86, 9-3-89, 10-6-91, 12-7-92, Formerly 10D-38.006, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.007 Admission Policies

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.065, 393.067, 393.13(3) FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.07, Amended 9-3-89, 12-7-92, Formerly 10D-38.007, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.011 Dietary Services

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067 FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.11, Amended 9-3-89, Formerly 10D-38.011, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.012 Drugs and Pharmaceutical Services

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067, 465, 465.019, 499, 893 FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.12, Amended 9-3-89, 12-7-92, Formerly 10D-38.012, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.013 Dental Services

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067(7) FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.13, Amended 9-3-89, 12-7-92, Formerly 10D-38.013, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.015 Training, Habilitation, Professional, and Special Programs and Services

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067(7), 393.13(2) FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.15, Amended 7-16-86, 9-3-89, 12-7-92, Formerly 10D-38.015, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.018 Psychological Services

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.065(2), 393.067 FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.18, Amended 9-3-89, Formerly 10D-38.018, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.023 Administrative Management

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067(7) FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.23, Amended 9-3-89, 12-7-92, Formerly 10D-38.023, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.024 Personnel Standards

History

Rulemaking Authority 393.067(7), 381.0035(4) FS. Law Implemented 393.067(7), 393.13(2)(c), 381.0035(1), (2), (3) FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.24, Amended 7-16-86, 9-3-89, 12-7-92, Formerly 10D-38.024, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.025 Fiscal Standards

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.13(3), (4)(b), 393.067(10), 402.17(2) FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.25, Amended 12-7-92, Formerly 10D-38.025, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.026 Plant Maintenance and Housekeeping

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067 FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.26, Amended 9-3-89, Formerly 10D-38.026, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.027 Rules of Procedures for Hearings

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.125 FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.27, Amended 9-3-89, 12-7-92, Formerly 10D-38.027, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.028 Life Safety and Fire Protection

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067(7) FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.28, Amended 9-3-89, 12-7-92, Formerly 10D-38.028, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.030 Construction and Physical Environment Standards

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067(7), 553, Part V FS. History–New 12-1-78, Amended 7-7-81, 9-20-82, Formerly 10D-38.30, Amended 9-3-89, 12-7-92, Formerly 10D-38.030, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.032 Severability

History

Rulemaking Authority 393.067(7) FS. Law Implemented 393.067 FS. History–New 12-1-78, Amended 7-7-81, Formerly 10D-38.32, 10D-38.032, Repealed 8-15-12.

Fla. Admin. Code R. 65B-38.033 Developmental Services Institutions and Developmental Services Funded Community Residential Facilities

History

Rulemaking Authority 393.067(7), 393.501(1) FS. Law Implemented 393.067(7), 393.067(19) FS. History–New 12-7-92, Formerly 10D-38.033, Repealed 8-15-12.

Division 65H Domestic Violence

Chapter 65H-1 DOMESTIC VIOLENCE

Fla. Admin. Code R. 65H-1.001 Certification

History

Rulemaking Authority 39.903, 39.905 FS. Law Implemented 39.905 FS. History–New 5-13-79, Amended 12-4-79, 12-13-85, Formerly 10A-8.03, Amended 6-22-87, Formerly 10A-8.003, 10M-48.002, Amended 3-12-00, Formerly 65C-6.002, Repealed 11-30-09.

Fla. Admin. Code R. 65H-1.002 Procedures for Funding

History

Rulemaking Authority 39.903, 39.905 FS. Law Implemented 39.903 FS. History–New 5-13-79, Amended 12-4-79, 11-1-83, 12-3-85, Formerly 10A-8.04, Amended 6-22-87, Formerly 10A-8.004, 10M-48.003, Amended 3-12-00, Formerly 65C-6.003, Repealed 11-30-09.

Fla. Admin. Code R. 65H-1.003 Standards for Certification

History

Rulemaking Authority 39.903, 39.905 FS. Law Implemented 39.905 FS. History–New 5-13-79, Amended 12-4-79, 1-11-83, 12-3-85, Formerly 10A-8.05, Amended 6-22-87, Formerly 10A-8.005, 10M-48.004, Amended 3-12-00, Formerly 65C-6.004, Repealed 11-30-09.

Fla. Admin. Code R. 65H-1.004 Confidentiality

History

Rulemaking Authority 415.608, 120.53 FS. Law Implemented 415.601 et seq. FS. History–New 5-13-79, Amended 12-4-79, 12-3-85, Formerly 10A-8.06, 10A-8.006, 10M-48.005, 65C-6.005, Repealed 11-30-09.

Fla. Admin. Code R. 65H-1.005 Evaluation

History

Rulemaking Authority 39.903 FS. Law Implemented 39.903 FS. History–New 5-13-79, Amended 12-4-79, 12-3-85, Formerly 10A-8.07, 10A-8.007, 10M-48.006, Amended 3-12-00, Formerly 65C-6.006, Repealed 11-30-09.

Fla. Admin. Code R. 65H-1.010 Purpose

History

Rulemaking Authority 39.903 FS. Law Implemented 39.905 FS. History–New 11-30-09, Repealed 4-16-12.

Fla. Admin. Code R. 65H-1.011 Definitions

For the purposes of this rule chapter, the following definitions apply:

(1) “Administrator” means the full-time employee who is responsible for the overall operation and day-to-day management of a certified domestic violence center.

(2) “Advisory Board” means a group of individuals whose purpose is to make recommendations to the board of directors regarding the operation of the domestic violence center, if the board of directors does not directly oversee that operation.

(3) “Board of Directors” means a legally constituted group of individuals whose function is to oversee operations of a certified domestic violence center either directly or through an advisory board.

(4) “Certification” means the Department’s formal recognition that a domestic violence center meets the minimum standards set forth in Section 39.905, F.S., and these rules.

(5) “Competency-based Core” means specialized knowledge and skills for the effective performance of domestic violence advocacy activities.

(6) “Dating Violence” as defined in Section 784.046, F.S.

(7) “Department” means the Florida Department of Children and Families, an employee of the Department, or a designated agent of the Department.

(8) “Domestic Violence” as defined in Section 741.28, F.S.

(9) “Domestic violence advocate” means an employee or volunteer of a certified domestic violence center who: provides direct services to individuals victimized by domestic violence; has received 30 hours of domestic violence core competency training; and, has been identified by the domestic violence center as an individual who may assert a claim to privileged communications with domestic violence victims under Section 39.905, F.S.

(10) “Domestic violence center” means an agency that provides services to victims of domestic violence as its primary mission and is certified under these rules.

(11) “Evaluation” means a process of reviewing the administrative and programmatic components of a certified domestic violence center to ensure compliance with minimum standards as set forth in this rule chapter and Section 39.905, F.S., and, if applicable, as stipulated in contract.

(12) “Participant” means a person who receives services from a certified domestic violence center.

(13) “Privilege” means confidential communications, including any related records, made between a person seeking or receiving services from a certified domestic violence center and the domestic violence advocate.

(14) “Provider” means an agency that provides services to victims of domestic violence and is an applicant for certification or certified under Section 39.905, F.S., and these rules.

(15) “Shelter” means a facility that provides temporary emergency housing to victims of domestic violence and their dependents.

(16) “Victim” means the spouse, ex-spouse, co-habitant in an intimate relationship, or individual who shares a child in common with a batterer who has perpetrated an act, alleged act, or attempted act of violence against them for the purpose of exercising power and control. The victim may also be an individual who has or had a dating relationship with the batterer.

(17) “Volunteer” means unpaid staff members trained in the dynamics of domestic violence who provide direct and indirect services to those seeking and receiving services from a domestic violence center.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.905 FS. History–New 11-30-09, Amended 5-4-20.

Fla. Admin. Code R. 65H-1.012 Application and Certification Process

(1) Certification Eligibility.

(a) To be eligible for certification an applicant shall be a not-for-profit corporation created for the purpose of operating a domestic violence center. The not-for-profit corporation may be affiliated with a local government entity or a larger private organization but must be a distinct entity with its own corporate structure and budget. Existing domestic violence centers initially certified prior to November 30, 2009, shall be exempt from the foregoing requirement. All funding and budget issues pertaining to the operation of the domestic violence program must be reported independently from other activities. The domestic violence center’s primary mission shall be the provision of services to victims of domestic violence, as defined in Section 741.28, F.S.

(b) When an applicant is seeking certification within the service area of an existing certified center, the applicant shall demonstrate the unmet need in that service area.

(c) Only applicants that meet the certification standards as detailed in this rule chapter and that have been in operation and providing domestic violence services for 18 consecutive months, including 12 months operation of an emergency shelter, as detailed in this rule chapter and Section 39.905, F.S., may apply to the Department for certification.

(d) Applicants for initial certification must demonstrate an ability to operate, garner community support, and maintain solvency by providing proof of the following:

Satisfactory food safety inspection report completed within the last 365 days by the local Department of Health office.
Satisfactory fire safety inspection report completed within the last 365 days by the local fire authority.
Financial ability to provide services and shelter.
Maintenance of all records pertaining to the operation of the domestic violence program and provision of services in a manner such that the records are readily accessible.

(2) Application. Applicants must first register for access to the Department of Children and Families’ Privilege and Certification System (PCS). Upon registration approval by the Department, the application for initial certification shall be submitted through PCS on Form CF 613, Domestic Violence Center Application for Initial Certification, (October 2025), which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18937. The full-time administrator, board president, or the designated representative of a corporation shall complete the application. The application shall include the following attachments:

(a) Business Plan. The business plan shall provide a comprehensive description of all administrative and programmatic activities for current and future operations. The plan must include the following:

Executive Summary. The executive summary shall include, at a minimum, the mission, goals, objectives, and history of organization.
Community Support. The applicant must demonstrate that the organization is publicly supported, both programmatically and financially. Written endorsement by local law enforcement agencies, and three letters of support from community partners shall also be included.
Financial Plan. The financial plan shall include the organization’s income statement, which identifies revenues by source and expenditures by category; 25 percent local match in the form of cash, in-kind services, or a combination thereof; an independent financial audit covering the previous 18 months operation as a domestic violence program, conducted by a certified public accountant licensed under Chapter 473, F.S.; and a plan for sustainability with projected revenues and expenditures for the 24 months of operation following date of certification.
Management Plan. The management plan shall include a detailed description of the organization’s legal and organizational structure, including names, contact information and resumes for the management team, board of directors, and, if applicable, any advisory boards. The plan must include documentation of the selection process, code of conduct, duties and responsibilities, training requirements, and minutes from the past six meetings of the board of directors, and, if applicable, any advisory boards. Copies of by-laws, IRS tax exemption determination letter, Federal Employment Identification (FEID) number, city business license, county business license, and certificate of status or acknowledgement letter of registration from the Florida Department of State shall also be included.
Market Analysis and Plan. The market analysis shall include a description of the local need for domestic violence services and how those needs are met or unmet. The applicant must demonstrate that services address a need identified in the most current statewide needs assessment approved by the Department. The current needs assessment may be obtained from the Office of Domestic Violence. Descriptions of the service area and demographics, efforts to avoid duplication of services, and strategies for public awareness and fundraising shall also be included.
Personnel Plan. The personnel plan shall include an organizational chart identifying all center employees. The plan must clearly describe each employee’s responsibilities, and include clear lines of authority, accountability, and lines of communication; processes for evaluations and disciplinary action; position descriptions; and the shift schedule for the emergency shelter. The personnel plan must also include the applicant’s staff training and development plan and meet the requirements provided in Rule 65H-1.013, F.A.C., and an explanation of measures utilized to maintain the safety of persons receiving services, including, at a minimum, any background screening, reference checks, verification of previous employment, and certifications of applicant’s employees.
Operations Plan. The operations plan shall include a description of the facilities with city of location, equipment, and assets. Approval of the shelter facilities signed by local authorized zoning, building, and other applicable permitting agencies, based upon inspections not more than 60 days prior to the date of filing the certification application is required. Those buildings that have pre-established schedules with local regulatory agencies for annual re-inspection may submit written documentation of the results of such inspection held within the past calendar year. The operations plan must also include the applicant’s emergency management plan and meet the requirements provided in Rule 65H-1.013, F.A.C.
Service Plan. The service plan shall include an identification and comprehensive description of each service required by Section 39.905, F.S., and any additional services and programs provided by the applicant. The description must illustrate the manner in which services will be integrated with existing resources for domestic violence victims, for example, inter-agency agreements. For each of the services required in Section 39.905, F.S., the applicant must address the needs of underserved communities including those with limited access to resources, and specific efforts to reach these populations within the organization’s service area. Documentation of services shall include services provided during the previous 18 months of operation as a domestic violence program and include the number of persons served for each required service, and the demographics of the people served.

(b) Operating Policies and Procedures Manual. The applicant’s operating policies and procedures manual must meet the requirements provided in Rule 65H-1.013, F.A.C.

(c) The Department will conduct an on-site review of the applicant’s facilities. Upon completion of the full application review, the applicant will be notified in writing of the status of its request for certification.

(3) Certification.

(a) Certification is for one year and automatically expires on June 30 of each year unless extended to allow implementation of a corrective action plan as set forth in Rule 65H-1.017, F.A.C.

(b) The Department will annually renew a center’s certification upon the June 30 expiration date provided the center has received a favorable monitoring report from the Department or contracted entity.

(c) Failure to comply with any of the requirements in Section 39.905, F.S. or this rule chapter constitutes grounds to deny, suspend, revoke the certification as provided in Rule 65H-1.017, F.A.C. However, if the corrective action period extends beyond the June 30 expiration date, the Department will extend the certification for a period not to exceed 180 calendar days to allow the center to complete a corrective action plan as provided in Rule 65H-1.017, F.A.C.

(d) Certification is non-transferable and valid only for the center and designated service area listed on the certificate issued by the Department.

(e) The center may operate shelters at different locations. If the center wishes to change the location of a shelter, close a shelter, or open additional shelter locations during an existing certification period, the center must notify the Department, in writing, at least 30 days prior to the change or addition, and request approval from the Department. The Department will grant approval for additional shelter locations if the center is financially and programmatically capable of supporting additional locations, the new or additional location is within the center’s designated service area, and there is no pending corrective action pertaining to the center. If the Department does not grant approval for additional sites, the provider may not utilize funds distributed through the formula as set forth in Rule 65H-1.018, F.A.C. to operate those locations.

(4) Provisional Certification.

(a) The Department may issue a provisional certification pursuant to section 39.905(1)(h), F.S., to applicants who have not met the requirements of paragraph (1)(c) and subparagraph (2)(a)3. of this rule, if the applicant meets all other statutory and administrative requirements of Chapter 65H-1, F.A.C. of a certified domestic violence center.

(b) Within 90 days of receiving provisional certification, the center must be able to staff its emergency shelter 24 hours a day, 7 days a week.

(c) The Department will not issue a provisional certificate when doing so would place the health, safety, or welfare of individuals at risk.

(d) The Department will take any monitoring and enforcement action as set out in Chapter 65H-1, F.A.C. against a center holding a provisional certification. The Department will revoke a provisional certification when a center is found to be out of compliance with certification standards to the extent operations place the health, safety, or welfare of participants at risk.

(e) A provisional certification expires 18 months after issuance and will not be reissued.

History

Rulemaking Authority 39.903, 39.905 FS. Law Implemented 39.903, 39.905 FS. History–New 11-30-09, Formerly 65H-1.001, 65H-1.002, Amended 2-5-15, 5-4-20, 1-11-26.

Fla. Admin. Code R. 65H-1.013 Administration and Operations

The provider shall develop and implement written policies and procedures that ensure compliance with all provisions of this rule chapter and Sections 39.905 and 39.908, F.S. The provider shall make the written policies and procedures available to all employees and volunteers upon their beginning date of employment or service and, thereafter, as revised. Employees and volunteers must indicate in writing that they have read and understand the policies and procedures, relevant to their position or volunteer duties, which must be documented in their personnel file. At a minimum, the operating policies or procedures shall address the following:

(1) Admission. The provider shall establish and implement written policies and procedures that identify who is eligible for services and how those services are accessed. Services shall not be denied to any person because of age, race, religion, color, disability, national origin, marital status, or gender. Prospective participants must be informed of the admission criteria and, if ineligible, the provider must provide referrals to other organizations that can provide assistance.

(2) Board of Directors. The provider shall establish and maintain a board of directors, which shall be composed of at least three citizens who reside within the center’s service area, one of whom must be an employee of a local, municipal, or county law enforcement agency whose jurisdiction includes some or all of the center’s service area. The board of directors should racially and ethnically reflect, to the extent possible, the participants served by the domestic violence center. The board of directors shall serve as the governing body responsible for fiscal oversight and strategic leadership specific to the operation of the center. The provider shall create an advisory board to make recommendations to the board of directors regarding operational functions specific to the domestic violence center if the board of directors does not directly provide fiscal oversight and strategic leadership to the domestic violence center. The provider shall develop by-laws, which must include membership selection process, term limits, code of conduct, conflict of interest, duties and responsibilities, and orientation and training requirements for the board of directors and any advisory boards.

(3) Confidentiality. The provider shall establish and implement written policies and procedures for maintaining safety, confidentiality, and privacy of persons receiving services. The provider shall also ensure that employees and volunteers receive written information on the restrictions relating to the disclosure of information about center participants and the location of shelter as provided in Section 39.908, F.S.

(4) Endorsement. The provider must obtain annual written cooperative agreements with the primary law enforcement agency within each county of the center’s service area.

(5) Emergency Management. The provider shall develop an emergency management plan that is coordinated with the applicable local emergency management agency.

(a) The plan must outline a comprehensive and effective program to ensure the safety and well-being of employees, volunteers, and center participants in the event of an emergency. The plan should address emergencies that the provider may reasonably expect in the center facilities. Examples are: natural or manmade disasters such as hurricanes or tornados; contamination of the air, ground, water, or food; fire; public health hazards such as outbreak of communicable, reportable diseases such as avian influenza, arboviral encephalitis, salmonella, severe acute respiratory syndrome (SARS), West Nile virus, etc.; significant incidents such as participant death or injury; security incidents such as intruders, hostage situations, kidnapping, and workplace violence; or human acts that may jeopardize the health, safety, or welfare of center employees, volunteers, or participants.

(b) The emergency management plan must include, at a minimum, the following elements: procedures for reporting emergencies or incidents as identified in paragraph (5)(a), above; identification of essential functions, programs, and personnel; procedures to implement the plan and personnel notification; delegations of authority and lines of succession; identification of alternative facilities; procedures for evacuation, including type of evacuation and exit route assignments; procedures to account for all staff members and participants; and identification and protection of records and databases.

(c) The provider must annually review and update the plan. A current plan shall be maintained in the center records and made available for inspection upon request.

(6) Financial Management. The provider is responsible for the sound financial management of the domestic violence center by ensuring proper financial controls are in place and by maintaining current financial documents described in Rule 65H-1.012, F.A.C.

(7) Incident Reporting. The provider shall notify the Department or contracted entity as soon as practical, and in no event more than 24 hours, after any incident that involves death or serious injury of a participant or their dependent, as well as any action by the participant or provider staff that results in an inquiry by public media.

(8) Personnel. The provider may not discriminate against employees, applicants for employment, or participants because of their age, race, religion, color, disability, national origin, marital status, or gender. Personnel should racially and ethnically reflect, to the extent possible, the participants they serve. The provider shall ensure that there is adequate staff coverage at all center facilities for the provision of required core services, as well as any additional services the center provides.

(a) A certified domestic violence center must have, at a minimum, the following paid staff positions:

One full-time administrator responsible for the management of the domestic violence center who reports to the board of directors. Qualifications include a bachelor’s degree from an accredited college or university and two years’ experience working in the domestic violence field, or four years minimum experience in an administrative/management capacity and two years’ experience working in the domestic violence field. The administrator must successfully complete 30 hours of domestic violence competency-based core training within 90 days of their date of employment. Upon successful completion, the administrator must register, according to Section 39.905, F.S., as someone who may claim privilege under Section 90.5036, F.S. In the event the administrator position becomes vacant, an interim administrator must be appointed until the position can be filled permanently. A board member may not serve in the position at any time.
One full-time advocate services manager responsible for managing all advocacy, counseling, and volunteer services. Qualifications include a bachelor’s degree from an accredited college or university, or four years of direct service experience in the field of domestic violence. The advocate services manager must successfully complete 30 hours of domestic violence competency-based core training within 90 days of their date of employment. Upon successful completion, the advocate services manager must register according to Section 39.905, F.S., as someone who may claim privilege under Section 90.5036, F.S.
One full-time or part-time accounting manager responsible for ensuring the integrity of the center’s financial records and preparation of financial statements. Qualifications include a minimum of two years accounting experience.
The provider must select one full-time employee within the center to be designated as the emergency coordinator and another to be the alternate emergency coordinator. The emergency coordinator is responsible for implementing the center’s emergency management plan and providing training to all employees and volunteers on their duties and responsibilities for implementing the plan.

(b) If the administrator or accounting manager positions listed above become vacant, or if the employee assigned to the position is unable to fulfill their duties and responsibilities due to an extended absence, the provider shall notify the Department or contracted entity within five business days of the vacancy or absence.

(d) The provider shall ensure that employees and volunteers comply with policies and procedures for maintaining the safety, confidentiality, and privacy of persons receiving services and with the prohibition against disclosure of any information about center participants and shelter location as provided in Section 39.908, F.S.

(e) The provider shall develop and implement standards of conduct and disciplinary action for violation of standards.

(f) The provider shall maintain current, accurate, and complete personnel records for all employees and direct-service volunteers, which shall include position descriptions and training records.

(9) Privilege. The provider shall ensure that all employees and volunteers who provide direct services register for advocate-victim privilege according to Section 90.5036, F.S. The provider shall ensure that a current and accurate list of said employees and volunteers with their position title is filed with the Department or contracted entity. The provider, as necessary, shall file amendments to the list.

(10) Record Keeping. The provider shall provide for the maintenance of records, including electronic storage media, regarding the administrative, fiscal, and programmatic operation of the domestic violence center. Records shall be current, complete, accurate, and maintained in such form as to permit Department or contracted entity evaluation during the hours of operation. Information about domestic violence center clients or the location of the domestic violence center may not be disclosed except as provided in Section 39.908, F.S. All records and files, including electronic storage media, shall be kept for a minimum period of six years after termination of certification, or if an audit has been initiated and audit findings have not been resolved at the end of six years, the records and files shall be retained until resolution of the audit findings. Records include, but are not limited, to the following:

(a) Case Management Records. The provider shall maintain case management records in compliance with Rule 65H-1.014, F.A.C.

(b) Fiscal Records. The provider shall maintain an accounting system capable of distinguishing between all revenue sources and expenditures and in accordance with generally accepted accounting principles (GAAP) as established by the Federal Accounting Standards Advisory Board. The provider’s fiscal records shall provide an accounting of the revenue and expenditures of the certified center that is separate and distinct from other programs and services that may be operated by a parent entity such as a local government or an umbrella agency. The provider’s fiscal records must be available for inspection by the Department or contracted entity upon request.

(c) Service Reports. The provider shall collect and compile a monthly record of all services provided. The record shall include the gender, age, ethnicity, and, if applicable, other information as required by contract, of the people served. The provider shall forward a monthly summary report to the Department or contracted entity each month for evaluation of domestic violence service trends.

(11) Staff Training and Development. The provider shall develop, implement, and review annually and revise as necessary a staff training and development plan to ensure that all new employees, current employees, and volunteers meet training requirements as required by this rule. The plan shall include policies and procedures for implementing training activities, course titles, descriptions, objectives, number of hours, names of instructors with title or position or source, dates or timeframes, and training requirements for each staff position. The training of each employee and volunteer shall be documented in the staff member’s personnel file or training record and shall include activities or course titles, number of hours, names of instructors and title or position, and dates of completion. The minimum training must include:

(a) Competency-Based Core Training. Advanced-level training on domestic violence that includes the knowledge and skills needed to work in domestic violence program areas such as crisis intervention, safety planning, and advocacy. All staff members who supervise, coordinate, and/or provide direct advocate or counseling services to center participants shall successfully complete 30 hours of domestic violence competency-based core training. The successful completion of this training is required in order for an employee and participant to assert the evidentiary privilege afforded by Section 90.5036, F.S.

(b) In-Service Training. Training designed to help employees and volunteers develop their knowledge and skills related to domestic violence and the successful performance of their job. All staff members who supervise, coordinate, and/or provide direct advocate or counseling services are required to successfully complete 16 hours of in-service training each state fiscal year. The training requirement is effective upon the first anniversary of their employment or service.

(c) Emergency Training. In addition to in-service training, all staff members shall receive, at a minimum, annual training on implementing the center’s emergency management plan as identified in subsection (5), above.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.905 FS. History–New 11-30-09, Formerly 65H-1.001, 65H-1.003, Amended 2-5-15, 5-4-20.

Fla. Admin. Code R. 65H-1.014 Services

To be eligible for certification, a domestic violence center shall provide the minimum services as set forth below and in Section 39.905, F.S. Providers may provide additional services beyond the minimum requirements. For services provided, the center must make specific efforts to address the needs of underserved populations within the center’s service area, including populations that are underserved because of disabilities, ethnicity, gender, race, language, or geographic isolation.

(1) Information and Referral. Education and recommendations on services to those persons seeking assistance. The provider shall maintain a comprehensive and current database of information and referral resources, which shall be made available for use by all direct service staff.

(2) Counseling. Supportive activities with victims of domestic violence.

(a) Counseling services shall incorporate supportive advocacy services such as crisis intervention, safety planning, assessment of risk, and intervening with the various social and legal agencies on behalf of the center participant, including legal advocacy, medical advocacy, housing advocacy, interpretation services, and additional services as needed.

(b) Counseling services may be based on the peer-counseling model. Individuals who need mental health counseling services may be served through referral to an outside provider.

(3) Case Management. A collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet a center participant’s needs.

(a) The provider shall provide one-on-one case management to participants who reside in shelter for 72 hours or more, and to non-resident participants upon two sessions with an advocate. This provision does not preclude providers from providing case management to residents housed less than 72 hours or to non-resident participants who have received less than two sessions with an advocate.

(b) Individual case records shall be maintained, shall be current, and shall include at a minimum:

Identification data including name, age, ethnicity, and other relevant information for the participant and any dependents; and
A case management plan that includes safety planning and service referrals.

(c) The provider shall develop procedures and maintain documentation for case management staffings. Case management staffings shall be held bi-weekly for the purposes of ensuring effective communication among staff about the progress of participants toward meeting their goals and objectives, as well as addressing individual participant issues.

(d) In order to ensure the safety of participants and their dependents the provider shall protect the confidentiality and privacy of persons receiving services. Center staff shall not disclose any personally identifiable information collected in connection with services or reveal individual participant information without the informed, written, time-limited consent of the participant, except in limited circumstances described in the Section 39.908, F.S.

(4) Emergency Shelter. Safe housing provided for adult victims of domestic violence and their dependents. The provider shall provide temporary emergency shelter to victims and their dependants for more than 24 hours. Shelters shall be staffed by domestic violence advocates 24 hours a day, seven days a week, including holidays.

(5) Hotline Services. A telephone operated 24 hours a day, seven days a week to provide crisis intervention, safety planning, information, and referral to victims of domestic violence or on behalf of a victim.

(a) The provider shall provide hotline services, available 24 hours a day, seven days a week staffed by domestic violence advocates who have successfully completed the 30 hours of domestic violence competency-based core training and are registered for privileged communications. The hotline telephone shall have a TTY/telephone relay service.

(b) The use of commercial telephone answering services or automated voice mail to cover the hotline are not permitted, except for the purpose of directing calls to a domestic violence advocate.

(6) Child Assessment: Evaluation of the basic needs of children served by the center and the referral of children to services if needed.

(a) Each child in emergency shelter for 72 hours or more shall be assessed for basic needs and given service recommendations by a domestic violence advocate with experience working with children. This provision does not preclude providers from providing an assessment of children housed less than 72 hours.

(b) Any person who knows, or has reasonable cause to suspect, that a child is abused or neglected shall report such knowledge or suspicion to the Department’s central abuse hotline as provided for in Section 39.201, F.S.

(7) Professional Training. Education on the dynamics of domestic violence provided to law enforcement personnel, other professionals, and paraprofessionals who have contact, as part of their work, with victims of domestic violence.

(8) Community Education. The efforts, activities, and presentations performed to increase public awareness about domestic violence and the availability of services for victims of domestic violence.

(a) The provider shall provide community education to promote awareness of the incidence, causes, and prevention strategies of domestic violence. Community education shall be presented both face-to-face and through the utilization of various media.

(b) Center employees shall participate in community task forces, interagency councils, and other organizational groups whose efforts are intended to improve services for victims of domestic violence.

(9) Exempted Services. The Department may exempt the 24-hour hotline, professional training, and community education requirement for centers where this requirement is already being met by another certified center in the same service area, pursuant to Section 39.905(1)(c), F.S.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.905, 39.908 FS. History–New 11-30-09, Formerly 65H-1.001, 65H-1.003, Amended 2-5-15, 5-4-20.

Fla. Admin. Code R. 65H-1.015 Emergency Shelter Facilities

(1) Design, Construction, and Accessibility. The provider shall ensure that the design and construction of new shelter facilities or alterations to an existing facility meet the minimum requirements of the applicable state and local governing agencies. All shelter facilities maintained by the provider shall meet the requirements of Sections 553.501-.5141, F.S., and the Americans with Disabilities Act Standards for Accessible Design in the Code of Federal Regulations, Title 28, Part 36, Appendix A. Facilities certified prior to the effective date of this rule must meet these minimum standards except where the cost of compliance with a particular standard would impose an undue burden on the provider, as described in the Code of Federal Regulations, Title 28, Section 35.150. Any alteration to a shelter facility certified prior to the effective date of this rule must meet the accessibility guidelines described above, as provided in the Code of Federal Regulations, Title 28, Section 36.402.

(2) Physical Safety and Well-being. The provider shall take precautionary measures to provide for the safety, confidentiality, privacy, and well-being of shelter residents.

(a) All shelter facilities maintained by the provider shall meet all applicable county and municipal building code enforcement requirements as provided in subsection (1) of this rule chapter.

(b) All shelter facilities must be in good repair, free from health and safety hazards, clean, and free from vermin infestation.

(c) To protect the privacy of shelter participants, electronic surveillance systems may not be installed in the participants’ living quarters of the shelter facilities. Electronic surveillance systems may be installed at entrance and exit doors and parking areas.

(d) All outside doors shall remain locked from the outside at all times; all windows shall be secured against entry; and outside and entrance way lighting shall be in place and functioning.

(e) If an outside play area is made available for children, the area shall be free of debris and broken or dangerous materials and shall be routinely checked for safety. Play areas shall be fenced in accordance with local ordinances to prevent access by children to all water hazards within or adjacent to outdoor play areas, such as pools, ditches, retention and fish ponds. The outdoor play area shall have and maintain safe and adequate fencing or walls a minimum of four feet in height. Fencing, including gates, must be continuous and shall not have gaps that would allow children to exit the outdoor play area. The base of the fence must remain at ground level and be free from erosion or build-up to prevent inside or outside access by children or animals. If the play area is in view of the public, privacy fencing is required.

(f) No firearms or weapons as defined in Section 790.001, F.S., shall be allowed within any building or upon any person located on the premises, excluding federal, state, or local law enforcement officers.

(g) No narcotics, alcohol, or other impairing drugs shall be present on the premises. This does not include prescription medications.

(h) Smoking is prohibited within the shelter facilities, all outdoor play areas, and in vehicles when being used to transport center participants. The provider may designate specific areas for smoking.

(i) Fire Safety. The provider shall ensure that each shelter facility has sprinklers or smoke alarms in each bedroom, and in all hallways and common areas. The provider shall ensure that an annual fire safety inspection, which conforms to fire safety standards as determined by each municipality, county, and special district with fire safety responsibilities as defined in Section 633.028, F.S., is conducted for each shelter facility. A current inspection report shall be maintained in the center records and made available for inspection upon request.

(j) Health Inspections. The provider shall ensure that each shelter facility has an annual sanitation inspection through their county health department. A current inspection report shall be maintained in the center records and made available for inspection upon request.

(3) Telephone. The shelter facility shall have telephones that are centrally located and readily available for staff member and participant use. Emergency numbers such as emergency medical services, fire department, law emforcement, hospital, and poison control center shall be posted by each telephone. There shall be at least one cellular telephone available for use at all times in the event of power and telephone line outages. TTY/telephone relay service for the hearing impaired is required.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.905 FS. History–New 11-30-09, Formerly 65H-1.001, 65H-1.003, Amended 2-5-15, 5-4-20.

Fla. Admin. Code R. 65H-1.016 Confidentiality

(1) To ensure the safety, confidentiality, and privacy of persons receiving services, the provider shall safeguard information identifying domestic violence emergency shelters and center participants as provided in Section 39.908, F.S. Confidential information may be in hardcopy or electronic format and may include name, address, phone number, case management plan and notes, safety plan, service plan, services provided, referrals, and other related information. Access to any participant identifying information shall be limited to staff members who have a legitimate interest in the case and have a need to know to carry out their job duties.

(2) The Department and the contracted entity shall have access to shelters and center records to the extent necessary to perform the oversight function. Providers may not provide individual participant records to stakeholders, partner agencies, and other entities that have an interest in provider operations, except as expressly authorized in Section 39.908, F.S. Client communications that satisfy the criteria for a privileged communication under Section 90.5036, F.S., may be disclosed only as provided in that statute.

(3) The provider shall ensure all center employees and volunteers are aware of and understand their obligation to comply with Section 39.908, F.S., which prohibits the disclosure of shelter location and any information regarding center participants without their express written, time-limited consent, except in limited circumstances described in the statute.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.908 FS. History–New 11-30-09, Formerly 65H-1.004, Amended 5-4-20.

Fla. Admin. Code R. 65H-1.017 Monitoring and Evaluation

The Department or contracted entity will monitor each certified center to evaluate compliance with the minimum standards provided in this rule chapter and in Section 39.905, F.S.

(1) To conduct evaluations, the Department or contracted entity shall have access to a center or subcontractor, its location, records relevant to the operation of said center or subcontractor, records of participants served, and any other information necessary for evaluation of compliance with this rule chapter and Section 39.905, F.S.

(2) The evaluation shall occur annually, through an on-site visit or desktop review, as determined by the Department or contracted entity. However, an evaluation may occur at any time there is a complaint to the Department or contracted entity. The contracted entity and the Department must be granted access to enter and inspect a center as provided in Sections 39.903 and 39.9035, F.S.

(3) Within 60 days after the evaluation, the provider will receive a written report from the Department or contracted entity detailing whether or not standards have been met. If any deficiencies were cited, the provider will be given ten business days from the date of the written report to submit a corrective action plan. The corrective action plan is subject to approval by the Department or contracted entity. The severity of the noncompliance may affect the period of time allowed for correction, but in no event shall the corrective action period exceed 90 days. Follow up visits or a desk review will be made by the Department or contracted entity to determine if the plan of correction is acceptable, has been implemented, or completed.

(4) The Department will renew a center’s annual certification based upon receipt of a favorable monitoring report issued by the Department or contracted entity as provided in Section 39.903(2), F.S.

(a) A favorable monitoring report means the Department or contracted entity has determined a center is in compliance with the requirements of this rule chapter, Sections 39.905 and 39.908, F.S., and the contracted entity’s contract for purposes of subsection 65H-1.012(3), F.A.C. The Department or contracted entity’s determination that a center was initially not in compliance with these requirements but has successfully completed a corrective action plan will also constitute a favorable monitoring report.

(b) An unfavorable monitoring report means the center is not in compliance with the requirements of this rule chapter, Section 39.905, F.S., the contracted entity’s contract, and has not successfully completed a corrective action plan as determined by the Department or contracted entity. An unfavorable monitoring report will result in suspension of a center’s certification, unless the circumstances are beyond the provider’s reasonable control, such as manmade or natural disasters, local zoning ordinances, or permitting processes.

(5) The Department will suspend a center’s certification without allowing an opportunity for corrective action in the event a violation poses an imminent risk of serious harm to the health or safety of participants or staff members. A suspension will continue until the provider completes a corrective action plan but will not exceed six months. If the provider does not successfully complete the corrective action plan within six months, the center’s certification will be revoked and certification renewal will be denied.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.903, 39.905 FS. History–New 11-30-09, Formerly 65H-1.005, Amended 2-5-15, 5-4-20.

Fla. Admin. Code R. 65H-1.018 Funding Procedures

(1) For each funding cycle, the Department or contracted entity will provide all eligible certified domestic violence centers with an application for funding with instructions for completion.

(2) Newly certified centers without previous funding from the Department or contracted entity must request an application for funding by July 1 for the following state fiscal year. Certification does not guarantee funding.

(3) In accordance with Section 39.905(7)(a), F.S., all funds collected and appropriated for certified domestic violence centers will annually be distributed by the Department or contracted entity through an allocation formula developed by the Department or contracted entity. The Department will review the allocation formula and any revisions made by the contracted entity to ensure that it includes the factors required by Sections 39.903 and 39.905, F.S.

(4) The Department or contracted entity shall provide final approval of applications for and shall award funds appropriated for certified domestic violence centers as provided in Section 39.903(7), F.S. The Department or contracted entity shall contract with successful applicants for the operation of certified domestic violence centers.

(5) The Department or contracted entity will conduct evaluations of certified domestic violence centers to ensure quality services are being provided to center participants.

(6) Funding is contingent upon completion of any corrective action required by the Department or contracted entity, unless the failure to complete the corrective action is attributable to circumstances that are beyond the provider’s reasonable control.

History

Rulemaking Authority 39.903 FS. Law Implemented 39.903, 39.905 FS. History–New 11-30-09, Formerly 65H-1.002, Amended 5-4-20.

Chapter 65H-2 Batterer Intervention Program Certification Minimum Standards

Fla. Admin. Code R. 65H-2.001 Purpose

History

Rulemaking Authority 741.32, 741.325 FS. Law Implemented 741.32, 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.002 Definitions

History

Rulemaking Authority 741.325 FS. Law Implemented 741.32, 741.325, 741.327 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.003 Program Application Requirements

History

Rulemaking Authority 741.325 FS. Law Implemented 741.32, 741.325, 741.327 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.004 Program Requirements

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.005 Program Curriculum

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.006 Facilitator Eligibility

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.007 Assessor Application Requirements

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.008 Assessment Requirements

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.009 Assessor Eligibility

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.010 Trainer Requirements

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.011 Conflicts of Interest

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.012 Monitoring

History

Rulemaking Authority 741.325 FS. Law Implemented 741.325 FS. History–New 4-26-07, Repealed 3-21-13.

Fla. Admin. Code R. 65H-2.014 Definitions

For the purposes of this rule chapter, the following definitions apply:

(1) “Assessment” means a psychosocial evaluation to determine if an individual is a batterer as defined in subsection (3) of this rule and engages in dynamics of power and control, including coercion. Assessment also includes an evaluation of an individual’s competency to consent to treatment, patterns of a co-occurring mental illness and substance abuse, as well as clinically significant neurological deficits, that necessitate referrals to treatment or other programs prior to or concurrent with participation in a batterers’ intervention program.

(2) “Assessor” means a person who performs the psychosocial assessment of individuals who have been referred to a certified batterers’ intervention program and who meets the qualifications set forth in this rule chapter.

(3) “Batterer” means a perpetrator of domestic violence, as defined in Section 741.28(2) F.S., or dating violence, as defined in Section 784.046(1)(d), F.S.

(4) “Batterers’ Intervention Program” means a 29-week program certified pursuant to this rule chapter that addresses the perpetration of violence by an intimate partner, spouse, ex-spouse, or a person who shares a child in common or who is a cohabitant in an intimate relationship for the purpose of exercising power and control by one over the other.

(5) “Certification” means a process of satisfying the requirements and minimum standards as set forth in this rule chapter and Section 741.325, F.S. for a certified batterers’ intervention program.

(6) “Change of ownership” means an event in which the Provider sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or, an event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a Provider is in any manner transferred or otherwise assigned. A change solely in the management company or board of directors is not a change of ownership.

(7) “Coercive control” means a pattern of domination that includes tactics to isolate, degrade, exploit, and control the victim.

(8) “Cognitive Behavioral Therapy Model” (CBT) means a therapeutic intervention that has been demonstrated to be effective for a range of problems whereby participants can learn to change their own thinking, problematic emotions, and behavior.

(9) “Curriculum” means the Department-approved educational content for a certified batterers’ intervention program.

(10) “Dating Violence” as defined in Section 784.046(1)(d), F.S.

(11) “Department” means the Florida Department of Children and Families.

(12) “Direct service staff” means the on-site director responsible for the day-to-day operation of a certified batterers’ intervention program, and individuals who are employed or contracted by a provider to conduct orientation, facilitate groups, or conduct assessments.

(13) “Domestic Violence” as defined in Section 741.28(2), F.S.

(14) “Equality Wheel” means a graphically designed tool that illustrates the dynamics of an equal, violence-free partnership.

(15) “Facilitator” means a group leader for a certified batterers’ intervention program.

(16) “Groups” means two or more participants attending interactive sessions with designated facilitators who manage discourse and topics of discussion.

(17) “Monitoring” means a process of reviewing the administrative and programmatic components of a certified batterers’ intervention program to ensure compliance with minimum standards as set forth in rule and statute.

(18) “Office of Domestic Violence” (ODV) means the Department’s office responsible for the oversight of certification and monitoring of batterers’ intervention programs.

(19) “Participant” means an individual:

(a) Who is adjudged to have committed a criminal act of domestic violence as defined in Section 741.28, F.S., or dating violence as defined by Section 784.046, F.S.,

(b) Against whom a final injunction for protection against domestic violence or dating violence is entered,

(d) Who volunteers to attend a program after committing an act of domestic violence or dating violence.

(20) “Power and Control Model” means intervention that recognizes domestic violence where one partner in an intimate relationship systematically uses tactics of emotional and physical abuse in order to maintain power and control over the other.

(21) “Power and Control Wheel” means a graphically designed tool that illustrates the tactics of abusive behaviors used by batterers to establish and maintain control over their partners.

(22) “Provider” means the owner and/or operator of a certified batterers’ intervention program.

(23) “Psychoeducational Model” means a psychotherapeutic intervention that utilizes a critical thinking program model and structured didactic interventions with batterers.

(24) “Victim” means an intimate partner, spouse, ex-spouse or one who shares a child in common or who is a cohabitant in an intimate relationship against whom the batterer has perpetrated an act of domestic or dating violence for the purpose of exercising power and control.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Fla. Admin. Code R. 65H-2.015 Program Application Requirements

(1) Application.

(a) Application for initial certification or for renewal of certification shall be made on Form CF 831, Batterers’ Intervention Program Certification Application, (August 2022), which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14616. The individual owner or the designated representative of a corporation or partnership shall complete the application.

(b) All program locations of a provider shall be included in the application.

(2) Initial Certification.

(a) An applicant for initial certification of a Batterers’ Intervention Program shall submit to the ODV the following:

Form CF 831, Batterers’ Intervention Program Certification Application,
The program’s policy and procedure manual,
All curricula, forms (including screening and assessment tools), and informational brochures used by the program,
Educational, experiential, and training documentation for each direct service staff and, if applicable, contracted assessor, and
Form CF 1649, Affidavit of Good Moral Character, (April 2021), which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14615, for each direct service staff. Thereafter, this information must be updated and maintained in such a form as to permit review for rule compliance by the Department.

(b) If the initial certification application includes all information and documentation set forth in paragraph (2)(a) above, the Department will issue a provisional certification. The provisional certification shall not exceed a period of six months. If the initial certification application meets all certification requirements, the certification shall be issued. The provisional license shall end on the date the Department issues the final certification decision.

(c) Certification is issued in the name of the owner, corporation, or partnership of the program. Certification is non-transferable and valid only for the program and location or locations named in the certificate. Any changes in ownership shall be reported to the Department at least 60 days prior to the change.

(d) The Department-issued certificate, or a copy of the certificate shall be displayed within public view at all program locations.

(3) Renewal of Certification.

(a) Certification must be renewed annually.

(b) An applicant for renewal of certification of a Batterers’ Intervention Program shall submit to the ODV the following:

Form CF 831, Batterers’ Intervention Program Certification Application, and
Any updates to the information initially provided in paragraph (2)(a) of this rule.

(c) The Batterers’ Intervention Program Certification Application and any accompanying documentation must be submitted to the ODV for renewal of certification at least 60 days prior to the expiration of certification to ensure that a lapse of certification does not occur.

(d) If the program does not submit its renewal application at least 60 days prior to the expiration date and a lapse in certification occurs, the certification shall expire, and the Department shall notify the Office of State Courts Administrator, the trial court administrator, and the certified domestic violence center(s) in the judicial circuits where the program provides services. The program will remain uncertified until it submits, and the Department approves a new application.

(e) Certification will be renewed if the program meets all requirements set forth in this rule chapter.

(4) Change of Location of Service. If the provider wishes to change a program's location of service or open additional locations within the circuit where certified, the provider shall notify the Department, in writing, at least 60 days prior to the change.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Fla. Admin. Code R. 65H-2.016 Program Requirements

To qualify for certification, a batterers’ intervention program shall meet and comply with the following minimum standards:

(1) Community Collaboration and Coordination.

(a) The program must coordinate its efforts within the community, particularly with victims and their families, the local justice system, social service agencies, including the certified domestic violence centers, and state and local governments to enhance the safety of victims and their children and establish protocols to effectively communicate to stakeholders any potential danger the batterer poses to the victim and/or children.

(b) The provider will inform courts, prosecutors, probation and parole, the victim, and other stakeholders as appropriate to the case of the batterer’s positive progress and compliance with program expectations, and if the batterer is not in compliance with the program expectations or demonstrates any risk of repeat violence or homicide.

(2) Personnel.

(a) The provider shall have a policy to provide confidential employee assistance to employees who are victims of domestic and dating violence, including referral to domestic violence centers for safety planning and other services, and continued employment where appropriate and safe.

(b) All direct service staff employed or contracted by a provider shall be required to undergo security background investigations as a condition of employment and continued employment. Background investigations shall be completed by the provider and shall at minimum be level 1 screening as defined in Section 435.03, F.S., and include local criminal records checks through local law enforcement agencies, and statewide criminal records checks through the Florida Department of Law Enforcement, Division of Criminal Justice Information Services (CJIS), including a check for registered sex offenders/sexual predators, and injunctions for protection against domestic violence. The local law enforcement screening shall also be conducted for the employee's or contractor’s previous address if she or he has lived in the current jurisdiction less than one year. Such background investigations shall be conducted at the expense of the employing agency.

An individual who has been a perpetrator of domestic, dating or sexual violence or stalking, as defined in Sections 741.28(2), 784.046(1)(d), 784.048, and 794.011 F.S., or was a respondent in a final injunction for protection against domestic, dating, or sexual violence or stalking in Florida or another state, based on the severity of the offense as established in the provider’s policies, shall be ineligible for employment unless the individual has successfully completed a certified batterers’ intervention program and remained violence free as defined by the aforementioned policies for a minimum period of five years preceding the hiring date.
An individual who is under any form of community supervision including probation, pre-trial diversion, or parole shall be ineligible for employment.

(c) All direct service staff of a certified provider shall complete annually, as a condition of employment and continued employment, Form CF 1649, Affidavit of Good Moral Character, which is incorporated by reference in Rule 65H-2.015, F.A.C.

(d) A provider may employ an otherwise disqualified individual, except as stipulated in subparagraphs (2)(b)1.-(2)(b)2. above, if the applicant can provide documentation that she or he has not been convicted of any of the disqualifying offenses for a minimum period of five years preceding the hiring date and demonstrates a commitment to non-violence as determined by criteria in the agency policies and procedures.

(e) The provider shall immediately terminate the employment or contract of any direct service staff convicted or found guilty, regardless of adjudication, or having entered a plea of nolo contendere, to any disqualifying offense while employed. The provider shall notify ODV of the termination within 24 hours.

(3) Fees. The program shall establish a policy regarding whether it will admit participants who require fee waivers or reduced fees because they are indigent or unable to pay the full program fee.

(4) Operating Policies and Procedures Manual.

(a) The provider shall maintain and follow written policies and procedures that direct the operation of the batterers’ intervention program that include the following:

Mission Statement and Philosophy,
Days and Hours of Operation and Group Schedules,
Intake and Enrollment,
Orientation and Curriculum Outline,
Record Keeping and Reporting,
Fee Collection and Acceptance of Indigent Participants,
Non-discrimination,
Accessibility to Persons with Disabilities,
Duty to Warn and Reporting of Criminal Behavior, and
Reporting of Enrollment and Discharge Information to Referral Source and Probation and Parole, if applicable,

(b) The provider shall maintain and follow personnel policies and procedures for the following: equal employment opportunity; code of professional ethics and moral conduct; confidentiality; non-fraternization; conflict of interest; violence free lifestyle; drug free workplace; sexual harassment, confidential employee assistance, and domestic violence in the workplace. The aforementioned policies and procedures shall be submitted with the certification application and made available during annual monitoring.

(5) Provision of Services.

(a) Services shall not be denied to any person because of race, ethnicity, national origin, religion, age, gender, sex, sexual orientation, or disability.

(b) A list of certified programs compiled and updated by the ODV, which is available on the Department's website, will be provided to the Office of the State Courts Administrator for distribution to the justice system for use when referring the batterer to a batterers’ intervention program. The program selected by the batterer shall perform the intake and enrollment, which shall include:

An explanation of program fees, rules, regulations, and expectations that includes at minimum, exceptions to confidentiality, refraining from perpetrating violence and violating pre-trial conditions or civil injunctions, refraining from use of substance prior to and during group, any special considerations surrounding recording of sessions or visitors to group (such as monitors), and when consent is required to release participant information.
A Participant Enrollment Form that includes at minimum personal demographics, economic status and income qualifications, history of perpetrated violence, source of referral, criminal and civil injunction history, and prior attendance at a batterers’ intervention program.

(c) The program shall not accept for enrollment a participant who has been or is currently enrolled in another certified batterers’ intervention program unless the program receives written approval via electronic mail for the participant to change programs from:

The referral source,
Probation and parole, if applicable, and
The program director of the batterers’ intervention program where the participant is currently or was enrolled.

Upon approved transfer, the program that the participant is currently or was enrolled in will provide within 48 hours an electronic copy of the participant’s file to the new program.

(d) The program shall conduct an initial eligibility screening of a participant to verify that the participant has perpetrated violence against an intimate partner, spouse, ex-spouse, or a person who shares a child in common or who is a cohabitant in an intimate relationship, for the purpose of exercising power and control by one over the other. Pursuant to Section 741.325(2), F.S., individuals who are not perpetrators of this type of violence are not appropriate for Batterers’ Intervention Programs and should not be accepted into the program.

(e) The program shall conduct an orientation session with each participant. An outline of the orientation shall be given to each participant and a signed statement from the participant acknowledging attendance shall be placed in the participant’s file. The orientation shall include:

Comprehensive definition of domestic violence, including coercive control, tactics of violence, and gender-based violence models.
Domestic violence and dating violence statistics.
Introduction of the Power and Control Wheel and Equality Wheel.
Overview of program rules, regulations, and expectations.
Outline of program content showing the dynamics of power and control, the effects of abuse on the victim, children and others, gender roles, socialization, and nature of the violence.

(f) Explanation of Assessments. The provider shall ensure that all participants are assessed to determine if they will benefit from mental health or substance abuse treatment programs prior to or concurrent with batterers’ intervention.

(6) Group Sessions.

(a) The provider shall use a psychoeducational and/or cognitive behavioral therapy group model that incorporates power and control dynamics in the program curriculum.

(b) The program shall be a minimum of 29 weeks in length and include a minimum of 24 weekly group sessions. Each session shall be for a time period of one hour and 30 minutes, excluding breaks.

(c) The provider must establish policies on excused and unexcused absences and the requirements for participants to make up and receive credit for missed group sessions. The policy must include the maximum number of unexcused absences allowed before the participant is terminated from the program.

(d) The provider shall maintain policies regarding participant conduct and expectations during group sessions. Groups shall be in-person or virtual to ensure safety and confidentiality. Virtual groups must require attendees to participate on camera with audio and must be accessible to all participants when offered regardless of personal access to technology.

(e) The provider shall maintain group sizes appropriate to the intervention model being utilized and not exceed a maximum number of over 23 people for a co-facilitated group and 15 people in single facilitated groups.

(f) The program shall accept new members into the group on an ongoing basis.

(g) The program must provide separate services for offenders based on sex or gender to ensure safety and the use of appropriate interventions.

(h) If a participant has limited English proficiency and the program does not employ or contract with staff who are fluent in the participant’s preferred language, the program will assess whether the participant has the ability to pay for an interpreter or utilize a translation language line. If the participant is unable to pay for an interpreter and there is no community resource to provide interpreter services free of charge, the program will assist the participant in finding a program that has bilingual staff or has the ability to provide interpreters. The program may permit the participant to use a family member or friend of the same sex to interpret in circumstances where the alternative options are not successful and there is documentation of the attempts to find an alternative. The program shall record in the participant’s file how it addressed the participant’s limited English proficiency.

(i) The program conducting a non-English speaking group shall have a facilitator who is fluent in that language.

(j) The program shall ensure continuity of weekly group sessions and not suspend or cancel weekly groups for a period of more than one week consecutively.

(7) Discharge Criteria.

(a) There are three categories of discharge from a certified program:

Completion indicates that the participant has completed the assessment performed by an assessor, has been in compliance with the program’s rules and contract, has participated in the group at an acceptable level as determined by the facilitator, and has paid required provider program fees.
Termination indicates the participant is inappropriate for the program according to the screening criteria outlined in paragraph (5)(d) of this rule as determined by a certified assessor or the program or has not successfully met the requirements of the program as specified in the contract or program rules.
Transfer indicates the participant has been approved to transfer to another program as required in subparagraph 65H-2.016(5)(b)2., F.A.C.

(b) When a participant is discharged from the program, the provider shall complete the following:

Document the reason(s) for discharge in the participant's file, and
Inform the victim as required in paragraph (8)(c) of this rule, and inform the referral source, probation and parole, if applicable, in writing, within three business days.

(8) Victim Participation and Notification.

(a) The provider must maintain policies and procedures on how it will communicate safely with victims, including obtaining victim contact information, providing initial notification that the perpetrator is attending a batterers’ intervention program, determining whether the victim wants to receive information about the perpetrator’s progress or provide information so that the provider can better understand the context of the perpetrator’s violence, and when and how to share information regarding threats of violence made by the perpetrator during group sessions. The provider must rely on the referral source, and/or other sources such as court documents or police reports to ensure the victim contact information is valid. Providers shall not utilize perpetrators to provide victim contact information.

(b) The provider shall document that it notified or attempted to notify the victim within three business days of the batterer’s enrollment in the program, and to confirm whether and how the victim wants to receive information about the batterer’s progress, non-compliance, and discharge. The letter/email or documentation of telephonic communication shall be dated and include contact information for the local certified domestic violence center, law enforcement, probation or parole, if applicable, and the state attorney’s office. Communication shall include information on the goals and objectives of the certified batterers’ intervention program and advise the victim that information disclosed by the victim to program staff is not privileged communication as defined in Section 90.5036, F.S.

(c) The provider shall document that it notified or attempted to notify the victim by electronic or telephonic communication within 24 hours of the batterer’s discharge from the program, and the reason for discharge: completion, termination, or transfer. Communication shall include contact information for the local certified domestic violence center, law enforcement, probation or parole, if applicable, and the state attorney’s office.

(d) The program shall keep copies of all notification letters, documentation of telephonic communications or attempts to contact the victim in the batterer’s file. Letters kept in the batterer’s file shall not disclose the physical address or any other contact information for the victim.

(9) Record Keeping and Reporting Requirements.

(a) General Requirements. A provider shall maintain complete and accurate records regarding the program, personnel, and program participants at the program’s office. Records shall be made available for review during the annual monitoring by the Department. Copies of required records with redacted personal information are acceptable for documentation.

(b) Personnel Records. The provider shall maintain complete and accurate records on each direct service staff employed or contracted by the program, which includes:

Name, address, home phone number, and date of birth;
Proof of identity, in the form of a copy of a valid government issued photo identification;
Proof of employment history check and security background investigations;
Current job description;
A resume or employment application;
Documentation of required education and work experience;
Documentation of required training and annual continuing education;
For individuals licensed under Chapters 490 and 491, F.S., a signed statement acknowledging confidentiality of information received;
Receipt of the program’s policy and procedure manual; and
Form CF 1649, Affidavit of Good Moral Character, renewed annually. This form is incorporated by reference in subparagraph 65H-2.015(2)(a)5., F.A.C.

(c) Program Participant Records. The provider shall maintain individual files on each program participant and retain the records for a minimum of five years from the date of discharge. Client files shall include the following information:

Proof of identity, in the form of a valid government issued photo identification;
Copy of the court order and police report, if applicable;
Financial assessment;
Completed assessment;
Record of attendance at orientation and groups with the dates of each session attended, missed, and made up;
Record of payment of all fees, including dates and amounts;
Copies of notification letters to the victim. Letters shall be dated and shall not disclose the physical address or any other contact information for the victim;
Copy of non-compliance reports, if any, to the referral source and probation and parole, if applicable; and
Copy of the discharge report to the referral source and probation and parole, if applicable.

(d) Health Insurance Portability and Accountability Act (HIPAA). The provider is responsible for determining if they must follow federal HIPAA requirements.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22

Fla. Admin. Code R. 65H-2.017 Program Curriculum

(1) The program curriculum shall be based on a psychoeducational or cognitive behavioral therapy intervention model that recognizes domestic violence and dating violence as the result of one person in an intimate relationship systematically using tactics of coercion, emotional abuse and physical violence in order to assert power and control over the other. The curriculum shall incorporate the following elements/content:

(a) An educational approach that assigns responsibility for the violence solely to the batterer and provides a strategy for assisting the batterer in taking responsibility for the violence,

(b) Encourages the batterer to develop critical thinking skills that will allow the batterer to rethink their behavior and identify behavior choices other than violence,

(d) Domestic violence is not provoked or the result of substance abuse and recognizes substance abuse patterns in domestic violence,

(e) The batterer’s ability to identify and articulate feelings,

(f) Communication skills and listening with empathy,

(g) Negotiation and conflict resolution skills,

(h) Addresses gender specific forms of violence and challenges stereotypical gender role expectations,

(i) Strategies for helping the batterer to develop and improve support systems,

(j) The effects of distorted thinking on emotions and behavior, and

(k) The effects of domestic violence on children.

(2) The program curriculum shall not include the following elements:

(a) Couples, marriage or family therapy, or any manner of victim participation;

(b) Anger management techniques that identify anger as the cause of domestic violence;

(c) Theories or techniques that identify poor impulse control as the primary cause of the domestic violence or identify psychopathology on the part of either party as a primary cause of domestic violence;

(d) Fair fighting techniques; or

(e) Faith-based ideology associated with a particular religion or denomination.

(3) The program curriculum shall be submitted with the initial certification application and in annual monitoring to the ODV which will review for compliance with rule and statute.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Fla. Admin. Code R. 65H-2.018 Facilitator Eligibility

(1) Facilitator Employment Credentials. A facilitator employed or contracted by a provider shall meet the following educational, experiential, and training requirements:

(a) Bachelor’s degree or, in lieu of a bachelor’s degree, two years of experience working with domestic violence victims and batterers;

(b) Completion of 40 hours of domestic violence training to include at a minimum, domestic violence tactics, risk indicators to homicide, culturally-informed/culturally competent practices, batterers as parents, the relationship of substance abuse and mental health in domestic violence, victim blaming, perpetrator accountability, participation in coordinated community response efforts, and court attendance during domestic violence cases;

(c) Completion of 21 hours of facilitator training on the power and control model of intervention, gender-based violence model, and group facilitation;

(d) Completion of 72 hours of supervised facilitating or co-facilitating batterers’ intervention groups. Within six months of promulgation of this rule, supervised facilitating or co-facilitating batterer’s intervention groups must be completed with a Florida certified batterer’s intervention program;

(e) Documentation for all facilitator training shall be submitted to the ODV for approval prior to a facilitator facilitating groups on their own. Facilitator training will be approved if it meets the standards set forth in this rule.

(2) Facilitator Continuing Education Training.

(a) Each facilitator shall complete a minimum of 12 hours of continuing education annually. The training must contribute to the advancement, extension, or enhancement of the facilitator’s skills and knowledge related to domestic violence and BIP facilitation. Training shall comply with the program curriculum as required in Rule 65H-2.017, F.A.C., and include information in any of the following areas as they pertain to intimate partner violence:

Current law,
Evaluation and intervention with families,
Victimization,
Effects on children,
Dating violence,
Intervention and prevention,
Substance abuse, and
The power and control model.

(b) Documentation for all continuing education training must be updated and maintained in the facilitator’s personnel file.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Fla. Admin. Code R. 65H-2.019 Assessor Eligibility

(1) Assessor Credentials. The provider must hire or contract with assessors who meet the following educational, experiential, and training requirements, and must maintain the necessary documentation to demonstrate compliance with these requirements:

(a) Licensed or eligible for license under Chapter 490, 491, or 397, F.S., and two years of supervised psychosocial assessment clinical experience. Individuals with a minimum of three years of experience conducting assessments for batterers’ intervention programs prior to the promulgation of this rule are exempt from this requirement.

(b) Completion of 30 hours of domestic violence training to include at a minimum, domestic violence tactics, risk indicators to homicide, culturally-informed practices, batterers as parents, the relationship of substance abuse in domestic violence, victim blaming, survivor-focused/trauma-informed services, participation in coordinated community response efforts, and court attendance during domestic violence cases.

(2) Assessor Continuing Education Training.

(a) Each assessor shall complete a minimum of 12 hours of continuing education annually. The training must contribute to the advancement, extension, or enhancement of the assessor’s skills and knowledge related to the assessment of a batterer. Training shall comply with the program curriculum as required in Rule 65H-2.017, F.A.C., and include information in any of the following areas as they pertain to intimate partner violence:

Current law,
Evaluation and intervention with families,
Victimization,
Effects on children,
Dating violence,
Intervention and prevention,
Substance abuse, and
The power and control model.

(b) Documentation for all continuing education training must be updated and maintained in the assessor’s personnel file.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Fla. Admin. Code R. 65H-2.020 Conflicts of Interest

(1) It is essential to the proper operation of batterers’ intervention programs that direct-service staff, program employees, assessors, concurrent treatment providers, and program participants do not engage in any activity that presents a conflict of interest or the appearance of a conflict of interest. The provider must maintain policies pertaining to conflicts of interest.

(2) If an assessor determines that the batterer who has been referred to a batterers’ intervention program should also be referred for further evaluation, the assessor shall provide a list of licensed or certified providers to the batterer. The assessor may not self-refer.

(3) Program staff or assessors providing direct services to program participants must not engage in direct counseling or therapy with the victim, and/or current partner of the program participant, or with family or household members of the victim and/or current partner.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Fla. Admin. Code R. 65H-2.021 Monitoring

(1) The Department will conduct monitoring of certified programs to ensure compliance of the minimum standards as set forth in this rule chapter.

(2) The first monitoring of a certified batterers’ intervention program may be conducted on-site within six (6) months after initial certification. Thereafter, a certified batterers’ intervention program will be monitored annually, through an on-site visit or desk review, as determined by the Department. However, monitoring may occur at any time there is a corrective action or a complaint to the Department.

(3) Within 30 calendar days after the monitoring, the provider will receive a written report from the Department indicating whether or not standards have been met.

(4) If Department monitoring indicates that a provider has violated or otherwise does not meet the standards set forth in this rule chapter, the provider will be given 30 calendar days from the date of the written report to submit a corrective action plan. The severity of the noncompliance may affect the period of time allowed for correction, but in no event shall the corrective action period exceed 90 days.

(a) The proposed corrective action plan must contain all of the following:

The actions the provider and its staff will take to correct each of the violations identified and to comply with the applicable requirements;
The name of the staff person(s) responsible for completing each action; and
A timeframe for accomplishing each action.

(b) The Department will reject any proposed corrective action plan that fails to identify all of the information described in paragraph (4)(a) of this rule or reflects a plan of action that does not address the violation(s). If the Department rejects a proposed corrective action plan, the Department shall notify the provider in writing of the reasons for rejection and require the provider to submit an amended corrective action plan addressing the deficiency or deficiencies within five business days of receipt of the Department’s notice rejecting the corrective action plan.

(c) The provider is responsible for ensuring that the corrective action plan is fully implemented within the timeframes designated in the corrective action plan, which includes documenting in writing all action taken to correct a violation.

(5) Failure of the provider to successfully complete the corrective action plan will result in suspension of a program’s certification, unless the Department finds that the failure to successfully complete the corrective action plan is due to extraordinary circumstances beyond the provider’s reasonable control. However, the Department will suspend a program’s certification immediately without allowing a corrective action in cases of recurring violations or intervention approaches contrary to those as set forth in this rule chapter.

(6) A provider that is notified by the Department that its certification is suspended for recurring violations, inappropriate intervention approaches, or failure to complete a corrective action may not apply for new certification for a period of one year from the date of suspension and shall not advertise itself as a certified Batterers’ Intervention Program during this time.

(7) A provider that is notified that its certification is suspended shall comply with the transfer requirements set forth in paragraph 65H-2.016(5)(c), F.A.C., to assist its participants in transferring to a certified batterers’ intervention program so that participants receive credit for their attendance at the decertified provider’s program.

(8) The Department’s primary communication with providers will be electronic. Providers shall have the capability to access the internet and to electronically submit certification documentation as required by the Department. Providers shall maintain a functional email address with the capability of receiving attachments and provide that address to the Department for the purposes of certification and monitoring.

History

Rulemaking Authority 741.327 FS. Law Implemented 741.32, 741.325, 741.327 FS. History‒New 9-4-22.

Division 65A Economic Self-Sufficiency Program

Chapter 65A-1 PUBLIC ASSISTANCE PROGRAMS

Fla. Admin. Code R. 65A-1.201 Administrative and Statutory Authority

History

Rulemaking Authority 409.026 FS. Law Implemented 409.026, 409.185, 409.235, 409.275, 409.903, 409.904, 410.033 FS. History–New 4-9-92, Amended 11-22-93, Formerly 10C-1.201, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.202 Administration

History

Rulemaking Authority 409.026, 410.033 FS. Law Implemented 409.026, 409.185, 409.235, 409.275, 409.903, 409.904, 410.033 FS. History–New 4-9-92, Formerly 10C-1.202, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.203 Administrative Definitions

Except as otherwise provided within, the following definitions apply to this chapter.

(1) Public Assistance: Food Assistance, Temporary Cash Assistance, Medicaid, Refugee Assistance, Optional State Supplementation.

(2) Economic Self-Sufficiency (ESS): The entity within the Department responsible for public assistance eligibility determination.

(3) Application: The ACCESS Florida Application, CF-ES 2337, 11/2011, incorporated by reference in Rule 65A-1.205, F.A.C., or an ACCESS Florida Web Application, CF-ES 2353, 09/2011, incorporated by reference in Rule 65A-1.205, F.A.C. An application must include at least the individual’s name, address and signature to initiate the application process.

(4) Date of Application: The date the Department receives an application. If a web or facsimile application is received after business hours, the next business day following receipt is the date of application. Applications may be submitted in person, by the postal system, facsimile or electronically.

(5) Intact Family: A living arrangement comprised of two parents and their mutual child(ren) including an unborn child.

(6) Assistance Group: All individuals within the standard filing unit who are potentially eligible for benefits.

(7) Standard Filing Unit: All individuals whose needs, income and/or assets are considered in the determination of eligibility for a category of assistance except individuals of any age who are prisoners, inmates, detainees or convicts under detention or custody of federal, state, or local penal, correctional, or other detention facilities or institutions for more than 30 days, are not eligible to participate even if they are participating in a residental Drug or Alcohol Treatment Program, including Department of Corrections and Department of Juvenile Justice facilities.

(8) Payee: The individual in whose name the assistance group benefits are issued and who assumes primary decision-making responsibility for the assistance group.

(9) Authorized/Designated Representative: An individual who has knowledge of the assistance group’s circumstances and is authorized to act responsibly on their behalf.

(10) Child in Care: Child(ren) who have been removed from the care of their parent(s) or relative(s), are under the temporary or permanent custody of the Department and receive Medicaid benefits.

(11) Florida Online Recipient Integrated Data Access (FLORIDA): The computer system used by ESS to assist in eligibility determination and benefit issuance.

(12) Mail: Written communication delivered by the postal system. Written communication delivered electronically to public assistance applicants, recipients and authorized/designated representatives who choose to receive electronic communication.

History

Rulemaking Authority 409.919, 414.095, 414.45 FS. Law Implemented 409.903, 409.904, 414.095, 414.31 FS. History–New 4-9-92, Amended 11-22-93, Formerly 10C-1.203, Amended 11-30-98, 9-12-04, 7-23-06, 1-24-13, 9-18-13.

Fla. Admin. Code R. 65A-1.204 Rights and Responsibilities

(1) An individual has the right to apply for assistance, to have eligibility determined, and if found eligible, to receive benefits. The applicant for or recipient of public assistance must assume the responsibility of furnishing information, documentation and verification needed to establish eligibility. If the information, documentation or verification is difficult for the individual to obtain, the Department must provide assistance in obtaining it when requested or when it appears necessary.

(2) The individual has the right of confidentiality in accordance with subsection (3), below, to receive prompt action, equitable treatment, notification of any case action taken and to receive a fair hearing due to an appeal of case action. The Department provides the individual with Your Rights and Responsibilities, CF-ES 2064, 07/2016, http://www.flrules.org/Gateway/reference.asp?No=Ref-07159, incorporated by reference, to explain these and other rights and responsibilities.

(3) All individuals have the right to a confidential relationship with the Department pursuant to the following federal regulations, federal statutes and Florida Statutes: for the Food Assistance Program, 7 U.S.C. §2020(e)(8), 7 C.F.R. §272.1(c), Sections 414.295, 414.31, F.S.; for the Medicaid Program, 42 U.S.C. §1396a(a)(7), 42 C.F.R. §§431.300-431.306, Sections 409.902, 414.295, F.S.; and, for the Cash Assistance Program, 42 U.S.C. §602(a)(1)(A)(iv), 45 C.F.R. §205.50, and Sections 414.106 and 414.295, F.S. Information obtained by the Department is considered confidential state agency material and is not subject to the Freedom of Information Act.

(4) Fair hearings are conducted in accordance with the Department’s hearing procedures in Chapter 65-2, F.A.C. The Office of Appeal Hearings Hearing Request, CF-ES 1007, 10/2005, incorporated by reference, can be used to request fair hearings. An individual can also request a fair hearing either orally or in writing without using the form.

(5) Copies of materials incorporated by reference are available from the Economic Self-Sufficiency Headquarters Office, 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700, or on the Department’s website at http://www.dcf.state.fl.us/dcfforms/Search/DCFFormSearch.aspx.

History

Rulemaking Authority 409.919, 414.45 FS. Law Implemented 409.903, 409.904, 414.095, 414.295, 414.31 FS. History–New 4-9-92, Amended 11-22-93, Formerly 10C-1.204, Amended 12-29-98, 5-9-02, 3-9-03, 6-4-12, 7-18-16.

Fla. Admin. Code R. 65A-1.205 Eligibility Determination Process

(1) The individual completes and submits a Department application for public assistance using either the ACCESS Florida Application, CF-ES 2337, 08/2016, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11698, or an ACCESS Florida Web Application (only accepted electronically), CF-ES 2353, 11/2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11627. The following non-English versions of the ACCESS Florida Application are incorporated by reference: CF-ES 2337C (Chinese), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11669, CF-ES 2337F (French-Canadian), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11700, CF-ES 2337H (Creole), 08/2016, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11701, CF-ES 2337I (Italian), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11702, CF-ES 2337P (Portuguese), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11703, CF-ES 2337R (Russian), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11704, CF-ES 2337S (Spanish), 08/2016, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11705, CF-ES 2337SC (Serbo-Croatian), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11726, and CF-ES 2337V (Vietnamese), 11/2011, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11727, Individuals applying for Family-Related Medical Assistance only or the Children’s Health Insurance Program (CHIP) must complete and submit the Family-Related Medical Assistance Application, CF-ES 2370, 09/2015, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11729. The following non-English versions of the Family-Related Medical Assistance Application are incorporated by reference: CF-ES 2370H (Creole), 09/2015, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11730, and CF-ES 2370S (Spanish), 09/2015, is available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11731. The Medical Assistance Referral form, CF-ES 2039, 08/2018, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11634, is submitted to initiate an Emergency Medical Assistance for Noncitizens determination and is used by providers to request a Florida Medicaid ID number assignment for newborns.

Applicants may apply for public assistance in person or by phone, mail, the internet, or fax. Individuals may also apply for Medicaid through the Federally Facilitated Marketplace (FFM).

An application for public assistance benefits must contain at least the individual’s name, address, and signature to initiate the application process. An eligibility specialist determines the eligibility of each household member for public assistance. An applicant can withdraw the application at any time without affecting their right to reapply.

An application for Medicaid coverage on behalf of a child(ren) in the care of the Department is made by completing and submitting the Child In Care Medicaid Application, CF-ES 2293, 01/2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11635.

(a) The Department must determine an applicant’s eligibility for public assistance initially at application and, if the applicant is determined eligible, at periodic intervals thereafter. If an applicant is determined ineligible for Medicaid benefits based on the modified adjusted gross income (MAGI) budgeting methodology as defined in subsection 65A-1.701(45), F.A.C., the Department will forward an electronic file to the Children’s Health Insurance Program (CHIP) or the Federally Facilitated Marketplace (FFM) for a determination of eligibility. It is the applicant’s responsibility to keep appointments with the eligibility specialist and furnish information, documentation and verification needed to establish eligibility. If the Department schedules a telephonic appointment, it is the Department’s responsibility to be available to answer the applicant’s phone call at the appointed time. The Department will provide the applicant a written notice of action taken on the case including information on fair hearing rights. The eligibility specialist must provide assistance in obtaining information, documentation or verification when requested by the applicant or when assistance appears necessary.

(b) The Department must verify the Social Security Numbers (SSNs) for each applicant for public assistance benefits, except individuals applying for Medicaid who:

Are not eligible to receive a SSN,
Do not have a SSN,
May only be issued an SSN for a valid non-work reason in accordance with 20 C.F.R. §422.104, or
Individuals who refuse to obtain an SSN because of well-established religious objections.

(c) The Department follows time standards for processing public assistance applications which vary by public assistance program type. The time standards for processing applications for the Food Assistance Program and Temporary Cash Assistance Program are set forth in 7 C.F.R. §273.2(g)(1) and 45 C.F.R. §206.10(a)(3)(i) and (ii), respectively. The time standard for processing applications for Medicaid is set forth in 42 C.F.R. §435.912 (a), (b), and (c). For Food Assistance and Temporary Cash Assistance Programs, time standards begin the date following the date the application was filed and end on the date the Department makes benefits available or mails a notice concerning eligibility, whichever is earlier.

For the Medicaid Program, the time standard begins on the date of application and ends on the date the Department mails an eligibility notice. The Department must process and determine eligibility within the following time frames:

Expedited Food Assistance ‒ 7 days.
Food Assistance ‒ 30 days.
Refugee Assistance, Medicaid not based on disability, Temporary Cash Assistance, Optional State Supplementation, Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI1) and Qualified Disabled and Working Individuals (WD) ‒ 45 days.
Medicaid based on disability ‒ 90 days.

All days counted after the date of application are calendar days. Applicant delay days do not count in determining the Department’s compliance with the time standard. The Department uses information provided on the Screening for Expedited Medicaid Appointments form, CF-ES 2930, 04/2007, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11636, to expedite processing of Medicaid disability-related applications. The following non-English versions of the Screening for Expedited Medicaid Appointments form are incorporated by reference: CF-ES 2930H (Creole), 04/2007, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11637; and CF-ES 2930S (Spanish), 04/2007, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11638. The “Are You Disabled and Applying for Medicaid?” brochure, CF/PI 165-107, 06/2008, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11725, describes required information for Medicaid Program eligibility determinations. The following non-English versions of the “Are You Disabled and Applying for Medicaid?” brochure are incorporated by reference: CF/PI 165-107H (Creole), 06/2008, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11723; and CF/PI 165/107S (Spanish), 06/2008, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11724.

(d) If the eligibility specialist determines during the interview or at any time during the processing of the application that the applicant must provide additional information or verification, or that a member of the assistance group must register for employment services, the eligibility specialist must give the applicant written notice to provide the requested information or verification, or to comply with the work registration process, allowing 10 calendar days from the date of a notice for additional information or verification or the interview date, whichever is later, to comply.

(e) For all programs, if the requested verifications are not returned within 10 calendar days from the date of written request or the interview, or 30 calender days from the date of application, whichever is later, the application will be denied unless the applicant requests an extension prior to the due date or there is physician delay or emergency delay, as defined in subparagraphs (h)2. and (h)3. below, justifying the additional extension. If the applicant completed the interview, if required, but failed to provide the required verifications and was denied, the applicant may provide the verifications within 60 calendar days after the original date of application and reuse the application that was denied. For food assistance and temporary cash assistance, the new date of application is the date the applicant provided all required verifications.

(f) For Medicaid only applications, when the applicant must provide medical information, the due date is 30 calendar days following the date of a written request for such information or the interview date, or 60 calendar days from the date of application, whichever is later.

(g) If the due date falls on a state holiday or weekend, the due date deadline is the next business day.

(h) In accordance with 42 C.F.R. §435.912 (e)(1) and (2), the types of unusual circumstance that might affect the application processing time for Medicaid applications include applicant delay, physician delay and emergency delay as defined below. Unusual circumstances are non-agency application processing delays, and the calendar time passing during such delay period(s) does not count as part of the application processing time standard for determining the timeliness of Medicaid eligibility decisions.

“Applicant delay” days are the number of calendar days attributed to the applicant that causes the eligibility decision to be made after the established time standard. Applicant delay can result from an applicant missing a scheduled appointment or failure to provide requested eligibility information, including requested medical information or requested verification. Applicant delay begins the date the applicant misses the deadline for the required action and ends the date the applicant takes the required action.
“Physician delay” days are the number of calendar days attributed to the applicant’s physician(s) that causes the eligibility decision to be made after the established time standard. Physician delay can result from a physician not providing requested medical evidence or from not conducting a medical examination timely. Physician delay begins 10 calendar days after the Department makes its initial request for medical evidence from the physician and ends the date the Department receives complete medical evidence that is responsive to the Department’s request; or, physician delay begins 14 calendar days after the Department requests a medical examination and ends the date the Department receives the complete medical examination results.
“Emergency delay” days are the number of calendar days attributed to situations that are beyond the control of the Department that causes the eligibility decision to be made after the established time standard. Emergency delay can result from disasters, unexpected office closure(s), and unexpected or unscheduled computer systems inaccessibility or unavailability. Emergency delay begins the day such an event begins and ends the day the Department is able to resume application processing.

(2) In accordance with 7 C.F.R. §273.14(b), 45 C.F.R. §206.10(a)(9)(iii), and 42 C.F.R. §435.916(a) or (b), and 42 C.F.R.§435.919, the Department must redetermine eligibility at periodic intervals.

(a) A complete eligibility review is the process of reviewing all factors related to continued eligibility of the assistance group.

(b) A partial eligibility review entails a review of one or more, but not all factors of eligibility. The Department schedules partial reviews based on known facts or anticipated changes in circumstances concerning the assistance group. The partial review does not usually require an interview unless needed to obtain the necessary information. The Department will complete a review of an unanticipated change concerning the assistance group when the change is reported.

(c) The Department will make a renewal of eligibility for Medicaid without requiring information from the individual if it is possible to do so based on reliable information contained in the individual’s case or other more current information available to the Department and send the individual a written notice concerning eligibility. The Department will request only the information needed to renew eligibility. If a renewal cannot be made based upon existing and available information, the Department will provide the individual with:

A notice, at least 30 calendar days prior to the end of the eligibility renewal date, informing them it is time to review their eligibility for continued benefits and the options available to complete the renewal process; and
A notice of the Department’s decision concerning the renewal of eligibility.

(d) The Department will reconsider the eligibility of an individual whose case is closed due to failure to submit the renewal application or to provide requested information, if the individual meets the renewal application conditions within three months after the date of closure in accordance with 42 C.F.R.§435.911 and 42 C.F.R. §435.916(f).

(3) The Department conducts phone or face-to-face interviews with applicants and recipients, or their authorized or designated representatives, when required for the application or to complete the eligibility review process. The Department conducts face-to-face interviews, upon request, in the Office of Economic Self-Sufficiency Program Offices, at the applicant’s or recipient’s home, or at other mutually agreed upon locations. The applicant or recipient, or their authorized or designated representative, must keep the interview appointment or reschedule a missed appointment. The Department mails a notice of missed interview to food assistance households who miss an interview.

(4) If an applicant or recipient does not sign and date the application, fails to keep an appointment or reschedule with the eligibility specialist, fails to submit the required documentation or verification, or fails to request an extension of the due date, the Department will deny the application because it cannot establish eligibility.

(5) The Department must substantiate information provided by the applicant or recipient as part of each determination of eligibility. For any public assistance program, when there is a question about the accuracy of the information provided, the Department will ask for additional information.

(a) Substantiation establishes accuracy of information by obtaining consistent, supporting information from the individual or other third parties. The information can be obtained or provided electronically, telephonically, in writing, or by personal contact.

(b) Documentation establishes the accuracy of information by obtaining and including in the case record an official document that supports the statement(s) made by the individual.

(6) The Department conducts data exchanges with other agencies and systems to obtain relevant public assistance eligibility information on each applicant and recipient. It uses data exchanges to verify or identify social security numbers, verify the receipt of other benefits from other sources or programs, verify other eligibility information reported by the applicant or recipient, and to discover unreported relevant eligibility information. For Medicaid eligibility, information obtained from the Federal Data Services Hub (FDSH) and State Wage Information and Collection Agency (SWICA) that does not adversly affect eligibilty is considered verified upon receipt and does not require third party verification.

(a) The Department conducts data exchanges with the Social Security Administration, the Internal Revenue Service, the Florida Department of Economic Opportunity, the Florida Department of Lottery, the Federal Data Services Hub, the Florida Department of Corrections, federal and state personnel and retirement systems, other states’ public assistance programs and files, and educational institutions.

(b) The Department compares information obtained through data exchanges with the information already on file. If the data exchange identifies new or different information than what is already on file, the Department conducts a partial eligibility review to determine whether benefit levels must change.

(c) The Department considers beneficiary and Supplemental Security Income (SSI) benefit data from the Social Security Administration, unemployment compensation benefits, the Department of Health, Department of Corrections, and information obtained from the Office of Vital Statistics verified upon receipt and does not require third party verification. Other information and data obtained by the Department may require third party verification before the Department will rely upon it to take adverse actions on a case. If the information provided by or on behalf of an individual is consistent with the information obtained by the Department, the Department will consider the information reasonably compatible and determine or renew eligibility, except where the law requires other procedures (such as citizenship, immigration status and identity).

(d) The Department will collect additional information as needed to determine eligibility for non-MAGI related Medicaid eligibility for:

Individuals whom the Department identifies based on information contained in the application as potentially eligible for non-MAGI related Medicaid coverage;
Individuals who request a determination of eligibility on a basis other than the MAGI rules. The Department will require individuals to provide only the information necessary to make an eligibility determination.

(7) In accordance with 42 C.F.R. §435.907(e)(3), the Department may collect SSNs of individuals who are not requesting assistance but must provide clear notice to non-applicants that providing the SSN is voluntary as well as provide information about the Department’s purpose for collecting the non-applicant’s SSN.

(8) In accordance with Food Assistance Program waivers, food assistance applicants and recipients who have been interviewed, but have not returned the requested verification by the due date, can be denied prior to the 30th day. Face-to-face interviews are not required.

(9) The following additional forms, which are incorporated into this rule by reference, can be used in the eligibility determination process:

(a) Verification of Employment/Loss of Income, CF-ES 2620, 05/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11642, CF-ES 2620H (Creole), 05/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11643, CF-ES 2620S (Spanish), 05/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11644;

(b) Verification of Dependent Care Expenses, CF-ES 2621, 03/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11645, CF-ES 2621H (Creole), 03/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11646, CF-ES 2621S (Spanish), 03/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11647;

(c) Verification of Shelter Expenses, CF-ES 2622, 03/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11648, CF-ES 2622H (Creole), 03/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11649, CF-ES 2622S (Spanish), 03/2010, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11650;

(d) School Verification, CF-ES 2623, 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11651, CF-ES 2623H (Creole), 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11652, CF-ES 2623S (Spanish), 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11653;

(e) Work Calendar, CF-ES 3007, 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11654, CF-ES 3007H (Creole), 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11655, CF-ES 3007S (Spanish), 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11656;

(f) Designation of Beneficiary, CF-ES 990, 01/2020, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11657;

(g) Medical Assistance Referral, CF-ES 2039, incorporated in subsection (1) of this rule;

(h) Authorization to Disclose Information, CF-ES 2514, 02/2007, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11658, CF-ES 2514H (Creole), 02/2007, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11660, CF-ES 2514S (Spanish), 02/2007, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11661; and

(i) Financial Information Release, CF-ES 2613, 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11662, CF-ES 2613H (Creole), 10/2005, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11663.

History

Rulemaking Authority 409.919, 414.095, 414.45 FS. Law Implemented 409.903, 409.904, 409.919, 414.045, 414.095, 414.31, 414.41 FS. History–New 4-9-92, Amended 11-22-93, 8-3-94, Formerly 10C-1.205, Amended 11-30-98, 9-27-00, 7-29-01, 9-12-04, 9-11-08, 7-1-10, 2-20-12, 3-25-20.

Fla. Admin. Code R. 65A-1.206 Lifeline Service

(1) The automatic Lifeline service enrollment process is an electronic interface between the Department and the Public Service Commission. Applicants and recipients can indicate their interest in receiving Lifeline service within the ACCESS Florida Web Application, CF-ES 2353, 09/2011, incorporated by reference in Rule 65A-1.205, F.A.C. After being determined eligible for Food Assistance or Medicaid, the Department sends an electronic file to the Public Service Commission to ensure automatic enrollment with the appropriate eligible telecommunications carrier.

(2) The CF-ES 2353 is available on the Department’s website at http://www.myflorida.com/accessflorida/.

History

Rulemaking Authority 364.10(2)(g)2. FS. Law Implemented 364.10 FS. History–New 2-3-09, Amended 4-23-17.

Fla. Admin. Code R. 65A-1.300 Cross Programmatic Policy Section

History

Rulemaking Authority 409.026 FS. Law Implemented 409.026, 409.185, 409.235, 409.275, 409.903, 409.904, 410.033 FS. History–New 4-9-92, Formerly 10C-1.300, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.301 Citizenship

(1) The individual whose needs are included must meet the citizenship and noncitizen status established in: P.L. 104-193, The Personal Responsibility and Work Opportunity Reconciliation Act of 1996; P.L. 105-33, the Balanced Budget Act of 1997; P.L. 105-185, the Agricultural Research, Extension, and Education Reform Act of 1998; P.L. 105-306, the Noncitizen Benefit Clarification and Other Technical Amendments Act of 1998; P.L. 109-171, the Deficit Reduction Act of 2005; and, the Immigration and Nationality Act.

(2) For Medicaid, an individual who indicates they are a U.S. citizen, and who is not subject to an exemption as specified in 42 C.F.R. 435.406(2007) (incorporated by reference). The Department will assist with obtaining documentation if the applicant or recipient indicates they are having a problem obtaining the documentation.

(3) The eligibility specialist must verify the immigration status of noncitizens through the United States Citizenship and Immigration Service (USCIS), formerly the United States Bureau of Citizenship and Immigration Services. Verification will be requested electronically using the alien number, or based on a USCIS or prior Immigration and Naturalization Services (INS) document provided by the applicant. The system of verification is known as the Verification Information System-Customer Processing System (VIS-CPS), which is part of the Systematic Alien Verification for Entitlements (SAVE) Program. When the noncitizen provides neither an alien number nor USCIS document to indicate their status, the noncitizen must contact the USCIS to obtain documentation or verification of noncitizen status. The department will assist in obtaining documentation if requested. If the noncitizen provides any form of USCIS documentation, regardless of the expiration date, showing an eligible Immigration Act section, the eligibility specialist must accept the documentation and verify the individual’s status. Electronic verification of an eligible immigration status is acceptable proof of the individual’s eligible status for all programs. Automated verification is attempted first. If automated verification cannot be obtained, noncitizenship status must be verified manually (i.e., secondary verification) through use of a USCIS form. Benefits will not be withheld when VIS-CPS indicates secondary (i.e., manual) verification is required and response from the secondary verification is pending, provided all other technical factors of eligibility are met. Benefit recovery is required when such individuals are determined to not have been in an eligible noncitizen status.

(4) Noncitizens who would experience an undue hardship in obtaining current USCIS documentation, hospitalized noncitizens or noncitizens with a medical disability will be considered eligible for benefits on the noncitizen factor of eligibility while awaiting the return of USCIS secondary or manual verification. Undue hardship includes living a prohibitive distance from the USCIS office, lack of transportation, inability to travel to or attend appointments due to a medical condition, or a long waiting period for an appointment with the USCIS. However, these individuals are subject to recoupment for any benefits issued while verification is pending should they subsequently be determined to have been in an ineligible noncitizen status.

History

Rulemaking Authority 409.919, 414.45 FS. Law Implemented 409.903, 409.904, 410.033, 414.095(3), 414.31 FS. History–New 4-9-92, Amended 11-22-93, Formerly 10C-1.301, Amended 4-18-99, 6-26-08.

Fla. Admin. Code R. 65A-1.302 Social Security Numbers

(1) To be eligible for public assistance, the individual must either provide the social security number (SSN) when known for each person whose needs are included in the assistance group or SFU or, apply for a SSN for each individual who either does not have a number assigned or whose number is unknown. The client’s verbal statement is sufficient to verify this information.

(2) If the SSN is unknown or has never been obtained, the individual must apply for a SSN through the local Department office or Social Security Administration (SSA) office. If the individual chooses to apply for a SSN through the Department Office, the eligibility specialist sends the completed form SS-5, Application for SSN, and original evidence of age, identification and citizenship to the local SSA office. Assistance is not denied, delayed, or discontinued when the individual (or his representative) has applied through the welfare enumeration system for a SSN, pending issuance and/or verification.

(3) If the individual (or his representative) fails to provide or apply for a SSN on his own behalf or on the behalf of the child(ren) without good cause, the needs of the individual or child, whichever is applicable, must be excluded from the assistance group.

History

Rulemaking Authority 414.45 FS. Law Implemented 409.903, 409.904, 410.033, 414.095(2), 414.31 FS. History–New 4-9-92, Formerly 10C-1.302.

Fla. Admin. Code R. 65A-1.303 Assets

(1) Specific policies concerning assets vary by program and are found in federal statutes and regulations and Florida Statutes.

(2) Any individual who has the legal ability to dispose of an interest in an asset owns the asset.

(3) Once the individual’s ownership interest of an asset(s) is established, the availability of that asset must be determined. Asset(s) determined not to be available are not considered in determining eligibility. Assets are considered available to an individual when the individual has unrestricted access to it. Accessibility depends on the legal structure of the account or property. An asset is countable, if the asset is available to a representative possessing the legal ability to make the asset available for another’s support or maintenance, even though the representative chooses not to do so. Assets not available due to legal restrictions are not considered in determining total available assets unless the legal restrictions were caused or requested by the individual or another acting at their request or on their behalf.

(4) Vehicles. The vehicle asset determination for cash assistance benefits will be completed in accordance with Section 414.075, F.S. Vehicles are excluded as assets in the eligibility determination for food assistance as provided in 7 CFR §273.8(f)(4).

History

Rulemaking Authority 409.919, 414.45 FS. Law Implemented 409.903, 409.904, 414.075 FS. History–New 4-9-92, Amended 9-19-94, Formerly 10C-1.303, Amended 8-22-05, 5-20-10.

Fla. Admin. Code R. 65A-1.400 Forms for Client Notice and Contact

The following forms are used for Public Assistance Programs to provide applicants and recipients with required notice of the agency’s and client’s rights and responsibilities and other necessary program information. These forms are hereby incorporated by reference.

(1) Forms that apply to two or more public assistance programs are:

(a) CF-ES Form 1007, Oct 05, Office of Appeal Hearings Hearing Request

(b) CF-ES Form 2064, Mar 12, Your Rights and Responsibilities

(d) CF-ES Form 2305, Oct 05, Relative Caregiver Program Request for Eligibility Consideration

(e) CF-ES Form 2332, Mar 05, Appointment Notice for Face-to-Face Interview

(f) CF-ES Form 2333, Mar 05, Eligibility Redetermination Letter

(g) CF-ES Form 2334, Mar 05, Request for Information

(h) CF-ES Form 2335, Mar 05, Request for Information for Elderly and Disabled Individuals

(i) CF-ES Form 2336, Nov 06, Interim Contact Letter

(j) CF-ES Form 2640, May 05, Temporary Cash Assistance (TCA)/Medicaid/Food Stamp Program Child Support Cooperation Notice

(k) CF-ES Form 2641, May 05, Claim Notice – Good Cause for Refusal to Cooperate

(l) CF-ES Form 2672, Oct 05, Real Property Agreement

(m) CF-ES Form 3052A, Feb 09, Change Report Form

(n) CF-ES Form 3103, Sep 02, Authorized Benefit Representative for Electronic Benefit Transfer

(2) The Food Stamp Program only forms are:

(a) CF-ES Form 2095, May 05, Food Stamp Work Registration Notice

(b) CF-ES Form 2331, Jan 05, Food Stamp Application for SSI Applicants

(3) The Medicaid only forms are:

(a) CF-ES Form 990, Sep 02, Designation of Beneficiary

(b) CF-ES Form 1056, Feb 03, KidCare Program Notice of Case Action

(d) CF-ES Form 2040, Feb 03, Informed Consent Form

(e) CF-ES Form 2059, Sep 02, Consent of Disclosure Statement

(f) CF-ES Form 2099, Jul 02, Medicaid Application for Breast and Cervical Cancer Treatment

(g) CF-ES Form 2277, Oct 05, KidCare Program Medicaid Eligibility Review

(h) CF-ES Form 2293, May 10, Child in Care Medicaid Application

(i) CF-ES Form 2514, Jul 03, Authorization to Release Medical Information

(j) CF-ES Form 2613, Oct 05, Financial Information Release

(k) CF-ES Form 2635, Sep 02, Protective Payee Agreement

(l) CF-ES Form 2700, May 10, Health Insurance Application for Pregnant Women

(m) CF-ES Form 2701, Feb 03, Request for Length of Treatment Information

(n) CF-ES Form 2930, Apr 07, Screening for Expedited Medicaid Appointment

(4) The Overpayment and Benefit Recovery only forms are:

(a) CF-ES Form 3400, Feb 2018, Request for Additional Information

(b) CF-ES Form 3410, Feb 2018, Waiver of Administrative Disqualification Hearing With a Program Loss

(d) CF-ES Form 3414, Nov 07, Disqualification Consent Agreement

(e) CF-ES Form 2338, Feb 2018, Contact Notice

(f) CF-ES Form 2339, Feb 2018, Request for Verification

(g) CF-ES Form 2340, Feb 2018, Home Visit Confirmation Notice

(5) The Temporary Cash Assistance only forms are:

(a) CF-ES Form 2082, Sep 05, Hardship Extension/Exemption Review

(b) CF-ES Form 2094, Jun 09, Statement of the Need for Care

(d) CF-ES Form 2299, Feb 03, Alcohol, Drug Abuse and Mental Health (ADM) Treatment Verification

(e) CF-ES Form 2601, Feb 03, Temporary Cash Assistance Program Refugee Assistance Program

(f) CF-ES Form 4192, May 05, Notice of Work Penalty

The edition date on some forms is listed with a notation that the edition replaces a previous edition that may still be used. This notation is to indicate that the new edition of the form does not implement a policy change and that supplies of the previous edition of a specific form may be exhausted prior to the use of the new edition.

(6) Copies of materials incorporated by reference are available from the Florida Department of Children and Families, Office of Public Benefits Integrity, 2415 North Monroe Street, Suite 400, Tallahassee, FL 32303-4190, or on the Department’s website at http://www.dcf.state.fl.us/DCFForms/Search/DCFFormSearch.aspx. Forms CF-ES 3410, CF-ES 3410A, CF-ES 2338, CF-ES 2339, and CF-ES 2340 can also be found at http://www.flrules.org/Gateway/reference.asp?No=Ref-09355; http://www.flrules.org/Gateway/reference.asp?No=Ref-09356; http://www.flrules.org/Gateway/reference.asp?No=Ref-09357; http://www.flrules.org/Gateway/reference.asp?No=Ref-09358; and http://www.flrules.org/Gateway/reference.asp?No=Ref-09359, respectively.

History

Rulemaking Authority 409.919, 410.033, 414.45 FS. Law Implemented 409.903, 409.904, 410.033, 414.065, 414.075, 414.085, 414.095, 414.105, 414.115, 414.122, 414.31 FS. History–New 4-9-92, Amended 7-1-93, 8-3-94, Formerly 10C-1.400, Amended 12-29-98, 3-18-03, 7-25-06, 1-8-12, 6-4-18.

Fla. Admin. Code R. 65A-1.502 Beginning Dates of Eligibility

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185, 409.235 FS. History–New 1-31-94, Amended 1-16-96, Formerly 10C-1.502, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.503 Determination of Continued Eligibility

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 1-31-94, Formerly 10C-1.503, Transferred to 65A-4.219.

Fla. Admin. Code R. 65A-1.504 Amount and Duration of Cash Payment

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 1-31-94, Amended 10-9-96, Formerly 10C-1.504, Amended 11-30-98, Transferred to 65A-4.220.

Fla. Admin. Code R. 65A-1.505 Payee

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185, 409.235 FS. History–New 1-31-94, Amended 4-26-94, Formerly 10C-1.505, Repealed 4-8-98.

Fla. Admin. Code R. 65A-1.506 Living in the Home of a Specified Relative

History

Rulemaking Authority 409.026 FS. Law Implemented 409.235 FS. History–New 1-31-94, Formerly 10C-1.506, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.5061 Teen Parents

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 10-9-96, Formerly 10C-1.5061, Amended 5-23-99, Transferred to 65A-4.217.

Fla. Admin. Code R. 65A-1.507 Age

History

Rulemaking Authority 409.026 FS. Law Implemented 409.235 FS. History–New 1-31-94, Formerly 10C-1.507, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.508 Residence

History

Rulemaking Authority 409.026 FS. Law Implemented 409.026, 409.235 FS. History–New 1-31-94, Formerly 10C-1.508, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.509 Citzenship

History

Rulemaking Authority 409.026 FS. Law Implemented 409.026, 409.235 FS. History–New 1-31-94, Formerly 10C-1.509, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.510 Deprivation of Parental Support or Care

History

Rulemaking Authority 409.026 FS. Law Implemented 409.235 FS. History–New 1-31-94, Amended 9-19-94, Formerly 10C-1.510, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.511 Need

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185, 409.235 FS. History–New 1-31-94, Formerly 10C-1.511, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.512 Income

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185, 409.235 FS. History–New 1-31-94, Formerly 10C-1.512, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.513 Budgeting

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185 FS. History–New 1-31-94, Amended 9-19-94, 3-5-95, Formerly 10C-1.513, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.514 Temporary Cash Assistance Eligibility for Pregnant Women

History

Rulemaking Authority 120.54(1), 414.45 FS. Law Implemented 414.095(1), (2)(b)5., (6) FS. History–New 1-31-94, Amended 1-16-96, Formerly 10C-1.514, Amended 10-16-97, Repealed 7-21-98.

Fla. Admin. Code R. 65A-1.515 Special Provisions for Families Who Qualify Due to Unemployment of a Parent

History

Rulemaking Authority 409.026, 409.255 FS. Law Implemented 409.185, 409.235, 409.255 FS. History–New 1-31-94, Formerly 10C-1.515, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.517 Immunization Program

History

Rulemaking Authority 120.54(1), 414.45 FS. Law Implemented 414.13 FS. History–New 4-26-94, Formerly 10C-1.517, Amended 7-22-97, Transferred to 65A-4.216.

Fla. Admin. Code R. 65A-1.518 The Family Transition Program (Welfare Reform)

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185, 409.235 FS. History–New 4-26-94, Formerly 10C-1.518, Repealed 4-8-98.

Fla. Admin. Code R. 65A-1.519 Child Care

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095(1) FS. History–New 3-5-95, Formerly 10C-1.519, Amended 8-18-97, 3-12-00, Transferred to 65A-4.218.

Fla. Admin. Code R. 65A-1.520 LearnFare and Family Cap Requirements

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185(2), 414.125 FS. History–New 11-18-96, Formerly 10C-1.520, Repealed 4-13-98.

Fla. Admin. Code R. 65A-1.521 Penalties for Nonparticipation in Work Requirements

History

Rulemaking Authority 414.065(4), 414.45 FS. Law Implemented 414.065(4), (7) FS. History–New 12-21-97, Transferred to 65A-4.205.

Fla. Admin. Code R. 65A-1.601 Food Stamp Program Definitions

History

Rulemaking Authority 414.45 FS. Law Implemented 414.31 FS. History–New 1-31-94, Amended 9-6-94, Formerly 10C-1.601, Amended 11-30-98, Repealed 4-17-06.

Fla. Admin. Code R. 65A-1.602 Food Assistance Program Case Processing

(1) Food Assistance Program case processing is done in accordance with the eligibility determination process in Rule 65A-1.205, F.A.C., and in 7 C.F.R. § 271.2, 273.1 – 273.18, 273.24 and 273.25.

(2) Responsible Member is defined as any member of the Standard Filing Unit (SFU) capable of representing the Assistance Group (AG) by providing sufficient and accurate information concerning the AG circumstances.

(3) Authorized Representative is defined as an adult non-household member authorized to represent the household during an interview. The authorized representative must be appointed in writing by the head of the AG, the spouse or responsible household member.

(4) 24-Month Certification Periods: Apply to AGs in which all members of the SFU meet all of the following criteria:

(a) Are elderly or disabled;

(b) Do not have any earned income; and,

(5) Able Bodied Adults Without Dependents (ABAWD). ABAWDs are required to report whenever their hours of employment are less than 20 hours per week, averaged monthly. They may have their certification period shortened in order to comply with the time limit provisions assigned to them. The CF-ES Form 2095 Food Assistance Work Registration Notice, (August 2025), incorporated by reference and available at, https://flrules.org/Gateway/reference.asp?No=Ref-18612, is used to inform food assistance participants who submit a paper application about work participation requirements.

(6) Food Assistance AG members between the ages of 18 through 59 who are not exempt from Food Assistance Employment and Training (E&T) Program requirements are required to participate in the Food Assistance E&T Program, accept a suitable job offer, and not voluntarily quit a job or reduce work hours below 30 hours per week without a good reason. The CF-ES Form 2095 Food Assistance Work Registration Notice is used to inform food assistance participants who submit a paper application about work participation requirements.

(7) Simplified Reporting (SR): Simplified Reporting is implemented pursuant to 7 C.F.R. § 273.12(a)(5) without a waiver and applies to all AGs. AGs assigned to the SR category will have a six-month certification period except for those that meet the criteria in subsections (4) and (5). The food assistance reporting requirements, per 7 C.F.R. § 273.12(a)(5)(v), do not change the reporting requirements for other programs such as Medicaid and Temporary Cash Assistance. The CF-ES Form 3052A, Change Report for Public Assistance Case Form, 7/2014, incorporated by reference, https://www.flrules.org/Gateway/reference.asp?No=Ref-06801, can be used to report beneficial changes.

(8) Child Support Enforcement (CSE) Cooperation. In accordance with section 414.32, F.S. and 7 C.F.R. § 273.11(o)(1), Child Support Enforcement cooperation by a custodial parent or caretaker relative is required as a condition of eligibility for their food assistance when an absent parent exists, unless good cause for non-cooperation exists. For the purposes of this section, “absent parent” is defined as a putative or identified noncustodial parent of a child under 18 years of age.

(a) When an application for benefits is received, information on good cause criteria will be provided using CF-ES Form 2641, Claim Notice Good Cause for Refusal to Cooperate, 4/2014, incorporated by reference, https://www.flrules.org/Gateway/reference.asp?No=Ref-04810. Copies of forms and materials incorporated by reference in this rule may be obtained on the Department’s website at https://myflfamilies.com/forms.

(b) Right to Claim Good Cause. The right to claim good cause exists when cooperation in establishing paternity of a child born out of wedlock or in establishing, modifying, or enforcing a child support order for the child or the parent or caretaker relative and the child may be against in the best interests of the child, or the parent or caretaker relative and the child pursuant to 7 C.F.R. § 273.11(o)(2)(i)(B) and (C), and (2)(iii). Good cause shall be determined by the Department of Revenue, Child Support Enforcement on food assistance only cases in accordance with Rule 12E-1.008(5), F.A.C.

(c) Upon determination by the Department of Revenue, Child Support Enforcement that the custodial parent or caretaker relative’s failure to cooperate was without good cause, a food assistance penalty will be imposed for the non-cooperative individual only and a notice of adverse action will be mailed to the individual pursuant to 7 C.F.R. § 273.11(o)(3) and (4). The non-cooperative individual’s income will be prorated in determining eligibility for the remaining AG members. The remaining AG members meeting eligibility requirements may be approved. The non-cooperative individual will be excluded until verification of CSE cooperation is received by the Department.

(d) Upon verification that the individual is cooperating with CSE and all other eligibility requirements have been met, action will be taken to add the individual to the AG or to remove the sanction and reinstate food assistance benefits pursuant to 7. C.F.R. § 273.11(o)(5).

(9) Food assistance filing units are categorically eligible if all members receive income from Temporary Cash Assistance through a public assistance program funded under Title IV-A of the Social Security Act.

The SFU does not contain a member disqualified under state or federal law.

(10) Filing units who are broad-based categorically eligible:

(a) Have no net income limit; and,

(b) Are not tested for resources (assets).

(11) The Department uses simplified income procedures for determining eligibility for food assistance. Simplified income is found in 7 C.F.R. § 273.9(c)(3)(v) and (c)(18)-(19).

(12) The Department uses simplified resource (asset) criteria in accordance with 7 C.F.R. § 273.8(e)(19), and excluding all resources (assets), except those of filing units containing a disqualified individual.

(13) If an individual meets a criteria for food assistance disqualification, that individual will be disqualfied for Temporary Cash Assistance, and if an individual will be disqualified for Temporary Cash Assistance that individual will be disqualified for food assistance, in accordance with subsection 414.065(1), F.S. and 7 C.F.R. § 273.11(k).

(14) Food assistance benefits are issued through the Electronic Benefit Transfer (EBT) system.

(15) Benefit Availability.

(a) Food assistance availability dates are staggered over the first 28 days of each month. Benefit availability to AGs is based on the 8th and 9th digits of the AG’s case number. AGs are able to receive their monthly allotment on their assigned availability date or any subsequent day in that month. Food assistance benefits placed in the EBT account may be accessed for 274 days after the date of their initial availability in the account.

(b) The EBT system supports mass overrides of benefit availability dates in instances of disasters or other emergencies. This permits individuals in areas where hurricanes or other disasters are threatening to be able to access their benefits earlier to prepare for such events.

History

Rulemaking Authority 414.45, 402.82 FS. Law Implemented 402.82, 414.31, 414.32 FS. History–New 1-31-94, Formerly 10C-1.602, Amended 7-29-01, 4-17-06, 1-8-15, 5-12-16, 4-12-17, 10-20-25.

Fla. Admin. Code R. 65A-1.603 Food Assistance Program Income and Expenses

(1) Rounding Income and Expenses. With the exception of the benefit reduction, cents resulting from budget calculations are retained at each level in determining the assistance group’s (AGs) food assistance benefits. The benefit reduction is rounded up to the next whole dollar.

(2) Standard Utility Allowance. A standard utility allowance (SUA) of $419 must be used by AGs who incur, or within the eligibility period expect to incur, heating or cooling expenses separate and apart from their rent or mortgage and by AGs who receive direct or indirect assistance authorized under the Low-Income Home Energy Assistance Act of 1981. Actual utility expenses are not allowed. Any additional utility expenses, including the telephone standard, are not used.

(3) Basic Utility Allowance. A basic utility allowance (BUA) of $339 must be used by AGs who do not incur heating or cooling expenses, but do incur utility expenses such as electricity, fuel, water, sewerage, or garbage pickup, separate and apart from their rent or mortgage. Actual utility expenses are not allowed. Any additional utility expenses, including the telephone standard, are not used.

(4) Telephone Standard. A telephone standard of $55 must be used by AGs who incur only a telephone expense. Actual telephone expenses are not allowed. Any additional utility expenses, including the SUA or BUA, are not used.

(5) Homeless Shelter Deduction. A homeless shelter deduction of $190 must be used by homeless AGs who do not receive free shelter throughout the month and incur or expect to incur shelter expenses unless higher expenses are claimed.

(6) Child Support Paid Out. Legally obligated child support payments are a deduction for the Food Assistance Program.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.31 FS. History–New 1-31-94, Formerly 10C-1.603, Amended 1-12-99, 5-25-03, 8-22-05, 2-17-09, 12-13-09, 11-1-10, 12-25-11, 10-16-12, 8-11-13, 11-30-14, 1-31-16, 6-6-17, 4-4-18, 8-15-18, 12-3-19, 11-25-20, 1-9-22, 2-6-23, 2-7-24, 2-5-25.

Fla. Admin. Code R. 65A-1.604 Food Stamp Issuance

History

Rulemaking Authority 414.45 FS. Law Implemented 409.942, 414.31 FS. History–New 1-31-94, Formerly 10C-1.604, Amended 3-18-03, Repealed 4-17-06.

Fla. Admin. Code R. 65A-1.605 Food Assistance Employment and Training

(1) The Food Assistance Employment and Training (E&T) Program is administered in accordance with the requirements of 7 C.F.R. §273.7, P.L. 104-193, The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and P.L. 107-171, Food Stamp Reauthorization Act of 2002.

(2) Each member of the assistance group (AG), who does not meet an exemption in accordance with 7 C.F.R. §273.7(b)(1), must work register for the Food Assistance E&T Program as a condition of eligibility for the receipt of food assistance. If a head of household refuses to comply with Food Assistance Program requirements without good cause at initial application or reapplication, the application will be denied for that reason. The eligibility specialist will use the Food Assistance Work Registration Notice, CF-ES 2095, incorporated by reference and available in Rule 65A-1.602, to work register each nonexempt member of the AG for the Food Assistance Program and to explain the employment and training requirements and possible penalties for noncompliance without good cause. Nonexempt head of households and AG members will be referred to the Local Workforce Development Board (LWDB) or contract provider when required to participate in assigned Food Assistance E&T Program activities.

(3) A head of household or AG member(s) who refuses or fails to comply with Food Assistance E&T Program requirements without good cause is ineligible to receive food assistance. The eligibility specialist will determine whether the individual meets an exemption in accordance with 7 C.F.R. §273.7(b), or if good cause for noncompliance exists in accordance with 7 C.F.R. §273.7(i). If not exempt, and good cause is not established, action will be taken to deny approval or to impose a food assistance penalty in accordance with 7 C.F.R. §273.7(f). When the head of household is noncompliant with Food Assistance E&T Program requirements, the minimum Food Assistance E&T Program penalty period will apply to the entire AG. If at the end of the minimum penalty period the head of household is still noncompliant, or does not meet a Food Assistance E&T Program exemption, the head of household will remain ineligible, but other members of the AG may reapply. If the noncompliant AG member is not the head of household, the penalty will only apply to that AG member until the individual serves the minimum penalty period or complies, whichever is later, or becomes exempt. The following Food Assistance E&T Program penalties for non-compliance with Food Assistance E&T Program requirements are applied.

(a) For the first noncompliance, food assistance benefits shall be terminated for a minimum of one month, or until compliance with Food Assistance E&T Program requirements, whichever is later, or the noncompliant AG member meets an exemption.

(b) For the second noncompliance, food assistance benefits shall be terminated for a minimum of three consecutive months, or until compliance with Food Assistance E&T Program requirements, whichever is later, or the noncompliant AG member meets an exemption.

(c) For the third noncompliance, food assistance benefits shall be terminated for a minimum of six consecutive months, or until compliance with Food Assistance E&T Program requirements, whichever is later, or the noncompliant AG member meets an exemption.

(d) Disqualification shall follow the AG member who was noncompliant. Assistance group ineligibility results when a disqualified individual joins a new AG as its head of household. The minimum penalty period of AG ineligibility referred to in paragraph (a), (b) or (c) above shall apply, as appropriate. If a disqualified individual joins the new AG as a member, only the disqualified AG member shall be ineligible for the remainder of the penalty period or the individual complies, whichever is later, or becomes exempt from Food Assistance E&T Program requirements.

(e) Food Assistance Program AG members who are subject to and determined to meet the work requirements or alternative requirement plan requirements under the Temporary Cash Assistance (TCA) Program will also meet Food Assistance E&T Program requirements in accordance with 7 C.F.R. §273.11(k). If the AG member is penalized for failure to meet TCA Program requirements, the eligibility specialist must determine if the AG member meets a Food Assistance E&T Program exemption. If the noncompliant AG member does not meet an exemption, Food Assistance E&T Program penalties specified in this rule will be applied.

(4) Penalties for refusal to comply with the requirements of the Food Assistance E&T Program shall not apply to non-English speaking persons if the Department failed to provide bilingual notices or forms in accordance with bilingual requirements of 7 C.F.R. §272.4.

(5) AG members between the ages of 18 through 59 who are not exempt from Food Assistance E&T requirements are referred to the LWDB for Food Assistance E&T Program participation.

(6) Able-Bodied Adults without Dependents (ABAWDs). Assistance group members who meet the definition of an ABAWD in 7 C.F.R. §273.24 and are not exempt are referred to the LWDB for Food Assistance E&T Program participation.

(a) Remote Areas. Assistance group members subject to ABAWD provisions and living in areas designated as remote by the Department must sign form CF-ES 2095 to work register, but will not be required to participate in Food Assistance E&T Program activities as long as the area is designated remote.

(b) Federal Waiver. In accordance with section 414.455, F.S., the Department must receive legislative approval prior to applying for, accepting, or renewing any federal waiver related to the Food Assistance E&T Program.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.31, 414.455 FS. History–New 10-1-87, Amended 4-13-92, Formerly 10C-32.001, Amended 3-3-99, Formerly 65A-32.001, 3-27-03, Amended 9-3-25.

Fla. Admin. Code R. 65A-1.606 Food Stamp Assets

History

Rulemaking Authority 414.45 FS. Law Implemented 414.075(2)(a), 414.31 FS. History–New 3-24-02, Repealed 8-22-05.

Fla. Admin. Code R. 65A-1.630 Legal Immigrant’s Temporary Income Bridge Program

History

Rulemaking Authority 414.45 FS. Law Implemented 409.185(2), 414.125 FS. History–New 2-23-98, Repealed 12-17-01.

Fla. Admin. Code R. 65A-1.701 Definitions

As used in Rules 65A-1.701 through 65A-1.716, F.A.C., the following terms have the following meanings unless a different meaning is given:

(1) Adoption Subsidy: A monthly payment to assist adoptive parents in caring for an adopted child who has been determined to meet the eligibility criteria of a special needs child.

(2) Adoptive Parent: A person who provides a child(ren) a permanent home through a court process, that once final, names the adoptive parent as the child’s legal parent.

(3) Affordable Care Act (ACA): The Patient Protection and Affordable Care Act in accordance with 42 U.S.C. §18001 et seq.

(4) Agency for Health Care Administration (AHCA): The designated single state agency responsible for the administration of the Florida Medicaid Program.

(5) Appropriate Placement: Placement of an individual into a Medicaid participating nursing facility that provides the type and level of care determined by the Florida Department of Elder Affairs (DOEA), Comprehensive Assessment and Review for Long-Term Care Services (CARES) or the receipt of approved Home and Community Based (HCBS) waiver services by an individual in accordance with an approved plan; or the receipt by an individual of hospice services provided by a Medicaid participating hospice provider; or by an individual in accordance with 42 U.S.C. §1396d.

(6) Assistance Group: All individuals within the standard filing unit (SFU) who are potentially eligible for benefits. For Family-Related Medicaid eligibilty, all applicants are considered to be an assistance group of one.

(7) Asset Verification System (AVS): The electronic verification process by which the Department verifies disclosed and undisclossed assets for individuals applying for Medicaid based on age or disability.

(8) Caretaker relative: A dependent child’s relative by blood, adoption, or marriage with whom the child is living, and who is assuming primary responsibility for the child’s care. The relative must be one of the following:

(a) The child’s legal or biological father, mother, grandfather, grandmother, brother, sister, including those of half-blood, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, first cousin once removed, nephew, or niece; and persons of preceding generations as denoted by prefix of “grand”, “great”, “great-great”, “great-great-great”, etc.; or

(b) The present or former spouse of a person listed in (a) above, even after the marriage is terminated by death or divorce.

(9) Child: A natural, adopted or stepchild.

(10) Child-Placing Agency: A child welfare agency that is any institution, society, agency, or facility which places children in foster homes for temporary care or in prospective adoptive homes for adoption.

(11) Children’s Health Insurance Program (CHIP): Premium health insurance coverage for children under age 19, as referenced in Rule 65A-1.703, F.A.C.

(12) Code: The Internal Revenue Code of Rules and Regulations.

(13) Community Spouse: The legal spouse of a married individual who lives in the community when one spouse is in or seeking institutional care.

(14) Community Spouse Income Allowance: The portion of an institutionalized spouse’s monthly income, if any, which may be protected for the community spouse’s maintenance needs if agreed to by the institutionalized spouse.

(15) Community Spouse Resource Allowance: The portion of the couple’s total assets which is protected for the community spouse and not considered to be available to the institutionalized spouse for purposes of determining eligibility.

(16) Coverage Group: A classification under which one or more individuals may be eligible for benefits.

(17) Department: The Department of Children and Families (DCF).

(18) Dependent: The person who depends upon another person for all or part of their support or maintenance.

(19) Eligible Couple: A married couple with both persons meeting the criteria for Medicaid eligibility. See the definition for “spouse.”

(20) Enrollment: The status of an individual who satisfies the non-financial and resource eligibility criteria for the Medically Needy Program but who is not eligible for any benefits until their share of cost is met.

(21) Excess Shelter Allowance: The amount by which the sum of a community spouse’s shelter expenses and the standard utility allowance exceeds 30 percent of the Minimum Monthly Maintenance Needs Allowance (MMMNA).

(22) Ex Parte Determination: An exploration of Medicaid eligibility under another Medicaid coverage group when an individual is no longer eligible under their current Medicaid coverage group based on available information.

(23) Familial Dysautonomia (FD): A home and community-based waiver program designed specifically for individuals who are diagnosed with this genetic disorder. The waiver provides support and services that will minimize the effects of the disease and stabilize the health of the participant to remain in a noninstitutionalized setting in the community. Participants for this waiver group must be age three through age 64.

(24) Family Size: The number of persons counted as members of an individual’s SFU.

(25) Federal Benefit Rate (FBR): Income standard levels established by the federal government to determine income eligibility and payment benefits for the Supplemental Security Income (SSI) Program.

(26) Federally Facilitated Marketplace (FFM): A federally designated entity used by small businesses and individuals to find, compare, and purchase qualified health plans.

(27) Foster Care: Twenty-four-hour substitute care for children removed by the courts and placed away from their parents or guardians and for whom the State agency has placement and care responsibility. This includes, but is not limited to, placements in foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, child care institutions, and preadoptive homes.

(28) Home and Community-Based Services Waiver (HCBS): A Waiver authorized under section 1915(c) of the Social Security Act. HCBS Waivers are designed to provide services for a particular targeted population based on the individual’s need for care and support that will delay or prevent institutionalization.

(29) Hospice: A coverage group which provides care and support to individuals who are terminally ill (with a life expectancy of six months or less).

(30) Hospital Swing Beds: Medicaid approved beds in rural hospitals designated to provide acute hospital care or nursing facility care.

(31) Household: Individuals residing together whose presence in the home may affect the eligibility of other individuals residing in the home.

(32) iBudget Florida: A home and community-based waiver program for individuals diagnosed before age 18 with a developmental disability, as defined in Section 393.063(12), F.S. The waiver provides support and services that will assist with stabilizing the health and welfare of the individual in a noninstitutionalized setting in the community.

(33) Income: For Family-Related Medicaid Programs refer to Rule 65A-1.707, F.A.C. For SSI-Related programs refer to 20 C.F.R. §416.1100 and Rule 65A-1.713, F.A.C.

(34) Institutional Care Program (ICP): A program that helps to pay for the cost of care in a nursing facility and provides Medicaid coverage.

(35) Institutional Vendor Payment: The payment made by the Medicaid Program to a Medicaid licensed nursing facility for the medical care of eligible individuals.

(36) Institutionalized Individual: An inpatient in a nursing facility, hospital swing bed, hospital distinct-part skilled nursing facility, or intermediate care facility for the developmentally disabled for whom Medicaid payments are paid based on the level of care provided.

(37) Institutionalized Spouse: An inpatient or individual seeking placement in a medical or nursing facility who is legally married to a community spouse.

(38) Intermediate Care Facility for individuals with Intellectual Disabilities (ICF/ID): An institution or distinct part of an institution for treatment, care or rehabilitation of the developmentally disabled or persons with related conditions as set forth in 42 C.F.R. §435.1010. These were formerly called “intermediate care facilities” for the mentally retarded (ICF/MR).

(39) Lawfully Residing Child: A child under the age of 19 who has a lawful immigration status or a qualified noncitizen status as provided for in the Immigration and Nationality Act.

(40) Medically Needy: Coverage which provides Mediciad eligibility for individuals whose countable income exceeds the applicable Medically Needy Income Levels (MNIL) in subsection 65A-1.716(2), F.A.C.

(41) Medically Needy Income Level (MNIL): Income in excess of the Medically Needy Income Level available to pay for medical care and services.

(42) Medicaid for Aged and Disabled (MEDS-AD): Medicaid coverage group for aged and disabled individuals with income at or below 88 percent of the federal poverty level.

(43) Minimum Monthly Maintenance Needs Allowance (MMMNA): The minimum monthly maintenance needs allowance recognized by the state for the community spouse of an institutionalized individual.

(44) Model Waiver: A home and community-based waiver program for individuals diagnosed with degenerate spinocerebellar disease. The waiver provides support and services that will assist with stabilizing the health and welfare of an individual to remain in a noninstitutionalized setting in the community. Participants for this waiver group are age 20 or younger.

(45) Modified Adjusted Gross Income (MAGI): The financial methodologies set forth in 42 C.F.R. §435.603 to determine the financial eligibility of all individuals for Medicaid, except for individuals identified in 42 C.F.R. §435.603(j).

(46) Modified Adjusted Gross Income (MAGI) Disregard: An amount that may be subtracted from net countable income of the SFU as provided for in 42 C.F.R. §435.603(d)(4) and subsection 65A-1.707(2), F.A.C.

(47) Modified Project Aids Care: A limited coverage group for individuals diagnosed with the Human Immunodeficiency Virus (HIV) Acquired Immunodeficiency Deficiency Syndrome (AIDS), who do not meet the criteria for enrollment in the Statewide Medicaid Managed Care Long Term Care Program and meet other program requirements.

(48) Non-Filer: An individual who is not required to file a tax return and does not expect to be claimed as a tax dependent on another person’s tax return.

(49) Others Outside of the Household (OOTH): An individual not living in the home, whom the tax-filer intends to claim on their federal tax return or an individual outside the home who intends to claim an individual on their federal tax return.

(50) Parent: A natural, legal, adoptive parent, or stepparent.

(51) Patient Responsibility: The amount by which AHCA must reduce its payments to a medical institution or intermediate care facility, or reduce its payments for home and community-based services provided to an individual towards their cost of care.

(52) Presumptive Eligibility by Hospitals: An abbreviated determination of eligibilty completed by a qualified hospital approved by AHCA.

(53) Program of All-Inclusive Care for the Elderly (PACE): An optional Medicaid program intended to serve the frail and elderly in the home and community. The PACE program includes a comprehensive medical and social service delivery system using an interdisciplinary team approach in an adult day health center that is supplemented by in-home and referral services in accordance with participants’ needs.

(54) Qualified Designated Provider (QDP): An entity approved to conduct presumptive eligibility determinations for Medicaid for pregnant women.

(55) Qualified Disabled Trust: A trust established by a parent, grandparent, legal guardian, or court on or after October 1, 1993, or a trust created by the individual if created on or after December 13, 2016, for the sole benefit of a disabled individual under the age of 65 which may consist of the disabled individual’s resources and income. The trust must provide that upon the death of the disabled individual the State shall receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of the disabled individual by the Medicaid program pursuant to the state’s Title XIX state plan.

(56) Qualified Hospital: A hospital that is an approved Medicaid provider under Florida’s Medicaid State Plan and approved to make presumptive eligibility determinations as outlined by AHCA.

(57) Qualified Income Trust: A trust established on or after October 1, 1993, for the benefit of an individual whose income exceeds the ICP income standard and who needs institutional care or HCBS. The trust must consist of only the individual’s pension, Social Security and other income. The trust must be irrevocable and provide that upon the death of that individual the State shall receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of that individual pursuant to the state’s Title XIX state plan.

(58) Qualified Noncitizen: A category of noncitizens who meet at least one of the sections of the Immigration and Nationality Act, 8 U.S.C. §1101 et seq., which allows them to receive Medicaid.

(59) Qualified Pooled Trust for the Disabled: A trust established by a disabled individual’s parent, grandparent, or legal guardian, or a court on or after October 1, 1993, for the sole benefit of the disabled individual and managed by a non-profit or not-for-profit association as defined in the Internal Revenue Code. A separate account must be maintained for each disabled beneficiary. For investment and management purposes, the separate accounts may be pooled together. To the extent that any amounts remaining in the beneficiary’s account upon their death are not retained by the trust, the trust must provide that upon the death of the disabled beneficiary, the State shall receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of that individual pursuant to the state’s Medicaid Title XIX state plan.

(60) Reasonably Compatible Income: Income reported that is consistent with information verified by an electronic data source and does not vary in a way that is meaningful for eligibility. Information is considered verified when the difference between reported income and information from electronic sources is no more than 10 percent.

(61) Resource Allowance: The amount of the couple’s total countable resources which may be allocated to the community spouse of an institutionalized person.

(62) Resources: Cash or other liquid assets, or any real or personal property that an individual owns and could convert to cash to be used for their support and maintenance. The terms “resources” and “assets” are used interchangeably in this rule chapter.

(63) Retroactive Coverage: The provision that allows individuals to apply for Medicaid for any of the three months prior to the month of application for Medicaid.

(64) Share of Cost (SOC): The amount of the individual’s or family’s income that exceed the Medically Needy Income Level (MNIL). A SOC represents the amount of allowable medical expenses that a Medically Needy assistance group must incur each month before becoming eligible to receive Medicaid.

(65) Sibling: A natural, adopted, or step brother or sister.

(66) Spouse: An individual lawfully married to another individual under state statute, federal regulation and federal laws.

(67) Standard Disregard: An amount based on the FPL and an average of the expenses and deductions allowed for a coverage group pursuant to Florida’s Medicaid State Plan, Approved Conversion Thresholds.

(68) Standard Filing Unit (SFU): All individuals whose needs, income, and/or assets are considered in the determination of eligibility for a category of assistance.

(69) Statewide Medicaid Managed Care Long Term Care (SMMC-LTC): A program for individuals who need long term care, support and services in nursing homes, in their own homes or other community-based settings.

(70) Tax Dependent: Someone for whom a deduction may be claimed under the Internal Revenue Service (IRS) tax code.

(71) Tax-Filer: An individual required to file federal income taxes and who claims the exemption amounts cited in 42 C.F.R. §435.603(f).

(72) Temporary Absence: A period of time for which Medicaid may continue when an otherwise eligible member is out of the home.

(73) Title XVI: The provisions of the Social Security Act that set forth Supplemental Security Income (SSI) policies and procedures. The terms “Title XVI” and “SSI” are used interchangeably in this rule chapter.

(74) Title XIX: The provisions of the Social Security Act that set forth Medicaid policies and procedures. The terms “Title XIX” and “Medicaid” are used interchangeably in this rule chapter.

(75) Working People with Disabilites (WPwD) eligibility: The increased income and resource limits allowed to indviduals aged 21 and older with earned income and who are enrolled in a HCBS waiver.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 4-1-03, 6-13-04, 8-10-06, 3-25-20, 9-22-21.

Fla. Admin. Code R. 65A-1.702 Special Provisions

(1) Date of Eligibility. Eligibility for Medicaid begins the first day of a month if an individual was eligible any time during the month, except as provided below:

(a) Presumptive Eligibility for Pregnant Women (PEPW). The period of presumptive eligibility for pregnant women begins when a Qualified Designated provider, as defined in Rule 65A-1.701, F.A.C., determines that the woman is eligible. Presumptive eligibility ends when a determination for full Medicaid is made (approved or denied), or on the last day of the month following the month the presumptive eligibility determination is made if an application for ongoing Medicaid coverage is not filed.

(b) Presumptive Eligibility by Hospitals. The period of presumptive eligibility by hospitals begins on the date the determination is made. Presumptive eligibility ends when a determination for full Medicaid is made (approved or denied) or on the last day of the month following the month the presumptive eligibility determination is made if an application for ongoing Medicaid coverage is not filed.

(c) Presumptive Eligiblity for Newborn (PEN). Eligibilty for a presumptively eligible newborn begins on the date of birth and continues for one year unless one of the following occurs:

The child leaves the state,
The child dies, or
There is a request for voluntary closure.

(d) Medically Needy Program. Enrollment under the Medically Needy Program begins on the first day of the month the individual satisfies the non-financial and resource eligibility criteria, if applicable, but not earlier than the third month prior to the month of application. Medicaid Eligibilty under the Medically Needy Program begins on the date their incurred allowable medical expenses equal the amount of their share of cost (SOC).

(e) Emergency Medicaid for Aliens (EMA). Coverage for individuals eligible for EMA begins the first day of a covered emergency and ends the day following the last day of the emergency medical situation. A Medicaid renewal date of 12 months will be assigned. Subsequent medical emergencies require documentation, but the individual will not have to file a new application and the Department will not make a new eligibility determination during this 12 month period. Changes in the SFU circumstances will continue to affect eligibility.

(2) Processing Medicaid Applications for Supplemental Security Income (SSI) Denials.

(a) The Department will use data obtained from the Social Security Administration’s (SSA) State Data Exchange (SDX) to identify individuals who have been denied SSI benefits.

(b) The Department will identify the individuals for whom the Department does not have an open Medicaid case or a pending Medicaid application at the time the SDX data is received. The Department will explore eligibilty under another coverage group with information based on available information receieved from the SDX data. If additional information is required to make a determination, these individuals or their SSA payee will be notified in writing to contact the Department within 30 calendar days. Failure to do so without good cause, will result in the issuance of a written notice of Medicaid denial for failure to follow through in determining eligibility.

(c) Good cause means illness of the individual or a family member, an accident involving the individual or a family member, hospitalization of the individual or a family member, death of the individual or a family member, natural disasters in a relevant geographical area, being away from home or the unexpected closure of a Department’s office.

(d) Those individuals whom the Department identifies as having an open Medicaid case or a pending Medicaid application at the time the SDX data is reviewed will not be required to contact the Department, unless additional information is needed to complete the eligibility process.

(e) A determination of eligibility will be completed on the individuals who respond to written notice to contact the Department.

(3) Ex Parte Process.

(a) When a recipient’s eligibility for Medicaid ends under one coverage group, the Department must evaluate their eligibility, using available information, under any other Medicaid coverage group before terminating Medicaid coverage. If additional information is required to make an ex parte determination it can be requested from the recipient. There is no requirement for the individual to contact the Department or file an application to initiate the ex parte review for continued Medicaid eligibility.

(b) All individuals who lose Medicaid eligibility under one coverage group will continue to receive Medicaid under that coverage group until the ex parte Medicaid renewal process is complete.

(c) Qualified individuals losing eligibility due to income that was calculated based on the Modified Adjusted Gross Income (MAGI) budgeting methodology will be transferred to the Children’s Health Insurance Program (CHIP) or the Federally Facilitated Marketplace (FFM) for a determination of eligibility.

(4) Requirement to File for Other Benefits. As a condition of eligibility for Medicaid, the Department must require an individual to take all necessary steps to obtain any annuities, pensions, retirement, and disabilty benefits to which they are entitled, unless they can show good cause, as defined in paragraph (2)(c) of this rule, for not doing so. Annuities, pensions, retirement and disability benefits include, but are not limited to, veterans' compensation and pensions, OASDI benefits, railroad retirement benefits, and unemployment compensation. After the Department notifies an individual that they must apply for the other benefit(s), if the individual fails to do so, they are not eligible for Medicaid.

(5) Child Support Enforcement Cooperation (CSE). For the purpose of establishing Medicaid eligibility, a pregnant woman is not required to cooperate with CSE as a condition of eligibility. Cooperation with CSE is also not required in Medicaid cases where benefits are only requested for a child.

(6) Re-evaluating Medicaid Adverse Actions for Individuals who do not Request a Hearing. The Department shall re-evaluate any adverse Medicaid determination upon a showing of good cause by the individual that the Department’s previous determination was incorrect. This provision applies only when benefits were terminated or denied in error or the amount of a share of cost or patient responsibility was determined incorrectly. A re-evaluation must be requested within 12 months from the effective date of the notice of adverse action.

(a) Good cause for establishing the previous determination was incorrect consists of any of the following:

Mathematical Error – The Department made a mechanical, computer or human error in its mathematical computations of resources or income requirements for Medicaid eligibility.
Records Error – The Department made an error in a Medicaid determination which caused an incorrect decision. For example, there is evidence showing that the individual’s resources satisfied Florida’s standard of eligibility but the application was denied on the basis of excess resources.
New and Material Evidence – The Department’s determination was correct when made but new and material evidence that the Department did not previously consider establishes that a different decision should be made.

(b) Good cause for not requesting a hearing within the prescribed 90 day time period exists when the failure was due to circumstances beyond the individual’s control or due to an unexpected closure of Department offices.

(c) Failure of the individual to provide information required by the Department to accurately determine eligibility for Medicaid where the failure was beyond the individual’s control constitutes good cause for re-evaluation. However, if the individual fails to cooperate with the Department in establishing eligibility, good cause for re-evaluation does not exist.

(d) The Economic Self Sufficiency Specialist (ESSS) is responsible for the initial determination of whether good cause for re-evaluation exists. The decision must be reviewed by the ESSS’s supervisor. If both the ESSS and the ESSS’s supervisor determine that good cause does not exist, the next level administrator, in consultation with the Regional Program Administrator, must review the decision.

If a determination is made by the Regional Program Administrator that good cause does not exist, the individual will be notified of the decision and of the right to to request a fair hearing.
If a determination is made by the Regional Program Administrator that good cause exists and the Department discovers that an error was made in the eligibility determination, benefits must be provided retroactively as follows:

a. If an application was denied, benefits will be awarded back to the date of application, provided all other eligibility requirements are met.

b. If an ongoing case was terminated, benefits will be awarded back to the effective date of the termination, provided all other eligibility requirements are met.

If a determination is made by the Regional Program Administrator that good cause exists and the original determination is determined to be correct, the individual will be notified of the Department’s decision. The individual has 90 calendar days from the date of notice of disposition to request a hearing. If at the end of 90 calendar days a hearing is not requested, the Department’s decision is final and binding upon the individual.

(7) Assignment of Rights to Benefits. Each individual applying for or receiving Medicaid must cooperate in securing the receipt of medical support and payments from third parties that are otherwise due to the individual, unless good cause exists for not cooperating. Good cause exists when the individual previously applied for and was denied third party benefits or medical support, and the reason for denial has not changed.

(8) Retroactive Medicaid. Retroactive Medicaid is based on an approved, denied, or pending application for ongoing Medicaid benefits. For applications submitted on or after February 1, 2019, retroactive coverage only applies to applications for children under age 21 and pregnant women, including their postpartum period.

(a) Retroactive Medicaid eligibility is not effective before the third month prior to the month of application. The individual must meet all Medicaid eligibility requirements during the retroactive months. A request for retroactive Medicaid can be made for a deceased individual by a designated representative or caretaker relative, by filing a medical assistance application. However, Qualified Medicare Beneficiaries (QMB’s) are not eligible for retroactive Medicaid benefits as indicated in Title XIX of the Social-Security Act §1902(e)(8).

(b) SSI Cash Assistance Recipients. Upon SSI approval, all SSI recipients receive a system-generated notice of potential entitlement for retroactive Medicaid benefits and a reply card to be returned to the Department if the SSI recipient is interested in receiving retroactive Medicaid benefits. If the SSI recipient or their designated representative or caretaker relative contacts the Department, the Department will proceed with an eligibility determination.

(9) Re-Enrollment. In order for an individual or family to be eligible for re-enrollment in the Medically Needy program, they must:

(a) Continue to satisfy the resource criteria, if applicable;

(b) Continue to satisfy all non-financial eligibility criteria; and

(c) Provide verifications as needed. The re-enrollment period may exceed 12 months when there is a delay in the Department’s processing of the re-enrollment.

(10) Limits of Coverage.

(a) Qualified Medicare Beneficiary (QMB). Under QMB coverage, individuals are eligible for Medicare cost-sharing benefits, including payment of Medicare premiums.

(b) Specified Low-Income Medicare Beneficiary (SLMB). Under SLMB coverage, individuals are eligible for payment of the Part B Medicare premium. If eligible, AHCA will pay the premium for up to three months retroactive to the month of application.

(d) Qualifying Individuals 1 (QI1). Under QI1 coverage, individuals are eligible for payment of their Medicare Part B premium. (This is coverage for individuals who would be eligible for QMB or SLMB coverage except that their income exceeds the limits for those programs.) If eligible, AHCA will pay the premium for up to three months retroactive to the month of application.

(11) Determining Share of Cost (SOC). The SOC is determined by deducting the appropriate Medically Needy Income Level from the individual’s or family’s income.

(12) Eligibility of SSI Cash Assistance Recipients. Eligible SSI recipients who are residents of Florida are automatically eligible for Medicaid pursuant to 42 C.F.R. §435.120.

(13) Trusts.

(a) The Department applies trust provisions set forth in §1902 of the Social Security Act.

(b) Funds transferred into a trust or other similar device established other than by a will prior to October 1, 1993, by the individual, a spouse, or a legal representative are available resources if the trust is revocable or if the trustee has any discretion over the distribution of the principal. Such funds are a transfer of a resource or income, if the trust is irrevocable and the trustee does not have discretion over distribution of the corpus, or if the individual is not the beneficiary. No penalty can be imposed when the transfer occurs beyond the 60 month look-back period. Any disbursements which can be made from the trust to the individual or to someone else on the individual’s behalf shall be considered available income to the individual. Any language which limits the authority of a trustee to distribute funds from a trust, if such distribution would disqualify an individual from participation in government programs, including Medicaid, shall be disregarded.

(c) Funds transferred into a trust, other than a trust specified in 42 U.S.C. §1396p(d)(4), by a person or entity specified in 42 U.S.C. §1396p(d)(2) on or after October 1, 1993, shall be considered available resources or income to the individual in accordance with 42 U.S.C. §1396p(d)(3) if there are any circumstances under which disbursement of funds from the trust could be made to the individual or to someone else for the benefit of the individual. If no disbursement can be made to the individual or to someone else on behalf of the individual, the establishment of the trust shall be considered a transfer of resources or income.

(d) The trustee of a qualified income trust, qualified disabled trust, or a pooled trust shall provide quarterly statements to the Department which identify all deposits to and disbursements from the trust for each month during the eligibility period.

(e) Undue Hardship. A period of ineligibility shall not be imposed if the Department determines that the denial of eligibility based on counting funds in an irrevocable trust according to provisions in paragraph 65A-1.702(13)(b), F.A.C., would create an undue hardship on the individual. Undue hardship exists when application of a trust policy would deprive an individual of food, clothing, shelter or medical care such that their life or health would be endangered. This can be caused by legal restrictions or by illegal actions of a trustee. All efforts by the individual, or their legal spouse or representative, to access the resources or income must be exhausted before this exception applies.

(14) Statewide Inpatient Psychiatric Program (SIPP). SIPP is for Medicaid eligible children under the age of 21 who require a residential level of care for treatment of a serious emotional disturbance. Those who are Medically Needy and those who are Medicare recipients are excluded from this program. Services must be received from a designated SIPP provider selected by the Agency for Health Care Administration (AHCA). SIPP providers must be licensed as a hospital or residential treatment center for children and adolescents by AHCA. This program provides an exception to provisions that residents of an institution for mental disease (IMD) are not eligible for Medicaid.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 4-22-98, 2-15-01, 9-24-01, 11-23-04, 5-31-06, 8-10-06, 3-25-20.

Fla. Admin. Code R. 65A-1.703 Family-Related Medicaid Coverage Groups

The Department determines eligibility for mandatory and optional Medicaid coverage groups for individuals, families and children described in “The Patient Protection and Affordable Care Act”, under “The Health Care and Education Reconciliation Act 2010”, Section 1931 of the Social Security Act, relevant provisions of the Medicaid Program under Title XIX of the Social Security Act, the Children’s Health Insurance Program under Title XXI of the Social Security Act and Section 409.903. F.S.

(1) The mandatory and optional Family-Related coverage groups are stated in each subsection of this rule that are entitled to coverage under the Florida Medicaid Program:

(a) Children under age 19.

(b) Children age 19 to 21.

(d) Children placed for adoption and adopted children.

(e) Former foster care individuals up to age 26.

(f) Parents and caretaker relatives of children.

(g) Pregnant women.

(2) For each coverage group listed in subsection (1) above there is no asset or resource limit, and the following additional criteria must be met to qualify under the specific coverage group:

(a) Children under age 19 and ages 19 to 21, the child must have never been married or emancipated, and must meet the eligibility criteria of Title XIX of the Social Security Act and the general requirements specified in Rule 65A-1.705, F.A.C. The countable net income for a child is based on the filing unit/family size of the coverage group. To determine eligibility for a child, if the countable net income is at or above the limit for the coverage group, the MAGI five percent disregard for the filing unit/family size is subtracted from the countable net income to determine if the child will qualify. If the countable net income for the child is below the income limit of the coverage group, the MAGI five percent disregard is not applied. Income limits are based on the coverage group, the filing unit/family size of the child and listed below, as follows;

The standard disregard is applied for a child under age one, children age 1-5.
The countable net income for the filing unit/family size of a child under age one must be less than or equal to 200 percent of the FPL.
The countable net income for the filing unit/family size of a child age one and up to age 19 is less than or equal to 133 percent of the FPL.
The countable net income for the filing unit/family size of a child age 19 to 21, must be less than or equal to the income limits included in Florida’s Medicaid State Plan.
To determine eligibility for a pregnant woman, the filing unit shall include each anticipated unborn child as a family member including the pregnant woman.

(b) Children in Foster Care. Children for whom the Department is assuming full or partial responsibility, the child must be:

Placed in either a foster home, a home of a relative or nonrelative, or an approved adoptive home by a child-placing agency, or the child must be placed with a residential child care agency; or
In an independent living facility; or
In a licensed emergency shelter home; or
In a publicly operated community residential facility.

Children under the age of 18 for whom there is a state adoption assistance agreement in effect, other than under Title IV-E of the Social Security Act, between the state and an adoptive parent. In addition to the adoption assistance agreement, the state adoption agency shall determine;

a. If the child has a pre-existing special need for medical or rehabilitative care that would have precluded adoption placement without receipt of Medicaid coverage under Florida’s Medicaid State Plan, and

b. Prior to execution of the adoption assistance agreement, the child:

I. Was receiving or was eligible to receive Medicaid or

II. Would have been eligible for Medicaid if the Title IV-E financial requirements specified in 42 U.S.C. §473(2)(A), had been used to determine Medicaid eligibility.

Children placed for adoption. Children under the age of 18 for whom there is a state adoption assistance agreement under Title IV-E of the Social Security Act in effect are deemed eligible for Medicaid even if the assistance payments are not being made. If an adoption assistance agreement is in effect, Medicaid eligibility begins when the child is placed for adoption according to state law even if an interlocutory or final judicial decree or adoption has not been issued.

(d) Former foster care individuals who are:

Under age 26.
In the Florida foster care system on their 18th birthday and receiving full Medicaid when they aged out of foster care.
There is no income or resource limit.
Not eligible and enrolled for other Medicaid mandatory coverage groups.

(e) Parents (natural or adoptive), caretaker relatives and their spouses may derive their eligibility from a child under age 18 (natural or adoptive) within the fifth degree of the relationship who has never married and is not emancipated residing with them, provided their filing unit/family size is equal to or below the income limit established in Florida’s Medicaid State Plan for the coverage group. The fifth degree of relationships includes the following individuals:

Brother, sisters (including step and those of half-blood),
Aunts, uncles, nieces and nephews,
First cousins (first cousins once removed), and
Individuals of preceding generations as denoted by prefix of “grand”, “great”, “great-great”, “great-great-great”, etc.

(f) Medicaid for pregnant women. To be eligible for this coverage group an expectant mother must meet the eligibility requirements specified in Rule 65A-1.705, F.A.C. The following additional eligibility criteria apply:

The countable net income of the filing unit/family size is at or below 185 percent of the FPL.
When eligibility is based solely on a pregnancy, the Department will accept the individual’s attestation of the number of expected births.
The expectant mother is not required to comply with Child Support Enforcement requirements.
Eligibility is extended through the month of birth and the two post-partum months regardless of changes in the income for the filing unit/family size. At the end of the extended period, an ex-parte determination must be completed and the individual notified of any changes in eligibility.

(3) Medically Needy. To be eligible for this coverage group the individual must meet the eligibility requirements prescribed in Rule 65A-1.705, F.A.C.

(a) Included in this coverage group are the following individuals:

Children under age 21,
A parent or caretaker relative and their spouse if living together with a child up to age 19, within the fifth degree of the specified relationships:

a. Brother, sisters (including step and those of half-blood),

b. Aunts, uncles, nieces and nephews,

c. First cousins (first cousins once removed),

d. Individuals of preceding generations as denoted by prefix of “grand”, “great”, “great-great”, “great-great-great”, etc.,

e. The natural and other legally adopted children and other relatives of the adoptive parents, if they are within the specified degree, and

f. Legal spouses of any person’s names in the above groups.

Pregnant Women, and
Children in foster care or receiving an adoption subsidy.

(b) The following provisions apply to Medically Needy:

The individual must have income at or below the respective Medically Needy Income Limit set forth in subsection 65A-1.716(2), F.A.C. If income exceeds the Medically Needy Income Limits refer to subsection 65A-1.707(9), F.A.C. Refer to paragraph 65A-1.713(1)(h), F.A.C. for additional income criteria applicable to the Medically Needy Program.
There is no asset or resource limit.

History

Rulemaking Authority 409.1451, 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 9-28-98, 2-15-01, 6-13-04, 3-25-20.

Fla. Admin. Code R. 65A-1.704 Family-Related Medicaid Eligibility Determination Process

(1) Public assistance staff determine eligibility for Family-Related Medicaid in accordance with Rules 65A-1.703, 65A-1.705 and 65A-1.707, F.A.C., at the time of the initial application and annually thereafter and when a change potentially affecting eligibility is reported.

(2) The Department must make a redetermination of eligibility for Medicaid without requiring information from the individual if it is able to do so based on reliable information contained in the individual's case or other more current information available to the Department.

(a) If the Department is able to renew eligibility based on the information available, the Department will send a written notice of the eligibility determination to the individual.

(b) If the Department is unable to redetermine eligibility based on the information available, the Department will provide the individual with:

A notice, at least 30 calendar days prior to the end of the eligibility redetermination date, that it is time to renew their eligibility and the options available to the individual to complete the redetermination. These options are:

a. Via the internet Web site,

b. By telephone,

c. Via mail,

d. In person, or

e. By fax.

If the individual fails to provide the information for renewal, eligibility cannot be determined, and coverage will end. A notice of adverse action advising the individual of the Department’s actions will be sent. Medicaid coverage will be reinstated back to the effective date of the closure if the individual provides the requested information within three months of the effective date of the closure and continues to be eligible.

(3) Presumptive Eligibility for Pregnant Women. Qualified Designated providers determine presumptive eligibility for pregnant women. The period of presumptive eligibility for pregnant women begins when a qualified designated provider, as defined in subsection 65A-1.701(53), F.A.C., determines that the woman is eligible. Presumptive eligibility ends when a determination (approved or denied) for full Medicaid is made, or on the last day of the month following the month the presumptive eligibility determination was made, if an application for ongoing Medicaid coverage is not filed. Citizenship status and providing a social security number (SSN) are not required for eligibility. A pregnant woman determined presumptively eligible may receive no more than one presumptive eligibility period per pregnancy.

(4) Presumptive Eligibility by Hospitals. Pregnant women, infants and children under age 19, parents and caretaker relatives and former foster care children may receive Medicaid eligibility during a presumptive period when determined eligible by a qualified hospital, as defined in subsection 65A-1.701(56), F.A.C. The period of presumptive eligibility begins on the date the determination is made. Presumptive eligibility ends when a determination (approved or denied) for full Medicaid is made, or on the last day of the month following the month the presumptive eligibility determination was made, if an application for ongoing Medicaid coverage is not filed. An individual may receive no more than one presumptively eligibility determination during a 12-month period, starting with the effective date of the initial presumptive eligibility period.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-7-01, 10-21-01, 4-1-03, 2-4-04, 6-26-08, 8-10-10, 2-26-20, 3-25-20.

Fla. Admin. Code R. 65A-1.705 Family-Related Medicaid General Eligibility Criteria

(1) The Family-Related Medicaid technical eligibility factors.

(a) The age criteria for children is specified in Rule 65A-1.703, F.A.C.

(b) The individual must be a resident of Florida as required by subsection 1902(a)(16) of the Social Security Act. Individuals who are physically present in Florida on a temporary basis may be considered residents of the State on a case-by-case basis if they indicate an intent to remain in Florida. A lawfully residing child under the age of 19 is considered to meet the residency requirement for Medicaid.

(c) An absence from the home of less than 30 days does not affect Medicaid eligibility. An individual is considered to be temporarily absent and may be eligible for Medicaid, under the following conditions:

The parent or relative continues to exercise care and control of the child during the absence.
A definite plan exists for the absent child or parent/relative to return to the home at the end of the temporary period.

(d) The individual must be a citizen of the United States, or a qualified non-citizen, or a lawfully residing child as defined in Rule 65A-1.701 F.A.C.

(e) The identity of each U.S. citizen, or qualified non-citizen, applying for or receiving Medicaid must be documented and verified.

(2) Standard Filing Unit (SFU).

(a) Taxpayers not claimed as a tax dependent: For individuals who expect to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made, and who do not expect to be claimed as a tax dependent by another taxpayer, the SFU consists of the taxpayer and, subject to paragraph (e) of this section, all persons whom such individual expects to claim as a tax dependent.

(b) Individuals claimed as a tax dependent: For individuals who expect to be claimed as a tax dependent by another taxpayer for the taxable year in which an initial determination or renewal of eligibility is being made, the SFU consists of the taxpayer claiming such individual as a tax dependent, except that the SFU must be determined in accordance with paragraph (c) of this section. Such individuals include:

Individuals other than a spouse or a natural, adopted, or stepchild who expect to be claimed as a tax dependent by another taxpayer;
Individuals under age 19, or in the case of full-time students under age 21, who expect to be claimed by one parent as a tax dependent and are living with both parents but whose parents do not expect to file a joint tax return; and
Individuals under age 19, or in the case of full-time students under age 21, who expect to be claimed as a tax dependent by a parent not living in the home. For purposes of this subparagraph:

a. A court order or binding separation, divorce, or custody agreement establishing physical custody controls; or

b. If there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights.

(c) Individuals who neither file a tax return nor are claimed as a tax dependent. In the case of individuals who do not expect to file a federal tax return and do not expect to be claimed as a tax dependent for the taxable year in which an initial determination or renewal of eligibility is being made, or who are described in subparagraph (4)(b)1., (4)(b)2., or (4)(b)3. of this section, the SFU consists of the individual and, if living with the individual:

The individual’s spouse;
The individual's natural, adopted or stepchildren under age 19 or, in the case of full-time students, age 21; and
Individuals under age 19, or in the case of full-time students under age 21, the individual's natural, adoptive, and stepparents and natural, adoptive, and stepsiblings under age 19, or in the case of full-time students under age 21.

(d) Married couples. In the case of a married couple living together, each spouse will be included in the SFU of the other spouse, regardless of whether they expect to file a joint tax return.

(e) If the taxpayer cannot reasonably establish that another individual is a tax dependent of the taxpayer for the taxable year in which Medicaid eligibility is being determined, the inclusion of the individual in the SFU of the taxpayer is determined in accordance with paragraph (c) of this section.

History

Rulemaking Authority 409.818, 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.818, 409.919 FS. History–New 10-8-97, Amended 9-28-98, 4-5-99, 11-23-99, 2-15-01, 9-24-01, 4-1-03, 6-26-08, 9-16-08, 2-26-20.

Fla. Admin. Code R. 65A-1.706 Family-Related Medicaid Needs Criteria

The standards set forth in Rule 65A-1.716, F.A.C., are used to determine an individual’s needs for Family-related Medicaid.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-15-01.

Fla. Admin. Code R. 65A-1.707 Family-Related Medicaid Income and Resource Criteria

(1) The Department uses the Modified Adjusted Gross Income (MAGI) based budgeting methodologies as defined in 26 U.S.C. 36B(d)(2)(B) to determine the financial eligibility of individuals applying for Medicaid. Resources are not considered as part of the eligibility determination for individuals whose eligibility is determined using MAGI methodologies. MAGI methodologies will not apply to the following:

(a) Individuals whose eligibility for Medicaid does not require a determination of income by the Department, including individuals receiving Supplemental Security Income (SSI).

(b) Individuals who are age 65 or older when age is a condition of eligibility.

(d) Individuals who request coverage for long-term services and supports, including nursing facility services, or individuals who request a level of care in any institution equivalent to nursing facility services, or individuals who request home and community-based services provided under a Medicaid waiver.

(e) Individuals who are being evaluated for Medicare cost sharing assistance.

(f) Individuals who are being evaluated for coverage as SSI-Related Medically Needy.

(2) Countable Net income is defined as: The sum of income counted for the assistance group based on the number of individuals and their income included in the SFU, except as provided in 42 C.F.R. §435.603(d)(4). To determine eligibility using MAGI-based income criteria, an amount equivalent to the MAGI five percent of the Federal Poverty Level (FPL) is subtracted from the countable income of the individual based on the size of the SFU. The standard disregard as defined at 65A-1.701(67) is subtracted from total gross income to determine countable net income. The MAGI five percent is not applied if the countable net income of the individual is at or below the income limit for the coverage group. This disregard is not applied in Medically Needy.

(3) MAGI-based income is defined as: Income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 26 U.S.C. 36B(d)(2)(B), with the exceptions specified in 42 C.F.R. §435.603(e).

(4) SFU: Refer to 65A-1.705(2), F.A.C., for information on households.

(5) Income standard for infants and children under age 19: The maximum income standard for infants under age one is 200 percent countable net income of the MAGI converted FPL and the maximum income standard for children ages one through 18 is 133 percent of the FPL, pursuant to Florida’s Medicaid State Plan, Approved Conversion Thresholds, 6/27/13, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11664 and https://ahca.myflorida.com/Medicaid/stateplan_aca.shtml.

(6) Income standard for Parents and Caretaker Relatives: The maximum income standard for parents and caretaker relatives is the state’s Aid to Families with Dependent Children (AFDC) payment standard in effect as of July 16, 1996, converted to a MAGI equivalent standard included in Florida’s Medicaid State Plan, Approved Conversion Thresholds.

(7) Income standard for children ages 19 and 20. The maximum income standard for children ages 19 and 20 is the state’s AFDC payment standard in effect as of July 16, 1996, converted to a MAGI equivalent standard included in Florida’s Medicaid State Plan, Approved Conversion Thresholds.

(8) Income standard for pregnant women. The maximum income standard for pregnant women is 185 percent of the FPL as specified in Florida’s Medicaid State Plan, Approved Conversion Thresholds.

(9) Medically Needy Income Level (MNIL). The Department deducts the MNIL, as provided in 65A-1.716(2) F.A.C., from the SFU countable income to determine the amount of Share of Cost (SOC) available to meet medical care and services each month.

(10) Exceptions to MAGI-based income referenced in 42 C.F.R. §435.603(e).

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 11-23-04, 2-20-07, 5-6-08, 6-4-12, 3-25-20.

Fla. Admin. Code R. 65A-1.708 Family-Related Medicaid Budgeting Criteria

(1) The Department uses a prospective budgeting method at the initial application and renewal of eligibility in the financial determination for Medicaid coverage for current and future months. A prospective budgeting methodology is used to determine eligibility based on the Department’s best estimate of the coverage group’s income and circumstances. This estimate shall be based on the Department’s expectation and knowledge of current or future circumstances. When eligibility is being determined for a prior month, the actual income and circumstances for that month shall be used.

(a) Weekly income is converted to a monthly amount by using the conversion factor of 4.

(b) Biweekly income is converted to a monthly amount by using the conversion factor of 2.

(d) When averaging income, the four most recent weeks of income shall be used if it is representative of the individual’s future earnings. A longer period of income history may be used if necessary to provide a more accurate indication of anticipated fluctuations in future income, for example self-employment in a seasonal industry, with the following exceptions:

Income from the most recent quarter provided to the State Wage Information Collection Agency (SWICA) within the Florida Department of Economic Opportunity (DEO) shall be used if it is representative of the individual’s future earnings.
In budgeting income received by an individual on a contractual basis, income received under an employment contract of less than one year will be prorated over the months it is intended to cover.

(2) There is no asset or resources test.

(3) The Department will apply the standard disregard as defined in subsection 65A-1.701(66) F.A.C., except Medically Needy.

(4) Budgeting for Medically Needy individuals.

(a) Determining share of cost (SOC). The Department will deduct the following amounts from an individual’s countable income to determine their SOC:

For individuals under age 21, parents and other caretaker relatives, and pregnant women, the Department will deduct the Medically Needy Income Level (MNIL) amounts found in subsection 65A-1.716(2), F.A.C., for Family-Related Medicaid coverage groups.
For aged, blind, or disabled individuals, the Department will deduct the MNIL amounts found in subsection 65A-1.716(2), F.A.C., SSI-Related Medicaid coverage groups.

(b) Meeting SOC. An individual is eligible (entitled to Medicaid) when their allowable medical bills are equal to or exceed the SOC. An individual who meets their share of cost must contact the Department to complete bill tracking and to be enrolled in Medicaid. When tracking medical expenses, the Department will:

Deduct incurred medical expenses. The Department shall deduct allowable medical expenses in chronological order, by date of service. To qualify as an allowable medical expense, it must be:

a. A recognized health insurance costs (premiums, copays and deductibles), or

b. Medical expenses that are unpaid and the payment of the expenses remains the responsibility of the individual or a member of the SFU, or

c. Medical expenses paid during the month for which bill tracking is being completed.

Global Prenatal Expenses. The individual has the option of using her total global prenatal bill, whether paid or unpaid, to meet her share of cost during a specified month (including month of delivery) or prorating it to cover several months during her pregnancy and not:

a. Subject to third party payment or

b. Previously used to meet SOC.

Medical expenses reimbursed by a state or local government not funded in full by federal funds, excluding Medicaid program payments, are allowable deductions.
Allowable medical expenses, such as medical services and personal care services in the home, provided or prescribed by a recognized member of the medical community.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 10-16-07, 3-25-20.

Fla. Admin. Code R. 65A-1.709 SSI-Related Medicaid Coverage

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Repealed 1-7-16.

Fla. Admin. Code R. 65A-1.710 SSI-Related Medicaid Coverage Groups

The Department covers all mandatory coverage groups and the following optional coverage groups:

(1) MEDS-AD Demonstration Waiver. A Medicaid coverage group for aged or disabled individuals (or couples), as provided in 42 U.S.C. §1396a(m).

(2) Institutional Care Program (ICP). A Medicaid coverage group that helps pay for the cost of care in a nursing facility for institutionalized aged, blind or disabled individuals (or couples) who would be eligible for cash assistance except for their institutional status and income as provided in 42 C.F.R. §§435.211 and 435.236.

(3) Hospice Program. A Medicaid coverage group that provides care and support to individuals who are terminally ill and meets the specific Medicaid hospice eligibilty requirements as provided in 42 U.S.C. §1396d(a). subsection 65A-1.711(3) and Rule 65A-1.713, F.A.C.

(4) Home and Community Based Services (HCBS). A Medicaid coverage group for aged, blind or disabled individuals that provides coverage for services and activities to prevent institutionalization and allow the individual to remain in the community. The approved HCBS Waivers as permitted by 42 U.S.C. §1396n and 42 C.F.R. §435.217 are intended to prevent institutionalizing individuals who:

(a) Satisfy all SSI-Related Medicaid financial and non-financial eligibility criteria; and

(b) Have resources and income within Institutional Care or MEDS-AD Demonstration Waiver Program limits.

(5) Medically Needy Program. A Medicaid coverage group, as allowed by 42 U.S.C. §§1396a and 1396d, for aged, blind or disabled individuals (or couples) whose countable income exceeds the applicable Medically Needy Income Level (MNIL) in subsection 65A-1.716(2), F.A.C.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 6-13-04, 8-10-06 (4), (6), 8-10-06 (6), (7), (8), 10-9-13, 1-12-20.

Fla. Admin. Code R. 65A-1.711 SSI-Related Medicaid Non-Financial Eligibility Criteria

To qualify for Medicaid an individual must meet the general and categorical requirements in 42 C.F.R. Part 435, subparts E and F (2007) (incorporated by reference), with the exception that individuals who are neither aged nor disabled may qualify for breast and cervical cancer treatment, and the following program specific requirements as appropriate. Individuals who are in Florida temporarily may be considered residents of the state on a case-by-case basis, if they indicate an intent to reside in Florida and can verify that they are residing in Florida.

(1) For MEDS-AD Demonstration Waiver, the individual must be age 65 or older, or disabled as defined in 20 C.F.R. §416.905 (2007) (incorporated by reference).

(2) For ICP benefits, an individual must be:

(a) Living in a licensed nursing facility, or confined to a hospital swing bed or to a hospital-based skilled nursing facility bed, or in an ICF/DD facility that is certified as a Medicaid provider and provides the level of care that the client needs as determined by the Department; or living in a Florida state mental hospital and be age 65 or over; and,

(b) Determined to be in medical need of institutional care services according to Rules 59G-4.180 and 59G-4.290, F.A.C., for nursing facility, hospital swing bed placements and placements in a hospital-based skilled nursing facility bed according to Chapter 65B-38, F.A.C., for ICF/DD facilities or according to Rule 59G-4.300, F.A.C., for state mental hospitals.

(c) If the individual is in a hospital swing bed or in a hospital-based skilled nursing facility bed, meet the requirements for length of stay prescribed in Rule 59G-4.200, F.A.C.

(3) To be eligible for the Hospice program, an individual must:

(a) Have a terminal illness and a written medical prognosis of six months or less to live if the illness runs its normal course, signed by the hospice medical director or physician member of the hospice interdisciplinary group, and the individual’s attending physician, if there is one;

(b) File an election of hospice care statement with the hospice provider as required in Rule 59G-4.140, F.A.C.;

(d) Waive all rights to Medicaid services for the duration of the election of hospice care as specified in Rule 59G-4.140, F.A.C.

(4) To be eligible for a Home and Community Based Services Waiver program, an individual must meet the requirements of Rule 59G-13.080, F.A.C. An individual cannot receive waiver coverage and institutional care program coverage at the same time. An individual residing in a nursing home may apply for the waiver, but the individual’s approval must be subject to their discharge and move into a community living arrangement. AHCA, in coordination with the program responsible for the daily operations of the waiver, requests the number of individuals to be served by the waiver as part of each waiver submission. The Centers for Medicare and Medicaid Services approve the request based on information provided by the state. Additionally, an individual must meet the criteria for one of the following waivers:

(a) Be at least 65 years of age and meet the requirements of subsection 65A-1.701(5), F.A.C., to participate in the Channeling waiver; or

(b) Be determined disabled in accordance with SSI disability criteria set forth in 42 C.F.R. §§435.540 (2007) and 435.541 (2007) (both incorporated by reference) and meet the requirements of subsection 65A-1.701(24), F.A.C., to participate in the Project AIDS Care waiver; or

(c) Be age 65 or older, or be 18 years of age through 64 years of age and disabled in accordance with SSI disability criteria set forth in 42 C.F.R. §§435.540 (2007) and 435.541 (2007) (both incorporated by reference), and meet the requirements of subsection 65A-1.701(1), F.A.C., to participate in the ADA/Home and Community Based Services waiver program; or

(d) Be disabled in accordance with SSI disability criteria set forth in 42 C.F.R. §§435.540 (2007) and 435.541 (2007) (both incorporated by reference) and meet the requirements of subsection 65A-1.701(10), F.A.C., to participate in the Developmental Services waiver program; or

(e) Be age 60 or older and meet the requirements in subsection 65A-1.701(3), F.A.C., to participate in the Assisted Living waiver; or

(f) Be age 18 through 64 and disabled in accordance with SSI disability criteria set forth in 42 CFR §§435.540 (2007) and 435.541 (2007) (both incorporated by reference) with a medical condition of traumatic brain injury or spinal cord injury in accordance with the Centers for Medicare and Medicaid Services approved Medicaid waiver.

(5) To be eligible as a QMB or for the SLMB coverage the individual must be entitled to Medicare.

(6) To be eligible for WD the individual must be entitled to enroll for Medicare Part A in accordance with Title XVIII, Section 1818A of the Social Security Act (42 U.S.C. §1395i-2a, 2000 Ed., Sup. V, incorporated by reference).

(7) In addition, optional coverage is provided in accordance with Secs. 1920B and 1902(aa) of the Social Security Act (2007), incorporated by reference, as it pertains to breast and cervical cancer treatment. This coverage is provided only for the duration of the individual’s treatment. Applicants are referred by the Department of Health. A face to face interview is not required as a result of this referral. The application form for this coverage is CF-ES 2099, Medicaid Application for Breast and Cervical Cancer Treatment, July 2002 (incorporated by reference). Additional rights and responsibilities are explained to applicants on Your Rights and Responsibilities, CF-ES 2064, 03/2012, incorporated by reference in Rule 65A-1.204, F.A.C.; this form is provided to each applicant. A form requesting verification of the length of treatment, CF-ES 2701, Request for Length of Treatment Information, Dec. 2001 (incorporated by reference), along with a return envelope are given to the applicant to obtain the required verification from the provider. Alternatively, this information may be obtained by the Department through telephone contact with the provider, when known.

(8) Copies of the forms incorporated by reference in this rule may be obtained from the Department of Children and Families, Economic Self-Sufficiency Program Office, 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 4-1-03, 8-10-06 (1), 8-10-06 (8), (9), 9-16-08.

Fla. Admin. Code R. 65A-1.712 SSI-Related Medicaid Resource Eligibility Criteria

(1) Resource Limits. If an individual’s total resources are equal to or below the prescribed resource limits at any time during the month the individual is eligible on the factor of resources for that month. The resource limit is the SSI limit specified in Rule 65A-1.716, F.A.C., with the following exceptions:

(a) For Medicaid for the Aged or Disabled Demonstration Waiver (MEDS-AD), an individual whose income is equal to or below 88 percent of the federal poverty level must not have resources exceeding the current Medically Needy resource limit specified in Rule 65A-1.716, F.A.C.

(b) For Qualified Medicare Beneficiary (QMB), an individual cannot have resources exceeding three times the SSI resource limit with increases based on the Consumer Price Index.

(d) For Specified Low Income Medicare Beneficiary (SLMB), an individual cannot have resources exceeding three times the SSI resource limit with increases based on the Consumer Price Index.

(e) For Qualifying Individuals 1 (QI1), an individual cannnot have resources exceeding three times the SSI resource limit with increases based on the Consumer Price Index.

(f) For Medically Needy, an individual or couple cannot have resources exceeding the applicable Medically Needy resource limit set forth in subsection 65A-1.716(3), F.A.C.

(g) For the Home and Community Based Services (HCBS) Waiver Program, an individual cannot have countable resources that exceed $2,000. If the individual’s income falls within the MEDS-AD Demonstration Waiver limit, the individual can have resources up to $5,000.

(2) Exclusions. The Department follows SSI policy prescribed in 20 C.F.R. §416.1210 and 20 C.F.R. §416.1218 in determining resource exclusions, with the exceptions in paragraphs (a) through (g), below, in accordance with 42 U.S.C. §1396a(r)(2).

(a) Resources of a comatose applicant (or recipient) are excluded when there is no known legal guardian or other individual who can access and expend the resource(s).

(b) The value of a life estate interest in real property is excluded.

(c) The cash surrender value of life insurance policies is excluded as resources if the combined face value of the policies is $2,500 or less.

(d) The individual, and their spouse, may designate up to $2,500 each of their resources for burial funds for any month. The designated funds may be excluded regardless of whether the exclusion is needed to allow eligibility. The $2,500 is not reduced by the value of excluded life insurance policies or irrevocable burial contracts.

(e) One automobile is excluded, regardless of value.

(f) Property that is essential to the individual’s self-support shall be excluded from resources if it is producing income available to the individual which is consistent with its fair market value. This includes real and personal property used in a trade or business; non-business income-producing property; and property used to produce goods or services essential to an individual’s daily activities. Liquid resources other than those used as part of a trade or business are not property essential to self-support. For the purpose of this section, mortgages are considered non-liquid resources, if they were entered into on or before September 30, 2004.

(g) An individual who is a beneficiary under a qualified state Long-Term Care Insurance Partnership Policy is given a resource disregard equal to the amount of the insurance benefit payments made to or on behalf of the individual for long term care services when determining if the individual’s countable resources are within the program limits to qualify for Medicaid Institutional Care Program (ICP), HCBS, the Program of All Inclusive Care for the Elderly (PACE), or hospice benefits.

(3) Transfer of Resources and Income. According to 42 U.S.C. §1396p(c), if an individual, the spouse, or their legal representative, disposes of resources or income for less than fair market value on or after the look back date, the Department must presume that the disposal of resources or income was to become Medicaid eligible and impose a period of ineligibility for ICP, Institutional Hospice or HCBS Waiver Programs. The Department will mail a Notice of Determination of Assets (or Income) Transfer, CF-ES 2264, 02/2007, incorporated by reference and available to http://www.flrules.org/Gateway/reference.asp?No=Ref-11422, to individuals who report a transfer for less than fair market value, advising of the opportunity to rebut the presumption and of the opportunity to request and support a claim of undue hardship per subparagraph (c)5., below. The Spanish version, CF-ES 2264S, 02/2007, and the Creole version, CF-ES 2264H, 02/2007, of the Notice of Determination of Assets (or Income) Transfer form are incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11423 and http://www.flrules.org/Gateway/reference.asp?No=Ref-11424, respectively. If the Department determines the individual is eligible for Medicaid on all other factors of eligibility except the transfer, the individual will be approved for general Medicaid (not ICP, Institutional Hospice or HCBS Waiver Programs) and advised of their penalty period using the Medicaid Transfer Disposition Notice, CF-ES 2358, 07/2013, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11455. The Spanish version, CF-ES 2358S, 07/2013, and the Creole version, CF-ES 2358H, 07/2013, of the Medicaid Transfer Disposition Notice are incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11457 and http://www.flrules.org/Gateway/reference.asp?No=Ref-11456, respectively. Transfers of resources or income made prior to January 1, 2010 are subject to a 36 month look back period, except in the case of a trust treated as a transfer in which case the look back period is 60 months. Transfers of resources or income made on or after January 1, 2010 are subject to a 60 month look back period.

(a) The Department follows the policy for transfer of resources in accordance with 42 U.S.C. §§1396p and 1396r-5. Transfer policies apply to the transfer of income and resources.

(b) When funds are transferred to a retirement fund, including annuities, within the transfer look back period the Department must determine if the individual will receive fair market compensation in their lifetime from the fund. If fair compensation will be received in their lifetime there has been no transfer without fair compensation. If not, the establishment of the fund must be regarded as a transfer without fair compensation. Fair compensation shall be calculated based on life expectancy tables published by the Office of the Actuary of the Social Security Administration. See Rule 65A-1.716, F.A.C.

Individuals and their spouses must disclose their ownership interest in any annuity, including annuities that are not subject to the transfer of resources provision, and if purchased on or after November 1, 2007 (and within the look back period) must name the state as a remainder beneficiary (for applicants at the time of approval or for recipients at time of annual review) in the first position for no more than the total amount of medical assistance paid on behalf of the institutionalized individual or in the second position after the community spouse and/or minor or disabled child unless the spouse, child or their representative disposes of the remainder for less than fair market value.
A purchase of an annuity (and other transactions that change the course of an annuity payment or treatment of income or principal) made on or after November 1, 2007 (and within the look back period) will be considered a transfer of resources for less than fair market value unless the annuity meets all of the following criteria for applicants at the time of approval and recipients at the time of annual review: (a) the State of Florida, Agency for Health Care Administration, is named as the primary beneficiary (or secondary as appropriate pursuant to subparagraph (b)1., above); (b) the annuity is irrevocable and non-assignable; (c) the annuity pays principal and interest in equal amounts during the term of the annuity, with no balloon or deferred payments; and (d) the annuity is actuarially sound based on standards published by the Office of the Chief Actuary of the Social Security Administration called the Period of Life Table as set forth in Rule 65A-1.716, F.A.C. (Life Expectancy Tables). If the annuity meets all of the above criteria, funds in the annuity are excluded as a resource and the periodic payments are counted as income in the eligibility determination and calculation of patient responsibility.

a. Transactions, such as additions of principal to an existing annuity or electing to annuitize an existing annuity that occurs on or after November 1, 2007 make an annuity (including an annuity purchased before November 1, 2007) subject to the transfer of resources provisions unless the criteria of paragraphs (2)(a) through (2)(d), above are met.

b. Annuities purchased on or after November 1, 2007 (and within the look back period), by or on behalf of the community spouse, must name the State of Florida, Agency for Health Care Administration, as primary (or secondary) beneficiary pursuant to subparagraph (b)1., above and must be actuarially sound based on the community spouse’s age and the life expectancy tables. Annuities purchased by or on behalf of the community spouse after approval of ICP, Institutional Hospice or HCBS Waiver Programs for the applicant spouse are not evaluated for transfer of resources provisions.

Individual Retirement Accounts (IRAs) or annuities (as described in Section 408 of the Internal Revenue Code) established by an employee or employer are not considered under the transfer of resources provision and are not required to name the state as the primary remainder beneficiary in accordance with subparagraph (b)1., above.

(c) No penalty or period of ineligibility shall be imposed against an individual for transfers described in 42 U.S.C. §1396p(c)(2).

In order for the transfer or trust to be considered to be for the sole benefit of the spouse, the individual’s blind or disabled child, or a disabled individual under age 65, the instrument or document must provide that:

a. No individual or entity except the spouse, the individual’s disabled child, or disabled individual under age 65 can benefit from the resources transferred in any way, either at the time of the transfer or at any time in the future; and

b. The individual must be able to receive fair compensation or return of the benefit of the trust or transfer during their lifetime.

If the instrument or document does not allow for fair compensation or return within the lifetime of the individual (using life expectancy tables noted in paragraph (b), above), it is not considered to be established for the sole benefit of the indicated individual and any potential exemption from penalty or consideration for eligibility purposes is void.
A transfer penalty shall not be imposed if the transfer is a result of a court entering an order against an institutional spouse for the support of the community spouse.
A transfer penalty shall not be imposed if the individual provides proof that they disposed of the resource or income solely for some purpose unrelated to establishing eligibility.
A transfer penalty shall not be imposed if the Department determines that the denial of eligibility due to transferred resources or income would impose an undue hardship on the individual. Undue hardship exists when imposing a period of ineligibility would deprive an individual of medical care such that their life or health would be endangered. Undue hardship also exists when imposing a period of ineligibility would deprive the individual of food, clothing, shelter or other necessities of life. All efforts to access the resources or income must be exhausted before this exception applies. The facility in which the institutionalized individual is residing may request an undue hardship waiver on behalf of the individual with the consent of the individual or their designated representative.

(d) Except for allowable transfers described in 42 U.S.C. §1396p(c)(2), in all other instances the Department must presume the transfer occurred to become Medicaid eligible unless the individual can prove otherwise.

An individual who disposes of a resource for less than fair market value or reduces the value of a resource prior to incurring a medical or other health care related expense which was reasonably capable of being anticipated within the applicable transfer look back period shall be deemed to have made the transfer, in whole or part, in order to qualify for, or continue to qualify for, medical assistance.
In cases where resources are held by an individual in common with others in a joint tenancy, tenancy in common, or similar arrangement, the individual is considered to have transferred resources or a portion thereof, as applicable, when action is taken by the individual or any other person authorized to access the resources that reduces or eliminates the individual’s ownership or control of such resource.
Promissory notes, loans and mortgages purchased on or after November 1, 2007 (and within the look back period) will be considered transfers of resources for less than fair market value to become Medicaid eligible unless the promissory notes, loans or mortgages meet all of the following criteria:

a. The repayment term is actuarially sound in accordance with the Life Expectancy Tables as referenced in subparagraph (b)2., above;

b. Payments must be made in equal amounts during the term of the loan, with no deferral and no balloon payments being possible; and

c. Debt forgiveness is not allowed. If these criteria are not met, for purposes of transfer of resources, the value of the promissory notes, loans or mortgages will be the outstanding balance due as of the date of application for ICP, Institutional Hospice or HCBS Waiver Programs.

A life estate interest purchased in another individual’s home on or after November 1, 2007 (and within the look back period) is considered a transfer of resources for less than fair market value. If the individual has not lived in the home for at least one year after the date of the purchase, the full amount of the purchase price paid for the life estate will be considered an uncompensated transfer without considering the value of the life estate. If the individual who purchased the life estate has resided in the home for at least one continuous year after the date of the purchase, the value of the life estate will be considered compensation and will be calculated by multiplying the current market value of the property at the time of the purchase by the life estate factor that corresponds to the individual’s age at the time of the purchase. The life estate tables can be found on the Social Security Administration’s website at https://secure.ssa.gov/apps10/poms.nsf/lnx/0501140120. Brief absences from the life estate property such as stays in a rehabilitation facility or vacations may not disrupt the client’s residency in the home. The facts of each absence will be evaluated to determine if the home continued to be the individual’s principal place of residence such as whether the person’s mail was delivered and received there or whether they paid the property taxes.
Compensation for a resource may be received in the form of cash, real or personal property or other valuable consideration provided. Compensation is the gross amount paid or to be paid for the resource based on the agreement at the time of transfer, or contract for sale, if earlier. Compensation received in the form of real or personal property is valued according to its fair market value (FMV). Fair market value is defined as the price for which a resource can reasonably be expected to sell on the open market. If compensation for the resource is in the form of jointly owned real or personal property, the value of the compensation received is the FMV of the fractional interest in the real or personal property transferred or received. Expenses attributed to the sale of a resource do not reduce the value of the compensation.

(e) Each individual shall be given the opportunity to rebut the presumption that a resource or income was transferred for the purpose of qualifying for Medicaid. No period of ineligibility shall be imposed if the individual provides proof that they intended to dispose of the resource or income at fair market value or for other valuable consideration, or provides proof that the transfer occurred solely for a reason other than to become Medicaid eligible or if the individual’s total countable resources (including the transferred resources) are below the program limits.

(f) The uncompensated value of a transferred resource is the difference between the fair market value of the transferred resource at the time of the transfer, less any outstanding loans, mortgages or other encumbrances on the resource, and the amount of compensation received at or after the time of the transfer.

(g) For transfers prior to November 1, 2007 (and within the look back period), periods of ineligibility are calculated beginning with the month in which the transfer occurred and shall be equal to the actual computed period of ineligibility, rounded down to the nearest whole number. For transfers made on or after November 1, 2007 (and within the look back period), periods of ineligibility begin with the later of the following dates:

The day the individual is eligible (pursuant to Rules 65A-1.711 through 65A-1.713, F.A.C.) for Medicaid and would be receiving institutional level care services in a nursing home facility, an institution with a level of care equivalent to that of a nursing facility, or home or community-based services furnished under a waiver based on an approved application for such care but for the application of the penalty period; or
The first day of the month in which the individual transfers the asset; or
The first day following the end of an existing penalty period. The Department shall not round down, or otherwise disregard, any fractional period of ineligibility of the penalty period but will calculate the period down to the day. There is no limit on the period of ineligibility. Once the penalty period is imposed, it will continue although the individual may no longer meet all factors of eligibility and may no longer qualify for Medicaid long-term care benefits, unless all assets or income are returned to the individual or fair market value compensation is paid for the transferred assets or income. If all transferred assets or income are returned to the individual, the penalty period is eliminated. Eligibility must be evaluated with returned assets included as though the individual had never transferred the assets or income.

a. Monthly periods of ineligibility due to transferred resources or income are determined by dividing the total cumulative uncompensated value of all transferred resources or income computed in accordance with paragraph 65A-1.712(3)(f), F.A.C., by the average monthly private pay nursing facility rate at the time of application as determined by the Department (refer to paragraph 65A-1.716(5)(d), F.A.C.).

(I) For transfers prior to November 1, 2007 (and within the look back period), where resources or income have been transferred in amounts or frequency or both that would make the calculated penalty periods overlap, the value of all transferred resources or income is added together and divided by the average cost of private nursing home care.

(II) For transfers prior to November 1, 2007 (and within the look back period), where multiple transfers are made in such a way that the penalty periods for each would not overlap, each transfer is treated as a separate event with its own penalty period.

(III) For transfers on or after November 1, 2007 (and within the look back period), the uncompensated value of all transfers will be added together to arrive at one total value with a penalty period assigned.

b. If an institutionalized individual is ineligible for ICP, Institutional Hospice or an HCBS Waiver Program due to a transfer of resources or income by the community spouse, and the community spouse becomes potentially eligible for ICP, HCBS, or Institutional Hospice, any remaining penalty period must be apportioned between the spouses. The Department shall apportion penalty periods by dividing any new or remaining penalty periods by two and attribute the quotient to each spouse. Any excess months may be attributed to the spouse that caused the penalty or according to the wishes of the couple or their representative.

c. Individuals who are ineligible due solely to the uncompensated value of a transferred resource or income are ineligible for ICP, Institutional Hospice or HCBS Waiver services payment, but are eligible for other Medicaid benefits.

(4) Spousal Impoverishment. The Department follows policy in accordance with 42 U.S.C. §1396r-5 for resource allocation and income attribution and protection when an institutionalized individual, including a hospice recipient residing in a nursing facility, has a community spouse. Spousal impoverishment policies are not applied to individuals applying for, or receiving services under, HCBS Waiver Programs, except for individuals in the Familial Dysautonomia and Model (Katie Beckett) waivers.

(a) When an institutionalized applicant has a community spouse all countable resources owned solely or jointly by the husband and wife are considered in determining eligibility.

(b) At the time of application only those countable resources which exceed the community spouse’s resource allowance are considered available to the institutionalized spouse.

(c) The community spouse resource allowance is equal to the maximum resource allocation standard allowed under 42 U.S.C. §1396r-5 or any court-ordered support, whichever is larger.

(d) After the institutionalized spouse is determined eligible, the Department allows deductions from the eligible spouse’s income for the community spouse and other family members according to 42 U.S.C. §1396r-5 and paragraph 65A-1.716(5)(c), F.A.C.

(e) If either spouse can verify that the community spouse resource allowance provides income that does not raise the community spouse’s income to the state’s minimum monthly maintenance income allowance (MMMIA), the resource allowance may be revised through the fair hearing process to an amount adequate to provide such additional income as determined by the hearing officer. Effective November 1, 2007, the hearing officers must consider all of the community spouse’s income and all of the institutionalized spouse’s income that could be made available to a community spouse. The hearing officers will base the revised community spouse resource allowance on the amount necessary to purchase a single premium lifetime annuity that would generate a monthly payment that would bring the spouse’s income up to the MMMIA (adjusted to include any excess shelter costs). The community spouse does not have to actually purchase the annuity. The community spouse will have the opportunity to present convincing evidence to the hearing officer that a single premium lifetime annuity is not a viable method of protecting the necessary resources for the community spouse’s income to be raised to the state’s MMMIA. If the community spouse requests that the revised allowance not be based on the earnings of a single premium lifetime annuity, the community spouse must offer an alternative method for the hearing officer’s consideration that will provide for protecting the minimum amount of assets required to raise the community spouse’s income to the state’s MMMIA during their lifetime.

(f) Either spouse may appeal the post-eligibility amount of the income allowance through the fair hearing process and the allowance may be adjusted by the hearing officer if the couple presents proof that exceptional circumstances resulting in significant inadequacy of the allowance to meet their needs exist. Exceptional circumstances that result in extreme financial duress include circumstances other than those taken into account in establishing maintenance standards for spouses. An example is when a community spouse incurs unavoidable expenses for medical, remedial and other support services which impact the community spouse’s ability to maintain themselves in the community and in amounts that they could not be expected to be paid from amounts already recognized for maintenance and/or amounts held in resources. Effective November 1, 2007, the hearing officers must consider all of the community spouse’s income and all of the institutionalized spouse’s income that could be made available to a community spouse. If the expense causing exceptional circumstances is a temporary expense, the increased income allowance must be adjusted to remove the expenses when no longer needed.

(g) The institutionalized spouse shall not be determined ineligible based on a community spouse’s resources if all of the following conditions are found to exist:

The institutionalized individual is not eligible for Medicaid Institutional Care Program because of the community spouse’s resources and the community spouse refuses to use the resources for the institutionalized spouse; and,
The institutional spouse assigns to the state any rights to support from the community spouse by submitting the Assignment of Rights to Support, CF-ES 2504, 10/2005, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11428, signed by the institutionalized spouse or their representative. The Spanish version, CF-ES 2504S, 10/2005, and the Creole version, CF-ES 2504H, 10/2005, of the Assignment of Rights to Support are incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11429 and http://www.flrules.org/Gateway/reference.asp?No=Ref-11430, respectively; and,
The institutionalized spouse would be eligible if only those resources to which they have access were counted; and,
The institutionalized spouse has no other means to pay for the nursing home care.

(5) Other Resource Policies.

(a) The Department follows the policy for home equity interest in accordance with 42 U.S.C. §1396p(f). Individuals shall not be eligible for ICP, Institutional Hospice or HCBS Waiver Programs on or after November 1, 2007, if the equity interest in the home exceeds the home equity limit.

The individual’s equity interest is based on the current market value of the home (including all contiguous property), minus any encumbrances such as a mortgage or other associated loans.
Unless evidence to the contrary is on file or is received, accept the individual or designated representative’s statement for the equity value of a home that is more than $25,000 below the home equity limit. For equity values within $25,000 of the home equity limit, the individual or designated representative must provide verification of current market value and indebtedness. Verification of the current market value must be obtained from a knowledgeable source commonly involved in the housing industry in the geographic locale, such as a real estate broker, mortgage broker, property appraiser, or builder. The verification must include the current market value, the name of the person providing the estimate, and the contact information of the business or agency for whom the person providing the estimate works.
Paragraph (5)(a), above, does not apply if the individual’s spouse, individual’s child under age 21 or the individual’s blind or disabled child (in accordance with 20 C.F.R. §§416.981-416.986 and 20 C.F.R. §§416.905-416.906) of any age is residing in the institutionalized individual’s home.
The home equity provision may be waived when denial of ICP, Institutional Hospice or HCBS Waiver Programs would result in demonstrated hardship to the institutionalized individual.
The Department will mail a Notice of Excess Home Equity Interest, CF-ES 2354, 05/2012, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11431, to individuals whose home equity interest exceeds the home equity limit, advising of the opportunity to have the home equity interest policy waived. The Spanish version, CF-ES 2354S, 05/2012, and the Creole version, CF-ES 2354H, 05/2012, of the Notice of Excess Home Equity Interest are incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11432 and http://www.flrules.org/Gateway/reference.asp?No=Ref-11433, respectively.

(b) An individual’s entrance fee in a continuing care retirement community or life care community shall be considered a resource, as set forth in 42 U.S.C. §1396p(g).

(c) The Department follows SSI policy prescribed in 20 C.F.R. §416.1208 in determining block accounts as countable resources. This applies regardless of whether the individual or their representative is required to petition the court to withdraw funds for the individual’s care. A blocked account is one in which state law protects an individual’s funds by specifically requiring that the funds be made available for the care and maintenance of the individual.

History

Rulemaking Authority 409.9102, 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.9102, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 9-28-04, 8-10-06 (1)(a), (f), 8-10-06 (1)(f), 8-10-06 (3)(g)1., 11-1-07, 12-24-09, 9-10-12, 10-6-13, 1-12-20.

Fla. Admin. Code R. 65A-1.713 SSI-Related Medicaid Income Eligibility Criteria

(1) Income limits. An individual’s income must be within limits established by federal or state law and the Medicaid State Plan. The income limits are as follows:

(a) For Medicaid for the Aged or Disabled (MEDS-AD) Demonstration Waiver, income cannot exceed 88 percent of the federal poverty level (FPL) after application of exclusions specified in subsection (2).

(b) For Qualified Medicare Beneficiary (QMB), income must be less than or equal to the FPL after application of exclusions specified in subsection (2).

(c) For Working Disabled (WD), income must be less than or equal to 200 percent of the FPL after application of exclusions specified in subsection (2).

(d) For Institutional Care Program (ICP), gross income cannot exceed 300 percent of the Supplemental Security Income (SSI) federal benefit rate after consideration of allowable deductions set forth in subsection (2). Individuals with income over this limit may qualify for institutional care services by establishing an income trust which meets criteria set forth in subsection 65A-1.702(15), F.A.C.

(e) For Home and Community-Based Services (HCBS), gross income cannot exceed 300 percent of the SSI federal benefit rate after consideration of allowable deductions set forth in subsection (2). Individuals with income over this limit may qualify for HCBS services by establishing a qualified income trust which meets criteria set forth in subsection 65A-1.702(15), F.A.C.

(f) For hospice services, income cannot exceed 300 percent of the SSI federal benefit rate or income must meet Medically Needy eligibility criteria, including the share of cost requirement. Effective October 1, 1998, institutionalized individuals with income over this limit may qualify for institutional hospice services by establishing an income trust which meets criteria set forth in subsection 65A-1.702(15), F.A.C.

(g) For Specified Low-Income Medicare Beneficiary (SLMB), income must be greater than 100 percent of the FPL but equal to or less than 120 percent of the FPL.

(h) For Medically Needy, income must be less than or equal to the Medically Needy income standard after deduction of allowable medical expenses.

(i) For Protected Medicaid, income cannot exceed the limits established in accordance with 42 U.S.C. §1383c (2000 Ed., Sup. IV) (incorporated by reference).

(j) For a Qualified Individual 1 (QI1), income must be greater than 120 percent of the FPL, but equal to or less than 135 percent of the FPL. QI1 is eligible only for payment of the Part B Medicare premium through Medicaid.

(2) Included and Excluded Income. For all SSI-related coverage groups the Department follows the SSI policy specified in 20 C.F.R. §416.1100, including exclusionary policies regarding the following: Veterans Administration (VA) benefits, VA aid and attendance (A&A), housebound (HB) unreimbursed medical expenses (UME), and reduced VA improved pensions, to determine which income to exclude. The following income types are exceptions and excluded:

(a) In-kind support and maintenance.

(b) Total of irregular or infrequent earned income if it does not exceed $30 per calendar quarter.

(d) Income placed into a qualified income trust for ICP, Institutional Hospice program or HCBS.

(e) Interest and dividends on countable assets are excluded in determining eligibility and counted in post eligibility computations, or for ICP, HCBS and other institutional programs.

(3) Excluded earned or unearned income must be verified to determine the amount that is deducted from the individual’s gross income.

(a) Excluded income from a veteran’s payment (UME, A&A and HB benefits) must be verified at the source. The request for Veteran’s Benefits Information, a VA award letter specifying the amount and type of excludable income or a collateral contact with the Department of Veterans Affairs may be used to verify excludable VA benefits.

(b) Income placed into a qualified income trust must be verified at the source. Bank statements or records are acceptable verification of deposits.

(c) Interest and dividends on countable assets, at application, must be verified at the source. Financial records from the institution holding the asset are acceptable verification.

(4) When Income Is Considered Available for Budgeting. The department counts income when it is received, when it is credited to the individual’s account, or when it is set aside for their use, whichever is earlier.

(a) If a regular periodic payment is occasionally received in a month other than the normal month of receipt and there is no intent to interrupt the regular payment schedule the department considers the funds to be available income in the normal month of receipt. Examples include checks advance dated because the regular payment date falls on a weekend or holiday, or electronic fund transfers or direct deposits which are posted to a bank account before or after the month they are payable.

(b) Florida State Retirement benefits are received the last workday of the month. The payment shall be considered income in the following month for SSI-related Medicaid purposes.

(5) Income Budgeting Methodologies. To determine eligibility SSI budgeting methodologies are applied except where expressly prohibited by 42 U.S.C. §1396 or another less restrictive option is elected by the state under 42 U.S.C. §1396a(r)(2). When averaging income, all income from the most recent consecutive four weeks shall be used if it is representative of future earnings. A longer period of past time may be used if necessary to provide a more accurate indication of anticipated fluctuations in future income.

(a) For MEDS-AD Demonstration Waiver, Protected Medicaid, Medically Needy, WD, QMB, SLMB, and QI1 to compute the community spouse income allocation for spouses of ICP individuals, the following less restrictive methodology for determining gross monthly income is followed:

When income is received monthly or more often than once per month the monthly income from that source shall be computed by first determining the weekly income amount and then multiplying that amount by 4. A five-week month shall not be treated any differently than a four-week month.
When unearned income is received less often than monthly the total amount will be prorated over the period it is intended to cover. If prorating income adversely affects the client it will be counted in the month received and not prorated.
When earned income is received less often than monthly, the department counts the total amount in the month received and does not prorate.

(b) For institutional care, hospice, and HCBS waiver programs the department applies the following methodology in determining eligibility:

To determine if the individual meets the income eligibility standard the client’s total gross income, excluding income placed in qualified income trusts, is counted in the month received. The total gross income must be less than the institutional care income standard for the individual to be eligible for that month.
If the individual’s monthly income does not exceed the institutional care income standard in any month the department will prorate the income over the period it is intended to cover to compute patient responsibility, provided that it does not result in undue hardship to the client. If it causes undue hardship it will be counted for the anticipated month of receipt.

(c) Medically Needy. The amount by which the individual’s countable income exceeds the Medically Needy income level, called the “share of cost,” shall be considered available for payment of medical care and services. The Department computes available income for each month eligibility is requested to determine the amount of excess countable income available to meet medical costs. If countable income exceeds the Medically Needy income level the Department shall deduct allowable medical expenses in chronological order, by day of service. Countable income is determined in accordance with subsection (2). To be deducted the expenses must be unpaid, or if paid, must have been paid in the month for which eligibility is being determined or incurred and paid during the three previous calendar months to the month for which eligibility is being determined. The paid expense may not have been previously deducted from countable income during a period of eligibility. Medical expenses reimbursed by a state or local government not funded in full by federal funds, excluding Medicaid program payments, are allowable deductions. Any other expenses reimbursable by a third party are not allowable deductions. Examples of recognized medical expenses include:

Allowable health insurance costs such as medical premiums, other health insurance premiums, deductibles and co-insurance charges; and,
Allowable medical services such as the cost of public transportation to obtain allowable medical services; medical services provided or prescribed by a recognized member of the medical community; and personal care services in the home prescribed by a recognized member of the medical community.

History

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 6-13-04, 8-10-06 (1), (4), 8-10-06 (1), 2-20-07, 10-16-07, 5-6-08, 1-12-20.

Fla. Admin. Code R. 65A-1.714 SSI-Related Medicaid Post-Eligibility Transment of Income

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, red book doesn’t give information, need to look it up.

Fla. Admin. Code R. 65A-1.7141 SSI-Related Medicaid Post Eligibility Treatment of Income

After an individual is determined eligible for Hospice, Institutional Care Program (ICP), Program of All-Inclusive Care for the Elderly (PACE), Individual Budgeting (iBudget), or Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) Program, the Department determines the individual’s patient responsibility. “Patient responsibility” is the amount the Agency for Health Care Administration (AHCA) must reduce its payments to a medical institution and intermediate care facility or payments for home and community based services provided to an individual towards their cost of care. Patient responsibility is based on the amount of income remaining after the following deductions are applied pursuant to 42 CFR §435.725 and 42 CFR §435.726. This process is called “post eligibility treatment of income.”

(1) For institutional care services and Hospice, the following deductions are applied to the individual’s income to determine patient responsibility in the following order:

(a) A Personal Needs Allowance (PNA) of $130. Individuals residing in medical institutions and intermediate care facilities shall have $130 of their monthly income protected for their personal need allowance.

(b) A PNA for individuals residing in the community. Individuals electing hospice services shall have an amount equal to the federal poverty level (FPL) protected as their personal needs allowance.

(c) An additional PNA for therapeutic wages. If the institutionalized individual earns therapeutic wages, an additional deduction from income equal to one-half of the monthly therapeutic wages, up to a maximum of $111, shall be applied and treated as an additional PNA protected for personal need.

(d) An additional PNA for court ordered child support. If the institutionalized individual is court ordered to pay child support an additional PNA is deducted in an amount equal to the court ordered support paid by the individual to meet their court ordered obligation. The additional PNA is applied only if a court ordered deduction was not made under another provision under the post eligibility process.

(e) The community spouse income allowance. The Department applies the formula and policies under §1924 of the Social-Security Act, and Rule 65A-1.716, F.A.C., to compute the community spouse income allowance after the institutionalized spouse is determined eligible for institutional care benefits.

(f) The community spouse’s excess shelter and utility expenses. The amount by which the sum of the spouse’s expenses for rent or mortgage payment (including principal and interest), taxes and insurance and, in the case of a homeowner’s association, condominium or cooperative, required maintenance charge, for the community spouse’s principal residence and utility expense exceeds thirty percent of the amount of the Minimum Monthly Maintenance Needs Allowance (MMMNA) is allowed. The utility expense is based on the current Food Assistance Program’s standard utility allowance as referenced in subsection 65A-1.603(2), F.A.C.

(g) For community hospice, spousal allowance. This allowance is equal to the Supplemental Security Income (SSI) Federal Benefit Rate (FBR), minus the spouse’s monthly income. A portion of the individual’s income equal to 100% of the Federal Poverty Level (FPL), minus the spouse and dependent’s income, if the individual has a spouse and dependent child in the community. (For FPL criteria, refer to subsection 65A-1.716(1), F.A.C.)

(h) For ICP or institutional Hospice, income is protected for the month of admission and discharge, if the individual’s income for that month is obligated to directly pay for their cost of food or shelter outside of the facility.

(i) Uncovered medical expense deduction. The following policy will be applied in considering medical deductions for institutionalized individuals and individuals receiving HCBS services to calculate the amount allowed for the uncovered medical expense deduction:

For institutionalized persons or residents of medical institutions and intermediate care facilities, the deduction includes:

a. Any premium, deductible, or coinsurance charges or payments for health insurance coverage.

b. For other incurred medical expenses, the expense must be for a medical or remedial care service and be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2), F.A.C., and be recognized in state law. For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be the amount of the deduction, not to exceed the maximum payment or fee recognized by Medicare, commercial payors, or any other third party payor, for the same or similar item, care, or service.

The expense must have been incurred no earlier than the three month period preceding the month of application providing eligibility.
The expense must not have been paid for under the Medicaid State Plan.
Other health insurance policies, including long term care insurance, are considered to be the first payor for medical items, care, or services covered by such policies and the remaining items can be used as an uncovered medical expense deduction. Therefore, to be deducted from the individual’s income, the individual must demonstrate that other insurance does not cover such medical items, care, or services.
The medical and remedial care expenses that were incurred as the result of imposition of a transfer of asset penalty is limited to zero.

(2) For the Program of All-Inclusive Care for the Elderly (PACE), the following deductions are applied to the individual’s income to determine patient responsibility:

(a) A deduction is made for the PNA based on the individual’s living arrangement as follows:

For an individual residing in the community, not in an assisted living facility (ALF), the PNA is equal to 300% of the FBR.
For an individual who is residing in an ALF, the PNA is computed using the ALF basic monthly rate (for three meals per day and a semi-private room), plus 20% of the FPL.
For an individual residing in a nursing home, the PNA is $130.

(b) A deduction is allowed when there is a spouse residing in the community for HCBS and ICP services.

For HCBS, a spousal deduction equal to the SSI standard FBR minus the spouse’s monthly income is allowed.
The Department will apply the formula and policies § 1924 of the Social-Security Act, and Rule 65A-1.716, F.A.C., to compute the community spouse income allowance after the institutionalized spouse is determined eligible for institutional care benefits.

(c) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

The service or item claimed as a deduction from the individual’s income must be a medical or remedial care service, be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.
For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be used as the deduction not to exceed the maximum payment or fee recognized by Medicare, commercial payers or any other third party payer for the same or similar item, care, or service.
Other resident health insurance policies will be treated as first payor and the beneficiary will have to demonstrate that the other insurance has not or will not cover the expense.
The medical or remedial care expenses that were incurred as the result of imposition of a transfer of assets penalty is limited to zero.

(d) If the institutionalized individual is court ordered to pay child support an additional PNA is deducted in an amount equal to the court ordered support paid by the individual to meet their court ordered obligation. Funds are protected only to the extent that the income was not already deducted under another provision in the post eligibility process.

(3) For the iBudget Florida waiver, the following deductions are applied to the individual’s income to determine patient responsibility in accordance with 42 CFR §435.726:

(a) A deduction is made for PNA in an amount that is equal to 300% of the FBR.

(b) A spousal deduction equal to the SSI standard FBR minus the spouse’s monthly income is allowed when the spouse is residing in the community.

(d) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

The service or item claimed as a deduction from the individual’s income must not be a medical or remedial care service, be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.
For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be used as the deduction not to exceed the maximum payment or fee recognized by Medicare, commercial payers or any other third party payer for the same or similar item, care, or service.
Other resident health insurance policies will be treated as first payor and the beneficiary will have to demonstrate that the other insurance has not or will not cover the expense.
The medical or remedial care expenses that were incurred as the result of imposition of a transfer of assets penalty is limited to zero.

(4) For the Statewide Medicaid Managed Care Long-Term Care Program, the following deductions are applied to the individual’s income to determine patient responsibility in accordance with 42 CFR §435.726:

(a) A deduction is made for the PNA based on the individual’s living arrangement as follows:

For an individual residing in the community, not in an ALF, the PNA is equal to 300% of the FBR.
For an individual who is residing in an ALF, the PNA is computed using the ALF basic monthly rate (for three meals per day and a semi-private room), plus 20% of the FPL.

(b) A deduction is allowed when there is a spouse residing in the community for HCBS and ICP services.

The Department will apply spousal impoverishment policy according to Section 1924 of the Social Security Act, Treatment of Income and Resources for Certain Institutionalized Spouses, as amended by Section 2404 of the Patient Protection and Affordable Care Act.
The Department will apply the formula and policies under §1924 of the Social Security Act, and Rule 65A-1.716, F.A.C., to compute the community spouse income allowance after the institutionalized spouse is determined eligible for institutional care benefits.

(c) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

The service or item claimed as a deduction from the individual’s income must be a medical or remedial care service, be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.
For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be used as the deduction not to exceed the maximum payment or fee recognized by Medicare, commercial payers or any other third party payer for the same or similar item, care, or service.
Other resident health insurance policies will be treated as first payor and the beneficiary will have to demonstrate that the other insurance has not or will not cover the expense.
The medical or remedial care expenses that were incurred as the result of imposition of a transfer of assets penalty is limited to zero.

History

Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919, 409.961 FS. History–New 5-29-05, 8-12-15, Amended 9-30-18.

Fla. Admin. Code R. 65A-1.715 Emergency Medical Services for Aliens

(1) Aliens who would be eligible for Medicaid but for their immigration status are eligible only for emergency medical services. Section 409.901(10), F.S., defines emergency medical conditions.

(2) The Utilization Review Committee (URC) or medical provider will determine if the medical condition warrants emergency medical services and, if so, the projected duration of the emergency medical condition. The projected duration of the emergency medical condition will be the eligibility period provided that all other criteria are continuously satisfied.

(3) Emergency services are limited to 30 consecutive days without prior approval. For continued coverage beginning with the 31st day prior authorization must be obtained from the Agency for Health Care Administration (Medicaid Program Office).

History

Rulemaking Authority 409.919 FS. Law Implemented 409.904, 409.919 FS. History–New 10-8-97.

Fla. Admin. Code R. 65A-1.716 Income and Resource Criteria

(1) The monthly federal poverty level figures based on the family size are as follows:

Family

Size

88% of Poverty Level

100% of Poverty Level

120% of Poverty level

133% of Poverty Level

135% of Poverty Level

185% of Poverty Level

200% of Poverty Level

$945

$1,074

$1,288

$1,428

$1,449

$1,986

$2,147

$1,278

$1,452

$1,742

$1,931

$1,960

$2,686

$2,904

$1,830

$2,434

$3,386

$3,660

$2,208

$2,938

$4,086

$4,417

$2,587

$3,441

$4,786

$5,174

$2,965

$3,944

$5,486

$5,930

$3,344

$4,447

$6,186

$6,687

$3,722

$4,950

$6,886

$7,444

$4,100

$5,453

$7,585

$8,200

$4,478

$5,957

$8,285

$8,957

$4,857

$6,460

$8,985

$9,714

$5,235

$6,963

$9,685

$10,470

For each addtl. person

$329

$374

$448

$497

$691

$747

(2) Monthly income levels for Family-Related and SSI (Supplemental Security Income)-Related Medically Needy Income Levels (MNIL) are by family size as follows:

Family Size

Monthly Income Level

Family-Related MNIL

SSI-Related MNIL

$180

$289

$180

$241

$387

$241

$303

$486

$364

$585

$426

$684

$487

$783

$549

$882

$610

$981

$671

1079

$733

1179

Add for each addtl. person

$62

$100

Exception: In determining eligibility for a pregnant woman, the income limits for Monthly Income Level and MNIL used shall be increased to the higher limit corresponding to the applicant’s actual family size. Family size shall include each anticipated unborn child as a family member.

(3) The resource limits for the Medically Needy program are as follows:

(a) Family-Related Medicaid: $0

(b) SSI-Related Medicaid:

$5,000 per individual; and
$6,000 per couple

Family Size

Monthly Asset Level

$5,000

$6,000

$6,500

$7,000

$7,500

$8,000

$8,500

$9,000

$9,500

For each additional person add $500.

Exception: In determining eligibility for a pregnant woman, the resource limit used shall be increased to the higher limit corresponding to the applicant’s actual family size, including each anticipated unborn child as a family member.

(4) The maximum resource limit is $2,000 for those individuals receiving Temporary Cash Assistance (TCA):

(a) Whose Medicaid coverage is based on payment standard income criteria. Refer to subsection 65A-1.716(2), F.A.C.; or

(b) Children living with their parent(s) and who, as children, would qualify for cash assistance except for their age. The maximum resource limit of $2,000 also applies to those coverage groups indicated in Rule 65A-1.703, F.A.C. However, there is no asset limit for the coverage groups specified in paragraphs 65A-1.703(3) through (5), F.A.C.

(5) The SSI-Related Medicaid Program Standards:

(a) SSI (42 U.S.C. §§1382 – 1383c) Resource Limits:

$2,000 per individual.
$3,000 per eligible couple, or per eligible individual with an ineligible spouse who is living together.

(b) The income limit which applies to an individual in Home and Community-Based Services (HCBS) Waivers, Institutional Care Programs (ICP), and Hospice is 300 percent of the Federal Benefit Rate (FBR) for individuals. For an individual enrolled in HCBS Working People with Disabilites (WPwD) who is employed and age 21 years or older, the financial standards are:

Income limit of 550 percent of the FBR, $4,367 for an eligible individual or $8,734 for an eligible couple.
Asset limit of $13,000 for an eligible individual or $24,000 for an eligible couple.

Resource Allocation. The amount of the couple’s total countable resources which may be allocated to the community spouse of an institutionalized person is equal to the maximum allowed by 42 U.S.C. §1396r-5(f)(2)(A).
Minimum Monthly Maintenance Needs Allowance (MMMNA). The minimum monthly maintenance needs allowance the Department recognizes for a community spouse is equal to 150 percent of the federal poverty level (FPL) for a family of two as set forth in 42 U.S.C. §1396r-5(d)(3)(A)(i) and (ii).
Excess Shelter Allowance. The community spouse’s shelter expenses must exceed 30 percent of the MMMNA to be considered excess shelter expenses to be included in the maximum income allowance: MMMNA × 30% = Excess Shelter Allowance, as defined in 42 U.S.C. §1396r-5(d)(3)(A)(ii). This standard changes July 1 of each calendar year.
Food Assistance Program Standard Utility Allowance. The amount specified in subsection 65A-1.603(2), F.A.C.
Cap of Community Spouse Needs Allowance. The MMMNA plus excess shelter allowance cannot exceed the maximum amount allowed under 42 U.S.C. §1396r-5(d)(3)(A)(C). This needs allowance changes January 1 of each year.

(d) The average monthly private pay nursing facility rate is $9,703.

(e) The average monthly Medicaid rate is $7,224.

(f) The following life expectancy tables are compiled from information published by the Office of the Chief Actuary of the Social Security Administration:

AGE

MALE LIFE EXPECTANCY

FEMALE LIFE EXPECTANCY

AGE

MALE LIFE EXPECTANCY

FEMALE LIFE EXPECTANCY

75.97

80.96

21.58

24.56

75.45

80.39

20.83

23.72

74.48

79.42

20.08

22.90

73.50

78.43

19.35

22.07

72.52

77.45

18.62

21.26

71.53

76.46

17.89

20.45

70.54

75.47

17.18

19.65

69.55

74.47

16.47

18.86

68.56

73.48

15.77

18.07

67.57

72.49

15.07

17.30

66.57

71.50

14.39

16.54

65.58

70.50

13.71

15.79

64.59

69.51

13.05

15.05

63.60

68.52

12.40

14.32

62.61

67.53

11.76

13.61

61.63

66.54

11.14

12.92

60.66

65.55

10.53

12.23

59.70

64.57

9.94

11.57

58.74

63.59

9.37

10.92

57.79

62.61

8.82

10.29

56.85

61.63

8.28

9.68

55.91

60.66

7.76

9.09

54.98

59.69

7.26

8.52

54.06

58.72

6.79

7.98

53.14

57.75

6.33

7.45

52.22

56.78

5.89

6.95

51.31

55.82

5.48

6.47

50.39

54.85

5.08

6.01

49.48

53.89

4.71

5.57

45.86

52.93

4.37

5.16

47.65

51.97

4.05

4.78

46.74

51.01

3.75

4.43

45.83

50.06

3.48

4.11

44.92

49.10

3.23

3.81

44.01

48.15

3.01

3.55

43.10

47.20

2.81

3.31

42.19

46.25

2.64

3.09

41.28

45.30

2.49

2.90

40.37

44.36

2.36

2.73

39.47

43.41

2.24

2.58

38.56

42.47

100

2.12

2.42

37.65

41.53

101

2.01

2.28

36.75

40.59

102

1.90

2.14

35.85

39.66

103

1.80

2.01

34.95

38.73

104

1.70

1.88

34.06

37.80

105

1.60

1.76

33.17

36.88

106

1.51

1.65

32.28

35.96

107

1.42

1.54

31.41

35.04

108

1.34

1.44

30.54

34.13

109

1.26

1.34

29.67

33.23

110

1.18

1.24

28.82

32.33

111

1.10

1.15

27.98

31.44

112

1.03

1.06

27.14

30.55

113

0.96

0.98

26.32

29.68

114

0.90

0.91

25.50

28.81

115

0.84

24.70

27.94

116

0.78

23.90

27.09

117

0.72

23.12

26.24

118

0.66

22.34

25.39

119

0.61

History

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 12-9-99, 2-15-01, 11-25-01, 7-28-02, 4-1-03, 9-10-03, 8-30-04, 8-10-06, 4-15-12, 10-16-12, 11-4-12, 9-18-13, 2-26-20, 9-22-21.

Fla. Admin. Code R. 65A-1.720 Medicare Buy-In Demonstration Project

History

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904 FS. History–New 11-11-99, Repealed 5-18-04.

Fla. Admin. Code R. 65A-1.730 Medikids

(1) The department has elected to contract with the Healthy Kids Corporation for MediKids eligibility determinations.

(2) The application for the MediKids program will be the Florida Healthy Kids and Florida KidCare Program Application.

History

Rulemaking Authority 409.818 FS. Law Implemented 409.818 FS. History–New 4-5-99.

Fla. Admin. Code R. 65A-1.801 Purpose

History

Rulemaking Authority 409.026 FS. Law Implemented 409.185, 409.235 FS. History–New 8-3-94, Formerly 10C-1.801, Repealed 10-8-98.

Fla. Admin. Code R. 65A-1.802 Administrative Definitions and Acronyms Applicable to RAP

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.802, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.803 General Eligibility

Determinations of eligibility for RAP and program specific definitions required in these eligibility determinations are conducted in accordance with 45 C.F.R., Chapter IV, Part 400, Subparts A through G, and Part 401. Additionally, the specific definition of a Cuban/Haitian entrant as used in this program is found in Section 501e of the Refugee Education Assistance Act of 1980.

History

Rulemaking Authority 402.86 FS. Law Implemented Specific Appropriation 435, 2000 General Appropriations Act. History–New 8-3-94, Formerly 10C-1.803, Amended 2-15-01.

Fla. Admin. Code R. 65A-1.804 Citizenship

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.804, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.805 Employment Registration and Participation in Employment and Language Training Programs

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.805, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.806 Need Requirement

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.806, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.807 Assets

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.807, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.808 Income

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.808, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.809 Budgeting

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 8-3-94, Formerly 10C-1.809, Repealed 2-15-01.

Fla. Admin. Code R. 65A-1.900 Overpayment and Benefit Recovery

This section sets forth the administrative policies applicable to the establishment and recovery of overpayments in the food assistance and cash assistance programs.

(1) Administrative Definitions Applicable to Overpayment and Benefit Recovery.

(a) Adult, for the purpose of this rule, is:

Eighteen years of age or older;
A teen parent receiving public assistance for themselves as an adult;
An emancipated minor; or
An individual who has been married even if the marriage ended in divorce.

(b) Cash Assistance, for the purposes of this rule includes, Temporary Cash Assistance, Work and Gain Economic Self-Sufficiency, Aid to Families with Dependent Children and Temporary Assistance for Needy Families.

(c) Delinquency, for the purposes of the Treasury Offset Program (TOP), is the failure to sign a Voluntary Repayment Agreement.

(d) Intentional Program Violation (IPV) or fraud, is defined pursuant to sections 414.39(1), (2) and (4), F.S., 7 C.F.R. §273.16(c) and 45 C.F.R. §235.110(a)(2). 7 C.F.R. §273.16 (2016) and 45 C.F.R. §235.110 (2016) http://www.flrules.org/Gateway/reference.asp?No=Ref-08254, are incorporated by reference and may be obtained by contacting the Office of Public Benefits of Integrity, Department of Children and Families, 2415 N. Monroe Street, Suite 400, Tallahassee, Florida 32303.

(e) Overpayment, is the amount of public assistance received for which an individual or assistance group is not entitled.

(f) Direct Reimbursement, Repayment is the repayment by an individual or assistance group to the Department or contractor for an overpayment claim. Repayment may be sought by the individual payee or assistance group members who met the criteria in subsection (1) of this rule.

(g) Recoupment of Benefits, is the deduction of repayment amounts from benefits prior to disbursing them.

(h) Refusal to Repay, occurs when the individual responsible for repayment:

Received notification of the overpayment or request for Voluntary Repayment Agreement as specified in subsection (8), and subsequently:

a. Fails to comply with the time frames as set forth in paragraph (8)(c);

b. Advises the Department either orally or in writing that they refuse to repay the amount owed; or

c. Fails to sign and return a Voluntary Repayment Agreement and repayment, which must be made in whole or in part by payment.

(i) Notification, for purposes of this rule, is any correspondence from the Department that advises an individual or assistance group of the status of an overpayment. Any notification will be in compliance with 7 C.F.R. §273.18(e)(3). 7 C.F.R. §273.18 (2016) http://www.flrules.org/Gateway/reference.asp?No=Ref-08254, is incorporated by reference and may be obtained by contacting the Office of Public Benefits of Integrity, Department of Children and Families, 2415 N. Monroe Street, Suite 400, Tallahassee, Florida 32303.

(j) Extreme hardship policy, only to cash assistance agency errors and occurs when monthly expenses for basic maintenance needs exceed monthly income. Expenses taken into account include food, shelter, medical, transportation, clothing and personal and household incidentals, child or adult care and court ordered child support payments. Any expenses paid by someone outside the household are not used. The Department requires verification documentation for all extreme hardships.

Food expenses exclude food assistance benefits.
Shelter expenses include rent, mortgage, mandatory maintenance or membership fees; loan repayments, including interest for the purchase of a mobile home; property taxes and insurance on the home; cost of fuel, electricity, water, sewerage and garbage pickup; and the basic service fees for one telephone.
Medical expenses include those not paid by insurance.
Transportation expenses include those necessary for household vehicles or public transportation.
Clothing and personal and household incidental expenses include those necessary for individuals in the household.
Child or adult care expenses include those costs paid to someone not residing in the household.
Court ordered child support payment expenses include those paid to someone not residing in the household.

(2) Individuals Responsible for Repayment of Overpayment.

(a) Individuals who received cash assistance overpayments as an adult will be responsible for repayment of the overpayment.

(b) Individuals who received food assistance overpayments as an adult will be responsible for repayment as specified in 7 C.F.R. §273.18(a)(4) (2015), incorporated by reference.

(d) Adults who apply for and/or receive assistance on behalf of others.

(e) Authorized/Designated Representative, for purposes of this rule, means an individual who has knowledge of the assistance group’s circumstances and is authorized to act responsibly on their behalf.

(3) Monthly Repayment Amounts.

(a) The monthly repayment amounts of all public assistance are subject to negotiation.

Any individual or assistance group adversely affected by the preceding subparagraph is entitled to a departmental review or hearing pursuant to Chapter 65-2, F.A.C.

(b) Any adult who applied for and/or received Medicaid benefits for themselves or the assistance group is liable or responsible for repayment. They will negotiate a repayment agreement with the Department or contractor.

(4) Methods of Repayment.

(a) The methods of repayment of cash assistance overpayment are as follows:

As specified in 45 C.F.R. §233.20(a)(13) (2016), 45 C.F.R. §233.20 (2016) http://www.flrules.org/Gateway/reference.asp?No=Ref-08254, is incorporated by reference and may be obtained by contacting the Office of Public Benefits of Integrity, Department of Children and Families, 2415 N. Monroe Street, Suite 400, Tallahassee, Florida 32303; or
Through application of child support credit. Child support credit exists when child support collected and retained by the state during any month in which overpayment occurred exceeds the amount of cash assistance to which the assistance group was entitled for that month after computation of the overpayment has been completed. The excess amount of child support can, if requested by the absent parent or recipient, be credited as repayment and the amount owed by the individual responsible for repayment will be reduced by that amount. In addition, all or part of the overpayment claim can be satisfied should the absent parent of an overpaid assistance group repay to the Department all cash assistance benefits received on behalf of the overpaid assistance group. Child support credit is not applicable to RAP overpayments.

(b) The method of repayment of all food assistance overpayment will be as specified in 7 C.F.R. §273.18(f)-(g).

(5) Refusal to Repay. When an individual or assistance group refuses to make repayment after a request to do so, the Department, at its discretion, may take appropriate civil action against the income or resources of the individual or assistance group involved.

(6) Compromising Food Assistance Claims. Effective August 1, 2001, a food assistance claim or any portion of a food assistance claim may be compromised with the exception of court ordered restitutions or IPVs. The Department reserves the right to approve or not approve the compromise.

(a) Individuals with an overpayment claim in food assistance may request a compromise of their claim using the compromise request included in the Notice of Case Action Form BVFSOE. If a prior request has been decided, then any pending request is bound by the prior decision, unless the individual or assistance group can demonstrate a change in circumstances.

(b) For purposes of a compromise request made pursuant to this rule, the Department will determine that the economic household circumstances reasonably demonstrate the overpayment claim will not be paid within three years of being notified of the overpayment claim. For purposes of this paragraph, the three-year period is 36 months after the date of the Notice of Case Action. A claim can and will be compromised to zero dollars when at least one of the following is present:

The death or prognosis of death of any liable individual within three years of being notified;
Pending litigation which shall not include administrative fair hearings or appeals of final orders from administrative fair hearings but does include proceedings of a bankruptcy court, that involves any liable individual’s obligation to repay the overpayment within three years of being notified;
Any liable individual is sentenced to a period of incarceration that will expire after the three-year period the overpayment is expected to be paid;
The liable individual(s) sole household’s income is based only on either elderly age or disability projecting a fixed, limited economic potential to repay the overpayment within three years; or
Other reasons for a compromise. The Department will not speculate about the liable individual’s ability to repay the overpayment. If the Department must speculate, the Department will deny the request and provide written notice of the decision.

(c) At the time of the compromise request, the individual or assistance group shall submit verification of subparagraphs 1. through 5., above. When a decision is made concerning the compromise request, the Department will provide written notice of the decision including information about hearing appeal rights.

(7) Computation of Overpayment.

(a) Overpayment computations will be made using the applicable program policies in effect during the certification period in which the overpayment occurred.

(b) When the Department determines that it needs additional documentation of expenses to compute overpayment, it will notify the individuals or assistance groups responsible for repayment of the information needed. The individual or assistance groups must provide any requested items within the time requested by the Department, or the expense will not be considered in computing the overpayment amount.

(8) Notification of Overpayment. The Department must notify the individuals or assistance groups responsible for repayment of overpayment in writing that overpayment exists and that they are required, by law, to repay the entire amount pursuant to Section 414.41(1), F.S., or that they may seek compromise of a food assistance overpayment pursuant to 7 C.F.R. §273.18(e)(3), and (7).

(a) The individual has a right to an administrative hearing in accordance with the Department’s hearings procedures in Chapter 65-2, F.A.C.

(b) The Department will send notification of overpayment to current and prior recipients by regular mail at the address the Department sends benefits or correspondence. The Department presumes delivery unless the postal service returns the notice to the Department. For the purposes of this rule, mail shall be defined as outlined in subsection 65A-1.203(12), F.A.C.

(c) The assistance group or individuals that receive notification will be considered to have refused to repay when they fail to contact the Department within 30 days from the date of notification for all food assistance or cash assistance errors including cash assistance errors for the Refugee Assistance Program (RAP) and Optional State Supplementation (OSS) Programs.

(9) Claim Thresholds. The Benefit Recovery Program will not pursue a claim in bankruptcy proceedings if the amount of the claim is at or below $1,250.

(10) Determination of Intentional Program Violation.

(a) Pursuant to Sections 414.33, 414.36 and 414.39, F.S., when the Department has information that an individual or assistance group has committed fraud or an IPV, it will refer the case to the Department of Financial Services (DFS) for investigation. In cases where DFS determines that an individual has committed fraud in the cash assistance or Food Assistance Programs, it will pursue a determination of IPV through either court action, administrative disqualification hearing, or both, where permitted by 7 C.F.R. §273.16(a) (2015), 45 C.F.R. §235.110 (2015) and Section 414.41, F.S. DFS will pursue a determination of IPV through court action in instances where it determines that an individual has committed fraud in the Medicaid Program.

(b) Individuals found by an administrative fair hearing officer or court to have committed an act of IPV while receiving, or attempting to receive, food assistance, cash assistance, or both will be disqualified from participation in the program(s) under which that act was committed or attempted in accordance with 7 C.F.R. §273.16(b) (2016), or Section 414.41, F.S.

(11) Treasury Offset Program.

(a) The Department will refer individuals who owe past-due, legally enforceable federal food assistance overpayment debts to the U.S. Department of the Treasury for purposes of collection of such debt through offset against federal payments pursuant to 26 U.S.C. §6402 (d)(1)-(2) and (f). Referral of individuals owing such debt will be completed in accordance with procedures and criteria contained in 26 C.F.R. §301.6402-6 and 31 C.F.R. Part 5 Subpart C et. seq., as provided for in 7 C.F.R. §3.46. 26 U.S.C. §6402 (2016), 26 C.F.R. §301.6402-6 (2016), 31 C.F.R. Part 5 Subpart C (2016) and 7 C.F.R. §3.46 (2016) http://www.flrules.org/Gateway/reference.asp?No=Ref-08254, are incorporated by reference and may be obtained by contacting the Office of Public Benefits of Integrity, Department of Children and Families, 2415 N. Monroe Street, Suite 400, Tallahassee, Florida 32303.

(b) A past-due, legally enforceable debt exists when an individual in receipt of overpayment as defined in section 414.41(1), F.S. and paragraph (1)(e) of this rule, is at least 120 days delinquent in repayment of the such overpayment, and the overpayment has not been discharged through administrative or legal action.

(c) The Department must make a reasonable attempt as defined in 26 C.F.R. §301.6402-6(d), to notify individuals owing such debt that:

The debt is past due; and,
Unless a signed Voluntary Repayment Agreement and payment is received within 60 days from the date on the notification, it will refer the debt to the U.S. Department of the Treasury for offset; and,
The individual debtor has 60 days from the date of notification to request a review in writing, via presentation of evidence to the Department, that all or part of the debt is not past-due or legally enforceable.

(d) The Department will consider evidence presented timely by an individual in receipt of notification described in subparagraph (11)(c)3., above, that indicates all or part of their debt is not past-due or legally enforceable, and will make a determination as to the status of that debt prior to referral for offset. The Department will notify the individual within thirty (30) days from the receipt of the review request. If it is found that the debt is past due and legally enforceable, the individual will be notified that they may request a Federal review by Food and Nutrition Services (FNS). This consideration process is separate and apart from the fair administrative hearings appeals process and will address only the past-due status or legal enforceability of all or part of the debt.

(e) The Department will provide a telephone number for use in obtaining information concerning the offset.

(12) The following forms, incorporated by reference, and, unless otherwise stated, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-08254, are used by the Department in the process of establishing and recovering overpayment:

(a) Request for Additional Information, CF-ES 3400, 04/2021, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17803;

(b) Waiver of Administrative Disqualification Hearing With a Program Loss, CF-ES 3410, Feb 2018, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09358;

(c) Waiver of Administrative Disqualification Hearing Without a Program Loss, CF-ES 3410A, Feb 2018, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09359;

(d) Disqualification Consent Agreement, CF-ES 3414, 07/2021, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17804;

(e) Notice of Compromise Decision, CF-ES 3110, 03/2010, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17805; and,

(f) Request for Information to Determine Compromise, CF-ES 3111, 03/2010 , available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17806.

(g) Notice of Case Action, CF-ES:

BVFSOI, 12/2010;
BVFSOE, 12/2010;
BVCAOP, 12/2008;
BVMAOP, 12/2008;
BVPFBI, 12/2008;
BVPFBE, 12/2008;
BVPCBL, 12/2008;
BVPMBL, 12/2008;
BV06D5, 12/2008;
BV10D5, 12/2008;
BV06D6, 12/2008;
BV10D6, 12/2008;
BV06D9, 12/2008;
BV10D9, 12/2008;
BV06DF, 12/2008;
BV10DF, 12/2008;
BV06DA, 12/2008;
BV10DA, 12/2008;
BV06DG, 12/2008;
BV10DG, 12/2008;
BV06DB, 12/2008;
BV10DB, 12/2008;
BV06DH, 12/2008;

24 BV10DH, 12/2008;

25 BV11OH, 12/2008;

BV11OD, 12/2008;
BVEBBL, 12/2008;
BV12OS, 12/2008.

(h) Treasury Offset Notification Letter 9/2016; and,

(i) Notice of Treasury Offset, CF-ES 3416, 03/2023, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17807;

(j) Management Review Notice, CF-ES 2341, Feb 2018, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09355;

(k) Trafficking Waiver of an Administrative Hearing, CF-ES 2372, Feb 2018, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09356; and

(l) Notification of Intent to Disqualify, CF-ES 3056, September 2018, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10089.

(m) Copies of the forms and materials incorporated by reference are available from the Office of Public Benefits Integrity Headquarters, 2415 N. Monroe Street, Suite 400, Tallahassee, Florida 32303. Forms are also available on the Department’s website at https://myflfamilies.com/forms.

History

Rulemaking Authority 414.41, 414.45 FS. Law Implemented 414.31, 414.36, 414.41 FS. History–New 7-21-92, Amended 1-5-93, 9-5-93, Formerly 10C-1.900, Amended 7-9-98, 4-2-00, 2-26-02, 3-18-03, 7-21-05, 1-19-09, 6-21-10, 5-24-17, 6-4-18, 11-26-18, 4-27-25.

Fla. Admin. Code R. 65A-1.901 Public Assistance Fraud Reward Program

(1) Intake Documentation. To facilitate tracking, eligible fraud reports are submitted using the CF-ES Form 3415, Report of Suspected or Known Public Assistance Fraud, 12/2014, incorporated by reference, https://www.flrules.org/Gateway/reference.asp?No=Ref-05434, and sent to the Department of Children and Families (Department); or by submitting the online form. The form can be completed online at the Department’s fraud reporting website, www.myflfamilies.com/ReportFraud, or mailed to DCF ACCESS Central Mail Center Fraud Report, P.O. Box 1770, Ocala, FL 34478-1770, or faxed to (850)487-0800. Reports not received through the Department’s fraud reporting website and those received by the Department of Financial Services (DFS) or the Florida Department of Law Enforcement (FDLE) will be submitted by a state employee on behalf of the reporter using the online form. Copies of forms and materials incorporated by reference in this rule may be obtained by the public from the Office of Public Benefits Integrity (OPBI) at 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700. Forms are also available on the Department’s website at http://www.dcf.state.fl.us/DCFForms/Search/DCFFormSearch.aspx.

(a) Once submitted, the report will be assigned a tracking number and a notification will be sent to the reporter containing the tracking number, and describing the responsibilities of the reporter to be eligible for the Public Assistance Fraud Reward Program.

(b) A reporter has the opportunity to opt-out of the reward program or to report the allegation anonymously. If a reporter chooses either of these options, the report will be processed, but the reporter will not be eligible to receive a reward.

(c) State employees and individuals under contract with the state are not eligible to be public assistance fraud report reward recipients if the information provided was obtained in the performance of their official duties.

(2) Review Process and Reward Criteria.

(a) In determining whether a reward is due to the reporter, the Department will meet to review the reported information and verify the following:

The report was made to the Department, the Department of Financial Services, or the Department of Law Enforcement;
The results of the reported information indicated a criminal violation of public assistance laws pursuant to Section 414.39, F.S.;
The reported information lead to the recovery of a fine, penalty or forfeiture of property;
The person who reported the information is identifiable for payment, and has not declined the reward;
The report contained original information that had not been previously reported or otherwise known to the Department, DFS, or FDLE.

(b) Only one award will be granted per case.

(c) The award amount shall be ten percent (10%) of the amount of the recovery collected by the Department, or $500,000, whichever is less, for a single case.

(3) Reward Disbursement. Subject to the availability of funds in the Federal Grants Trust Fund, in compliance with the requirements in Section 414.39(11), F.S., the Department will calculate the amount of the reward, and will request issuance of a check drawn on the Department’s Federal Grants Trust Fund. DFS will issue the check to the reporter.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.39 FS. History–New 7-9-15.

Chapter 65A-2 OPTIONAL STATE SUPPLEMENTATION

Fla. Admin. Code R. 65A-2.022 Rights and Responsibilities

(1) Any individual has the right to apply for Optional State Supplementation (OSS) and, if found eligible according to these rules and Section 409.212, F.S., to receive an established monthly payment. Individuals residing in Assisted Living Facilities (ALF) and Adult Family Care Homes (AFCH) are eligible to receive OSS payments to assist with the cost of room and board. Individuals residing in facilities covered by subsection 65A-2.032(7), F.A.C., and within the coverage groups specified in subsections 65A-2.033(1) through (4), F.A.C., are also eligible to receive OSS payments. Additionally, individuals residing in Mental Health Residential Treatment Facilities (MHRTFs) enrolled as qualified Medicaid providers of Assistive Care Services (ACS) with the Agency for Health Care Administration (AHCA) are eligible to receive OSS payments to assist with room and board. Individuals residing in MHRTFs that are not enrolled as qualified Medicaid providers of ACS by AHCA, under subsections 65A-2.033(3) and (4), F.A.C., are eligible for OSS payments that are inclusive of room, board and personal care. The individual’s use of the personal needs allowance is not restricted.

(2) An authorized representative as defined in subsection 65A-1.203(9), F.A.C., may be designated to act on behalf of the individual in any matter pertaining to the individual’s OSS eligibility. Designation may be made by the individual, or a person knowledgeable of the individual’s affairs may be self-designated as the individual’s representative. The authorized representative may be identified on the Appointment of a Designated Representative, CF-ES 2505, 07/2013, http://www.flrules.org/Gateway/reference.asp?No=Ref-03155, incorporated by reference. The following non-English versions of the Appointment of a Designated Representative form are incorporated by reference: CF-ES 2505H (Creole), 07/2013, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13629, and CF-ES 2505S (Spanish), 07/2013, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13630.

(3) The individual is responsible for providing all facts necessary to establish initial and continuing eligibility. The individual is also responsible to notify the Department of any changes in circumstances that could affect their eligibility within ten days of the date of the change.

(4) The Department is responsible for determining eligibilty within the required time standard in accordance with subsections 65A-2.023(1) and (2), F.A.C., equitable treatment in accordance with Rules 65A-1.204 and 65A-2.031, F.A.C., and timely notification in accordance with subsection 65A-2.023(2), F.A.C., of any decision regarding an individual’s payment or eligibility status.

(5) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.22, 10C-2.022, Amended 12-16-01, 5-14-02, 10-2-13, 10-26-21.

Fla. Admin. Code R. 65A-2.023 Application and Determination of Eligibility

(1) An individual applying to receive an Optional State Supplementation (OSS) payment must submit an ACCESS Florida Application, CF-ES 2337, 08/2016, incorporated by reference in Rule 65A-1.205, F.A.C. Once the completed, dated and signed application is received, and date stamped as received by the Department, the application process begins.

(2) Applications are processed and the eligibility decision is made in accordance with the standards in Rule 65A-1.205, F.A.C., with the exception that the ACCESS Florida Application is the application for the OSS Program. The individual is notified of the eligibility decision by a Notice of Case Action, CF-ES 2235, 02/2012, http://www.flrules.org/Gateway/reference.asp?No=Ref-01205, incorporated by reference. The following non-English versions of the Notice of Case Action are incorporated by reference: CF-ES 2235H (Creole), 02/2012, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13627, and CF-ES 2235S (Spanish), 02/2012, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13628.

(3) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.23, Amended 2-9-88, Formerly 10C-2.023, Amended 12-16-01, 6-4-12, 10-26-21.

Fla. Admin. Code R. 65A-2.024 Determination of Continued Eligibility

(1) The individual receiving Optional State Supplementation (OSS) must notify the Department of changes in circumstances as indicated in subsection 65A-2.022(3), F.A.C. The Department, in cooperation with the individual, must redetermine the individual’s eligibility for continued assistance at least annually.

(2) Individuals who do not cooperate with the Department by providing required information or documentation shall have their case terminated, as continuing eligibility cannot be established.

(3) If an individual leaves the special living arrangement for a period of 30 consecutive days, the individual is no longer eligible for continued OSS benefits and must reapply in order for their eligibility to be determined.

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Amended 10-7-80, Formerly 10C-2.24, 10C-2.024, Amended 12-16-01.

Fla. Admin. Code R. 65A-2.031 Advance Notice: Written Ten Day Advance Notice

(1) Written notification must be given or mailed to an individual receiving Optional State Supplementation ten days in advance of action to terminate or reduce the payment.

(2) Exception. Conformity to ten day advance notice is waived in the following situations, but written notification must be given or mailed to the individual or their authorized representative prior to the effective date of the action:

(a) When termination is due to death;

(b) When an individual or their authorized representative requests termination or reduction of assistance in writing;

(c) When the Department is unable to locate an individual as evidenced by the return of a letter of a recent date, with an indication that the letter could not be delivered due to no forwarding address, and no further information for locating the individual is available;

(d) When an administrative or fair hearing has been denied, the benefits that were continued without reduction pending the outcome of the hearing may be reduced with no advance notice of adverse action to the individual, or

(e) When systems transactions fail to reduce or terminate assistance correctly and notice has previously been given.

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.31, 10C-2.031, Amended 12-16-01.

Fla. Admin. Code R. 65A-2.032 Optional State Supplementation Eligibility Criteria

(1) An eligible individual must be age 65 or older, or age 18 or older and blind or disabled as defined by Title XVI of the Social Security Act (SSA). Federal disability criteria are found at 20 C.F.R. §§416 et seq.

(2) An eligible individual must be living in the state of Florida with the intent to remain.

(3) An eligible individual must be a United States citizen or a qualified noncitizen as defined in 8 U.S.C. §1641(b).

(4) An eligible individual must have income within standards established by the Department in subsection 65A-2.036(3), F.A.C.

(5) An eligible individual must have assets within SSA Title XVI standards for Supplemental Security Income (SSI).

(6) An individual must apply for and seek a determination of eligibility for all other monetary benefits for which they may be entitled or otherwise potentially eligible as required by 20 C.F.R. §416.210 for the SSI Program and by 42 C.F.R. §435.608 for the Medicaid Program.

(7) An eligible individual must be living in a licensed Assisted Living Facility as defined in Section 429.02(5), F.S.; a licensed Adult Family Care Home as defined in Section 429.65(2), F.S.; or a licensed Mental Health Residential Treatment Facility as defined in Section 394.67(23), F.S. Additionally, the facility must meet the individual’s needs based on objective medical and social evaluations and care plans, in accordance with Chapter 59A-36, 59A-37 or 65E-4, F.A.C., respectively.

(8) Pursuant to Section 429.67(8), F.S., the Department of Children and Families will refer residents who receive Optional State Supplementation (OSS) to adult family care homes by providing the resident with the Adult Family Care Home Referral Notice, CF-ES 2202, 08/2009, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13625. The following non-English versions of the Adult Family Care Home Referral Notice are incorporated by reference: CF-ES 2202H (Creole), 08/2009, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13625, and CF-ES 2202S (Spanish), 08/2009, http://www.flrules.org/Gateway/reference.asp?No=Ref-13626.

(9) When appropriated OSS funding is insufficient to meet fiscal demands, a proportional reduction will be applied to OSS payments, but shall not affect maintenance of effort required per 42 U.S.C. §1382g.

(10) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.212(7), 429.67(8) FS. Law Implemented 409.212, 429.67(8) FS. History–New 1-1-77, Amended 9-29-81, 10-31-83, Formerly 10C-2.32, Amended 9-30-86, Formerly 10C-2.032, Amended 12-16-01, 2-25-10, 10-26-21.

Fla. Admin. Code R. 65A-2.033 Optional State Supplementation Coverage Groups

To be determined eligible for Optional State Supplementation (OSS), an individual must qualify under one of the following coverage groups.

(1) The individual must be eligible for and receiving a check from the Supplemental Security Income (SSI) Program administered by the Social Security Administration. The Department accepts receipt of SSI as meeting all factors of OSS eligibility criteria in Rule 65A-2.032, F.A.C., except age and placement need as specified in subsections 65A-2.032(1) and (7), F.A.C., which must be verified by Department staff.

(2) The individual must meet all SSI and OSS eligibility criteria, except for income which must be equal to or less than the OSS income standard established by the Department. These individuals must meet eligibility criteria in Rule 65A-2.032, F.A.C.

(3) The individual must have been eligible for and receiving Aid to the Aged, Blind or Disabled from the state as of December 1973. This federally mandated coverage group did not qualify for the same level of benefits under SSI in 1974. For this coverage group, the special living facility criteria at subsection 65A-2.032(7), F.A.C., does not apply.

(4) The individual must: reside in an Assisted Living Facility or Mental Health Residential Treatment Facility; have been eligible for and receiving OSS payments for August 2001; have become ineligible for OSS as of September 2001 solely because their income exceeds the applicable OSS income standard of $609.40; and, not be categorically eligible for full Medicaid benefits as of September 2001. Additionally, in regard to an Adult Family Care Home (AFCH), the individual must: reside in an AFCH; have been eligible for and receiving OSS payment for December 2001; have become ineligible for OSS as of January 2002, solely because their income exceeds the applicable OSS income standard of $623.40; and, not be categorically eligible for full Medicaid benefits as of January 2002. As long as the individual continues to meet all OSS eligibility criteria and the income standard test in paragraph 65A-2.036(3)(b), F.A.C., they will remain eligible for payment under the provider rates in paragraph 65A-2.036(4)(b), F.A.C. Once an OSS recipient no longer meets all OSS eligibility criteria or the income standard in paragraph 65A-2.036(3)(b), F.A.C., they will no longer be eligible under this coverage group.

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.33, Amended 9-30-86, 2-9-88, Formerly 10C-2.033, Amended 12-16-01, 5-14-02.

Fla. Admin. Code R. 65A-2.034 Definitions of Special Living Arrangements

History

Rulemaking Authority 409.212(7) FS. Law Implemented 410.212 FS. History–New 1-1-77, Formerly 10C-2.34, Amended 9-30-86, 2-9-88, Formerly 10C-2.034, Repealed 12-16-01.

Fla. Admin. Code R. 65A-2.035 Income Calculation

(1) To be determined eligible for Optional State Supplementation, an individual must not have gross monthly income, after the following exclusions, in excess of Department standards, as found in subsection 65A-2.036(3), F.A.C.:

(a) Gross income, less an earned income exclusion of $65 plus one-half of the remaining earned income;

(b) Other federal exclusions to the individual’s income; and,

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Amended 9-29-82, Formerly 10C-2.35, Amended 1-27-91, Formerly 10C-2.035, Amended 12-16-01.

Fla. Admin. Code R. 65A-2.036 Optional State Supplementation Base Provider Rates and Program Standards

(1) The Department establishes the base provider rates for specialized living arrangements (the amount the individual is to pay the facility) specified in subsection (4), below, within funds appropriated by the Legislature. Base provider rates may vary depending upon type of specialized living facility and covered services in such facilities.

(2) Within the funds appropriated by the Legislature, Optional State Supplementation (OSS) eligible individuals receive a standard personal needs allowance (PNA), the amount the individual keeps for personal needs. The PNA is established by Legislative proviso language. The individual’s PNA does not vary due to type of specialized living facility and covered services in such facilities.

(3) Optional State Supplementation Program Financial Standards. Optional State Supplementation Program financial standards are subject to Florida legislative appropriations and federal cost-of-living adjustments.

(a) The monthly income eligibility standard for residents of Assisted Living Facilities (ALFs), Adult Family Care Homes (AFCHs) and, except as specified in paragraph (b), below, Mental Health Residential Treatment Facilities (MHRTFs) is $1,045.40.

(b) The monthly income eligibility standard for residents of MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of Assistive Care Services (ACS), and for individuals with coverage under subsections 65A-2.033(3) and (4), F.A.C., is $1,152.00.

(4) Optional State Supplementation Base Provider Rates. Optional State Supplementation base provider rates are subject to Florida legislative appropriations and federal cost-of-living adjustments.

(a) For ALFs, AFCHs and, except as specified in paragraph (b), below, MHRTFs, the monthly base provider rate is $991.40 and is inclusive of room and board only.

(b) For MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of ACS, and for the individuals covered under subsections 65A-2.033(3) and (4), F.A.C., the monthly base provider rate is $1,152.00 and is inclusive of room, board and personal care.

(5) To calculate the amount of the OSS payment, the base provider rate is added to the standard PNA to determine the individual’s total needs. From this sum, the individual’s gross income, minus the allowable exclusions at Rule 65A-2.035, F.A.C., is subtracted, resulting in the amount of the OSS payment.

(6) Payment for the month of admission to the special living arrangement shall be prorated if the month of admission is the month of application or later. For months other than the month of admission, payment begins the first day of the month.

(7) The monthly income eligibility standards of paragraphs (3)(a) and (b), above, and the base provider rates established at subsection (4) above, shall be increased by the annual cost-of-living adjustment to the federal benefit rate, provided the average state optional supplementation contribution does not increase as a result.

(8) The payment is issued monthly through an automated delivery system.

(9) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Amended 9-27-79, 10-7-80, 9-29-81, 9-29-82, 10-31-83, 11-28-83, 9-30-84, 10-1-85, Formerly 10C-2.36, Amended 1-1-87, 2-9-88, 11-6-88, 2-16-89, 3-1-90, 1-27-91, 2-19-95, Formerly 10C-2.036, Amended 1-27-99, 12-16-01, 5-14-02, 11-26-18, 6-30-19, 6-11-20, 10-26-21, 6-24-25.

Chapter 65A-4 TEMPORARY CASH ASSISTANCE

Fla. Admin. Code R. 65A-4.100 Relocation Assistance

History

Rulemaking Authority 414.45, 414.155 FS. Law Implemented 414.155 FS. History–New 5-30-99, Repealed 12-26-00.

Fla. Admin. Code R. 65A-4.201 Criteria for Hardship Extensions and Exemptions to Cash Assistance Time Limit

(1) Hardship Extension and Exemption Determinations. An extension or exemption from the time limit for receipt of Temporary Cash Assistance (TCA) cannot be authorized until a hardship review is completed, using the Hardship Extension Review, CF-ES 2082, 05/2023, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16454. The following non-English versions of the Hardship Extension Review form are incorporated by reference: CF-ES 2082H (Creole), 05/2023, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16455, and CF-ES 2082S (Spanish), 05/2023, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16456.

(2) A recommendation and the decision about hardship eligibility will be based on the criteria established in this rule and Section 414.105, F.S. If all hardship criteria are met, the Department will approve the participant for continued receipt of TCA for the amount of time recommended by the Local Workforce Development Board (LWDB).

(3) Diligent participation. To meet the diligent participation criteria, the participant must: have no more than one work sanction imposed in the last 18 months of receipt of cash assistance; and be in compliance with the individual responsibility plan as determined by the LWDB or its designee’s contracted career manager.

(4) Extraordinary barriers to employment. The following criteria are extraordinary barriers to employment:

(a) The individual has been a custodial parent with a child under three months of age.

(b) The individual has been a single custodial parent caring for a child who has not attained age six, and proves the inability to obtain needed child care due to the unavailability of appropriate child care within a reasonable distance from the home or worksite, unavailability or unsuitability of informal child care by a relative or under other arrangements, or unavailability of appropriate and affordable formal child care arrangements.

(c) The individual could not participate in assigned work activities due to a medical incapacity. The individual is required to comply with the course of treatment necessary for the individual to resume participation. The individual was excused from work activity requirements if the medical incapacity was verified by a licensed physician.

(d) An individual was temporarily unable to participate in assigned work activities due to circumstances beyond their control as determined by LWDB or its designee.

(5) Significant barriers to employment. Significant barriers to employment include illiteracy, language barriers, domestic violence, local labor surplus, underemployment, living in an area with a high unemployment rate, homelessness, previous felony convictions and unavailability of support services or transportation.

(6) A participant who did not request a hardship extension or exemption when the initial CF-ES 2082 was signed can request a hardship extension or exemption by completing the hardship review process. If the individual has not received TCA benefits or services for more than 30 days, the ACCESS Florida Application, CF-ES 2337, 08/2016 , incorporated by reference in Rule 65A-1.205, F.A.C., or an ACCESS Florida Web Application (only accepted electronically), CF-ES 2353, 11/2020, incorporated by reference in Rule 65A-1.205, F.A.C., must also be completed.

(7) Hearing Rights. Participants whose cash assistance is being terminated because they have reached their lifetime limit and have been denied a hardship extension or exemption can request a fair hearing in accordance with the Department’s hearing procedures in Chapter 65-2, F.A.C. Unless waived, cash assistance will be continued or reinstated in accordance with 45 C.F.R. 205.10(a)(6), when the request for a hearing is received by the end of the last day of the month prior to the effective date of the adverse action indicated on the notice. The notice allows at least 10 days for the request. If the last day of the month falls on a holiday or weekend, the deadline is the next business day. The assistance group must repay cash assistance if the hearing decision is in favor of the Department.

(8) Review of Hardship Extension and Exemption Cases. A review of hardship extension and exemption cases must be completed at least once every two years using the hardship extension and exemption review process of this rule, except for domestic violence cases which must be redetermined no less often than every six months in accordance with 45 C.F.R. §260.55(b).

History

Rulemaking Authority 414.45 FS. Law Implemented 414.105, 414.14 FS. History–New 9-28-98, Amended 5-27-01, 2-22-06, 11-13-06, 8-12-12, 3-13-24.

Fla. Admin. Code R. 65A-4.202 Calculation of Assistance Time Limits

History

Rulemaking Authority 414.45 FS. Law Implemented 414.105(3) FS. History–New 1-27-99, Amended 6-20-01, Repealed 2-22-06.

Fla. Admin. Code R. 65A-4.203 Personal Care of a Disabled Family Member

(1) Family Member. A family member is any individual related to any member of the assistance group by blood or marriage. The disabled family member must reside in the home with the caregiver. The family member with the disability can be a child or any adult member of the family, whether or not this person is a Temporary Cash Assistance (TCA) recipient.

(2) Disability. In order for an individual to receive an exemption to program time limits due to their responsibility to care for a disabled family member, the disability must be verified. Acceptable verification is:

(a) The family member’s receipt of temporary or permanent disability benefits issued by a government or private source,

(b) A statement by a physician or licensed or certified psychologist certifying the family member is disabled, or

(c) Completion by a physician of Part B of the Statement of the Need for Care, CF-ES 2094, 06/2009, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16457. The following non-English versions of the Statement of the Need for Care are incorporated by reference: CF-ES 2094H (Creole), 06/2009, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16458, and CF-ES 2094S (Spanish), 06/2009, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16459.

(3) Need for Personal Care. The disabled family member must require the physical presence of the individual to provide care, supervision, or arrange services. Personal care of the family member includes the provision of daily care services, supervision of care, and transportation. Verification of the family member’s need for personal care must be provided verbally for individuals whose disability has already been verified or in writing by completing Part A of the CF-ES 2094. Any of the following will also be accepted as verification of disability and the need for personal care:

(a) Receipt of hospice services;

(b) Receipt of Home and Community Based Services’ waiver assistance;

(d) A statement by a physician licensed under Chapter 458 or 459, F.S., which includes a diagnosis of disability necessitating care and a prognosis estimating the length of the disability;

(e) A Comprehensive Assessment and Review for Long-Term Care Services disability approval prepared by Department of Elder Affairs’ staff;

(f) A Multi-Handicapped Assessment Team evaluation from Department of Health, Children’s Medical Services’ staff;

(g) Receipt of Multiple Disciplinary Development Services, or

(h) Verification by a children’s mental health or substance abuse provider certifying that a child meets the criteria for serious emotional disturbance or psychoactive substance use disorder, and a statement by a licensed psychiatrist indicating the need for care or supervision of the child that includes a DSM-V diagnosis, recommended treatment for the child and caregiver, and prognosis indicating the estimated length of time care is needed.

(4) Alternative Care. The caregiver must indicate a lack of alternative care in both the local community and from other family members verbally for individuals whose disability has already been verified or in writing by completing Part A of the CF-ES 2094. Alternative care might not be available because the service to meet a specific need does not exist in the community or the cost of the service is prohibitive.

(5) Co-existing Conditions. Each of the conditions detailed in subsections (2) through (4), above, must exist in order for an exemption from temporary cash assistance time limits due to the provision of care for a disabled family member to be granted.

(6) Welfare Transition Employment and Training. Care of a family member with a disability is an exemption from work activity requirements. Individuals meeting the criteria for an exemption from the time limits are not required to work register.

(7) Two Parent Families. When two or more able-bodied parents live in the household with the disabled family member, only one parent will be allowed an exemption to program time limits due to responsibility for care of a disabled family member.

(8) Periodic Evaluation of Exemption. The exemption from time limits will be reevaluated annually for TCA.

History

Rulemaking Authority 414.45, 414.065(4)(g) FS. Law Implemented 414.065, 414.105(9) FS. History–New 4-27-99, Amended 9-3-07, 9-21-09, 3-13-24.

Fla. Admin. Code R. 65A-4.205 Penalties for Nonparticipation in Work Requirements

(1) Penalty Requirements. The provisions for receipt of temporary cash assistance (TCA) include the requirement of individuals who do not meet exemptions to participate in work activities or alternative requirement plans. For the purposes of this rule “work activities” include alternative requirement plans. Failure to do so, without good cause, will result in penalties being applied in accordance with Section 414.065(1), F.S. Individuals who also receive food assistance and fail to meet TCA work requirements will be considered noncompliant with food assistance work requirements in accordance with 7 CFR, Section 273.7. Individuals will be notified at program entry of the work activities requirement and penalties for noncompliance without good cause on the ACCESS Florida Web Application, incorporated by reference in Rule 65A-1.205, F.A.C., or the Communication and Work Activity Referral form, CF-ES 2097, Nov 2019, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11578 for paper applications. The Spanish version, CF-ES 2097S, Nov 2019, and Creole version, CF-ES 2097H, Nov 2019, of the Communication and Work Activity Referral form are incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11580 and http://www.flrules.org/Gateway/reference.asp?No=Ref-11579, respectively.

(2) Compliance with work requirements and determination of good cause for failure to comply with work requirements will be determined by the Local Workforce Development Board (LWDB) designee, in accordance with Sections 414.065(1) and (4), F.S. Other good cause reasons for failure to comply include the temporary inability to participate due to circumstances beyond the participant’s control such as:

(a) A family emergency due to the inability to find suitable child care for a sick child under age 12;

(b) Hospitalization, medical emergency or death of an immediate family member;

(d) Lack of transportation;

(e) Court appearance, or

(f) Caring for a disabled family member when the need for care has been verified and alternative care is not available.

(3) Individuals failing to comply with work activities will be mailed notification of the failure and possible sanction by the LWDB designee within two working days following the failure. The notification must inform the individuals they have 10 calendar days from the date the notification is mailed to contact the LWDB designee to have a good cause determination made or to comply with the work requirement or penalty action will be imposed. During the 10-day period, the LWDB designee is required to make both oral and written attempts to contact and to counsel the participant to:

(a) Determine if the participant had good cause for failing to meet the work requirement;

(b) Refer to or provide services, if appropriate, to assist with the removal of barriers to participation;

(c) Understand the consequences for failure to comply with work or alternative requirement plan activity requirements without good cause;

(d) Provide information regarding transitional benefits in accordance with Section 445.028(2), F.S., if the participant subsequently obtained employment; and,

(e) Understand that compliance with work activity during the 10-day period will avoid the imposition of a sanction. The LWDB designee must provide the participant with another work activity within the 10-day period if it is impossible for the participant to comply with the original assigned activity.

(4) Upon failure of the individual to respond by the date indicated, the LWDB designee will notify the department to impose a sanction in accordance with Section 414.065(1)(a), F.S. Upon receipt of the sanction request, the department will notify the individual of the penalty action using the Notice of Work Penalty form, CF-ES 4192, 04/2007, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11581. The Spanish version, CF-ES 4192S, 4/2007, and Creole version, CF-ES 4192H, 4/2007, of the Notice of Work Penalty form are incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11583 and http://www.flrules.org/Gateway/reference.asp?No=Ref-11582, respectively. An individual who provides verification of good cause for failure to respond within the 10-day time frame will not be penalized.

(5) Temporary cash assistance groups who are receiving food assistance at the time of the disqualification for failure to perform a required TCA work activity, will also be disqualified for food assistance in accordance with federal food assistance policy at 7 CFR Sections 273.7(f)(6) and 273.11(j)(4) and (k). Food assistance penalty periods are to be applied in accordance with 7 CFR Section 273.7(f)(2). If the noncompliant individual is the head of household, the entire household will be disqualified from receipt of food assistance in accordance with 7 CFR Section 273.7(f)(4). The department must determine if the noncompliant individual meets a food assistance work exemption before imposing a food assistance penalty. The food assistance penalty is not to be imposed if the individual meets a food assistance exemption. Individuals who are penalized for food assistance due to noncompliance with TCA work requirements cannot have a penalty lifted by opting not to receive TCA.

(6) Temporary cash assistance penalties are to be applied in accordance with Section 414.065(1)(a), F.S. The fourth and each subsequent penalty prior to reinstatement as being in full compliance with TCA program requirements will be applied pursuant to Section 414.065(1)(a)3., F.S.

(7) Time limits. If, during the penalty period, temporary cash assistance is received for children under age 16 through a protective payee, the months in which the penalties are applied will be counted as months receiving temporary cash assistance for purposes of the time limits in Section 414.105, F.S.

(8) Reinstatement of Benefits. Reinstatement of benefits requires the filing of an ACCESS Florida Application, incorporated by reference in Rule 65A-1.205, F.A.C., or an ACCESS Florida Web Application (only accepted electronically), incorporated by reference in Rule 65A-1.205, F.A.C., and a face-to-face interview, unless the individual demonstrates compliance and action is being taken to reinstate benefits within 30 days from the beginning date of the penalty. Cash assistance benefits will be reinstated in accordance with Section 414.065(1)(a), F.S., as determined by the LWDB designee, as long as all other factors of eligibility are met and any minimum penalty period has been served. Food assistance benefits will be reinstated in accordance with 7 CFR Section 273.7(g) of the food assistance requirements. If at the end of the food assistance penalty period the head of household is still in noncompliance, the head of household remains ineligible, but other members of the assistance group may reapply. If the other assistance group members are reapproved for food assistance, the pre-sanction TCA grant amount must be included in the food assistance benefit calculation.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.065(1), (4) FS. History–New 12-21-97, Formerly 65A-1.521, Amended 6-10-01, 2-26-20.

Fla. Admin. Code R. 65A-4.206 Work Requirements Under Medical Incapacity, SSI/SSDI, and Mental Health/Substance Abuse Treatment

(1) The provisions for receipt of temporary cash assistance (TCA) include the requirement of individuals who do not meet exemptions to participate in work activities or alternative requirement plans which allow an individual to meet program requirements based on the individual’s medical ability to comply. Individuals who claim a medical incapacity or who have an application or an appeal pending for Supplemental Security Income (SSI) or Social Security Disability Income (SSDI) are required to meet TCA program requirements in accordance with Sections 414.065(4)(d) and (f), F.S. The department will refer all applicants who do not meet an exemption under Sections 414.065(4)(d) and (f), F.S., to the Local Workforce Development Boards (LWDB) designee. The LWDB designee will determine the individual’s work or alternative requirement plan activities.

(2) Non-exempt individuals who are given an exception from participation in certain work activities due to medical incapacity, shall be required to comply with the course of medical treatment necessary for the individual to resume participation in work activities.

(3) Individuals claiming a medical incapacity either preventing them from participating in work activities or limiting their participation in work activities shall provide a statement from a physician licensed under Chapter 458 or 459, F.S., specifying the nature of the disability or incapacity, the duration of disability or incapacity, the number of hours per week that the individual can participate in activities, the percentage of the individual’s disability and any other limitations on participation in work activities.

(4) The individual basing their exemption from TCA work activities on an application or an appeal for SSI or SSDI disability benefits must provide a copy of the disability receipt file, notices, letters, or other verification from the Social Security Administration to verify a pending SSI or SSDI disability decision.

(5) An alternative requirement plan will be designed consistent with the individual’s limitations.

(6) The individual basing their exemption from TCA work activities on an application or appeal for SSI or SSDI disability benefits shall be informed that if denied all extensions to time limits count toward their cash assistance life time limit of 48 months.

(7) Outpatient Mental Health or Substance Abuse Treatment. An individual may be excepted from TCA work requirements for up to five hours per week to participate in outpatient mental health or substance abuse counseling or treatment. The total number of hours cannot exceed 100 per year. The LWDB designee will be responsible for verifying the need for treatment, attendance, and compliance with treatment requirements of the mental health or substance abuse professional.

(8) The LWDB designee will review the case at least monthly to determine the status of the SSI or SSDI application or appeal.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.065(4)(d), (e), (f), 414.105 FS. History–New 4-16-00, Amended 9-4-01, 2-2-20.

Fla. Admin. Code R. 65A-4.207 Age

(1) To be included in a Temporary Cash Assistance (TCA) benefit, a child must be a minor child as defined in Section 414.0252(8), F.S. An unmarried child means the child has never been married or if married, the marriage was annulled.

(a) A secondary school is considered grades 6 through 12.

(b) Full-time is defined as the number of hours considered to be full-time by the educational institution the child is attending.

(2) A child is eligible to receive TCA on the factor of age through the month of the child’s 18th birthday, or through the month of the child’s 19th birthday, if attending secondary school or an equivalent level of career training on a full-time basis unless born on the first day of the month.

History

Rulemaking Authority 414.095(18), 414.45 FS. Law Implemented 414.0252, 414.095 FS. History–New 1-11-98, Amended 9-6-09, 3-13-24.

Fla. Admin. Code R. 65A-4.208 Need

(1) The Department determines financial eligibility by comparing the income, assets and needs of standard filing unit members to the eligibility/payment standard applicable to the assistance group pursuant to Section 414.095, F.S. Assistance group members are always members of the standard filing unit and their income, assets and needs are counted. The income and assets of standard filing unit members who are not part of the assistance group are counted, but their needs are not.

(2) For Temporary Cash Assistance (TCA), the following individuals are included in the assistance group:

(a) The minor child(ren) for whom assistance is requested, provided they meet all non-financial state and federal Temporary Assistance to Needy Families TCA eligibility criteria, as set forth in section 414.095(2) and (14), F.S.

(b) The parent(s), provided the parent meets all non-financial TCA eligibility criteria.

(c) All minor siblings (including half-brothers and half-sisters) living with the child for whom assistance is requested or if not living with such child, all minor siblings who are determined to be temporarily absent from the home by the Department, provided the siblings meet all TCA non-financial eligibility criteria.

(3) The following individuals are included in the standard filing unit. However, their needs are not counted, and they are not included in the assistance group.

(a) The parent(s) who is not eligible to be included in the assistance group due to non-financial reasons, but who is living in the home with the child, or if not living with such child, is deemed to be temporarily absent by the Department.

The individual must be considered a resident of Florida. Individuals who are in Florida temporarily may be considered residents of the state on a case-by-case basis, if they indicate an intent to reside in Florida and can verify that they are residing in Florida.

(b) A 16-18 year old who is not in school and who refuses to participate in the TCA employment and training program, unless good cause exists for non-participation in the employment and training program or school prescribed in Rule 65A-4.2131, F.A.C.

(4) For TCA, the following individuals shall be included in the assistance group, at the option of the parent or specified relative:

(a) Stepbrothers, stepsisters or other children in the home who meet all TCA non-financial criteria.

(b) Specified or caretaker relatives other than the parent under the following conditions:

The mother or legal father does not live in the home,
The specified or caretaker relative lives in the home with the child and is the child’s primary caretaker; and,
The specified or caretaker relative meets all eligibility criteria.

(c) The child of a non IV-E foster care minor parent whose child(ren) has not been adjudicated dependent and whose needs are not included in the foster care board payment.

(5) For TCA, the following individuals cannot be included in the assistance group or standard filing unit:

(a) Individuals receiving Supplemental Security Income (SSI) benefits;

(b) Individuals receiving Optional State Supplementation;

(d) Individuals who are receiving assistance under the Refugee Assistance Program;

(e) Essential persons for SSI purposes;

(f) Non-parent caretaker relatives who would otherwise be included in the assistance group except that they are on strike. When a parent or caretaker relative whose needs are counted is on strike, the entire assistance group is ineligible for TCA.

(6) The needs of an unwed minor parent who resides with their parent, and the needs of the minor parent’s child will be included in the same benefit, unless the minor parent also qualifies as an eligible dependent child in their parent’s benefit. If a minor parent’s child is included in the grandparent’s benefit then the needs of the minor parent must also be included in the same benefit. If a minor parent is included in the parent’s benefit, the minor parent will not receive a separate benefit for the minor parent’s child.

(7) The needs of an unwed minor parent and the unwed minor parent’s child who reside with a specified relative (not the parent) must be included in the same benefit, unless the relative receives assistance for one or more siblings of the unwed minor parent. When the needs of the siblings of an unwed minor parent are included in the specified relative’s benefit, the needs of the unwed minor parent must be included in the relative’s benefit. If the needs of the minor parent are included in the specified caretaker relative’s benefit, the minor parent will not receive a separate benefit for their child. Their child’s needs will be included in the specified caretaker relative’s benefit.

(8) When a recipient leaves one assistance group and becomes a member of another assistance group, the needs of the individual shall be included in the new assistance group beginning with the first full month the individual resided with the new assistance group if eligible on all other factors. If this would result in duplicate assistance, the individual’s needs must be removed from the former assistance group and a referral must be made to Benefit Recovery on the former assistance group.

(9) A relative caregiver may self-refer, or be referred, to the Relative Caregiver Program using CF-ES 2305, Relative Caregiver Program Request for Eligibility Consideration, 10/2005, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16460, or by using the ACCESS Florida Web Application (only accepted electronically), CF-ES 2353, 11/2020, incorporated by reference in Rule 65A-1.205, F.A.C., or the ACCESS Florida Application, CF-ES 2337, 08/2016, incorporated by reference in Rule 65A-1.205, F.A.C. The following non-English versions of the Relative Caregiver Program Request for Eligibility Consideration are incorporated by reference: CF-ES 2305H (Creole), 10/2005, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16461, and CF-ES 2305S (Spanish), 10/2005, available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16462.

History

Rulemaking Authority 414.095(18), 414.45 FS. Law Implemented 414.095(2)(a), (b), (5), (14) FS. History–New 1-11-98, Amended 5-10-05, 6-29-06, 9-16-08, 3-13-24.

Fla. Admin. Code R. 65A-4.209 Income

(1) Income is cash received at periodic intervals from any source including but not limited to wages, benefits, contributions, and rental property. Cash is money or an equivalent, such as a check, money order or other negotiable instrument. Income must be substantiated and documented as a condition of eligibility for Temporary Cash Assistance (TCA) as in subsection 65A-1.205(5), F.A.C.

(2) To be financially eligible for TCA, the total average gross monthly income less any applicable disregards of the standard filing unit cannot exceed the applicable payment standard for the assistance group.

(a) The earned monthly income of the minor child who is a full-time student in an elementary or secondary school or an equivalent level of career training does not count in the eligibility determination. All income of the minor child received under the Workforce Innovation and Opportunity Act (WIOA) does not count in the eligibility determination. The definition of minor child is in Section 414.0252(8), F.S. The definition of full-time attendance is in paragraph 65A-4.207(1)(b), F.A.C. Student refers to the minor child whose needs are included in the benefit as a minor child not as a parent or relative. The definition of secondary school is in paragraph 65A-4.207(1)(a), F.A.C.

(b) Total gross monthly income includes earned and unearned income from all sources. The countable net income of a stepparent living in the home with the TCA child, or of a parent living in the home with the minor mother payee, or of an ineligible noncitizen’s parents during the five year disqualification period prescribed by the Personal Responsibility and Work Opportunity Act of 1996, or of the sponsor and the sponsor’s spouse of certain noncitizens is considered in determining the gross unearned income of the assistance group.

(c) Income of an adult received under the WIOA does not count in the eligibility determination, except for wages paid directly by an employer.

(d) Infrequent or irregular unearned income not exceeding $60 per calendar quarter such as gifts for Christmas, birthdays or graduation does not count in the eligibility determination.

(3) The Department considers the income and resources of the following individuals:

(a) All standard filing unit members.

(b) A stepparent living in the home. The Department considers a temporarily absent stepparent to be part of the family unit.

The sponsoring agency or organization must fulfill its financial responsibilities to the noncitizen unless the agency or organization is no longer in existence at the time that the applicant or recipient applies.
A noncitizen who reports support from an individual sponsor is required to have the sponsor and the sponsor’s spouse provide information about their income and assets. If they do not give complete information and will not provide complete information upon request by the Department, the noncitizen and other sponsored members of the assistance group will be found ineligible for TCA because available income and assets cannot be determined. Eligibility for the noncitizen and other sponsored members of the assistance group cannot be established when required verification is not obtained. Verification is not required of a noncitizen who self-declares non-support from the sponsor.
This policy does not affect unsponsored members of the assistance group. If the sponsor and spouse receive TCA as a parent payee or receive Supplemental Security Income, none of the sponsor’s income is considered to be available to the noncitizen.

(d) The parent(s) of a teen parent, when the teen parent is a TCA recipient minor child who lives in the same household with the parent(s) who is not included in the TCA benefit.

(e) The stepparent of a teen parent, when the teen parent is a TCA recipient minor child who lives in the same household with the stepparent who is not included in the TCA benefit.

(f) The IRCA parent (one that received legalization under the Immigration Reform and Control Act of 1986).

History

Rulemaking Authority 414.085(2), 414.095(18), 414.45 FS. Law Implemented 414.085, 414.095 FS. History–New 1-11-98, Amended 5-17-07, 9-6-09, 4-29-24.

Fla. Admin. Code R. 65A-4.210 Budgeting

(1) The Department uses a prospective budgeting system. In a prospective budgeting system, eligibility and the amount of the temporary cash assistance benefit for a payment month are based on the Department’s estimate of the assistance group’s projected income and circumstances for that month. This estimate shall be based on the Department’s expectation and knowledge of current or future circumstances based on income and circumstances in the month for which benefits are being calculated. When eligibility or the benefit amount is being determined for a month which has passed prior to the month of the application authorization, the actual income and circumstances for that month will be used. In converting income to a monthly income, the conversion factor of 4.3 shall be used for weekly income; the conversion factor of 2.15 shall be used for biweekly income; and the conversion factor of 2 shall be used for semi-monthly income. When averaging income, all income from the most recent four weeks shall be used if it is representative of the individual’s future earnings. A longer period of past time may be used if necessary to provide a more accurate indication of anticipated fluctuations in future income in accordance with 7 CFR 273.10(c)(1)(ii). In budgeting income received by an individual on a contractual basis, the income is allocated over the period it is intended to cover.

(2) The amount of assistance payment is determined by subtracting the net available income amount, rounded to the nearest dollar, from the applicable payment standard found in Section 414.095(10), F.S.

(3) When a change in the receipt of income is reported and verification is not received by the eligibility specialist in time to adjust the benefit and also give a 10-day notice of the change in the benefit amount, the budget is computed based on the individual’s statement of the amount of income received. The benefit amount will be adjusted if it is learned that income was incorrectly budgeted following receipt of the verification through the authorization of an auxiliary payment or referral to benefit recovery.

(4) Self Employment Income.

(a) Operating costs, except depreciation and capital expenditures, are deducted from the gross income of self-employment, including farming.

(b) A standard deduction of $58 per month for each boarder is allowed for individuals providing room and board in their home.

(c) One dollar per day per child is deducted from the self employment income of individuals providing child care in their home. This deduction is not allowed if the child for whom care is being provided is a resident of the same dwelling in which the person providing care resides.

(d) Twenty-five percent of the gross rental receipts from improved property owned by the parent or relative is deducted, if they are responsible for the costs of repairs and upkeep.

(e) Fifteen percent of the gross rental receipts from unimproved rental property owned by the parent or relative is deducted if they are responsible for the costs of upkeep of fences, wells, etc.

(f) A deduction from rental income is also recognized for taxes and the interest portion of mortgage payments on property other than homestead property. Homestead property is determined by the local property appraiser office.

(g) Income from self employment must be verified. The applicant or recipient must make all business records available to the the eligibility specialist upon request.

(h) Self-employed individuals have the option of having their average income determined based upon the four weeks prior to application or redetermination of eligibility or the last 12 months to determine a representative average. A longer period of past time may be used if necessary to provide a more accurate indication of anticipated fluctuations in future income.

(5) Child support payments, received or expected to be received, are counted as unearned income. Fees charged by the court or another agency for collecting the payments are deducted. Child support payments which are collected by the State and retained to offset the individual’s public assistance debt are not considered income in the budget except as required by 45 CFR 302.51. Non-recurring child support is budgeted in accordance with the Department’s lump sum policy set forth in subsection (6), below.

(6) Non-earned lump sum income is treated in accordance with 7 CFR 273.9. Lump sum income received as earned income will be treated as an asset in the month of receipt.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.085, 414.095(10), (11), (12), (14) 414.14 FS. History–New 5-3-98, Amended 5-17-07, 3-13-24.

Fla. Admin. Code R. 65A-4.212 Up-Front Diversion

(1) Pre-screening. Individuals applying for temporary cash assistance (TCA) and who indicate an interest for up-front diversion must be TCA eligible in order to be referred to the Local Workforce Development Board (LWDB) designee for screening to determine up-front diversion eligibility. LWDBs will complete an up-front diversion screening to determine if due to an unexpected circumstance or emergency situation they have short-term barriers to obtain and maintain employment or child support that could be met through up-front diversion or if ongoing TCA is needed.

(2) Screening. The LWDB designee is responsible for screening applicants to determine if due to an unexpected circumstance or emergency situation they have short-term barriers to obtain and maintain employment or child support that could be met through up-front diversion or if ongoing TCA is needed. The LWDB is also responsible for administering an intake survey at the time of screening in accordance with section 445.035, F.S.

(3) Eligibility. The LWDB designee is responsible for determining up-front diversion eligibility and approval on a case-by-case basis for the receipt of up-front diversion services, up-front diversion payment amount, or both in accordance with Section 445.017, F.S. The applicant must meet the following eligibility criteria for up-front diversion:

(a) The applicant has a child(ren) under age 18 (or age 18 if the child is still a full-time student in secondary school or at the equivalent level of vocational or technical training) residing in the home or a pregnant woman in the family and meets TCA eligibility criteria in accordance with Sections 414.0252(8) and 414.095(5), (14)(a), F.S.;

(b) An explanation by the family of the unexpected circumstance or emergency situation and what may be needed to resolve it; and,

(c) A determination by the LWDB designee and the applicant whether or not the up-front diversion intervention will assist the family to overcome barriers to employment or child support and eliminate the need for ongoing TCA.

(4) Unexpected Circumstances or Emergency Situations. Some examples of unexpected circumstances or emergency situations that may be considered short-term barriers to obtain and maintain employment or child support in this regard are: automobile repairs; catching up on shelter payments to prevent eviction; catching up on utility bills, except for cable television and long distance telephone charges, to prevent interruption of service; medical services; replacement of income lost due to medical leave without pay; emergency child care while seeking permanent child care; and, clothing, shoes, tools or equipment necessary for employment.

(5) Verification.

(a) Identity. Identity will be verified through readily acceptable documentation that includes work or school ID cards, driver’s license, voter’s registration cards and birth certificates.

(b) Acceptance of the applicant’s statement, unless questionable, as to household composition, income, resources, or other information pertinent to determining eligibility for TCA.

(6) Restriction on Application for TCA. The LWDB designee will notify applicants that receipt of up-front diversion will restrict application for TCA for three months unless an emergency is demonstrated to the LWDB designee. Both the applicant and LWDB designee must sign an agreement noting the restriction.

(7) Approval for Payment. The LWDB designee is responsible for determining the approval or denial of a family for receipt of up-front diversion services and determining the level of financial need for a one-time only payment of up to, but not to exceed $1,000, or both. Up-front diversion services, such as child care or transportation, cannot exceed four months in accordance with 45 CFR Section 260.31(b). Families who are diverted from the receipt of ongoing TCA through up-front diversion may be eligible to receive transitional support services such as child care and transportation as specified in subsection (11), of this rule. The LWDB designee must stipulate the amount of the authorized payment and inform the department.

(8) Denial or Opts Not to Receive. Individuals who are denied or opt not to receive up-front diversion are instructed to complete the entire work registration process for TCA.

(9) Violation of Agreement. If the family that has received an up-front diversion payment applies for TCA within three months, the family must be referred to the LWDB designee for work registration and verification of a determination that a demonstrated emergency exists. Upon receipt of the determination that the family meets emergency criteria, the department will complete the TCA eligibility determination and calculate the repayment value of the up-front diversion payment. The up-front diversion repayment amount will be withheld from any TCA benefit for which the family is otherwise eligible. The amount to be withheld will be based on proration of the up-front diversion payment over eight months.

(10) Processing Time Frame. Once approval of up-front diversion is received, the department must expedite the process and approve the payment within five working days.

(11) Medicaid, Food Assistance, and Time Limits Impact. Up-front diversion assistance does not count toward the TCA time limits. The application for up-front diversion will not impact the application for food assistance and/or Medicaid as long as the eligibility requirements of those programs are met.

(12) Transitional Child Care and Transitional Services. Individuals who receive up-front diversion may be eligible for transitional child care or transitional services to accept, maintain, actively seek employment, or to upgrade skills if their income does not exceed 200 percent of the federal poverty level and they meet the eligibility criteria in accordance with Sections 445.029, 445.030, 445.031 and 445.032, F.S.

History

Rulemaking Authority 414.45, 445.017(6) FS. Law Implemented 445.017 FS. History–New 1-27-98, Amended 6-10-01, 2-2-20, 6-24-25.

Fla. Admin. Code R. 65A-4.213 Learnfare

History

Rulemaking Authority 414.45 FS. Law Implemented 414.125 FS. History–New 4-13-98, Amended 10-14-99, Repealed 10-30-00.

Fla. Admin. Code R. 65A-4.2131 Learnfare Requirements

(1) Learnfare Requirements. Temporary cash assistance (TCA) will be reduced when a participant’s dependent school-age child(ren) is determined to be habitually truant or a school dropout or the parent or caretaker relative whose needs are included in the TCA assistance group fails to attend a school conference each semester.

(2) School Conference. A parent or caretaker relative with a child subject to school attendance requirements must have a conference with an appropriate school official during each semester. The parent’s or caretaker relative’s statement of completion of the school conference must be obtained at a regularly scheduled redetermination. If a redetermination is due during the summer when school is not in session, the conference verification from the previous semester will be sufficient documentation of compliance.

(3) Exemption from School Conference. Caretaker relatives whose needs are not included in the TCA assistance group and parents or caretaker relatives that home school their children with the approval of the local school district are exempt from the school conference requirement.

(4) Participants are notified at TCA application of their right to request a fair hearing using Your Rights and Responsibilities, CF-ES 2064, 07/2016, incorporated by reference in Rule 65A-1.204, F.A.C. Upon notification by the local school district that a participant’s dependent child is habitually truant or a dropout or a parent or caretaker relative fails to attend a school conference, the Department must determine if good cause exists in accordance with Section 414.1251(1), F.S. If good cause does not exist, the Department will advise the participant and impose Learnfare penalties in accordance with Sections 414.1251(1) and (2), F.S.

(5) School-Age. Dependent children who are age 6, or who will be age 6 by February 1 of any school year, or who are over age 6 but under age 18 are subject to school attendance unless exempted from education participation requirements by the local school district.

(6) Referral to the Local Workforce Development Board. If a participant’s dependent child is age 16 or 17 and is exempted from education participation by the school district, the child is to be referred to the local workforce development board or its designee to participate in TCA work or alternative requirement plan activities.

(7) Reinstatement of Benefits. Before benefits may be reinstated, the participant must notify the Department and provide verification that the participant’s dependent child identified as a habitual truant or dropout is in compliance with Learnfare attendance requirements in accordance with Section 414.1251(1), F.S., or the parent or caretaker relative has met the school conference requirement.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.1251 FS. History–New 6-2-02, Amended 9-12-07, 3-13-24.

Fla. Admin. Code R. 65A-4.214 Family Cap Requirements

(1) Family Cap. The first child born to a recipient of Temporary Cash Assistance (TCA) more than 10 months from the date of application will be added to the TCA group at one-half the incremental increase for an additional person. In the case of multiple births, each child will be added at one-half the incremental increase. Second or subsequent children subject to this policy and born to a TCA recipient will not increase the benefit amount. These subsequent children are considered ineligible for TCA. The income and assets of the second and subsequent child(ren) will be considered in the budget calculation, except for child support income. A child subject to the family cap will be considered TCA eligible for all other purposes, including Medicaid and categorical eligibility for food assistance. Once imposed, the cap continues to apply to a child unless an exception provided for by Section 414.115(2), F.S., is met.

(2) A parent who receives Supplemental Social Security Income (SSI) and those who receive cash assistance from another state are not considered TCA recipients for purposes of this policy.

(3) Incapacity, Institutionalization or Incarceration. Once the incapacity, institutionalization or incarceration of the birth parent ceases to exist, the child will again be subject to the family cap.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.115 FS. History–New 4-13-98, Amended 4-27-99, 3-9-03, 3-13-24.

Fla. Admin. Code R. 65A-4.215 Temporary Cash Assistance Eligibility of Pregnant Women

(1) The applicant’s statement will be accepted for the ninth month of pregnancy. The ninth month is defined as the calendar month in which the due date falls. Restrictions from work activities and the month the last trimester begins must be verified in writing or verbally by a licensed physician for Temporary Cash Assistance (TCA) benefits to be authorized before the ninth month of pregnancy.

(2) The standard filing unit is determined pursuant to Rule 65A-1.203, F.A.C. Only the needs of the pregnant woman are considered in the budget calculation. The needs of the unborn child are not considered until birth.

(3) Pregnant women who are residents of state institutions, are in foster homes or other state-funded homes, or are having their care paid by the Department in licensed maternity homes are not eligible.

(4) Minors who are mandatory assistance filing unit members as children in another TCA case are not eligible under this rule because of Sections 414.095(2)(b)1. and (2)(b)4., F.S.

(5) In active cases when the newborn is determined eligible for TCA, the newborn is added for direct assistance effective the date of birth, even when payment is authorized in a later month.

(6) When the pregnancy terminates by other than a live birth, eligibility for direct assistance continues through the month of delivery or termination of the pregnancy. Notice of cancellation must be sent to the client, but 10 days advance notice is not required.

(7) When the mother does not bring the child home following delivery due to placement in foster care or adoption, eligibility continues through the month of delivery. The child is eligible for TCA for the month of birth only. A notice of cancellation must be given to the client, but 10 days advance notice is not required.

(8) When an application is received prior to the last month of pregnancy from a pregnant woman with no other children or, in a situation where the woman is restricted from work activity prior to the third trimester, TCA will be denied. The applicant will have hearing rights as provided in subsection 65A-4.201(11), F.A.C. If the application can be processed in accordance with processing standards established in Rule 65A-1.205, F.A.C., so that in the event of approval, the approval will not occur prior to the last month of pregnancy or the third trimester of pregnancy, the application will not be denied solely because it is premature. When the application is denied solely because it was made prior to a period when the pregnant woman could be eligible, the Economic Self-Sufficiency specialist will advise the applicant of the periods of eligibility and the conditions of eligibility for the last month of pregnancy or the third trimester of pregnancy.

History

Rulemaking Authority 414.45, 414.095 FS. Law Implemented 414.095 FS. History–New 5-3-98, Amended 9-19-04, 3-13-24.

Fla. Admin. Code R. 65A-4.216 Immunization Program

(1) Immunization. Applicants and recipients for Temporary Cash Assistance (TCA) who have a child under age five, must complete the appropriate childhood immunizations.

(2) A child whose needs have been removed from the TCA grant due to failure of the recipient to provide verification of immunization(s) or exemption through good cause, will remain eligible for Medicaid. The child’s needs will be reinstated when the individual provides proof that the immunization sequence is up-to-date or complete, or that good cause for failure to immunize exists. Good cause exemptions from the immunization requirement include religious reasons or a permanent medical condition that prohibits immunization.

(3) Any written statement containing information that the immunizations are current, the date the next immunization is due and the dated signature of a health care professional licensed under Chapter 458, 459 or 460, F.S., or authorized designee is acceptable as verification for immunization requirements. DH Form 680, 07/2010, Florida Certification of Immunization, incorporated by reference in Rule 64D-3.046, F.A.C. is an example of acceptable verification. Oral verification through direct contact between Departmental staff and the health care professional or their authorized designee is allowed when the participant is unable to obtain written verification. DH Form 680 when signed by a healthcare professional licensed under Chapter 458, 459 or 460, F.S., also will be used as verification of good cause for failure to immunize a child due to a permanent medical condition. DH Form 681, 07/2008, Religious Exemption from Immunization, incorporated by reference in Rule 64D-3.046, F.A.C. signed by the county public health director or administrator is acceptable verification of good cause for failure to immunize a child because of religious beliefs.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.13 FS. History–New 4-26-94, Formerly 10C-1.517, Amended 7-22-97, Formerly 65A-1.517, Amended 10-11-99, 3-13-24.

Fla. Admin. Code R. 65A-4.217 Teen Parents

(1) A teen parent is defined as an individual who has a child(ren) of their own and who meets the definition of a minor child as stated in Section 414.0252, F.S. Participation in an approved program leading to a GED meets full-time student status for this purpose.

(2) The statement of the responsible adult will be acceptable verification that the teen parent lives with a responsible adult. All teen parents must provide proof that the teen parent has enrolled in a program meeting the school attendance requirement as a condition of eligibility for the teen parent and the teen parent’s child(ren). If the teen parent is not in school but expresses an interest in attending school, the assistance group will be given a 10-day pending period to provide verification of registration and attendance.

(3) Teen parents who receive their own grants and reside in the home of their parent(s) will have a portion of the parent(s)’ income deemed to determine the teen parent’s and the teen parent’s child(ren)’s eligibility using parent to child deeming.

(4) Parent-to-child deeming involves the following steps:

(a) Determine the parent’s total gross monthly income from all sources, including any lump sum income.

(b) If earned income is involved, deduct the $90 standard disregard and add gross unearned income.

(c) Subtract the consolidated need standard (100 percent of poverty level) for the parent and any other individuals in the home who are not in the assistance group, but who are dependents of the parent, from the total of the net earned income and gross unearned income.

(d) Determine the number of non-assistance group members whom the parent claims or can claim as dependents for Internal Revenue purposes. Subtract the total documented monthly amount the parent actually pays to, or on behalf of, such non-assistance group dependents from the amount remaining following the step in paragraph (c).

(e) Deduct the documented amount of court-ordered child support or alimony the parent pays to non-assistance group members. This is other than those in paragraph (d). Court-ordered payments for child support or alimony include mortgage payments, medical or life insurance payments, school tuition fees and other school costs, that the individual may pay to a third party.

(f) The balance following these steps is considered unearned income in the teen parent’s budget.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 10-9-96, Formerly 10C-1.5061, Amended 5-23-99, Formerly 65A-1.5061, Amended 2-2-20.

Fla. Admin. Code R. 65A-4.218 Child Care

(1) Access to Child Care. Temporary Cash Assistance (TCA) participants, including former recipients and families redirected from receipt of TCA through up-front diversion who are applying for transitional child care, may access subsidized child care assistance through referral to the Florida Community Coordinated Care for Children (4C-agency). The Local Workforce Development Board (LWDB) designee will inform participants of the availability of child care assistance and will make the necessary referrals to the 4C-agency. Child care assistance is provided to TCA participants solely for assistance in complying with TCA work activities and for transitional child care.

(2) Conditions of Eligibility.

(a) Temporary cash assistance recipients may receive subsidized child care assistance when it is necessary for them to participate in TCA work or training activities allowed by federal regulation and approved by the LWDB designees. Child care to maintain employment will be provided for the hours of employment and reasonable time for travel to and from the child care facility and place of employment and return. The need for child care and condition of need will be verified by LWDB designee.

(b) In order for a child care subsidy to be provided, the participant must need care for the child and have an obligation to pay for child care.

(c) The child for whom care is provided must be within the specified degree of relationship for receipt of temporary cash assistance and included in the TCA assistance group. This, however, includes a child who would be in the TCA assistance group except for the receipt of Supplemental Security Income.

(d) Child care disregards will not be allowed in the determination of eligibility for temporary cash assistance.

(3) Transitional Child Care.

(a) Transitional child care is defined as child care for families whose income does not exceed 200 percent of the federal poverty level and:

Whose TCA has ceased due to new or increased employment hours or earnings or due to increased child support or who opt not to receive TCA, or
Who have been redirected from receipt of TCA through up-front diversion.

(b) Child care must be needed to accept, maintain, or actively seek employment and to upgrade skills in accordance with Section 445.030(2), F.S.

(c) If an individual applies after the beginning of the transitional child care benefit period and needs reimbursement or payment for child care that has already been obligated for or paid during the transitional child care benefit period, the individual will be referred to the 4-C.

(4) Good Cause.

(a) Individuals who lose their job rather than quit their job or who have good cause for quitting their job, if eligible for subsidized child care on all other factors, may continue to receive subsidized child care while they look for other employment. The maximum period of this extension is 30 days. The subsidized child care assistance will be provided only for actual job search.

(b) Examples of good cause reasons are:

Position ends, job lay-off or business closure,
Job requirements are illegal or against the moral or religious beliefs of the parent,
Working conditions or job duties could be harmful to the physical or mental health of the parent,
Sexual or racial discrimination or harassment on the job,
Change in job requirements for which the parent is not qualified,
Change in hours or location of employment that is not feasible due to child care or transportation arrangements, or
Family or health problems of the parent or child(ren) requiring an extensive period of time off, which the parent is unable to arrange with the employer.

(5) Recipient Notification. The recipient will be informed as to availability of and qualifications for child care services by LWDB or their contracted providers, or the 4-C agency.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095(1), 445.030, 445.032 FS. History–New 3-5-95, Formerly 10C-1.519, Amended 8-18-97, 3-12-00, Formerly 65A-1.519, Amended 5-1-01, 2-2-20, Technical Change 8-18-26.

Fla. Admin. Code R. 65A-4.219 Determination of Continued Eligibility

History

Rulemaking Authority 414.45 FS. Law Implemented 414.095 FS. History–New 1-31-94, Formerly 10C-1.503, 65A-1.503, Amended 7-2-03, Repealed 2-22-06.

Fla. Admin. Code R. 65A-4.220 Amount and Duration of Cash Payment

(1) The Department determines the amount of cash assistance payment that a person receives by using the applicable payment standard minus the total net available income. A resulting deficit must be rounded down to the nearest $1.00 in determining the benefit amount. The minimum grant is $10. Persons eligible for benefits of under $10 do not receive Temporary Cash Assistance (TCA) but are considered TCA recipients for other purposes, including Medicaid and food assistance coverage.

(2) The eligibility specialist selects the applicable standard for the assistance group based on the size of the assistance group and the assistance group’s shelter obligation.

(a) The three shelter payment standards in Section 414.095(10), F.S., are referred to as Tiers I, II and III. They may also be referred to as payment standards. The tier that applies to an assistance group with a shelter obligation greater than $50 or that is homeless is Tier I. The tier that applies to an assistance group with a shelter obligation greater than $0 and less than or equal to $50 is Tier II. The tier that applies to an assistance group with a zero shelter obligation or a teen parent living in the home of a parent, other adult relative, or legal guardian regardless of any shelter obligation is Tier III.

(b) The Department uses Tier I and II for assistance groups who have a shelter obligation, such as a mortgage, rent or room and board payment. A shelter obligation exists when the assistance group has the responsibility to pay for the cost of housing. When the parent or relative payee’s needs are included in the benefit amount, their shelter obligation is used. When the parent or stepparent payee’s needs are not included, they must indicate that the child(ren) is required to share their shelter cost. When a relative payee’s needs are not included, the Department accepts their statement that the child(ren) is required to share their shelter cost.

(3) In order for an assistance group to be eligible on the factor of need, the Department must make an initial determination that the assistance group’s adjusted gross income does not exceed the applicable Department eligibility standard. The eligibility standard is equal to 185 percent of the Consolidated Need Standard (CNS) and is based on the size of the assistance group. The CNS is equal to 100 percent of the current federal poverty level.

(4) For the purpose of the three tier shelter standard, the definition of a homeless family is one which lacks a fixed, regular, and adequate nighttime residence, or one who has a primary nighttime residence that is:

(a) A supervised publicly or privately operated shelter designed to provide temporary living accommodations, including homeless shelters and shelters for victims of domestic violence;

(b) An institution that provides a temporary residence for individuals intended to be institutionalized, or

(5) Payments are made in monthly increments throughout the period of eligibility.

(a) If the Department determines that a loss of benefits has occurred and the household is entitled to the restoration of those benefits, the Department will take action to restore lost benefits.

(b) Benefits will not be restored if the benefits were lost more than 12 months prior to the month the loss was discovered.

(6) The Department may continue assistance for only one month following the month of departure when the recipient moves out of the state and requests the extension.

(7) Residency is not affected during temporary absences.

(a) Temporary absence exists when an absence is 30 days or less. If the absence is greater than 30 days, the individual must provide the Department with verification of intent to return to the state by submitting the following:

The reason(s) the absence has been prolonged (e.g., medical treatment),
Plans to return to the state, and
The date the individual intends to return to the state.

(b) Temporary absence may exist when the absence is greater than 30 days if there is an intent to return to Florida. In determining continuation of TCA for temporarily absent assistance groups, TCA will continue if:

The assistance group has maintained its residence in Florida during the temporary absence period, and
The assistance group plans to return to Florida when the reason for the temporary absence has ended.

Another state has determined the individual is a resident of their state for TCA purposes,
The individual leaves the U.S. with the intent to establish permanent residence outside the U.S., or
There is no intent to return to Florida.

(8) The Department must designate a protective payee so an application can be approved or TCA can be continued for other assistance group members, when the payee of the TCA group is disqualified due to fraud. Protective payee requirements for TCA are the same as those listed in Section 414.065(2), F.S. Form CF-ES 2635, Protective Payee Agreement, 07/2014, is incorporated herein by reference, https://www.flrules.org/Gateway/reference.asp?No=Ref-05058. The following non-English versions of the Protective Payee Agreement are incorporated by reference: CF-ES 2635H (Creole), 07/2014, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-16463, and CF-ES 2635S (Spanish), 07/2014, available at https://www.flrules.org/Gateway/reference.asp?No=Ref-16464.

History

Rulemaking Authority 414.45, 414.095(14)(k), 414.095(18) FS. Law Implemented 414.14, 414.095 FS. History–New 1-31-94, Amended 10-9-96, Formerly 10C-1.504, Amended 11-30-98, Formerly 65A-1.504, Amended 2-10-03, 3-10-09, 3-18-15, 3-13-24.

Fla. Admin. Code R. 65A-4.221 Drug Testing for Temporary Cash Assistance Applicants

History

Rulemaking Authority 414.0652, 414.45 FS. Law Implemented 414.0652 FS. History–New 3-6-12, Repealed 11-24-15.

Fla. Admin. Code R. 65A-4.301 Drug Screening and Testing of Temporary Cash Assistance Applicants

History

Rulemaking Authority 414.45 FS. Law Implemented 414.70 FS. History–New 11-11-99, Repealed 2-4-02.

Chapter 65A-24 INDIVIDUAL AND FAMILY GRANT PROGRAM

Fla. Admin. Code R. 65A-24.010 Purpose

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.010, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.011 Implementation

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.011, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.012 Legal Base and Authority

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.012, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.014 Terms, Definitions, Abbreviations, Acronyms

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.014, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.015 General Eligibility

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.015, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.016 Eligible Categories

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.016, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.017 Time Limitations for Program Administration

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.017, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.018 Ineligible Categories of Assistance

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.018, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.019 Reconsideration Review and State Fair Hearing

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.019, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.020 Fraud, Duplication of Benefits, Grant Misapplication, Exemptions from Garnishment

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.020, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.021 Criminal and Civil Penalties

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.021, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.023 Applications, Locations, Time Limitations

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.023, Amended 9-28-99, Repealed 11-14-10.

Fla. Admin. Code R. 65A-24.024 Document, Substantiate, Verify

History

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History–New 10-1-87, Formerly 10C-24.024, Amended 9-28-99, Repealed 11-14-10.

Chapter 65A-33 EMERGENCY FINANCIAL ASSISTANCE FOR HOUSING PROGRAM

Fla. Admin. Code R. 65A-33.003 Definitions

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 7-15-93, Formerly 10C-33.003, Amended 2-16-00, Transferred to 65I-1.001.

Fla. Admin. Code R. 65A-33.004 Eligibility Factors Other Than Income

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 7-15-93, Formerly 10C-33.004, Amended 2-16-00, Transferred to 65I-1.002.

Fla. Admin. Code R. 65A-33.005 Determination of Eligibility Based on Income

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Formerly 10C-33.005, Amended 2-16-00, Transferred to 65I-1.003.

Fla. Admin. Code R. 65A-33.006 Income

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Formerly 10C-33.006, Amended 2-16-00, Transferred to 65I-1.004.

Fla. Admin. Code R. 65A-33.007 Verification

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.007, Amended 2-16-00, Transferred to 65I-1.005.

Fla. Admin. Code R. 65A-33.008 Program Administration

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.008, Amended 2-16-00, Transferred to 65I-1.006.

Fla. Admin. Code R. 65A-33.009 Eligible Payments

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, Formerly 10C-33.009, Transferred to 65I-1.007.

Fla. Admin. Code R. 65A-33.010 Ineligible Payments

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Formerly 10C-33.010, Transferred to 65I-1.008.

Fla. Admin. Code R. 65A-33.011 Type and Amount of Assistance

History

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.011, Amended 2-16-00, Transferred to 65I-1.009.

Division 65C Family Safety and Preservation Program

Chapter 65C-1 HOME CARE FOR DISABLED ADULTS

Fla. Admin. Code R. 65C-1.001 Purpose of the Home Care Program

History

Rulemaking Authority 410.033 FS. Law Implemented 410.031, 410.033 FS. History–New 5-3-81, Amended 10-17-84, Formerly 10A-9.01, Amended 6-11-91, Formerly 10A-9.001, Amended 8-13-00, 1-23-05, Repealed 2-18-16.

Fla. Admin. Code R. 65C-1.002 Definitions

In addition to the definitions used in Sections 410.031-.036, F.S., the following definitions shall apply to this rule:

(1) “Activities of Daily Living (ADL)” means functions and tasks for self care, which shall include ambulation, mobility, bathing, dressing, eating, grooming, and other personal hygiene activities.

(2) “Basic Subsidy” means a specific amount of subsidy payment, determined by the financial status of the home care client, which is provided monthly to assist with support and maintenance of the home care client, and which includes costs of housing, food, clothing, and incidentals.

(3) “Case Management” means the planning, arrangement for and coordination of appropriate community-based services for home care client. Case management includes assessment of needs, development of a service plan, arrangement for services, and on-going monitoring of the home care client’s situation to ensure that needed services are received.

(4) “Department” means Department of Children and Families.

(5) “Disabled Adult” means any person at least 18 years of age, but under 60 years of age, who lacks the ability to perform the normal activities of daily living and to live independently or with relatives or friends without the provision of community-based services, and is impaired due to one or more permanent physical or mental limitations. Disabled adult also means a person who is currently domiciled in this state and who intends to remain in this state.

(6) “Domicile” means the place where the home care client legally resides, that is, his or her permanent home.

(7) “Home Care Client” means an individual who meets all eligibility requirements for this program and who, without home care supportive services, could require placement in an institution or nursing home.

(8) “Medical Subsidy” means a specific amount of subsidy payment provided monthly to assist in defraying the costs of medical, pharmaceutical, and dental services not covered by Medicare, Medicaid or any form of insurance and which maintains the health of the home care client.

(9) “Provider” means an adult person(s) who applies and is approved to provide home care to a home care client on a non-profit basis.

(10) “Special Supplement” means a reimbursement for specialized services, supplies, or equipment, which are pre-authorized by the department, and which are required to maintain the health and well-being of the home care client. This supplement is separate from the basic and medical subsidies, is provided if a documented need exists, and shall be provided based on the availability of allocated funds. Reimbursement may be authorized for purchased recurring or non-recurring services, equipment, and supplies.

History

Rulemaking Authority 410.033 FS. Law Implemented 410.033 FS. History–New 5-3-81, Amended 2-11-82, Formerly 10A-9.02, Amended 6-11-91, Formerly 10A-9.002, Amended 8-13-00, 1-23-05.

Fla. Admin. Code R. 65C-1.003 Screening and Application

(1) Requests to make application for the Home Care for Disabled Adults Program may be initiated by the potential home care client or others, on behalf of the potential home care client, through district, regional, or zone Adult Services Offices.

(2) If funding is not available to move an individual into the Home Care for Disabled Adults Program, the individual is screened by departmental staff using the Adult Services Screening for Consideration for Community-Based Programs, CF-AA 1022, October 2014, and placed on the Home Care for Disabled Adults Waiting List or other Adult Services programmatic waiting list for the appropriate service that meets the need of the individual. The focus of the Adult Services Screening for Consideration for Community-Based Programs shall be on individuals who are at risk of nursing home placement and at risk of abuse, neglect, and exploitation. The Adult Services Screening for Consideration for Community-Based Programs is incorporated by reference and is available at www.flrules.org/Gateway/reference.asp?No=Ref-11128. Form CF/PI 140-43, Due Process Rights, July 2014, which is referenced in form CF-AA 1022, is incorporated by reference and is available at www.flrules.org/Gateway/reference.asp?No=Ref-11129.

(3) The application process shall include:

(a) Applicant assessment and determination of program and financial eligibility;

(b) Provider assessment and determination of provider eligibility;

(d) Applicant and provider notification of eligibility status.

(4) The application process must be completed before subsidy approval is granted.

History

Rulemaking Authority 410.033 FS. Law Implemented 410.033 FS. History–New 5-3-81, Formerly 10A-9.03, Amended 6-11-91, Formerly 10A-9.003, Amended 8-13-00, 1-23-05, 10-14-19.

Fla. Admin. Code R. 65C-1.004 Eligibility

History

Rulemaking Authority 410.033 FS. Law Implemented 410.036 FS. History–New 5-3-81, Amended 2-11-82, Formerly 10A-9.04, Amended 6-11-91, Formerly 10A-9.004, Amended 8-13-00, 1-23-05, Repealed 2-18-16.

Fla. Admin. Code R. 65C-1.005 Financial Determination

History

Rulemaking Authority 410.033 FS. Law Implemented 410.035 FS. History–New 5-3-81, Amended 2-11-82, Formerly 10A-9.05, Amended 6-11-91, Formerly 10A-9.005, Amended 8-13-00, 1-23-05, Repealed 2-18-16.

Fla. Admin. Code R. 65C-1.006 Provider Requirements

A provider in the Home Care for Disabled Adults Program shall meet, at minimum, the eligibility criteria outlined herein. Each provider shall:

(1) Be a responsible adult willing to and capable of accepting responsibility for the social, physical, and emotional needs of the home care client in a family-type living arrangement;

(2) Be an individual, relative or non-relative, who has a positive personal relationship with the home care client and who, if not family, is accepted by the home care client as surrogate family; or be a responsible adult who maintains a positive personal relationship with the home care client and is an individual with whom the home care client has made a financial arrangement for the provision of home care services;

(3) Reside in and be physically present in the home to provide services, supervision, and assistance with the arrangement of services for the home care client, and be responsible for making alternative arrangements for care to be assumed by another responsible adult, when the provider is temporarily absent from the home, in keeping with the standards set forth for the Home Care for Disabled Adults Program;

(4) Be responsible for maintaining the residential dwelling free of conditions that pose threat to the life, safety, health, or well-being of the home care client;

(5) Grant written authorization for a background check, at least annually, through the department’s central abuse hotline information system for abuse, neglect, or exploitation of a vulnerable adult, as defined in Section 415.102, F.S., or child, as defined in Section 39.01, F.S., and shall:

(a) Be without record of criminal conviction of abuse, neglect, or exploitation of a vulnerable adult or child;

(b) Not have been the perpetrator in a confirmed report of abuse, neglect, or exploitation of a vulnerable adult, investigated or completed prior to September 1, 2000 by the Department of Children and Families and maintained in the department’s central abuse hotline information system;

(c) Not have been the perpetrator in a confirmed report of abuse, neglect, or exploitation of a child, investigated or completed prior to October 1, 1995 by the Department of Children and Families and maintained in the department’s central abuse hotline information system;

(d) Not have been a possible responsible person in a report with verified findings of abuse, neglect, or exploitation of a vulnerable adult, investigated or completed on or after September 1, 2000 by the Department of Children and Families and maintained in the department’s central abuse hotline information system;

(e) Not have been a possible responsible person in a report with verified findings of abuse, neglect, or exploitation of a child, investigated or completed on or after October 1, 1995 by the Department of Children and Families and maintained in the department’s central abuse hotline information system;

(f) Provide written information on felony or first degree misdemeanor charges, as requested.

(g) The department shall grant an exemption from any disqualifying offense if the department has clear and convincing evidence to justify the exemption; and,

(6) Be without evidence of representing themselves to the public as a home or home-type facility, group living home, half-way house, assisted living facility, adult family care home, or other similar facility offering room, board and personal services for pay or profit.

History

Rulemaking Authority 410.033 FS. Law Implemented 410.033, 410.034 FS. History–New 5-3-81, Amended 2-11-82, Formerly 10A-9.06, Amended 6-11-91, Formerly 10A-9.006, Amended 8-13-00, 1-23-05.

Fla. Admin. Code R. 65C-1.007 Home Study Standards

(1) The Home Care Counselor shall conduct a home study, an assessment of the home environment and physical surroundings in which the Home Care for Disabled Adults applicant or home care client currently resides or intends to reside with the provider, to determine the fitness of the private residential home, in keeping with the assessed needs of the applicant or home care client and the standards as established for this Program. The Home Care Counselor shall note any condition that he or she believes may pose a physical danger to the home care client, shall formulate a written recommendation as to case approval or denial, and shall submit this recommendation, with accompanying documentation, to the designated district, regional, or zone authority for final review and decision. The home study is completed at least annually.

(2) Home study standards shall include:

(a) General.

The home shall be a family-type dwelling occupied as the primary residence of the home care provider and shall serve as the primary domicile of the home care client.
Floors and furnishings shall be free of unsanitary conditions that would attract rodents, vermin, and insects.
The yard and area surrounding the residence shall be free of litter and refuse that could serve as breeding areas for insects, vermin, and rodents.
Windows shall be covered or screened to secure the residence from flies and insects.
There shall be at least one telephone with 9-1-1 capability that is operational and that is hard-wired into the home; or at least one cellular telephone with 9-1-1 capability that is operational, audible, and functions inside the home; or a written emergency plan describing how an emergency will be handled without immediate telephone access, shall be developed by the provider. This emergency plan shall be approved by district or regional Adult Services Program Office or zone staff.

(b) Bedroom.

Bedding and linens shall be provided and shall be clean and changed as dictated by the physical condition of the home care client.
There shall be two means of egress from the bedroom occupied by the home care client. This may include a window which may be used by the home care client for exiting the bedroom in case of an emergency.

The primary bathroom that is used by the home care client shall have a toilet, lavatory, and bathtub or shower, all in working order.
Portable toilets may be utilized provided waste is disposed of by a sanitary method.
There shall be arrangements for bathing the home care client, based on the home care client’s physical condition and functional ability, including bathing facilities with hot and cold running water available for the home care client.
Soap, clean towels, and washcloths shall be provided.

(d) Food Preparation and Dining Areas.

Food preparation and food storage areas shall be clean, dry, free of odors, free of rodents, and free of infestation of insects and vermin.
Homes shall have kitchen facilities necessary for perishable food storage and meal preparation.

(e) Fire Protection.

An operating smoke detector shall be present in each dwelling.
Flammable materials such as gasoline, paint, lacquer and paint thinner, alcohol, oxygen, turpentine, contact cement, charcoal, lighter fluid, and cleaning fluids shall be stored away from sources of heat and shall be stored outside or away from the kitchen and other inside living areas of the main residence. They shall not be stored in a garage if a fuel-burning appliance is located in the garage.
Combustible materials such as newspapers and rags shall not be stored near a furnace, hot water heater, space heater, or other sources of heat.
Frayed, cracked, or broken electrical wiring and extension cords shall be removed and replaced. Extension cords shall not extend from one room to another. No more than two extension cords shall be used at one time in multi-outlet adapters.
Electric space heating units shall bear the Underwriters Laboratories (UL) label. Kerosene heaters, unvented gas, and unvented oil heaters are prohibited. Only vented heaters, which shall be properly vented to the outside, or shall be so constructed as to not require venting, are permitted. The use of a propane heater (liquefied petroleum - LP) which has a gas cylinder stored in the body of the heater or other types of self-contained fuel supplies are prohibited. Only heaters which are stable and constructed so as not to tip over are permitted.

(f) Firearms. Firearms and ammunition shall be stored separately from each other in locked storage areas.

History

Rulemaking Authority 410.033 FS. Law Implemented 410.034 FS. History–New 5-3-81, Amended 2-11-82, Formerly 10A-9.07, Amended 6-11-91, Formerly 10A-9.007, Amended 8-13-00, 1-23-05.

Fla. Admin. Code R. 65C-1.009 Petition Proceedings

(1) The Home Care Counselor shall conduct an assessment of the home environment, physical structure and surroundings, to determine the fitness of the residential dwelling in keeping with the assessed needs of the Home Care for Disabled Adults applicant or home care client and the established standards for the Home Care Program as found in Chapter 410, F.S., and Chapter 65C-1, F.A.C. A copy of Chapter 410, F.S., and Chapter 65C-1, F.A.C., shall be provided without cost upon request to the Adult Services Program Office, 2415 North Monroe Street, Suite 400, Tallahassee, Florida, 32303-4190.

(2) When a home is determined not to be fit by the standards set forth in the Home Care Program:

(a) The Home Care for Disabled Adults applicant or the home care client shall be notified in writing of determination of unfitness and shall be informed of the basis for such determination.

(b) The Home Care for Disabled Adults applicant or the home care client is provided due process under Chapter 120, F.S., for resolution of the question of fitness of the home.

History

Rulemaking Authority 410.033 FS. Law Implemented 410.034 FS. History–New 5-3-81, Amended 2-11-82, Formerly 10A-9.09, Amended 6-11-91, Formerly 10A-9.009, Amended 1-23-05.

Chapter 65C-2 COMMUNITY CARE FOR DISABLED ADULTS

Fla. Admin. Code R. 65C-2.002 Definitions

(1) “Adult Day Care” means a social program which provides a protective environment where preventive remedial and restorative services are provided to adults in need of such care.

(2) “Adult Day Health Care” means an organized day program of therapeutic, social, dietary and health activities and services provided to disabled adults for the purpose of restoring or maintaining optimal capacity for self care.

(3) “Case Management Service” means a client centered series of activities which includes planning, arranging for, and coordination of appropriate community-based services for an eligible Community Care for Disabled Adults client. Case management service is an approved service, even when delivered in the absence of other services. Case management service includes intake and referral, comprehensive assessment, development of a service plan, arranging for services and monitoring of client’s progress to assure the effective delivery of services and reassessment.

(4) “Chore Service” means the performance of house or yard tasks such as seasonal cleaning, yard work, lifting and moving, simple household repairs, and other tasks not performed by specialized staff for eligible persons who are unable to do these tasks.

(5) “Emergency Alert Response Service” means a community based electronic surveillance service system established to monitor the safety of individuals in their own homes and which alerts qualified assistance to the client in need.

(6) “District” also means Department region.

(7) “Escort Service” means the personal accompaniment of an individual to and from service providers, or personal assistance to enable clients to obtain other required services needed to implement the service plan.

(8) “Group Activity Therapy” means a service provided by a professional staff person to three or more eligible clients and includes, the following activities: physical, recreational, educational, social interaction, and communication skill building through the use of groups. The purpose of this service is to prevent social isolation and to enhance social and interpersonal functioning.

(9) “Health maintenance services” means as defined in Section 410.603, F.S.

(10) “Home Delivered Meals Service” means a hot or other nutritionally sound meal that meets one-third of the current daily recommended dietary allowances served in the home to a homebound disabled adult.

(11) “Home Health Aide Service” means a health or medically-oriented task furnished to an individual in his residence by a trained home health aide. The home health aide must be employed by a licensed home health agency and supervised by a licensed health professional who is an employee or contractor of the home health agency.

(12) “Homemaker Service” means the accomplishment of specific home management tasks including housekeeping, meal planning and preparation, shopping assistance, and routine household activities by a trained homemaker.

(13) “Home Nursing Service” means part-time or intermittent nursing care administered to an individual by a licensed professional or practical nurse or advanced registered nurse practitioner, as defined in Chapter 464, F.S., in the place of residence used as the individual’s home, pursuant to a plan of care approved by a licensed physician.

(14) “Interpreter Service” means assistance in communicating provided to a disabled adult client who has a speech or hearing impairment or a language barrier.

(15) “Medical Equipment or Supplies” means long-term or disposable devices or material to aide in diagnosis, treatment and rehabilitation of a disease or condition.

(16) “Medical Therapeutic Service” means those corrective or rehabilitative services which are prescribed by a physician or nurse practitioner licensed in the State of Florida. Provided by a professionally licensed, registered or certified individual, these services are designed to assist the client to maintain or regain sufficient functional skills to live in his place of residence. Such therapies include physical, occupational, speech-language therapy, and respiratory therapy.

(17) “Personal Care Service” means individual assistance with or supervision of essential activities of daily living, such as bathing, dressing, ambulating, supervision of each self-administered medication, eating, and assistance with securing health care from appropriate sources. Personal care service shall mean the provision of medical, nursing, dental or mental health services by the personal care service staff.

(18) “Provider” or “Service Provider” means the entity contracted by the Department to operate a disabled adults program.

(19) “Respite Care” means relief or rest for a caregiver from the constant supervision, companionship, therapeutic and personal care on behalf of a client for a specified period of time. The purpose of the service is to maintain the quality of care to the client for a sustained period of time through temporary, intermittent relief of the primary caregiver.

(20) “Transportation Service” means the movement of a client to and from service providers or community resources which are essential to the implementation of the care plan.

History

Rulemaking Authority 410.606 FS. Law Implemented 410.601-.606 FS. History–New 1-24-89, Amended 6-24-96, Formerly 10A-16.002, Amended 12-8-98, 7-27-21.

Fla. Admin. Code R. 65C-2.005 Service Provider Requirements

(1) Pursuant to Section 410.604(3), F.S., each community care for disabled adults program and service provider shall include case management service and at least one other community service. Community services include the following:

(a) Adult day care;

(b) Homemaker service;

(d) Escort service;

(e) Group activity therapy;

(f) Health maintenance service;

(g) Home delivered meal service;

(h) Interpreter service;

(i) Medical equipment or supplies;

(j) Respite care;

(k) Transportation service;

(l) Adult day health care;

(m) Emergency alert response service;

(n) Home health aide service;

(o) Home nursing service;

(p) Medical therapeutic service; and

(q) Personal care service.

(2) The service provider and direct service staff responsibilities include:

(a) Coordinating services for physically or mentally disabled adults;

(b) Utilizing services provided by recipients of services in lieu of fees and contributions;

(d) Demonstrating innovative approaches to program management, staff training, and service delivery that impact cost avoidance, cost effectiveness, and program efficiency with prior approval from the contract manager; and

(e) Providing for appeals regarding denial, reduction or termination of services to clients and for appeals regarding contracts for services.

(3) All providers receiving Community Care for Disabled Adult funds shall provide services only to those persons who meet eligibility criteria as defined in Section 410.603(2), F.S., and only to the extent the funds are available. Persons who request services but are not eligible shall be referred to other agencies for possible assistance.

(4) Providers shall administer services as specified in their contract with the Department and maintain current service records on project participants.

(5) Providers must furnish written documentation that their agency will provide a minimum of 10 percent of the funding necessary to support the program. Cash or in-kind resources may be used to meet this matching requirement.

(6) The Department shall ensure that all providers use volunteers to the fullest extent possible in the provision of services and in all aspects of program operations. Agencies utilizing volunteers shall provide training, supervision, and a negotiated liability insurance package.

(7) All agencies receiving Community Care for Disabled Adult funds shall maintain individual client fiscal and program records and provide reports as required by the Department at least on a quarterly basis. Client records shall be maintained in a confidential manner.

(8) Any changes in program objectives, staffing or other information as stipulated in the contract shall be presented, in writing, as provided in the contract for Department approval prior to the implementation of the change. Whenever a change is contemplated which will affect the original budgeted amount of any cost category or individual salary, such contemplated changes shall require prior approval from the Department.

History

Rulemaking Authority 410.606 FS. Law Implemented 410.604-.605 FS. History–New 1-24-89, Amended 6-24-96, Formerly 10A-16.005, Amended 12-8-98, 7-27-21.

Fla. Admin. Code R. 65C-2.006 Provider Application Procedures

History

Rulemaking Authority 410.606 FS. Law Implemented 410.601-.606 FS. History–New 1-24-89, Formerly 10A-16.006, Amended 12-8-98, Repealed 7-27-21.

Fla. Admin. Code R. 65C-2.007 Fees for Services

(1) Priority for services is based on need for services combined with the income level of the prospective client. First, eligibility must be determined through the administration of the APS Screening for Consideration for Community-Based Programs, CF-AA 1022, 10/2009, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13318, and verification of the client’s income. If the income is above the existing institutional care program eligibility standard, then a fee for services will be assessed based on the client’s care plan. Once an applicant is deemed eligible and a priority candidate for services, a determination shall be made as to an amount that the applicant will be charged for those services based on an overall ability to pay. Partial payments may also be assessed.

(2) The case service manager shall request information from the applicant or his spouse, relative or guardian if needed, as follows:

(a) Monthly income to include all earnings, payments and pensions to the applicant. Assets are not included.

(b) Expenses to include housing and utilities, telephone, food, medical expenses, transportation and insurance.

(c) Necessary monthly expenses as defined in subsection (b), shall be subtracted from monthly income as defined in subsection (a), to determine the applicant’s disposable income and overall ability to pay. Applicants who have $200.00 or more remaining after expenses are subtracted shall be assessed a fee, as provided in subsection (d), and requested to pay toward the cost of service he receives.

(d) The applicant will be asked to pay 10 percent of his disposable income or the unit cost of the service he is to receive, whichever is less. The unit cost will be determined from the most recent unit cost report of the provider or the fixed rate charged in a contract.

(3) In those situations where the applicant is currently receiving a service on a private pay basis and can continue to pay for the service, the applicant shall not receive the service under state Community Care for Disabled Adult funds. If the service is available on a private pay basis from another agency and the client assessment has determined that the applicant can pay for the service, then the applicant shall be referred to the other agency for the services. However, if the applicant is able to pay for a service, but the service is not available from any other agency, then the Community Care for Disabled Adults provider shall provide the service, inform the applicant of the dollar amount or in-kind service, and require such fee toward the cost of the service. If the client is unwilling to pay the assessed fee or contribute the in-kind services of specific value, services shall be denied.

(4) Clients shall have the opportunity to perform volunteer services in lieu of making payments.

(5) At the time the ability to pay is determined, the applicant shall attest to the truthfulness of the financial status submittal by signing a sworn written statement.

(6) Client payments shall be directed to the provider and may be used to expand the Community Care for Disabled Adults program.

(7) Redetermination of a client’s ability to pay shall be on an annual basis. The client may request redetermination based upon a change of financial status.

History

Rulemaking Authority 410.606 FS. Law Implemented 410.604 FS. History–New 1-24-89, Amended 6-24-96, Formerly 10A-16.007, Amended 12-8-98, 7-27-21.

Fla. Admin. Code R. 65C-2.008 Community Care Costs

The total cost of services, estimated or actual, for an individual receiving Community Care for Disabled Adults services shall not exceed the average general revenue portion of medicaid nursing home bed within a given district.

History

Rulemaking Authority 410.606 FS. Law Implemented 410.604 FS. History–New 6-24-96, Formerly 10A-16.008.

Chapter 65C-6 DOMESTIC VIOLENCE

Fla. Admin. Code R. 65C-6.002 Certification

History

Specific Authority 39.903, 39.905 FS. Law Implemented 39.905 FS. History–New 5-13-79, Amended 12-4-79, 12-13-85, Formerly 10A-8.03, Amended 6-22-87, Formerly 10A-8.003, 10M-48.002, Amended 3-12-00, Transferred to 65H-1.001.

Fla. Admin. Code R. 65C-6.003 Procedures for Funding

History

Specific Authority 39.903, 39.905 FS. Law Implemented 39.903 FS. History–New 5-13-79, Amended 12-4-79, 11-1-83, 12-3-85, Formerly 10A-8.04, Amended 6-22-87, Formerly 10A-8.004, 10M-48.003, Amended 3-12-00, Formerly 65C-6.003, Transferred to 65H-1.002.

Fla. Admin. Code R. 65C-6.004 Standards for Certification

History

Specific Authority 39.903, 39.905 FS. Law Implemented 39.905 FS. History–New 5-13-79, Amended 12-4-79, 1-11-83, 12-3-85, Formerly 10A-8.05, Amended 6-22-87, Formerly 10A-8.005, 10M-48.004, Amended 3-12-00, Transferred to 65H-1.003.

Fla. Admin. Code R. 65C-6.005 Confidentiality

History

Specific Authority 415.608, 120.53 FS. Law Implemented 415.601 et seq. FS. History–New 5-13-79, Amended 12-4-79, 12-3-85, Formerly 10A-8.06, 10A-8.006, 10M-48.005, Transferred to 65H-1.004.

Fla. Admin. Code R. 65C-6.006 Evaluation

History

Specific Authority 39.903 FS. Law Implemented 39.903 FS. History–New 5-13-79, Amended 12-4-79, 12-3-85, Formerly 10A-8.07, 10A-8.007, 10M-48.006, Amended 3-12-00, Transferred to 65H-1.005.

Chapter 65C-9 UNDOCUMENTED FOREIGN NATIONAL CHILDREN

Fla. Admin. Code R. 65C-9.001 Purpose

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.001(1), 409.145, 415.501, 415.5016, 415.502 FS. History–New 6-12-95, Formerly 10M-47.001, Repealed 11-16-15.

Fla. Admin. Code R. 65C-9.002 Definitions

(1) Undocumented Alien Child is defined as an unmarried person under the age of 18 who is not a citizen or national of the United States, and who is not in possession of valid Immigration and Naturalization Services (INS) issued documents authorizing the juvenile to be in the United States.

(2) PRUCOL (“Person residing in the United States under color of law”) is defined as a person who is known to INS and whose forced departure from the United States is not imminent.

(3) SAVE (“Systematic Alien Verification for Entitlements Unit”) is a subdivision of the INS District Offices that verifies the validity of purported INS documents for purposes of entitlement.

(4) Special Immigrant Juvenile Visa is an immigrant visa available to a person who has been declared dependent by a juvenile court, who was deemed eligible for long term foster care, and for whom it has been determined that it would not be in her best interest to return to her or her parents’ previous country of nationality or country of last habitual residence.

(5) INS Custody is defined as physical presence in an INS facility.

(6) Immigration Proceedings are defined as either exclusion or deportation proceedings before the Executive Office for Immigration Review.

(7) Special Interest Order is defined as an order from the Circuit Court establishing that the child has met the requirements for a special juvenile immigrant visa.

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.001(1), 409.145, 415.501, 415.5016, 415.502 FS. History–New 6-12-95, Formerly 10M-47.002.

Fla. Admin. Code R. 65C-9.003 Procedure for Handling Undocumented Foreign National Children Alleged to Be Abused, Neglected or Abandoned

(1) All calls received by the statewide Department of Children and Family Services Abuse hotline (“Hotline”) will be screened without regard to the immigration status of the alleged victim or the family or household of the victim, pursuant to the procedures established in Chapter 65C-10, F.A.C. A child’s immigration status will be determined through SAVE only, concurrent with the ongoing investigation into allegations of abuse, abandonment or neglect, and only in an effort to promote the child’s best interests which includes ascertaining, in good faith, a child’s eligibility for public benefits or need for a special immigrant juvenile visa. No such status check or other contact shall be made for the purpose of seeking the child’s or the family’s detention by INS or the initiation or resumption of deportation or exclusion proceedings against the child or the child’s family, irrespective of the outcome of the dependency proceeding. No Department of Children and Family Services staff member may attempt to place any alien child in INS custody. The immigration status of a child shall have no bearing on either the care or service rendered by Department of Children and Family Services to a child or on judicial proceedings undertaken by Department of Children and Family Services on behalf of the child. In the event an abuse report is determined to be unfounded, Department of Children and Family Services shall not thereafter communicate with the INS concerning the child or the child’s family.

(2) Absent an immediate and life-threatening emergency, no call will be accepted by the Hotline for alleged abuse, abandonment, or neglect of an undocumented alien child who is documented to be in INS custody. Such callers will be referred to the appropriate officials within the United States Department of Justice to investigate and to take appropriate remedial steps if any are necessary. Such referrals shall, however, be promptly documented by the Hotline. All other calls of alleged abuse, abandonment or neglect will be taken by the Hotline and investigated by Department of Children and Family Services, regardless of a child’s immigration status.

(3) Department of Children and Family Services Protective Investigators will respond to the scene to determine the safety of the child, without regard to immigration status, and stabilize the situation, pursuant to Chapter 65C-10, F.A.C.

(4) Department of Children and Family Services shall not place in a dependency petition reference to a child’s alienage or immigration status, or to the INS unless such reference is in good faith material to the grounds for the petition’s allegation of abuse, neglect or abandonment.

(5) Nothing contained in this rule shall preclude Department of Children and Family Services from, following appointment for the child of legal counsel and a Guardian Ad Litem, requesting the assistance of a private international social service agency in determining the appropriateness of reunification of the child with family members abroad, in accordance with criteria established by Florida law for determining the appropriateness of reunification within the United States. No child shall depart the United States under this provision prior to exhaustion of all judicial appeal periods following a court order authorizing same, absent agreement on behalf of the child by his or her counsel.

(6) No extension of time to comply with Chapter 39’s deadline for filing a dependency petition shall be sought by Department of Children and Family Services to ascertain a child’s immigration status. Nothing contained in this paragraph shall preclude Department of Children and Family Services from seeking reasonable extensions of time when necessary to promote the best interests of the child to the extent authorized by statute or the Florida Rules of Juvenile Procedure.

(7) When an undocumented or PRUCOL alien child is adjudicated dependent and deemed eligible for long term foster care and it is determined to be in the child’s best interest to remain in the United States, Department of Children and Family Services shall promptly seek a special interest order from the Circuit Court on the child’s behalf. If Department of Children and Family Services determines that such child, who has been adjudicated dependent, does not meet the criteria for entry of a special interest order, the Department of Children and Family Services official making that decision shall advise the child, if of suitable age, the child’s Guardian Ad Litem, and counsel, if any, in writing of the specific factual or legal basis for the decision. A copy of this notice shall become part of the child’s case file.

(8) Department of Children and Family Services shall either (a) directly or pursuant to service contract handle the application for a special juvenile immigrant visa on behalf of a child for whom a special interest order has been obtained by Department of Children and Family Services or (b) ensure that a volunteer attorney for Department of Children and Family Services submits the visa application within sixty (60) days of the entry of the special interest order, failing which the obligation to do so shall revert to the Department of Children and Family Services.

(9) In the event a working group or committee is established between INS and Department of Children and Family Services with respect to actual or prospective dependent children who are undocumented or PRUCOL aliens, the district administrator whose district participates in such group or committee shall invite a representative of the Guardian Ad Litem program and legal services or legal aid agency, if any, to at least become an observer, if not a participant of that group or committee.

(10) Department of Children and Family Services shall promptly furnish a complete copy of this rule to each of its personnel responsible for discharging Department of Children and Family Service’s obligations under Chapters 39, 409 and 415, F.S.

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.001(1), 409.145, 415.501, 415.5016, 415.502 FS. History–New 6-12-95, Amended 5-2-96, Formerly 10M-47.003.

Chapter 65C-10 CHILD PROTECTIVE INVESTIGATIONS

Fla. Admin. Code R. 65C-10.001 Definitions

History

Specific Authority 415.514 FS. Law Implemented 415.503, 39.01, 39.012 FS. History–New 7-14-91, Amended 7-6-92, 10-26-93, Formerly 10M-29.002, Repealed 11-15-06.

Fla. Admin. Code R. 65C-10.002 Reports of Child Abuse and Neglect

History

Specific Authority 415.514 FS. Law Implemented 415.502, 415.504, 415.505 FS. History–New 7-14-91, Amended 7-6-92, 10-26-93, Formerly 10M-20.003, Repealed 11-15-06.

Fla. Admin. Code R. 65C-10.003 Child Protective Investigations

History

Specific Authority 39.012, 415.514 FS. Law Implemented 415.505, 415.504(4)(c), 39.401, 39.402(1), (2), (3) FS. History–New 7-14-91, Amended 7-6-92, 10-26-93, Formerly 10M-29.004, Repealed 11-15-06.

Fla. Admin. Code R. 65C-10.004 Medical Screening and Medical Examination of Children Alleged to be Abused or Neglected

History

Specific Authority 415.514 FS. Law Implemented 415.504, 415.5055, 415.507, 39.407 FS. History–New 7-14-91, 7-6-92, 10-26-93, Formerly 10M-29.005, Repealed 11-15-06.

Fla. Admin. Code R. 65C-10.005 Institutional Child Protective Investigations

History

Specific Authority 415.514 FS. Law Implemented 415.505(1), (2)(a)-(d) FS. History–New 7-14-91, Amended 7-6-92, 10-26-93, Formerly 10M-29.007, Repealed 11-15-06.

Fla. Admin. Code R. 65C-10.006 Criminal and Abuse History Checks

History

Specific Authority 415.514 FS. Law Implemented 415.509(1)(a)3. FS. History–New 7-14-91, Amended 7-6-92, 10-26-93, Formerly 10M-29.016, Repealed 11-15-06.

Chapter 65C-11 PROTECTIVE SERVICES

Fla. Admin. Code R. 65C-11.001 Definitions

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.01, 39.403(2), 39.409(2), 39.41(1)(a), 39.441(2), 39.442(2)(a)1., 409.145(1), (2), 415.503, 415.504, 415.505(1)(f), 827.04 FS. History–New 5-26-92, Amended 1-18-94, Formerly 10M-5.008, Repealed 11-15-06.

Fla. Admin. Code R. 65C-11.002 Ongoing Assessment and Documentation Requirements

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.403(2), 39.409(2), 39.41(1)(a), 39.441(2), 39.442(2)(a)1., 409.145(1), (2), 415.505(1)(f) FS. History–New 5-26-92, Amended 1-18-94, Formerly 10M-5.023, Repealed 11-15-06.

Fla. Admin. Code R. 65C-11.003 Relative Placements

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.401(3)(a), 39.41(1)(a)1., 2., 3., 7., 409.145(1), (2), 415.505(1)(f) FS. History–New 5-26-92, Amended 1-18-94, Formerly 10M-5.032, Repealed 11-15-06.

Fla. Admin. Code R. 65C-11.004 Non-Relative Placements

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.41(1)(a)1., 7., 409.145(1), (2), 409.175(9), (10), 415.505(1)(f) FS. History–New 5-26-92, Amended 1-18-94, Formerly 10M-5.033, Repealed 11-15-06.

Fla. Admin. Code R. 65C-11.005 Termination of Supervision

History

Rulemaking Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.403(2), 39.409(2), 39.41(1)(a), 39.41(8), 39.441(2), 39.442(2)(a)1., 39.442(7), 409.145(1), (2), 415.505(1)(f) FS. History–New 5-26-92, Amended 1-18-94, Formerly 10M-5.040, Repealed 11-15-06.

Chapter 65C-12 EMERGENCY SHELTER CARE

Fla. Admin. Code R. 65C-12.001 Definitions

History

Specific Authority 39.012, 409.026(8), 415.514 FS. Law Implemented 39.01, 39.40(3), (4), 39.402, 39.403(2)(b), 39.404(3), 39.407, 39.408, 409.145(1)(d), (2)(a), 409.165(1), 409.175(2), 415.503, 415.505(1)(f)3. FS. History–New 5-26-92, Formerly 10M-41.004, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.002 Health Screenings and Assessments

History

Specific Authority 39.012 FS. Law Implemented 39.407 FS. History–New 5-26-92, Formerly 10M-41.007, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.003 Medical Treatment

History

Specific Authority 39.012 FS. Law Implemented 39.407 FS. History–New 5-26-92, Amended 12-25-96, Formerly 10M-41.008, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.004 Ongoing Health Care

History

Specific Authority 39.012 FS. Law Implemented 39.407 FS. History–New 5-26-92, Amended 12-25-96, Formerly 10M-41.009, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.005 Medicaid Eligibility Procedures

History

Specific Authority 409.026(8) FS. Law Implemented 409.903(4) FS. History–New 5-26-92, Formerly 10M-41.010, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.006 Mental Health and Substance Abuse Services for Children

History

Specific Authority 39.012 FS. Law Implemented 39.407 FS. History–New 5-26-92, Formerly 10M-41.011, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.007 Placement Procedures

History

Specific Authority 39.012, 415.514 FS. Law Implemented 39.402, 415.504(4)(c)1.i., 415.505(1)(b)10., 415.508 FS. History–New 5-26-92, Formerly 10M-41.013, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.008 Case Supervision Responsibilities

History

Specific Authority 39.012, 409.026(8) FS. Law Implemented 39.402, 409.145(1)(d), (2)(a), 409.165(1) FS. History–New 5-26-92, Amended 12-25-96, Formerly 10M-41.015, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.009 Voluntary Placements

History

Specific Authority 39.012, 415.514, FS. Law Implemented 39.403(2)(b), 415.505(1)(f)3. FS. History–New 5-26-92, Formerly 10M-41.019, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.010 Central Placement Authority

History

Specific Authority 409.026(8) FS. Law Implemented 409.145(1)(d), (2)(a), 409.165(1) FS. History–New 5-26-92, Formerly 10M-41.029, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.011 Shelter Audits

History

Specific Authority 409.026(8) FS. Law Implemented 409.145(1)(d), (2)(a), 409.165(1) FS. History–New 5-26-92, Formerly 10M-41.022, Repealed 11-15-06.

Fla. Admin. Code R. 65C-12.012 Monitoring of Emergency Shelters

History

Specific Authority 409.026(8) FS. Law Implemented 409.145(1)(d),(2)(a), 409.165(1) FS. History–New 5-26-92, Amended 12-25-96, Formerly 10M-41.024, Repealed 11-15-06.

Chapter 65C-13 FOSTER CARE LICENSING

Fla. Admin. Code R. 65C-13.001 Definitions

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Amended 7-18-95, Formerly 10M-6.015, Amended 11-30-97, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.002 Private Agency Foster Homes

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.016, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.003 Pre-Service and In-Service Training

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.017, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.004 Initial Licensing Procedures for Foster Homes, Emergency Shelters and Group Homes

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.018, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.005 Changes During the Licensed Year

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.019, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.006 Relicensing Procedures

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.020, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.007 Respite Care

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.022, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.008 Prospective Foster Parent Inquiries

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-18-95, Formerly 10M-6.0221, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.009 Parent Preparation and Mutual Selection

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.023, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.010 Substitute Care Parents' Role as a Team Member

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.024, Amended 11-30-97, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.011 Minimum Standards for Licensure of Family Foster Homes, Family Emergency Shelter Homes and Family Group Homes

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.025, Amended 11-30-97, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.012 Substitute Family Records

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 5-27-92, Formerly 10M-6.028, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.013 Definitions and Glossary

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.01, 39.45, 409.145, 409.165 FS. History–New 5-20-92, Amended 7-18-95, Formerly 10M-6.125, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.014 Entry into Foster Care

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.41, 39.45, 39.46, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.126, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.015 The Prevention and Management of Sexual Assault in Foster Care

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.01, 39.41, 39.45, 39.46, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.132, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.016 Health Care

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.01, 39.41, 39.45, 39.46, 409.145, 409.165, 743.0645 FS. History–New 5-20-92, Formerly 10M-6.138, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.017 Services for HIV Infected Children

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.01, 39.41, 39.45, 39.46, 381.004, 384.29, 384.30, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.140, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.018 Services to Parents of Children in Foster Care

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.41, 39.45, 39.46, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.143, Amended 9-10-98, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.019 Administrative Review

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.41, 39.45, 39.46, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.148, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.020 Permanency Staffings

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.01, 39.41, 39.46, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.150, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.021 Post-Placement and Protective Supervision

History

Rulemaking Authority 39.012 FS. Law Implemented 39.001, 39.41, 39.45, 39.46, 409.145, 409.165 FS. History–New 5-20-92, Formerly 10M-6.152, Repealed 4-6-08.

Fla. Admin. Code R. 65C-13.022 Definitions

History

Rulemaking Authority 409.175(5)(a) FS Law Implemented 409.175 FS. History–New 4-6-08, Amended 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.023 Background Screening Requirements

History

Rulemaking Authority 39.012, 39.0121, 409.175(5)(a), 435.01(2) FS. Law Implemented 39.0121, 39.0138, 409.175(5)(f), 435.04, 435.05 FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.024 Parent Preparation Pre-service Training

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.025 Initial Licensing and Unified Home Study

History

Rulemaking Authority 409.145(5), 409.175(5)(a), 435.01(2) FS. Law Implemented 409.145(2), 409.175(5)(a), (f), (6)(a), (b), 435.04 FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, 1-7-19, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.026 Continuing Education

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.027 Changes During the Licensed Year

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.028 Re-Licensing

History

Rulemaking Authority 409.145(5), 409.175(5)(a) FS. Law Implemented 409.145(2), 409.175(5)(a), (6)(b) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.029 Licensed Out-of-Home Team Member Roles

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, Repealed 3-6-18.

Fla. Admin. Code R. 65C-13.030 Standards for Licensed Out-of-Home Caregivers

History

Rulemaking Authority 409.145(5), 409.175(5)(a) FS. Law Implemented 409.145(2), 409.175(5)(a) FS. History–New 4-6-08, Amended 7-21-10, 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.031 Terms of a License

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.032 Over-Capacity Assessments and Exceptions

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175(3)(a), 409.175(3)(b), (c), 409.175(5)(a)4. FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.033 Babysitting, Overnight Care, Extended Overnight Care and Other Supervision Arrangements

History

Rulemaking Authority 39.4091(4), 409.175(5)(a) FS. Law Implemented 39.4091(2), 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.034 Foster Care Referrals and Investigations

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Fla. Admin. Code R. 65C-13.035 Administrative Actions, Appeals and Closures

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a), (6) FS. History–New 4-6-08, Amended 3-6-14, 3-6-18, Repealed 4-30-20.

Chapter 65C-14 CHILD-CARING AGENCY LICENSING

Fla. Admin. Code R. 65C-14.001 Definitions

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 7-1-87, Amended 9-19-90, Formerly 10M-9.003, Amended 11-30-97, 10-20-16, 5-26-21, Transferred to 65C-46.001.

Fla. Admin. Code R. 65C-14.002 Licensed Child Caring Agencies

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.004, Repealed 3-9-16.

Fla. Admin. Code R. 65C-14.003 Application Packet and Licensing Documents

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(6) FS. History–New 7-1-87 Amended 9-19-90, 2-17-93, Formerly 10M-9.005, Amended 10-20-16, 1-2-18, 5-26-21, Transferred to 65C-46.002.

Fla. Admin. Code R. 65C-14.004 On Site Visits

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.008, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.005 Grievance Procedure

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.014, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.006 Administration and Organization

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)1., 8. FS. History–New 7-1-87, Formerly 10M-9.015, Amended 10-20-16, 5-26-21, Transferred to 65C-46.003.

Fla. Admin. Code R. 65C-14.007 Buildings, Grounds, Equipment, and Interior Accommodations

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 3. FS. History–New 7-1-87, Formerly 10M-9.016, Amended 10-20-16, 5-26-21, Transferred to 65C-46.004.

Fla. Admin. Code R. 65C-14.008 Interior Accommodations

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.017, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.009 Ventilation and Lighting

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.018, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.010 Safety, Sanitation, and Food Service Requirements

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 3. FS. History–New 7-1-87, Formerly 10M-9.019, Amended 6-3-12, 10-20-16, 1-2-18, 5-26-21, Transferred to 65C-46.005.

Fla. Admin. Code R. 65C-14.011 Fire Regulations

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.020, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.012 Transportation Safety

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.021, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.013 Food and Nutrition

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.022, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.014 Health and Medical Services

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 3., 9. FS. History–New 7-1-87, Formerly 10M-9.023, Amended 10-20-16, 5-26-21, Transferred to 65C-46.006.

Fla. Admin. Code R. 65C-14.015 Administration of Medication

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.024, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.016 Incident Notification Procedures

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.025, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.017 Child Abuse and Neglect and Incident Notification Procedures

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)1., 10. FS. History–New 7-1-87, Formerly 10M-9.026, Amended 10-20-16, 5-26-21, Transferred to 65C-46.007.

Fla. Admin. Code R. 65C-14.018 Individual Needs and Rights of Children in Care

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 12. FS. History–New 7-1-87, Formerly 10M-9.027, Amended 10-20-16, 5-26-21, Transferred to 65C-46.008.

Fla. Admin. Code R. 65C-14.019 Recreation, Leisure Activities and Work Experience

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.028, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.020 Clothing and Personal Belongings

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.029, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.021 Discipline and Behavior Management

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a)1., 13. FS. History–New 7-1-87, Formerly 10M-9.030, Amended 10-20-16, Transferred to 65C-46.009.

Fla. Admin. Code R. 65C-14.022 Child Records and Confidentiality Requirements

History

Rulemaking Authority 409.175(5), 381.004(2)(e)11. FS. Law Implemented 409.175(5)(b)1., 9., 13., 381.004(2)(e)11., (f) FS. History–New 7-1-87, Formerly 10M-9.031, Amended 10-20-16, 5-26-21, Transferred to 65C-46.010.

Fla. Admin. Code R. 65C-14.023 Personnel and Staffing Requirements

History

Rulemaking Authority 409.145(5), 409.175(5), 435.01 FS. Law Implemented 409.145(2)(e), 409.175(5)(b)1., 4., 5., 7., 9., 435.05 FS. History–New 7-1-87, Formerly 10M-9.033, Amended 10-20-16, 5-26-21, Transferred to 65C-46.011.

Fla. Admin. Code R. 65C-14.024 Staffing Requirements

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.034, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.025 Volunteers

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.035, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.026 Organization

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.036, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.027 Confidentiality Related to HIV Infected Children

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175, 381.609(3)(f)10. FS. History–New 9-19-90, Formerly 10M-9.037, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.040 Admission, Placement, and Ongoing Services

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(a)1., 2., 9., 10. FS. History–New 7-1-87, Formerly 10M-9.041, Amended 10-20-16, 5-26-21, Transferred to 65C-46.012.

Fla. Admin. Code R. 65C-14.041 Medical Information

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.042, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.042 Orientation

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.043, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.043 Child’s Case Record

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.044, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.044 Placement Agreement

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.045, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.045 Program Services for Children in Care

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.046, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.046 Continuing Service Plan and Review

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.047, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.047 Educational and Vocational Services

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.048, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.048 Discharge Planning and Aftercare Services

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)9. FS. History–New 7-1-87, Formerly 10M-9.049, Amended 10-20-16, 5-26-21, Transferred to 65C-46.013.

Fla. Admin. Code R. 65C-14.049 Religious and Ethnic Heritage

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.050, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.050 Interior Space

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.052, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.051 Food Service

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.053, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.052 Health Care

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.054, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.053 Apparel and Allowance

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87,Formerly 10M-9.055, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.054 Personnel

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.056, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.055 Job Functions and Staff Qualifications

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.057, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.056 Staff Development

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.058, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.060 Standards for Contracted Emergency Shelters

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.061, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.061 Standards for Runaway Shelters

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.066, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.062 Medical Care in All Runaway Shelters

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.067, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.070 Specific Rules for Maternity Residences

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.070, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.071 Admission and Planning

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.071, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.072 Medical Information

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.072, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.073 Discharge

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.073, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.074 Counseling Services

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.074, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.075 Education and Vocational Service

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.075, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.076 Orientation

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.076, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.077 Case Record

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.077, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.078 Interior Furnishings and Space

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.079, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.079 Staffing Requirements for Maternity Residences

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.080, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.080 Food Service

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.081, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.081 Health Care

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.082, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.082 Apparel and Allowance

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.083, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.083 Personnel

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.084, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.084 Job Functions and Staff Qualifications

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.085, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.085 Staff Development

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.086, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.090 Exemptions

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.087, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.091 Administrative Organization

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.088, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.092 Course Admission and Planning

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Amended 8-3-88, Formerly 10M-9.089, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.093 Medical History

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.090, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.094 Program Orientation

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.091, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.095 Case Record

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.092, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.096 Case Plan

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.093, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.097 Food Service

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.094, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.098 Health

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.095, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.099 Aquatic Safety Procedures

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.096, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.100 Fire and Weather Safety

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.097, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.101 Sedentary Programs

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.098, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.102 Mobile Programs

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.099, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.103 Personnel Practices

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.100, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.104 Job Descriptions

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.101, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.105 Training

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.102, Repealed 1-12-16.

Fla. Admin. Code R. 65C-14.110 Specific Exemptions for Wilderness Camps

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.104, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.111 Structural and Safety Requirements

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.105, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.112 Clothing and Personal Needs

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.106, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.113 Water Safety

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.107, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.114 Admission, Education and Case Record Procedures

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.108, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.115 Wilderness Camp Personnel Policies

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-1-87, Formerly 10M-9.109, Repealed 10-20-16.

Fla. Admin. Code R. 65C-14.116 Administrative Actions, Appeals and Closures

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)1., (6), (9)(a) FS. History–New 10-20-16, Amended 7-6-21, Transferred to 65C-46.014.

Fla. Admin. Code R. 65C-14.117 Standards for Contracted Emergency Shelters

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 12-24-17, Amended 5-26-19, Transferred to 65C-46.015.

Fla. Admin. Code R. 65C-14.118 Standards for Runaway Shelters

History

Rulemaking Authority 409.175(5), 409.441 FS. Law Implemented 409.175, 409.441 FS. History–New 12-24-17, Amended 5-26-21, Transferred to 65C-46.016.

Fla. Admin. Code R. 65C-14.1181 Standards for Maternity Homes

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.017.

Fla. Admin. Code R. 65C-14.1182 Standards for Wilderness Camps

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.018.

Fla. Admin. Code R. 65C-14.1183 Standards for At-Risk Houses

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.019.

Fla. Admin. Code R. 65C-14.119 Standards for Safe Houses

History

Rulemaking Authority 409.1678(2)(c)7., (2)(e) FS. Law Implemented 409.1678 FS. History–New 1-12-16, Amended 10-24-19, Formerly 65C-43.003, Amended 5-26-21, Transferred to 65C-46.020.

Fla. Admin. Code R. 65C-14.120 Record Keeping for Children in Safe Houses

History

Rulemaking Authority 409.1678(2)(e) FS. Law Implemented 409.1678 FS. History–New 10-24-19, Formerly 65C-43.0035, Repealed 7-6-21.

Fla. Admin. Code R. 65C-14.121 Standards for Qualified Residential Treatment Program Credential

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.021.

Fla. Admin. Code R. 65C-14.122 Standards for Unaccompanied Alien Children (UAC) Homes and Unaccompanied Refugee Minor Programs

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.022.

Fla. Admin. Code R. 65C-14.123 Standards for Traditional and Residential Homes

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.023.

Fla. Admin. Code R. 65C-14.124 Licensing Process and Procedures

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Transferred to 65C-46.024.

Fla. Admin. Code R. 65C-14.125 Foster Care Referrals and Investigations

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 7-6-21, Transferred to 65C-46.025.

Chapter 65C-15 CHILD-PLACING AGENCIES

Fla. Admin. Code R. 65C-15.001 Definitions

All definitions for this rule chapter are located in Rule 65C-30.001, F.A.C.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, 9-14-94, Formerly 10M-24.003, Amended 12-4-97, 11-14-16.

Fla. Admin. Code R. 65C-15.002 Licensed Child-Placing Agencies

History

Rulemaking Authority 63.202, 409.175 FS. Law Implemented 63, 409.175, 409.165 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.004, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.003 Licensing Application Packet and Licensing Documents

(1) Application for an agency license shall be made on the “Master License Application for Child-Placing Agencies,” CF-FSP 5135, (March 2026), which is hereby incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-19467. The application shall be signed by the owner, chief executive officer or executive director exercising authority over the operation, policies and practices of the agency. All information requested in the application form and the rule must be submitted as part of the application.

(2) Applicants requesting to be licensed as a child-placing agency serving as a community based care lead agency shall meet requirements pursuant to Section 409.986, F.S. through s. 409.997, F.S. prior to providing services.

(3) A licensed agency may operate satellite offices without separate licenses for those offices. However, each satellite office must be disclosed in the application for license by submitting a copy of form CF-FSP 5135, incorporated in subsection (1), of this rule, for each office. If the agency opens a satellite office during the licensed term, the agency shall file form CF-FSP 5135 not less than 30 business days prior to the opening of the new office; a full application packet is not required.

(4) Each satellite office shall be required to submit client records and personnel files for review.

(a) Description of the services, if the satellite office will offer the same services as the parent agency; and,

(b) Prior to issuance of a license and annually thereafter, the child-placing agency satellite office must be inspected by the Department. The Department must complete an on-site visit inspection when a complaint or concern rises to the level of for potential violation of licensing standards. The Department may conduct scheduled or unannounced visits to a satellite office.

(c) Licensed child placing agencies requesting to provide the same services for private adoptions or foster home maintanence outside of the licensed area are not required to have a satellite office when service delivery is conducted in the home of the prospective family and all staff and client files are stored electronically. All files must be made available for review upon request by the Department.

(5) The agency shall have an office and professional staff permanently housed within the state.

(6) Upon determination that the applicant meets the state licensing requirements, a license shall be issued to a specific agency, at a specific location, noting all satellite office locations.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.005, Amended 11-14-16, 2-25-18, 7-14-26.

Fla. Admin. Code R. 65C-15.004 On-Site Visits and Complaint Investigation

(1) All child-placing agencies shall be inspected at least annually. Regional licensing staff of the Department may make either scheduled or unannounced visits to a licensed home, facility or agency at any time to investigate and evaluate compliance with the licensing requirements.

(2) The Department shall investigate complaints to determine if the agency is meeting the licensure requirements.

(3) The child-placing agency shall fully cooperate with the Department whenever complaint investigations are conducted.

(4) The Department shall investigate any report questioning the certification status or compliance of a child-placing agency with requirements of Section 409.175, F.S., or alleging violations of Chapter 65C-15, F.A.C., by the agency.

(5) The Department shall advise the owner, chief executive officer, or executive director of the child-placing agency that there is a licensing complaint when initiating an investigation.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.009, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.0041 Corrective Action Plan

(1) A corrective action plan (CAP) must be imposed on the child-placing agency when a violation of licensing standards has occurred, and the child-placing agency has the ability to understand and correct the infraction.

(2) Corrective action plans are not created for child-placing agencies who have previously committed licensing violations and were unable to benefit from the remedial efforts. The Department may seek action to revoke the license.

(3) The child-placing agency must submit a written CAP to the Department within seven calendar days from the date of receipt of the inspection. The CAP must be signed by the chief executive officer or designee of the child-placing agency.

(a) The CAP must include the following:

Identify the violation;
The actions the child-placing agency will take to correct each of the violations identified;
The date by which the violation must be corrected; and
The actions the child-placing agency will take to ensure the violation identified does not occur again.

(b) The Department will reject any proposed CAP that fails to identify all the information described in paragraph (3)(a) of this rule or reflects a plan of action that does not address the violation(s). If the Department rejects a proposed CAP, the Department must notify the child-placing agency in writing of the reasons for rejection and require the submission of an amended CAP addressing the deficiency or deficiencies within five calendar days of receipt of the Department’s notice rejecting the CAP. Failure to submit a CAP that is sufficient for Department approval within 30 days of the inspection completion date may be considered non-compliant and be subject to administrative action.

(4) Once the CAP is approved by the Department, the date to resolve all violations in the corrective action plan must not exceed 30 days from the inspection completion date, unless a date is directed or extended by the Department.

(5) The Department may deny, suspend, or revoke a license when the child-placing agency does not complete the CAP successfully.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-14-26.

Fla. Admin. Code R. 65C-15.0042 Administrative Actions

(1) The Department is the licensing authority for all child-placing agencies and has final authority for approval, denial, revocation, or suspension of any license under Chapter 120, F.S.

(2) Denial of Initial and Renewal Licensure Application.

(a) The Regional Licensing Authority shall have 90 days following receipt of a complete application packet to grant or deny the application in accordance with Section 120.60, F.S.

(b) If the Regional Licensing Authority determines that the applicant should not be licensed, the applicant shall be notified in writing within 10 business days of the determination, identifying the reasons for the denial, the statutory authority for the denial and the applicant’s right of appeal pursuant to Chapter 120, F.S.

(c) The applicant shall be afforded the opportunity to withdraw the application. If the applicant elects to withdraw the application in leu of denial, this must be documented in the licensing file.

(3) Administrative Action for Existing Child-Placing Agencies. The Department may consider the following factors when determining whether a child-placing agency’s license will be revoked:

(a) Whether the agency has had licensing violations during the term of the license,

(b) Whether the agency has a history of intakes, institutional abuse and neglect reports, and special condition referrals.

(d) The agency does not have the ability to protect the children in care.

(e) Whether the agency has failed to comply with a corrective action plan during the term of the license; and,

(f) Whether the agency has the ability and willingness to implement a corrective action plan.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 7-14-26.

Fla. Admin. Code R. 65C-15.005 Disclosure

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.014, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.006 Statement of Purpose

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.015, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.007 Incorporation

History

Rulemaking Authority 63, 409.175 FS. Law Implemented 63.212(1), 409.175, 167.11 FS. History–New 12-19-90, Formerly 10M-24.016, Repealed 12-4-97.

Fla. Admin. Code R. 65C-15.008 Governing Body

History

Rulemaking Authority 63.212, 409.175 FS. Law Implemented 63.212, 409.175, 617.026 FS. History–New 12-19-90, Formerly 10M-24.017, Repealed 12-4-97.

Fla. Admin. Code R. 65C-15.009 Responsibilities of the Governing Body

History

Rulemaking Authority 63, 409.175 FS. Law Implemented 63.212, 409.175, 617.026 FS. History–New 12-19-90, Formerly 10M-24.018, Repealed 12-4-97.

Fla. Admin. Code R. 65C-15.010 Finances

(1) Financial Ability. The child-placing agency must provide written documentation of financial ability to operate.

(a) Initial Operational Expenses. Child-placing agencies beginning operation must have the capital necessary for a six (6) month period of operation.

(b) Annual Budget. The child-placing agency must prepare a written budget annually of anticipated income and expenditures necessary to provide the services described in its statement of purpose. The child placing agency must provide the annual budget to the Department.

(c) Financial Audit. The child-placing agency must have its financial records audited annually. All audit reports must be submitted at time of license renewal and available to the Department upon request at any time during the licensing year. All awarded grants for the coverage of adopion fees shall be documented in the child-placing agnecy’s audit or documentation of financial review.

Financial audits are required for child-placing agencies who expend equal to or in excess of the threshold, as outlined in Section 215.97, F.S. Annual audits must be conducted by an independent certified public accountant (CPA) licensed pursuant to Chapter 473, F.S.
Child-placing agencies that do not meet the audit threshold must provide proof of a financial review conducted by an external auditor or an independent certified public accountant (CPA) licensed pursuant to Chapter 473, F.S.

(2) Fees and Costs.

(a) When fees for services, including adoption and foster care services, are charged, the child-placing agency must have a fee schedule disclosing all fees for services. This schedule must list the specific services covered by each fee and outline whether the child-agency accepts monetary grants for adoption fee coverage.

The child-placing agency must file the fee schedule with the Department at licensure and when changes are made to the fee schedule during the licensing year.
Adoption fees must be established based on the costs of services outlined in Section 63.097, F.S. The child-placing agencies must have the fee schedule reviewed by the Department annually and when updates are made to ensure that the schedule complies with Section 63.097, F.S., for adoption related services.

(b) This fee schedule must be given to all persons requesting services from the child-placing agency. The child-placing agency must provide individuals with the fee schedule at the time the application is made.

A fee agreement and any modifications to it must be executed with each applicant.
The fee agreement must list the fees charged and the services to be provided, including provisions for payment.
The fee agreement shall outline all grants awarded for adoption fees and the specific service the grant covered on behalf of each applicant, and any fees that were reimbursed to the applicant.

(3) Where payments are made to foster parents:

(a) The child-placing agency must have a written payment schedule and statement on payment procedures; and,

(b) The child-placing agency must provide foster parents with written notification of changes in the schedule at least 30 calendar days prior to the change.

(4) The child-placing agency must not require applicants, adoptive parents or their representatives to provide gratuities, such as money or other things of value or services, beyond the established fee.

(5) Adoption entities as defined in Section 63.032, F.S., must submit information quarterly in accordance with Section 63.097, F.S., to the Department’s electronic system located on the Department’s website.

(a) This information must be submitted no later than the 15th day of the month following the preceding quarter.

(b) An adoption entity that finalizes an adoption within a quarter must attest no later than the 15th day of the month following the preceding quarter that all finalized adoptions have been reported in the Department’s electronic system located on the Department’s website.

Quarter 1 is January through March,
Quarter 2 is April through June,
Quarter 3 is July through September, and
Quarter 4 is October through December.

History

Rulemaking Authority 63.233, 409.175 FS. Law Implemented 63.097, 409.175 FS. History–New 12-19-90, Formerly 10M-24.019, Amended 11-14-16, 11-24-24, 7-14-26.

Fla. Admin. Code R. 65C-15.011 Changes in Agency Function or Purpose

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.020, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.012 Notification of Critical Injury, Illness or Death

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.021, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.013 Right to Privacy

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.023, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.014 Office Equipment and Transportation

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.024, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.015 Policies and Procedures

(1) Policies and procedures set forth in this rule must be available for review by the Department prior to initial licensure. Any policies or procedures that are updated during the certification year must be submitted during certification or 30 days prior to the implementation of the new policy if proposed changes result in substantial changes that alters the original direction or intent of the programming of the child-placing agency. Policies may be submitted electronically.

(2) Written policies and procedures must be available to all employees and volunteers upon their beginning date of employment or service and, thereafter, as revised. Employees and volunteers must indicate in writing that they have read and understand the policies and procedures, relevant to their position or volunteer duties, which must be documented in their personnel file.

(3) The child-placing agency shall have written personnel policies and procedures developed and adhered to, to address the following:

(a) Personnel Policies. Must outline the recruitment, retention, and effective performance of qualified personnel.

Job descriptions and titles for each position, defining the qualifications, duties and lines of authority;
Salary scales;
A description of employee benefits;
Provisions which will encourage professional growth through supervision, orientation, in-service training, and staff development;
Annual evaluation of the work and performance of each staff member;
Procedures governing payment of bonuses or other extraordinary compensation to employees or contract providers of the agency.
Background screening requirements and mandatory reporting by staff to report all state, national, and federal arrests to the child-placing agency. The child-placing agency shall report all arrests to the Department.
Use of volunteers;
Steps taken when staff are named in an active abuse and neglect investigation with the Department; and
Description of the termination procedures established for resignation or discharge;

(b) Grievance process for families and employees that indicate timeframes for responding to the grievance, escalation process, and steps taken when the grievance involves allegations regarding the actions of an employee or volunteer.

(c) Fee for Service. Description of the services provided, the fees associated with each service, and the conditions under which fees are charged and waived. The policy must outline the agency’s requirement to provide referrals for individuals when fees for service are not waived.

(d) Confidentiality. Maintaining the confidentiality and privacy of records. The child-placing agency must also ensure that employees and volunteers receive written information on the restrictions relating to the disclosure of information about families.

(e) Abuse and Neglect Reporting. The requirement of any person who knows, or has reasonable cause to suspect, that a vulnerable child or adult is abused or neglected, must report such knowledge or suspicion to the Department’s Abuse Hotline. Policy should outline training requirements and acknowledgement forms.

(f) Emergency Management Plan. A comprehensive and effective plan to ensure the safety and well-being of employees and volunteers in the event of an emergency. The child-placing agency must annually review and update the plan. A current plan must be maintained by the child-placing agency and made available for inspection upon request. The emergency management plan must address the following:

Emergencies that may be reasonably expected in the licensed child-placing agency. Examples include natural or manmade disasters such as floods, hurricanes or tornados; contamination of the air, ground, water, or food; fire; public health hazards such as outbreak of communicable, reportable diseases; significant incidents such as death or injury; security incidents such as intruders, hostage situations, kidnapping, and workplace violence; human acts that may jeopardize the health, safety, or welfare of employees, volunteers, or participants; or shelter-in-place in the event of an emergency that requires the house to lockdown.
Procedures for reporting emergencies or incidents.
Procedures to implement the plan and personnel notification; delegations of authority and lines of succession.
Identification of alternative facilities; procedures for evacuation, including type of evacuation and exit route assignments.
Procedures to account for all staff members and participants; and identification and protection of records and databases.
Procedures requiring the child-caring agency to confirm if the agency is in a flood zone and outline processes for when a flood warning is issued.
Procedures for reporting threats to designated individuals within the agency. Procedures should include reporting threats to the Department when the threat poses or causes harm to staff, families, and children.

(g) Placement. Must outline the child-placing agencies procedure to securing a legal placement for children that is safe and nurturing. All placements shall be in a safe environment where drugs and alcohol are not abused.

(h) Incident Reporting. The child-placing agency shall submit the “Incident Reporting” form CF 1959, (June 2025), which is herein incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-19469, to the Department as soon as practical, and in no event more than 24 hours after an incident outlined in the form has occurred.

(i) Transportation. The child-placing agency must outline procedures on the use of personal or agency issued vehicles to include:

Accountability of passengers to include identifying designated staff responsible for completing a censes count for children being transported, reporting any discrepencies found in the census count, checking the rear seat of all vehicles at the end of each transport, utilization of a tracking tool for all transportation involving children that captures name of transporter, date and time of transportation, name of child being transported, and indication if critical incidents occurred during the transportation.
Valid drivers license
Requirement of car insurance.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.025, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.016 Staff Functions and Qualifications

(1) The child-placing agency shall have a personnel file for each employee, that shall be available on site for review by the Department, which shall include the following:

(a) The application for employment;

(b) Verification that the background screening requirements, have been completed and met, including:

“Attestation of Good Moral Character,” form CF 1649, (June 2025), incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-19470.
National and Florida criminal records check through fingerprinting every five years;
Local ciminal record checks through local law enforcement every five years;
Florida abuse and neglect record checks annually through the Department’s child abuse registry, in accordance with subsection 39.202(2), F.S.

a. Any employee or prospective employee with a verified report for sexual abuse is not permitted to work for the child-placing agency.

b. Any employee or prospective employee with a verified report for abuse and neglect other than sexual abuse, and when an employee is named as the alleged caregiver responsible in a report not substantiated for sexual abuse, shall be reviewed by the Department to determine safety concerns for the employee being considered for hire or continued employment.

c. Any licensee with three or more child abuse and neglect investigations within a five year period pursuant to subsection 39.302(7), F.S., shall be reviewed by the Department to determine licensure or continued licensure.

The licensee, staff, and volunteers being screened under this rule shall provide all names under which he or she has been known to complete background screenings.
All staff and volunteers must report all state, national, and federal arrests to the child-placing agency. The child-placing agency shall report all arrests to the Department within 24 hours of notification from the staff.

(d) Annual performance evaluations and any disciplinary actions taken;

(e) Training record and conferences attended;

(f) Valid Identification;

(g) Employment history check prior to hire; and

(h) Signed acknowledgement of child abuse and neglect laws, reporting requirements, and confidentiality.

(i) Diploma or degree, if applicable.

(j) A copy of Child Welfare Professional Certification for employees who conduct child welfare services as set forth in paragraph (2)(d) of this rule.

(2) Qualifications:

(a) A director shall be responsible for the general management and administration of the agency in accordance with the licensing requirements and the policies of the governing body. The director shall have a degree in social work or in a related area of study specified in Section 402.402(1)(b), F.S. and four (4) years’ of experience in human services or child welfare programs. Additional related areas of study include human services, criminology, criminal justice, juvenile justice, behavioral science, child protection, education, law and protection, mental health, public administration, and public health.

(b) A supervisor shall be responsible for the supervision, evaluation, or monitoring of employees.

Supervisors providing oversight of social work functions or child welfare programs shall maintain qualifications in accordance with Section 402.402(1), F.S. The supervisor must have at least two (2) years’ experience in human services or child welfare programs.
Supervisors responsible for providing oversight of administrative staff shall meet the qualifications outlined in the agencies written personnel policies and procedures for recruitment, retention, and effective perfomance of qualified personnel.

(d) Child-placing agencies providing child welfare services in accordance with Section 402.40(2)(b), F.S., must ensure persons providing child-welfare services or supervisors providing oversight of child welfare programs, receive child welfare training and certification outlined in Chapter 65C-33, F.A.C.

(3) The Department may prohibit individuals who served as a board member, executive director or other officer of an agency that has failed to secure a license to operate as a child-placing agency or continued in operation after the revocation or suspension of the agency’s license, from employment or association with a licensed child-placing agency for a period of two (2) years’ after termination or cessation of that illegal operation.

(4) Staff Development.

(a) The child-placing agency shall have a written plan for the orientation, ongoing training and development of all staff.

(b) The child-placing agency shall ensure that the supervisory and social work staff receive in-service training during each full year of employment. Activities related to supervision of the staff member’s routine tasks shall not be considered training activities for the purpose of this requirement. In-service training shall be documented in the employee’s personnel file or other agency tracking system.

(5) Volunteers who work directly with children for periods of more than 10 hours in any given month must be screened in the same manner as the employees of the child-placing agency. A volunteer who assists on an intermittent basis for less than 10 hours per month need not be screened as long as he or she is under direct and constant supervision by persons who have been screened in accordance with Section 409.175, F.S.

(a) A child-placing agency that utilizes volunteers to work directly with children or their families shall:

Develop a description of duties and specific responsibilities;
Develop a plan for orientation and training in the philosophy of the agency, the needs of the children in care and their families, and the importance of confidentiality; and,
Provide for how volunteers will participate in carrying out the service plans for children and families with whom they are working, if applicable.

(b) Volunteers who assume the same or substantially similar responsibilities as a paid employee shall have the same qualifications and training as the paid employee for the position and shall receive the same supervision and evaluation as the paid employee.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.026, Amended 11-14-16, 3-1-23, 7-14-26.

Fla. Admin. Code R. 65C-15.017 Personnel

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.027, Amended 11-14-16, 7-25-17, Repealed 3-1-23.

Fla. Admin. Code R. 65C-15.018 Staff Development

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.028, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.019 Volunteers

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.029, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.020 Intake Procedures and Practices for Children in Foster Care and Residential Care

History

Rulemaking Authority 39, 63, 409.175 FS. Law Implemented 39, 63, 409.175 FS. History–New 12-19-90, Formerly 10M-24.031, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.021 Services to Families and Children in Foster Care

(1) Placement Services:

(a) The child-placing agency shall provide placement services to families and children in foster care in accordance with Chapter 65C-30, F.A.C.

(b) When making placement decisions, the child-placing agency shall consider the cultural, religious, and ethnic values of each child.

(d) Child placing agencies shall only place children removed from the legal custodian in an approved relative home, licensed foster home, adoptive home, or independent living program, as outlined in subsection 39.001(1), in addition to a non-relative home, licensed child-caring agency, or other state issued licensed home and/or facility that provides the most stable and potentially permanent living arrangement for the child.

(2) Agency Services:

(a) The child-placing agency shall provide services to children in foster care in accordance with Rule Chapter 65C-28, F.A.C.

(b) Within 90 days of the child-placing agency taking a child into care for the purpose of adoption, the agency shall file a petition for termination of parental rights or for temporary custody.

(3) Right to Privacy. The child-placing agency shall ensure that any public appearances in which the child is identified as a foster child are voluntary and that the written consent of the child’s parent, guardian or the case management organization’s authorized individual is on file. Consent forms shall be updated annually.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.032, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.022 Agency Services to Children in Foster Care

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.034, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.023 Foster Home Licensing

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.036, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.024 Foster Home Studies

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.037, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.025 Monitoring and Annual Licensing Study

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.038, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.026 Recommendations to Deny an Application for License or Revoke a Family Foster Home License

(1) The Department is the licensing authority for all foster home licenses and has final authority for approval, denial, revocation, or suspension of any license under Chapter 120, F.S.

(2) The child-placing agency shall send the Department written notice of its recommendation to deny an application for license or revoke a family foster home license. The child-placing agency shall state the reasons it is recommending denial or revocation and shall provide the Department with documentation supporting its findings and violation of Chapter 65C-45, F.A.C. and section 409.175, F.S.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.039, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.027 The Agency’s Responsibilities to Licensed Out-of-Home Caregivers

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.040, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.028 Adoption Home Study

(1) All child-placing agencies shall conduct adoption home studies in accordance with Rules 65C-16.002 and 65C-16.005, F.A.C.; however, private adoption agencies are exempt from the requirements of subsections 65C-16.005(4)-(5), F.A.C.

(2) All private adoption agencies shall provide the Department copies of the educational materials provided by the agency to the adoptive parents in accordance with subparagraph 63.902(3)(e), Florida Statutes, prior to the initial licensure or re-licensure.

History

Rulemaking Authority 39.012, 63.233, 409.175 FS. Law Implemented 39.0138, 63.092, 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.042, Amended 11-14-16, 11-26-18.

Fla. Admin. Code R. 65C-15.029 Services to Adoptive and Birth Parents

(1) The child-placing agency shall provide adoptive services in accordance with rule Chapter 65C-16, F.A.C.

(2) If a child-placing agency pays, directly or indirectly, for a pregnant female to come to Florida for the purpose of placing the child, when born, for adoption with the agency, then the agency shall be responsible for returning the female to the state of origin, if she wishes to return, immediately after she is able to travel. If the mother decides not to place the child with the agency for adoption, then the agency shall be responsible for returning the mother and child to the state of origin, if the mother wishes to return, immediately after the baby is ready to travel.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.043, Amended 11-14-16.

Fla. Admin. Code R. 65C-15.030 Case Records

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.045, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.031 Child’s Case Records

(1) The child-placing agency shall arrange storage for records of a child receiving services under Chapter 39, F.S., until the child is 30 years’ of age. Case records shall be permanently retained of children placed by child-placing agency for adoption, their biological families and adoptive families. Files may be retained electronically.

(2) The child-placing agency shall maintain current records for each child placed in any setting.

(3) The following information shall be contained in each file:

(a) Demographic information including the name, address, social security number, sex, religion, race, birth date, and birth place of the child;

(b) The name, address, telephone number, social security numbers, and marital status of the parents or guardians of the child;

(c) The name, address, and telephone number of siblings if placed elsewhere and other significant relatives, if available;

(d) Copies of legal documents of importance to the type of care, such as birth record and any court dispositions;

(e) The medical history, which shall include, if available, cumulative health records, addresses of all health care providers who provided treatment, examination or consultation regarding the child, as well as all psychological and psychiatric reports;

(f) The social assessment and background of the family and parents;

(g) A summary which reflects the dates of contact, initial assessment, case plan, and content of the worker’s visits;

(h) The circumstances leading to the decision of the parents to place the child, the agency’s involvement with the parents, including services offered, delivered, or rejected;

(i) Educational records and reports, if applicable;

(j) Summary of case reviews which reflect the contacts with and the status of all family members in relation to the case plan, as well as the achievements or changes in the goals;

(k) Summary of any administrative or outside service reviews on the progress of each child toward goal determination;

(l) Summary of child’s contacts with family members which reflect the quality of the relationships and the way the child is coping with the family members; and,

(m) A record of the child’s placements with names of caregivers, addresses, and the dates of care.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.046, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.032 Family Case Record

(1) A child-placing agency the provides services to children shall have on file a record of the child’s family. Files may be retained electronically.

(2) The family case record must be available for the Department’s review and contain the following:

(a) Demographic information, including address, birth dates, race, religion, family composition, and persons important to the child;

(b) The social history, including any psychological or psychiatric reports and medical histories;

(d) The agency’s assessment and initial case plan;

(e) Signed agreements between the agency and family or legal guardian;

(f) Summary of dates of contact and progress toward goals;

(g) Permanency status; and,

(h) Discharge summary.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.047, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.033 Family Foster Home Records

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.048, Repealed 11-14-16.

Fla. Admin. Code R. 65C-15.034 Adoptive Home Records

(1) A child-placing agency the provides services to applicants pursuing adoption shall have on file a record of the adoptive home. Files may be retained electronically.

(2) The child-placing agency shall keep records for each adoptive family which shall contain:

(a) All documentation required pursuant to Rule 65C-16.005, F.A.C.

(b) The application for adoption;

(d) A copy of the information given to the parents concerning the child or children to be placed for adoption with them;

(e) Summary containing the placement decision, pre-placement and post-placement contacts with the family and the adoptive child, including services provided to stabilize the placement and decisions regarding finalization of the adoption; and,

(f) All legal documents pertaining to the adoption.

(g) For private adoptions, a copy of a signed agreement to adopt that advises the family if the biological parent has a history of three or more known instances of rescinding their consent to adopt.

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Amended 10-27-93, Formerly 10M-24.049, Amended 11-14-16, 7-14-26.

Fla. Admin. Code R. 65C-15.035 Agency Closure

History

Rulemaking Authority 409.175 FS. Law Implemented 409.175 FS. History–New 12-19-90, Formerly 10M-24.050, Amended 11-14-16, Repealed 7-14-26.

Fla. Admin. Code R. 65C-15.036 Intercountry Adoption Services

(1) The child-placing agency which engages in intercountry adoptions shall provide to the adoptive parents all legal documents pertaining to the adopted child that have been obtained from the child’s country of origin.

(2) Any child-placing agency which conducts intercountry adoptions and is accredited by the United States Department of State shall remain in good standing with the accreditation body. A copy of the accreditation and survey must be submitted to the Department.

(3) If the Hague Convention on Protection of Children and Co-operation in Respect of Intercountry Adoption suspends or revokes accreditation of a child-placing agency, the Department will consider the action of the accreditation suspension or revocation grounds for revocation of the child-placing agency’s license.

(4) The agency shall comply with all applicable adoption laws of the child’s country of origin, the United States, and the state of Florida.

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a) FS. History–New 10-27-93, Formerly 10M-24.052, Amended 11-14-16, 6-15-17, 7-14-26.

Fla. Admin. Code R. 65C-15.037 Interstate Adoptions

(1) Interstate adoption is the process of adopting a child across state lines.

(2) All interstate adoptions shall comply with the Interstate Compact on the Placement of Children, Section 409.401, F.S.

(3) The child-placing agency must comply with the other state’s child placing requirements and advertisement requirements.

(4) Each child-placing agency must provide written confirmation of the intent to practice in another state. Copies of any inter-agency agreements entered into in compliance with the other state’s laws must be submitted to the Department.

History

Rulemaking Authority 409.401, 409.175 FS. Law Implemented 409.401, 409.175 FS. History–New 5-17-98, Amended 11-14-16, 7-14-26.

Chapter 65C-16 ADOPTIONS

Fla. Admin. Code R. 65C-16.001 Definitions

Definitions in this Rule Chapter shall have the same meaning as defined in Section 39.01, F.S. Additionally, the following terms are defined:

(1) “Abuse Hotline” means the Department’s single statewide toll-free telephone number established for the purpose of receiving reports of child abuse, abandonment or neglect.

(2) “Florida Adoption Exchange” means the Department of Children and Families statewide website where a child or sibling group available for adoption without an identified family will appear for recruitment of an adoptive family.

(3) “Adopted from the Department” means a child permanently committed to the custody of the Department for the purpose of adoption and has been adopted by parents who have an approved adoption home study by the Department.

(4) “Adoptive Home Application” means a Department-approved application that captures information needed to complete a general or child specific adoption home study.

(5) “Adoption Home Study” or “Preliminary Home Study” means a written evaluation of the adoptive parents’ capacity for adoptive parenthood. The study assesses the applicants’ home and living environment, their marriage, if any, family and social history, relationships, and criminal history, if any.

(6) “Adoption Information Center” means Florida’s Adoption Information and Referral Service, a statewide service for pregnant women considering placement of a child for adoption, adopted adults and birth parents and relatives seeking reunions and prospective adoptive parents interested in adopting a child.

(7) “Adoption Reunion Registry” means a voluntary computer database which acts as a repository for current names, addresses and telephone numbers of parties to any Florida adoption.

(8) “Adoption Applicant Review Committee” means a committee that provides consultation and assistance to an adoption counselor when the counselor and supervisor are recommending denial of an adoption home study, or adoption case situations which present challenging issues, such as when multiple families apply to adopt the same child.

(9) “Adoptive Placement” means the child is placed in the home of the prospective adoptive parents and the Adoption Assistance Agreement is fully executed and in effect.

(10) “At-Risk Placement” means a placement of a minor in the home of an approved adoptive parent prior to the termination of the minors’ parents’ parental rights.

(11) “Difficult-to-place” for a child has the same meaning as provided in Section 409.166(2), F.S. A difficult-to-place child must meet the requirements of the Social Security Act Sec. 473, 42 U.S.C. 673, where conditions or characteristics make it harder to place a child for adoption without providing adoption assistance.

(12) “Disruption” means the termination of a pre-adoptive placement or adoption placement prior to legal finalization.

(13) “Dissolution” means the return of a child to out-of-home care and the subsequent termination of the parental rights of the adoptive parents.

(14) “Extension of Maintenance Adoption Subsidy” means benefits provided to a family for a child who meets the eligibility criteria established in Section 409.166(4), F.S.

(15) “Interstate Compact on the Placement of Children” means an agreement among states, enacted into law in all 50 states, the District of Columbia and the Virgin Islands, which governs the interstate movement of children. It establishes procedures for the interstate adoptive or out of home placement of children, including post-placement supervision.

(16) “Match Staffing” means a staffing that is convened to match a child available for adoption without an identified adoptive family with prospective adoptive families with non-child-specific approved adoption home studies.

(17) “Prospective Adoptive Parent” means a caregiver who has applied to adopt a child, but the Adoption Assistance Agreement has not been signed.

(18) “Pre-adoptive Placement” means a child is placed in the home of a prospective adoptive parent, but the Adoption Assistance Agreement has not been signed.

(19) “Significant Emotional Tie” means a substantial attachment between a child and his or her caretaker that is critical to a child’s present and future well-being. The assessment of this attachment must include such factors as the length of time the child has known the caretaker and the attachment that exists in the relationship. This term is also used in the evaluation of a child’s eligiblity for adoption subsidy when the question of eligibility rests solely on his or her adoption by the current caregiver.

History

Rulemaking Authority 39.012, 39.0121, 63.233, 409.166(8), 409.167(6) FS. Law Implemented 39.01, 63.092, 63.165, 409.166, 409.167 FS. History–New 4-28-92, Amended 4-19-94, Formerly 10M-8.0013, Amended 12-4-97, 8-19-03, 11-30-08, 7-7-16, 12-16-18, 8-15-21, 7-20-23, 6-10-25.

Fla. Admin. Code R. 65C-16.002 Adoptive Family Selection

(1) A person seeking to adopt a child who does not meet the definition of difficult-to-place, will be referred to the Adoption Information Center. Birth parents seeking adoption planning for their children will also be referred to the Adoption Information Center.

(2) Pre-adoptive placements must be made consistent with the best interest of the child. The assessment of the best interest of the child must include the current and projected future needs of the child, consideration of the birth family’s medical and mental health history, the strengths of the potential adoptive family to meet the child’s needs, and the factors listed in Section 39.01375, F.S. The pre-adoptive placement decision must be shaped by the following considerations:

(a) Grandparent. A grandparent who is entitled to notice pursuant to Section 63.0425, F.S., shall be notified of the hearing on the petition to terminate parental rights. If grandparents apply to adopt the child prior to a Memorandum of Agreement to Adopt being signed by another applicant, the application must be evaluated through an adoptive home study.

(b) Current caregiver. If the current caregiver applies to adopt the child, the application must be evaluated through an adoption home study. The adoption home study must assess the length of time the child has lived with the current caregiver, the depth of the relationship existing between the child and the caregiver, and whether it is in the best interest of the child to be adopted by the caregiver.

(c) Relatives and nonrelatives with whom child has a relationship. Persons known to the child, but who do not have custody of the child, may wish to be considered for adoption. If such persons apply to adopt the child prior to a Memorandum of Agreement to Adopt being signed, the application must be evaluated through an adoption home study. The depth of the relationship existing between the child and the applicant must be assessed and included in the adoption home study. The “Memorandum of Agreement,” CF-FSP 5072, July 2021, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13386.

(d) Family new to the child. Many families who pursue adoption do not have a specific child in mind when they apply. These families must be provided information about the children available for adoption through the department, and must be helped, through training, preparation, and the adoption home study process, to determine if the adoption of a difficult-to-place child is appropriate for their family.

(3) Siblings.

(a) Considerations regarding siblings shall be consistent with the directives in Sections 39.01375, 39.4015, 39.4022, and 39.4024, F.S.

(b) In situations where consideration is being given to separating siblings who are in an open dependency case, placing siblings in different adoptive families, or making recommendations for post adoption sibling contact, a Multidisciplinary Team (MDT) Staffing pursuant to Sections 39.4022, 39.4024, F.S. and Rule 65C-30.023, F.A.C. shall be held.

(c) Subsequent reviews after termination of parental rights shall take place pursuant to Section 39.4024(5), F.S., at least once every 6 months, to reassess sibling placement, visitation, and other sibling contact decisions in cases where siblings are separated, not visiting, or not maintaining contact. The reviewing team shall include the adoption case counselor, and if applicable the licensing specialist.

(d) If the Department takes into custody a child who is known to be a sibling of a previously adopted child(ren), the Department, community-based care (CBC) lead agency or subcontractor staff shall advise the siblings’s adoptive parents of this occurrence at the time of removal. The application of these adoptive parents will be given the same consideration as an application for adoption by a relative, as described above. Family finding efforts shall continue throughout the duration of the case consistent with Section 39.4015(3)(a), F.S.

(4) Requests for consideration made after the Memorandum of Agreement to Adopt has been signed. Once a Memorandum of Agreement is signed by the prospective adoptive parents, the Department will not complete an adoption home study on any new applicant to adopt the child, unless court ordered.

(5) In addition to the factors listed in Section 39.01375, F.S., the following factors must be considered in determining the best interest of the child when selecting an adoptive family and when multiple families apply to adopt the same child.

(a) Attachment. Consideration must be given to the quality and length of the attachment to the current and potential caregiver. The age of the child at placement with current caregiver and the child’s current age must be considered in assessing attachment. The ease with which the child attached to the current family and any indications of attachment difficulty in the child’s history must be evaluated. The number of moves and number of caregivers the child has experienced will be an important factor in determining the likelihood that the child will form a healthy attachment to a new caregiver.

(b) Siblings. Consideration must be given to whether the potential caregiver is willing to adopt all members of a sibling group when it is in each child’s best interest or whether the potential caregiver is willing to promote sibling relationships when adoption of all members of the sibling group is not in each child’s best interest.

(d) Permanence. The capacity and willingness of the prospective adoptive parent to access needed services and meet the child’s need for permanence must be evaluated. The ability of the prospective adoptive parent to understand the needs of adoptive children in different developmental stages and his or her awareness of the inherent challenges of parenting an adopted child must be carefully considered.

(e) Post communication or contact. The willingness and capacity of the prospective adoptive parent to:

Establish and promote the child’s relationship with his or her siblings, when appropriate; and
Agree to post-adoption communication or contact between the child and his or her siblings or a significant adult when it has been determined to be in the best interest of the child.

(6) In any pre-adoptive placement of a Native American child, the federal “Indian Child Welfare Act” (ICWA) governs the order of placement preference. While the Indian Child Welfare Act gives a placement preference, it allows each tribe to establish a different order of preference by resolution, and that order must be followed. The Act lists the placement preference for adoption of an Indian child in the following order:

(a) A member of the child’s extended family;

(b) Other members of the Indian child’s tribe, or

(7) Child Study. The case manager or adoption counselor must evaluate every adoptive child’s current, projected or future needs by documenting their review of all available information regarding the child and the birth family’s medical and social history. A seperate, written child study is only required to aid in identifying a pre-adoptive placement when the current caregiver has not applied to adopt or to document a child’s difficult-to-place factors for a subsidy exception pursuant to subsection 65C-16.013(8), F.A.C. A child study shall include:

(a) Developmental History. A developmental history must be obtained from the birth parents whenever possible. When the child has been in care for a period of time, developmental history obtained from birth parents must be supplemented by direct study and observation by the case manager or adoption counselor, foster parents, pediatrician, and if indicated, psychologist, teacher and other consultants. The developmental history must include:

Birth and health history,
Early development,
Child’s characteristic way of responding to people,
Deviations from the normal range of development; and,
Child’s prior experiences, including continuity of care, separations, and information regarding other known significant relationships and placements the child has had prior to and since entering foster care.

(b) Medical History. A medical examination must be completed by a licensed physician, preferably a pediatrician, to determine the child’s state of health and significant health factors which may interfere with normal development. The medical history must take into consideration the following:

Circumstances of birth and possible birth trauma,
Congenital conditions which may or may not have been corrected or need additional correction or treatment,
Physical handicaps that may interfere with normal activity and achievement,
Significant illnesses and health of the child, parents and other family members; and,
Immunization record of the child.

(c) Family History. Family history shall be obtained from birth parents when possible and shall include any medical and mental health information about both parents and any siblings. Information about the child’s birth family shall include:

Age of both parents,
Race, national origin or ethnicity,
Religion,
Physical characteristics,
Educational achievements and occupations,
Health, medical history and possible hereditary problems,
Personality traits, special interests and abilities,
Child’s past and present relationship with family members and the significance of these relationships; and,
Actual or potential impact of past abuse, neglect or abandonment.

(d) Psychological and Psychiatric Evaluations. Psychological or psychiatric evaluations of children known or suspected of having mental health problems must be obtained prior to the adoption placement. Any child who will be placed for adoption with medical subsidy for treatment of a psychological or psychiatric condition must have had such an evaluation within the 12 month period preceding the adoption placement.

(e) Heredity. There are no hereditary factors that rule out adoptive planning for a child. Genetic and medical professionals will assist in deciding which hereditary conditions limit life expectancy or adversely affect normal development.

(f) Pre-placement Physical Examination. Prior to placement every child must have received his or her most recent well-child check-up as recommended by the American Academy of Pediatrics guidelines. No child will be placed without a physical that has been conducted within 12 months of placement unless there is a known or suspected medical condition. When there is a known or suspected medical condition, a physical within six (6) months prior to placement will be required. If the adoptive family prefers, an additional examination may be completed at their expense, and a copy provided for the child’s case record. It is important that this examination be thorough and provide the potential adoptive family and the case manager and adoption counselor with a clear understanding of the child’s physical condition.

(g) Education. An educational history must be documented for the child, including all schools attended, current grade, and a summary of the child’s report cards and his or her 504 or Individual Educational Plan, if applicable. An interview with the child’s current teacher is required in order to document issues related to academics, socialization skills and behavioral concerns.

(8) A copy of the child study shall be provided to the prospective adoptive parents prior to the pre-adoptive placement. The identity of the birth family shall be protected when providing the child study to the family.

History

Rulemaking Authority 39.012, 39.0121(7), (12), (13), 39.4024, 63.233 FS. Law Implemented 39.01375, 39.4015, 39.4022, 39.4024, 63.039(1), 63.0425, 63.0427, 63.085, 63.093 FS. History–New 2-14-84, Formerly 10M-8.02, Amended 5-20-91, 4-28-92, 4-19-94, 8-17-94, 1-8-95, Formerly 10M-8.002, Amended 12-4-97, 12-23-97, 8-19-03, 11-30-08, 7-7-16, 9-22-21, 7-20-23, 6-10-25.

Fla. Admin. Code R. 65C-16.003 Case Reviews

(1) The purpose of case reviews is to ensure that efforts to achieve the permanency goal of adoption are conducted and documented in the child welfare information system and ongoing judicial review social studies reports for every child with an adoption goal.

(2) The case review requirements for children in adoption planning consist of two (2) types of reviews:

(a) Match Staffings. Staff responsible for case planning for children who are permanently committed to the Department with a goal of adoption shall meet every 45 days to discuss and assess the strengths and needs of children without an identified adoptive family with the goal of matching them with approved prospective adoptive families. The available families for the waiting children will be sought from but not limited to the child welfare information system, the community-based care (CBC) agencies, AdoptUSKids, and Children Awaiting Parents (CAP).

The staffing will be conducted by a team of at least three (3) individuals, preferably with adoption experience. The child’s case will be presented by the adoption case manager.
The staffing team shall determine all potential matches from the pool of prospective adoptive families.
Once the potential adoptive families have been identified, the staffing team will rate each family based on the family’s ability to meet the identified needs of the child based on information documented in the child welfare information system, the Child Study and the adoptive parent’s home study. The documentation must include a key of the rating scale used by the team.
The team will be required to obtain input (either verbally or in writing) from adults with significant knowledge of the child’s needs, including the adoption case manager, dependency case manager, current caregiver, the child, if age appropriate, guardian ad litem, school professional, and therapist.

(b) Supervisory Consultation. Supervisory consultation is an on-going function of direct service supervision. Consultation must be directed at ensuring thorough case assessment, case planning and service delivery. Supervisory consultation must be provided to every direct service staff member regardless of prior training and experience, and must include individual supervisory case conferences, at least every 90 calendar days.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.621, 39.701, 39.811(8), (9), 39.812 FS. History–New 4-28-92, Amended 4-19-94, Formerly 10M-8.0023, Amended 12-4-97, 8-19-03, 11-30-08, 7-7-16, 8-15-21, 6-10-25.

Fla. Admin. Code R. 65C-16.004 Recruitment, Screening and Application Process/Adoptive Applicants

(1) The community-based-care (CBC) or subcontractor staff shall ensure that an assessment of adoptive parent resource needs is completed at the beginning of each calendar year, and that recruitment activities are planned for the year based on the results of the assessment.

(2) The recruitment activities must be designed to meet the needs of all children in foster care who need adoptive families and must include opportunities for an exchange of information and communication with potential adoptive applicants at least every 90 days.

(3) The recruitment activities shall reflect the ethnic and racial diversity of children needing a pre-adoptive placement pursuant to the Indian Child Welfare Act, 25 U.S.C. 1901, et seq., and Multi-Ethnic Placement Act, 42 U.S.C.A. §1996.

(4) Within 10 business days after a child has been permanently committed to the Department, the adoption information screens in the child welfare information system must be completed by the adoption case manager, adoption recruiter, or designee.

(a) When a child or sibling group has no identified adoptive family and is or are legally free for adoption, the child or sibling group must appear on the Florida Adoption Exchange. The child must be documented with an available status, a child web memo and a current child web ready photo in the child welfare information system. If the child is a member of a sibling group that is seeking to be adopted together by a single family, each child must be documented with the same sibling identification number, sibling web memo and sibling web ready photo in the child welfare information system.

(b) The child and sibling web memos must be reviewed and web authorized by a supervisor or designated second level reviewer.

(c) For children under age five (5), the child or sibling photo and child or sibling web memo must be updated every six (6) months. For children age five (5) or older, the child or sibling web photo and child or sibling web memo must be updated annually.

(d) When a child has an identified adoptive family, the required data for the federal and state reports must be documented in the child welfare information system before the adoption case is closed.

(e) Children without an identified adoptive family must also be registered on the national adoption website, AdoptUSKids, and local recruitment resources, such as a Heart Gallery, after the child is documented on the Florida Adoption Exchange.

(5) The prospective adoptive parents’ initial inquiry to the Department or to the CBC or subcontractor staff, whether written or verbal, shall be documented in the statewide child welfare information system. Prospective adoptive parents who indicate an interest in adopting children must be referred to a Department-approved adoptive parent training program. The Department shall approve adoptive parent training programs that meet the requirements set forth in subsection (6) of this rule.

(6) Adoptive parent training must be a minimum of 21 hours and must include, but is not limited to:

(a) Orientation regarding agency purpose, objectives, resources, policies, and services;

(b) Effects of abuse and neglect in adoption;

(d) Management of difficult child behavior that can be intensified by placement, by prior abuse or neglect, and by prior placement disruptions;

(e) Care of children at various developmental levels, including appropriate discipline;

(f) Transition of a child into and out of foster care, including issues of separation, loss, and attachment;

(g) Prevention of placement disruptions;

(h) Psychotropic medication. The training must include the administration of psychotropic medication, including the use of psychotropic medications to treat children, the proper dosage of medications, and the importance of monitoring for possible side effects and adverse reactions. Training on psychotropic medications shall also include an overview of Section 39.407, F.S., and rule Chapter 65C-35, F.A.C., which govern the administration of psychotropic medication; and

(i) Adoptive parent’s role in supporting and promoting the educational progress of the child.

(7) If space is limited in scheduled classes, slots in the classes will be assigned in the following priority order:

(a) Persons with an existing relationship with a specifically identified difficult-to-place child who is waiting for adoption placement, or that child’s sibling.

(b) Persons who have expressed an interest in adopting a specifically identified difficult-to-place child waiting for adoption, or that child’s sibling.

(c) Persons who have explicitly stated their willingness to adopt difficult-to-place children available for placement through the Department or its designee.

(8) Persons who are an active duty member of a uniformed services branch will receive credit for approved adoptive parent training courses completed in another state which align with requirements outlined in Section 409.175(14), F.S.

(9) Once the prospective adoptive parents complete the approved adoptive parent training program, the Department will complete home studies in the following priority order:

(a) Persons with an existing relationship with a specifically identified difficult-to-place child who is waiting for pre-adoptive placement, or that child’s sibling.

(b) Persons who have expressed an interest in adopting a specifically identified difficult-to-place child waiting for adoption, or that child’s sibling.

(c) Persons who have explicitly stated their willingness to adopt difficult-to-place children available for placement through the Department or its designee.

(10) Any prospective adoptive parent, who has completed the approved adoptive parent training program, and does not fall into the categories under paragraphs (9)(a)-(c), may be referred to the Adoption Information Center. Pursuant to Section 63.092(3), F.S., the Department is required to perform the preliminary home study only if there is no licensed child-placing agency, child-caring agency registered under Section 409.176, F.S., licensed professional, or agency described in Section 61.20(2), F.S., in the county where the prospective adoptive parent resides.

(11) The adoption case manager shall ensure the initiation and completion dates of the adoption home study are documented on the demographic tab of the unified study in the child welfare information system.

(a) The date the adoption home study was initiated shall be documented once all of the following have occurred:

The prospective adoptive parent(s) is applying for a specific child.
The prospective adoptive parent(s) has completed the approved adoptive parent training as prescribed in subsection 65C-16.005(6), F.A.C.
The prospective adoptive parent(s) and all household members have completed all required background screenings outlined in Rule 65C-16.007, F.A.C., with a favorable outcome.
An application to adopt a specific child has been made on the “Adoptive Home Application” form, CF-FSP 5071, July 2021, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13385.

(b) The adoption home study completion date shall be the date the adoption case manager submits the adoption home study to his or her supervisor for review.

History

Rulemaking Authority 39.012, 39.0121, 39.0137, 63.233, 409.175(5)(a), 409.988(2)(e) FS. Law Implemented 39.0137, 39.811(8)-(9), 39.812(1), (4)-(5), 63.092, 409.175(5)(a), 409.175(14), 409.167, 409.986(2), 409.988(2) FS. History–New 7-18-95, Formerly 10M-8.0042, Amended 8-19-03, 11-30-08, 7-7-16, 8-15-21, 7-20-23, 6-10-25.

Fla. Admin. Code R. 65C-16.005 Evaluation of Applicants

(1) No person shall be denied the opportunity to become an adoptive parent on the basis of race, color or national origin. The placement of a child with a particular family must not be denied or delayed on the basis of race, color or national origin of the family or the child.

(2) An adoption home study which includes observation, screening and evaluation of the child and adoptive applicants shall be completed by a staff person with the CBC, subcontractor agency, or other licensed child-placing agency prior to the pre-adoptive placement of the child. The aim of this evaluation is to select families who will be able to meet the physical, emotional, social, educational and financial needs of a child, while safeguarding the child from further loss and separation from siblings and significant adults. The adoption home study is valid for 12 months from the approval date.

(3) In determining which home studies and applications for adoption will be approved, all of the following criteria, not listed in any order of priority, must be considered:

(a) The child’s choice, if the child is developmentally able to participate in the decision. The child’s consent to the adoption is required if the child is age 12 or older unless excused by the court;

(b) The ability and willingness of the adoptive family to adopt some or all of a sibling group, although no individual child shall be impeded or disadvantaged in receiving an adoptive family due to the inability of the adoptive family to adopt all siblings. The needs of each individual child must be considered, as well as the family’s demonstrated efforts to maintain the sibling connection;

(c) The commitment of the applicant to value, respect, appreciate, and educate the child regarding his or her racial and ethnic heritage and to permit the child the opportunity to know and appreciate that ethnic and racial heritage;

(d) The family’s child rearing experience. Applicants with previous child-rearing experience and who have a demonstrated history of having provided consistent financial and emotional support to other minor children, either birth or adopted, will be considered. Applicants who do not have previous child-rearing experience as a parent but who demonstrate the capacity to parent a difficult-to-place child by providing care or supervision of a child, such as in a role as an aunt or uncle, teacher, foster parent or friend, will also be considered. Families with no child-rearing experience must also be assessed for their capacity to provide care for a difficult-to-place child;

(e) Applicants who have experienced an adoption disruption or dissolution in the past shall be assessed regarding the reasons for the disruption or dissolution, the family’s openness in dealing with the problems that led to the disruption or dissolution, their willingness to accept help with the problems, and their continued support of the child through his or her change of placement;

(f) Marital Status. Applications to adopt will be accepted from married couples and from single adults. Consideration should be given as to stability of the marriage and/or any significant relationships. In determining stability, adoption staff shall consider the length of the marriage or relationship and any history of repeated separations and reconciliations;

(g) Residence. Florida families must be prepared to remain in Florida long enough to have the adoption home study completed, the child placed, and the adoption finalized. Families from other states wishing to adopt Florida children may apply and be studied by an agency authorized or licensed to practice adoption in their state of residence. Out-of-state placements must comply with Section 63.207, F.S.;

(h) Income. The family must have legal and verifiable income and resources to ensure financial stability and security to meet expenses incurred in the care of the family. While a family’s income must meet the needs of its current members, a family interested in a difficult-to-place child must not be precluded from consideration if the availability of an adoption subsidy would enable them to adopt a difficult-to-place child. Management of current income and the ability to plan for future changes in income so that the child’s social, physical and financial needs will be met are as important as the amount of income;

(i) Housing. Housing must provide space and the living conditions necessary to promote the health and safety of the family;

(j) Health. Applicants will be required to fully disclose health history for themselves and each member of the household, to include current physical, mental or emotional health status, any condition that is progressive and debilitating in its course, and any past and current treatment and services received for such condition. A current physical shall not be required unless the applicant has disclosed a physical, mental or emotional condition that jeopardizes the safety and permanency of the child’s placement;

(k) Other Children, Including Adult Children, of the Family. When families have children by birth or adoption, the anticipated impact of a new child on the family must be considered. Contact must be attempted with all children of the adoptive family in order to determine the anticipated impact on the family and as part of the assessment of the potential adoptive parent’s capacity to parent a difficult-to-place child;

(l) Other Household Members. Other household members must be interviewed and included in the assessment of the adoptive family to determine the anticipated impact on the family. For household members who will serve in a caregiving capacity, the following areas shall be assessed: attachment to child, parenting history, physical and mental health, background checks and references;

(m) Working Parents. The willingness and ability of prospective adoptive parents who are employed outside the home to make arrangements to be with the child during the transition period must be considered. It is desirable that one parent be free to devote full time to the care of the child for a period of time after placement. The exact length of time is determined by the needs and the age of the child, and the needs of the child must be given priority over the employment situation of the parent;

(n) Department, community-based-care lead agency (CBC) or Sub-Contractor Employees, Guardian ad Litem Employees, or Guardian ad Litem volunteers. Employees of the Department, the Guardian ad Litem program, and the CBC, including subcontractor staff, and Guardian ad Litem volunteers, may be considered as adoptive applicants. In situations where the employee or volunteer has a close working relationship with the foster care or adoption staff in his or her local area, or had such a relationship within the past two (2) years, completion of the applicant’s adoption home study process shall be conducted by a licensed child-placing adoption agency outside the local area. The CBC agency must be notified within 72 hours when an application to adopt is received from a Department, CBC agency employee. The CBC agency will make a decision regarding whether the adoption home study for the employee will be completed by the CBC agency or if the services of another agency will be sought. If the decision is to have the employee’s adoption home study and subsequent placement handled by another agency, the CBC agency shall make the necessary arrangements with the chosen agency. When an adoptive applicant is a member of a board or group which has actual or perceived authority over the Department, its CBC agency, its staff or operations, such applicant will be referred to another circuit or a local licensed child placing agency for handling;

(o) Criminal History. All adoptive parent applicants must disclose to the Department, CBC agency, or subcontractor agency any prior or pending local, state or national criminal proceedings in which they have been or are involved;

(p) Background Screening. All adoptive applicants and household members must complete the requirements for background screening as outlined in Rule 65C-16.007, F.A.C.;

(q) References. A minimum of three (3) references shall be required using form CF-FSP 5494 “Adoption or Foster Home Licensing Character Reference” (August 2025), incorporated by reference and available at available at http://flrules.org/Gateway/reference.asp?No=Ref-18568. Only one (1) reference may be obtained from an employer of each applicant and only one (1) of the references may be obtained from a relative. All other references must be obtained from persons who either: 1) have observed the applicants in situations that give some indication for their capacity for parenthood, or 2) who as the result of their relationship to the applicant, possess documentation or knowledge of the applicant’s capacity for parenthood. All references may be obtained verbally by the child welfare professional and documented unless providing a written document electronically is more expeditious. References may include the case manager and Guardian ad Litem volunteers or staff who have been assigned to the child’s case when no conflict of interest exists;

(r) The “Acknowledgement of Firearms Safety Requirements” form CF-FSP 5343, July 2017, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13390, must be signed and dated by the adoptive applicants as a part of the adoption home study process. A copy of the signed form must be retained as a part of the approved adoption home study and a signed copy must be provided to the prospective adoptive parents.

(s) Rebuttable Presumption. When a current caregiver who meets the requirements of Section 39.522(3), F.S., applies to adopt the child, consideration must be given as to whether the presumption that it is in the child’s best interest to remain in the current placement can be rebutted by the information learned during the evaluation process.

(4) Family Preparation and Study Process.

(a) Adoption staff must conduct a minimum of two (2) visits with the prospective adoptive parent, one of which must be completed in the home. The adoption staff must adhere to the requirements as outlined in Section 63.093, F.S., regarding the family’s preparation and home study process.

(b) The staff person conducting the adoption home study must clearly document in the adoption home study the reasons why the relative or non-relative caregiver will not be required to complete adoptive parent training.

(c) At the beginning of each year CBC agencies responsible for adoption services must establish a 12 month training calendar. Providers must also have the ability to conduct extra training classes when the number of families waiting for a training class cannot be accommodated in the regularly scheduled sessions.

(5) Family Preparation Through Use of the Individual Study Process.

(a) Although the most preferred method of preparing applicants for adoptive parenthood is the adoptive parent training group process, there will be exceptional cases in which an individual study approach must be used. Some examples of factors which might lead to a decision to prepare an applicant family via an individual study are as follows:

Extreme distance which would cause hardship for the family.
Small numbers of inquiring families at irregular times.
Families who are adopting subsequent children and have already been trained; and,
Cases in which the applicant may need individualized education on portions of the curriculum even though the child has been living in the home for an extended period and there is evidence of well functioning relationships.

(b) Each decision to use the individual study approach must be approved in writing by the CBC or subcontractor agency, and the adoption home study must include justification for use of this method.

(6) Families Who Adopt Again. Prior approval of a family to adopt does not automatically deem the family appropriate to adopt again. Consideration of any family for placement of a subsequent child requires an updating of the previous adoption home study. The update shall include an assessment of the following:

(a) Issues Related to the Previously Adopted Child. This shall include a brief description of the child, his or her incorporation into the family, and the skills the parents have demonstrated in providing for this child;

(b) Motivation of the family in seeking to adopt another child at this time;

(c) School adjustment of the previously adopted child, including the communication and ongoing relationship with the local school system. If a child is home schooled, the child’s socialization, community visibility and peer relationships must be assessed;

(d) Health Needs. Any significant medical problems and any impact they have had on the previous adoption or might be expected to have on subsequent placements;

(e) Housing needs and the capacity of the home to comfortably accommodate another child;

(f) Income. Any major changes in the family income must be discussed. A determination shall be made as to whether or not the addition of another child, even with adoption subsidy, will tax the family’s ability to manage within their current income;

(g) Marriage. The effect of the previous adoption on the marriage;

(h) Extended Family and Neighbors. How the previous adoption has been perceived, received or rejected by family. How neighbors perceive the family relationships, including the visibility of the child within the neighborhood, when available;

(i) Updated References. A minimum of two (2) references shall be obtained when updating an adoption home study toward placement of an additional child. References shall address how the family seems to have managed with the previously adopted child and how they believe the family will cope with additional children. References must be obtained from persons who either: 1) have observed the applicants in situations that give some indication for their capacity for parenthood, or 2) who as the result of their relationship to the applicant, possess documentation or knowledge of the applicant’s capacity for parenthood. The case manager shall attempt to obtain a reference from an adult child of the applicant, if applicable. Only one (1) of the references may be obtained from a relative. All references may be obtained verbally by the child welfare professional and documented unless providing a written document eletronically is more expeditious. References may include child welfare professionals and Guardian ad Litem volunteers or staff who have been assigned to the child’s case when no conflict of interest exists;

(j) Abuse Hotline/Criminal Records Check. Abuse hotline and criminal records checks must be conducted pursuant to Sections 39.0138 and 39.521, F.S., as part of each subsequent application to adopt; and,

(k) Other Major Changes. Address any additional family members not considered in the initial study. Also address any other major changes such as job changes, deaths, and serious illness or medical conditions which may have had an effect on the family or which may compromise the applicant’s ability to meet the needs of another child.

(7) The Written Adoption Home Study. A written report, generally referred to as the adoption home study, must be prepared for each studied family. The adoption home study must address the issues discussed in subsections (1) through (6), above, along with the requirements set out in section 63.092(3), F.S. If the prospective adoptive parent is the current caregiver, the following applies:

(a) The case manager or adoption counselor may review the last approved home study in the child welfare information system with the prospective adoptive parent in person or virtually, determine if any information has changed, and document their assessment and any changes.

(b) The case manager or adoption counselor may complete a general adoption home study before termination of parental rights has been granted.

(c) If the child was placed before the termination of parental rights, the placement or licensing home study may serve as the adoption home study but must also include the requirements set out in section 63.092(3), F.S.

(8) At the conclusion of the preparation and study process, the counselor and supervisor will make a decision about the family’s appropriateness to adopt. The decision to approve or not to approve will be reflected in the final recommendation included in the adoption home study. If the recommendation is for approval, the adoption home study will be submitted to the CBC or subcontractor agency for approval. If the counselor and supervisor do not recommend approval for a child specific adoption home study, the case will be reviewed by an Adoption Applicant Review Committee according to the directions provided in subsection 65C-16.005(9), F.A.C.

(9) Adoption Applicant Review Committee. Each CBC agency responsible for providing adoption services for children in the Department’s custody must establish an Adoption Applicant Review Committee.

(a) The committee must consist of at least five (5) people who have completed the Department adoption competency training. A Department representative who has knowledge of the applicant’s national and state criminal history and child abuse and neglect history must be a member of the committee. The CBC agency will select a committee member to serve as the committee chair.

(b) The committee will provide consultation and assistance to the adoption counselor on any child-specific adoption home study in which the counselor and supervisor are recommending denial, or adoption case situations which present challenging issues. Requests for committee review may be made by the adoption counselor, the Department or the CBC agency. Requests for committee review must be made in writing and forwarded to the CBC agency. While the committee is available to review any challenging case, all cases with the following issues, except as set forth below, must be referred to the committee.

Multiple families who have approved home studies and have applied to adopt the same child.
Health. Applicants in which it is determined that the adoptive applicant is experiencing a serious or chronic medical condition and such condition compromises or could compromise the applicant’s ability to provide the physical, emotional, social and economic support necessary for the child to thrive.
Adult and Child Abuse, Abandonment and Neglect Record Check. Applicants in which the Adult and/or Child Abuse, Abandonment and Neglect Record Check reveals verified findings of abuse, neglect, or abandonment which did not result in a disqualifying felony conviction, and cases in which abuse or neglect was not substantiated. When an applicant has one (1) or more investigations with findings of verified or not substantiated, all of the investigations that involve the applicant must be reviewed to assess if there are reoccurring circumstances that may affect the safety and well-being of the children in the home.
Criminal History. In cases in which the required criminal history checks pursuant to Sections 39.0138 and 39.521, F.S., reveal that the applicant(s) or other household members have been convicted of crimes specified in Section 39.0138(3), F.S., their application must be denied. When the applicant or any other adult household member was named as caregiver responsible in a report verified for sexual abuse, this shall be an automatic disqualifier for an adoption applicant. A referral to the Adoption Applicant Review Committee will not be required. The applicant must be advised that he or she cannot be approved. If the criminal history check reveals that the applicant or other household member was convicted of a law violation listed in Section 39.0138(4), F.S., within the last five (5) years, the applicant cannot be considered for approval, until five (5) years after the date of conviction. After five (5) years have passed, the applicant shall be referred to the Adoption Applicant Review Committee if the applicant submits a new Adoptive Home Application, CF-FSP 5071, incorporated in Rule 65C-16.004, F.A.C.
Cases in which the applicant is a current or former foster parent and the review of the foster parent file reveals that there have been care and supervision concerns or a violation of licensing standards.

(c) The review committee chairperson will convene the committee within 10 business days of receipt of the request and provide all necessary written documents to the committee members no less than five (5) business days prior to the committee convening. Each committee member shall submit their recommendation to the chair within five (5) business days of the conclusion of the review. The chair shall submit the “Adoption Application Review Committee (AARC) Recommendation Cover Letter,” form CF-FSP 5498, (August 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18569, to the Department and the CBC agency within 10 business days of the committee’s recommendation, but no later than 15 business days from the conclusion of the review. The Department will make the final decision after reviewing the committee’s recommendation to ensure the evaluzation of the application complies with Chapter 65C-16 and Florida Statutes.

(d) The CBC agency will provide the applicant with written notification of the decision to approve within 10 business days of receipt of the Department’s final decision. When the Department denies an application to adopt a child, the Department must adhere to the protocols set forth in Section 39.812, F.S.

(e) The county of jurisdiction shall complete all Adoption Applicant Review Committee staffings on any child or any adoption home study related to the child. If the county of jurisdiction can not complete the staffing due to a conflict, a request shall be made, in consultation with the Department or designee, to transfer the staffing to another county.

History

Rulemaking Authority 39.012, 63.093, 63.233 FS. Law Implemented 39.0138, 63.042, 63.062, 63.092, 63.093, 63.207 FS. History–New 2-14-84, Formerly 10M-8.05, Amended 4-28-92, 4-19-94, 8-17-94, 1-8-95, 7-18-95, Formerly 10M-8.005, Amended 12-23-97, 8-19-03, 11-30-08, 7-7-16, 8-15-21, 7-20-23, 10-16-25.

Fla. Admin. Code R. 65C-16.006 Use of References

History

Rulemaking Authority 63.022, 409.145 FS. Law Implemented 63.022, 409.145 FS. History–New 5-20-91, Formerly 10M-8.00512, 10M-8.0052, Repealed 12-4-97.

Fla. Admin. Code R. 65C-16.007 Abuse Hotline and Registry and Criminal Records Checks

(1) Abuse and neglect history checks must be conducted on all adoptive applicants and other household members 12 years of age and older, pursuant to Sections 39.0138 and 39.521, F.S. The applicants must be informed of this requirement early in the home study process and must provide written consent for the checks to be completed. Abuse and neglect history checks must be current within 30 calendar days of adoption home study approval in the child welfare information system.

(a) When the adoptive applicant or other adult household member has lived in another state within five (5) years of the request for a home study, a child abuse and neglect registry check of the other state must be requested. In states that do not use a centralized intake or state automated child welfare system (CCWIS), the Florida child welfare professional is required to contact the county administered child protection program to complete the record check. If the other state does not have a local or county child abuse and neglect registry, the counselor must determine whether to approve the applicant based on all other information required by Rules 65C-16.002, 65C-16.004, and 65C-16.005, F.A.C.

(b) Any request for information from the child welfare information system must be in writing and must include a statement of statutory authorization to receive the information.

(c) All Department personnel and other agencies and professionals using information from the child welfare information system, or any child abuse case record shall be informed that misuse of such information may cause them to be held personally liable, any person injured or aggrieved by such disclosure may be entitled to damages, and unauthorized release of abuse reports may result in criminal prosecution.

(2) Local, statewide, and national criminal records checks and juvenile records checks must be conducted on all adoptive applicants and other household members 18 years of age and older. Local, statewide, and juvenile records checks must be conducted on all household members 12 through 17 years of age.

(a) If the criminal records checks reveal that the applicant or household member has been convicted of a crime specified in Section 39.0138(3), F.S., the application must be denied.

(b) If the criminal records checks reveal that the applicant or household member has been convicted of a crime specified in Section 39.0138(4), F.S., the applicant can not be considered for adoption until five (5) years after the date of conviction. After five (5) years have passed, the applicant shall be referred to the Adoption Applicant Review Committee if the applicant submits a new Adoptive Home Application, CF-FSP 5071, incorporated in Rule 65C-16.004, F.A.C.

(c) If the criminal records checks reveal that the applicant or household member has been found guilty or entered a plea of guilty or nolo contendere for crimes other than those listed in Section 39.0138(3) or (4), F.S., the applicant shall be evaluated as to the extent of his or her rehabilitation. Factors to be considered will include the severity of the action resulting in the record, how much time has elapsed since the offense, circumstances surrounding the incident, and whether records indicate single or repeated offenses. Referral of these applicants to the Adoption Applicant Review Committee is not required but they must be submitted to the community-based-care (CBC) agency or designee for approval.

(d) If the juvenile records check reveals a juvenile record, this information must be addressed in the home study and a determination must be made regarding possible impact on the adopted child.

(3) Federal, state and local background checks are valid for one year from the date of the last background screening.

(4) Abuse Reports Involving Adoptive Parents.

(a) When the Department receives reports of abuse, neglect or abandonment by adoptive parents whose adoptions have been finalized, they will be handled as any other family on whom a report has been received.

(b) In cases where such reports are received on families whose adoptions are not finalized, the protective investigator will consult with the adoption counselor or supervisor who knows the family and children.

(c) If an allegation of abuse, neglect or abandonment is made directly to the case manager or adoption counselor, the Florida Abuse Hotline must be notified immediately. The report will be transmitted to the local Protective Investigation unit. Complaints which do not contain allegations of abuse, neglect or abandonment and are made directly to the case manager or adoption counselor shall be investigated by the case manager or adoption counselor.

(d) If an investigation of an abuse, neglect or abandonment report by protective investigations reveals that the subject of the report is an adoptive parent whose adoption has not been finalized, the case manager or adoption counselor must be notified within 72 hours and must assume responsibilities in the investigation as outlined above.

(e) If abuse or neglect is established but does not warrant removal of the children, consideration shall be given to providing post adoption services, including a referral to the multidisciplinary team, to the family for a specified period of time. Prior to the expiration of the specified period of time, input from the CBC or subcontractor agency must be sought to assess progress being made and the likelihood that the consent to the adoption will be issued. The CBC or subcontractor agency shall convene a meeting to decide if the placement will be terminated and the child returned to foster care or if a recommendation to issue consent for finalization of the adoption will be given.

(f) Whether the recommendation is finalization of the adoption or removal of the children, information about the report, services provided to the family, and reasons for the final decision must be documented and provided to the court.

History

Rulemaking Authority 39.012, 39.0121, 63.233 FS. Law Implemented 39.0138, 39.521(1)(b)1., 39.701, 39.811(8), (9), 63.092(3), 63.125 FS. History–New 5-20-91, Formerly 10M-8.00513, Amended 4-28-92, 4-19-94, 8-17-94, 1-8-95, Formerly 10M-8.0053, Amended 12-23-97, 8-19-03, 11-30-08, 7-7-16, 8-15-21, 6-10-25.

Fla. Admin. Code R. 65C-16.008 Dispute Resolutions and Appeals

History

Rulemaking Authority 409.145 FS. Law Implemented 409.145 FS. History–New 5-20-91, Formerly 10M-8.00514, Amended 4-19-94, 7-18-95, Formerly 10M-8.0054, Amended 8-19-03, 11-15-06, 11-30-08, Repealed 7-11-16.

Fla. Admin. Code R. 65C-16.009 Adoption Placement

(1) The effective date of the adoptive placement is the date the child is placed in the home of the prospective adoptive parent and all signatures are obtained on the Adoption Assistance Agreement.

(2) The adoption placement process incorporates the following:

(a) Selection of the family. The counselor will assess the abilities of the approved adoptive family to parent a specific child before considering presentation of the child’s information;

(b) Presentation of all family and medical information to the family regarding the child and to the child regarding the family. Within 30 days of the Termination of Parental Rights Petition being filed, the case manager or adoption counselor shall request the child’s birth records, and ensure that all medical, psychiatric, and dental records that are relevant are requested and uploaded into the child welfare information system.

(c) All known information must be shared with the approved adoptive parent using the “Disclosure Information to Adoptive Parents” form, CF-FSP 5328, December 2010, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13388, no later than the point of adoptive placement but can occur at the time of a family being matched to a child. A Spanish version of the Disclosure Information to Adoptive Parents form, CF-FSP 5328S, December 2010, is also incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13389. Within 30 days of the Termination of Parental Rights Petition being filed, the case manager or adoption counselor shall confirm documents referenced in the form are uploaded in the child welfare information system.

(d) First supervised meeting shall occur with a family who has an approved home study, or with a family who is known to the child, is in the process of having a home study completed, and has cleared all required background checks. The first visit at minimum must be observed by the assigned adoption case manager.

(e) A transition plan must be developed by the adoption case manager, current caregiver, when appropriate, new caregivers, and all providers who have on-going involvement with the child no later than 14 days prior to transition. The transition plan must respect the child’s developmental stage and psychological needs.

(f) Get acquainted period and pre-placement visits can vary depending on the age and child’s history;

(g) Identify and access needed services prior to the day of placement; and,

(h) Day of placement.

(3) The decision on final placement is based on the child’s readiness and the cues given by the child to the counselor that he or she is ready to move in with his or her new family.

(4) An out-of-state placement for the purpose of adoption shall have the prior authorization of the court and of the Interstate Compact on the Placement of Children (ICPC).

(5) The mechanics of final placement include:

(a) An assessment of the child and family’s adjustment during the transition activities, all needed services for the child and family have been identified and are active at the time of placement;

(b) The child’s case manager or adoption counselor will be present to facilitate the transition to the adoptive family at the time of placement; and,

(6) When it is necessary for the child to travel to the home of the adoptive parent for placement, the child shall be accompanied by the person with whom he or she has the most meaningful relationship. If this person is a member of the foster family, the community-based-care (CBC) agency will provide financial reimbursement for any costs incurred.

(7) At-Risk Placement.

(a) Occasionally it may be in the child’s best interest to be placed in a prospective adoptive applicant’s home prior to completion of legal termination of parental rights. Examples of situations where an at-risk placement may be appropriate include:

The child’s termination of parental rights is on appeal and all known relatives have been considered and have been found unavailable or not appropriate;
The child has been voluntarily surrendered and termination of parental rights by the court is anticipated;
A petition for termination of parental rights has been filed and it appears unlikely that the child can be returned to the biological parents; and,
The child must be moved from his or her current foster home placement, and the placement in a pre-adoptive placement will result in one less move for the child.

(b) Pre-adoptive families entering into an at-risk placement must have an approved adoptive parent home study and understand that there is no guarantee that permanent commitment to the Department will occur. Families entering into an at-risk placement must indicate in writing that they understand and accept the risks involved.

History

Rulemaking Authority 39.012, 39.0121, 63.233 FS. Law Implemented 39.521, 63.092 FS. History–New 4-28-92, Formerly 10M-8.0058, Amended 8-19-03, 11-30-08, 7-7-16, 9-22-21, 6-10-25.

Fla. Admin. Code R. 65C-16.010 Adoption Placement – Post-Placement Services

(1) The Department has a legal responsibility to provide services until the finalization of an adoption. This period shall be a minimum of 90 days from the date the child was placed in the home of the adoptive parent. The first home visit must be made within one (1) week after placement, unless the child has been residing in the home for more than 30 days. There shall be a minimum of three (3) home visits in placements. For placements which do not proceed smoothly, additional and more frequent contacts are necessary. The adoptive child must be contacted a minimum of once every 30 days until adoption finalization. The entire family must be seen together at least once during the post-placement supervision period.

(2) Some placements are, by nature, complex and will require additional services during the post-placement period. All needed services must be identified and accessed prior to the day of finalization of an adoption.

(3) Children with severe emotional and behavioral difficulties who required specialized services to maintain stability in their foster home often need the same services in the adoptive home. An ongoing assessment of the effectiveness of services implemented at the time of placement must be a part of placement supervision to determine if the current services are effective or if additional services are needed.

(4) Multidisciplinary Team. During the post-placement supervision period, adoptive families may access the services of the Multidisciplinary Team. When the services of the team are needed, the case manager or adoption counselor shall initiate contact with the identified single point of access.

(5) At the end of the supervisory period, the case manager or adoption supervisor and the adoption counselor, or the community-based-care (CBC) agency, must make a final assessment of the placement. Before the final adoption hearing, or within 90 days after the adoption petition is filed with the court by the adoptive family, whichever occurs first, a final home investigation must be completed as directed in Section 63.125, F.S., and a written report on the findings, including a recommendation on the granting of the adoption petition, must be filed with the court. In addition to the requirements of Section 63.125, F.S., the following must be addressed in the written report to the court:

(a) A summary of issues discussed in Rule 65C-16.005, F.A.C., Evaluation of Applicants, and Rule 65C-16.007, F.A.C., Abuse Hotline and Registry and Criminal Records Checks.

(b) A full discussion regarding any unusual circumstances in the adoptive family, including health records and findings, and financial problems.

(6) After the post-placement period has been completed, the CBC agency or subcontractor staff, shall sign the consent to adoption and forward it to the adoptive parents’ attorney. Any available or readily obtainable family and medical history of the child and birth parents must be attached to the consent. If the family and medical history contains identifying information about the biological family, that information must be deleted prior to presenting it to the family.

(a) At the time of the adoptive placement, the CBC agency or subcontractor case manager or adoption counselor shall complete the original and two (2) copies of Section A and B of the Certified Statement of Final Decree of Adoption, DH 527, August 2008, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06977, and verify the information with the adoptive parents. The CBC agency or subcontractor case manager or adoption counselor shall then forward the Certified Statement of Final Decree of Adoption to the parent’s attorney.

(b) When a placement disrupts, the CBC agency or subcontractor case manager or adoption counselor shall record a disruption summary, which provides an evaluation and assessment of the reasons for the disruption, preventable measures taken to prevent the disruption and services provided to the child following the disruptions in the child welfare information system within 72 business hours of the disruption. In addition to assessing and summarizing the reasons for the disruption, the summary must also assess the impact the failed placement had on the child and issues which must be resolved before another placement can be considered. Any specific attributes or skills which will be necessary in the next adoptive parents must also be included. This summary must be recorded within 10 days after the disruption occurs.

History

Rulemaking Authority 39.012, 39.0121, 63.233 FS. Law Implemented 39.812, 63.125 FS. History–New 2-14-84, Formerly 10M-8.06, Amended 4-28-92, 4-14-94, 1-8-95, Formerly 10M-8.006, Amended 12-4-97, 8-19-03, 11-30-08, 7-7-16, 8-15-21, 6-10-25.

Fla. Admin. Code R. 65C-16.011 Confidentiality – Human Immunodeficiency Virus (HIV) Infected Clients

Prior to the adoptive parent’s confirming their decision to adopt, the adoptive parents shall be told that the child being considered by them has tested positive for HIV but cannot be told the child’s identifying information, including the child’s name. Once the decision to adopt has been confirmed, the community-based-care agency or subcontractor agency shall disclose to adopting parents the full name of a child who has been tested positive for HIV.

History

Rulemaking Authority 381.004(2)(e), (11) FS. Law Implemented 381.004(2)(e), (11) FS. History–New 5-20-91, Amended 4-19-94, Formerly 10M-8.0061, Amended 8-19-03, 11-30-08, 7-7-16.

Fla. Admin. Code R. 65C-16.012 Types of Adoption Assistance

(1) The community-based-care (CBC) or sub-contractor agency adoption staff shall inform prospective adoptive parents of the availability of all of the benefits listed below.

(2) Maintenance Subsidy. A monthly payment may be made for support and maintenance of a difficult-to-place child until the child’s 18th birthday.

(3) Extension of Maintenance Adoption Subsidy. A monthly payment made for support and maintenance of a difficult-to-place young adult until the young adult’s 21st birthday.

(4) Post Adoption Services. Post adoption services shall include:

(a) Temporary case management;

(b) Adoptive parents’ support groups or newsletters;

(d) Assistance to cover the cost of medical, surgical, hospital and related services needed as a result of a physical or mental health condition of the child which existed prior to the adoption.

(5) Other Medical Services. Other medical services available may include on-going Medicaid coverage and continuing eligibility with Children’s Medical Services for children who were receiving such services prior to adoption.

(6) Reimbursement for Non-recurring Adoption Expenses. Nonrecurring adoption expenses are those necessary adoption fees, court costs, attorney’s fees, and other expenses that are directly related to the legal adoption of a difficult-to-place child.

(7) Tuition Fee Exemption. Children who were in the custody of the Department and who were adopted from the Department after May 5, 1997, are eligible for an exemption of undergraduate college tuition fees at Florida universities or community colleges as stated in Section 1009.25, F.S.

(8) Federal Adoption Tax Credit. Families that adopt children who are considered difficult-to-place are eligible for a tax credit based on expenses related to the adoption or a reimbursable amount based on the year of the adoption finalization. Staff must inform adoptive parents of this tax benefit and the website www.irs.gov to obtain Form 8839, and the instructions for completing Form 8839.

(9) Adoption assistance for eligible children will be paid irrespective of the child’s state of residence. Adoptive parents receiving adoption assistance are obligated to notify the Department or CBC of any change of address.

History

Rulemaking Authority 409.166(8) FS. Law Implemented 409.166 FS. History–New 2-14-84, Formerly 10M-8.18, 10M-8.018, Amended 8-19-03, 11-30-08, 7-7-16, 12-16-18, 7-20-23.

Fla. Admin. Code R. 65C-16.013 Determination of Maintenance Subsidy Payments

(1) The purpose of adoption subsidy is to make available to prospective adoptive parents financial aid which would enable them to adopt a difficult-to-place child, which must be established by a written child study or other form of documentation. Every adoptive family must be advised of the availability of adoption subsidy and the purpose for which it is intended. Except as set forth in subsection (6) below, placement without subsidy must be the placement of choice unless it can be shown that such placement is not in the best interest of the child.

(2) The child’s and the family’s need for subsidy must be determined prior to the adoptive placement. A family who enters into their initial subsidy agreement when the child is 16 or 17 years of age must make an election on the initial “Adoption Assistance Agreement” of whether or not to participate in the Extension of Maintenance Adoption subsidy program. No subsidy payment may be made prior to all parties signing the “Adoption Assistance Agreement,” form CF-FSP 5079, (May 2025), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18068.

(a) A family who enters into their initial subsidy agreement when the child is 16 or 17 years of age are eligible for the Federal Title IV-E Extension of Maintenance Adoption Subsidy.

(b) A family who enters into their initial subsidy agreement when the child is 14 or 15 years of age are eligible for the State Funded Extension of Maintenance Adoption Subsidy.

(d) If the Department or community-based-care (CBC) agency has responsibility for placement and care of the child, the CBC agency in the county where the court has jurisdiction is responsible for entering into the Adoption Assistance Agreement and paying the adoption subsidy, even if the child is placed in an adoptive home in another county.

(e) If the Department or CBC agency does not have responsibility for placement and care of the child, the CBC agency in the adoptive parents’ county of residence is responsible for determining whether the child meets the definition of difficult-to-place, entering into the Adoption Assistance Agreement and paying the adoption subsidy.

(f) When the need for subsidy is not determined prior to placement, and the adoptive parents feel they have been wrongly denied subsidy benefits on behalf of an adopted child, they have the right to appeal the denial pursuant to Chapter 120, F.S. If it is found that the subsidy was wrongly denied, retroactive payment will be made dating back to the date the family officially requested subsidy in writing. Retroactive payment dating back to the date of placement will not be approved.

(3) Medical or mental health evaluations shall be required to document the need for maintenance subsidy that exceeds the statewide standard foster care board rate. When this is the case, these evaluations must be no more than 12 months old at the time of initial subsidy determination.

(4) Efforts to place the child in a non-subsidized placement must be documented in the child’s record. Documentation shall include at least one (1) of the following:

(a) List of other families considered;

(b) Letters to agencies specifically seeking a home for the child, or

(5) No child shall remain unnecessarily in foster care while the Department searches for a non-subsidized placement, if a family who can meet the difficult-to-place factors of the child is available, but requires a subsidy.

(6) The CBC or subcontractor agency adoption staff shall inform the caregiver that adoption subsidy, unlike foster care board rate payments, is not intended to cover the complete cost of the child’s care. The maintenance subsidy payment is intended to assist the adoptive parent in supporting the extra costs associated with adopting a difficult-to-place child.

(7) Initial Maintenance Subsidy. The initial determination of the monthly maintenance subsidy shall be based on the needs of the child at the time of the negotiation and the projected long-term needs of the child based on the family, and medical and mental and behavioral health history of the child and birth family or, for adoptions finalized on or after July 1, 2007, as stated in Section 409.166, F.S. Negotiations for the initial maintenance subsidy shall begin at $417 monthly.

(8) A maintenance subsidy may be negotiated up to 100% of the statewide Level II – Level V board rate. A subsidy may exceed 100% of the statewide Level II – Level V board rate when an exception is granted by the Department and documented on the “Maintenance Adoption Subsidy Approval” form CF-FSP 5077, incorporated by reference in Rule 65C-16.0131, F.A.C. Requests for exceptions must be in writing and supported by a written child study. In determining whether to grant an exception, the Department shall consider the medical, behavioral, and therapeutic needs of the child at the time of the negotiation, as well as the projected long-term needs of the child based on the family and medical history of the child and birth family. In no case shall the subsidy exceed the foster care maintenance payment for which the child is or would be eligible if the child had been placed in a family foster home. Maintenance subsidy is not intended to cover services which can be obtained through family insurance, Medicaid, Children’s Medical Services, medical subsidy, or through special education plans provided by the public school district. If a licensed or unlicensed prospective adoptive parent requests a subsidy exception that falls within the board rate approved by the Office of Licensing, only the “Maintenance Adoption Subsidy Approval” form CF-FSP 5077, approved adoption home study and child study is required to be submitted to the Department for approval. If a licensed or unlicensed prospective adoptive parent requests a subsidy exception more than the approved board rate, the request must include the “Maintenance Adoption Subsidy Approval” form CF-FSP 5077, approved adoption home study, child study and any supporting documentation to justify the increased rate.

(9) The “Adoption Assistance Agreement,” incorporated in subsection (2) of this rule, must be signed and dated by all parties prior to the finalization of the adoption and uploaded into the child welfare information system. The effective date of the agreement is the date the child was placed with the family as a pre-adoptive placement and the Adoption Assistance Agreement was signed by the potential adoptive caregiver and the CBC or subcontracted agency. If not completed on the same date, the effective date will be the latter of the dates. Payments may not be made for any months in which there is no adoption assistance agreement in place.

(10) An initial “Adoption Assistance Agreement” with the approved applicant shall not be executed when a denied adoption applicant has requested a review of the denial pursuant to Chapter 120, F. S.

(11) The family must be advised by the adoption case manager that it is their responsibility to notify the Department or CBC of any change in circumstances, including moving out of state, no later than 48 hours after the change.

(12) The adoption subsidy agreement remains in effect until:

(a) The child dies.

(b) The child reaches 18 years of age or is emancipated.

(c) The parents are no longer legally responsible for the support of the child, including the death of a parent when the adoption is by a single parent or both parents when the adoption is by a married couple, or the parental rights of the adoptive parents have been terminated.

(d) The parents are no longer providing any support to the child. Support includes emotional and/or financial support, even in situations when the child is no longer living in the home.

(e) The child is placed in out-of-home care due to a court ordered removal.

(f) The Department discovers the child was mistakenly determined eligible for benefits.

(13) Adoptive parents may request an increase in the maintenance subsidy after the initial subsidy agreement was approved due to increased needs related to conditions of the child that were identified as current or future needs of the child prior to the adoptive placement or the circumstances of the family have changed in order to meet the increased needs of the child.

(a) The negotiation of this increase shall be based on the Level II – Level V board rate at the time of the request. Requests for increases must be provided in writing by the adoptive parents and approval shall be based on the merit of each case.

(b) If the increase request is approved, retroactive payment will be made dating back to the date the family officially requested the increased subsidy in writing.

(c) If the increase request is denied, the designated Department staff shall send a denial letter with notification of the adoptive parents’ right to appeal the denial pursuant to Chapter 120, F.S. If it is found that the increase was wrongfully denied, the effective date of the new subsidy will be the date the increase request was received. A new subsidy agreement must be signed by all parties with the new approved amount documented.

(14) No child will have his or her subsidy payment reduced based on application of this rule.

(15) Any child who has been determined eligible for adoption subsidy whose adoption has been dissolved by termination of parental rights or by the death of the adoptive parents must continue to meet the definition of difficult-to-place in the subsequent adoption in order to be eligible for adoption assistance.

(16) No change shall be made to a maintenance subsidy without concurrence of the adoptive parents except as provided by federal regulation or state law. The subsidy agreement is not transferable to another caregiver.

(17) No more than the documents listed in the “Adoption Revenue Maximization Eligibility Checklist,” form CF-FSP 5493, (May 2025), hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-18069, is required for submission to the CBC Lead Agency Revenue Maximization staff for preliminary subsidy eligibility determination.

History

Rulemaking Authority 409.166(8) FS. Law Implemented 409.166(4) FS. History–New 2-14-84, Formerly 10M-8.20, Amended 5-20-91, 4-19-94, Formerly 10M-8.020, Amended 12-23-97, 8-19-03, 11-30-08, 7-7-16, 10-30-16, 12-18-16, 9-25-17, 2-5-18, 12-16-18, 8-15-21, 11-7-22, 7-20-23, 6-10-25, Technical Change 3-19-26.

Fla. Admin. Code R. 65C-16.0131 Determination of Extension of Maintenance Subsidy Payments

(1) The purpose of the Extension of Maintenance Adoption Subsidy is to make available to prospective adoptive parents financial aid that would enable them to adopt a difficult-to-place child who is 14 - 17 years of age. Every adoptive family adopting a child at the age of 14 - 17 must be advised of the availability of Extension of Maintenance Adoption Subsidy and the purpose for which it is intended.

(2) Extension of Maintenance Adoption Subsidy payments may be made until the young adult reaches age 21, if the child is engaged in one of the qualifying activities specified in Section 409.166(4)(d), F.S.

(3) The young adult and the family’s need for subsidy must be determined prior to the young adult’s 18th birthday and no subsidy payment will be made until after the young adult turns 18 years old and all parties have signed the “Extension of Maintenance Adoption Assistance Agreement Between the Department of Children and Families, Young Adult And Adoptive Parents Regarding Subsidy Payments and Services,” CF-FSP 5433, (October 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14820.

(a) If the Department or community-based care (CBC) agency was responsible for the placement and care of the young adult, the CBC agency in the county where the court had jurisdiction is responsible for entering into the Extension of Maintenance Adoption Assistance Agreement and paying the Extension of Maintenance Adoption Subsidy, even if the young adult and family lives in another county.

(b) If the Department or CBC agency was not responsible for the placement and care of the young adult at the time of adoption, the CBC agency in the adoptive parents’ county of residence is responsible for determining whether the young adult meets the requirements to receive the Extension of Maintenance Adoption Subsidy, must enter into the Extension of Maintenance Adoption Agreement and pay the Extension of Maintenance Adoption Subsidy.

(c) When the need for the Extension of Maintenance Adoption Subsidy is not determined prior to the child’s 18th birthday and the adoptive parents feel they have been wrongly denied the subsidy benefits on behalf of an adopted child, they have the right to appeal the denial pursuant to Chapter 120, F.S. If it is found that the subsidy was wrongly denied, retroactive payment will be made dating back to the date the family requested the subsidy in writing.

(4) Medical and/or mental health evaluations shall be required to document the need for an enhancement to the Extension of Maintenance Adoption Subsidy that exceeds the statewide standard foster care board rate and the young adult’s initial subsidy amount. Medical and/or mental health evaluations must be no more than 12 months old.

(5) The CBC or subcontractor agency adoption staff shall inform the adoptive parent(s) that the Extension of Maintenance Adoption Subsidy, unlike foster care board rate payments, is not intended to cover the complete cost of the young adult’s care. The Extension of Maintenance Adoption payment is intended to be a continuation in assisting the adoptive parent with the extra costs associated with supporting the young adult who is considered difficult-to-place.

(6) The determination of the monthly Extension of Maintenance Adoption Subsidy is based on the needs of the young adult at the time of the negotiation and the projected future needs of the young adult based on the family and medical history of the young adult and birth family or, for adoptions finalized on or after January 1, 2019, as stated in Section 409.166(4), F.S.

(7) An Extension of Maintenance Adoption Subsidy may be negotiated up to 100% of the statewide Level II – Level V board rate. A subsidy may exceed 100% of the statewide Level II – Level V board rate only when an exception is granted by the Department and documented on the “Maintenance Adoption Subsidy Approval” form CF-FSP 5077, August 2018, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13407. Requests for exceptions must be in writing. In determining whether to grant an exception, the Department shall consider the medical, behavioral, and therapeutic needs of the young adult at the time of the negotiation, as well as the projected long-term needs of the young adult based on the mental health, substance use and/or misuse, and medical history of the young adult and birth family. In no case shall the subsidy exceed the foster care maintenance payment for which the young adult is or would be eligible if the young adult had been placed in a Level II – Level V family foster home. The Extension of Maintenance Adoption Subsidy is not intended to cover services which can be obtained through family insurance, Medicaid, Children’s Medical Services, medical subsidy, or through special education plans provided by the public school district.

(8) The “Extension of Maintenance Adoption Assistance Agreement,” incorporated in subsection (3) of this rule, must be signed and dated by all parties prior to the young adult’s 18th birthday and uploaded into child welfare information system in the file cabinet located in the post adoption case. The effective date of the agreement is the date the young adult turns 18 years old. Payments may not be made for any months in which there is no Extension of Maintenance Adoption Assistance Agreement in place and/or the child is not participating in a qualifying activity.

(9) The child welfare professional shall advise the family that it is their responsibility to notify the Department or CBC of any change in circumstances, including moving out of state, no later than 48 hours after the change.

(10) The Extension of Maintenance Adoption Assistance Agreement remains in effect until whichever of the following occurs first:

(a) The young adult reaches 21 years of age.

(b) The young adult no longer meets one of the qualifying activities specified in Section 409.166(4)(d), F.S.

(d) The adoptive parents are no longer providing any support to the young adult, the young adult marries, or the young adult enters the military. Support includes emotional and/or financial support, even in situations when the young adult is no longer living in the home.

(e) The Department discovers the young adult was mistakenly determined eligible for benefits.

(f) The young adult dies.

(g) The adoptive parent(s) die.

(11) If the adoptive parent and young adult have not provided documentation that the young adult is participating in a qualifying activity, the Department or designee must retain the maintenance subsidy payment until such documentation is provided.

(12) The adoptive parent and young adult can re-enter the Extension of Maintenance Adoption Subsidy Program until the youth reaches the age of 21 if they provide documentation to support that the young adult meets one of the qualifying activities pursuant to Section 409.166 (4)(a)-(d), F.S.

(13) Adoptive parents may request an increase in the maintenance adoption subsidy after the Extension of Maintenance Adoption Assistance Agreement was approved due to increased needs of the young adult or a change in the family’s ability to meet the needs of the young adult.

(a) The negotiation of this increase shall be based on the Level II – Level V board rate at the time of the request. Requests for increases must be submitted in writing by the adoptive parents to the CBC that issues the subsidy payment and approval shall be based on the merit of each case.

(b) If the increase request is approved, retroactive payment will be made dating back to the date the family requested the increased subsidy in writing.

(c) If the increase request is denied, the designated Department staff shall send a denial letter with notification of the adoptive parents’ right to appeal the denial pursuant to Chapter 120, F.S. If it is found that the increase was wrongfully denied, the effective date of the new subsidy will be the date the written request for an increased was received. A new Extension of Maintenance Adoption Assistance Agreement must be signed by all parties with the new approved amount documented.

(d) If the young adult is no longer participating in one of the qualified activities pursuant to Sections 409.166(4)(a)-(d), F.S., the designated Department staff shall send a denial letter with notification of the adoptive parents’ right to appeal the denial pursuant to Chapter 120, F.S.

(14) No change shall be made to an Extension of Maintenance Adoption Subsidy without concurrence of the adoptive parents except as provided by federal regulation or state law. The Extension of Maintenance Adoption Assistance Agreement is not transferable to another caregiver.

History

Rulemaking Authority 409.166(8) FS. Law Implemented 409.166(4) FS. History–New 12-16-18, Amended 8-15-21, 11-7-22, 7-20-23, 6-10-25.

Fla. Admin. Code R. 65C-16.014 Post Adoption Services

(1) The adoption case manager will provide information, in writing, to the birth and adoptive parents informing them of their rights to consent to the release of adoption records pursuant to Sections 63.162 and 63.165, F.S., within 30 days of adoption finalization.

(2) After finalization, the adoptive family may require temporary case management support, information and referral assistance and related post adoption services. Each community-based-care (CBC) agency shall provide post adoption services that include the following:

(a) At least one (1) full-time designated post adoption services staff;

(b) At least one (1) monthly adoptive parent support group(s) or monthly newsletters; and,

(3) The need for medical assistance, formerly known as medical subsidy, must be established prior to the adoption placement, although the service might not actually be needed until a later date. Medical assistance is established to cover short-term medical or mental health needs of the child that are not covered through Medicaid, Children’s Medical Services, or Children’s Mental Health Services. The type of service and estimated cost must be documented on the signed initial Adoption Assistance Agreement prior to adoption finalization and approved by the designated Department staff, pursuant to the conditions set forth in Section 409.166(4), F.S. When this need is not established prior to the placement and the adoptive parents feel they have been wrongly denied a service on behalf of an adopted child, they have the right to to appeal the denial pursuant to Chapter 120, F.S. If it is found the service was wrongfully denied, the effective date of the service will be the date the family officially requested the service. Retroactive payment dating back to the date of placement will not be approved.

(4) An individualized service must be terminated when the condition for which it was granted no longer exists or on the child’s 18th birthday, whichever occurs first. Children needing residential mental health services will be referred to the Department’s Substance Abuse and Mental Health Program Office.

(5) The cost for a service will not be paid when those costs can be or are covered by the adopting family’s medical insurance, Children’s Medical Services, Children’s Mental Health Services, Medicaid, Agency for Persons with Disabilities or local school districts.

(6) The adoptive parents must obtain the approval of the CBC agency or subcontractor agency prior to planning for the use of a service if the adoptive parents will be seeking reimbursement.

(a) Once approval has been obtained, the adoptive parents must submit a copy of the bill for the service to the CBC agency or subcontractor agency to initiate reimbursement. The bill must be clearly legible and must specify the name of the child, the service rendered, the date of the service, and the charge for the service.

(b) If the adoptive parents and the CBC agency are in agreement, payments can be made directly to the service provider.

(7) When a request for a post-adoption service(s) is denied, the CBC agency shall notice the Department of the denied service. The Department shall notify the adoptive parent(s) of any denial of post-adoption services and advise them of the option for review of the denial pursuant to the Administrative Procedures Act, Chapter 120, F.S.

History

Rulemaking Authority 409.166(8) FS. Law Implemented 409.166 FS. History–New 2-14-84, Formerly 10M-8.21, 10M-8.021, Amended 12-23-97, 8-19-03, 11-30-08, 7-7-16, 1-22-18, 8-15-21.

Fla. Admin. Code R. 65C-16.015 Non-Recurring Adoption Expenses

(1) Under any adoption assistance agreement with adoptive parents of a difficult-to-place child, the state is authorized to make payments to the adoptive parents as referenced in Section 409.166(7), F.S. Such costs may include expenditures for physical and psychological examinations of the adoptive parents if required as a part of the adoption process, as well as transportation, lodging and food for the child or adoptive parents when necessary to complete the placement or adoption process.

(2) Agency adoption fees shall be established by written agreement between the agency and family prior to the performance of the requested service. If these children are otherwise eligible, agency fees shall be counted as an allowable expense under non-recurring adoption expenses. It is not necessary that the family be receiving maintenance adoption subsidy to be eligible for reimbursement of non-recurring adoption expenses.

(3) In cases where siblings are placed and adopted either separately or as a unit, each child is treated as an individual with separate reimbursement for nonrecurring expenses up to the maximum amount of $1,000 per child.

(4) There can be no income eligibility requirements for adoptive parents in determining whether payments for non-recurring expenses of adoption will be made.

(5) Adoptive parents cannot be reimbursed for out-of-pocket expenses for which they have been otherwise reimbursed.

(6) Except where it would be contrary to the best interest of the child, an effort must be made to place the child without adoption assistance prior to reimbursement for non-recurring adoption expenses.

(7) The following procedures will initiate payments for reimbursement of nonrecurring adoption expenses:

(a) All adoptive parents of difficult-to-place children will be advised by the staff person conducting the adoption home study of the availability of nonrecurring expense reimbursement;

(b) Reimbursement for eligible costs may be made to the adoptive parent or directly to a vendor. All adoptive parents will be advised by the staff person conducting the adoption home study to keep copies of receipts of expenditures related to the adoption. Copies of such receipts must be available in the subsidy record. Eligible expenses include court costs, attorney fees, birth certificates, costs of required physicals and psychological examinations, costs of transportation, lodging and food for the child and/or adoptive parents when necessary to complete the adoption process, and the cost of the adoption home study if the child is in the custody of a private agency;

(c) When a placement decision has been made, the adoption assistance agreement shall be negotiated with the family and must include a statement of the projected cost to be reimbursed for nonrecurring adoption expenses, as well as proposed maintenance and medical subsidy amounts if appropriate;

(d) Payments for nonrecurring expenses can be made up to one (1) year following the finalization of the adoption.

History

Rulemaking Authority 409.166(8) FS. Law Implemented 409.166 FS. History–New 5-20-91, Amended 4-19-94, Formerly 10M-8.0221, Amended 8-19-03, 11-30-08, 7-7-16, 7-20-23.

Fla. Admin. Code R. 65C-16.016 Access to Closed Adoption Records

(1) The confidentiality of adoption records, original birth records, and adoption court files is protected by sealing them upon adoption finalization. Persons seeking information from those records will be referred to the Office of Child Welfare, Florida Adoption Reunion Registry for assistance.

(a) Non-identifying information

The Department, community-based-care (CBC) agency, or other adoption entity shall disclose all available non-identifying information to adoptive parents before the adoption becomes final or upon the adoptive parent’s request.
The Department or CBC shall release all available non-identifying information to adult adoptees who were former foster children upon their request after they reach the age of majority.
The Department or private adoption entity shall release only non-identifying information to adult adoptees who were placed for adoption through a private adoption.

(b) Identifying information

Identifying information shall only be released pursuant to Sections 63.162 and 63.165, F.S.
Prior to releasing identifying information to an adult adoptee who was in foster care, any information that is confidential pursuant to state or federal law must be redacted, such as social security numbers, HIPAA information, reporter information in child protective investigations and information related to domestic violence centers.

a. Final release approval of the redacted record shall be by the Department’s legal counsel or designated reviewer.

b. A log of all redacted information, including the page number where the redaction is located and a brief description of what was redacted, shall be attached to the redacted record when it is provided to the Department’s legal counsel or designated reviewer for final release approval.

c. Redacted records of child protective investigations with the log of all redacted information shall be forwarded to the regional legal counsel for final release approval.

(2) The Department or CBC agency shall retain as confidential all records relating to each child who was adopted through the Department or contracted provider. These confidential records shall be referred to as “Department closed adoption records” and shall be retained in the circuit/region or with the CBC agency until requested by the Department.

(3) The Department, CBC agency, or private adoption entity shall index all closed adoption records by the names of the adoptive parents, and, where available, the files must be cross-referenced by the birth and adoptive names of the minor.

(4) Requests for information from closed adoption records must be made in writing. Written requests for the release of closed adoption records must include the following:

(a) A form of identification from the requestor, such as a photocopy of the requestor’s driver’s license or birth certificate;

(b) The name of the adoptive parents, if known; and,

(5) No information will be released by telephone.

(6) In the event that a licensed child-placing agency closes, the agency shall provide all closed adoption records to the Department. Upon receipt of the adoption records, the Department shall assume all further responsibility for the records.

History

Rulemaking Authority 39.012, 39.0121(3), 63.233 FS. Law Implemented 39.00145(1), (2), 63.162(2)-(4), (6) FS. History–New 5-20-91, Amended 4-28-92, 4-19-94, Formerly 10M-8.024, Amended 8-19-03, 11-30-08, 7-7-16, 8-15-21.

Fla. Admin. Code R. 65C-16.017 Florida Adoption Reunion Registry

(1) The state registry of adoption information created in Section 63.165 F.S., is also known as the Florida Adoption Reunion Registry. The Department shall retain and maintain the registry records on a permanent basis.

(2) Any person may register by completing and submitting the “Application for Adoption Registry Services,” CF 1490, July 2021, hereby incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13384, indicating to whom they consent to release identifying information about themselves.

(3) Adoptee birth data shall be verified by registry staff, with the assistance of the Vital Records section of the Office of Vital Statistics in the Department of Health. In cases where birth information cannot be verified and registration is not possible, applicants will be notified of data used as a basis for search and given opportunity to correct or change that data for resubmission. Should verification of the birth information still not be possible, no further attempts will be made to process that application. If the applicant desires to submit new or different information, a new application must be submitted.

(4) The applications, signed by registrants, will be placed on file and kept for 99 years.

(5) The Department shall mail a letter to registrants acknowledging receipt of the application.

(6) Updating of Registry Information.

(a) Any registrant may change the name, address or telephone number associated with their registration, may limit or restrict their consent to release information, or may completely withdraw from the registry at any time using the “Application for Adoption Registry Services,” CF 1490, July 2021, hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13384.

(b) Responsibility for update rests with registrants and only the most current information on file will be disclosed to designated recipients upon their completion of registration procedures.

(7) The Department shall offer counseling services to registrants at the time of registration. Counseling, as referenced in Section 63.165(2), F.S., shall consist of professional advice provided by the Department, by designated staff employed by the Department, by agencies licensed by the State of Florida to provide adoption services, or by other persons who have adoption training or experience.

History

Rulemaking Authority 63.233 FS. Law Implemented 63.165 FS. History–New 8-19-03, Amended 11-30-08, 7-7-16, 4-20-17, 7-20-17, 8-15-21.

Fla. Admin. Code R. 65C-16.018 Adoption Benefits for Qualifying Employees of State Agencies

History

Rulemaking Authority 409.1663(6) FS. Law Implemented 409.1663 FS. History–New 11-30-08, Repealed 12-14-10.

Fla. Admin. Code R. 65C-16.019 Intervention in Dependency Cases

(1) This rule applies when:

(a) The child is in the custody of the Department;

(b) Parental rights have not been terminated;

(d) An adoption entity files a petition to intervene in the dependency case.

(2) Intervention. An adoption entity’s intervention does not relieve the Department of its responsibility to assess whether the best interest of the child is met. At the time of the intervention hearing, the Department shall inform the court as to whether it opposes or supports the motion for intervention. The Department shall oppose the adoption entity’s intervention if the adoption entity fails to provide the Department with the intervention preliminary home study.

(3) The intervention preliminary home study shall be completed by the private adoption entity and shall include the following:

(a) When a prospective adoptive family is identified, the home study must document that the family and medical history of the child’s family and the current and projected needs of the specific child were discussed.

(b) When a prospective adoptive family is identified, the preliminary home study must be updated to include a determination that the family has the strengths to meet the identified current and projected needs of the specific child including the adoptive parents’ willingness to access needed services.

(4) The Department shall evaluate the intervention preliminary home study of the adoption entity’s prospective adoptive parent and any other relevant information available to the Department to determine whether the placement will be in the child’s best interest using the “Intervention Best Interest Checklist” form, CF-FSP 5451, July 2021, incorporated and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13391, based on the following factors:

(a) Each parent’s compliance with the case plan at the time of consent;

(b) Any concerns about the parent’s reason for executing the consent;

(d) The status of notification of relatives that adoption is the new permanency goal;

(e) The status of notification of the adoptive parents of siblings that adoption is the new permanency goal;

(f) The quality and length of the child’s relationship with the child’s current caregiver;

(g) The quality and length of the child’s relationship with any prospective adoptive parents;

(h) The current placement and status of other siblings;

(i) The wishes of the child, if the child is of the appropriate age and maturity to express a preference;

(j) The length of time the child has been in his or her current placement;

(k) All the needs of the child, including the child’s physical health, mental health, educational needs, and attachment concerns;

(l) The Department or community-based care agency (CBC) shall check the child abuse and neglect registries of all states where the prospective adoptive parents and other adults living in the pre-adoptive placement resided in the previous five (5) years.

(5) The Intervention Best Interest Checklist must be uploaded into the child welfare information system and shared with Children’s Legal Services within 48 hours of completion by the adoption case manager.

(6) If the court grants the intervention, the CBC or subcontractor shall terminate their supervision and end the removal episode of the child in the child welfare information system with a discharge reason of transferred to another agency. The CBC or subcontractor shall not close the case in the child welfare information system until finalization of the adoption.

(7) If the court grants the intervention, the adoption entity shall prepare a transition plan in conjunction with the CBC or subcontractor, the current caregiver, and prospective adoptive parents. The transition must respect the child’s developmental stage and psychological needs, ensure the child has all of his or her belongings, and allow for a gradual transition from the caregiver’s home.

(8) If the court grants the intervention, the adoption entity shall provide monthly supervision reports to the Department through Children’s Legal Services until the finalization of the adoption. The adoption entity’s monthly supervision reports shall contain:

(a) Date and location of each face-to-face contact with the child;

(b) A summary of the child’s academic performance, if the child attends school;

(c) A summary of the child’s current health status, including mental health, the dates of any health related appointments in the previous month, the identity of any health providers seen, and a list of the child’s current medications, if any;

(d) The type and frequency of the child’s interactions with his or her siblings;

(e) A description of any unmet needs and recommendations for meeting the identified needs; and,

(f) A description of how the child is attaching with the prospective adoptive parent.

(9) Until the child’s adoption is finalized, the Department shall continue to report the child’s status to the court and shall continue to collect the information necessary for its dependency case and for its efforts to ensure a permanent placement for the child. This information shall be contained in documents the adoption entity provides to the Department, CBC or its subcontractor, including the adoption entity’s monthly supervision reports and the intervention preliminary home study of the prospective adoptive parents.

(10) After the child is placed with the adoption entity’s prospective adoptive parent, the Department, through an attorney for the Department, shall schedule regular status reviews with the court to monitor the child’s progress with the prospective adoptive parent until the adoption finalization. CLS shall file the adoption entity’s monthly supervision reports with the court for these status reviews and shall provide a copy of all monthly supervision reports to the CBC agency or its subcontractor for its case record.

(11) Department’s Case Record. When an adoption entity intervenes in a dependency court case, the Department, CBC agency, or its subcontractor shall maintain an open inactive case record on the child until the adoption is finalized. For this case record, the Department, CBC agency, or its subcontractor shall collect and maintain the following:

(a) The intervention preliminary home study;

(b) Other documentation relating to the placement with the prospective adoptive parents; and,

(12) If the adoptive family requests subsidy and the child is determined eligible for maintenance adoption subsidy, all required documentation supporting the request must be provided to the CBC or subcontractor and the private adoption screen in the child welfare information system must be completed if the subsidy is approved.

(13) Department’s Legal Case File. When an adoption entity intervenes in a dependency court case, the Department, through an attorney for the Department, shall maintain a legal case file until the adoption is finalized. For this file, the Department shall collect and maintain the following:

(a) The intervention preliminary home study;

(b) Any other evidence presented during the intervention hearing relating to the placement with the prospective adoptive parents;

(d) The final adoption home study; and,

(e) The final order of adoption.

(14) Final Adoption Home Study. The intervening adoption entity shall provide the court and the Department with a final adoption home study before a final order of adoption is granted. The final adoption home study shall meet the following requirements:

(a) The final adoption home study must be performed by a licensed child-placing agency, a child-caring agency registered under Section 409.176, F.S., a licensed professional, or an agency as described in Section 61.20(2), F.S., unless the petitioner is a stepparent or relative.

(b) The final adoption home study shall contain:

The information from the intervention preliminary home study.
Documentation of a minimum of two (2) scheduled visits with the child and the child’s adoptive parent after the child is placed in the pre-adoptive placement to determine the safety and well-being of the child. One of the visits must be in the home.
Relevant information about the child’s needs and the services accessed by the adoptive parents to meet those needs; and,
Any other information relevant to the prospective adoptive family.

(15) A determination of eligibility for maintenance adoption subsidy and, if eligible, the signing of the Adoption Assistance Agreement, CF-FSP 5079, incorporated in subsection 65C-16.013(2), F.A.C., shall be completed prior to finalization of the adoption. The adoption entity with custody of the child shall provide all documentation regarding eligibility to the CBC. See Rule 65C-16.013, F.A.C., for more information of determination of maintenance adoption subsidy payments.

(16) The Department must be given notice of the adoption finalization hearing.

(17) The intervening adoption entity shall file the final order of adoption in the child’s dependency case for purposes of case closure.

(18) If at any time the child is returned to the custody of the Department, the intervening adoption entity shall provide the Department will all legal filings from the adoption case.

History

Rulemaking Authority 63.233 FS. Law Implemented 63.082(6), 63.092 FS. History‒New 7-7-16, Amended 8-15-21, 7-20-23, 6-10-25.

Fla. Admin. Code R. 65C-16.020 Communication or Contact

(1) This rule applies to communication or contact between a child who is the subject of a petition for adoption under Chapter 63, F.S., and his or her siblings or other relatives, after:

(a) The parents’ rights to the child have been terminated; and,

(b) The child’s custody has been awarded to the Department pursuant to Section 39.811, F.S.

(2) Communication or Contact Pending Adoption.

(a) The Department shall make a recommendation to the court regarding the appropriateness of communication or contact with the child’s siblings and other relatives for the period of time after the termination of parental rights and prior to adoption.

(b) The Department’s recommendation shall include:

A statement and rationale as to why the recommended communication or contact with each specified relative is in the best interest of the child and does not interfere with the permanency goal for the child.
A recommendation for the nature and frequency communication or contact with each specified relative.
A justification for any recommendations against communication or contact with siblings and grandparents.

(3) Communication or Contact Post-Adoption.

(a) Prior to the termination of parental rights, the Department shall have discussions with the child, if age appropriate, and the prospective adoptive parent, if known, to identify any siblings or other relatives who may be appropriate for post-adoption communication or contact with the child. When the prospective adoptive parent is identified after the termination of parental rights, this discussion must occur prior to adoptive placement. During these discussions, the Department shall convey the following information to the prospective adoptive parent:

That the Department shall make a recommendation regarding post-adoption communication or contact to the court.
That the adoptive parent shall retain the right to petition for a review of the communication or contact order issued in the final order of the adoption at any time.
That the validity of the adoption shall not be contingent upon the adoptive parent following the terms of the post-adoption communication or contact arrangement stated in the final order of adoption.
That the adoptive parent shall not have his or her ability to change residence within or outside the State of Florida restrained because of the post-adoption communication or contact arrangement stated in the final order of adoption.

(b) The Department shall make a recommendation to the court regarding post-adoption communication or contact with the child’s siblings and other relatives.

Siblings. The Department’s recommendation to the court regarding post-adoption communication or contact with the child’s siblings shall address communication or contact with each sibling known to the Department at the time of the adoption’s finalization, regardless of whether the sibling has been previously adopted.

a. If the child’s sibling has been previously adopted, the Department must take into account the provisions regarding post-adoption communication in the final order of adoption for that sibling. The Department shall not recommend post-adoption communication or contact with a sibling where the communication or contact will violate the sibling’s final order of adoption.

b. The Department shall provide a justification for all recommendations against communication or contact with siblings known to the Department at the time of the adoption’s finalization.

Other Relatives. Excluding siblings, the Department shall not recommend post-adoption communication or contact with any relative without the agreement of the prospective adoptive parent. The Department, in making its recommendation to the court, shall provide a recommendation for the nature and frequency of post-adoption communication or contact with the specified relatives.

History

Rulemaking Authority 63.233 FS. Law Implemented 63.0427 FS. History‒New 7-7-16.

Fla. Admin. Code R. 65C-16.021 Adoption Benefits for Qualifying Employees of State Agencies and Other Eligible Applicants

(1) The adoption benefit is a non-qualified plan under Section 125 of the Internal Revenue Code, subject to withholding taxes.

(2) To apply for this benefit, the applicant shall use the “Adoption Benefits For State Employees And Other Eligible Applicants,” form CF-FSP 5327, (October 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18915.

(a) The applicant shall complete Part I of the application.

(b) The applicant shall then deliver the application to his or her agency head to complete Part II of the application. Upon completion, the agency head shall return the original application to the applicant.

(c) The applicant shall then deliver the application to the community-based care agency that facilitated or subcontracted the facilitation of the adoption to complete Part III of the application.

(d) The applicant shall submit the completed application to the Department’s email address provided on the application.

(e) For multiple adoptions, the applicant shall submit a separate application for each child.

(3) The Department shall review all timely applications and determine who is eligible to receive the benefit.

(a) Applications will be processed in the order they were received.

(b) If applications are received on the same date, those with the earlier final order of adoption shall have priority.

(c) Eligible applicants who are denied a benefit due to lack of funds do not have to submit a new application. These eligible applicants will automatically be considered for payment of the benefit from later appropriations.

(d) Disbursement of award benefits is contingent upon the availability of appropriated funds.

History

Rulemaking Authority 409.1664(6) FS. Law Implemented 409.1664 FS. History‒New 11-22-15, Amended 1-2-18, 12-7-20, 11-22-22, 6-10-25, 1-8-26.

Chapter 65C-17 MASTER TRUST

Fla. Admin. Code R. 65C-17.001 Authority

History

Rulemaking Authority 402.17(1)(a)9. (1996 Supp.), 402.33(2), (7)(a) FS. Law Implemented 402.17, 402.17(2)(c) (1996 Supp.) FS. History–New 4-6-99, Amended 5-18-03, Repealed 1-3-16.

Fla. Admin. Code R. 65C-17.002 Definitions

For purposes of this rule chapter and the Master Trust Declaration, the following shall apply:

(1) “Account” means the client beneficiary’s trust account within the Master Trust.

(2) “Child support” means either a court-ordered obligation, enforced under Chapter 61, and Sections 409.2551-.2557, F.S., or a court-ordered or voluntary contribution paid directly to the child’s current needs trust account pursuant to Section 402.17(2)(a), F.S., for monetary support for the care, maintenance, training, and education of a child. For purposes of this rule chapter, child support does not include benefit payments such as Supplemental Security Income, Social Security, Veterans’ Administration, or other benefits which do not require a court order for collection.

(3) “Client” means a child or young adult:

(a) Under the age of 21 who is under the placement and care responsibility of the Department of Children and Families (Department) in out-of-home care as a result of a dependency proceeding under Chapter 39, F.S., or

(b) Between the ages of 18 to 23 who meets the criteria for services under s. 409.1451(2) F.S., but not in the legal custody of the Department; and

(c) Who has received, or will receive, money or tangible or intangible property for their sole use and benefit from any other person or entity, that is placed in the possession or control of the Department and for whom a separate trust for such individual does not exist.

(4) “Committee” means the members appointed by the Department to review all fee waiver and change in personal allowance requests. The committee must be composed of a minimum of three members, must not include the child welfare professional assigned to the client’s case, and be balanced as to representation from the community-based care lead agency (lead agency) fiscal, lead agency operation/program, and Department regional staff.

(5) “Cost of care” also referred to as “fees” means the total amount, as recorded in the Department’s child welfare information system, the Department has paid for the care of the child including, but not limited to, foster care room and board payment, Child Placing Agency (CPA) fees, or medical or mental health services not covered by Medicaid or other sources.

(6) “Current needs” of a client beneficiary means food, clothing, shelter, and medical expenses that are necessary for the client’s daily living in a healthy manner. Current needs may also include, but are not limited to:

(a) The cost of care for the child’s foster care placement;

(b) The cost of providing medical, psychological, psychiatric, or dental treatment which cannot, after diligent search or inquiry, be provided from other sources, including Medicaid, but not including general revenue;

(c) Personal comfort items or expenses including electronic devices, books, art supplies, sports equipment, and special activity fees; and

(d) Transportation for the client to independently travel to and from work, school or other activities.

(7) “Fee waiver” means a reduction or deferment of assessed fees pursuant to the procedures established in this rule chapter. Any client who has a Master Trust account is eligible to apply for a fee waiver.

(8) “Fiscal” means community-based care lead agency staff that are accountable for receiving and managing funds that are held in the Master Trust.

(9) “Long-term needs” of a Master Trust client beneficiary must be defined to include, but not limited to, the following:

(a) Educational or vocational needs including educational testing, vocational aptitude testing and counseling; therapy; remedial tutoring or classes; tuition, fees, books and supplies for school or training; equipment, tools, uniforms or other special clothing, and safety equipment to do a job; supported employment services, including payments for a job coach; attendant care or child care expenses; prepaid college tuition insurance plan; and

(b) Youth and young adult transition services including finanical assistance for tangible and intangible expenses related to education, employment, and other life skill training opportunites for the 13-21 year old population.

(10) “Master Trust” means, as the context requires, either the Master Trust Declaration, or the designated client trust accounts or subaccounts created within the Master Trust.

(11) “Personal Allowance” means an amount set aside from a client’s Social Security Administration Title II (SSA), Supplemental Security Income (SSI), Veterans’ (VA) or other federal benefit payment for the client’s personal needs before any amounts are applied to the cost of care.

(12) “Plan for Achieving Self-Support (PASS)” means a plan submitted to and approved by the Social Security Administration, to help clients who receive Supplemental Security Income (SSI) set aside money from other sources to pay for items or services needed to achieve a specific work goal.

(13) “Subaccount” refers to one or more of the subaccounts that may be established within the client’s trust account within the Master Trust. The subaccounts which are currently authorized under the Master Trust Declaration include the:

(a) Current needs subaccount,

(b) Long-term needs subaccount,

(d) Medicaid income trust subaccount, and

(e) Self-sufficiency-independent living plan subaccount.

History

Rulemaking Authority 402.17(1)(a)9., 402.33(2), (7)(a) FS. Law Implemented 402.17, 402.17(2)(c), 402.33 FS. History–New 4-6-99, Amended 5-18-03, 8-21-24.

Fla. Admin. Code R. 65C-17.003 Planning and Budgeting Functions

(1) As Trustee, the Department and its contracted providers have a fiduciary responsibility to hold and manage Master Trust accounts. The determination to designate funds to separate subaccounts should be made to balance current and long-term needs of the client. In all instances, neither the client, the client’s family, nor the client’s assistance group have any power or authority to alter, modify, change, amend or revoke the Master Trust Declaration as a whole, or as applied to that client’s trust account, or any subaccount(s). The money or property, tangible or intangible, placed in the account, or any subaccount, of the client is not available to the client’s family or assistance group for their current needs.

(2) The Department or community-based care lead agency (lead agency) on the behalf of the Department, as representative payee, must have access to revocable subaccounts that are created for the benefit of clients who receive benefit payments, child support payments, third-party benefits, or any other money or property. Funds for the client’s current needs will be disbursed by the Department or lead agency on behalf of the Department, as Trustee, pursuant to Sections 402.17 and 402.33, F.S. As to a client’s account or subaccount(s), the Master Trust terminates when the client is no longer in the custody, care, or control of the Department with limited exceptions as set forth in Section 402.17, F.S.:

(a) Requests and authorization for withdrawals of funds from the client’s account must be submitted utilitizing the Master Trust Withdrawal Request and Authorization, form CF-FSP 5463, (July 2024), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16892. If a single item expenditure equals at least $500 or if a total purchase amount equals at least $1000, the lead agency must receive approval from the Department designee prior to purchase. The Department designee must review and return a decision to approve or deny the request within 10 calendar days.

(b) The lead agency must notify the client’s parent(s) (unless termination of parental rights has occurred), the guardian ad litem (if one is appointed), and the child’s attorney (if one is appointed) if the total purchase amount is equal to $500 or more.

(c) A personal allowance in the amount of $30.00 per month must be set aside in the current needs subaccount for each client receiving a federal benefit. If the client receives more than one federal benefit type, the personal allowance is deducted from each. A request for change in personal allowance must be approved for an increased amount, as referenced in rule 65C-17.005(2).

(d) Clients who receive Supplemental Security Income (SSI) benefits, are eligible to submit a Plan to Achieve Self-Support (PASS) , form SSA-545-BK, to the Social Security Administration for approval. The approved Plan enables the Department to set aside funds from other sources for long-term educational or vocational needs of the client as enumerated in the Plan, without affecting SSI eligibility. Unless waived, the cost of PASS preparation fees, such as vocational testing, counseling, or other pertinent services, shall be charged against the client’s applicable subaccount. A PASS, Independent Living, or other case plan shall be developed for each member of this Master Trust client beneficiary group. A copy of the plan shall be kept in the client’s case file and a copy shall also be filed with the court exercising jurisdiction over the client. As part of the PASS or Independent Living plan, a vocational assessment may be completed to assist in identifying a reasonable work goal based on strengths and abilities.

(e) If a client has other special needs which cannot be provided by the Department, another local, state, or federal source, such as Medicaid, other community resources, from the client’s family members, or other responsible party, the fee waiver process established in rule 65C-17.005, F.A.C., may be used to request sufficient funds to provide the essential item to the client.

(f) Pursuant to the General Provisions of the Master Trust Declaration, each client, his or her parent(s) or legal guardian(s) (unless termination of parental rights has occurred), and, if applicable, the client’s attorney or guardian ad litem, shall receive an annual accounting of the receipts, disbursements and current balance of the client’s subaccount(s). Records regarding the client’s subaccount shall be available for review by the client, parent(s) or legal guardian(s), and, if applicable, the client’s attorney or guardian ad litem, but are otherwise confidential.

(g) When a client placed with a non-licensed caregiver is anticipated to receive or is receiving money or property, the lead agency must assist the caregivers in applying for the benefit or becoming the representative payee of benefit payments.

(h) The lead agency must provide to Children’s Legal Services (CLS) a completed Notarized Designation of Client Money and Property, form CF-FSP 5222, (July 2024), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16893, and Notice of Fee Assessment And Rights of Foster Child, form CF 285D, (July 2024), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16894, within seven calendar days from the establishment of the client’s Master Trust account.

(i) Within 15 calendar days of the establishment of the client’s Master Trust account, the lead agency must complete the “Master Trust Expenditure Plan”, CF-FSP 5312, (July 2024), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16895.

(j) After the monthly personal allowance is set aside, the lead agency must submit from the remaining funds the full amount of the client’s cost of care for the month the payment is allocated to the Department’s Office of Revenue Management. The exception to this rule is if a fee waiver has been approved.

(k) The lead agency must prepare a quarterly accounting record which must include all transactions from the date of the last quarterly accounting record.

(l) The lead agency is responsible for monitoring the client’s subaccounts. A completed Notice of Fee Assessment and Rights of Foster Child, form CF 285D, and a copy of the client’s most recent quarterly accounting record must be included in each Judicial Review Social Study Report filed with the court.

(m) Clients aged 17 who are receiving SSI and are seeking to continue receiving benefits as an adult, must cooperate with the lead agency in completing the required social security administration adult application process. To meet timely submission expectations, the lead agency must assist the client with initiating the required social security administration adult application process 180 days prior to the client’s 18th birthday.

History

Rulemaking Authority 402.17(1)(a)9., 402.33(2), (7)(a) FS. Law Implemented 402.17, 402.17(2)(c), 402.33 FS. History–New 4-6-99, Amended 5-18-03, 8-21-24.

Fla. Admin. Code R. 65C-17.004 Criteria for Fee Waiver and Change in Personal Allowance

(1) A request for fee waiver or change in personal allowance shall be for a specific sum and no longer than six months in duration. A request shall be effective the month the request and all supporting documentation is received by the Department. However, the effective date may be retroactive to the month form CF 285D, Notice of Fee Assessment and Rights of the Foster Child, is filed with the court in accordance with 65C-17.003(2)(h): for the effective date to be retroactive, the application with supporting documentation must be submitted to the Department within three months of the date form CF 285D is filed with the court.

(2) The request must be client specific and individualized based on the client’s current or long-term needs.

(3) A decision to grant a fee waiver or change in personal allowance must be made by utilizing the following criteria:

(a) Expressed preferences of the client. When age and developmentally-appropriate, the committee shall consider the clients preferences in relation to short-term and long-term goals.

(b) Needs of the client. The committee shall consider the specific needs and abilities of a client when reviewing requests for services, equipment, and items to be purchased and their potential to improve the client’s quality-of-life.

(c) Status of the case. The client’s permanency goal and goal date must be considered. If the goal is reunification, the committee shall consider whether the funds are utilized to promote a successful reunification while monitoring subaccount balances to avoid making the client or family ineligible for benefits when the client returns home. When Another Planned Permanent Living Arrangement (APPLA) is the permanency goal, educational, vocational needs, and youth and young adult transition services become the primary focus for utilization of funds.

(d) Amount and duration of request. The committee shall consider the amount of money currently available in the current needs account and other income or assets the client may have outside of the account. If the client receives SSI benefits, the committee should consider if the expenditure plan sufficiently reflects that the funds that would accumulate upon approval will not exceed the maximum countable $2,000 resource limit.

(e) Other resources reasonably available to the client. The committee shall consider other resources such as other family or community support that can be used to meet the needs of the client. A fee waiver shall not be used to purchase goods or services for which the client is eligible from community agencies or other federal and state programs, unless such goods or services are shown to be unavailable.

History

Rulemaking Authority 402.17(1)(a)9., 402.33(2), (7)(a) FS. Law Implemented 402.17, 402.17(2)(c), 402.33 FS. History–New 4-6-99, Amended 8-21-24.

Fla. Admin. Code R. 65C-17.005 Fee Waiver and Change in Personal Allowance Procedures

(1) Notice regarding the clients ability to request a fee waiver for cost of care or a change in personal allowance must be filed with the court with the completed Notice of Fee Assessment and Rights of Foster Child, form CF-285D, which is incorporated by reference in Rule 65C-17.004, F.A.C. at the time the Master Trust is established and with each judicial review thereafter.

(2) Requests for fee waiver or a change in personal allowance must be directed through the lead agency to the Department utilizing the Application for Review of Assessed Fee and Committee Findings, form CF 285E, (July 2024) incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16896.

(3) The request must specify the period of time for which the request is being made. The request must include all documentation necessary to substantiate the request including, a copy of the Master Trust Expenditure Plan, an itemized budget, vendor quotes or estimates, bills, certified statements. If the client receives SSI benefits, the Master Trust Expenditure Plan must reflect that the funds that would accumulate upon approval of the fee waiver or change in personal allowance will not exceed the maximum countable $2,000 resource limit.

(4) The review must be conducted by the committee and the committee recommendation submitted to the Department for approval within 10 business days from receiving a request with all required documentation. Within 5 business days of receiving the committee recommendation, the Department must review the recommendations of the committee and provide a decision of approval or denial of the request.

(5) If the fee waiver or the change in personal allowance request is denied, in whole or in part, the party requesting the fee waiver or change in personal allowance must be notified in writing. After notification, the party has the right to request an administrative hearing within 21 days of the date of denial, pursuant to Chapter 120, F.S.

(6) If the fee waiver or change in personal allowance request is approved, Application for Review of Assessed Fee and Committee Findings, form CF 285E, must indicate the effective date, duration, and amount for which the request is approved.

History

Rulemaking Authority 402.17(1)(a)9., 402.33(2), (7)(a) FS. Law Implemented 402.17, 402.17(2)(c), 402.33 FS. History–New 4-6-99, Amended 8-21-24.

Fla. Admin. Code R. 65C-17.006 Department Caseworker and Legal Responsibilities

History

Rulemaking Authority 402.17(1)(a)9. (1996 Supp.), 402.33(2), (7)(a) FS. Law Implemented 402.17, 402.17(2)(c) (1996 Supp.) FS. History–New 5-18-03, Repealed 7-15-24.

Chapter 65C-19 CERTIFICATION OF PUBLIC AGENCY FUNDS AS TITLE IV-E MATCH (LOCAL MATCH PROCESS)

Fla. Admin. Code R. 65C-19.001 Definitions

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.002 Claiming Allowable Expenditures

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.003 Title IV-E Eligibility Criteria

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.004 Allowability of Costs

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.005 Time Studies

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.006 Cost Pool

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.007 Allowable Maintenance Costs

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.008 Nonreimbursable expenditures

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.009 Accounting/Claiming Procedures

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Fla. Admin. Code R. 65C-19.010 Eligibility/Reimbursability Determination

History

Rulemaking Authority 39.0121(7) FS. Law Implemented 409.26731 FS. History–New 7-4-01, Repealed 11-24-19.

Chapter 65C-20 FAMILY DAY CARE STANDARDS AND LARGE FAMILY CHILD CARE HOMES

Fla. Admin. Code R. 65C-20.008 Application

(1) A standard application for licensing, using CF-FSP Form 5133, May 2019, Application for a License to Operate a Family Child Care Home, which is incorporated by reference and available at https://www.myflfamilies.com/services/child-family/child-care or from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10482, shall be submitted initially and annually thereafter to the Department. The applicant may complete the application through an online process through the Department’s Child Care Administration, Regulation, and Enforcement System (CARES), which can be accessed at https://cares.myflfamilies.com/security/login.

(2) A standard application for licensing, using CF-FSP Form 5238, May 2019, Application for a License to Operate a Large Family Child Care Home, which is incorporated by reference and available at https://www.myflfamilies.com/services/child-family/child-care or from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10580, shall be submitted initially and annually thereafter to the Department. The applicant may complete the application through an online process through the Department’s Child Care Administration, Regulation, and Enforcement System (CARES), which can be accessed at https://cares.myflfamilies.com/security/login. A license to operate a large family child care home may be used to operate a family child care home when the number of children in care meets the definition of a family day care home. A license to operate a family child care home cannot be used to operate a large family child care home.

(3) Each completed CF-FSP Form 5133 or CF-FSP Form 5238 must be submitted with the licensure fee pursuant to s. 402.315, F.S.

(4) A completed CF-FSP Form 5133 or CF-FSP Form 5238 for renewal of an annual license must be submitted to the licensing authority at least 45 days prior to the expiration date of the current license to ensure that a lapse of licensure does not occur. Failure to submit a completed CF-FSP Form 5133 or CF-FSP Form 5238 at least 45 days prior to the expiration date of the current license constitutes a licensing violation as defined in paragraph 65C-20.012(3)(d), F.A.C.

(5) A submitted CF-FSP Form 5133 or CF-FSP Form 5238 will not be considered complete until the licensing authority receives proof of background screening clearance on the operator of the family child care home or the large family child care home, substitutes, and on all other household members who are subject to background screening pursuant to sections 402.313(3) and 402.3131(2), F.S. If the designated substitute changes during the licensure year, prior to taking care of children, the new designated substitute for the operator must comply with background screening requirements and the licensing authority must receive proof of background screening clearances.

(6) The Department may issue a provisional license allowing a home to operate for a designated period of time while working to correct one or more licensing standard(s) not met, provided the operator is making adequate provisions to ensure the health and safety of the children in care. A provisional license may not be issued as the initial license and is a not a disciplinary sanction.

(7) During the hours of operation, the family child care home or large family child care home must not be used for any business or purpose unrelated to providing child care that can interfere with compliance with child care standards or permit the presence of individuals who do not meet screening and training requirements when children are present.

(8) Family Child Care Home and Large Family Child Care Home Standards. Family Child Care Homes and Large Family Child Care Homes must follow the standards found in the “Family Child Care Home and Large Family Child Care Home Handbook,” (December 2025), incorporated herein by reference. The handbook may be obtained from the Department’s website at www.myflfamilies.com/services/child-family/child-care or from the following link: https://flrules.org/Gateway/reference.asp?No=Ref-19079.

(9) The following documents and forms are also incorporated by reference as part of this rule:

(a) CF Form 5268A, October 2017, In-Service Training Record – Family Day Care Home/Large Family Child Care Home. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08750.

(b) CF/PI 175-28, September 2007, Selecting a Family Day Care Home Provider. A copy may be obatined from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08751.

History

Rulemaking Authority 402.309, 402.313, 402.3131, 402.405 FS. Law Implemented 402.302(13), 402.305, 402.309, 402.313, 402.3131 FS. History–New 7-2-98, Amended 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, 10-25-17, 6-12-19, 1-9-22, 9-1-26.

Fla. Admin. Code R. 65C-20.009 Staffing Requirements

History

Rulemaking Authority 402.313 FS. Law Implemented 402.313 FS. History–New 7-2-98, Amended 5-21-00, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, Repealed 10-25-17.

Fla. Admin. Code R. 65C-20.010 Health and Safety Related Requirements

History

Rulemaking Authority 402.313 FS. Law Implemented 402.313 FS. History–New 7-2-98, Amended 1-4-01, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, Repealed 10-25-17.

Fla. Admin. Code R. 65C-20.011 Health Records

History

Rulemaking Authority 402.313 FS. Law Implemented 402.313 FS. History–New 7-2-98, Amended 5-21-00, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, Repealed 10-25-17.

Fla. Admin. Code R. 65C-20.012 Enforcement

This rule establishes the grounds under which the Department may issue an administrative fine, deny, suspend, revoke a license or registration or place a licensee or registrant on probation status as well as uniform system of procedures to impose disciplinary sanctions.

(1) Definitions.

(a) “Day” means a weekday, excluding weekends and holidays.

(b) “Differential Monitoring” is a regulatory method for determining the frequency or depth of monitoring based on an assessment of a program’s history of compliance with licensing rules.

(c) “Key Indicator Standards” are any standards identified that statistically predict overall compliance with all standards.

(d) “Probation” is a licensing status indicating the license is in jeopardy of being revoked or not renewed due to violations within the control of the provider. Probation may require the licensee to comply with specific conditions intended to ensure that the licensee comes into and maintains compliance with licensing standards. Examples of such conditions include the following: a deadline to remedy an existing violation, a specified period during which compliance with licensing standards must be strictly maintained; and, specified conditions under which the home must operate during the probationary period.

(e) “Standards” are requirements for the operation of a licensed family day care home or large family child care home provided in statute or in rule.

(f) “Supplemental Standards” are any standards not identified as a Key Indicator that if not met, pose a greater risk of harm to children in care.

(g) “Technical Assistance” means a Department offer of assistance to a licensee or registrant to correct the statutory or regulatory violations.

(h) “Violation” is a noncompliance with a licensing standard as described in an inspection report resulting from an inspection under Section 402.311, F.S., as follows regarding Class I, Class II, and Class III Violations.

“Class I Violation” is an incident of noncompliance with a Class I standard as described on CF-FSP Form 5318, (December 2025), Family Child Care Home Standards Classifications Summary and CF-FSP Form 5317, (December 2025), Large Family Child Care Home Standards Classification Summary, which is incorporated by reference. A copy of CF-FSP Forms 5318 and 5317 may be obtained from the Department’s website www.myflfamilies.com/services/child-family/child-care or from the following links: https://flrules.org/Gateway/reference.asp?No=Ref-19082 and https://flrules.org/Gateway/reference.asp?No=Ref-19083. However, any violation of a Class II standard that results in death or serious harm to a child shall escalate to a Class I violation. Class I violations are the most serious in nature.
“Class II Violation” is an incident of noncompliance with an individual Class II standard as described on CF-FSP Form 5318 and CF-FSP Form 5317. Class II violations are less serious in nature than Class I violations.
“Class III Violation” is an incident of noncompliance that occurs at least three times within a 2-year period with an individual Class III standard as described on CF-FSP Form 5318 and CF-FSP Form 5317. Class III violations are less serious in nature than either Class I or Class II violations.

(2) Authority. The operation of a family day care home is prohibited unless registered or licensed, as required by county ordinance or resolution. The department or local licensing agency shall have the authority to seek an injunction in the circuit court where the home is located to stop the continued operation of a family day care home that is not licensed or registered. For licensed family day care homes, the department or local licensing agency shall also have the authority to seek an injunction in the circuit court where the home is located to stop the continued operation if the family day care home is in violation of the minimum standards. Pursuant to Section 120.60(6), F.S., an emergency suspension order may also be used to stop the continued operation if the family day care home poses immediate serious danger to the public health, safety, or welfare of the children who are enrolled.

(3) Disciplinary Sanctions.

(a) Enforcement of disciplinary sanctions for all Class I violations and for repeated Class II and Class III violations shall be applied progressively for each. The documents entitled, Reconciliation of 2009 and 2017 Family Child Care Home Standards Classification Summaries and Reconciliation of 2009 and 2017 Large Family Child Care Home Standards Classification Summaries, CF-FSP Form 5422 and CF-FSP 5421, October 2017, which are incorporated into this rule, provide an alignment of the 2009 and 2017 Classification Summaries for purposes of progressive enforcement. A copy may be obtained at the following links: http://www.flrules.org/Gateway/reference.asp?No=Ref-08755, and http://www.flrules.org/Gateway/reference.asp?No=Ref-08756. In addition, providers will be offered technical assistance in conjunction with all violations. The classification of standard violations within the Family Day Care Home Standards and Large Family Child Care Home Classification Summaries and the progressive disciplinary actions prescribed for each class by this rule are based on the provisions of Section 402.310(1)(b), F.S.

(b) Each standard violation has an assigned classification based on the nature or severity of the violation(s) as identified within CF-FSP Form 5318 and CF-FSP Form 5317.

(c) Technical assistance shall be provided for all violations. A grace period is provided, wherein a violation that has occurred more than two years prior to a subsequent violation of the same standard will not be counted for purposes of progressive discipline. A violation that has been withdrawn by the Department or has been dismissed as the result of an administrative proceeding held pursuant to Chapter 120, F.S., contesting an administrative complaint will not be counted for purposes of progressive discipline. A violation that is only reflected in an inspection report does not relieve the Department of its burden to prove that violation for purposes of progressive discipline upon the alleged occurrence of a subsequent violation.

(d) Failure to submit a completed CF-FSP Form 5133, Application for a License to Operate a Family Child Care Home, which is incorporated by reference in subsection 65C-20.008(1), F.A.C., or CF-FSP Form 5238, Application for a License to Operate a Large Family Child Care Home, which is incorporated by reference in paragraph 65C-20.008(2), F.A.C., for renewal of an annual license at least 45 days prior to the expiration date of the current license constitutes a licensing violation. A $100.00 late fine will be imposed and must be paid before the license is renewed.

(e) Disciplinary sanctions for licensing violations shall be progressively enforced as follows:

Class I Violations.

a. For the first and second violation of a Class I standard, the Department shall, upon applying the factors in section 402.310(1)(a)1., F.S., impose a fine not less than $100.00 nor more than $500.00 per day for each violation, and may impose other disciplinary sanctions in addition to the fine.

b. For the third and subsequent violation of a Class I standard, the Department shall suspend, deny or revoke the license. The Department, upon applying the factors in section 402.310(1)(b), F.S., may also levy a fine not less than $100.00 nor more than $500.00 per day for each violation in addition to any other disciplinary sanction.

Class II Violations.

a. For the second violation of the same Class II standard, the Department shall issue an administrative complaint imposing a fine of $50.00 for each violation.

b. For the third violation of the same Class II standard, the Department shall impose a fine of $60.00 per day for each violation.

c. For the fourth violation of the same Class II standard, the Department shall place the provider’s license on probation status for a period not to exceed six months, and shall also impose a fine of $75.00 per day for each violation.

d. For the fifth and subsequent violation of the same Class II standard, the Department shall suspend, deny, or revoke the license and shall also impose a fine of $100.00 per day for each violation. However, for a fifth violation of a Children’s Health and/or Immunization standard, the Department will not place the provider’s license on probation status.

Class III Violations.

a. For the third violation of the same non-compliant standard that is not classified as a Class I or Class II, the Department shall deem the standard a Class III standard and impose a fine of $25.00 for each violation. This violation, and subsequent violations of the same standard within a two-year period will be classified as “Class III.”

b. For the fourth violation of the same Class III standard, the Department shall impose a fine of $30.00 per day for each violation.

c. For the fifth violation of the same Class III standard, the Department shall place the provider’s license on probation status for a period not to exceed six months, and impose a fine of $40.00 per day for each violation.

d. For the sixth and subsequent violation of the same Class III standard, the Department shall suspend, deny, or revoke the license, and impose a fine of $50.00 per day for each violation. However, for the sixth and subsequent violation of the same Class III Children’s Health and/or Immunization standard, the Department will place the provider’s license or registration on probation status for a period not to exceed six months in lieu of suspending, denying, or revoking the license or registration.

(4) A license will not be renewed if a licensee has not paid all previously owed fines to the Department.

(5) Administrative Action. In response to an intent to deny, revoke or a cease-and-desist letter from the Department, the existing provider shall provide the Department with a list of all currently enrolled children and their primary caregiver’s contact information. Department regional staff will attempt to contact at least one primary caregiver for each enrolled child to inform them of impending actions against the provider to allow families time to seek other care if they so choose.

(6) Access. The family child care home or large family child care home operator must allow access to the entire premises of the home to inspect for compliance with minimum standards. Access to the family day care home or large family child care home also includes access by the parent, legal guardian, and/or custodian, to their child(ren) while in care.

History

Rulemaking Authority 402.310, 402.313, 402.3131, 402.305 FS. Law Implemented 402.305, 402.310, 402.313, 402.3131 FS. History–New 7-2-98, Amended 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, 10-25-17, 6-12-19, 1-9-22, Amended 7-28-22, 9-1-26.

Fla. Admin. Code R. 65C-20.013 Large Family Child Care Homes (LFCCH)

History

Rulemaking Authority 402.309, 402.3131 FS. Law Implemented 402.302, 402.302(13), 402.305, 402.309, 402.3131 FS. History–New 5-21-00, Amended 1-4-01, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, Repealed 10-25-17.

Fla. Admin. Code R. 65C-20.014 Gold Seal Quality Care Program

History

Rulemaking Authority 402.281 FS. Law Implemented 402.281 FS. History–New 5-1-08, Amended 1-13-10, 7-7-15, 10-25-17, 6-12-19, Transferred to 6M-10.001.

Chapter 65C-22 CHILD CARE STANDARDS

Fla. Admin. Code R. 65C-22.001 General Requirements

(1) Application.

(a) A standard application for licensing, using CF-FSP Form 5017, May 2019, Application for a License to Operate a Child Care Facility, which is incorporated by reference and available at https://www.myflfamilies.com/services/child-family/child-care or from the following link http://www.flrules.org/Gateway/reference.asp?No=Ref-10461, shall be submitted initially and annually thereafter to the Department. The applicant may complete the application through an online process through the Department’s Child Care Administration, Regulation, and Enforcement System (CARES), which can be accessed at https://cares.myflfamilies.com/security/login.

(b) Each completed CF-FSP Form 5017 must be submitted with the licensure fee pursuant to Section 402.315, F.S.

(c) The completed CF-FSP Form 5017 must be signed by the individual owner, prospective owner, or the designated representative of a partnership, association, or corporation, and must include background screening clearance documents for the owner/operator/director, and an approved fire inspection or an alternative fire safety plan approved by the local fire marshal office. Child care facilities that have a well system must maintain current written records indicating the well system meets the requirements of the Department of Health on an annual basis.

(d) A completed CF-FSP Form 5017 for renewal of an annual license must be submitted to the licensing authority at least 45 days prior to the expiration date of the current license to ensure that a lapse of licensure does not occur. Failure to submit a completed CF-FSP Form 5017 at least 45 days prior to the expiration date of the current license constitutes a licensing violation as defined in paragraph 65C-22.010(2)(c), F.A.C.

(2) Urban Child Care.

(a) In order to be classified as an urban child care facility, the applicant, prior to submitting an application for licensure must:

Obtain written documentation from the local governing body that confirms the geographical area has been declared urban; and,
Consult with the licensing authority to verify that the required outdoor play space, required by section 3.4.4, B of the Child Care Facility Handbook does not exist or cannot be made available. Urban designation will not be granted if the licensing authority determines space for an outdoor play area is available. Outdoor play space is “available” if appropriate space:

a. Is adjacent to the facility, or

b. Can be reached by a route that is free of hazards and is within 1/8 mile of the facility.

(b) If requirements in subparagraph 1., above, are met, the applicant must complete and submit the CF-FSP Form 5017.

(c) No application for an urban child care facility designation will be approved by the licensing authority without the above criteria being met.

(3) License.

(a) A child care facility license is issued in the name of the owner. The owner may be an individual, partnership, limited liability company (LLC), corporation, or other business or ownership entity recognized by the State of Florida. The license is non-transferable between owners and locations.

(b) During the hours of operation, the child care facility must not be used for any business or purpose unrelated to providing child care that can interfere with compliance with child care standards or permit the presence of individuals who do not meet screening and training requirements when children are present. A child care facility that utilizes any area that is subject to use by persons outside of the program must have exclusive control of such area when used by the program and provide effective measures to exclude individuals who do not meet screening and training requirements from that area.

(d) The Department may issue a provisional license allowing a facility to operate for a designated period of time while working to correct one or more licensing standard(s) not met, provided the owner is making adequate provisions to ensure the health and safety of the children in care. With the exception of Section 402.309(3), F.S. a provisional license may not be issued as the initial license and is not a disciplinary sanction.

(4) Change of ownership.

(a) At least one week prior to changing ownership of a child care facility, in compliance with Section 402.305, F.S., one of the following methods of notification to custodial parents or legal guardians must be observed:

Posting a notice in a conspicuous location at the facility,
Incorporating information into an existing newsletter, or
Distribute individual letters or flyers.

(b) A completed CF-FSP Form 5017 for a change of ownership must be submitted by the new prospective owner to the licensing authority prior to the final sale of the business. The Department has 45 days from receiving a completed application to issue a license to the new prospective owner.

(5) Supervision.

(a) Children that are delivered to a location offsite from the facility by someone other than the parent or guardian become the responsibility of the child care program at that designated location and time as agreed upon by the provider and the parent/guardian. The provider is responsible for the supervision of the child upon the child’s arrival at the designated point. If a child is not present at the time of pick-up, prior to leaving the designated location, child care personnel must contact the facility to notify them of the child’s absence. Child care personnel at the facility must contact the child’s parent or legal guardian to notify them of their child’s absence.

(b) Direct supervision means actively watching and directing children’s activities within the same room or designated outdoor play area, during transportation, any activity outside of the facility, and responding to the needs of each child while in care. Child care personnel at a facility must be assigned to provide direct supervision to a specific group of children, and be present with that group of children at all times.

(6) Child Care Standards. Child care programs must follow the standards found in the “Child Care Facility Handbook,” (December 2025), incorporated herein by reference. The handbook may be obtained from the Department’s website at www.myflfamilies.com/services/child-family/child-care or from the following link: https://flrules.org/Gateway/reference.asp?No=Ref-19085.

(7) The following documents and forms are also incorporated by reference as part of this rule:

(a) CF-FSP Form 1649A, July 2024, Child Care Attestation of Good Moral Character. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-17974.

(b) CF-FSP Form 5131, May 2019, Background Screening and Personnel File Requirements. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10462.

(c) CF-FSP Form 5191, May 2019, Birth Through Five Florida Child Care Professional Credential (FCCPC) Training Program Provider Application. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10581.

(d) CF-FSP Form 5211, May 2019, Florida Child Care Staff Credential Verification Application. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10469.

(e) CF-FSP Form 5217, October 2017, Volunteer Acknowledgement. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08732.

(f) CF-FSP Form 5219, May 2019, Child Care Application for Enrollment. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10466.

(g) CF-FSP Form 5252, October 2017, Florida Child Care and Education Program Director Credential. A copy may be obtained from the Department’s website at www.myflfamilies.com/childcare or from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08734.

(h) CF-FSP Form 5257, May 2019, School-Age Florida Child Care Professional Credential (FCCPC) Training Program Provider Application. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10467.

(i) CF-FSP Form 5268, October 2017, Child Care In-Service Training Record. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08736.

(j) CF-FSP Form 5270, October 2017, Florida Child Care Professional Credential Certificate. A copy may be obtained from the Department’s website at www.myflfamilies.com/childcare or from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08737.

(k) CF-FSP Form 5290, May 2019, Florida Child Care and Education Program Director Credential and Renewal Application. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10470.

(l) CF/PI 175-24, (December 2025), Know Your Child Care Facility. A copy may be obtained from the following link: https://flrules.org/Gateway/reference.asp?No=Ref-19086.

(m) DH 680, July 2010, Florida Certificate of Immunization. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08744.

(n) DH 681, July 2008, Religious Exemption From Immunization. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08745.

(o) DH 3040, July 2013, School Entry Health Exam. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08746.

(p) CF-FSP 5429, Meal Pattern for Children, June 2024. Copies may be obtained from the following link: https://flrules.org/Gateway/reference.asp?No=Ref-19087.

(q) CF-FSP 5428, Meal Pattern for Infants, June 2022. Copies may be obtained form the following link: https://flrules.org/Gateway/reference.asp?No=Ref-19088.

(r) USDA MyPlate, August 2011. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-03036.

(s) Center for Disease Control guidelines, January 2013. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-03037.

(t) Caring for Our Children Basics, Health and Safety Foundations for Early Care and Education, June 2015. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08726.

(u) Title 16, Parts 1219, 1220 &1221 Code of Federal Regulations, 2014. A copy may be obtained from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08743.

History

Rulemaking Authority 402.305, 402.309, 402.310 FS. Law Implemented 402.305, 402.309, 402.319, 402.3054, 402.3055, 402.308, 402.310, 435.05 FS. History–New 6-1-97, Amended 3-17-99, 7-26-00, 1-4-01, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, 8-1-13, 10-25-17, 1-29-20, 1-9-22, 4-30-25, 9-1-26.

Fla. Admin. Code R. 65C-22.0011 Definitions

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 8-1-13, Repealed 10-25-17.

Fla. Admin. Code R. 65C-22.002 Physical Environment

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 6-1-97, Amended 7-2-98, 3-17-99, 7-13-03, 9-12-04, 6-30-05, 4-12-07, Repromulgated 5-1-08, Amended 1-13-10, 8-1-13, Repealed 10-25-17.

Fla. Admin. Code R. 65C-22.003 Training

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 6-1-97, Amended 7-2-98, 3-17-99, 7-26-00, 10-10-01, 4-2-02, 7-17-03, 9-12-04, 6-30-05, 4-12-07, 5-1-08, 1-13-10, 8-1-13, Repealed 10-25-17.

Fla. Admin. Code R. 65C-22.004 Health Related Requirements

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 6-1-97, Amended 3-17-99, 7-26-00, 4-2-02, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, 8-1-13, Repealed 10-25-17.

Fla. Admin. Code R. 65C-22.005 Food and Nutrition

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 6-1-97, Amended 3-17-99, 7-26-00, 1-4-01, 7-13-03, 9-12-04, 4-12-07, Repromulgated 5-1-08, Amended 1-13-10, 8-1-13, Repealed 10-25-17.

Fla. Admin. Code R. 65C-22.006 Record Keeping

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 6-1-97, Amended 7-2-98, 3-17-99, 7-26-00, 1-4-01, 7-13-03, 9-12-04, 4-12-07, 5-1-08, 1-13-10, 8-1-13, Repealed 10-25-17.

Fla. Admin. Code R. 65C-22.007 Evening Child Care

(1) Hours of Care. Evening Child Care, as defined in Section 402.302(7), F.S., means child care provided during evening hours and may encompass the hours of 6:00 p.m. to 7:00 a.m.

(2) Supervision. During evening child care hours, staff must remain awake at all times. While children are awake, direct supervision as described in paragraph 65C-22.001(5)(b), F.A.C., must be provided. When children are sleeping, supervision, as defined in section 2.4.2 of the Child Care Facility Handbook, is required.

(3) Exemptions. Child care standards, as outlined in Sections 402.301 through 402.305, F.S., and Rules 65C-22.001, F.A.C., apply to Evening Child Care with the following exceptions:

(a) Outdoor Play Area. For facilities that provide only evening child care, outdoor play space is not required. An open area within the existing indoor floor space designated for play that promotes the development of gross motor skills must be available.

(b) Credentialed staff, pursuant to Section 402.305(3), F.S., are not required for Evening Child Care.

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 7-2-98, Amended 9-12-04, 4-12-07, Repromulgated 5-1-08, Amended 1-13-10, 8-1-13.

Fla. Admin. Code R. 65C-22.008 School Age Child Care

(1) Application for licensure. Application for a license or for renewal of a license to operate a school-age child care program must be made on CF-FSP Form 5272, May 2019, Application for a License to Operate a School-Age Child Care Facility, which is incorporated by reference. CF-FSP Form 5272 may be obtained from the Department’s website at www.myflfamilies.com/services/child-family/child-care or from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-10468. In lieu of a standard application, the applicant may complete an online process through the Department’s Child Care Administration, Regulation, and Enforcement System (CARES), which can be accessed at https://cares.myflfamilies.com/security/login.

(2) Licensing: A school-age child care program must be licensed prior to operation and for continued operation, unless the program demonstrates that it is exempt pursuant to subsection (3), below. The license is issued in the name of the owner. The owner may be an individual, partnership, association, company or corporation, and the license must be posted in a conspicuous location where the school-age child care program is operating.

(3) Exemptions: A school-age child care program is not required to be licensed as long as the program complies with the minimum background screening requirements provided in Sections 402.305 and 402.3055, F.S., and if the program demonstrates that conditions of one of the following criteria outlined in paragraphs (a)-(e), below, are met. A school-age program exempted under paragraph (3)(a), (c), or (d), below, may become licensed if it chooses to meet all of the applicable licensing standards in subsection (5), below.

(a) Programs on School Sites. The program is located on a public/nonpublic school site; and:

Is operated and staffed directly by that school or through a formal agreement, such as a contract, between the school (or school district, when the latter reserves authority for such agreements) and a provider which names the school/school district as the responsible party for the operation of the program. A lease for space or user agreement, with or without the endorsement of the program by the school/school district, does not meet the formal agreement requirement.
Serves only the school-age children attending the school during the school day. The program may provide services during any out-of-school time, including before school, after school, on teacher planning days, holidays, and intercessions that occur during the school district’s academic calendar year.
Follows the standards set forth by the Florida Building Code State Requirements for Public Educational Facilities pursuant to Section 402.305(5), F.S., programs operated in public school facilities, regardless of the operator.

(b) Instruction/Tutorial Programs. The program is not designated as a Gold Seal Quality Care provider and has a single instructional/tutorial purpose and that purpose is the only service that the program provides. Some examples of these programs include, but are not limited to, tutoring; a computer class; a ballet class; a karate class; baseball instruction or other sport; the program cannot provide any service beyond the instructional and tutorial/academic activity; and:

Does not cater, serve or prepare meals. The program may choose to provide drinks and ready-to-eat snacks that are individually pre-packaged and do not require refrigeration.
Does not advertise or otherwise represent that the program has attributes of child care, as defined in Section 402.302(1), F.S.
Enrollment information shall clearly define the duration of the instructional sessions. Session time per child may not exceed two hours per day. If tutoring is provided in multiple academic areas, the total combined session times cannot exceed three hours per day.
Does not contract to deliver a school readiness program pursuant to Section 1002.88, F.S.
Does not provide transportation directly or through a contract or agreement with an outside entity, during the hours of operation for the purposes of field trips.

(c) Open Access Programs. The program is not designated as a Gold Seal Quality Care provider and meets all of the following criteria:

Operates/Serves children for less than four hours per day; however, the program may provide services during any out-of-school time, including before school, after school, on teacher planning days, holidays, and intercessions that occur during the school district’s official academic calendar year.
Does not advertise or otherwise represent that the program is an afterschool child care program or that the program offers supervision.
Allows children to enter and leave the program at any time without permission, prior arrangements, or supervision, and the program does not assume responsibility for supervision.
Does not provide transportation, directly or through a contract or agreement with an outside entity, during the hours of operation for the purposes of field trips; and,
Does not serve or prepare any meals or snacks other than drinks and ready-to-eat snacks that are individually pre-packaged and do not require refrigeration.
Does not contract to deliver a school readiness program pursuant to Section 1002.88, F.S.

(d) National Organization Programs. Any program that is not designated as a Gold Seal Quality Care provider and is providing care for school aged children that is operated by, or in affiliation with a national membership non-profit or not for profit organization that certifies membership organizations, as of February 1, 2017, in at least ten states, that was created for the purpose of providing activities that contribute to the development of good character or good sportsmanship or to the education or cultural development of minors in this state, that charges a membership fee for children and may receive grant funding for services. Such is certified by its national association as complying with the association’s purposes, procedures, minimum standards and mandatory requirements for all of its before school, after school or out-of-school time programs. The program must notify the Department prior to operating and annually, thereafter, of any operation of before school, after school or out-of-school time programs, provide verification of certification and good standing by its national association for all of its before school, after school or out of school time programs, and complete an annual attestation for compliance with background screening requirements. The Attestation of Compliance, CF-FSP 5218A, May 2019, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10465. Failure by a program to comply with such reporting, providing required verifications, and screening requirements shall result in the loss of the program’s exemption from licensure.

(e) Grades Six and Above Programs. The program is not designated as a Gold Seal Quality Care provider and provides child care exclusively for children in grades six and above.

(4) School-age exempt providers shall submit prior to operating and upon request of the Department, an Attestation of Compliance with background screening requirements, and providers must attest that the program continues to operate in the manner as presented to the Department for the exemption determination. Prior to any changes in operation, the program shall submit a written notification to the Department outlining the proposed changes for a redetermination. Failure by a program to comply with such reporting, providing required verifications, and screening requirements shall result in the loss of the program’s exemption from licensure.

(5) School-Age Child Care Standards. School age child care programs must follow the standards found in the School-Age Child Care Facility Handbook, (December 2025), incorporated herein by reference. The handbook may be obtained from the Department’s website at www.myflfamilies.com/services/child-family/child-care or from the following link: https://flrules.org/Gateway/reference.asp?No=Ref-19084.

History

Rulemaking Authority 402.305 FS. Law implemented 402.305 FS. History-New 9-12-04, Amended 4-12-07, 5-1-08, 1-13-10, 8-1-13, 3-30-17, 6-12-19, 1-9-22, 4-9-26.

Fla. Admin. Code R. 65C-22.009 Gold Seal Quality Care Program

History

Rulemaking Authority 402.281 FS. Law Implemented 402.281 FS. History–New 5-1-08, Amended 1-13-10, 8-1-13, 7-7-15, 10-25-17, 6-12-19, Transferred to 6M-10.002.

Fla. Admin. Code R. 65C-22.010 Enforcement

This rule establishes the grounds under which the Department shall issue an administrative fine, deny, suspend, revoke a license or registration or place a licensee or registrant on probation status as well as uniform system of procedures to impose disciplinary sanctions.

(1) Definitions.

(a) “Day” means a weekday, excluding weekends and holidays.

(b) “Probation” is a licensing status indicating the license is in jeopardy of being revoked or not renewed due to violations of licensing standards. Probation may require the licensee to comply with specific conditions intended to ensure that the licensee comes into and maintains compliance with licensing standards. Examples of such conditions are: a deadline to remedy an existing violation, a specified period during which compliance with licensing standards must be strictly maintained; and specified conditions under which the facility must operate during the probationary period.

(d) “Technical Assistance” means a Department offer of assistance to a licensee or registrant to correct the statutory or regulatory violations.

(e) “Violation” means noncompliance with a licensing standard as described in an inspection report resulting from an inspection under Section 402.311, F.S., as follows with regard to Class I, Class II, and Class III Violations.

“Class I Violation” is an incident of noncompliance with a Class I standard as described on CF-FSP Form 5316, (December 2025), Child Care Facility Standards Classification Summary and CF-FSP Form 5427, (December 2025), School-Age Child Care Facility Standards Classification Summary, which are incorporated by reference. Copies of the CF-FSP Form 5316 and CF-FSP Form 5427 may be obtained from the Department’s website at www.myflfamilies.com/services/child-family/child-care or from the following links: https://flrules.org/Gateway/reference.asp?No=Ref-19089 and https://flrules.org/Gateway/reference.asp?No=Ref-19090. However, any violation of a Class II standard that results in death or serious harm to a child shall escalate to a Class I violation. The effective date of a termination of a provider’s Gold Seal Quality Care designation is the date of the Department’s written notification to the provider. However, any violation of a Class II standard that results in death or serious harm to a child shall escalate to a Class I violation. Class I violations are the most serious in nature.
“Class II Violation” is an incident of noncompliance with an individual Class II standard as described on CF-FSP Form 5316. Class II violations are less serious in nature than Class I violations.
“Class III Violation” is an incident of noncompliance that occurs at least three times within a 2-year period with an individual Class III standard as described on CF-FSP Form 5316. Class III violations are less serious in nature than either Class I or Class II violations.

(2) Disciplinary Sanctions.

(a) Enforcement of disciplinary sanctions for all Class I violations and for repeated Class II and Class III violations shall be applied progressively. The document entitled, Reconciliation of 2012 and 2017 Child Care Facility Classification Summaries, CF-FSP Form 5420, October 2017, which is incorporated into this rule, provides an alignment of the 2012 and 2017 Child Care Facility Classification Summaries for purposes of progressive enforcement. A copy of the CF-FSP Form 5420 may be obtained from the Department’s website or from the following link: http://www.flrules.org/Gateway/reference.asp?No=Ref-08741. In addition, providers will be offered technical assistance in conjunction with all violations. The classification of standard violations within the Child Care Facility Standards Classification Summary and the progressive disciplinary actions prescribed for each class by this rule are based on the provisions of Section 402.310(1)(b), FS.

(b) A grace period is provided, wherein a violation of a standard that has occurred more than two years prior to a subsequent violation of the same standard will not be counted for purposes of progressive discipline. However, for the purposes of continued licensure or registration, the program’s violation history will be considered. A violation that has been withdrawn by the Department or has been dismissed as the result of an administrative proceeding held pursuant to Chapter 120, F.S., contesting an administrative complaint will not be counted for purposes of progressive discipline. A violation that is only reflected in an inspection report does not relieve the Department of its burden to prove that violation for purposes of progressive discipline upon the alleged occurrence of a subsequent violation.

(c) Failure to submit a completed CF-FSP Form 5017, Application for a License to Operate a Child Care Facility, which is incorporated by reference in paragraph 65C-22.001(1)(a), F.A.C., for renewal of an annual license at least 45 days prior to the expiration date of the current license constitutes a licensing violation. A $100.00 late fine will be imposed and must be paid before the license is renewed.

(d) Disciplinary sanctions for licensing violations shall be progressively enforced as follows:

Class I Violations.

a. For the first and second violation of a Class I standard, the Department shall, upon applying the factors in Section 402.310(1), F.S., impose a fine not less than $100.00 nor more than $500.00 per day for each violation, and may impose other disciplinary sanctions in addition to the fine.

b. For the third and subsequent violation of a Class I standard, the Department shall suspend, deny or revoke the license. The Department, upon applying the factors in Section 402.310(1), F.S., may also impose a fine not less than $100.00 nor more than $500.00 per day for each violation in addition to any other disciplinary sanction.

Class II Violations.

a. For the second violation of the same Class II standard, the Department shall impose an administrative fine of $50.00 for each such violation.

b. For the third violation of the same Class II standard, the Department shall impose an administrative fine of $60.00 per day for each such violation.

d. For the fifth and subsequent violation of the same Class II standard, the Department shall suspend, deny, or revoke the license, and shall also impose an administrative fine of $100.00 per day for each such violation.

Class III Violations.

a. For the third violation of the same non-compliant standard that is not classified as a Class I or Class II, the Department shall deem the standard a Class III standard and impose an administrative fine of $25.00 for each such violation. This violation, and subsequent violations of the same standard within a 2-year period will be classified as “Class III”.

b. For the fourth violation of the same Class III standard, the Department shall impose an administrative fine of $30.00 per day for each such violation.

c. For the fifth violation of the same Class III standard, the Department shall place the provider’s license on probation status for a period not to exceed six months, and shall also impose an administrative fine of $40.00 per day for each such violation. However, for the fifth violation of a Children’s Health and Immunization standard, the Department will not place the provider’s license on probation status.

d. For the sixth and subsequent violation of a Class III standard, the Department shall suspend, deny, or revoke the license, and the Department shall also impose an administrative fine of $50.00 per day for each such violation. However, for the sixth and subsequent violation of the same Class III Children’s Health and Immunization standard, the Department will place the provider’s license or registration on probation status for a period not to exceed six months in lieu of suspending, denying, or revoking the license or registration.

(3) When the Department has reasonable cause to believe that grounds exist for the denial, suspension, or revocation of a license or registration, the conversion of a license or registration to probation status, or the imposition of an administrative fine, it shall determine the matter in accordance with procedures prescribed in Chapter 120, F.S. Imposition of an administrative fine shall be accomplished through an administrative complaint. Denial of a license or registration or conversion to probationary status pursuant to Section 402.310, F.S., may be accomplished through an administrative complaint or a notice of intent to deny a pending renewal application.

(4) A license will not be renewed if a licensee has not paid all previously owed fines to the Department.

History

Rulemaking Authority 402.305, 402.310 FS. Law Implemented 402.305, 402.310 FS. History–New 5-1-08, Amended 1-13-10, 8-1-13, 10-25-17, 6-12-19, 1-9-22, 9-1-26.

Chapter 65C-23 AT-RISK HARDSHIP EXEMPTION AND PREVENTION SERVICES

Fla. Admin. Code R. 65C-23.001 Assessment

The Department will conduct an assessment to determine if a minor child of a family participating in the Temporary Cash Assistance (TCA) Program should be recommended for a hardship extension at the end of the eligibility period. This recommendation will result from a review using Substitute Care Review form, CF-ES 2089, Sept 2019, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11322, to determine if the termination of the child’s temporary cash assistance would likely result in the child being placed into emergency shelter or foster care.

History

Rulemaking Authority 414.45 FS. Law Implemented 414.105(3) FS. History–New 4-21-99, Amended 12-3-19.

Fla. Admin. Code R. 65C-23.002 Healthy Families Florida

History

Rulemaking Authority 445.019 FS. Law Implemented 409.153 FS. History–New 7-23-01, Repealed 11-16-15.

Chapter 65C-24 RELATIVE CAREGIVER

Fla. Admin. Code R. 65C-24.001 Definition of Terms

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.002 Federal Funding Requirements

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.003 Home Study Requirements

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.004 Relative Caregiver Program Benefit Payments

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.005 Legal Requirements

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.006 Permanency Planning Requirements

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.007 Placement Supervision

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.008 Child Care

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.009 Child Support Collection

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.010 Eligibility Requirements

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.011 Eligibility Process

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History– New 6-1-99, Repealed 1-26-09.

Fla. Admin. Code R. 65C-24.012 Determining the Amount of the Monthly Benefit Payment

History

Specific Authority 39.012, 39.0121(10), 39.5085(2)(a), (b), (d) FS. Law Implemented 39.5085 FS. History–New 6-1-99, Repealed 1-26-09.

Chapter 65C-25 SPECIALIZED CHILD CARE FACILITIES FOR THE CARE OF MILDLY-ILL CHILDREN

Fla. Admin. Code R. 65C-25.001 Definitions

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 5-21-00, Amended 7-13-03, 11-26-19, Repealed 10-23-25.

Fla. Admin. Code R. 65C-25.002 Admission and Assessment

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 5-21-00, Amended 11-26-19, Repealed 10-23-25.

Fla. Admin. Code R. 65C-25.003 General Information

History

Rulemaking Authority 402.302, 402.305, 402.310 FS. Law Implemented 402.302, 402.305, 402.310 FS. History–New 5-21-00, Amended 7-13-03, 12-29-19, Repealed 10-23-25.

Fla. Admin. Code R. 65C-25.004 Physical Environment

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 5-21-00, Amended 7-13-03, Repealed 11-26-19.

Fla. Admin. Code R. 65C-25.005 Personnel Requirements

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 5-21-00, Repealed 11-26-19.

Fla. Admin. Code R. 65C-25.006 Health and Safety

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 5-21-00, Amended 7-13-03, Repealed 11-26-19.

Fla. Admin. Code R. 65C-25.007 Food and Nutrition

History

Rulemaking Authority 402.305 FS. Law Implemented 402.305 FS. History–New 5-21-00, Amended 7-13-03, Repealed 11-26-19.

Fla. Admin. Code R. 65C-25.008 Record Keeping

History

Rulemaking Authority 402.305 FS. Law Implemented 402.302, 402.305, 402.3055 FS. History–New 5-21-00, Amended 7-13-03, Repealed 11-26-19.

Fla. Admin. Code R. 65C-25.009 Enforcement

History

Rulemaking Authority 402.305, 402.310 FS. Law Implemented 402.305, 402.310 FS. History–New 11-26-19, Repealed 10-23-25.

Chapter 65C-26 TEACHER EDUCATION AND COMPENSATION HELPS (T.E.A.C.H.) SCHOLARSHIP PROGRAM

Fla. Admin. Code R. 65C-26.001 General Information

History

Specific Authority 402.3017 FS. Law Implemented 402.3017 FS. History–New 5-29-01, Transferred to 60BB-4.997.

Fla. Admin. Code R. 65C-26.002 Program Guidelines

History

Specific Authority 402.3017 FS. Law Implemented 402.3017 FS. History–New 5-29-01, Transferred to 60BB-4.998.

Fla. Admin. Code R. 65C-26.003 Allocation Methodology

History

Specific Authority 402.3017 FS. Law Implemented 402.3017 FS. History–New 5-29-01, Transferred to 60BB-4.999.

Chapter 65C-27 SUITABILITY ASSESSMENTS

Fla. Admin. Code R. 65C-27.001 Definitions

History

Rulemaking Authority 39.407(6)(i) FS. Law Implemented 39.407(6) FS. History–New 12-30-01, Amended 3-12-17, 12-3-19, Repealed 2-7-23.

Fla. Admin. Code R. 65C-27.002 Timeframes

History

Rulemaking Authority 39.407(6)(i) FS. Law Implemented 39.407(6) FS. History–New 12-30-01, Amended 3-12-17, 12-3-19, Repealed 2-7-23.

Chapter 65C-28 OUT-OF-HOME CARE

Fla. Admin. Code R. 65C-28.001 Definitions

All definitions for this rule are located in Rule 65C-30.001, F.A.C.

History

Rulemaking Authority 39.012, 39.0121, 39.5085(2)(a), 63.233, 409.175(5) FS. Law Implemented 39.401(3), 39.407, 39.5085, 39.521, 39.701, 409.145(1), 409.165(1), 409.175, 409.401 FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.002 Family Time

(1) Family Time between a Child in Out-of-Home Care and Parents.

(a) Family Time between the child and the child’s parents shall occur in accordance with court orders. If the court order conflicts with the safety plan, the child welfare professional shall contact Children’s Legal Services to determine what steps will be taken to modify family time. If at any time the safety of the child can not be assured, family time shall be suspended for up to 72 hours and the child welfare professional shall contact Children’s Legal Services to determine what steps will be taken to modify family time.

(b) The Department or contracted service provider shall arrange for family time when the child or parent is out of the home. The family time plan details will be addressed and included in any child safety plan established.

(c) When a child welfare professional or designee either supervises or is a part of a visit, the activities and interactions between the child and parent during the visit shall be documented in FSFN within 48 hours of the visit.

(2) Family Time among Siblings. The child welfare professional responsible for the case shall ensure that separated siblings under supervision maintain family time unless the family time would be contrary to the safety or well-being of any of the children. Sibling family time shall only be limited or terminated by order of the court.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.402(9) FS. History– New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.003 Medical Treatment

(1) If a child in out-of-home care appears to be suffering from illness or injury requiring medical intervention, the child welfare professional, upon notification, or the out-of-home caregiver shall take the child to the child’s health care provider for a health care screening or treatment. If there is a medical emergency or an urgent need for medical attention, the child shall be taken to the nearest available health care provider or hospital.

(2) Ongoing health care and treatment shall include physical, dental and vision examinations as required by rule Chapter 59G-4, F.A.C., “Medicaid Services.”

(a) If a child is Medicaid eligible, these services shall be sought first through Medicaid providers. If a child is not Medicaid eligible, or if a Medicaid provider is not available or appropriate, then necessary services shall be obtained using other providers.

(b) If the child welfare professional responsible for the case receives a notice for a scheduled child health check-up, he or she shall immediately send copies to the child’s custodial parent, the child’s licensed out-of-home caregiver or relative or non-relative caregiver. Information pertaining to the child’s health check-up shall be documented in FSFN by the child welfare professional responsible for the case within 48 hours of notification of completion of the medical appointment.

(3) The parents shall remain financially responsible for the medical care and treatment of a child in out-of-home care when that medical care and treatment is not covered by Medicaid. For children who are not covered by Medicaid but have private insurance coverage, the child welfare professional and the out-of-home caregiver shall cooperate with the child’s health insurance provider in identifying medical providers that will accept the insurance coverage. Unless the child is Medicaid eligible, the parent is responsible for payment in all situations in which the child receives a medical examination or treatment, irrespective of the parent’s consent to such examination or treatment. However, the inability or failure of the parent to meet this payment responsibility shall not delay the receipt of a medical exam or treatment. The financial responsibility of the parent ends when parental rights are terminated.

(4) The child welfare professional and licensed caregivers shall receive training in regard to and comply with the federal Health Insurance Portability and Accountability Act which provides procedures regarding the management and protection of personal health information. The child welfare professional shall inform relative and non-relative caregivers regarding the requirements of HIPAA.

(5) Required Actions to Gain Medical Consent at Time of the Shelter Hearing. The Children’s Legal Services attorney shall request a blanket court order authorizing the custodian, as named in the order, to give consent for ordinary medical treatment and medication on an ongoing basis. No consent is needed for treatment or medication rendered in the event of an emergency as documented by the attending physician.

(6) Consent for Medical Care of Children in Out-of-Home Care When Parental Rights Have Not Been Terminated. There are three types of medical care and treatment, each of which requires its own method to obtain consent for medical treatment. This may include a relative or non-relative who has been granted custody by the court. The attending physician shall determine the type of care needed.

(a) Ordinary Medical Care and Treatment. After a child is adjudicated dependent, the contracted service provider may delegate authority to consent to ordinary medical care and treatment to the out-of-home caregiver if the child remains in the custody of the Department. Children’s Legal Services shall request the court order placing the child in out-of-home care specify individuals who are authorized to consent to ordinary medical care and treatment for the child.

(b) Extraordinary Medical Care and Treatment. If the health care provider determines that an illness or injury requires medical treatment beyond ordinary medical care and treatment, but is not an emergency, the express and informed consent of the child’s parent for the treatment shall be sought. If a parent provides express and informed consent for any extraordinary medical procedure, the form and content of the consent shall be as directed by the prescribing health care professional.

If the parent is unavailable, unwilling or unable to provide informed consent for the proposed medical care, the child welfare professional shall consult with the medical provider to determine if the treatment should be required. If consultation with the medical provider results in a determination that the treatment should be required, the child welfare professional shall seek and obtain an order of the court authorizing the treatment prior to the treatment being rendered. In cases when the child is prescribed psychotropic medications, the procedures established in Section 39.407(3), F.S., will be followed.
If a court order is required to obtain authorization for any extraordinary medical procedure, the following information shall be included in the request for a court order:

a. Present diagnosis and known past medical interventions for the treatment of this condition,

b. A statement that the prescribing health care professional has reviewed all medical information concerning the child that has been provided,

c. The name and requested administration range for any medication requested,

d. A statement recommending the proposed procedure signed by the attending physician,

e. An analysis of the risks and benefits of the prescribed treatment for the particular child,

f. Alternatives to the treatment being recommended and the rationale for selecting the particular treatment recommended; and,

g. Interventions other than the extraordinary medical care and treatment that are or shall be ongoing in conjunction with the care and treatment.

(c) Emergency Medical Care and Treatment. Although parents shall be involved whenever possible, obtaining consent is not required for emergency care and treatment. If the emergency care and treatment is provided without parental consent, the child welfare professional shall ensure the parent and the guardian ad litem, if appointed, are notified no later than 48 hours from the time the child welfare professional was notified of the care and treatment. The child’s case file shall contain a statement signed by the attending physician that the situation was an emergency and the care was needed to ensure the child’s health or physical well-being. The case file shall also contain documentation that the parent and guardian ad litem, if appointed, were notified after the treatment was administered. If the parents are unable to be located all attempts to locate and notify parents shall be documented in the child’s case file.

(7) Consent for Medical Care for Children in the Custody of the Department when Parental Rights Have Been Terminated.

(a) Ordinary and Emergency Medical Care and Treatment. When a child is placed in the custody of the Department following the termination of parental rights, the Department or contracted service provider shall provide consent for ordinary medical care or emergency care of the child. The child welfare professional responsible for the case shall provide documentation of the consent for the ordinary medical care or emergency care and document in FSFN.

(b) Extraordinary Medical Care and Treatment. When a child is placed in the custody of the Department following the termination of parental rights, the Department or contracted service provider shall not provide consent for extraordinary medical care or treatment. Authorization for the extraordinary medical care or treatment shall be obtained by the Department or contracted service provider from the court.

(8) Required Documentation for Medical Care and Treatment.

(a) During the initial removal or no later than the first court proceeding thereafter, the child welfare professional responsible for the case shall request the following information from the child’s parents, family members, other caregivers, or health care providers: medical history of the child; medical history of the child’s family and medical consents from the child’s parent or guardian. This information shall be placed in the Child’s Resource Record.

(b) All actions taken to obtain medical history and parental consent for medical screening, treatment, medications or immunizations shall be documented in FSFN and a copy provided to the out-of-home caregiver for placement in the Child’s Resource Record. If parental consent is received, a copy of the “Consent for Treatment and Release of Medical Information,” CF-FSP 4006, Oct 2005, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06738, shall be placed in the child’s case file and a copy provided to the caregiver for placement in the Child’s Resource Record, as defined in Rule 65C-30.001, F.A.C.

(c) A copy of any court orders authorizing treatment shall be documented in FSFN, and a copy provided to the out-of-home caregiver for placement in the Child’s Resource Record.

(d) Any notification provided to parents or others regarding a child’s medical treatment shall be documented in FSFN.

(9) Notification of parents. The child welfare professional shall ensure that the child’s parent is notified of any medical treatment of the child where the parent was not involved in providing consent for the treatment within 48 hours from the time the child welfare professional was notified of the treatment.

History

Rulemaking Authority 39.012, 39.0121(6), (12), (13), 39.407(1), 743.0645 FS. Law Implemented 39.407, 743.064 FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.004 Comprehensive Placement Assessment

History

Rulemaking Authority 39.012, 39.0121(2), (6), (12), (13), 39.0137, 39.307(7), 39.523(5), 409.145(5) FS. Law Implemented 39.307(1)(b), 39.407, 39.523, 409.145(2) FS. History–New 5-4-06, Amended 5-8-16, 5-30-19, 5-20-21, Repealed 12-25-22.

Fla. Admin. Code R. 65C-28.005 Changing Placements

History

Rulemaking Authority 39.012, 39.0121(3), (12), (13), 409.145(5), 409.165(3) FS. Law Implemented 39.522, 409.145, 409.165(4) FS. History–New 5-4-06, Amended 5-8-16, Repealed 12-25-22.

Fla. Admin. Code R. 65C-28.006 Permanency Staffings

(1) Permanency staffings shall be held:

(a) When preparing for a permanency hearing; and,

(b) As the Department or contracted service provider deems necessary.

(2) A family team meeting or conference may be used to achieve the purposes of a permanency staffing.

(3) The appropriateness of concurrent goals shall be evaluated at each permanency staffing.

(4) The following persons shall be invited to attend:

(a) Children’s Legal Services (CLS) attorney;

(b) Child’s out-of-home caregiver;

(d) Child’s surrogate parent, if appointed;

(e) Case management staff, including the child’s child welfare professional and his or her supervisor;

(f) Other service providers who are involved with the family and are determined by the child welfare professional to have information pertinent to the issue of permanency;

(g) The child’s parents, if available; and,

(h) The child, depending on his or her age, maturity level, and ability to effectively participate in the staffing.

(5) The child welfare professional shall document in FSFN efforts made to provide the child an opportunity to participate.

(6) Follow-up actions from the staffing shall be documented in FSFN. The child welfare professional and his or her supervisor shall ensure that all follow up tasks are completed and the recommendations from the staffing, details of all services provided since the last review and any recommended changes of the permanency goal are recorded in the Judicial Review Social Study Report (JRSSR) and reported to the court.

(7) A comprehensive JRSSR draft shall be provided to CLS at least 10 business days prior to the judicial review hearing. CLS shall review the draft report for legal sufficiency and, if corrections are necessary, return the draft report to the child welfare professional within eight (8) business days prior to the judicial review hearing. Corrections to the JRSSR shall be completed in order to provide copies to all parties at least 72 hours prior to the hearing.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.701(2), (3) (4) FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.007 Voluntary Licensed Out-of-Home Care

(1) Voluntary Non-Medical Licensed Out-of-Home Care.

(a) Before accepting a voluntary non-medical licensed placement, the community-based care lead agency shall ensure a thorough review is done on the circumstances of the child and family including:

An evaluation of whether the family’s current situation is temporary and the basis upon which a mutual decision regarding the child’s short-term placement out of the home can be made.
A history of the family shall be reviewed, including prior abuse reports and prior out-of-home episodes.
A child shall not be accepted for voluntary placement unless current circumstances clearly indicate an out-of-home care placement of 90 days or less is anticipated and no dependency issue exists.

(b) The child welfare professional shall begin to identify available social, physical health, mental health, educational, and other support services within the community that would enable the parent, guardian or relative to adequately provide for the child’s care.

(c) The child welfare professional shall, prior to considering placement in out-of-home care, assist the family in using and coordinating available services, including the identification of relatives and non-relatives able to care for the child.

(d) The child welfare professional shall provide for the child’s educational stability by determining if the child should remain in his or her current school during the time of the placement.

(2) Voluntary Medical Licensed Out-of-Home Care. If a child’s medical complexity is such that the parent is unable to provide or arrange for necessary care for the child and the Department or contracted service provider has determined the child would benefit from out-of-home care, the parent may apply for voluntary placement in licensed medical out-of-home care. Voluntary medical placement is contingent upon:

(a) The child having medical needs identified and eligible for medical foster care as determined by the Children’s Multidisciplinary Assessment Team (CMAT); and,

(b) It appears that the conditions necessitating the voluntary placement can be resolved and reunification with the parent or legal guardian can occur within 180 days.

(3) Once a child has been determined eligible for medical out-of-home care, the child welfare professional shall coordinate with the Medical Foster Care program in the local area regarding arrangements necessary to meet the child’s needs.

(4) Voluntary Placement Agreement. When the child is placed into licensed out-of-home care voluntarily, the parent or, legal guardian or relative requesting the placement and the Department or contracted service provider shall enter into a written “Voluntary Placement Agreement,” CF-FSP 5004, March 2016, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06691.

(5) Return of Child. When a parent or legal guardian requests in writing the return of a child in voluntary licensed placement, the child shall be immediately released once it has been verified the person requesting custody of the child:

(a) Is the same person who placed the child into voluntary placement;

(b) Has resolved the conditions that led to the voluntary placement; and,

(c) Appears to present no risk of harm to the child. If there appears to be a threat, the child shall not be released and the Department or contracted service provider shall seek a judicial determination at a shelter hearing. The child welfare professional shall immediately report allegations to the Florida Abuse Hotline.

(6) Timeframes for voluntary licensed out-of-home length of stay.

(a) A child voluntarily placed in non-medical licensed out-of-home care may not remain in out-of-home care on a voluntary basis beyond 90 days unless the Regional Managing Director, community-based care lead agency Executive Director, or a designee has determined the specific circumstances of a child or family necessitates continued placement beyond 90 days and has given written authorization for continuance. However, a child may not remain voluntarily placed beyond 180 days.

(b) If a child placed voluntarily in non-medical licensed out-of-home care remains in care beyond 90 days, a judicial hearing shall take place within the first 180 days and the resulting court order shall include a judicial determination that the continued placement is in the child’s best interest and that reasonable efforts have been made to reunify the family. This judicial determination shall occur within 180 days of the voluntary service agreement.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.402(15) FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.008 Relative Caregiver Program Requirements

(1) In order for a relative to receive a monthly Relative Caregiver Program (RCP) payment or a nonrelative caregiver to receive financial assistance (NCFA), the requirements of Section 39.5085, F.S., shall be met.

(2) Relative Caregiver Program Payments.

(a) A Unified Home Study completed by a case manager with the lead agency or subcontractor assigned to the geographical area where the child and caregiver reside shall be completed in accordance with Section 39.521(2)(o), F.S. In regard to a child in a permanent guardianship or a permanent placement with a fit and willing relative, if a Unified Home Study has already been completed on the placement, another Unified Home Study is not required.

(b) The child shall be adjudicated dependent and be in the court-ordered temporary legal custody of the relative pursuant to Section 39.521, F.S., or in the court-ordered permanent guardianship or permanent placement with a fit and willing relative pursuant to Section 39.6221 or 39.6231, F.S.

(c) The child shall live in an approved home of an adult relative who meets a specified degree of relationship to the parent or stepparent of the child by blood or marriage. If the parent or stepparent of the child is not related to the caregiver or is not within the required degree of relationship to the parent or stepparent of the child, the child must be a half-sibling of another child who is related to the caregiver and both children shall have been court ordered into the same placement.

Half-sibling eligibility for RCP payment shall meet the following requirements:

a. A child who is not related to the caregiver is eligible for RCP payment as long as their half-sibling is related to the caregiver and remains in the court-ordered custody of the caregiver.

b. When the half-sibling who is related to the caregiver becomes 18 years of age or leaves the legal custody of the caregiver for any reason, the half-sibling who is unrelated to the caregiver loses eligibility for continued RCP payment.

Termination of marriage for the parent or other relatives affects eligibility for RCP payment as follows:

a. The termination of the marriage of a stepparent from the parent due to death or divorce shall not disqualify relatives of the former stepparent as eligible caregivers if the relatives are within the required degree of relationship to the former stepparent. The former stepparent shall be considered to be within the required degree of relationship to the parent and shall be eligible for the RCP payment if all other eligibility factors are met.

b. The termination of the marriage of a non-blood relative to a blood relative due to death or divorce shall not disqualify the non-blood relative as an eligible caregiver if the blood relative to whom he or she was married is within the required degree of relationship to the blood relative, or if the non-blood relative was within the required degree of relationship to the blood relative prior to the non-blood relative’s death.

(d) The child shall not live in a home where either parent or stepparent resides. If the parent is in the home 30 consecutive days or longer, the child’s eligibility for the RCP payment ends.

(e) The child shall reside in the state of Florida. Children who move out-of-state or are placed out-of-state with a relative caregiver are not eligible for a RCP payment. A child placed with a relative in Florida by another state is not eligible for the RCP payment.

(f) Failure by the relative caregiver to cooperate with the Child Support Enforcement Program in regard to a child shall terminate that child’s eligibility to receive the RCP payment while in that placement. If the child is not eligible due to the relative caregiver’s lack of cooperation:

The child remains eligible for Medicaid and other services necessary to ensure his or her safety and well-being.
Eligibility for the RCP payment for other children in the same placement is not affected if the relative caregiver is cooperating with the Child Support Enforcement Program in regard to those children.

(g) Once all of the preceding eligibility requirements in this section are met, the eligibility requirements of the temporary cash assistance programs in Chapters 65A-1 and 65A-4, F.A.C., applicable to “child only cases” in the Temporary Cash Assistance Program (TCA) shall be met, with the following exceptions:

The basic monthly payment schedule (not including Medicaid, family support services, flexible funds utilized in accordance with Section 409.165, F.S., subsidized child-care and other services available through the Department or contracted service provider or other local, state or federal programs), is based on the age of the child.
The monthly amount of the payment for the initial six (6) months, before any deductions for income of the child, shall be at a rate equal to the rate established in Section 409.145(3), F.S., pursuant to Section 39.5085(2)(d)2., F.S.
Pursuant to Sections 39.5085(2)(d)3. and 4., F.S., the subsequent monthly amount of payment, before any deductions for income of the child, shall be:

a. Age zero (0) through five (5) years – $242.

b. Age six (6) through 12 years – $249.

c. Age 13 to 18 years – $298.

Financial eligibility is based on a comparison of the income of the child to the benefit payment standard for the child’s age. The difference between the RCP payment standard for the child’s age and the income of the child is the amount of the payment; and,
Each child applying for or receiving the RCP payment is a filing unit of one and only the child’s income and assets are considered in establishing or maintaining eligibility. In this regard, a child receiving a Supplemental Security Income grant is ineligible for an RCP payment.

(h) When a relative caregiver is approved as a guardian pursuant to Section 39.6221 or 39.6231, or Chapter 744, F.S., after an adjudication of dependency, completion of a Unified Home Study and placement by the court with the relative, continuing eligibility for the RCP payment shall not be affected.

(i) A child receiving an RCP payment shall not simultaneously receive a TCA grant, except when timely action has not been taken by the Department or a contracted service provider to convert a payment from TCA to RCP. When converting from TCA to RCP, the ESS case will be processed as a change and the payment will be effective the next recurring month. No auxiliaries to restore lost RCP payments may be issued without approval of the circuit/region ESS Program Office.

Restoration of RCP benefits must be issued when:

a. An application for RCP payment has been denied in error, or

b. A TCA payment is not terminated timely (the next recurring month) following the establishment of all RCP eligibility requirements. This includes delays by the lead agency or subcontractor assigned following a determination of potential placement eligibility in accordance with Section 39.5085, F.S., to timely communicate the potential placement eligibility within five (5) calendar days of making this determination.

A child may not be included in a TCA assistance group and receive full RCP payments in the same month. Any auxiliaries approved for the restoration of RCP payments for months in which the child received TCA payments shall only be authorized for the difference between the amount of the TCA payment and the amount of the RCP payment during the affected months.

(j) The following changes in an active services case of a child in the RCP program may impact eligibility and/or the RCP payment:

The child is adopted,
The child’s age changes, resulting in a change to a new age group,
The child leaves the relative caregiver’s household,
The child has an increase or decrease in unearned income, or
The parent or stepparent resides in the relative caregiver’s household for over 30 consecutive days.
The child moves from the state of Florida, or
The relative caregiver becomes licensed as a foster placement.

(k) Relative caregivers apply for TCA or RCP benefits through the ESS program.

(l) When supervision of a child has been terminated due to court ordered custody of the child under Section 39.6221 or 39.6231, F.S., any documentation required for the relative or child to receive services needed in support of the placement shall be provided by the Department of contracted service provider.

(m) When a relative or nonrelative caregiver has been approved as a permanent guardian pursuant to Section 39.6221, F.S. , and wants to apply for relative or nonrelative caregiver funds after the case has closed, court ordered supervision does not need to be reinstated for the approval of an application.

(3) Nonrelative Caregiver Financial Assistance (NCFA).

(a) Eligibility Requirements.

NCFA is available to nonrelative caregivers who would be unable to serve as a caregiver without financial assistance.

a. Persons outside the fifth degree by blood or marriage to the parent or stepparent of a child are eligible to receive NCFA provided all other eligibility requirements are met. This does not include the stepparent or a former stepparent of the child.

b. Nonrelative caregivers who receive Supplement Security Income (SSI) on the behalf of the child shall not be eligible to receive NCFA.

c. Nonrelative caregivers who receive Social Security Disability Insurance (SSDI) or Social Security Survivor Benefits on the behalf of the child in an amount less than the monthly payments for NCFA, as set forth in paragraph (3)(d) of this rule, shall be eligible to receive NCFA. The amount of the monthly NCFA payment shall be the difference between the monthly NCFA payment set forth in paragraph (3)(d) of this rule, and the amount of the child’s SSDI or Social Security Survivor Benefit.

To be eligible for NCFA, the nonrelative caregiver must have the following:

a. A completed Unified Home Study which includes the requirements set forth in Section 39.521(2)(o), F.S.,

b. A court order adjudicating the child dependent,

c. A court order placing the child in the care and custody of the nonrelative caregiver and finding that the placement is in the best interest of the child; and,

d. A signed statement by the nonrelative caregiver expressing financial need to continue to care for the child long term.

A nonrelative may receive the NCFA payment for a minor parent who is in his or her care, and for that minor parent’s child, if both children have been adjudicated dependent and meet all other eligibility requirements. The minor parent may not receive a TCA payment for him or herself and his or her child while the nonrelative receives the NCFA payment for either or both of them. If the minor parent applies for TCA for him or herself and his or her minor child, the NCFA payment must be terminated.
A child who is eligible for a Relative Caregiver payment based on his or her placement with a half-sibling who is related to the caregiver is not eligible for NCFA.
Eligibility for NCFA shall be reassessed annually by reviewing the eligibility criteria in paragraph (3)(a) of this rule.

(b) Application.

Nonrelative caregivers seeking financial assistance must complete an “Application for Nonrelative Caregiver Financial Assistance,” CF-FSP 5398, (April 2023), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15340.
The nonrelative caregiver must sign the financial attestation portion of the application to indicate his or her financial need for assistance to care for the child on a long term basis.

The Nonrelative Caregiver Payment Administrator shall review the application, conduct the eligibility reassessment, and send a completed “Notice of Action,” CF-FSP 5399, June 2018, incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09989, to the nonrelative caregiver through email, if available, or by regular U.S. mail within five (5) business days of receipt of the application.
The Notice of Action shall indicate whether the application was approved or denied, and if the application was denied, the reason for the denial and the nonrelative caregiver’s right to appeal.

(d) Payment.

The monthly amount of the payment for the initial six (6) months, before any deductions for income of the child, shall be at a rate equal to the rate established in Section 409.145(3), F.S., pursuant to Section 39.5085(2)(d)2., F.S.
Pursuant to Sections 39.5085(2)(d)3. and 4., F.S., the subsequent monthly amount of payment, before any deductions for income of the child, shall be:

a. Age zero (0) through five (5) years – $242.

b. Age six (6) through 12 years – $249.

c. Age 13 to 18 years – $298.

Payments shall be made using a pro-rated daily amount for the days the child resided in the nonrelative caregiver’s home during the calendar month.
Payments shall be issued one (1) month in arrears.
Nonrelative caregivers are eligible to receive payments effective the day all eligibility requirements specified in the Application for Nonrelative Caregiver Financial Assistance, CF-FSP 5398, incorporated in subparagraph (3)(b)1. of this rule, were met or the day the nonrelative caregiver applied, whichever is later.
When a child’s absence from the home requires a placement change in the child welfare information system (e.g. placement for treatment services), but the child remains in the care and custody of the nonrelative caregiver, financial assistance payments will be suspended for up to 60 days. If the child remains absent from the home on the 61st day, financial assistance payments will be terminated.
The nonrelative caregiver must notify the Nonrelative Caregiver Payment Administrator if the child’s placement changes or if there is a change in the nonrelative caregiver’s ability to care for the child in his or her home.
Contingent upon continued availability of funding and continued eligibility, nonrelative caregiver financial assistance payments shall continue until:

a. The child reaches age 18,

b. The child is adopted,

c. The child is no longer placed in the home of the nonrelative caregiver,

d. The child has an increase or decrease in unearned income, or

e. The child moves from the state of Florida, or

f. The nonrelative caregiver becomes licensed as a foster placement.

When a payment ends due to lack of funding or a disqualifying event as listed in sub-subparagraphs (3)(d)8.a.-e. of this rule, the Nonrelative Caregiver Payment Administrator shall complete a Notice of Action, CF-FSP 5399, incorporated in subparagraph (3)(c)1. of this rule, indicating the reason for the termination of payments. The Nonrelative Caregiver Payment Administrator shall send the completed Notice of Action to the nonrelative caregiver via e-mail, U.S. mail, or similar service within 30 days of receiving the notice of change.

History

Rulemaking Authority 39.012, 39.0121, 39.5085(2)(a) FS. Law Implemented 39.5085 FS. History–New 5-4-06, Amended 4-27-15, 8-22-16, 9-3-18, 11-11-18, Amended 9-22-21, 5-23-23.

Fla. Admin. Code R. 65C-28.009 Transition to Adulthood

(1) Beginning at age 13, children and young adults in out-of-home care require additional support and coordination necessary to develop the skills to successfully transition to adulthood. The additional supports and coordination are typically provided through independent living services programs; however, most life skills will be developed through normal day to day activities in the child and/or young adult’s natural living environments.

(a) Independent living services may also be referenced as transitional services. These types of services encompass a range of assistance categories, all geared toward preparing children and young adults for independence. The categories of programs and services to prepare for the transition to a successful adulthood include an independent living needs assessment, academic support, post-secondary educational support, career preparation, employment programs or vocational training, budget and financial management, housing education and home management training, health education and risk prevention, family support and healthy marriage education, mentoring and, when young adults are eligible supervised independent living, room and board financial assistance, education financial assistance, and other financial assistance.

(b) Children and young adults with physical, intellectual, emotional, or psychiatric conditions shall be provided with an equal opportunity to develop life skills and, if able, participate in the continuum of independent living services.

(c) Community-based care (CBC) lead agencies must ensure children and young adults are assessed and provided with age and/or developmentally appropriate training opportunities to develop independent living skills. The CBCs shall provide a list of age-appropriate activities and responsibilities to the child and caregiver to assist with specific life skills. For older youth, the CBCs must make the youth aware of available independent living services, community resources, and how to apply for the services.

(d) Both independent living informal and formal needs assessments of life skill competency must be completed to determine the child’s or young adult’s strengths and needs.

Informal assessments shall be conducted monthly during routine home visits to evaluate progress of the skills developed based on the child’s or young adult’s participation in age-appropriate life activities as defined in Sections 39.4091 and 409.145, F.S. Informal assessments shall be documented on the “Life Skills Progress Documentation Log,” CF-FSP 5444, Apr 2019, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10803, and shall be shared with caregivers for independent living skills development.
Formal assessments are designed to take inventory of the child or young adult’s strengths and needs regarding independent living skills competency. The child welfare professional may utilize the child’s or young adult’s case records or other life skill assessment tools to conduct the assessment.

a. At minimum, formal independent living needs assessments shall be administered annually beginning at age 16 years of age.

b. The outcome of the assessment shall be the basis of an individualized life skills plan that details the activities needed for a child’s or young adult’s preparation to adulthood.

In addition to self-disclosure from the child or young adult on the development of skills, a statement regarding the progress shall also be received from the caregiver and provided in a social study report for judicial review. If a young adult is not living with a caregiver, a statement on the progress from the child welfare professional must be included in the social study report for judicial review.
Life skill deficiencies identified through informal and formal assessments shall be included in a case plan and when applicable in the transition plan.
Formal and informal assessments shall be uploaded into the child welfare information system.

(2) Beginning at age 14, children and young adults in out-of-home care require an evaluation of their consumer credit history annually to check for accuracy.

(a) CBCs must ensure credit reports are obtained for each eligible child and young adult from each of the three main reporting agencies: Transunion, Equifax, and Experian.

(b) CBCs must ensure a copy of the results are provided to the child or young adult.

(c) CBCs must ensure assistance is provided regarding interpreting the results of the credit report and when needed assisting in resolving any inaccuracies.

(d) Credit reports shall be uploaded into the child welfare information system.

(3) Beginning at age 14, any case plan development must be in consultation with the child or young adult.

CBCs must ensure the case plan includes a document regarding the rights of the child or young adult to education, health, visitation, court participation, and safety.

(4) Beginning at age 15, children and young adults shall be provided the opportunity to obtain a driver’s license or learner’s permit. CBCs must ensure that efforts to assist the youth in obtaining a driver’s license or learners permit are reported to the court.

(5) Beginning at age 16, children shall be assisted with developing a transition plan which is to be finalized and filed with the court at the 16 and 17-year-old’s judicial review hearing required by Section 39.701(3), F.S. and finalized prior to the youth’s 18th birthday.

(a) Children with an identified permanency goal of Another Planned Permanent Living Arrangement (APPLA) must have the court’s determination that APPLA is the best permanency plan for the child and why it is not in the child’s best interest to return home, be adopted, or be placed with a legal guardian or fit and willing relative.

(b) The child welfare professional shall request the court order include the following:

The court’s inquiry of the child regarding the desired permanency outcome;
A finding that the CBC has made ongoing efforts to return the child home or secure a placement with a fit and willing relative, a legal guardian, or an adoptive parent;
A description of how the child’s current placement is following the reasonable and prudent parent standard; and
A finding that the CBC has provided the child with opportunities to engage in age or developmentally appropriate activities.

(6) Beginning at age 17, children are to be provided with the records and resources listed in subparagraphs 39.701(3)(b)1.-15., F.S. At each Judicial Review hearing during the child’s 17th year, form CF-FSP 5426, (August 2025), “Records and Resources Exchanged”, incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18603, shall be attached to the judicial review social study report and filed with the court along with the most recent “My Pathway to Success Plan”, form CF-FSP 5425, (August 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18604.

(7) At age 17, the CBC shall request the removal of the disability of nonage during the Judicial Review hearing pursuant to Section 39.701(3), F.S., for youth who are eligible to open a bank account. Upon receipt of the judicial review order, the CBC and the caregiver shall assist the youth in opening a bank account and provide financial literacy, such as budgeting and managing the bank account.

(8) The young adults who have aged out of care shall be informed annually until the age of 23 of the Office of Continuing Care, the purpose of the office, the type of support the office provides, and how to contact the office, pursuant to Section 414.56, F.S., and the aftercare services. During the annual contact, the CBC staff shall determine if the young adult is potentially eligible for Extended Foster Care or Postsecondary Educational Services and Support and inform the young adult of the options for entering the programs.

(9) Youth in out of home licensed care shall be provided the knowledge to learn the value and use of money through an allowance and opportunities for spending and saving. The concept of earning money and income should also be discussed with the youth.

(a) To determine if a youth is of sufficient age and understanding to manage their own allowances, CBCs shall use information gathered from any informal or formal life skills assessments and any multidisciplinary team (MDT) or transition staffing that was held for the youth.

(b) Youth who have been determined to be of sufficient age and intellectual ability to manage their allowance shall have the following factors addressed in their “Placement Transition Plan”, CF-FSP 5466, (November 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14973 and under the financial plan section in the independent living “My Pathway to Success Plan”:

The youth’s current placement.
The caregiver responsible for providing the allowance.
The frequency and the amount of the allowance provided to the youth.
Expiration of allowances if youth transition to a relative or non-relative placement or is reunified.
Collaboration between the caregiver and the youth in developing independent living skills to address finance and budgeting to include, but not limited to:

a. Reviewing the monthly balance with the youth.

b. Discussion on spending and saving the allowance.

c. Determining who is responsible for maintaining the youth’s allowance.

(c) The caregiver and the CBC shall ensure there is a designated individual responsible for maintaining the allowance for youth who are unable to manage their allowance.

(d) Allowance.

Allowance shall be provided at least monthly.
Allowance shall not be tied to behavior or completion of chores.
Children shall not be expected to use their allowance to purchase personal hygiene items, school supplies, clothing, or other necessities.
Allowance shall not be withheld as punishment.

(10) Compliance with subsections (1) through (8) shall be documented in the child welfare information system.

(11) Requirements for the Step into Success Program are set forth in section 409.1455, F.S.

History

Rulemaking Authority 39.012, 39.0121(13), 39.4091(4), 409.145(5), 409.1455(12) FS. Law Implemented 39.4091, 39.6012(3)(c), 39.6035, 39.6251, 39.701, 409.145, 409.14515, 409.1455 FS. History–New 5-4-06, Amended 5-8-16, 7-29-19, 12-27-22, 10-19-25.

Fla. Admin. Code R. 65C-28.010 Minor Parents in the Custody of the Department

(1) When a minor child in the custody of the Department becomes a parent or enters licensed out-of-home care with his or her own child, the parent and child shall reside together in the same placement unless the younger child’s safety cannot be managed with an in-home safety plan. A petition for adjudication of dependency shall not be filed for the younger child unless there are grounds for dependency of that child independent of the minor parent’s dependency.

(2) In the event that the minor parent’s child is not dependent, the cost of care of the child of a minor parent shall be included in the maintenance payment for the minor parent. There shall be one (1) payment that is enhanced to include the child’s needs. If the minor parent is Title IV-E of the Social Security Act eligible, the total payment is Title IV-E reimbursable.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.402(7) FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.011 Criminal, Delinquency and Abuse/Neglect History Checks for Release to a Parent, Placement with a Relative and Non-Relative and Approval of Informal Safety Management Providers

(1) The following criminal, delinquency and abuse/neglect history checks shall be performed when a child is initially placed or remains with a relative or non-relative:

(a) For all household members age 12 or older, an abuse/neglect records check through the Department’s information system containing statewide abuse/neglect records. When the applicant or any other household member is designated as the “caregiver responsible” in a report verified for sexual abuse, the applicant shall be automatically disqualified for placement.

(b) For all household members age 12 or older, a local criminal records check must be requested through local law enforcement. When circumstances exist that prevent local law enforcement from conducting local criminal record checks, a search of the Comprehensive Case Information System (CCIS) may be used until a local criminal records check can be obtained. The child welfare profesional shall make ongoing efforts to obtain a local criminal records check. A request for call outs regarding the household members from police and sheriff’s offices must be made and reviewed prior to placement when results are available.

(c) For all household members between the ages of 12 and 26, a delinquency records check through the Florida Department of Juvenile Justice.

(d) For all household members age 12 or older, a state criminal records name check through the Florida Crime Information Center (FCIC).

(e) For all household members age 18 or older, a name check through the National Crime Information Center (NCIC) when there are exigent circumstances that require an emergency placement within 72 hours.

(f) If the child is placed in the household, the fingerprints of these persons age 18 or older that are not disqualified by the FCIC/and or NCIC name check shall be submitted to the Florida Department of Law Enforcement no later than within seven (7) calendar days of the FCIC and/or NCIC name check. When an emergency name-based background check is conducted, but no placement is subsequently made and no disqualifiers exist, the child welfare professional will notify the appropriate Department regional NCIC point of contact within three (3) calendar days.

(g) For household members age 18 or older who are known to have resided in another state in the preceding five (5) years, a request shall be made to the other state for an abuse and neglect history check. When the applicant or any other household member is designated as the “caregiver responsible” in a report verified for sexual abuse, the applicant shall be automatically disqualified for placement.

(h) For any household member whose NCIC check returns an arrest history for a charge that may have implications for child safety, a request shall be made for out-of-state local criminal information to determine if the placement shall be finalized.

(i) For all household members aged 12 and older, a Clerk of Court Search in the household member’s county of residence or a search of the CCIS must be conducted by the child welfare professional for ongoing services.

(j) For all household members age 18 and older, a Florida Sexual Offenders and Predators Registration check must be conducted by the child welfare professional.

(2) Prior to approval of a relative or nonrelative who agrees to provide informal safety management services, including family-made arrangements, the child welfare professional will conduct background screening to include child abuse history, a Florida Sexual Offenders and Predators registration check and local criminal history check.

(3) The court shall be informed of all results, including the disposition of all criminal offenses that are received regarding any proposed or existing relative or non-relative placement.

(4) Any relatives or non-relatives who wish to become licensed as foster parents must meet the licensing requirements of rule Chapter 65C-45, F.A.C., including the criminal, delinquency and abuse/neglect history check requirements for licensed out-of-home caregivers.

(5) Updating Home Study and Recommendation for Court Ordered Custody. Persons who are approved relative/non-relative caregivers, parents, and any adult household members shall be re-screened at least annually and prior to case closure when a child placed is remaining in the home. Annual screening shall include a local criminal records check, an abuse and neglect record check clearance through the Child Welfare Information System, records of any call outs to the home by law enforcement that did not result in criminal charges, and any 911 calls to the home. A request for call outs regarding the household members from police and sheriff’s offices must be made and reviewed prior to completing the homestudy update when results are available. Any criminal, delinquency and abuse/neglect history check results received subsequent to placing a child shall be considered in regard to the child’s safety and shall be provided to the court. If any disqualifying results are received, the child welfare professional responsible for the case shall notify Children’s Legal Services within 24 hours of receipt.

(6) Release of a Child to a Parent. Prior to recommending to the court that a child be released to a parent, the parent and household members shall undergo all criminal, delinquency and abuse/neglect history checks that are required for placement with relatives and non-relatives.

(7) Criminal, Delinquency and Abuse/Neglect History Check Results. The Department or contracted service provider shall not make or recommend a relative or non-relative placement if analysis of the results of criminal, delinquency and abuse/neglect history checks indicate that the child’s health, safety, or welfare may be jeopardized in the placement or if the relative or non-relative has a disqualifying offense pursuant to Section 39.0138(2), F.S.

(a) Results of Abuse/Neglect Records Check. The results of an abuse/neglect records check indicating that a person is named in some capacity in an abuse/neglect report shall not be used to deny placement in the home where that person resides unless that person is identified as a caregiver responsible for the abuse, neglect or abandonment alleged in the report. Factors to be considered in denying placement include how much time has elapsed since the incident, the extent of a person’s rehabilitation, and recent history that supports the person’s changed life circumstances and/or behaviors.

(b) Criminal Offenses.

For placements with relatives or non-relatives, Sections 39.0138(2)-(3), F.S., lists criminal offenses that disqualify these persons for placement of the child. If the criminal records checks reveal that the applicant has been found guilty regardless of adjudication for crimes other than those listed in Section 39.0138(2) or (3), F.S., the applicant shall be evaluated as to the extent of his or her rehabilitation. Factors to be considered will include the severity of the action resulting in the report, how much time has elapsed, circumstances surrounding the report, and whether records indicate an ongoing pattern of family conditions or behaviors.
For releases to a child’s parent, there are no offenses that automatically disqualify the parent regardless of whether the offense was committed by the parent or a household member. For releases to parents, prior to the release, information obtained from the criminal, delinquency and abuse/neglect history checks shall be provided by the child welfare professional or Children’s Legal Services attorney to the court, which shall make the final decision regarding the placement decision when the results of the checks raise concerns about the safety of the child.

(c) Delinquency Results. If the juvenile records check reveals a juvenile record, this information must be addressed in the home study and a determination must be made regarding possible impact on the child being placed.

(8) Criminal, Delinquency and Abuse/Neglect History Checks on Additional Persons Subsequent to Placement in a Relative’s or Non-Relative’s Household. The Department shall conduct criminal, delinquency and abuse/neglect history checks as required in Sections 39.0138 and 39.521, F.S., on any new household members if they have not otherwise received the checks within the previous 12 months. The court shall be informed of the results within 72 hours of their receipt.

(9) Out-of-State Placements and Releases. Any out-of-state placement or release shall have the prior authorization of the court and of the ICPC.

History

Rulemaking Authority 39.012, 39.0121(1), 39.0138(1) FS. Law Implemented 39.0138, 39.401(3), 39.521(2)(o)2. FS. History–New 5-4-06, Amended 5-8-16, 2-5-18, 11-25-20, 8-15-21, 9-3-25.

Fla. Admin. Code R. 65C-28.012 Other Parent Home Assessment and Home Studies for Relative and Non-Relative Placements

(1) Prior to release or placement of a child with another parent, an “Other Parent Home Assessment,” CF-FSP 5411, October 2013, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06741, must be completed.

(2) For each non-licensed placement, a home study shall be completed by the child welfare professional responsible for the case prior to the placement of the child in the out-of-home caregivers’ home. In all instances, the completed home study shall be filed with the court.

(3) In fulfilling the requirements of Section 39.521, F.S., a summary of the results of the home study shall be prepared, which shall include the recommendation to be made to the court. This summary includes the following categories, each of which shall be summarized:

(a) Whether each proposed out-of-home caregiver understands and is able to meet the child’s need for protection.

(b) Whether each proposed out-of-home caregiver understands the child’s need for care and permanency and can provide long-term permanency if needed.

(c) Whether each proposed out-of-home caregiver has been informed regarding rights and responsibilities in the dependency process.

(d) Whether each proposed out-of-home caregiver will provide nurturing care and can ensure a safe home.

(e) Whether each proposed out-of-home caregiver has a history free from child abuse and free of a criminal record.

(f) Whether each proposed out-of-home caregiver is financially able to care for the child and a determination of whether the out-of-home caregivers’ financial situation would cause total dependence on financial assistance to care for the child. This shall include a summary of the out-of-home caregivers’ understanding of the financial assistance, if any, and other services that will be available from the Department or contracted service provider to assist in caring for the child.

(g) Whether each proposed out-of-home caregiver has been counseled on available support in the community.

(h) Whether or not the placement is to be recommended and an explanation of the decision.

(4) Unless developmentally inappropriate, a determination shall be made and documented regarding the child’s preferences on the placement.

(5) If the home study is not approved and the child is in the placement, the Department or contracted service provider shall request an emergency hearing to inform the court of the findings and make a recommendation for an alternate placement.

(6) If the child is not in the household where the home study was completed and the proposed out-of-home caregiver is not selected, the proposed caregiver shall be verbally so advised by the child welfare professional responsible for the case within five (5) business days and then documented in FSFN.

(7) If a child is placed in the custody of a relative or non-relative pursuant to order of the court after the Department or contracted service provider recommends against such placement, the relative or non-relative shall be allowed to participate in the Relative Caregiver Program in the same manner as if the Department or contracted service provider had approved the home study.

(8) When a child has been placed in the custody of a relative or non-relative by the court against the recommendation of the Department or contracted service provider, the child welfare professional responsible for the case shall notify his or her supervisor of the court’s determination. The supervisor shall schedule a staffing to be held within three (3) business days of the court decision to discuss the reasons for the negative home study and to develop a plan of action that includes identifying services and/or safety management for the family with whom the child is placed and that addresses the child’s needs.

(9) When a child has been placed in a relative or non-relative household and other children have already been placed in the home by the Department or contracted service provider, an updated Unified Home Study addressing issues surrounding placement of an additional child in the household shall be prepared and provided to the court in conjunction with a recommendation regarding placing an additional child in the home.

History

Rulemaking Authority 39.012, 39.0121(12), (13), 39.5085 FS. Law Implemented 39.5085(2), 39.521(2)(r) FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.013 Indian Child Welfare Act

The Indian Child Welfare Act of 1978 (the Act) is federal legislation found in 25 U.S.C. 1901 et seq., that governs child custody proceedings involving children who are members of an Indian tribe or Alaskan Native children as defined by the Act.

(1) The child welfare professional shall determine at the onset of each child protective investigation if the child is a member of an Indian tribe or Alaskan Native child as defined by the Act. To determine eligibility, the child welfare professional shall complete the Verification of Indian Child Welfare Act Eligibility form, CF-FSP 5323, January 2008, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11417, and submit it to the Children’s Legal Services (CLS) attorney. A Spanish version of the Verification of Indian Child Welfare Act Eligibility form, CF-FSP 5323S, January 2008, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11418. If a child involved in a child protective investigation is suspected of being eligible for the protections of the Indian Child Welfare Act, CLS shall notify the Tribe immediately, but in no case later than one business day, and all legal proceedings and case planning activities shall be in compliance with the provisions of the Act and with any existing written Tribal Agreements between the Department and the child’s tribe, unless or until it is determined that the Child is not eligible for the protections of the Act. All child protective investigations, ongoing safety and case management, and legal proceedings activities shall be documented in the Florida Safe Families Network (FSFN).

(2) The Indian child’s parent or Indian custodian and his or her tribe shall be noticed of all legal and case planning activities. Any correspondence to or from the tribe shall be documented in FSFN and made a part of the court record and the Department or contracted service provider shall request to the court that the child’s eligibility for the protections of the Indian Child Welfare Act be included in all findings and orders of the court.

(3) The criteria for enrollment in a tribe is established by the individual tribe and its decision is conclusive.

(4) If the tribe does not respond to written notification by the Department that an Indian child is the subject of an investigation, the Department or contracted service provider shall continue with ongoing efforts to communicate with the tribe. If the Indian tribe does not respond after continued efforts to communicate with the tribe have been made, the Department or contracted service provider shall write or call the Bureau of Indian Affairs area office located in the geographic region of the United States in which the child’s tribe is located. Cases in which Indian ancestry has been reported to the Department or contracted service provider shall be handled as ICWA cases until proven to be otherwise.

(5) If the tribe does not assume legal jurisdiction, the tribe shall continue to receive notice of all judicial hearings and case planning reviews and be kept informed of changes in the status of the case. The tribe has a right to examine all reports or other documents filed with the court.

(6) If the tribe assumes legal jurisdiction, all case file documents (except the name of the reporter of the abuse, abandonment or neglect) and the child shall be released to the tribe.

(7) Placement of an Indian child shall be made in accordance with the placement preferences outlined in the Act. Attempts to place a child in accordance with the placement preferences outlined in the Act, and any failure to do so, shall be documented in FSFN. The placement preferences apply upon each move of the child while in out-of-home care.

(8) The Department or contracted service provider shall consult with Children’s Legal Services regarding issues related to compliance with the provisions of the Indian Child Welfare Act. Consultation and the results of the consultation shall be documented in FSFN.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.0137 FS. History–New 5-4-06, Amended 5-8-16, 1-12-20.

Fla. Admin. Code R. 65C-28.014 Behavioral Health Services

(1) A child shall be referred for a Comprehensive Behavioral Health Assessment (CBHA):

(a) When a child is in shelter status, the child welfare professional responsible for the case shall refer the child for a CBHA within seven (7) calendar days of being removed from his or her household, or

(b) If a child is already in out-of-home care and is exhibiting emotional or behavioral issues that might result, or may have already resulted, in the child losing his or her placement, the child welfare professional responsible for the case may refer the child for a CBHA to assist in determining services that would allow the child to maintain his or her placement. This may be done if a CBHA has not been conducted on the child within the past year; and,

(c) The child has been determined to be Medicaid enrolled. If the child is not Medicaid enrolled, the child welfare professional responsible for the case shall take all steps necessary to ensure the child becomes enrolled as soon as possible, including assisting the child’s out-of-home caregiver to establish enrollment.

(2) The child welfare professional shall review and consider any interventions or services recommended in a CBHA. The child welfare professional has the primary responsibility throughout the case for coordinating, managing, and monitoring all aspects of the child’s care and treatment. Each referral and the coordinating, managing, and monitoring efforts for the referral shall be documented in FSFN.

(3) The CBHA recommendations will be considered when developing the child’s case plan.

(4) The child welfare professional responsible for the case shall ensure the CBHA is filed with the court.

(5) If the child is also served by the Department of Juvenile Justice (DJJ), the child welfare professional responsible for the case shall document in FSFN attempts to coordinate planning and service delivery with DJJ staff.

(6) When service needs are identified, children shall be referred to mental health providers in the community who accept the child’s Medicaid Managed Medical Assistance plan. If a Medicaid provider is not available, the child welfare professional shall refer to a provider that best meets the child’s needs.

(7) When the child welfare professional determines that a Behavioral Health Multidisciplinary Team is needed to address the behavioral needs of the child, the child welfare professional shall convene a meeting of the team. The team shall:

(a) Review all referrals for services to ensure that the child and family receive essential services to assist them in meeting the permanency goals as well as ensuring the child’s safety and well-being and, if needed, make recommendations for any additional referrals;

(b) Provide recommendations for modifications in the case plan. This information is to be placed into the Judicial Review Social Study Report (JRSSR) prior to each judicial review and shall be documented in FSFN.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.701 FS. History–New 5-4-06, Amended 5-8-16.

Fla. Admin. Code R. 65C-28.015 Residential Mental Health Treatment

(1) Initial Consideration of Need for Residential Treatment. Residential mental health treatment is provided to a child for the specific purpose of addressing the child’s mental health needs through observation, diagnosis and treatment in a therapeutic setting, which includes therapeutic group homes and residential treatment centers as defined in Section 394.67, F.S. Residential mental health treatment shall not be used for emergency placements or to provide secure shelter for the child. If the child is in acute psychiatric crisis, the child shall be referred to a crisis stabilization unit for emergency screening and stabilization in accordance with Sections 394.463 and 394.467, F.S.

(2) Suitability Assessment Process. Definitions and timeframes are provided in Chapter 65C-27, F.A.C.

(3) Behavioral Health Needs of Children in Out-of-Home Care. The behavioral health needs of children shall be addressed on an ongoing basis. Behavioral health services for the child or adolescent shall continue while determining the need for residential treatment and while seeking placement in accordance with recommendations.

(4) Out-of-State Placements.

(a) It is the policy of the Department that children will not be placed in a state other than Florida for residential mental health treatment. Exceptions to this policy must meet the requirements outlined in subparagraph (a)1. or (a)2.:

1.The reunification plan is for the child to join family members who live in the other state; and,

a. The home study on the family in the other state is complete and approved; and,

b. Placement in residential treatment is for a transitional period not to exceed three (3) months.

The community-based care (CBC) lead agency has attempted to meet the placement and treatment needs of the child within the state of Florida and in-state placements have failed. The CBC must document:

a. Efforts to locate alternate treatment options in-state,

b. The reasons the out-of-state residential treatment center was selected,

c. A current suitability assessment recommending placement into residential treatment,

d. A plan for independent review to be conducted within 60 days of initial placement,

e. A plan for ongoing monitoring of the child’s treatment progress, including 90-Day Reviews,

f. A plan for face-to-face contacts by a child welfare professional with the child every 30 days; and,

g. An initial discharge plan.

(b) The CBC Chief Executive Officer or designee must obtain approval from the Department prior to the placement of any child or adolescent in residential mental health treatment outside of Florida. The Department will grant approval of out-of state placement upon documentation that the requirements of paragraph (4)(a), above, have been met.

(c) The CBC must comply with the requirements of the Interstate Compact for the Placement of Children (ICPC) and shall provide documentation of compliance with this rule as part of its request to the ICPC office. The ICPC office will not process the request without this information.

(d) The CBC will notify Children’s Legal Services (CLS) so that proper notice to all parties and approval from the court can be obtained prior to placement.

(e) Upon placement out-of-state for residential treatment, the child welfare professional and CBC point of contact shall remain involved in the child’s treatment and discharge planning. 90-Day Reviews are an essential component to this monitoring and have the following requirements:

90-Day Reviews to determine the suitability of continued placement in residential treatment must be conducted by an independent evaluator who is a psychiatrist or psychologist licensed in the State of Florida who has at least three (3) years of experience in the diagnosis and treatment of serious emotional disturbances in children and adolescents,
At a minimum, these reviews must include:

a. A records review of the treatment plan,

b. A review of the treatment record and progress notes to determine the child’s/adolescent’s progress toward achieving the goals and objectives of the treatment plan,

c. An evaluation of the child/adolescent via telephone, video teleconference, or face-to-face,

d. Whether the child/adolescent has been provided with a clinically appropriate explanation of the nature and purpose of the treatment; and,

e. A written report of the independent evaluator’s findings, including recommendations, submitted to the CBC point of contact or designee; and,

f. An opportunity for the guardian ad litem to provide input.

(5) Reviews and Reports of Children in Residential Treatment Centers. The Department or each contracted service provider shall establish systems to ensure that reports required by Section 39.407(6), F.S., and Florida Rules of Juvenile Procedure 8.350 are prepared and distributed timely and that all requirements for filing with the court are met. This standard shall also apply to out-of-state residential mental health treatment.

History

Rulemaking Authority 39.012, 39.0121(13), 394.4781(4) FS. Law Implemented 39.407(6), 394.4781, 394.4785, 394.479 FS. History–New 5-4-06, Amended 5-8-16, 11-7-17, 12-3-19.

Fla. Admin. Code R. 65C-28.016 Psychotropic Medications

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 5-4-06, Repealed 12-14-10.

Fla. Admin. Code R. 65C-28.017 Exit Interviews

(1) The child welfare professional or designee shall conduct an exit interview with every child age five and older up until the eighteenth birthday who leaves a licensed out-of-home care placement if the child has resided in that placement for 30 days or more. Attempts shall be made to conduct an exit interview with young adults who exit extended foster care.

(a) The interview shall be conducted within five business days of the child’s exit from the licensed out-of-home care placement.

(b) The child welfare professional will make and document a minimum of three attempts to interview a youth who is 17 years old before transitioning from licensed out-of-home care to adulthood. All attempts shall be documented in the CCWIS system.

(c) If the child alleges abuse, neglect, or any maltreatment during the exit interview, the interviewer shall make an immediate report to the Florida Abuse Hotline.

(d) If the child reports issues relating to the quality of care that do not rise to the level of abuse, neglect, or maltreatment, the interviewer shall report these issues to the licensing unit responsible for licensing the out-of-home caregiver or group care facility within three business days of completion of the exit interview and document the notification in the CCWIS system.

(2) The information gathered during the interview shall be dependent on the age of the child. The interviewer’s observations and any information to explain the child’s responses shall be recorded on the Child Exit Interview form, CF-FSP 5455 (February 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14109.

(3) Prior to completing the Child Exit Interview form, the child welfare professional or designee shall inform the child of the purpose of the exit interview and how the information will be used.

(4) The child welfare professional or designee shall not be required to complete an exit interview in the following circumstances:

(a) When there has been a change in placement type to reflect adoptive placement, but no physical change in placement has occurred.

(b) If a child was on runaway status and returns to the same placement.

(d) If the child is hospitalized for a medical or mental health reason and returns to the home.

(e) If the child is placed in the Department of Juvenile Justice detention center and returns to the home.

(5) When needed as a result of safety or quality of care issues raised by the child, the Department or contracted service provider shall develop a corrective action plan. The type of plan can range from providing more intense supervision, support, or training for the caregiver to a more formal corrective action plan or a recommendation for revocation of the license.

(6) When corrective action is necessary, written follow-up shall be completed within 90 days.

(7) Upon completion of the child exit interview, the child welfare professional or designee shall perform the following tasks:

(a) The completed interview form, any Department or contracted service provider response, and documented of any follow-up shall be placed in the child’s case record;

(b) A copy of the completed interview form shall be provided to licensing staff with the community-based care lead agency and the Department’s Regional Licensing team and placed in the out-of-home caregivers’ licensing file within two business days of the interview; and

(8) All child welfare professionals or designees who conduct exit interviews shall receive training from the community-based care lead agency (CBC) or its contracted provider. All trainings developed by the CBC or contracted provider must include components that address appropriate methods to conduct the delivery of an exit interview and instructions regarding creating safe and private environments for the child to complete the interview.

(9) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 39.012, 39.0121(13), 409.1415(4), 409.145(4) FS. Law Implemented 409.1415 FS. History–New 5-4-06, Amended 3-15-22.

Fla. Admin. Code R. 65C-28.018 Meeting the Child’s Educational Needs

(1) School stability (for school-age children) and child care or early education program stability (for birth to school age) will be prioritized for children in out-of-home care, unless it is not in the best interest of the child to remain in the school or program of origin as documented in the child welfare information system. For purposes of this rule, child care and early education programs for infants and toddlers are collectively referred to as “programs.”

(a) The child welfare professional shall request a multidisciplinary team (MDT) staffing, pursuant to Section 39.4022, F.S., when a child has an educational change pursuant to Section 39.4023(2)(a), F.S.

(b) The child welfare professional shall invite all participants outlined in Section 39.4023(4)(c)3., F.S., and or any other party deemed necessary to the MDT staffing to determine if it is in the child’s best interest to remain in the program or school of origin and, if not, which school or program the child will attend in the future. Participants may attend the MDT utilizing methods outlined in Section 39.4023(4)(c)3., F.S.

(d) Child care or early educational settings include any setting defined in Sections 402.302(2), (8), and (11), F.S., or set forth in Section 39.604(5)(b), F.S.

(e) At minimum, factors pursuant to Section 39.4023(4)(c)4. and Section 39.4023(4)(c)5., F.S., must be considered when making a determination for the child’s educational change.

(f) The child welfare professional shall document the best interest determination for changing the child’s educational setting or program and recommendation of each participant on the Education Transition Plan, form CF-FSP 5462, (June 2022), incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-14521.

(g) The child welfare professional shall develop an individualized transition plan pursuant to Section 39.4023(4)(e), F.S., each time a child makes a school change, child care, or early education change.

When a school, child care, or early education program change occurs as a result of a placement change, the transition plan shall follow the guidelines and timeframes pursuant to Section 39.4023(3)(d), F.S.
Transition plans must be completed immediately following the MDT, but no later than 24 hours, when the MDT reaches a unanimous decision and changes to the school, child-care, or early education program are not related to the child’s placement change. If the MDT cannot reach a unanimous decision, the transition plan must be completed after the Department representative renders a final decision, but no later than five (5) business days from the Department’s decision.

(h) If remaining in the child care or early education program of origin is deemed to not be in the child’s best interest, then the change in programs shall be made in accordance with Sections 39.604(6) and 39.4023(4)(d), F.S.

(2) School Enrollment and Records. When a child enters care or changes schools as the result of a change in placement or any other reason, the child welfare professional responsible for the case shall immediately prepare and submit the necessary paperwork, in accordance with local agreement, to notify the child’s school that the child is in out-of-home care. If the child changes schools, the child welfare professional shall provide the child’s new school with any documentation in the child’s record that is required for enrollment.

(3) Documentation of the best interest determination to change the child’s school shall be provided by the child welfare professional to the child’s new school.

(4) When a child remains in the school of origin, the child welfare professional shall, in accordance with local agreement, contact the foster care liaison or other designees as identified within the school district for the child’s school of origin to make arrangements for transportation to the school of origin, in accordance with local agreement.

(5) Special Education Considerations.

(a) When a child has, is suspected of having, or is identified in any assessment of having a disability, the child welfare professional shall communicate with the child’s parent or legal guardian to determine if they are willing and able to continue to serve as the child’s educational decision maker.

(b) If the child’s parent or legal guardian is unwilling or unable to serve as the child’s educational decision maker, the child welfare professional shall determine whether the out-of-home caregiver, excluding child-caring agency staff and therapeutic foster parents, is willing and able to attend the necessary training and to serve as the child’s surrogate parent.

(c) If the child’s parent, legal guardian, or out-of-home caregiver is unable to act as the child’s educational decision maker, the child welfare professional shall request the Children’s Legal Services (CLS) attorney seek the appointment of a surrogate parent from the dependency court or the district school superintendent.

(6) Documentation. The child welfare professional shall document in the child welfare information system the following for each child:

(a) Information about the current school, educational setting, child care, or early education program of the child.

(b) All schools, or educational settings, child care, or early education programs the child has attended since the date the child has been in out-of-home care.

(d) The number of high school credits each child age 14 years or older has earned.

(e) The child’s surrogate parent, if one has been appointed.

(f) The reason for any change in the child’s educational or program setting.

(g) Information regarding the child’s educational or program records shall be uploaded in the child welfare information system in the File Cabinet (Image Category selected is “Education”), which may include:

Report cards;
Transcripts;
Individual Education Plan; and
A 504 plan.

(h) The Education Transition Plan, form CF-FSP 5462, shall be uploaded to the child welfare information system meeting module using the meeting type of Placement-Transition, Educational Transitions, or Child Care/Early Childhood Transitions.

History

Rulemaking Authority 39.012, 39.0121(13), 39.4022(11), 39.4023 FS. Law Implemented 39.0016, 39.6012(2)(b)4., 39.604, 39.4022, 39.4023 FS. History–New 5-8-16, Amended 6-15-17, 2-14-19, Amended 7-27-22.

Fla. Admin. Code R. 65C-28.019 Normalcy

(1) Caregiver decision-making.

(a) Supervising agency approval is not required for decisions made by the out-of-home caregiver regarding a child’s participation in childhood activities. Childhood activities include attending or participating in:

Extracurricular clubs,
School and community sports,
Youth group activities,
Service organizations,
Birthday parties and sleep-overs,
Outings with peers,
Driver’s education,
Vacations with the out-of-home caregiver’s family or other families,
School or camp field trips; and,
Summer and school break camps.

(b) Community-based care lead agencies shall provide training to all foster parents and contracted agencies to ensure normalcy for all children in care, pursuant to Sections 39.4091 and 409.145, F.S.

(2) To ensure quality parenting, out-of-home caregivers shall:

(a) Timely complete all required in-service training;

(b) Mentor and coach birth parents, when available;

(d) Refrain from making disparaging remarks to the child about his or her family;

(e) Participate in school parent-teacher conferences;

(f) Ensure the child attends all scheduled health care appointments, including medical and behavioral health;

(g) Deliver age-appropriate life skills training to children ages 13 and older;

(h) As part of progress updates, share information with the supervising agency and Department about the child’s progress, family’s progress, if known, and visitation; and,

(i) Be supportive of transitions, including reunification, another adoptive placement, or any other changes in placement.

History

Rulemaking Authority 39.012, 39.4091(4), 409.145(5) FS. Law Implemented 39.4091, 409.145 FS. History–New 5-8-16.

Fla. Admin. Code R. 65C-28.020 Fingerprint Exemptions for Household Members

(1) Household members, excluding current and potential caregivers, 18 years of age and older, who have a physical, developmental, or cognitive disability that prevents that person from safely submitting fingerprints can request an exemption from the fingerprinting requirements set forth in Section 39.0138(1), F.S.

(2) Individuals seeking the exemption must provide supportive documentation from a licensed health professional outlining justification that the individual is unable to submit fingerprints safely due to a disability, and that the disability does not present a safety concern for children in the home. The supporting documentation must be provided to the child welfare professional no later than 10 calendar days after an emergency placement.

(3) The child welfare professional shall complete a “Fingerprint Exemption Request” form, CF-FSP 5436, Feb 2019, incorporated by reference and available at https://www.flrules.org/Gateway/Reference.asp?No=Ref-10319, and submit it to the Department’s regional managing director or designee for review within 72 business hours of receiving the supporting documentation.

(4) The Department’s regional managing director or designee shall make a determination to grant or deny the exemption request within 10 days of receiving the request. In determining whether to grant an exemption, the regional managing director or designee shall consider the requirements outlined in Section 39.0138(2)(b), F.S.

a. The Department will upload the Fingerprint Exemption Request form into the Caretaker Screening Information System (CSIS) within five (5) business days of an exemption determination.

b. The Department will provide the signed Fingerprint Exemption form to the requesting agency.

c. The requesting agency will upload the determination into the Florida Safe Families Network (FSFN) provider file cabinet upon receipt.

(5) If the Department determines that the individual does not qualify for a fingerprint exemption, the individual shall be notified in writing within 10 business days of the determination, identifying the reasons for the denial, the statutory authority for the denial and the individual’s right of appeal pursuant to Chapter 120, F.S.

(6) A Level 1 screening, pursuant to Section 435.03, F.S., shall be completed on all individuals exempted from submitting fingerprints. For emergency placements, results received from the emergency background checks, with the purpose code x, shall meet the level I requirements outlined in Section 435.03, F.S.

History

Rulemaking Authority 39.0138(2)(a) FS. Law Implemented 39.0138 FS. History–New 4-7-19.

Fla. Admin. Code R. 65C-28.021 Qualified Residential Treatment Programs

This rule applies to qualified residential treatment programs (QRTP). A QRTP is a licensed child-caring agency that provides care for youth who have serious emotional or behavioral disorders or disturbances.

(1) Placement of a child in a qualified residential treatment program (QRTP) is for the specific purpose of addressing the child’s emotional and behavioral health needs through observation, diagnosis, and treatment in a treatment setting. QRTPs must not be used for emergency placements or to provide secure shelter for the child. If the child is in acute psychiatric crisis, the child must be referred to a crisis stabilization unit for emergency screening and stabilization in accordance with Sections 394.463 and 394.467, F.S.

(2) The community-based care (CBC) lead agency must maintain documentation of a child's placement in a QRTP and is responsible for ensuring that each child receives an assessment prior to placement in the QRTP.

(3) For placement in a behavioral qualified residential treatment program (BQRTP) licensed pursuant to Rule 65C-46.0211, F.A.C. the assessment must be completed by the Qualified Individual (QI). A Qualified Individual is the child’s treating licensed clinical professional, a Qualified Evaluator outlined in s. 39.407(6), F.S., or a Comprehensive Behavioral Health Assessor who has a preexisting clinical relationship with the child, who meets the qualifications as required in the Agency for Health Care Administration, “Specialized Therapeutic Services Coverage and Limitations Handbook,” March 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16546.

(a) A child may be placed in a BQRTP based on the preliminary assessment recommendation from a QI. However, the final assessment by QI must be completed within 30 calendar days to continue placement in the setting.

(b) A preliminary assessment must include the following components:

A face-to-face attempt with the child,
Review of the Comprehensive Placement Assessment completed during the placement multidisciplinary team staffing pursuant to Rule 65C-30.023, F.A.C., and
The reasons that support the preliminary recommendation for placement.

(4) If a preliminary assessment recommends placement of a child in a BQRTP but the child is not placed within 60 days of the preliminary assessment, an MDT staffing must occur to determine if the recommended level of care continues to be in a BQRTP.

(5) For placements in a QRTP credentialed pursuant to Rule 65C-46.021, F.A.C., the assessment must be completed by a Qualified Evaluator (QE) pursuant to s. 39.407(6), F.S. The assessment must include the components set forth in paragraph (6).

(6) Each placement assessment must include the following components:

(a) Short term and long term mental and behavioral health goals;

(b) The use of the Child and Adolescent Needs and Strengths (CANS) Trauma Comprehension assessment tool, March 2013, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13092.

(c) A review of prior treatment records and consultation with relevant parties in the child’s life, including, but not limited to, the guardian ad litem, case manager, current caregiver, the child’s family, Department of Juvenile Justice staff, treating clinical professional, and the child’s attorney;

(d) The recommendation of the child’s treating clinical professional; and

(e) An interview with the child.

While face to face contact is the preferred method for contact with the child, telehealth may be utilized.
If the child refuses to participate in the interview, the assessment must include good faith efforts to engage the child. Good faith efforts are defined as documented efforts that demonstrate the assessor took all steps in light of the child’s age, intelligence, emotional development and stability, and demeanor to enable the child to participate in a conversation to determine whether the child needs QRTP placement.

(7) For a child placed in a BQRTP, if the QI’s final assessment does not recommend continued placement, the child welfare professional must request a reconsideration in the event the child has experienced a decompensation in mental, emotional, or behavioral health functioning.

(8) If the reconsideration by the QI does not result in a recommendation to continue placement in a BQRTP, the child welfare professional must:

(a) Make arrangements to have the child moved from the program within 30 calendar days of the recommendation.

(b) Request a multidisciplinary team staffing pursuant to s. 39.4022. F.S., to determine placement.

(9) If the QE assessor does not recommend initial QRTP placement, the child welfare professional must request a reconsideration in the event the child has experienced a decompensation in mental, emotional, or behavioral health functioning.

(10) When a child is placed in a BQRTP based on a preliminary assessment, within 60 calendar days after initial placement, the Department must receive a ruling from the court approving or disapproving the placement based on the final assessment, determination, and documentation made by the QI or QE.

(11) When the assessor recommends placement in a QRTP, within 60 calendar days after initial placement, the Department must request the court to approve or disapprove the placement based on the assessment, determination, and documentation made by the assessor. If placement in the QRTP is approved by the court the child welfare professional must request the following if the child remains placed in a QRTP:

(a) A court review every 90 days after the initial 60 day-review, and

(b) An independent assessment which must be completed prior to each 90-day review by the court.

(12) If the assessor does not recommend initial or continued placement in a QRTP, but the court orders the child to be placed in a QRTP, the child welfare professional must request a reconsideration.

(13) If at any time the court denies the motion to place the child into a QRTP or orders the placement of the child into a less restrictive setting during a review hearing, the child welfare professional will follow local protocol to coordinate the referral and placement of the child into the least restrictive setting that is best suited to meet the child’s needs. If the child is already in a QRTP, the child welfare professional must make arrangements to have the child moved from the QRTP within 30 calendar days of the determination.

(14) Upon immediate placement of a child in a QRTP, a copy of the assessment must be provided to all parties pursuant to s. 39.407(6)(d) F.S.

(15) A child may not be placed in a QRTP for more than 12 consecutive months or 18 nonconsecutive months, or in the case of a child who has not attained age 13, for more than six consecutive or non-consecutive months, without approval of the Department. Requests for approval must be made using the Qualified Residential Treatment Program (QRTP) Extended Placement Request Form, CF-FSP 5450, Apr 2021, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13075. The Department must consider the recommendations of the multidisciplinary team staffing conducted within the last 90 calendar days and the most recent assessment recommendation in deciding whether to approve the continued placement. A copy of the signed approval must be attached to the child’s case plan. The Department must provide a determination within seven business days from receipt of the request from the CBC.

(16) Discharge and Aftercare Support.

(a) The child welfare professional must participate in discharge planning and aftercare support to meet the needs of the child with intent for the child to reside in the most appropriate, least restrictive setting. Planning must include input from the child, child’s parent or guardian, caregiver, child’s attorney, and guardian ad litem.

(b) Aftercare support must be provided for a minimum of six months post discharge. Aftercare support is not required for youth who discharge to another QRTP setting or higher level of care such as a residential treatment program, also known as Statewide In-Patient Psychiatric Program (SIPP), or therapeutic group home which are defined in s. 39.407(6), F.S.

The BQRTP must provide after care support to all children discharged if placed within a 50-mile radius of the BQRTP. The child-welfare professional is responsible for aftercare support when a youth is discharged to a placement setting outside a 50-mile radius of the BQRTP.
All youth discharged from a QRTP credentialed pursuant to Rule 65C-46.021, F.A.C., will receive after care support from the QRTP credentialed provider.

(c) The child welfare professional must ensure written aftercare progress reports provided by the QRTP are uploaded into the state’s official system of record and the child welfare professional must notify the court of the child’s progress during a judicial review.

(17) A child who elopes or is admitted to a higher level of care for crisis services, such as a Baker Act, from a QRTP may be readmitted into the same or newly identified QRTP without an additional assessment as long as the child was not discharged from the QRTP.

(18) If a child transfers from one QRTP to another without a lapse in placement, a new assessment is not required. The CBC must coordinate a multidisciplinary staffing with both QRTP providers to complete a transition plan pursuant to s. 39.4023, F.S.

History

Rulemaking Authority 39.0121, 409.175(5), FS. Law Implemented 39.407, 409.175, FS. History‒New 5-23-21, Amended 4-15-24, 7-1-25.

Fla. Admin. Code R. 65C-28.022 State Institutional Claims for Damages Caused by Children in Out-of-Home Care

(1) Definitions.

(a) “Department” means the Department of Children and Families.

(b) “Child” means a child in licensed out-of-home care.

(c) “Claimant” means a licensed caregiver who submits a restitution claim alleging property damages and/or direct medical expenses for his or her injuries under Section 402.181, F.S.

(d) “Damages” means physical harm caused by something in such a way as to impair its value, usefulness, or normal function. Routine maintenance incidental to running a household, such as cleaning floors, counters, appliances, dishes, and clothing, as well as lawn maintenance, are not damages that can be reimbursed.

(e) “Incident” means the occurrence of property damage and/or medical injury resulting from the same or similar event or occurrence in time.

(f) “Preponderance of the evidence” means the party bearing the burden of proof must present evidence which shows that the fact to be proven is more probable than not.

(g) “Restitution” means recompense for injury or loss.

(h) “Restitution claim” means any reimbursement claim resulting from property damages and/or direct medical expenses for injuries caused by a resident(s) that has not been restored or recompensed through another entitlement.

(2) Individuals providing care and supervision for children in licensed out-of-home care may seek restitution for direct medical expenses and/or property damage caused by a child. The individual may seek restitution on behalf of a child in licensed out-of-home care whose medical expenses and/or property damages were caused by another child in licensed out-of-home care.

(3) If the child was responsible at the time the injury or damage occurred, the claimant may receive restitution up to $1,500 per claimant per incident based on the child’s legal status and upon availability of funding.

(a) When a child is in shelter legal status (pursuant to a court’s shelter order), restitution up to $1,000.00 may be claimed.

(b) When a child is in foster care legal status (pursuant to a court order granting custody to the Department for placement in foster care), restitution up to $1,500.00 may be claimed.

(c) The child’s placement, such as a foster home, group home, or residential treatment center, has no bearing on the above distinction. It is based solely on the child’s legal status at the time the injury or damage occurred.

(4) Responsibilities of the Claimant.

(a) A claimant filing a restitution claim under Section 402.181, F.S., with the Department has the burden to prove, by a preponderance of the evidence:

That damages occurred, by means of photographs;
That the action(s) of a child in licensed out-of-home care is the direct cause of claimant’s property damages and/or direct medical expenses for injuries; and
The monetary amounts of the claimant’s damages and/or expenses, by means of a receipt or at least two written estimates or quotes.

(b) Only one restitution claim can be submitted per claimant per incident.

(c) The claimant must complete and file the Restitution Claim Form, CF-FSP 5459, (October 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14898, within 90 days of the occurrence of the incident upon which the claim is based. The claimant must file a completed, signed copy of the Restitution Claim Form with a child welfare professional.

(d) If the claimant received compensation for the same incident not pursuant to Section 402.181, F.S., such as from workers’ compensation, homeowner’s insurance, private insurance, or any other entitlement, the Institutional Claims Fund may be used only to request restitution for any deductible amount and/or repair of damage the other compensation did not pay. Documentation from such compensation must be included with the form and receipts.

(5) Responsibilities of the child welfare professional.

(a) When a claimant advises the child welfare professional of expenses they have incurred as a result of personal injury or property damage caused by a child in out-of-home care, the child welfare professional shall:

Assist the claimant in applying for funding by assisting the completion of the Restitution Claim Form.
Ensure that the form is completed in its entirety and that legible receipts or estimates from a licensed vendor are attached.
Confirm the damage described on the application through observation of the home or facility, or by reviewing validated documentation provided by the claimant.
Confirm that the claimant has provided pictures of the damage, two written estimates for repair, or receipt(s) if the repair has been paid for.
Review the circumstances of the claim and have the claimant sign the form.

(b) The child welfare professional shall complete Part A. of the State Institutional Claims for Damages Recommendation form, CF-FSP 5453, (October 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14897. The child welfare professional shall submit the State Institutional Claims for Damages Recommendation form, Restitution Claim Form, and all supporting documentation to the Department designee.

(6) Approval and Denial of Claims.

(a) The Department will only consider a claim that is filed on a completed Restitution Claim Form and State Institutional Claims for Damages Recommendation form, which are signed by both the claimant and child welfare professional. Incomplete forms will be returned without approval or denial due to insufficient information.

(b) Subject to available funding, the Department will approve claims that include all required documentation and meet the requirements articulated in this rule within 90 days of receipt of the completed State Institutional Claims for Damages Recommendation form.

(c) If the request for restitution is denied, the applicant shall be notified in writing, including notice of the applicant’s right to appeal pursuant to Chapter 120, F.S.

(d) If the request for restitution is granted, the applicant shall be notified in writing.

(e) In the event a claim is denied, and the claimant requests a 120 hearing, the child welfare professional must attend the hearing.

(f) Claims for damages shall not be granted for:

A child purchasing entertainment through the internet using the licensed caregiver’s account or credit card.
Damages resulting from circumstances where the biological or adoptive child and foster child are equally responsible.
Damages resulting from circumstances where the foster child and claimant are equally responsible.

History

Rulemaking Authority 402.181(3) FS. Law Implemented 402.181 FS. History‒New 3-20-22, Amended 11-22-22.

Fla. Admin. Code R. 65C-28.024 Placement Transitions

(1) A placement transition multidisciplinary team (MDT) staffing must be held when there are changes in physical custody after a child is placed in out-of-home care. This rule applies to transitions when there are changes in physical custody after a child is placed in out-of-home care.

(a) This rule does not apply to transitions for children transitioning to adulthood. The requirements specific to transitioning to adulthood can be found in Rule 65C-28.009, F.A.C., of this chapter.

(b) This rule does not apply to transitions for children due to an adoption intervention. The requirements specific to adoption interventions can be found in Rule 65C-16.009, F.A.C.

(2) Placement Transition MDT Staffing and Transition Plan.

(a) The placement transition MDT staffing shall adhere to all requirements identified in subsection 65C-30.023(2), F.A.C.

(b) The MDT facilitator or child welfare professional must invite, at a minimum, participants set forth in Sections 39.4023(3)(d) and 39.4022(4)(a), F.S., to the placement transition MDT staffing.

(d) When the child that is the subject of the placement transition is an infant and/or under school age, additional factors must be addressed in the transition plan pursuant to Section 39.4023(3)(e), F.S.

(e) The facilitator shall ensure the following is discussed during the placement transition MDT:

Maintaining and updating of the child resource record as defined in Rule 65C-30.001, F.A.C.;
Caregiver roles and responsibilities pursuant to the parenting partnership agreement as defined in Section 409.1415, F.S.
Requirement of a Behavior Management Plan as defined in Rule 65C-30.001, F.A.C. The facilitator or child welfare professional shall ensure the plan is attached to the Placement Transition Plan, form CF-FSP 5466, (November 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14958.
Services for the child and supports for the out-of-home caregiver when a disability is determined and a need for services is identified.

(f) If the child is suspected or identified as needing medical foster care, the child welfare professional or other designated staff shall refer the child to the local Children’s Multidisciplinary Assessment Team (CMAT) Staffing within five (5) business days.

(g) If the CMAT Staffing determines the child is eligible for medical foster care services, the child welfare professional or other designated staff shall coordinate with the Medical Foster Care program in the local area regarding arrangements necessary to meet the child’s needs.

If the child is suspected of having a developmental delay or condition and an eligible determination for services has not been made, the child welfare professional responsible for the case shall ensure that a referral for an assessment is completed within five (5) business days.
If the child is suspected of having a mental health need and an eligible determination for services has not been made, the child welfare professional responsible for the case shall ensure a referral for an assessment is completed within five (5) business days. A child shall not be referred for a clinical assessment for the purpose of being placed in a clinical setting when not necessary.
The preferred out-of-home placement for a child with a communicable disease who is exhibiting symptoms is with a relative, non-relative, or licensed out-of-home caregiver(s) specifically trained for such purpose.

a. The Department or contracted provider shall obtain either parental consent or a court order to allow medical treatment or testing when necessary for infants suspected or known to have communicable diseases.

b. When a child with a communicable disease and is asymptomatic but exhibiting behaviors likely to increase the risk of transmission, the child shall be placed in a home with a properly trained caregiver to ensure the safety of other household members.

Services shall be coordinated and provided in accordance with the Medical Foster Care Statewide Operational Plan, April 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14960.

(h) The Child Welfare Professional is required to develop an individualized placement transition plan using the Placement Transition Plan, form CF-FSP 5466, incorporated in this rule.

(3) Documentation.

(a) Parental notification of any placement changes shall be documented in the state’s child welfare information system unless the court previously excused the Department from further efforts to locate the parent. If the parent(s) is unable to be located, efforts to locate and notify the parent shall be documented in the state’s child welfare information system.

(b) The Placement Transition MDT Staffing and the Placement Transition Plan shall be documented in the meeting module of the state’s child welfare information system within 2 business days of the staffing.

(4) Within 1 business day, the child welfare professional, facilitator, or department designee will provide written notice to Children Legal Services (CLS) and provide a copy of the Placement Transition Plan, form 5466. The notice shall indicate when the child has a new placement and the reason for the placement change, and when there is a non-consensus with a Placement Transition MDT staffing the notice shall be provided pursuant to Rule 65C-30.023, F.A.C.

History

Rulemaking Authority 39.012, 39.4022(11), 39.4023(7), 409.1415(4) FS. Law Implemented 39.4022, 39.4023, 409.1415 FS. History‒New 12-25-22.

Chapter 65C-29 PROTECTIVE INVESTIGATIONS

Fla. Admin. Code R. 65C-29.001 Definitions

All definitions for this rule are located in Rule 65C-30.001, F.A.C.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.301, 39.302, 39.307 FS. History–New 5-4-06.

Fla. Admin. Code R. 65C-29.002 Reports of Child Abuse, Neglect or Abandonment

(1) The Department shall maintain an automated master file for all calls received by the Florida Abuse Hotline for screening. This file shall contain information on all calls received concerning a child and be maintained in the Department’s automated system of record.

(2) The telephone number from which a call to the Florida Abuse Hotline is placed (Caller ID) shall only be used for subsequent contact in the following circumstances:

(a) If the telephone number provided by Caller ID is the same as provided by the reporter.

(b) If the caller is a child who is self-reporting abuse, neglect or abandonment and the child’s immediate location is unclear or not known, the Department employee or agent shall attempt to verify the location.

(c) If all means to locate any child victim and attempts to contact the reporter at the telephone number provided by the reporter are unsuccessful. The purpose of this is to obtain additional information that would allow the child and/or family to be located and seen.

(3) In instances where the alleged perpetrator’s caregiving status to the child is unknown or unclear, a report shall be accepted and an investigation commenced until such time that the alleged perpetrator’s role as a caregiver can be determined.

(4) When a report is being accepted, the Florida Abuse Hotline counselor shall ask all reporters to provide the following information:

(a) Information regarding subjects of the report including name, race, sex, date of birth, social security number, ethnicity, school, employment, address, phone number and/or other acceptable means to locate the victim if the address is not known;

(b) The relationship between the victim and the alleged perpetrator;

(c) Names and contact information for any person who can provide assistance to the child or additional information about the family’s circumstances;

(d) The type of maltreatment alleged and the nature and extent of harm suffered by the victim, including when the incident occurred or whether it is a chronic, ongoing situation;

(e) Any known history of abuse, neglect or abandonment of persons named in the report;

(f) Whether the alleged perpetrator continues to have access to the victim and the possibility of continued maltreatment;

(g) Current condition of the child;

(h) Other children in the environment; and,

(i) The name and occupation of the reporter, relationship between the child and the reporter, contact information for the reporter, and any other information the reporter believes will be of assistance.

(5) The Florida Abuse Hotline shall process and document all allegations reported.

(a) The Florida Abuse Hotline counselor shall search for prior reports to determine if the current allegations have been reported in the past.

(b) The Florida Abuse Hotline counselor shall determine if the caller is reporting the same incident as that contained in a prior closed report. If the current allegations do not offer new information, additional subjects, new evidence, or additional allegations or incidents, a new report shall not be generated.

(c) The Florida Abuse Hotline counselor shall search the comprehensive child welfare information system to determine if the victim, alleged perpetrator, or other subjects of the report have any active, open investigations or history of prior reports or service provision. The Florida Abuse Hotline counselor shall provide this information to child protective investigation staff at the time of report notification.

(6) Depending upon the timing and type of information received, reports shall be entered into the comprehensive child welfare information system as “Initial” investigations, “Additional” investigations, or “Supplemental” reports.

(a) Initial Investigations: Initial investigations are reports containing allegations of maltreatment that do not concern an active, open investigation.

(b) Additional Investigations: Additional investigations are reports containing new information about one or more subjects of an active, open investigation.

An additional investigation includes any of the following:

a. A new alleged perpetrator in the same household,

b. A new victim,

c. A new subject in the same household,

d. A new maltreatment,

e. A new incident of the same maltreatment,

f. New information that requires an immediate response, or

g. A child dies due to maltreatment during an open protective investigation.

If any of the following apply, a new investigation identified by a different report number shall be created:

a. Information involves a different household from the existing report.

b. An institutional investigation can only be sequenced (i.e., added as an “Additional”) to another institutional investigation.

c. Special Conditions Reports which do not contain maltreatment allegations cannot be sequenced to any investigations.

(c) Supplemental Reports: Supplemental reports provide clarifying but non-essential information to active investigations. Child-on-child sexual abuse reports shall only be sequenced as supplemental reports when the inappropriate sexual behavior or juvenile sexual abuse involves the same victim, alleged abuser, and behaviors.

(d) Except for specific circumstances surrounding child deaths, additional allegations of abuse, neglect or abandonment discovered by the investigator during the course of an investigation do not need to be called to the Florida Abuse Hotline as an additional report. The investigator shall add these new maltreatments directly to the investigation.

(e) The following do not constitute reports of abuse, neglect or abandonment but callers shall be given appropriate community referral information if available:

Complaints of withholding or misuse of child support which do not allege child abuse, neglect or abandonment,
Disputes concerning custody of a child in which there is no reasonable cause to suspect abuse, neglect or abandonment,
Complaints concerning infants or children in automobiles who are not in legally required child restraint devices unless one or more of the following circumstances are present:

a. The parent or legal guardian was charged with driving under the influence of drugs or alcohol.

b. The parent or legal guardian received a traffic citation(s) for reckless driving.

c. A child was seriously injured or killed during an accident.

Requests for service that may require action, such as:

a. Transportation needs,

b. Need for food assistance,

c. Need for housing,

d. Day care needs,

e. Need for employment or public assistance,

f. Need for job training or education,

g. Need for help with utilities or rent,

h. Need for homemaker or housekeeper services, or

i. Adult family members in need of services.

Complaints concerning children running away from parents or legal custodians; persistently disobeying reasonable and lawful demands of parents or legal custodians; and being out of control,
Complaints concerning licensing violations, such as overcrowding, poor sanitation, inadequate staffing ratios, and lack of a fire sprinkler system,
Requests from a hospital to have a home “checked” before a child is released,
Requests from a hospital for the Department to grant permission to treat a child due to the hospital’s inability to contact the child’s parent, custodian or legal guardian,
Complaints concerning head lice,
Complaints that a child is not attending school. These complaints shall be directed to the local school district,
Calls regarding the placement disruption of a child in out-of-home care, whether the child is in a licensed or non-licensed placement, shall be accepted by the Florida Abuse Hotline as foster care referrals. However, if the placement disruption is as a result of an incident of child abuse, neglect or abandonment by the placement caregiver, a report of child maltreatment shall be accepted by the Florida Abuse Hotline,
Calls regarding a family’s failure to comply with the conditions of the voluntary or court-ordered case plan, unless such failure has resulted in a new incident of abuse or neglect, shall be accepted by the Florida Abuse Hotline as foster care referrals. This includes calls involving post-placement supervision case management issues,
Calls concerning a married minors,
Calls concerning emancipated minors living on their own,
Calls alleging that a parent or caregiver refers to a child only by pronouns that correspond to the child’s sex, refuses to refer to a child by pronouns that do not correspond to the child’s sex, or refuses to otherwise affirm a child’s perception of his or her sex, if that perception is inconsistent with the child’s sex.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.201 FS. History–New 5-4-06, Amended 12-31-14, 8-23-18, 1-11-26.

Fla. Admin. Code R. 65C-29.003 Child Protective Investigations

(1) Responding to Reports.

(a) The child protective investigator supervisor may downgrade an immediate response to a 24-hour response only if the local investigative unit has obtained additional information from the reporter or law enforcement subsequent to the information collected by the Florida Abuse Hotline that indicates the child is no longer in imminent danger of being harmed. The rationale for this determination shall be approved by the supervisor and documented in the Florida Safe Families Network (FSFN).

(b) When a report is received on a child who is a resident of Florida and the alleged maltreatment occurred in Florida, but the child is temporarily out of state, the investigation shall be commenced by contacting the child welfare agency responsible for child abuse or neglect investigations in the state where the child is temporarily located. The purpose of the contact is to request a timely face-to-face interview with the child in order to ascertain his or her safety, and to determine when the child is expected to return to Florida.

(c) In instances where the Florida Abuse Hotline accepts an abuse report but the child protective investigator subsequently determines through obtaining additional information that the allegations or facts do not meet the criteria for an investigation, the report shall be closed as “No Jurisdiction,” after review and approval by the child protective investigator supervisor.

(2) Investigative Requirements. For every report received, the following actions shall be completed:

(a) A determination shall be made as to whether the reporter should be contacted prior to commencement of the investigation to obtain additional information on the child or family or to clarify information obtained by the Florida Abuse Hotline. If the reporter is a professional mandatory reporter under Section 39.201(1)(b)2., F.S., within 24 hours of being assigned the investigation, the child protective investigator must provide his or her contact information and advise the reporter that he or she may provide a written summary of their concerns which shall become part of the child’s electronic case file. When circumstances preclude contacting a reporter prior to commencement (such as when a concern for child safety and the need for expediency warrants a post-commencement contact) or when an attempted contact is unsuccessful, the investigator shall contact the reporter after the initial on-site response is completed.

(b) All household members residing in the maltreating caregiver’s home and not identified in the original intake must be added to the investigation within 24 hours of the individual’s identity and presence in the home becoming known. All household members shall be assessed as to their relationship and role within the family, interactions, and caregiving role over the children in the home.

(c) Information shall be collected describing the physical, developmental and behavioral characteristics and overall functioning of the children in the home and documented in the case record. While interviewing and visually observing the child, the child protective investigator shall be sensitive to issues arising from a child’s age and developmental stage, ethnicity, and gender.

(d) Information shall be collected on the parent’s or caregiver’s overall functioning, parenting style and disciplinary and behavior management practices and documented in the case record. Any person alleged to have maltreated a child shall be interviewed.

(e) If during the course of the investigation it is determined that there is a need to remove physical evidence from the home, other than taking a child into protective custody, the investigator shall request local law enforcement to initiate a criminal investigation.

(f) Determine whether any person alleged to have maltreated a child is employed in an institutional setting or holds a professional license. In instances which the caregiver is found to be responsible for abuse, neglect, or abandonment, the child protective investigator (CPI) shall determine whether information obtained provides credible evidence to support that children or vulnerable adults within the caregiver’s employment may have been or are at risk of being similarly maltreated, in which case the CPI must contact the Florida Abuse Hotline to initiate an institutional investigation.

(g) Abuse history and criminal records checks shall be obtained by the child protective investigator on all household members age 12 or older not screened by the Florida Abuse Hotline at the time the report was accepted. The criminal records and abuse checks shall be initiated within 24 hours of the individual’s identity and presence in the home becoming known to the investigator. Records checks shall also be completed on any adult visitor to the home who provides care or supervision to the child outside the parent’s immediate presence while visiting the home. If the family has lived in another state within the past five (5) years, the child protective investigator shall contact the appropriate child protection agencies in the state where the family resided and request abuse history check on all subjects and household members of the report. The investigator shall contact law enforcement agencies in the other state to request local criminal history information when necessary for assessment purposes.

(h) Safety Assessments.

The child protective investigator shall complete a present danger assessment for all investigations, excluding institutional and special conditions investigations. Upon completion of the present danger assessment, the child protective investigator shall complete all additional investigation activities necessary to assess for impending danger threats in the home unless it is determined, with supervisory approval, that the report is:

a. Patently unfounded, or

b. A false report.

Cessation of investigative activities may not occur prior to the investigator obtaining the approval of the child protective investigator’s supervisor.

When a child protective investigator identifies the presence of present or impending danger, the investigator shall take the least intrusive actions to ensure the child’s immediate and on-going safety. If the child protective investigator determines the need to engage ongoing services, whether these services are non-judicial or court ordered, a case transfer conference shall be convened between the investigator, contracted service provider and the parent(s) to arrange for the provision of case management services.

(3) Safety Planning Requirements. For every report received in which a danger threat has been identified, the following actions shall be completed:

(a) Upon the identification of a danger threat, the child protective investigator shall determine if, with the provision of safety management services and the implementation of an in-home safety plan, the child can safely remain at home.

If the child cannot remain in the home with safety management services, the child protective investigator must develop an out-of-home safety plan and identify the conditions for return. If the family has not made a family-made arrangement prior to the Department’s intervention or the family-made arrangement is inappropriate due to the circumstances surrounding the danger threat(s) in the home, the child protective investigator shall take the child into protective custody and place the child in accordance with the placement priority in Section 39.4021(2), F.S., and the best interest criteria as established in Section 39.01375, F.S.

(b) If a child is removed from the home, the child protective investigator shall maintain the child in the current school setting unless it is determined that continuing attendance is not in the child’s best interest, or ongoing safety issues require transfer to a new school.

(c) Supervisors shall review all safety plans within 24 hours of identification of present or impending danger to ensure that the plan appropriately addresses the identified danger threats.

(4) Supervisors shall conduct an initial supervisory consultation with the investigator within five (5) days of the assignment of the investigation to discuss the status of the investigation and the assessment activities conducted to date.

(5) A second tier consultation shall review and document in FSFN all reports in which:

(a) An in-home present danger safety plan is initiated with the family.

(b) There are no identified danger threats in the home, i.e. the child is assessed as “safe,” but the child’s risk assessment score is very high.

(d) There is a child death with surviving siblings in the home.

(6) The child protective investigator shall determine in all investigations whether a child is an Indian child or Alaskan Native child, as defined by the Indian Child Welfare Act, codified at 25 U.S.C. s. 1901 et seq. When it is determined that the child is an Indian child or Alaskan Native child, the child protective investigator shall comply with the provisions of the Act.

(7) If the child protective investigator, while acting in his or her professional capacity or within the scope of employment, knows or has reasonable cause to suspect that animal cruelty, as defined in Section 828.27, F.S., has occurred at the same address, he or she shall report such knowledge or suspicion in accordance with the requirements in Section 39.208(2), F.S. The child protective investigator must document the notification to a local animal control agency in the FSFN.

(8) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 39.012, 39.0121, 39.208(6), 39.301(14)(c) FS. Law Implemented 39.01375, 39.208, 39.301, 39.4021 FS. History–New 5-4-06, Amended 12-31-14, 12-13-15, 3-29-16, 6-5-16, 12-24-17, 7-16-20, 1-9-22.

Fla. Admin. Code R. 65C-29.004 Institutional Child Protective Investigations

(1) If the institutional report involves a Department of Juvenile Justice (DJJ) facility or institution, the child protective investigator shall comply with the investigations of abuse or neglect in DJJ program requirements pursuant to the Interagency Agreement between the Agency for Health Care Administration, Agency for Persons with Disabilities, Department of Children and Families, Department of Juvenile Justice, Department of Education, Department of Health, Guardian ad Litem Program, and Florida’s Office of Early Learning To Coordinate Services for Children Served by More than One Agency (Interagency Agreement), signed October 31, 2012, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-04812. The Department and sheriff’s offices shall develop local protocols for the implementation of the Interagency Agreement.

(2) If the report has been assigned an immediate initial response by the Florida Abuse Hotline, it may be downgraded to a 24-hour response, if approved by the immediate supervisor. Approval shall be based on a determination that the child is not currently being harmed or at risk of harm. The rationale for the change shall be approved by the supervisor and documented in FSFN.

(3) Upon receipt of such report, the child protective investigator shall provide the following notifications:

(a) If the institution is exempt from licensing under Section 409.176, F.S., the Florida statewide child care organization responsible for registering non-licensed residential child caring agencies or family foster homes shall be notified;

(b) If the institution is a Department of Juvenile Justice contracted facility or a Department of Juvenile Justice operated facility, immediate notification to the Department of Juvenile Justice State Program Office shall be made;

(c) If the institution is a residential child caring facility, as defined in Sections 409.175 and 409.176, F.S., the facility’s superintendent or designee shall be notified upon initial contact at the institution;

(d) If the institution is a child caring facility, as defined in Section 402.302, F.S., notify the agency responsible for licensing and/or regulatory oversight. Upon initial contact at the facility, the child protective investigator shall verify the name of the licensing or regulatory agency and obtain a contact number for such agency;

(e) If the facility is exempt from licensing, as specified under Sections 409.176 and 402. 316, F.S., notify the owner or operator of the facility;

(f) Notify the child’s attorney, if one has been appointed;

(g) Notify the child’s guardian ad litem of the receipt of the report and ongoing investigation.

(4) For each institutional report he or she receives, the child protective investigator shall:

(a) Review the agency, facility, or program’s prior history of reports and determine which investigations occurred under the current management structure or owner to be able to associate a pattern of reports and responsibility for corrective actions to the appropriate individual or program manager, administrator, or owner.

(b) Conduct a face-to-face contact with the alleged victim. If the child is no longer located at the institution or facility, the on-site visit will occur where the child is located at the time the report is received.

For institutional reports where the alleged child victim is no longer located at the institution or facility, the child protective investigation shall be transferred to the county where the institution or facility is located immediately upon completion of the face-to-face contact with the alleged victim and assessment and documentation of the child safety factors.
For institutional reports involving multiple alleged victims, only the names and related demographic information of those child victims for whom there has been a determination of not substantiated or verified findings shall be part of the final report.
The child protective investigator shall inform the parent or legal custodian of any danger threat(s) to the child and discuss what actions are required on the caregiver’s part to ensure the child’s safety.
If the child’s school, daycare, or institution denies the child protective investigator access to the alleged victim, the investigator shall immediately contact a Children’s Legal Services attorney in order to seek court authorization to gain access to the alleged victim.

(c) Determine the nature and extent of the maltreatment. If the child has been examined by either the institution’s medical staff or any other medical professional, the investigator shall consult with such medical staff and obtain a copy of the medical records generated as a result of such examination.

(d) Determine the identity of the person responsible for the maltreatment, including the name, address, gender, and race. In instances which the employee is found to be responsible for abuse, neglect or abandonment in an institutional setting, the child protective investigator (CPI) shall determine whether there is reasonable cause to suspect the employee’s children were abused, abandoned, or neglected by the employee, in which case the CPI must contact the Florida Abuse Hotline.

(e) Determine if immediate safety actions are necessary to protect the child from further abuse, neglect or abandonment. If the program or facility’s owners or administrators have not taken actions to address a situation of harm or threatened harm to a child in their care, the child protective investigator may restrict the alleged perpetrator’s access to the child if:

The caregiver has harmed a child or made credible threats to harm a child and continues to have access to the child, or
The investigator determines that the safety measures of the facility are insufficient to ensure that a child is not further harmed.

(f) Determine the child’s need for services, if any, and advise the child’s parent or legal custodian of the community resources available to help the child and family cope with the maltreatment.

(g) Discuss the report findings and the child’s need for services or treatment with the child’s parents or legal guardians, case manager and/or DJJ counselor, if assigned and guardian ad litem, if appointed.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.302 FS. History–New 5-4-06, Amended 12-31-14.

Fla. Admin. Code R. 65C-29.005 Children Denied Shelter (Lockouts)

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.01, 39.012, 39.201, 39.301 FS. History–New 5-4-06, Repealed 12-31-14.

Fla. Admin. Code R. 65C-29.006 Foster Care Referrals

(1) Foster care referrals involve concerns about possible licensing violations and regulatory infractions for children in an emergency shelter or out-of-home placement, or placement disruptions, case plan, and safety plan violations for children under the supervision of the Department or its authorized agents. Foster care referrals do not contain allegations of abuse, neglect or abandonment. If child maltreatment is identified or suspected during assessment of the foster care referral, the responder shall contact the Florida Abuse Hotline for the purpose of reporting the maltreatment and initiating a separate child protective investigation.

(2) The unit or agency responsible for licensing the foster home, group home or emergency shelter home shall initiate the assessment within 72 hours of receipt of the referral.

(3) In cases involving licensed care, the licensing unit or agency staff shall complete the assessment and determine corrective actions required, if any, within five (5) working days of the receipt of the referral.

(4) In cases involving unlicensed relatives, non-relative caregivers, or families under the supervision of the Department or its authorized agents, the assigned child welfare professional shall complete the assessment and determine corrective actions required, if any, within five (5) working days of the receipt of the referral.

History

Rulemaking Authority 39.012, 39.0121, 409.175 FS. Law Implemented 39.201, 409.175(8)(b) FS. History–New 5-4-06, Amended 12-31-14, 1-7-19.

Fla. Admin. Code R. 65C-29.007 Child-on-Child Sexual Abuse

(1) To reduce the stigma of child-on-child sexual abuse and reduce further harm to the child victim(s), the child protective investigator shall use a family-centered, trauma-informed approach to conduct the assessment process.

(2) Referrals for services shall not be initiated when, in the determination of the protective investigator, the reported incident contains elements of normal sexual exploration that is voluntary, spontaneous, and typically involves same-age children.

(3) Referrals for services shall be initiated when sexual behaviors are documented to be repetitive, unresponsive to adult intervention and supervision, equivalent to adult criminal violations, and pervasive – representative of a wide array of developmentally unexpected sexual acts.

(4) Case planning and determination of treatment needs are to be conducted through a multi-disciplinary staffing approach involving the child’s parents, child protective investigative staff, law enforcement, representatives of the child protection team of the Department of Health or Children Advocacy Centers, and community-based care providers under contract with the Department to provide ameliorative and treatment services as appropriate.

(5) In those situations where the parent or legal guardian does not agree with the multidisciplinary staffing recommendations for further assessment or treatment for the juvenile sexual offender or child exhibiting inappropriate sexual behavior, the child protective investigator will staff the case with Children’s Legal Services for consideration of filing a petition for dependency to address the child’s on-going need for therapeutic interventions.

History

Rulemaking Authority 39.012, 39.0121, 39.307(7) FS. Law Implemented 39.307 FS. History–New 5-4-06, Amended 12-31-14.

Fla. Admin. Code R. 65C-29.008 Initial Health Care Assessment for Children Alleged to Be Abused, Neglected or Abandoned

(1) Unless a child is exhibiting signs or symptoms of illness, an initial health care assessment by a licensed health care professional shall be completed for every child placed with a relative, non-relative, or in licensed care within five (5) working days of the removal. A child who appears to be sick or in physical discomfort shall be examined by a licensed health care professional immediately but not longer than 24 hours.

(2) Whenever possible, the assessment should be conducted by the child’s regular pediatrician, physician’s assistant, or nurse practitioner. In instances when the child has not been regularly seen by a pediatrician, physician’s assistant, or nurse practitioner, the assessment shall be completed by one of the following listed in preferential order:

(a) A physician, physician’s assistant, or nurse practitioner selected by the parent or legal guardian, or

(b) Medical staff from the Child Protection Team (CPT).

(3) Only non-invasive medical procedures may be used on children during health care assessments unless the child’s parent gives permission or a court order has been obtained authorizing the invasive procedure. Any procedure that involves penetration of the child’s skin or internal body cavity beyond a natural or artificial body orifice is considered invasive.

History

Rulemaking Authority 39.012, 39.0121, 39.407 FS. Law Implemented 39.407 FS. History–New 5-4-06, Amended 12-31-14, 12-29-24.

Fla. Admin. Code R. 65C-29.009 Criminal, Juvenile and Abuse/Neglect History Checks

(1) For each report received, the child protective investigator shall request a local history check from local law enforcement on all subjects of the report, household members and any adult visitor to the home who provides care or supervision of the child outside the parent’s immediate presence within 24 hours of the person’s identity and demographic information becoming known to the investigator. The request for the local law enforcement history check shall include any call-out history to the family’s residence.

(2) For any persons residing in the household or additional subjects of the report that were not included in the initial record checks completed by the Florida Abuse Hotline, the child protective investigator shall request the Hotline to complete additional checks on these individuals within 24 hours of the person’s identity and demographic information becoming known to the investigator; and

(a) Perform a check of the Department’s statewide automated child welfare system for prior and/or current child protective investigations and/or ongoing services involvement with these persons.

(b) Request a local criminal history check from local law enforcement.

(c) Perform a Florida Clerk of the Courts search in the household member’s county of residence or a search of the Comprehensive Case Information System (CCIS), in cases when a placement is being considered.

(3) If the family has moved to Florida from another state within the past five (5) years, the child protective investigator shall contact the appropriate law enforcement and child protection agencies in the state where the family resided and request a criminal, including local, and abuse history check on all subjects and household members of the report.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.301 FS. History–New 5-4-06, Amended 12-31-14, 11-15-20.

Fla. Admin. Code R. 65C-29.010 False Reports

(1) When a child protective investigator suspects that a false report has been made, the investigator shall advise the reporter of the potential administrative fines, civil and criminal penalties associated with the filing of a false report.

(2) In determining whether a report has been filed maliciously, the Department shall consider the following factors:

(a) There are no indicators of abuse, neglect or abandonment as alleged in the report.

(b) The reporter has made contradictory or inconsistent statements when questioned about how the reported information was obtained.

(c) Prior allegations made by this reporter have been determined to be patently unfounded or to have no indicators of abuse, neglect or abandonment.

(d) There is credible evidence that the reporter has a history of disputes or seeking retaliation against the alleged perpetrator or other family members.

(e) There is a history of unresolved custody issues between the reporter and the alleged perpetrator or other family members.

(3) Child protective investigators and child protective investigator supervisors shall, in consultation with the Children’s Legal Services attorney, and with the consent of the alleged perpetrator, refer the suspected false report to the local law enforcement agency having jurisdiction along with the following information:

(a) The report number and a copy of the investigative file;

(b) All factors that were considered in the determination that the report constitutes a suspected false report;

(d) The identification of the physical location from where the call originated.

History

Rulemaking Authority 39.012, 39.0121, 39.205(7) FS. Law Implemented 39.206, 39.205(7) FS. History–New 5-4-06, Amended 12-31-14.

Fla. Admin. Code R. 65C-29.011 Out-of-Town Inquiries

(1) Out-of-town inquiries (OTIs) are requests for information exchange between child protective investigators working in counties of different jurisdiction.

(a) Requests for interviews of subjects of reports;

(b) Requests for intra-state home studies for relative/non-relative emergency placements; and,

(2) Any request made on behalf of children that lawfully requires the initiation of interstate compact for placement of children procedures are not eligible to utilize the OTI process.

(3) OTIs may be initiated by a child protective investigator, the court, or an out-of-state social service agency.

(4) Upon initiating the request for an OTI, the investigator requesting the OTI shall document the purpose for the request and the specific actions required to be completed in the investigative record.

(5) OTIs shall be commenced within 24 hours of the receipt of the request unless the OTI involves an emergency placement or response to imminent child safety. When an emergency placement is being sought or imminent child safety is involved, the OTI shall be commenced immediately.

(6) OTIs requesting information for planned placements, adult subjects of a report, or children not alleged to be a victim shall be completed within five (5) working days of the receipt of the OTI request, unless otherwise agreed upon at the time of the OTI request. Upon completion of the OTI actions, the child protective investigator shall document all requested information in the investigative record.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.0121 FS. History–New 5-4-06, Amended 12-31-14.

Fla. Admin. Code R. 65C-29.012 Transfer of Child Protective Investigations Within and Between Circuits

(1) The transfer of a child protective investigation within and between circuits shall be initiated by the supervisor requesting the transfer via telephone or e-mail within 24 hours of identification of the need for transfer.

(2) Prior to initiating the request for transfer, the supervisor shall ensure that all information collected to date and the specific circumstances warranting the transfer are fully documented in the investigative file.

(3) Any disagreements regarding the acceptance of a transfer request between supervisors shall be referred directly to each region’s program manager or designee for resolution within 24 hours of the refusal of the transfer request.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.0121 FS. History–New 5-4-06, Amended 12-31-14.

Fla. Admin. Code R. 65C-29.013 Diligent Efforts to Locate

(1) The child protective investigator shall make diligent efforts to locate a family prior to closing the investigation. When the family cannot be located at the time of the initial visit, the investigator shall conduct follow-up visits to the home during different times of the day and night, including weekends.

(2) If the family has not been located within 72 hours, the child protective investigator shall re-contact the reporter, if known, to determine if the family has recently moved or has fled to avoid the abuse investigation. If the reporter is anonymous and the child protective investigator has made diligent efforts to locate the child, the child protective investigator shall use the caller ID number in the abuse report to contact the reporter for the purpose of locating the child.

(3) When the child protective investigator has reason to suspect that the family has fled to avoid the investigation, the child protective investigator, child protective investigations supervisor, and counsel from Children’s Legal Services shall conduct a legal staffing to determine if sufficient probable cause exists to file a shelter petition based on credible evidence that the child is in imminent danger.

(4) When the child protective investigator has made a preliminary determination that the family has fled to avoid the investigation, a ‘Statewide Alert’ will be issued in ESFN.

(5) Prior to closing an investigation when a family cannot be located, the supervisor must determine if “diligent efforts to locate” the family have been expended. The supervisor must assess the following in making that determination:

(a) A thorough investigative search has been completed in an attempt to locate the family.

(b) A Statewide Alert has been issued on the family, when needed.

(6) Children who have been ordered to be taken into protective custody shall be referred to the Florida Department of Law Enforcement (FDLE) Missing Child Tracking System (MCTS) and on-going search activities shall be transferred to the Regional Criminal Justice Coordinator for the purpose of ensuring continuing efforts to locate the child.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.402 FS. History–New 5-4-06, Amended 12-31-14.

Fla. Admin. Code R. 65C-29.014 High Risk Tracking and Review

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.01, 39.012, 39.0121 FS. History–New 5-4-06, Repealed 12-31-14.

Chapter 65C-30 GENERAL CHILD WELFARE PROVISIONS

Fla. Admin. Code R. 65C-30.001 Definitions

This rule includes the definitions for the following rules: Chapter 65C-15, F.A.C., “Child-Placing Agencies”; Chapter 65C-16, F.A.C., “Adoptions”; Chapter 65C-28, F.A.C., “Out-Of-Home Care”; Chapter 65C-29, F.A.C., “Protective Investigations”; Chapter 65C-30, F.A.C., “General Child Welfare Provisions”; Chapter 65C-44, F.A.C., “Guardianship Assistance Program” Chapter 65C-45, F.A.C., “Levels of Licensure”; and Chapter 65C-46, F.A.C., “Child-Caring Agency Licensing.”

(1) “Additional Investigation Report” means a report to the Florida Abuse Hotline, by the same or different reporter, made prior to the date of investigation closure and containing information about one (1) or more subjects of an open report, which adds:

(a) New allegations of maltreatment;

(b) New incidents of the same maltreatment contained in the initial report;

(d) New information alleging that the immediate safety or well-being of the child is threatened thereby changing the investigation response time from a 24-hour response to an immediate response.

(2) “Adoption Exchange System (AES)” means the Department’s statewide information system of children receiving adoption services, and families seeking to adopt special needs children.

(3) “Adoption process” means any of the following: Recruitment of prospective adoptive parents; recruitment of individuals for the release of a child, including a child not yet born, for the purpose of adoption as part of a plan leading to the eventual placement of a child for adoption; provision of medical care or payment of maintenance costs and expenses during pregnancy in consideration for the release of a child for adoption; assessment and preparation of families before placement as part of a plan leading to the eventual placement of a child for adoption; and supervision of families, after placement and prior to the final adoption, has occurred.

(4) “Adult Household Member” means a person 18 years of age or older who is present in the home on a permanent or indefinite basis or the adult paramour who frequents the home of a household member, regardless of whether the person has unsupervised contact with children.

(5) “Allegation” means a statement by a reporter to the Florida Abuse Hotline that child abuse, neglect or abandonment is known or suspected.

(6) “Application Packet” means the entire set of completed documents required by the child-placing agency , child-caring agency, and foster home to provide to the Department for review when requesting the issuance of a license.

(7) “Attestation” means a community-based care lead agency’s certification that supporting documentation for the initial licensure or re-licensure of a family foster home is in compliance Section 409.175, F.S., with Florida state law and Chapter 65C-45, F.A.C.

(8) “Behavior Management Plan” means an agreement established with substitute caregivers to assist and supervise specific children that have behaviors that may result in harm.

(9) “Behavioral Health Multidisciplinary Team” means the group of people brought together by the child welfare professional to plan and coordinate behavioral health related services.

(10) “Capacity Waiver” means a documented approval, prior to placement, that authorizes exceptions to the licensed capacity and the total number of children or infants to be cared for in a family foster home.

(11) “Case” means a group of one (1) or more persons who are associated with one another and for whom the Department provides services and arranges the provision of services.

(12) “Case File” means all information for a case contained in the Department’s comprehensive child welfare information system (CCWIS), also referred to as the child welfare information system, as well as the supporting documentation gathered during provision of services to that family. The “case file” may also refer to a duplicate, paper copy of the electronic case file and the supporting paper documentation. The Department’s CCWIS is the official system of record for each intake, investigation, and all subsequent casework to provide a complete, current, accurate and unified case history.

(13) “Case Manager” means a child welfare professional who is responsible for ongoing safety management and service provision of children who, through assessment of a child protective investigator, have been determined to be unsafe.

(14) “Case Transfer” means the process of transferring primary responsibility for a case.

(15) “Child Health Check-up” means regular physical exams, growth measurements, immunizations, vision and hearing screenings, dental screenings and, if necessary, other tests, services, and referrals for diagnosis and treatment as outlined in the Florida Medicaid Child Health Check-Up Coverage and Limitations Handbook, October 2003, incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06455.

(16) “Child Maltreatment Index” is a document that defines specific types of abuse, neglect or abandonment; and guides decision making by staff at the Florida Abuse Hotline and Child Protective Investigations regarding screening decisions and investigative findings. The “Child Maltreatment Index,” CF Operating Procedure No. 170-4, (October 2025), is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18938.

(17) “Child-on-Child Sexual Abuse” means any sexual behavior between children which occurs without consent, without equality, or as a result of coercion.

(18) “Child-Placing Agency” as defined in s. 409.175, F.S.

(19) “Child Welfare Services” as defined in s. 402.40(2), F.S.

(20) “Child Protective Investigator (CPI)” means a child welfare professional who is responsible for investigating alleged child maltreatment and conducting assessments regarding the safety of children.

(21) “Child’s Resource Record” means a standardized record developed and maintained for every child entering out-of-home care that contains copies of the basic legal, demographic, available and accessible educational, and available and accessible medical and psychological information pertaining to a specific child, as well as any documents necessary for a child to receive medical treatment and educational services.

(22) “Child Welfare Professional” as defined in Rule 65C-33.001, F.A.C. means an individual who is primarily responsible for case activities that has met the criteria for Florida Certification as a Child Protective Investigator, Case Manager or a Licensing Counselor.

(23) “Children’s Legal Services (CLS)” means Department of Children and Families attorneys or attorneys from contracted entities dedicated to representing the Department in Chapter 39, F.S., proceedings.

(24) “Children’s Multidisciplinary Assessment Team (CMAT)” means an inter-agency coordinated effort of Medicaid in the Agency for Health Care Administration; the Department of Children and Families; the Agency for Persons with Disabilities; and Children’s Medical Services in the Department of Health. The CMAT makes recommendations for medically necessary services for children birth to 21 years old who are medically complex or medically fragile.

(25) “Collateral Contacts” mean face to face, telephonic or written communication with persons who provide relevant information for a child protection investigation but who are not subjects of the reports.

(26) “Commencement” means the date and time that the investigator attempted or achieved a face-to-face contact with the child victim by visiting the site where the victim was reportedly located.

(27) “Communicable Disease” means any disease caused by transmission of a specific infectious agent, or its toxic products, from an infected person, an infected animal, or the environment to a susceptible host, either directly or indirectly.

(28) “Community-Based Care ” or “lead agency” as defined in s. 409.986, F.S.

(29) “Comprehensive Behavioral Health Assessment (CBHA)” means an in-depth assessment of the child’s emotional, social, behavioral, and developmental functioning within the family home, school, and community, as well as the clinical setting.

(30) “Comprehensive Child Welfare Information System (CCWIS)” means the Department’s comprehensive, statewide automated system that supports child welfare practice. A CCWIS holds the state’s official case file for all children and families served and licensed providers and eligibility determinations to support IV-E reimbursement.

(31) “Concurrent Case Planning” or “Concurrent Planning” means as defined in Section 39.01(19), F.S.

(32) “Conditions for Return” means a written statement or statements of the specific conditions, circumstances, or behaviors that must exist within a child’s home before a child can safely return and remain in the home with an in-home safety plan while the parents continue to work towards reaching case plan outcomes.

(33) “Consent for Medical Treatment” or “Informed Consent for Medical Treatment” means consent voluntarily given after a sufficient explanation and disclosure of the purpose of the proposed treatment and the alternative treatments available.

(34) “Contracted Provider” means any licensed child-placing agency that has entered into a contract with the Department for the purposes of recruitment, training, evaluation and/or supervision of licensed out-of-home caregivers.

(35) “Contracted Service Provider” means a private agency that has entered into a contract with the Department or with a community-based care lead agency to provide supervision of and services to dependent children and children who are at risk of abuse, neglect, or abandonment.

(36) “County of Jurisdiction” means the county where the court of jurisdiction is located, or, in cases of non-judicial supervision, the county where the family has resided for 30 consecutive days.

(37) “Court Ordered Supervision” means the court has ordered the Department or contracted service provider to supervise the child and family over a period of time.

(38) “Criminal, Delinquency and Abuse/Neglect History Check” means the act of assessing the history of persons through a criminal records check pursuant to Section 435.04, F.S., and criminal, juvenile and abuse/neglect history checks pursuant to Section 39.0138, F.S., as described in Sections 39.401(3) and 39.521(2)(r), F.S.

(39) “Critical Junctures” means times during an investigation or services case when events that affect child safety are occurring in the investigation or services case. Critical junctures include the following:

(a) When safety analysis has resulted in a decision to remove a child from home.

(b) At the birth or death of a sibling or the addition of a new family member, including paramours.

(d) Before a child is returned home from substitute care.

(e) Before the case is closed or dismissal of court jurisdiction is recommended.

(40) “Danger Threat” means caregiver behaviors, attitudes, motives, emotions and/or situations posing a specific threat of severe harm to a child.

(41) “Emergency Medical Care and Treatment” means care or treatment of a child who has been injured or is suffering from an acute illness, disease, or condition if, within a reasonable degree of medical certainty, delay in initiation or provision of medical care or treatment would endanger the health or physical well-being of the child.

(42) “Level II Enhanced Foster Home” means a foster home in which the caregivers have completed additional training hours as specified in Rule 65C-45.002, F.A.C., is designed to accept placements for children with enhanced complexities, to include sibling groups, and is eligible to receive enhanced foster care room and board payments.

(43) “Evidence” for the purpose of child protective investigations means any and all materials, documents, first party observations and specific facts that are relevant to prove and support specific allegations of abuse, neglect or abandonment.

(44) “Exigent Circumstances” mean situations in which it is anticipated that a child will be placed with a relative or non-relative within 72 hours.

(45) “Extraordinary Medical Care and Treatment” means care or treatment of a child that is outside of the routine medical and dental care included in the definition of ordinary medical care and treatment. This includes surgery, anesthesia, and administration of psychotropic medications.

(46) “Family Made Arrangement” means a safety action intiated and completed by a parent/legal guardian to temporarily relocate a child from the family’s home to a responsible adult chosen by the parent/legal guardian.

(47) “Family Assessment,” “Family Functioning Assessment,” “Ongoing Family Functioning Assessment,” and “Progress Update” means a decision-making and documentation process conducted in response to a child abuse and/or neglect report or any other instances in which safety needs to be assessed throughout the life of an active investigation or ongoing services case to help evaluate danger threats, child vulnerability, parental protective capacities and to determine the safety response, case outcomes and goals.

(48) “Family Preservation Services” mean services provided to children (and their families) that have been found to be unsafe and include safety management services, treatment services and child well-being services.

(49) “Family Support Services” mean services provided to children (and their families) who have been found to be safe and at high or very high risk of future maltreatment.

(50) “Family Team Meeting” means the process that enables families to create and utilize a team of persons and professionals to assist with safety and/or case planning.

(51) “Family Time” means vistation and other forms of contact between children and parents, siblings who are separated, and grandparents.

(52) “Finding” means the investigative determination that there is credible evidence to support or refute the alleged child maltreatment.

(53) “Florida Abuse Hotline” means the Department’s central abuse reporting intake assessment center, which receives and processes reports of known or suspected child abuse, neglect or abandonment 24 hours a day, seven days a week.

(54) “Licensing Referrals” mean calls to the Florida Abuse Hotline regarding concerns about the care provided in a licensed foster home or child-caring agency and by the child-placing agency, that do not meet the criteria for acceptance of a report of abuse, neglect or abandonment.

(55) “Group Care Facility” or “Licensed Group Care Facility” means a “residential child-caring agency” as defined in Section 409.175, F.S.

(56) “Guardianship” means a legally established relationship between a child and adult who is appointed to protect the child’s best interests and to provide the child’s care, welfare, education, discipline, maintenance, and support.

(57) “Household” means a common residence shared by two (2) or more individuals, whether related or not.

(58) “Household Member” means any person who resides in a household, including the caregiver and other family members residing in the home. Household members include adult visitors to the home who provide care of the child outside the parent’s sight and/or sound supervision.

(59) “Immediate” or “immediately” means as soon as possible, but no later than four (4) hours.

(60) “Inappropriate Sexual Behavior” means sexually reactive behaviors of a child including acting-out sexually, engaging in inappropriate sex play for age and maturity or demonstrating a premature understanding of sex.

(61) “Independent Living Services” means services to assist older children in foster care and young adults who were formerly in foster care obtain life skills and education for independent living and employment, have a quality of life appropriate for their age, and assume personal responsibility for becoming self-sufficient adults.

(62) “Indian Child Welfare Act (ICWA),” 25 U.S.C. 1901 et seq, means the federal act that governs child custody proceedings involving American Indian or Alaskan Native children in state courts.

(63) “Individual Educational Plan (IEP)” means a written assessment for a child with a disability or special educational needs that is developed and implemented in accordance with the “Individuals with Disabilities Education Improvement Act of 2004 (IDEA),” 20 U.S.C. §1400 et seq.

(64) “Informal safety service provider” means a responsible adult identified by a parent or legal guardian who agrees to provide safety management services as specified in a safety plan.

(65) “Interstate Compact” or “Interstate Compact on the Placement of Children (ICPC)” means a uniform law enacted in all fifty states, the District of Columbia and the U.S. Virgin Islands. It establishes a contract among the states and jurisdictions that ensures orderly procedures for the interstate placement and post-placement supervision of children and codifies responsibilities for those involved in placing the child.

(66) “Investigative Search” means making inquiries of written records and electronic databases to locate subjects of a report when reasonable efforts to locate the family have been expended, but failed to locate the family.

(67) “Licensed family foster home” means “family foster home” as defined Section 409.175, F.S.

(68) “Licensed Out-of-Home Caregiver” means any person or agency licensed under Section 409.175, F.S., to provide 24 hour care. This term also refers to foster parents.

(69) “Licensing Authority” means the Department of Children and Families.

(70) “Maltreatment” means behavior that is harmful and destructive to a child’s cognitive, social, emotional, or physical development. This is referenced in the Child Maltreatment Index, incorporated in subsection (16) of this rule as the harm that occurred as the result of maltreatment.

(71) “No Jurisdiction” means a designation given to abuse reports that have been accepted by the Florida Abuse Hotline, but upon further investigation or after the initial contact, the CPI determines that the Department does not have the authority to investigate because the allegations and/or facts surrounding the report do not meet statutory criteria including:

(a) The alleged perpetrator is a staff member in a general hospital, while acting in an official capacity (excluding a psychiatric ward);

(b) The alleged perpetrator is a law enforcement officer or employee of a jail, municipal or county detention facilities, Juvenile Bootcamp Facility, or Department of Corrections, while acting in an official capacity;

(d) The allegations are of harm or threatened harm to a child who is residing and located in another state at the time of the report, or

(e) The allegations are of harm or threatened harm to a child who resides on federal property such as an Indian reservation or military base (unless there is an agreement with the appropriate authorities to surrender jurisdiction to the Department).

(72) “Non-judicial case” means the child has been determined to be unsafe, a safety plan is required and the family has consented to services and supervision aimed at addressing the conditions that make the child unsafe.

(73) “Non-relative” or “non-relative caregiver” means any person who does not meet the definition of a relative and who is caring for a child placed in his or her custody.

(74) “Other Parent Home Assessment” means the assessment of a parent and the parent’s household prior to the child’s release or placement, in order to determine if the parent will be able to safely care for the child.

(75) “Ordinary Medical Care and Treatment” means ordinary and necessary medical and dental examinations and treatments. Included in this definition are blood testing, preventive care including ordinary immunizations, tuberculin testing, and well-child care.

(76) “Out-of-County Services” mean supervision and/or services provided when case participants reside in multiple counties.

(77) “Out-of-Home Care” means the placement of a child in licensed and approved settings, arranged and supervised by the Department or contracted service provider, outside of the home of the parent.

(78) “Partnership Plan” means a written agreement between licensed out-of-home caregivers and the supervising agency representative that specifies each party’s duties and responsibilities to children served and to the Department and/or child-placing agency.

(79) “Patently Unfounded” means incidents reported in good-faith to the Hotline which, after intitial contact with participants, are subsequently determined to have no basis in fact as demonstrated by readily observable and corroborated information. This is not the presence of evidence to refute or the absence of evidence to support the maltreatment, but rather the presence of evidence in direct contrast to what was reported.

(80) “Permanency” means achieving a permanent home for a child in accordance with Section 39.621, F.S.

(81) “Permanency Hearing” means a judicial review hearing conducted pursuant to Section 39.621(4), F.S.

(82) “Permanency Staffing” means a case review meeting prior to each permanency hearing for the purpose of permanency goal planning for a child.

(83) “Placement” means the supervised placement of a child in a setting outside the child’s own home.

(84) “Post-Placement Supervision” means services provided to children and families upon reunification, which aim to support and preserve the family unit during the transition period.

(85) “Primarily Lives and Works Outside of Florida” means anyone who does not meet the definition of “primary residence and place of employment in Florida.”

(86) “Primary Residence and Place of Employment in Florida” means a person who lives and works in Florida at least six (6) months of the year and intends to do so for the foreseeable future or military personnel who designate Florida as their place of residence in accordance with the Servicemembers Civil Relief Act, 50 U.S.C. App. §§501-597b.

(87) “Psychotropic Medication” means any medication prescribed with the primary intent to stabilize or improve mood, mental status, behavioral symptomatology, or mental illness.

(88) “Reasonable Effort to Locate” means that the overall efforts of a child protective investigative unit have been sufficiently thorough to allow for case closure despite the inability to locate the family within 60 days of receipt of the report. Reasonable efforts to locate include contacts to locate the child through the school system, Economic Self Sufficiency records, additional contacts with the reporter or others named in the report, and telephone or city directory checks.

(89) “Receiving County” means the county to which a child or family is relocating or has relocated while supervision and services continue.

(90) “Receiving Unit” means the staff in a child protective investigations unit to which a request for an out-of-town inquiry (OTI) or a report transfer is made.

(91) “Relative Caregiver” means a person who meets the definition of a relative as set forth in Sections 39.5085(2)(a)1.-3., F.S.

(92) “Relative Caregiver Program (RCP)” means a program defined in Section 39.5085(2), F.S., and includes non-relative caregiver financial assistance.

(93) “Removal Episode” means the entire period of time a child is in out-of-home care, beginning with the child’s removal from his or her primary residence and ending when permanency is achieved, the child becomes 18 years old, the child is emancipated by marriage or a court order, or the child dies. A new removal episode begins with each reentry into care.

(94) “Report” or “Hotline Report” or “Intake” means the document created from an allegation to the Florida Abuse Hotline alleging knowledge or a suspicion that a child has been abused, neglected, or abandoned by a parent, guardian, adult household member or other person responsible for a child’s welfare.

(95) “Residential Treatment Center” means “Residential treatment center for children and adolescents” as defined in Section 394.67, F.S.

(96) “Respite Care” means the temporary, (over 24 hours) intermittent care of a foster child by an individual other than the child’s out-of-home caregiver, regardless of whether the respite provider is paid by the lead agency.

(97) “Reunification” means the safe return of a child to the child’s home with an in-home safety plan.

(98) “Safe” means the absence of danger threats to a child.

(99) “Safety Management Services” means services that will manage or control the condition that is making a child unsafe.

(100) “Second Tier Consultation” means a consultative process in which additional guidance and feedback related to an open child protective investigation is received from a manager.

(101) “Sending County” means the county of jurisdiction that makes a request for supervision or continuation of non-judicial supervision to a receiving county when a child or family receiving services is relocating or has relocated to another county.

(102) “Sending Unit” means the staff in a child protective investigations unit initiating a request for an out-of-town inquiry (OTI) or an investigation transfer to another unit.

(103) “Sex” means the classification of a person as either male or female based on the organization of the human body of such person for a specific reproductive role, as indicated by the person’s sex chromosomes, naturally occurring sex hormones, and internal and external genitalia present at birth.

(104) “Shelter Status” means the legal status that begins when the child is taken into protective custody of the Department and ceases when the court grants custody to a parent, or, after disposition of the petition for dependency, the court orders the child released to a parent or placed in the temporary custody of the Department, a relative, or a non-relative.

(105) “Significant Caregiver Responsibility” means that the specific adult household member has taken responsibility for major caregiving duties.

(106) “Special Condition Referrals” means requests brought to the attention of the Department that require a response by the Department or lead agency. These requests do not constitute willful abuse, neglect, or abandonment. These include the following situations:

(a) When the caregiver has been or is about to be incarcerated and plans must be made for the child’s immediate care;

(b) When the caregiver has been or is about to be hospitalized and plans must be made for the child’s immediate care;

(d) When the caregiver is having difficulty caring for a child to the degree that it appears very likely that without intervention, abuse, neglect, or abandonment will occur;

(e) Licensing referrals,

(f) Service referrals, or

(g) Reports of child on child abuse.

(107) “Subject of a Report” means any person named in an abuse, neglect or abandonment report.

(108) “Supervision” means responsibility for managing a safety plan and a case plan to ensure enhancement of diminished protective capacities and/or permanency for unsafe children.

(109) “Supervising Agency” means any licensed child-placing agency that oversees and supports a family foster home and assists applicants in the licensing process.

(110) “Supplemental Report” means a report, whether by the same or another reporter, pertaining to the same incident currently under investigation, which involves the same subjects and same alleged maltreatments, but improves upon what is already known, such as providing a better address, corrected spelling of names, or other collateral contacts. These reports do not always require additional investigative activity, however upon review may warrant action.

(111) “Threatened Harm” means a behavior that is not accidental and which is likely to result in harm to the child.

(112) “Tribal Agreement” means a formal written agreement between the Department and a federally recognized American Indian tribe that guides interaction between the Department and the tribe in matters pertaining to child welfare, including child protective investigations and proceedings involving American Indian and Alaskan Native children in state courts.

(113) “Unified Home Study” or “homestudy” means written documentation of an on-site assessment of a potential caregiver that is completed prior to the child’s placement to evaluate the caregiver’s capacity to provide a safe, stable, and supportive home environment, and determines if the physical environment is safe and can meet the child’s needs.

(114) “Voluntary Licensed Placement” means placement of a child in licensed out-of-home care when a parent or legal guardian requests the assistance of the Department or contracted service provider in planning for the temporary care and supervision of a child.

(115) “Well-Being” means a child’s emotional, developmental, educational, social, physical and mental health needs.

History

Rulemaking Authority 39.012, 39.0121, 39.5085(2)(a), 409.175(5) FS. Law Implemented 39.401(3), 39.5085, 39.521, 39.701, 409.145(1), 409.165(1), 409.401, 409.175 FS. History–New 5-4-06, Amended 2-25-16, 6-29-17, 12-4-17, 10-22-18, 6-3-20, 10-24-21, 1-11-26.

Fla. Admin. Code R. 65C-30.002 Safety Planning and Case Transfer

(1) Prior to case transfer, the child protection investigator (CPI) is responsible for development, management and modification of safety plans; after case transfer the case manager is responsible for ongoing safety plan development, for safety management, including safety plan modifications. The child welfare professional will have access to an array of formal safety management services available through the lead agency.

(2) All safety plans shall be developed with the involvement of the child’s parents or legal guardians and in-home plans shall contain the safety management services required to prevent removal or reentry of the child.

(a) Present danger threats shall be addressed prior to the child welfare professional leaving the home, unless their personal safety is threatened by their presence within the home. If the child welfare professional has to leave the home to ensure their own safety, law enforcement shall be contacted, and the plan implemented as soon as it’s safe to return to the location;

(b) The child welfare professional responsible for the case shall develop a safety plan in response to impending danger threats.

(3) An in-home safety plan will be developed in response to impending danger when all of the following conditions are met:

(a) The parents/legal guardians are willing for an in-home safety plan to be developed and implemented and have agreed to cooperate with all identified safety service providers;

(b) The home environment is calm and consistent enough for an in-home safety plan to be implemented and for safety service providers to be in the home safely;

(d) The results of scheduled professional evaluations are not necessary for purposes of safety planning; and,

(e) The parents/legal guardians have a physical location in which to implement an in-home safety plan.

(4) The child welfare professional responsible for the safety plan must determine that any informal provider, including relatives or a parent not in the home, is capable of, and has committed to, implementing his or her role in the safety plan.

(a) The child welfare professional responsible shall ensure that child abuse and criminal history checks are completed on all informal providers.

(b) When an out-of-home plan is initiated, the child welfare professional must complete face-to-face contacts with the child and caregiver at least once every seven (7) calendar days.

(c) In all cases involving an American Indian or Alaskan Native child in which either an out-of-home plan is initiated, or the potential outcome is a dependency action, the Indian Custodian and the child’s tribe shall be notified immediately of the pending placement with notification of all subsequent staffing or case transfer activities as required by the Indian Child Welfare Act. The child welfare professional shall also check to see if there is an Agency Memorandum of Agreement in place with the respective Indian tribe and follow all outlined requirements.

(5) When an out-of-home safety plan for impending danger is initiated, the conditions for return and visitation with the parent will be established.

(a) The child welfare professional responsible for the case shall determine the child’s supervision and care needs pursuant to Rule 65C-30.023, F.A.C., to ensure that the child is placed with a responsible adult who can meet the child’s needs.

(b) The child welfare professional responsible for the case shall complete:

An Other Parent Home Assessment if releasing or placing the child with a parent, or
The Unified Home Study functionality in the child welfare information system if placing the child with a relative or non-relative caregiver.

(6) Once the investigation and family functioning assessment have been completed, the CPI shall schedule a case transfer conference at which time a case manager will assume responsibility for ongoing safety and case management.

(a) The CPI or child protective investigator supervisor shall present the case to the lead agency or its designee at the case transfer conference.

(b) The case transfer conference shall:

Address the identification of danger threats, caregiver protective capacities and child vulnerability, including assessment information provided by the Child Protection Team;
Share all critical information on the family, including the parent’s or legal guardian’s level of cooperation in complying with safety actions as part of a lead agency managed safety plan;
If a child has been voluntarily moved outside the family home by a parent as a part of a family made arrangement, discuss:

a. The reasons for short term separation;

b. Parents retention of full legal responsibility including decision-making authority and access to the child;

c. Impacts to the child’s safety given the parents retention of rights;

d. The safety manager’s ability to care for and protect the child; and

e. How long the short-term arrangement will last.

If a child has been removed from the home by the Department, discuss the conditions for return related to the reasons for removal; and
Ensure a smooth transition from one component of the child protection/child welfare system to another.

Up-to-date investigative activities;
A completed family functioning assessment containing sufficient, reconciled and corroborated assessment information. Sufficient means enough information has been gathered to support the identification of danger threats, caregiver protective capacities, and child vulnerability;
The name and location of child’s school and/or child care provider, if available;
The name and location of child’s medical provider(s) and any health or medical information, if available;
Any documented diligent efforts to identify and locate all relatives of the child, to include parents of siblings;
The child’s date and location of birth if the child is under court ordered supervision, if available;
A photograph of the child who was removed or will be placed under court ordered supervision, if available;
Fingerprints of the child placed in out-of-home care, if available;
The status of the inquiry into whether the child may have Native American heritage;
The results of criminal, delinquency and abuse/neglect history checks performed on a relative or non-relative caregiver;
Any court or other documents related to shelter; and,
Any other documentation or actions agreed upon between the Department staff or sheriff’s office performing the investigation and the contracted service provider.

(d) Once the case transfer conference has been completed, full responsibility for the case by the case management provider will begin, including monitoring or modifying the safety plan.

(e) In non-judicial cases, the case manager shall seek court supervision of a case if the parent(s) are not demonstrating efforts to achieve case plan outcomes that address the child’s need for safety or if a higher level of intrusiveness is required to manage child safety.

(f) There shall be no discrimination against a child based on the child’s immigration status.

(7) Child welfare professionals shall work collaboratively to determine all additional actions related to safety plan modifications, pursuant to Rule 65C-30.015, F.A.C., to ensure the child’s needs for safety, permanency, and wellbeing are met. If consensus cannot be reached between the CPI, case manager, service provider(s), and Children’s Legal Services related to safety plan modifications, a multidisciplinary staffing shall be conducted within 14 business days to address ongoing concerns;

(a) The child welfare professional responsible for the case shall schedule the multidisciplinary staffing;

(b) Additional stakeholders to attend the staffing may include, but are not limited to, the child protective investigator’s supervisor, case management agencies supervisor, program directors, and guardian ad litem.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.301(7), (9), 39.402(7), (15), 39.522(1) FS. History–New 5-4-06, Amended 2-25-16, 9-9-19, 11-25-24.

Fla. Admin. Code R. 65C-30.003 Diligent Search

(1) Within 30 calendar days of the removal of a child from the physical custody of his or her parent or guardian, the child protective investigator (CPI) shall initiate a diligent search to identify and locate any absent parent.

(a) If the child remains in out-of-home care following closure of an investigation by a CPI, the case manager shall continue diligent search activities until released by the court.

(b) In addition, the CPI shall initiate and the case manager shall continue diligent efforts to locate and provide notice to the following relatives: all adult grandparents, all parents of a sibling of the child, where such parent has legal custody of such sibling, and other adult relatives of the child (including any other adult relatives suggested by the parents).

(2) Other Diligent Search Activities.

(a) When a child is in an out-of-home placement with a relative or non-relative and the placement disrupts, the child welfare professional shall make diligent efforts to locate an adult relative, legal custodian or other appropriate adult willing and able to care for the child.

(b) When the diligent search involves an American Indian or Alaskan Native child, documentation of written correspondence with the child’s tribe and to the Secretary of the Interior through the Eastern Regional Office of the Bureau of Indian Affairs shall be included in the case file by the case manager and included in the court record.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.502(8), (9) FS. History–New 5-4-06, Amended 2-25-16.

Fla. Admin. Code R. 65C-30.004 Identification of Children

(1) Photographing of Children.

(a) Children to be photographed:

All children under court ordered supervision in-home shall be photographed within 15 days after the case has been staffed and transferred.
All children placed in out-of-home care shall be photographed within 72 hours of the beginning of a removal episode.
Upon return to care, any child who has been on runaway status shall have his or her photograph taken immediately.

(b) The child’s identity shall be verified by the child welfare professional or other staff person familiar with the child. The photograph and identifying information shall be maintained in the child welfare information system.

(c) Photographs shall be updated at the completion of each home visit for children involved in ongoing services as follows:

For children under the age of five (5) years, every six (6) months; and,
For all other children, annually.

(2) Fingerprinting of Children.

(a) For any in out-of-home care that has a missing child episode, fingerprinting must be obtained no later than 1 hour upon initial recovery. The record of the fingerprints shall be maintained in the child’s case file. If the child is under age three (3), a means of obtaining the child’s footprints shall be explored.

(b) These fingerprints shall be used only to identify a child who is missing.

(3) Birth Verification of Children.

(a) A copy of a birth certificate or birth verification shall be obtained for each child under court ordered in-home supervision within 30 days after the case transfer conference.

(b) A copy of a birth certificate or birth verification shall be obtained for each child entering out-of-home care within 45 days after the case transfer conference.

(c) For children born out-of-state or out-of-country, verification of the child’s birth shall be requested within 15 days from initial placement and documented in the case file. Refer to subsection 65C-30.007(12), F.A.C., regarding the necessary actions when it is determined that a child was born in another country and has not established legal alien status.

(4) Social Security Cards for Children

(a) For children in out-of-home care, the child welfare professional shall request a copy of the child’s social security card within 30 days after the case transfer conference.

(b) For newborns who have not had an application for a social security card submitted, the child welfare professional shall submit an application within 15 days of the case transfer conference.

(5) At the time of adoption finalization, it is the responsibility of the case manager to coordinate with the adoptive parents to determine whether the child will have a new Social Security Number (SSN) or retain the same SSN after adoption.

(6) Dental Records of Children. The child welfare professional shall obtain dental records for children ages three (3) and older in out-of-home care every seven (7) months.

History

Rulemaking Authority 39.012, 39.0121(3), (13), 39.5075(8), 63.233 FS. Law Implemented 39.5075 FS. History–New 5-4-06, Amended 2-25-16, 11-25-24.

Fla. Admin. Code R. 65C-30.005 Ongoing Family Functioning Assessment

(1) The case manager shall complete an ongoing family functioning assessment within 30 calendar days following the case transfer.

(a) The progress update shall be updated and approved at least every three (3) months or at critical junctures until termination of services.

(b) Ongoing family functioning assessments and progress updates will be documented using the child welfare information system functionality.

(2) The ongoing family functioning assessment involves the case manager and the family in a joint effort to identify and analyze the family strengths and resources, child well-being, as well as the contributing factors and underlying conditions that contribute to the child’s safety and risk of maltreatment. The ongoing family functioning assessment must include information from the Initial Health Care Assessment and Comprehensive Behavioral Health Assessment, and the Comprehensive Placement Assessment.

History

Rulemaking Authority 409.145(5) FS. Law Implemented 409.145(1) FS. History–New 5-4-06, Amended 2-25-16, 11-25-24.

Fla. Admin. Code R. 65C-30.006 Case Planning

(1) Each child under Department or contracted service provider’s supervision shall have a case plan developed and documented using the case plan functionality in the child welfare information system using the Ongoing Family Functioning Assessment to guide case plan outcomes.

(2) Case Plan Development.

(a) Case management shall develop a case plan in consultation with the family and child, if age and developmentally appropriate.

(b) Prior to signing the case plan, the Department shall explain the provisions of the plan to all persons involved in its implementation, including, when appropriate, the child.

Comply with the case plan so permanency with the child may occur within the shortest period of time possible, but no later than one (1) year after removal or adjudication of the child;
Notify all parties and the court of barriers to completing case plan tasks within seven (7) business days of being made aware of the barrier;
Maintain contact with their attorney and their case manager and provide updated contact information if their phone number, address, or e-mail address changes; and
Provide the court and all parties with identification and location information for individuals who may be available as a placement for the child in out of home care.

(d) When a child is placed in a qualified residential treatment program or behavioral qualified residential treatment program (QRTP or BQRTP), the case plan must include the following:

Documentation outlining the most recent assessment recommendation for placement;
Date of the most recent placement;
The treatment or service needs of the child;
A transition plan for the child specifying the following:

a. Placement setting upon discharge;

b. Efforts to achieve permanency if child remains in out-of-home care;

c. Discharge criteria; and

d. Aftercare support recommendations for the child and caregiver(s).

A copy of the signed QRTP Extended Placement Request approval by the Department, if a child is placed in a BQRTP and QRTP setting for longer than 12 consecutive months or 18 nonconsecutive months, or in the case of a child who has not attained age 13, for more than 6 consecutive or non-consecutive months. The QRTP Extended Placement Request form is incorporated in Rule 65C-28.021, F.A.C. See Rule 65C-28.021, F.A.C. for approval criteria.

(3) The case manager shall seek court supervision of a case when the parent(s) are not demonstrating efforts to achieve case plan outcomes that address the child’s need for safety.

(4) Every case involving a child in an out-of-home placement shall be evaluated to determine if concurrent case planning is appropriate.

(5) The case manager shall:

(a) For judicial cases, refer parents for services no later than seven (7) calendar days after the date of the case plan approval by the court, unless the case plan specifies that a task may not be undertaken until another specified task has been completed or otherwise approved by the court.

(b) For non-judicial cases, refer parents for services no later than seven (7) calendar days after the date the case plan was signed by the parent.

(d) Meet with the parent(s) to discuss plan progress, eliminate barriers to case progress, resolve conflicts or disagreements and discuss the expected frequency of such meetings.

(e) Ensure that tasks and services necessary to meet the child’s well-being needs as identified in the Family Functioning Assessment and the Comprehensive Behavioral Health Assessment (CBHA) are documented in the case plan and that services are obtained to meet these needs, including a referral within seven (7) days of removal for a CBHA for any child who is in out-of-home care and has been determined to be Medicaid enrolled, as per Rule 65C-28.014, F.A.C.

(c) Ensure that visitation between a child in an out-of-home placement and his or her separated siblings, parents, relatives and other people of significance in the child’s life is addressed in the case plan.

(6) Case Plan Updates and Amendments.

(a) The case plan shall be updated or amended, as necessary in the following circumstances:

The court orders a change or makes decisions that affect the case plan,
There is a change in the child’s placement, which affects the case plan,
A change occurs with the parents protective capacities,
The child’s permanency goal changes,
New information concerning the child’s safety or well-being is obtained that was not available at the time the previous case plan was prepared, or
There was an error or oversight in the case plan.

(b) Prior to amending the case plan, the case manager shall:

Discuss the changes with the parents, guardian ad litem, current caregivers, service providers, the CLS attorney and the child, when appropriate,
Provide the CLS attorney with modifications to the case plan for filing with the court.

(c) Extraordinary Circumstances. If circumstances are so extraordinary that an extension of the case plan beyond 12 months is warranted and is in the child’s best interests, the reasons for the extension shall be specifically documented and presented to the court. The request for extension shall be made no later than the 12-month permanency review hearing with supportive documentation contained in the Judicial Review Social Study Report.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.6011, 39.6012, 39.6013, 39.602 FS. History–New 5-4-06, Amended 2-25-16, 12-22-19, 3-15-21, 11-25-24.

Fla. Admin. Code R. 65C-30.007 Case Management Responsibilities After Case Transfer

(1) Contacts with Children.

(a) The case manager shall make face-to-face contact with every child under supervision and living in Florida no less frequently than every 30 days in the child’s residence. If the child lives in a county other than the county of jurisdiction, this shall be accomplished as provided in Rule 65C-30.018, F.A.C.

(b) Initial contact shall occur within two (2) working days of case transfer or the date of the court order for supervision, whichever occurs first.

(d) The safety plan shall establish the frequency of visitation by the case manager, but in no case shall the contact be less frequently than every 30 days.

(e) Face-to-face contacts with the child and caregiver shall occur at least once every seven (7) days as long as the child remains in shelter status. The frequency of contact, while in shelter status, may be modified after the case management supervisor documents in the child welfare information system that all of the following conditions have been met:

The child is in the care of a relative, non-relative, or a licensed foster parent and is not demonstrating any behaviors that may lead to a placement disruption.
The child has not experienced any placement changes and the case has been open to case management for more than 30 days.
The child’s needs have been assessed and all therapeutic services needed are being provided.
The child, if developmentally appropriate, and the out-of-home caregiver are in agreement with the modification to the frequency of contact with the case manager.
The safety plan for the family does not require more frequent face-to-face contact between the child and case manager.

(f) If the frequency of face-to-face visits while in shelter status are modified pursuant to paragraph (e), above, the case manager must document the reasons why the child is still in shelter status in the child welfare information system.

(g) After disposition, the frequency of contacts may be modified, but in no case shall contacts be less frequently than every 30 days for a child.

The case manager must document all contacts in the child welfare information system, including case plan and safety plan monitoring, no later than 2 business days from the contact.
Contact with a child outside the child’s current place of residence shall occur in an environment in which the child is comfortable, such as an early education or child care program, school setting, or child’s therapeutic setting.

(h) At least every 90 days, or more frequently if warranted based on the safety plan, the case manager shall make an unannounced visit to the child’s current place of residence. When a child is with a parent in a certified domestic violence shelter or a residential treatment program, visitation arrangements shall be coordinated with program staff and may occur outside of the facility.

(2) Contacts with Parent or Legal Guardian, and Caregiver Living in Florida.

(a) The case manager shall establish and maintain regular face-to-face contact a minimum of every 30 days with the parents or legal guardians and caregiver of any child unless parental rights have been terminated or the court rules otherwise. If the parent, legal guardian, or caregiver lives in a county other than the county of jurisdiction, this shall be accomplished as provided by Rule 65C-30.018, F.A.C.

(b) During these contacts case manager shall discuss with parents, legal guardians or caregiver the safety plan, the case plan progress and the child’s progress in terms of health, and well-being.

(c) If the case manager learns that a new household member has moved into the child’s home, the following background checks must be completed and documented as part of the ongoing family functioning assessment or progress update, and the judicial review and the Unified Home Study must be updated within 30 days:

Local criminal records check, including 911 calls, for new household members aged 12 and older;
Florida Crime Information Center (FCIC) check for new household members aged 12 and older;
Juvenile delinquency check for new household members aged 12 to 26;
Department of Corrections Offenders Search for new household members aged 18 and older;
Florida Department of Law Enforcement (FDLE) Florida Sexual Offenders and Predators Search & National registry check for new household members aged 18 and older;
Florida abuse/neglect history check on all new household members;
Out-of-state abuse/neglect records for new household members aged 18 and older who have resided in any other state during the past five years; and
A records check conducted by a Florida Clerk of Court or the Comprehensive Case Information System (CCIS), at a minimum in the location where the local criminal records check is conducted, for all new household members aged 12 and older.

(3) Child and parent or caregiver living out of Florida. The office of the Florida Interstate Compact on the Placement of Children shall ensure that the child welfare staff in the receiving state is notified of the Florida requirement for face-to-face contact a minimum of every 30 days with the child and the parent or legal guardian.

(a) The case manager shall maintain contact a minimum of every 30 days with the supervising worker in the other state to obtain updates regarding the child and family’s progress.

(b) Documentation of the contact and progress by the child and family shall be entered in the child welfare information system.

(4) If a face-to-face visit with a child or parent or legal guardian is not completed, the case manager shall document in the child welfare information system alternate contacts completed or attempted. The case manager’s immediate supervisor shall review the circumstances surrounding the attempted visit and expectations as to further efforts to complete the visit.

(5) If a child is on runaway status or his or her whereabouts are unknown, the case manager shall meet the requirements of Rule 65C-30.019, F.A.C. Documentation of the efforts to locate the child shall be documented in the child welfare information system.

(6) All contacts and attempted contacts shall be documented in the case file within two (2) business days of the contact or attempted contact. The documentation shall provide evidence of the following:

(a) Sufficiency of current safety plan and whether it is the least intrusive;

(b) Progress towards completion of case plan outcomes;

(d) Observations of the child’s development, physical condition and interaction with the parent or caregiver and household members;

(e) Assessment of progress in tasks and services aimed at ensuring the child’s health, safety and well-being needs; and,

(f) For children in an out-of-home placement:

Age 13 and older, documentation shall include comments from the child and caregiver concerning progress in learning identified life skills,
Frequency of visitation between the child, siblings and parents, any reason visitation is not occurring, and efforts to facilitate visits.

(7) In addition to the contacts required every 30 days, the case manager shall maintain ongoing communication with all service providers involved with the child and family to determine the sufficiency as well as the effectiveness of any safety management or treatment services. Both progress in and problems with service delivery shall be documented and steps shall be taken to resolve any delays or problems in service delivery or client participation.

(8) While service intervention is in progress, the case manager shall gather information from the parent(s), children and other family members, providers, and other relevant persons to:

(a) Determine whether or not the service is addressing the identified diminished caregiver protective capacities;

(b) Monitor and document whether the safety management services are still sufficiently managing the danger;

(c) Share information with the provider, such as changes in the family situation, changes with the child, any feedback from the family regarding the service and its effectiveness for them;

(d) Request progress reports and updates on problems and successes regarding the treatment; and,

(e) Take actions to modify the case plan when activities are no longer sufficient to support the achievement of case plan outcomes.

(f) Document all contacts with service providers.

(9) A safety plan must be modified to provide the least intrusive safety actions when any of the following changes occur:

(a) Conditions for return of the child have been met.

(b) A new danger threat has been identified.

(d) There is any change in the required criteria for an in-home safety plan:

The parent’s willingness to cooperate with safety service providers.
The family conditions or behaviors associated with a calm and consistent home environment.
The availability of safety service provider(s).
Results of a professional evaluation are necessary or have been received, which inform changes to the current safety plan.
The parents have a home location which is adequate for implementation of an in-home safety plan.

(10) If the case manager becomes aware of conditions or activities in the child’s home, current living arrangment or another location that threaten the safety of the child, the case manager shall take such steps as are necessary to protect the child. All concerns shall be relayed to the caregiver and to licensing staff, as appropriate. The case manager shall notify Children’s Legal Services (CLS) of the new placement and CLS shall notify the court.

(11) The case manager is responsible for knowing if a child is at risk of disruption and working with the caregiver to avoid such disruption. Should a placement change be necessary, the child will continue to be placed in the least restrictive setting. The case manager shall notify CLS of the new placement and CLS shall notify the court.

(12) Determination of Citizenship and Required Actions for Children Who Are Not U.S. Citizens.

(a) For each child adjudicated dependent due to abuse, neglect or abandonment, the case manager shall determine whether the child is a U.S. citizen.

If the child is not a U.S. citizen, the case manager shall determine whether the permanency plan for the child will include remaining in the United States or whether there is an option for a safe reunification with the parent or legal guardian located in another country. This includes a consideration of whether the parents or legal guardian can successfully complete a case plan.
If the permanency plan will include the child remaining in the United States, and the child is in need of documentation to effectuate this plan, the case manager shall refer the case to an authorized legal services immigration provider for a determination as to whether the child “may be eligible” for special immigrant juvenile (SIJ) status [see 8 C.F.R. §204.11(a)] or other immigration relief.
Within 60 days of an order finding that the child is eligible for SIJ status, the case manager shall assure that contracted or pro bono legal services have sufficient documentation to file a petition for SIJ status and the application for adjustment of status to the appropriate federal authorities on behalf of the child.

a. The case manager shall give the legal services provider proof of the child’s age. This proof may include a passport or some other official foreign identity document issued by a foreign government. Any foreign document must be translated into English. If such a document is not available, the case manager must discuss with either the legal services provider or CLS the possibility of obtaining a court Order with specific findings regarding the child’s age.

b. If a child has also been adjudicated delinquent, the case manager shall obtain all DJJ records and give them to the legal service provider to submit with the federal application for SIJ status. These records must be certified copies of the records of disposition.

(b) Requirement to Inform the Court.

During the first judicial review regarding the case, the Department, CBC or contracted service provider shall report to the court whether the child is a U.S. citizen.
If the child is not a U.S. citizen, the Department, CBC or contracted service provider shall inform the court of the steps that have been taken to address the child’s citizenship or residency status.
The information shall be provided to the court through a Judicial Review Social Study Report or testimony of the case manager, or it may be provided through both means.
The child shall be referred to an authorized immigration legal service provider as soon as it is clear that there may be an issue regarding the child’s immigration status.

(c) Provision of Needed Services. Regardless of the citizenship or immigration status of the child, he or she must be provided any needed services. If federally funded programs, such as Medicaid, are dependent on citizenship or a qualified alien status, the benefits and services must be provided with state general revenue funds or with the funding provided to the supervising CBC provider.

History

Rulemaking Authority 39.012, 39.0121(13), 39.5075(8) FS. Law Implemented 39.0138, 39.5075, 39.6011, 39.6012 FS. History–New 5-4-06, Amended 2-25-16, 4-17-16, 8-22-16, 9-21-20, 11-25-24.

Fla. Admin. Code R. 65C-30.008 Child Welfare Professional Responsibilities to Parents

(1) For children remaining in the home, the case manager shall assist the parents in order to:

(a) Resolve the situation that resulted in the need for a lead agency managed safety plan;

(b) Understand and meet their child’s needs, including the child’s need for safety;

(d) Work toward the case outcomes.

(2) For a child in an out-of-home placement, the case manager shall assist the parents in maintaining continuing contact with the child through visitation, letters, phone calls, and any other methods to maintain contact, when in the best interest of the child. All contact shall be in accordance with any order of the court.

(3) For a child in an out-of-home placement with a case plan goal of reunification, the case manager shall ensure the parents are provided with reunification services. Reunification services shall:

(a) Identify and remedy the problems that have resulted in the removal of the child.

(b) Assist the parents in making changes that will permit a safe reunification of the family and recommend services to ameliorate such problems.

(d) Help the parent understand the possibility of permanent separation from the child if that becomes necessary.

(4) For all children in the dependency system, regardless of placement, the case manager shall ensure that parents have the information necessary to contact their case manager. If a new case manager is assigned to a case, the new case manager shall notify the parent within two business days of case assignment and provide updated contact information.

(5) The case manager shall document services offered, services utilized and the effects of these services, and shall communicate at least every 30 days with the parents on progress made or lack of progress. This information shall provide the basis for casework decisions and recommendations to the court.

(6) If the court-approved goal of the case plan for a child in an out-of-home placement is not reunification, the case manager must continue reunification services until either released by the court or parental rights are terminated. The case manager has no obligation to offer or provide reunification services to the parents, unless it is necessary for the child’s well-being or is otherwise court ordered.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.0136, 39.6012(1) FS. History–New 5-4-06, Amended 2-25-16, 12-22-19.

Fla. Admin. Code R. 65C-30.009 Least Intrusive Interventions

(1) When the child welfare professional determines the protective, treatment and remedial services necessary to ensure the child’s safety, well-being and need for permanency, the following shall be the priority order of least intrusive options considered and shall be informed by the safety analysis:

(a) Child remains in home with no judicial actions.

(b) Child remains in home with judicial actions.

(2) Prior to a child being removed from the home, the Department shall determine if, with the provision of appropriate and available safety management services, the child could safely remain at home. If at any time it is determined the child’s safety and well-being are in danger, the safety plan shall be modified to control for the danger threat, which may include increasing the level of intrusiveness.

(3) The following outlines the tiered protocol to services that allows the Department to diligently support family continuity prior to placing children in out-of-home care.

(a) In-home Non-judicial Services. In this initial tier, the child will remain at home and the Department or contracted service provider shall manage the safety plan and work in partnership with the family, without judicial intervention, to develop a case plan based on the identified needs in the Family Functioning Assessment. If, during the course of In-home Non-judicial Services, there is no progress in increasing the diminished protective capacities or the safety plan is no longer sufficiently controlling the danger, the case manager shall increase the level of intrusiveness of the safety management services and pursue judicial intervention.

(b) In-home Judicial Services. In-home Judicial Services occur when it has been determined through safety analysis that the child can remain in the home with safety management services while receiving services under the supervision of the court. Judicial oversight is needed for the family to engage in treatment services and to achieve the case plan outcomes.

(4) Court Ordered Relative/Non-Relative Placements. When a child is removed from his or her parents or legal guardian due to abuse, neglect or abandonment, the Department or contracted service provider shall request the names, relationships and addresses of both parents, maternal and paternal relatives, and any non-relatives who are known to the family and who may be able to provide for the health and safety of the child and have an established relationship with the child and will make diligent efforts to identify and locate relatives and any parents of siblings.

(a) Prior to making an emergency placement with a relative or non-relative, an on-site check of the safety and appropriateness of the caregiver’s home and initial criminal, delinquency and abuse/neglect history check activities shall be performed, followed by the fingerprinting of all adult household members in the caregiver’s home and further criminal, delinquency and abuse/neglect history check activities as set forth in Rule 65C-28.011, F.A.C.

(b) Prior to the child’s placement the child welfare professional shall complete a home study of the selected caregiver’s home, as set forth in Rule 65C-28.012, F.A.C. When more than one (1) caregiver is being considered for placement, the rationale for the placement decision must be documented in the child welfare information system. When a caregiver is denied placement, a home study will need to be completed to document the reason for denial.

Temporary Assistance for Needy Families (TANF) funded Temporary Cash Assistance Program (TCA) grant through the Office of Economic Self-Sufficiency (ESS) for relatives within the fifth degree of relationship by blood, marriage or adoption to the child, which would include Medicaid eligibility for the child. If the caregiver is a relative of the child, he or she shall be referred to ESS to apply for a TCA grant immediately upon the child’s placement.
Relative Caregiver Program payment available for relatives through ESS, post-disposition, if the caregiver is a relative who is within the fifth degree by blood or marriage to the parent or stepparent of the child (this is a broader degree of relationship than for TCA), in accordance with the criteria outlined in Section 39.5085(2)(a)1., F.S. Where there is a half-sibling of the related child whose parent or stepparent does not meet the degree of relationship to the caregiver required for eligibility, the half-sibling shall also be referred in accordance with the criteria outlined in Section 39.5085(2)(a)2., F.S. See paragraph 65C-28.008(2)(c), F.A.C., regarding the degree of relationship requirements for RCP eligibility.
Non-Relative Caregiver financial assistance available after adjudication and disposition.
The option of becoming a licensed caregiver.

History

Rulemaking Authority 39.012, 39.0121(1), (13) FS. Law Implemented 39.301(9)(b), 39.401(4), 39.5085, 39.6012(1) FS. History–New 5-4-06, Amended 2-25-16, 11-25-24.

Fla. Admin. Code R. 65C-30.010 Voluntary Protective Services

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.301 FS. History–New 5-4-06, Repealed 2-25-16.

Fla. Admin. Code R. 65C-30.011 Placement Responsibilities of the Child Welfare Professional

(1) The child welfare professional making the placement shall:

(a) Provide or arrange for the transport of the child to the placement;

(b) Advise the caregiver as to the reason or circumstances that caused the child to be placed;

(c) Facilitate the adjustment of the child to the placement. The child welfare professional shall be aware of, and attend to, the child’s emotional needs;

(d) Ensure that the child’s special physical, medical, developmental, educational or emotional needs are met as specified in Rule 65C-30.023, F.A.C. A behavior management plan is required for children with the following behaviors:

Juvenile sexual abuse;
Aggressive behaviors;
Wounding or killing animals; or
Property destruction.

(e) Provide information about the out-of-home caregiver to the child, as age or developmentally appropriate;

(f) Provide any formal assessment of the child to the child’s parent, out-of-home caregiver, Children’s Legal Services attorney, and guardian ad litem and child’s attorney, if appointed;

(g) Encourage and provide necessary support to the parent and out-of-home caregiver in participating in the assessment or medical evaluation process;

(h) Provide service referrals whenever a physical, medical, developmental, educational, or emotional need is suspected;

(i) Document in the child welfare information system any notification provided to parents and others regarding a child’s assessment and any referrals made as a result of the assessment;

(j) If there is any potential that a child may qualify for social security survivor benefits, social security disability benefits or Supplemental Security Income due to disability, or other benefits, ensure that an application is made for the benefits on behalf of the child and documented in the child welfare information system;

(k) Arrange for services for the child and supports for the out-of-home caregiver, if a disability is determined and a need for services is identified;

(l) Ensure that the needs of the child for emotional safety and recovery are addressed and that precautions are taken in regards to the safety of other children in the same setting, if a child is identified as a victim of sexual abuse and needs to be placed in out-of-home care; and

(m) Provide the caregivers with written, detailed, and complete information regarding the circumstances surrounding the child’s behavior so that they can avoid any unwitting replication of those circumstances, if a child who is known to have exhibited any behaviors that may result in harm. Information given provided to caregivers shall include the dates of all known incidents; the nature of the relationship between the child and victim; the types of behavior exhibited; a brief narrative outlining the event; the types of treatment needed or provided; and any current treatment outcomes.

(2) Continuation of Medical Care and Treatment. The child’s medical care and treatment shall not be disrupted by change of placement. To the extent possible, the child welfare professional making the placement shall arrange for transportation in order to continue the child with his or her existing treating physicians for any on-going medical care. If this is not possible, the child welfare professional shall secure a copy of the child’s medical records from the treating physician within three (3) working days of the change to a new provider. The child welfare professional is responsible for the following tasks relating to on-going medical care and treatment:

(a) Discuss with the caregiver all known health care facts regarding the child;

(b) Review with the caregiver all health care and Medicaid information contained in the child’s resource record;

(c) Obtain any prescription medication currently taken by the child. To continue medication as directed, the child welfare professional shall obtain the medication in labeled medication bottles, inventory the medications provided, and transport the medications to the child’s caregiver. The inventory shall include:

The child for whom the medication is prescribed,
The condition and purpose for which the medication is prescribed for this child,
The prescribing physician’s name and contact information,
The pharmacy from which the prescription was obtained and the contact information,
The prescription number,
The drug name and dosage,
The times and frequency of administration, and if the dosages vary at different times,
Any identified side effects,
Any other specific instructions regarding the medication; and,
A space for the caregiver to sign and date the medication inventory to indicate receipt of the child’s medication.

(d) If the child is taking unlabeled medications or prescription information is insufficient, the child welfare professional shall contact the prescribing physician, if available, to ensure the proper identification and labeling of the medication or to arrange for a medical evaluation in order that treatment not be interrupted; and

(e) If a child uses medically assistive devices, the child welfare professional shall ensure that these devices are taken with the child to the out-of-home placement and that the caregiver receives instruction concerning the use of the devices from the child’s health care provider.

(3) The Child’s Resource Record. A child’s resource record shall be developed for every child entering out-of-home care. The child welfare professional making the placement is responsible for the initial development, monitoring, updating and transporting of the child’s resource record.

(a) The out-of-home caregiver shall be provided with the child’s resource record. The child’s resource record from previous placement(s) shall be reviewed with the out-of-home caregiver upon the child’s new placement. The child welfare professional shall discuss with the out-of-home caregiver the caregiver’s role in maintaining and updating the child’s resource record. If the caregiver reports that materials are missing from the child’s resource record, the child welfare professional shall be provided all available materials within five days.

(b) The child welfare professional shall review confidentiality requirements with each caregiver. The caregiver is responsible for maintaining confidentiality of the child’s resource record documents.

(d) Since some of the information necessary in the child’s resource record is not available immediately upon initial removal, the documents required in the child’s resource record shall be placed in the record as available. The child’s resource record shall include the following information:

Medical, dental, psychological, psychiatric and behavioral history,
Copies of documentation regarding all on-going medical, dental, psychological, psychiatric and behavioral services, including child health check-ups provided through Medicaid,
Parental consent for treatment or court order,
Copy of the Medicaid card,
Copy of the Shelter Order,
Copy of the court order or “Voluntary Placement Agreement” placing or accepting the child into out-of-home care. The “Voluntary Placement Agreement,” CF-FSP 5004, October 2005, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06451,
Copy of the Case Plan,
Copy of the most recent Judicial Review Social Study Report,
All available school records,
An envelope for storing pictures,
The most recent photograph available,
Copy of the child’s birth certificate or birth verification certified by the Office of Vital Statistics, as appropriate,
Documentation of immigration status, including certificate of citizenship, if available; and,
The names and phone numbers of staff to be contacted in emergencies.

(e) Where the Department or contracted service provider has originals of documents required to be included in the child’s resource record, the original documents shall be placed in the child’s case file and the copies shall be kept in the child’s resource record.

(f) Where medical or educational information is not available and accessible, written documentation of the efforts made to obtain the information shall be documented in the child welfare information system.

(g) The child’s resource record shall be physically located with the caregiver, whether the child is in licensed care or placed with a relative or non-relative. The child’s caregiver shall ensure that the child’s resource record is updated after every health care, psychological, psychiatric, behavioral and educational service or assessment provided to the child.

(h) The case manager shall ensure that medical and court-related documentation are kept current at each visit that is made at least every 30 days. If additional information is needed in the child’s resource record, the case manager and the caregiver shall work together to ensure that the child’s resource record is updated.

(4) Transportation. The caregiver shall have the primary responsibility for ensuring the transportation of children in out-of-home care to and from hearings, visitation and other activities. If the caregiver cannot arrange or provide transportation, he or she shall contact the child welfare professional who shall be responsible for developing contingency transportation plans. When the licensed caregiver refuses to perform these required transportation responsibilities, the child welfare professional shall notify licensing staff of the refusal.

(5) Review of Licensed Caregiver Performance. At the time of license renewal for a licensed out-of-home caregiver, the case manager shall complete a “Case Manager/Case Worker Review of Foster Parent,” CF-FSP 5223, March 2013, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06452.

(6) Completion and Review of the Partnership Plan. The person making the placement shall complete the “Partnership Plan for Children in Out-of-Home Care,” CF-FSP 5226, January 2015, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-06453, review with out-of-home caregivers the information provided on the form and its relevance to their responsibilities, obtain a signature of the out-of-home caregiver attesting acknowledgment of the requirements at time of placement, and place in the child’s case record.

(7) When a child is placed in a relative’s or non-relative’s home, the child welfare professional shall inform the relative or non-relative that he or she may seek licensure as a caregiver in accordance with Chapter 65C-45, F.A.C., to be eligible for payment as a shelter or foster parent and provide information regarding the Relative Caregiver Program, including non-relative financial assistance.

History

Rulemaking Authority 39.012, 39.0121(2), (6), (12), (13), 39.307(7), 409.145(5) FS. Law Implemented 39.307(1)(b), 39.401(3)(b), 39.402(8)(h)6., 39.407(3)(b), 409.145(2) FS. History–New 5-4-06, Amended 2-25-16, 8-2-21, 11-25-24.

Fla. Admin. Code R. 65C-30.012 Permanency Goal Selection

(1) Permanency Goals. Permanency goals, as set forth in Section 39.621(2), F.S., shall be selected based on the best interest of the individual child. The primary permanency option is to maintain a child with his or her parents or legal custodian followed by reunification of the child with his or her parents or legal custodian whenever possible.

(2) Reasonable efforts to achieve the permanency goal shall be made during the first 12 months following the date the child was removed from his or her home.

(3) The following shall be assessed in determining the best permanency goal for a child in out-of-home care:

(a) Whether interventions provided will alleviate the causes of removal;

(b) Current family relationships and other significant relationships that provide the child stability and a sense of connection and provide possible permanent living options. This includes connections with family members from the child’s home of removal;

(c) Physical, Medical, Emotional, Psychological, Developmental and Educational Needs. The child welfare professional shall give consideration to matching the child with caregivers able to provide for the child’s needs on a long-term basis. The child welfare professional shall ensure that the caregivers are provided the education, training and support necessary to enable them to meet the child’s needs;

(d) Placement options that provide the most family-like and least restrictive settings. The child welfare professional shall explore the current caregiver’s ability and willingness to provide a permanent home for the child;

(e) Child’s Preferences. The child welfare professional shall provide youth of sufficient age, maturity, and understanding with information and education regarding permanency goal options to assist the child in making an informed decision as to his or her preference in achieving permanency.

(4) Permanency Goal Requirements. The particular situation of each child and family shall be considered by the child welfare professional in determining the best permanency goal for a particular child. Youth of sufficient age, maturity, and understanding shall be informed of the availability of long-term caregivers or opportunities for independence. Reunification shall be ruled out as an option prior to changing the permanency goal to any other option. The case documentation shall provide justification that the permanency option recommended to the court is the most appropriate one for the child.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.621 FS. History–New 5-4-06, 2-25-16.

Fla. Admin. Code R. 65C-30.013 Judicial Reviews and Court Reports

(1) Judicial Review Social Study Report.

(a) The case manager will develop Judicial Review Social Study Reports (JRSSR) using the JRSSR functionality in the child welfare information system.

(b) When a combined report is prepared for children who are referenced in court by the same case number, each child shall be addressed individually in the report.

(c) Any event that may impact the child’s placement and educational stability; and Department or contracted service provider actions relating to the child shall be included in the JRSSR.

(d) In addition to the requirements of Section 39.701(2)(a), F.S., the JRSSR shall also include a recommendation to the court as to the child’s placement and supervision until the next review. This recommendation shall be supported by the other information provided in the report.

(e) The JRSSR requirements are the same whether the JRSSR is prepared for a Citizen’s Review Panel, General Magistrate pursuant to Rule 8.257, Florida Rules of Juvenile Procedure, or for a hearing held by a judge.

(f) All Multidisciplinary Team Staffings outlined in Rule 65C-30.023, F.A.C.; and Transition Plans as outlined in Rule 65C-28.024, F.A.C.; completed within the last 6 months will be included in the JRSSR.

(g) The JRSSR shall include the date the child was provided with the verbal and written instructions on reporting abuse, abandonment, or neglect, pursuant to Section 39.4085, F.S.

(2) Other Requests for Court Action.

(a) Whenever a need arises for court action outside the regular review period, the Department or contracted service provider shall, through Childen’s Legal Services (CLS), request such action from the court. The need for petitioning the court for such action shall include:

When the danger threat to the child can be managed through an in-home safety plan or has been ameliorated,
When the child’s caregiver or a service provider is failing to perform actions as required and the performance is necessary for reunification and the welfare of the child,
When requesting a modification to visitation, such as frequency or change from supervised to unsupervised for a child in out-of-home care,
When the conditions for return have been met, reunification should occur prior to the next regularly scheduled review.

(b) The Department or contracted service provider shall, through CLS, request such action from the court and provide the court sufficient information to make an informed decision on the request.

(c) Copies of any petition or report shall be provided by the CLS attorney to the parties as required for any judicial review.

(d) A motion or pleading shall be prepared by the CLS attorney for each request for court action.

(e) Except in the case of an emergency, all pleadings and attachments shall be provided by the CLS attorney to the parties and others as required for a judicial review.

(f) If emergency request is made, notice to the parties and copies of the request shall be furnished by the CLS attorney by the means most likely to provide actual notice, including those notifications required for Indian and Alaskan Native children under the provisions of the Indian Child Welfare Act.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.701 FS. History–New 5-4-06, Amended 2-25-16, 3-1-23.

Fla. Admin. Code R. 65C-30.014 Post-Placement Supervision and Services

(1) The child’s best interest and safety considerations, including conditions of return, shall be evaluated prior to recommending reunification and throughout the post-placement supervision period. The child’s adjustment shall be evaluated throughout the post-placement supervision period.

(2) The case plan for post-placement supervision shall be completed, filed with the court and served on all parties at least 72 hours prior to the court hearing in which reunification is recommended. If the court returns custody to the parent contrary to the Department or contracted service provider’s recommendation, the post-placement supervision case plan shall be completed, filed with the court and served on all parties within 14 working days of the court hearing. The effective date is the date custody changed to the parent.

(3) The case plan for post-placement supervision shall include:

(a) Case plan outcomes that are informed by the ongoing family functioning assessment or progress update assessment;

(b) An in-home safety plan;

(c) Routine health care, as well as follow-up care for physical health, mental health or substance abuse service needs that have been identified if related to identified diminished caregiver protective capacities;

(d) Specific provisions regarding the need for child-care or early education programs; and,

(e) Frequency for contacts by child welfare professional.

(4) Post-placement services. Services to be provided by the case manager in reunification cases include:

(a) Continuous monitoring of the in-home safety plan, and modification of the safety plan if necessary;

(b) Exchange of information with parents;

(d) Return to the parents of original documents, including the child’s social security card and birth certificate;

(e) Determine in accordance with Section 402.17(7), F.S., and subsection 65C-17.006(3), F.A.C., of the disposition of any of Master Trust moneys being held for the child;

(f) Provide a copy of the child’s resource record contents, including any Individual Educational Plans that were approved while the child was in out-of-home care;

(g) Assistance in using community and other family resources;

(h) Coordination with the school district regarding educational stability so, whenever possible, the child can continue attending the same school following reunification;

(i) Evaluation of the family’s progress as a unit; and,

(j) Evaluation of the child’s progress. The case manager shall be aware of the child’s development, school attendance and adjustment, health and medical care, child-care arrangements, treatment plans, nutrition, recreation, community activities and family dynamics.

(5) If not already enrolled in a licensed child care program or licensed early education program, children from birth to age of school entry shall be assessed by the case manager regarding the need for child care services. If additional oversight of the child is determined by the case manager to be needed, intensive in-home services may be recommended to the court as an alternative to a licensed child-care program or licensed early education program.

(6) At every three (3) month period of post-placement supervision, the case manager shall:

(a) Evaluate with the family their adjustment following the return of the child and their progress toward completion of outcomes in the case plan;

(b) Assess any continuing safety concerns;

(d) Prepare a report that addresses the issues noted in the post-placement supervision case plan and the outcome of the current family functioning assessment with input from service providers. There shall also be provided a recommendation for case termination or extension of supervision.

(7) When requesting an extension of post-placement supervision from the court, specific details explaining safety, risks, service needs and the parent’s case plan accomplishments shall be provided to the court.

(8) Reunification with a parent outside of Florida requires approval through the Interstate Compact on the Placement of Children, Section 409.401, F.S.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.521(1)(a) FS. History–New 5-4-06, Amended 2-25-16.

Fla. Admin. Code R. 65C-30.015 New Reports Received, Removal and Placement of Children

(1) When a new report of abuse, neglect, or abandonment is received on an active case, the child protective investigator (CPI) shall:

(a) Notify the case manager and Children’s Legal Services within one (1) business day; and

(b) Conduct a multidisciplinary staffing based upon the criteria as outlined in subsection (6) of this rule as soon as possible, but no later than 14 business days, to assess the need for modifications to the safety plan. If the decision is made to leave the child in the home even though other children are currently placed in out-of-home care, the approval of a case management organization or community-based care administrator shall be obtained and documented in the child welfare information system by the case manager.

(2) Children’s Legal Services shall notify the court within two (2) business days of receipt of the new intake report if there is an open judicial case.

(3) If, during contact with the child or family, the case manager has cause to immediately remove the child due to a dangerous situation, the case manager shall call 911 immediately.

(a) The case manager shall remain with the child until the child can be removed by a law enforcement officer or a CPI; however, the case manager is not required to remain with the child if the situation threatens the personal safety of the case manager.

(b) In situations involving immediate or life-threatening danger to the child, the case manager is authorized to physically remove the child from the situation until physical custody of the child can be given to a CPI.

(4) In all cases, the new child information shall be added to the family functioning assessment in the child welfare information system.

(5) The CPI and case manager shall maintain ongoing communication via telephone until the investigation is closed. When the CPI or case manager is unavailable, an email shall be sent to the child welfare professional and supervisor to schedule a follow up time. These ongoing discussions shall address:

(a) Whether the existing safety management services are sufficient to control newly identified or ongoing danger threats within the home.

(b) Whether to require additional accountability of the parents through dependency proceedings and whether an out-of-home safety plan should replace an in-home safety plan.

(c) Whether to modify the permanency goal and whether additional assessments are needed to inform new service provisions.

(d) Any other case updates.

(6) A multidisciplinary staffing shall be conducted with 14 business days of receiving the new intake between the family, CPI, case manager, services provider(s), guardian ad litem, Children’s Legal Services, and anyone else who may have relevant information to re-assess child safety, permanency and well-being for families who have two or more of the following risk factors:

(a) The parent/ legal custodian is 25 years of age or younger;

(b) The parent/ legal custodian or an adult currently living in or frequently visiting the home has a history of substance abuse, mental illness, or domestic violence;

(c) The parent/ legal custodian or an adult currently living in or frequently visiting the home has been previously found to have physically or sexually abused a child;

(d) The parent/ legal custodian or an adult currently living in or frequently visiting the home has been the subject of multiple allegations of abuse or neglect;

(e) The child is physically or developmentally disabled;

(f) The child is three (3) years of age or younger;

(g) The family is under post placement supervision; or

(h) Post-adoption families.

(7) The safety determination within the investigation for any child under protective supervision shall remain unsafe until:

(a) An assessment has been conducted and a determination made that the caregiver protective capacities are adequate, and all danger threats have been eliminated or are being managed by a parent(s) or legal guardian(s); and

(b) A progress update regarding the assessment and results has been entered in the child welfare information system.

(8) When a minor child in foster care is pregnant or becomes a parent, the case manager shall assist him or her in arriving at a plan for their future.

(a) The case manager shall staff any decision not to remove the infant from the minor parent (foster child) with his or her supervisor and document the staffing decision in the child welfare information system.

(b) If the minor parent chooses to keep the child or is uncertain, placement of the parent and child shall be, unless contrary to the best interests of the infant, in the same foster home or group home in order to strengthen attachment and provide the minor parent with the opportunity to learn child-caring skills from the foster parent or residential program staff.

(c) If the minor parent decides to place the infant for adoption, the case manager shall refer the parent to a licensed child-placing agency.

(d) In cases where the minor foster child’s emotional or mental capacity to parent are in question or the minor foster child has a juvenile delinquency history involving acts of violence, the case manager shall obtain a psychological or psychiatric evaluation of the parent prior to the birth of the child to assess coping skills, mental health issues, and the ability to provide adequate care, supervision, and protection for the child. The findings and recommendations set forth in the evaluation shall be considered in determining if the parent can provide a safe environment for the child.

History

Rulemaking Authority 39.012, 39.0121(2) FS. Law Implemented 39.301(4), (9)(a), 39.401 FS. History–New 5-4-06, Amended 2-25-16, 6-17-19, 11-25-24.

Fla. Admin. Code R. 65C-30.016 New Children in Families under Supervision

(1) The case manager shall immediately report to the supervisor a pending birth, a child born into a family, or any other circumstance adding a new child who is living in a home that is under supervision.

(2) The case manager shall visit the home where the new child will or already resides and conduct an assessment to determine the safety of the new child in the home. The assessment shall be filed with the court.

(3) The case manager shall staff the case with his or her supervisor to determine if any actions are needed, including a consultation with Children’s Legal Services regarding the filing of a petition on the new child.

(4) In all cases, modifications to the existing safety plan shall be made to address the new child.

(5) The new child’s name and demographics shall be entered into the child welfare information system as part of the existing case immediately upon learning of the child’s presence.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.6013, 39.701(1) FS. History–New 5-4-06, Amended 2-25-16, 11-12-17, 11-25-24.

Fla. Admin. Code R. 65C-30.017 Coordination of Services for Youth Involved with the Department of Juvenile Justice

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.001(1)(m), 39.601, 39.701 FS. History–New 5-4-06, Repealed 12-13-15.

Fla. Admin. Code R. 65C-30.018 Out-of-County Services

(1) When children and young adults and/or their parents or caregivers relocate to a county outside of the county of jurisdiction, out-of-county services will be provided when requested for:

(a) Completing a home study of an other parent, relative, nonrelative, or prospective adoptive family.

(b) Assisting with case supervision of judicial or nonjudicial cases in accordance with Chapters 65C-28, 65C-30, and 65C-35, F.A.C. The primary case manager will contact the out-of-county case manager every other month, at a minimum, to ensure all F.A.C. requirements are in compliance and collaborate to resolve any barriers. If there is an emergency safety, permanency, or well-being issue that must be addressed, the out-of-county case manager will contact the primary case manager within 48 hours.

(c) Providing and coordinating supervision and/or services to children and young adults receiving Independent Living Services as defined in subsection 65C-30.001(60), F.A.C., to include Postsecondary Education Services and Support (PESS), Extended Foster Care and Aftercare Services. Service Portability for young adults participating in PESS and Aftercare Services is addressed in Section 409.1451(5), F.S.

(2) Procedures shall be developed through a statewide working agreement that is updated as necessary between the community-based care (CBC) lead agencies regarding the request, timely processing, coordination of any services (including requests for home studies and case supervision), and on-going communication. The statewide agreement must be followed by all agencies.

(3) Home studies of other parents, relatives, or nonrelatives shall be conducted as outlined in Rule 65C-28.012, F.A.C. With the exception of adoption home studies, the county completing the home study is responsible for the appoval or denial of the homestudy.

(4) Adoption home studies shall be:

(a) Requested and initiated at the time a petition for termination of parental rights is filed; and,

(b) Conducted as outlined in Rule 65C-16.005, F.A.C.

(5) If the receiving county is recommending a denial of the adoption home study, the case will be reviewed by an Adoption Applicant Review Committee (AARC) in the county of jurisdiction, in accordance with subsection 65C-16.005(9), F.A.C. If the AARC determines that the home study should be approved, the home study must be updated in the child welfare information system by the receiving county, showing the home study as approved based on the recommendation of the AARC.

(6) Supervised Living Arrangements for young adults in Extended Foster Care shall be assessed as outlined in Section 39.6251(4), F.S.

(7) If supervision services will be requested following completion of a home study the receiving contracted service provider shall be provided an opportunity to visit the placement and review the home study prior to a recommendation being made to the court in the sending county. If the sending and receiving counties are not in agreement, the dispute resolution procedures in subsection (9), of this rule, will be followed.

(8) Once a request has been accepted, communication regarding the case shall be made directly between the contracted service provider service units in the two (2) counties involved.

(9) When disputes arise between the county of jurisdiction and the receiving county and the individual contracted service providers or CBC lead agencies cannot reach a resolution, the regional liaison within the region or the liaisons in the two (2) regions involved shall assist in reaching a resolution. When necessary, the CBC lead agency chief executive officers, or their designees, will be consulted in seeking a resolution. As a last resort, the Department shall be consulted in reaching a resolution.

(10) Once case supervision and/or coordination of services for the child, young adult, or any other case participant have been accepted by the contracted service provider in the receiving county, the case manager or child welfare professional in the receiving county shall perform all required case supervision and documentation, including providing information for safety planning, case planning, and judicial reviews to the case manager or child welfare professional in the county of jurisdiction.

(a) The responsibility to perform these duties shall continue until the child’s case is closed, the person receiving services is no longer a case participant, or the child moves from the service area.

(b) The case manager or child welfare professional in the county of jurisdiction shall retain primary responsibility and accountability for the case as long as the case remains open in that jurisdiction.

(11) The case managers or child welfare professionals in the county of jurisdiction and the receiving county shall collaborate and reach an agreement prior to taking any significant case actions. If the sending and receiving counties are not in agreement, the dispute resolution procedures in subsection (9), of this rule, must be followed. Significant case actions include the following:

(a) A transfer of jurisdiction to the receiving county. A case may be considered for a transfer of jurisdiction when:

It is in the best interest of the child; and,
The receiving jurisdiction agrees to the transfer.

(b) Case closure.

(d) Other actions requiring court approval in a judicial case.

(12) The case manager in the county of jurisdication shall notify the case manager or child welfare professional in the receiving county within two (2) business days of the court’s oral pronouncement granting termination of parental rights. The case manager in the county of jurisdication shall provide the case manager or child welfare professional in the receiving county a copy of a court’s signed termination order no longer than 30 days from the order being signed.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.521, 39.6011, 39.6012, 39.701 FS. History–New 5-4-06, Amended 2-25-16, 12-24-17, 11-25-24.

Fla. Admin. Code R. 65C-30.019 Missing Children

(1) Notification to Law Enforcement.

(a) Exigent Circumstances. The child’s caregiver, legal guardian, child welfare professional or designee shall immediately report a child as missing to law enforcement when:

The child is under age 13,
The child has a physical or mental incapacity, or a developmental or behavioral challenge that renders the situation more dangerous than it would be for a child with more maturity or resources,
The child is with others who may endanger his or her safety,
The child is known or believed to be in a dangerous or life-threatening situation,
The child has been identified as a victim of human trafficking, or
The child is missing under circumstances inconsistent with established behaviors.

(b) When none of the criteria in paragraph (a), apply, the child’s caregiver, legal guardian, child welfare professional or designee may take up to four hours from the time the child is first suspected to be missing to actively search for and attempt to locate the child prior to contacting local law enforcement. Active search efforts include:

Searching the child’s belongings.
Calling/texting the child’s cell phone.
Checking the child’s computer, social media accounts, or other online accounts.
Contacting the child’s friends, relatives, or known associates.
Searching areas that the child is known to frequent.
Contacting the child’s school.
Contacting the child’s employer.

(c) Caregiver or Legal Guardian Notification to Child Welfare Professional. After notifying law enforcement, the caregiver or legal guardian shall immediately notify the child welfare professional or designee that the child’s whereabouts are unknown. If the child welfare professional learns that the child’s caregiver or legal guardian has not reported the child as missing to local law enforcement within the timeframes set forth in paragraphs (1)(a)-(b) of this rule, the child welfare professional or designee shall immediately report the child as missing to local law enforcement.

(2) Take Into Custody and Pickup Orders. If a child in an active child protective investigation or is part of a family receiving ongoing in-home case management services is determined to be missing, the child welfare professional shall staff the case with Children’s Legal Services or the contracted legal provider immediately but no later than 24 hours after the child is determined to be missing, to assess whether a Take Into Custody or Pickup Order should be obtained.

(a) Factors in this assessment should include but are not limited to:

Law enforcement will not initiate efforts to locate the child without a court order.
The caregiver or legal guardian of a child not in the custody of the Department is refusing to cooperate with efforts to locate the child, including:

a. The caregiver or legal guardian has not reported the child as missing to local law enforcement within the timeframes set forth in paragraphs (1)(a)-(b) of this rule, and continues to refuse to do so despite being informed of the requirement.

b. There is reason to believe the child’s whereabouts are known by the caregiver or legal guardian and the lack of cooperation is for the purpose of denying the child welfare professional access to the child, or the family has or is about to flee to avoid further agency intervention.

Parent case plan compliance.
Caregiver’s protective capacity.
The most recent progress update or family functioning assessment.
The most recent present or impending danger safety plan.

(b) If a Pickup or Take Into Custody Order is determined to be appropriate, Children’s Legal Services or the contracted legal provider shall attempt to obtain a court order as soon as possible, but no later than four hours, from the point of determination.

(c) If the Pickup or Take Into Custody Order has been or will be sought, missing child procedures will be followed in accordance with subsections (1) and (3)-(6) of this rule.

(d) If the Pickup or Take Into Custody Order is not sought or is denied by the court, diligent search efforts to locate the child(ren) or family must be made until the case is closed in accordance with Rules 65C-30.003 and 65C-29.013, F.A.C. and a Request to Locate Alert shall be placed on the child welfare information system case file.

(3) The child welfare professional or designee shall enter the electronic missing child report (MCR) in the child welfare information system as quickly as possible but no later than 24 hours of determining that the child is missing.

(4) Notification Requirements.

(a) When the whereabouts of a child in the custody of the Department are unknown, the child welfare professional or designee shall notify as applicable the following based on their engagement in the case: his or her immediate supervisor, the Regional Criminal Justice Coordinator (RCJC), the child’s caregivers or legal custodians, guardian ad litem and attorney ad litem, Children’s Legal Services or the contracted legal provider, the child’s therapist, the child’s Juvenile Probation Officer, the Region Compact Specialist, the United States Customs and Border Protection and the Department of State, and any other person the child welfare professional deems essential who is not otherwise prohibited by law, Florida Administrative Code, or court order, within four hours of learning a child’s whereabouts are unknown.

(b) Children’s Legal Services or the contracted legal provider must file notice with the court within one business day after being notified that a child is missing. Notice to the court shall be documented in the child welfare information system within one business day of court notification.

(c) The Department shall review the missing child report to ensure that it meets reporting criteria for case opening with the Florida Department of Law Enforcement (FDLE)/Missing and Endangered Person Information Clearinghouse and the National Center for Missing and Exploited Children.

(5) Efforts to Locate Missing Child.

(a) The child welfare professional shall make efforts to locate the child at least once a week, until:

The child is located,
The child turns 18, or
If investigation has not yet been transferred to case management and the child protective investigator has obtained sufficient information to close the investigation, including:

(I) The conditions or circumstances which were the basis for the pickup order no longer exist.

(II) Another state child welfare agency with comparable jurisdiction to the Department has interviewed all available subjects of the investigation and reports no concerns with the child’s current living situation and the investigator obtains the issuing court’s approval to dismiss the Take Into Custody or Pickup order.

The dependency or ongoing services case is closed by the court, or the Pickup or the Take Into Custody Order is denied by the court having jurisdiction over the child. Prior to case closure, all agencies notified that the child was missing must be contacted and notified that the case will be closed. A copy of the case file will be offered to local law enforcement for their continuing efforts to locate the child, in the event a missing persons case remains active with law enforcement.

(b) Child welfare professionals or their designees shall be responsible for conducting both field-based and desk activities to locate the child, including:

Onsite visits to locations where the child may be found.
Onsite collateral source contact interviews (e.g., interviews of teachers, employers, relatives, etc.),
Use of electronic databases and information systems (e.g., parent locator services, ACCESS Florida, Accurint, etc.); and,
Checking mobile apps that are popular among youth.

(c) For children reported missing while the family is involved in a child protective investigation, the investigator or designee shall make efforts to locate the child until the closure of the investigation. Upon closure of the investigation, the efforts to locate will transfer to the Regional Criminal Justice Coordinator or their designee.

(d) A missing child staffing must be held at a minimum every thirty days to provide updates to the individuals notified in paragraph (4)(a) of this rule. This meeting will be scheduled by the individual responsible for completing efforts to locate the child or their designee.

(e) All efforts to locate the child shall be documented as a Missing Child – Attempt to Locate note type in the child welfare information system within two business days of the effort to locate.

(6) Procedures Required When Child is Located.

(a) Upon learning that a missing child has been located, the child welfare professional shall respond immediately to the child’s location to assess the child’s safety. If the child is located outside of the child welfare professional’s service area, but within the state of Florida, the child welfare professional shall immediately make an Out of Town Inquiry (OTI) or case management request of the county in which the child is located to assess the child’s safety. If the child is located outside of the state of Florida, the child welfare professional shall immediately contact their Regional Criminal Justice Coordinator and the Department of Juvenile Justice (DJJ) Interstate Compact on Juveniles (ICJ) office to determine next steps. The Department Interstate Compact on the Placement of Children (ICPC) office must also be contacted if placement of the child in another state may be appropriate.

When the child is located, the child welfare professional or designee shall immediately notify all individuals and agencies previously notified pursuant to paragraph (4)(a) of this rule.
If the child welfare professional has reason to believe the child’s caregiver or legal guardian was uncooperative with efforts to locate the child for the purpose of denying the child welfare professional access to the child and immediate notification would further impede the investigation or dependency case, the caregiver or legal guardian may be notified of the child’s whereabouts after the child’s safety has been assessed.

(b) The child welfare professional shall interview the child within 24 hours to determine the child’s need for additional services and/or change in placement. The interview shall:

Determine the primary factors that contributed to the child running away (if the child ran away); and,
Inquire into the child’s experience while absent from care, including identifying if the child has a history of running away, sexual abuse, or the child discloses being trafficked or reporting sexual exploitation. If any one of these indicators are present, the child welfare professional shall screen the child to determine if the child is a possible victim of trafficking pursuant to Chapter 65C-43, F.A.C.

(c) If a change in placement is required, the child welfare professional must follow the outcome of the multidisciplinary team (MDT) staffing outlined in Section 39.4022, F.S. and transition planning outlined in Section 39.4023, F.S.

(d) All notifications provided in paragraph (4)(a) of this rule, and all efforts to interview the child shall be documented in the child welfare information system as a Missing Child – Debriefing note type within one business day of the attempted interview.

(e) The child welfare professional or designee shall document the child’s recovery in the child welfare information system by completing the electronic Rapid or Standard Recovery within 24 hours upon learning that a missing child has been located, has turned 18 years of age, or whose case was judicially closed (unless this ruling is under consideration for or in the process of appeal). The Department shall review the missing child recovery report to ensure that the case meets case closure criteria with the FDLE/Missing and Endangered Person Information Clearinghouse.

History

Rulemaking Authority 39.012, 39.0121(16), 39.0141 FS. Law Implemented 39.0141, 39.4022 FS. History–New 5-4-06, Amended 2-25-16, 1-11-18, 6-5-23.

Fla. Admin. Code R. 65C-30.020 Child Fatalities

(1) Any employee of the Department or the contracted service providers who conduct child protective investigations, who has knowledge of a child’s death and who has reasonable cause to suspect that the child died as a result of abuse, neglect or abandonment shall immediately report the death to the Florida Abuse Hotline. A report is required even when there are no surviving children living in the home.

(2) Whenever a case manager learns that a child under supervision has died, that case manager shall immediately orally report the occurrence through the established chain of command to the community-based care (CBC) lead agency Chief Executive Officer or designee. Upon learning of the death, the CBC Chief Executive Officer or designee shall immediately orally notify the regional Department leadership or designee and regional child fatality prevention specialist. Written notice shall be made within 24 hours of the death.

(3) The Hotline Director or designee shall provide written notification of all child deaths alleged to have occurred in Florida as a result of abuse, neglect or abandonment, within two (2) hours of the oral notification:

(a) Secretary of the Department;

(b) State and Regional Department Leadership;

(d) General Counsel.

(4) Upon receipt of a call concerning a child death, Florida Abuse Hotline staff shall:

(a) Screen the call to determine whether the allegation meets the statutory requirement for accepting a report of death due to abuse, neglect or abandonment;

(b) Enter the maltreatment type of abuse or neglect, as well as any other maltreatment type that indicates how the child is suspected to have died as a result of abuse, neglect or abandonment;

(c) When a report is received involving an alleged victim in an open protective investigation that has died as a result of abuse, neglect or abandonment which resulted in the open protective investigation, the report shall be categorized as a “supplemental” report and the maltreatment of “death” shall be added to the existing protective investigation by the Hotline.

(d) When a report is received involving an alleged victim in an open protective investigation that has died as a result of a new incident of abuse, neglect or abandonment, an “additional” sequence shall be added to the open investigation.

(5) Whenever it appears that a child died as a result of abuse, neglect or abandonment, or when a child dies for reasons unrelated to abuse, neglect or abandonment during the course of an active child protective investigation, a child protective investigator (CPI) shall notify the regional child fatality prevention specialist and conduct a thorough investigation of the circumstances surrounding the death. The investigation shall consist of:

(a) Gathering all information necessary to determine whether the death was due to abuse, neglect or abandonment, including:

The child’s death certificate,
A copy of the medical examiner’s final report, if an autopsy was conducted,
A copy of any law enforcement investigation of the death,
All criminal history records and abuse, neglect or abandonment reports pertaining to the caretaker responsible for the child’s death; and,
All prior child protection records pertaining to the child and the caregiver responsible for the child’s death.
The results of any drug screens completed. The CPI will ask the alleged maltreating caregiver to voluntarily submit to a drug screen during the investigation of all child deaths related to inadequate supervision, unsafe sleep and drowning. This does not preclude the CPI asking the alleged maltreating caregiver for a drug screen during other investigations when substance misuse is suspected and may be a contributing cause to a child’s death. Exceptions to this requirement will be made when law enforcement has already obtained the drug screen.

(b) Reviewing information entered into the child welfare information system for accuracy and completeness prior to closure. For the purposes of documenting the “Victim Seen” time in the child welfare information system, the date and time of the professional collateral contact with medical staff or law enforcement personnel attesting to the child’s death shall suffice to record the “First Seen” date and time for the victim. Appropriate findings shall be entered for maltreatment.

(c) Ensuring that the automated investigative file clearly reflects the cause and circumstances surrounding the child’s death. The date of death and findings from the medical examiner and law enforcement (including the status of criminal prosecution, if applicable) shall be included in the automated investigative file to the extent that information is available prior to closing the report;

(d) Keeping the regional Child Fatality Prevention Specialist informed of significant developments during the investigation and ensuring that the specialist receives copies of all pertinent documentation, such as autopsy and law enforcement reports;

(e) Ensuring that the report is not closed until it has been reviewed by the regional Child Fatality Prevention Specialist and he or she has advised the supervisor that the death report has been approved for closure; and,

(f) Notifying the regional Child Fatality Prevention Specialist when a child dies during an open investigation in which there were no allegations of abuse or neglect.

(6) The Department or any contracted service provider shall cooperate with any law enforcement requests related to an investigation of the child’s death.

(7) Any Department employee, community-based care provider staff member providing child protection services shall cooperate with the Department of Children and Families, Critical Incident Rapid Response Team, and participate as needed on the Department of Health local Child Abuse Death Review team.

(8) The Department shall convene a Critical Incident Rapid Response Team when there is a child fatality that meets criteria in accordance with Section 39.2015, F.S. The regional Child Fatality Prevention Specialist shall conduct a case review on all child fatalities in which it is alleged that abuse, neglect or abandonment was or may have been a factor in the child’s death, and in situations where a child died while a participant on an active investigation or while receiving ongoing services without concerns of abuse, neglect or abandonment.

History

Rulemaking Authority 39.012, 39.0121(13) FS. Law Implemented 39.201(2)(a), 39.2015(1), (6), 39.301(9)(a), (11), (16), (17) FS. History–New 5-4-06, Amended 2-25-16, 1-9-17, 7-25-17, 11-25-24.

Fla. Admin. Code R. 65C-30.021 Child Death Reviews

The Department shall conduct multidisciplinary reviews of all child deaths where there was a prior report with a verified finding to the Department within the previous 12 months in accordance with Section 39.2015, F.S. The regional Child Fatality Prevention Specialist shall conduct a death review on all child deaths in which it is alleged that abuse, neglect or abandonment was or may have been a factor in the child’s death, and in situations where a child died while receiving ongoing services.

History

Rulemaking Authority 39.012, 39.0121(12) FS. Law Implemented 39.2015(2) FS. History–New 5-4-06, Amended 2-25-16.

Fla. Admin. Code R. 65C-30.022 Termination of Services

(1) Supervision of a child shall be terminated unless:

(a) A lead agency-managed safety plan is still necessary;

(b) Supervision is court ordered, or

(2) Prior to terminating any services case, the case manager shall complete a progress update in the child welfare information system and/or a Judicial Review Social Study Report (JRSSR). The case manager shall also determine whether there is an open or pending child protective investigation or whether within the previous three (3) months a child abuse, neglect or abandonment report has been received on any child in the case. For both court ordered and non-judical cases, if any of these situations apply, the supervisor of the case manager supervisor shall be required to review and approve the case closure before a non-judical case may be closed or a recommendation may be made to the court to close a court ordered case.

(a) For court ordered supervision cases, the case manager shall complete a progress update for review by the case manager supervisor and submission to the court through CLS. However, when a JRSSR is prepared at the time of the request to terminate supervision, it may be used as a termination summary to provide the information needed by the court to make the termination decision.

(b) The termination summary or JRSSR shall include:

Reason for Department involvement,
Progress toward resolving the issues that resulted in Department intervention; current status of safety, and an explanation of case plan outcomes that were met and those that were not; and,
The reason for termination.

(3) For court ordered in-home protective supervision, supervision shall not be terminated until authorized by court order.

History

Rulemaking Authority 39.012, 39.0121(12), (13) FS. Law Implemented 39.701(2)(a) FS. History–New 5-4-06, Amended 2-25-16, 11-25-24.

Fla. Admin. Code R. 65C-30.023 Multidisciplinary Team Staffing

(1) An integrated multidisciplinary team (MDT) staffing must be held when a decision is required to determine the most suitable out-of-home placement, educational placement, or any other important decisions in the child’s life which is so complex that the child welfare professional determines convening an MDT staffing is necessary to ensure the best interest of the child.

(2) General Provisions.

(a) The MDT staffing must incorporate the goals outlined in Section 39.4022(3), F.S., that allow for engagement and collaboration of all participants to reach a consensus in the best interest for the child and youth.

(b) The child welfare professional shall ensure, at minimum, an MDT staffing occurs for the following circumstances:

Emergency Placement Changes and Planned Placement Changes made by the department or the community-based care lead agency;
Locating and placing missing children;
Human Trafficking Placements;
Reunifications;
Sibling Separations;
Placement Transitions outline in Section 39.4022(2)(a), F.S., including transitions between foster home ;
Children in placements for Nine Months or More;
Education and Childcare/Early Childhood Changes;
Reinstatement of Parental Rights.

(c) MDT staffings are not required for placements involving an intervention through an adoption entity pursuant to Section 63.082(6), F.S., when a child is temporarily moved for respite care, or when a child under the Indian Child Welfare Act (ICWA) pursuant to 25 U.S.C. §1901 et seq., is transferred to their Tribe for ongoing care and supervision.

(d) When requesting an MDT staffing, the child welfare professional must include all supporting documentation not available in the child welfare information system. Documents not available at the time of the initial referral, shall be submitted by the child welfare professional no later than two (2) business days prior to the scheduled MDT staffing.

(e) The MDT staffing shall be conducted by a trained facilitator who has obtained the following qualifications:

Department approved adoption competency training;
Mediator or conflict resolution training;
Trauma informed care training;
Motivational interviewing training; and
Program service delivery in Economic Self-Sufficiency and Substance Abuse Mental Health training.

(f) The facilitator is responsible for conducting the following upon receipt of a request for an MDT staffing:

Reviewing all requests to determine if the MDT staffing meets the criteria outlined in paragraph (2)(b);
Scheduling timely MDT staffing based on the complexity of the case;
Responding to all appropriate requests for an MDT staffing within two (2) business days from receipt of the referral;
Inviting, at a minimum, participants set forth in Section 39.4022(4)(a), F.S., to the MDT staffing and a member of an Indian Tribe or Alaskan Native as defined in 25 U.S.C. §1903, if the child is a member of that Indian tribe or Alaskan Native, to ensure placement preferences of the Tribe as outlined in 25 USC 1915(c);

a. The Designated Tribal Agent for Service of Notice is the individual or individuals named in the Federal Register as being the official contact designated by the tribe for notification and legal service in compliance with the Indian Child Welfare Act. The Designated Tribal Agents for Service of Notice can be located at http://www.bia.gov/WhoWeAre/BIA/OIS/HumanServices/index.htm.

b. If the Designated Tribal Agent designates a tribal representative to act on behalf of the Tribe for purposes of representing the Tribe’s interests throughout the dependency proceedings, then the facilitator shall invite that tribal representative.

Inviting additional participants as outlined Section 39.4022(4)(b), F.S.;
Providing the participants who are permitted under Chapter 39, F.S., with supporting documentation no later than one (1) business day prior to the MDT staffing;
Ensuring participants are notified of their responsibility to maintain the confidentiality of any information shared during the MDT staffing as outlined in Section 39.4022(9), F.S. by providing a written statement to all participants that reads: “The information being disclosed during the MDT staffing is confidential and protected by state law. State law prohibits you from making any further disclosure unless otherwise permitted by state law.”;
Informing parents that their confidential case information will be discussed with any participants invited to the staffing;
Ensuring required participants are given the option to attend the MDT staffing in person or remotely; and
Considering combining MDT staffings when multiple needs and decisions can be addressed simultaneously.

(g) Parents shall be invited unless they are subject to one of the circumstance outlined in Section 39.4022(4)(a)1.b., F.S.

(h) The MDT staffing shall not be delayed pursuant to Section 39.4022(6)(a)2., F.S.

(i) All members of the MDT staffing are required to participate in the decision-making process. Each participating individual must provide reasons that support their decision pursuant to Sections 39.01375 and 39.4021, F.S.

(j) The child welfare professional shall follow the final decision of the MDT staffing when a unanimous decision has been made and complete a Placement Transition MDT Staffing and Transition Plan pursuant to Rule 65C-28.024, F.A.C.

(k) When the participants do not reach a unanimous consensus decision, the following shall occur.

The facilitator shall provide written notification to the assigned CLS attorney and managing attorney for the circuit at the conclusion of the staffing, but no later than 24 hours following the staffing. The notification must include, at minimum, the participant’s names, type of MDT staffing, and a statement outlining the position of each member.
The facilitator shall submit the MDT staffing packet, to include any assessment tools, supporting documents, MDT staffing recommendations, and written report within two (2) business days of the conclusion of the MDT staffing to the Department representative.

(l) The facilitator shall immediately schedule a transition plan MDT staffing pursuant to Section 39.4023, F.S. within seven (7) business days from the final decision from the Department representative.

(m) The facilitator must ensure the child’s best interest for remaining in school or child-care or educational program, pursuant to Rule 65C-28.018, F.A.C., are considered during each MDT staffing.

(n) Participants must consider all factors for reinstatement of parental rights as outlined in Section 39.8155, F.S. Biological or adoptive parents whose rights have been restored are not eligible to receive adoption assistance as outlined in Section 409.166(5), F.S.

(3) Emergency and Planned Placement.

(a) Whenever a child is unable to safely remain at home with a parent or requires a change of placement, the most appropriate placement shall be determined upon completion of the Comprehensive Placement Assessment and MDT staffing. The child shall be placed according to Section 39.523, F.S., and in addition to in the most appropriate setting available that meets the needs of the child and is in the child’s community.

(b) Federal laws, Multiethnic Placement Act of 1994, 42 U.S.C.A. §671(a)(18), and Interethnic Adoption Provisions of the Small Business Job Protection Act of 1996, P.L. 104-188, 110 Stat. 175, require that every placement decision for children in the care or custody of the Department be made without regard to the race, ethnicity, color, or national origin of the child or the adult with whom the child is to be placed.

(c) A Comprehensive Placement Assessment shall be conducted prior to making a referral for a clinical assessment for the purpose of rendering a diagnosis of mental illness or emotional or behavioral disorders or for the purpose of satisfying placement requirements in a clinical licensed clinical setting. The assessment shall not be used to formulate a diagnosis.

(d) The child welfare professional shall complete the Comprehensive Placement Assessment, CF-FSP form 5438, (November 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14961, document any reasons why the child was not placed in the recommended level of care and physical placement selected for the child.

(e) The MDT staffing must occur prior to placement when the child is removed by a child protective investigator at initial removal.

(f) Planned placements require an MDT staffing to be held prior to the intended date of the child’s change in physical placement.

(g) Absent an emergency, the current caregiver shall notify the CBC, at a minimum of 45 days in advance, when requesting a change of placement.

(h) Participants must consider the following factors during the MDT staffing:

Appropriateness of the initial and subsequent placements;
Factors outlined in the comprehensive placement assessment;
The child’s expressed interests and desires related to their placement and how to accommodate them;
Placement with siblings;
Impact of the placement change to the current caregiver;
Monetary allowance for children in out-of-home care pursuant to Section 409.14515(6), F.S.; and
The approved unified home study when moving a child to a relative or non-relative placement.

(4) Placement Following Recovery from a Missing Children Episode. Participants must consider the factors outlined in Rule 65C-30.019, F.A.C., during the MDT staffing when determining the most appropriate placement for the child upon recovery from a missing child episode, in addition to the following factors:

(a) The child’s current or past experiences while missing;

(b) Potential human trafficking involvement;

(d) Behavioral, developmental, mental, medical, and physical behaviors;

(e) The child’s expressed interests and desires related to their placement and how to accommodate them;

(f) Factors that contributed to the runaway episode;

(g) The comprehensive placement assessment; and

(h) Services for the child and/or caregiver to prevent future missing child episodes.

(5) Human Trafficking.

(a) The child welfare professional shall submit a referral requesting an MDT staffing when a child has been identified or suspected as a victim of human trafficking, and follow local protocols developed to support the MDT staffing pursuant to Section 409.1754(2), F.S. The child welfare professional must use the Human Trafficking (HT) MDT Staffing Form, CF-FSP 5461, (November 2022), incorporated by reference and available at available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14962.

(b) In addition to the participants required to be invited to the MDT staffing pursuant to subparagraph (2)(f)4. of this rule, and Section 409.1754(2)(a), F.S., efforts shall be made to ensure the following individuals are invited to the staffing:

The Department Criminal Justice Coordinator;
Service providers who specialize in human trafficking; and

(c) Participants must consider the following factors, during the MDT staffing to determine placement for a survivor of human trafficking:

The child’s human trafficking screening tool (HTST), incorporated in Rule 65C-43.001, F.A.C.;
The Level of Human Trafficking Placement Tool, CF-FSP 5460, (November 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14963, if applicable;
The comprehensive placement assessment, CF-FSP form 5438, incorporated in paragraph (3)(d) of this rule; and
Placement in a treatment facility with a human trafficking program safe house, or safe foster home.

(6) Reunification.

(a) Participants must consider the following factors during the MDT staffing when making a determination to reunify the child:

The most current progress update, protective capacity, and safety analysis;
Recommendations for the future development of an in-home safety plan;
Child’s behaviors that could pose a threat to self or others;
Implementation of supports to assist with transitioning the child to the parent or legal guardian;
Identification of supports and/or services necessary to assure a timely, smooth, and successful adjustment for the child and family after the transitions occur;
Requirements for conditions for return and due diligence to achieve reunification outlined in Section 39.521(1)(e)9., F.S.; and
The comprehensive placement assessment.

(b) If the court orders reunification prior to an MDT staffing, the child welfare professional must immediately request a Placement Transition MDT staffing and Transition Plan as outlined in Rule 65C-28.024, F.A.C.

(7) Sibling Separation.

(a) Prior to the consideration of separate placement for siblings, the child welfare professional shall follow the requirements pursuant to Section 39.4024(3)(a)1., F.S. and complete the Sibling Placement Assessment Tool CF-FSP 5465, (November 2022), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14964.

(b) When siblings are placed in out-of-home care at different time frames, the participants shall follow requirements outlined Section 39.4024(3)(a)2., F.S.

(c) When a sibling of a child in out-of-home care has been identified an MDT staffing must be scheduled within three (3) business days of notification to consider placement of the siblings together.

(d) Participants must follow all requirements pursuant to Sections 39.01375, 39.4021, 39.522(3), F.S., and Rules 65C-16.005, and 65C-16.002, F.A.C., when conducting an MDT staffing for the purpose of separating siblings because of an adoption.

(e) When an action may result in separation of siblings that are currently placed together, the child welfare professional shall follow requirements pursuant to Section 39.4024(5)(b), F.S.

(f) Participants must consider factors pursuant to Section 39.4024(3)(b), F.S, when placing siblings together.

(g) Placement Transition MDT staffngs and Transition Plans must be completed pursuant to Rule 65C-28.024, F.A.C., when a change in placement occurs. The transition plan must outline communication and visitation amongst siblings pursuant to Section 39.4024(4)(a), F.S.; and sibling contact information. The plan should include contact information for emancipated youth and youth that are reunified upon parental consent.

(h) When the determination has been made to separate siblings, follow-up MDT staffings must as outlined in Section 39.4024, F.S.

(8) Children in a placement for Nine Months or More.

(a) When a placement move is requested for children in a placement for nine (9) months or more, a multidisciplinary staffing must be held in the timeframe pursuant to Section 39.522(3)(c)1., F.S., if the factors identified in Section 39.522(3)(b)1., F.S. and the following have been met:

The caregiver or other household members in the current placement has no verified reports of abuse, abandonment or neglect;
The caregiver or other household member of the current placement has not been named as an alleged perpetrator in a sexual abuse report; and
The caregiver has either:

a. Applied to adopt and has a valid and approved adoption home study;

b. A valid and approved relative or nonrelative home study; or

c. An active foster home license.

(b) If the decision, recommends a placement change, a Placement Transition MDT staffing and Transition Plan must be completed as outlined in Rule 65C-28.024, F.A.C.

The child welfare professional or facilitator will provide CLS with the approved transition plan and recommendation to change the child’s placements.
If the current caregiver did not attend the MDT staffing, the child welfare professional or facilitator will provide a written notice to the current caregiver outlining the MDT decision or the Department representative decision, if applicable.

3.The written notice and the date the current caregiver received the notice will be provided to CLS within 72 hours of the Post Disposition Change in Custody MDT staffing.

(c) The transition of the child to the new placement shall not begin until the requirements outlined in Section 39.522(3)(c), F.S, have been met.

(9) Education and Placement Transitions.

(a) The child welfare professional shall request an MDT pursuant to Section 39.4023, F.S., to ensure the child’s educational setting and placement setting change is in the best interest of the child.

(b) In addition to the requirements outlined in subsection (2) of this rule section, the MDT staffing must include all requirements pursuant to Rule 65C-28.018, F.A.C., for educational transitions or child-care/early childhood transitions, and Rule 65C-28.024, F.A.C., for placement transitions.

(10) Within five (5) business days of the MDT staffing conclusions, the facilitator shall upload the packet and supporting documentation, as appropriate, in the meeting module associated with the appropriate meeting type in the child welfare information system. Supporting documentation obtained directly from the child welfare information system for inclusion in the MDT packet, does not require an additional upload.

History

Rulemaking Authority 39.012, 39.4022(11), 39.4023(7), 39.4024(8), 39.523(5) FS. Law Implemented 39.4022, 39.4023, 39.4024, 39.522, 39.523 FS. History–New 12-25-22.

Fla. Admin. Code R. 65C-30.024 Case Record Face Sheet

(1) The child welfare professional shall document relevant case information, pursuant to Section 39.00146(2), F.S., in the child’s electronic case file contained in the Comprehensive Child Welfare Information System (CCWIS).

(2) The case record face sheet shall include the recommendations of the multidisciplinary team meeting made pursuant to Section 39.4022, F.S., and transition plans, pursuant to Section 39.4023, F.S.

(3) All information required under Section 39.00146(2), F.S., and subsection (2) above shall be entered into CCWIS within two business days after which the information is electronically transferred into the case record face sheet.

(4) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 39.00146(5) FS. Law Implemented 39.00146 FS. History‒New 3-3-22.

Chapter 65C-31 SERVICES TO YOUNG ADULTS FORMERLY IN THE CUSTODY OF THE DEPARTMENT

Fla. Admin. Code R. 65C-31.001 Definitions

History

Rulemaking Authority 39.5075(8), 409.1451(10) FS. Law Implemented 39.5075, 409.1451 FS. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.002 Case Management for Young Adults Formerly in Foster Care

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451 FS. History–New 7-27-06, Repealed 1-8-17.

Fla. Admin. Code R. 65C-31.003 Aftercare Support Services for Young Adults Formerly in Foster Care

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(1), (2), (3)(a), (c), (d), (5)(a) F.S. History–New 7-27-06, Repealed 10-19-15.

Fla. Admin. Code R. 65C-31.004 Road to Independence Scholarship

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(1), (2), (3)(a), (c), (d), (5)(b) FS. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.005 Transitional Support Services for Young Adults Formerly in Foster Care

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(1), (2), (3)(a), (c), (d), (5)(c) FS. History–New 7-27-06, Repealed 10-19-15.

Fla. Admin. Code R. 65C-31.006 Young Adult Services Documentation Requirements

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(1), (2), (3)(a), (c), (d), (5)(a), (c) FS. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.007 High School Needs Assessment

History

Rulemaking Authority 409.1451(10) F.S. Law Implemented 409.1451(5)(b)4. F.S. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.008 Post Secondary Needs Assessment

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(1), (2), (3)(a), (c), (d), (5)(b) FS. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.009 Independent Living Benefits Due Process Notification

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(5)(e) FS. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.010 Jurisdictional and Service Requirements for Young Adults Formerly in the Custody of the Department

History

Rulemaking Authority 39.012, 39.0121(13), 39.5075(8), 409.1451(10) FS. Law Implemented 39.013, 39.5075, 39.701(6)(a), 409.1451(5)(d) FS. History–New 7-27-06, Repealed 2-7-19.

Fla. Admin. Code R. 65C-31.011 Independent Living Program Budget Management

History

Rulemaking Authority 409.1451(10) FS. Law Implemented 409.1451(5) FS. History–New 7-27-06, Repealed 2-7-19.

Chapter 65C-32 PARENT EDUCATION AND FAMILY STABILIZATION COURSE

Fla. Admin. Code R. 65C-32.001 Definitions

(1) “Complaint” means an allegation of a violation of Sections 61.21(2)-(3), F.S., and the rules adopted pursuant to Rule Chapter 65C-32, F.A.C.

(2) “Department” means the Department of Children and Families.

(3) “Distance learning” means instruction provided through correspondence or via the Internet, pursuant to Rule 65C-32.002, F.A.C.

(4) “Evidence-based” means that the curriculum has been studied by independent researchers using sound methodology, and in peer-reviewed publications consistently found to be effective at increasing knowledge or improving parenting or child outcomes in multiple studies across a variety of populations.

(5) “Formal Course Guidebook” means a guidebook containing the background and objectives of the course, instructional methods and lesson plans, materials for distribution, and evaluation tools including educational outcomes and client satisfaction.

(6) “Indigent” means a determination of civil indigent status made by the clerk of the circuit court in which the underlying custody case is being heard.

(7) “Instructor” means the individual(s) qualified to provide instruction in a live classroom setting or answer participant questions regarding online or correspondence course content.

(8) “Letter of Non-Compliance” means a written notification advising the provider of the specified statute or rule violation(s).

(9) “Parenting Course” means the Parent Education and Family Stabilization Course designated pursuant to Section 61.21(2)(a), F.S., to provide information to parents as that information relates to court actions between the parents involving parental responsibility, care, time-sharing, and support of a child or children.

(10) “Provider” means an individual or legal entity qualified to develop and implement the Parent Education and Family Stabilization Course meeting the qualifications for approval pursuant to Rule Chapter 65C-32, F.A.C.

(11) “Research-informed” means that the curriculum is based on a review of research findings related to post-divorce adjustment, co-parenting and the effects of divorce on children, including abuse and neglect.

(12) “Revocation” means withdrawal of approval of a parenting course.

(13) “Verified finding” means to substantiate a complaint of non-compliance with Section 61.21, F.S., or the rules in this chapter.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(2), (3) FS. History–New 11-25-07, Amended 4-17-16.

Fla. Admin. Code R. 65C-32.002 Parenting Course Delivery

(1) A parenting course shall be a minimum of four (4) hours of course instruction, including the time required for instruction, participant exercises and an end of course test. Online courses shall have a mechanism that prevents participants from completing the course in less than four (4) hours.

(2) The parenting course content shall include a variety of teaching methods, such as lectures, group discussions, role-plays, videotapes, or other instructional activities.

(3) Each online or correspondence provider offering a parenting course shall incorporate a means for participants to communicate with the course instructor for questions. Course content specific questions shall be answered by the instructor within one (1) business day of receiving the question.

(4) All courses shall include a means of verifying the identity of participants.

(5) The instructor of a classroom parenting course and the instructor of an online or correspondence parenting course who is designated and available to communicate with participants shall possess the following qualifications:

(a) Bachelor’s degree in counseling, social work, psychology, education or related field and have at a minimum two (2) years’ experience in dealing with family, parenting, and divorce related issues, or

(b) Has a minimum of four (4) years related work experience in dealing with family, parenting, and divorce-related issues.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(2) FS. History–New 11-25-07, Amended 4-17-16.

Fla. Admin. Code R. 65C-32.003 Required Components of the Parenting Course

(1) All parenting courses developed pursuant to the requirements of Section 61.21, F.S., and Rule Chapter 65C-32, F.A.C., shall be named the “Parent Education and Family Stabilization Course.” Course providers are permitted to assign a unique name to their curriculum.

(2) The provider of a parenting course shall provide to each participant a printed disclaimer in written form which states the following: “The components of the parenting course are intended for educational purposes only. The presentation of this material is not intended to constitute mental health therapy, give information on specific mental health disorders nor medications to treat mental health disorders. Participants are encouraged to discuss specific mental health questions with a licensed mental health therapist of their choice.”

(3) The legal component of the parenting course shall provide general Florida family law principles. The presentation of this material is not intended to constitute legal advice and the course material must direct the participant to consult with a licensed attorney for answers to specific legal questions.

(4) The components required for the Parent Education and Family Stabilization Course in the state of Florida shall include the following:

(a) Divorce as Loss. This component shall include recognition of divorce as the loss of the current family structure and processes experienced by adults and children in working through loss. In addition, a distinction shall be made between loss of the current family structure and the continuing parental role;

(b) Permanency of Parental Role/Shared Parenting. This component shall include information about how children are positively impacted by a continuing relationship with both parents and the types of support children need from both parents;

(c) Developmental Stages of Childhood. This component shall include information on the developmental stages of childhood, as well as how a divorce may impact development, what parents can do to minimize the impact of the divorce, and when to seek additional help for a child experiencing problems;

(d) Communicating with Children in a Divorce Situation. This component shall include information about discussing divorce-related issues with children in reference to the developmental stage of the child;

(e) Communicating with the Other Parent. This component shall include the negative impact of a parent expressing anger toward the other parent in front of the children, the benefits to children of keeping them out of the middle of parental conflict, and how to establish a relationship with the other parent which shall minimize the children’s exposure to parental conflict;

(f) Abuse. This component shall include information on the power and control dynamics of domestic violence and the statewide toll-free domestic violence hotline telephone number where services may be accessed. An explanation of child abuse and neglect and the statutory mandate to report such incidences to the Florida Abuse Hotline must also be included, in addition to the penalties for false reporting;

(g) Legal Concepts. This component shall include general information about Florida family law, including references to statutory definitions as they relate to court issues involving divorcing parents with minor children and financial responsibilities to the child(ren); and,

(h) Parenting Time. This component shall include information about the benefits to children of maintaining a stable and consistent relationship with both parents, suggestions about how to develop a parenting plan, and effective communication between the parents about parenting time.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(2) FS. History–New 11-25-07, Amended 4-17-16.

Fla. Admin. Code R. 65C-32.004 Parenting Course Test

(1) Each parenting course shall include an end of course test designed to demonstrate the level of comprehension of the learning objectives by the participants.

(2) Participants shall have an unlimited number of attempts to pass the end of course test.

(a) Any time a participant receives a score of less than 70% on the end of course test, the instructor shall review the missed material with the participant prior to the participant retaking the test. For online courses, missed questions shall refer the participant to the appropriate section requiring review prior to the participant retaking the test.

(b) Providers shall not require additional fees for any additional time or instruction required for participants to pass the end of course test.

(3) A certificate of completion shall be distributed to each participant who completes a four (4) hour minimum Parent Education and Family Stabilization Course and receives a score of at least 70% on the end of course test.

(a) The certificate of completion shall include the name of the course, the provider’s name and contact information, the unique name of the curriculum, if applicable, and the date the parent began the course and the date the parent finished the course.

(b) Providers must have a means of verifying certificate authenticity.

(c) Providers must maintain a list of class participants and copies of all certificates of completion issued for five (5) years.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(2) FS. History–New 11-25-07, Amended 4-17-16, 6-5-16.

Fla. Admin. Code R. 65C-32.005 Parenting Course Approval

(1) Each applicant seeking approval of a Parent Education and Family Stabilization course shall submit a formal course guidebook and attachments to the Department of Children and Families, Office of Child Welfare, for review.

(a) The formal course guidebook shall include:

Course components pursuant to Rule 65C-32.003, F.A.C.;
Course learning objectives;
All course materials, including instructor’s manuals and videos;
Definitions of key terms. The key terms include legal and mental health terms to be introduced in the parenting course;
End of course test;
References. A list of resources to reference the source(s) of information in the course content;
Evaluation form. The provider may provide an evaluation form for participants upon completion of the parenting course. If an evaluation form is provided, it shall be included in the formal course guidebook; and,
Resource list. A list of available resources in and around the community that is furnished to each course participant.

(b) The attachments shall include:

Signed letter of introduction on letterhead,
Documentation that the curriculum is evidence-based or research-informed,
Resumes. The provider shall submit the resumes of all instructors. Providers shall submit to the Department a cover letter and the resume of any instructor hired after initial approval of the course. The cover letter and resume shall be submitted within seven (7) business days of hire,
Accessibility. For online courses, the course provider shall provide a means for the Department to access their course for the approval process,
Communication. Each distance learning provider shall submit to the Department its means of communicating with the participant to answer questions or interact with the participant,
Instructional Techniques. A list of all instructional techniques used during the presentation of the course by a provider or instructor,
Language. Information regarding the availability of different languages in which the course is offered,
Registration Information. This requirement shall include course name, address, phone number, and email address of the provider, and website address if available,
Amount charged to participants for taking the course; and,
Indigent status fees. This requirement shall include a means for indigent parents to complete their course, such as scholarships, acceptance of court waivers, and sliding fee scales if available.

(2) Currently approved parenting courses must provide proof of compliance with Rules 65C-32.003 through 65C-32.005, F.A.C., within six (6) months of the effective date of these rules. Failure to provide proof of compliance within six (6) months of the effective date of these rules shall result in revocation of course approval.

(3) Providers shall submit to the Department an updated formal course guidebook or updated attachments when any information provided to the Department for initial approval changes. An updated formal course guidebook or updated attachments shall be submitted within seven (7) business days of the change.

(4) Parenting course approval is valid for three (3) years.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(3) FS. History–New 11-25-07, Amended 4-17-16.

Fla. Admin. Code R. 65C-32.006 Parenting Course Approval Process

(1) The approval process shall be:

(a) The Department shall notify the provider via letter or email within five (5) business days of receipt of the application packet;

(b) The Department shall review the packet within 30 business days of notification to the applicant;

(c) After a review of the packet, the Department shall notify the applicant whether the course is approved or whether additional information is needed;

(d) The applicant shall have 90 calendar days provide the additional information;

(e) If the additional information is provided within 90 calendar days, the Department shall make a final determination on approval of the course. If the additional information is not provided within 90 calendar days, the Department shall return the application packet with a letter indicating that the course is not approved.

(2) The Department shall approve all applications that meet the criteria set forth in Section 61.21(2), F.S., and Rules 65C-32.002-.005, F.A.C.

(3) The notification of Department approval shall be included in all course materials.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(3) FS. History–New 11-25-07, Amended 4-17-16.

Fla. Admin. Code R. 65C-32.007 Complaints

(1) All complaints shall be in writing to the Department and shall include the following information:

(a) Date of the alleged violation of Section 61.21, F.S., or the rules in this chapter;

(b) Name of the parenting course;

(d) Basis and content of the complaint.

(2) The Department shall handle the complaints of non-compliance in the following manner:

(a) The Department shall review the rule and designate the rule violation(s) as specified in the complaint;

(b) The Department shall notify the provider of the specified alleged rule violation(s) within five (5) business days of receipt of the complaint;

(c) The provider shall have the opportunity to respond to the alleged rule violation(s) within 15 business days of the receipt of notice of the alleged rule violation; and,

(d) The Department shall determine the validity of the alleged rule violation(s) within 45 calendar days of receipt of the provider’s response to the complaint.

(3) A letter of non-compliance shall be issued to the provider of the course if the complaint is founded.

(4) The provider shall have 60 calendar days after the receipt of the letter of non-compliance to come into compliance.

(5) Prior to the final action of denying or revoking approval of a course, the provider shall have the opportunity to request either a formal or informal administrative hearing to show cause as to why the action should not be taken.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21 FS. History–New 11-25-07, Amended 4-17-16.

Fla. Admin. Code R. 65C-32.008 Revocation of Course Approval

The following shall subject a parenting course to revocation of approval:

(1) A verified finding that course approval or certification was obtained by fraudulent means, such as providing documentation for approval which was based on false documentation;

(2) A verified finding that a course has been altered in any manner, such as course contents or change of course materials, that is contrary to course requirements per Section 61.21(2), F.S., or Rules 65C-32.002-.005, F.A.C.;

(3) Providing mental health therapy to participants;

(4) Providing individual legal advice to participants;

(5) Solicitation of participants from the sessions to become private clients or patients;

(6) The use of the Department’s past or present logo, or

(7) Failure to comply with subsection 65C-32.005(2), F.A.C.

History

Rulemaking Authority 61.21(3)(e) FS. Law Implemented 61.21(3) FS. History–New 11-25-07, Amended 4-17-16.

Chapter 65C-33 CHILD WELFARE TRAINING AND CERTIFICATION

Fla. Admin. Code R. 65C-33.001 Definitions

(1) “Agency” or “Employing Agency” refers to the Department, or any Sheriff’s Office or community-based care (CBC) provider under Grant Agreement or under contract with the Department to provide child welfare services.

(2) “Break in Service” refers to an interruption of an individual’s continuous employment in a position requiring Child Welfare Professional certification.

(3) “Certification” refers to the process whereby an individual must demonstrate the knowledge, skills, abilities and priorities necessary to competently discharge the duties of a Florida Child Welfare Professional, as evidenced by the successful completion of all applicable classroom instruction, field training, testing, and job-performance requirements of his or her position classification.

(4) “Certification Designation” refers to one (1) of the three (3) Child Welfare Professional categories in which an individual is eligible for certification. Each designation (Child Protective Investigator, Case Manager, and Licensing Counselor) has a training, testing and certification requirement.

(5) “Certified Florida Child Welfare Professional” or “Certified” refers to the designation earned by an individual who has met the criteria for Florida certification as a Child Protective Investigator, a Case Manager, or a Licensing Counselor.

(6) “Child Welfare Pre-Service Training Program” (also known as “Pre-Service”) refers to the multi-faceted child welfare pre-service curriculum, the primary component of which is classroom instruction. The Pre-Service Training Program may also include on-line learning and supervised agency-specific field activities.

(7) “Classroom Instruction” refers to the delivery and facilitation of approved, mandatory child welfare curricula.

(8) “Continuing Education” refers to all training in which a certified Child Welfare Professional participates in order to help develop or enhance his or her core competencies on an on-going basis.

(9) “Department” refers to the Florida Department of Children and Families.

(10) “Field Activities” or “Field Training” refers to one type of experiential learning which may be included in the State of Florida Child Welfare Pre-Service Training Program.

(11) “Florida Safe Families Network” (also known as “FSFN”) refers to the Department’s Statewide Automated Child Welfare Information System (SACWIS). FSFN serves as the statewide electronic case record for all child abuse investigations and case management activities in Florida.

(12) “Full Certification” refers to the certification awarded after the provisionally certified professional has completed specified on-the-job experience and direct supervision requirements.

(13) “Group Supervision” refers to supervision provided to two (2) or more staff, either certified or uncertified, at the same time.

(14) “Individual Supervision” refers to face-to-face contact between a qualified supervisor and a provisionally certified professional during which the applicant apprises the supervisor of the status of a case, the case is discussed, the supervisor provides the applicant with oversight and guidance in working the case, and evaluates the applicant’s performance.

(15) “Intern” refers to an undergraduate or graduate level student undergoing supervised, practical training in the field of social work, child welfare, or a similar human services field.

(16) “OnLine Learning” refers to one type of learning experience, provided via a computer, which may be included in the State of Florida Child Welfare Pre-Service Training Program.

(17) “Position Classification” refers to the position in which a person is or has been employed.

(18) “Post-Test” refers to the competency-based, criterion-referenced, proctored, written or on-line test which is administered at the conclusion of the State of Florida Child Welfare Pre-Service Training Program classroom curriculum.

(19) “Primary case responsibility” refers to the principal person, unit or geographical area assigned to perform child welfare services for a specific child, investigation, family, or case.

(20) “Provisional Certification” refers to the certification of a Child Welfare Professional that is awarded after successful completion of pre-service training and the post-test, or the waiver test, prior to achieving full certification.

(21) “Pre-Service Child Welfare Trainer” refers to the Child Welfare Trainer who engages in instruction of any part of the Pre-Service Curriculum.

(22) “Secondary Worker” refers to a person, unit or geographical area assigned by the supervisor to perform child welfare services for a specific child, investigation, family, or case in a minor capacity or to a lesser degree than that individual which maintains the “primary” case responsibility.

(23) “Trainee” refers to an individual who is participating in pre-service training and has not yet received Provisional Certification.

(24) “Training Caseload” refers to the reduced number of cases assigned to each provisionally certified Child Welfare Professional after having successfully completed the pre-service curriculum and passing the post-test, or passing the waiver test.

(25) “Training Entity” refers to the employing agency which is responsible for the delivery of pre-service and continuing education to a particular circuit, region or geographical area.

(26) “Trainer Program” refers to the program approved by the Department through which Pre-Service Child Welfare Trainers are provided training, coaching, and evaluation to achieve and maintain competency in the training Pre-Service Curriculum.

(27) “Waiver Plan” refers to an individualized, written plan between the Child Welfare Professional, his or her supervisor, and a child welfare trainer, which, when the waiver process is implemented, addresses any supplemental training or activities needed by the Child Welfare Professional.

(28) “Waiver Process” refers to the procedure whereby an individual who meets the minimum educational and experiential criteria of a Child Welfare Professional is eligible to take a “waiver test” and enter into an individualized “waiver plan,” in lieu of participating in the pre-service training and post-test requirements.

(29) “Waiver Test” refers to the competency-based, criterion-referenced, proctored, written or online test which may be administered to individuals whose prior experience allows them the opportunity to take the test in lieu of completing the pre-service training requirements in order to achieve provisional certification.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15, 5-28-18.

Fla. Admin. Code R. 65C-33.002 Certification for Child Welfare Professionals

(1) Every Child Welfare Professional is required to be certified within one (1) year of the date of having successfully completed either the post-test or the waiver test for his or her position classification.

(2) Certification is based upon meeting the standards and successfully completing the professional requirements established by the Third Party Credentialing Entity.

(3) Each type of child welfare certification has a training, testing and certification requirement.

(4) There are three (3) designations for Child Welfare Professionals that require certification:

(a) Child Protective Investigator;

(b) Case Manager; and,

(5) The employing agency shall ensure that all certification requirements are met within the specified time frames for those positions requiring certification.

(6) To be certified, each Child Welfare Professional candidate must meet the training and certification requirements for his or her position classification.

(7) An individual may hold multiple certifications at the same time as long as he or she holds or has held the position classification or certification designation for which he or she is certified.

(8) Third Party Credentialing Entities are responsible for the internal monitoring of all trainings, certification activities and certification status of every Child Welfare Professional employed by the Department, sheriffs’ office and community-based care providers.

(9) Certification is valid for a period of two (2) years.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.003 Child Welfare Pre-Service Training

(1) The Department-approved State of Florida Child Welfare Pre-Service Training Program curriculum is primarily comprised of classroom instruction, but may also include on-line learning and agency-specific field activities. Department approval shall be based on whether the curriculum meets the standards set forth in section 402.40(5), F.S.

(2) The pre-service classroom instruction involves the delivery and facilitation of curricula by a child welfare trainer in the classroom.

(a) At the discretion of the training entity, some pre-service classes may include guest speakers as subject matter experts regarding relevant topics; however, although agency or area-specific information may be added to the curriculum, nothing in the existing, Department-approved curriculum may be deleted or revised.

(b) With the exception of interns as referenced in subsection 65C-33.003(6), F.A.C., a training entity or employing agency may arrange for non-employed individuals to participate in pre-service classroom instruction; however, these individuals shall not be administered the waiver test or post-test.

(c) Pre-service classroom instruction may be observed by individuals involved in the administration, delivery, design, or oversight of pre-service training for purposes of assessing the effectiveness of training delivery, or evaluating the need for enhancement of curriculum design.

Advanced notice of the observation may be provided, but is not required.
No more than two (2) individuals shall observe the same class session at the same time, and the observer(s) shall neither disrupt the class nor interact with the trainer(s) or class participants at any time while the class is in session.

(3) There is a 100% mandatory attendance requirement for all pre-service classroom instruction, absent special circumstances documented and accommodated by the employing agency or the training entity.

(a) It is the responsibility of the employing agency to ensure that each trainee attends and completes all of the pre-service classroom, on-line and field instruction required for his or her position classification.

(b) Any missed training classes, modules or material must be completed by the trainee prior to the trainee taking the post-test.

(4) Field Activities.

(a) If field activities are provided to trainees during the pre-service training, the employing agency shall ensure the activities are supervised and reviewed by certified Child Welfare Professionals.

(b) At the discretion of the supervisor, field activities may include opportunities for the trainee to shadow or be mentored by experienced certified staff, and may take place in the agency unit or in the field, as long as the trainee is accompanied by and under the direct supervision of a certified Child Welfare Professional at all times.

(5)(a) Under no circumstances shall a trainee carry a caseload, be assigned responsibility for any cases, conduct unaccompanied or unsupervised home visits, perform unsupervised home studies or interviews of children or adults, be ultimately responsible for any assessment of risk, or otherwise have primary responsibility for any investigation, child, family or case, until he or she successfully completes the pre-service training and passes the post-test.

(b) In order to meet each trainee’s need for a variety of opportunities in the practical application of concepts learned in pre-service training, a trainee may be assigned as a secondary worker in the FSFN or other Department-approved system to no more than four (4) active cases during his or her pre-service training, for the sole purpose of performing and practicing newly-learned skills while accompanied and supervised at all times by a certified Child Welfare Professional. Although assigned as a secondary worker, the trainee shall not bear ultimate responsibility for any aspect of the case. Every piece of casework completed by the trainee shall be reviewed and approved by either the primary worker on the case, the supervisor of the primary worker on the case or other certified Child Welfare Professional, prior to the piece of casework being included and saved in the active case file or FSFN case record.

(6) Interns. Interns may be utilized to assist child welfare staff in the performance of their job duties. Interns are permitted to seek certification and are subject to the same restrictions and requirements as employees.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.004 Pre-Service Training Post-Test

(1) The training entity is responsible for proctoring the post-test, and for ensuring that there is technical support available, in the event of an emergency related to the administration of the test.

(2) Only individuals hired by the employing agency in a Child Welfare Professional position, as well as interns working with the agency, are eligible to take the post-test. Prior to proctoring the post-test, the training entity is responsible for verifying each trainee’s eligibility to take the post-test by ensuring that every trainee has satisfactorily completed all pre-service training requirements.

(3) The Third Party Credentialing Entity is responsible for addressing and accommodating the special testing needs of a trainee, by prior discussion with the trainee and the supervisor, in order to determine if accommodations are warranted and able to be afforded the trainee, while ensuring that all pre-service participants are treated fairly and provided with equal opportunities for successful post-test completion.

(4) The post-test shall be administered and scored by the Third Party Credentialing Entity or contracted provider. Immediately upon completion of the post-test, the test proctor shall provide each trainee with his or her preliminary post-test score. Within five (5) business days of the completion of the test, the Third Party Credentialing Entity shall send the trainee his or her official score via U.S. mail or electronic mail. Each employing agency shall develop protocols with regard to the dissemination of an individual’s post-test score to personnel within the agency.

(5) Disruptions During Testing.

(a) If equipment failure, building disruption, or other unforeseen circumstances occur during the course of the administration of the post-test, and the disruption affects any participants taking the test, arrangements shall be made by the training entity to re-administer the post-test as soon as practical to those participants affected by the disruption.

(b) The re-administration of the post-test to the affected participant(s) must be conducted in a manner consistent with the time and proctoring standards followed in the initial post-test administration, ensuring that all participants are treated fairly and provided with equal opportunities for successful post-test completion.

(c) For issues not addressed above which arise during the administration of the post-test, the trainer/test proctor shall contact the Third Party Credentialing Entity for guidance. The Third Party Credentialing Entity shall keep a record of these issues/requests detailing the date and time of the call; the name, title and agency of the caller; the nature of the issue; and the resolution provided by the Third Party Credentialing Entity. A copy of this log shall be provided to the Department on a quarterly basis, or as requested.

(6) A trainee must achieve the minimum established passing score or higher on the post-test in order to receive Provisional Certification. The minimum established passing score of the post-test is determined by the Third Party Credentialing Entity.

(7) Retaking the Post-Test. If re-taking the post-test, the re-test must be administered no later than 15 business days following the date of the initial post-test, absent special circumstances accommodated by the employing agency or the training entity.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15, 5-28-18.

Fla. Admin. Code R. 65C-33.005 Provisional Certification

(1)(a) A trainee must successfully complete all of the required pre-service training and pass the post-test, or pass the waiver test, in order to receive provisional certification.

(b) Any Child Protective Investigator, Case Manager, or Licensing Counselor who has either successfully completed the waiver test and entered into a waiver plan, or successfully completed the pre-service training and passed the post-test, is considered to be a Provisionally Certified Child Welfare Professional, and, as such, may perform all tasks required by the position held, while completing his or her certification process.

(c) The Third Party Credentialing Entity is responsible for issuing provisional certification certificates and maintaining a certification database.

(2) Training Caseload.

(a) Upon receiving provisional certification, each Child Protective Investigator, Case Manager and Licensing Counselor shall be given a training caseload of a reduced number of investigations (for Child Protective Investigators), a reduced number of cases (for Case Managers), or a reduced number of foster family home studies (for Licensing Counselors) for 30 calendar days.

(b) The training caseload for Child Protective Investigators shall be limited to no more than four (4) open, active investigations at any time, and shall not exceed a total of eight (8) investigations during the 30 calendar days following the date the individual passed the waiver or post-test.

(c) The training caseload for Case Managers shall be limited to no more than five (5) open, active cases, and shall not exceed 10 children at any time during the 30 calendar days following the date the individual passed the waiver or post-test.

(d) The training caseload for Licensing Counselors shall be limited to no more than three (3) open, active home studies at any time; and shall not exceed a total of five (5) licensed foster homes during the 30 calendar days following the date the individual passed the waiver or post-test.

History

Rulemaking Authority 402.40, 402.731(1) FS. Law Implemented 402.40, 402.731(1) FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.006 Full Certification

(1) A provisionally certified Child Welfare Professional must meet the following requirements to earn Full Certification:

(a) Complete 1,040 hours of on-the-job experience in his or her certification designation;

(b) Complete six (6) field observations, as defined by the Third Party Credentialing Entity;

(d) Have 10 hours of group supervision; and,

(e) Have an additional 10 hours of individual and/or group supervision with an attestation from the supervisor that the Child Welfare Professional has the ability to competently perform child welfare services.

(2) Absent special circumstances, a Child Welfare Professional has one (1) year from provisional certification to attain full certification.

(3) The Third Party Credentialing Entity is responsible for issuing full certification certificates and maintaining a certification database.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.007 Additional Requirements for Supervisor Certification

History

Rulemaking Authority 402.40, 402.731(1) FS. Law Implemented 402.40, 402.731(1) FS. History–New 10-14-10, Repealed 10-19-15.

Fla. Admin. Code R. 65C-33.008 Certification Renewal

(1) Certification renewal is a condition of continued employment for positions requiring certification.

(2) In order to be eligible for certification renewal, a certified Child Welfare Professional must continue to fulfill his or her job requirements and participate in a minimum of 40 hours of continuing education every two (2) years from the date of his or her most recent certification. Unless accommodations are made by the Third Party Credentialing Entity to address an individual’s special circumstances, an individual must be removed from a position requiring certification if certification renewal is not achieved within two (2) years.

(3) Multiple Certifications.

(a) An individual may renew his or her certification in multiple classifications or certification designations as long as he or she holds or has held the position classification or certification designation for which he or she is being renewed;

(b) There is no limit to the length of time an individual may hold multiple Child Welfare certifications, as long as the individual continues to meet the certification renewal requirements.

(4) An individual’s certification can be renewed for a position classification or certification designation if he or she meets the following requirements:

(a) Achieved initial certification in each of the position classifications or certification designations as indicated by possession of a valid certification issued by a Third Party Credentialing Entity;

(b) Is currently employed in a Florida child welfare position in good standing;

(d) Participates in and maintains his or her own documentation of a minimum of 40 hours of continuing education every two (2) years.

(5) When a certified individual has a break in service of less than one (1) year and can meet the requirements for renewal as stated in subsection (6), above, his or her certification can be renewed.

(6) Continuing education must meet the requirements set by the Third Party Credentialing Entity and shall include a wide variety of core competency elements (e.g., interpersonal skills, conflict resolution, law and policy issues, cultural diversity, and investigative and casework related processes) in order to help expand the knowledge, proficiency and awareness of each certified Child Welfare Professional. In addition, continuing education shall be administered by qualified providers approved by the Third Party Credentialing Entity.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.009 Certificate Issuance

History

Rulemaking Authority 402.40, 402.731(1) FS. Law Implemented 402.40, 402.731(1) FS. History–New 10-14-10, Repealed 10-19-15.

Fla. Admin. Code R. 65C-33.010 Waiver Process

(1) The waiver process is the procedure by which individuals who already meet criteria established by the Third Party Credentialing Agency are eligible to take a waiver test and enter into an individualized waiver plan in lieu of participating in the training requirements to achieve provisional certification.

(2) A waiver test shall never be given if the individual whose certification was previously revoked for cause by the Third Party Credentialing Entity.

(3) Any individual who does not pass the waiver test on his or her first attempt, shall participate in the entire pre-service curriculum, and shall successfully complete all pre-service training requirements.

(4) The employing agency shall require the participation in the entire pre-service training and post-test process of any individual for whom training needs or known job performance deficits have been identified, prior to the assignment of primary responsibility for any investigation, child, family or case.

(5) The Waiver Test.

(a) There must be no waiver test preparation classes conducted or pre-service curriculum study materials provided to any individual in order to help prepare him or her for the waiver test.

(b) The waiver test must be administered within 10 business days of the individual’s start date in the position into which he or she was hired.

(c) The employing agency shall maintain written documentation of the individual’s applicable educational and employment experience as verification of the employee’s eligibility to take the waiver test.

(d) The waiver test taken by an individual shall be the version designed for the position classification into which the individual is hired.

(e) If the individual fails the waiver test, no waiver plan is developed, and the individual must participate in the pre-service training in trainee status, regardless of any prior education or previous experience.

(6) The minimum established passing score of the waiver test shall be determined by the Third Party Credentialing Entity offering the certification.

(7) The waiver test is administered and scored by the Third Party Credentialing Entity and, upon conclusion of the waiver test, the test proctor shall provide the individual with his or her preliminary waiver test score immediately upon completion of the test. Within five (5) business days of the completion of the test, the Third Party Credentialing Entity shall send the trainee his or her official score via U.S. mail or electronic mail. Each employing agency shall develop protocols with regard to the dissemination of an individual’s waiver test score to personnel within the agency.

(8) The Waiver Plan.

(a) The employing agency shall ensure that, upon successful completion of the waiver test Child Welfare Professional enters into an agency-designed waiver plan.

(b) Within five (5) business days of having passed the waiver test, the Child Welfare Professional shall meet with his or her supervisor and a child welfare trainer in order to enter into and sign an individualized waiver plan, which shall address:

The requirement that the individual participate in pre-service classes and activities in the track of the new position classification that he or she had not previously attended or completed, and participate in any other identified classroom, field and online training and activities needed to bring the individual up to the current standard of a Florida Child Welfare Professional in the same position classification;
The requirement that full certification shall be completed within one (1) year of the date of passing the waiver test; and,
The roles, tasks, responsibilities and specific time frames for completion assigned to each party, in order to address identified needs and enhance or update current knowledge in order to help ensure that the individual has access to the resources and supports necessary for his or her successful job performance and completion of the certification process.

(9) As part of any waiver plan, the employing agency may require that an individual participate in additional trainings and activities, regardless of certification status, education or experience. These additional requirements depend upon such factors as the type, length and degree of the individual’s previous child welfare or other applicable experience; the individual’s prior job performance history; duration of the individual’s break in service (if applicable); and changes in Florida law, policy and practice which may have occurred since the individual last attended pre-service training.

(10) Regardless of certification status or any prior education or previous experience, until such time as the waiver plan has been reviewed, completed and signed by all parties, the Child Welfare Professional who has passed the waiver test shall not carry a caseload, assign or be assigned responsibility for any cases, conduct any unaccompanied or unsupervised home visits, perform any unsupervised home studies or interviews of children or adults, be ultimately responsible for any assessment of risk, be tasked with any oversight or approval of the work of others, or otherwise have primary responsibility for or provide oversight of any investigation, child, family or case.

(11) Each Child Protection Professional who passes the waiver test shall be given provisional certification.

(12) There is no waiver procedure for the full certification portion of the certification process, or for the 40 continuing education training hours required every two (2) years for certification renewal.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.011 Certification Revocation

(1) The Third-Party Credentialing Entity is responsible for certification revocation.

(2) The Department, community-based care agencies, sheriffs’ offices, and their contracted providers shall report all ethical violations of any certified child protection professional to the Third Party Credentialing Entity.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 10-14-10, Amended 12-24-15.

Fla. Admin. Code R. 65C-33.012 Child Welfare Trainer Certification

History

Rulemaking Authority 402.40, 402.731(1) FS. Law Implemented 402.40, 402.731(1) FS. History–New 10-14-10, Repealed 10-19-15.

Fla. Admin. Code R. 65C-33.013 “Supervising for Excellence” Trainer Certification

History

Rulemaking Authority 402.40, 402.731(1) FS. Law Implemented 402.40, 402.731(1) FS. History–New 10-14-10, Repealed 10-19-15.

Fla. Admin. Code R. 65C-33.014 Third Party Credentialing Entities’ Application and Review Process

(1) Each Third Party Credentialing Entity applying for Department approval pursuant to section 402.40, F.S., shall submit to the Office of Child Welfare at 1317 Winewood Boulevard, Building 1, 3rd floor, Tallahassee, Florida 32399, the following documentation for review:

(a) Letter of introduction;

(b) Proof of nonprofit status;

(c) Proof that the applicant has accreditation from the National Commission for Certifying Agencies and has completed the Commission’s self-assessment checklist;

(d) Listing of professional requirements and standards that child welfare applicants must achieve in order to obtain and maintain a certification;

(e) Examination instruments used to assess mastery of core competencies and that comply with the National Commission for Certifying Agencies’ certification and psychometric standards;

(f) Professional code of ethics and disciplinary process for all persons holding child welfare certification, including a process for immediate notification to employing agencies upon indication that one of their employees has violated the code of ethics;

(g) Description of the applying entity’s database of all persons holding child welfare certification, that includes any history of ethical violations and how the database will be available to the public;

(h) Listing of the annual continuing education requirements for persons holding child welfare certification;

(i) Description of a continuing education provider program to ensure that only qualified providers offer continuing education opportunities for those certified; and,

(j) Procedures requiring the maintenance of an advisory committee, including representatives from each region of the Department, each sheriff’s office providing child protective services, and each community-based care lead agency, who shall be appointed by the organization they represent.

(2) Upon receipt of an application, the Department shall review the application and, within 30 days after such receipt, notify the applicant of any apparent errors or omissions and request any additional information.

(a) The applicant shall have 30 days to submit additional information.

(b) For good cause shown, the Department will grant a request for an extension of time for submitting the additional information.

(c) An application is complete upon receipt of all requested information and correction of any error or omission for which the applicant was timely notified.

(d) An application must be approved or denied within 90 days after receipt of an application or receipt of the additional information, when applicable.

(e) Approval or denial shall be based on whether the applicant meets the standards set forth in section 402.40(3), F.S.

(3) Each applicant shall be given written notice, by certified mail, that the Department intends to grant or deny, or has granted or denied, the application to become a credentialing entity.

(a) The notice shall be given within 30 days of the Department’s decision and shall state with particularity the grounds or basis for the issuance or denial of the application.

(b) The application will be denied if the applicant fails to meet the requirements prescribed in Section 402.40(3), F.S., or if there is a lack of funding.

History

Rulemaking Authority 402.40(6) FS. Law Implemented 402.40(3) FS. History–New 12-24-15.

Fla. Admin. Code R. 65C-33.015 Revocation or Suspension of Department Approval of Third-party Credentialing Entity Status

(1) No revocation or suspension of the Department’s approval of Third Party Credentialing Entity status can be made unless the Department has served, by certified mail, a letter, which provides notice to the credentialing entity of the facts or conduct which warrant the intended action. The letter shall be served to the credentialing entity at least 30 days prior to the intended action.

(2) The Department shall suspend its approval for Third Party Credentialing Entity status when the credentialing entity no longer complies with requirements in section 402.40, F.S.

(a) The credentialing entity shall have 60 days from receipt of notice to come into compliance with the requirements of section 402.40, F.S.;

(b) If the credentialing entity fails to come into compliance within 60 days from receipt of notice, the Department shall revoke its approval.

(3) Notwithstanding subsection (1) of this rule, the Department shall immediately revoke Department’s approval for Third Party Credentialing Entity status if the Department finds an immediate danger to the public safety or welfare or that approval to become a credentialing entity was obtained through fraudulent means.

History

Rulemaking Authority 402.40(6) FS. Law Implemented 402.40(3) FS. History–New 12-24-15.

Fla. Admin. Code R. 65C-33.016 Trainer Program

(1) Every Child Welfare Trainer hired after August 1, 2019 who engages in instruction of the Pre-Service Curriculum, herein referred to as “Pre-Service Child Welfare Trainer,” must apply for the Trainer Program within three (3) months of hire into a position of Pre-Service Child Welfare Trainer. Any Pre-Service Child Welfare Trainer hired prior to August 1, 2019, must apply for the Trainer Program within three (3) months of the program’s inception. If the Pre-Service Child Welfare Trainer is not a Certified Florida Child Welfare Professional, he or she must pass the waiver test before applying to the Trainer Program. If the waiver test is not passed, then the Pre-Service Child Welfare Trainer must follow requirements outlined in subsections 65C-33.010(3)-(4), F.A.C.

(2) The program provider, in consultation with the Department, shall create an instrument to evaluate an applicant’s level of content knowledge and delivery skills.

(a) The instrument must assess content knowledge, including, at a minimum: comprehension of the Pre-Service curricula, as well as policies and adherence to the fidelity of the Child Welfare Practice Model as related to Pre-Service training.

(b) The instrument must assess delivery skills, including, at a minimum: use of adult learning principles to both engage and manage content and behavior in a learning environment.

(3) Upon application to the Trainer Program, the program provider will evaluate the applicant and categorize him or her into one of the following levels:

(a) Level 1: Pre-Service Child Welfare Trainers who require both content knowledge and delivery skills training.

(b) Level 2a: Pre-Service Child Welfare Trainers who are deemed competent for content knowledge but require training for delivery skills.

(c) Level 2b: Pre-Service Child Welfare Trainers who are deemed competent for delivery skills but require training for content knowledge.

(d) Level 3: Pre-Service Child Welfare Trainers who are deemed competent for content knowledge and delivery skills.

(4) If the applicant is categorized as Level 1, 2(a), or (2)(b) after application evaluation, then the applicant will be required to complete the Trainer Program, instructed by the program provider, that addresses content knowledge and/or delivery skills as referenced in paragraphs (2)(a)-(b) of this rule. Until such time as the Child Welfare Pre-Service Trainer attains Level 3, the employing agency shall assess and provide necessary supports for the Child Welfare Pre-Service Trainer while engaging in duties related to instruction of the Pre-Service curricula.

(5) At the end of the training program, the Child Welfare Pre-Service Trainer will be assessed on content knowledge and/or delivery skills using the instrument created in accordance with subsection (2) of this rule. The applicant attains Level 3 upon a satisfactory assessment by the program provider. Once a Pre-Service Child Welfare Trainer attains a Level 3, he or she may apply for certification as a Pre-Service Child Welfare Trainer with the Third Party Credentialing Entity in accordance with the requirements set forth in rule 65C-33.002, F.A.C.

(6) If after a year the Pre-Service Child Welfare Trainer has not reached Level 3, a written plan must be established by the employing agency, based on input from the program provider, to address identified gaps in the trainer’s skills and abilities and to assist the trainer in attaining Level 3.

(a) The plan must be specific as to the steps that will be taken by both the agency and the trainer to achieve Level 3 status.

(b)The plan must be kept up-to-date by the employing agency.

(c) If Level 3 is not achieved within six (6) months of the date of the implementation of the written plan, the trainer cannot continue instructing Pre-Service curriculum.

(d) The Child Welfare Trainer may re-apply for the Trainer Program after six (6) months has elapsed in a non-training role.

(7) In order to maintain certification and stay at Level 3, the Child Welfare Trainer must complete a minimum of 20 hours of in-service training annually. Hours must include at least one (1) course provided by the Trainer Program. If Pre-Service Child Welfare Trainer certification lapses, the trainer must reapply for the Trainer Program.

(8) The requirements to become a certified Pre-Service Child Welfare Trainer will not apply to individuals who:

(a) Are teaching the Pre-Service curriculum as part of an academic program in which undergraduate or graduate students are enrolled in a college or university with the goal of attaining a degree; and

(b) Have an agreement with the Department in regard to incentive programs within Universities working to increase the eligible population of students with social work or behavioral health care degrees who may be interested in child welfare careers.

History

Rulemaking Authority 402.40 FS. Law Implemented 402.40 FS. History–New 5-28-18.

Chapter 65C-35 Psychotropic Medication for Children in Out of Home Care

Fla. Admin. Code R. 65C-35.001 Definitions

(1) “Assent” means a process by which a provider of medical services helps the patient achieve a developmentally appropriate awareness of the nature of his or her condition; informs the patient of what can be expected with tests and treatment; makes a clinical assessment of the patient’s understanding of the situation and the factors influencing how he or she is responding; and solicits an expression of the patient’s willingness to accept the proposed care.

(2) “Behavioral Health Assessment” means Comprehensive Behavioral Health Assessments as outlined in the Medicaid Community Behavioral Health Services Coverage and Limitations Handbook and all other assessments performed by mental health professionals. The Medicaid Community Behavioral Health Services Coverage and Limitations Handbook, March 2014, is hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-08083.

(3) “Caregiver” means a person who is approved in writing by the Department as responsible for providing for the child’s daily needs, or any other person legally responsible for the child’s welfare in a residential setting.

(4) “Case Manager” means a child welfare professional who is responsible for ongoing safety management and service provision of children who, through assessment by a child protective investigator, have been determined to be unsafe.

(5) “Case Plan” means the dependency case plan as defined in Section 39.01(11), F.S., which refers to the services plan jointly developed between the family and dependency case manager, delineating specific interventions aimed at addressing the contributing factors and underlying conditions that led to child maltreatment.

(6) “Chemical Restraint” means the use of a medication as a restraint to control behavior or restrict freedom of movement that is not an accepted treatment for the person’s medical or psychiatric condition.

(7) “Children’s Legal Services (CLS)” means Department of Children and Families attorneys or attorneys from contracted entities dedicated to representing the Department in Chapter 39, F.S., proceedings.

(8) “Child Protective Investigator (CPI)” means a child welfare professional who is responsible for investigating alleged child maltreatment and conducting assessments regarding the safety of children.

(9) “Community-based Care Lead Agency” means the not-for-profit or governmental community-based care provider responsible for the provision of support and services for eligible children who have been abused, abandoned, or neglected and their families.

(10) “Current Prescription” means a medication that is prescribed to the child and that the child is being administered or is directed to be administered at the time the child is taken into custody.

(11) “Department” means the Department of Children and Families.

(12) “Express and Informed Consent” means voluntary written consent from a competent person who has received full, accurate, and sufficient information and explanation about a child’s medical condition, medication, and treatment to enable the person to make a knowledgeable decision without being subjected to any deceit or coercion. Express and informed consent for the administration of psychotropic medication may only be given by a parent whose rights have not been terminated, or a legal guardian of the child. Sufficient explanation includes the following information, provided and explained in plain language by the prescribing physician or psychiatric nurse to the consent giver: the medication, reason for prescribing it, and its purpose or intended results; side effects, risks, and contraindications, including effects of stopping the medication; method for administering the medication, and dosage range when applicable; potential drug interactions; alternative treatments; and the behavioral health or other services used to complement the use of medication, when applicable.

(13) “Florida Safe Families Network (FSFN)” means the Department’s comprehensive, statewide automated case tool that supports child welfare practice. FSFN holds the state’s official case file for all children and families served. FSFN is the Statewide Automated Child Welfare Information System (SACWIS) for the state of Florida.

(14) “Guardian ad Litem” is defined in Section 39.820(1), F.S.

(15) “Lead Agency” means the not-for-profit or governmental community-based care provider responsible for the provision of support and services for eligible children who have been abused, abandoned, or neglected and their families.

(16) “Legal Guardian” means a permanent guardian as described in Section 39.6221, F.S., or a “guardian” as defined in Section 744.102, F.S., or a relative with a court order of temporary custody under Chapter 751, F.S. Case managers and Guardians ad Litem do not meet the definition of legal guardian.

(17) “Medical Report” means a report prepared by the prescribing physician or psychiatric nurse that includes information required by Section 39.407(3)(c), F.S. The “Medical Report” form, CF-FSP 5339, Sept 2019, is hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11323.

(18) “Out-of-Home Care” means the placement of a child in licensed and non-licensed settings, arranged and supervised by the Department or contracted service provider, outside of the home of the parent.

(19) “Pre-Consent Review” means a review by a child psychiatrist of a proposed medication regimen to determine whether or not the proposed prescribed medication and dosage are consistent with accepted medical practice given the diagnosis and physical condition of the child. A pre-consent review is not a second opinion.

(20) “Prescribing Physician” means a physician licensed under Chapter 458 or 459, F.S.

(21) “Psychiatric Nurse” means an advanced nurse practitioner certified under Chapter 464, F.S. and defined in Chapter 394, F.S.

(22) “Psychotropic Medication” means any medication prescribed with the intent to stabilize or improve mood, mental status, behavioral symptomatology, or mental illness and those substances, though prescribed with the intent to treat other medical conditions, have the effect of altering brain chemistry, including any medications in the following categories.

(a) Antipsychotics;

(b) Antidepressants;

(d) Lithium;

(e) Stimulants

(f) Non-stimulant Attention Deficit Hyperactivity Disorder medication;

(g) Anti-dementia medications and cognition enhancers; and

(h) Anticonvulsants.

(23) “Residential treatment center” means “Residential treatment center for children and adolescents” as defined in Section 394.67, F.S.

(24) “Resource Record” means the child’s standardized record that contains copies of all available and accessible medical and psychological information (including behavioral health information) pertaining to the child as described in subsections 65C-30.001(21) and 65C-30.011(4), F.A.C.

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Amended 4-20-17, 6-29-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.002 Behavioral Health Services

(1) Behavioral health services shall be provided to children in out-of-home care once the need for such services is identified. Prior to prescribing a psychotropic medication, the physician or psychiatric nurse must consider other treatment interventions that may include medical, mental health, behavioral, counseling, or other services. All decision-making shall be guided by the principle that it is important to comprehensively address all of the concerns in a child’s life – family, legal, health, education, and social/emotional issues – as well as to provide behavioral supports and parent training, so that a child’s behavioral and mental health issues can be addressed in the least restrictive setting and in a comprehensive treatment plan.

(2) The child’s case manager shall ensure that all behavioral health services that are identified in behavioral health assessments or prescribed by a medical or mental health professional have been integrated into the child’s case plan and are provided to the child.

(3) Prior to prescribing a psychotropic medication, the physician or psychiatric nurse must consider the child’s history for conditions that may indicate the presence of brain injury (for example, blows to head, fetal alcohol syndrome, loss of consciousness, head scars, fever above 104°) and document any follow-up assessments or referrals on the Medical Report.

(4) The administration of medication for the sole purpose of chemical restraint is strictly prohibited.

History

Rulemaking Authority 39.407(3)(g), 39.0121 FS. Law Implemented 39.407(1), (3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.003 Parent or Legal Guardian Involvement

(1) The child protective investigator (CPI) or case manager shall facilitate the attendance of the child’s parent (where parental rights are intact) or legal guardian at all medical appointments. The CPI or case manager shall make the following minimum efforts to assist the prescribing physician or psychiatric nurse in obtaining expressed and informed consent from the child’s parent or legal guardian:

(a) Attempt to invite the parent or legal guardian to the doctor’s appointment and facilitate transportation to the appointment, if necessary;

(b) Facilitate telephone or tele-medicine participation between the prescribing physician or psychiatric nurse and the parent or legal guardian when unable to attend in person.

(2) If the parent or legal guardian is unable to attend medical appointments, the CPI or case manager shall:

(a) Attempt to contact the parent or legal guardian upon learning of the recommendation for psychotropic medication by the prescribing physician or psychiatric nurse and provide specific information on how and when to contact the physician or psychiatric nurse; and

(b) Provide a copy of the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C., to the child’s parent or legal guardian, which includes the prescribing physician’s or psychiatric nurse’s contact information.

(3) When the court has authorized the provision of psychotropic medication, the CPI or case manager must continue to try to involve the parent or legal guardian in the child’s ongoing medical treatment planning, and shall continue to facilitate the parent or legal guardian’s communication with the prescribing physician or psychiatric nurse so that the parent or legal guardian has the opportunity to consider whether to authorize the provision of any new medications or dosages, unless the parent or legal guardian’s rights have been terminated.

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.004 Caregiver Involvement

(1) The caregiver’s schedule must be taken into consideration when scheduling appointments. The caregiver must make every effort to attend medical appointments and obtain the information about medications, possible side effects, and provide information about the child to the prescriber as requested. Caregivers do not have the authority to provide expressed and informed consent for psychotropic medication. However, nothing in this rule prohibits caregivers from expressing their concerns regarding prescribing psychotropic medication to children.

(2) If the caregiver is unable to attend the appointment and it cannot be rescheduled, then the child protective investigator (CPI) or case manager or his or her designee who has received training on psychotropic medications in accordance with Rule 65C-35.014, F.A.C., shall attend the appointment. The designee must also be familiar with the child.

(a) The CPI or case manager shall provide to the designee, in writing, the child’s medical and mental health history, behaviors, concerns, and effects of the current psychotropic medications on the child.

(b) The CPI or case manager shall provide a copy of the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C., to the caregiver and review the report with the caregiver to ensure the caregiver’s understanding of the report.

(3) The caregiver shall monitor the child and report to the prescribing physician or psychiatric nurse and the CPI or case manager any behavior or other incident that could indicate an adverse reaction or side effect. The caregiver must seek emergency medical care for the child if the presence of an adverse reaction or side effect to the medication is affecting the child’s health or safety.

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.005 Child Involvement in Treatment Planning

(1) The prescribing physician or psychiatric nurse must discuss the proposed course of treatment with the child, in developmentally appropriate language the child can understand. The physician or psychiatric nurse must explain the risks and benefits of the prescribed medication to the child.

The physician or psychiatric nurse will discuss with the child the following:

(a) The medication proposed;

(b) The reason for the medication;

(d) Alternative treatment options;

(e) The method of administering the medication;

(f) An explanation of the nature and purpose of the treatment;

(g) The recognized side effects, risks and contraindications of the medication;

(h) Drug-interaction precautions;

(i) Possible side effects of stopping the medication;

(j) How treatment will be monitored; and,

(k) The physician or psychiatric nurse plan to reduce and/or eliminate ongoing administration of the medication.

(2) The prescribing physician or psychiatric nurse must ascertain the child’s position with regard to the medication and consider whether to revise the recommendation based on the child’s input. The child’s position must be noted in the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C. The child protective investigator (CPI) or case manager shall provide the child with a copy of the Medical Report if the child is of sufficient maturity and intellectual capacity to understand the report.

(a) It is the physician or psychiatric nurse responsibility to inform the child as clearly as possible and as fully as is appropriate. However, the child’s failure to understand or assent to treatment is not, by itself, sufficient to prevent the administration of a prescribed medication. Likewise, the child’s assent to the treatment is not a substitute for expressed and informed consent by a parent or legal guardian or a court order. Children are more likely to be successful in treatment if they fully understand and participate in treatment decisions.

(b) The CPI or case manager shall request that Children’s Legal Services file a motion for the appointment of an attorney for the child when the child declines to assent or the prescribing physician or psychiatric nurse determines that the child is not developmentally able to provide assent, or when the child has a diagnosis of a developmental disability as defined in Section 393.063, F.S.

(3) Whenever the child requests the discontinuation of the psychotropic medication, and the prescribing physician or psychiatric nurse refuses to order the discontinuation, the CPI or case manager shall request that Children’s Legal Services request an attorney be appointed for the child. Children’s Legal Services will notice all parties and file a motion with the court, presenting the child’s concerns, the physician or psychiatric nurse’s recommendation, and any other relevant information, pursuant to Section 39.407(3)(d)1., F.S.

History

Rulemaking Authority 39.01305, 39.407(3)(g) FS. Law Implemented 39.01305, 39.407(3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.006 Taking a Child Into Custody Who Is Taking Psychotropic Medication

(1) When a child protective investigator (CPI) takes a child into custody he or she must ascertain whether the child is taking psychotropic medications. If so, the CPI must determine the purpose of the medication, the name and phone number of the prescribing physician, or psychiatric nurse, the dosage, instructions regarding administration (e.g., timing, whether to administer with food), and any other relevant information.

(2) The CPI must seek written authorization from the parent or legal guardian to continue administration of currently prescribed psychotropic medications. The authorization shall be documented on the “Emergency Intake” form, CF-FSP 5314, May 2010, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-08063. This authorization is good for the first 60 calendar days the child is in shelter status.

(a) In order for medication to be administered to a child, the medication must be a current prescription, in the original container, and clearly marked.

(b) If the medication is not in the original container, is not clearly marked, or is not the child’s current prescription, the child shall not be continued on the medication unless the prescribing physician or psychiatric nurse or the dispensing pharmacy confirms that the child is currently on the prescribed medication and provides a new prescription to be filled or refilled.

(3) If parental authorization is not obtained and the CPI receives a medical opinion that the child needs to continue taking the medication, the medical opinion must be in writing and provided to Children’s Legal Services.

(4) Children’s Legal Services must file a motion requesting that continuation of the medication be determined at the shelter hearing.

(a) The motion must indicate the prescribing physician or psychiatric nurse’s reasons for wanting to continue the medication and provide the court with any other available information relevant to the request.

(b) If the CPI is unable to obtain the reason for continuing the medication from the prescribing physician or psychiatric nurse, he or she must document all efforts to obtain the information from the prescribing physician or psychiatric nurse and file it with the court prior to the shelter hearing.

(5) Authorization in a shelter order to continue the medication shall be valid only until the arraignment hearing on the petition for dependency, or for 28 calendar days following the date of removal, whichever occurs first.

(6) Within 28 calendar days of removal, or no later than the arraignment hearing on the petition for dependency, whichever occurs first, the child must be evaluated by a physician or psychiatric nurse to determine whether it is appropriate to continue the medication.

(7) The CPI shall document in FSFN all actions in regards to the provision of the medication within three (3) business days of receipt of the parent or legal guardian authorization or court order approving the medication.

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.007 Authority to Provide Psychotropic Medications to Children in Out-of-Home Care

(1) Parents or legal guardians retain the right to consent to or decline the administration of psychotropic medications for children taken into state care until such time as their parental rights, or court ordered guardianship or custodial rights, have been terminated.

(2) In no case may the child protective investigator (CPI), case manager, child’s caregiver, or staff from Residential Treatment Centers provide express and informed consent for a child in out-of-home care to be prescribed a psychotropic medication.

(3) If the parents’ or guardians’ legal rights have been terminated, their identity or location is unknown, they decline to approve administration of psychotropic medication, or withdraw consent to the administration of psychotropic medication and any party to the dependency action believes that administration of the medication is in the best interest of the child and medically necessary, then authorization to treat with psychotropic medication shall be pursued as follows:

(a) The case manager shall consult with the prescribing physician or psychiatric nurse within one (1) business day of being notified that the parent:

Is unavailable,
Withdraws consent,
Declines to consent, or
Is found by the prescribing physician or psychiatric nurse to lack the ability to provide express and informed consent.

(b) If the prescribing physician or psychiatric nurse determines that the medication is medically necessary for the child despite the lack of authorization, the case manager must obtain a completed Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C., from the prescribing physician or psychiatric nurse. If the parent or legal guardian withdraws consent that was previously provided or declines to consent to the administration of psychotropic medication, the parent or legal guardian’s decision, and any reason provided therefore, must be recorded by the prescribing physician or psychiatric nurse in the Medical Report. If the prescribing physician or psychiatric nurse determines that the parent or legal guardian cannot provide express and informed consent, the basis for that determination must be recorded by the prescribing physician or psychiatric nurse in the Medical Report.

(c) Within three (3) business days of receiving the Medical Report from the prescribing physician or psychiatric nurse, the child welfare professional must submit the Medical Report and any supporting documentation to Children’s Legal Services, with a request for legal action to obtain a court order authorizing the administration of the prescribed medication.

(d) Children’s Legal Services must file a motion seeking court authorization for the provision of the psychotropic medication. Except as provided in Section 39.407(3)(e), F.S., court authorization must occur before the psychotropic medication is administered to the child.

(4) Psychotropic medications may be administered in advance of a court order or parental authorization in accordance with Sections 39.407(3)(b)1. and 39.407(3)(e), F.S.

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(2), (3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.008 Parent or Legal Guardian Declines to Consent to or Withdraws Consent for the Provision of Psychotropic Medication

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Repealed 4-20-17.

Fla. Admin. Code R. 65C-35.009 Parent or Legal Guardian Rights Terminated; Parent or Legal Guardian Refuses to Participate; or Parent or Legal Guardian Location or Identity Unknown

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3) FS. History–New 3-17-10, Repealed 4-20-17.

Fla. Admin. Code R. 65C-35.010 Emergency Administration of Psychotropic Medication

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(1), (2), (3) FS. History–New 3-17-10, Repealed 4-20-17.

Fla. Admin. Code R. 65C-35.011 Medication Monitoring and Administration

(1) The monitoring of the use of psychotropic medication provided to children will be the joint responsibility of the prescribing physician or psychiatric nurse, the caregiver, the child protective investigator (CPI) or case manager, and the CPI or case manager’s supervisor. Child protective investigator supervisors and case manager supervisors shall provide ongoing review and oversight of children prescribed psychotropic medications.

(2) The caregiver and CPI or case manager are responsible for implementing the medication plan developed by the prescribing physician or psychiatric nurse. The case manager or child protective investigator shall ensure any additional medical evaluations and laboratory tests required are completed. The CPI or case manager shall add all information to the child’s Resource Record and report the results of evaluations and tests to Children’s Legal Services, all parties, and the prescribing physician or psychiatric nurse.

(3) Psychotropic medications will be administrated only by the child’s caregivers. Children who are age and developmentally appropriate must be given the choice to self-administer medication under the supervision of the caregiver or school personnel. Children assessed as appropriate to self-administer medication must be educated by the physician or psychiatric nurse or caregiver on the following:

(a) The method of administering the medication;

(b) The recognized side effects, risks and contraindications of the medication;

(d) Possible side effects of stopping the medication; and,

(e) How medication administration will be supervised by the caregiver.

(4) The Department, community-based care agency or its contracted service provider will develop locally approved medication logs for documenting the administration of psychotropic medications and any side effects or adverse reactions.

(a) The caregiver is responsible for filling out the medication administration logs.

(b) The case manager shall obtain the medication logs at each home visit and include the medication logs in the child’s FSFN record.

(5) Any person with information that questions the child’s health and safety, including the signs or symptoms of side effects or adverse reactions to the medication, shall as soon as possible bring that information to the attention of the prescribing physician or psychiatric nurse, CPI or case manager, the CPI or case manager’s supervisor, and emergency services shall be arranged to protect the child’s safety and well-being. The child’s CPI or case manager shall provide this information to Children’s Legal Services. Children’s Legal Services shall notify the court and all parties within three (3) business days of the reported concerns.

(6) The case manager or designee who has received training on psychotropic medications in accordance with Rule 65C-35.014, F.A.C., shall attend medication reviews.

(7) All details about prescribed psychotropic medications, updates (including changes in dosage or physician or psychiatric nurse prescribed cessation of the medication) and all actions taken by the CPI or case manager will be entered into the Florida Safe Families Network (FSFN) by the CPI or case manager within three (3) business days of the action.

(8) Whenever a child in out-of-home care is receiving psychotropic medications pursuant to expressed and informed consent by the parent or legal guardian or as authorized by an order of the court, the Department shall fully inform the court of the child’s medical and behavioral status at each subsequent Judicial Review hearing and shall furnish copies of all pertinent medical records contained in the child’s Resource Record that have been generated since the previous court hearing, including the Medical Report, incorporated by reference in Rule 65C-35.001, F.A.C.

(9) If a child on psychotropic medication is moved from an out-of-home placement and placed into another out-of-home placement, the CPI or case manager must obtain the child’s Resource Record and any prescription psychotropic medication currently taken by the child.

(10) The CPI or case manager shall explain to the current and previous caregivers the importance of communication regarding the child’s medication monitoring and administration and recommend that they exchange contact information.

(11) The CPI or case manager shall obtain the medication in original labeled medication bottles, inventory the medications provided, and transport the medications to the child’s new caregiver.

(12) To ensure that the medication is continued as directed by the prescribing physician or psychiatric nurse, the CPI or case manager shall provide the caregiver with the following information:

(a) The full name of the child for whom the medication is prescribed;

(b) The condition and purpose for which the medication is prescribed for the child;

(d) The pharmacy from which the prescription was obtained and the contact information;

(e) The prescription number;

(f) The drug name and dosage;

(g) The times, frequency and method of administration, and if the dosages vary at different times;

(h) Any identified side effects, risks and contraindications (including possible side effects of stopping the medication);

(i) Any other specific instructions regarding the medication;

(j) The physician or psychiatric nurse’s plan to reduce and/or eliminate ongoing administration of the medication; and,

(k) The dates and time of any follow-up appointments, including appointments for laboratory testing.

(13) If the child is moved from an out-of-home placement and placed in another out-of-home placement and the medication is in an unlabeled container or prescription information is insufficient, the CPI or case manager shall contact the prescribing physician or psychiatric nurse, if available, and dispensing pharmacist to ensure the proper identification and labeling of the medication by examining the pills (if unlabeled) or to arrange for a medical evaluation in order that treatment not be interrupted.

(14) Community-based care lead agencies shall develop and implement protocols which ensure collaboration among those responsible for a child’s care, specifically addressing the use of psychotropic medication and the need to share all relevant information with all parties involved in the child’s care.

History

Rulemaking Authority 39.407(3)(g), 39.0121 FS. Law Implemented 39.407(2), (3) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.012 Requests for Second Opinions and Pre-Consent Reviews

(1) Second Opinions.

(a) The child protective investigator (CPI) or case manager may seek a second medical opinion at any time after consultation with a supervisor as to the need for a second opinion.

(b) When any party files a motion requesting that the court order a second medical opinion, the court may order the Department or its contracted service provider to obtain a second opinion within a reasonable timeframe as established by the court. Within one (1) business day of the court’s order, the CPI or the case manager will make a referral for an appointment for the second opinion.

(c) The CPI or case manager must obtain the second opinion within twenty-one (21) calendar days of the court ordering the second opinion.

(2) Pre-Consent Reviews. The CPI or case manager shall seek a pre-consent review when:

(a) A physician or psychiatric nurse proposes prescribing psychotropic medication or changing the dosage of prescribed psychotropic medication outside the dosage parameters documented in the Medical Report; and,

(b) The child is age birth through 17 years; and

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3)(d)1. FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.013 Medical Report

(1) If the parent or caregiver is unable to attend the medical appointment, the prescribing physician or psychiatric nurse must complete, review, and sign the Medical Report form, incorporated by reference in Rule 65C-35.001, F.A.C. The physician or psychiatric nurse may submit a medical report on a form of their choice as long as the form includes all information required on the Medical Report that is incorporated by reference into Rule 65C-35.001, F.A.C.

(2) When the parent and caregiver are able to attend the medical appointment and the parent provides express and informed consent for the child to be administered psychotropic medications, the prescribing physician or psychiatric nurse must complete Section 5: Parental Consent of the Medical Report Form. The parent must sign this section of the form attesting to his or her consent.

(a) The child protective investigator (CPI) or case manager shall provide to Children’s Legal Services the parent’s consent, as well as documentation noting the medications prescribed to the child, within three (3) business days of receipt of the parental consent and documentation.

(b) Children’s Legal Services shall notice all parties to the case of the parent’s consent to the administration of psychotropic medications and file the consent and documentation of prescribed medications with the court.

(3) When court authorization is needed to provide psychotropic medication, the CPI or case manager must document efforts made to enable the prescribing physician or psychiatric nurse to obtain express and informed consent from the child’s parent or legal guardian on the Medical Report form. Efforts to enable the prescribing physician or psychiatric nurse must include:

(a) Dates and times the CPI or case manager attempted to contact the parent or legal guardian by phone or other means upon learning of the recommendation for psychotropic medication by the prescribing physician or psychiatric nurse;

(b) Dates, times, and methods used to attempt to contact the parent or legal guardian and provide them with specific information for how and when to contact the physician or psychiatric nurse; and,

(c) Efforts to facilitate transportation arrangements to the appointment and/or telephone calls between the parent or legal guardian and the prescribing physician or psychiatric nurse.

(4) The Medical Report form must be uploaded in FSFN within (3) business days of receipt of the completed document.

History

Rulemaking Authority 39.407(3)(g) FS. Law Implemented 39.407(3)(c) FS. History–New 3-17-10, Amended 4-20-17, 5-28-18, 12-3-19.

Fla. Admin. Code R. 65C-35.014 Training on Psychotropic Medication

(1) All child protective investigators and sheriff’s officers who conduct child investigations shall receive training from Department trainers or trainers with the Sherriff’s Office. Case managers shall receive training from the community-based care lead agency (CBC) or its contracted provider on medication management and administration. Training must be completed prior to assuming responsibility for a child who is prescribed psychotropic medication.

(2) Approved trainings are available on the Center for Child Welfare’s website at http://www.centerforchildwelfare.org, or training may be developed by the CBC or its contracted provider. The training must include the following components:

(a) An overview of the use and effects of psychotropic medications;

(b) An overview of evidence-based interventions and treatment options;

(d) Medication management, roles and responsibilities; and,

(e) Monitoring for side effects of psychotropic medications.

(3) The Department shall review all training curriculum on the use and administration of psychotropic medications to ensure that it includes the required components specified in subsection (2) of this rule. If the required components are included, the Department shall approve the curriculum.

(4) All caregivers responsible for administering psychotropic medication must be trained by the CBC or its contracted provider on the components specified in subsection (2) of this rule, within 30 calendar days of the child’s placement into the caregiver’s home.

History

Rulemaking Authority 402.40(6), 409.175(5)(a) FS. Law Implemented 402.40(5)(a), 409.175(14)(a) FS. History–New 4-20-17, Amended 5-28-18, 10-22-18.

Chapter 65C-38 STATE AUTOMATED CHILD WELFARE SYSTEM (SACWIS) CHECKS FOR THE PLACEMENT OF CHILDREN

Fla. Admin. Code R. 65C-38.001 Definitions

The following definitions are to be used for Chapter 65C-38, F.A.C.

(1) “Florida Safe Families Network (FSFN)” means the Department’s State Automated Child Welfare System (SACWIS). FSFN serves as the statewide electronic case record for all child abuse investigations and case management activities in Florida.

(2) “Verified Maltreatment Finding” means a finding by the child protective investigator that a preponderance of credible evidence exists to support the allegations of abuse, neglect or abandonment. A verified maltreatment finding includes an out-of-state finding of “substantiated.”

History

Rulemaking Authority 39.012, 39.0121, 39.0138 FS. Law Implemented 39.0138 FS. History–New 2-24-15.

Fla. Admin. Code R. 65C-38.002 Child Abuse, Abandonment and Neglect Record Check

(1) The Department, community-based care lead agency and its subcontracted providers shall check the electronic FSFN case record for information on all persons being considered for placement of a child, including parents and all members of the household, 12 years of age and older, and other visitors to the home 18 years or older who have unsupervised contact with the child.

(2) Out-of-state child welfare background checks shall be conducted on any household member 18 years of age or older who has resided outside the state of Florida within the past five years. In states that do not use a centralized intake or state automated child welfare system (SACWIS) the Florida child welfare professional is required to contact the county administered child protection program to complete the record check.

(3) When a child welfare background check reveals an individual seeking placement of the child, or any adult household member or other adult visitor to the home has a verified maltreatment finding associated with a child fatality or termination of parental rights, the Department, community-based care lead agency or its subcontracted provider shall not recommend placement of the child with that individual without the approval of the Regional Managing Director or his or her designee.

(4) When a child welfare background check reveals an individual seeking placement of the child, or any adult household member or other adult visitor to the home has a Florida or out-of-state verified maltreatment finding associated with a prior adult or child protective investigation, the following factors shall be considered in determining whether placement with the individual will jeopardize the safety of the child being placed:

(a) Severity of the maltreatment, based upon:

Age of the child,
Location of the injury on the child’s body,
Multiplicity of the injuries,
Degree of trauma experienced by the child.

(b) Duration of the maltreatment (i.e., one time incident or numerous incidents over time).

(d) Amount of time that has elapsed since the most recent agency involvement and any rehabilitative changes in the individual’s life that would indicate an increased level of caregiver protective capacity such that the individual would no longer represent a threat to a child.

(e) The individual has established a strong bond with the child and has cared for and protected the child in the recent past, and:

Has demonstrated adequate knowledge, skill and resources to fulfill caregiving responsibilities and tasks,
Is physically and mentally able to provide for the child’s care; and,
Understands and supports all aspects of the safety plan to keep the child safe.

(5) When a child welfare background check reveals any child residing in the household has been involved in juvenile sexual abuse or has displayed inappropriate sexual behavior the Department, community-based care lead agency or its subcontracted provider shall not recommend placement of another child in that home unless it is determined that an assessment was conducted and treatment services were provided to the child involved in juvenile sexual abuse and/or the child who has exhibited inappropriate sexual behavior to the degree that safety of the child being placed will not be jeopardized.

History

Rulemaking Authority 39.012, 39.0121, 39.0138 FS. Law Implemented 39.0138 FS. History–New 2-24-15.

Chapter 65C-41 EXTENDED FOSTER CARE

Fla. Admin. Code R. 65C-41.001 Definitions

(1) “Adverse action” means any action by the Department, community-based care lead agency, or its contracted service provider that denies a young adult’s application for readmission to extended foster care, or that discharges a young adult from extended foster care.

(2) “Designated staff” means a case manager or other child welfare professional designated by the community-based care lead agency or its contracted service provider assigned to work with youth and young adults in transition to handle all matters pursuant to Extended Foster Care.

(3) “Extended Foster Care” means the program available pursuant to Section 39.6251, F.S.

(4) “Extended Foster Care Agreement” means a document that contains the youth’s or their legal guardian’s informed consent to participate in the program.

(5) “Extended Foster Care Voluntary Placement Agreement” means a document that contains the young adult’s or their legal guardians informed consent to participate in the program, the application, and authorization for the Department to have placement and care responsibility.

(6) “Fair hearing” means a hearing that is conducted pursuant to the procedural requirements of Rules 65-2.042 through 65-2.069, F.A.C.

(7) “Shared Living Plan” means a document that contains detailed information about the living arrangement between applicable parties.

(8) “Supervised Living Arrangement” means that the young adult is living independently under a supervised arrangement, approved by the community-based care lead agency, pursuant to Section 39.6251(4), F.S.

(9) “Supervised Living Arrangement Assessment” means a document that contains an evaluation of the young adult’s living environment.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.6251 FS. History–New 11-2-15, Amended 2-7-19.

Fla. Admin. Code R. 65C-41.002 Application Procedures

(1) Children in the legal custody of the Department or living in licensed care on the date of their 18th birthday do not need to apply for Extended Foster Care. If the child exercises his or her option to remain in foster care under the jurisdiction of the court, the child and designated staff shall complete an “Extended Foster Care Agreement,” CF-FSP 5432, Jan 2020, incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11497. The agreement and any supporting documentation must be attached to the transition plan that is updated during the 90-day period immediately prior to the date on which the youth will attain 18 years of age, uploaded in the child welfare information system, and be filed with the court at the last review hearing before the child’s 18th birthday.

(2) A young adult may apply for readmission to extended foster care at any time before his or her 21st birthday. Prior discharge from the program is not a barrier to readmission. A young adult shall be admitted provided the young adult meets the eligibility requirements of Section 39.6251, F.S. Young adults who voluntarily re-enter foster care after turning 18 years of age following dismissal of dependency are considered to be entering a new foster care episode. Applications for admission must be readily available to young adults. The application form to be used is “Extended Foster Care Voluntary Placement Agreement,” CF-FSP 5377, Jan 2020, incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11496.

(a) To enter extended foster care after having left foster care, the young adult must complete the Extended Foster Care Voluntary Placement Agreement and provide proof of participating in a qualifying activity. Designated staff shall offer to assist the young adult with completing the form and/or obtaining necessary documentation.

If the young adult is unable to participate in a qualifying activity due to a physical, intellectual, emotional, or psychiatric condition, the young adult shall either furnish documentation of the condition or execute a consent for release of records to the designated staff to obtain the documentation. The designated staff shall attach documentation of the inability to participate in a qualifying activity to the Extended Foster Care Voluntary Placement Agreement.
All young adults with diagnosed disabilities or mental health needs shall be provided an equal opportunity to participate in extended foster care. A young adult with diagnosed disabilities or mental health needs may need additional support; therefore, the designated staff will work in consultation with all of the young adult’s service providers, guardian ad litem, and attorney, if applicable.

(b) If the young adult does not meet eligibility requirements, designated staff shall offer to assist the young adult in choosing and enrolling in a qualifying activity and applying for Aftercare Services.

(c) The young adult must be notified within 10 business days of submitting the application whether the application was approved or denied, or whether additional information, including supporting documentation, is needed.

The decision to approve or deny shall be based solely on whether the young adult meets the requirements of Section 39.6251, F.S.
If the decision is to readmit the young adult into extended foster care, within three (3) business days, the designated staff shall request the Children’s Legal Services attorney or legal representative of the Department to petition the court for reinstatement of jurisdiction.
Reinstatement of jurisdiction must occur within 90 days from the time the Extended Foster Care Voluntary Placement Agreement is signed by all parties.
Upon verification and approval of eligibility, the signed Extended Foster Care Voluntary Placement Agreement shall be uploaded into the child welfare information system.
If the decision is to deny the application for extended foster care, the community-based care agency shall make a recommendation of denial to the Department’s designated regional operations representative for review and agreement. If the Department disagrees with the denial and is unable to obtain consensus with the community-based care lead agency, documentation should then be forwarded to the Department’s regional representative in the Office of the General Counsel. If after consultation, there is continued disagreement, documentation should be forwarded to the Department’s headquarters representative in the Office of Child and Familing Well-Being for continued review. The Department’s headquarters representative will make the final determination in the conflict resolution. Upon reaching agreement with the adverse action, designated staff shall provide a “Notice of Denial for Readmission into Extended Foster Care,” CF-FSP 5410, Sept 2018, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10157, and an “Application for Aftercare Services,” CF-FSP 5391, incorporated by reference and available in Rule 65C-42.002, F.A.C. The “Due Process Rights” form, CF/PI 175-74, incorporated by reference and available in Rule 65C-42.002, F.A.C., and a “Request for Fair Hearing,” CF-FSP 5380, incorporated by reference and available in Rule 65C-42.004, F.A.C., shall be attached to the Notice of Denial for Readmission into Extended Foster Care.
If additional information is needed, the young adult shall have 10 business days from notification to submit the information. Designated staff shall offer to assist the young adult in obtaining the additional information. If the young adult fails to provide the additional information, the young adult will be denied readmission into extended foster care.

History

Rulemaking Authority 39.012, 39.0121, 39.6251, 409.1451 FS. Law Implemented 39.6251, 409.1451 FS. History–New 11-2-15, Amended 1-7-19, 2-4-20, 10-19-25.

Fla. Admin. Code R. 65C-41.003 Eligibility Requirements

(1) Section 39.6251, F.S., sets forth the eligibility requirements for a young adult to remain in extended foster care.

(2) A young adult is considered to have been living in licensed care on the date of his or her 18th birthday if the young adult was living licensed care or the legal custody of the Department on the date of his or her 18th birthday.

(3) To meet the educational requirements set forth in Sections 39.6251(2)(a)-(b), F.S., the young adult must comply with the academic and attendance requirements of his or her particular educational institution.

(4) If the young adult’s qualifying activity is employment, the young adult must be employed at least 80 hours per month. Due to the nature of scheduling of flexible or part-time shifts and seasonal employment, the community-based care lead agency may determine the young adult meets this requirement over an aggregate time period of the previous 90 days.

(5) If the young adult’s qualifying activity is participating in a program or activity designed to promote or eliminate barriers to employment, the young adult must comply with the requirements of the program or activity.

(6) A young adult may change qualifying activities and remain in extended foster care. A change in qualifying activity shall be documented by the young adult and designated staff in the transition plan and by execution of a new “Extended Foster Care Agreement” CF-FSP 5432, incorporated and available in Rule 65C-41.002, F.A.C. This change may also require the designated staff to amend the case plan.

(7) If a young adult is unable to participate full-time in a program or activities listed in Sections 39.6251(2)(a)-(d), F.S., due to a physical, intellectual, emotional, or psychiatric condition that limits participation, designated staff shall:

(a) Determine whether there is documentation in the young adult’s case file, school records, or medical records that establishes an inability to participate full-time. If there is no existing documentation, staff shall assist the young adult in securing supporting documentation of the condition from a person licensed under one of the following chapters of Florida Statutes: 458 (M.Ds.), 459 (O.Ds.), 460 (chiropractors), 461 (podiatrists), 463 (optometrists), 464 (nurses), 466 (dentists only), 468 Part I (speech pathologists and audiologists), 468 Part III (occupational therapists), 468 Part V (respiratory therapists), 468 Part X (dieticians and nutritionists), 486 (physical therapists), 490 (psychologists), and 491 (clinical social workers, mental health counselors, and marriage and family counselors); and

(b) Develop or amend the case plan to address the condition and the accommodations or modifications to be implemented to achieve goals detailed in the transition plan.

(8) Participation by the Young Adult in Case Management and Judicial Proceedings. In addition to engaging in one or more of the qualifying activities set forth in Section 39.6251(2), F.S., the young adult must continue to reside in an approved supervised living arrangement and meet face to face in the home every month with designated staff. The young adult shall be encouraged to participate in ongoing transition and case planning, and judicial review and permanency hearings.

(a) The young adult must sign necessary releases to enable the designated staff to document the young adult’s participation in the qualifying activity or activities.

(b) The designated staff must consult with the young adult in drafting the case plan.

(c) In preparation for each judicial review hearing, the designated staff must collaborate with the young adult in preparing the Judicial Review Social Study Report (“JRSSR”).

History

Rulemaking Authority 39.012, 39.0121, 39.6251(10) FS. Law Implemented 39.6251 FS. History–New 11-2-15, Amended 2-7-19, 11-18-19, 7-22-20, 10-19-25.

Fla. Admin. Code R. 65C-41.0031 Supervised Living Arrangement

(1) Residing in a supervised environment is not intended to be a barrier to independence; however, every living arrangement must meet all the requirements as detailed in Section 39.6251(4), F.S.

(2) Approved Living Arrangements.

(a) A comprehensive assessment shall be made to determine the appropriateness of the young adult’s living arrangement, using the “Supervised Living Arrangement Assessment,” CF-FSP 5431, Sept 2018, incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10159. This form is to be used for placement in Extended Foster Care (EFC). Prior to completing the assessment, the designated staff must have reviewed the youth or young adult’s case file and inspected the home environment proposed as the EFC living arrangement. The completed assessment shall be uploaded into the child welfare information system and becomes an addendum to the young adult’s transition plan and also supports the young adult’s case plan.

(b) Designated staff shall decide whether a living arrangement will be approved on a case-by-case basis, taking into consideration the needs and desires of the young adult and the level of supervision and support the young adult requires.

(c) The community-based care lead agency shall withhold approval for a living arrangement if the living arrangement jeopardizes the young adult’s safety and well-being.

(d) Living environments in which young adults are involuntarily placed do not meet the conditions of an appropriate supervised independent living setting unless consent for placement is through a court appointed guardian.

(e) A young adult who may require continued, intensive therapeutic or medical care will be assessed in consultation with the young adult and the young adult’s team of service providers, guardian ad litem, and attorney, if applicable.

(f) A young adult may share housing with other persons provided that any household members are approved based on an assessment of the young adult’s needs and safety concerns.

(g) The community-based care lead agency is not responsible for any portion of the expenses of any other household member who is not receiving extended foster care services.

(3) Shared Living Plans.

(a) Once a living arrangement has been approved, designated staff shall develop a plan in collaboration with the young adult and other applicable parties using the “Shared Living Plan” form, CF-FSP 5430, Sept 2018, incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10158. The plan outlines the expectations, addressing the fundamental and routine needs, to enable a successful living arrangement. The completed plan becomes an addendum to the young adult’s transition plan and shall be uploaded in the child welfare information system.

(b) The young adult must notify the designated staff and other agreed upon parties (if applicable) of any changes in circumstances in the living arrangement, including a change of occupants or a planned absence from the home.

(c) In the event the extended foster care living arrangement is obtained before the young adult reaches age 18, designated staff shall make scheduled visits with the youth to the approved living arrangement as a part of the transition.

History

Rulemaking Authority 39.012, 39.0121 FS. Law Implemented 39.6251 FS. History–New 1-7-19, Amended 11-18-19, 10-19-25.

Fla. Admin. Code R. 65C-41.004 Case Planning and Management Reviews

(1) Transition and Case Plans. Each young adult in extended foster care must have both a transition plan and a case plan developed. Designated staff shall work with the young adult on the development and updates to each plan.

(a) Transition Plan. The provisions of the transition plan form the basis of the young adult’s case plan and delineate the young adult’s short-term and long-term goals, the young adult’s obligations, and the obligations of the foster parent, caregiver or group home, the designated staff, and any other service provider.

The transition plan shall be coordinated with the case plan; however, a change in the transition plan does not require an amendment to the case plan or a return to court unless the change in the transition plan conflicts with a provision of the case plan.
All young adults with diagnosed disabilities or mental health needs shall be provided with an equal opportunity to participate in transition planning. A young adult with a diagnosed disability or mental health need may need additional support; therefore, the designated staff shall work in consultation with the young adult and the young adult’s service providers, guardian ad litem, and attorney, if applicable.

(b) Case Plan. The young adult must have a case plan while in extended foster care.

The case plan must include:

a. A description of the qualifying activity or activities in which the young adult will engage to maintain eligibility for remaining in extended foster care. If the young adult has chosen an alternate or secondary qualifying activity, it shall be included in the case plan,

b. A description of the programs and services identified, in consultation with the young adult, to assist the young adult to successfully participate in the chosen qualifying activities, and a designation of who is responsible for providing these programs and services, and who is responsible for paying the costs of such programs and services,

c. A description of the young adult’s long-term goals for living independently and the services to be provided to assist the young adult in meeting those goals; and,

d. A designation of the permanency goal of transition from care to independent living.

The young adult’s case plan shall be initiated within 30 days of the young adult’s 18th birthday or approval of entry into extended foster care, and shall include the young adult’s long-term goals.
The case plan shall be reviewed with the young adult prior to each judicial review hearing, and shall be updated as necessary.

(2) Provision of Services. The community-based care lead agency must ensure that the young adult is provided necessary services. Necessary services include:

(a) Those services that are identified in the young adult’s case plan.

(b) Supervision of the young adult at a level that is consistent with the young adult’s individual educational, developmental and health care needs, permanency plan and independent living goals as assessed with input from the young adult.

(c) Life skills instruction, counseling, educational support, employment preparation and placement, and development of support networks that are consistent with the young adult’s assessed needs and interests, and with the goals identified by the young adult in the transition plan and case plan.

(d) Face-to-face contact with the young adult shall occur every 30 days in the home, pursuant to paragraphs 65C-30.007(1)(a)-(c), F.A.C.

During the visit designated staff must assess for safety and discuss the young adult’s transition and continue to assess life skill development.
If applicable, designated staff shall update the Supervised Living Arrangement Assessment and Shared Living Plan.

(e) Any additional services that are necessary to assist the young adult in eliminating barriers to participation in extended foster care.

(3) Procedures for a Young Adult Wishing to Remain in Extended Foster Care until their 22nd birthday. A young adult must be actively participating in extended foster care on his or her 21st birthday, and have a documented disability, in order to remain in care until his or her 22nd birthday. A licensed clinical professional listed in paragraph 65C-41.003(7)(a), F.A.C. may provide documentation that demonstrates that an extra year might be helpful, including resources to support the young adult’s progress toward living independently.

(a) The designated staff for a young adult who has a documented disability shall discuss with the young adult and any designated decision-making authority for the young adult, within 180 days of the young adult’s 20th birthday, whether the young adult wishes to remain in extended foster care after his or her 21st birthday. This discussion shall occur during the transition planning for possible discharge based on reaching the maximum age for participation.

(b) If the young adult who has a documented disability requests discharge from, or otherwise opts out of continuing in extended foster care beyond the 21st birthday, the designated staff shall provide the form “My Decision to Leave Extended Foster Care,” CF-FSP 5375, January 2015, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05784, and specify that the young adult has requested discharge from the program on their 21st birthday.

(4) Portability. The services provided under this rule are portable across county lines, between lead agencies, and across state lines if the other state is willing to provide assistance.

(a) The service needs that are identified from the transition plan, the Supervised Living Arrangement Assessment, Shared Living Agreement, and Extended Foster Care Agreement or Extended Foster Care Voluntary Placement Agreement shall be provided by the community-based care lead agency where the young adult is currently residing, but shall be funded by the community-based care lead agency that initiated the transition plan.

(b) If the young adult who has a documented disability requests discharge from, or otherwise opts out of continuing in extended foster care beyond the 21st birthday, the designated staff shall provide the form “My Decision to Leave Extended Foster Care,” CF-FSP 5375, incorporated in this rule, and specify that the young adult has requested discharge from the program on their 21st birthday.

History

Rulemaking Authority 39.012, 39.0121 FS. Laws Implemented 39.6035, 39.6251, 39.701(4)(a) FS. History–New 11-2-15, Amended 1-7-19, 1-4-26.

Fla. Admin. Code R. 65C-41.005 Termination from Program

(1) A young adult shall be given notice of termination from the extended foster care program when the young adult fails to participate in a qualifying activity or fails to reside in an approved living arrangement. In the event the designated staff determines that the young adult is ineligible, the designated staff shall make a recommendation of program termination to the Department’s designated regional operations representative for review and agreement. If the Department disagrees with program termination and is unable to obtain consensus with the community-based care lead agency, documentation should then be forwarded to the Department’s regional representative in the Office of the General Counsel. If after consultation, there is continued disagreement, documentation should be forwarded to the Department’s headquarters representative in the Office of Child and Family Well-Being Welfare for continued review. The Department’s headquarters representative will make the final determination in the conflict resolution. Upon reaching agreement with the adverse action, designated staff shall offer to assist the young adult in resuming eligibility requirements and provide to the young adult a “Notice of Extended Foster Care Program Termination,” CF-FSP 5376, (August 2025), which is hereby incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18605. The “Due Process Rights” form, CF/PI 175-74, incorporated by reference and available in Rule 65C-42.002, F.A.C., a “Request for Fair Hearing,” CF-FSP 5380, incorporated by reference and available in Rule 65C-42.004, F.A.C., and an “Application for Aftercare Services,” CF-FSP 5391, incorporated by reference in Rule 65C-42.002, F.A.C., shall be attached to the Notice of Extended Foster Care Program Termination.

(a) A young adult shall be terminated from the extended foster care program for failure to participate in one or more qualifying activities set forth in Section 39.6251(2), F.S., unless that failure is based on a documented disability.

(b) A young adult shall be terminated from the extended foster care program for failure to reside in the approved living arrangement. The length of the young adult’s acceptable absence from the approved living arrangement shall be discussed during transition planning and documented in the “Shared Living Plan,” CF-FSP 5430, incorporated by reference in subsection Rule 65C-41.0031, F.A.C.

(2) If the young adult intends to leave extended foster care, the designated staff shall discuss with the young adult options for remaining in extended foster care or applying for Aftercare or Postsecondary Education Services and Support (PESS). If, after discussion with the designated staff, the young adult still intends to leave extended foster care, the designated staff shall provide the young adult with the form “My Decision to Leave Extended Foster Care,” CF-FSP 5375, which is incorporated by reference in Rule 65C-41.004, F.A.C. Upon receipt of the completed and signed form, the designated staff shall upload the form into the child welfare information system and provide the young adult a copy of the completed form.

(3) If the young adult reaches 21 years of age, program eligibility automatically ends unless the young adult met the disability criteria to remain until 22 years of age as referenced in Section 39.6251(5)(a), F.S.

History

Rulemaking Authority 39.012, 39.0121, 39.6251(10) FS. Law Implemented 39.6251 FS. History–New 11-2-15, Amended 2-7-19, 1-12-20, 10-19-25.

Fla. Admin. Code R. 65C-41.006 Conflict Resolution and Appeals

(1) The Department, the community-based care lead agency and its contracted service provider staff shall treat all young adults fairly and afford them due process. A young adult applying for or receiving extended foster care services has the right to receive written notice of adverse actions by the Department or its contracted service provider and to resolve issues about eligibility by meeting with representatives of the Department or its contracted service provider or through the fair hearing process. The fair hearing process is available to any young adult who is determined to no longer be eligible for extended foster care, or who has been denied readmission into extended foster care.

(2) Notice of Adverse Action. The community-based care lead agency shall give timely and written notice to the young adult regarding any decision to deny readmission or terminate participation in extended foster care.

(a) The notice shall be provided on the form “Notice of Extended Foster Care Program Termination,” CF-FSP 5376, incorporated by reference in Rule 65C-41.005, F.A.C.

(b) The notice shall be considered timely:

When the notice concerns an application for readmission into care, if it is delivered to the young adult within 10 business days of the lead agency receiving the application.
When the notice concerns any decision to discharge a young adult from participation in extended foster care, if it is delivered to the young adult at least 30 calendar days before the action described in the notice becomes effective.

(c) A “Request for Fair Hearing,” CF-FSP 5380, incorporated by reference and available in Rule 65C-42.004, F.A.C., and “Due Process Rights,” CF/PI 175-74, incorporated by reference and available in Rule 65C-42.002, F.A.C, shall be attached to the notice. 45 C.F.R. §205.10 is referred to on CF/PI 175-74 because the regulation requires states to provide for a system of fair hearings. 45 C.F.R. §205.10, July 1992, is incorporated by reference and available at http://www.gpo.gov/fdsys/granule/CFR-1997-title45-vol2/CFR-1997-title45-vol2-sec205-10/content-detail.html and https://www.flrules.org/Gateway/reference.asp?No=Ref-05781.

(e) The notice shall be sent by certified mail or provided to the young adult by hand delivery. The notice shall also be sent via email if the young adult has provided an email address. If the young adult has provided a telephone number, designated staff shall call the young adult and advise him or her that the notice has been sent and also is available for pickup at the community-based care lead agency office. Documentation of hand delivery and email shall be made in the young adult’s file contemporaneously with the hand and e-mail delivery. The certified mail receipt shall also be placed in the young adult’s file.

(3) Request for Fair Hearing.

(a) A young adult shall have 30 calendar days from the date of receipt of the notice of adverse action to request a fair hearing. If the young adult requests the fair hearing within 10 business days of the date of receipt of the notice of adverse action terminating participation in extended foster care, then the young adult shall remain in extended foster care pending the resolution of the fair hearing. The notice shall be provided on the form “Notice of Extended Foster Care Program Termination,” CF-FSP 5376, incorporated by reference in Rule 65C-41.005, F.A.C. or “Notice of Denial for Readmission into Extended Foster Care,” CF-FSP 5410, incorporated by reference in Rule 65C-41.002, F.A.C.

(b) The request for a fair hearing may be made orally or in writing.

The form “Oral Request for Fair Hearing,” CF-FSP 5381, incorporated by reference, shall be used by the designated staff to document oral requests for a fair hearing. This form is available in Rule 65C-42.004, F.A.C..
Written requests may be prepared by the young adult on the form “Request for Fair Hearing,” CF-FSP 5380, incorporated and available in Rule 65C-42.004, F.A.C., or in any other manner the young adult chooses.

(c) The request for a fair hearing is made on the date the young adult sends a written request for fair hearing by U.S. Mail or email, or hand-delivers the written request to the staff member of the agency (or his or her designee) who sent the notice of adverse action. An oral request for a fair hearing is made on the date the young adult speaks with his or her designated staff, the community-based care lead agency providing him or her with independent living services, or the Department of Children and Families, Office of Appeal Hearings in Tallahassee. If the deadline to request a fair hearing is a Saturday, Sunday or state or federal holiday, the request shall be timely if it is made on or before the first business day after the weekend or holiday.

(4) Transmittal of Hearing Request to the Department or its Contracted Service Provider.

(a) Within one (1) business day of receiving the young adult’s request for a fair hearing, staff shall send the request for a fair hearing and notice of adverse action by facsimile or email transmission to the legal representative for the Department and the Office of Appeal Hearings of the Department of Children and Families.

(b) If a request for a hearing is not sent by the young adult within 30 days, the request shall be forwarded to the Florida Department of Children and Families’ Office of Appeal Hearings with a notation that the request was late.

(c) Staff shall forward a copy of all documentation supporting the decision regarding participation in extended foster care to the Regional Legal Counsel and the legal representative for the Department within three (3) business days of receipt of the young adult’s request for fair hearing.

(5) Additional Local Preparation for Fair Hearings.

(a) The staff person receiving the request shall, within five (5) business days, prepare copies of the young adult’s complete extended foster care file and copies of the young adult’s case file records from his or her dependency case file during the young adult’s 17th year of age to provide to both the young adult and the legal representative for the Department or its contracted service provider. Staff shall provide the complete file to both the young adult and the legal representative for the Department or its contracted service provider, whether or not a request has been made.

(b) The designated staff responsible for the young adult’s extended foster care case (the designated staff in the county where the young adult’s participation originated) shall coordinate and participate in the fair hearing, even if the hearing takes place in a different county or region. The fair hearing shall take place in the county in which the young adult lives.

History

Rulemaking Authority 39.012, 39.0121, 39.6251(10) FS. Law Implemented 39.6251 FS. History–New 11-2-15, Amended 1-7-19, 1-12-20, 10-19-25.

Chapter 65C-42 ROAD TO INDEPENDENCE

Fla. Admin. Code R. 65C-42.001 Definitions

The following definitions are to be used in this chapter.

(1) “Adverse action” means any action by the Department, community-based care lead agency, or its contracted service provider that denies, in whole or in part, a young adult’s application for Postsecondary Education Services and Support or Aftercare Services, or that discharges a young adult from Postsecondary Education Services and Support or Aftercare Services.

(2) “Aftercare Services” means services provided pursuant to Section 409.1451(3), F.S.

(3) “Court-approved dependency guardian” means the caregiver for a child placed in out-of-home care pursuant to a custody order entered by the dependency court. The term includes a permanent guardian under Section 39.6221, F.S., and a permanent placement with a fit and willing relative under Section 39.6231, F.S.

(4) “Designated Staff” means a case manager or other child welfare professional assigned by the community-based care lead agency or its contracted service provider to work with young adults ages 18 to 23 to handle all matters pursuant to the Postsecondary Education Services and Support (PESS) and Aftercare Services programs.

(5) “Education and Training Voucher ” means the federally funded program, codified in 42 U.S.C. 677, for young adults formerly in foster care that provides monthly stipends to assist in meeting the cost of postsecondary education.

(6) “Emergency Situation” means a circumstance or event that impacts the youth and young adult in the Postsecondary Education Services and Support (PESS) program and whose resources are insufficient to meet the emergency.

(7) “Extended Foster Care” means the program available pursuant to Section 39.6251, F.S.

(8) “Fair hearing” means a hearing that is conducted pursuant to the procedural requirements of Rules 65-2.042 through 65-2.069, F.A.C.

(9) “Postsecondary Education Services and Support (PESS)” means the program available to young adults who meet the eligibility requirements in Section 409.1451(2), F.S., that provides services and support to assist with postsecondary education.

(10) “Road to Independence Program” means the programs described in Section 409.1451, F.S.

History

Rulemaking Authority 39.012, 409.1451(12) FS. Law Implemented 409.1451, 39.6251 FS. History–New 10-4-15, Amended 5-22-19, 1-3-23, 10-19-25.

Fla. Admin. Code R. 65C-42.002 Postsecondary Education Services and Support

(1) Application for Postsecondary Education Services and Support (PESS). Each young adult who wishes to receive a PESS stipend shall complete and sign an application for this program.

(2) If it is determined that the young adult is not eligible for PESS, designated staff shall determine whether the young adult is eligible for Education and Training Voucher (ETV) financial assistance utilizing the Postsecondary Education Services and Support (PESS) and Education and Training Voucher (ETV) Initial, Renewal and Reinstatement Application, CF-FSP 5382, incorporated in subsection (3) of this rule. The young adult’s eligibility for or ability to obtain other funding for postsecondary education shall not be considered when determining eligibility for PESS.

(3) Initial Application Process for PESS Stipend. Designated staff shall provide the young adult with the “Postsecondary Education Services and Support (PESS) and Education and Training Voucher (ETV) Initial, Renewal and Reinstatement Application,” CF-FSP 5382, (August 2025), which is hereby incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18606.

(a) Designated staff shall assist the young adult in completing the application or meeting eligibility requirements.

(b) All young adults with diagnosed disabilities or mental health needs shall be provided with an equal opportunity to participate in the PESS program. A young adult with a diagnosed disability or mental health need may require additional support; therefore, the designated staff shall work in coordination with all of the young adult’s service providers, guardian ad litem, and attorney, if applicable, as needed.

A high school diploma or its equivalent, in accordance with paragraph 409.1451(2)(a), F.S.,
Admittance for enrollment as a full-time student or its equivalent in an eligible postsecondary educational institution or as a part-time student if he or she has a recognized disability or other challenge or circumstance that would prevent full-time attendance; and,
A complete and error-free submission of the Free Application for Federal Student Aid (FAFSA) and application to any grants or scholarships suggested by the post-secondary institution based on the FAFSA submission.

(d) Designated staff shall verify the following:

The young adult was living in licensed foster care or in the legal custody of the department on his or her 18th birthday or is currently living in foster care; or was at least 14 years of age when adopted from foster care or placed with a court-approved dependency guardian after spending at least six (6) months in licensed care within the 12 months immediately preceding such placement or adoption. A young adult is considered to have been living in licensed care on the date of his or her 18th birthday if the young adult was in the legal custody of the Department on the date of his or her 18th birthday,
The young adult spent at least six (6) months in licensed care before reaching his or her 18th birthday,
The young adult has reached 18 years of age but is not yet 23 years of age; and,
The young adult signed an agreement to allow the Department and the community-based care lead agency access to school records.

(4) Provision of Services. The designated staff must ensure that the young adult is offered the necessary services and shall:

(a) Work with the young adult to update the independent living transition plan, pursuant to Section 39.6035, F.S., in preparation for self-sufficiency. The plan shall be reassessed at least every six (6) months for as long as services are provided.

(b) Collaborate with the young adult in the coordination of life skills, counseling, financial planning pursuant Section 409.1451(2), F.S., educational support, and identification of supportive networks that are consistent with the young adult’s needs and interests, and the goals identified in the transition plan.

(c) Maintain contact with the young adult. Designated staff and the young adult shall determine the frequency of contact and how often, if ever, the contact shall be face-to-face. During any contact, designated staff shall review and discuss with the young adult progress in life skill development, and the young adult’s transition plan and shall identify additional services that are necessary to assist the young adult in transitioning toward self-sufficiency.

(d) Inform the young adult of the Office of Continuing Care, its purpose, the support the office provides, and how to contact the office, pursuant to Section 414.56, F.S.

(e) Provide assistance upon request by the young adult in choosing and/or enrolling in an eligible post-secondary educational institution, providing information about aftercare services and completing an “Application for Aftercare Services,” CF-FSP 5391, (November 2022), which is hereby incorporated by reference, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14977, or “Application for Aftercare Services (Relative/Non-Relative/Guardianship/Adoption),” CF-FSP 5024, (August 2025), which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18607, shall also be provided. Aftercare Services in accordance with Section 409.1451(3), F.S., may be utilized temporarily to assist the young adult in working toward qualifying for PESS.

(5) The community based lead agency must notify a young adult within 10 business days from the date of submission of the application whether the application was approved or denied, or whether additional information, including supporting documentation, is needed.

(a) If additional information is needed, the young adult shall have 10 business days from the time of notification to submit the information. Designated staff shall offer to assist the young adult in obtaining the additional information within the required timeframe.

(b) If the application is denied, designated staff shall notify the young adult of other available services in which he or she may be eligible for, including Extended Foster Care, funding through ETV, Aftercare Services, and other services that may be locally available.

(c) If the application is denied, designated staff shall also provide the young adult with information detailing the procedure for appeal and the brochure “Due Process Rights,” CF/PI 175-74, August 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05830.

(6) Renewal Application Process. Designated staff shall offer to assist the young adult in completing an updated “Postsecondary Education Services and Support (PESS) and Education and Training Voucher (ETV) Initial, Renewal and Reinstatement Application,” CF-FSP 5382, incorporated in this rule. The young adult must obtain and provide documentation of continuing to meet all renewal eligibility requirements. The annual renewal period is based on the initial date of enrollment into PESS.

(a) Designated staff shall ask each young adult who is receiving PESS if he or she wishes to apply to renew the award during the 90-day period before the end of the annual award period, and no later than 30 calendar days before the end of the annual award period.

(b) Designated staff shall process the application and shall notify the young adult of the approval or denial, as required by subsection 65C-42.002(5), F.A.C.

(7) Reinstatement of PESS. The reinstatement process shall be the same as for an initial application pursuant to subsection 65C-42.002(3), F.A.C. The young adult must meet initial and renewal eligibility requirements for reinstatement of PESS.

(8) The young adult is eligible for financial assistance under PESS during the summer months if he or she is enrolled in the eligible postsecondary educational institution, as determined by the postsecondary institution. Summer session enrollment may be utilized to assist in achieving academic progress when determining renewal eligibility.

(9) Termination of PESS. Upon termination of PESS, the Department or contracted agency shall notify the young adult of his or her right to request a fair hearing, pursuant to rule 65C-42.004, F.A.C.

(10) A young adult will be terminated from PESS if he or she becomes incarcerated for a period longer than 30 days. This shall not preclude a young adult from applying for reinstatement of PESS after release provided they meet eligibility criteria under subsection 65C-42.002(7), F.A.C.

(11) Documentation requirements. For each young adult receiving a PESS or ETV stipend, the Department or its contracted service provider shall maintain an active case file in the child welfare information system. The child welfare information system is the system of record and must contain:

(a) Documentation of the young adult’s current demographic information, including name, address, date of birth, social security number, and the name of the school he or she is attending;

(b) A copy of the young adult’s complete application signed by the young adult and approval authority;

(d) All supporting documentation required for eligibility; and

(e) Description of the types of services and support provided to the young adult.

(12) Portability. The services provided under this rule are portable across county lines and between lead agencies. The service needs that are identified when a young adult applies for PESS shall be provided by the lead agency where the young adult is currently residing but shall be funded by the lead agency that approved the application.

(13) A community-based care lead agency may add its logo to forms.

History

Rulemaking Authority 409.1451(11) FS. Law Implemented 409.1451 FS. History–New 10-4-15, Amended 5-28-18, 1-3-23, 10-19-25, Technical Change 1-20-26.

Fla. Admin. Code R. 65C-42.003 Aftercare Services

(1) Eligibility. A young adult is eligible for Aftercare Services if he or she:

(a) Reached the age of 18 while in licensed foster care or in the legal custody of the department, or lived in out-of-home care for at least 6 months after turning 14 years of age, and did not achieve reunification with his or her parent or guardian, but is not yet 23 years of age;

(b) Is not enrolled in Extended Foster Care (EFC) pursuant to section 39.6251, F.S., Post-secondary Education Support Services (PESS) pursuant to section 409.1451(2), F.S., Extension of Guardianship Assistance Program (EGAP) pursuant to section 39.6225, F.S., or Extension of Maintenance Adoption Subsidy (EMAS) pursuant to section 409.166(4), F.S. Young adults experiencing an emergency situation without sufficient funds to meet the need, but is currently enrolled in PESS may receive funding through Aftercare Services if available.

(2) Application for Aftercare Services. Designated staff shall assist a young adult who is requesting Aftercare Services and was in licensed foster care or the legal custody of the department in completing the “Application for Aftercare Services,” CF-FSP 5391, incorporated in Rule 65C-42.002, F.A.C. Designated staff shall assist a young adult who is requesting Aftercare Services and was in an out-of-home placement other than licensed care in completing the “Application for Aftercare Services (Relative/Non-Relative/Guardianship/Adoption),” CF-FSP 5024, incorporated in Rule 65C-42.002, F.A.C.

(3) If the application is not completed at the time of the request for referrals or services, designated staff shall offer to assist the young adult in completing the application within 10 business days. Referrals may be provided prior to the completion of the application.

(4) A young adult seeking Aftercare Services and Support shall also complete the “My Pathway to Success Plan,” CF-FSP 5425, incorporated by reference and available in Rule 65C-28.009, F.A.C. The My Pathway to Success Plan shall be completed by the designated staff in consultation with the young adult.

(5) All young adults with diagnosed disabilities or mental health needs shall be provided with an equal opportunity to receive Aftercare Services. A young adult with a diagnosed disability or mental health need may require additional support; therefore, the designated staff shall work in coordination with all of the young adult’s service providers, guardian ad litem, and attorney, if applicable, as needed.

(6) The My Pathway to Success Plan shall include the:

(a) Amount of temporary financial assistance being provided and the specific reason(s) for the assistance; and

(b) Specific activities the young adult will complete in order to achieve self-sufficiency or transition into extended foster care, EGAP, EMAS, or PESS.

(c) In the event a young adult in PESS has an emergency situation, the My Pathway to Success Plan should include the specific reason for the young adult’s emergency situation, results of the assessment confirming the young adult’s resources are insufficient, and the additional amount of financial assistance needed to resolve the emergency situation.

(7) In assessing the young adult’s needs, designated staff may consider such details as eviction notices, utility terminations, and moving expenses.

(8) The designated staff shall re-assess the My Pathway to Success Plan every three (3) months for as long as services are provided. The community-based care lead agency may discontinue Aftercare Services pursuant to Rule 65C-42.004, F.A.C., if the young adult has not made efforts to complete the activities outlined in his or her My Pathway to Success Plan.

(9) Processing Application for Aftercare Services.

(a) Designated staff shall have 10 business days from the date of submission to review the application and approve or deny the award.

(b) If the application is denied, designated staff shall notify the young adult within 10 business days of submitting the application. Designated staff shall also provide the young adult with information detailing the procedure for appeal and the brochure “Due Process Rights,” CF/PI 175-74, which is incorporated by reference in Rule 65C-42.002, F.A.C. Designated staff shall notify the young adult of other available services, including Extended Foster Care, funding through PESS or Education and Training Vouchers, the Office of Continuing Care, Extension of Guardianship Assistance Program, Extension of Maintenance Adoption Subsidy, and services that are locally available.

(10) If the request for assistance is to prevent homelessness, no application is required before services are provided and services shall be provided as expeditiously as possible, but in no case longer than 24 hours. If the application is not completed at the time of the request for referrals or services, designated staff shall offer to assist the young adult in completing the application within 10 business days.

(11) Providing Aftercare Services.

(a) Referrals for services shall be provided to the young adult as expeditiously as possible and no later than 10 business days of approval. Once approved, services shall be provided as soon as they are available.

(b) Cash assistance shall be provided directly to a vendor for such items as security deposits for rent or utilities, until such time designated staff and the young adult determine the young adult can successfully manage the full amount of the assistance.

Daycare referrals for the young adult’s minor children.
Extracurricular activities related to secondary or postsecondary education.
Financial assistance to resolve an emergency situation that is a barrier to achieving self-sufficiency.

(12) Portability. The services provided under this rule are portable across county lines and between lead agencies. The service needs that are identified when a young adult applies for Aftercare Services shall be provided by the lead agency where the young adult is currently residing but shall be funded by the lead agency that approved the application.

(13) Confidentiality. The young adult’s status as a former foster youth and recipient of public benefits is confidential and shall not be revealed to anyone without the young adult’s permission.

(14) Documentation requirements. For each young adult receiving Aftercare Services, the Department or its contracted service provider shall maintain an active case file in the child welfare information system containing:

(a) Requests for service referrals;

(b) Requests for temporary cash assistance;

(d) Documentation showing case management assistance given to the young adult to access the services directly.

(15) A community-based care lead agency may add its logo to forms.

History

Rulemaking Authority 409.1451(11) FS. Law Implemented 409.1451 FS. History–New 10-4-15, Amended 1-3-23, 10-19-25.

Fla. Admin. Code R. 65C-42.004 Appeals

(1) The Department, the community-based care lead agency and its contracted service provider staff shall treat all young adults fairly and afford them due process. A young adult applying for or receiving Postsecondary Education Services and Support (PESS) or Aftercare Services has the right to receive written notice of adverse actions by the Department or its contracted service provider and to resolve issues about eligibility by meeting with representatives of the Department or its contracted service provider or through the fair hearing process. The fair hearing process is available to any young adult who is determined to no longer be eligible for either of these programs, whose benefits have been reduced or changed, or whose application for either of these programs has been denied.

(2) Notice of Adverse Action. The community-based care lead agency shall give timely written notice to the young adult regarding any decision to deny an application for or terminate participation in PESS or Aftercare Services.

(a) The notice shall be provided on the form “Notice of Termination or Reduction of Aftercare Services,” CF-FSP 5402, February 2015, or “Notice of Termination of Post Secondary Education Services and Support (PESS),” CF-FSP 5407, February 2015. Forms CF-FSP 5402 and CF-FSP 5407 are available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05836, and http://www.flrules.org/Gateway/reference.asp?No=Ref-05837, respectively. A community-based care lead agency may add its logo to forms CF-FSP 5402 and 5407.

(b) The notice shall be considered timely:

When the notice concerns an application for PESS or Aftercare Services, if it is delivered to the young adult within 10 business days of the lead agency receiving the application.
When the notice concerns any decision to terminate or reduce funds for a young adult in PESS or Aftercare Services, if it is delivered to the young adult at least 30 calendar days before the action described in the notice becomes effective.

(c) A “Request for Fair Hearing,” CF-FSP 5380, August 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05831, and “Due Process Rights,” CF/PI 175-74, incorporated by reference and available in Rule 65C-42.002, F.A.C., shall be attached to the notice. 45 C.F.R. §205.10 is incorporated by reference and available at http://www.gpo.gov/fdsys/granule/CFR-1997-title45-vol2/CFR-1997-title45-vol2-sec205-10/content-detail.html and http://www.flrules.org/Gateway/reference.asp?No=Ref-05829. A community-based care lead agency may add its logo to form CF-FSP 5380 and CF/PI 175-74.

(d) The notice shall be sent by certified mail and regular mail or provided to the young adult by hand delivery. If the young adult has provided a telephone number, designated staff shall call the young adult and advise him or her that the notice has been sent and also is available for pickup at the community-based care office. The notice shall also be sent via email, if the young adult has provided an email address. Documentation of hand delivery and email shall be made in the young adult’s file contemporaneously with the hand and email delivery. The certified mail receipt shall also be placed in the young adult’s file.

(3) Request for a Fair Hearing.

(b) The request for a fair hearing may be made orally or in writing.

The form “Oral Request for Fair Hearing,” CF-FSP 5381, August 2014, incorporated by reference, shall be used by the designated staff case manager to document oral requests for a fair hearing. This form is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-05832. A community-based care lead agency may add its logo to form CF-FSP 5381.
Written requests may be prepared by the young adult on the form “Request for Fair Hearing,” CF-FSP 5380, incorporated in this rule, or in any other manner the young adult chooses.

(c) The request for a fair hearing is made on the date the young adult sends a written request for fair hearing by U.S. Mail or email, or hand-delivers the written request to the staff member of the agency (or his or her designee) who sent the notice of adverse action. An oral request for a fair hearing is made on the date the young adult speaks with his or her case manager or designated staff, the community-based care agency providing him or her with independent living services, or the Department of Children and Families, Office of Appeal Hearings in Tallahassee. If the deadline to request a fair hearing is a Saturday, Sunday or holiday, the request shall be timely if it is made on or before the first business day after the weekend or holiday.

(4) Transmittal of Hearing Request to the Department or Its Contracted Service Provider.

(a) Within one (1) business day of receiving the young adult’s request for a fair hearing, staff shall send the request for fair hearing and notice of adverse action by facsimile or e-mail transmission to the legal representative for the Department and the Office of Appeal Hearings of the Department of Children and Families.

(b) If a request for a hearing is not received by the lead agency from the young adult within the stated timeframes, the request shall be forwarded to the Florida Department of Children and Families’ Office of Appeal Hearings with a notation that the request was late.

(c) Staff shall forward a copy of all documentation supporting the decision regarding participation in PESS or Aftercare Services to the Regional Legal Counsel and the legal representative for the Department within three (3) business days of receipt of the young adult’s request for fair hearing.

(5) Additional Local Preparation for Fair Hearings.

(a) The staff person receiving the request for a fair hearing shall, within five (5) business days, prepare copies of the young adult’s complete PESS or Aftercare Services file, as applicable, and copies of the young adult’s case file records from his or her dependency case file during the young adult’s 17th year of age to provide to both the young adult and the legal representative for the Department or its contracted service provider. Staff shall provide the complete file to both the young adult and the legal representative for the Department or its contracted service provider, whether or not a request has been made.

(b) The designated staff responsible for providing PESS or Aftercare Services (the designated staff in the county where the young adult’s participation originated) shall coordinate and participate in the fair hearing, even if the hearing takes place in a different county or region. The fair hearing shall take place in the county in which the young adult lives.

History

Rulemaking Authority 409.1451 FS. Law Implemented 409.1451 FS. History–New 10-4-15, Amended 10-19-25.

Chapter 65C-43 PLACEMENT AND SERVICES FOR COMMERCIALLY SEXUALLY EXPLOITED CHILDREN

Fla. Admin. Code R. 65C-43.001 Initial Screening Instrument

(1) Any child or young adult suspected of being commercially sexually exploited or labor trafficked shall be assessed using the “Human Trafficking Screening Tool Administration Guide (HTST),” CF-FSP 5406, July 2023, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15927. For the purpose of this rule chapter, a young adult is defined as someone who has reached 18 years of age but is not yet 23 years of age and who is in extended foster care or who is receiving other independent living services. In addition, any child or young adult who meets the criteria as defined in the list of indicators in the HTST, shall be assessed using the HTST.

(2) Any professional administering the HTST must meet the training requirements set forth in Rule 65C-43.005, F.A.C., and must have completed the Department approved training for the HTST prior to administering the tool.

(3) The HTST shall be initiated within 24 hours of identifying one or more of the indicators listed in the HTST. For a child or young adult whose whereabouts are unknown, the HTST shall be initiated within 24 hours of the debriefing of a recovered child or young adult if the debriefing results in indicators of human trafficking as listed in the HTST.

(4) If the HTST was previously administered by the Department of Juvenile Justice or one of the shared agencies as listed in the HTST, incorporated in subsection (1) of this rule, the results of the HTST shall be used in determining the most appropriate placement for the child or young adult.

History

Rulemaking Authority 409.1754(1)(c) FS. Law Implemented 409.1754 FS. History–New 1-12-16, Amended 10-24-19, 10-9-23.

Fla. Admin. Code R. 65C-43.002 Reporting

Each lead agency and regional Department of Children and Families, Family Safety Office shall provide the following information about children and young adults the lead agency serves to the Department’s Office of Child Welfare’s Human Trafficking Unit on a monthly basis:

(1) The total number of children and young adults assessed using the Human Trafficking Screening Tool (HTST);

(2) The total number of children and young adults determined to be victims of commercial sexual exploitation;

(3) The total number of children and young adults assessed for placement in a safe foster home or safe house;

(4) The total number of children and young adults who were referred to specialized non-residential services in the community to address their needs as a victim of commercial sexual exploitation;

(5) The total number of children and young adults who were placed in a safe foster home or safe house;

(6) The total number of children and young adults who were referred to a safe foster home or safe house, but placement was unavailable;

(7) The total number of children and young adults who were not placed in a safe foster home or safe house due to lack of funding or funding eligibility;

(8) The total number of children and young adults who were not placed in a safe foster home or safe house due to lack of recommendation;

(9) The total number of children and young adults who were not placed due to a runaway episode;

(10) The total number of children and young adults who were referred to a safe foster home or safe house who were not placed due to their choice not to go;

(11) Specifically for each child and young adult:

(a) Date the Human Trafficking Screening Tool was administered;

(b) The name and working title of the person who administered the screening tool;

(d) Child protective investigation findings for the current commercially sexually exploited child (CSEC) investigation;

(e) Date the safe foster home/safe house assessment was completed;

(f) The placement that resulted from the screening, including whether a safe foster home or safe house placement was made;

(g) Referrals to any specialized services and the type, date, and outcome of those referrals; and

(h) Whether or not the community-based care agency accrued costs for specialized services.

(12) The information specifically for each child and young adult required in subsection (11) of this rule shall be captured utilizing Part 1 of the “Screening, Placement and Services Checklist for Sexually Exploited Children and Young Adults Reporting Checklist,” CF-FSP 5413, May 2019, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11145. The information required in subsections (1) through (10) of this rule shall be captured utilizing Part 2 of the “Screening, Placement and Services Checklist for Sexually Exploited Children and Young Adults.”

History

Rulemaking Authority 39.0121(2), 409.1754(1)(c) FS. Law Implemented 39.524, 409.1754 FS. History–New 1-12-16, Amended 1-24-19, 10-24-19.

Fla. Admin. Code R. 65C-43.003 Criteria for Certification of Safe Houses

History

Rulemaking Authority 409.1678(2)(c)7., (2)(e) FS. Law Implemented 409.1678 FS. History–New 1-12-16, Amended 10-24-19, Transferred to 65C-14.119.

Fla. Admin. Code R. 65C-43.0035 Record Keeping for Children in Safe Houses

History

Rulemaking Authority 409.1678(2)(e) FS. Law Implemented 409.1678 FS. History–New 10-24-19, Transferred to 65C-14.120.

Fla. Admin. Code R. 65C-43.004 Training for Foster Parents of Safe Foster Homes and Staff of Safe Houses

(1) Foster parents and direct care staff of residential child-caring agencies must have completed all pre-service training, as prescribed in Section 409.145(2)(e), F.S., and Rule 65C-45.002, F.A.C., prior to the submission of the application to become a safe foster home or safe house.

(2) Foster parents and direct care staff must complete 24 hours of specialized training in commercial sexual exploitation prior to receiving certification to care for commercially sexually exploited children and young adults.

(3) Specialized intensive curriculum about commercially sexually exploited children must be approved by the Department. In determining whether a curriculum will be approved, the Department will consider whether the curriculum addresses the subjects specified in subsection (4), of this rule, and whether the instructor has met the following preferred criteria:

(a) Has a bachelor’s degree in social work or a related area of study; or a bachelor’s degree in psychology, sociology, counseling, special education, education, human development, child development, family development, marriage and family therapy, criminal justice, adult learning or nursing; and two years of experience working with sexually exploited children, or

(b) Has a master’s degree in social work or a related area of study; or a master’s degree in psychology, sociology, counseling, special education, education, human development, child development, family development, marriage and family therapy, criminal justice, adult learning or nursing, or

(d) In addition, all instructors must have received training on the following topics: Human Trafficking, Motivational Interviewing, Trauma-focused Cognitive Behavioral Therapy, and Co-occurring Disorders.

(4) The specialized intensive training on commercially sexually exploited children shall include:

(a) Distinctions between sexual abuse, sexual exploitation, and sexual trafficking;

(b) Language and sensitivity;

(d) Exploiters;

(e) Tactics of coercion and control;

(f) Impact of sexual exploitation;

(g) Stockholm Syndrome and trauma bonding;

(h) Identifying victims;

(i) Meeting the needs of victims;

(j) Trauma triggers;

(k) Trauma-informed care;

(l) Vicarious trauma and self-care strategies;

(m) Behavior management activities; and

(n) Intersection of labor trafficking and commercial sexual exploitation.

(5) Once certified, foster parents of safe foster homes and direct care staff of safe houses must complete eight (8) hours of continuing education annually focused on human trafficking.

History

Rulemaking Authority 409.1678(2)(e) FS. Law Implemented 409.1678 FS. History–New 1-12-16, Amended 11-24-19.

Fla. Admin. Code R. 65C-43.005 Specialized Training in Serving Human Trafficking Victims

(1) Child protective investigators and case managers, and their supervisors, must receive a minimum of six (6) hours of specialized training on human trafficking approved by the Department prior to accepting cases with children or young adult victims of human trafficking. The specialized training in human trafficking shall be conducted by a Department-approved trainer and consist of:

(a) Three (3) hours of live training pertaining to human trafficking;

(b) One (1) hour of live training pertaining to Legislative language addressing human trafficking; and

(2) Child protective investigators and case managers must each year receive a minimum of one (1) hour of ongoing training per quarter on human trafficking or related topics in order to continue receiving cases with child or young adult victims of human trafficking.

(3) The training curriculum and any revision to the training curriculum must be approved by the Department. Training curriculum will be approved if it meets the requirements of paragraphs (1)(a)-(c) of this rule.

(4) Completion of the training shall be entered into FSFN, using the training tracker.

History

Rulemaking Authority 409.1678(2)(e) FS. Law Implemented 409.1754(3)(a) FS. History–New 1-12-16, Amended 11-24-19.

Fla. Admin. Code R. 65C-43.006 Administrative Actions

(1) Prior to a moratorium on referrals or revocation of certification for a safe foster home or safe house, the Regional Licensing Authority shall review the following:

(a) Licensing history, including history of corrective action plans; and,

(b) History of abuse and neglect reports and foster care referrals.

(2) If the certification violation poses an immediate threat to the health, safety, or welfare of the youth or young adults, the community-based care lead agency or child-caring agency shall coordinate the placement of all youth or young adults into other licensed settings as soon as possible, but in no case later than 48 hours. Upon identification of a new placement, transition shall occur in accordance with Section 409.145(2)(c), F.S. The case manager shall participate in the coordination of securing a new placement.

(3) If the change in placement is a result of circumstances addressed in subsection (2) of this rule, the case manager shall document in FSFN and provide the following information within 72 hours of the new placement for each child and young adult to the Regional Licensing Authority:

(a) Date of placement change;

(b) Reason for the change in placement;

(d) Identification of all parties notified of the placement disruption, including the medical, behavioral and psychiatric providers.

(4) If the certification violation does not pose an immediate threat to the health, safety, or welfare of the children or young adults, the Regional Licensing Authority shall send a notification of noncompliance to the foster parent or child-caring agency by certified mail within 10 business days of the decision.

(5) The notification of noncompliance shall cite the specific certification standard(s) in which the safe foster home or safe house is in noncompliance and shall include a timeframe in which the foster parent or child-caring agency must come into compliance with the certification standard(s).

(6) Within 10 business days of receipt of notification of noncompliance, the foster parent or child-caring agency shall notify the Regional Licensing Authority of any intent to come into compliance with certification. In addition, the foster parent or child-caring agency must provide the Regional Licensing Authority with the following for each child and young adult:

(a) Proposed alternate placement;

(b) Current and proposed service providers, if a change occurs;

(d) Current and proposed medical providers, if a change occurs; and,

(e) Current and proposed behavioral and psychiatric providers, if a change occurs.

(7) No new placements of sexually exploited children or young adults shall occur until all certification violations have been resolved.

(8) Certification violations are not considered resolved until approved by the Regional Licensing Authority.

(9) If certification violations have not been resolved and approved by the Regional Licensing Authority, the foster parent or child-caring agency will be notified by certified mail within 10 business days of the reasons why the certification violations have not been resolved.

(10) If the foster parent or child-caring agency does not come into full compliance with certification standards within 10 business days of the notification of reasons why the certification violations have not been resolved, the Regional Licensing Authority shall send the foster parent or child-caring agency notice by certified mail that the certification is revoked.

(11) Except as prescribed in subsection (2) of this rule, upon notification of certification revocation, the lead agency or child-caring agency shall secure new placement for each youth or young adult within five (5) business days.

(12) Except as prescribed in subsection (3) of this rule, the sending agency shall provide the Regional Licensing Authority within 10 business days of the change in placement of each child or young adult the following information:

(a) The name of the receiving safe foster home or safe house;

(b) The date of the transfer; and,

History

Rulemaking Authority 409.1678(2)(e) FS. Law Implemented 409.1678 FS. History–New 1-12-16.

Chapter 65C-44 Guardianship Assistance Program

Fla. Admin. Code R. 65C-44.001 Definitions

(1) “Child” for purposes of this rule chapter means an individual who has not attained 18 years of age.

(2) “Extended Guardianship Assistance Agreement” means an agreeement that outlines the payment amount and services provided for a qualifying young adult.

(3) “Extended Guardianship Assistance Payment” means a monthly payment provided to a caregiver for the care and support of a qualifying young adult.

(4) “Guardianship Assistance Agreement” means an agreement that outlines the payment amount and services provided for a qualifying child.

(5) “Guardianship Assistance Payment” means a monthly payment provided to the caregiver for care and support of a qualifying child.

(6) “Successor Guardian” means an adult identified by the caregiver and approved by the Department who will assume care and responsibility for the child if the caregiver is no longer able to care for the child.

(7) “Young adult” as defined in section 39.6225, F.S.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 7-23-19, Amended 12-29-24.

Fla. Admin. Code R. 65C-44.002 Types of Guardianship Assistance

The child welfare professional shall inform prospective guardianship caregivers of the availability of all of the benefits listed below:

(1) Guardianship Assistance Payment.

(2) Other Medical Services. Other medical services available include on-going Medicaid coverage and continuing eligibility with Children’s Medical Services for children who were receiving such services prior to case closure in permanent guardianship.

(3) Reimbursement for Non-Recurring Guardianship Assistance Expenses. Non-recurring guardianship expenses are expenses necessary for pursuing legal permanent guardianship. Payments must be requested in writing prior to case closure in permanent guardianship.

(4) Tuition Fee Exemption. Children who were in the custody of a permanent guardian may be eligible for an exemption of undergraduate college tuition fees at Florida universities or community colleges pursuant to section 1009.25, F.S.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 6-30-19.

Fla. Admin. Code R. 65C-44.003 Determination of Guardianship Assistance Payments

(1) The purpose of the guardianship assistance payment is to make financial assistance available to permanent guardians to enable them to provide care for a qualifying child. Every permanent guardian must be advised of the availability of a guardianship assistance payment and the purpose for which it was intended.

(2) An application to participate in the Guardianship Assistance Program must be made on the “Application for Guardianship Assistance Program” form, CF-FSP 5442, June 2019, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10805.

(a) Presumptive eligibility must be completed prior to execution of the Guardianship Assistance Agreement.

(b) For families that have submitted an application for the guardianship assistance program, the child welfare professional shall begin the presumptive eligibility determination process once a goal change to permanent guardianship has occurred or a concurrent goal of permanent guardianship has been added. Presumptive eligibility shall be completed on the guardianship assistance page in the child welfare information system.

A primary goal change to permanent guardianship; or
A concurrent goal added for permanent guardianship; and
A permanency hearing has been held and permanent guardianship was determined to be in the child’s best interest; and
A caregiver has received a foster care board payment for at least six (6) consecutive months.

(3) The child’s and family’s need for guardianship assistance payment must be determined prior to the court case closing in permanent guardianship. Guardianship assistance payments shall not be made prior to all parties signing the “Guardianship Assistance Agreement,” CF-FSP 5437, incorporated in Rule 65C-44.004, F.A.C.

(4) If the Department or community-based care lead agency (Lead Agency) has responsibility for placement and care of the child, the Lead Agency in the county where the court has jurisdiction is responsible for entering into the Guardianship Assistance Agreement and paying guardianship assistance payments.

(5) When the need for guardianship assistance payments is not determined prior to case closure and the permanent guardians believe they have been wrongly denied guardianship assistance payments on behalf of a child, they have the right to appeal the denial in accordance with the rules and procedures of the state’s fair hearing and appeal process. If it is found that the guardianship assistance payment was wrongly denied, retroactive payment will be made dating back to the date the permanent guardian requested guardianship assistance payments in writing. Retroactive payment dating back to the date of placement will not be approved.

(6) Medical or mental health evaluations shall be required to document the need for any guardianship assistance payment that exceeds the statewide standard foster care board rate. Evaluations must be completed within the last 12 months of initial guardianship assistance payment determination.

(7) The Lead Agency or subcontracted agency child welfare professional shall inform the caregiver that the guardianship assistance payments, unlike the foster care board rate payments, are not intended to cover the complete cost of the child’s care. The guardianship assistance payment is intended to assist the permanent guardian in supporting the extra cost associated with providing care for a child.

(8) The initial determination of the monthly guardianship assistance payment shall be based on the needs of the child at the time of negotiation and the projected future needs of the child based on the family and medical history of the child and birth family, or for cases that meet guardianship assistance program requirements and are closed in permanent guardianship on or after, July 1, 2019, as stated in section 39.6225, F.S. Negotiations for the initial guardianship assistance payment shall begin at $333 monthly.

(9) A guardianship assistance payment may be negotiated up to 100% of the statewide foster care board rate. A payment may exceed 100% of the statewide foster care board rate based on a family’s level of licensure pursuant to section 409.175(5) F.S., when an exception is granted by the Department or designee and documented on the “Guardianship Assistance Payment Approval” form CF-FSP 5440, (December 2024), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17366. Requests for exceptions must be in writing. In determining whether to grant an exception, the Department or designee shall consider the medical, behavioral, and therapeutic needs of the child at the time of the negotiation, as well as the projected future needs of the child based on the family and medical history of the child and birth family. In no case shall the guardianship assistance payment exceed the foster care maintenance payment for which the child is or would be eligible if the child had been placed in a family foster home. Guardianship assistance payments are not intended to cover services which can be obtained through family insurance, Medicaid, Children’s Medical Services, or through special education plans provided by the public school district.

(10) The effective date of the agreement is the date that all requirements for the Guardianship Assistance Program have been met. Payments may not be made for any months in which there is no Guardianship Assistance Agreement in place.

(11) The permanent guardian must be advised by the child welfare professional that it is their responsibility to notify the Department or Lead Agency of any change in circumstances, including moving out of state, no later than 48 hours after the change.

(12) The Guardianship Assistance Agreement shall be terminated:

(a) Upon the death or incapacity of the guardian(s) if no successor legal guardian is named.

(b) Upon the death of the child.

(d) When it is determined that the child is no longer receiving support from the guardian(s).

(e) Upon request of the guardian(s).

(13) Permanent guardians may request an increase in the guardianship assistance payments after the initial Guardianship Assistance Agreement was approved due to increased needs related to conditions of the child that were identified as current or future needs of the child prior to the permanent guardianship placement or the circumstances of the family have changed to meet the increased needs of the child.

(a) If the increase request is approved, retroactive payment will be made dating back to the date the permanent guardian officially requested the increased guardianship assistance payment in writing.

(b) If the increase request is denied, the designated Department staff shall send a denial letter with notification of the permanent guardian’s right to appeal in accordance with the rules and procedures of the state’s fair hearing and appeal process. If it is found that the increase was wrongfully denied, the effective date of the new payment will be the date the increase request was received.

(14) No child will have his or her guardianship assistance payment reduced based on application of this rule.

(15) No change shall be made to a guardianship assistance payment without concurrence of the permanent guardian except as provided by the federal regulation or state law. The Guardianship Assistance Agreement is not transferable but should include a successor guardian.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 7-23-19, Amended 12-29-24.

Fla. Admin. Code R. 65C-44.004 Guardianship Assistance Agreement

The “Guardianship Assistance Agreement Between the Department of Children and Families and Guardians Regarding Payments and Services,” CF-FSP 5437, (December 2024), incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17367, must be signed and dated by all parties prior to case closure in permanent guardianship and uploaded into the child welfare information system database.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 7-23-19, Amended 12-29-24.

Fla. Admin. Code R. 65C-44.0045 Successor Guardians

(1) A successor guardian should be identified and documented on the Guardianship Assistance Agreement.

(2) The successor guardian is not required to be a relative, fictive kin or a licensed caregiver.

(3) The successor guardian must successfully complete the following criminal, delinquency and abuse/neglect history checks prior to being added to the Guardianship Assistance Agreement:

(a) Fingerprints;

(b) Statewide criminal records check through the Florida Department of Law Enforcement;

(d) Federal criminal records check through the Federal Bureau of Investigations;

(e) Local criminal records check through law enforcement agencies, including records of any responses to the home by law enforcement that did not result in criminal charges;

(f) Abuse and neglect records check through the child welfare information system; and

(g) Civil court records check regarding domestic violence complaints and orders of domestic violence complaints and orders of protection.

(4) Successor guardians are not required to have a completed Unified Home Study at the point of being identified but must have a home study completed and approved in child welfare information system prior to placement.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 7-23-19, Amended 12-29-24.

Fla. Admin. Code R. 65C-44.005 Non-recurring Guardianship Expenses

(1) Under any Guardianship Assistance Agreement, the state is authorized to make payments to the guardian for non-recurring, one time, expenses the guardian has incurred in connection with the guardianship. Non-recurring guardianship expenses are court costs, attorney fees, and other expenses which are directly related to the guardianship.

(2) Agency fees shall be established by written agreement between the agency and family prior to the performance of the requested service. If these children are otherwise eligible, agency fees shall be counted as an allowable expense under non-recurring guardianship expenses. It is not necessary that the family be receiving guardianship assistance payment to be eligible for reimbursement of non-recurring guardianship expenses.

(3) In cases where siblings are placed separately or as a unit, each child is treated as an individual with separate reimbursement for non-recurring expenses up to the maximum amount of $2,000 per child.

(4) There are no income eligibility requirements for guardians in determining whether payments for non-recurring expenses of guardianship will be made.

(5) Guardians cannot be reimbursed for out-of-pocket expenses for which they have been otherwise reimbursed.

(6) The following procedures will initiate payments for reimbursement of non-recurring guardianship expenses:

(a) All guardians will be advised by the staff person conducting the home study of the availability of non-recurring expense reimbursement;

(b) Reimbursement for eligible costs may be made to the guardian or directly to a vendor. The staff person conducting the home study shall advise all guardians to keep copies of receipts of expenditures related to pursuing guardianship. Copies of such receipts shall be entered into the payment record in child welfare information system. Eligible expenses include court costs, attorney fees, birth certificates, costs of required physicals and psychological examinations, costs of transportation, lodging and food for the child and/or guardian when necessary to complete the guardianship process, and the cost of the home study if the child is in the custody of a private agency;

(c) When completing program eligibility, the Guardianship Assistance Agreement shall be negotiated with the family and must include a statement of the projected cost to be reimbursed for non-recurring guardianship expenses as well as proposed guardianship assistance payments.

(d) Payments for non-recurring expenses can be made up to one (1) year following the closing in permanent guardianship.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 7-23-19, Amended 12-29-24.

Fla. Admin. Code R. 65C-44.006 Extension of Guardianship Assistance Agreement

(1) Families shall be notified of the Extension of Guardianship Assistance Payment when they are entering into an agreement for a child who has attained 14-17 years of age.

(2) The initial agreement shall notate that the caregiver intends to opt into the Extension of Guardianship Assistance Program.

(3) The “Extension of Guardianship Assistance Agreement Between the Department of Children and Families, Young Adult and Guardians Regarding Payments and Services,” CF-FSP 5434, June 2019, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10806, shall be executed prior to the child’s 18th birthday.

(4) The young adult must meet the eligibility criteria as stated in section 39.6225, F.S.

(5) Extension of Guardianship Assistance Payments may be made until the young adult reaches 21 years of age, if the young adult is determined to meet eligibility criteria during the annual redetermination periods.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 7-23-19, Amended 12-29-24.

Fla. Admin. Code R. 65C-44.007 Redetermination of Guardianship Assistance Payment and Extended Guardianship Assistance Payment

(1) An annual redetermination for Guardianship Assistance Payment eligibility shall be completed every 12 months. Failure of the guardian to submit a completed “Guardianship Assistance Program Eligibility Redetermination” form prior to the end of the 12-month redetermination date shall result in suspension of the Guardianship Assistance Payment. The “Guardianship Assistance Program Eligibility Redetermination” form, CF-FSP 5441, May 2019, is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-10578.

(2) A redetermination for Extended Guardianship Assistant Payment eligibility shall be completed every six (6) months.

(a) The guardian must provide documentation that the young adult for whom they are receiving Extended Guardianship Assistance Payment continues to meet the eligibility criteria in section 39.6225(9), F.S.

(b) Failure of the guardian to submit a completed “Guardianship Assistance Program Eligibility Redetermination” form prior to the end of the 6-month redetermination date shall result in suspension of the Guardianship Assistance Payment.

(3) The “Guardianship Assistance Program Eligibility Redetermination” form will be uploaded into the file cabinet under the child or young adult’s program eligibility page in child welfare information system database.

History

Rulemaking Authority 39.6225(11) FS. Law Implemented 39.6225 FS. History–New 6-30-19, Amended 12-29-24.

Chapter 65C-45 LEVELS OF LICENSURE

Fla. Admin. Code R. 65C-45.001 Background Screening Requirements for all Levels of Licensure

(1) The Department shall conduct background screenings for all persons considered by the Department for initial licensure, re-licensure, or re-screenings for 3-year licensure for out-of-home caregivers and all adult household members age 18 and older, pursuant to Sections 409.175 and 39.0138, F.S.

(2) These screenings shall include:

(a) Statewide criminal records check through the Florida Department of Law Enforcement to be obtained through fingerprinting;

(b) Federal criminal records check through the Federal Bureau of Investigation to be obtained through fingerprinting;

(c) Local criminal records check through local law enforcement agencies, including records of any responses to the home by law enforcement that did not result in criminal charges;

(d) Records check of the Florida Sexual Offenders and Predators registry;

(e) Abuse and neglect records check through the Department’s Florida Safe Families Network (FSFN) which shall be documented on the “Central Abuse Hotline Record Search” form, CF 1651, April 2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11811;

Only abuse and neglect reports in which the applicant or any other household member was named as the caregiver responsible for the abuse or neglect shall be used for initial licensing recommendations by the community-based care agency (CBC).
When the applicant or any other household member was named as caregiver responsible in a report verified for sexual abuse, this shall be an automatic disqualifier for licensure.
The Department’s Regional Family Safety Office shall review the following reports to determine whether a license shall be issued:

a. When the applicant or any other household member was named in any capacity in three (3) or more reports within a five (5) year period, regardless of classification; or

b. When the applicant or any other household member was named as caregiver responsible in a report not substantiated for sexual abuse.

For homes being considered for licensure for longer than one (1) year under Section 409.175(6)(j), F.S., all abuse reports with any findings shall be considered.
Determinations made based on abuse and neglect reports shall be the made in accordance with the standards set forth in Rule 65C-38.002, F.A.C.

(f) Civil court records check regarding domestic violence complaints and orders of protection.

(3) If the applicant or any other adult household member has resided in any other state during the past five (5) years, requests for abuse and neglect histories and the results of such requests shall be included with the application file.

(4) Each applicant and adult household member being screened shall sign an “Affidavit of Good Moral Character,” CF 1649, Nov 2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-12404, and a “Release of Information,” CF-FSP 5090, April 2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11814.

(5) Each applicant and household member being screened under this rule shall provide all the names under which he or she has been known.

(6) The following screenings shall be completed for household members 12-17 years of age:

(a) Juvenile records check through the Florida Department of Juvenile Justice or Florida Department of Law Enforcement (FDLE) Shield; and

(b) Federal criminal records check through the Federal Bureau of Investigation are not required for household members 12-17 years of age.

Only abuse and neglect reports in which the household member was named responsible for the abuse or neglect shall be considered for initial licensing recommendations by the CBC or contracted provider.
When the household member was named in a report verified for sexual abuse, this shall be an automatic disqualifier for licensure.
The Department’s Regional Family Safety Office shall review the following reports to determine whether a license shall be issued:

a. When the household member was named in any capacity in three (3) or more reports within a five (5) year period, regardless of classification; and

b. When the household member was named in a report not substantiated for sexual abuse.

For homes being considered for licensure for longer than one (1) year under Section 409.175(6)(j), F.S., all abuse reports with any findings shall be considered.
Determinations made based on abuse and neglect reports shall be the made in accordance with the standards set forth in Rule 65C-38.002, F.A.C.

(7) All records obtained as a part of the background screening shall be considered in the process of determining whether to issue a foster care license or, if there is a current license, whether the license should be revoked. Such records shall include findings of delinquency; any misdemeanor or felony criminal arrests resulting in a conviction or withhold of adjudication; any criminal traffic offenses resulting in a conviction or withhold of adjudication, and any civil cases of domestic violence and orders for protection. Crimes perpetrated in other states that are misdemeanors in that state but would be felonies listed under Section 435.04, F.S., if committed in Florida shall be considered as disqualifying offenses by the Department for licensing decisions. Crimes identified as disqualifying offenses under Section 39.0138, F.S., are automatic disqualification for licensure.

(8) Screenings identified in paragraphs 65C-45.001(2)(a)-(b), that are completed through the Agency for Health Care Administration (AHCA) Background Screening Clearinghouse are valid for five years. Screenings identified in paragraphs 65C-45.001(2)(a)-(b), not completed through the AHCA Background Screening Clearinghouse are valid for one year. Screenings identified in paragraphs 65C-45.001(2)(c)-(f) and 65C-45.001(6)(a)-(b) are valid for one year. All screenings must be valid within 60 days of re-licensure or rescreening for three-year licensure.

(9) Fingerprint exemptions as referenced in Section 39.0138, F.S., can be granted for household members if the criteria in Rule 65C-28.020, F.A.C., is met.

History

Rulemaking Authority 39.012, 39.0121, 409.175(5), 435.01(2) FS. Law Implemented 39.0121, 39.0138, 409.175(5), 435.04, 435.05 FS. History–New 4-26-20, Amended 11-25-20.

Fla. Admin. Code R. 65C-45.002 Parent Preparation Pre-service and Inservice Training for all Levels of Licensure

(1) Parent preparation pre-service and in-service training shall meet the requirements of Section 409.175(14), F.S.

(2) Applicants who have previously completed a Department-approved pre-service training curriculum in the past five years, and who can provide proof of completion, shall not be required to complete pre-service training except portions of the training curriculum that have been updated since their previous completion. Applicants who completed pre-service training in another state shall be exempt from pre-service training if the curriculum meets the content requirements established in Section 409.175(14), F.S., for pre-service training offered in Florida. Supervising agencies shall submit a copy of the curriculum to the Department for review and approval if the previously completed training is not an approved curriculum in Florida. The Department shall approve training curriculum that meets the content requirements specified in Section 409.175(14), F.S.

(3) Pre-service training shall include the following:

(a) The reasonable and prudent parenting standards, pursuant to Sections 39.4091 and 409.145, F.S., and the balance of normalcy for children in care and their safety;

(b) Legal rights, roles, responsibilities, and expectations of foster parents;

(d) Agency policies, services, laws, and regulations;

(e) Development of life skills for teens in care;

(f) The caregiver’s role in supporting and promoting the educational progress of the child;

(g) Trauma-informed care, including recognizing the signs, symptoms, and triggers of trauma;

(h) The Multiethnic Placement Act and the Americans with Disabilities Act; and

(i) For individuals being licensed as a level II-V, training must also include the administration of psychotropic medication, including the use of psychotropic medications to treat children, the proper dosage of medication, the importance of monitoring for possible side effects, and the timely reporting of side effects and adverse reactions. Training on psychotropic medications shall also include an overview of Section 39.407, F.S., and rule Chapter 65C-35, F.A.C., which govern the administration of psychotropic medication.

(4) Each applicant shall complete orientation prior to, but no later than, the first preservice training class.

(5) The Department will approve Enhanced Level II foster home trainings that include at minimum the following components:

(a) Attachment-based intervention;

(b) Trauma-informed intervention;

(d) Development of safety;

(e) Teaching of self-management and coping skills;

(f) Social connections and support systems;

(g) Behavior management; and

(h) Parental resilience relationship development.

(6) Applicants seeking approval as an Enhanced Level II Foster Home, as defined in 65C-30.001, F.A.C., must complete a Department-approved Enhanced Level II foster home training.

(7) In-service training must be completed annually prior to re-licensure. The types of in-service training shall be based upon the needs of the family and any previous or current children in the home.

(8) Each parent preparation pre-service training class shall be led by a child protection professional certified pursuant to Section 402.40, F.S., who has a bachelor’s degree or a master’s degree from an accredited college or university, and who has successfully met any curriculum-specific requirements to train the Department-approved parent preparation pre-service training curriculum. An online training approved by the Department may also be provided. The Department shall review all parent preparation pre-service training curriculum to ensure that it meets the content requirements specified in Section 409.175(14), F.S. If the required hours and content requirements are met, the Department shall approve the curriculum. Each parent preparation pre-service training class shall follow the recommendations of the curriculum designer regarding the number and type of facilitators involved in the training process. If the child-placing agency is the designer of the curriculum, the number and types of facilitators to be involved in the training process must be clearly defined.

(9) The community-based care lead agency is authorized to approve the completion of pre-service training. If individualized training is done, the certified child welfare professional is responsible for complying with the requirements set forth for parent preparation pre-service training in Section 409.175, F.S., and the requirements set forth in this rule.

(10) Anyone who wishes to become a licensed out-of-home caregiver shall attend parent preparation pre-service training, as defined in subsections (1) and (2) of this rule, offered by any licensed child-placing agency. Agencies shall work cooperatively with each other and prospective licensed out-of-home caregivers to ensure the ongoing availability of such training.

(11) When prospective out-of-home caregivers successfully complete the parent preparation pre-service training but do not continue the licensing process or commence but fail to complete the parent preparation pre-service training, the supervising agency staff shall document the reason the process was discontinued in Florida Safe Families Network (FSFN).

(12) The completed parent preparation pre-service training is valid for five (5) years from the date of verified curriculum completion.

(13) The community-based care lead agency will utilize culturally and linguistically appropriate competency and awareness when recruiting out-of-home caregivers. The agency will provide prospective out-of-home caregivers with cultural competency training to address a variety of cultural backgrounds, values, customs, and beliefs.

(14) Preservice training curriculum(s) must be reviewed every seven years by the Department.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5), (14) FS. History–New 4-26-20, Amended 12-25-22.

Fla. Admin. Code R. 65C-45.003 Foster Home Initial Licensing Requirements for all Levels of Licensure

(1) General.

(a) Each applicant wishing to become a licensed out-of-home caregiver shall complete the following:

An “Application for License to Provide Out-of-Home Care for Dependent Children,” CF-FSP 5007, July 2017, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11812. Persons living together in a caretaking role must both sign the application;
A “Release of Information” form, incorporated by reference in Rule 65C-45.001, F.A.C.;
A “Partnership Plan for Children in Out-of-Home Care,” CF-FSP 5226, January 2015, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11815; and
A “Confidentiality Agreement,” CF-FSP 5087, October 2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-12289.

(b) The child-placing agency completing the Unified Home Study shall, at a minimum, conduct one (1) visit to the applicant’s home, inspect the entire indoor and outdoor premises, document the conditions, and conduct face-to-face interviews with all household members. The dates, names of persons interviewed, and summary of these interviews shall be documented in the Unified Home Study.

(c) The supervising agency is responsible for advising the applicant of all rules, regulations, and standards that apply to the applicant if a license is issued.

(d) If an emergency/planned placement home study has been denied due to a caregiver or current household member having a criminal history disqualifier pursuant to Section 39.0138, F.S., the child welfare professional is not required to complete a level I licensure.

(2) Attestation may be used during the initial licensure and re-licensure of a family foster home. The Department issues the license based on the community-based care lead agency’s attestation that the licensure or re-licensure file complies with state law and rule. If the child-placing agency is not contracted with a community-based care lead agency, it may submit its attestation directly to the Department.

(a) “Attestation for Foster Home Licensure,” CF-FSP 5357, April 2020, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11818.

(b) Community-based care lead agencies participating in the attestation model for licensure must enter into a Memorandum of Agreement with the Department. The “Memorandum of Agreement for Adoption of Attestation Model for Family Foster Home Licensing,” CF-FSP 5356, (August 2022), is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-14665.

(3) Initial Licensing Unified Home Study. A staff person, certified pursuant to Section 402.40, F.S., from the supervising agency shall perform a thorough assessment of each prospective licensed out-of-home caregiver and document this assessment in the Unified Home Study section of the child welfare information system. The assessment shall include:

(a) Demographics, including:

Names, dates of birth, addresses, and contact numbers for the caregiver(s), other household members, including biological children, and non-resident children of caregivers;

2.Verification of Social Security information; and

Names, dates of birth, and types of placement of all children who are currently placed in the home (by the Department or another agency) and who exited the home within one (1) year from initiation of the UHS.

(b) Verification of background checks.

(c) Employment. Description of the current employment status for each parent, including occupation, place of employment, work hours, and flexibility of schedule in case of emergencies, medical, or school appointments for children.

(d) Financial Capacity and Income. Description and documentation of the applicant’s current financial capacity and how the impact of the additional children in the home will be addressed.

(e) Child Care. Description of child care arrangements, including transportation to and from the child care provider, if applicable.

(f) Assessment and Unified Home Study details, including the following:

Current or past experiences with child abuse or neglect, alcohol and/or substance abuse, alcohol and/or substance abuse treatment, and domestic violence;
Any health or mental health conditions, including medication(s);
How the caregiver(s) is (are) able to participate in a professional team supporting the child by sharing necessary information with other professionals on the team and maintaining the confidentiality of the child and caregiver as required by law, regulation, and professional ethics; participating in planning activities, court hearings, staffings, and other key meetings; and
How the caregiver(s) is (are) willing and able to make a loving commitment to the child(ren)’s safety and well-being by:

a. Providing supervision and positive methods of discipline;

b. Encouraging the child in his or her strengths and respecting the child’s individuality and likes and dislikes;

c. Providing opportunities to develop the child’s interests and skills;

d. Maintaining awareness of the impact of trauma on behavior;

e. Involving the child in family and community activities;

f. Providing transportation to child care, extracurricular activities, and school (if requested by the community-based care lead agency. This request shall not be made to circumvent the requirements of the Every Student Succeeds Act (ESSA), 20 U.S.C. ss. 6301 et seq. (2018), incorporated by reference and https://www.flrules.org/Gateway/reference.asp?No=Ref-11822; and

g. Ensuring the child’s safety by employing safety measures, including in the household, for transportation, and with pets.

(I) Transportation. The licensed out-of-home caregiver shall have access to transportation available 24 hours a day. All vehicles used to transport children shall be in safe condition and equipped with seat belts for each child transported as required by Section 316.614, F.S., and car seats as required by Section 316.613, F.S. The licensed out-of-home caregiver shall not knowingly allow children to be transported in an uninsured vehicle. Vehicles shall be smoke free, including e-cigarettes and vapor smoke, when children are being transported. The licensed out-of-home caregiver shall ensure safety equipment is utilized.

(II) Animals. Provide a description of any household pets, exotic pets, or livestock residing on the premises. Descriptions shall include observations of the care, behavior, and/or maintenance and safety plan relating to each animal. The applicant shall have measures in place to assure safety of children from any potentially dangerous animals, and this information shall be documented in the home study, if applicable;

How the caregiver(s) is (are) willing and able to respect and honor any child’s culture, religion, and ethnicity; meet any child’s special physical or psychological needs; support any child’s individual situation. If the caregiving family’s religion, culture, or other factors will impair their ability to meet the needs of certain children, an explanation of what the family’s limitations are, and how limitations could impact children placed in their home.
How the caregiver(s) is (are) willing and able to commit to maintaining any child they accept in their home until it is in the child’s best interest to leave the home. An explanation of any problems a long-term commitment may present for the caregiver.
How the caregiver(s) will address challenges in caring for a child, including available supports and resources. These challenges may include, for example, fire setting, sexual reactive behaviors, mental health, substance abuse, and reactive attachment behaviors, and may potentially require a Child Placement Agreement. The “Child Placement Agreement,” CF-FSP 5414, Jan 2017, is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11821.
How the caregiver(s) is (are) willing and able, when applicable, to participate in transition planning for any child, and maintaining a relationship with any child after he or she leaves the home.
How the caregiver(s) is (are) willing and able to assist the caregiver(s) from which the child was removed in improving their ability to care for and protect the child and to provide continuity for the child after reunification.
How the caregiver(s) is (are) willing and able to assist any child in family time/visitation and other forms of communication with family members, when applicable.
How the caregiver(s) will:

a. Maintain records that are important to any child’s well-being, including child resource records, medical records, school records, photographs, and records of special events and achievements.

b. Ensure that these records are made available to other partners in the child welfare system and to the child and family, as applicable.

How the caregiver(s) is (are) willing and able to advocate for children in their care, as needed, with the child welfare system, the court, and community agencies, including schools, child care, health and mental health providers, and employers.
A description of previous parenting experience, if applicable.
How the caregiver(s) is (are) willing and able to participate fully in any child’s medical, psychological, and dental care, including providing transportation to and from, attending appointments, and communicating with professionals.
How the caregiver(s) is (are) willing and able to support any child’s school success by:

a. Participating in school activities and meetings, including disciplinary and/or Individualized Education Plan (IEP) meetings;

b. Assisting with school assignments, supporting tutoring programs, meeting with teachers and working with an Educational Surrogate, if one has been appointed, and encouraging any child’s participation in extra-curricular activities;

c. For any child who has a disability or is suspected of having a disability, attending Educational Surrogate Parent training, if needed or recommended by the court, and thereafter advocating for the child(ren) in the school system; and

d. Maintaining any child(ren) in the school of origin, unless it is not in the child(ren)’s best interest to do so, or maintaining any child(ren) in the school of origin until a logical juncture in the academic year, if it is not possible or not in the child(ren)’s best interest to remain in the school of origin for the remainder of the school year.

(g) Applicant’s motivation to foster and his or her commitment to the foster care experience, including how other family members and extended family feel about the decision to foster.

(h) Attendance and/or completion of any training related to licensure, including pre-service training, and home interview dates.

(i) Other Adult Household Members. The responsibilities the applicant(s) will expect the other adults in the household to have with children placed in the home.

(j) Social History. A description of the following shall be included:

Background and Family History. Background and family history, including education, types of discipline used in the family, the family’s willingness and ability to use appropriate discipline as described in the “Partnership Plan for Children in Out-of-Home Care,” incorporated by reference in subsection (1) of this rule, family values, and any prior residences in or out of Florida.
Marital Status and Other Significant Relationships.
Health. Applicants will be required to fully disclose health history for themselves and each member of the household, to include current physical, mental, or emotional health status, any condition that is progressive and debilitating in its course, and any past and current treatment and services received for such condition. A current physical shall not be required unless the applicant has disclosed a physical, mental, or emotional condition that jeopardizes the safety and permanency of the child’s placement.
Parenting experience of each applicant. All of the applicant’s children, including adult children, shall be identified whether they reside in the home or not. If the applicant has parenting experience with children other than their biological or adopted children, circumstances under which this experience was acquired shall be discussed. This section should also include a description of the experience, as opposed to just listing the identities of the applicant’s children or the children they may have parented.
Family Life. Document observations of family members’ personalities and their interpersonal relationships. Describe family activities, hobbies and interests, and civic involvement, including how children placed in the home will participate in these activities, as well as family vacations. For each child living in the home, describe the child’s school, grades, achievements, and interests. Describe each child’s relationship with the applicant(s) and siblings in the home, as well as his or her feelings about having a foster child in the home.
Religion. Assess and document the family’s attitudes regarding seeking medical treatment, celebrating holidays or birthdays, and respecting the religious beliefs of the child’s family of origin.

(k) Home and Neighborhood:

Physical description of the home, including the number of bedrooms and bathrooms, type and number of available beds and current sleeping arrangements, storage space for children’s personal belongings, living area, dining area, and other interior space. Interior and exterior photographs must be included. Interior photographs shall include all common living areas, the child’s bedroom and bathroom, the storage space for the child’s personal belongings, and any other area to which the child may have access.
A description of safety precautions in the home, including location and verification of operating fire extinguishers and smoke detectors, storage of medications, cleaning supplies, toxins, and safety nets for trampolines. The description shall also include the storage of alcoholic beverages, location of burglar bars, fireplaces, handrails on stairways, and space heaters, if applicable.
Water Safety. A description of the outdoor area, including swimming pools, canals, ponds, lakes, streams, septic tanks, and other potential water hazards, and documentation of the counselor’s discussion with the applicant regarding the requirements for supervision and how the applicant will ensure safety and adequate supervision.
A completed “Foster Home Inspection Checklist,” CF-FSP 5397, October 2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-12290.

(4) All assessments, provider contacts, and documentation regarding individuals requesting licensure and the licensure process shall be documented in FSFN within 48 business hours of completion.

History

Rulemaking Authority 409.145(4), 409.175(5), 435.01(2) FS. Law Implemented 409.145(2), 409.175(5)(a)-(b), (6)(a)-(b), 435.04 FS. History–New 4-26-20, Amended 11-9-20, 9-14-22.

Fla. Admin. Code R. 65C-45.004 Summary, Recommendations, and Process for Submission of Initial Licensure

(1) Summary and Recommendations.

(a) Recommendation for licensure shall describe the characteristics of children most appropriate for placement in the home. These characteristics shall include level of licensure, number of children, age, gender(s), types of behaviors, and special needs. Explore and address any limitations or concerns and under what conditions the prospective family would not be willing or able to accept a child.

(b) If recommending denial of licensure, the summary shall specify the licensing standards the applicant is unable to meet and attach all supporting documentation. The Department must notify the applicant regarding the appeal process pursuant to Chapter 120, F.S.

(c) The Unified Home Study shall be reviewed and signed by the applicant, child welfare professional and his or her supervisor. A copy of the Unified Home Study shall be provided to the applicant.

(2) The complete application file shall be submitted in accordance with the traditional or attestation model for licensure.

(a) A request for additional information shall be submitted by the Regional Licensing Authority within 10 business days of receipt of the file.

(b) A licensing application file shall consist of the following documentation:

“Application for License to Provide Out-of-Home Care for Dependent Children,” incorporated by reference in Rule 65C-45.003, F.A.C.;
Licensing Unified Home Study;
Proof of income, including:

a. If the applicant is self-employed, verification of income and length of employment shall be obtained through the applicant’s business license, date of incorporation, or IRS Form 1099;

b. If the applicant is not self-employed, verification shall be obtained via documentation from the applicant’s employer that indicates the applicant’s current employment and income. Employment verification must be current and within 30 days of submission to the licensing specialist.;

c. Documentation of any other legal verifiable income;

Parent Preparation Pre-service Training certificate;
Documentation of water safety training, if applicable. As a prerequisite to licensure, potential licensed out-of-home caregivers who have swimming pools or whose homes are adjacent to bodies of water unprotected by a barrier of at least four (4) feet high will be required to complete a basic water safety course administered by the American Red Cross, YMCA, or a trainer certified in water safety training. This requirement does not apply to homes with temporary wading pools or portable pools with a depth of less than two (2) feet;
Verification of criminal history screening for applicant and all household members as specified in Rule 65C-45.001, F.A.C., including:

a. “Affidavit of Good Moral Character,” incorporated by reference in Rule 65C-45.001, F.A.C.;

b. Local law enforcement check;

c. Civil court records check;

d. Florida Department of Law Enforcement records check;

e. Federal Bureau of Investigation clearance letter;

f. Abuse history background check through the Florida Safe Families Network (FSFN) which shall be documented on the “Central Abuse Hotline Record Search” form, incorporated by reference in Rule 65C-45.001, F.A.C.;

g. Requests for abuse and neglect histories from any other state in which the applicant or any other adult household member has resided during the past five (5) years; and

h. Records check of the Florida Sexual Offenders and Predators registry.

References for Level I caregivers shall include a minimum of one reference per applicant regarding the applicant’s ability to meet the needs of the child. Personal references cannot be obtained from individuals related to the applicant;
All personal and adult child references must be completed through face-to-face interviews or telephonically. School or childcare references may be obtained electronically;
References for Levels II-V caregivers shall include:

a. Two (2) personal references who are not related to the applicant(s) and who have known the applicant(s) for at least two (2) years. Each of the two personal references must provide information related to the applicant’s parenting skills. References must be verified either verbally or in writing by the supervising agency staff and documented in the Unified Home Study in FSFN.

b. References from the adult children of each applicant. These references shall address the applicant’s suitability to become a licensed out-of-home caregiver. All unsuccessful attempts to solicit information shall be documented in FSFN, and the overall impact of the missing information considered as a part of the recommendation to grant or deny a license.

c. If any school-aged child residing in the home is currently enrolled in an elementary, middle, junior high, or high school, one reference from each school level is required. References shall be documented in the Unified Home Study in FSFN.

d. One reference from the child care provider of a preschool-aged child residing in the home who is enrolled in a child care program. References shall be documented in the Unified Home Study in FSFN.

e. References and documentation regarding any previous licensure as out-of-home caregivers.

Family Documents:

a. Valid driver’s license(s); and

b. Proof of vehicle insurance.

All prospective licensed out-of-home caregivers must complete the “Acknowledgement of Firearms Safety Requirements,” form CF-FSP 5343, July 2017, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11816.

(3) Unless otherwise outlined in a “Memorandum of Agreement Adoption of the Attestation Model for Family Foster Home Licensing,” incorporated by reference in Rule 65C-45.003, F.A.C., the Regional Licensing Authority is responsible for ensuring that the licensing application file is complete and that all licensing requirements are met for the issuance of the license. If the child-placing agency is contracted with a community-based care lead agency, the licensing application file shall contain documentation of a review by the community-based care lead agency and the Regional Licensing Authority and a recommendation for approval or denial by the community-based care lead agency.

(4) If the application file is approved, a license shall be issued to the applicant(s). The license shall include the name and address of the caregiver(s), the name of the supervising agency, the licensed capacity, and the dates for which the license is valid. The Regional Managing Director or designee within upper level management shall sign the license. Any limitations shall be displayed on the license.

(5) A copy of the license shall be provided by the Regional Licensing Authority to the community-based care lead agency or supervising agency. The community-based care lead agency or supervising agency is responsible for ensuring the license is sent to the foster parent.

(6) When the Department determines that the application shall be denied, the Department shall within 10 business days notify the applicant by certified mail and supervising agency in writing, identifying the reasons for the denial of the license, the statutory authority for the denial of the license, and the applicant’s right of appeal pursuant to Chapter 120, F.S. The denial and reason(s) for denial shall be recorded in FSFN by the supervising agency.

(7) Voluntary withdrawal of an application by an applicant shall be documented in FSFN and does not require formal action by the Department.

History

Rulemaking Authority 409.145(5), 409.175(5), 435.01(2) FS. Law Implemented 409.145(2), 409.175(5), (6), 435.04 FS. History‒New 4-26-20, Amended 11-9-20.

Fla. Admin. Code R. 65C-45.005 Level I Waivable Requirements

(1) Pursuant to Section 409.175(5)(a)1.b., F.S., items not related to safety can be waived for Level I licensure requirements.

(2) Items deemed waived will not be required for an applicant to obtain a Level I-Child Specific License through the Department;

(3) The waiving of items not related to safety must be approved in writing by the Regional Managing Director or Department designee. In determining whether to approve or deny a request for waiver, the Regional Managing Director or Department designee shall consider the strengths of the caregiver and the needs of the child with respect to the particular requirement.

(4) The community-based care agency (CBC) or contracted provider shall make efforts to assist a caregiver with meeting the waivable requirements.

(5) Waivable Requirements.

(a) A licensing specialist who has been trained by the Department, community-based care agency (CBC), or other state entity, such as the local health department, in the areas of water supply, food holding temperature, plumbing, pest control, sewage, and garbage disposal, shall complete the “Foster Home Inspection Checklist,” incorporated by reference in Rule 65C-45.003, F.A.C.;

(b) Evacuation and disaster preparedness plans; and

(c) Child care. Child care for children in licensed out-of-home care shall be in a licensed early education or child care program chosen by the caregiver(s). These providers must be participating in the school readiness program through the local early learning coalition. Examples of licensed early education or child care programs include:

Gold Seal accredited child care providers or providers participating in a quality rating system;
Licensed child care providers;
Public school providers; and
License exempt child care providers, including religious exempt, registered, and non-public schools.
The cost of child care shall be assumed by the licensed out-of-home caregiver to the extent that subsidized child care is unavailable.

(d) The home shall have space and furnishings to accommodate the number of people living in the home and be accessible to all members of the family.

(e) Each family foster home shall have a working telephone in the home that is accessible at all times. Emergency telephone numbers shall be displayed prominently in the home. Licensed out-of-home caregivers shall notify the supervising agency within one (1) business day if their telephone number changes.

(f) Each child shall be provided with a clean, permanent bed and mattress of his or her own. The bed shall be of sufficient size to accommodate the child.

(g) Infants shall have their own crib which shall be maintained in good and safe condition and have a clean mattress that fits snugly in the crib frame. Cribs shall not have drop sides or be placed close to windows with curtains or cords in which the child might become entangled.

(h) Bunk beds shall be safe and sturdy. Bunk beds shall be equipped with safety rails on the upper tier for a child under the age of 10 or for any child whose physical, mental, or emotional condition indicates the need for such protection. Beds bunked higher than two (2) tiers must have a manufacturer sticker of safety and must not be placed under or near ceiling fans. Children five (5) years old and younger may not sleep on the third tier of a three-tiered bunk bed.

(i) Each child shall be provided with clean linens. Waterproof mattress covers should be provided for all beds and cribs as developmentally appropriate and necessary.

(j) The entry to a child’s bedroom shall not be located so as to require the child to pass through another room (to include all bedrooms, offices, or rooms that are not common areas) or a bathroom in order to enter their bedroom.

(k) A child shall never share a bed with an adult or other child, regardless of age.

(l) Children over 36 months of age shall not share a bedroom with a child of the opposite gender unless efforts are being made to maintain a sibling group. In instances where efforts are being made to maintain a sibling group, the foster family, licensing agent, and case manager shall work together in determining arrangements for the safety and best interests of the children involved. Rationale for any decision made for children over the age of 36 months to share a bedroom shall be documented in the Florida Safe Families Network (FSFN).

(m) Children over the age of 12 months shall not share a bedroom with an adult, except in the following circumstances:

When one of the children sharing a bedroom reaches his or her 18th birthday and the out-of-home caregiver and the supervising agency approve the sleeping arrangement;
When it is deemed to be medically necessary as documented by a health care provider;
When a teen parent is sharing a bedroom with his or her child;
When a child is transitioning past his or her first birthday; or
When the adult is a former dependent child who is sharing a room with a sibling.

(n) Each licensed home shall have a first aid kit available and accessible to all caregivers.

(o) Each floor in the home shall have a fully charged, unexpired 2A10BC fire extinguisher. One (1) of the fire extinguishers shall be adjacent to the kitchen. There shall also be at least one (1) operating smoke alarm on each floor. There shall be a smoke alarm in each bedroom area.

(p) The home shall not be heated by unvented gas-fired space heaters or oil heaters unless they are equipped with an oxygen depletion sensor and the home has a carbon monoxide alarm. All gas-fired devices shall be equipped with an automatic pilot gas shut-off control. All electrical wiring shall meet required building codes.

(q) All fireplaces, space heaters, steam radiators, and hot surfaces shall be shielded against accidental contact. Access by children under six (6) years of age shall be restricted by a barrier.

(r) Extension cords shall not extend from one room to another except for situations involving emergency loss of power. Multiple electric outlet adapters shall not be used for more than two (2) extensions at one (1) time.

(s) Each licensed out-of-home caregiver shall have a current written plan for evacuation in the event of a natural or man-made disaster. The plan shall include where the family intends to go and information as to how the family may be reached and must be shared with the supervising agency.

(6) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.145(4), 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 4-26-20, Amended 11-9-20, 12-28-21.

Fla. Admin. Code R. 65C-45.006 Level II Non-Child-Specific Foster Home Initial Licensing Requirements

(1) Individuals applying for a Level II-Non-Child Specific Foster Home License shall meet all licensing requirements in Rule 65C-45.003, F.A.C., as well as all items identified in paragraph 65C-45.005(1)(b), F.A.C.

(2) The licensing counselor shall complete one (1) additional licensing home study visit to the applicant’s home to inspect the entire home.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(a) FS. History–New 4-26-20, Amended 11-9-20.

Fla. Admin. Code R. 65C-45.007 Level III Safe Foster Home for Victims of Human Trafficking Initial Licensing Requirements

(1) Certification of Safe Foster Homes

(a) Certification Standards. The child-placing agency must submit a letter of recommendation to the Regional Licensing Authority that the licensed foster home be certified as a safe foster home. The letter of recommendation must be accompanied by the following:

An “Application for Certification as a Safe Foster Home or Safe House,” CF-FSP 5403, February 2015, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11820;
A copy of the applicant’s current foster home license and the applicant’s licensing history, placement capacity, and gender to be served;
A signed “Prudent Parenting Partnership Plan for Sexually Exploited Children or Young Adults,” CF-FSP 5404, February 2015, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11823;
A description of child caring arrangements and sleeping arrangements;
Documentation of completed pre-service training, including specialized training in sexual exploitation, pursuant to subsections 65C-43.004(1)-(2), F.A.C., and continuing educational training hours, if applicable;
Documentation of compliance with the requirements applicable to safe foster homes set forth in Sections 409.1678(2)(c)-(d), F.S.;
Documentation of compliance with the licensing requirements in Rules 65C-45.002, and 65C-43.003, F.A.C.;
A treatment plan that outlines the plan to address the child or young adult’s individualized needs and progress reports;
A recent photograph of the child or young adult; and
The discharge summary.

(b) Security. Each safe foster home shall establish and maintain a security design that promotes ongoing supervision for the oversight of youth or young adults placed in the home as prescribed in Section 409.1678(2)(c)6., F.S.

(2) Approval Process for Certification of Safe Foster Homes.

(a) The CBC shall have 30 business days to provide the supporting documentation to the Regional Licensing Authority. If no additional information is provided, or if it is provided after 30 business days, the certification application shall be denied.

(b) The Regional Licensing Authority shall have 30 business days following receipt of a certification application packet to approve or deny the application.

History

Rulemaking Authority 409.1678(2)(c)7., (2)(e), 409.175(5) FS. Law Implemented 409.1678, 409.175(5)(a) FS. History–New 4-26-20.

Fla. Admin. Code R. 65C-45.008 Level IV Therapeutic Foster Home and Level V Medical Foster Home Initial Licensing Requirements

(1) Individuals seeking Level IV or V Licensure, must meet all Level II licensure requirement pursuant to Rule 65C-45.003, F.A.C.;

(2) The licensing counselor shall complete one (1) additional licensing home study visit to the applicant’s home to inspect the entire home.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(a) FS. History–New 4-26-20, Amended 9-14-22.

Fla. Admin. Code R. 65C-45.009 Changes During the Licensed Year for all Levels of Licensure

(1) Law Enforcement Involvement. The licensed out-of-home caregiver shall report any household member’s involvement with law enforcement over the course of the licensed year to the supervising agency within one business day of the occurrence. Law enforcement involvement includes Florida and out of state arrests, incidents of domestic violence, driving infractions, and any local law enforcement response to the home involving incidents that threaten the safety of any children.

(2) When a licensed out-of-home caregiver makes a formal request to place the home on hold, no new children shall be placed in the home. Licensed out-of-home caregivers shall submit a written request to include the date at which they would like to accept children in their home.

(3) Household Circumstance Changes. In addition, the caregiver shall report to the community-based care lead agency within one (1) business day:

(a) A change in household composition, including plans for changes in sleeping arrangements;

(b) A change of physical address;

(d) A physical or mental health concerns that impact the ability to provide care for the child;

(e) A change in contact information;

(f) A change in employment or significant change in work or school schedule. A significant change is defined as one that impacts the ability to provide care for the child; and

(g) A change in marital or relationship status, including reconciliation or separation.

When a licensed out-of-home caregiver marries, moves in with, or reconciles with an unlicensed spouse or partner, the unlicensed spouse or partner shall submit fingerprints for background screening prior to moving into the residence, unless previously completed within the past five years and the background screenings remain in good standing.

a. The unlicensed spouse or partner shall also attend parent preparation pre-service training if not previously completed within the last five years and meet all licensing requirements. The unlicensed spouse or partner shall have three months from the date of marriage, moving in together, or reconciliation to complete pre-service training. If a determination has been made and documented by the child welfare professional in the Comprehensive Child Welfare Information System (CCWIS) as to the unavailability of a pre-service training class, the unlicensed spouse or partner shall complete pre-service training within six months.

b. Upon completion of pre-service training, the unlicensed spouse or partner shall complete and submit an “Application for License to Provide Out-of-Home Care for Dependent Children,” incorporated by reference in Rule 65C-45.003, F.A.C. Failure to meet the licensing and background screening provisions which may threaten the safety of any child in care or place the home in violation of the licensing standards is grounds for denial or revocation of an application or license.

c. The home shall remain licensed and previously placed children may remain in the home pending the outcome of the Unified Home Study assessment and approval of the license application.

(I) No new children shall be placed in the home until the application has been completed and approved.

(II) The supervising agency will update the Unified Home Study, including interviews with all children in the home, verification of satisfactory background screening, and verification of income and expenses, and submit to the community-based care lead agency within 30 calendar days of marriage, moving in together, or reconciliation.

In cases of separation, divorce, or death of a spouse or partner, the supervising agency shall update the Unified Home Study submit to the Regional Licensing Authority a summary and assessment of the impact to the children placed in the home within 30 calendar days of the change in marital status.

a. The child welfare professional must offer and refer household members for services based on the outcome of the assessment.

b. The Unified Home Study shall summarize the satisfaction of licensing requirements and shall include interviews with the children, if age appropriate, verification of income and expenses, and the remaining caregiver’s plan to meet all financial obligations.

c. The updated Unified Home Study shall be completed in the CCWIS.

(4) The supervising agency shall assess and document the impact on the household within two (2) business days of learning one of these events has occurred or is likely to occur.

(5) All new household members age 18 and older shall be fingerprinted prior to moving into the residence, and those fingerprints shall be submitted to the Florida Department of Law Enforcement within five (5) business days of the receipt of the fingerprints by the supervising agency. All household members shall meet the requirements for background screening.

(6) All minor household members residing in the residence shall be fingerprinted immediately upon turning 18 years of age.

(7) The supervising agency shall submit a new “Application for License to Provide Out-of-Home Care for Dependent Children,” incorporated by reference in Rule 65C-45.003, F.A.C., to the Regional Licensing Authority for the issuance of an amended license.

(8) Change of Location. A licensed out-of-home caregiver shall notify the supervising agency no less than 30 calendar days prior to the expected date of the relocation.

(a) The supervising agency shall assist the licensed out-of-home caregiver in identifying a new supervising agency.

(b) The current supervising agency shall notify the new agency of the licensed out-of-home caregivers’ intent to transfer within two business days of being notified by the caregiver. The new supervising agency shall accept the transfer request within two business days and be assigned to initiate the transfer process.

(c) When a licensed out-of-home caregiver is in good standing and requests a transfer of their family foster home license within the state, the new supervising agency shall initiate licensing process for transfer within 15 calendar days of accepting the transfer request from the current supervising agency. All background screenings, trainings, and required forms previously completed under the current supervising agency shall be transferred and accepted for licensure by the new supervising agency or accessed through CCWIS.

(d) Within 15 calendar days of the licensed out-of-home caregiver’s physical relocation, the new supervising agency shall have all remaining transfer requirements outlined in subsection (9) completed.

(e) To be deemed in good standing the licensed out of home caregiver must meet the following criteria:

No current or past corrective action plan in the last 12 months of the relocation notification.
No pending administrative actions.
No open abuse report or special conditions referral.
No background screening related concerns to include the issuance of a background screening exemption.

(f) For licensed out-of-home caregivers that do not meet the criteria in paragraph (8)(e) the new supervising agency shall complete all transfer requirements for a licensed out-of-home caregiver within 30 calendar days of the family relocating to the new residence.

(9) Transfer Documentation Requirements. The following are requirements for an in-state relocation of a family foster home.

(a) Preservice Training. When the preservice training for the licensed caregiver was completed more than five years prior to the transfer, the caregiver’s training remains valid throughout the transfer of licensure process and considered to have met the training requirements outlined in subsection 65C-45.002(12), F.A.C.

(b) Florida Sexual Offender and Predator records check (neighborhood search) shall be conducted on the licensed out-of-home caregiver’s new residence.

(d) Application for License to Provide Out-of-Home Care.

(e) Release of Information.

(f) Foster home inspection checklist.

(g) Disaster preparedness plan.

(h) Evacuation plan.

(10) The new supervising agency shall complete at least one home visit prior to licensure.

(11) The amended application packet shall be submitted to the Regional Licensing Authority for review and issuance of an amended license within two business days of completion of the transfer requirements.

(12) If approved, an amended license shall be issued and shall expire on the same date as the previous license.

(13) If licensure of the new home is not recommended and there are children currently placed in the home, the primary case manager shall assess whether alternative placement is necessary within four hours of being notified by the supervising agency.

(14) If the decision is made to deny the new application, the Regional Licensing Authority will notify the applicant and supervising agency by certified mail within five (5) business days of the decision to deny, identifying the reasons for the denial of the license, the statutory authority for the denial of the license, and the applicant’s right of appeal pursuant to Chapter 120, F.S. The denial and reason(s) for denial shall be recorded in CCWIS by the supervising agency. If there are any children who moved with the caregiver from the former region, the Regional Licensing Authority will notify the new supervising agency within 24 hours of the decision to deny the application. The new supervising agency shall notify the former supervising agency and the contracted service provider responsible for courtesy supervision within 24 hours of receiving the notice. All possible placement options, the possible risk to the children, and their best interest shall be considered, and a decision made regarding their placement within 24 hours of receipt of the notification. The removal and placement of the children is the responsibility of the former supervising agency and the contracted service provider with primary responsibility for supervision of the children.

(15) Out of State. If there are children to move out of state with the licensed out-of-home caregiver, the primary case manager is required to initiate an Interstate Compact for the Placement of Children request pursuant to Section 409.401, F.S.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 4-26-20, Amended 11-9-20, 3-19-26.

Fla. Admin. Code R. 65C-45.010 Standards for all Licensed Out-of-Home Caregivers

(1) Requirements.

(a) All licensed out-of-home caregivers shall comply with subsections 65C-28.003(1), (3), (4), 65C-28.009(2), 65C-28.018(1), and Rule 65C-28.019, F.A.C.

(b) Placement capacity requirements shall comply with Section 409.175(3), F.S.

(c) Each licensed out-of-home caregiver shall sign a “Partnership Plan for Children in Out-of-Home Care,” incorporated by reference in Rule 65C-45.003, F.A.C. The agreement shall be reviewed and discussed with a licensing counselor prior to initial licensure and again at each re-licensure. The document must be signed by a representative from the supervising agency, the potential or licensed out-of-home caregiver, and at placement by the case manager.

(d) The child’s resource record (CRR) shall be maintained by the licensed out-of-home caregiver. The CRR is a standardized record developed and maintained for every child entering out-of-home care that contains copies of the basic legal, demographic, available and accessible educational, and available and accessible medical and psychological information pertaining to a specific child, as well as any documents necessary for a child to receive medical treatment and educational services. Where medical or educational information is not available and accessible, written documentation of the efforts made to obtain the information must be in the file. The CRR shall be housed where the child is placed and shall accompany the child to every health encounter and shall be updated as events occur.

(2) Physical Environment.

(a) Outdoor Area.

The exterior of the home and premises shall be free from objects, materials, and conditions which constitute a danger to children. All garbage and trash shall be covered and removed regularly.
The home shall have a safe outdoor play area on the property or within walking distance. All outdoor play equipment shall be kept in good repair. If the home is located on a busy street, there shall be a safety plan for supervision. There shall not be large, potentially dangerous items stored in the safe outdoor play area, such as old refrigerators, stacks of lumber and unregistered vehicles or boats.

(b) Water Safety and Supervision.

The level of supervision for children in close proximity to any body of water, including swimming pools, shall be made by the licensed out-of-home caregiver pursuant to Section 39.4091(2)(c), F.S.
Children who are placed in licensed homes which are adjacent to any body of water or that have swimming pools shall be instructed in water safety regardless of age or swimming capability.
Wading pools shall be set up and maintained according to the manufacturer’s instructions. Wading pools shall be emptied and stored when not in use and shall be filled with clean water before each use.
All pools above or in ground shall be equipped with at least one of the following life-saving devices: ring buoy; rescue tube; flotation device with a rope; or shepherd’s hook of sufficient length to cover the area.

Swimming pools shall contain the safety features outlined in the Residential Pool Safety Act, Section 515.27, F.S. Homes with swimming pools licensed prior to the enactment of the Residential Pool Safety Act shall be considered to have met this requirement.
All doors and windows providing direct access from the home to the pool shall comply with Section 515.27, F.S. All other barriers to the pool shall comply with Section 515.29, F.S.
When the swimming pool is not in use, all entry points shall be locked.

(d) Above Ground Pools.

If the sides of an above ground pool are at least four (4) feet tall, they may be used as the barrier for that pool.
Above ground pools with steps or ladders shall have them secured, locked, or removed when the pool is not in use.
If the pool cannot be emptied after each use, the pool shall have a working pump and filtering system.
Hot tubs and spas not adjoined to an in-ground pool shall be required to have a safety cover that is locked when not in use.

(e) Interior Environment.

The home shall have space and furnishings to accommodate the number of people living in the home and be accessible to all members of the family.
Each child shall be provided with storage space for personal belongings and a designated space for hanging clothes in or near the bedroom occupied by the child.
Bath and toilet facilities shall be clean and in good working order with a door for privacy.
The door of each bathroom shall have a lock.
The home shall be clean and free of hazards to the health and physical well-being of the family.
All toys and equipment shall be in safe condition and kept clean and sanitary.
All rooms used by children shall be at a comfortable temperature. Rooms shall be dry and well ventilated.
All doors and windows used for ventilation shall be screened.
Rooms used by children shall be clean and well lit.
Homes shall be smoke free, including e-cigarettes and vapor smoke.

(f) Sleeping Arrangements and Personal Space.

All sleeping areas shall be in bedrooms separate from the public areas of the house. Children’s bedrooms shall have space that allows for walking, personal storage, and sleeping for the number of children sleeping in the room.
An adult shall be within sight and/or sound of rooms where children under six (6) years of age are sleeping.
An adult shall have a means of access to all rooms of the house.
Children of any age shall not sleep on a living room sofa, cot or foldaway bed as a regular sleeping arrangement.
The entry to a child’s bedroom shall not be located so as to require the child to pass through another room (to include all bedrooms, offices, or rooms that are not common areas) or a bathroom in order to enter their bedroom.

(g) Family Foster Home Safety.

All poisonous chemicals shall be in a locked location.
Each licensed home shall have a first aid kit available and accessible to all caregivers.
All medications shall be stored in a location that is locked and inaccessible to children.
Alcoholic beverages shall be stored in a location out of reach of children.
Storage of guns shall comply with the requirements of the “Acknowledgement of Firearms Safety Requirements,” incorporated by reference in Rule 65C-45.004, F.A.C.
All water heaters shall be set at a temperature of 120 degrees Fahrenheit or below.

(h) Fire Safety.

All homes shall comply with Chapter 69A-41, F.A.C.
The home shall be safe from fire hazards. All combustible items shall be stored away from sources of heat. Exits, stairways and hallways shall be free of obstacles that would hamper an emergency evacuation. The home shall have at least two exits. All doors leading to the outside with locks shall be capable of being opened from the inside and outside.
Heating and cooling units, washers, dryers, refrigeration systems, stoves and hoods shall be properly installed, vented and maintained, as determined during the assessment of the physical environment of the home or the health inspection.
Each bedroom shall have at least two means of exit in case of emergency. Bedrooms above ground level must have a means of escape that will allow for safe exit. If the child’s bedroom is equipped with burglar bars, the caregiver shall demonstrate that the burglar bars can be released to allow exit. A key placed near a window does not qualify as an approved emergency release method. Age-appropriate training on opening of the burglar bars shall be provided to each child upon placement.
The licensed out-of-home caregiver shall have an evacuation plan posted in a conspicuous place in the home. The plan shall specifically provide for the safe exit of children who are incapable of understanding the plan or participating in drills. This plan should be shared with all children as appropriate to their age and level of understanding upon placement in the home.
Volatile materials shall not be stored where water heaters are located or near other sources of heat. Attic space shall not be used for the storage of volatile materials.

(i) Transportation Safety. The licensed out-of-home caregiver shall not transport children in truck beds, motorcycles, or any other high-risk method of transportation. The licensed out-of-home caregiver shall comply with Chapter 316, F.S., related to transportation of children.

(3) Food and Nutrition.

(a) Licensed out-of-home caregivers shall provide nutritionally balanced meals and age appropriate snacks daily.

(b) Licensed out-of-home caregivers are expected to provide for any special dietary needs of children placed in their home. The licensed out-of-home caregiver shall be sensitive to the parent’s input regarding special dietary needs.

(4) Discipline.

(a) Licensed out-of-home caregivers shall discipline children with kindness, consistency, and understanding, and with the purpose of helping the child develop responsibility and self-control.

(b) Licensed out-of-home caregivers shall use positive methods of discipline. Acceptable methods of discipline include: reinforcing acceptable behavior, expressing verbal disappointment of the child’s behavior, loss of privileges, grounding, restricting the child to the house or yard, sending the child out of the room and away from the family activity, and redirecting the child’s activity.

(d) Licensed out-of-home caregivers shall not use corporal punishments of any kind.

(e) Licensed out-of-home caregivers shall not delegate discipline or permit punishment of a child by another child or by another adult not in a caregiver role.

(f) Licensed out-of-home caregivers shall not engage in harassment, make disparaging comments, or permit harassment or bullying of children by other youth.

(g) Licensed out-of-home caregivers shall not withhold meals, clothing, allowance, or shelter as a form of discipline.

(h) Licensed out-of-home caregivers shall not ridicule or punish a child for bed-wetting or other lapses in toileting.

(i) No child shall be mechanically restrained or locked in any enclosure, room, closet, bathroom, or area of the house or premises, for any reason.

(j) Licensed out-of-home caregivers shall not threaten a child with removal or with a report to authorities or prohibit visitation with family as consequences for unacceptable behavior.

(k) Licensed out-of-home caregivers will seek the assistance of the child’s case manager or therapist for behavior problems.

(5) Placement of a child in a home licensed by the Agency for Persons with Disabilities (APD) shall be approved by the APD prior to placement. A home licensed by the APD may be utilized for placement of children eligible for both programs without obtaining a separate license if the child is receiving Supplemental Security Income (SSI).

(6) Licensed Out-of-Home Caregivers Providing Child Care.

(a) Licensed out-of-home caregivers contracting with a community-based care lead agency are authorized by Section 409.988(2)(c), F.S., to provide child care as a Licensed Family Day Care Home, as defined in Section 402.302, F.S., and may be dually licensed.

(b) All licensing standards and requirements for family foster homes and family day care homes shall be met and maintained.

(c) Licensed out-of-home caregivers shall limit their hours of operation as a Family Day Care Home to between 6:00 a.m. and 7:00 p.m.

(d) The out-of-home caregiver shall not be paid both the foster care board rate and child care subsidy for the same child.

(e) A family foster home providing child care under this section shall be inspected a minimum of twice per year, at least once by daycare licensing staff and once by the supervising agency’s licensing specialist. The inspection is to assess the impact of the child care operation on the children in care.

(f) Where family foster homes are also licensed as a Family Day Care Home, the Department shall coordinate inspections with a licensing counselor from the childcare licensing program.

(g) Complaint investigations shall be conducted in conjunction with a representative from child care licensing.

(7) Caregiver Standards.

(a) A licensed out-of-home caregiver shall be a stable, responsible, and mature individual who is at least 21 years of age.

(b) Persons living together in a caretaking role, as determined by the supervising agency, shall both sign the application.

(c) In determining whether persons are living together in a caretaking role, the supervising agency shall consider whether:

The person living in the home is the partner (paramour) of the primary caregiver; or
The person living in the home will have responsibility for caring for the children in the home and addressing their needs.

(d) At least one (1) licensed out-of-home caregiver in the home shall be able to effectively communicate with any children placed in the home.

(e) A licensed out-of-home caregiver shall not operate the home as an adult boarding or rooming home or an adult daycare facility.

(8) When an out-of-home caregiver has a dispute or conflict with the Department or feels there has been a violation of their rights pursuant to Section 39.4087, F.S., CBC or their sub-contracted providers, they may request in writing a formal meeting to address and resolve concerns.

(9) When the dispute is with the CBC or a subcontracted provider, the meeting must include at minimum:

(a) The case manager and their supervisor;

(b) A representative from the lead CBC agency

(10) When the dispute is with an employee of the Department, the meeting must include:

The Department employee and a supervisory representative.

(11) Documentation of the dispute or concerns addressed, discussion to resolve the concerns and the meeting attendees must be uploaded into the FSFN provider file cabinet.

(12) All assessments, provider contacts, and documentation regarding individuals requesting licensure and the licensure process shall be documented in FSFN within 48 business hours of completion.

(13) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.145(4), 409.175(5) FS. Law Implemented 409.145(2), 409.175(5) FS. History–New 4-26-20, Amended 11-9-20, 12-28-21.

Fla. Admin. Code R. 65C-45.011 Supports for all Levels of Licensure

(1) Community-based care lead agencies and their contracted providers will provide ongoing support to licensed out-of-home caregivers. Support can include but is not be limited to:

(a) Access to foster parent support groups;

(b) Service resources for children placed in the home;

(d) Service resources for caregivers.

(2) Contact shall be made to the licensed caregiver at least quarterly.

History

Rulemaking Authority 409.145(5), 409.175(5) FS. Law Implemented 409.145(2), 409.175(5) FS. History–New 4-26-20.

Fla. Admin. Code R. 65C-45.012 Relicensing requirements for all Levels of Licensure

(1) Requirements.

(a) Relicensing procedures shall be initiated by the supervising agency and the relicensing file shall be submitted to the licensing authority at least 30 calendar days prior to expiration of the current license. However, if the attestation model is used, the relicensing file shall be submitted to the licensing authority at least 10 business days prior to expiration of the current license. The relicensing process shall not be initiated more than 90 calendar days prior to the expiration of the current license.

(b) The supervising agency shall conduct a minimum of one (1) face-to-face visit in the home and interview all household members prior to re-licensure.

(c) Out-of-home caregivers requesting to be relicensed shall complete the “Application for License to Provide Out-of-Home Care for Dependent Children,” incorporated by reference in Rule 65C-45.003, F.A.C.

(d) An applicant shall sign all required relicensing documentation.

If a home inspection was deemed satisfactory at initial licensure, a new home inspection is not required for five (5) years unless a change to the home has been identified. At the end of each five (5) year period, an updated satisfactory home inspection is required.
If an unsatisfactory home inspection was waived at initial licensure pursuant to paragraph 65C-45.005(5)(a), F.A.C., the homeowner shall advise the licensing specialist whether any changes to the home have been made since initial licensure. If changes have been made, a new home inspection shall be conducted. At minimum, a waived home health inspection must be reviewed at least every five (5) years.
Health inspections completed by the Department of Health shall be requested 60 days in advance of the home’s relicensing due date to facilitate the receipt of an environmental health inspection report that indicates the home complies with the requirements specified in the “Foster Home Inspection Checklist,” prior to the expiration of the license. The “Foster Home Inspection Checklist” is incorporated in Rule 65C-45.003, F.A.C.

(e) The supervising agency shall ensure that all required background screening has been completed pursuant to Rule 65C-45.001, F.A.C., with the exception of subsection 65C-45.001(3), F.A.C.

(f) Applicants for renewal shall provide the agency with:

Documentation of at least one (1) hour of continuing education annually; and
A current driver’s license and current auto insurance coverage information, as applicable.

The licensing specialist shall observe vehicles used for transporting children for seatbelt compliance and any obvious safety hazards and document any concerns in the Unified Home Study.

(2) Relicensing Unified Home Study for all levels of licensure. As a part of the relicensing application file, the supervising agency shall make a thorough assessment and evaluation of each licensed out-of-home caregiver and document this evaluation using the Unified Home Study module in FSFN.

(a) The licensing counselor shall inspect the entire premises of the home, including all interior and exterior areas, for continued compliance with licensing standards.

(b) In addition to the questions in the unified home study, the updated home study shall include an assessment of fostering experiences over the past licensing year, including:

Documentation of updated water safety training, if applicable;
Assessment of background screening, pursuant to Rule 65C-45.001, F.A.C.;
Updated evacuation and disaster preparedness plan if changes in the layout of the home or means of egress have occurred;
Description of how the licensed out-of-home caregiver has managed behavior with children placed in the home;

5.a. Documentation of the licensed out-of-home caregiver’s support and integration of children into the family, such as attendance at and involvement with children’s activities, ensuring children have reliable transportation to school, social events, medical appointments, and inclusion in other family activities. The supervising agency will describe the licensed out-of-home caregiver’s attentiveness to the provision of clothing and allowances to the children in his or her care.

b. Documentation of the level of cooperation of licensed out-of-home caregivers with the children’s families, including visitation for children placed in the home during the previous licensing year. The supervising agency will describe how the family has worked with the supervising agency and other service providers.

c. Documentation of the licensed out-of-home caregiver’s compliance with proper administration and monitoring of medication for children in out-of-home care and cooperation with medical directives and appointments, if applicable.

d. Documentation of the maintenance of school and resource records for each child in placement.

Investigations, Special Condition Referrals, Concerns or Complaints. A summary assessment of investigations and special condition referrals, incident reports, accidents and complaints during the previous licensing period; and
Summary. All forms and information obtained as a part of the relicensing process shall be summarized in a written narrative.

(c) The Unified Home Study shall be completed, reviewed, and approved in FSFN. The home study shall also be signed and dated by the counselor responsible for completing the study and the counselor’s supervisor. The licensed out-of-home caregiver shall be offered an opportunity to sign the home study and must be provided a copy. The signature pages shall be uploaded as an attachment to the Unified Home Study in FSFN.

(4) Relicensing Process for all levels of licensure.

(a) A supervising agency shall conduct an annual relicensing evaluation of the agency’s licensed homes in order to make a recommendation, prior to licensing expiration, to the Department regarding renewal of the family’s license.

(b) If the region does not participate in the attestation model for license, the Regional Licensing Authority shall determine if the relicensing application file is complete and notify the community-based care lead agency in writing of the need for any additional materials or information within 10 business days of receipt of the relicensing list. The community-based care lead agency must submit the necessary materials or information to the Regional Licensing Authority within 10 business days of receipt of the written notice. A license cannot be issued until all information has been received.

(c) If approved, a license shall be issued to the applicant no later than 10 business days from receipt of the complete relicensing file.

(d) If the completed file of materials was received prior to the expiration of the existing license, upon approval the renewal date of licensure shall begin on the day the existing license expires.

(e) If the submitted application file is not complete at the time the existing license expires, the renewal date of licensure shall be the actual date of approval by the Regional Licensing Authority. No child shall be placed or remain in an unlicensed setting.

(f) A copy of the license shall be provided by the Regional Licensing Authority to the community-based care lead agency for dissemination to the supervising agency or directly to the supervising agency if the agency does not contract with the community-based care lead agency. The supervising agency is responsible for sending the license to the family.

(g) If the supervising agency or Regional Licensing Authority determines that the out-of-home caregivers have not met the standards for continued licensure, the licensing authority shall consult with the regional legal counsel, community-based care lead agency, and supervising agency concerning the appropriate course of action.

(h) If the Regional Licensing Authority denies the application for re-licensure, the applicant shall be notified in writing within 10 business days of the determination, identifying the reasons for the denial, the statutory authority for the denial and the applicant’s right of appeal pursuant to Chapter 120, F.S. The applicant shall be afforded the opportunity to withdraw the application. If the applicant elects to withdraw the application, this must be documented in FSFN.

(5) Three-Year License. A family foster home shall not be issued a 3-year license unless the following criteria are met:

(a) The family has been licensed for at least the three (3) previous consecutive years.

(b) The family has not been the subject of a report of child abuse or neglect with verified findings of maltreatment or a foster care referral leading to a performance improvement plan/corrective action plan.

The family has not been placed on a performance improvement plan/corrective action plan during the last three (3) years.
The family has clear background checks. An exemption from disqualification pursuant to Section 435.07, F.S., shall not be considered a clear background check.

(6) Applicants Previously Licensed or Approved in another State or Region.

(a) If the applicants were licensed previously in another state or outside the region in which they are seeking licensure, the supervising agency shall make a written request to the previous licensing agency for a reference, copies of the initial and previous licensing studies, closing summaries, information about any complaints, foster care referrals or concerns expressed regarding the prospective family’s parenting ability, reason for closure, and the results of their background screening and abuse history check.

(b) The written request and all information received from the originating state or region shall be included in the application file. All attempts to obtain the information shall be documented.

(7) Re-opening of Previously Licensed Out-of-Home Caregivers within the Region.

(a) If the applicants were licensed previously in the same region where they are currently seeking licensure, the supervising agency shall obtain and review information from the previous supervising agency which describes the applicants’ performance and history as licensed out-of-home caregivers. All attempts to obtain the information shall be documented.

(b) Applicants shall complete all initial licensing requirements with the exception of pre-service training, if previously completed within five (5) years.

(d) Required background screening for previously licensed out-of-home caregivers shall be completed no more than 12-months prior to the submission of the application.

(e) The requirements in Rule 65C-45.006, F.A.C., shall be met.

(8) All assessments, provider contacts, and documentation regarding individuals requesting licensure and the licensure process shall be documented in FSFN within 48 business hours of completion.

History

Rulemaking Authority 409.145(5), 409.175(5) FS. Law Implemented 409.145(2), 409.175(5), (6)(b) FS. History–New 4-26-20, Amended 11-9-20.

Fla. Admin. Code R. 65C-45.0121 Level II Non-Child-Specific Foster Home Relicensing Requirements

Individuals applying for relicensure of a Level II Non-Child Specific Foster Home shall meet all relicensing requirements in Rule 65C-45.012, F.A.C., as well as the following requirements:

(1) The supervising agency shall obtain from the licensed out-of-home caregiver documentation of an additional seven (7) hours of continuing education annually.

(2) The supervising agency shall obtain and review information about the home from the “Case Manager/Case Worker Review of Foster Parent,” CF-FSP 5223, February 2015, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11890 and the “Quality of Licensed Caregiver’s Home – Community Input,” CF-FSP 5225, March 2007, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11892. The “Case Manager/Case Worker Review of Foster Parent” and at least one “Quality of Licensed Caregiver’s Home – Community Input” shall be completed for every child who has been placed for a minimum of 30 calendar days. The supervising agency and case manager must staff and address any issues raised by the case manager in the re-licensing home study. The staffing and any measures taken shall be documented in the Florida Safe Families Network (FSFN).

(3) The supervising agency shall obtain the completed “Exit Interview about Foster Parents” form, CF-FSP 5353, Apr 2020, incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-11893. This form must be completed for every child over the age of five (5) who exits the home following a placement of 30 calendar days or longer. The supervising agency must review the exit interviews and address issues raised in the exit interviews in the relicensing summary. Any measures taken to address issues of concern shall be documented in FSFN. The re-licensing file must contain all applicable exit interviews. If exit interviews are not provided with the re-licensing file, the supervising agency must document in FSFN efforts made to secure the exit interviews, and the proper administrator of the community-based care lead agency and supervising agency shall be notified.

(4) The supervising agency shall obtain from the licensed out-of-home caregiver a completed “Foster Parent’s Review of the Case Worker/Care Manager” form, CF-FSP 5224, Apr 2020, incorporated by reference and https://www.flrules.org/Gateway/reference.asp?No=Ref-11891, and review information from case managers who supervised children in the home during the previous licensing year. The supervising agency must address any issues raised by the licensed out-of-home caregiver with the case management staff and in the relicensing home study.

(5) The supervising agency shall review and discuss with the licensed out-of-home caregiver the “Partnership Plan for Children in Out-of-Home Care,” incorporated by reference in Rule 65C-45.003, F.A.C., with the licensee, and document the date of the discussion in FSFN.

(6) The Unified Home Study must include:

(a) History of Placement Activity. Placement activity during the previous licensing year shall be identified and discussed. If the family requested that a child be moved, the reasons and circumstances must be addressed. The narrative must provide detail about each child who has left the home and address how the family has worked with each child;

(b) Youth Exit Interviews. An exit interviews obtained in accordance with subsection (3) of this rule; and

(c) Staff Feedback. A summary of feedback from lead and/or supervising agency staff members as it relates to the family’s continued suitability and performance as a licensed out-of-home caregiver.

(7) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.145(4), 409.175(5) FS. Law Implemented 409.145, 409.175 FS. History‒New 5-4-20, Amended 12-28-21.

Fla. Admin. Code R. 65C-45.0122 Level III Safe Foster Home for Victims of Human Trafficking Relicensing Requirements

Individuals applying for relicensure of a Level III Safe Foster Home for Victims of Human Trafficking shall meet all relicensing requirements in Rule 65C-45.012, F.A.C., as well as the following requirements:

(1) Individuals must also be licensed as a Level II foster home; and

(2) Foster parents must meet all training requirements set forth in Rules 65C-43.004 and 65C-43.005, F.A.C.

History

Rulemaking Authority 409.145(5), 409.175(5) FS. Law Implemented 409.145, 409.175 FS. History-New 5-4-20.

Fla. Admin. Code R. 65C-45.0123 Level IV Therapeutic Foster Home and Level V Medical Foster Home Relicensing Requirements

Individuals applying for relicensure of a Level IV Therapeutic Foster Home or Level V Medical Foster Home shall meet all relicensing requirements in Rule 65C-45.012, F.A.C., as well all licensing standards required by the Agency of Health Care Administration.

History

Rulemaking Authority 409.145(5), 409.175(5) FS. Law Implemented 409.145, 409.175 FS. History-New 5-4-20.

Fla. Admin. Code R. 65C-45.013 Conflict of Interest for all Levels of Licensure

Employees, Relatives and Sub-Contractors as Licensed Out-of-Home Caregivers. Licensing of employees of the Department, county sheriff’s offices, community-based care lead agencies and their subcontracted providers or their relatives who desire to become out-of-home caregivers is allowable if the following conditions are met:

(1) No actual or perceived conflict of interest exists that could result in preferential treatment concerning the licensing process or the placement and movement of children placed in the potential licensed family foster home.

(2) All initial, relicensing, and ongoing maintenance of the licensed foster home activities shall be completed by a licensed child-placing agency outside of the employee’s service area and submitted to the Regional Licensing Authority for approval.

(3) The executive director or designee in upper level management of the community-based care lead agency or supervising agency responsible for submitting the employee, relative, or subcontractor licensing file to the Department has reviewed and approved the submission of the application to the Department.

(4) The Regional Licensing Authority obtains approval of the application from the Regional Managing Director or designee prior to issuing a family foster care license for an employee, relative, or subcontractor.

(5) Enhanced Level II Foster Homes in which the child-placing agency and foster parent have a Department-approved working agreement regarding the terms and conditions of the foster parent’s responsibilities as a caregiver for the child-placing agency are exempt from this rule. The Department will approve working agreements that contain at minimum the following:

(a) Purpose of the agreement;

(b) Identification of foster parent;

(d) Terms and Use of Residence;

(e) Foster parent responsibility;

(f) Reasons residency can be terminated.

(6) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.145(4), 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 4-26-20, Amended 12-28-21.

Fla. Admin. Code R. 65C-45.014 Terms of a License for all Levels of Licensure

(1) The Regional Licensing Authority shall request in writing any additional information required for the purposes of making a licensing determination within 10 business days of receipt of an application file. The Regional Licensing Authority shall grant or deny an initial license application in accordance with the timeframes set in Section 409.175(6)(d), F.S. The decision on whether to grant or deny the initial license application shall be based on whether the applicant has submitted a completed application file or attestation and has a favorable home study in accordance with Rules 65C-45.004 and 65C-45.012, F.A.C.

(2) Offices, conference rooms, and other non-home-like settings shall not be licensed for placement of children in care.

(3) The license shall reflect the name of the licensee, the licensee’s physical address, city and county, the name of the supervising agency, and the license number along with its beginning and expiration dates.

(4) If the Regional Licensing Authority determines that a reduction in the licensure period of a three (3) year license is warranted based on a licensing violation, it shall notify the supervising agency and the applicant in writing, identifying the reasons for the reduction in the licensure period and the statutory authority for the reduction.

(5) Authorized licensing staff of the Regional Licensing Authority or supervising agency may make unannounced inspections of a licensed family foster home. The inspection may include examination of all rooms and areas on the property and interviews of all household members.

(6) All licenses shall be signed by the regional managing director or designee in upper level management.

(7) License Modifications.

(a) Modifications shall be made to a license at the request of the licensed out-of-home caregiver following assessment of licensing staff, or as a result of corrective measures.

(b) Modifications which alter information set forth on the existing license shall result in the issuance of a new license. This new license shall expire on the same date as on the existing license.

(c) If a request for modification occurs within (90) days of the expiration of the license, the supervising agency shall conduct all activities consistent with re-licensure. The new license shall be valid for one (1) year from the new date of issuance.

(d) An extended license issued pursuant to Section 409.175(7) F.S., shall not be issued if there is a failure to comply with background screening requirements.

(8) File Retention.

(a) The supervising agent shall retain a central file in the region for every family foster home licensed. The file shall include:

All initial and subsequent licensing documentation, as well as all other licensing related activities, including documentation of background screening requirements;
Complaint investigation information;
Waivers and exceptions;
Other additional documentation obtained regarding the licensed home; and
A termination summary for homes which are closed and the reason for closing. The termination summary should be entered into a Provider Note in the Florida Safe Families Network (FSFN).

(b) Central files must be maintained in a secure location and made available for monitoring or auditing purposes.

(c) An electronic version of the licensing file shall be maintained by the supervising agency in the electronic filing cabinet located in FSFN. The supervising agency shall develop a policy that addresses the destruction of paper files; this policy must be reviewed and approved by Regional Licensing Authority.

(d) Central files of prospective licensed out-of-home caregivers who do not become licensed shall be retained by the supervising agency for a period of five (5) years.

(e) Central files of licensed out-of-home caregivers shall be maintained for 20 years after closure.

(f) Central files of applicants who are denied licensure shall be maintained for a period of 20 years after the issuance of the denial or final denial order date, whichever is later.

(9) This rule will be renewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 4-26-20, Amended 12-28-21.

Fla. Admin. Code R. 65C-45.015 Capacity Assessments

(1) Licensure Capacity.

(a) The supervising agency shall make a recommendation to the Department regarding licensure capacity. The Department shall issue the licensure capacity for a home based on the factors set forth in Section 409.175(3)(a), F.S.

(b) Licensure capacity shall be reviewed during the annual reassessment for licensure.

(c) For purpose of this rule, dependent child means a child with an open dependency case placed in licensed out-of-home care.

(2) Placement Capacity.

(a) The total number of children placed in a home shall not exceed the placement capacity as outlined in Section 409.175(3)(b), F.S.

(b) Dependent children residing in a home prior to licensure which cause the home to exceed the maximum placement capacity in paragraph (a) of this section may be permitted to remain in the home once licensed. No new licensed placements may be made in the home until the number of children placed falls below the maximum placement capacity.

(c) There shall be no more than two infants under 24 months of age in a licensed home, including caregiver’s own children.

(3) Over-Capacity Placement Waiver Requests. Over-capacity placement waiver requests may be considered for paragraph (2)(a) under the following circumstances to allow:

(a) A parenting youth in foster care to remain with his or her child,

(b) Siblings to remain together,

(d) A family with special training or skills to provide care to a child who has a severe disability.

(4) Over-Capacity Placement Assessments.

(a) The assessment of each child in the home and of the child being placed in the home shall be completed using the Over-Capacity Assessment module in the state’s child welfare information system by the Child Placing Agencies or Department designated child welfare professional.

(b) The assessment must include:

The medical, mental, physical, and behavioral needs of each child;
A clear, concise explanation of why the over-capacity waiver should be approved including the reason it has been determined that this is the most appropriate available placement;
A description of any special services or support systems which may be necessary to assure the well-being of the child being placed;
A description of how the home can physically accommodate the additional child. Accommodations shall include a bed, adequate closet space and room for personal possessions, and adequate privacy;
Information concerning how the needs of any particularly vulnerable child currently in placement can be adequately protected;
Placement needs and risk factors for children who have been sexually victimized or who are sexually aggressive; and
Verification that there are no active complaints, licensing standards in violation, active abuse reports, or foster care referrals for the proposed placement.

(5) Approval of Over-Capacity Placement Waivers.

(a) Over-capacity placement waiver approvals shall be approved verbally or in writing by the Department.

(b) Approval of over-capacity placement waivers must be provided prior to placing any children in the home over the placement capacity as outlined in subsection (2).

(d) Subsequent approvals for the same child or children may be approved for 90-day extensions verbally and in writing by the Department.

(e) The approval for the over-capacity placement waiver is child-specific and shall automatically expire when the number of children falls below the maximum placement capacity as outlined in paragraph (2)(a).

(f) All child placements in an over-capacity placement shall be recorded in the state’s child welfare information system by the supervising agency within 24 hours of placement.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(3) FS. History–New 4-26-20, Amended 9-14-22.

Fla. Admin. Code R. 65C-45.016 Babysitting, Overnight Care, Extended Overnight Care, and Other Supervision Arrangements for all Levels of Licensure

(1) The licensed out-of-home caregiver is responsible for ensuring that individuals providing babysitting are suitable for the age, developmental level, and behaviors of the children. The licensed out-of-home caregiver shall use a reasonable and prudent parent standard, as defined in Section 39.4091(2)(c), F.S., in choosing the babysitters or assessing a child’s ability to stay home alone.

(2) The licensed out-of-home caregiver is responsible for ensuring babysitters receive instructions that cover protocol for handling emergencies, including telephone numbers for the licensed out-of-home caregiver, case manager, and physician. The discipline policy and confidentiality policy shall be clearly explained.

(3) Babysitting does not have to occur in a licensed setting.

(4) If the alternate care being provided for the child meets the definition of “child care” as defined in Section 402.302, F.S., the child care personnel must meet the standards set forth in Section 402.305(2), F.S.

(5) Extended overnight care.

(a) Families shall take children in their care on family vacations and trips whenever possible. Caregivers shall notify the child welfare professional in advance of all overnight stays exceeding three (3) nights.

(b) The following procedures apply when the caregiver must be absent for more than three (3) nights and the child cannot accompany him or her:

Foster parents will be allowed to select families or individuals who are well known to them to care for the children in their absence. At the time of licensing and relicensing, licensed caregivers shall identify the families or individuals who provide temporary alternate care for the children in their care.
Except in emergency circumstances, the adults in these families must have criminal and child abuse background checks including fingerprinting. In emergency circumstances, a full background screening will be initiated the next business day. Such persons shall be recorded in the Unified Home Study module in the Florida Safe Families Network (FSFN).

History

Rulemaking Authority 39.4091(4), 409.175(5) FS. Law Implemented 39.4091(2), (3), 409.175(5) FS. History–New 4-26-20.

Fla. Admin. Code R. 65C-45.017 Foster Care Referrals and Investigations for all Levels of Licensure

(1) The Regional Licensing Authority maintains responsibility for ensuring follow-up actions are taken on all foster care referrals and investigations. The supervising agency shall ensure that all licensed out-of-home caregivers are notified of foster care referrals. Licensed out-of-home caregivers shall be notified of investigations by the child protective investigator.

(2) The Regional Licensing Authority, community-based care lead agency, and supervising agency have the right to inspect the entire premises of the licensed out-of-home caregiver at any time.

(3) Foster Care Referrals. Upon receipt by the child protection investigation unit of a foster care referral regarding a foster home, the foster care referral shall be immediately forwarded to the appropriate supervising agency licensing staff. The licensing staff receiving the foster care referral shall:

(a) Respond to the foster care referral and document any needed actions within 48 hours;

(b) Prepare a written corrective action plan (CAP) to correct the deficiencies that are identified as a result of a foster care referral and upload the CAP into the file cabinet in the state’s Comprehensive Child Welfare Information System (CCWIS). The plan shall be developed by the supervising agency in conjunction with the licensed out-of-home caregivers and shall be approved by the Regional Licensing Authority; and

(4) Investigations. When the supervising agency or Regional Licensing Authority is notified of an investigation, a staffing shall be coordinated according to local protocol. If licensing violations are found which do not pose an immediate threat to the health, safety, or well-being of the child, the supervising agency shall prepare a written corrective action plan to correct the deficiencies and upload the CAP into the file cabinet in the state’s CCWIS. The plan shall be developed by the supervising agency in conjunction with the licensed out-of-home caregivers and shall be approved by the Regional Licensing Authority.

(5) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5), (8) FS. History–New 4-26-20, Amended 12-28-21.

Fla. Admin. Code R. 65C-45.018 Administrative Actions, Appeals, and Closures for all Levels of Licensure

(1) General Information. The Department is the Regional Licensing Authority for all family foster homes and has final authority to approve or deny any license.

(a) The denial or revocation of a license shall be recorded in the Florida Safe Families Network (FSFN) by the Regional Licensing Authority.

(b) The Regional Licensing Authority shall notify the community-based care lead agency and supervising agency within 10 business days of negative action taken regarding a license.

(2) Documentation Requirements Prior to Administrative Action.

(a) Before making a determination that a license shall be denied or revoked, the following shall be documented in the licensing file:

All qualifying abuse reports and all reports of licensing violations and the outcome of the investigation;
List of all deficiencies or conditions, other than abuse or neglect of the children, which compromise the safety or well-being of the children;
The length of time and frequency of the noncompliance with the licensing requirements or deficiencies in caring for children;
The date of written notification to the licensee as to the deficiency and time given to the licensee to correct the deficiency;
The licensing staff’s efforts to help the licensee come into compliance; and
Any barriers which prohibit the licensee from correcting the deficiencies;

(b) All license revocations and denials shall comply with requirements of Chapter 120, F.S.

(c) All documentation shall be reviewed with the Department’s legal counsel. The notice of revocation or denial shall not be sent to the out-of-home caregiver without approval of both the Department’s legal counsel and the Regional Licensing Authority.

(3) Denial of Initial Licensure.

(a) The Regional Licensing Authority shall have 30 business days following receipt of a complete application packet to grant or deny the application in accordance with Section 120.60, F.S., and notify the supervising agency of the decision.

(b) If the Regional Licensing Authority determines that the applicant should not be licensed, the supervising agency shall notify the applicant in writing within 10 business days of the determination, identifying the reasons for the denial, the statutory authority for the denial, and the applicant’s right of appeal pursuant to Chapter 120, F.S. The applicant shall be afforded the opportunity to withdraw the application. If the applicant elects to withdraw the application, it must be documented in writing in the licensing file.

(c) If the applicant does not withdraw the application, the supervising agency shall provide to the Regional Licensing Authority information to support the recommendation of the denial. When the Regional Licensing Authority determines that the license should be denied, they shall notify the applicant in writing within 10 business days of the decision, identifying the reasons for the denial, the statutory authority for the denial, and the applicant’s right of appeal pursuant to Chapter 120, F.S.

(4) Administrative Action for Existing Family Foster Homes.

(a) If licensing violations are found such that the child’s physical, mental, or emotional health is or has been adversely impacted as a result of the violation or is in danger of being adversely impacted, the licensing counselor shall consult with his or her supervisor and the child’s case manager for an immediate review of the safety of any children in the home and a call shall be made to the Abuse Hotline.

(b) If licensing violations are found which do not pose an immediate threat to the health, safety, or welfare of the children, the supervising agency shall prepare a written corrective action plan to correct the deficiencies. The plan shall be developed by the supervising agency in conjunction with the licensed out-of-home caregivers and shall be approved by the Regional Licensing Authority.

(c) Written notification shall be sent to the licensed out-of-home caregiver that specifies the deficiency, expected corrective action, time frame for completion, and that failure to comply within the time frame specified shall result in the license being revoked. The approved corrective action plan shall be put in writing by the supervising agency and signed by the licensed out-of-home caregiver.

(d) Corrective action plans are created for licensed out-of-home caregivers who have the ability to understand and correct the infraction. Corrective action plans are not created for licensed out-of-home caregivers who have previously committed licensing violations and were unable to benefit from remedial efforts. In these cases, the supervising agency shall work with the licensing authority, the Department’s legal counsel, and community-based care lead agency to determine whether action should be taken to revoke the license.

(e) Failure of the licensed out-of-home caregiver to timely comply with the corrective action plan shall result in denial of re-licensure and/or revocation of the license.

(f) The licensed out-of-home caregiver shall be given notice if the supervising agency determines that it cannot recommend re-licensure.

(g) If the licensed out-of-home caregiver disagrees with the supervising agency’s recommendation, he or she may still request renewal of the license. The supervising agency shall accept the application and refer the licensed out-of-home caregiver’s file to the Regional Licensing Authority with a recommendation for denial.

(h) A decision to revoke or deny further licensure is made after a review is done in conjunction with the Department’s legal counsel, supervising and lead agencies. The notice must be delivered via personal service or certified mail. The notice shall include the statutory and rule violations that were found and advise of the action to be taken and the right to challenge the action through an administrative proceeding as provided in Chapter 120, F.S.

(5) Voluntary Closures.

(a) The supervising agency shall conduct an exit interview with licensed out-of-home caregivers who are closing. This interview is an opportunity to explore any recommendations for improvement that the licensed out-of-home caregiver may be willing to share.

(b) The supervising agency shall document the reason for closure and whether relicensing would be recommended in FSFN.

(c) If relicensing would not be recommended, the licensing file shall document the reasons relicensing would not be recommended.

(d) If the closure is voluntary and in lieu of revocation or denial of a license, the supervising agency shall document the reason for the denial in FSFN.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5), (9) FS. History–New 4-26-20.

Chapter 65C-46 CHILD-CARING AGENCY LICENSING

Fla. Admin. Code R. 65C-46.001 Definitions

(1) “At-Risk house” means a child-caring agency providing care and support services to children and youth who are at risk of becoming sex trafficking victims.

(2) “Campus” means a characteristic describing a child-caring agency that has multiple buildings, units, or cottages on the same property.

(3) “Child or youth at risk of sex trafficking” means an individual who has experienced trauma, such as abuse, neglect, and/or maltreatment, and presents with one or more of the accompanying risk factors:

(a) History of running away and/or homelessness.

(b) History of sexual abuse and/or sexually acting out behavior.

(d) Family history of or exposure to human trafficking.

(e) Out-of-home placement instability demonstrated by repeated moves from less restrictive levels of care.

(4) “Child-caring agency,” as defined in this rule chapter, means a child-caring institute licensed by the Department to provide care and supervision to children and youth in a group home, facility, shelter, treatment program, or wilderness camp.

(5) “Direct care staff” means personnel who are employed, contracted, or volunteer as a caregiver or have unsupervised contact with children.

(6) “Emergency shelter” means a child-caring agency that provides 24-hour care and supervision for youth in need of shelter on a temporary basis.

(7) “Facility” means the building and campus of a residential child-caring agency, as defined by Section 409.175(2), F.S.

(8) “Florida Association of Christian Child-Caring Agencies (FACCCA)” means the authority responsible for the registration and oversight of faith-based residential group homes, family foster homes, and adoption agencies.

(9) “Gender” or “gender identity” means a person’s internal identification or self-image as male or female. Gender identity may or may not correspond to the gender that is listed on the person’s birth certificate. The terms “male,” “female,” or “nonbinary” describe how a person identifies.

(10) “Gender expression” refers to the way a person expresses gender through appearance, dress, grooming habits, mannerisms and other characteristics.

(11) “Governing body” means the board of trustees, the partnership, the corporation, the association, or the person or group of persons who maintain and control the provider organization and which is legally responsible for the operation of the child-caring agency.

(12) “Inappropriate,” for the purpose of this rule chapter, means behaviors assessed by the child welfare professional that are determined to be not suitable based on the child’s age and may cause harm to one’s self.

(13) “Maternity home” means a child-caring agency that provides care and specialized support for prenatal, post-partum, or parenting youth.

(14) “Non-direct care staff” means personnel who are employed, contracted, or volunteer in positions that are not in a caregiver role and do not have direct or unsupervised contact with children.

(15) “Public institution” means a child-caring agency owned or run by the County, State, or Federal Government that provides 24-hour care.

(16) “Residential group home” means a child-caring agency that provides care to meet the physical, emotional, and social needs of children.

(17) “Runaway shelter” means a child-caring agency that provides 24-hour care and supervison for children who are in conflict with their parents or who runaway or are recovered from a missing child episode.

(18) “Safe house” means a child-caring agency certified by the Department that provides 24-hour care and supervision to care for sexually exploited children, as outlined in Section 409.1678, F.S.

(19) “Service Plan” means the goal-oriented, time limited, individualized program of action for a child and the child’s family developed by the child-caring agency in cooperation with the child’s family.

(20) “Sexual orientation” means a person’s emotional or physical attraction to members of the same gender, a different gender, or any gender.

(21) “24-hour care and supervision,” as used in this rule chapter, means a child-caring agency whose staffing model provides 24-hour supervision for children based on the program’s required staffing ratio, also known as shift care.

(22) “Traditional group home” means a child-caring agency that provides care to meet the physical, emotional, and social needs of children. A traditional group home is located in a single family or multi-family community with a licensed bed capacity no greater than 14.

(23) “Transgender” means having a gender identity that is different than the person’s gender listed on the person’s birth certificate.

(24) “Trauma-informed” means an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma.

(25) “Treatment Plan” means an individualized, structured, and goal-oriented schedule of services with measurable objectives. A treatment plan details the treatment to be provided and expected outcome, and expected duration of the treatment.

(26) “Unaccompanied alien children home (UAC),” as defined in this rule chapter, means a child-caring agency that provides care for unaccompanied alien minors, as outlined in rule Chapter 65C-9, F.A.C.

(27) “Unaccompanied refugee minor program (URMP)” means a federally funded and state administered program that provides care of unaccompanied refugee minors, as further defined in Rule 65F-1.001, F.A.C.

(28) “Qualified residential treatment program (QRTP)” means a licensed therapeutic group home with a child-caring agency credential that provides care for youth who have serious emotional or behavioral disorders or disturbances.

(29) “Wilderness camp” means a child-caring agency that provides care to meet the physical, emotional, and social needs of children.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 7-1-87, Amended 9-19-90, Formerly 10M-9.003, Amended 11-30-97, 10-20-16, 5-26-21, Formerly 64C-14.001.

Fla. Admin. Code R. 65C-46.002 Application Packet and Licensing Documents

(1) Licensing packets for a child-caring agency shall be uploaded into the states official system of record and include the following:

(a) The “License Application for Child-Caring Agencies,” CF-FSP 5412, (October 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18939 and all supporting documentation. The application shall be signed by the licensee who is the executive director exercising authority over and has the responsibility for the operation, policies, and practices of the agency. If the application packet is approved, a license shall be issued. The license shall include the name and physical address of the provider, the license capacity, and the dates for which the license is valid. The Department shall sign the license. Any limitations shall be displayed on the license.

(b) Agencies providing care for one to six or seven to 14 children shall complete the “Community Residential Homes Local Ordinance Certification,” CF 1786, (October 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18940. This application form certifies to the Department that the proposed group home meets the dispersion and notification requirements of Chapter 419, F.S.

(c) The child-caring agency shall provide a description of the geographic area the child-caring agency serves or intends to serve, to include if serving on a county, region or statewide level, with the specific services it provides or proposes to provide. Applicants who apply for an initial license shall furnish evidence that the services will be used by referral sources or other documentation of the need for the services which shall be verified by the Department. The child-caring agency shall indicate if it plans to serve dependent and/or non-dependent populations.

(2) Policies and procedures must be available for review and approved by the Department’s licensing team prior to initial licensure. Any policies or procedures that are updated during the licensing year must be made available for review prior to the implementation of proposed changes.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(6) FS. History–New 7-1-87 Amended 9-19-90, 2-17-93, Formerly 10M-9.005, Amended 10-20-16, 1-2-18, 5-26-21, Formerly 64C-14.003, Amended 7-27-22, 7-9-26.

Fla. Admin. Code R. 65C-46.003 Administration and Organization

(1) Statement of Purpose. The child-caring agency shall have a written statement of its purpose. The statement shall contain a description of all the services the child-caring agency provides and the methods of service delivery. The statement shall be available to the Department, referral sources, and the public on request.

(2) Business Registration. Child-caring agencies shall be registered to conduct business under Florida law. Agencies incorporated outside of the State of Florida shall be authorized to do business under Florida law.

(3) Governing Body. Each incorporated child-caring agency shall have a governing body.

(a) For profit organizations shall maintain advisory boards which review the operational policies and practices, inspect facilities and programs, conduct interviews with children and staff members, and review matters affecting the care of and services to children. Members of advisory boards shall not have a proprietary interest in the child-caring agency or program.

(b) The child-caring agency shall maintain a list of the members of its governing body. This list shall be available to the Department and must:

Include the name, address, and term of membership of each member; and,
Identify each office and the term of that office.

(c) The governing body shall meet no less than once per year. Membership of the governing body shall not be fewer than three members.

(4) Responsibilities of the Governing Body.

(a) Employ a qualified executive director, as prescribed in subsection 65C-46.011(9), F.A.C., and delegate responsibilities to that person for the administration and operation of the child-caring agency.

(b) Evaluate in writing the executive director’s performance annually.

(c) Approve the annual budget of anticipated income and expenditures necessary to provide the services described in its statement of purpose. The governing body shall also approve the annual financial audit report.

(d) Establish written personnel practices.

(e) Maintain written minutes of all meetings, which shall be open to inspection by the Department.

(f) Develop written policies for selection criteria and rotation of its members.

(g) Develop a written plan for the storage of children’s records in the event of the closing of the child-caring agency and/or facility.

(h) Adhere to the confidentiality policies of the child-caring agency and the Department. The governing body shall not have access to resident names or files maintained by the child-caring agency. The files must use unique identification numbers for each resident to replace the resident’s name.

(5) Grievance. The child-caring agency shall have a written and posted grievance procedure which allows children in care or others to make complaints without fear of retaliation.

(a) The grievance procedure shall be written in a clear and simple manner that is developmentally appropriate. It should be prominently posted in areas frequented by children and where they can read it without scrutiny.

(b) The written grievance procedure shall be provided to:

The Department.
At the time of admission, the child, his or her parent or guardian, and the child’s attorney and guardian ad litem, if appointed and requested.
Others, upon request.

(d) The child-caring agency will post the contact information of the Department’s Ombudsman in areas frequented by children and where they can read it without scrutiny.

(6) Organizational Chart.

(a) The child-caring agency shall maintain a current organizational chart showing the administrative structure including the lines of authority. The organizational chart shall indicate direct care roles and non-direct care roles. This chart shall be available to the Department.

(b) The child-caring agency shall also maintain an employee roster indicating staff with direct and non-direct roles, date of hire and termination, and identification of staff that are trained in cardiopulmonary resuscitation.

(c) The child-caring agency shall provide written notification to the Department’s regional licensing team within 30 days prior of changes in the agency’s executive director, statement of purpose, admission criteria, business name, address, or licensing setting.

(7) Finance. The child-caring agency shall provide written documentation that it has sufficient funds to meet all requirements for licensure.

(a) Facilities beginning operation shall provide evidence of sufficient funding for operation of the program for at least six months.

(b) The child-caring agency shall prepare a written budget annually.

Financial audits are required for nonprofit and for-profit child-caring agencies who expend equal to or in excess of $750,000 of state financial assistance, as outlined in Section 215.97, F.S. Annual audits must be conducted by an independent certified public accountant (CPA) licensed pursuant to Chapter 473, F.S.
Child-caring agencies who do not meet the audit threshold must provide proof of a financial review conducted by external auditors.

(d) If fees for services are charged, the child-caring agency shall have a written policy which describes the relationships between fees and services provided and the conditions under which fees are charged or waived. This policy shall be available to any person upon request.

(e) If funding is obtained through public solicitation, a charitable permit for such solicitation shall be procured as required by Chapter 496, F.S.

(8) Municipal, county, or other governmentally operated residential child-caring agencies subject to licensing under Section 409.175, F.S., shall, within their administrative structure and as governed by other federal, state, and local laws, provide for the duties and responsibilities described in this section.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)1., 8. FS. History–New 7-1-87, Formerly 10M-9.015, Amended 10-20-16, 5-26-21, Formerly 64C-14.006, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.004 Buildings, Grounds, Equipment, and Interior Accommodations

(1) Grounds, Equipment, and Recreational Areas.

(a) The grounds shall be well kept.

(b) Indoor and outdoor recreation areas shall be provided with equipment and safety measures designed for the needs of the resident children according to the age, physical and mental ability of the children.

(c) Safety regulations shall be established for all hazardous equipment and children shall be prohibited from the use of such equipment unless it is included in planned work experience.

(d) Pools shall meet the requirements of Chapter 515, F.S.

(e) The recreational area shall be safe and free from hazardous conditions. Recreational equipment shall have no jagged or sharp projections or other hazardous construction and shall be maintained in a structurally sound condition.

(f) Outdoor recreational areas shall be well-drained and kept free of litter and trash.

(2) Interior Accommodations.

(a) The facility shall be decorated and furnished to create a homelike environment. Furnishings shall be safe, easy to maintain, and selected for their suitability to the age and development of the children in care.

(b) Living Room: The building or cottage shall have one (1) centrally located living room, or in the case of wilderness camps another form of meeting space, for the informal use of children, large enough to accommodate indoor recreational use.

(c) Dining Area: The building or cottage shall have one (1) or more dining areas large enough to comfortably accommodate the number of children who reside there, as well as staff who dine with the children.

(d) Space shall be available for children to study quietly.

(e) If offices for administrative functions are housed in the facility, they must be separate from the children’s living area.

(f) There must be adequate space to allow staff and clients to talk privately and without interruption.

(g) Bathrooms.

The facility shall have toilets, wash basins, and bathing units as follows:

a. At least one (1) toilet, washbasin, and tub or shower easily accessible to the bedroom area for every six (6) children,

b. Toilets and tubs or showers that provide for individual privacy.

The facility shall have bathrooms with non-slip surfaces in showers or tubs, toilet paper and holders, and individual hand towels or disposable paper towels, mirrors at a height for convenient use by children and a place for storage of toiletries unless storage is provided elsewhere.
A facility that cares for nonambulatory children shall have grab bars in toilet and bathing areas and doors wide enough to accommodate a wheelchair or walking device.

(h) Bedrooms.

Child-caring agencies shall not permit nonambulatory children to sleep above the first floor.
Child-caring agencies shall provide each child with a closet or chest of drawers for clothing and personal belongings which shall be reserved solely for the individual child’s use.
Child-caring agencies shall provide each child with a safe, permanent, and comfortable bed and non-institutional mattress in good repair. The beds shall be no shorter than the child’s height and no less than 30 inches wide. Where bunk beds are used, there shall be sufficient room to allow the occupants of both bunks to sit up in bed. Bunk beds shall be safe and sturdy. Bunk beds shall be equipped with safety rails on the upper tier for any child whose physical, mental, or emotional condition indicates the need for such protection. Beds bunked higher than two (2) tiers must have a manufacturer sticker of safety and must not be placed under or near ceiling fans. Cribs with drop-down sides, foldaway beds, and cots shall not be utilized.
Children over 36 months of age shall not share a bedroom with a child of a different sex unless efforts are being made to maintain a sibling group or doing so is required for the safety or wellbeing of each child. The group home, licensing agent and case manager shall work together in determining arrangements for the safety and best interests of each child involved and obtain written approval from the community-based care agency. Rationale for any decision made for children over the age of 36 months to share a bedroom with a child(ren) of a different sex shall be documented in the state’s official system of record.
Clean sheets, pillows, pillow cases, and blankets shall be provided to each child upon arrival. Sheets and pillowcases shall be changed at least once a week.
Children shall have the opportunity to personalize and decorate their bedrooms with furnishings and possessions. Personalizations should not display any offensive or discriminatory material. The child-caring agency shall review the policies outlining offensive or discriminatory items with the child upon admission.

(i) Laundry. Laundry facilities shall be located in an area separate from areas occupied by children. If children are allowed to participate in the laundering of their personal items, space for sorting, drying, and ironing shall be made available.

(3) Buildings.

(a) The facility shall have outside ventilation by means of windows, louvers, air conditioners, or mechanical ventilation in rooms used by children.

(b) The facility shall have screens for each window and door used for outside ventilation.

(c) The facility shall have light fixtures to provide for the comfort and safety of children. Classrooms, study areas, bathrooms and food service areas shall be illuminated.

(d) All incandescent bulbs and fluorescent light tubes shall be protected with covers or shields.

(e) Hallways to bedrooms shall be illuminated at night.

(f) The facility shall have at least one (1) bedroom for every four (4) children. However, if the applicant or licensee, in a written request, demonstrates that it is in the best interest of each child in a particular set of children in a particular circumstance to have more than four (4) children in a bedroom, the Department, upon on-site inspection, shall grant the request if it determines that the evidence and statement support the applicant’s or licensee’s request. The approval of the request shall be valid only for the particular set of children in the particular circumstances cited in the written request. The bedrooms shall have 50 square feet for the initial occupant and an additional 50 square feet for each additional occupant.

(g) All interior areas of the facility occupied by children shall be temperature-controlled in a manner conducive to comfort, safety, and privacy. Table fans and floor fans shall have protective covers.

(h) The child-caring agency seeking restitution for injury or damages caused by foster children shall submit a state institutional claim for damages with the applicable child welfare professional to file on behalf of the agency, as referenced in Section 402.181, F.S.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 3. FS. History–New 7-1-87, Formerly 10M-9.016, Amended 10-20-16, 5-26-21, Formerly 64C-14.007, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.005 Safety, Sanitation, and Food Service Requirements

(1) Inspections. Prior to the issuance of a license or to relicensing, the home or facility shall be inspected by a representative from the Department of Health trained in environmental health practices. Written approval of satisfactory health and sanitary conditions must be on file. In the event the Department of Health is not available to complete the inspection, the Department’s licensing authority may complete the inspection using the “Child-Caring Agency Inspection Checklist” form CF-FSP 5490, (July 2024), which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-16824.

(2) Radon Testing.

(a) Child-caring agencies shall verify with the Department of Health if they are required to test for radon based on the home or facility location and building type.

(b) Child-caring agencies required to test for radon shall follow the protocols and procedures outlined by the Department of Health.

(c) Child-caring agencies may perform radon testing through state certified individuals or businesses or by using a radon testing kit provided that the instructions are followed.

(3) Fire Safety.

(a) All child-caring agencies must be inspected annually by the local fire department or persons certified by the Division of the State Fire Marshal in fire prevention and safety in accordance with rule Chapter 69A-41, F.A.C., Uniform Fire Safety Standards for Residential Child Care Facilities. A report of the inspections and approval must be on file with the Department prior to issuance of a license or relicensing of the facility.

(b) Fires, explosions or major damage to facilities which threaten the health and safety of the residents shall be reported to the Department within 24 hours of the occurrence and reports of such incidents shall be kept on file in the facility.

(c) Procedures for fire and other emergency situations, including the route of evacuation, shall be posted in conspicuous places and shall be reviewed with staff and children on a scheduled basis. The evacuation map shall:

Clearly identify all exits of the home, i.e. doors, windows;
Identify the location of any emergency equipment, such as fire extinguishers or first aid kits; and
Identify safe assembly points in the event of an evacuation.

(d) Fire drills shall be held no less than monthly and records of such drills shall be kept on file.

(e) Hallways, stairs and exit areas shall be well-lit and kept clear for safe exit.

(4) Transportation.

(a) Vehicles used to transport children shall be maintained in safe operating condition.

(b) The number of persons in a vehicle used to transport children shall not exceed the number of available seats. Appropriate restraining devices shall be used when transporting children.

(c) The child-caring agency shall ensure the staff ratio requirements outlined in subsection 65C-46.011(11), F.A.C., are met when transporting children.

(d) Buses or vans used to transport six or more children shall be equipped with a first aid kit.

(e) The child-caring agency shall provide confirmation of liability insurance.

(f) The child-caring agency shall develop written procedures on the use of vehicles to include the accountability of passengers.

(5) Swimming Pools, Aquatic Activities, and Bodies of Water.

(a) All child-caring agencies with swimming pools, spas, or open water hazards must have a person on staff who has completed a community water safety course administered by American Red Cross, YMCA, or a certified water safety provider.

(b) Swimming pools located on the premises of a detached one-family or two-family dwelling or a one-family townhouse not more than three stories high shall comply with the safety feature requirements of the Residential Pool Safety Act, Section 515.27(1), F.S. Facilities with swimming pools licensed prior to the enactment of the Residential Pool Safety Act shall be considered to have met this requirement.

(c) Child-caring agencies serving eight or more residents who do not meet the criteria outlined in paragraph (5)(b) shall comply with the required safety features for public swimming pools set forth in Section 514.0315, F.S.

(d) The child-caring agency shall not permit a child to participate in an aquatic activity requiring higher skills than the child’s ability, except during formal instruction.

(e) The level of supervision for children in close proximity to any body of water, including swimming pools, shall be in accordance with subparagraph 409.145(2)(a)3., F.S.

(f) Lifesaving equipment shall be provided during aquatic activities and shall be immediately accessible in case of an emergency. All child-caring agencies with swimming pools, spas or near open water hazards must have lifesaving equipment availble and accessible in case of an emergency. Equipment shall include the following:

A whistle or other audible signal device;
A first aid kit; and
A ring buoy, rescue tube, life jacket or other flotation device with a rope attached which is of sufficient length for the area.

(g) Above ground pools with steps or ladders shall have them secured, locked, or removed when the pool is not in use.

(h) Wading pools shall be set up and maintained according to the manufacturer’s instructions. Wading pools shall be emptied and stored when not in use and shall be filled with clean water before each use.

(i) Child-caring agencies shall ensure the following requirements are met for boating activities:

Life jackets shall be worn during all boating activities;
Boat safety drills shall be conducted with all children and staff regarding man-overboard, capsize situations, and emergency evacuations prior to any travel on all water crafts;
Staff ratio requirements outlined in subsection 65C-46.011(11), F.A.C., shall be met to ensure ongoing care and supervision; and
Staff must complete boat safety training to minimize drowning while boating. Training shall include topics on boat safety drills, utilization of life jackets, and how to prepare and execute an emergency evacuation plan.

(j) Child-caring agencies who own a water craft or vessel shall:

Provide confirmation of liability insurance for all insurable vessels or water craft used for extended travel.
Have a satisfactory inspection completed by the Department’s licensing authority for all extened travel to ensure adequate sleeping arrangements.

(6) Other Safety Measures.

(a) The child-caring agency shall have communication access available for use at all times by staff and youth. Methods of communication may include mobile or landline telephones, computers for video communication or conferencing, or mobile devices equipped to make phone calls.

(b) Child-caring agencies shall have the following postings in a clear and conspicuous location:

Emergency numbers, such as 911, poison control, and the Florida Abuse Hotline.
Department approved, youth in foster care Rights and Expectations brochure.
Department’s Human trafficking awareness signage pursuant to subsection 409.175(5), F.S. Human trafficking awareness posters developed by the Department that must include:

a. Indicators of human trafficking;

b. Phone numbers of local law enforcement and Florida Department of Law Enforcement for reporting human trafficking;

c. Language that is clear and developmentally appropriate; and

d. Appropriate pictures or graphical art.

(c) The executive director and program director, and house parent shall be required to sign the “Acknowledgement of Firearms Safety Requirements” form CF-FSP 5343, February 2015, which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13066.

(d) All pets must be assessed for any safety concerns involving interaction with children in the home.

(7) Disaster Preparedness and Evacuation Plan.

(a) Each licensed child-caring agency shall have a written disaster preparedness and evacuation plan for each facility in the event of a natural or man-made disaster. The plan shall include:

An outline of the facility identifying all emergency exits;
The location to which the agency intends to relocate the children and caregivers;
Emergency contact information for caregivers and the director of the agency;
A process for notifying the Department, community-based care lead agency, and legal gaurdian when relocation is necessitated, to include out of state travel; and
A list of emergency supplies maintained at each facility.

(b) The disaster preparedness and evacuation plan shall be updated at re-licensure and whenever changes are made during the licensure year. The child-caring agency must review the preparedness plan no less than 30 days prior to the beginning of hurricane season to ensure any amendments are updated.

(d) The child-caring agency shall maintain ongoing communication with the regional licensing authority throughout an evacuation until their safe return. Communication must include:

Accounting for the census prior to and throughout the evacuation;
Confirmation of the address in which the agency is relocating to;
Anticipated date of return;
Any challenges to meeting staff ratio requirements outlined in subsection 65C-46.011(11), F.A.C.; and
Providing the basic needs such as: food, clothing, and medical treatment for children.

(e) The child-caring agency shall notify the regional licensing authority within one calendar day upon learning of any structural damages to the property or building, including loss of electricity and water. The child-caring agency shall provide the regional licensing authority with a plan to correct the damages identified.

(f) The child-caring agency shall develop a plan to shelter-in-place in the event of an emergency that requires the facility to lockdown.

(8) Communicable Disease Prevention and Preparedness.

(a) The child-caring agency shall develop policies and procedures outlining admission criteria, prevention measures to prevent the spread of a pandemic or epidemic, accommodations for visitation and schooling, capacity and ratio, plans for emergency volunteers, and safety measures for children and staff.

(b) In the event of a pandemic or epidemic, the child-caring agency may utilize resources issued by the Florida Department of Health (DOH).

(9) Food Service.

(a) The child-caring agency shall have a procedure for the overall management of the food service. All menus shall be approved by a registered dietitian for nutritional adequacy every two years. Residential programs participating in the United States Department of Agriculture Food and Nutrition Service shall be considered to have met this requirement upon submission of confirmation to the regional licensing authority.

(b) The child-caring agency shall serve the same food to staff members and the children, except when age or special dietary requirements dictate differences. Staff on duty shall eat their meals with the children.

(c) All child-caring agencies shall serve three well-balanced meals a day in the morning, noon, and evening and provide snacks between meals. The child-caring agency shall ensure meals are provided when children are attending school, working outside of the facility or are not present in the facility during mealtime.

(d) Facilities shall retain their menus for a six month period which shall be available for review by the Department.

(10) Child-caring agencies shall ensure that the design and construction of facilities meet the minimum requirements of the applicable state and local governing agencies.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 7-1-87, Formerly 10M-9.019, Amended 6-3-12, 10-20-16, 1-2-18, 5-26-21, Formerly 64C-14.010, Amended 8-11-24.

Fla. Admin. Code R. 65C-46.006 Health and Medical Services

(1) General.

(a) The child-caring agency shall have a staff member on duty trained to administer first aid, including cardiopulmonary resuscitation (CPR), at all times.

(b) The child-caring agency shall ensure that a first aid kit is available to staff members in each living unit with contents consistent with the American Red Cross recommendations and the needs of children in care. The first aid kit shall be stored in a location accessible to adults, however, out of reach of young children. Contents shall be restocked as needed, and any expired products shall be discarded and replaced.

(c) All medical care beyond the provision of first aid shall be under the direction of a licensed medical professional operating within the scope of his or her license.

(d) The child-caring agency shall immediately notify the child’s parent or guardian, child’s attorney, guardian ad litem, and the child-placing agency or the Department if the child is in the custody of the Department, of any serious illness, any incident involving serious bodily injury, pregnancy or childbirth, or any psychiatric episode requiring the hospitalization of a child.

(e) Provision shall be made for the temporary isolation of children with communicable disease. When such isolation is necessary, close supervision by staff shall be provided.

(f) All child-caring agencies shall establish and maintain cooperative agreements with community agencies, out-of-area programs, or individuals for services not directly provided by the agency, including a plan for handling emergency medical and dental needs of clients.

(g) All child-caring agencies shall have written procedures, in case of emergencies or life threatening situations, including arrangements for emergency transport services for clients. Plans for provision of supervision must be made in cases of emergency when on duty staff are required to accompany a child to a hospital emergency room.

(2) Medication.

(a) All medicines and drugs, including prescription and over-the-counter, shall be kept securely locked.

(b) The following shall be documented in the child’s file upon admission:

1.The prescribing doctor’s name,

Reason for prescription,
Quantity of medication in container at admission; and,
Method of administration of medication either orally, topically, or injected.

(c) All medicines and drugs shall be administered only by agency staff, except for children of parenting teens who are not in the custody of the Department. A log shall be kept of the administration of all medication which shall include the following:

Name of the child for whom medication is prescribed or to whom over the counter medication is administered;
Reason for medication administration;
Amount of medication administered;
Time of day the medication was administered;
Written acknowledgment by the child (by signature or initials) of receipt of medication, when age appropriate;
Signature of staff member who administered the medication; and
Notation and reason for lack of medication administration, if applicable.

(d) The child-caring agency shall not permit medication prescribed for one child to be given to another child.

(e) All child-caring agencies shall have written procedures for the administration of medications.

(3) Medical Information and Health Screenings.

(a) The child-placing agency shall obtain available medical information and consents prior to admission of a child.

(b) Medical information and consents shall include the following:

Completion of a well-child check-up by a licensed physician or report of such an examination performed within twelve (12) months prior to admission.
The child’s medical history, including immunizations, and, in the case of parenting teens, the medical history of the infant or toddler.
Written consent from the child’s parent or guardian or a court order authorizing routine medical and dental procedures for the child, and to authorize emergency procedures when written parental consent cannot be obtained.

(c) The child-caring agency shall obtain the child’s medical information that was not available prior to child’s admission into the facility within 30 days of admission. Efforts to obtain the information shall be documented in the child’s record.

(d) The child-caring agency shall have a written detailed policy for preventive, routine, emergency, and follow-up medical and dental care for all children.

(e) The child-caring agency is responsible for meeting the physical health needs of each child in its care.

The child-caring agency shall ensure that each child has an annual physical examination and follow-up care as recommended. For children under three (3) years, a well-child checkup shall be obtained in accordance with the American Academy of Pediatrics periodicity schedule.
The child-caring agency shall ensure that each child has a dental examination every six (6) months and follow-up care as recommended.
The child-caring agency shall ensure pregnant youth have prenatal and postnatal care, if not served in a maternity home. The child-caring agency shall assess pregnant youth to determine if postpartum testing and referrals are required.

(f) The child-caring agency, in conjunction with the case manager, shall provide or arrange for medically recommended glasses, hearing aids, prosthetic devices, corrective physical or dental devices, or equipment recommended by a physician for children in care.

(g) The child-caring agency shall maintain confidential medical and dental records for each child in care. The records shall include the dates of immunizations, medications, examinations, and any treatments for specific illness or medical emergencies.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 3., 9. FS. History–New 7-1-87, Formerly 10M-9.023, Amended 10-20-16, 5-26-21, Formerly 64C-14.014.

Fla. Admin. Code R. 65C-46.007 Child Abuse and Neglect and Incident Notification Procedures

(1) The child-caring agency shall have and follow procedures for handling any suspected incidents of child abuse or neglect involving staff or residents.

(2) The child-caring agency shall require each staff member to read and sign a statement which recites Section 39.201, F.S., and outlines the staff member’s responsibility to report all incidents of child abuse and neglect.

(3) All suspected cases of child abuse and neglect shall be reported to the Florida Abuse Hotline in accordance with Chapter 39, F.S., including incidents of child-on-child sexual abuse.

(4) A provision shall be made for reporting and recording any suspected incident of abuse or neglect or endangerment to the program director of the child-caring agency.

(5) There shall be an immediate provision for protecting the victim and preventing a recurrence of the alleged incident pending investigation.

(6) The following critical incidents, defined in CF Operating Procedure No. 215-6, April 1, 2013, HRSR 0-10-1 dated January 1, 1986, which is herein incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-07456, shall be reported in accordance with the child-placing agency’s incident reporting procedures for children in the care and custody of the Department:

(a) Child arrest.

(b) Child death.

(d) Child on child sexual abuse.

(e) Employee arrest.

(f) Employee misconduct.

(g) Missing child or young adult.

(h) Security incident.

(i) Sexual abuse/sexual battery.

(j) Injury to child or young adult requiring medical attention from a physician.

(k) Injury to staff requiring medical attention from a physician.

(l) Suicide attempt of child or young adult.

(7) Critical incidents shall be reported to the primary worker or supervisor as soon as the immediate needs of those involved in the incident have been addressed and other required notifications, such as to law enforcement, have been completed.

(a) Upon notification, the primary worker shall follow the local incident reporting procedures which shall result in entry of the incident’s details into the Department’s Incident Reporting and Analysis System (IRAS). All critical incidents must be entered into IRAS within one (1) business day of the critical incident.

(b) The primary worker or supervisor and the program director or designee shall coordinate notification to the parents or legal guardian.

(8) If a child who is being served voluntarily and is not in the care and custody of the Department is involved in any critical incident, the program director or designee shall notify the parents or legal guardian directly and the Department by submission of the child-caring agencies internal incident report within one (1) business day.

(9) All child-caring agencies shall report incidents in accordance with the Department’s incident reporting procedures outlined in CF Operating Procedure No. 215-6, incorporated in subsection (6), of this rule.

(10) Copies of incident reports shall be provided upon request to the caregiver or legal custodian to include the community-based care agency, the Department, guardian ad litem, child’s attorney, and parent(s).

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)1., 10. FS. History–New 7-1-87, Formerly 10M-9.026, Amended 10-20-16, 5-26-21, Formerly 64C-14.017.

Fla. Admin. Code R. 65C-46.008 Individual Needs and Rights of Children in Care

(1) The child-caring agency shall have written policies to involve children in community activities and services. The child-caring agency shall arrange for recreational and cultural enrichment and shall provide transportation and supervision as needed for use of community resources to assure that resident children are allowed to become a part of the community.

(2) The child-caring agency shall ensure that any public appearances by the children involving publicity are voluntary and that the written consent of the child’s parent or guardian is on file.

(3) The facility shall have a log of available indoor and outdoor recreational activities. Such activities shall be based on the group and individual interests and needs of the children in care.

(4) The child-caring agency shall assign chores appropriate to the age and ability of the children in care. Chores shall not conflict with schooling, visits with the children’s family, or any other activities associated with meeting the goals of the service or treatment plan.

(5) There shall be daily time for youth to pursue individual interests and time for privacy.

(6) The child-caring agency shall maintain a system of accounting for the whereabouts of children.

(7) The child-caring agency shall ensure that each child has the individual items necessary for personal hygiene and grooming.

(a) These items shall be accessible to each child unless it is unsafe for the child.

(b) Each child shall have training in personal care, hygiene, and grooming appropriate to the child’s age and sex.

(8) The child-caring agency shall ensure that each child has clean, well fitting, seasonal clothing, appropriate to the child’s age and individual needs.

(9) The child-caring agency shall involve the child in the selection, care and maintenance of the child’s personal clothing, as appropriate to the child’s age and ability. The child-caring agency shall allow a child to possess and bring personal belongings. The child-caring agency may limit or supervise the use of these items while the child is in care using with the reasonable and prudent parent standard in accordance with Section 409.145, F.S.

(10) The child-caring agency shall send all personal clothing and belongings with the child when the child leaves the facility or will return clothing and personal items to the child-placing agency, parent or guardian, or child’s attorney or guardian ad litem, when applicable.

(11) A child and the child’s parent or legal guardian (unless parental rights have been terminated by a court of competent jurisdiction) have the right to determine the child’s religious affiliation. The child-caring agency shall make arrangements for an alternative activity for children not attending religious services.

(12) The child-caring agency shall treat all youth with respect, and understand the child’s history, needs, and risk factors associated with child abuse, neglect and trauma.

(13) The child-caring agency shall allow youth to have scheduled and unscheduled contact with family and persons with meaningful relationships so long as there is no violation of an existing court order.

(14) Youth shall be permitted to contact their case manager and/or legal guardian, guardian ad litem, attorney ad litem, and Children’s Ombudsman.

(15) Allowance.

(a) The child-caring agency shall provide opportunities for children placed by the Department to learn the value and use of money by providing an allowance and opportunities for earning, spending, and saving.

(b) Allowance shall be provided at least monthly.

(d) Children shall not be expected to use their allowance to purchase personal hygiene items, school supplies, clothing, or other necessities.

(e) Allowance shall not be withheld as punishment.

(f) The child-caring agency shall have a means of keeping children’s money secure. A record of monies being held for children shall be kept separate from the facility’s financial accounts.

(g) For privately placed youth, the child-caring agency shall document the discussion of allowance in the placement agreement.

(16) Interpreters, Translators and Language Options. The child-caring agency shall identify and assess the language needs of each child and provide the following, as needed:

(a) A range of oral and written language assistance options, including American Sign Language;

(b) Written materials in languages other than English; and

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)2., 12. FS. History–New 7-1-87, Formerly 10M-9.027, Amended 10-20-16, 5-26-21, Formerly 64C-14.018, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.009 Discipline and Behavior Management

(1) The child-caring agency shall have written policies on discipline and behavior management which shall be provided to each child, parent or guardian, child-placing agency staff, and the Department. The policies for discipline and behavior management shall emphasize positive, instead of punitive, methods and shall include the following:

(a) Means for teaching children which emphasize praise and encouragement for exhibiting self-control and desirable behavior;

(b) Methods for protecting children or others when a child is out of control and the child’s behavior is likely to endanger him or herself, other persons or property.

(2) If separation from others is used as a control measure, the facility shall have an unlocked, lighted, well-ventilated room of at least 50 square feet and within hearing distance of a staff member. The time limit for isolation shall not exceed 15 minutes.

(3) The child-caring agency must ensure staff use the behavior management techniques, including crisis management and passive physical restraint, in accordance with the training completed by each staff.

(4) The child-caring agency staff must ensure all children are provided with placement free from:

(a) Harassment. Staff shall not ridicule, intimidate, humiliate, or bully children.

(b) Mistreatment. Staff must not threaten a child with removal from the child-caring agency; engage in discrimination prohibited by state or federal law; deny the child of basic necessities, medical treatment, therapeutic services, or contacts with family, case manager or legal representatives as a form of punishment; or assign excessive exercise or work duties that are inappropriate to the child’s age or development.

(c) Abuse. Children shall not be physically, mentally, emotionally, or verbally abused or administered chemical or mechanical restraints.

(d) Inappropriate discipline. Staff shall not use physical punishment, inflicted in any manner on the body.

History

Rulemaking Authority 409.175(5)(a) FS. Law Implemented 409.175(5)(a)1., 13. FS. History–New 7-1-87, Formerly 10M-9.030, Amended 10-20-16, Formerly 64C-14.021, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.010 Child Records and Confidentiality Requirements

(1) The child-caring agency shall maintain a permanent record of all resident children and document efforts to obtain the information which shall be made available to the Department upon request. The record shall include the following:

(a) The name and birth date of the child;

(b) The name and address of the child’s parents or guardians or child-placing agency;

(d) The child’s custody status.

(2) The child-caring agency shall maintain individual records for each child and document efforts to obtain the information. The child’s record shall include the following:

(a) The name, sex, race, religion, birth date, and birthplace of the child;

(b) The name, address, and telephone number of the parent or guardian, siblings, grandparents, or other persons significant to the child;

(c) A social history of the child, the child’s family and other significant persons, and any other information required by the child-caring agency;

(d) Copies of legal documents relating to the child;

(e) Date of admission, source of referral, and any available assessments from the referring agency including the Comprehensive Placement Assessment, incorporated by reference in Rule 65C-30-023, F.A.C., and the Comprehensive Behavioral Health Assessment, referenced in Rule 65C-28.014, F.A.C.;

(f) Child’s placement agreement, also known as the precautionary or behavioral agreement;

(g) Medical history, health record, treatment and clinical records, progress reports, prescriptions, and any psychological and psychiatric reports;

(h) Educational records and reports;

(i) Vocational exploration and training and employment records, if applicable;

(j) Records of special or critical incidents in the child’s life;

(k) The child’s case plan, treatment plan, and service plan reviews and revisions reflecting the child’s and family’s goal achievement, as applicable to the population served (i.e. dependency youth, community youth, etc.);

(l) Visitation schedule outlining frequency of contact with parents, relatives, friends, or others with whom the child may have a significant relationship;

(m) Referrals to other agencies; and,

(n) Discharge summary.

(3) Information in case records shall be kept confidential. This includes sharing information with other children in the group home.

(4) Staff entries in case records shall be dated and signed.

(5) The case record shall be maintained for a minimum of five (5) years after a child has been discharged.

(6) The child-caring agency shall dispose of conficential records in a manner that protects the clients privacy and security of their protected health information.

(7) The identity of any child who has tested positive for the HIV virus shall be disclosed to an employee of the Department or child-caring or child-placing agency directly involved in the placement, care, or custody of such child and only when the employee needs to know such information in order to safely perform job duties. An employee has a need to know the identity of a child and the child’s test results if:

(a) The employee is involved in case specific services, such as assessing needs, determining eligibility, arranging care, monitoring case activities, permanency planning and providing care for the child in residential placement, or

(b) The employee is involved in case specific supervision or monitoring of cases for eligibility or legal compliance or casework services, or

(8) The identity of a child who has tested positive for the HIV virus must be disclosed to a foster family, or child-caring or child-placing agency licensed pursuant to Florida Statutes, who is directly involved in the care of such child and has a need to know such information. The identity of the child shall be disclosed only after the following conditions have been met:

(a) The Department or child-placing or child-caring agency has provided all available information, including HIV test results, social information and special needs, in a manner that does not permit identification of the child; and,

(b) The decision to place the child in a specific placement has been confirmed.

(9) The child-caring, child-placing agency, foster home or adoptive home who has accepted an HIV infected child for care shall be given a statement in writing which includes the following language: “This information has been disclosed to you from confidential records. The confidentiality of this record is protected by state law. State law prohibits you from making any further disclosure of such information without the specific written consent of the person to whom such information pertains, or as otherwise permitted by state law. A general authorization for the release of medical or other information is NOT sufficient for this purpose.”

(10) The child’s record shall contain documentation that the written statement was given to the child-caring, child-placing agency or to the foster or adoptive parents.

(11) The case files shall not be segregated or flagged in any way which would permit their identification as case files of HIV infected children.

History

Rulemaking Authority 409.175(5), 381.004(2)(e)11. FS. Law Implemented 409.175(5)(b)1., 9., 13., 381.004(2)(e)11., (f) FS. History–New 7-1-87, Formerly 10M-9.031, Amended 10-20-16, 5-26-21, Formerly 64C-14.022, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.011 Personnel and Staffing Requirements

(1) Personnel Policy.

(a) The child-caring agency shall have written personnel policies and practices conducive to the recruitment, retention, and effective performance of qualified personnel. These policies and practices shall include the following:

Written job descriptions and titles for each position defining the qualifications, duties, lines of authority, and distinguishing position type as “direct care” or “non-direct care” in alignment with definitions in Rule 65C-46.001, F.A.C.;
Provisions which will encourage professional growth through supervision, orientation, in-service training prior to unsupervised contact, and staff development;
Provisions for newly hired direct care staff members to accompany trained staff until new staff members complete pre-service training requirements;
Procedures for annual evaluation of the work and performance of each staff member, which include provisions for employee participation in the evaluation process;
A description of the termination procedures established for resignation or discharge;
A grievance procedure for employees and a plan for review of the personnel policies and practices with staff participation no less than once every three (3) years, and for revision when necessary.
Procedures for the background screening, supervision, and use of volunteers.
Procedures for when staff are named in an active and closed child abuse and neglect investigation with the Department or when staff have a confirmed report for abuse or neglect with the Department.
Procedures and policy mandating all staff to report all state, national, and federal arrests to the provider. Providers shall report all arrests to the Department within 24 hours of notification from the staff.

(2) Personnel File. The child-caring agency shall have a personnel file for each employee which shall include the following:

(a) Identification confirming staff employed to work directly with children are at least 18 years of age;

(b) The application for employment;

(c) An employment history check for staff employed with another agency within the past two years, prior to hire with the child-caring agency;

(d) A minimum of two (2) character reference letters or reference checks from individuals unrelated to the applicant verifying that the applicant is of good moral character and is suitable to work with children, and for executive directors, the individual’s work performance does not affect their ability to perform in an executive role. History and reference checks may be from the prior employer;

(e) Verification of background screening completion prior to hire;

(f) A signed “Attestation of Good Moral Character,” CF 1649, (June 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18941;

(g) A signed “Partnership Plan for Children in Out-of-Home Care,” CF-FSP 5226, (October 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18942, for staff employed in a caregiver role.

(h) Employee’s start and termination dates and reason for termination;

(i) Annual performance evaluations and any disciplinary actions taken;

(j) Training record and conferences attended;

(k) Signed acknowledgement of child abuse and neglect laws, reporting requirements, and confidentiality;

(l) Copy of any physical restraint certification(s) or training(s) completed, if applicable;

(m) Signed acknowledgement of review of discipline policies; and

(n) Copy of certification for completion of cardiopulmonary resuscitation (CPR) training.

(3) Personnel File Retention.

(a) The child-caring agency shall have written procedures which safeguard the confidentiality of the personnel records.

(b) The child-caring agency shall maintain the personnel file of an employee who leaves the facility for a period of five (5) years.

(4) Background Screenings.

(a) Direct and non-direct care staff must obtain the following background screenings when being considered for employment and for continued employment:

National criminal records check from the FBI through fingerprinting every five (5) years;
Statewide criminal records check from the FDLE through fingerprinting every five (5) years;
Juvenile records check through fingerprinting every five (5) years, as applicable;
Local criminal record checks through local law enforcement agencies every five (5) years;
Florida abuse and neglect records checks through the Department’s child abuse registry every 12 months;
National sex offender and predator check through the Dru Sjodin National Sex Offender Public Website every 12 months;
Civil court records checks regarding domestic violence complaints and orders of protection every 12 months; and
If the applicant has resided in any other state during the past five (5) years, requests for abuse and neglect histories must be made of those states, and the results of such requests included with the personnel file.

(b) Juvenile records checks through the Florida Department of Juvenile Justice for ages 12 to 17 of children of child-caring agency staff who reside in the group home.

(c) Any other adult household member residing in the group home will be required to meet the background screening requirements in the same manner as staff of the child-caring agency.

(d) The regional licensing team shall obtain records of any responses to the child-caring agency by law enforcement, every 12 months.

(e) Child-caring agencies must use the Department approved tool to account for the completion of background screenings for all employees, household members, and volunteers.

(f) All staff, household members, and volunteers being screened under this rule shall provide all names under which he or she has been known to complete background screenings.

(5) If the abuse and neglect record check request indicates the employee or prospective employee has an active or closed report, the child-caring agency shall request of the employee to obtain a copy of their report. The child-caring agency is responsible for reviewing the report and discussing any verified findings for abuse and neglect, or not substantiated for sexual abuse, with the prospective employee or those seeking continued employment.

(6) Any employee or prospective employee with a verified report for sexual abuse is not permitted to work in the child-caring agency. Any employee or prospective employee with a verified report for abuse and neglect other than sexual abuse, when an employee is named caregiver responsible in a report not substantiated for sexual abuse, and when staff are named in three or more child abuse and neglect investigations within a five year period pursuant to Section 39.302(7), F.S., shall be reviewed by the Department to determine safety concerns for the employee being considered for hire or continued employment.

(7) Applicants may be hired to work for the parent organization of the child-caring agency to begin pre-service and specialized training once confirmation that the out of state abuse and neglect history requests were made for individuals that resided out of state in the past five years and all background screenings in this paragraph are completed. The applicant shall not be hired to work in the child-caring agency or any program related to the child-caring agency, have contact with any child, and access to child files, until the results of the out of state abuse and neglect histories are received and included in the personnel file.

(8) The Department shall drug test a staff member if there are allegations or indications that he or she is using illegal substances.

(9) Qualifications.

(a) Child-caring agency personnel shall have the following qualifications:

Executive directors, shall have a master’s degree from an accredited college or university; or bachelor’s degree from an accredited college or university and at least three (3) years of experience in management or supervision; or five (5) years of experience in management or supervision and with at least two (2) of the five (5) years having experience in social services.
Program directors, or staff serving a similar function, who are responsible for supervising, evaluating, and monitoring the delivery of services within the child-caring agency and for supervising supervisors of direct care staff shall have a bachelor’s degree in social work or in a related area of study specified in Section 402.402(1)(b), F.S., from a college or university and four (4) years of experience working with children; or master’s degree from an accredited college or university and at least two (2) years of experience in social services.
Staff responsible for the supervision, evaluation, or monitoring of the direct care staff shall have a bachelor’s degree in social work or in a related area of study from an accredited college or university and at least two (2) years of experience working with children; or two (2) years of college and three (3) years of experience working with children; or at least five (5) years of experience working in child welfare without a post-secondary degree.
Staff who provide therapy to children and their families shall meet the qualifications as required in the “Agency for Health Care Administration, Community Behavioral Health Services Coverage and Limitations Handbook,” March 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13094.

(b) A child-caring agency shall not hire any individual who does not meet the criteria set forth in subparagraphs (9)(a)2. and 3. above, without the approval of the Department’s Regional licensing authority or designee. The Regional licensing authority or designee shall grant approval if the individual has relevant education, training, and experience in social services to substitute for the requirements set forth in subparagraphs (9)(a)2. and 3., above. The child-caring agency shall provide at least the following information in support of such approval:

Documentation of any post-secondary education completed by the person listing the person’s completed coursework, i.e. copy of official or unofficial transcript; and
Documentation of the individual’s relevant experience in social services, or coursework, or training in social services.

(c) No person who has served as a board member, executive director, or other officer of an agency that has failed to secure a license to operate as a child-caring agency or continued in operation after the revocation or suspension of the agency’s license shall be employed by or associated with a licensed child-caring agency for a period of two (2) years’ after termination or cessation of that illegal operation.

(10) Training.

(a) The child-caring agency shall have a training policy that outlines the plan for the orientation, ongoing training, and professional development of all staff members.

(b) Orientation. The child-caring agency shall provide an initial orientation for all new employees during the first two (2) weeks of their employment. This orientation shall include job responsibilities, agency administrative procedures, confidentiality, Health Insurance Portability and Accountability Act (HIPAA), program goals, agency purpose and objectives, resources and services, identification of and reporting responsibilities in regard to child abuse and neglect, and supervision of residents.

(c) Pre-Service Training. All direct care staff shall receive a minimum of 21 hours of caregiver preparation training prior to unsupervised contact with children. Topics shall include, but are not limited to:

Emergency and safety procedures;
Medication administration, including psychtropic medication as outlined in Rule 65C-35.014, F.A.C;
Communicable diseases;
Pool and water safety;
Reasonable and prudent parenting and normalcy for youth placed in a child-caring agency;
Role of staff as a team member in the development of service and or treatment plans, as applicable;
Transition, separation and loss, and attachment of youth in foster care;
Behavior management techniques, including crisis management and passive physical restraint;
Trauma-informed care, including recognizing the signs, symptoms, and triggers of trauma; and for maternity homes, the impact of trauma on the parent-child relationship;
Sexual abuse and interventions;
Human trafficking awareness;
The care of children at various developmental levels;
Multiethnic Placement Act (MEPA) and Americans with Disabilities Act (ADA);
Prevention of placement disruptions;
Adverse Childhood Experiences (ACE) and the impact of trauma and resilency; and
Restorative practices to strengthen and respond to conflict.
Missing children procedures in accordance with Rule 65C-30.019, F.A.C.

(d) In-Service Training. The child-caring agency shall ensure that direct care staff receive at least 40 hours of training activities after the first year of employment and every year thereafter. Activities related to supervision of the staff member’s routine tasks shall not be considered training activities for the purposes of this requirement. Topics shall include, but are not limited to:

Understanding of children’s emotional needs and problems which affect and inhibit their growth;
Family relationships and the impact of separation;
Substance abuse: recognition and prevention;
The care of children at various developmental levels;
Behavior management techniques, including crisis management and passive physical restraint;
Trauma-informed care, including recognizing the signs, symptoms, and triggers of trauma; and for maternity homes, the impact of trauma on the parent-child relationship; and
Preserving cultural connections in children.

(e) The child-caring agency shall submit training curriculums to the regional licensing team for approval.

Training curriculums shall:

a. Meet the conditions set forth in paragraphs (10)(b)-(d), above;

b. Outline the titles of the training topics;

c. Hours for each training;

d. Identify any internal trainings required by the child-caring agency; and

e. Method of delivery for each training.

The child-caring agency may use the same training approved by another contracted agency or accrediting body when the training topics are the same and meet the criteria.
The child-caring agency must submit the training curriculum(s) for review every seven years by the Department.

(f) Child-caring agencies that require specialized training for staff must be completed within two months from the completion of pre-service training. This does not apply to safe houses outlined in Rule 65C-46.020, F.A.C.

(g) The child-caring agency may accept the training hours of newly hired staff that complete training with another child-caring agency.

Training hours shall be reviewed and approved by the child-caring agency to ensure the trainings meet the agency’s program requirements and all licensing requirements outlined in paragraphs (10)(b)-(d), above and all specialized training in accordance with the child-caring agency’s license.
Staff that terminated employment prior to completing the in-service training must provide written confirmation that the pre-service training was completed in the past five (5) years.

(h) Child caring agencies who change license types, shall come into compliance with new training requirements within four (4) months of the new license being issued.

(11) Volunteers.

(a) A child-caring agency which utilizes volunteers to work directly with children shall:

Develop a description of duties and specific responsibilities; and
Develop a plan for the orientation and training in the philosophy of the child-caring agency, the needs of the children in care, and the needs of their families.

(b) Records shall be kept which document the hours and activities of volunteers.

(c) Volunteers who perform the same or substantially similar services for children as a paid employee shall have the same qualifications and training as the paid employee for the position and shall receive the same supervision and evaluation as the paid employee.

(d) Volunteers that have unsupervised contact with children will be required to meet the background screening requirements outlined in the same manner as direct care staff.

(e) Volunteers who have supervised contact with children for more than 10 hours per month will be required to meet the background screening requirements in the same manner as direct care staff.

(12) Staff Ratio.

(a) The child-caring agency shall develop policies and procedures for the supervision of children.

(b) The child-caring agency shall have staff coverage at all times to provide for the services identified in the agency’s statement of purpose.

(c) The child-caring agency shall develop and follow a written staff to child ratio formula. The formula shall be appropriate to the agency’s purpose and to the types, ages, and functioning levels of the children in care. The staff to child ratio shall assure the children’s safety, protection and privacy, as well as physical, hygienic, emotional and developmental needs. The staff to child ratio shall be at least:

One direct care staff member or trained volunteer to six (6) children, when children six (6) years of age or older are awake and one (1) to 12 when children are sleeping, or
Children under the age of six (6) shall be supervised by a staffing ratio of one (1) to four (4) when children are awake and one (1) to six (6) when children are sleeping.
For child-caring agencies that serve parenting young adults, the child of the young adult shall be counted in the staff to child ratio if the child is in the custody of the Department. The child of the young adult shall not be counted in the staff to child ratio if the child is in the custody of the young adult.
The child-caring agency shall designate a staff member on the premises when children are present in the home or expected to be present, and when children are or will be in need of supervision.
The child-caring agency shall have and follow a written plan to provide additional emergency staff when only one (1) staff member is on duty.
The child-caring agency shall count any children living with staff families in the child to staff ratio.
The child-caring agency shall provide supervision to each staff member working with children and parents.

History

Rulemaking Authority 409.145(4), 409.175(5), 435.01 FS. Law Implemented 409.175(5)(b)1., 4., 5., 7., 9., 435.05 FS. History–New 7-1-87, Formerly 10M-9.033, Amended 10-20-16, 5-26-21, Formerly 64C-14.023, Amended 10-24-21, 7-9-26.

Fla. Admin. Code R. 65C-46.012 Admission, Placement, and Ongoing Services

(1) The child-caring agency shall have written admission procedures which:

(a) Establish admission criteria which includes the ages of the children and young adults to be served;

(b) List the materials and forms required from the parent or guardian, or child-placing agency, and child; and,

(c) For runaway shelters, include written policies and procedures governing the conditions under which it will serve children without parental consent.

(2) The child-caring agency shall have written preplacement procedures which include a consideration of the needs of all children in the facility and professional staff expertise.

(3) All written admission and preplacement procedures shall be made available to the child, the child’s parent or guardian, the child-caring or child-placing agency and the Department.

(4) The admission of each child in the care and custody of the Department to a child-caring agency shall follow completion of a pre-admission study completed by the child-placing agency, and shall include the following:

(a) A determination that group care is appropriate for the child’s needs. This determination shall be based upon interviews with the child, parent or guardian, or other persons with relevant information.

(b) A determination that the child-caring agency proposed for placement can meet the child’s needs without negatively impacting the other children within the same facility or disrupting service milieu.

(d) A social history of the child, the child’s family, and any other information required by the child-caring agency.

(e) A written placement agreement signed by the parents or guardian, or agency having legal custody of the child admitted, including financial arrangements, and regulations and procedures designated to encourage and facilitate parental visitation.

(5) Each child shall be provided with a safe and appropriate placement free from harassment, mistreatment, or abuse. The placement shall be the most suitable in meeting the child’s individual needs.

(6) Age Differential.

(a) No child under the age of 10 years, or the age of enrollment in the fifth grade of school, shall be admitted to a child-caring agency.

(b) A child under the age of 10 years old may be placed in a child caring agency under the following situations:

When the comprehensive placement assessment and the multidisciplinary team (MDT) staffing recommend placement in a child-caring agency; and
When the child meets the eligibility requirements for admission into a child caring agency.

To prevent separation of a parenting young adult and child when placement in a maternity home is not feasible. If the parenting young adult and child are placed outside of a maternity home, the child-caring agency shall provide the services outlined in Rule 65C-46.017, F.A.C. The child of the parenting young adult must meet the eligbility requirements for admission into a child-caring ageny.
A non-dependent child meets the criteria for placement in an unaccompanied alien minor home, emergency shelter, or runaway shelter.

(d) An MDT staffing must occur and approve the placement for a child under the age of 10 prior to admission in each individual child-caring agency.

(e) A youth who turns 18 years old may remain in the child-caring agency if receiving services under the Department’s Extended Foster Care Program and Road to Independence Program. Young adults may continue room sharing arrangements until there is a disruption or transition, at which point the young adult can no longer share a room with a minor. Young adults residing in the child-caring agency are included in the overall capacity. All young adults age 18 and older residing in a licensed setting serving children under the age of 18 must comply with finger printing screenings and abuse check requirements pursuant to paragraph 65C-46.011(4)(a), F.A.C.

(f) The child-caring agency can not admit a young adult who is 18 years old upon admission unless they meet the requirements of the extended foster care program under Chapter 65C-41, F.A.C.

(7) Admission Orientation.

(a) The child-caring agency shall provide prior to or at admission an orientation to living in the facility for each child and the child’s parent or guardian or child-placing agency staff. The orientation shall include the following:

Rules of the facility;
Expectations for the caregivers;
Expectations for the child which include being respectful of others in the home regardless of differing cultural, religious, or ethnic values;
Services offered; and
Behavior management practices.

(b) The child-caring agency shall provide each child, the child’s parent or guardian, the child’s attorney and guardian ad litem, if appointed and requested, and the Department with written policies governing the care of children, including visitation and discipline policies.

(c) The child-caring agency shall have written policies that encourage and support family visits, mail, telephone calls, and other forms of communication with parents, relatives, friends or others with whom the child may have a significant relationship. A copy of the policies shall be provided to each child, the child’s parent or guardian, the child’s attorney and guardian ad litem, if appointed and requested, child-placing staff, and the Department.

(8) The child-caring agency shall have a written agreement or plan with the child and parent or guardian, and the Department or the licensed child-placing agency which describes the following:

(a) The frequency of contact with the child’s family and staff from the agency.

(b) A plan for sharing information about the child’s care and development with the parent or guardian, and the Department.

(d) Visitation plans for the child’s parent or guardian, agency or the Department.

(e) Provisions for service or treatment plan development and review.

(f) The conditions under which the child will be discharged from the program.

(g) A designation of responsibility for post-release services.

(9) The written agreement shall be kept in the child’s file and shall be available for review by the Department.

(10) A trauma-informed approach shall be used in all child-caring agencies.

(11) Each child’s needs and trauma history shall be considered when making roommate assignments.

(12) Service Plans.

(a) The child-caring agency shall initiate a written service plan within 14 business days of placement and must be completed by day 30 for each child admitted into care.

(b) Service plans shall outline details of the supports, activities, and resources required for the child to achieve individual goals. A service plan is not required if the child-caring agency develops a treatment plan.

(c) The service plan shall be developed with input from the child, child’s parents or guardian, child welfare professional, the child’s attorney and guardian ad litem, and other appointed representatives and a representative of the referring agency, if appropriate; and child-caring agency staff.

(d) The service plan shall include the following:

An assessment of the child’s and family’s needs, strengths, weaknesses, and problems;
An assessment of the child’s life skills; educational, vocational, recreational and physical and behavioral health needs; and a plan for meeting the child’s needs;
Arrangements for individual or group counseling, as needed; and,
A projection in regard to the child’s length of stay and an initial plan for discharge.

(e) The child-caring agency shall review each child’s service plan every 30 days.

(f) The child-caring agency shall update the service plan as needed or at least every six (6) months.

(g) The update shall involve the child, the facility staff members working directly with the child, the parent or guardian, and the child-placing agency or Department.

(h) At the time of the update, the service plan shall be revised to include the following:

Progress made toward achieving the goals established in the previous service plan.
Any changes in the service plan.
A projected date for the child’s release from care.

(13) Treatment Plans.

(a) Child-caring agencies responsible for developing treatment plans must complete written plans within 14 business days of placement for each child admitted into care.

(b) The treatment plan shall be developed with input from the child, child’s parent(s) or guardian, child welfare or community-based care case manager, foster parents, if applicable, child’s attorney, and guardian ad litem, if appointed, or any other party involved with the development of the plan.

Treatment goals;
Action steps which will be taken to accomplish identified goals;
Target dates for the accomplishment of action steps and goals;
A description of the services to be provided and the frequency of such services;
The assignment of a primary therapist or counselor;
The youth’s diagnosis, including diagnostic codes; and
Discharge criteria.

(d) The child-caring agency shall review each child’s treatment plan at least every 30 days. The review shall involve the child, the facility staff members working directly with the child, the parent or guardian, and the child-placing agency or Department.

(e) The treatment plan shall be updated as needed or at least every six (6) months.

(f) The treatment plan shall be reviewed and signed by the youth, if appropriate, and clinician and placed in the child’s file.

(14) Education and Vocational Requirements.

(a) Each child in residence shall attend school in accordance with Section 1003.21(1)(a), F.S. The child-caring agency shall plan jointly with school personnel and the parent or guardian or child-placing agency staff to place children in appropriate grades and classes and to help them make an adjustment to their school.

(b) Maintaining the child’s school stability while in out-of-home care in the school or educational setting the child attended prior to entry into the facility is first priority, unless remaining in the same school or educational setting is not in the best interest of the child for safety or other reasons as documented in the state’s official system of record. Children shall be encouraged to participate in afterschool clubs, sports, and other extracurricular activities.

(c) If an on-campus educational program is provided to resident children, the program shall be designed to meet the educational needs of each child. All on-campus educational programs must be accredited.

(15) If non-school age children are enrolled in child care, priority consideration for the choice of child care setting shall be chosen by the caregiver in the following order:

Gold Seal accredited child care providers or providers participating in a quality rating system,

Licensed child care providers,

Public school providers,

License exempt child care providers, including religious exempt, registered, and non-public schools.

(a) Child-caring agencies which provide therapeutic or psychiatric treatment programs shall integrate such programs with the child’s educational program.

(b) The child-caring agency shall encourage children of legal work age to find employment in the community in accordance with the service or treatment plan. The child welfare professional is responsible for ensuring the child’s transition plan is aligned with the child’s service or treatment plan. The child-caring agency shall ensure children have transportation to and from their employment.

(c) The child-caring agency shall encourage and assist children, as age-appropriate, to explore opportunities for higher education.

(d) The child-caring agency shall provide education and hands-on instruction in life skills which shall include the following:

Vocational exploration opportunities;
Problem solving and decision making;
Independent living skills;
Social skills;
Internet safety; and
In maternity homes, parenting skills and family planning.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5) FS. History–New 7-1-87, Formerly 10M-9.041, Amended 10-20-16, 5-26-21, Formerly 64C-14.040, Amended 7-27-22, 7-9-26.

Fla. Admin. Code R. 65C-46.013 Discharge Planning and Aftercare Services

(1) The child-caring agency shall have a written policy on discharge planning and aftercare services which shall specify the availability of services and identify the staff member or agency responsible for follow-up and implementation of the plan.

(2) A child may only be discharged to the parent, guardian or child-placing agency, unless the child-caring agency is otherwise directed by the court.

(3) The child-caring agency shall prepare a written discharge summary and document this in the child’s case record at least 45 calendar days prior to the projected date of release from the facility, unless the release is unplanned and unforeseen. A copy of the discharge summary shall be provided to the parent or guardian or referral agency at least seven (7) calendar days prior to the proposed release date, unless the release is unplanned and unforeseen.

(4) Discharge planning shall include input from the child, the child’s parent or guardian, foster parents, caregiver, Department, child’s attorney, and guardian ad litem, and a copy shall be provided to the child’s welfare professional.

(5) The discharge summary shall include the following:

(a) A copy of the discharge plan;

(b) A summary of services, an assessment of goal achievement, and identification of the needs which remain to be met;

(c) Recommendations for the child and family following release from care, including provisions for support and referrals;

(d) The date and reasons for release, the name, address, telephone number and relationship of the person or agency to whom the child is being discharged; and

(e) A copy of the child’s medical, dental, educational and other records for the use of the person or agency who will assume care of the child.

(6) A copy of the discharge summary shall be provided to the parent(s) or legal guardian, child’s attorney, and guardian ad litem.

(7) The child-caring agency shall have procedures for adequate follow-up or aftercare services. Aftercare plans shall, at minimum, reflect recommendations for services, where appropriate, and document any referrals generated, and include at least one (1) documented contact with the discharged child or his or her family within the first 30 days following discharge. Documentation shall be placed in the child’s file and made available to the Department or child welfare professional upon request.

(8) The child-caring agency shall consider evidenced-based prevention services as a component of aftercare, based on service availability.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)9. FS. History–New 7-1-87, Formerly 10M-9.049, Amended 10-20-16, 5-26-21, Formerly 64C-14.048.

Fla. Admin. Code R. 65C-46.014 Administrative Actions, Appeals and Closures

(1) General Information. The Department is the Regional Licensing Authority for all child-caring agencies and has final authority for approval, denial, revocation, or suspension of any license under Section 120, F.S.

(a) The denial, revocation, or suspension of a license shall be recorded in the state’s official system of record by the Regional Licensing Authority.

(b) The Regional Licensing Authority shall notify the community-based care (CBC) lead agency and contracted providers immediately of negative action taken regarding a license.

(2) Denial of Initial and Renewal Licensure Application.

(a) The Regional Licensing Authority shall have 90 days following receipt of a complete application packet to grant or deny the application in accordance with Section 120.60, F.S.

(c) The applicant shall be afforded the opportunity to withdraw the application. If the applicant elects to withdraw the application, this must be documented in the licensing file.

(3) Administrative Action for Existing Child-Caring Agencies.

(a) If a licensing violation requires the children to move out of the home or facility temporarily while the violation is remedied, then the license must be suspended.

(b) The Department shall consider the following factors when determining whether a child-caring agency’s license will be revoked:

Whether the agency has had licensing violations during the term of the license,
Whether the agency has a history of intakes, institutional abuse and neglect reports, and special condition referrals,
Whether the licensing violations compromise the safety or well-being of children,
Whether the agency can protect the children in care,
Whether the agency has failed to comply with a corrective action plan during the term of the license; and,
Whether the agency has the ability and willingness to implement a corrective action plan.

(4) Documentation Requirements Prior to Administrative Action.

(a) Before making a determination that a license shall be denied, suspended or revoked, the following shall be documented in the licensing file:

All qualifying abuse reports and all reports of licensing violations and the outcome of the investigation,
List of all deficiencies or conditions, other than abuse or neglect of the children, which compromise the safety or well-being of the children,
The length of time and frequency of the noncompliance with the licensing requirements or deficiencies in caring for children,
The date of written notification to the licensee as to the deficiency and time given to the licensee to correct the deficiency,
The Regional Licensing Authority’s, contracted providers, and/or CBC lead agency’s efforts to help the licensee come into compliance, and
Any barriers which prohibit the licensee from correcting the deficiencies.

(b) All documentation shall be reviewed with the Department’s legal counsel. The notice of revocation or denial shall not be sent to the child-caring agency without approval of the Department’s legal counsel and Regional Licensing Authority.

(5) The decision to revoke, suspend, or deny further licensure is made after a review is done in conjunction with the Department’s legal counsel. The notice must be delivered via personal service or certified mail. The notice shall include the statutory and rule violations that were found and advise of the action to be taken and the right to challenge the action through an administrative proceeding as provided in Chapter 120, F.S.

(6) Voluntary Closures.

(a) Child-caring agencies that close voluntarily, shall notify the Department in writing at least 30 calendar days prior to closing.

(b) All child-caring agencies that cease operation, for any reason, shall coordinate the following:

Transition of any children in its care to the applicable child-placing agency or to the Department; and,
Return of all open and closed records to the Department within 30 days of closure.

The reason for closure and whether re-licensing would be recommended,
Any reasons the child-caring agency would not be recommended,
If the closure is voluntary and in lieu of revocation or denial of a license, the concerns of the Department regarding the child-caring agency.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175(5)(b)1., (6), (9)(a) FS. History–New 10-20-16, Amended 7-6-21, Formerly 64C-14.116, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.0141 Corrective Action Plans

(1) A corrective action plan (CAP) must be imposed on the child-caring agency when a violation of licensing standards has occurred which do not pose an immediate threat to the health, safety, or welfare of the children, and the child-placing agency has the ability to understand and correct the infraction.

(2) Corrective action plans are not created for child-caring agencies who have previously committed licensing violations and were unable to benefit from the remedial efforts. The Department may seek action to revoke the license.

(3) The child-caring agency must submit a written CAP to the Department within seven calendar days from the date of receipt of the inspection. The CAP must be signed by the executive director or designee of the child-caring agency.

(a) The CAP must include the following:

Identify the violation;
The actions the child-caring agency will take to correct each of the violations identified;
The date by which the violation must be corrected; and
The actions the child-caring agency will take to ensure the violation identified does not occur again.

(b) The Department will reject any proposed CAP that fails to identify all the information described in paragraph (a) of this rule or reflects a plan of action that does not address the violation(s). If the Department rejects a proposed CAP, the Department must notify the child-caring agency in writing of the reasons for rejection and require the submission of an amended CAP addressing the deficiency or deficiencies within five calendar days of receipt of the Department’s notice rejecting the CAP. Failure to submit a CAP that is sufficient for Department approval within 30 days of the inspection completion date may be considered non-compliant and be subject to administrative action.

(5) The Department may deny, suspend, or revoke a license when the child-placing agency does not complete the CAP successfully.

History

Rulemaking Authority 409.175(5), FS. Law Implemented 409.175 FS. History–New 7-9-26.

Fla. Admin. Code R. 65C-46.015 Standards for Contracted Emergency Shelters

Child-caring agencies contracted to provide services as an emergency shelter shall comply with the licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the following program standards:

(1) There shall be communication access available to residents for making and receiving approved private calls. Restrictions on private calls shall be based on the effect of the call on the child, i.e. potential runaway, self-harming, or other destructive and unsafe behaviors, and any existing court orders regarding contact.

(2) All contracted emergency shelters shall be available for services on a 24-hour basis, 7 days a week.

(3) No contracted emergency shelters shall refuse to accept and provide care for children because of a minor illness or injury.

(4) A contracted emergency shelter staff member shall discuss program goals, available services, and rules governing conduct with each resident upon admission to the shelter. This discussion must be documented by a facility staff member on a form developed by each facility and stored in the child’s file. The employee and resident must sign the completed form. This requirement does not apply to resident infants or children who are not capable of understanding due to disability or stage of cognitive development.

(5) All contracted emergency shelters shall cooperate with child welfare professionals who place clients in a contracted shelter program by enrolling the children in school or by providing an educational component in the shelter.

(6) All contracted emergency shelters shall have on the premises individual records that identify if a child is placed through the child welfare system.

(7) All contracted emergency shelters shall provide 24 hour care and supervision.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 12-24-17, Amended 5-26-19, Formerly 64C-14.117.

Fla. Admin. Code R. 65C-46.016 Standards for Runaway Shelters

(1) Child-caring agencies who provide services as a runaway shelter shall comply with the licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C., in additon to the program standards outlined in this rule.

(a) All runaway shelters shall be available for services on a 24-hour basis, 7 days a week.

(b) A runaway shelter staff member shall discuss program goals, available services and rules governing conduct with each resident upon admission to the shelter. This discussion must be documented by a facility staff member on a form developed by the facility and stored in the youths file. The employee and resident must sign the completed form.

(c) There shall be communication access available to residents for making and receiving approved private calls. Restrictions on private calls shall be based on the effect of the call on the child, i.e. potential runaway, self-harming or other destructive and unsafe behaviors, and any existing court orders regarding contact.

(d) A runaway shelter’s client population will consist of those children who are in conflict with their parent(s) or legal guardian, or who have run away from other community placements.

(e) Runaway shelters that provide residential care to runaway children shall provide separate housing for persons age 18 and older.

(f) When a child is referred to a runaway shelter without the knowledge of Department or a child voluntarily requests placement, the runaway shelter staff will attempt to notify the child’s parents or legal guardian immediately. This procedure shall occur except in cases where there have been allegations of abuse or neglect by the parents. In these cases the runaway shelter shall contact the Department according to Section 39.201, F.S.

(g) Runaway shelters shall have a plan or procedure for assuring quality care to clients which includes professional review and monitoring of client assessments, service, and discharge planning.

(h) Runaway shelters shall provide 24-hour care and supervision.

(2) Client Rights and Service Expectations.

(a) Information about client rights shall be made available in a language which the client and the client’s parent or legal guardian can understand (i.e. sign language or in verbal or written form). The notice shall be in language that is clear and developmentally appropriate. It shall be prominently posted in areas frequented by clients and where they can read it without scrutiny.

(b) All runaway shelters shall have a written summary of client rights which is made available in the agency’s reception area and which is handed to clients during their initial contact with the agency.

Upon self-referral; and
Through referrals by the child welfare system, juvenile justice system, community mental health system, or community referral systems.

(d) All runaway shelters shall provide early intervention counseling services for troubled youth, runaway youth, and families with 24-hour access with emphasis toward crisis or time of need and shall include the following services:

Individual or group counseling, available daily, to each youth admitted into the shelter.
Family counseling available to each family whose child is admitted to the program on a residential or non-residential basis.
Weekly case management sessions, involving appropriate program staff, to review current cases and the types of counseling which are being provided.

(e) All runaway shelters shall inform clients of the basic expectations for clients using its services, the hours during which services are available, and any rules set by the agency covering client conduct with particular reference to any activity which could result in the discontinuation of services.

(f) All runaway shelters shall inform clients of any waiting period for service, the lack of a particular service, or of its determination that it cannot meet the clients needs and that service elsewhere would be more appropriate.

(g) All runaway shelters shall conduct service planning with the client’s full participation. The client shall be encouraged to retain as much responsibility as possible. The shelter shall make attempts to involve parents or legal guardians.

(3) Basic Service Requirements.

(a) All runaway shelters shall have an active outreach component which includes direct contact with the youth themselves, with law enforcement officials, youth workers, school and transportation personnel, child protective agencies, and others likely to encounter runaway or homeless youth.

(b) Within the first 24 hours of admittance into the shelter, a direct care staff member shall conduct an initial screening and initiate an individualized service plan for each client. This plan shall be reviewed by a supervisor within 72 hours.

(c) The initial screening shall include an assessment of immediate emergency needs, including food, housing, and clothing, and relevant family, social, emotional, educational, health, and employment history.

(d) Any child or young adult suspected of being sexually exploited or who meets the indicators listed in paragraphs 65C-43.001(1)(a)-(e), F.A.C., shall also be assessed using the “Human Trafficking Screening Tool Administration Guide (HTST),” CF-FSP 5406, February 2015, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-08852. A young adult is defined as someone who has reached 18 years of age but is not yet 23 years of age. The Human Trafficking Screening Tool shall be administered in accordance with Rule 65C-43.001, F.A.C.

(e) All runaway shelters shall provide a comprehensive, integrated program of crisis counseling with a range of counseling services which includes immediate crisis intervention, short-term counseling, and referrals to, or arrangements for, long-term treatment, when appropriate.

(f) A designated runaway shelter staff member shall be responsible for assuring continuity of care from emergency services and crisis counseling through the provisions for aftercare and follow-up.

(g) Runaway shelter staff with case management responsibility shall have the necessary skills to utilize community resources and maintain linkages and obtain services needed by the agency’s clients.

(h) A runaway shelter shall not deny emergency services to youth and their families due to their inability to pay.

(i) All runaway shelters shall provide for a 35 day maximum stay for runaway youth, and shall document in writing any exceptions. All exceptions shall be consistent with a runaway shelter’s policies and shall be monitored by clinical supervisory staff.

(4) Discharge Planning and Aftercare Services.

(a) Discharge planning shall include the consideration of a variety of alternative living arrangements, including return to family whenever possible, and when in the best interest of the youth; referral to long-term community-based residential facilities, or independent community living arrangements, including residence with friends, relatives, or others.

(b) Aftercare plans shall be developed under the direction of clinical supervisory staff and shall have the active participation of the client being served.

(c) Aftercare plans shall include referrals for ongoing individual or family counseling, and arrangements for services including education, career planning, and legal assistance, when appropriate.

(d) Plans for aftercare services shall clearly distinguish the different needs of runaway and homeless youth, and shall document individualized aftercare plans that are developed to meet those needs.

(e) All non-local youth shall be provided with referrals to appropriate services in the youth’s home area.

(f) All runaway shelters shall have procedures for adequate follow-up care and shall require at least one (1) contact with the discharged child or his or her family within the first 30 days following discharge.

(5) Confidentiality and File Requirements. The facility shall maintain an individual file on each youth admitted into the facility.

(a) The file on each youth shall include an intake form which contains basic background information, counseling notations, information on the services provided both directly and through referrals to community agencies and individuals, disposition data, and any follow-up and evaluation data which are compiled by the shelter.

(b) The file on each youth shall be maintained in a secure place and shall not be disclosed in part or in whole without the written permission of the client and parent(s) or legal guardian, except as allowed by law.

History

Rulemaking Authority 409.175(5), 409.441 FS. Law Implemented 409.175, 409.441 FS. History–New 12-24-17, Amended 5-26-21, Formerly 64C-14.118.

Fla. Admin. Code R. 65C-46.017 Standards for Maternity Homes

(1) The child-caring agency providing services for prenatal, post-partum or parenting youth must meet the licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the program standards outlined in this rule.

(2) Training. The child-caring agency shall ensure all direct care staff complete pre-service training requirements in paragraph 65C-46.011(9)(c), F.A.C. The pre-service training shall include an additional 20 hours related to the care of prenatal, postpartum, and parenting youth or young adults. Of the 40 hours of annual in-service training required in paragraph 65C-46.011(9)(d), F.A.C., eight hours shall be focused on prenatal care, postpartum, and parenting youth or young. Training topics shall include, but are not limited to:

(a) Mother/child health and development;

(b) Developmental stages, ages birth to five;

(d) Pregnancy and childbirth, basic infant care, and safety; and

(e) Parent and child relationships.

(3) The child-caring agency may utilize a shift or house parent staffing model.

(4) The child-caring agency may provide services to any youth who is pregnant or parenting, in addition to providing care for sibling groups of a youth who is pregnant or parenting.

(5) Basic Service Requirements. The child-caring agency shall offer the following services:

(a) Pre-natal and childbirth education;

(b) Parenting education to include safe and health parenting practices, child development of infants and toddlers, active and responsive caregiving, and emerging language and literacy;

(d) Individual/group/family counseling;

(e) Clinical services to address trauma, childhood sexual exploitation, trafficking, and the parent/child relationship; and

(f) Ongoing multi-disciplinary team staffing to determine appropriate placements, service needs, and support from community partners.

(6) The child-caring caring agency shall ensure youth acknowledge receipt of training for infant safety and care, infant water safety, nutrition for children ages zero (0) to five (5), and safe sleep practices. The acknowledgement shall be signed in placed in the youth’s file.

(7) The service plan shall outline details of the supports and resources to allow the pregnant or parenting youth to be successful with, but not limited to, school, employment, and providing for the care of their child.

(a) If the pregnant or parenting youth is under the care and supervision of the Department, the CBC shall provide a daycare referral to allow the young parent to attend school or employment. The child-caring agency must provide transportation to and from the daycare so the teen mother may attend school.

(b) The CBC shall collaborate with the child-caring agency to ensure the young parent has diapers, food, and clothing for their child.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.1181.

Fla. Admin. Code R. 65C-46.018 Standards for Wilderness Camps

(1) The child-caring agency providing 24-hour care to youth as a wilderness camp must meet the licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the program standards in this rule.

(2) Location.

(a) The location of a camp shall not present a fire, health, or safety hazard.

(b) A wilderness camp shall only be established at a location where land that does not have a surplus of water.

(3) Child-caring agencies shall provide each child with a closet or chest of drawers for clothing and personal belongings which shall be reserved for the individual child’s use or an alternative storage.

(4) Emergency Response and Prevention Plan.

(a) The child-caring agency shall have a system in place that provides for an immediate response in case of an emergency. The system must include the ability to immediately notify appropriate agency staff, police, fire department, physician, poison control center, ambulance, or other emergency services that may be needed.

(b) A travel plan shall be developed which includes an itinerary and a pre-established check-in time for any programs which are mobile in the wilderness. This plan shall be kept on file at the program’s office or left with a designated home base person.

(c) A pre-established emergency assistance plan shall be initiated upon the failure of a traveling group to meet the check-in time.

(5) A wilderness camp may utilize a shift or house parent staffing model.

(6) The child caring agency shall ensure staff receive program specific wilderness training to include topics such as safety, technical skills, leadership, and problem solving skills.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.1182.

Fla. Admin. Code R. 65C-46.019 Standards for At-Risk Houses

(1) The child-caring agency providing services for youth who are at risk of sex trafficking must meet the licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the program standards outlined in this rule.

(2) The child-caring agency may utilize a shift or house parent staffing model.

(3) The child-caring agency shall develop policies and procedures for all services provided, and home or facility security plans.

(4) Training.

(a) The child-caring agency shall ensure all direct care staff complete pre-service training requirements in paragraph 65C-46.011(9)(c), F.A.C., and receive an additional 12 hours of Department-approved, specialized training on human trafficking. The specialized training must be completed within two months from the completion of pre-service training. The 12-hour Department approved training on human trafficking shall be delivered by a trainer certified by the Department. Staff who complete pre-service training are permitted to have unsupervised contact with children during the completion of the specifialized training. Training topics shall include:

Pathways to entry and vulnerabilities;
Human trafficking and at-risk children;
Understanding the impact of trauma;
Essential service delivery and collaboration; and
Motivational Interviewing.

(b) The child-caring agency shall ensure there are available staff trained in a Department-approved human trafficking prevention education curriculum to facilitate to youth residing in the home.

(c) Of the 40 hours of annual in-service training required in paragraph 65C-46.011(9)(d), F.A.C., eight (8) hours shall be focused on human trafficking.

(5) Admission. Prior to admission, the child-caring agency shall ensure the child or youth meets criteria for “at risk of sex trafficking,” as defined in Rule 65C-46.001, F.A.C.

(6) Client Services. The child-caring agency must provide high-quality, supportive services for youth to include, but are not limited to:

(a) Family/group/individual counseling;

(b) Treatment and intervention for sexual assault, if applicable;

(d) Life skills;

(e) Vocational or educational supports;

(f) Discharge planning;

(g) Behavioral health care, if applicable;

(h) Mentoring; and

(i) Programming related to the prevention of sex-trafficking including healthy relationships, interpersonal boundaries, community engagement, etc.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.1183, Amended 7-27-22.

Fla. Admin. Code R. 65C-46.020 Standards for Safe Houses

(1) The child-caring agency providing services for commercially sexually exploited children (CSEC) must meet the licensing requirements set forth Rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the program requirements outlined in this rule.

(2) The child-caring agency shall submit the following documentation to the Department’s Licensing Authority for certification as a Safe House:

(a) “Application for Certification as a Safe Foster Home or Safe House,” CF-FSP 5403, February 2015, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13067;

(b) Facility’s security plan;

(d) Copy of supervision policies and procedures;

(e) Documentation of specialized training hours completed for all staff; and

(f) Documentation of compliance with the requirements applicable to safe houses set forth in Sections 409.1678(2)(c)-(d), F.S.

(3) The child-caring agency shall ensure all direct care staff complete pre-service training requirements in paragraph 65C-46.011(9)(c), F.A.C., and an additional 24-hours of specialized training in commercial sexual exploitation prior to unsupervised contact with youth. Specialized training requirements are outlined in subsection 65C-43.004(4), F.A.C. Staff must complete eight hours of continuing education annually focused on human trafficking.

(4) Appropriate Security. Individuals identified for the purpose of detecting human trafficking activity and part of the emergency response to search for missing children as outlined in s. 409.1678(2)(c), F.S., must meet the following criteria:

(a) Each child-caring agency shall have an employee, contracted individual, or law enforcement agency who is:

On-site during the evening hours between 7PM to 7AM, seven days a week, which must be outlined in their policies and procedures; and
Available 24-hours a day, seven days a week for response to search for missing children.

(b) Background Screenings and Trainings.

Hired Security: Shall complete background screening requirements outlined in subsection 65C-46.011(4), F.A.C., a Department approved training on missing children and personal security, and training requirements outlined in subsection 65C-46.020(3), F.A.C.
Contracted Security: Child-caring agencies that contract with an individual must ensure the individual:

a. Has two years of experience working in the field of law enforcement, military, or investigations, and

b. Met Level II background screening requirements under s. 435, F.S., and

c. Has received missing children and human trafficking training from the child-caring agency or as part of their prior experience in 2.a.

Law Enforcement Agency: A child-caring agency that contracts or executes a memorandum of understanding with a law enforcement agency for security shall not require additional trainings and background screenings.

(c) The child-caring agency must ensure completion of trainings and background screening are maintained in the personnel file for hired and contracted individuals.

(5) Policies and Procedures.

(a) The child-caring agency shall develop policies and procedures for all services and security plans that meet minimum standards as set forth in Section 409.1678(2), F.S., including an emergency response plan with local law enforcement agencies.

(b) Changes made to any policies and procedures shall be submitted to the Department’s Licensing Authority within 10 business days of the proposed change. Changes shall be reviewed prior to implementation to ensure they meet minimum standards as set forth in Section 409.1678(2), F.S.

(6) Safe House Tiers. The child-caring agency shall indicate in its policy if they will serve as a Tier 1 or Tier 2 safe house, with Tier 1 being least restrictive and Tier 2 being more restrictive.

(7) Admission and Discharge.

(a) The admission plan shall identify any exclusionary criteria and outline the intake and discharge procedures. This shall include criteria for requests for change of placement and early or unsuccessful discharge.

(b) Current or historical trauma-related behaviors and coping mechanisms, such as the following, should not be used as a reason to deny a placement request or discharge a youth, unless it can be determined that such behavior will create an imminent risk to the safety or stability of other residents in the home:

Running away;
Non-violent delinquent offenses (with consideration of violent offenses on a case-by-case basis);
Recruitment or similar behaviors;
Violent behaviors that do not pose an imminent risk to others;
Mental health diagnoses that do not require a higher level of care; or
Occasional substance abuse, separate from deep end substance abuse which places the child in imminent danger and requires detox.

(c) The child-caring agency shall outline in their program policy responses to behaviors, as mentioned in paragraph (7)(b) of this rule, that support and develop the child’s healthy recovery and resilience.

(d) Prior to a discharge determination, the child-caring agency shall complete a re-evaluation of the child’s service plan and multidisciplinary team staffing with the case management agency and community-based care’s human trafficking liaison.

(8) Ratio.

(a) The facility shall have at least one bedroom for every two children or young adults.

(b) There shall always be at least one direct care staff member to every four children or young adults.

(9) Client Services. The child-caring agency shall provide client services as outlined under Section 409.1678(2)(d), F.S.

History

Rulemaking Authority 409.1678(2)(c), (2)(e) FS. Law Implemented 409.1678 FS. History–New 1-12-16, Amended 10-24-19, Formerly 65C-43.003, Amended 5-26-21, Formerly 64C-14.119, Amended 7-27-22, 4-18-24.

Fla. Admin. Code R. 65C-46.021 Standards for Qualified Residential Treatment Program Credential

(1) Entities applying for a qualified residential treatment program credential to provide services for youth who have serious emotional or behavioral disorders or disturbances must meet the licensing requirements set forth in Section 394.875(2), F.S., and rule Chapter 65E-9, F.A.C., in addition to the program standards in this rule.

(2) The entity shall complete the “Application for Credential as a Qualified Residential Treatment Program” CF-FSP 5452, (October 2025), incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18943.

(3) The entity must provide a copy of their active state license issued by AHCA.

(4) Background Screening Requirements.

(a) All direct care staff employed by the entity must obtain the following background screenings:

National and statewide criminal records checks under Chapters 435 and 39, F.S., through fingerprinting every five (5) years;
Juvenile records check through fingerprinting every five (5) years as applicable;
Florida abuse and neglect records checks through the Department’s child abuse registry every 12 months; and
Out of state abuse history records check if the individual resided out of state in the past five years from the time of the request for a QRTP credential.

(b) Juvenile records checks through the Florida Department of Juvenile Justice for ages 12 to 17 of children of QRTP staff who reside in the group home.

(c) Any other adult household member residing in the group home will be required to meet the background screening requirements in the same manner as staff of the QRTP.

(5) File Requirements. The QRTP shall obtain a copy of the child’s suitability assessment, as defined in Rule 65C-28.021, F.A.C., and place in the child’s file. QRTPs serving non-dependency youth shall obtain a copy of an independent assessment confirming the child meets criteria to receive services in a qualified residential treatment program.

(6) The QRTP shall work in conjunction with the qualified evaluator conducting all assessments.

(7) Training. All staff must complete training in trauma-informed care. The QRTP must submit to the regional licensing authority a staff roster outlining the dates of completion for the trauma-informed care training.

(8) Staffing. The QRTP shall have registered or licensed nursing staff and other licensed clinical staff who are:

(a) On-site as outlined in the QRTP’s trauma informed treatment model;

(b) Available 24-hours a day, seven (7) days a week for response; and

(9) Accreditation. The QRTP must be accredited by any of the following organizations:

(a) Commission on Accreditation of Rehabilitation Facilities (CARF);

(b) The Joint Commission, formerly known as Joint Commission on Accreditation of Healthcare Organizations (JCAHO);

(d) Any other not-for-profit accrediting agency approved by the Office of Child Welfare (OCW).

(10) Basic Service Requirements.

(a) The QRTP shall develop a policy outlining the programs trauma-informed treatment model that addresses the clinical needs of children with emotional or behavioral disorders or disturbances and is able to implement the treatment identified for the child. The policy shall address the staffing requirements needed to implement the trauma-informed model.

(b) The QRTP must provide time-limited, high-quality, supportive services for youth including, but not limited to:

Substance abuse and mental health screening and treatment, if applicable;
Family/group/individual therapy;
Behavioral management;
Psychiatric services;
Support groups;
Specialized intervention services;
Social & rehabilitative services; and
Psycho-educational services.

(c) The QRTP shall facilitate participation of family members in the child’s treatment program including, but not limited to:

Inclusion in family therapy;
Outreach to family members, including siblings;
Documenting how family members are integrated into the treatment process for the child, including post-discharge; and
Documenting how sibling connections are maintained.

(d) The QRTP shall ensure the emotional safety and recovery are assessed and precautions are taken in regard to the safety of other children in the same setting.

(11) The QRTP is responsible for the development of treatment plans.

(12) Discharge and Aftercare Plan.

(a) The QRTP shall have and use on an ongoing basis a written procedure on discharge planning and aftercare supports that specifies the availability of services and the persons responsible for implementation of the aftercare supports.

(b) The QRTP shall provide discharge planning and family-based aftercare support for at least six (6) months post-discharge.

(c) Discharge planning shall include input from the child, the child’s parent or guardian, foster parents, caregiver, Department, and guardian ad litem, and a copy shall be provided to the child’s welfare professional.

(d) The child’s diagnosis shall be considered during discharge planning and development.

(e) Aftercare support plans shall be developed at least one month prior to discharge.

(f) Aftercare support shall be developed to meet the needs of a child with intent for the child to reside in the most appropriate, least restrictive setting.

(g) Aftercare Support Eligibility for Dependency Youth. Aftercare support must be offered to all children who have a suitability assessment and court order recommending placement in a QRTP setting. Aftercare support is not required for youth who discharge to another QRTP setting or higher level of care such as a Statewide In-Patient Psychiatric Program (SIPP).

(h) Aftercare Supports. The QRTP shall provide the following aftercare supports:

Community service coordination for the youth and their family/caregiver;
Ensure all service referrals have been linked and barriers to access services are eliminated;
Provide a minimum of two (2) contacts per month. While face to face contact is the preferred method for contact with the youth and family/caregiver, the QRTP may utilize telehealth;
Provide written progress reports every 30 calendar days to the youth’s child welfare professional.

(i) The QRTP may contract/sub-contract these or related services to a community provider qualified to provide such services.

(13) The QRTP must inform the DCF regional licensing authority within one (1) business day of any disciplinary actions executed by AHCA.

(14) Entities seeking a QRTP credential or entities issued a QRTP credential by the regional licensing authority are subject to requirements outlined in Rules 65C-46.014 and 65C-46.024, F.A.C.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.121, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.0211 Standards for Licensed Behavioral Qualified Residential Treatment Programs

(1) Each behavioral qualified residential treatment program (BQRTP) providing services for youth who have serious emotional or behavioral disorders or disturbances must meet the licensing requirements set forth in rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the program standards in this rule.

(2) File Requirements. Each BQRTP shall obtain a copy of all of the child’s assessments completed as outlined in 65C-28.021, F.A.C., and place it in the child’s file. Each BQRTP serving non-dependency youth shall obtain a copy of an independent assessment confirming the child meets criteria to receive services in a BQRTP.

(3) Each BQRTP shall work in conjunction with the qualified individual, as defined in Rule 65C-28.021, F.A.C., conducting all assessments.

(4) Training.

(a) Each BQRTP shall ensure all direct care staff complete pre-service training requirements in Rule 65C-46.011(9)(c), F.A.C., and receive an additional 24 hours of specialized training specific to the treatment of serious emotional or behavioral disorders or disturbances. Topics shall include the following:

Emotional disturbances in children and common behavioral problems exhibited;
Behavior management, theory, and skills;
Discipline, limit-setting, logical consequences, problem-solving, and relationship building skills;
Crisis intervention and emergency procedures;
Behaviors and emotional issues of children who have been sexually abused, are sexually reactive, or have developmental disabilities;
Working with biological or adoptive families;
Motivational Interviewing; and
Understanding the impact of trauma.

(b) Of the 40 hours of annual in-service training required in rule 65C-46.011(9)(d), F.A.C., eight (8) hours shall focus on the treatment of serious emotional or behavioral disorders or disturbances.

(5) Staffing.

(a) Each BQRTP shall have staff experienced in addressing maladaptive behaviors, registered or licensed nursing staff, and other licensed clinical staff who are:

On-site as outlined in the BQRTP’s trauma-informed treatment model;
Available 24-hours a day, seven (7) days a week for response; and
May be contracted providers.

(b) Each BQRTP may utilize a shift care staffing model or house parent model.

(6) Accreditation. Each BQRTP must be accredited by one of the following organizations:

(a) Commission on Accreditation of Rehabilitation Facilities (CARF);

(b) The Joint Commission;

(d) Any other not-for-profit accrediting agency approved by the Department.

(7) Admission.

(a) Each BQRTP shall develop an admission plan that outlines the intake procedures and

identifies exclusionary criteria.

(b) Children requiring services and treatment for acute emotional or behavioral disorders or disturbances outlined in s. 394.492(5) and (6), F.S., should be referred to a residential treatment center licensed under 65E-9, F.A.C.

(8) Basic Service Requirements.

(a) Each BQRTP shall develop a policy outlining the program’s trauma-informed treatment model that addresses the clinical needs of children with emotional or behavioral disorders or disturbances and is able to implement the treatment identified for the child. The policy shall address the staffing requirements needed to implement the trauma-informed model.

(b) Each BQRTP must provide time-limited, high-quality, supportive services for youth including:

Substance abuse and mental health screening and treatment, if applicable;
Family/group/individual therapy;
Behavioral management;
Psychiatric services;
Support groups;
Specialized intervention services;
Social & rehabilitative services; and
Psycho-educational services.

(c) Each BQRTP shall develop a policy outlining the requirement to facilitate participation of family members in the child’s treatment program including:

Inclusion in family therapy;
Outreach to family members, including siblings;
Documenting how family members are integrated into the treatment process for the child, including post-discharge; and
Documenting how sibling connections are maintained.

(d) Each BQRTP shall ensure that emotional safety and recovery are assessed, and precautions are taken in regard to the safety of other children in the same setting.

(9) Each BQRTP is responsible for the development of treatment plans as outlined in Rule 65C-46.012(13), F.A.C. Any BQRTP enrolled as a Medicaid provider, must complete treatment plans in accordance with Medicaid policy requirements.

(10) Discharge and Aftercare Plans.

(a) The provider shall have, and use on an ongoing basis, a written procedure on discharge planning and aftercare supports that specifies the availability of services and the persons responsible for implementation of the aftercare supports.

(b) Each BQRTP shall provide discharge planning and family-based aftercare support for at least six (6) months post-discharge.

(d) The child’s diagnosis(es) shall be considered during discharge planning and development.

(e) Aftercare support plans shall be developed at least one month prior to discharge.

(f) Aftercare support shall be developed to meet the needs of a child with intent for the child to reside in the most appropriate, least restrictive setting.

(g) Aftercare Support Eligibility for Dependency Youth. Aftercare support must be offered to all children placed in a BQRTP setting. Aftercare support is not required for youth who discharge to another BQRTP setting or higher level of care to include residential treatment programs, also known as Statewide Inpatient Psychiatric Program (SIPP), or a therapeutic group home which are defined in s. 39.407(6), F.S.

(h) Aftercare Supports. Each BQRTP shall provide the following aftercare supports:

Community service coordination for the youth and their family/caregiver;
Ensure all service referrals are linked and barriers to access services are eliminated;
Provide a minimum of two (2) contacts per month, with at least one face to face contact, with the youth and family/caregiver;
Provide written progress reports every 30 calendar days to the youth’s child welfare professional, if in foster care.

(i) When a youth is discharged to a placement setting outside a 50-mile radius of the provider, the BQRTP must coordinate aftercare support with the community-based care lead agency having jurisdiction of the youth. The community-based care lead agency shall resume responsibility for the aftercare support services provided to the dependency youth.

(j) Each BQRTP may contract/sub-contract with a community provider qualified to provide aftercare services.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 1-28-24.

Fla. Admin. Code R. 65C-46.022 Standards for Unaccompanied Alien Children (UAC) Homes and Unaccompanied Refugee Minor Programs

(1) The child-caring agency providing services for unaccompanied minor children (UAC) must meet the licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C., in addition to the program standards in this rule.

(2) The child-caring agency shall ensure a contractual or grant agreement was executed with the Office of Refugee and Resettlement (ORR) in order to provide care and services to unaccompanied and/or undocumented minor children.

(3) The child-caring agency shall ensure all direct care staff complete training hours on immigration in child welfare, cultural awareness, and human trafficking related topics, as outlined in the Section 4.3.6. of the Office of Refugee and Resettlement (ORR) UAC Program Policy, March 11, 2019, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13072.

(4) The child-caring agency providing care to unaccompanied children shall not provide care to dependent youth in the same home or under the same license.

(5) The child-caring agency may utilize a shift care or house parent staffing model.

(6) The director and direct care staff shall sign the “Partnership Plan for Unaccompanied Alien and Refugee Minor Children” form, CF-FSP 5446, Apr 2021, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-13069.

(7) The child-caring agency shall provide a copy of their education plan outlining how education will be provided for youth.

(8) The child-caring agency shall notify the Department of any changes in the contract/grant agreement, and submit an updated copy, to include ORR’s decision to no longer utilize the facility.

(9) Record retention of child files shall be relinquished to the ORR when the child-caring agency no longer selects to maintain a license.

(10) Incident reports shall be available to the licensing Department upon request.

(11) The child-caring agency must develop policies and procedures on the administration and management of medication. A licensed health care provider must write or verbally order all nonprescription medications. Verbal orders must be documented in the child’s file. The child-caring agency must align all health and safety policies with guidelines of the Office of Refugee Resettlement located at Health and Safety The Administration for Children and Families (hhs.gov).

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.122.

Fla. Admin. Code R. 65C-46.023 Standards for Traditional and Residential Homes

(1) The child-caring agency licensed as a traditional group home, as defined in Rule 65C-46.001, F.A.C., or residential group home, as defined in Rule 65C-46.001, F.A.C., and serving non-dependency youth must meet licensing requirements set forth in Rules 65C-46.001 through 65C-46.014, F.A.C.

(2) Children and youth placed in out-of-home care must have a Comprehensive Placement Assessment that recommends placement in a group care setting/program that has been identified but is unavailable at the time of placement.

(3) Requirements for Serving Youth Entering Out-of-Home Care.

(a) Transition planning shall be initiated 48 hours after placement.

(b) The child-caring agency shall collaborate with the child welfare professional to provide and/or assist with the following services:

Coordination of assessments including, but not limited to, suitability assessments, Early and Periodic Screening Diagnostic and Treatment (EPSDT), or assessments of preliminary mental and/or behavioral health needs.
Coordinate referrals to and arrangements for continued services in a least restrictive setting.
Assess family connections/relationships to assist with family finding efforts.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.123, Amended 7-9-26.

Fla. Admin. Code R. 65C-46.024 Licensing Process and Procedures

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 5-26-21, Formerly 64C-14.124, Repealed 7-27-22.

Fla. Admin. Code R. 65C-46.025 Foster Care Referrals and Investigations

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 7-6-21, Formerly 64C-14.125, Repealed 7-27-22.

Fla. Admin. Code R. 65C-46.026 Standards for Physically Secure Shelter

(1) Child-caring agencies providing services as a physically secure shelter to children adjudicated as a child in need of services as defined in Section 984.03, F.S., shall comply with the licensing requirements set forth in Rules 65C-46.001 through 65C-46.0141, F.A.C., in addition to the program requirements outlined in this rule.

(2) Each child-caring agency shall submit a copy of an executed contractual agreement with the Department of Juvenile Justice prior to initiating licensure as a physically secure shelter. The child-caring agency may submit an award from the Department of Juvenile Justice to begin licensure and shall submit the executed contract no later than seven business days from issuance of a license.

(3) Admission and Discharge.

(a) Each child admitted to the child-caring agency shall be court ordered into the physically secure shelter pursuant to Section 984.226, F.S.

A copy of the court order must be placed in the child’s file.
The child-caring agency may accept children under the age of 10 if the court orders placement of the child in the physically secure shelter.

(b) The child-caring agency shall maintain a waitlist that must be submitted to the Department and the Department of Juvenile Justice upon request. The waitlist shall outline:

Child’s name, date of birth, address of residence,
Judicial Circuit with jurisdiction of the child in need of services,
Name of the referring individual, agency, email, and phone number,
Date of referral, and
Outcome of referral and date outcome was rendered.

The child-caring agency shall participate in the multidisciplinary team staffing in accordance with Rule 65C-30.023, F.A.C., when a child is transferred to the custody of the Department pursuant to Chapter 984, F.S.
The child-caring agency shall prepare for and coordinate the child’s discharge from the physically secure shelter within 24 hours of the court ordering the child’s transfer to the custody of the Department, and in alignment with Social Security Act 471(a)(37).

(4) Client Services. The child-caring agency shall provide the following services for children based on the assessment completed at admission and services ordered by the courts:

(a) Family and individual counseling;

(b) Substance abuse and mental health screening;

(d) Behavioral health care with a focus on trauma informed care.

(5) Training.

(a) The child-caring agency shall ensure all direct care staff complete pre-service training requirements in paragraph 65C-46.011(10)(c), F.A.C., and receive an additional 12 hours of Department-approved, specialized training on behaviors and trauma. The specialized training must be completed within two months from the completion of pre-service training. Staff who complete pre-service training are permitted to have unsupervised contact with children during the completion of the specialized training. Training topics shall include:

Emotional disturbance in children and common behavioral problems exhibited;
Suicide awareness and prevention;
Discipline, limit-setting, logical consequences, problem-solving, and relationship-building skills;
Crisis intervention and emergency procedures;
Mental health and substance abuse;
Trauma response practices.

(b) Of the 40 hours of annual in-service training required in paragraph 65C-46.011(10)(d), F.A.C., eight hours shall be focused on behaviors and trauma.

(c) Staff conducting youth searches required in subsection 65C-46.026(8), F.A.C., shall complete training on how to conduct a frisk.

(6) Ratio and Supervision.

(a) The child-caring agency shall have at least one bedroom for every two children.

(b) There shall always be at least one direct care staff member to every four children.

(d) Staff shall account for the whereabouts of children under their supervision at all times. Staff shall conduct and document resident counts minimally at the beginning of each shift, after each outdoor activity, and during any emergency and elopement.

(e) The child-caring agency shall track daily census to include, at a minimum, the total daily census count, new admissions, releases or direct discharges, transfers, and children temporarily away from the program.

(f) If at any time the child-caring agency cannot account for any child’s whereabouts or discrepancies are found between resident counts and the tracking of daily census, staff shall reconcile immediately and take follow-up action as outlined in the child-caring agency’s procedures for missing children.

(g) The child-caring agency shall ensure that staff observe children at least every hour while they are in their bedroom, either during sleep time or at other times, such as during an illness or room restriction. Staff shall conduct the observations in a manner to ensure the safety and security of each child and shall document real-time observations manually or electronically.

(7) Physical Security Features.

(a) The child-caring agency shall provide physical security features that are environmentally secure, staff secure, and hardware-secure with locking doors. The child-caring agency may use walls and fencing as additional hardware features if the child-caring agency is the only home or facility located on the premises. Child-caring agencies shall not use walls and fencing as the feature for security if there are other licensed homes or facilities on the premises.

(b) Each child-caring agency shall have the following features:

Electronic search equipment,
Door locks on entry, exit, and passage doors, with a manual override capability if locks are electronic,
Secure windows of break-resistant or screened glass, or secured through alarms,
Camera surveillance system,
Exterior security lighting, and
Radio or cellular phone communication devices for staff.

(8) Youth Searches.

(a) The child-caring agency shall complete a screening to search the child and the child’s belongings at admission to the program, when returning from outings, and when there are concerns for the safety and well-being of the child in the shelter.

(b) Authorized staff conducting a screening shall prepare the children by explaining the purpose of the search and what it entails. Staff shall not use physical force on children and shall treat the child with dignity and respect to minimize the child’s stress and embarrassment.

(c) Frisk searches shall be conducted outside the child’s clothing by a single staff member of the same sex. The single staff member must be supervised by an additional staff member of the same sex. All frisk searches shall be documented on a tracking log and placed in the child’s file.

(d) Use of electronic search equipment is authorized to supplement any frisk search authorized in this rule section. A single staff member may conduct electronic searches on a child of the opposite sex. The single staff member must be supervised by an additional staff member of the same or opposite sex. All electronic searches shall be documented on a tracking log and placed in the child’s file.

(9) Audio or Video Recordings.

(a) Each child-caring agency that has any on-site video or audio system with recording capability shall maintain at least a 90-day history of recordings unless the equipment does not have the capacity to maintain a 90-day history, in which case the program shall maintain the recordings to the extent of the equipment’s capacity, but no less than 30 days. Recording shall be made available to the Department and Department of Juvenile Justice upon request.

(b) The child-caring agency shall not place video or audio in bedrooms or bathrooms.

(10) Key Control. Each child-caring agency shall establish a key control system that, at a minimum, addresses the following:

(a) Key assignment and usage, including restrictions on usage;

(b) Inventory and tracking of keys;

(d) Procedures addressing missing or lost keys; and

(e) Reporting and replacement of damaged keys.

(11) Contraband. The child-caring agency shall develop a policy and procedure for contraband. The policy and procedure shall address the following areas:

(a) Illegal Contraband: At no time shall illegal contraband and prohibited items, as defined in Section 985.711, F.S., be allowed in the child-caring agency. The policy and procedure shall address the requirements of and limitations on staff use of provider issued cellular phones or portable communication devices, with documentation maintained designating the allowable device type as issued to the specific staff member. The policy and procedure may allow specified staff, medical and mental health personnel, school board personnel, vocational education personnel, emergency services personnel, and designated subcontracted staff to possess a non-facility-issued cellular phone or portable communication device for work purposes only.

(b) The child-caring agency shall develop a process for documenting contraband incidents, searches, and the result of each search. Any item or situation that may compromise safety or security shall be reported immediately to the program director or designee. Programs shall ensure that a staff member is designated for this purpose 24 hours per day, seven days a week.

(12) Elopements. The child-caring agency shall follow the Department’s missing child procedures outlined in Rule 65C-30.019, F.A.C.

(13) Visitation.

(a) The child-caring agency shall develop visitation procedures that must be reviewed with the child upon placement in the physically secure shelter. The procedures must include the requirement for visitors to provide identification and refrain from bringing contraband and phones into the facility. The Department and the Department of Juvenile Justice are exempt from the visitor procedures.

(b) The child-caring agency shall maintain a visitation log for each child that is placed in the child’s file.

History

Rulemaking Authority 409.175(5) FS. Law Implemented 409.175 FS. History–New 3-19-26.

Division 65E Mental Health Program

Chapter 65E-4 COMMUNITY MENTAL HEALTH REGULATION

Fla. Admin. Code R. 65E-4.014 Standards for Client Records, Treatment and Quality Assurance

History

Rulemaking Authority 394.78 FS. Law Implemented 394.4573, 394.75, 394.78 FS. History–New 11-3-82, Formerly 10E-4.14, Amended 4-20-89, 5-23-96, Formerly 10E-4.014, Amended 12-20-98, Repealed 6-19-25.

Fla. Admin. Code R. 65E-4.016 Mental Health Residential Treatment Facilities

(1) Licensure of Mental Health Residential Treatment Facilities. To be licensed as a mental health residential treatment facility an applicant must provide a long term, homelike residential environment that provides care, support, assistance and limited supervision in daily living to adults diagnosed with a serious and persistent major mental illness who do not have another primary residence.

(a) Residential treatment facilities that primarily provide treatment for substance use are excluded from licensure under this rule.

(b) Short-term residential treatment facilites, regulated under Chapter 65E-12, F.A.C., are excluded from this rule chapter.

(2) Definitions. The definitions provided in this section are limited to this rule 65E-4.016, F.A.C.

(a) “AHCA” means the Agency for Health Care Administration.

(b) “Apartment” means a self-contained dwelling unit with kitchen and bathing facilities and living, dining and sleeping space for use by one to four residents who maintain a common household.

(c) “Business Day” means a day in which the Department’s Office of Substance Abuse and Mental Health is operating for business Monday through Friday between 8:00 a.m. and 5:00 p.m. (Eastern Standard Time).

(d) “Governing Board” means the individual or individuals responsible for and having authority for the policies, bylaws, operations, and standards of service and activities of the residential treatment facility. If the facility is operated by an organization that delivers comprehensive mental health services, the governing body of such organization shall be considered the facility’s governing board. If the facility is owned by a partnership or single owner, the partners or single owner shall be regarded as the facility’s governing board.

(e) "Licensed Medical Practitioner" means a medical provider who is a physician licensed under Chapter 458 or Chapter 459, F.S., or an advanced practice registered nurse or physician assistant who works under the supervision of a licensed physician and an established protocol pursuant to Sections 458.347, 458.348, 464.003, and 464.0123, F.S.

(f) “Medication Administration” means opening a container of medication, removing a prescribed dosage, and giving the medication to the person for whom it is prescribed. This includes administering injections and eyedrops.

(g) “Medication Supervision” means activities which assist an individual to self-medicate. These activities include prompting a resident to take medication, opening containers and reading labels to the resident, and checking the self-administered dosage against the label of the container.

(h) “Mental Illness” as defined in Section 394.455, F.S.

(i) “Office of Health Facility Regulation” means the AHCA program responsible for receiving license applications, coordinating licensure survey activities and issuing or denying the license.

(j) “Physician” means a person licensed to practice medicine or osteopathic medicine in Florida as defined in Section 394.455, F.S.

(k) “Peer Review” means the review of a staff member’s professional work by comparably trained and qualified individuals performing similar tasks.

(l) “Quality Assurance Program” means a systematic approach designed to evaluate the quality of care provided by an agency and to promote and maintain efficient and effective mental health services, as defined in Section 394.67, F.S.

(m) “Rehabilitation” means an educationally based process which provides the opportunities for mentally ill persons to attain the physical, emotional and intellectual skills needed to live, learn, work or socialize in their own particular environments. The process includes developing the resources needed to support or strengthen their level of functioning in these environments.

(n) “Resident” means any individual 18 years of age or older receiving services in any mental health residential treatment facility, program or service.

(o) “Residential Treatment Facility (RTF or facility),” as defined in Section 394.67, F.S.

(p) “Restraint” as defined in Section 394.455, F.S.

(q) “Seclusion” as defined in Section 394.455, F.S.

(r) “Self-Preservation” means the ability of a person to perceive danger and take appropriate action to keep safe from injury.

(s) “Treatment” means services which are provided to persons, individually or in groups, which include rehabilitation, counseling, supportive therapy, chemotherapy, psychotherapy or any other accepted therapeutic, educational or supportive process.

(t) “Utilization Review” means the process of using predefined criteria to evaluate the necessity and appropriateness of services and allocated resources to assure that the program’s services are necessary, cost effective and effectively utilized.

(3) Licensure Procedure. Every RTF is required to obtain a license from AHCA unless specifically excluded from licensure under the provisions of Section 394.875, F.S. All applicants for licensure must comply with the requirements of Chapter 394, Part IV, F.S.

(a) Buildings that are separated from one another in which a similar level of residential care and treatment is provided, as defined in this rule may be licensed as one facility under the following circumstances:

Such buildings are not separated by another building, part of a building or buildings used for other purposes; and
Such buildings are not separated by obstructions that impede the rapid movement of staff between them.

(b) When different levels of residential care and treatment are provided in one building, each level must be licensed as a separate RTF.

(c) The application for licensure, AHCA Form, 3180-5005, “Health Care Licensing Application, Residential Treatment Facility,” is incorporated by reference in Rule 59A-35.060, F.A.C.

Each RTF shall maintain a program narrative which contains the following:

a. List of services provided, including a description of each service;

b. Staffing pattern description, including the hours and days of on-premises and on-call staff coverage, and the number and types of staff on duty for each shift; and

c. Resident population description, that are applicable to the level of RTF for which the licensure application is being submitted.

Each RTF shall maintain Proof of liability insurance coverage from a licensed insurer in an amount not less than $300,000 per occurrence with a minimal annual aggregate of not less than $1,000,000.

(d) The license shall be displayed in a conspicuous location inside the facility. For Levels III, IV, and V such license may be held available for inspection at the administrative offices of the facility or the organization which operates the facility.

(4) Residential Treatment Facility Licensure Classifications.

(a) Level IA. A Level IA facility provides a structured group treatment setting with 24 hours per day, seven days per week supervision for residents who have major skill deficits in activities of daily living and independent living, and are in need of intensive staff supervision, support and assistance. Nursing services are provided on this level but are limited to medication administration, monitoring vital signs, first aid, and individual assistance with ambulation, bathing, dressing, eating and grooming.

Resident Eligibility Criteria. Persons who enter Level I facilities must meet the following minimum criteria:

a. Diagnosed as having mental illness;

b. Age 18 or older;

c. Ambulatory or capable of self-transfer;

d. Able to participate in treatment programming and services;

e. Free of major medical conditions requiring ongoing 24 hours per day, 7 days per week nursing services;

f. Assessed as having the potential, with staff supervision, to self-administer medication, maintain personal hygiene, and participate in social interaction; and

g. Does not exhibit chronic inappropriate behavior which disrupts the facility’s activities or is harmful to self or others.

Staffing Pattern. Level IA facilities must maintain a minimum of 1-10 staff to resident ratio with never less than two staff on the premises at all times. There must be 24 hours per day, seven days per week nursing supervision, provided minimally by a licensed practical nurse under the direction of an on-call licensed medical practitioner or registered nurse.

(b) Level IB. Level IB facilities shall meet all Level IA criteria with the exception of fire safety requirements. Level IB fire safety requirements are specified in sub-subparagraph 65E-4.016(17)(b)2.a., F.A.C.

(c) Level II. A Level II facility provides a structured group treatment setting with 24 hour per day, seven days per week supervision for five or more residents who range from those who have significant deficits in independent living skills and need extensive supervision, support and assistance to those who have achieved a limited capacity for independent living, but who require frequent supervision, support and assistance.

Resident Eligibility Criteria. A person who enters Level II facilities, in addition to meeting the eligibility criteria specified in Level I, must meet the following criteria:

a. Self-administers medication with staff supervision;

b. Maintains personal hygiene and grooming with staff supervision;

c. Initiates and participates in social interaction with staff supervision;

d. Performs assigned household chores with staff supervision; and

e. Is capable of self-preservation in accordance with subparagraph 65E-4.016(17)(b)2., F.A.C.

Staffing Pattern. Level II facilities must maintain a minimum of 1-15 staff to resident ratio with never less than one staff on the premises when residents are present during normal waking hours. During normal sleeping hours, a minimum of 1-22 staff to resident ratio is required. The facility must have procedures to mobilize additional staff 24 hours daily in the event of emergency need.

(d) Level III. A Level III facility consists of collocated apartment units with an apartment or office for staff who provide on-site assistance 24 hours per day, seven days per week. The facility may be comprised of a block of apartments within a large apartment complex. The residents served in this facility have a moderate capacity for independent living.

Resident Eligibility Criteria. A person who enters Level III facilities, in addition to meeting the criteria specified in Levels I and II, must meet the following criteria:

a. Self-administers and monitors own medication with minimal prompting;

b. Performs household chores with minimal prompting;

c. Maintains personal hygiene and grooming with minimal prompting;

d. Utilizes recreational and social resources with staff encouragement;

e. Utilizes community transportation systems;

f. Manages income with assistance; and

g. Expresses problems and concerns to appropriate persons.

Staffing Pattern. Level III facilities must maintain a minimum 1-20 staff to resident ratio with never less than one staff on the premises when residents are present during normal waking hours. During normal sleeping hours, a minimum of 1-40 staff to resident ratio is required. The facility must have procedures to mobilize additional staff 24 hours daily in the event of emergency need.

(e) Level IV. A Level IV facility provides a semi-independent, minimally structured group setting for four or more residents who have attained most of the skills required for independent living and require minimal staff support.

Resident Eligibility Criteria. A person who enters Level IV facilities, in addition to meeting the eligibility criteria specified in Levels I, II and III, must demonstrate proficiency in performing at least the following skills without daily supervision:

a. Self-administers and monitors own medications;

b. Performs household chores and activities;

c. Maintains personal hygiene and grooming;

d. Manages income;

e. Utilizes recreational and social resources;

f. Procures food and other items necessary to maintain a household;

g. Prepares meals either individually or cooperatively; and

h. Utilizes community transportation systems.

Staffing Pattern. Level IV facilities staff shall be on-premises each business day during the hours established by the governing board and shall have a minimum of weekly on-premises contacts with residents. A facility administrator or supervisor must be on-call after business hours and on weekends (on-call staff are persons trained to manage the on-call needs of the individuals served).

(f) Level V. A Level V facility provides a semi-independent, minimally structured apartment setting for one to four residents who have attained adequate independent living skills and require minimal staff support. The apartments in this setting are owned or leased by the service provider and rented to residents. All residential units within a campus on this level that are operated by a service provider, shall be considered the premises of the facility.

Resident Eligibility Criteria. Persons who enter Level V facilities, in addition to meeting the eligibility criteria specified in Levels I, II and III, must demonstrate proficiency in performing at least the following skills:

a. Self-administers and monitors own medications;

b. Performs household chores and activities;

c. Maintains personal hygiene and grooming;

d. Manages income;

e. Utilizes recreational and social resources;

f. Procures food and other items necessary to maintain a household;

g. Prepares meals either individually or cooperatively; and

h. Utilizes community transportation system.

Staffing Pattern. Level V facilities staff shall be on-premises each business day during the hours established by the governing board and shall have a minimum of weekly on-premises contacts with residents. A facility administrator or supervisor must be on-call after business hours and on weekends (on-call staff are persons trained to manage the on-call needs of the individuals served).

(5) Organization and Administration.

(a) Governing Board Responsibilities. The governing board of each RTF shall be responsible for policies, by-laws, operations and standards of service.

(b) Administrative Management.

Each RTF Level I, II, and III shall have an administrator who is responsible for its daily operations.
RTFs shall comply with Chapter 394, F.S., and all other applicable Florida Statutes; all applicable sections of Chapters 65E-4 and 65E-14, F.A.C.; and all other applicable rules of the Florida Administrative Code.
RTFs shall develop and maintain all records required by Chapter 394, F.S., and applicable administrative rules.

Personnel policies and procedures shall be developed and provided to each employee.
There shall be a written description for each position in the facility. Position descriptions shall include the following:

a. Functions;

b. Responsibilities;

c. Supervision; and

d. Minimum academic and experience requirements.

Confidential personnel records shall be maintained for each employee of the residential program. These records shall contain the following information:

a. Qualifications for the position;

b. Verified pre-employment references;

c. Evaluation of performance on at least an annual basis;

d. Dates and subjects of in-service training and attendance at conferences, workshops and other relevant activities;

e. Beginning date of employment; and

f. Date and reason for separations.

Each RTF shall post a weekly schedule of work hours.
The facility’s personnel recruitment and selection process shall ensure that there is no discrimination prohibited by state or federal law.
The RTF shall make available to employees a written orientation to the program’s operation, a copy of their current job description, a copy of this rule and a copy of patient’s rights as established in s. 394.459, F.S. The receipt or availability of this information shall be documented in personnel records.

(d) Staff Composition, Organization and Coverage.

Organization. RTFs shall have a written organizational plan for the administrative and direct services staff which clearly explains the responsibilities of the staff for services provided by the program. The plan shall also include lines of authority, accountability and communication.
RTFs shall have direct or telephone access to at least one qualified professional as defined in Section 394.455, F.S., 24 hours a day, seven days a week. If the professional is not a psychiatrist or psychiatric nurse, the facility shall also arrange for the regular, consultative and emergency services of a psychiatrist or psychiatric nurse licensed to practice in Florida. Back-up coverage shall be provided by staff trained to handle acute problems on a 24 hours per day, seven days per week on-call basis.
Staff Development. Staff development and education programs shall be planned and conducted on a regular and continuing basis. Documentation of these sessions shall include date, subject, attendance and instructor. Attendance at professional workshops and conferences should also be documented and placed in employees’ personnel records.

(6) Resident Eligibility Criteria. Eligibility criteria may be developed if such criteria are needed to ensure that individual’s admitted by the facility are compatible with the facility’s capability to serve them, or to further delineate the minimum skills or behaviors that a person needs to function in the facility’s environment. The RTF shall maintain policies and procedures to screen individuals at risk for suicide attempt or threats, intentional self injury, homicide, and aggressive behavior. Policies and procedures shall include appropriate response to suicidal thoughts and behaviors, de-escalation practices, and maintain the safety of residents from other residents.

(7) Intake. The intake criteria specified in this subsection shall apply to either a freestanding RTF or to one which first admits a resident if such RTF is part of a system of residential care and treatment. The following assessment and evaluation information shall be obtained or developed by the RTF in order to determine a resident’s eligibility.

(a) Physical Assessment.

For each resident accepted into a facility from a state institution, a medical summary consisting of a problem list, current status, significant lab reports and a copy of the most recent physical examination shall have preceded the resident to the program. The medical summary shall be placed in the resident’s record.
If a physical examination has not been completed within 60 days prior to the resident’s admission to the RTF, the examination shall be initiated within 24 hours of the admission. A licensed medical practitioner shall complete the examination within 30 days. The physical examination shall be placed in the resident’s record.
Physical examination requirements shall include:

a. A medical history, including responses to medication, physical diseases and physical limitations;

b. The date of the last physical examination;

c. A description of physical status, including diagnosis and any functional limitation;

d. Recommendations for care, including medication, diet and therapy; and

e. To the extent possible, a determination of the presence of a communicable disease.

(b) Psychiatric or psychological assessment.

Developmental problems, including past experiences that may have affected development;
Peer group relationships and activities;
Social skills and deficits;
Past and present relationship with family and community;
Prior placement settings;
Recreational experiences, activities and interests;
Expectations and role of the family in the treatment process;
Psychiatric history, including any previous treatment and the reason for termination;
Vocational history; and
Educational history.

(8) Admission.

(a) Each resident, within 24 hours of admission to a facility, shall be provided an orientation which includes the following:

Explaining the facility’s services, activities, performance expectations, rules and regulations, including providing to the resident written facility rules;
Familiarizing the resident with the facility’s premises, the neighborhood and public transportation systems;
Scheduling the resident’s activities; and
Explaining resident rights and grievance procedures.

(b) The following documentation shall be placed in the resident’s file:

A signed statement by the resident or guardian that the resident has received an orientation which meets the required criteria;
A signed statement that the resident has either read or has been explained facility rules;
A signed statement indicating the resident's financial obligations to the facility and the person responsible for meeting such obligations;
For incompetent residents, a statement identifying and locating the guardian of record, legal guardian or court ordered custodian with responsibility for medical and dental care and signed consent for treatment from such person;
Written arrangements for phone calls, visits, and, when indicated, family participation in the treatment process;
Written arrangements for clothing, allowances and gifts; and
For forensic residents, a copy of any court order, charges pending and any other legal status documents and procedures to be followed if the resident leaves the program without approval.

(9) Assessment and Treatment Planning. RTF staff or the treatment team shall begin within 72 hours of admission and complete within 30 days of admission a functional assessment and individual treatment plan for each resident. Interventions which are needed to remedy serious deficits shall not be delayed until the assessment and individual treatment plan are completed.

(a) Assessment. The functional assessment shall determine the resident’s ability to utilize the skills needed to function successfully in the RTF environment, and shall identify any obstacles to the resident’s learning or using such skills. The assessment shall include determining any risk to themselves or other residents.

(b) Treatment Planning.

Treatment goals or objectives shall be achievable, have a reasonable time frame for achievement, and be stated in terms of measurable and observable changes.
The treatment plan shall be developed with and signed by the resident or guardian. If the resident or guardian refuses to sign, the reason for this, if determinable, must be documented in the case record.
RTF staff or the treatment team shall review the treatment plan at least monthly and note this in the record.
RTF staff or the treatment team shall update and revise the treatment plan when goals or objectives are accomplished or when additional resident deficits which are in need of intervention are identified. The treatment plan shall be updated at least every 60 days for facility Levels I, II and III and at least every 120 days for facility Levels IV and V.
Family members, guardians or significant others shall be included in treatment planning, treatment, and discharge planning to the extent permitted or requested by the resident and when the staff has determined that such participation will be in the best interests of the resident.

(10) Treatment Services and Activities. RTFs shall provide services and activities which are adaptable to the individual needs of residents, promote personal growth and development, and prevent deterioration or loss of ability.

(a) Policy and Procedures Manual. Each RTF shall have a policy and procedures manual which guides its services and activities. The manual shall be periodically reviewed and revised as the needs of individual residents or the living group change, and shall be available to staff and residents.

(b) Social and Recreational Activities. RTFs shall provide or refer residents to recreational and social activities during the hours they are not involved in other planned or structured activities. Recreational and social activities shall be planned with resident participation and posted in a conspicuous location.

(c) Religious Activities. Opportunity shall be provided for all residents to participate in religious services and other religious activities within the framework of their individual and family interests.

(d) Resident Tasks. A resident may be assigned tasks related to facility operation, including but not limited to cooking, laundering, housekeeping and maintenance, only if such tasks are in accordance with the treatment plan and are done with staff supervision.

(e) Physical Health Care Services.

A facility shall have available, whether within its organizational structure or by written agreements, procedures or contractswith outside health care clinicians or facilities, a full range of services for the treatment of illnesses and maintenance of general health.
Staff shall have a basic knowledge of and receive training in the health needs and problems of residents.
Direct service staff shall report resident illnesses and significant physical dysfunctions in a timely manner to the resident’s licensed medical practitioner and note such in the resident’s record.

(f) Medication. RTFs shall have written policies and procedures regarding the following aspects of medication management.

Storage.

a. No prescription drug shall be kept in the facility unless it has been legally dispensed and labeled for the person for whom it is prescribed.

b. Residents may keep their medication in a secure place in their room, except when such medication is required to be personally carried for frequent or emergency use.

c. Medication may be centrally stored under the following conditions:

(I) If the preservation of medicines requires refrigeration;

(II) When medication is determined and documented by the licensed medical practitioner to be a safety risk if kept in the personal possession of the person for whom it was prescribed;

(III) If the resident is forgetful or disoriented and is not capable of taking medications as prescribed; or

(IV) When, because of physical arrangements and the conditions or habits of other persons in the program, the medications are determined by the administrator, nurse or licensed medical practitioner to be a safety risk to others.

d. Centrally stored medications shall be:

(I) Kept in a locked cabinet or other locked storage receptacle;

(II) Accessible only to the staff responsible for distribution of medication; and

(III) Located in an area free of dampness and abnormal temperatures, except in the case of a medication requiring refrigeration.

e. Each container of medication shall be labeled according to state law.

f. Prescription medications which are not taken with the person upon terminating residence shall be returned to a responsible relative or a guardian, or if none exists, given to a pharmacist to destroy. Notation of drug disposition shall be entered in the resident’s record.

g. Staff not licensed by the State of Florida to administer medication may assist a resident in the self-administration of medication by:

(I) Obtaining the medication from the centrally stored or other location;

(II) Reminding the resident that it is time for the medication to be administered;

(III) Preparing the necessary paraphernalia, such as water, juice, cups, spoons, and medicine cups;

(IV) Steadying arm, hand or other parts of the resident’s body;

(V) Returning to the medication container unused doses of solid medication not used by the resident; and

(VI) Returning the medication container to the centrally stored or other location.

Distribution of Centrally Stored Medication.

a. A staff person who has access to and is responsible for the distribution of centrally stored medication shall be available at all times.

b. Staff may distribute medication only to the person for whom it is prescribed.

Medication Administration.

a. Professionals licensed to administer medications in accordance with Chapter 464, F.S., may administer medications in accordance with the licensed medical practitioner’s directions.

b. A licensed practical nurse may administer medications when under the direction of a registered nurse, a licensed medical practitioner, or a licensed dentist who must be accessible by telephone.

(g) Emergency Services. All direct service staff shall be provided training to handle emergency medical and mental health situations.

RTFs shall have written policies and procedures regarding handling and reporting of emergencies. Such policies and procedures shall be reviewed at least annually by all staff.
RTFs shall not use seclusion.
With the exception of half bed rails used under the prescription and supervision of a licensed medical practitioner, RTFs shall not use restraints.
A minimum of one RTF staff member per shift shall maintain current first aid and CPR certification.
Each RTF shall have procedures for managing aggressive behavior.
First aid kits shall be available to facility staff at all times. Contents of the first aid kits shall be selected by the staff or consulting medical personnel and shall include items designed to meet the needs of the facility.
RTFs shall have written policies and procedures for obtaining emergency diagnosis and treatment of dental problems.
RTFs shall have written policies and procedures for providing emergency medical and psychiatric care.

a. There shall be written, posted procedures which clearly specify who is available and authorized to provide necessary emergency psychiatric or medical care and how to arrange for referral or transfer to another facility, including ambulance arrangements, when necessary.

b. RTFs shall transfer residents who pose an imminent physical danger to themselves or others to an appropriate acute care facility.

(I) RTFs shall develop and maintain written transfer procedures, including a cooperative agreement with appropriate acute care facilities.

(II) RTFs shall maintain a registry of all transfers to acute care facilities and shall notify the referring court in the case of forensic residents, if appropriate.

(11) Critical Incident Reporting. RTFs shall develop policies and procedures for submitting critical incidents into the AHCA Incident Reporting System (AIRS system) within one business day of the occurrence of the incident. The link to access the AIRS system is: https://apps.ahca.myflorida.com/SingleSignOnPortal.

(12) Discharge, Termination and Transfer.

(a) A discharge, termination or transfer summary shall be included in the resident’s record. The summary shall address items (b) – (i):

(b) If required by the court, the program shall obtain court approval for the discharge of forensic residents and submit to the court any required reports.

(c) Residents shall be actively engaged in the discharge planning process from the time of admission. Residents shall be assisted as needed in securing living arrangements or shelter and obtaining a timely aftercare appointment for needed services, including continuation of prescribed psychotropic medications prior to discharge.

(d) Residents shall be provided education and written information about his or her illness and psychotropic medications including other prescribed and over-the-counter medications, the common side-effects of any medications prescribed and any adverse clinically significant drug-to-drug interactions common between medication and other commonly available prescribed and over-the-counter medications.

(e) The individual shall be provided with information on any resources, services and community-based peer support services that are available in the community.

(f) Residents shall be referred to substance use treatment programs, trauma or abuse recovery focused programs, or other self-help groups, if indicated by assessments.

(g) Residents shall be provided with resource information on the Suicide & Crisis Lifeline and local Mobile Response Team services.

(h) Residents shall be provided information about advance directives, including resources to assist with preparation and use.

(i) For residents who are diagnosed with an intellectual or developmental disability according to Chapter 393, F.S., the facility shall provide the parents or guardians with information on how to access appropriate resources from the Agency for Persons with Disabilities.

(13) Resident Rights. The legal and civil rights of residents shall be safeguarded.

(a) Residents shall be informed of their rights, including the right to legal counsel and all other requirements of due process. Receipt of such information shall be documented by the signatures of the resident or guardian.

(b) RTFs shall be administered in a manner that protects the resident’s rights, life and physical safety.

(d) The facility’s space and furnishings shall enable the staff to provide appropriate supervision while respecting the resident’s right to privacy.

(e) Each facility shall have written policies and procedures which allow resident communication and visits with family members and other visitors when such visits do not interfere with treatment activities. Such policies and procedures shall be provided to the resident and family and updated when changes occur.

If treatment interventions require restriction of communication or visits, as set forth in the program’s policies and procedures, treatment staff shall evaluate these restrictions at least weekly for their effectiveness and continuing need. The review must be documented and signed by the facility administrator, and placed in the resident’s record.
Restriction of communication or visits required for practical reasons, including the expense of travel or telephone calls, shall be determined with the resident’s family or guardian.

(f) The resident’s opinions and recommendations shall be considered in the development and continued evaluation of the facility and its operations. The facility shall have written policies and procedures for receiving and responding to resident communications concerning its program.

(g) RTFs shall have written policies concerning resident grievance procedures.

(h) Residents shall not be subjected to remarks which ridicule them, their families or others.

(i) RTFs shall have written procedures for suspending residents from the facility which are approved by the governing board and the district administrator.

(j) RTFs shall not exploit a resident or require a resident to make public statements acknowledging gratitude to the program.

(k) Residents shall not be required to perform at public gatherings.

(l) RTFs shall not use identifiable pictures of a resident without written consent from the resident or guardian. Before any such pictures are used, a signed consent form indicating how they will be used shall be placed in the resident’s record.

(m) Residents shall be allowed to wear their own clothing as appropriate.

Training and assistance in the selection and proper care of clothing shall be available.
Clothing shall be suited to the climate.
Clothing shall be in good repair, of proper size and similar to the clothing worn by the resident’s peers in the community.

(14) Resident Records.

(a) Policies and Procedures for Resident Records. RTFs shall have written policies and procedures regarding resident records that include the following:

Resident records shall be confidential, current and accurate;
Resident records shall be stored in a locked room or container;
The information in resident records shall be safeguarded against loss, defacement, tampering or use by unauthorized persons;
Confidentiality of the information contained in a resident’s record and communication between staff members and residents shall be protected as stated in section 394.4615, F.S., and chapter 65E-5, F.A.C. Records may only be removed from the jurisdiction and safekeeping of the facility or the organization operating a facility according to written policies and procedures as required by law;
Records may only be removed from the jurisdiction and safekeeping of the RTF according to written policies and procedures as required by law; and
Each RTF shall provide training in verbal and written confidentiality requirements to all staff as part of new staff orientation and ongoing staff development.

(b) Maintenance of Records. Each RTF shall have a master filing system which includes a comprehensive record of each resident’s involvement in every aspect of the program.

Level I, II and III facilities operating under an organization that maintains a master filing system not on the RTF premises shall, in lieu of the master resident record, maintain for each resident a record that contains the following information:

a. Demographic information;

b. Psychosocial assessment;

c. Health assessment;

d. Current medication profile;

e. Individual treatment plan and plan amendments;

f. Emergency contact sheet; and

g. Progress notes.

RTFs shall adopt policies regarding the storage, disposal or destruction of resident records that protect against disclosure of confidential information in compliance with Chapter 119, F.S. Resident records shall be maintained minimally for seven years after the date of the last entry.
Resident record services shall be directed, staffed and equipped to facilitate processing, checking, indexing, filing, retrieval and review of all resident records.
There shall be adequate space, equipment and supplies, compatible with the needs of the resident record services, to enable the personnel to function effectively and to maintain clinical records readily accessible.

(15) Program Evaluation.

(a) Quality Assurance.

RTFs shall have or be part of an established quality assurance program with written policies and procedures that include the following:

a. Composition of review committees;

b. Case review procedures;

c. Criteria and standards used in the review process and procedures for their development; and

d. Procedures to assure dissemination of the results and corrective action.

Each quarter a peer review and a utilization review shall be conducted which ensure that:

a. Resident admissions are appropriate;

b. Services are delivered in the least restrictive environment possible;

c. Resident rights are protected;

d. When permitted by the resident, the resident’s family or significant others are involved in resident assessment, treatmentplanning and discharge planning;

e. Service plans are comprehensive and relevant to residents’ needs;

f. Minimum standards for resident records are met;

g. Minimum therapeutic dosages of medication are prescribed and appropriately administered;

h. Medical emergencies are handled appropriately;

i. Specialty cases such as suicides, death, violence, staff abuse, and resident abuse are reviewed;

j. All critical incident reports are reviewed,

k. The length of stay for each resident is appropriate;

l. Supportive services are ordered and obtained as needed;

m. Continuity of care is provided; and

n. Delay in receiving services is minimal.

(b) The program shall conduct an annual review of program effectiveness, program goals, policies, procedures and service treatment provision.

(16) Facility Standards.

(a) Building Construction Requirements.

The construction and renovation of a facility shall comply with the building codes in Rule 61G20-1.001, F.A.C., as adopted by the Florida Building Commission and enforced by local jurisdictions.
Sewage, including liquid wastes from cleaning operations, shall be disposed of in a public sewage system or other approved sewage system in accordance with chapter 64E-6, F.A.C., Standards for Individual Sewage Disposal Facilities.
All sanitary facilities shall comply with the requirements of chapter 64E-10, F.A.C.
All plumbing shall comply with the plumbing code legally applicable to the area where the facility is located.
Water supply requirements are contained in Rule 64E-12.003, F.A.C.
Heat shall be supplied from a central heating plant or by a heating system which meets with applicable fire safety codes.

(b) Health and Safety.

Disaster Preparedness.

a. The facility shall have or operate under a safety committee with a safety director or officer who is familiar with the applicable fire safety standards contained in Chapter 69A-44, F.A.C., as adopted by the State Fire Marshal. The committee’s functions may be performed by an already existing committee or governing board subcommittee with related interests and responsibilities.

b. The facility shall have or be a part of a written internal and external disaster plan, developed with the assistance of qualified fire, safety and other experts.

(I) The plan shall identify the availability of fire protection services and provide for the following:

(A) Use of the fire alarm;

(B) Transmission of the alarm to the fire department;

(D) Isolation of the fire;

(E) Evacuation of the fire area, with posted evacuation routes;

(F) Preparation of the building for evacuation; and

(G) Fire extinguishment.

(II) The plan shall be made available to all facility staff and posted in appropriate areas within the facility.

(III) There shall be records indicating the nature of disaster training and orientation programs offered to staff.

c. RTFs are required to use the AHCA’s online Health Facility Reporting System (HFRS) to report its emergency status, planning or operations.

Fire Safety.

a. RTFs shall comply with all applicable ire codes contained in Chapter 69A-44, F.A.C., as adopted and enforced by the State Fire Marshal.

(I) For facility Level IB, which may have no more than three residents incapable of self-preservation, and for facility Levels II, III, IV, and V, which may have no residents incapable of self-preservation, each resident record shall have a signed statement by a licensed medical practitioner or licensed psychologist regarding the resident’s capability of self-preservation.

(II) Facility Levels IB, II, III, IV, and V shall have a prompt evacuation capability.

b. Level IV and V facilities shall have a written policy on the safe use of extension cords and adapters. The use of extension cords and adaptors is prohibited in Level I, II and III facilities.

c. Electrical cords and appliances shall be maintained in a safe condition.

d. Portable heating devices shall be used only in emergency situations as defined in agency procedures approved by the governing board.

e. Flammable liquids or gas cylinders shall not be positioned near flame or heat sources, nor stored with combustible materials.

f. Emergency Power. The facility shall provide egress lighting that will operate in the event of a power failure.

g. Smoking. The program shall have a written policy governing smoking in the facilities.

(I) The smoking policy shall be conspicuously posted and made known to all residents, staff and visitors.

(II) Smoking shall be prohibited in any area of the facility where combustible supplies, materials, liquids or gases are in use or stored.

(III) Ambulatory residents shall not be permitted to smoke in bed.

(IV) Unsupervised smoking by residents confined to bed shall be prohibited.

(V) Wastebaskets and ashtrays shall be made of noncombustible materials, and wastebaskets shall not be used as ashtrays.

h. Fire Safety Inspections.

(I) A fire safety inspection must be obtained before occupying any new physical facility or addition.

(II) The program shall secure, on a yearly basis or as required by statute, a documented fire safety inspection, including an inspection of electrical equipment.

(III) A report of the most recent fire inspection must be kept on file and accessible to authorized individuals.

Personal Safety.

a. The grounds and all buildings on the grounds shall be maintained in a safe and sanitary condition, as required in Chapter 386, F.S., Nuisances Injurious to Health.

b. The building shall be free of hazards such as cracks in the floors, walls, or ceiling; warped or loose boards, tile, linoleum, handrails or railings; and broken window panes or missing window screens.

c. Protection shall be provided from sharp or jagged projections, “invisible” glass, moving parts, heated surfaces, heavy objects that could fall, or any other potentially hazardous condition.

d. The facility shall be free of unsafe accumulations of possessions, including equipment and supplies of residents, staff or owner.

e. Grab bars shall be nonremovable.

f. The temperature of the hot water supply shall be regulated and shall be between 105º-115º at the outlet.

g. Any electrical fans, except ceiling paddle fans, shall be screened. All electrical fans, including paddle fans, shall be placed in a safe location.

h. All potentially dangerous or toxic substances shall be stored in a cabinet or enclosure, away from food or other areas that could constitute a hazard to the residents.

i. If for clinical reasons access to potentially dangerous grooming aids or other personal articles is contraindicated for residents in Level I, II and III facilities, staff shall explain to the resident the conditions under which the articles may be used and shall document the clinical rationale for these conditions in the resident’s record. If clinically indicated, the personal articles of residents in facility Levels I, II and III may be kept under lock and key by staff. Such actions shall be reviewed weekly for effectiveness and continued need.

j. The facility shall develop and enforce policies pertaining to the maintenance, supervision and safe use of any special activity areas or equipment.

(I) Indoor and outdoor recreational areas shall be provided with safeguards designed for the needs of the residents.

(II) Outdoor recreational areas shall be well drained and kept free of litter and trash.

(III) If swimming pools are available in facilities with eight or more residents, such pools shall be supervised at all times when they are in use.

k. Security. The facility shall develop a written policy which includes procedures that provide security for residents, staff and visitors, consistent with the conditions and risks associated with the facility's location.

Health and Sanitation.

a. Appropriate health and sanitation inspection certificates shall be obtained before occupying any new physical facility or addition, and at least yearly or as required by statute, thereafter. A report of the most recent inspection must be on file and accessible to authorized individuals.

b. Hot and cold running water under pressure shall be readily available in all washing, bathing and food preparation areas.

c. Garbage Disposal.

(I) All garbage from residential areas shall be collected daily and taken to storage facilities. Garbage shall be removed from storage facilities frequently enough to prevent a potential health hazard or at least twice per week. Wet garbage shall be collected and stored in impermeable, leakproof, fly-tight containers pending disposal. All containers, storage areas and surrounding premises shall be kept clean and free of vermin.

(II) If public or contract garbage collection service is available, the facility shall subscribe to these services unless the volume makes on site disposal feasible. If garbage are disposed of on premises, the method of disposal shall not create sanitary nuisance conditions.

d. Pets and Live Animals.

(I) The facility shall formulate a policy regarding the availability and care of pets and other animals consistent with the requirements of good health, sanitation and local ordinances.

(II) Live animals shall not be allowed in the kitchen or food service areas while food is uncovered or exposed.

e. The kitchen and food preparation area shall be well-lighted, ventilated and located apart from areas which could cause food contamination. All doors and windows in the kitchen and food preparation areas that open to the outside shall be screened.

f. The floors, walls, shelves, tables, utensils and equipment in all rooms where food or drink is stored, prepared or served or where utensils are washed shall be kept clean and in repair. Stored food shall be protected from vermin, rodents and other contamination.

For food service areas with a capacity of 13 or more residents, all matters pertaining to food service shall comply with the provisions of chapter 64E-11, F.A.C.
Third Party Food Service. When food service is provided by a third party, the provider shall meet all conditions stated in this section, and shall comply with chapter 64E-11, F.A.C. There shall be a formal contract between the facility and provider containing assurances that the provider will meet all food service and dietary standards imposed by this rule with an exception of the level IV and V RTF’S. Sanitation reports and food service establishment inspection reports shall be on file in the facility.
Staff.

a. The facility or organization which operates the facility shall be responsible for the supervision of food service staff.

b. The staff shall perform their duties in a safe and sanitary manner, be knowledgeable of foods that meet regular diets and participate in continuing in-service education on at least an annual basis. A minimum of one staff member from each facility or organization which operates the facility serving food shall complete the Food Service Management Training Course at the county public health unit.

c. All employees shall wear clean garments and keep their hands clean at all times while engaged in preparing or serving food and drink.

d. Staff and residents engaging in the preparation and service of food shall use effective restraints to keep hair from food and contact surfaces.

e. No person having a communicable disease in the transmittable stage or who is a carrier of organisms that may cause a communicable disease shall prepare or serve food for others.

f. Duty assignments shall be posted in the kitchen area in facilities having three or more food service staff.

Diet and Nutrition. The facility shall have policies and procedures to assure proper nutritional care of its residents, whether the food is prepared by residents, staff or a third party.

a. For residents who need therapeutic diet services, a licensed medical practitioner’s order for each diet and the meal pattern, including types and amounts of food to be served, shall be on file. Therapeutic diets shall be prepared and served as ordered by the licensed medical practitioner. Staff shall ensure that residents on special diets follow the licensed medical practitioner’s orders.

b. Regular diets shall meet the nutritional needs of residents.

c. An up-to-date diet manual, such as the Diet Manual of the Florida Dietetic Association, Inc., shall be used as the standard reference in planning regular and therapeutic diets.

d. The dietary allowances shall be met by offering a variety of foods adapted to the food habits, preferences and physical abilities of the residents and prepared by the use of standardized recipes.

e. For facilities serving 3 meals a day, no more than 14 hours shall elapse between the end of an evening meal and the beginning of a morning meal containing a protein food. Intervals between other meals shall not be less than 4 hours and not more than 6 hours.

f. Group facilities shall plan menus at least 1 week in advance for regular and therapeutic diets. The menus shall be dated and posted where easily viewed by residents, corrected as served, and kept on file for 6 months.

Food Preparation, Sanitation and Storage.

a. All food and drink shall be clean, wholesome, free from spoilage and prepared so as to be safe.

b. Group facilities shall maintain a 1-week supply of non-perishable food, based on the number of weekly meals the program serves.

c. Food shall be served attractively and at safe temperatures.

d. Sufficient and appropriate eating ware shall be on hand.

e. Schedules for cleaning of equipment, storage and work areas shall be in writing and on file.

f. Reports of sanitation inspections shall be on file, showing corrections of any deficiencies.

g. After each use, all nondisposable eating and drinking utensils shall be thoroughly cleansed with hot water and an effective detergent, rinsed free of such solution and sanitized.

h. All food and drink at risk of spoilage shall be kept at or below 45º F, or above 140º F, except when being prepared or served.

i. Each refrigerator or freezer used for storage of perishable foods shall be provided with an accurate indicating thermometer located in the warmest part toward the front side of the refrigerator or freezer so that the temperature can be easily and readily observed.

j. Freezers should be kept at or below 0º F.

Dining.

a. Dining tables shall seat small groups of residents unless other arrangements are justified on the basis of resident needs.

b. Dining rooms in Level I or II facilities shall be adequately supervised and staffed to provide assistance to residents when needed and to assure that each resident receives an adequate amount of and variety of food.

c. The dining area shall be suitably lighted, ventilated and furnished.

(d) Environment.

The facility shall establish an environment that enhances the positive self-image of residents and preserves their human dignity.

a. Residential facilities shall not be identified by an exterior sign or vehicle sign that labels the residents or special functions of the facility.

b. Vehicle traffic and parking relating to the facility shall be similar to that of surrounding structures or residences.

c. Residences and grounds shall be furnished in a manner similar to a normal home living environment.

The grounds of the facility shall have adequate space for resident activities.
The facility shall be accessible to handicapped persons or the facility shall have written policies and procedures that describe how handicapped individuals can gain access to the facility for necessary services.
Areas that accommodate the following shall be available:

a. A full range of social activities;

b. Private conversations;

c. Group activities; and

d. Resident privacy, when appropriate.

All areas of the facility occupied by residents shall be climatically controlled in a manner conducive to the comfort and privacy of the residents.

a. A temperature of at least 72° F shall be maintained during waking hours in all areas used by residents. During hours when residents are normally asleep, a temperature of at least 68º F shall be maintained. These temperature requirements apply unless otherwise mandated by federal or state authorities.

b. Temperatures of all inside areas of buildings used by residents shall not exceed 85º F.

c. When cooling devices are used, they shall be placed or adjusted in a manner which minimizes drafts.

Drinking water shall be readily available and easily accessible to residents.
Mirrors reasonably free of distortion shall be placed in appropriate places to aid in grooming and to enhance self-awareness.
Clocks and calendars shall be provided to promote awareness of time and day.
The use of door locks or closed sections of the building shall comply with all applicable safety standards.
Clean, well-lighted and ventilated laundering facilities for resident use shall be available on the premises or in the immediate neighborhood.
A telephone which allows private conversations shall be available and easily accessible within the facility.
Facility lighting shall promote clear perceptions of people and functions. When and where appropriate, lighting shall be controlled by residents.
Whenever feasible, the environment shall provide views of the outdoors.
Books, magazines, newspapers, arts and crafts materials, radios and televisions shall be available in accordance with residents’ recreational, cultural and educational backgrounds and needs.
Bedrooms.

a. All resident bedrooms shall be ventilated, well-lighted and located convenient to a bathroom.

b. Resident bedrooms designated for single occupancy shall provide a minimum inside measurement of 80 square feet of usable floor space.

c. Resident bedrooms designated for multiple occupancy shall provide a minimum inside measurement of 60 square feet of usable floor space per bed and be limited to four occupants.

d. All resident bedrooms shall open directly into a corridor, a common use area or the outside, except in those facilities comprised of apartments.

e. Each resident bedroom where furnishings are supplied by the facility shall be furnished with at least the following equipment per resident:

(I) Personal storage space such as dressers, chests or wardrobes;

(II) Upon request, a table and comfortable chair;

(III) Adequate space for hanging clothes; and,

(IV) A clean, comfortable bed in good repair with a mattress that is clean and free of odors, stains, rips, tears or lumpy stuffing, and is not less than 36 inches in width and 72 inches in length, with the top surface of the mattress at a comfortable height to assure easy access by residents; and

(V) Bedding appropriate to the seasons, including a pillow, pillow case, sheets, blankets and spread.

f. The placement of residents in a bedroom shall be appropriate to their ages, developmental levels and clinical needs and to meet the goals of the facility.

g. Sleeping areas shall be assigned on the basis of the residents’ needs for group support, privacy or independence.

h. Bedroom doors shall not have vision panels.

i. Residents shall be allowed to keep and display personal belongings and to add personal touches to the decoration of their rooms. The facility shall have written policies to govern the appropriateness of such decorative display.

j. Each resident will be provided a place in which personal belongings may be securely stored.

Bathrooms.

a. A toilet and lavatory facility shall be provided for every six residents, and toilets shall be equipped with seats.

b. A minimum of one tub or shower facility, equipped with non-slip devices, shall be provided for every eight residents.

c. Bathrooms shall be ventilated, adequately lighted and have clearly labeled hot and cold running water.

d. Each bathroom shall have a door in working order to assure privacy.

e. When there is more than one toilet or bathing facility in a bathroom, provisions are required for privacy.

f. Bathrooms used by physically handicapped residents shall be equipped to ensure safety and independent mobility.

g. Sole access to toilet or bathing facilities shall not be through another resident’s sleeping room, except in facilities comprised of apartments.

Common Living Areas.

a. A room, separate from sleeping areas, shall be provided where residents may read or engage in socialization or other leisure time activities.

b. A minimum of 35 square feet of living and dining space per resident shall be provided by all facilities except those comprised of apartments. This space shall include living, recreational and other space designated accessible to residents, but shall not include bathrooms, corridors, storage space, or screened porches which cannot be adapted for year round use. Facilities with bedrooms which include living space may count the square footage that is in excess of the bedroom square footage requirements as part of the 35 square footage living and dining space requirements.

(e) Housekeeping and Maintenance.

Housekeeping.

a. The facility shall have written policies and procedures for maintaining a clean and sanitary environment, including the following:

(I) The proper use, cleaning and care of equipment,

(II) The proper use of housekeeping and cleaning supplies,

(III) Appropriate techniques for evaluating the effectiveness of cleaning; and,

(IV) The roles of staff and residents in maintaining a clean and safe environment.

b. Furniture and furnishings shall be clean and reasonably attractive.

c. Odors shall be controlled by appropriate sanitation practices, effective cleaning procedures and proper use of ventilation.

d. The facility shall be free of unsafe or unsightly clutter or accumulations of possessions, equipment or supplies.

e. Bedding shall be kept clean and free of odors or stains.

(I) Mattresses and pillows shall be sanitized between uses by different residents.

(II) Blankets and bedspreads shall be washed or dry cleaned at least quarterly.

(III) Bed linens shall be washed at least weekly, or more frequently if necessary.

Maintenance.

a. The interior and exterior of buildings shall be reasonably attractive and in good repair. Loose, cracked or peeling wallpaper shall be promptly replaced, repaired or removed and the exposed area repainted to provide a satisfactory finish.

b. The facility grounds shall be maintained in a safe and reasonably attractive manner.

c. Furniture and furnishings shall be kept in good repair.

d. All heating, air conditioning, electrical, mechanical, plumbing and fire protection systems shall function properly.

History

Rulemaking Authority 394.879(1) FS. Law Implemented 394.67, 394.875, 394.876, 394.877, 394.879, 394.903 FS. History–New 2-27-86, Amended 7-29-96, Formerly 10E-4.016, Amended 12-20-98, 7-28-25.

Chapter 65E-5 MENTAL HEALTH ACT REGULATION

Fla. Admin. Code R. 65E-5.024 Types of Receiving Facilities

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.455 FS. History–New 12-28-82, Formerly 10E-5.24, 10E-5.024, Repealed 11-29-98.

Fla. Admin. Code R. 65E-5.026 Special Responsibilities of Receiving Facilities

History

Rulemaking Authority 394.453, 394.4595(5), 394.78 FS. Law Implemented 394.453, 394.457, 394.4593, 394.459, 394.74, 394.75, 394.94(2), 394.77 FS. History–New 12-28-82, Amended 2-28-85, Formerly 10E-5.26, Amended 7-19-89, 5-2-96, Formerly 10E-5.026, Repealed 11-29-98.

Fla. Admin. Code R. 65E-5.027 Responsibility of Community Mental Health Centers and Clinics

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.453, 394.4573 FS. History–New 12-28-82, Amended 2-28-85, Formerly 10E-5.27, Amended 5-2-96, Formerly 10E-5.027, Repealed 11-29-98.

Fla. Admin. Code R. 65E-5.032 Patient Rights

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459, 394.459(1), (3), (5), (6), (7), (9), (10), (11), (12) FS. History–New 12-28-82, Amended 2-28-85, Formerly 10E-5.32, Amended 11-4-86, 1-2-97, Formerly 10E-5.032, Repealed 11-29-98.

Fla. Admin. Code R. 65E-5.050 Forms and Clinical Record Requirements

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.455, 394.457(5)(a) FS. History–New 4-4-05, Amended 1-8-07, Repealed 4-2-12.

Fla. Admin. Code R. 65E-5.100 Definitions

As used in this chapter the following words and phrases have the following definitions:

(1) “Advance directive” as defined in Section 765.101, F.S.

(2) “Assent” is an affirmative agreement by the minor to remain at the receiving facility for examination and treatment.

(3) “Assessment” means the systematic collection and integrated review of individual-specific data. It is the process by which individual-specific information, such as examinations and evaluations, are gathered, analyzed, monitored, and documented to develop the individual’s recovery plan and to monitor recovery. Assessment specifically includes efforts to identify the individual’s key medical and psychological needs, competency to consent to treatment, patterns of a co-occurring mental illness and substance use disorder, as well as clinically significant neurological deficits, traumatic brain injury, organicity, physical disability, developmental disability, need for assistive devices, and physical or sexual abuse or trauma.

(4) “Care coordination” as defined in Section 394.4573(1)(a), F.S.

(5) “Clinical review for minors” means the process of collecting and analyzing information about a minor presenting for voluntary admission or transfer to voluntary status at a receiving facility. The review must include an interview with the minor, and may include collection of collateral information, for the purpose of determining if the minor voluntarily assents to the admission or transfer. The clinical review shall be conducted by a qualified professional or registered nurse or clinical staff with at least a master’s degree in psychology, social work, counseling education, mental health counseling, or marriage and family therapy.

(6) “Discharge plan” means a written plan describing the proposed aftercare needs and how they will be met, including living arrangements, transportation, physical health, treatment, and recovery supports.

(7) “Emergency treatment order (ETO) means a written emergency order for psychotropic medications, as described in Rule 65E-5.1703, F.A.C.; or a written emergency order for seclusion or restraint, as described in Rule 65E-5.180, F.A.C.

(8) Examination means the integration of the physical examination required under Section 394.459(2), F.S., with other diagnostic activities to determine if the individual is medically stable and to rule out abnormalities of thought, mood, or behavior that mimic psychiatric symptoms but are due to non-psychiatric medical causes such as disease, infection, injury, toxicity, or metabolic disturbances. Examination includes the identification of individual specific risk factors for treatment such as elevated blood pressure, organ dysfunction, substance use, or trauma.

(9) “Facility” as defined in Section 394.455, F.S.

(10) “Health care proxy” means a competent adult who has not been expressly designated by an advance directive to make health care decisions for a particular incapacitated individual, but is authorized pursuant to Section 765.401, F.S., to make health care decisions for such individual.

(11) “Health care surrogate” means any competent adult expressly designated by a principal’s advance directive to make health care decisions on behalf of the principal upon the principal’s incapacity.

(12) "High utilization" means an individual experiencing an increased utilization of acute behavioral health services demonstrated by:

a. Three (3) or more evaluations or admissions into a crisis stabilization unit or inpatient psychiatric hospital within 180 days; or

b. Acute care admissions that last 16 days or longer.

(13) “Individual” or “Individual receiving services” means any person receiving services in any substance use or mental health treatment facility, program, or service which is operated, funded, or regulated by the Department.

(14) “Managing entity” as defined in Section 394.9082(2)(e), F.S.

(15) “No-wrong-door model” as defined in Section 394.4573(1)(d), F.S.

(16) “Personal Safety Plan” is a form used to document information regarding calming strategies that the individual identifies as being helpful in avoiding a crisis. The plan also lists identified triggers that may signal or lead to agitation or distress.

(17) “Physician” as defined in Section 394.455, F.S.

(18) “Physician assistant” as defined in Section 394.455, F.S.

(19) “Pro re nata (PRN)” means an individualized order issued at the discretion of a physician or psychiatric nurse, as circumstances require.

(20) “Protective medical devices” mean a specific category of medical restraint that includes devices, or combinations of devices, to restrict movement for purposes of protection from falls or complications of physical care, such as geri-chairs, posey vests, mittens, belted wheelchairs, sheeting, and bed rails. The requirements for the use and documentation of use of these devices are for specific medical purposes rather than for behavioral control.

(21) “Psychiatric nurse” as defined in Section 394.455, F.S.

(22) “Qualified professional” as defined in Section 394.455, F.S.

(23) “Receiving facility” as defined in Section 394.455, F.S.

(24) “Receiving system” means one or more facilities serving a defined geographic area which are responsible for assessment and evaluation, both voluntary and involuntary, and treatment, stabilization, or triage for patients who have a mental illness, a substance use disorder, or co-occurring disorders, as authorized in Section 394.461(5), F.S.

(25) “Recovery Plan” or “service plan” or “treatment plan” means a written strength-based plan developed by the individual and his or her recovery team to facilitate achievement of the individual’s recovery goals. This plan is informed by assessment data, and describes the individual’s clinical, rehabilitative, and support needs and the strategy for meeting those needs. The recovery plan specifies measurable goals and objectives, and documented progress in meeting specified goals and objectives.

(26) “Recovery Team” or “service team” or “treatment team” means an assigned group of individuals with specific responsibilities identified in the recovery plan who support and facilitate an individual’s recovery process.

(27) “Restraint” as defined in Section 394.455, F.S.

(28) “Seclusion” as defined in Section 394.455, F.S.

(29) “Seclusion and Restraint Oversight Committee” means a group of staff members or volunteers that monitors the use of seclusion and restraint in a facility in order to assist in safely reducing the use of these practices.

(30) “Signature” means either a written or an electronic signature. In accordance with s. 668.004, F.S., an electronic signature shall have the same force and effect as a written signature.

(31) “Standing order” means a broad protocol or delegation of medical authority that is generally applicable to a group of individuals. As limited by this chapter, it prohibits improper delegations of authority to staff that are not authorized by the facility, or not permitted by practice licensing laws, to independently make such medical decisions; such as decisions involving determination of need, medication, routes, dosages for psychotropic medication, or use of restraints or seclusion upon an individual.

(32) “Telehealth” as defined in Section 456.47(1), F.S.

(33) “Transportation plan” means a plan that describes methods of transport to a facility within the designated receiving system for individuals subject to involuntary examination or involuntary admission and may identify responsibility for other transportation to a participating facility when necessary and agreed to by the facility, as described in Section 394.462, F.S.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.455, 394.457, 394.4655 FS. History–New 11-29-98, Amended 4-4-05, 1-8-07, 5-7-08, 4-9-13, 8-23-23.

Fla. Admin. Code R. 65E-5.110 Delegation of Authority

In order to protect the health and safety of persons treated in or served by any receiving or treatment facility or any service provider, any delegation of an administrator’s authority pursuant to chapter 394, F.S., or these rules shall be documented in writing prior to exercising the delegated authority. Routine delegations of authority shall be incorporated in the facility’s written policies.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394, 394.457(5)(a), 394.4655 FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.115 Mental Health Personnel

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.455, 394.457(5)(a) FS. History–New 4-4-05, Amended 1-8-07, Repealed 4-2-12.

Fla. Admin. Code R. 65E-5.120 Forms

All forms referred to in this chapter are available from the Department’s website, https://www.myflfamilies.com/crisis-services/baker-act/baker-act-forms. All forms incorporated in this rule chapter contain the information necessary to comply with the statutory and rule requirements. Forms may be modified for the following purposes: to accommodate electronic health record formats; for provider and individual identification; and, for electronic signatures and dates. All forms shall be maintained in the individual’s clinical record.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.457(5) FS. History–New 11-29-98, Amended 4-4-05, 7-20-23, 12-29-24.

Fla. Admin. Code R. 65E-5.130 Continuity of Care Management System

Persons receiving case management services.

(1) At the time of admission receiving facilities shall inquire of the person or significant others as to the existence of any advance directives and as to the identity of the person’s case manager. If a case manager for the person is identified, the administrator or designee shall request the person’s authorization to notify the person’s case manager or the case management agency of the person’s admission to the facility. If authorized, such notification shall be made within 12 hours to the published 24-hour telephone listing for the case manager or case management agency. This inquiry, notification, and the identity of the case manager or case management agency, if any, shall be documented on the face sheet or other prominent location in the person’s clinical record.

(2) A department funded mental health case manager, when notified by a receiving facility that a client has been admitted, shall visit that person as soon as possible but no later than two working days after notification to assist with discharge and aftercare planning to the least restrictive, appropriate and available placement. If the person is located in a receiving facility outside of the case manager’s district or region of residence, the department funded mental health case manager may substitute a telephone contact for a face-to-face visit which shall be documented in the case management record and in the person’s clinical record at the receiving facility.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4573(2) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.1301 Transfer Evaluations for Admission to State Mental Health Treatment Facilities from Receiving Facilities

(1) A person in a receiving facility shall not be transferred to a state treatment facility without the completion of a transfer evaluation, in accordance with Section 394.461(2), F.S., using mandatory form CF-MH 3089, Feb. 05, “Transfer Evaluation,” which is hereby incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter. The process for conducting such transfer evaluations shall be developed by the community mental health center or clinic and be approved by the district or regional office of the department where the center or clinic is located and shall include:

(a) Designation of the contracted mental health centers or clinics that are responsible for conducting the transfer evaluations, including the receiving facilities or persons for which each center or clinic is responsible;

(b) Establishment of the time within which a mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), F.A.C., shall be completed. This form shall be completed by the designated community mental health center and submitted to the court for all persons for whom involuntary placement in a state treatment facility is sought, and directly to the state treatment facility for all persons for whom voluntary admission is sought; and,

(c) Specification of the minimum training and education of the persons qualified to conduct the transfer evaluations and the training and educational qualifications of the evaluators’ immediate supervisor. Unless otherwise established in writing by the district or region, the evaluator shall have at least a bachelor’s degree and the immediate supervisor a master’s degree in a clinical or human services area of study.

(2) A community mental health center or clinic shall evaluate each person seeking voluntary admission to a state treatment facility and each person for whom involuntary placement in a state treatment facility is sought, to determine and document:

(a) Whether the person meets the statutory criteria for admission to a state treatment facility; and,

(b) Whether there are appropriate more integrated and less restrictive mental health treatment resources available to meet the person’s needs.

(3) Following an evaluation of the person, the executive director of the community mental health center or clinic shall recommend the admission to a state treatment facility or, if criteria for involuntary placement are not met, to alternative treatment programs and shall document that recommendation by completing and signing the form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), F.A.C.

(a) The executive director’s responsibility for completing and signing mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), F.A.C., may be delegated in writing to the chief clinical officer of the center or clinic.

(b) An original signature on the mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), F.A.C., is required.

(c) A copy of the mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), F.A.C., shall be retained in the files of the community mental health center or clinic.

(d) The completed and signed mandatory form CF-MH 3089, “Transfer Evaluation,” as referenced in subsection 65E-5.1301(1), F.A.C., shall be forwarded to the court before the hearing at which a person’s involuntary placement in a state treatment facility will be considered. The evaluator, or in the absence of the evaluator, another knowledgeable staff person employed by the community mental health center or clinic, shall be present at any hearing on involuntary placement in a state treatment facility to provide testimony as desired by the court.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.455(29), 394.461(2) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.1302 Admissions to State Treatment Facilities

(1) Receiving facilities must obtain approval from the state treatment facility prior to the transfer of a person. A state treatment facility shall be permitted to accept persons for transfer from a receiving facility if the administrator of the receiving facility has provided the following documentation, which documentation shall be retained in the person’s clinical record:

(a) Recommended form CF-MH 7000, Jan. 98, “State Mental Health Facility Admission Form,” with all required attachments, which is hereby incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter;

(b) Recommended forms CF-MH 3040, Feb. 05, “Application for Voluntary Admission,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or CF-MH 3008, Feb. 05, “Order for Involuntary Inpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter; and,

(2) Use of recommended form CF-MH 7002, Feb. 05, “Physician to Physician Transfer,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for documentation when completed by the referring physician or in the absence of the referring physician the physician’s designee within state law and approved facility protocols and practice guidelines, at the time of transfer. The form shall accompany the person to the state treatment facility and upon arrival shall be presented to admitting staff.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4573(2) FS. History–New 11-29-98, Amended 4-4-05, 4-9-13.

Fla. Admin. Code R. 65E-5.1303 Discharge from Receiving and Treatment Facilities

(1) Before discharging an individual who has been admitted to a facility, the individual shall be encouraged to actively participate in treatment and discharge planning activities and shall be notified in writing of his or her right to seek treatment from the professional or agency of the individual’s choice and the individual shall be assisted in making appropriate discharge plans.

(2) Discharge planning shall include the requirements in Section 394.468(2), F.S. In addition, the facility shall document consideration of the following:

(a) The individual’s transportation resources;

(b) The individual’s access to stable living arrangements;

(c) How assistance in securing needed living arrangements or shelter will be provided to individuals who are at risk of re-admission within the next 3 weeks due to homelessness or transient status and prior to discharge shall request a commitment from a shelter provider that assistance will be rendered;

(d) Assistance in obtaining a timely aftercare appointment for needed services, including continuation of prescribed psychotropic medications. Aftercare appointments for psychotropic medication, and care coordination or case management shall be requested to occur not later than seven (7) days after the expected date of discharge. If the discharge is delayed, the facility shall notify the aftercare provider. The facility shall coordinate with the aftercare service provider and shall document the aftercare planning;

(e) To ensure an individual’s safety and provide continuity of prescribed psychotropic medications, such prescribed psychotropic medications, prescriptions, or multiple partial prescriptions for psychotropic medications, or a combination thereof, shall be provided to an individual when appropriate when discharged to cover the intervening days until the first scheduled psychotropic medication aftercare appointment. Discharge planning shall address the availability of and access to prescribed psychotropic medications in the community;

(f) The individual shall be provided education and written information about his or her illness and psychotropic medications including other prescribed and over-the-counter medications, the common side-effects of any medications prescribed and any adverse clinically significant drug-to-drug interactions common between that medication and other commonly available prescribed and over-the-counter medications;

(g) The individual shall be provided with information on any resources, services and community-based peer support services that are available in the community.

(h) The individual shall be referred to substance use treatment programs, trauma or abuse recovery focused programs, or other self-help groups, if indicated by assessments;

(i) The individual shall be provided with resource information on the National Suicide Prevention Lifeline and local Mobile Response Team services;

(j) The individual shall be provided information about advance directives, including resources to assist with preparation and use; and

(k) For individuals who are diagnosed with an intellectual or developmental disability according to Chapter 393, F.S., the facility shall provide the parents or guardians with information on how to access appropriate resources from the Agency for Persons with Disabilities.

(l) The facility staff shall assist the individual in making appointments, upon request or when indicated.

(3) Receiving and treatment facilities shall have written discharge policies and procedures which shall contain:

(a) Agreements or protocols for transfer and transportation arrangements between facilities;

(b) Protocols for assuring that current medical and legal information, including medication administered on the day of discharge, is transferred before or with the individual to another facility; and,

(4) When a state mental health treatment facility has established an anticipated discharge date for discharge to the community which is more than seven days in advance of the individual’s actual discharge, at least seven (7) days notice must be given to the community agency which has been assigned case management responsibility for the implementation of the individual’s discharge plan. When an impending discharge is known seven (7) days or less prior to the discharge, the staff of the state mental health treatment facility shall give verbal and written notice of the impending discharge to the community case management agency within one (1) working day after the decision to discharge is made. Form CF-MH 7001, (July 2023), “State Mental Health Facility Discharge Form,” which is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-15787, may be used for this purpose.

(5) On the day of discharge from a state mental health treatment facility, the referring physician, or his or her designee, within the requirements of section 394.4615, F.S., and the policies and procedures required by subsection (3) of this rule, shall immediately notify the community aftercare provider or entity responsible for dispensing or administering medications. Form CF-MH 7002, (July 2023), “Physician to Physician Transfer,” which is incorporated by reference and available at https://www.flrules.org/Gateway/reference.asp?No=Ref-15788, may be used for this purpose.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.4573, 394.459(11), 394.460 FS. History–New 11-29-98, Amended 4-4-05, 4-9-13, 8-23-23.

Fla. Admin. Code R. 65E-5.1304 Discharge Policies of Receiving and Treatment Facilities

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(11) FS. History–New 11-29-98, Amended 4-4-05, Repealed 4-9-13.

Fla. Admin. Code R. 65E-5.1305 Discharge from a State Treatment Facility

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4573, 394.459(11), 394.468 FS. History–New 11-29-98, Amended 4-4-05, Repealed 4-9-13.

Fla. Admin. Code R. 65E-5.140 Rights of Persons

(1) Every person admitted to a designated receiving or treatment facility or ordered to treatment at a service provider shall be provided with a written description of his or her rights at the time of admission. Recommended form CF-MH 3103, Feb. 05, “Rights of Persons in Mental Health Facilities and Programs,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose. A copy of the rights statement, signed by the person evidencing receipt of the copy, shall be placed in the person’s clinical record and shall also be provided to the person’s guardian, guardian advocate, representative, and health care surrogate or proxy.

(2) To assure that persons have current information as to their rights, a copy of the Florida Mental Health Act (Chapter 394, Part I, F.S.) and Mental Health Act Regulations (Chapter 65E-5, F.A.C.) shall be available, and provided upon request, in every psychiatric unit of each receiving and treatment facility and by each service provider and, upon request shall be made available for review by any person, guardian, guardian advocate, representative, or health care surrogate or proxy. The administrator or designee of the facility or service provider shall make physicians, nurses, and all other direct service staff aware of the location of these documents so they are able to promptly access them upon request.

(3) Posters delineating rights of persons served in mental health facilities and by service providers, including those with telephone numbers for the Florida Abuse Hotline, Florida Local Advocacy Council, and the Advocacy Center for Persons with Disabilities, shall be legible, a minimum of 14 point font size, and shall be posted immediately next to telephones which are available for persons served by the facility or provider.

(4) Each person shall be afforded the opportunity to exercise his or her rights in a manner consistent with Section 394.459(1), F.S. The imposition of individual or unit restrictions and the development of unit policies and procedures shall address observance of protecting rights of persons served in developing criteria or processes to provide for care and safety.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.459(1), (12), 394.4655 FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.150 Person’s Right to Individual Dignity

(1) Freedom of movement is a right of persons in mental health receiving and treatment facilities. Any restriction of this right requires a physician’s order based upon risk factors. Each receiving and treatment facility shall have policies that describe freedom of movement and access to grounds. When a suitable area is immediately adjacent to the unit, the staff shall afford each person an opportunity to spend at least one half hour per day in an open, out of doors, fresh air activity area, unless there is a physician’s order prohibiting this, with documentation in the person’s clinical record of the clinical reasons that access to fresh air will not be accommodated.

(2) Use of special clothing for identification purposes such as surgical scrubs or hospital gowns to identify persons who are in need of specific precautions or behavior modification restrictions is prohibited as a violation of individual dignity. Prison or jail attire shall not be permitted for persons admitted or retained in a receiving facility except while accompanied by a uniformed law enforcement officer, for purposes of security. Under non-psychiatric medical circumstances, use of special clothing may be ordered by the person’s physician on an individual basis. Documentation of the circumstances shall be included in the person’s clinical record.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(1) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.160 Right to Treatment

(1) Patients shall have the opportunity to participate in the preparation of their own treatment and discharge plans at receiving and treatment facilities and by service providers. In instances when the person refuses or is unable to participate in such planning, such refusal or inability shall be documented in the person’s clinical record.

(2) Comprehensive service assessment and treatment planning, including discharge planning, shall begin the day of admission and shall also include the person’s case manager if any, the person’s friends, family, significant others, or guardian, as desired by the person. If the person has a court appointed guardian, the guardian shall be included in the service assessment and treatment planning. Obtaining legal consent for treatment, assessment and planning protocols shall also include the following:

(a) How any advance directives will be obtained and their provisions addressed and how consent for treatment will be expeditiously obtained for any person unable to provide consent;

(b) Completion of necessary diagnostic testing and the integration of the results and interpretations from those tests. The results and interpretation of the results shall be reviewed with the person;

(c) The development of treatment goals specifying the factors and symptomology precipitating admission and addressing their resolution or mitigation;

(d) The development of a goal within an individualized treatment plan, including the individual’s strengths and weaknesses, that addresses each of the following: living arrangements, social supports, financial supports, and health, including mental health. Goals shall be inclusive of the person’s choices and preferences and utilize available natural social supports such as family, friends, and peer support group meetings and social activities;

(e) Objectives for implementing each goal shall list the actions needed to obtain the goal, and shall be stated in terms of outcomes that are observable, measurable, and time-limited;

(f) Progress notes shall be dated and shall address each objective in relation to the goal, describing the corresponding progress, or lack of progress being made. Progress note entries and the name and title of writer must be clearly legible;

(g) Periodic reviews shall be comprehensive, include the person, and shall be the basis for major adjustments to goals and objectives. Frequency of periodic reviews shall be determined considering the degree to which the care provided is acute care and the projected length of stay of the person;

(h) Progress note observations, participation by the person, rehabilitative and social services, and medication changes shall reflect an integrated approach to treatment;

(i) Facilities shall update the treatment plan, including the physician summary, at least every 30 days during the time a person is in a receiving or treatment facility except that persons retained for longer than 24 months shall have updates at least every 60 days;

(j) The clinical record shall comprehensively document the person’s care and treatment, including injuries sustained and all uses of emergency treatment orders; and,

(k) Persons who will have a continued involuntary outpatient placement hearing pursuant to Section 394.4655(7), F.S., or continued involuntary inpatient placement hearing pursuant to Section 394.467(7), F.S., shall be provided with comprehensive re-assessments, the results of which shall be available at the hearing.

(3) The physical examination required to be provided to each person who remains at a receiving or treatment facility for more than 12 hours must include:

(a) A determination of whether the person is medically stable; and,

(b) A determination that abnormalities of thought, mood, or behavior due to non-psychiatric causes have been ruled out.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.459(2), 394.4655(7), 394.467(7) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.1601 General Management of the Treatment Environment

(1) Management and personnel of the facility’s treatment environment shall use positive incentives in assisting persons to acquire and maintain socially positive behaviors as determined by the person’s age and developmental level.

(2) Each designated receiving and treatment facility shall develop a schedule of daily activities listing the times for specific events, which shall be posted in a common area and provided to all persons.

(3) Interventions such as the loss of personal freedoms, loss of earned privileges or denial of activities otherwise available to other persons shall be minimized and utilized only after the documented failure of the unit’s positive incentives for the individuals involved.

(4) Facilities shall ensure that any verbal or written information provided to persons must be accessible in the language and terminology the person understands.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(2), (11) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.1602 Individual Behavioral Management Programs

When an individualized treatment plan requires interventions beyond the existing unit rules of conduct, the person shall be included, and the person’s treatment plan shall reflect:

(1) Documentation, signed by the physician that the person’s medical condition does not exclude the proposed interventions;

(2) Consent for the treatment to be provided;

(3) A general description of the behaviors requiring the intervention, which may include previous emergency interventions;

(4) Antecedents of that behavior;

(5) The events immediately following the behavior;

(6) Objective definition of the target behaviors, such as specific acts, level of aggression, encroachment on others’ space, self-injurious behavior or excessive withdrawal;

(7) Arrangements for the consistent collection and recording of data;

(8) Analysis of data;

(9) Based on data analysis, development of intervention strategies, if necessary;

(10) Development of a written intervention strategy that includes criteria for starting and stopping specific staff interventions and the process by which they are to occur;

(11) Continued data collection, if interventions are implemented; and,

(12) Periodic review and revision of the plan based upon data collected and analyzed.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(2), (11) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.170 Right to Express and Informed Consent

(1) Establishment of Consent.

(a) Receiving Facilities. As soon as possible, but no longer than 24 hours from entering a designated receiving facility on a voluntary or involuntary basis, each individual shall be examined by a physician or psychiatric nurse to assess the individual’s ability to provide express and informed consent to admission and treatment. Admission to a facility requires clear evidence demonstrating the individual’s mental illness and suitability for treatment. For adults, voluntary admission and treatment is contingent upon a determination of competence to provide express and informed consent. In the case of minors, voluntary admission and treatment requires express and informed consent from a parent or legal guardian. Documentation of the assessment results shall be placed in the individual’s clinical record. The facility shall determine whether an individual has been adjudicated as incapacitated and whether a guardian has been appointed by the court. If a guardian has been appointed by the court, the limits of the authority of the guardian shall be determined prior to allowing the guardian to authorize treatment. A copy of any court order delineating a guardian’s authority to consent to mental health or medical treatment shall be obtained by the facility and included in the individual’s clinical record prior to allowing the guardian to give express and informed consent to treatment for the individual.

(b) Treatment Facilities. Upon entering a designated treatment facility on a voluntary or involuntary basis, each individual shall be examined by a physician or psychiatric nurse to assess the individual’s ability to provide express and informed consent to admission and treatment, which shall be documented in the individual’s clinical record. The examination of an individual alleged to be incapacitated or incompetent to consent to treatment, for this purpose, may be limited to documenting the letters of guardianship or order of the court. If the individual has been adjudicated as incapacitated and a guardian appointed by the court or if an individual has been found to be incompetent to consent to treatment and a guardian advocate has been appointed by the court, the limits of authority of the guardian or guardian advocate shall be determined prior to allowing the guardian or guardian advocate to authorize treatment for the individual. A copy of any court order delineating a guardian’s authority to consent to mental health or medical treatment shall be obtained by the facility and included in the individual’s clinical record prior to allowing the guardian to give express and informed consent to treatment for the individual.

(c) If the admission is voluntary, the individual’s competence to provide express and informed consent for admission shall be documented by a physician or psychiatric nurse. Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” which is incorporated by reference and available in Rule 65E-5.270, F.A.C. may be used for this purpose. The completed form or other documentation shall be retained in the individual’s clinical record. Facility staff monitoring the individual’s condition shall document any observations which suggest that the individual may no longer be competent to provide express and informed consent to his or her treatment. In such circumstances, staff shall notify the physician or psychiatric nurse and document in the individual’s clinical record that the physician or psychiatric nurse was notified of this apparent change in clinical condition.

(d) In the event there is a change in the ability of an individual on voluntary status to provide express and informed consent to treatment, the change shall be immediately documented in the individual’s clinical record. An individual’s refusal to consent to treatment is not, in itself, an indication of incompetence to consent to treatment.

If the individual is assessed to be competent to consent to treatment but refuses treatment and meets the criteria for involuntary inpatient placement, the facility administrator shall file with the court a petition for involuntary services. Form CF-MH 3032, “Petition for Involuntary Services,” which is incorporated by reference and available in Rule 65E-5.270, F.A.C. may be used for this purpose.
If the individual is assessed to be incompetent to consent to treatment, and meets the criteria for involuntary inpatient placement or involuntary outpatient services, the facility administrator shall expeditiously file with the court both a petition for the adjudication of incompetence to consent to treatment and appointment of a guardian advocate, and a petition for involuntary inpatient placement or involuntary outpatient services. Upon determination that the individual is incompetent to consent to treatment and does not have a guardian with the authority to consent to mental health treatment appointed, the facility shall expeditiously pursue the appointment of a duly authorized substitute decision-maker that can make legally required decisions concerning treatment options or refusal of treatments for the individual. Forms CF-MH 3106, (August 2025), “Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18648, and CF-MH 3032, “Petition for Involuntary Services,” which is incorporated by reference and available in Rule 65E-5.270, F.A.C., may be used for this purpose.

(e) Competence to provide express and informed consent shall be established and documented in the individual’s clinical record prior to the approval of a transfer from involuntary to voluntary status or prior to permitting the individual to consent to his or her own treatment if he or she had been previously determined to be incompetent to consent to treatment. Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” incorporated by reference and available in Rule 65E-5.270, F.A.C., properly completed by a physician or a psychiatric nurse may be used for this purpose.

(f) Any guardian advocate appointed by a court to provide express and informed consent to treatment for the individual shall be discharged and a notice of such guardian advocate discharge provided to the court upon the establishment and documentation that the individual is competent to provide express and informed consent.

(g) If the individual entering a designated receiving or treatment facility has been adjudicated incapacitated under Chapter 744, F.S., as defined in Section 394.455, F.S., express and informed consent to treatment shall be sought from the individual’s guardian.

(h) If the individual entering a designated receiving or treatment facility has been determined by a physician or psychiatric nurse to be incompetent to consent to treatment as defined in Section 394.455, F.S., express and informed consent to treatment shall be expeditiously sought by the facility from the individual’s guardian advocate or health care surrogate or proxy.

(i) A copy of the letter of guardianship, court order, or advance directive shall be reviewed by facility staff to ensure that the substitute decision-maker has the authority to provide consent to the recommended treatment on behalf of the individual. If the facility relies upon the expression of express and informed consent for individual’s treatment from a substitute decision-maker, a copy of this documentation shall be placed in the individual’s clinical record and shall serve as documentation of the substitute decision-maker’s authority to give such consent. With respect to a health care proxy, where no advance directive has been prepared by the individual, facility staff shall document in the individual’s clinical record that the substituted decision-maker was selected in accordance with the list of individuals and using the priority set out in Section 765.401, F.S. When a health care surrogate or proxy is used, the facility shall immediately file a petition for the appointment of a guardian advocate.

(2) Authorization for Treatment.

(a) Express and informed consent, includes the right to ask questions about the proposed treatment, to receive complete and accurate answers to those questions, and to negotiate treatment options. An individual who is competent to consent shall be asked to give express and informed consent for admission or treatment. If the individual is incompetent to consent to treatment, such express and informed consent shall be obtained from the duly authorized substitute decision-maker for the individual before any treatment is rendered, except where emergency treatment is ordered by a physician for the safety of the individual or others. Chapter 394, Part I, F.S., and this rule chapter govern mental health treatment.

(b) A copy of information disclosed while attempting to obtain express and informed consent shall be given to the individual and to any substitute decision-maker authorized to act on behalf of the individual.

(c) When presented with an event or an alternative which requires express and informed consent, a competent individual or, if the individual is incompetent to consent to treatment, the duly authorized substitute decision-maker shall provide consent to treatment, refuse consent to treatment, negotiate treatment alternatives, or revoke consent to treatment. Form CF-MH 3042a, (August 2025) “General Authorization for Treatment Except Psychotropic Medications,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18649, or its equivalent, shall be completed at the time of admission to permit routine medical care, psychiatric assessment, and other assessment and treatment except psychotropic medications. The more specific form CF-MH 3042b, (August 2025) “Specific Authorization for Psychotropic Medications,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18650, or its equivalent, shall be completed prior to the administration of any psychotropic medications, except under an emergency treatment order. The completed forms, or equivalent documentation, shall be retained in the individual’s clinical record.

(d) No facility or service provider shall initiate any mental health treatment, including psychotropic medication, until express and informed consent for psychiatric treatment is sought from an individual legally qualified to give it, except in instances where emergency treatment is ordered by a physician or psychiatric nurse to preserve the immediate safety of the individual or others.

(3) Receiving and treatment facilities shall request copies of any advance directives completed by individuals admitted to the facilities, from the individual or the individual’s family or representative.

(4) In addition to any other require

(a) Identification of the proposed psychotropic medication, together with a plain language explanation of the proposed dosage range, the frequency and method of administration, the recognized short-term and long-term side effects, any contraindications which may exist, clinically significant interactive effects with other medications, and similar information on alternative medications which may have less severe or serious side effects.

(b) A plain language explanation of all other treatments or treatment alternatives recommended for the individual.

(5) If a change in psychotropic medication is recommended which was not previously acknowledged and consented to in accordance with the above, an explanation and disclosure of the altered treatment plan must be provided by the physician or psychiatric nurse, express and informed consent must be obtained from the individual authorized to provide consent, and both must be documented in the individual’s clinical record prior to the administration of the treatment or psychotropic medication.

(6) The facility or service provider staff shall explain to a guardian, guardian advocate, or health care surrogate or proxy, the duty of the substitute decision-maker to provide information to the facility or service provider on how the substitute decision-maker may be reached at any time during the individual’s hospitalization or treatment to provide express and informed consent for changes of treatment from that previously approved.

(7) Electroconvulsive therapy when recommended to the individual or the individual’s substitute decision-maker by a physician or psychiatric nurse shall be documented in the individual’s clinical record. Form CF-MH 3057, (August 2025), “Authorization for Electroconvulsive Treatment,” which is incorporated by reference and available http://flrules.org/Gateway/reference.asp?No=Ref-18651, may be used for this purpose. If used, this form shall also be signed by the individual, if competent, by the guardian advocate, if previous court approval has been given in accordance with Section 394.4598(7), F.S., by the guardian where the individual has been found by the court to be incapacitated, or by the health care surrogate if the individual had expressly delegated such authority to the surrogate in the advance directive. Express and informed consent from the individual or his or her substitute decision-maker, as required by Section 394.459(3), F.S., including an opportunity to ask questions and receive answers about the procedure, shall be noted on or attached to form CF-MH 3057, or its equivalent, as documentation of the required disclosures and of the consent. Each signed authorization form is permission for the individual to receive a series of up to, but not more than, the stated number of electroconvulsive treatments identified on the form. Additional electroconvulsive treatments require additional written authorization. The signed authorization form shall be retained in the individual’s clinical record and shall comply with the provisions of Section 458.325, F.S.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.459, 394.4597, 394.4598, 394.4599, 394.4625(1), 394.463, 394.4655, 458.325, 765.401 FS. History–New 11-29-98, Amended 4-4-05, 11-27-25.

Fla. Admin. Code R. 65E-5.1703 Emergency Treatment Orders for the Administration of Psychotropic Medications

(1) An emergency treatment order for the administration of psychotropic medications shall be consistent with the least restrictive treatment interventions.

(a) The issuance of an emergency treatment order requires a physician’s or psychiatric nurse’s review of the individual’s condition for causal medical factors, such as the following:

Insufficient blood levels of psychotropic medication;
Medication interactions with psychotropic or other medications;
Side effects or adverse reactions to medications;
Organic, disease or medication based metabolic imbalances or toxicity; or
Other biologically based or influenced symptoms.

(b) All emergency treatment orders may only be issued by a physician licensed under the authority of Chapter 458 or 459, F.S., or a psychiatric nurse as defined by Section 394.455, F.S. practicing within the framework of an established protocol with a psychiatrist, if the physician or psychiatric nurse deem that such treatment is necessary.

(c) The physician or psychiatric nurse must review, integrate and address any metabolic imbalances in the issuance of an emergency treatment order.

(d) Absent more appropriate interventions, an emergency treatment order is for immediate administration of rapid response psychotropic medications to an individual to expeditiously treat symptoms, that if left untreated, present an immediate danger to the safety of the individual or others.

(2) An emergency treatment order for psychotropic medication supersedes the individual’s right to refuse psychotropic medication if based upon the physician’s or psychiatric nurse’s assessment that the individual is not capable of exercising voluntary control over his or her own symptomatic behavior and that these uncontrolled symptoms and behavior are an imminent danger to the individual or to others in the facility. When emergency treatment with psychotropic medication is ordered for a minor or an incapacitated or incompetent adult, facility staff shall document attempts to promptly contact the guardian, guardian advocate, or health care surrogate or proxy to obtain express and informed consent for the treatment in advance of administration where possible and if not possible, as soon thereafter as practical.

(3) The physician’s or psychiatric nurse’s initial order for emergency treatment may be by telephone or by telehealth but such a verbal order must be reduced to writing upon receipt and signed by a physician within 48 hours.

(4) Each emergency treatment order shall only be valid and shall be authority for emergency treatment only for a period not to exceed 48 hours.

(5) Standing orders, PRN orders, or other similar protocol are prohibited for emergency treatment.

(6) The need for each emergency treatment order must be documented in the individual’s clinical record in the progress notes and in the section used for physician’s orders and must describe the specific behavior which constitutes a danger to the individual or to others in the facility, and the nature and extent of the danger posed.

(7) If two emergency treatment orders are issued for the same individual within any seven (7) day period, and the individual does not have a guardian, guardian advocate, or health care surrogate or proxy, the petition for the appointment of a guardian advocate pursuant to the provisions of Section 394.4598, F.S., to provide express and informed consent shall be filed with the court within two (2) court working days.

(8) While awaiting court action, treatment may be continued without the consent of the individual, but only upon the written emergency treatment order of a physician or psychiatric nurse who has determined that the individual’s behavior each day during the wait for court action continues to present an immediate danger to the safety of the individual or others and who documents the nature and extent of the emergency each day of the specific danger posed. Such orders may not be written in advance of the demonstrated need for same.

(9) To assure the safety and rights of the individual, and because emergency treatment orders by a physician or psychiatric nurse absent express and informed consent are permitted only in an emergency, any use of psychotropic medications other than rapid response psychotropic medications requires a detailed and complete justification for the use of such medication. Both the nature and extent of the imminent emergency and any orders for the continuation of that medication must be clearly documented as required above.

(10) For children in the care and custody of the Department, policies and procedures shall include requirements for working with child protective investigators and case managers and obtaining necessary court authorizations to comply with section 39.407, F.S. and Chapter 65C-35, F.A.C.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.459(3), 394.4598, 394.463(2)(f), 394.46715 FS. History–New 11-29-98, Amended 4-4-05, 4-9-13, 8-23-23, 10-16-25.

Fla. Admin. Code R. 65E-5.180 Right to Quality Treatment

The following standards shall be required in the provision of quality mental health treatment:

(1) Each receiving and treatment facility and service provider shall, using nationally accepted accrediting standards for guidance, develop written policies and procedures for planned program activities designed to enhance the person’s self image, as required by Section 394.459(2)(d), F.S. These policies and procedures shall include curriculum, specific content, and performance objectives and shall be delivered by staff with content expertise. Medical, rehabilitative, and social services shall be integrated and provided in the least restrictive manner consistent with the safety of the persons served.

(2) Each facility and service provider, using nationally accepted accrediting standards for guidance, shall adopt written professional standards of quality, accuracy, completeness, and timeliness for all diagnostic reports, evaluations, assessments, examinations, and other procedures provided to persons under the authority of Chapter 394, Part I, F.S. Facilities shall monitor the implementation of those standards to assure the quality of all diagnostic products. Standards shall include and specify provisions addressing:

(a) The minimum qualifications to assure competence and performance of staff who administer and interpret diagnostic procedures and tests;

(b) The inclusion and updating of pertinent information from previous reports, including admission history and key demographic, social, economic, and medical factors;

(d) The timely availability of all reports to users;

(e) Reports shall be legible and understandable;

(f) The documentation of facts supporting each conclusion or finding in a report;

(g) Requirements for the direct correlation of identified problems with problem resolutions that consider the immediacy of the problem or time frames for resolution and which include recommendations for further diagnostic work-ups;

(h) Requirement that the completed report be signed and dated by the administering staff; and,

(i) Consistency of information across various reports and integration of information and approaches across reports.

(3) Psychiatric Examination. Psychiatric examinations shall include:

(a) Medical history, including psychiatric history, developmental abnormalies, physical or sexual abuse or trauma, and substance abuse;

(b) Examination, evaluative or laboratory results, including mental status examination;

(d) Course of psychiatric interventions including:

Medication history, trials and results,
Current medications and dosages,
Other psychiatric interventions in response to identified problems,

(e) Course of other non-psychiatric medical problems and interventions;

(f) Identification of prominent risk factors including physical health, psychiatric and co-occurring substance abuse; and,

(g) Discharge or transfer diagnoses.

(4) So that care will not be delayed upon arrival, procedures for the transfer of the physical custody of persons shall specify and require that documentation necessary for legal custody and medical status, including the person’s medication administration record for that day, shall either precede or accompany the person to his or her destination.

(5) Mental health services provided shall comply with the following standards:

(a) In designated receiving facilities, the on-site provision of emergency psychiatric reception and treatment services shall be available 24-hours-a-day, seven-days-a-week, without regard to the person’s financial situation.

(b) Assessment standards shall include provision for determining the presence of a co-occurring mental illness and substance abuse, and clinically significant physical and sexual abuse or trauma.

(c) A clinical safety assessment shall be accomplished at admission to determine the person’s need for, and the facility’s capability to provide, an environment and treatment setting that meets the person’s need for a secure facility or close levels of staff observation.

(d) The development and implementation of protocols or procedures for conducting and documenting the following shall be accomplished by each facility:

Determination of a person’s competency to consent to treatment within 24 hours after admission,
Identification of a duly authorized decision-maker for the person upon any person being determined not to be competent to consent to treatment,
Obtaining express and informed consent for treatment and medications before administration, except in an emergency; and,
Required involvement of the person and guardian, guardian advocate, or health care surrogate or proxy, in treatment and discharge planning.

(e) Use of age sensitive interventions in the implementation of seclusion or in the use of physical force as well as the authorization and training of staff to implement restraints, including the safe positioning of persons in restraints. Policies, procedures and services shall incorporate specific provisions regarding the restraining of minors, elders, and persons who are frail or with medical problems such as potential problems with respiration.

(f) Plain language documentation in the person’s clinical record of all uses of “as needed” or emergency applications of psychotropic medications, and all uses of physical force, restraints, seclusion, or “time-out” procedures upon persons, and the explicit reasons for their use.

(g) The prohibition of standing orders or similar protocols for the emergency use of psychotropic medication, restraint, or seclusion.

(h) Provision of required training for guardian advocates including activities and available resources designed to assist family members and guardian advocates in understanding applicable treatment issues and in identifying and contacting local self-help organizations.

(6) Each facility shall develop a written policy and procedure for receiving, investigating, tracking, managing and responding to formal and informal complaints by a person receiving services or by an individual acting on his or her behalf.

(a) The complaint process shall be verbally explained during the orientation process and provided in writing in language and terminology that the person receiving services can understand. It will explain how individuals may address complaints informally through the facility staff and treatment team, and formally through the staff person assigned to handle formal complaints, as well as the administrator or designee of the facility. The person receiving services shall also be advised that he or she may contact the Local Advocacy Council, the Florida Abuse Registry, the Advocacy Center for Persons with Disabilities, or any other individual or agency at anytime during the complaint process to request assistance. The complaint process, including telephone numbers for the above named entities, shall be posted in plain view in common areas and next to telephones used by individuals receiving services. Any complaint may be verbal or written. Any staff person receiving an informal or formal complaint dealing with life-safety issues will take immediate action to resolve the matter.

(b) Informal complaints are initial complaints that are usually made verbally by a person receiving services or by an individual acting on his or her behalf. If resolution cannot be mutually agreed upon, a formal written complaint may be initiated.

(c) When the person receiving services, or a person acting upon that person’s behalf, makes a formal complaint a staff person not named in the complaint shall assist the person in initiating the complaint. The complaint shall include the date and time of the complaint and detail the issue and the remedy sought. All formal complaints shall be forwarded to the staff person, or designee, who is assigned to track and monitor formal complaints. All formal complaints shall be tracked and monitored for compliance and shall contain the following information:

The date and time the formal complaint was originally received by staff,
The date and time the formal complaint was received by the staff assigned to track formal complaints,
The nature of the complaint,
The name of the person receiving services,
The name of the person making the complaint,
The name of the individual assigned to investigate the complaint,
The date the individual making the complaint was notified of the individual assigned to investigate the complaint,
The due date for the written response; and,
At closure, the written disposition of the formal complaint.

(d) The investigation shall be completed within 7 days from the date of entry into the system for tracking complaints.

(e) A written response must be given or mailed to the person receiving services within 24 hours of disposition. The individual acting on behalf of the person receiving services shall be notified of the completion of the investigation but will not be given specific details of the disposition unless they have a legal right to the information or a signed release of information is in place.

(f) The disposition of a complaint may be appealed to the administrator of the facility. If appealed, the facility administrator or designee shall review the written complaint and the initial disposition. Within five working days, the facility administrator or designee will make a final decision concerning the outcome of the complaint and will provide a written response within 24 hours to the person receiving services. A copy of the written response shall also be given to the staff member assigned to track complaints.

(7) Seclusion and Restraint for Behavior Management Purposes. All facilities, as defined in Section 394.455(10), F.S., are required to adhere to the standards and requirements of subsection (7).

(a) General Standards.

Each facility will provide a therapeutic milieu that supports a culture of recovery and individual empowerment and responsibility. Each person will have a voice in determining his or her treatment options. Treatment will foster trusting relationships and partnerships for safety between staff and individuals. Facility practices will be particularly sensitive to persons with a history of trauma.
The health and safety of the person shall be the primary concern at all times.
Seclusion or restraint shall be employed only in emergency situations when necessary to prevent a person from seriously injuring self or others, and less restrictive techniques have been tried and failed, or if it has been clinically determined that the danger is of such immediacy that less restrictive techniques cannot be safely applied.
There is a high prevalence of past traumatic experience among persons who receive mental health services. The response to trauma can include intense fear and helplessness, a reduced ability to cope, and an increased risk to exacerbate or develop a range of mental health and other medical conditions. The experience of being placed in seclusion or being restrained is potentially traumatizing. Seclusion and restraint practices shall be guided by the following principles of trauma-informed care: assessment of traumatic histories and symptoms; recognition of culture and practices that are re-traumatizing; processing the impact of a seclusion or restraint with the person; and addressing staff training needs to improve knowledge and sensitivity.
When a person demonstrates a need for immediate medical attention in the course of an episode of seclusion or restraint, the seclusion or restraint shall be discontinued, and immediate medical attention shall be obtained.
Persons will not be restrained in a prone position. Prone containment will be used only when required by the immediate situation to prevent imminent serious harm to the person or others. To reduce the risk of positional asphyxiation, the person will be repositioned as quickly as possible.
Responders will pay close attention to respiratory function of the person during containment and restraint. All staff involved will observe the person’s respiration, coloring, and other possible signs of distress and immediately respond if the person appears to be in distress. Responding to the person’s distress may include repositioning the person, discontinuing the seclusion or restraint, or summoning medical attention, as necessary.
Objects that impair respiration shall not be placed over a person’s face. In situations where precautions need to be taken to protect staff, staff may wear protective gear.
Unless necessary to prevent serious injury, a person's hands shall not be secured behind the back during containment or restraint.
The use of walking restraints is prohibited except for purposes of off-unit transportation and may only be used under direct observation of trained staff. In this instance, direct observation means that staff maintains continual visual contact of the person and is within close physical proximity to the person at all times.
The person shall be released from seclusion or restraint as soon as he or she is no longer an imminent danger to self or others.
Seclusion or restraint use shall not be based on the person’s seclusion or restraint use history or solely on a history of dangerous behavior. Dangerous behaviors include those behaviors that jeopardize the physical safety of oneself or others.
Seclusion and restraint may not be used simultaneously for children less than 18 years of age.
A person who is restrained must not be located in areas, whenever possible, subject to view by persons other than involved staff or where exposed to potential injury by other persons. This does not apply to the use of walking restraints.
Each facility utilizing seclusion or restraint procedures shall establish and utilize a Seclusion and Restraint Oversight Committee.

(b) Staff training.

Staff must be trained as part of orientation and subsequently on at least an annual basis. Staff responsible for the following actions will demonstrate relevant competency in the following areas before participating in a seclusion or restraint event or related assessment, or before monitoring or providing care during an event:

Strategies designed to reduce confrontation and to calm and comfort people, including the development and use of a personal safety plan,
Use of nonphysical intervention skills as well as bodily control and physical management techniques, based on a team approach, to ensure safety,
Observing for and responding to signs of physical and psychological distress during the seclusion or restraint event,
Safe application of restraint devices,
Monitoring the physical and psychological well-being of the person who is restrained or secluded, including but not limited to: respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by facility policy associated with the one hour face-to-face evaluation,
Clinical identification of specific behavioral changes that indicate restraint or seclusion is no longer necessary,
The use of first aid techniques; and,
Certification in the use of cardiopulmonary resuscitation, including required periodic recertification. The frequency of training for cardiopulmonary resuscitation will be in accordance with certification requirements, notwithstanding provision paragraph (7)(b).

Prior intervention shall include individualized therapeutic actions such as those identified in a personal safety plan that address individual triggers leading to psychiatric crisis. Recommended form CF-MH 3124, Feb. 05, “Personal Safety Plan,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for the purpose of guiding individualized techniques. Prior interventions may also include verbal de-escalation and calming strategies. Non physical interventions shall be the first choice unless safety issues require the use of physical intervention.
A personal safety plan shall be completed or updated as soon as possible after admission and filed in the person’s medical record.

a. This form shall be reviewed by the recovery team, and updated if necessary, after each incident of seclusion or restraint.

b. Specific intervention techniques from the personal safety plan that are offered or used prior to a seclusion or restraint event shall be documented in the person's medical record after each use of seclusion or restraint.

c. All staff shall be aware of and have ready access to each person’s personal safety plan.

(d) Implementation of Seclusion or Restraint.

A registered nurse or highest level staff member, as specified by written facility policy, who is immediately available and who is trained in seclusion and restraint procedures may initiate seclusion or restraint in an emergency when danger to oneself or others is imminent. An order for seclusion or restraint must be obtained from the physician, Advanced Registered Nurse Practitioner (ARNP), or Physician’s Assistant (PA), if permitted by the facility to order seclusion and restraint and stated within their professional protocol. The treating physician must be consulted as soon as possible if the seclusion or restraint was not ordered by the person's treating physician.
An examination of the person will be conducted within one hour by the physician or may be delegated to an Advanced Registered Nurse Practitioner, Physician’s Assistant, or Registered Nurse (RN), if authorized by the facility and trained in seclusion and restraint procedures as described in paragraph (7)(b). This examination shall include a face-to face assessment of the person’s medical and behavioral condition, a review of the clinical record for any pre-existing medical diagnosis or physical condition which may contraindicate the use of seclusion or restraint, a review of the person’s medication orders including an assessment of the need to modify such orders during the period of seclusion or restraint, and an assessment of the need or lack of need to elevate the person’s head and torso during restraint. The comprehensive examination must determine that the risks associated with the use of seclusion or restraint are significantly less than not using seclusion or restraint and whether to continue or terminate the intervention. A licensed psychologist may conduct only the behavioral assessment portion of the comprehensive assessment if authorized by the facility and trained in seclusion and restraint procedures as described in paragraph (7)(b). Documentation of the comprehensive examination, including the time and date completed, shall be included in the person’s medical record. If the face-to-face evaluation is conducted by a trained Registered Nurse, the attending physician who is responsible for the care of the person must be consulted as soon as possible after the evaluation is completed.
Each written order for seclusion or restraint is limited to four hours for adults, age 18 and over; two hours for children and adolescents age nine through 17; or one hour for children under age nine. A seclusion or restraint order may be renewed in accordance with these limits for up to a total of 24 hours, after consultation and review by a physician, ARNP, or PA in person, or by telephone with a Registered Nurse who has physically observed and evaluated the person. When the order has expired after 24 hours, a physician, ARNP, or PA must see and assess the person before seclusion or restraint can be re-ordered. The results of this assessment must be documented. Seclusion or restraint use exceeding 24 hours requires the notification of the Facility Administrator or designee.
All orders must be signed within 24 hours of the initiation of seclusion or restraint.
The order shall include the specific behavior prompting the use of seclusion or restraint, the time limit for seclusion or restraint, and the behavior necessary for the person's release. Additionally, for restraint, the order shall contain the type of restraint ordered and the positioning of the person, including possibly elevating the person’s head for respiratory and other medical safety considerations. Consideration shall be given to age, physical fragility, and physical disability when ordering restraint type.
An order for seclusion or restraint shall not be issued as a standing order or on an as-needed basis.
In order to protect the safety of each person served by a facility, each person shall be searched for contraband before or immediately after being placed into seclusion or restraints.
The person shall be clothed appropriately for temperature and at no time shall a person be placed in seclusion or restraint in a nude or semi-nude state.
Every secluded or restrained person shall be immediately informed of the behavior that resulted in the seclusion or restraint and the behavior and the criteria reflecting absence of imminent danger that are necessary for release.
For persons under the age of 18, the facility must notify the parent(s) or legal guardian(s) of the person who has been restrained or placed in seclusion as soon as possible, but no later than 24 hours, after the initiation of each seclusion or restraint event. This notification must be documented in the person's medical record, including the date and time of notification and the name of the staff person providing the notification.
For each use of seclusion or restraint, the following information shall be documented in the person's medical record: the emergency situation resulting in the seclusion or restraint event; alternatives or other less restrictive interventions attempted, as applicable, or the clinical determination that less restrictive techniques could not be safely applied; the name and title of the staff member initiating the seclusion or restraint; the date/time of initiation and release; the person’s response to seclusion or restraint, including the rationale for continued use of the intervention; and that the person was informed of the behavior that resulted in the seclusion or restraint and the criteria necessary for release.

(e) During Seclusion or Restraint Use.

When restraint is initiated, nursing staff shall see and assess the person as soon as possible but no later than 15 minutes after initiation and at least every hour thereafter. The assessment shall include checking the person's circulation and respiration, including necessary vital signs (pulse and respiratory rate at a minimum).
The person over age 12 who is secluded shall be observed by trained staff every 15 minutes. At least one observation an hour will be conducted by a nurse. Restrained persons must have continuous observation by trained staff. Secluded children age 12 and under must be monitored continuously by face-to-face observation or by direct observation through the seclusion window for the first hour and then at least every 15 minutes thereafter.
Monitoring the physical and psychological well-being of the person who is secluded or restrained shall include but is not limited to: respiratory and circulatory status; signs of injury; vital signs; skin integrity; and any special requirements specified by facility policies. This monitoring shall be conducted by trained staff as required in paragraph (7)(b).
During each period of seclusion or restraint, the person must be offered reasonable opportunities to drink and toilet as requested. In addition, the person who is restrained must be offered opportunities to have range of motion at least every two hours to promote comfort. Each facility shall have written policies and procedures specifying the frequency of providing drink, toileting, and check of bodily positioning to avoid traumatizing a person and retaining the person’s maximum degree of dignity and comfort during the use of bodily control and physical management techniques.
Documentation of the observations and the staff person’s name shall be recorded at the time the observation takes place.

(f) Release from Seclusion or Restraint and Post-Release Activities.

Release from seclusion or restraint shall occur as soon as the person no longer appears to present an imminent danger to themselves or others. Upon release from seclusion or restraint, the person’s physical condition shall be observed, evaluated, and documented by trained staff. Documentation shall also include: the name and title of the staff releasing the person; and the date and time of release.
After a seclusion or restraint event, a debriefing process shall take place to decrease the likelihood of a future seclusion or restraint event for the person and to provide support.

a. Each facility shall develop policies to address:

(I) A review of the incident with the person who was secluded or restrained. The person shall be given the opportunity to process the seclusion or restraint event as soon as possible but no longer than within 24 hours of release. This debriefing discussion shall take place between the person and either the recovery team or another preferred staff member. This review shall seek to understand the incident within the framework of the person’s life history and mental health issues. It should assess the impact of the event on the person and help the person identify and expand coping mechanisms to avoid the use of seclusion or restraint in the future. The discussion will include constructive coping techniques for the future. A summary of this review should be documented in the person’s medical record.

(II) A review of the incident with all staff involved in the event and supervisors or administrators. This review shall be conducted as soon as possible after the event and shall address: the circumstances leading to the event, the nature of de-escalation efforts and alternatives to seclusion and restraint attempted, staff response to the incident, and ways to effectively support the person's constructive coping in the future and avoid the need for future seclusion or restraint. The outcomes of this review should be documented by the facility for purposes of continuous performance improvement and monitoring. The review findings will be forwarded to the Seclusion and Restraint Oversight Committee; and,

(III) Support for other persons served and staff, as needed, to return the unit to a therapeutic milieu.

b. Within 2 working days after any use of seclusion or restraint, the recovery team shall meet and review the circumstances preceding its initiation and review the person’s recovery plan and personal safety plan to determine whether any changes are needed in order to prevent the further use of seclusion or restraint. The recovery team shall also assess the impact the event had on the person and provide any counseling, services, or treatment that may be necessary as a result. The recovery team shall analyze the person’s clinical record for trends or patterns relating to conditions, events, or the presence of other persons immediately before or upon the onset of the behavior warranting the seclusion or restraint, and upon the person’s release from seclusion. The recovery team shall review the effectiveness of the emergency intervention and develop more appropriate therapeutic interventions. Documentation of this review shall be placed in the person’s clinical record.

c. The Seclusion and Restraint Oversight Committee shall conduct timely reviews of each use of seclusion and restraints and monitor patterns of use, for the purpose of assuring least restrictive approaches are utilized to prevent or reduce the frequency and duration of use.

(g) Reporting.

All facilities, as defined in Section 394.455(10), F.S., are required to report each seclusion and restraint event to the Department of Children and Families. This reporting shall be done electronically using the Department’s web-based application either directly via the data input screens or indirectly via the File Transfer Protocol batch process. The required reporting elements are: Provider tax identification number; Person’s social security number and identification number; date and time the seclusion or restraint event was initiated; discipline of the person ordering the seclusion or restraint; discipline of the person implementing the seclusion or restraint; reason seclusion or restraint was initiated; type of restraint used; whether significant injuries were sustained by the person; and date and time seclusion or restraint was terminated. Facilities shall report seclusion and restraint events on a monthly basis. Events that result in death or significant injury either to a staff member or person shall be reported to the department’s web-based system in accordance with department operating procedures.
All facilities that are subject to the Conditions of Participation for Hospitals, 42 Code of Federal Regulations, part 482, under the Centers for Medicare and Medicaid Services (CMS), must report to CMS any death that occurs in the following circumstances:

a. While a person is restrained or secluded,

b. Within 24 hours after release from seclusion or restraint, or

c. Within one week after seclusion or restraint, where it is reasonable to assume that use of the seclusion or restraint contributed directly or indirectly to the person’s death.

Each death described in this section shall be reported to CMS by telephone no later than the close of business the next business day following knowledge of the persons’ death. A report shall simultaneously be submitted to the Director of Mental Health/Designee in the Mental Health Program Office headquarters in Tallahassee, FL. The address is: 1317 Winewood Blvd., Tallahassee, Florida 32399-0700.

The Department shall collect and review the data on a monthly basis. The Director of Mental Health shall be informed of any deaths or significant injuries related to seclusion or restraint and significant trends regarding seclusion and restraint use.

(h) Nothing herein shall affect the ability of emergency medical technicians, paramedics or physicians or any person acting under the direct medical supervision of a physician to provide examination or treatment of incapacitated persons in accordance with Section 401.445, F.S.

(8) Use of Protective Medical Devices with Frail or Mobility Impaired Persons.

(a) When ordering safety or protective devices such as posey vests, geri-chairs, mittens, and bed rails which also restrain, facility staff shall consider alternative means of providing such safety so that the person’s need for regular exercise is accommodated to the greatest extent possible.

(b) Where frequent or prolonged use of safety or protective devices is required, the person’s treatment plan shall address debilitating effects due to decreased exercise levels such as circulation, skin, and muscle tone and the person’s need for maintaining or restoring bowel and bladder continence.

(c) The treatment plan shall include scheduled activities to lessen deterioration due to the usage of such protective medical devices.

(9) Elevated Levels of Supervision. Receiving and treatment facilities shall ensure that where one-on-one supervision is ordered by a physician, it shall be continuous and shall not be interrupted as a result of shift changes or due to conflicting staff assignments. Such supervision shall be continuous until documented as no longer medically necessary by a physician.

History

Rulemaking Authority 394.457(5), 394.457(5)(b), 394.459(4)(b), 394.879 FS. Law Implemented 394.457, 394.459(2)(d), (4), (4)(b)3., 394.879, 401.445 FS. History–New 11-29-98, Amended 4-4-05, 2-8-07, 5-7-08.

Fla. Admin. Code R. 65E-5.1802 Maintenance of the Facility

The facility shall ensure the proper functioning and maintenance of the facility structure, finishes, fixtures, furnishings, and equipment. The facility shall ensure the ready availability of necessary medical equipment or devices for the populations served, including restraint equipment that is suitable to the safety and medical needs of the persons being served.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(4) FS. History–New 11-29-98.

Fla. Admin. Code R. 65E-5.190 Right to Communication and Visits

(1) If the treatment team imposes any restrictions on whom a person in a receiving or treatment facility may communicate, such restrictions and justification shall be recorded in the person’s clinical record. Recommended form CF-MH 3049, (December 2024), “Restriction of Communication or Visitors,” which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17368 may be used for this purpose. Facility staff shall make competent adults aware that they have the ability to waive the confidentiality of their presence in a receiving or treatment facility and allowing all or specified individuals the person selects access to private and open communication with the person. Recommended form CF-MH 3048, (December 2024), “Confidentiality Agreement,” incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-17369 may be used for this purpose.

(2) Immediate access to a telephone shall be provided to each person requesting to call his or her legal counsel, Florida Abuse Registry, Florida Local Advocacy Council, or the Advocacy Center for Persons with Disabilities.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(5) FS. History–New 11-29-98, Amended 4-4-05, 12-29-24.

Fla. Admin. Code R. 65E-5.200 Right to Care and Custody of Personal Effects

Each designated receiving and treatment facility shall develop policies and procedures governing what personal effects will be removed from persons for reasons of personal or unit safety, how they will be safely retained by the facility, and how and when they will be returned to the person or other authorized individual. Policies and procedures shall specify how contraband and other personal effects determined to be detrimental to the person will be addressed when not returned to the person or other authorized individual. An inventory of personal effects shall be witnessed by two staff and by the person, if able, at the time of admission, at any time the inventory is amended, and at the time the personal effects are returned or transferred. Recommended form CF-MH 3043, Feb. 05, “Inventory of Personal Effects,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(6) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.210 Right to Vote in Public Elections

The facility shall have voter registration forms and applications for absentee ballots readily available at the facility or in accordance with the procedures established by the supervisor of elections, and shall assure that each person who is eligible to vote and wishes to do so, may exercise his or her franchise. Each designated receiving and treatment facility shall develop policies and procedures governing how persons will be assisted in exercising their right to vote.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(7) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.220 Right to Habeas Corpus

(1) Upon admission to a receiving or treatment facility, each person shall be given notice of his or her right to petition for a writ of habeas corpus and for redress of grievances. Recommended form CF-MH 3036, Feb. 05, “Notice of Right to Petition for Writ of Habeas Corpus or for Redress of Grievances,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose. A copy of the notice shall be provided to the guardian, guardian advocate, representative, or the health care surrogate or proxy, and the person’s clinical record shall contain documentation that the notice was provided. A petition form shall be promptly provided by staff to any person making a request for such a petition. Recommended form CF-MH 3090, Feb. 05, “Petition for Writ of Habeas Corpus or for Redress of Grievances,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(2) Receiving and treatment facilities shall accept and forward to the appropriate court of competent jurisdiction a petition submitted by the person or others in any form in which it is presented.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.459(8) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.230 Guardian Advocate

(1) Upon filing with the court a copy of the completed recommended form CF-MH 3106, “Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate,” which is incorporated by reference and available in Rule 65E-5.170, F.A.C., or its equivalent, shall be given to the individual, the individual’s representative if any, and to the prospective guardian advocate with a copy retained in the individual’s clinical record.

(2) If the court finds the individual incompetent to consent to treatment a guardian advocate shall be appointed. Form CF-MH 3107, (August 2025), “Order Appointing Guardian Advocate,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18652, or other order used by the court, may be used for documentation of this finding. The order shall be provided to the individual, guardian advocate, representative, and to the facility administrator for retention in the individual’s clinical record.

(3) The individual’s clinical record shall reflect that the guardian advocate has been appointed by the court and has completed the training required by Section 394.4598(4), F.S., and further training required pursuant to a court order, prior to being asked to provide express and informed consent to treatment. Recommended form CF-MH 3120, (August 2025), “Certification of Guardian Advocate Training Completion,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18653 may be used for this purpose.

(4) When a guardian advocate previously appointed by the court cannot or will not continue to serve in that capacity, and the individual remains incompetent to consent to treatment, the facility administrator shall petition the court for a replacement guardian advocate. A copy of the completed petition shall be given to the individual, the current guardian advocate, the prospective replacement guardian advocate, individual’s attorney, and representative, with a copy retained in the individual’s clinical record. Form CF-MH 3106, “Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate,” which is incorporated by reference and available in Rule 65E-5.170, F.A.C., may be used for this documentation if Parts I and III are completed.

(5) If a guardian advocate is required by Section 394.4598, F.S., or otherwise to petition the court for authority to consent to extraordinary treatment, a copy of the completed petition form shall be given to the individual, the individual’s attorney, and a copy shall be retained in the individual’s clinical record. Form CF-MH 3108, (August 2025), “Petition Requesting Court Approval for Guardian Advocate to Consent to Extraordinary Treatment,” which is incorporated by reference available at http://flrules.org/Gateway/reference.asp?No=Ref-18654 may be used for this purpose. Any order issued by the court in response to such a petition shall be given to the individual, attorney representing the individual, guardian advocate, and to the facility administrator, with a copy retained in the individual’s clinical record. Form CF-MH 3109, (August 2025), “Order Authorizing Guardian Advocate to Consent to Extraordinary Treatment,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18655, or other order used by the court may be used for such documentation.

(6) At any time an individual, who has previously been determined to be incompetent to consent to treatment and had a guardian advocate appointed by the court, has been found by a physician or psychiatric nurse practicing within the framework of an established protocol with a psychiatrist, to have regained competency to consent to treatment, the facility shall notify the court that appointed the guardian advocate of the individual’s competence and the discharge of the guardian advocate. Form CF-MH 3121, (August 2025), “Notification to Court of Competence to Consent to Treatment and Discharge of Guardian Advocate,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18656 may be used for this purpose.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4598 FS. History–New 11-29-98, Amended 4-4-05, 11-24-25.

Fla. Admin. Code R. 65E-5.2301 Health Care Surrogate or Proxy

(1) During the interim period between the time a person is determined to be incompetent to consent to treatment by one or more physicians, pursuant to Section 765.204, F.S., and the time a guardian advocate is appointed by a court to provide express and informed consent to the person’s treatment, a health care surrogate designated by the person, pursuant to Chapter 765, Part II, F.S., may provide such consent to treatment.

(2) In the absence of an advance directive or when the health care surrogate named in the advance directive is no longer able or willing to serve, a health care proxy, pursuant to Chapter 765, Part IV, F.S., may also provide interim consent to treatment.

(3) Upon the documented determination that a patient is incompetent to make health care decisions for himself or herself by one or more physicians, pursuant to Section 765.204, F.S., the facility shall notify the surrogate or proxy in writing that the conditions under which he or she can exercise his or her authority under the law have occurred. Recommended form CF-MH 3122, Feb. 05, “Certification of Person’s Incompetence to Consent to Treatment and Notification of Health Care Surrogate/Proxy,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(4) If the surrogate selected by the person is not available or is unable to serve or if no advance directive had been prepared by the person, a proxy may be designated as provided by law. Recommended form CF-MH 3123, Feb. 05, “Affidavit of Proxy,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(5) A petition for adjudication of incompetence to consent to treatment and appointment of a guardian advocate shall be filed with the court within 2 court working days of the determination of the patient’s incompetence to consent to treatment by one or more physicians, pursuant to Section 765.204, F.S. Recommended form CF-MH 3106, “Petition for Adjudication of Incompetence to Consent to Treatment and Appointment of a Guardian Advocate,” as referenced in subparagraph 65E-5.170(1)(d)2., F.A.C., may be used for this purpose.

(6) The facility shall immediately provide to the health care surrogate or proxy the same information required by statute to be provided to the guardian advocate. In order to protect the safety of the person, the facility shall make available to the health care surrogate or proxy the training required of guardian advocates and ensure that the surrogate or proxy communicate with the person and person’s physician prior to giving express and informed consent to treatment.

(7) Each designated receiving and treatment facility shall adopt policies and procedures specifying how its direct care and assessment staff will be trained on how to honor each person’s treatment preferences as detailed in his or her advance directives. The person being served shall be provided information about advance directives and offered assistance in completing an advance directive, if willing and able to do so.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4598, 765, Parts I, IV, 765.204 FS. History–New 11-29-98, Amended 1-16-01, 4-4-05.

Fla. Admin. Code R. 65E-5.250 Clinical Records; Confidentiality

(1) Except as otherwise provided by law, verbal or written information about an individual shall only be released when the competent individual, or a duly authorized legal decision-maker such as guardian, guardian advocate, legal guardian, or health care surrogate or proxy provides consent to such release. When such information is released, a copy of a signed authorization form shall be retained in the individual’s clinical record. Form CF-MH 3044, (August 2025), “Authorization for Release of Information,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18657 may be used as documentation. Consent or authorization forms may not be altered in any way after signature by the individual or other authorized decision-maker nor may an individual or other authorized decision-maker be allowed to sign a blank form.

(2) Facility staff shall inform each individual that he or she has the right to waive, in writing, the confidentiality of his or her presence in a receiving or treatment facility and to communicate with all or collectively as specified by the individual. Form CF-MH 3048, “Confidentiality Agreement,” which is incorporated by reference and available in Rule 65E-5.190, F.A.C., may be used for this purpose.

(3) For purposes of Section 394.4615(3)(b), F.S., a “qualified researcher” is one who after making application to review confidential data and who, after documenting his or her bona fide academic, scientific or medical credentials and describing the particular research which gives rise to the request, is determined by the administrator of a receiving or treatment facility or by the Secretary of the department, to be eligible to review such data. In making that determination the administrator or the Secretary shall weigh the individual’s right to privacy against the benefit of disclosure and shall determine whether the disclosure is in the best interest of the state. Personal identifying information obtained by such a qualified researcher shall not be further disclosed without the express and informed consent of the individual or individual authorized to provide consent for him or her.

(4) When an individual’s access to his or her clinical record or any part of his or her record is restricted by written order of a physician or psychiatric nurse, such restriction shall be documented in the individual’s clinical record and provided to the individual and the individual’s guardian, guardian advocate, attorney, and representative. The order restricting access to clinical records expires after seven days but may be renewed, after review, for a subsequent seven (7) day periods. If the request is denied or such access is restricted, a written response shall be provided to the individual. Form CF-MH 3110, (August 2025), “Restriction of Access to Own Record,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18658 may be used for such documentation.

(5) Each receiving facility shall develop detailed policies and procedures governing release of records to each individual requesting release, including criteria for determining what type of information may be harmful to the individual, establishing a reasonable time for responding to requests for access, and identifying methods of providing access that ensure clinical support to the individual while securing the integrity of the record.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4615 FS. History–New 11-29-98, Amended 4-4-05, 11-27-25, Technical Change 1-8-26.

Fla. Admin. Code R. 65E-5.260 Transportation

(1) Each law enforcement officer or other transporter who takes an individual into custody for involuntary examination under the Baker Act shall provide the receiving facility or access center the original or an electronic copy of one of the following:

(a) Form CF-MH 3001, “Ex Parte Order for Involuntary Examination,” which is incorporated by reference in 65E-5.280, F.A.C., or other form provided by the court;

(b) Form CF-MH 3052a, “Report of a Law Enforcement Officer Initiating Involuntary Examination,” which is incorporated by reference in 65E-5.280, F.A.C.; or

(c) Form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination,” which is incorporated by reference in 65E-5.280, F.A.C.

(2) Each law enforcement officer or other transporter who takes an individual into custody for involuntary admission under the Marchman Act shall provide the receiving facility or access center the original or an electronic copy of one of the following:

(a) Form CF-MH 4057, (August 2025), “Certificate of Professional for Emergency Assessment for Substance Abuse Services,” which is incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-18460; or

(b) Form CF-M 4002, (August 2025), “Report of Law Enforcement Officer Initiating Protective Custody,” which is incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-18461.

(3) The designated law enforcement agency or other transporter shall transport the individual to the most appropriate facility pursuant to the county’s approved transportation plan, documenting this transport on Form CF-MH 3100, (August 2025), “Transportation to Receiving Facility,” which is hereby incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-18462. Section 394.463(2)(a)2. F.S. contains requirements if law enforcement is transporting a minor. The designated law enforcement agency may decline to transport an individual to a receiving facility if the county has contracted with an emergency medical transport service or private transport company or as stated in the transportation plan, and the law enforcement agency and the emergency medical transport service or private transport company agree that the continued presence of law enforcement personnel is not necessary for the safety of the individual or others. Part II of Form CF-MH 3100, “Transportation to Receiving Facility,” documenting the agreement between law enforcement and the transport service shall accompany the individual to the receiving facility. When the transportation is conducted by a mental health overlay program or a mobile crisis response service, the program or service shall complete Part III of Form CF-MH 3100 “Transportation to Receiving Facility,” which shall accompany the individual to the receiving facility. The completed form shall be retained in the individual’s clinical record.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.462, 394.463 FS. History–New 11-29-98, Amended 4-4-05, 1-8-07, 7-5-16, 8-23-23, 10-16-25.

Fla. Admin. Code R. 65E-5.2601 Transportation Exception Plan

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.462(3) FS. History–New 11-29-98, Amended 4-4-05, Repealed 7-20-23.

Fla. Admin. Code R. 65E-5.270 Voluntary Admission

(1) The following applies to voluntary admission of adults:

(a) Providers must complete Form CF-MH 3040, (August 2025), “Application for Voluntary Admission – Adults,” which is hereby incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18639, to document an application of a competent adult for admission to a receiving facility.

(b) Form CF-MH 3098, (August 2025), “Application for Voluntary Admission – State Treatment Facility,” which is hereby incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18640, may be used to document an application of a competent adult for admission to a state treatment facility.

(c) Any application for voluntary admission shall be based on the individual’s express and informed consent. Form CF-MH 3104, (August 2025), “Certification of Individual’s Competence to Provide Express and Informed Consent,” which is hereby incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18641, may be used to document the competence of an individual to give express and informed consent to be on voluntary status. The original of the completed form shall be retained in the individual’s clinical record.

(d) Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” incorporated in this rule, may be used to document a person applying for transfer from involuntary to voluntary status is competent to provide express and informed consent. The original of the completed form shall be filed in the individual’s clinical record. A change in legal status must be followed by notice sent to individuals pursuant to Section 394.4599, F.S.

(2) The following applies to voluntary admission of minors:

(a) Form CF-MH 3097, (August 2025), “Application for Voluntary Admission – Minors,” which is hereby incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18642, must be used to document a parent or legal guardian’s application for admission of a minor to a receiving facility.

(b) Before a minor is admitted to a receiving facility on a voluntary status, the parent or legal guardian will provide express and informed consent, and the receiving facility shall perform a clinical review to determine the voluntariness of the minor’s assent. The clinical review shall consist of the following:

Interview the minor and review the reason(s) the minor is presenting for admission, with consideration to age, intellectual/developmental disabilities, and language skills, and
Explain to the minor and the parent or legal guardian what they should expect while admitted to the facility, along with the admission and examination process in language appropriate for age and developmental level.

(c) If the minor’s voluntary assent is verified by the facility as a result of the clinical review, Part II of Form CF-MH 3097, “Application for Voluntary Admission – Minors” must be completed.

(d) If the minor’s assent is not verified during the clinical review, or if the child is not capable of assenting, the receiving facility must:

Release the minor to their parent or legal guardian with appropriate follow up referrals, in accordance with Rule 65E-5.1303, F.A.C.; or
If the minor meets the criteria for involuntary examination, a professional authorized by Section 394.463(2), F.S., must initiate and complete Form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination”, which is incorporated by reference in Rule 65E-5.280, F.A.C., and the facility shall adhere to the involuntary examination standards in Rule 65E-5.2801, F.A.C.

(e) Form CF-MH 3097, “Application for Voluntary Admission – Minors,” incorporated in this rule must be used to document a minor applying for transfer from involuntary to voluntary status as set forth in paragraphs (2)(a) through (d) above.

(f) The original completed form(s) shall be filed in the minor’s clinical record.

(3) All individuals on voluntary status shall be advised of their right to request discharge. Form CF-MH 3051a, (August 2025), “Notice of Right of Individual on Voluntary Status to Request Discharge from a Receiving Facility,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18643, or CF-MH 3051b, (August 2025), “Notice of Right of Individual on Voluntary Status to Request Discharge from a Treatment Facility,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18644, may be used to document the giving of such advice. A copy of the notice or its equivalent shall be given to the individual and to the individual’s parent or legal guardian if a minor, with the original of each completed application and notice retained in the individual’s clinical record.

(4) The initial assessment of an individual identified pursuant to Section 394.4625(1)(b), F.S., shall be done prior to moving the individual from his or her residence to a receiving facility for voluntary admission. Form CF-MH 3099, (August 2025), “Certification of Ability to Provide Express and Informed Consent for Voluntary Admission and Treatment from Facilities Licensed under Chapter 400, F.S.,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18645, may be used for this purpose. If the facility licensed under Chapter 400, F.S. did not first arrange for completion of an independent evaluation of the resident’s competence to provide express and informed consent to admission and treatment before moving the individual, the receiving facility shall notify the Agency for Health Care Administration by using the Agency’s Complaint Administration’s online complaint form HCF Complaint Form | AHCA - Health Care Facility Complaint Form (myflorida.com). The receiving facility shall document submissions of online complaints in the individual’s clinical record.

(5) If an individual refuses mental health treatment, the individual shall not be eligible for admission on voluntary status. An individual on voluntary status who refuses to consent to or revokes consent to treatment must be discharged from a designated receiving or treatment facility within 24 hours after such refusal or revocation, unless the individual is transferred to involuntary status or unless the refusal or revocation is freely and voluntarily rescinded by the individual. When an individual refuses or revokes consent to treatment, facility staff shall document this immediately in the individual’s clinical record. Form CF-MH 3105, (August 2025), “Refusal or Revocation of Consent to Treatment,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18646, may be used for this purpose. Should an individual withdraw his or her refusal or revocation of consent to treatment, the individual shall be asked to complete Part III of Form CF-MH 3105, “Refusal or Revocation of Consent to Treatment,” or similar documentation, and the original shall be retained in the individual’s clinical record.

(6) An oral or written request for discharge made by any individual following admission to the facility shall be immediately documented in the individual’s clinical record. Form CF-MH 3051a, “Notice of Right of Individual on Voluntary Status to Request Discharge from a Receiving Facility,” or CF-MH 3051b, “Notice of Right of Individual on Voluntary Status to Request Discharge from a Treatment Facility,” which are incorporated in this rule, may be used for this purpose. This form may also be completed by a relative, adult friend, or attorney of the individual.

(7) When an individual on voluntary status refuses treatment or requests discharge and the facility administrator makes the determination that the individual will not be discharged within 24 hours from a designated receiving or treatment facility the request must be communicated to a physician, clinical psychologist with at least three (3) years of postdoctoral experience in the practice of psychology, or psychiatrist as quickly as possible but no later than 12 hours after the request is made. A petition for involuntary inpatient placement or involuntary outpatient services shall be filed within two (2) court working days with the court by the facility administrator. Form CF-MH 3032, (August 2025) “Petition for Involuntary Services,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18647, may be used for this purpose. The first expert opinion by a psychiatrist shall be obtained on the petition form within 24 hours of the request for discharge or refusal of treatment to justify the continued admission of the individual for their safety or the safety of others, and the petition shall be filed with the court within two (2) court working days after the request for discharge or refusal to consent to treatment was made. If the petition is not filed within two (2) court working days, the individual must be discharged. Pending the filing of the petition, the individual may be held and emergency treatment rendered in the least restrictive manner, upon the order of a physician or psychiatric nurse.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.4599, 394.4625 FS. History–New 11-29-98, Amended 4-4-05, 7-20-23, 12-2-25.

Fla. Admin. Code R. 65E-5.280 Involuntary Examination

(1) Court Order. Sworn testimony shall be documented by using Form CF-MH 3002, (July 2023), “Petition and Affidavit Seeking Ex Parte Order Requiring Involuntary Examination,” which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15765, or other form used by the court. Documentation of the findings of the court on Form CF-MH 3001, (August 2025), “Ex Parte Order for Involuntary Examination,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18659, or other order used by the court, shall be used when there is reason to believe the criteria for involuntary examination are met. The ex parte order for involuntary examination shall accompany the individual to the receiving facility.

(2) Law Enforcement.

(a) If a law enforcement officer in the course of his or her official duties initiates an involuntary examination, the officer shall complete Form CF-MH 3052a, “Report of Law Enforcement Officer Initiating Involuntary Examination,” (August 2025), which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18660.

(b) Form CF-MH 3052a, “Report of Law Enforcement Officer Initiating Involuntary Examination” shall accompany the individual to the receiving facility.

(3) Professional Certificate.

(a) A professional authorized by Section 394.463(2)(a)3., F.S., who determines, after personally examining an individual believed to meet the involuntary examination criteria within the preceding 48 hours, that the criteria are met, is authorized to execute Form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination,” (August 2025), which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18661.

(b) Form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination,” shall be executed immediately after it is completed by arranging for transportation to a designated receiving facility. The Certificate is valid throughout the state. The completed certificate shall accompany the individual to a receiving facility.

(4) Emergency Medical Conditions.

(a) Form CF-MH 3101, (July 2023), “Hospital Determination that Individual Does Not Meet Involuntary Placement Criteria,” which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15769 may be used to document the results of the examination prescribed in Section 394.463(2)(h), F.S.

(b) Receiving facilities shall develop policies and procedures that expedite the transfer of individuals referred from non-designated hospitals after examination or treatment of an emergency medical condition, within the 12 hours required by Section 394.463(2)(i), F.S.

(c) The 72-hour involuntary examination period set out in Section 394.463(2)(g), F.S., shall not be exceeded. In order to document the 72-hour period has not been exceeded, Form CF-MH 3102, (July 2023), “Request for Involuntary Examination After Stabilization of Emergency Medical Condition,” which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15770 may be used for this purpose. The form may be sent to a designated receiving facility at which appropriate medical treatment is available.

(5) The Department requires specific data to identify trends and patterns experienced by individuals served under Part I of Chapter 394, F.S., to be included in required reports, to support justifications for program funding and to implement the provisions of Section 394.463(2)(e), F.S. Web-based Baker Act Data Collection Form CF-MH 3118, (May 2026), titled “Baker Act Data Collection Form,” which is incorporated by reference and available at https://flrules.org/Gateway/reference.asp?No=Ref-19628, shall be completed in its entirety by the assessor conducting the initial screening and only submitted one time from the admitting facility for the episode of care. Effective July 1, 2023, designated receiving facilities shall submit the required data within five (5) business days through the Department’s statewide Baker Act data collection portal, which can be accessed at https://dcfapps.myflfamilies.com/BakerAct. Instructions on training requirements and how to submit the Baker Act data, petitions, and forms may be found at https://myflfamilies.com/BADCS. The Baker Act Data Collection Form must be accompanied by the following:

(a) Form CF-MH 3001, “Ex Parte Order for Involuntary Examination,” or other order provided by the court;

(b) Form Mandatory form CF-MH 3052a, “Report of Law Enforcement Officer Initiating Involuntary Examination;” or

(d) Form CF-MH 3100, “Transportation to Receiving Facility,” if the individual is transported by a law enforcement officer, medical transport, mental health overlay program, mobile response team or private transport. Form CF-MH 3100 is incorporated by reference and available in Rule 65E-5.260, F.A.C.

(6) If a person is delivered to a receiving facility for an involuntary examination from any program or residential services provider licensed under the provisions of Chapter 400 or 429, F.S., without an ex parte order, Form CF-MH 3052a, “Report of Law Enforcement Officer Initiating Involuntary Examination,” or Form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination,” the receiving facility shall notify the Department by the method and timeframe required by Section 394.463(2)(b), F.S.

(7) Form CF-MH 3045, (July 2023), “Notice of Individual’s Admission for Involuntary Examination,” which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15772, may be used when notifying authorized individuals of an individual’s involuntary admission to a receiving facility.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.463 FS. History–New 11-29-98, Amended 4-4-05, 1-8-07, 7-5-16, 5-4-20, 8-14-23, 11-24-25, 8-20-26.

Fla. Admin. Code R. 65E-5.2801 Minimum Standards for Involuntary Examination Pursuant to Section 394.463, F.S

The involuntary examination is also known as the initial mandatory involuntary examination.

(1) Whenever an involuntary examination is initiated by a circuit court, a law enforcement officer, or a mental health professional as provided in section 394.463(2), F.S., an examination by a physician or clinical psychologist or psychiatric nurse must be conducted in person or via telehealth, without unnecessary delay, to determine if the criteria for involuntary services are met and the results documented in the individual’s clinical record. The examination, conducted at a facility licensed under chapter 394 or 395, F.S., must contain:

(a) A thorough review of any observations of the individual’s recent behavior;

(b) A review of Form CF-MH 3100, “Transportation to Receiving Facility,” which is incorporated in Rule 65E-5.260, F.A.C., and one of the following forms which are incorporated in Rule 65E-5.280, F.A.C.: Form CF-MH 3001, “Ex Parte Order for Involuntary Examination,” or other form provided by the court, Form CF-MH 3052a, “Report of Law Enforcement Officer Initiating Involuntary Examination,” or Form CF-MH 3052b, “Certificate of Professional Initiating Involuntary Examination.”

(d) An examination of the individual in a timely manner to determine if the individual meets criteria for release.

(2) If the physician or clinical psychologist with three (3) years clinical experience or psychiatric nurse conducting the initial mandatory involuntary examination determines that the individual does not meet the criteria for involuntary inpatient placement or involuntary outpatient services, the individual can be offered voluntary services, if the individual meets criteria for voluntary admission, or released directly from the receiving facility or the hospital providing emergency medical services. Such determination must be documented in the individual’s clinical record.

(3) If not released, Form CF-MH 3040, “Application for Voluntary Admission - Adults,” which is incorporated in Rule 65E-5.270, F.A.C., or Form CF-MH 3097, “Application for Voluntary Admission – Minors,” which is incorporated in Rule 65E-5.270, F.A.C., may be used if the individual wishes to apply for voluntary admission.

(4) Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” which is incorporated in Rule 65E-5.270, F.A.C., or an equivalent form, may be used to document whether the individual is competent to provide express and informed consent.

(5) All results and documentation of all elements of the initial mandatory involuntary examination shall be retained in the individual’s clinical record.

(6) If the individual is not released and does not consent the individual shall be examined by a physician, clinical psychologist, or psychiatrist nurse to determine if the criteria for involuntary inpatient or involuntary outpatient services are met.

(7) After the initial mandatory involuntary examination, the individual’s clinical record shall include all items reviewed during the examination along with the intake interview notes and the psychiatric evaluation, including the mental status examination or the psychological status report.

(8) Disposition Upon Initial Mandatory Involuntary Examination.

(a) The release of an individual from a receiving facility or its contractor or hospital must be conducted in accordance with s. 394.463(2)(f), F.S. Form CF-MH 3111, (August 2025), “Approval for Release of Individual on Involuntary Status from a Receiving Facility,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18662, may be used for this purpose. A copy of the form used shall be retained in the individual’s clinical record.

(b) In order to document an individual’s transfer from involuntary to voluntary status, Form CF-MH 3040, “Application for Voluntary Admission - Adults,” which is incorporated in Rule 65E-5.270, F.A.C., or Form CF-MH 3097, “Application for Voluntary Admission – Minors,” which is incorporated by reference in Rule 65E-5.270, F.A.C., completed prior to transfer, may be used.

(c) An individual for whom an involuntary examination has been initiated shall not be permitted to consent to voluntary admission until after examination by a physician or psychiatric nurse to confirm his or her ability to provide express and informed consent to treatment. Form CF-MH 3104, “Certification of Individual’s Competence to Provide Express and Informed Consent,” which is incorporated in Rule 65E-5.270, F.A.C., may be used for documentation.

(d) If the facility administrator, based on facts and expert opinions, believes the individual meets the criteria for involuntary inpatient or involuntary outpatient services or is incompetent to consent to treatment, the facility shall initiate involuntary services within 72 hours of the individual’s arrival by filing a petition for involuntary services. Form CF-MH 3032, “Petition for Involuntary Services,” which is incorporated in Rule 65E-5.270, F.A.C., may be used for this purpose. Such petition shall be signed by the facility administrator or designee within the 72-hour examination period. The petition shall be filed with the court within the 72-hour examination period or, if the 72 hours ends on a weekend or legal holiday, no later than the next court working day thereafter. A copy of the completed petition shall be retained in the individual’s clinical record and a copy given to the individual and his or her duly authorized legal decision-maker or representatives.

(e) When an individual on involuntary status is released, notice shall be given to the individual’s guardian or representative, to any individual who executed a certificate for involuntary examination, and to any court which ordered the individual’s examination with a copy retained in the individual’s clinical record. Form CF-MH 3038, (July 2023), “Notice of Release or Discharge,” which is incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15793, may be used for this purpose.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.463, 394.4655 FS. History–New 11-29-98, Amended 4-4-05, 8-23-23, 11-27-25.

Fla. Admin. Code R. 65E-5.285 Involuntary Outpatient Placement

(1) Petition for Involuntary Outpatient Placement.

(a) Each criterion alleged must be substantiated by evidence, as follows:

Evidence of age must be substantiated, whenever there is any question as to whether the person may be age 18 or older.
A diagnosis of mental illness shall be substantiated by 2 professionals as provided in Section 394.4655(2)(a), F.S., who have recently examined the person and whose observations of the person’s condition are consistent with the statutory definition of mental illness, pursuant to Section 394.455(18), F.S., and the clinical description of that diagnosis as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, which is incorporated by reference and may be obtained from the American Psychiatric Association, 1000 Wilson Boulevard, Arlington, VA 22209-3901.
The clinical determination that a person is unlikely to survive safely in the community without supervision must be substantiated by evidence of current or past behaviors.
The person’s history of lack of compliance with treatment for mental illness must be substantiated by evidence showing specific previous incidents in which the person was non-compliant with treatment, including time periods in which the person was non-compliant with treatment.
The person’s involuntarily admission to a receiving or treatment facility or the mental health services in a forensic or correctional facility at least twice in the preceding 36 months, or the person’s acts of serious violent behavior toward self or others or attempted serious bodily harm to self or others at least once during the preceding 36 months, shall be substantiated by evidence.
Evidence of the unlikelihood of the person to voluntarily participate in the recommended treatment plan, and either his or her refusal of voluntary placement or inability to determine whether placement is necessary must be substantiated by behaviors, events, and statements by the person supporting this finding.
Evidence of the person’s treatment history and current behavior must be presented, including time periods of such treatment to substantiate the conclusion that the person needs involuntary placement in order to prevent a relapse or deterioration that would be likely to result in serious bodily harm to self or others or a substantial harm to his or her well-being.
Evidence must be presented to substantiate the likelihood of how the person will benefit from involuntary outpatient placement.
Evidence must be presented to substantiate each less restrictive alternative that was examined that would have offered an opportunity for the improvement of the person’s condition.

(b) Petition Filed by Receiving Facility Administrator.

If a person is retained involuntarily in a receiving facility, a petition for involuntary outpatient placement must be filed with the circuit court by the facility administrator within the 72-hour examination period, or if the 72 hours ends on a weekend or legal holiday, the petition shall be filed no later than the next court working day thereafter. Recommended form CF-MH 3130, Feb. 05, “Petition for Involuntary Outpatient Placement,” as referenced in subparagraph 65E-5.170(1)(d)2., F.A.C., may be used for this purpose. A copy of the completed petition shall be retained in the person’s clinical record.
A petition filed by a receiving facility administrator shall be filed in the county where the facility is located.
The administrator of the receiving facility or a designated department representative shall identify the service provider that will have the responsibility of developing a treatment plan and primary responsibility for service provision under an order for involuntary outpatient placement, unless the person is otherwise participating in outpatient psychiatric treatment and is not in need of public financing for that treatment. Recommended form CF-MH 3140, Sept. 06, “Designation of Service Provider for Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.
A treatment plan, complying with the requirements of Section 394.4655, F.S., and this rule, shall be attached to the petition, along with a certification from the service provider that:

a. The proposed services are available in the person’s local community,

b. There is space available in the program or service for the person,

c. Funding is available for the program or service,

d. The service provider agrees to provide those services; and,

e. Proposed services have been deemed to be clinically appropriate by a physician, clinical psychologist, clinical social worker, mental health counselor, marriage and family therapist, or psychiatric nurse, as defined in Section 394.455, F.S., who consults with, is employed by, or has a contract with the service provider.

Recommended form CF-MH 3145, Sept. 06, “Proposed Individualized Treatment Plan for Involuntary Outpatient Placement and Continued Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for the development of a treatment plan.
If the service provider developing a treatment plan, pursuant to involuntary outpatient placement determines the person is in need of services that cannot be proposed due to non-availability of services, funding, a willing provider, or other reason, it shall submit a completed recommended form CF-MH 3150, Feb. 05, “Notice to Department of Children and Families of Non-Filing of Petition for Involuntary Outpatient Placement or Diminished Treatment Plan Due to Non-Availability of Services or Funding,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter.
A copy of the petition for involuntary outpatient placement and the proposed treatment plan shall be provided within 1 working day after filing by the clerk of the court to the respondent, department, guardian or representative, state attorney, and counsel for the respondent. A notice of filing of the petition shall be provided by the clerk of court using recommended form CF-MH 3021, Feb. 05, “Notice of Petition for Involuntary Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other form adopted by the court.

A petition for involuntary outpatient placement filed by a treatment facility administrator shall be filed prior to the expiration of the involuntary inpatient placement order in the county where the person will be living after discharge from the treatment facility.
A copy of form CF-MH 7001, Jan. 98, “State Mental Health Facility Discharge Form,” as referenced in subsection 65E-5.1305(1), F.A.C., shall be attached to the petition.
The service provider designated by the department that will have primary responsibility for service provision shall provide a certification to the court, attached to the petition, that the services recommended in the discharge plan are available in the local community and that the provider agrees to provide those services.
The petition shall have attached an individualized treatment or service plan that addresses the needs identified in the discharge plan developed by the treatment facility as represented by form CF-MH 3145, “Proposed Individualized Treatment Plan for Involuntary Outpatient Placement and Continued Involuntary Outpatient Placement,” as referenced in subparagraph 65E-5.285(1)(b)5., F.A.C. The plan must have been deemed to be clinically appropriate by a physician, clinical psychologist, psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker, as defined in Section 394.455, F.S.
A copy of the petition for involuntary outpatient placement and the proposed treatment plan shall be provided within 1 working day after filing by the clerk of the court to the respondent, department, guardian or representative, state attorney, and counsel for the respondent. A notice of filing of the petition shall be provided by the clerk of court using recommended form CF-MH 3021, Feb. 05, “Notice of Petition for Involuntary Placement,” as referenced in subparagraph 65E-5.285(1)(b)7., F.A.C., or other equivalent form adopted by the court.

(2) Hearing on Petition for Involuntary Outpatient Placement.

(a) The clerk of court shall provide notice of the hearing, using recommended form CF-MH 3021, Feb. 05, “Notice of Petition for Involuntary Placement,” as referenced in subparagraph 65E-5.285(1)(b)7., F.A.C., or other form used by the court.

(b) A hearing on the petition for involuntary outpatient placement shall be conducted within 5 working days after the filing of the petition in the county in which the petition is filed. The person is entitled, with the concurrence of counsel, to at least 1 continuance of the hearing, for a period of up to 4 weeks. Recommended form CF-MH 3113, Feb. 05, “Notice to Court – Request for Continuance of Involuntary Placement Hearing,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(c) The person and his representative or guardian shall be informed by the court of the right to an independent expert examination and that if the person cannot afford such an examination, the court shall provide for one. Recommended form CF-MH 3022, Feb. 05, “Application for Appointment of Independent Expert Examiner,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(d) Recommended form CF-MH 3033, Feb. 05, “Notification to Court of Withdrawal of Petition on Involuntary Inpatient or Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used if the facility administrator seeks to withdraw the petition for involuntary outpatient placement prior to the hearing. The facility will retain a copy in the person’s clinical record. When a facility withdraws a petition for involuntary placement, it shall notify the court, state attorney, public defender or other attorney for the person, and guardian or representative by telephone within 1 business day of its decision to withdraw the petition, unless such decision is made within 24 hours prior to the hearing. In such cases, the notification must be made immediately.

(e) If the court determines the person does not meet the criteria for involuntary outpatient placement, but instead meets the criteria for involuntary inpatient placement use of recommended form CF-MH 3001, Feb. 05, “Ex Parte Order for Involuntary Inpatient Examination,” as referenced in subsection 65E-5.260(1), F.A.C., or other order used by the court, may be used.

(f) If the court determines the person meets the criteria for involuntary assessment, protective custody, or involuntary admission pursuant to Section 397.675, F.S., and issues an order for one of the same, recommended form CF-MH 3114, Feb. 05, “Order Requiring Involuntary Assessment and Stabilization for Substance Abuse and for Baker Act Discharge of Person,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other order entered by the court, may be used.

(3) Court Order.

(a) If the court concludes that the person meets the criteria for involuntary outpatient placement pursuant to Section 394.4655, F.S., it shall prepare an order. Recommended form CF-MH 3155, Feb. 05, “Order for Involuntary Outpatient Placement or Continued Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other order entered by the court, may be used for this purpose. This signed order shall be given to the person, guardian, guardian advocate or representative, counsel for the person, state attorney, and administrator of the receiving or treatment facility, with a copy of the order retained in the person’s clinical record.

(b) Upon receipt of the court order for involuntary outpatient placement, the administrator of a treatment facility will provide a copy of the court order and adequate documentation of a person’s mental illness to the service provider, including any advance directives, a psychiatric evaluation of the person, and any evaluations of the person performed by a clinical psychologist, mental health counselor, marriage and family therapist, or clinical social worker.

(c) In order for the department to implement the provisions of Section 394.463(2)(e), F.S., and to ensure that the Agency for Health Care Administration will be able to analyze the data it receives pursuant to that section, service providers shall forward copies of each recommended form CF-MH 3155, “Order for Involuntary Outpatient Placement or Continued Involuntary Outpatient Placement,” as referenced in paragraph 65E-5.285(3)(a), F.A.C., or other order provided by the court, accompanied by mandatory form CF-MH 3118, “Cover Sheet to Agency for Health Care Administration,” as referenced in subsection 65E-5.280(5), F.A.C., to: BA Reporting Center, FMHI-MHC 2637, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3807.

(d) At any time material modifications are proposed to the court ordered treatment plan for which the person and his or her substitute decision-maker if any, agree, the service provider shall submit recommended form CF-MH 3160, Feb. 05, “Notice to Court of Modification to Treatment Plan for Involuntary Outpatient Placement and/or Petition Requesting Approval of Material Modifications to Plan,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter or other form adopted by the court. Each person undergoing involuntary outpatient placement and his or her substitute decision-maker if any, must be given a copy of this form by the service provider, and if requested, the service provider shall assist the person or substitute decision-maker in its completion. If the person or his substitute decision-maker object to the modifications proposed by the service provider or wish to propose modifications not proposed by the service provider, recommended form CF-MH 3160, Feb. 05, “Notice to Court of Modification to Treatment Plan for Involuntary Outpatient Placement and/or Petition Requesting Approval of Material Modifications to Plan,” as referenced in this subsection, or other form adopted by the court may be used.

(e) If a physician has determined the person who is subject to a court order for involuntary outpatient placement has failed or has refused to comply with the treatment ordered by the court, and in his or her clinical judgment, efforts were made to solicit compliance and the person meets the criteria for involuntary examination, the person may be brought to a receiving facility pursuant to Section 394.463, F.S. Mandatory form CF-MH 3052b, “Certificate of a Professional Initiating Involuntary Examination,” as referenced in subsection 65E-5.260(1), F.A.C., shall be used.

(4) Continued Involuntary Outpatient Placement.

(a) A request for continued involuntary outpatient placement by the service provider administrator shall be filed prior to the expiration of the period for which the treatment was ordered. Recommended form CF-MH 3180, Feb. 05, “Petition Requesting Authorization for Continued Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, may be used as documentation of that request. The petition shall be filed with the clerk of the circuit court in the county where the person who is the subject of the petition resides.

(b) The petition requesting authorization for continued involuntary outpatient placement shall contain the signed statement of the person’s physician or clinical psychologist justifying the request and shall be accompanied by the following additional documentation:

Evidence justifying the request by the physician or clinical psychologist for continued involuntary outpatient placement, including how the person meets each of the statutorily required criteria,
A brief summary of the person’s treatment during the time he or she was subject to involuntary outpatient placement; and,
An individualized plan of continued treatment.

(c) If the service provider developing a treatment plan pursuant to involuntary outpatient placement determines the person is in need of services that cannot be proposed due to non-availability of services, funding, a willing provider, or other reason, it shall submit completed recommended form CF-MH 3150, Feb. 05, “Notice to Department of Children and Families of Non-Filing of Petition for Involuntary Outpatient Placement or Diminished Treatment Plan Due to Non-Availability of Services or Funding,” as referenced in subparagraph 65E-5.285(1)(b)6., F.A.C. This completed form shall be submitted to the BA Reporting Center, FMHI-MHC 2637, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3807.

(d) Each criterion alleged must be substantiated by evidence.

(e) The clerk of court shall provide notice of the hearing, using recommended form CF-MH 3021, Feb. 05, “Notice of Petition for Involuntary Placement,” as referenced in subparagraph 65E-5.285(1)(b)7., F.A.C., or other form approved by the court.

(f) The person and his or her attorney may agree to a period of continued outpatient placement without a court hearing. Should such a hearing be waived, recommended form CF-MH 3185, Feb. 05, “Notice to Court of Waiver of Continued Involuntary Outpatient Placement Hearing and Request for Order,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used for this purpose.

(g) Use of recommended form CF-MH 3033, Feb. 05, “Notification to Court of Withdrawal of Petition on Involuntary Inpatient or Involuntary Outpatient Placement,” as referenced in paragraph 65E-5.285(2)(d), F.A.C., if the facility administrator seeks to withdraw the petition for continued involuntary outpatient placement prior to the hearing. The facility will retain a copy in the person’s clinical record. When a facility withdraws a petition for continued involuntary outpatient placement, it shall notify the court, state attorney, public defender or other attorney for the person, and guardian or representative by telephone within 1 business day of its decision to withdraw the petition, unless such decision is made within 24 hours prior to the hearing. In such cases, the notification must be made immediately.

(h) Based on the findings at the hearing, the court may extend the period of involuntary outpatient placement, release the person from involuntary outpatient placement, or find the person eligible for voluntary status. Recommended form CF-MH 3155, Feb. 05, “Order for Involuntary Outpatient Placement or Continued Involuntary Outpatient Placement,” as referenced in paragraph 65E-5.285(3)(a), F.A.C., or other equivalent form adopted by the court may be used. A copy of the completed order shall be filed in the person’s clinical record and a copy shall be provided to the person, attorney, facility administrator, and guardian, guardian advocate or representative.

(i) In order for the department to implement the provisions of Section 394.463(2)(e), F.S., and to ensure that the Agency for Health Care Administration will be able to analyze the data it receives pursuant to that section, service providers shall forward copies of each recommended form CF-MH 3155, “Order for Involuntary Outpatient Placement or Continued Involuntary Outpatient Placement,” as referenced in paragraph 65E-5.285(3)(a), F.A.C., or other order provided by the court, accompanied by mandatory form CF-MH 3118, “Cover Sheet to Agency for Health Care Administration,” as referenced in subsection 65E-5.280(5), F.A.C., to: BA Reporting Center, FMHI-MHC 2637, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3807.

(j) If at any time material modifications are proposed to the court ordered treatment plan to which the person and his or her substitute decision-maker, if any, agree, the service provider shall submit recommended form CF-MH 3160, Feb. 05, “Notice to Court of Modification to Treatment Plan for Involuntary Outpatient Placement and/or Petition Requesting Approval of Material Modifications to Plan,” as referenced in paragraph 65E-5.285(3)(d), F.A.C., or other form adopted by the court. If the person or his substitute decision-maker object to the modifications proposed by the service provider or wish to propose modifications not proposed by the service provider, recommended form CF-MH 3160, Feb. 05, “Notice to Court of Modification to Treatment Plan for Involuntary Outpatient Placement and/or Petition Requesting Approval of Material Modifications to Plan,” as referenced in paragraph 65E-5.285(3)(d), F.A.C., or other form adopted by the court may be used.

(k) If a physician has determined the person who is subject to a court order for involuntary outpatient placement has failed or has refused to comply with the treatment ordered by the court, and in his or her clinical judgment, efforts were made to solicit compliance and the person meets the criteria for involuntary examination, the person may be brought to a receiving facility pursuant to Section 394.463, F.S. Mandatory form CF-MH 3052b, “Certificate of a Professional Initiating Involuntary Examination,” as referenced in subsection 65E-5.260(1), F.A.C., shall be used.

(5) Discharge from Involuntary Outpatient Placement.

(a) At any time a person no longer meets each of the criteria for involuntary outpatient placement, the administrator of the service provider shall discharge the person from treatment or transfer the person, if the person is able and willing to provide express and informed consent, to voluntary status.

(b) The administrator of the service provider will provide notification to the person, guardian, guardian advocate, representative, attorney for the person, and the court that ordered such treatment, with a copy placed in the person’s clinical record. Recommended form CF-MH 3038, Feb. 05, “Notice of Release or Discharge,” as referenced in paragraph 65E-5.2801(8)(e), F.A.C., may be used for this purpose.

(c) At any time a person who is subject to an order for involuntary outpatient placement or continued involuntary outpatient placement, or the guardian, guardian advocate, health care surrogate or proxy, or attorney representing the person, believes any one of the criteria for involuntary outpatient placement are no longer met, a petition for termination of an involuntary outpatient placement order may be filed with the circuit court having jurisdiction. Recommended form CF-MH 3170, Feb. 05, “Petition for Termination of Involuntary Outpatient Placement Order,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other form adopted by the court may be used for this purpose. If the court determines to conduct a hearing on the petition, notice of the hearing shall be provided by the clerk of court, pursuant to Section 394.4599, F.S.

History

Rulemaking Authority 394.46715 FS. Law Implemented 394.455, 394.455(18), 394.4599, 394.463, 394.4655, 394.4655(2)(a), 397.675 FS. History–New 4-4-05, Amended 1-8-07.

Fla. Admin. Code R. 65E-5.290 Involuntary Inpatient Placement

(1) If a person is retained involuntarily after an involuntary examination is conducted, a petition for involuntary inpatient placement or involuntary outpatient placement shall be filed with the court by the facility administrator within the 72-hour examination period, or if the 72 hours ends on a weekend or legal holiday, the petition shall be filed no later than the next court working day thereafter. Recommended form CF-MH 3032, “Petition for Involuntary Inpatient Placement,” as referenced in subparagraph 65E-5.170(1)(d)1., F.A.C., or recommended form CF-MH 3130, “Petition for Involuntary Outpatient Placement,” as referenced in subparagraph 65E-5.170(1)(d)2., F.A.C., or other forms adopted by the court may be used for this purpose. A copy of the completed petition shall be retained in the person’s clinical record.

(2) Each criterion alleged must be substantiated by evidence.

(3) Use of recommended form CF-MH 3021, Feb. 05, “Notice of Petition for Involuntary Placement,” as referenced in subparagraph 65E-5.285(1)(b)7., F.A.C., or other form used by the court, when properly completed, will satisfy the requirements of Section 394.4599, F.S. A copy of that completed form, or its equivalent, shall be retained in the person’s clinical record. Whenever potential involuntary inpatient placement in a state treatment facility is proposed, a copy of the completed notice form shall also be provided to the designated community mental health center or clinic for purposes of conducting a transfer evaluation.

(4) Recommended form CF-MH 3113, Feb. 05, “Notice to Court – Request for Continuance of Involuntary Placement Hearing,” as referenced in paragraph 65E-5.285(2)(b), F.A.C., may be used by the counsel representing a person in requesting a continuance. A completed copy of the form used shall be provided to the facility administrator for retention in the person’s clinical record.

(5) Recommended form CF-MH 3022, Feb. 05, “Application for Appointment of Independent Expert Examiner,” as referenced in paragraph 65E-5.285(2)(c), F.A.C., may be used to request the expert examiner.

(6) Recommended form CF-MH 3033, Feb. 05, “Notification to Court of Withdrawal of Petition on Involuntary Inpatient or Outpatient Placement,” as referenced in paragraph 65E-5.285(2)(d), F.A.C., may be used if the facility administrator seeks to withdraw the petition for involuntary placement prior to the hearing. The facility shall retain a copy in the person’s clinical record. When a facility withdraws a petition for involuntary inpatient placement, it shall notify the court, state attorney, attorney for the person, and guardian or representative by telephone within 1 business day of its decision to withdraw the petition, unless such decision is made within 24 hours prior to the hearing. In such cases, the notification must be made immediately. In all cases involving potential involuntary inpatient placement in a state treatment facility, a copy of the notification form shall also be provided to the designated community mental health center or clinic responsible for conducting a transfer evaluation.

(7) If the court determines the person meets the criteria for involuntary assessment, protective custody, or involuntary admission pursuant to Section 397.675, F.S., and issues an order, recommended form CF-MH 3114, Feb. 05, “Order Requiring Involuntary Assessment and Stabilization for Substance Abuse and for Baker Act Discharge of Person,” as referenced in paragraph 65E-5.285(2)(g), F.A.C., or other order used by the court, may be used for this purpose.

(8) If at any time prior to the conclusion of the hearing on involuntary inpatient placement, the person instead meets the criteria for involuntary outpatient placement, the court may order the person evaluated for involuntary outpatient placement. Recommended form CF-MH 3115, Feb. 05, “Order Requiring Evaluation for Involuntary Outpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, or other order adopted by the court, may be used.

(9) If the court concludes that the person meets the criteria for involuntary inpatient placement pursuant to Section 394.467, F.S., it shall prepare an order. Recommended form CF-MH 3008, “Order for Involuntary Inpatient Placement,” as referenced in paragraph 65E-5.1302(1)(b), F.A.C., or other order used by the court, may be used for this purpose. This signed order shall be given to the person, guardian, guardian advocate or representative, counsel for the person, state attorney, and administrator of the receiving or treatment facility, with a copy of the order retained in the person’s clinical record.

(10) In order for the department to implement the provisions of Section 394.463(2)(e), F.S., and to ensure that the Agency for Health Care Administration will be able to analyze the data it receives pursuant to that section, designated receiving facilities and treatment facilities shall forward copies of each recommended form CF-MH 3008, “Order for Involuntary Inpatient Placement,” as referenced in paragraph 65E-5.1302(1)(b), F.A.C., or other order provided by the court, accompanied by mandatory form CF-MH 3118, “Cover Sheet to Agency for Health Care Administration,” as referenced in subsection 65E-5.280(5), F.A.C., to: BA Reporting Center, FMHI-MHC 2637, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3807.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.463(2)(e), 394.467, 397.675 FS. History–New 11-29-98, Amended 4-4-05, 1-8-07.

Fla. Admin. Code R. 65E-5.300 Continued Involuntary Inpatient Placement at Treatment Facilities

(1) In order to request continued involuntary inpatient placement, the treatment facility administrator shall, prior to the expiration of the period during which the treatment facility is authorized to retain the person, file a request for continued placement. Recommended form CF-MH 3035, Feb. 05, “Petition Requesting Authorization for Continued Involuntary Inpatient Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used as documentation of that request. The petition shall be filed with the Division of Administrative Hearings within 20 days prior to the expiration date of a person’s authorized period of placement or, in the case of a minor, the date when the minor will reach the age of majority. The petition shall contain the signed statement of the person’s physician or clinical psychologist justifying the request and shall be accompanied by the following additional documentation:

(a) Evidence justifying the request by the physician or clinical psychologist for involuntary inpatient placement, including how the person meets each of the statutorily required criteria;

(b) A brief summary of the person’s treatment during the time he or she was placed; and,

(2) Each criterion alleged must be substantiated by evidence.

(3) The administrative law judge shall provide notice of the hearing. Recommended form CF-MH 3024, Feb. 05, “Notice of Petition for Continued Involuntary Placement,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, may be used for this purpose. Copies shall be provided to the person, attorney, and guardian, guardian advocate or representative, with a copy of the notice filed in the person’s clinical record.

(4) If the administrative law judge finds evidence that the person has regained his or her competency to consent to treatment, the administrative law judge shall notify the court appointing the guardian advocate. Recommended form CF-MH 3116, Feb. 05, “Findings and Recommended Order Restoring Person’s Competence to Consent to Treatment and Discharging the Guardian Advocate,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, may be used for this purpose.

(5) Based on the findings of the hearing, the administrative law judge may return the person to involuntary placement pending the next statutorily required periodic hearing, release the person from placement, or find the person eligible for voluntary status. Recommended form CF-MH 3031, Feb. 05, “Order for Continued Involuntary Inpatient Placement or for Release,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter, may be used for this purpose. A copy of the completed order shall be filed in the person’s clinical record and a copy shall be provided to the person, attorney, facility administrator, and guardian, guardian advocate or representative.

(6) In order for the department to implement the provisions of Section 394.463(2)(e), F.S., and to ensure that the Agency for Health Care Administration will be able to analyze the data it receives pursuant to that section, designated receiving facilities and treatment facilities shall forward copies of each recommended form CF-MH 3031, “Order for Continued Involuntary Inpatient Placement or Release,” as referenced in subsection 65E-5.300(5), F.A.C., accompanied by mandatory form CF-MH 3118, “Cover Sheet to Agency for Health Care Administration,” as referenced in subsection 65E-5.280(5), F.A.C., to: BA Reporting Center, FMHI-MHC 2637, 13301 Bruce B. Downs Boulevard, Tampa, Florida 33612-3807.

History

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.463(2)(e), 394.467(7) FS. History–New 11-29-98, Amended 4-4-05, 1-8-07.

Fla. Admin. Code R. 65E-5.310 Transfer of Persons Among Facilities

(1) Recommended form CF-MH 3046, Feb. 05, “Application for and Notice of Transfer to Another Facility,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter may be used to request the transfer of a person to another receiving or treatment facility. This application, or its equivalent, shall be completed and filed with the facility administrator or designee. A copy of the completed application shall be retained in the person’s clinical record.

(2) The administrator of the facility or designee at which the person resides shall, without delay, submit an application for transfer to the administrator of the facility to which a person has requested transfer. Upon acceptance of the person by the facility to which the transfer is sought, the administrator of the transferring facility or his or her designee shall mail the statutorily required notices to the person, the person’s attorney, guardian, guardian advocate or representative, retaining a copy in the person’s clinical record. Recommended form CF-MH 3046, “Application for and Notice of Transfer to Another Facility,” as referenced in subsection 65E-5.310(1), F.A.C., may be used for this documentation.

(3) If the proposed transfer of a person originates with the administrator of the facility or his or her designee or with the treating physician a notice of transfer is required. The notice shall be completed by the administrator or designee of the transferring facility, after acceptance of the person by the facility to which he or she will be transferred, with copies provided prior to the transfer to those required by law, with a copy retained in the person’s clinical record. Recommended form CF-MH 3046, “Application for and Notice of Transfer to Another Facility,” as referenced in subsection 65E-5.310(1), F.A.C., may be used for this purpose.

(4) All relevant documents including a copy of the person’s clinical record, shall be transferred prior to or concurrent with the person to the new facility.

(5) Each facility shall develop and implement policies and procedures for transfer that provide for safety and care during transportation.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.4599, 394.4685 FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.320 Discharge of Persons on Involuntary Status

A receiving or treatment facility administrator shall provide prompt written notice of the discharge of a person on involuntary status to the person, guardian, guardian advocate, representative, initiating professional, and circuit court, with a copy retained in the person’s clinical record. Recommended form CF-MH 3038, “Notice of Release or Discharge,” as referenced in paragraph 65E-5.280(7)(e), F.A.C., may be used as documentation of such notice. If the discharge occurs while a court hearing for involuntary placement or continued involuntary placement is pending, all parties including the state attorney and attorney representing the person, shall be given telephonic notice of the discharge by the facility administrator or his or her designee.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.463(3), 394.469 FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.330 Training

(1) In order to ensure the protection of the health, safety, and welfare of persons treated in receiving and treatment facilities, required by Section 394.457(5)(b), F.S., the following is required:

(a) Each designated receiving and treatment facility shall develop policies and procedures for abuse reporting and shall conduct training which shall be documented in each employee’s personnel record or in a training log.

(b) All staff who have contact with persons served shall receive training in verbal de-escalation techniques and the use of bodily control and physical management techniques based on a team approach. Less restrictive verbal de-escalation interventions shall be employed before physical interventions, whenever safety conditions permit.

(c) All staff who have contact with persons served shall receive training in cardiopulmonary resuscitation within the first six months of employment if not already certified when employed and shall maintain current certification as long as duties require direct contact with persons served by the facility.

(d) A personnel training plan that prescribes and assures that direct care staff, consistent with their assigned duties, shall receive and complete before providing direct care or assessment services, 14 hours of basic orientation training, documented in the employee’s personnel record, in the following:

Rights of persons served by the facility and facility procedures required under Chapter 394, Part I, F.S., and Chapter 65E-5, F.A.C.,
Confidentiality laws including psychiatric, substance abuse, HIV and AIDS,
Facility incident reporting,
Restrictions on the use of seclusion and restraints, consistent with unit policies and procedures, and this chapter,
Abuse reporting required by Chapter 415, F.S.,
Assessment for past or current sexual, psychological, or physical abuse or trauma,
Cross-training for identification of, and working with, individuals recently engaging in substance abuse,
Clinical risk and competency assessment,
Universal or standard practices for infection control,
Crisis prevention, crisis intervention and crisis duration services,
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, as referenced in subparagraph 65E-5.285(1)(a)2., F.A.C.; and,
Honoring preferences contained in advance directives prepared by persons served by the facility.

(2) In addition to the training required in this rule, procedures must assure that mental health services staff shall annually receive 12 hours continuing training in the skills and knowledge employed in performing their respective responsibilities. Employees during their first year of employment shall undergo no less than the 14 hours of orientation, as described in paragraph (1)(c), above, and 12 hours of in-service training.

(3) Procedures shall require that individuals who deliver the staff training curriculum for mental health services shall be qualified by their experience and training in the content presented.

(4) A plan shall be developed and implemented providing for the mandatory training for employees, emergency room personnel and physicians in the Baker Act, relative to their positions and responsibilities, and any implementing local coordination agreements or protocols.

History

Rulemaking Authority 394.457(6)(a) FS. Law Implemented 394.457(5)(b), (6), 394.459(4), 415 FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.350 Eligibility Criteria and Procedures for Designation of Receiving Facilities

(1) Facilities shall not begin to hold or treat involuntary an individual under a Baker Act until licensed by AHCA and designated in accordance with this rule chapter and with Chapters 394 or 395, F.S.

(2) The following types of facilities are authorized to provide acute psychiatric treatment and are eligible to apply for designation as receiving facilities:

(a) Hospitals;

(b) Crisis Stabilization Units (CSU);

(d) Short-term Residential Treatment Facilities (SRT) connected to a county or regional Behavioral Health Receiving System, and are programmatically integrated with a designated CSU or CCSU.

(3) Designated receiving facilities shall contribute data to the Florida Health Information’s Exchange Encounter Notification Services through AHCA.

(4) Application and Supporting Documentation for Designation as a Receiving Facility. An applicant must complete and submit form CF-MH 3125, (July 2023), “Application for Designation as a Receiving Facility,” which is hereby incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15801. Applications may be submitted through the Department’s statewide electronic licensing and designation system.

(5) Application for Renewal of Designation or Change of Address.

(a) An application for renewal designation must be submitted for every 3 calendar years, after approval of initial applications or 90 calendar days in advance of the relocation of a facility to a new address.

(b) The application for renewal designation shall be submitted to the Department at least 60 calendar days prior to the expiration of its existing designation.

(c) An application for re-designation must be submitted by a facility to the Department within 30 calendar days of a change of ownership, controlling ownership of the facility or of the contractual management entity for the psychiatric service.

(d) Any change in the name of a facility, that remains under the same ownership and management, must be reported in writing to the Department’s regional office within 30 calendar days after the effective date of the change. Upon receipt of the notification, the Department will issue a letter confirming receipt of the notification and extending designation until a replacement certificate of designation showing the correct facility name is received by the facility.

(6) Certificate of Designation.

(a) Upon approval by the Secretary or the Secretary’s designee, the Department shall issue a Certificate of Designation which shall include the following information on its face.

Effective date and expiration date,
Name of the owner and licensee as stated on the facility license issued by AHCA; and,
Street address of where services are provided.

(b) The certificate shall be prominently displayed to the general public at the service site.

(7) Facilities shall provide the Department with a written notice 120 days prior to surrendering their designation and shall include a written transition plan to minimize disruptions in access to crisis care in the community. At a minimum the transition plan shall address the following:

(a) The specific reasons for surrendering the designation as a receiving facility;

(b) Collaborative plan with the regional managing entity and surrounding counties to ensure continuity of crisis care in the community;

(d) Identification of any agreements with other receiving facilities to accept transfers or expand bed capacity; and

(e) Identification of any agreements with other community providers to refer individuals to hospital diversion programs such as short-term residential treatment, Community Action Teams, or Florida Assertive Community Treatment.

History

Rulemaking Authority 394.461(6) FS. Law Implemented 394.461 FS. History–New 11-29-98, Amended 4-4-05, 8-31-23, 12-28-23.

Fla. Admin. Code R. 65E-5.351 Minimum Standards for Designated Receiving Facilities

(1) Any facility designated as a receiving facility failing to comply with this chapter may have such designation suspended or withdrawn.

(2) Each receiving facility shall have policies and procedures that prescribe, monitor and enforce all requirements specified in Chapter 65E-5, F.A.C.

(3) Each receiving facility shall assure that its reception, screening, and inpatient services are fully operational 24-hours-per-day, 7-days-per-week.

(4) Each receiving facility shall have a compliance program that monitors facility and professional compliance with Chapter 394, Part I, F.S., and this chapter. Every such program shall specifically monitor the adequacy of and the timeframes involved in the facility procedures utilized to expedite obtaining informed consent for treatment. This program may be integrated with other activities.

(5) A public receiving facility that is affiliated with a publicly funded community mental health center shall ensure the centralized provision and coordination of acute care services for eligible individuals with an acute mental illness.

History

Rulemaking Authority 394.461(5) FS. Law Implemented 394.461(5) FS. History–New 11-29-98.

Fla. Admin. Code R. 65E-5.352 Procedures for Complaints and Investigations in Receiving Facilities

Complaints with regard to the provisions of this chapter shall be filed with the district or region mental health and substance abuse program supervisor, or designee, of the district or region in which the violation is alleged to have occurred. The district or region mental health and substance abuse program supervisor shall appoint one or more employees to determine if an investigation is warranted. If warranted, the investigation may include the assistance of other agencies having jurisdiction over the facility. If the district or region mental health and substance abuse program supervisor determines that a violation of this chapter has occurred:

(1) Corrective action shall be required and a reasonable time in which to correct the violation shall be accorded to the facility, or

(2) If the corrective action is not sufficient, or the district or region mental health and substance abuse program supervisor determines that the violation warrants suspension or removal of designation, such action shall be considered pursuant to Rule 65E-5.353, F.A.C.

History

Rulemaking Authority 394.461(5) FS. Law Implemented 394.461(5) FS. History–New 11-29-98, Amended 4-4-05.

Fla. Admin. Code R. 65E-5.353 Criteria and Procedures for Conditional, Suspension or Withdrawal of Designation of Receiving Facilities

(1) After the Department issues an initial designation, pursuant to 65E-5.350 and 65E-12, F.A.C., the Department has the ability to issue the following:

(a) Conditional Designation. A conditional designation may be issued when the Department determines failure to meet one or more of the standards for designation or maintenance of designation under this chapter, and the provider is implementing a corrective action plan in response to violations issued by the Department or the Agency for Health Care Administration.

(b) Suspension of Designation. When the Department determines that it is more likely than not that a facility, or its related entities, has failed to consistently meet one or more of the standards for designation or maintenance of designation under this chapter, it may suspend designation pending corrective action plan implementation. During the suspension period, no persons on involuntary status may be admitted to the facility. No re-application for designation as a receiving facility is required for reinstatement of designation.

Designation may be withdrawn upon approval of the Department when it determines that it is more likely than not that any pattern of violations, or combination of violations, of Chapter 394, F.S., this rule chapter, and Chapter 65E-12, F.A.C., exists such as deficient admission, transfer or care practices, deficient observation or documentation of rights abuses, deficient discharge practices, deceptive or misleading practices in marketing, admission recruitment or referral practices; fraudulent clinical or billing practices; or patient brokering is evident. Examples of such offenses include violations by the facility, or parties acting on behalf of or in concert with the facility, or acting under its supervision, having engaged in deceptive, fraudulent, exploitative, abusive, or neglect type violations of Florida law, including Chapters 394 and 415, F.S., Sections 817.505 and 458.331, F.S.
Upon re-application after withdrawal of designation, the Department must have clear and convincing evidence that the problems with the facility, or its practitioners, leading to withdrawal of designation have been corrected and will not reoccur. This may include required internal and external monitoring to document continued satisfactory performance.

(2) The Department shall continuously collect and monitor information relative to complaints or allegations against designated facilities from sources such as individuals, local advocacy or self-help groups, local organizations including law enforcement, the Agency for Health Care Administration, and the Florida Local Advocacy Council.

(3) A corrective action plan (CAP) must be completed to address any violations identified by the Department.

(4) The facility must submit a written corrective action plan (CAP) to the Department within seven calendar days from the date of written notification of violations. The CAP must be signed by the executive director or designee of the provider.

(a) The CAP shall include the following:

Identify the violation;
The actions the facility will take to correct each of the violations identified;
The date by which the violation shall be corrected; and
The actions the facility will take to ensure the violation identified does not occur again.

(b) Unless a date is directed or extended by the Department, the date to resolve the violation shall not exceed 30 days from the date of the written notification of the violation..

History

Rulemaking Authority 394.461(6) FS. Law Implemented 394.461 FS. History–New 11-29-98, Amended 4-4-05, 3-21-24.

Fla. Admin. Code R. 65E-5.400 Baker Act Funded Services Standards

(1) Applicability. Designation as a public receiving facility is required for any facility licensed under the authority of Chapter 395 or 394, F.S., to be eligible for payment from Baker Act appropriations. Designation does not in and of itself represent any agreement to pay for any services rendered pursuant to Chapter 394, Part I, F.S., or this chapter. Public receiving facilities, under contract with the department, serve as a local focal point for district or region public information dissemination and educational activities with other local Baker Act involved entities and public agencies.

(2) Baker Act Funding.

(a) Only public receiving facilities, pursuant to Section 394.455(25), F.S., and only the costs of eligible Baker Act services provided to diagnostically and financially eligible persons may be paid with Baker Act appropriations.

(b) Baker Act services shall first be provided to acutely ill persons who are most in need of mental health services and are least able to pay.

(c) Persons receiving Baker Act funded services must meet financial eligibility criteria as established by the federal poverty guidelines. Public receiving facilities may provide Baker Act funded services to acutely ill persons who are financially ineligible if the total number of days of service paid for with Baker Act funds for financially ineligible persons does not exceed 20 percent of the total number of days paid for with Baker Act funds.

(d) An individual’s diagnostic and financial eligibility shall be documented on mandatory form CF-MH 3084, Feb. 05, “Baker Act Service Eligibility,” which is incorporated by reference and may be obtained pursuant to Rule 65E-5.120, F.A.C., of this rule chapter.

(3) This section applies to all Baker Act funded providers. All services including hospital inpatient facilities, crisis stabilization units, short-term residential treatment programs, and children’s crisis stabilization units providing services purchased by the department under this chapter shall be consistent with licensure requirements and must comply with written facility policies and procedures.

(4) Training. The training required in Rule 65E-5.330, F.A.C., is required for all direct service staff employed by publicly funded Baker Act service providers.

(5) Emergency Reception and Screening.

(a) Providers authorized by the department shall have a policy and procedure manual for the specific service being provided. The administration of the provider organization shall ensure the completeness and accuracy of the manual and that organizational operations are in accordance with the manual. The manual must be approved by the respective departmental district or regional office for completeness and consistency in implementing this chapter and Chapter 394, Part I, F.S. The manual shall be consistent with the provisions of Chapter 394, Part I, F.S., and with Chapter 65E-5, F.A.C., and must include the following:

Procedures for responding to requests for services that specify a prompt screening to determine the person’s immediacy of need, and for prioritizing access to services with limited availability. Staff skills shall be specific to the unique needs of the persons to be served,
A description of the services offered, recipient eligibility criteria, how eligible recipient facilities or individuals are informed of service availability, service locations, costs, criteria for response, hours of operation, staffing with staff qualifications and supervision, and organizational line of authority to the operating entity,
Procedures to be utilized to implement and document staff training in accord with Rule 65E-5.330, F.A.C., staff proficiency or competency including the performance of any subcontractors employed to provide services, and how training will be used to effect remediable identified deficiencies,
Procedures for a complaint and grievance system that provide a prompt response to the individuals served, and mechanisms to monitor and evaluate service quality, and the outcomes attained by individuals served. Facility personnel shall provide each person served with a listing of his or her rights and a telephone number to which complaints may be directed,
Procedures to determine if the individual has a case manager from a mental health center or clinic, as well as notification and coordination of activities with the case manager,
Procedures to maintain a clinical record for each individual served and its safeguarding in accordance with Section 394.4615, F.S.; and,
Procedures to inform the public of the availability of services.

(b) Procedures must assure that a psychiatrist or a physician shall be available on-call for consultation at all times and hours during which emergency reception and screening services are operated.

(6) Mobile Crisis Response Service and Mental Health Overlay Program Requirements.

(a) The criteria and operational requirements for a mobile crisis response service and a mental health overlay program is defined in Sections 394.455(19) and 394.455(17), F.S., respectively. The operation of these services is expressly limited to the program’s contract with the department.

(b) Providers authorized by the department to provide mobile crisis response services and mental health overlay programs shall have a policy and procedure manual for the specific service being provided. The administration of the provider organization shall ensure the completeness and accuracy of the manual and that organizational operations are in accordance with the manual. The manual must be approved by the departmental district or regional office in which the facility is located. The manual shall be consistent with the provisions of Chapter 394, Part I, F.S., and these rules, and shall include:

A description of the services offered, eligibility criteria, how eligible recipient facilities or individuals are informed of service availability, criteria for response, hours of operation, staffing with staff qualifications and supervision, and organizational line of authority to the operating entity,
Procedures to be utilized to implement the provisions of Section 394.4625, F.S., including staff training, proficiency or competency assessment instruments to be administered, credentialing, and distribution of results obtained,
A description of on-site evaluation, educational, assistance or supportive services, if provided, to be rendered by mental health overlay programs. The extent and frequency of services offered must be described. Staff skills shall be specific to unique needs of the persons to be served,
Procedures for the provision of a complaint and grievance procedure to be used by individuals served, and mechanisms to monitor and evaluate the service’s quality and the outcomes attained by individuals served. Personnel shall provide each person served with a listing of his or her rights and a telephone number to which complaints may be directed,
Procedures that require the provider’s issuance of, and the employees wearing of identification badges including a photograph of employee, organization’s name, and employees name and identification number, if full name is not used, for all employees responding to, or working in, off-site situations,
Procedures that assure determination of whether the individual has a case manager from a mental health center or clinic, and require notification and coordination of activities with the case manager; and,
Procedures that require the maintenance of a clinical record for each individual served and safeguarding it in accordance with Section 394.4615, F.S.

(c) Procedures must require employee’s clinical activities and performance, as opposed to primarily administrative functions, are supervised by one of the following: a psychiatrist, physician, clinical psychologist, clinical social worker, mental health counselor, marriage and family therapist, or psychiatric nurse, as defined in Section 394.455, F.S.

(d) Procedures must assure that a physician or psychiatrist shall be available on-call for consultation at all times and hours during which mental health overlay programs and mobile crisis response services are operated.

(e) Procedures must be consistent with Section 394.462, F.S., and these rules, and must limit transportation of an involuntary person by the mental health overlay program or mobile crisis response service to only directly transporting individuals to the nearest designated receiving facility. In addition, the following provisions shall be met and described in the manual:

Liability insurance of no less than $100,000 per person shall be provided.
The vehicle shall be equipped with a Type 2A10BC fire extinguisher, seat belts, 2-way communication radio or cellular telephone with accompanying emergency telephone numbers, and a functioning air conditioner and heater.
Staff having the responsibility for transporting people shall be trained and experienced in transporting people with mental illness and substance abuse who may become confused, volatile, or combative.
At least 2 members shall be present to transport an individual. The total number of people in the vehicle at any time shall not exceed the legal seating capacity.
Firearms shall not be worn or carried in the vehicle.
Physical restraints, such as canvas cuffs, shall not be used except by personnel trained in their use, and only when necessary to protect the person being transported from injury to themselves or others. Any use of physical or mechanical restraints shall be fully and completely documented in the person’s clinical record.
The vehicle used to transport people shall be unmarked, maintained and operated in accordance with Chapter 316, F.S., and in a manner that protects the individual’s rights, dignity and physical safety.
Procedures must require the immediate reporting of any unusual incidents or injuries, upon arrival at the intended destination.

(7) Requirements for Mental Health Overlay Programs in Nursing Homes, Assisted Living Facilities, Adult Day Care Centers, and Adult Family Care Homes.

(a) All plans, contracts and activities shall recognize that the primary responsibility for the care and treatment of individuals rests with the nursing home, assisted living facility, adult day care center, or adult family care home.

(b) Activities representative of those services appropriate to be provided by a mental health overlay program include:

Assisting in the development or implementation of individual care plans,
Assessing and making recommendations for needed physical or psychiatric services to the facility administrator; and,
Providing training to facility staff or residents in various mental health skills or knowledge, such as anger management, psychotropic medications, depression, loss, physical and sexual trauma, and competency to consent determinations.

History

Rulemaking Authority 394.457(3), (5)(c), (6)(a) FS. Law Implemented 316, 394, Part I, 394.455(2), (4), (17), (19), (21), (23), (25),(34), (35), 394.4615, 394.462, 394.4625, 394.463, 395 FS. History–New 11-29-98, Amended 4-4-05, 1-8-07.

Fla. Admin. Code R. 65E-5.601 Operation and Administration of State Mental Health Treatment Facilities

(1) In order to protect the welfare of the individuals residing in state civil mental health facilities, the department shall establish the following grievance process for residents of all state civil mental health treatment facilities. The process shall be explained during the orientation process and in written orientation materials.

(2) Any grievance may be verbal or written. When the grievance is verbal, the facility will provide a party not named in the dispute to assist the resident in writing the grievance. The grievance shall detail the issue and the remedy sought. All resident grievances shall be addressed to the resident advocate and the unit director or treatment team leader. The Resident Advocacy Office shall monitor all grievances.

(3) The grievance shall be date-stamped upon receipt by the unit director or treatment team leader. At a minimum, the resident shall receive a written response to the grievance within 14 calendar days from date of receipt. The resident or the resident’s representative may appeal the disposition of a grievance to the facility administrator.

(4) The steps for filing a grievance as stated in this rule shall be conspicuously posted in the living areas where the residents can read the steps.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.457(2), 394.459(5) FS. History–New 2-1-04.

Fla. Admin. Code R. 65E-5.602 Rights of Residents of State Mental Health Treatment Facilities

(1) Each state civil mental health treatment facility shall make telephones available for residents. Any restriction on telephone usage shall be documented in the clinical record. Such documentation shall specify the reason for the restriction, its duration, and the treatment goals and interventions aimed at lifting the restriction. At no time, shall there be a restriction of telephone access to his or her legal counsel, the Florida Abuse Registry, Local or Statewide Advocacy Councils, or the Advocacy Center for Persons with Disabilities.

(2) The Department shall protect the confidentiality of records within the facility and in transport to other facilities and other therapeutic services.

(3) Each state civil mental health treatment facility shall post instructions conspicuously in living areas and visiting areas where residents and visitors can read the instructions on how to report a complaint.

(4) Each state civil mental health treatment facility shall establish visiting hours for each of its residential units. The visiting hours shall be based on the needs of residents and their visitors and shall minimize interruption of the individual’s treatment program schedules. Each state civil mental health treatment facility shall post its visiting hours in places where residents and visitors frequent. Visiting hours shall be provided to the resident, family, and representatives at the time of admission. Visitors may request exceptions to posted visiting hours with the Unit Director or treatment team leader.

(5) Each state civil mental health treatment facility shall establish with the local county supervisor of elections, a process for allowing eligible residents to register and to vote in public elections. The process shall be published and provided to each resident and conspicuously posted in living areas where residents can read it. The resident’s representative shall also be informed of the process. The facility shall make available voter registration forms, applications for absentee ballots, and absentee ballots.

(6) No state civil mental health treatment facility shall initiate any mental health treatment, including psychotropic medication, until express and informed consent for psychiatric treatment is obtained from a person legally qualified to give it, except in the following situations:

(a) Where emergency psychotropic medication treatment is ordered by a physician, as defined in Section 394.455(21), F.S., to preserve the immediate safety of the resident or others in the facility;

(b) When a person is admitted to a state mental health treatment facility and has a current prescription for psychotropic medication(s), is unable to provide express and informed consent, is determined by the admitting physician to be in need of the medication prescribed prior to admission and an alternative decision maker is being pursued through the court, or

(7)(a) Any limitation or restriction of a resident’s access to the grounds or treatment program shall be based on clearly documented evidence of risks to self or others.

(b) The time span during which residents are allowed access to the grounds shall be specified conspicuously and posted in living areas. Access to grounds may be limited during the hours a resident is scheduled to attend prescribed programming. Access to grounds status shall be established and documented in the clinical record for all newly admitted persons within 72 hours of admission.

(c) An individualized plan shall be developed and documented in the clinical record for residents who have been identified by the treatment team as experiencing significant loss of independent access to grounds.

(d) Those residents certified by the facility as experiencing long-term loss of independent access to grounds based on physical health issues or adaptive deficits shall be provided opportunities to go outside unless medically contraindicated.

(e) Any change to access to the grounds status shall be based on the treatment team’s assessment. An assessment of risk shall consider, at a minimum, the following categories of risk:

Suicide attempts or threats,
Intentional self-injury,
Homicide,
Assault,
Elopement,
Substance abuse,
Physically vulnerable,
Psychotropic medication issues; and,
Other potentially harmful behaviors.

(f) Decisions about changes in access to grounds status shall be based in part on an assessment of risk, with criteria influencing access changes being documented and filed in the person-centered record.

(g) Teams shall show progressive actions taken to manage significant, recurring issues for residents in the least restrictive manner possible. The exception shall be those changes where a resident’s access to the grounds is limited due to serious, acute health/safety matters. Interventions must be documented in order to show the use of the least intrusive, most positive methods for the restoration of freedom of movement and follow through with treatment before the use of more restrictive options.

(h) Residents who disagree with limitations to grounds access shall have a right to a review of those limitations. Each treatment facility shall publish procedures to insure the limitations are reviewed. The resident or the resident’s representative may appeal the restriction to the facility administrator through the grievance process.

(i) Residents shall retain their access to grounds status when transferred from one residential area to another, unless their psychological or physical condition has changed, based on a comprehensive risk assessment.

(j) Residents who do not have full access to the grounds shall be provided the opportunity to exit the building for outside time and physical exercise on a daily basis, excluding severe weather conditions, for at least a half-hour per day. Residents have the right to decline to go outside, if they so choose.

(k) All residents with full or prescribed access to grounds (as indicated in their individualized service plan) shall be provided with an orientation to grounds and boundaries of the facility.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.457(2), 394.459(5), (12) FS. History–New 2-1-04.

Fla. Admin. Code R. 65E-5.603 Minimum Standards for Mobile Crisis Response Service or Mobile Response Team (MRT)

(1) MRTs must provide immediate, behavioral health crisis services to:

(a) Focus on crisis diversion and the reduction of involuntary examination

(b) Assess the individual for risk of suicidal and homicidal thoughts or behaviors.

(c) Assess the individual for mood disturbances such as depression, anxiety, delusional thoughts, or hallucinations that may contribute to and exacerbate the crisis.

(d) Identify social and environmental factors that may contribute to escalating the crisis and consider services and supports available to reduce them.

(e) Screen for appropriate level of care for a mental health receiving facility, an addiction receiving facility, or a detoxification facility.

(2) MRTs must, at a minimum:

(a) Ensure that each county has MRT services which are available to individuals of all ages experiencing a behavioral health crisis, in addition to populations specified in s. 394.495, F.S.

(b) Be operational 24 hours a day, 7 days a week.

1.Brief description of MRT services, purpose and contact information;

2.Program description;

3.Counties served.

(d) Disseminate program and contact information to the community, electronically, in-person or via paper formats.

(e) Triage new requests for MRT intervention to determine the level of severity and prioritize requests that meet the clinical threshold for an in-person response. When the clinical threshold for an in-person response is met, MRTs must respond in-person or via telehealth within 60 minutes after prioritization in the location where the crisis is occurring. Telehealth may be used at the request of the person served or when the MRT determines an onsite response is unsafe, within 60 minutes.

(f) Provide an array of crisis-oriented services to any individual in crisis and their families, designed to address their needs, including:

Screening and standardized assessments completed for the presence of an emotional disturbance, serious emotional disturbance, substance use, or mental illness including depression, risk for suicide, and risk to harm others.
Crisis de-escalation.
Safety planning, and connection to community services as necessary to address the immediate crisis event and ongoing behavioral health needs.
Care coordination and referral services, for at least 72 hours post crisis intervention including:

a. In person or via electronic means to facilitate a warm hand-off to referred services and follow-up services. Warm hand-off means that the MRT provider actively connects the individual to another service provider(s).

b. Follow-up on each referral, with the individual or the referred services to determine the outcome and need for additional referrals, services or resources among partnering agencies, stakeholders, providers, families, and caregivers.

c. Confirmation that the individual who received the mobile crisis response was connected to a service provider and prescribed medications, if needed.

(g) Adhere to standards for informed consent and confidentiality compliance.

(h) MRTs that choose to provide transportation to receiving facilities must comply with policies and procedures for transportation in s. 394.462, F.S.

(i) Establish formal agreements with the local school district(s) and the Department of Juvenile Justice that identify roles and responsibilities of each party, including obtaining parental consent or consent from minors aged 13 years or older when MRT services are provided by a licensed mental health professional pursuant to s. 394.4784(2), F.S.

(j) Establish formal and informal partnerships with key entities providing behavioral health services and supports to individuals and their families to facilitate continuity of care.

(k) Establish response protocols through formal agreements such as contracts or Memorandum of Understanding with local law enforcement agencies, 9-1-1 dispatch, 2-1-1 call centers, 9-8-8 Florida Lifeline centers, local community-based care lead agencies, the Department of Juvenile Justice, local schools (including public K-12 schools), colleges, and universities.

(3) MRT services exclude:

(a) Any emergency medical services.

(b) Services performed outside of MRT’s professional scope of practice.

(4) For children and adolescents, MRTs:

(a) May accept and consider suicide risk and threat assessments completed on the same day of the response by qualified school board staff pursuant to s. 394.495(3), F.S. and approved by the Florida Department of Education pursuant to s. 1012.583, F.S.

(b) Must review suicide risk and threat assessments completed on the same day of the response by qualified school staff pursuant to s. 394.495(3), F.S. If the suicide risk and threat assessments are thoroughly completed and received timely by qualified school staff, the MRT shall utilize such suicide risk and threat assessments to avoid duplicated assessments.

(5) Each direct service staff person, at a minimum, must complete training requirements within the first 90 days of hire in the following topics.

(a) Crisis de-escalation.

(b) Safety planning.

(c) Common types of mental health disorders and substance use disorders as well as the respective referral options for further assessment and ongoing services.

(d) Baker Act and Marchman Act protocols.

(e) Training to meet the specialized needs of older adults.

(6) Each MRT must be comprised of the following staff at a minimum:

(a) A licensed behavioral health professional must be available via an on-call schedule 24-hours-a-day, seven-days-a-week.

(b) At least one (1) master’s level professional.

(d) A board-certified or board-eligible psychiatrist or psychiatric nurse practitioner must be available via an on-call schedule.

(7) MRT providers may enroll as Medicaid providers. All MRTs applying for Florida Medicaid enrollment must apply in accordance with the Medicaid enrollment application requirements identified in Rule 59G-1.060, F.A.C., Provider Enrollment Policy.

History

Rulemaking Authority 394.457(5) FS. Law Implemented 394.457, 394.495 FS. History - New 10-20-25.

Fla. Admin. Code R. 65E-5.604 Minimum Standards for 988 Florida Lifeline Call Centers

(1) Definitions as used in this rule section:

(a) “988 Florida Lifeline” means the network of 988 suicide and crisis lifeline call centers within Florida that connect individuals experiencing emotional distress to trained crisis counselors who provide de-escalation, crisis intervention, and connection to community-based behavioral health services.

(b) “Automatic call distribution (ACD) queuing technologies” means a specialized phone system that can distribute incoming calls based on pre-defined call routing rules, which is the algorithm used by the technology that determines where a call is routed.

(c) “Dual-tone-multi-frequency (DTMF) functionality” means that a device or a system can send and receive audio tones to communicate with other devices over telephone lines, allowing for the transmission of digits and signals through sound signals of two different frequencies at the same time.

(d) “National Lifeline Administrator” means the organization that provides federal oversight for the national 988 suicide and crisis lifeline network.

(e) “Public Safety Answering Points (PSAP)” means a physical or virtual entity where 9-1-1 calls are delivered by the 9-1-1 service provider.

(2) 988 Florida Lifeline call centers must adhere to the following standards:

(a) 988 Florida Lifeline call centers must obtain and maintain accreditation through one of the following:

American Association of Suicidology (AAS);
International Council for Helplines (formerly CONTACT USA);
Alliance of Information and Referral Systems (AIRS);
The Joint Commission;
Commission on Accreditation of Rehabilitation Facilities (CARF);
Council on Accreditation (COA); or
Utilization Review Accreditation Commission (URAC)

(b) Have liability insurance that covers directors, officers, staff, and volunteers who respond to crisis calls in the amount of at least $1,000,000 per occurrence and $3,000,000 aggregate, unless otherwise approved by the Department and the National Lifeline Administrator.

(c) 988 Florida Lifeline call centers must pass National Lifeline Administrator tests of their telephone system to ensure compatibility with the Lifeline’s routing system. Centers using ACD queuing technologies must have DTMF functionality.

(d) Have a written policy that addresses the handling of frequent contacts including:

Procedures for responding to frequent contacts;
Tracking familiar contacts; and
Establishing an action plan.

(e) Have a written follow-up policy that addresses:

Eligibility requirements;
Consent criteria;
Modalities for follow-up;
Timeline for completing follow-up contacts;
Required number of outreach attempts; and
Required structure of a follow-up call.

(f) Have a written suicide safety policy that specifically addresses actions to be undertaken by crisis counselors in working with those at risk of suicide, including:

Assessment and intervention;
Supervisory support and training; and
Community engagement and collaboration with emergency service providers.

(g) Have a written policy for providing warm transfers, referrals, and resources that address:

Connecting contacts to the Veterans Crisis Line, the Spanish subnetwork, or the local PSAP; and
Referral procedures for contacts received outside the Center’s primary coverage area.

(h) Provide the following services 24 hours per day, seven days per week to all individuals contacting the 988 Florida Lifeline:

Active engagement and supportive crisis counseling.
Safety assessments, evaluations, and development of individualized safety or crisis plans.
Alternatives to crisis service interventions, such as mobile response teams (MRTs).
Connection to community-based resources, including mental health and substance use treatment services.

(i) Facilitate coordination through formal written agreements with MRTs, designated receiving facilities, and other community partners to enhance crisis response.

(j) Collaborate with local PSAPs to implement an interoperability plan, ensuring rapid access to the appropriate level of care for all contacts and addressing:

Information sharing;
Call transfer protocol;
Operational analytics; and
Training considerations.

(k) Maintain and update monthly a database of behavioral health resources and service providers to support referrals and warm hand-offs.

(l) Collaborate with the Department and other community partners to develop consistent public messaging about the 988 Florida Lifeline.

(m) Ensure that all crisis counselors complete the following minimum required trainings prior to answering 988 Florida Lifeline calls:

988 Lifeline Core Trainings provided by the National Lifeline Administrator.
Training on the use of emergency services that address:

a. The Center’s Suicide Safety Policy.

b. General procedures and technical processes for contacting PSAP personnel and requesting law enforcement or emergency medical services (EMS).

c. General procedures and technical processes for receiving and handling any warm transfers of mental health calls from 9-1-1.

d. Detailed overview of local PSAPs, including identification of PSAPs that handle specific public safety needs, such as State Patrol, Sheriff, police, EMS, and any other relevant parties within their region.

(n) Adhere fully to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Florida Electronic Health Records Exchange Act, in accordance with s. 408.051, F.S., ensuring confidentiality and the protection of personal health information.

(o) Report all critical incidents to the Department’s electronic Incident Reporting and Analysis System (IRAS).

History

Rulemaking Authority 394.9088(2) FS. Law Implemented 394.9088 FS. History – New 2-18-26.

Chapter 65E-9 Licensure of Residential Treatment Centers

Fla. Admin. Code R. 65E-9.001 Applicability

These rules shall apply to all residential treatment centers, including therapeutic group homes, under contract with the department or the agency to provide treatment services to children with an emotional disturbance or serious emotional disturbance who are admitted to services pursuant to chapter 39 or 394, F.S. These rules shall also apply to providers that serve children through age 20 who are committed under section 985.19, F.S.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Repromulgated 9-24-08.

Fla. Admin. Code R. 65E-9.002 Definitions

(1) “Abuse” means any willful or threatened act that results in any physical, mental, or sexual injury or harm that causes or is likely to cause the child’s physical, mental, or emotional health to be significantly impaired. Abuse of a child includes acts or omissions. Corporal discipline of a child by a parent or legal custodian for disciplinary purposes does not in itself constitute abuse when it does not result in harm to the child.

(2) “Administrator” means the chief executive or administrative officer of a residential treatment center or therapeutic group home or his or her designee.

(3) “Agency” or “AHCA” means the Agency for Health Care Administration and the terms are used interchangeably to refer to the Agency for Health Care Administration.

(4) “Assessment” means the appraisal or evaluation of a child’s current condition based on but not limited to clinical and functional data, physical examination, medical history, and current symptomatology.

(5) “Behavior analysis” is the science in which procedures derived from the principles of behavior are systematically applied to increase skill acquisition and reduce problematic behavior, to improve socially significant behavior to a meaningful degree and to demonstrate experimentally that the procedures used were responsible for the improvement in behavior.

(6) “Child” means any person under the age of 18 and, as used in this rule unless otherwise specified, includes the term “adolescent” as defined in section 394.492(1), F.S.

(7) “Collocation” means the simultaneous operation by a provider of two or more programs on the same grounds or in the same building with complete separation of the children served by the programs.

(8) “Cultural competence” means attaining and applying knowledge, skills, and attitudes that respect the child and family’s individual values and beliefs, so far as to enable administrators and staff to provide effective care and treatment for diverse populations.

(9) “Department” means the Department of Children and Family Services (DCF) unless otherwise specified.

(10) “DSM” means the latest edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.

(11) “Direct care staff” means a staff member who has direct contact with the child and has primary responsibility, identified in their job description, for providing personal care, assistance, and supervision to a child.

(12) “Drug used as restraint” means the administration of any drug to help control a child’s behavior or restrict the child’s freedom of movement, and is not a standard treatment for the child’s medical or psychiatric condition.

(13) “Emergency safety intervention” means the use of restraint or seclusion as an immediate response to an emergency safety situation.

(14) “Emergency safety situation” means unanticipated child behavior that places the child or others at immediate risk for serious injury if no intervention occurs.

(15) “Employee” means all salaried and hourly wage personnel of the residential treatment center, including therapeutic group home, as well as contracted persons, who may be professionals and licensed or certified pursuant to Florida law or other persons who may meet qualifications as set forth in this rule.

(16) “Family” means the child’s biological, adoptive or foster parent(s), guardian, siblings, grandparents, aunts and uncles, and other related or unrelated persons who have a significant relationship with the child. For children placed pursuant to chapter 39, F.S., the term family also includes the child’s guardian ad litem.

(17) “Family centered care” means an approach to the planning, delivery and evaluation of health care services that is governed by mutually beneficial partnerships between health care providers and the family. Family centered care is characterized by collaborating with the family, focusing on the families’ strengths, recognizing the families’ expertise, fostering family empowerment, promoting information sharing among all parties in a complete and unbiased manner, and programs that are flexible.

(18) “Governing body” means the board of trustees, the partnership, the corporation, the association, or the person or group of persons who maintain and control the provider organization and which is legally responsible for the operation of the provider organization.

(19) “Human Trafficking” as defined in Section 787.06 F.S.

(20) “Mechanical restraint” means any device attached or adjacent to a child’s body that the child cannot easily remove that restricts freedom of movement or normal access to the child’s body. However, mechanical restraint does not include physical devices, such as orthopedic prescribed appliances, surgical dressings and bandages, protective helmets and supportive body bands, or other physical holding when necessary for routine physical examinations and tests for orthopedic, surgical and other similar medical treatment purposes or when used to provide support for the achievement of functional body position or proper balance or to protect a patient from falling out of bed or to permit a patient to participate in ongoing activities without the risk of physical harm.

(21) “Medically stable” means good physical health, with no acute or chronic health problems for which medical treatment beyond routine medical care is required or anticipated. Children with a chronic, but stable illness, managed with medication and routine monitoring, such as diabetes or a well controlled seizure disorder, may be considered medically stable.

(22) “Medication administration” means the obtaining and giving of a single dose of medication, prescription or over-the-counter, by an authorized person to a child for his or her consumption.

(23) “Multidisciplinary team” means the group of individuals brought together to plan and coordinate mental health and related services to meet the needs of the child and their family in the most appropriate and least restrictive setting. Members of the team should include the child, unless clinically contraindicated, the child’s parent or legal guardian and other caregivers, such as: the foster parent; the child welfare service worker; the child’s therapist; the child’s behavioral analyst; the child’s Individual Education Plan surrogate; and others who have information or services to offer for the child’s treatment plan.

(24) “Neglect” means when a child is deprived of, or is allowed to be deprived of, necessary food, clothing, shelter, or medical treatment or a child is permitted to live in an environment when such deprivation or environment causes the child’s physical, mental, or emotional health to be significantly impaired or to be in danger of being significantly impaired. The foregoing circumstances shall not be considered neglect if caused primarily by financial inability unless actual services for relief have been offered to and rejected by such person. A parent or legal custodian legitimately practicing religious beliefs in accordance with a recognized church or religious organization who thereby does not provide specific medical treatment for a child shall not, for that reason alone, be considered a negligent parent or legal custodian. Neglect of a child includes acts or omissions.

(25) “Physical restraint” means the application of physical force without the use of any device, for the purpose of restricting the free movement of a child’s body. The term restraint does not include briefly holding without undue force a child in order to calm or comfort him or her, or holding a child’s hand to safely escort him or her from one area to another. Such term may also be known as “personal restraint.”

(26) “Plan of correction” means a written document that specifies actions a provider will take and the time frame within which the provider will come into compliance with chapter 394, F.S., or these rules.

(27) “Primary diagnosis” means the principal mental disorder, per the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, that is the medically necessary reason for clinical care and the primary focus of treatment.

(28) “Provider” means an individual, organization, corporation, including subcontractor, that is under contract with the department to provide children’s mental health services in a residential treatment center.

(29) “Psychotropic medication” means any drug prescribed with the primary intent to stabilize or improve mood, mental status, behavioral self-control, or mental illnesses.

(30) “Residential treatment center” means a 24-hour residential program, including a therapeutic group home, which provides mental health treatment and services to children as defined in section 394.492(5) or (6), F.S., and which is a private for-profit or not-for-profit corporation under contract with the department or the agency. This rule does not change the chapter 419, F.S., designation of a program as a “community residential home.”

(31) “Restraint” means a “drug used as restraint,” “mechanical restraint,” or “personal or physical restraint,” as defined in this section. Physical escort is excluded from this definition.

(32) “Screening” means the act of assessing the background of personnel and volunteers.

(33) “Seclusion” means the involuntary confinement of a resident alone in a room or an area that the resident is physically prevented from leaving.

(34) “Serious injury” means any significant impairment of the physical condition of the child as determined by qualified medical personnel. This includes, but is not limited to, burns, lacerations, bone fractures, substantial hematoma, and injuries to internal organs, whether self-inflicted or inflicted by someone else as defined in 42 C.F.R., §483.352.

(35) “Staff” means all owners, operators, employees, whether full-time, part-time and/or volunteers working in a residential treatment center, or other facility licensed by this rule, who may be employed or contracted by or do volunteer work for a person, corporation, or organization. The term does not include those who do not work on the premises where treatment is provided or either have no direct contact with a child or have no contact with a child outside of the presence of the child’s parent or guardian.

(36) “Supervision of self-administration of medications” means the provision of overseeing, guiding and assisting a child in the self-administration of a dose of medication, including prescription and over-the-counter medications.

(37) “Therapeutic group home” means a 24-hour residential program providing community-based mental health treatment and mental health support services in a home-like setting to no more than 12 children who meet the criteria in section 394.492(5) or (6), F.S.

(38) “Time-out” means the restriction of a child for a brief period of time (30 minutes or less) to a designated area from which the child is not physically prevented from leaving, for the purpose of providing the child an opportunity to regain self-control and when the use is consistent with the child’s treatment plan. This procedure is sometimes known as “brief isolation.” Regardless of name, the actions taken define the procedure and are therefore subject to this rule.

(39) “Treatment” means the planned, individualized program of medical, psychological, and/or rehabilitative services designed to promote resiliency and facilitate recovery of function, in part through remediation of symptoms of a primary diagnosis, and/or other medical or behavioral condition that significantly impacts the treatment of a primary diagnosis.

(40) “Treatment plan” means the written summary of the child’s individualized treatment goals, measurable objectives and treatment services to be provided. The treatment plan is the goal-oriented, time limited, individualized plan of action, which directs the treatment and services provided for the child and family.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08, 5-28-25.

Fla. Admin. Code R. 65E-9.003 Licensure

(1) An entity operating as a residential treatment center, including therapeutic group homes, shall first obtain a license from the Agency. All applicants for licensure must comply with the application requirements of chapters 394, part IV, 408, part II, F.S., and the requirements of the Agency in rule chapter 59A-35, F.A.C.

(2) Buildings that are separated from one another in which a similar level of residential care and treatment is provided may be licensed as one facility under the following circumstances:

(a) Such buildings are not separated by another building, part of a building, or buildings used for other purposes; and,

(b) Such buildings are not separated by obstructions that impede the rapid movement of staff between them.

(3) Accredited Programs. Programs accredited by The Joint Commission (TJC), Commission on Accreditation of Rehabilitation Facilities, (CARF), Council on Accreditation (COA), or National Committee for Quality Assurance (NCQA) shall provide proof of accreditation as required by section 394.741, F.S. Application for licensure by accredited programs does not preclude monitoring by the department or managing entity under contract with the department, the Agency, county public health unit, local fire authority having jurisdiction and fire marshal, nor compliance with the provisions of these rules.

(4) Liability insurance coverage.

(a) Applicants shall provide proof of professional liability insurance coverage from an authorized insurer in an amount no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000.

(b) Applicants shall provide proof of general liability insurance coverage from an authorized insurer in an amount no less than $300,000 per occurrence with a minimal annual aggregate of no less than $1,000,000.

(5) The license shall be displayed in a conspicuous location inside the facility.

(6) Program Closure. If the licensee voluntarily closes the facility, the licensee shall notify the Department and the Agency in writing at least 30 days prior to such closure. The program which is closing, with the assistance of the Department, managing entity under contract with the Department, Medicaid managed care plan and the Agency, shall attempt to relocate all persons receiving services, with their valid lawful consent, in other programs to which respective clinical records shall be transferred at the time the resident is relocated. The licensee shall notify the Agency, the Department and the managing entity under contract with the Department where the files of previously discharged residents will be stored.

(7) Program Closure Following Receivership Proceedings. By accepting a license under this chapter, the licensee agrees to cooperate with the Department and the AHCA in accepting the adversely affected individuals when closure of a program follows receivership proceedings as defined in section 394.903, F.S.

(8) Enforcement of these rules shall be in accordance with sections 394.879 and 394.902, F.S.

History

Rulemaking Authority 394.875(8), 394.879 FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08, 10-15-15.

Fla. Admin. Code R. 65E-9.004 Administrative Enforcement

(1) Provider staff shall cooperate with the Agency and Department personnel during surveys, complaint investigations, monitoring visits, implementation of correction plans, license application and renewal procedures, and other activities necessary to ensure compliance with chapter 394, F.S., and this rule.

(2) Administrative sanctions shall be imposed as authorized in section 394.879(4), F.S., for:

(a) Deficiencies which are not corrected within the time frame set by the Agency and for repeat deficiencies;

(b) Exceeding the licensed capacity;

(d) Failure to timely submit a renewal application in compliance with subsection 65E-9.003(7), F.A.C., or a change of ownership application in compliance with rule 65E-9.003, F.A.C.

(3) Moratorium on admissions.

(a) An immediate moratorium on admissions shall be placed on the facility when it has been determined that any condition in the facility presents an immediate or direct threat to the health, safety, and well being of children in the facility. The following situations are examples of threats constituting grounds for a moratorium:

Inappropriate or excessive use of restraint and seclusion;
The presence of children who need more care than can be provided by the facility;
Food supply inadequate to provide proper nutrition to children;
Lack of sufficient staff who are skilled and competent to provide for or to meet the immediate needs of the children;
Notification by the local fire marshal’s office or county health Department that conditions exist which impose an immediate threat to the children; or
Significant or repeated staff error resulting in failure to administer medications as prescribed.

(b) Moratoriums shall not be lifted until the deficiencies have been corrected and the Agency has determined through an appraisal visit that there is no danger or threat to the children's health, safety, or well being. The removal of the moratorium shall be conveyed and confirmed by written notification.

(c) During the moratorium, no new children or previously discharged children shall be admitted to the facility. Children for whom the provider is holding a bed may return to the facility only after the child’s parent or guardian has been informed that the facility is under a moratorium on admissions and with the prior approval of the local Agency field office.

(d) When a moratorium is placed on a facility, the Agency notice of the moratorium shall be posted and visible to the public at the facility until the moratorium is lifted.

History

Rulemaking Authority 39.407, 394.875(10) FS. Law Implemented 394.875 FS. History–New 7-25-06.

Fla. Admin. Code R. 65E-9.005 Operating Standards

(1) Governing body.

(a) Each provider shall have a governing body that exercises authority over the provider’s operation, policies and practices, and compliance with this rule.

(b) For-profit and not-for-profit organizations shall maintain advisory boards that review the operational policies and practices, inspect facilities and programs, conduct interviews with children and staff members, and review matters affecting the care of and treatment for children.

(c) The governing body shall meet no less than once per year. Membership of the governing body shall not be fewer than five (5) members. The provider shall maintain a list of its members, which shall be available to the Agency and the Department and shall:

Include the names, address, and terms of membership of each member; and
Identify each office and the term of that office.

(d) Responsibilities of the governing body:

Ensure organizational policies are in place for the administration and operation of the residential treatment center, including a qualified administrator;
Evaluate in writing the administrator’s performance annually;
Approve the annual budget of anticipated income and expenditures necessary to provide the services described in its statement of purpose and approve the annual financial audit report;
Establish and ensure compliance with written personnel practices;
Maintain written minutes of all meetings, which shall be open to inspection by the Agency and the Department, upon request;
Develop written policies for selection criteria and rotation of its members;
Develop and follow a written plan for the storage of records, including children's records, in the event of the closing of the program;
Ensure implementation of an effective quality improvement program that addresses at least the following components:

a. Credentials review and granting of clinical privileges to health care providers including but not limited to physicians, Advanced Nurse Practitioners, psychologists and other staff who oversee/supervise the delivery of mental and behavioral health services;

b. Monitoring of quality indicators; and

c. Mortality reviews.

Staff development plan for at least 15 hours per year on job related training to each staff whose duties require direct observation or contact with children.

(2) Written procedures. The provider shall establish and implement written procedures that ensure compliance with all provisions of this rule.

(3) Organization.

(a) Program. The provider shall have a written description of its philosophy, purpose, objectives, treatment program, services and methods of service delivery. This document shall be available to the Agency, the Department, referral sources, the parent(s), guardian or foster parent(s) and the public upon request. The program description shall include:

A description of the population of children served, including age and gender, types of disorders, and financial requirements;
The intake and admission process;
The types of treatment the provider can offer, based on a child’s individual needs;
Methods for involving the parent or guardian in assessment, treatment, discharge, and follow-up care plans; and
An organizational chart describing each unit or division and its services, goals, procedures, staffing patterns and relationship to other services and divisions and how these contribute to the goals of the program.

(b) Administration. The provider shall have a written organizational plan, including an organizational chart, for administrative and clinical staff, which clearly explains the responsibilities of staff for services provided by the program. This plan shall include:

Lines of authority, accountability and communication; and
The names and credentials of the provider’s clinical director and all clinical staff assigned responsibility on any shift for supervision of direct care staff. All clinical staff assigned supervisory responsibility shall have training or experience in child care activities and in the handling of medical and psychiatric emergencies.

(d) Audit. The provider shall have financial records audited annually.

(e) Fees. A sliding fee schedule shall be developed consistent with the provisions of rule 65E-14.018, F.A.C., If fees are charged, the provider shall have a written policy describing the relationships between fees and services provided and the conditions under which fees are charged or waived. This policy shall be available to any person upon request.

(f) Solicitation of funds. If provider funding is obtained through public solicitation, a charitable permit for such solicitation shall be procured.

(g) Notification of changes. The provider shall provide written notification within 30 days to the Department and the Agency of changes in the provider’s administrator, statement of purpose, program, or admission criteria.

(h) Personnel policies, procedures and records.

Personnel policies and practices shall be designed, established, followed and maintained to promote the objectives of the provider’s program and to ensure there are sufficient staff to support a high quality of care and treatment.
All paid personnel and volunteers shall be screened prior to employment, which shall include employment history checks, checks of references, local criminal records checks through local law enforcement agencies, fingerprinting, statewide criminal records checks through the Florida Department of Law Enforcement, and federal criminal records checks through the Federal Bureau of Investigation.
The provider shall have and implement written personnel procedures covering the following areas: job classification; pay plan; staff selection; probation or work-test period; tenure of office; dismissal; salary increases; health evaluations; holidays; leave policies; new employee training/orientation; ongoing staff development training; performance evaluation; employment benefits; and personnel records.
Each new employee shall be given a copy of the written personnel procedures when hired and documentation of receipt shall be maintained in the employee’s personnel file. A procedure shall be established and implemented on an ongoing basis for notifying employees of changes in established policies and procedures.
There shall be clear job descriptions for all staff, including position title, immediate supervisor, responsibilities and authority, which shall be used as a basis for periodic evaluations by the supervisor.
Accurate and complete personnel records shall be maintained on each employee. Content shall include:

a. Current background information, including the application, references, proof of satisfactory background screening results as required by section 394.4572, F.S., and documentation to justify initial and continued employment of the individual. Applicants for positions requiring licensure, certification or accreditation shall be employed only after the provider has verified the license or accreditation. Evidence of renewal of license as required by the licensing agent shall be maintained in the employee’s personnel record;

b. Current performance evaluation;

c. Record of any continuing education or staff development programs completed.

(i) Need for service. The provider’s written policies shall include a description of the specific services it offers or proposes to offer.

(j) Incorporation. Organizations incorporated outside of the State of Florida must be authorized to do business under Florida law and such proof of authorization to do business in Florida must be maintained in the provider’s licensing file. A copy of the annual report filed with the Florida Department of State, Division of Corporations and a copy of the cancelled check verifying payment of the fee or a current certificate of status issued by the Florida Division of Corporations shall constitute proof of authority to operate in Florida.

(k) Delegation of authority. To protect the health and safety of children served, any delegation of an administrator’s authority pursuant to chapter 394, F.S., or these rules shall be documented in writing prior to exercising the delegated authority. This documentation shall be placed in the individual’s employee record. Routine delegations of authority shall be incorporated in the provider’s written procedures.

(l) Incident notification.

The provider shall comply with the department’s and the agency’s procedures for reporting incidents that pose risk of serious psychological and physical harm to children being served.
The provider shall develop and implement on an ongoing basis a written procedure for incident notification, reflecting the requirements of the department’s operating procedure CFOP 215-6, which is incorporated by reference.

(4) Fiscal accountability.

(a) The provider shall maintain separate accounting and fiscal records and all providers receiving state funds shall permit audits of such records and accounts, at any reasonable time, by the Agency, the Department and all funding agencies to ensure that contracted services are being provided as required by their contract and that the standards of the Department and Agency are met.

(b) The provider shall have and follow a schedule of public rates and charges for all services provided and these shall be made available to all referral sources and families.

(c) The provider shall have and maintain an insurance coverage that provides comprehensive liability insurance with minimum coverage of $300,000 per claim and $1,000,000 aggregate.

(d) Providers shall return to the Department and Agency any funds paid for services not actually performed or any funds owed the Department or Agency because of unallowable expenditures, as stipulated in the contract and within the timeframe defined in the contract.

(5) Facility standards.

(a) Buildings, grounds and equipment.

If the facility accepts children with physical handicaps, the facility shall be handicap accessible.
Grounds shall have space for children’s activities, which shall be designed based on the type of activities offered and age appropriateness. The grounds shall be maintained in a safe and reasonably attractive manner and kept free of standing water, debris, garbage, trash and other hazardous conditions.
Indoor and outdoor recreation areas shall be provided with equipment and safety measures designed for the needs of children according to age, physical and mental ability.
Safety regulations shall be established and followed for all hazardous equipment and children shall be prohibited from the use of such equipment.
Pools. Facilities licensed for eight or more children shall meet the public swimming pool requirements of chapter 514, F.S. Facilities licensed for one through seven children shall meet the residential swimming pool requirements for chapter 515, F.S.
The interior and exterior of buildings and the furniture and furnishings shall be safe, comfortable, reasonably attractive, in good repair and shall function for the purpose for which such building and furniture has been designed.
All heating, air conditioning, electrical, mechanical, plumbing and fire protection systems shall function properly and be in compliance with local codes.
Therapeutic group home beds shall meet the requirements of chapter 419, F.S., Community Residential Homes.

(b) Interior accommodations.

The facility’s space and furnishings shall enable staff to respect the child’s right to privacy and provide adequate supervision.
The facility shall have a common area large enough to accommodate group activities for the informal use by children.
The facility shall have one or more dining areas large enough to comfortably accommodate the number of persons normally served.
The facility shall have indoor recreation space large enough to accommodate the number of children scheduled for indoor activities.
Study areas shall have tables, chairs, appropriate lighting and bookshelves suitable for children’s use.
For residential treatment centers, if administrative offices are housed in the facility, they shall be separated from the children’s living area. Administrative offices do not include nursing or staff monitoring stations. Therapeutic group homes may have an office space in the facility for administrative purposes, including storage of children’s records.
There shall be a room available, which may be used for multiple purposes, to allow staff and children to talk privately and without interruption.
Potable drinking water shall be readily available and easily accessible to children.
Clocks and calendars shall be provided.
Bathrooms shall be provided and shall be separated from halls, corridors and other rooms by floor to ceiling walls. Children shall not have to go through another child’s bedroom to get to a bathroom. Each bathroom shall have:

a. At least one toilet, washbasin, and tub or shower easily accessible to the bedroom area for each six children;

b. When multiple toilets are located in a single room, they shall be separated by individual toilet stalls to provide individual privacy;

c. Bathrooms with non-slip surfaces in showers or tubs;

d. Toilet paper and holders, individual hand towels or disposable paper towels and soap dispensers;

e. Distortion-free mirrors at a height convenient for use by children;

f. A place for toiletry storage; and

g. In a facility that houses children with physical handicaps that limit mobility, all toilet and bathing areas shall meet the requirements of the Florida Building Code for accessibility.

Bedrooms.

a. Children shall not share sleeping areas with adolescents, and children or adolescents shall not share sleeping areas with adults.

b. Separate sleeping areas shall be provided for boys and girls.

c. The provider shall not permit children with physical handicaps that limit mobility to sleep above the first floor.

d. Bedrooms shall have at least 50 square feet of usable floor space per resident.

e. Bedrooms with multiple occupancy shall be limited to a maximum of 4 occupants.

f. Bedrooms for children shall be separated from halls, corridors, and other rooms by floor to ceiling walls.

g. Children’s bedrooms shall be ventilated, well-lighted and located convenient to a bathroom and shall have at least one operable exterior window.

h. Each bedroom shall be furnished with the following equipment for each child: personal storage space, such as a dresser; space for hanging clothes; a bed and mattress in good repair, which is at least 36 inches wide and 72 inches long, bedding suited to the seasons and a pillow.

i. Clean sheets, pillow cases, and blankets shall be provided for each child upon arrival. Sheets and pillowcases shall be laundered at least weekly unless greater frequency is indicated. A bedspread must be provided. Blankets or quilts must be available for use during cold weather. Bedspreads and blankets or quilts must be laundered at least quarterly, or more often, as needed.

j. Sleeping areas shall be assigned based on children’s individual needs for group support, privacy or independence and shall be appropriate to their ages, developmental levels and clinical needs.

k. Children shall be allowed to keep and display personal belongings and to add personal touches to the decoration of their rooms. The provider shall have and follow written procedures specifying what types of decoration are acceptable.

A seclusion room must meet the following standards:

a. Be a single room of at least 50 square feet and shall be constructed to minimize the child’s hiding, escape, injury or suicide;

b. Allow staff full view of the resident in all areas of the room from outside of the room;

c. Doors.

(I) Doors will be made of solid-core hardwood, metal or other hard, shatter-resistant material.

(II) Doors must open outward and lock using a keyless locking device that will unlock upon activation of building fire alarm and will fail safe open on loss of power to the device.

(III) The door will have no other features greater than eighteen inches from the floor to which cloth or other material may be securely hung or tied.

d. Floors and walls.

(I) Floors and walls will be solid, smooth, and high impact resistant without metal or other protrusions.

(II) Walls will lack features that are higher than eighteen inches from the floor to which cloth or other material may be securely hung or tied.

(III) Floor tiles and baseboards are acceptable if attached securely to the floor and walls.

e. Ceilings less than nine feet above the floor shall be monolithic with no appendages that can be securely grasped or tied onto with cloth or other material.

f. Vents less than nine feet above the floor will be covered with small wire mesh, a metal plate, or other high impact resistant material (with holes no larger than three-sixteenth inch) in such a way that one would be unable to securely tie or hang cloth or other material from it and have no exposed sharp edges.

g. Lighting.

(I) Lighting less than nine feet above the floor will:

(A) Be recessed and covered with shatter-resistant material;

(B) Have no sharp exposed edges and lack space between it and the ceiling (or other mounting surface);

(II) The lighting fixture need not be recessed if it is security-rated to withstand high impact and has a shatter-resistant cover.

(III) Material used to fill space between the fixture and the mounting surface will be hard epoxy or other material that cannot be easily removed.

h. Mirrors and cameras. If mirrors and cameras are located in the seclusion room and are less than nine feet above the floor, they will:

(I) Be covered with shatter-resistant material;

(II) Have no sharp exposed edges and lack space between them and the ceiling (or other mounting surface);

(III) Not possess features to which cloth or other material can be securely tied or hung;

i. Sprinklers. Sprinklers less than nine feet above the floor will:

(I) Be recessed inside a cone-shaped or other suitable housing onto which cloth or other material cannot be securely tied or hung; sprinkler systems shall be installed in accordance with National Fire Protection Association Standard 13.;

(II) Lack space between the base of the housing and the surface to which it is attached;

(III) Will use material to fill between the fixture and the ceiling that is hard epoxy or other material that cannot be easily removed.

j. Windows.

(I) Windows, when present, will be made of shatter-resistant material.

(II) Any glass window that is not shatter resistant will be covered with a security-rated screen or other material that prevents access to the glass.

(III) Window cranks will be flush with the window.

k. A toilet room shall be conveniently located near the seclusion room without entering into or through a common use area. It shall not open directly into or be located within the seclusion room. Toilets and sinks will be smooth and devoid of handles or parts to which cloth or other material could be securely tied or hung.

l. Smoke detectors.

(I) Smoke detectors less than nine feet above the floor will be recessed in the wall or ceiling, or enclosed in small wire mesh or other suitable material housing that prevents access to the smoke detector.

(II) The wire mesh or other enclosure will have holes that are not larger than three-sixteenth inch and lack features to which cloth or other material can be securely tied or hung and shall not prevent the smoke detector from properly functioning in accordance with National Fire Protection Association, 72, National Fire Alarm Code.

m. Electrical outlets.

(I) Electrical outlets are not permitted.

(II) Electrical switches, e.g., to adjust lighting, are permissible if switches cannot be removed by the child or otherwise manipulated to gain access to the wiring.

(III) Switches will not protrude so far that they permit serious self-injury.

n. Beds when present will:

(I) Be made of metal, heavy molded plastic, or other solid impact resistant material;

(II) Be secured to the floor or wall to prevent the child from standing it upright and using it as a prop; and

(III) Lack features to which cloth or other material can be securely tied, if it is higher than twenty-four inches above the floor.

o. Mattresses and blankets.

(I) Each child placed in seclusion will have immediate access to one plastic or vinyl-covered mattress and at least one fire retardant, triple-stitched blanket made of tear resistant material.

(II) Mattresses and blankets will be cleaned after each use, prior to being used by another child.

p. Each seclusion room will be inspected and certified as compliant with the above standards at least yearly and at any time damage or structural change occur.

Ventilation and lighting.

a. The facility shall provide outside ventilation by means of windows, louvers, air conditioners, or mechanical ventilation in rooms used by children. Windows and doors used for outside ventilation shall be operable and shall have screens in good repair.

b. All areas of the facility occupied by children shall be temperature-controlled in a manner conducive to comfort, safety and privacy. Unless otherwise mandated by federal or state authorities, a temperature of 72 to 82 degrees Fahrenheit during waking hours and 68 to 82 degrees Fahrenheit during sleeping hours shall be maintained in all areas used by children. Cooling devices shall be placed or adjusted in a manner that minimizes drafts. Table fans and floor fans shall have protective covers.

c. The facility shall provide sufficient lighting for the comfort and safety of children, including in classrooms, study areas, bathrooms and food service areas.

d. All incandescent bulbs and fluorescent light tubes shall be protected with covers or shields.

e. Hallways to bedrooms and bathrooms shall be illuminated at night.

f. The facility shall provide egress lighting that will operate if there is a power failure.

(6) Health, sanitation and safety.

(a) Before a license is issued, and annually thereafter, the facility shall be inspected by the local office of the Department of Health to review compliance with state and local ordinances and health codes. Current written approvals or certificates of health and sanitary conditions and inspection reports shall be on file in the facility.

(b) The provider shall have and follow written health, sanitation and safety procedures.

(c) The use of door or window locks or closed sections of the building shall comply with all applicable safety and fire code standards.

(d) The facility shall have telephones, centrally located and readily available for staff and children’s use in each living unit of the facility. Emergency numbers such as the fire department, police, hospital, physician, poison control center, ambulance and Florida Abuse Hotline shall be posted by each telephone. There shall be at least one cellular telephone available for use at all times in the event of power and telephone line outages.

(e) Poisons and toxic substances shall be prominently and distinctly marked, labeled as to contents, kept stored under lock and key, kept inaccessible to children, and used in a manner as not to contaminate food or constitute a hazard to children.

(7) Housekeeping.

(a) The facility and its contents shall be kept free from dust, dirt, debris and noxious odors.

(b) All rooms and corridors shall be maintained in a clean, safe, and orderly condition, and shall be properly ventilated to prevent condensation, mold growth, and noxious odors.

(d) All mattresses, pillows, and other bedding; window coverings, including curtains, blinds, and shades, cubicle curtains and privacy screens; and furniture shall be kept clean.

(e) Floors shall be kept clean and free from spillage, and non-skid wax shall be used on all waxed floors.

(f) Aisles in storage areas shall be kept unobstructed.

(g) All garbage and refuse shall be collected daily, removed from the building and stored in a manner to make it inaccessible to insects and rodents.

(h) Garbage storage rooms and outside area shall be kept clean, vermin-proof, and large enough to store the garbage containers that accumulate. Outside storage of unprotected plastic bags, wet strength paper bags, or baled units containing garbage is prohibited. Garbage containers, dumpsters, and compactor systems located outside shall be stored on or above a smooth surface of non-absorbent material, such as concrete or machine-laid asphalt, that is kept clean and maintained in good repair.

(i) Garbage shall be removed from storage areas as often as necessary to prevent sanitary nuisance conditions. If garbage is disposed of on the premises, the method of disposal shall not create a sanitary nuisance and shall comply with the provisions of chapter 62-701, F.A.C.

(j) Laundry facilities shall be located in an area separate from areas occupied by children. If children are allowed to participate in the laundering of their personal items, space for sorting, drying, and ironing shall be made available. If children are using laundry facilities, they shall be supervised by a staff member at all times.

(8) Codes and standards.

(a) Before a license is issued and annually thereafter, the facility shall be inspected by the State Fire Marshal's office or other person certified pursuant to section 633.081, F.S., by the Division of State Fire Marshal as a fire safety inspector. A current report of inspections and satisfactory approval shall be on file in the facility.

(b) Residential treatment centers and therapeutic group homes shall comply with National Fire Protection Association 101, the edition adopted in rule 69A-3.012, F.A.C., Chapter 32 for new residential board and care facilities or Chapter 33 for existing residential board and care facilities, as applicable. Secured (locked) facilities shall meet the requirements of Chapter 18 Health Care Occupancy for new facilities or Chapter 19 Health Care Occupancy for existing facilities, as applicable.

(c) All new residential unlocked facilities and additions and renovations to existing facilities shall be in compliance with the Florida Building Code, as described in Chapter 3 of Section 310.1 (R4) and new secured (locked) facilities and additions and renovations shall meet the requirements of Institutional Occupancy Section 308.3 Group I-2 as described in the current edition of the Florida Building Code adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206.

(d) All new residential unlocked facilities and additions and renovations to existing facilities and new secured (locked) facilities and additions and renovations shall meet the accessibility requirements of Chapter 11, Section 11-6.1(1), of the Florida Building Code, as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206.

(9) Transportation safety.

(a) Vehicles used to transport children shall be maintained in safe operating condition.

(b) The number of persons in a vehicle used to transport children shall not exceed the number of seats and seat belts. Seat belts shall be worn by all passengers when transporting children. Buses without seat belts are exempt from this requirement.

(c) Buses or vans used to transport children shall be equipped with a first aid kit and a non-expired fire extinguisher, rated 5BC.

(10) Disaster and emergency preparedness.

(a) EMERGENCY PLAN COMPONENTS. Each facility shall prepare a written comprehensive emergency management plan in accordance with CF-MH 1065, “Emergency Management Planning Criteria for Residential Treatment Facilities,” dated 08/2007, which is incorporated by reference. This document is available on the Department’s website at https://www.myflfamilies.com/general-information/publications-forms/. The comprehensive emergency management plan must, at a minimum address the following:

Provision for all hazards.
Provision for the care of residents remaining in the facility during an emergency including pre-disaster or emergency preparation; protecting the facility; supplies; emergency power; food and water; staffing; and emergency equipment.
Provision for the care of residents who must be evacuated from the facility during an emergency including identification of such residents and transfer of resident records; evacuation transportation; sheltering arrangements; supplies; staffing; emergency equipment; and medications.
Provision for the care of additional residents who may be evacuated to the facility during an emergency including the identification of such residents, staffing, and supplies.
Identification of residents with mobility limitations who may need specialized assistance either at the facility or in case of evacuation.
Identification of and coordination with the local emergency management agency.
Arrangement for post-disaster activities including responding to family inquiries, obtaining medical intervention for residents; transportation; and reporting to the county office of emergency management the number of residents who have been relocated and the place of relocation.
The identification of staff responsible for implementing each part of the plan.

(b) Evacuation routes shall be posted in conspicuous places and reviewed with staff and children on a semi-annual basis. Evidence of these periodic reviews shall be maintained in the facility’s files and available upon request.

(c) EMERGENCY PLAN APPROVAL. The plan shall be submitted for review and approval to the county emergency management agency.

Any revisions must be made and the plan resubmitted to the county office of emergency management within 30 days of receiving notification from the county agency that the plan must be revised.
Newly-licensed facility and facilities whose ownership has been transferred, must submit an emergency management plan within 30 days after obtaining a license.
The facility shall review its emergency management plan on an annual basis. Any substantive changes must be submitted to the county emergency agency for review and approval.

a. Changes in the name, address, telephone number, or position of staff listed in the plan are not considered substantive revisions for the purposes of this rule.

b. Changes in the identification of specific staff must be submitted to the county emergency management agency annually as a signed and dated addendum that is not subject to review and approval.

Any plan approved by the county emergency management agency shall be considered to have met all the criteria and conditions established in this rule.

(d) PLAN IMPLEMENTATION. In the event of an internal or external disaster the facility shall implement the facility’s emergency management plan in accordance with section 252.356, F.S.

All staff must be trained in their duties and are responsible for implementing the emergency management plan.
If telephone service is not available during an emergency, the facility shall request assistance from local law enforcement or emergency management personnel in maintaining communication.

(e) FACILITY EVACUATION. The facility must evacuate the premises during or after an emergency if so directed by the local emergency management agency.

The facility shall report the evacuation to the local office of emergency management or designee and to the area Department of Children Mental Health Program Office within six hours of the evacuation order and when the evacuation is complete if the evacuation is not completed within the six hour period.
The facility shall not be re-occupied until the area is cleared for reentry by the local emergency management agency or its designee and the facility can meet the immediate needs of the residents.
A facility with significant structural damage must relocate residents until the facility can be safely re-occupied.
The facility is responsible for knowing the location of all residents until the resident has been relocated from the facility.
The facility shall provide the Agency with the name of a contact person who shall be available by telephone 24-hours a day, seven days a week, until the facility is re-occupied.
The facility shall assist in the relocation of residents and shall cooperate with outreach teams established by the Department of Health or emergency management agency to assist in relocation efforts. Resident needs and preferences shall be considered to the extent possible in any relocation decision.

(11) Aquatic safety. For facilities that offer aquatic programs, the provider shall have and implement on an ongoing basis procedures that include:

(a) Children shall not participate in an aquatic activity without continuous supervision by staff trained in water rescue and lifesaving procedures.

(b) Before allowing children to participate in an aquatic activity, their swimming ability levels shall be assessed.

(c) The provider shall not permit a child to participate in an aquatic activity requiring higher skills than the child's swimming abilities, except during formal swimming instruction.

(d) A method, such as the buddy system, shall be established and enforced during aquatic activities.

(e) Lifesaving equipment shall be immediately accessible during aquatic activities. Minimum lifesaving equipment shall include:

A whistle or other audible signal device;
A first aid kit; and
A ring buoy, rescue tube, life jacket or other appropriate flotation device with an attached rope of sufficient length for the area.

(f) Life jackets shall be worn during all boating activities.

(g) Before any extended travel in a water craft, drills shall be practiced to approximate “man overboard” and capsize situations.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.

Fla. Admin. Code R. 65E-9.006 Program Standards

(1) Additional standards for therapeutic group homes. The primary mission of the therapeutic group home is to provide treatment of serious emotional disturbance. Distinguishing features of a therapeutic group home include the following:

(a) Meets the requirements of a single-family unit or community residential home as defined in chapter 419, F.S.; the home is a non-secure or unlocked facility;

(b) The use of mechanical restraint or drugs used as restraint is prohibited;

Physical restraint must be applied only during potential emergency or crisis situations for no more than 30 minutes;
If the use of physical restraint is required during the child’s stay, the treatment team shall formally review the child’s treatment plan, at least monthly, and revise at the time of the review if determined necessary, to actively address and eliminate its use. As part of its review, the treatment team will determine whether implementation of an individual behavior plan is necessary, considering such factors as the frequency and duration of the physical restraint incidents and the age and cognitive ability of the child; and
The guidelines in rule 65E-9.013, F.A.C., related to physical restraint shall be met in addition to those listed above.

(d) The use of seclusion is prohibited. If time-out is used, the provider shall comply with the procedures outlined in subsection 65E-9.013(11), F.A.C.;

(e) Children or adolescents must be medically stable;

(f) Children or adolescents being served attend school in the community and engage in community recreational and social activities;

(g) Treatment plan includes treatment and support services, goals and objectives designed to enable children being served to transition to a less restrictive level of care or be reunited with their family; and

(h) Treatment and other mental health services are provided in a family-like setting, and the provider may employ professional parents to staff the home.

(2) Collocation.

(a) Upon written approval of the Department and the Agency, a provider may collocate other programs with programs serving children admitted under chapter 394 or section 39.407, F.S.

(b) The collocated programs may share administration and facility services, such as housekeeping, food preparation, and maintenance.

(c) Children admitted to these other programs shall be separated from the other children by staff supervision and shall not co-mingle or share a common space at the same time.

(3) Treatment and services.

(a) Treatment shall be individualized, child and family centered, culturally competent, and based on the child’s assessed strengths, needs, and presenting problems that precipitated admission to the program.

(b) Treatment services shall be provided as part of an individualized written treatment, plan that complies with rule 65E-9.009, F.A.C., of this chapter.

(c) Treatment modalities and services shall be in accordance with the child’s psychiatric, behavioral, emotional and social needs and be incorporated into their individualized treatment plan and discharge plan.

(d) The provider shall ensure that all staff caring for or providing treatment or services for the child:

Have current information about the child’s treatment plan and goals, including the child’s permanency goals if admitted pursuant to section 39.407, F.S.; and
Direct all aspects of the child’s treatment, services and daily activities toward meeting the child’s specific treatment goals.

(e) The provider shall ensure that all staff providing a treatment modality to the child are qualified to provide that treatment modality.

(f) Discussions are held on an on-going basis with the individuals involved in implementing treatment.

(g) Treatment shall not be aversive, coercive, or experimental.

(h) Treatment provided, including behavior analysis services, shall be consistent with nationally recognized standards.

(i) When multiple modalities of treatment are provided, such as psychotherapy, behavior management, and medication, the treatment shall be coordinated among the treatment professionals.

(j) Treatment progress shall be monitored on a continuous basis and the treatment adjusted as needed to meet the child’s individual treatment goals.

(k) The provider must have policies and procedures for serving children or young adults who are victims of commercial sexual exploitation, in accordance with Section 409.1678(3), F.S.

(4) Activities.

(a) Basic routines shall be outlined in writing and made available to staff and children on a continuing basis.

(b) The daily program shall be planned to provide a framework for daily living and periodically reviewed and revised as the needs of the individual child or the living group change.

(d) The facility shall have a written plan for a range of age-appropriate indoor and outdoor recreational and leisure activities provided for children, including activities for evenings and weekends. Such activities shall be based on the group and individual interests and developmental needs of the children in care.

(e) Books, magazines, newspapers, arts and crafts materials, radios and televisions shall be available in accordance with children’s recreational, cultural and educational backgrounds and needs.

(f) Provisions shall be made for each child to have daily time for privacy and pursuit of individual interests.

(g) The facility shall have a written policy addressing the involvement of children in community activities and services, which includes how the appropriate level of community involvement is determined for each child.

(5) Education. The provider shall arrange for or provide an educational program for children, that complies with the State Board of Education, rule 6A-6.0361, F.A.C., effective date 2-18-93, hereby incorporated by reference.

(6) Food and nutrition.

(a) If the provider serves meals to staff members, they shall serve staff and children substantially the same food, except when age or special dietary requirements dictate differences.

(b) The provider shall serve three well-balanced meals a day in the morning, noon, and evening and provide snacks. If a child is admitted between meals, snacks will be provided. When children are attending school or are not present in the facility during mealtime, the provider shall make arrangements for the children’s meals.

(c) The provider shall retain menus, with substitutions, for a 12-month period, which shall be available for review. Menus shall be posted 24 hours before serving of the meal. Any change shall be noted. Menus shall be evaluated by a consultant dietitian for nutritional adequacy at least annually. The provider shall maintain records of the dietician’s reviews.

(d) The provider shall plan and prepare special diets as needed (e.g., diabetic, bland, high calorie). No more than fourteen hours shall elapse between the end of the evening meal and the beginning of the morning meal where a protein is served. Meals shall meet general requirements for nutrition published by the department or currently found in the Recommended Daily Diet Allowances, Food and Nutrition Board; or by the Florida Dietetic Association.

(7) Health, medical, and emergency medical and psychiatric services.

(a) The provider shall develop and implement on an ongoing basis written procedures for health, medical, and emergency medical and psychiatric services describing how the provider obtains or provides general and specialized medical, psychiatric, nursing, pharmaceutical and dental services.

(b) The procedure shall clearly specify which staff are available and authorized to provide necessary emergency psychiatric or medical care, or to arrange for referral or transfer to another facility including ambulance arrangements, when necessary. The procedure shall include:

Handling and reporting of emergencies. Such procedures shall be reviewed at least yearly by all staff and updated as needed;
Obtaining emergency diagnoses and treatment of dental problems;
Facilitating emergency hospitalization in a licensed medical facility;
Providing emergency medical and psychiatric care; and
Notifying and obtaining consent from the parent or legal guardian in emergency situations. This procedure shall be discussed with the child’s parent or guardian upon admission. The discussion shall be documented in the child’s file.

(c) The provider shall have a staff member on duty at all times, when children are present in the facility, who is trained and currently certified to administer first aid and CPR.

(d) The provider shall immediately notify the child's parent or guardian and the placing organization or the department of any serious illness, any incident involving serious bodily injury, or any severe psychiatric episode requiring the hospitalization of a child.

(e) The provider shall have available, either within the provider organization or by written agreement with health care providers, a full range of services for treatment of illnesses and maintenance of general health. Agreements shall include provisions for on-site visits, office visits, and hospitalization.

(f) Children who are physically ill shall be cared for in surroundings familiar to them, if medically feasible, as determined by a physician. If medical isolation is necessary, it shall be provided. There shall be a sufficient number of qualified staff available to give care and attention within a setting designed for such care.

(g) A complete physical examination shall be provided for each child in the provider's care every 12 months and more frequently, if indicated.

(h) Immunization of all children shall be kept current in accordance with the American Academy of Pediatrics guidelines.

(i) Each staff member shall be required to report to the program’s physician and note in the child’s record any illnesses or marked physical dysfunction of the child.

(j) All staff shall have training in the handling of emergency medical situations.

(k) Emergency medical services shall be available within 45 minutes, 24 hours a day, seven days a week.

(l) The program physician's name and telephone number shall be clearly posted in areas accessible by staff and others within the facility.

(m) There shall be a first aid kit available to staff for each unit or building for facilities with multiple units or buildings and one per facility for single unit or building facilities. Contents of the first-aid kits shall be selected by the medical staff.

(n) The provider shall have a written agreement with a licensed hospital verifying that routine and emergency hospitalization will be available.

(8) Administration of medication.

(a) Pharmaceutical services, if provided, shall be maintained and delivered as described in the applicable sections of chapters 465 and 893, F.S., and the Board of Pharmacy rules.

(b) All medicines and drugs shall be kept in a double locked location. Prescription medications shall be prescribed only by a duly licensed physician or an ARNP or physician’s assistant working under the direction of a licensed physician.

Name of the child for whom it is prescribed;
Physician’s name, and reason for medication;
Quantity of medication in container when received;
Method of administration of medication (i.e., orally, topically, or injected);
Amount and dosage of medication administered;
Time of day and date medication is to be administered or self-administered and time of day and date medication was taken by the child; and
Signature of staff member who administered or supervised self-administration of the medication.

(d) The provider shall not permit medication prescribed for one child to be given to another child.

(e) Children capable of self-medication shall be supervised by a staff person who has been trained in medication supervision.

(f) For children not capable of self-medication, only a licensed nurse or unlicensed staff who has received training as required by this rule shall administer medications.

(9) Religious and ethnic heritage. The provider shall offer opportunities for children to participate in religious services and other religious and ethnic activities within the framework of their individual and family interests, treatment modality and provider setting. The option to celebrate holidays in the child’s traditional manner shall be provided and encouraged.

(10) Interpreters, translators and language options. The provider shall establish procedures for identifying and assessing the language needs of each child and providing:

(a) A range of oral and written language assistance options, including American Sign Language;

(b) Written materials in languages that are spoken by the child other than English; and

(11) Clothing and personal needs.

(a) The provider shall complete a written inventory of personal belongings of each child upon admission and account for all personal belongings upon discharge. This written inventory shall be maintained in the child’s case file and a copy given to the parent or guardian at admission and discharge.

(b) The provider shall ensure each child has individual personal hygiene and grooming items readily available and has training in personal care, hygiene, and grooming appropriate to the child’s age, gender, race, culture and development.

(c) The provider shall involve the child in the selection, care and maintenance of personal clothing as appropriate to the child’s age and ability. Clothing shall be maintained in good repair, sized to fit the child and suited to the climate and season.

(d) The provider shall allow a child to possess personal belongings. The provider may limit or supervise the use of these items while the child is in care.

(e) When needed, protection from the weather or insects shall be provided, such as rain gear and insect repellent.

(f) The provider shall return all of the child’s personal clothing and belongings to the parent or guardian when the child is discharged from the facility.

(12) Child’s record.

(a) The provider shall have written procedures regarding children’s records, including provisions to ensure that clinical records are maintained in accordance with section 394.4615, F.S.

(b) The provider shall develop an individualized record for each child. The form and detail of the records may vary but shall, at a minimum, include:

Identification and contact information, including the child’s name, date of birth, Social Security number, gender, race, school and grade, date of admission, and the parent or guardian’s name, address, home and work telephone numbers;
Source of referral;
Reason for referral to residential treatment, e.g., chief complaint, presenting problem(s);
Record of the complete assessment;
DSM diagnosis;
Treatment plan;
Medication history;
Record of medication administered by program staff, including type of medication, dosages, frequency of administration, persons who administered each dose, and method of administration;
Documentation of course of treatment and all evaluations and examinations, including those from other facilities, such as emergency rooms or general hospitals;
Progress notes;
Treatment summaries;
Consultation reports;
Informed consent forms;
A chronological listing of previous placements, including the dates of admission and discharge, and dependency and delinquency actions affecting the minor’s legal status;
Written individual education plan for the child, when applicable;
The discharge summary, which shall include the initial diagnosis, clinical summary, treatment outcomes, assessment of child’s treatment needs at discharge, the name, address and phone number of the person to whom the child was discharged and follow-up plans. In the event of death, a summary shall be added to the record and shall include circumstances leading to the death. All discharge summaries shall be signed by the clinical or medical director;
For out of state children, copies of completed interstate compact ICPC 100A and ICPC 100B forms (February 2002) and a copy of each Interstate Compact Transmittal Memorandum and any attachments thereto that were sent to the Residential Treatment Center by the department’s Interstate Compact on the Placement of Children Office;
Documentation of any use of restraint, seclusion or time out;
A copy of each incident report that includes a clear description of each incident; the time, place, and names of individuals involved; witnesses; nature of injuries, if any; cause, if known; action(s) taken; a description of medical services provided, if any; by whom such services were provided; and any steps taken to prevent a recurrence. Incident reports shall be completed by the individual having first hand knowledge of the incident, including paid and volunteer staff, emergency or temporary staff, and student interns; and
Documentation that all of the various notices and copies required by these rules were properly given.

(d) Recording. Entries in the child’s record shall be made by staff having pertinent information regarding the child. Staff shall legibly sign and date each entry. Symbols and abbreviations shall be used only when there is an explanatory notation. Final diagnosis, both psychiatric and physical, shall be recorded in full without the use of symbols or abbreviations.

(e) Maintenance of records.

Each provider shall maintain a master filing system, including a comprehensive record of each child’s involvement in the program.
Records for children currently receiving services shall be kept in the unit where the child is being treated or be directly and readily accessible to the clinical staff caring for the child.
The program shall maintain a system of identification and coding to facilitate prompt location and ongoing updating of the child’s clinical records.
Records may be removed from the program’s jurisdiction and safekeeping only as required by law or rule.
The provider shall establish procedures regarding the storage, disposal, or destruction of clinical records, which are compatible with the protection of rights.
Records for each child shall be kept for at least five years after discharge.
The provider shall maintain a permanent admission and discharge register of all children served, including name of the child, the child’s parent or guardian, address, date of admission and discharge, child’'s date of birth, custody status, person to which the child was discharged, and address to which discharged.

(13) Quality assurance program. The provider shall develop and follow a written procedure for a systematic approach to assessing, monitoring and evaluating its quality of care and treatment, improving its performance, ensuring compliance with standards, and disseminating results. The quality assurance program shall address and include:

(a) Appropriateness of service assignment, intensity and duration, appropriateness of resources utilized, and adequacy and clinical soundness of care and treatment given;

(b) Utilization review;

(d) A written system for quality improvement, approved by the provider’s governing board that includes:

A written delineation of responsibilities for key staff;
A policy for peer reviews;
A confidentiality policy complying with all statutory confidentiality requirements, state and federal; and
Written, measurable criteria and norms assessing, evaluating, and monitoring quality of care and treatment.

(e) A description of the methods used for identifying and analyzing problems, determining priorities for investigation, resolving problems, and monitoring to assure desired results are achieved and sustained;

(f) A systematic process to collect and analyze data from reports, including, but not limited to, incident reports, grievance reports, department and agency monitoring or inspection reports and self-inspection reports;

(g) A systematic process to collect and analyze data on process outcomes, client outcomes, priority issues chosen for improvement, and satisfaction of clients;

(h) A process to establish the level of performance, priorities for improvement, and actions to improve performance;

(i) A process to incorporate quality assurance activities in existing programs, processes and procedures;

(j) A process for collecting and analyzing data on the use of restraint and seclusion to monitor and improve performance in preventing situations that involve risks to children and staff. The provider shall:

Collect and regularly analyze, at least quarterly, restraint and seclusion data to ascertain that restraint and seclusion are used only as emergency interventions, to identify opportunities for reducing the rate and improving the safety of restraint and seclusion use, and to identify any need to redesign procedures;
Aggregate quarterly restraint and seclusion data by all settings, units or locations, including:

a. Shift;

b. Staff who initiated the procedure;

c. Details of the interactions prior to the event;

d. Details of the interactions during the event;

e. The duration of each episode;

f. Details of the interactions immediately following the event;

g. Date and time each episode was initiated and concluded;

h. Day of the week each episode was initiated;

i. The type of restraint used;

j. Whether injuries were sustained by the child or staff; and

k. Age and gender of each child for which emergency safety interventions had been found necessary.

Prepare and submit a report quarterly to the district/region mental health program office, including the aggregate data and:

a. Number and duration of each instance of restraint or seclusion experienced by a child within a 12-hour timeframe;

b. The number of instances of restraint or seclusion experienced by each child; and

c. Use of psychoactive medications as an alternative for or to enable discontinuation of restraint or seclusion.

(k) Analysis of the use of time-out shall be conducted quarterly by the treatment team and shall include:

Patterns and trends, for example, by shift, staff present, or day of the week;
Multiple instances of time-out within a 12-hour timeframe;
Number of episodes per child; and
Instances of extending time-out beyond 30 minutes.

(14) Department’s human trafficking awareness signage pursuant to subsection 394.875(8)(b), F.S. Human trafficking awareness posters developed by the Department shall include the contents set forth in subparagraph 65C-46.005(6)(b)3., F.A.C.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08, 5-28-25.

Fla. Admin. Code R. 65E-9.007 Staffing

(1) Personnel procedures. The provider shall have written personnel procedures that, at a minimum, address the following items:

(a) The recruitment, retention, training and effective performance of qualified staff;

(b) The types and numbers of clinical, managerial and direct care staff needed to provide children with care and treatment in a safe and therapeutic environment;

(c) The requirement of the provider, as a mandated reporter, to report all suspected cases of child abuse, neglect and exploitation involving any employee, volunteer, or student to the Abuse Registry and the department, in accordance with chapter 39 and section 394.459, F.S.

(2) Staff communication. The provider’s personnel procedures shall ensure and require the inter-communication among staff of information regarding children necessary to the performance of each staff responsibility, including between working shifts, staff changes and consultations with professional staff. Where one staff member or one program group relies upon information provided through this required free interchange of information, these interactions shall be documented in writing and maintained in the respective children’s case files.

(3) Staff composition. The provider shall have the following staffing, any of which may be part-time, if the required equivalent full-time coverage is provided, except for those positions with a required specified staffing ratio:

(a) Psychiatrist.

For residential treatment centers, the provider shall have on staff or under contract a psychiatrist, licensed under chapter 458, F.S., who is board certified or board eligible in child and adolescent psychiatry to serve as medical director for the program and such position shall oversee the development and revision of the treatment plan and the provision of mental health services provided to children. A similarly qualified psychiatrist who consults with the board certified psychiatrist may provide back-up coverage. A psychiatrist shall be on call “24 hours-a-day,” seven “days-a-week,” and shall participate in staffings. For children committed under Section 985.19, F.S., a psychologist as defined in paragraph 65E-9.007(3)(d), F.A.C., may be used in lieu of the medical director to oversee the development and revision of the treatment plan and the provision of mental health services provided to children.
For therapeutic group homes, the provider shall have on staff or under contract a board certified or board eligible psychiatrist or have a definitive written agreement with a board certified or board eligible psychiatrist or an organization to provide psychiatric services to children in the home, including participation in staffings.

(b) Medical doctor. The provider shall have an agreement with a pediatrician, family care physician, medical group or prepaid health plan to provide primary medical coverage to children in the facility.

A registered nurse shall supervise the nursing staff during the times that the children are present in the facility and normally awake, the nursing staff to child ratio shall be no less than 1:30, and during normal sleeping hours, the nursing staff to child ratio shall be no less than 1:40.
For therapeutic group homes that do not use restraint or seclusion in their program, the provider is not required to have a registered nurse or other nursing staff on duty, but shall have definitive written agreements for obtaining necessary nursing services.

(d) Psychologist. Each provider shall have on staff or under contract, at a minimum, one licensed psychologist or have definitive written agreements with an individual psychologist or psychological organization to provide such services as needed.

(e) Direct care staff. At a minimum, two (2) direct care staff shall be awake and on duty at all times. In addition, the following direct care staff-to-child ratios shall be provided and maintained:

During hours when children are present in the facility and normally awake, the direct care staff to child ratio shall be no less than 1:4; and
During hours when the children are normally asleep, the direct care staff to child ratio shall be no less than 1:6; and
While residents are away from the facility, the staffing ratio for those residents shall be no less than 1:4. The need for more intensive staffing will be determined by the child's physician; and
Direct care staff shall not divide time on their shift between programs located in other areas of the facility or other buildings; and
While transporting residents of residential treatment centers other than group homes, the driver shall not be counted as the direct care staff providing care, assistance or supervision of the child. For therapeutic group home residents, prior to a single staff person transporting one or more children in a motor vehicle, children must be assessed to ensure the safety of the children and staff.

(f) If the provider’s program includes behavior analysis services, a certified behavior analyst, a master’s level practitioner, or professionals licensed under chapter 490 or 491, F.S., with documented training and experience in behavior management program design and implementation shall be employed on staff or under contract, either full-or part-time, to provide ongoing staff training and quality assurance in the use of the behavior management techniques, which may include, but are not limited to those listed in sub-subparagraph 65E-9.007(5)(e)4.c., F.A.C.

(g) The provider shall be able to demonstrate and provide as necessary, upon request, the ability to acquire and the past uses of the consultation services of dieticians, speech, hearing and language specialists, recreation therapists, and other specialists, when same will be or has been needed.

(4) Staff qualifications.

(a) The administrator shall have a master’s degree in administration or be of a professional discipline such as social work, psychology, counseling, or special education and have at least two years administrative experience. The administrator may be a corporate administrator, who is not located on site. If the administrator is not routinely located on site, an individual qualified by training and experience who is routinely located on site must be appointed in writing to act as the administrator’s designee. A person with a baccalaureate degree may also qualify for administrator with seven years experience of child and adolescent mental health care and three years administrative experience. Persons occupying this position upon promulgation of this rule may be allowed to continue in this position.

(b) The medical director shall have experience in the diagnosis and treatment of child and adolescent mental health and be board certified or board eligible in psychiatry with the American Board of Psychiatry.

(c) The clinical director shall have a minimum of a master’s degree and at least two years of “specialty” experience in a clinical capacity with severely emotionally disturbed children. If the clinical director is not full-time, there shall be a full-time service coordinator who is a master’s level practitioner.

(d) Individual, group and family therapy shall be provided by a licensed practitioner, pursuant to Florida Statutes, that includes a psychiatric advanced registered nurse practitioner, psychologist, psychiatrist, clinical social worker, mental health counselor or a master’s level individual working under the direct supervision of a licensed practitioner, as listed above.

(e) Staff responsible for treatment and discharge planning shall have a minimum of a bachelor’s degree in psychology, counseling, social work, special education, health education or related human services field with at least two years of experience working with children with emotional disturbance. These staff shall be supervised by a master’s level clinician.

(f) Direct care staff employed to work directly with children shall be at least 18 years of age and have a high school diploma or general education development (GED) certificate. Persons occupying this position upon promulgation of this rule may be allowed to continue in this position.

(5) Staff orientation and training.

(a) The provider shall have, and implement on an ongoing basis, a written plan for the orientation, ongoing training, and professional development of staff.

(b) The provider shall implement orientation and training programs for all new employees and ongoing staff training to increase knowledge and skills and improve quality of care and treatment services.

(c) The provider shall conduct orientation for each new employee during the first 2 months of employment. The orientation shall include specific job responsibilities, policies and procedures, care and supervision of children, and competency-based first aid and CPR.

(d) The provider shall document training received by staff, including staff name and position, training subject, date completed and signature of instructor. The documented training shall be filed in the staff member’s personnel record and be available for review by the Department and the Agency.

(e) The provider shall implement a minimum of 40 hours of in-service training annually for all staff and volunteers who work directly with children. Continuing education for professional licenses and certifications may count towards training hours if the training covers the appropriate areas. This training shall cover all policies and procedures relevant to each position and shall, at a minimum, include each of the following:

Administrative:

a. Administrative policies and procedures and overall program goals;

b. Federal and state laws and rules governing the program;

c. Identification and reporting of child abuse and neglect;

d. Protection of children’s rights; and

e. Confidentiality.

Safety:

a. Disaster preparedness and evacuation procedures;

b. Fire safety;

c. Emergency procedures;

d. Violence prevention and suicide precautions; and

e. First aid and CPR, with competency demonstrated annually.

Child development:

a. Child supervision skills;

b. Children’s physical and emotional needs;

c. Developmental stages of childhood and adolescence;

d. Family relationships and the impact of separation;

e. Substance abuse recognition and prevention; and

f. Principles and practices of child care.

Treatment services:

a. Individualized treatment that is culturally competent;

b. Treatment that addresses issues the child may have involving sexual or physical abuse, abandonment, domestic violence, separation, divorce, or adoption;

c. Behavior management techniques include, but are not limited to: preventing problem behavior, defining and teaching expectations, teaching and encouraging the child’s long-term use of new skills as alternative behaviors, contingency management, teaching and promoting choice making and self-management skills, time-out, point systems or level systems, de-escalation procedures, and crisis prevention and intervention;

d. Treatment plan development and implementation;

e. Treatment that supports the child’s permanency goals; and

f. The provider shall ensure ongoing training and be able to produce documentation of such training on the use of restraint and seclusion, physical escort, time-out, de-escalation procedures and crisis prevention and intervention.

(I) Before staff may participate in any use of restraint or seclusion, staff shall be competency trained to minimize the use of restraint and seclusion, to use alternative, non-physical, non-intrusive behavioral intervention techniques to handle agitated or potentially violent children, and to use restraints and seclusion safely.

(II) Staff shall complete a training course in the safe and appropriate use of seclusion and restraint and in the use of alternative non-intrusive behavior management techniques. The training course shall be provided by individuals qualified by education, training, and experience to provide such training. Competencies shall be demonstrated on a semiannual basis. Training requirements for all staff who participate in the use of restraint and seclusion shall include:

(A) An understanding of the underlying causes, e.g., medical, behavioral and environmental, of consequential behaviors exhibited by the children being served;

(B) How staff behaviors can affect the behaviors of others, especially children with a history of trauma;

(C) The use of non-physical interventions, such as de-escalation, mediation, active listening, self-protection and other techniques, such as time-out for the purpose of preventing potential and intervening in emergency safety situations;

(D) Recognizing signs of respiratory and cardiac distress in children;

(E) Recognizing signs of depression and potential suicidal behaviors;

(F) Certification in the use of cardiopulmonary resuscitation (CPR). Competency based re-certification in CPR is required annually;

(G) How to monitor children in restraint or seclusion; and

(H) The safe use of approved restraint techniques, including physical holding techniques, take-down procedures, and the proper application, monitoring and removal of restraints.

(III) Training requirements for staff who are authorized to monitor a child’s condition and perform assessments while the child is in seclusion or restraint shall include:

(A) Taking vital signs and interpreting their relevance to the physical safety of the child;

(B) Tending to nutritional and hydration needs;

(D) Addressing hydration, hygiene and elimination;

(E) Addressing physical and psychological status and comfort;

(F) Assisting children to de-escalate to a point that would allow for the discontinuation of restraint or seclusion;

(G) Recognizing when the emergency safety situation has ended and the safety of the child and others can be ensured so the restraint or seclusion can be discontinued; and

(H) Recognizing the need for and when to contact a medically trained licensed practitioner or emergency medical services in order to evaluate and treat the child’s physical status.

(6) Volunteers and students.

(a) A provider that uses volunteers to work directly with children shall:

Screen the volunteers in accordance with section 394.4572, F.S.;
Develop descriptions of duties and specific responsibilities expected of each volunteer;
Provide orientation and training, including policies and procedures, the needs of children in care, and the needs of their families;
Ensure that volunteers who perform any services for children have the same qualifications and training as a paid employee for the position and receive the same supervision and evaluation as a paid employee; and
Keep records on the hours and activities of volunteers.

(b) A provider that accepts students who will have direct contact with residents shall:

Screen the students in accordance with section 394.4572, F.S.;
Develop, implement, and maintain on an ongoing basis a written plan describing student tasks and functions. Copies of the plan shall be provided to each student and his or her school;
Designate a staff member to supervise and evaluate the students and conduct orientation and training, including policies and procedures, the needs of children in care and the needs of their families;
Ensure that students do not assume the total responsibilities of any paid staff member (students shall not be counted in the staff to client ratio).

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.

Fla. Admin. Code R. 65E-9.008 Admission

(1) Admission procedures subsections (3) through (6), do not apply to children placed in accordance with section 985.19, F.S.

(2) The provider shall have and utilize written admission procedures that address:

(a) Admission criteria;

(b) List of materials and forms required from the parent, guardian or referring organization;

(c) Outline of the pre-placement procedures for the child, parent or guardian, the referring organization and the department; and

(d) Orientation for the child and parent or guardian, and guardian ad litem.

(3) Acceptance of a child for residential treatment in a residential treatment center, including therapeutic group home, shall be based on the assessed needs of the child, family, or guardian recommendations, and the determination that the child requires treatment of a comprehensive and intensive nature and the provider’s ability to meet those needs.

(4) Children placed by the department and funded in full or in part by state, Medicaid, or local matching funds shall be admitted only after they have on recommendation of the appropriate multidisciplinary team, been personally examined and assessed for suitability for residential treatment. For children in departmental custody, the assessment must be by a qualified evaluator as defined in section 39.407(6)(b), F.S., Children in parental custody must be assessed by a clinical psychologist or by a psychiatrist licensed to practice in the State of Florida, with experience or training in children’s disorders. For children currently in residential placement, recommendations of the facility treatment team may serve as authorization for placement in therapeutic group homes. The assessment must result in a report whose written findings are that:

(a) The child has an emotional disturbance as defined in section 394.492(5), F.S., or a serious emotional disturbance as defined in section 394.492(6), F.S.;

(b) The emotional disturbance or serious emotional disturbance requires treatment in a residential treatment center;

(d) The treatment provided in the residential treatment center is reasonably likely to resolve the child’s presenting problems as identified by the qualified evaluator;

(e) The provider is qualified by staff, program and equipment to give the care and treatment required by the child’s condition, age and cognitive ability;

(f) The child is under the age of 18; and

(g) The nature, purpose and expected length of the treatment have been explained to the child and the child’s parent or guardian and guardian ad litem.

(5) Children in the legal custody of the department shall be placed in accordance with section 39.407, F.S., and the Amendment to the Rules of Juvenile Procedure, FLA. R. JUV. P. 8.350.

(6) The provider may establish additional admission criteria to ensure that the program admits only children the program is capable of serving.

(7) Admission packet. The provider shall require documentation in the child’s admission packet, including:

(a) The child’s parent or guardian has given expressed and informed consent to treatment;

(b) A funding source has been secured for the expected duration of the treatment. If the department is the funding source, there shall be written authorization from the department’s mental health program office that approved the funding;

(c) The admission packet shall request the identification of a discharge placement for the child upon their completion of treatment and the identification of a contact person who will participate in treatment and discharge planning;

(d) The location of the parent or legal guardian or court ordered custodian with responsibility for medical and dental care, including consent for medical and surgical care and treatment and a statement signed by the parent or legal guardian, and a copy given to the parent or legal guardian, requiring the parent or legal guardian to notify the provider of any change in the parent’s or legal guardian’s address or telephone number;

(e) Order of court commitment or a voluntary placement agreement with parents, guardian, or legal custodian;

(f) Arrangements for family participation in the program, including phone calls and visits with the child;

(g) Arrangements for clothing and allowances;

(h) Arrangements regarding the child leaving the facility with or without the clinical director’s consent;

(i) Written policies specifying the child’s rights as defined in rule 65E-9.012, F.A.C.;

(j) Written acknowledgment of receipt and understanding by the parent or legal guardian and guardian ad litem of the provider’s policy regarding the use of restraint or seclusion during an emergency safety situation;

(k) Psychiatric and psychological evaluations with diagnosis and prior treatment history and psychosocial evaluations, including family relationships, legal status and prior placement history;

(l) Educational evaluation, including current individual education plan and school placement; and

(m) Medical information, including a listing of current medications:

If a physical examination was not performed within the 90 days prior to admission and documentation of such examination was not provided, a physical examination shall be initiated within 24 hours of admission by a medical professional. This medical professional may be a registered nurse, physician’s assistant, Advanced Registered Nurse Practitioner or medical doctor who has authority to perform physical examinations of a medical nature.
The child’s medical history;
Written consent from the child’s parent or guardian for the provider to authorize routine medical and dental procedures for the child, and to authorize emergency procedures when written parental consent cannot be obtained; and
Immunization status and completion according to the U.S. Public Health Service Advisory Committee on Immunization Practices and the Committee on Control of Infectious Diseases of the American Academy of Pediatrics.

(8) Placement agreement. The provider shall have and make available upon request a written agreement between the provider, the child’s parent, guardian, and the department, which shall be kept in the child’s file and available for review by the department and agency. The written agreement shall be signed and dated by each of the parties involved. Any revisions or modifications to the written agreement shall be signed and dated. The agreement shall include, at a minimum:

(a) The frequency and types of regular contact between the child's family and the provider staff;

(b) A plan for sharing information about the child’s care and development with the parent, guardian, the guardian ad litem, and the department;

(d) The designation of staff responsible for working with the child’s parent, guardian, guardian ad litem and the organization that signs the placement agreement;

(e) Visitation plans for the child’s parent, guardian, guardian ad litem or the department. The visitation plans must be flexible to accommodate work and other important schedules of the child’s family;

(f) Provisions for treatment plan reviews;

(g) The financial plan for payment of care and any fees to be covered;

(h) The conditions under which the child will be released from the program;

(i) A designation of responsibility for aftercare services. If the child is assessed as needing transition to adult mental health services, designation of responsibility for assisting with the transition will be documented;

(j) A written description of complaint procedures, including a method of appeal to the provider management for complaints not resolved to the satisfaction of the child or parent or guardian; and

(k) A statement signed by the parent or guardian acknowledging they are aware of their responsibility to keep the provider aware of any changes in their address or telephone number.

(9) Interstate compact.

(a) Before the provider accepts placement of a child from out-of-state, the provider shall receive written approval from the department’s Office of the Interstate Compact on the Placement of Children. In order to receive written approval from the department, the provider shall require as part of the admission process that the person responsible for the child prepare an interstate compact placement request package and send it to the state Interstate Compact on the Placement of Children Office in their state of residence for processing and mailing to the department’s Interstate Compact on the Placement of Children Office in Florida.

(b) This interstate compact placement request package shall contain an ICPC 100A Interstate Compact Placement Request, Form CF 794, February 2002, which is hereby incorporated by reference, or a substantially similar form used by the state or jurisdiction of residence of the sending organization or person. It shall also contain a letter on the Florida Residential Treatment Center letterhead stationery indicating that the child has been accepted for placement, or that the child is being considered for placement, and any other supporting documents that may be required under Article III of the Interstate Compact. The signed, dated and approved ICPC 100A shall be evidence of the approval required by the department and shall be placed and maintained in the child’s record.

(c) Within 10 business days of physical arrival of a child from out-of-state, the provider shall complete, date, and sign an ICPC 100B Interstate Compact Report on Child’s Placement Status, Form CF 795, February 2002, which is hereby incorporated by reference, place a copy of the form in the child’s record, and mail the original and two copies to: Office of the Interstate Compact on the Placement of Children, Child Welfare Program Office, Florida Department of Children and Family Services, 1317 Winewood Boulevard, Tallahassee, FL 32399-0700.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.

Fla. Admin. Code R. 65E-9.009 Treatment Planning

(1) Within fourteen business days after admission, a written treatment plan shall be developed with input from, interpreted and provided to, and signed and dated by the child, the child’s parent(s) or guardian, child welfare or community based care case manager, foster parents and guardian ad litem, if applicable, and any other party involved in the development of the plan. If a child is determined to be incapable of signing the treatment plan, a written justification of the determination must be documented in the child’s record.

(2) The provider shall explain the treatment plan to the child, the child’s parent and/or child welfare or community based care case manager, and the guardian ad litem and submit a copy of the plan to these individuals and the department’s district/regional office.

(3) The multi-disciplinary professional staff, including the psychiatrist, shall participate in the preparation of the treatment plan and any major revisions.

(4) The treatment plan shall, with input from the child and parent or guardian, guardian ad litem, and other stakeholders (e.g.; child welfare or community based care case manager, other community agencies or organizations) as necessary, include:

(a) Clinical consideration of the child’s physical, behavioral, and psychological needs, developmental level and chronological age, primary diagnosis, family situation, educational level, expected length of stay, and the designated person or organization to whom the child will be discharged;

(b) Service agencies with which the child will be involved and other support systems that may contribute to the success of treatment;

(c) Documentation that all substance abuse, behavioral and mental health needs have been identified, unless adequate clinical justification is written in the child’s record for not doing so;

(d) Documentation reflecting the child and family’s strengths and needs and the child’s social and recreational needs and interests;

(e) A clear description of the presenting problem(s), including descriptions of behaviors and reason(s) for admission, and the treatment and services to be provided in response to the presenting problem(s) that necessitate residential treatment;

(f) Observable and measurable goals and objectives that are time-limited and written in behavioral and measurable terms, based on the child and family’s strengths and needs;

(g) Written objectives of what the child and family, when applicable, will do or accomplish;

(h) Written interventions of what the staff will do;

(i) The frequency of treatment services and treatment modalities, projected time frames for completion and the staff member prescribing the treatment and/or those responsible for ensuring its provision specified for each major problem or need;

(j) Goals that reflect improved functioning which when attained, constitutes the criteria for discharge for the particular need or problem;

(k) The expected degree of the parent or guardian’s involvement and planned regular provider contact with the child's parent or guardian.

(5) The provider shall review the treatment plan within 30 days of admission and at least monthly thereafter with input from the child and parent or guardian, guardian ad litem, and other stakeholders (e.g.; child welfare or community based care case manager, other community agencies or organizations) to assess the appropriateness and suitability of the child’s placement in the program, to evaluate the child’s progress toward treatment goals, to review and modify, when necessary, the treatment plan and treatment approaches, to review and update the discharge plan and to determine if the child is ready to move to a less restrictive placement.

(6) The provider shall prepare a written report of findings at a minimum of every 30 days and submit the report, and pending discharge plans, to the department and parent(s) or legal guardian.

History

Rulemaking Authority 39.407, 394.875(10) FS. Law Implemented 394.875 FS. History–New 7-25-06.

Fla. Admin. Code R. 65E-9.010 Length of Stay

(1) The provider shall involve the child and the child’s parent or guardian to the fullest extent possible at all stages of treatment planning and discharge planning toward the goal of reintegrating the child into the community.

(2) The child’s discharge plan shall be reviewed and, if necessary, revised during each review of the treatment plan.

(3) The provider shall design individualized services and treatment for the child to address the child’s presenting problems on admission with a goal of discharge to the community or to a step-down program within 120 days of admission for residential treatment centers and 365 days for therapeutic group homes.

History

Rulemaking Authority 39.407, 394.875(10) FS. Law Implemented 394.875 FS. History–New 7-25-06.

Fla. Admin. Code R. 65E-9.011 Discharge and Discharge Planning

(1) The provider shall have and use on an ongoing basis a written procedure on discharge planning and aftercare services that specifies the availability of services and the persons responsible for implementation of the aftercare plan.

(2) Discharge planning shall begin at the time of admission. A discharge plan shall be developed, written and interpreted in collaboration with the child, parent or guardian, department, foster parents and guardian ad litem, if applicable, within ten days of admission, and a projected date for discharge shall be included in the child’s treatment plan. A copy of the discharge plan shall be given to the parent or guardian, the guardian ad litem, and the department.

(3) Discharge planning shall include input from the child, the child’s parent or guardian, foster parents, department, and guardian ad litem.

(4) Discharge planning may include a period of transition into the community, such as home visits and meetings with community mental health service providers.

(5) Discharges shall be approved and signed by the treating psychiatrist.

(6) A child may be discharged only to the parent, guardian or placing organization, unless the provider is otherwise ordered by the court.

(7) The provider shall finalize the discharge plan and have it approved and signed by the treatment team. A copy of this discharge plan shall be provided to the parent or legal guardian, guardian ad litem and department at least 30 days before the proposed discharge date, which, at a minimum, shall include:

(a) The initial formulation and diagnosis;

(b) A summary of treatment and services which have been provided, the outcomes of treatment in relation to the child’s presenting problem on admission, and identification of needs for continuing treatment and services in the community following discharge;

(c) Recommendations for the child and parent or guardian following release from care, including referrals for community-based mental health services;

(d) The projected date of discharge and the name, address, telephone number and relationship of the person or organization to whom the child will be discharged; and

(e) A copy of the child’s medical, dental, educational, medication and other records for the use of the person or organization who will assume care of the child following discharge.

(8) Aftercare plans shall be developed by the provider staff under the guidance of the clinical director and shall encourage the active participation of the child and parent or guardian and guardian ad litem.

(9) The provider shall have and utilize written procedures for follow-up care, including a written plan for follow-up services and at least one contact with the discharged child and his parent or guardian and guardian ad litem within the first 30 days following discharge.

(10) For children age 17, the provider shall assess their needs for continuing services in the adult mental health service system and assist them in planning for and accessing those services.

(11) Within 10 business days of the physical departure of a child placed from out-of-state, the provider shall complete, date, and sign an Interstate Compact Report on Child’s Placement Status, (ICPC-100B) Form, CF 795, 10/05, which is hereby incorporated by reference, place a copy of the form in the child’s record, and mail the original and two copies of the form to: Office of the Interstate Compact on the Placement of Children, Child Welfare Program Office, Florida Department of Children and Family Services, 1317 Winewood Boulevard, Tallahassee, FL 32399-0700. A copy of the form may be obtained at the department’s website, www.dcf.state.fl.us/publications/efors/0795.pdf.

(12) Notwithstanding subsections (1)-(11) of rule 65E-9.011, F.A.C., Providers who serve children committed under section 985.19, F.S., shall abide by the following standards with regard to discharge planning:

(a) The provider shall finalize the discharge summary and have it approved and signed by the treatment team. At least 30 days before the proposed discharge, a copy of the discharge summary shall be sent to the child’s home district. The provider and district shall coordinate with each other to assist the district in the development of the discharge plan based on the provider’s recommendations for services after discharge.

(b) Once noticed by the court of a pending hearing related to child’s competency to proceed, the discharge summary shall be copied to the parties identified in section 985.19, F.S.

(c) A copy of this discharge summary shall be provided to the parent or legal guardian, guardian ad litem and department at least 30 days before the proposed discharge date, which, at a minimum, shall include:

The initial formulation and diagnosis;
A summary of treatment and services which have been provided, the outcomes of treatment in relation to the child’s presenting problem on admission, and identification of needs for continuing treatment and services in the community following discharge;
Recommendations for the child and parent or guardian following release from care;
The name, address, telephone number and relationship of the person or organization to whom the child will be discharged; and
A copy of the child's medical, dental, educational, medication and other records for the use of the person or organization who will assume care of the child following discharge.

(13) Discharge summaries shall be developed by the provider staff under the guidance of the clinical director and shall encourage the active participation of the child and parent or guardian and guardian ad litem.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.

Fla. Admin. Code R. 65E-9.012 Rights of Children

(1) The provider shall protect children’s rights under the federal and state constitutions and as specified in sections 394.459 and 394.4615, F.S. The provider shall also ensure that:

(a) Physical punishment and treatment modalities that place the child at risk of physical injury or pain or death, including electroconvulsive or other convulsive therapy, “cocoon therapy,” or other hazardous procedures shall never be used.

(b) Children shall not be subjected to cruel, severe, unusual or unnecessary punishment or assigned excessive exercise or work duties, nor shall they be subjected to physical or mental abuse or corporal punishment.

(d) Children shall not be subjected to hazing, verbal abuse, coercion or remarks that ridicule them, their families or others.

(e) Children shall not be denied food, water, clothing, or medical care.

(f) Children shall not be exploited or required to make public statements to acknowledge gratitude to the provider program or perform at public gatherings.

(g) Identifiable pictures of children shall not be used without prior written consent of the parent or guardian. The signed consent form for any such usage shall be event-specific, indicate how the pictures will be used, and placed in the child’s clinical record.

(2) Discipline. The provider shall have and implement written procedures on an ongoing basis regarding methods used for the discipline of children. The procedures shall include identification of staff authorized and trained to impose discipline, staff training requirements, methodology, monitoring, incident reporting, and quality improvement.

(3) Child abuse and neglect.

(a) The provider, as a mandated reporter, shall report to the department and the Abuse Registry all suspected cases of child abuse, neglect, and exploitation in accordance with chapter 39 and section 394.459, F.S.

(b) Each child shall have ready access to a telephone in order to report an alleged abuse, neglect or exploitation. The provider shall inform each child verbally and in writing of the procedure for reporting abuse. A written copy of that procedure, including the telephone number of the abuse hotline and reporting forms, shall be posted in plain view within eighteen inches of the telephone(s) designated for use by the children.

(c) The provider shall establish and implement a written procedure for the immediate protection of the alleged victim or any other potential victim and prevention of a recurrence of the alleged incident pending investigation by the department or law enforcement.

(d) The provider shall require each paid and volunteer staff member, upon hiring and every 12 months thereafter, to read and sign a statement summarizing the child abuse and neglect laws and outlining the staff member’s responsibility to report all incidents of child abuse and neglect. Such signed statements shall be placed in each employee’s personnel file.

(e) Residents’ rights posters, including those with the telephone numbers for the Florida Abuse Hotline, Statewide Advocacy Council and the Advocacy Center for Persons with Disabilities, shall be legible, a minimum of 14 point font size, and shall be posted immediately next to telephones which are available for residents’ use.

(4) Confidentiality related to HIV-infected children. The provider shall protect the confidentiality of HIV-infected children as specified in section 381.004, F.S. The provider shall also ensure that:

(a) The identity of any child upon whom an HIV test is performed and the child’s HIV test result shall be disclosed to an employee of the department or child-caring or child-placing organization directly involved in the placement, care or custody of such child only when the employee or organization needs to know such information to provide:

Case-specific services, such as assessing needs, determining eligibility, arranging care, monitoring case activities, permanency planning or providing care for the child;
Case-specific supervision or monitoring of cases for eligibility or legal compliance or casework services; or
Case-specific clerical and vouchering support.

(b) The identity of a child upon whom an HIV test is performed shall be disclosed to a foster family or child-caring or child-placing organization licensed pursuant to Florida Statutes, which is directly involved in the care of such child and has a need to know such information. The identity of the child shall be disclosed only after the following conditions have been met:

The Department or child-placing or child-caring organization has provided to the foster family or child-caring or child-placing organization all available information, including HIV test results, social information and special needs, in a manner that does not permit identification of the child; and
The prospective placement has agreed to accept the child and the decision to place the child in that specific placement has been confirmed.

(c) The child’s record shall contain documentation of the date and time that the written statement was given to the child-caring, child-placing organization or to the foster or adoptive parents.

(d) The case files of HIV-infected children shall not be segregated or flagged in any way that would permit their identification as case files of HIV-infected children or in any way different from the files of non-HIV-infected children.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.

Fla. Admin. Code R. 65E-9.013 Restraint, Seclusion, and Time-Out

(1) General requirements.

(a) Providers shall comply with guidelines for the use of restraint, seclusion and time-out as specified in chapter 394, F.S., in addition to the guidelines specified in this rule.

(b) Restraint or seclusion shall not result in harm or injury to the child and shall be used only:

To ensure the safety of the child or others during an emergency safety situation; and
Until the emergency safety situation has ceased and the child’s safety and the safety of others can be ensured, even if the restraint or seclusion order has not expired.

(c) Restraint or seclusion shall not be used for purposes of punishment, coercion, discipline, convenience, or retaliation by staff or to compensate for inadequate staffing.

(d) An order for restraint or seclusion shall not be issued as a standing order or on an as-needed basis.

(e) Restraint or seclusion shall be used in a manner that is safe and proportionate to the severity of the behavior and the child’s chronological and developmental age; size; gender; physical, medical and psychiatric condition, including current medications; and personal history, including history of physical or sexual abuse.

(f) Only staff who have completed a competency-based training program that prepares them to properly use restraint or seclusion shall apply these procedures to children.

(g) Restraint that impedes respiration (e.g., choke hold or basket hold), places weight on the child’s upper torso, neck, chest or back, or restricts blood flow to the head is prohibited.

(h) Ambulatory or walking restraints (e.g., shackles that bind the ankles and waist-wrist shackles) may only be used during transportation under the supervision of trained staff. The use of ambulatory or walking restraints is prohibited except for purposes of off-premise transportation.

(i) The provider’s medical or clinical director shall be responsible for providing oversight of ongoing monitoring, quality improvement and staff training in the use of restraint and seclusion and in the use of less intrusive, alternative interventions.

(2) Provider procedures. The provider’s procedures shall address the use of restraint, seclusion and time-out. A copy of the procedures shall be provided to children and their parents or guardians, foster parents and guardian ad litem, if applicable, upon admission, to all staff, and to the department. The procedures shall include provisions for implementing the requirements of this section and the provider’s strategies to:

(a) Reduce and strive to eliminate the need for and use of restraint and seclusion;

(b) Prevent situations that might lead to the use of restraint or seclusion;

(d) Train staff on how restraint and seclusion are experienced by children and the effect they have on children with a history of trauma; and

(e) Preserve the child’s safety and dignity when restraint or seclusion is used.

(3) Authorization of restraint or seclusion.

(a) Restraint or seclusion shall be used and continued only pursuant to an order by a board certified or board eligible psychiatrist licensed under chapter 458, F.S., or licensed physician with specialized training and experience in diagnosing and treating mental disorders and who is the child’s treatment team physician. If the child’s treatment team physician is unavailable, the physician covering for the treatment team physician may meet these qualifications. Physicians allowed to order seclusion and restraint, pursuant to this rule, must be trained in the use of emergency safety interventions prior to ordering them.

(b) The ordering physician shall order the least restrictive intervention that is most likely to be effective in resolving the emergency safety situation.

(c) If the ordering physician is not available on-site to order the use of restraint or seclusion, a verbal telephone order shall be obtained by, at a minimum, a registered nurse or other licensed staff, such as a licensed practical nurse (LPN), at the time the restraint or seclusion is initiated or immediately after it ends. At the time the order is received, the registered nurse or other licensed staff, such as an LPN, shall consult with the ordering physician about the child’s physical and psychological condition. The order and consultation shall be documented in the child’s case file. If an emergency exists where restraint or seclusion is needed but the physician is not present or available by telephone, a psychiatric nurse, advanced nurse practitioner, physician assistant, or registered nurse may apply the restraint or place the child in seclusion, with follow up information provided to the physician as soon as is reasonably possible.

(d) The verbal order given by the physician shall be followed with their signature verifying the verbal order within seven calendar days and the signed verification shall be maintained in the child’s case file.

(e) The ordering physician shall be available to staff for consultation, at least by telephone, throughout the period of the intervention.

(f) Each order for restraint or seclusion shall:

Be limited to no longer than the duration of the emergency safety situation;
Not exceed two hours for children or adolescents ages nine through seventeen or one hour for children under age nine; and
Be documented, whether verbal or written, and maintained in the child’s case file.

(g) If restraint or seclusion exceeds a total of six hours within a 24-hour period for a child age nine through seventeen or a total of three hours for a child under age nine, there must be a written explanation as to why the child was not transferred to a more acute program.

(h) If a child requires the use of seclusion or restraint at any time during their stay, the treatment team shall formally review and actively address their use during the child's regularly scheduled treatment team review meetings, no less frequently than two times per month, until deemed no longer necessary. The reviews shall assess the frequency, patterns and trends, and identify ways to prevent the need for seclusion and restraint use. The treatment team's review of and efforts to eliminate seclusion and restraint use with a specific child shall be documented as part of the child’s treatment team review. In addition, if a child is restrained a total of two times within a thirty day period, or is in seclusion a total of three times within a thirty day period, the treatment team will oversee the development and monitor the implementation of a formal child-specific plan to aggressively address the need for seclusion and restraint use with that child.

(i) Within one hour of the initiation of restraint or seclusion, the ordering physician or other licensed practitioner, as permitted by the state and facility, (including a psychiatric nurse, advanced nurse practitioner, physician assistant, or registered nurse) trained in the use of emergency safety interventions, shall conduct a face-to-face assessment of the physical and psychological well being of the child, including:

The child’s physical and psychological status;
The child’s current behavior;
The appropriateness of the intervention measures; and
Any physical or psychological complications resulting from the intervention.

(j) Each order for restraint or seclusion shall include:

The ordering physician’s name;
The date and time the order was obtained; and
The emergency safety intervention ordered, including the length of time for which the physician authorized its use, which length of time shall not exceed the time limits set forth in subparagraphs 65E-9.013(3)(f)1.-.3, F.A.C.

(4) Documentation. Staff shall document the intervention in the child’s record, with documentation completed by the end of each shift during which the intervention begins and continues. Documentation shall include:

(a) Each order for restraint or seclusion;

(b) The time the emergency safety intervention began and ended;

(c) The specific circumstances of the emergency safety situation, the rationale for the type of intervention selected, the less intrusive interventions that were considered or tried and the results of those interventions;

(d) Time-specific assessments of the child’s physical and psychological condition;

(e) The name, position, and credentials of all staff involved in or witnessing the emergency safety intervention;

(f) Time and date of notification of the child’s parent or guardian and guardian ad litem;

(g) The behavioral criteria and assistance provided by staff to help the child meet the criteria for discontinuation of restraint or seclusion;

(h) Summary of debriefing of the child with staff;

(i) Description of any injuries sustained by the child during or as a result of the restraint or emergency safety intervention and treatment received for those injuries;

(j) Review and revise, if necessary, the child’s treatment plan, including a description of procedures designed to prevent the future need for and use of restraint or seclusion; and

(k) Before restraint or seclusion were ordered for the child, the ordering physician assessed whether there were pre-existing medical conditions or physical disabilities, history of sexual or physical abuse, or current use of psychotropic medication that could present a risk to the child and results of such review are documented in the order for restraint or seclusion and the child’s record.

(5) Consultation with treatment team physician. If the physician ordering the use of restraint or seclusion is not the child’s treatment team physician, the ordering authorized to receive the verbal order shall:

(a) Consult with the child’s treatment team physician as soon as possible and inform the team physician of the emergency safety situation that required the child to be restrained or placed in seclusion; and

(b) Document in the child’s record the date and time the team physician was consulted.

(6) Notification.

(a) Notification upon admission. At admission, the provider shall:

Explain and provide a written copy of the provider’s procedures regarding the use of restraint and seclusion to the child, the child’s parent or guardian, and guardian ad litem, if applicable. The provider shall document that the child and the parent or guardian, and guardian ad litem were informed of the provider’s policies on the use of restraint and seclusion. This documentation shall be filed in the child’s record.
Communicate the procedures in a language the child and the parent or guardian understand, including American Sign Language or through an interpreter or translator if needed.
Include in the procedures contact information, including phone number and mailing address, of the Advocacy Center for Persons with Disabilities, Inc.
Consult with the child’s parent or guardian and foster parent and guardian ad litem, if applicable to determine if there are any known physical or psychological risks that would rule out the use of such interventions for the child. The results of such interview shall be documented in the child’s record.

(b) Notification of use of restraint or seclusion.

As soon as possible, but no later than 24 hours after the initiation of each emergency safety intervention, the provider shall notify the parent or guardian that the child has been restrained or placed in seclusion.
The provider shall document in the child’s record that the parent or guardian was notified, including the date and time of notification and the name of the staff person providing the notification.

(7) Monitoring of the child during and immediately after restraint.

(a) Staff trained in the use of emergency safety interventions shall be physically present and continually visually assessing and monitoring the physical and psychological well-being of the child and the safe use of restraint throughout the duration of the emergency safety intervention.

(b) If the emergency safety situation continues beyond the time limit of the physician’s order for the use of restraint, the staff person authorized to receive the verbal order, as identified in paragraph 65E-9.013(4)(c), F.A.C., shall immediately contact the ordering physician to receive further instructions or new orders for the use of restraint and shall document such notification in the child’s case file.

(c) A physician, or other licensed staff member as identified in paragraph 65E-9.013(4)(i), F.A.C., trained in the use of emergency safety interventions, shall evaluate and record the child’s physical condition and psychological well-being immediately after the restraint is removed.

(8) Monitoring of the child during and immediately after seclusion.

(a) Staff trained in the use of emergency safety interventions and in assessment of suicide risk shall be physically present in or immediately outside the seclusion room, continually visually assessing, monitoring, and evaluating the physical and psychological well-being of the child in seclusion. Video or auditory monitoring shall not be used as substitutes for this requirement.

(b) If the emergency safety situation continues beyond the time limit of the physician’s order for the use of seclusion, the staff person authorized to receive the verbal order, as identified in paragraph 65E-9.013(3)(c), F.A.C., shall immediately contact the ordering physician to receive further instructions or new orders for the use of seclusion and such notification shall be documented and maintained in the child’s case file.

(c) A physician or other licensed staff member, as identified in paragraph 65E-9.013(3)(i), F.A.C., trained in the use of emergency safety interventions, shall evaluate the child’s physical condition and psychological well-being immediately after the child is removed from seclusion and documentation of such evaluation shall be maintained in the child’s case file.

(d) Staff shall immediately obtain medical treatment from qualified medical personnel for a child injured during or as a result of an emergency safety intervention.

(9) Discontinuation of restraint or seclusion. As early as feasible in the restraint or seclusion process, the child shall be told the rationale for restraint or seclusion and the behavior criteria necessary for its discontinuation that ensures the safety of the child and others. Restraint or seclusion shall be discontinued as soon as the child meets the behavioral criteria.

(10) Post-restraint or seclusion practices.

(a) After the use of restraint or seclusion, staff involved in an emergency safety intervention and the child shall have a face-to-face discussion, which is also known as a debriefing. Whenever possible, subject to staff scheduling, this discussion shall include all staff involved in the intervention. The child’s parent or guardian shall be invited to participate in the discussion. The provider shall conduct the discussion in a language that is understood by the child and the child’s parent or guardian. The discussion shall provide both the child and staff the opportunity to discuss the circumstances resulting in the use of restraint or seclusion and strategies to be used by the staff, the child, or others to prevent the need for the future use of restraint or seclusion. The discussion must occur within 24 hours of the emergency intervention, subject to the following exceptions:

Allowances may be made to accommodate the schedules of the parent(s) or legal guardian(s) of the child when they request an opportunity to participate in the debriefing and when staff deem their participation appropriate.
Allowances may be made to accommodate shift changes, vacation schedules, illnesses, and all applicable federal, state, and local labor laws and regulations.

(b) After the use of restraint or seclusion, the staff involved in the emergency safety intervention, and appropriate supervisory and administrative staff, shall conduct a debriefing session that includes a review and discussion of:

The emergency safety situation that required the intervention, including a discussion of the factors that caused or preceded the intervention;
Alternative, less intrusive techniques that might have prevented the need for the restraint or seclusion;
The procedures, if any, that staff are to implement in the future to prevent any recurrence of the use of restraint or seclusion; and
The outcome of the intervention, including any injuries that resulted from the use of restraint or seclusion and the treatment provided for those injuries.

(c) Staff shall document in the child’s record that both debriefing sessions took place and shall include in that documentation the names of staff present for the debriefing, names of staff excused from the debriefing, and any changes to the child’s treatment plan or facility procedures that resulted from the debriefings.

(d) The provider shall maintain a record of each emergency safety situation, the interventions used, and their outcomes. These records shall be maintained in a manner that allows for the collection and analysis of data for agency monitoring and provider performance improvement and shall be available for such purposes upon request.

(e) Staff shall document in the child’s record all injuries that occur during or as a result of an emergency safety intervention, including injuries to staff resulting from that intervention.

(f) Staff involved in an emergency safety intervention that results in an injury to a child or staff shall meet with supervisory staff and evaluate the circumstances that caused the injury and develop a plan to prevent future injuries.

(g) The provider shall immediately notify the child’s parent or guardian of any serious occurrence, including a child’s death, a serious injury to a child, or a suicide attempt. The provider shall also report the serious occurrence to the Department, the agency, and the state advocacy council the same day or no later than close of business the next business day for a serious occurrence that occurs after 5:00 p.m. or over a weekend. The report shall include the name of the child involved in the serious occurrence, a description of the occurrence, and the name, street address, and telephone number of the facility.

(11) Time-out.

(a) Time-out shall be used only for the purpose of providing a child with the opportunity to regain self-control and not as a consequence or punishment.

(b) If time-out is used with a child, child-specific guidelines for the use and duration of time-out, based on the professional judgment of the child’s treatment team, shall be specified in the child’s treatment plan, upon consideration of the child’s age, maturity, health, and other factors. In addition, the child’s parent or guardian shall sign an informed consent form detailing the circumstances under which time-out will be used and how the procedure is to be implemented.

(c) Time-out shall be initiated only by staff who have completed competency-based training in the use of time-out and such training shall be documented in their personnel record.

(d) Time-out may take place either in or away from the area of activity or other children, such as in the child’s room.

(e) The designated area shall be a room or area that is part of the living environment the child normally inhabits or has access to during routinely scheduled activities and from which the child is not physically prevented from leaving.

(f) If the child requires physical contact in order to move to the area or room, staff shall end the contact immediately once the child is in the designated area.

(g) The child shall not be physically prevented from leaving the time-out area.

(h) The criterion for being able to end time-out without further intervention shall be specified to the child at this time in a neutral manner.

(i) Time-out shall be terminated after the child meets the behavioral criterion for the specified time period, which shall not exceed 5 minutes at a time. If the child meets the criterion earlier, staff shall end the procedure immediately.

(j) If the child has not been able to meet the criterion for exiting time-out within 30 minutes, staff shall notify the ranking clinician on duty or on-call, who shall assess how the procedure was implemented, assess the child’s condition, and determine whether to end the procedure, reduce the exit criterion, or continue the procedure.

(k) When time-out is imposed, staff shall directly and continuously observe the child.

(l) The child’s treatment team shall review the use of time-out during that child’s treatment team meetings, but no less frequently than two times per month. This review shall consist of assessing the frequency, patterns and trends, questioning the function(s) of the behavior(s) that resulted in the use of time-out, possible ways to prevent the behavior(s) and the appropriateness of the exit criteria used.

(m) For each instance that time-out is used, staff who initiate the procedure shall document in the child’s record:

The circumstances leading to the use of time-out;
The specific behavior criteria explained to the child that would allow for discontinuation of time-out;
When and how the child was informed of the behavior criteria;
The time the procedure started and ended; and
Any injuries sustained and treatment provided for those injuries.

(n) A separate time-out log shall be maintained that records:

The shift;
The staff who initiated the process;
The time the procedure started and ended;
The date and day of the week of each episode;
The age and gender of the child; and
Client ID.

History

Rulemaking Authority 394.875(8) FS. Law Implemented 394.875 FS. History–New 7-25-06, Amended 9-24-08.

Fla. Admin. Code R. 65E-9.014 Medication Administration and Use of Psychotropic Medications

(1) The provider shall develop, implement and maintain written policies and procedures governing the administration of medication and the supervision of and assistance with self-administered medication. These policies and procedures shall include, but not be limited to, management of the medication administration program, training, inventory control, accounting, and disposal of medications. In addition, these policies and procedures shall be consistent with the Comprehensive Drug Abuse Prevention and Control Act of 1970, 21 U.S.C.; chapter 893, F.S., the Drug Abuse and Prevention and Control Act; DEA compliance policy guidelines on disposal of controlled substances, CFR 21, Title 21, Section 1307.21, Disposal of Controlled Substances, and related department rules and regulations.

(2) Children shall never be permitted to have medication in their possession or to take any medication without direct supervision of an authorized person.

(3) Psychotropic medication shall not be used as a substitute for treatment, for the convenience of staff, or in quantities that interfere with the child’s treatment progress.

(4) The use of psychotropic medication shall be described in the child’s treatment plan and shall include the desired goals and outcomes of the medication.

(5) Informed consent for the administration of psychotropic medication.

(a) Informed consent from the parents or legal guardian of any child must be obtained by the provider, in accordance with section 394.459, F.S., when the dosage of current approved medications are changed and when the type of medication is changed.

(b) The requirements for obtaining express and informed consent for a child in the care and custody of the state are governed by section 39.407, F.S.

(6) If the circumstances requiring the administration of the medication constitute an emergency, such administration shall be governed by the provisions of section 743.064 or 394.463(2)(f), F.S., as applicable.

(7) There shall be no pro re nata (PRN) orders for psychotropic medications.

(8) There shall be no standing orders for psychotropic medications.

(9) Children receiving antipsychotic medications shall be assessed for abnormal involuntary movements by a physician or registered nurse using a recognized standardized rating scale upon admission and quarterly thereafter.

(10) Refills for medications shall be ordered only by a physician or nurse licensed in the state of Florida. Prescriptions shall be timely refilled to prevent missed dosages.

(11) Administration of medication by unlicensed staff.

(a) For therapeutic group homes or residential treatment centers with 12 beds or less, where services are rendered in a smaller home-like setting, unlicensed staff employed by the facility, who have satisfactorily completed a competency-based training for administration of unit dose medication, shall administer prescribed prepackaged, pre-measured, oral medications, prescribed topical, otic, nasal and ophthalmic medications in accordance with section 464.022(1), F.S.

(b) Medications requiring subcutaneous or intra-muscular administration and rectal and vaginal suppository medications will be administered, at a minimum, by a Florida licensed nurse.

(c) The medication administration course used to train unlicensed staff shall be eight hours, at a minimum, in length and must meet the following criteria:

The course must consist of at least the following topics:

a. Basic knowledge and skills necessary for safe and accurate medication administration and charting.

b. Roles of the physician, nurse, pharmacist, and direct care staff in medication ordering, dispensing, and administration.

c. Procedures for recording/charting medications.

d. Interpretation of common abbreviations used in administration and charting of medications.

e. Knowledge of facility medication system.

f. Safety precautions used in medication administration and charting.

g. Methods and techniques of medication administration.

h. Problems and intervention in the administration of medication.

i. Observation and reporting of medication side effects and adverse effects.

j. Observation and reporting of effects of medications including outcomes of psychotropic medication treatment.

k. Documenting and reporting of medication errors.

l. Appropriate storage of medications.

The content must be taught by a Florida licensed physician, consulting pharmacist, physician assistant, advanced registered nurse practitioner, or registered nurse.
Training must be competency-based and shall consist of lecture and a clinical practicum. This training shall be documented and such documentation filed in the staff member’s personnel file.
During the practicum, the trainee must be observed twice administering medications error free during their regularly scheduled medication time. The observation must include error free charting completed by the trainee after the medication(s) has been administered. The practicum observations must be made by a Florida licensed physician, consulting pharmacist, physician assistant, advanced registered nurse practitioner, or registered nurse.
Training regarding the administration of prescribed topical, otic, nasal and ophthalmic medications will only be completed by unlicensed staff authorized to do so following competency-based training and observation of proficiency by a licensed practitioner.
Monitoring of medication administration shall be performed, at a minimum, quarterly by the supervising registered nurse for each facility. In addition, a Florida registered nurse must be available to facility staff via telephone or paging device 24 hours per day.
At a minimum, four (4) hours of continuing education is required on an annual basis.
When a psychotropic medication is initiated, a registered nurse or pharmacist will assure or make provisions for the instruction of the facility staff regarding side effects and adverse effects of the prescribed medication, including when to notify the physician if undesirable side effects or adverse effects are observed.
All staff identified to receive training in medication administration must be high school graduates or have passed an equivalency exam (GED).

(12) Self administration of medication.

(a) For therapeutic group homes or residential treatment centers with 12 beds or less unlicensed staff employed by the facility, who have satisfactorily completed competency-based training in administering medication and supervising children with self administration of unit dose medication, shall be authorized to supervise with self administration of prescription and over-the-counter medications.

(b) Only children who have been assessed by a physician and determined to be capable of self-administering their medications shall be permitted to do so under the supervision of an authorized person. Documentation of such assessment and determination shall be filed in the child’s medical records.

(c) Staff involved with supervising and assisting with the self-administration of medications shall complete competency-based training of a minimum of four hours annually by a registered nurse or licensed pharmacist. This training shall be documented and filed in the staff member’s personnel file.

(d) The course shall consist of at least the following topics:

Basic knowledge and skills necessary for providing supervision for self-administration of medication;
Understanding a prescription label;
Procedures for recording/charting medications in the medication log;
Interpretation of common abbreviations used in administration and charting of medications;
Observation and reporting of side effects, adverse effects and outcomes of psychotropic medication treatment; and
Recognizing, documenting and reporting of medication errors.

(e) Upon completion of the course, the trainee shall be able to demonstrate the ability to:

Measure liquid medications, break scored tablets, and crush tablets in accordance with prescription directions;
Recognize the need to obtain clarification of an “as needed” prescription order;
Recognize a medication order which requires judgment or discretion, and advise the child, child's health care provider or facility employer of the inability to assist in the administration of such orders;
Complete a medication observation record;
Retrieve and store medication; and
Recognize the general signs of adverse reactions to medications and report such reactions.

(13) Storage of medications.

(a) All drugs, including nonprescription drugs, shall be stored under double lock (e.g., a locked cabinet within a locked room or in a locked container within a locked cabinet).

(b) External and internal medications and ophthalmic preparations shall be stored separately from each other.

(d) Poisons and other toxic chemicals shall not be stored in a medication storage area.

(e) No medication shall be repackaged by facility staff.

(14) Telephone physician orders for medication may only be accepted by another physician, a licensed practical nurse, a registered nurse, a physician’s assistant, ARNP or a licensed pharmacist. Telephone orders shall be immediately recorded in the child’s medical record. Faxed physician orders are acceptable with a physician’s signature. The original physician’s order must be obtained within 72 hours of receipt of the faxed order.

History

Rulemaking Authority 39.407, 394.875(10) FS. Law Implemented 394.875 FS. History–New 7-25-06.

Chapter 65E-10 PSYCHOTIC AND EMOTIONALLY DISTURBED CHILDREN - PURCHASE OF RESIDENTIAL SERVICES RULES

Fla. Admin. Code R. 65E-10.013 Applicability

History

Rulemaking Authority 394.4781(3) FS. Law Implemented 394.4781(3), (4) FS. History–New 3-1-84, Formerly 10E-10.13, Amended 4-8-96, 8-12-96, Formerly 10E-10.013, Amended 4-3-12, Repealed 10-24-21.

Fla. Admin. Code R. 65E-10.014 Definitions

History

Rulemaking Authority 394.4781(3), (4) FS. Law Implemented 394.4781(3) FS. History–New 3-1-84, Formerly 10E-10.14, Amended 4-8-96, Formerly 10E-10.014, Amended 9-14-98, 4-3-12, Repealed 10-24-21.

Fla. Admin. Code R. 65E-10.016 Licensing Requirements

History

Rulemaking Authority 394.4781(3), (4) FS. Law Implemented 394.4781(4) FS. History–New 3-1-84, Formerly 10E-10.16, Amended 4-8-96, Formerly 10E-10.016, Amended 4-3-12, Repealed 10-24-21.

Fla. Admin. Code R. 65E-10.018 Client Eligibility for Placement in Residential Treatment Programs

History

Rulemaking Authority 394.4781(3) FS. Law Implemented 394.4781(3), (4) FS. History–New 3-1-84, Formerly 10E-10.18, Amended 4-8-96, Formerly 10E-10.018, Amended 4-3-12, Repealed 10-24-21.

Fla. Admin. Code R. 65E-10.019 Cost Sharing

History

Rulemaking Authority 394.4781(3)(c) FS. Law Implemented 394.4781(3)(c), (4), 409.2561 FS. History–New 3-1-84, Formerly 10E-10.19, 10E-10.019, Repealed 4-3-12.

Fla. Admin. Code R. 65E-10.021 Standards for Residential Treatment Programs Serving Emotionally Disturbed Children and Adolescents

History

Rulemaking Authority 394.4781(3), (4) FS. Law Implemented 394.4781(3) FS. History–New 3-1-84, Formerly 10E-10.21, Amended 4-8-96, Formerly 10E-10.021, Amended 9-14-98, Repealed 4-3-12.

Chapter 65E-11 BEHAVIORAL HEALTH SERVICES

Fla. Admin. Code R. 65E-11.001 Purpose; Construction

The purpose of this chapter is to implement the provisions of Section 409.8135, F.S., by setting forth uniform procedures and standards for providing behavioral health services to non-Medicaid eligible children with special health care needs who are enrolled in the Title XXI part of the KidCare Program with regard to; the scope of behavioral health services including duration and frequency, clinical guidelines for referral to behavioral health services, behavioral health services standards, performance-based measures and outcomes for behavioral health services, and practice guidelines for behavioral health services to ensure cost-effective treatment and to prevent unnecessary expenditures.

History

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

Fla. Admin. Code R. 65E-11.002 Definitions

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.

History

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

Fla. Admin. Code R. 65E-11.003 Scope of Behavioral Health Services

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

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

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

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

(b) Targeted Case Management; and,

(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:

District identifier,
Provider name,
Provider Federal Identification number (FID),
Description of Alternative Service,
Definition of Alternative Service,
Unit type; and,
Unit cost.

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

County in which service was provided,
Provider Federal Identification number (FID),
Client social security number,
Alternative Service provided,
Name of medication, strength, and schedule if applicable,
Units; and,
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,

(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.

History

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

Fla. Admin. Code R. 65E-11.004 Clinical Guidelines for Referral

(1) Every child referred to the Behavioral Health Network shall be screened as a first step in determining the child’s eligibility for services. If the screening indicates the child has the potential to meet the Behavioral Health Network clinical eligibility criteria described in this section, an assessment shall be conducted.

(2) A child shall be considered eligible for behavioral health services from the Behavioral Health Network when the child is determined to be Title XXI eligible for the Florida KidCare Program, be at least five (5) years of age and not yet nineteen (19) years of age, and

(a) The child requires a level of care not available in the other KidCare programs and care is in excess of the benchmark behavioral health benefit package as described in Chapter 409, F.S.; and,

(b) The child is expected to show improvement or achieve stability as a direct result of the services to be rendered under the benefit package specified in Rule 65E-11.003, F.A.C.; and,

(d) The child’s family indicates a willingness to participate in the goals and objectives outlined in the child’s treatment plan; and,

(e) The child meets one of the following clinical eligibility criteria described below as determined by the Lead Agency or their designee for making clinical eligibility determinations:

The child has a DSM-IV Axis I clinical classification of mental disorders or substance-related disorders,
A child diagnosed with Attention-Deficit/Hyper Activity Disorder as the primary DSM-IV-R Axis I diagnosis does not qualify for Behavioral Health Network services; and,
The child demonstrates a significant level of functional impairment as measured by the Children’s Global Assessment Scale (C-GAS), with a score of fifty or below.

(3) Disenrollment Criteria. A child shall be considered disenrolled from the Behavioral Health Network at midnight of the last day of the current enrollment month if one of the following occurs:

(a) The parent has neglected to pay the premium;

(b) The child turns 19 years old;

(d) The child moves out of state;

(e) The child is placed in residential treatment exceeding thirty days;

(f) The child becomes an inmate of a public institution, or

(g) The child no longer meets the Behavioral Health Network’s treatability or clinical eligibility criteria.

(4) When determining or reviewing a child's eligibility under the program, the applicant shall be provided with notice of changes in eligibility. When a transition from the Behavioral Health Network to another program is appropriate, the Behavioral Health Liaison shall notify the Children’s Medical Services case manager in writing and shall ensure the affected family is afforded a transition which promotes continuity of behavioral health care coverage.

(5) The department shall be the final authority on all admissions, transfers, and discharges of children into and from the Behavioral Health Network and retains the right to override any decision of a Lead Agency with regard to a child’s admission, transfer, and discharge.

(6) In the case of any dispute between the department and a Lead Agency, an enrolled child shall remain in the Behavioral Health Network and continue to receive care at the expense of the Lead Agency for the duration of the resolution of the dispute.

History

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

Fla. Admin. Code R. 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:

Criteria for and the primary source of verification of each behavioral health provider’s current license, education, relevant training, board certification, and experience,
Solicitation of reference checks from professional peers regarding each behavioral health provider’s competence and past practice,
Standards to ensure clinical evaluation, and treatment records review and confidentiality that are consistent with statutes and rules of the department,
Standards for the enrolled child’s rights and responsibilities that are consistent with Sections 397.501 and 394.459, F.S.,
Standards for managing the enrolled child and his or her family’s complaints and appeals,
Standards for subcontracting with Providers of Behavioral Health Services,
Standards to assess and ensure the enrolled child and his or her family’s satisfaction with services, and knowledge of grievance and appeals procedures,
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,
Care Planning Standards that includes significant child and family participation,
Treatment Services Standards that assure children and their families have access to a broad array of flexible, community-based services and supports,
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.

History

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

Fla. Admin. Code R. 65E-11.006 Performance-Based Measures and Outcomes

(1) Contractual agreements between the department and Providers of Behavioral Health Services shall minimally contain performance-based measures addressing the standards described in Rule 65E-11.005, F.A.C., and practice guidelines in Rule 65E-11.007, F.A.C.

(2) Providers of Behavioral Health Services which hold current accreditation for behavioral health services from the accrediting bodies described in Rule 65E-11.005, F.A.C., shall be deemed to have met the minimal standards described in this chapter. Notwithstanding the previous statement, no program shall be exempted from any of the fiscal and accounting requirements described in Chapter 287, F.S., rules of the department, and federal statutes and regulations governing the state’s implementation of the Title XXI program.

(3) Providers of Behavioral Health services, within their scope of services, shall assist enrolled children to achieve the following outcomes:

(a) Children are connected to natural support networks when such connection is in the best interest of the child or adolescent;

(b) Children have access to services;

(d) Children and families are active participants in the planning and selection of treatment;

(e) Children receive services in the most integrated setting appropriate to the child;

(f) Children are linked to integrated and community-based services;

(g) Children are provided with supports and skills to prepare for adulthood.

(4) Reports. Providers of Behavioral Health Services shall report the services provided to each enrolled child by complying with the Department’s Substance Abuse and Mental Health Integrated Data System. For those alternative services not specifically included in the Department’s Substance Abuse and Mental Health Integrated Data System, Providers of Behavioral Health Services shall follow the reporting requirements found in paragraph 65E-11.003(6)(a), and subsection 65E-11.007(14), F.A.C.

(5) Subcontractors. Subcontractors in coordination with the Lead Agency shall be responsible for monitoring the behavioral health services standards, performance measures and practice guidelines described in this rule for each subcontracted behavioral health services in order to assure that the provisions of this rule have been fully met.

History

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

Fla. Admin. Code R. 65E-11.007 Practice Guidelines for Behavioral Health Services to Ensure Cost-Effective Treatment and to Prevent Unnecessary Expenditures

(1) Treatment Plan. A written treatment plan shall be developed within 10 working days of enrollment into the Behavioral Health Network for each enrolled child. At a minimum, the plan shall include clear time-limited treatment objectives, related interventions, clinical criteria for discharge, and evidence that the child and family, consistent with the statutes and rules of the department for family involvement, has been included in the development of the treatment plan.

(a) A board certified child psychiatrist or a Licensed Practitioner of the Healing Arts with experience treating children who have mental or substance-related disorders shall serve as the authorizing authority for necessary services. The Lead Agency shall communicate the details of the plan to the local Children’s Medical Services Area Office. The plan shall be reviewed and updated no later than ninety (90) days apart.

(b) Notwithstanding paragraph 65E-11.007(1)(a), F.A.C., above, if the provider can demonstrate that a board certified child psychiatrist or a Licensed Practitioner of the Healing Arts with experience treating children who have mental or substance-related disorders is not available for participation due to the lack of availability, a psychiatrist with experience treating children who have mental disorders or a medical doctor with experience treating children for substance-related disorders shall serve as the authorizing authority for necessary services.

(2) Behavioral health services financed through the Behavioral Health Network shall not begin until after the child’s enrollment as defined in Rule 65E-11.003, F.A.C.

(3) Written Policies and Procedures. The department shall not enter into any contract with a Provider of Behavioral Health Services unless the provider has developed written policies and procedures to comply with the requirements of this rule.

(4) Written policies and procedures shall be approved by the department prior to implementation of said policies and procedures and shall be based on the standards described in Rule 65E-11.005, F.A.C., for treating behavioral health disorders and shall additionally address the following:

(a) The operation of the utilization management program;

(b) An annual review by a quality improvement committee;

(c) Documentation required for specific service approvals and denials, along with the timeframes for communicating decisions to the appropriate Behavioral Health Services provider;

(d) Collection of data to review the criteria and process used to evaluate services for medical necessity as described in subsection 65E-11.002(18), F.A.C.;

(e) Collection of data measuring lengths of stay, utilization of services, and the procedures to be followed when the data indicates patterns of deviation from the norm;

(f) The review of procedures to be used in formulating recommendations for admission, discharge, and disenrollment consistent with subsections 65E-11.005(2) and 65E-11.007(4), F.A.C.;

(g) The review of client service utilization data in the aggregate, with a targeted focus on high users and low users of service as compared to the norm. Such client service data shall minimally include length of service by treatment modality, office visits, days per intake, and the penetration and length of stay in intensive outpatient and acute inpatient services;

(h) Procedures to ensure that a professional described in Chapter 397, 490, or 491, F.S., and who also has 5 years experience in the diagnosis and treatment of children with mental or substance-related disorders supervise utilization management decisions;

(i) A comprehensive quality assessment and performance improvement program consistent with the provisions of Section 394.907, F.S. Such program shall include an analysis of a representative sample of both current and closed cases to determine whether:

The intake assessments performed after enrollments are thorough, timely, complete, and appropriate to the child’s presenting condition,
The service goals and objectives are based on the results of the intake assessments and include the concerns of the enrolled child and his family,
The services delivered are consistent with the service goals and objectives outlined in the Treatment Plan,
The services delivered are appropriate based on the enrolled child’s presenting condition and are in compliance with the Lead Agency’s clinical policies, scope of services and practice guidelines as indicated,
The management information system tracks how client data is monitored and reported, ensures it is complete and accurate based on the presenting conditions of the children being served, and is utilized in performance improvement,
The process for grievances and appeals is accessible, and affords the child and his family due process in circumstances where behavioral health services were denied, suspended or reduced and that a child and his family grievances and appeals are documented, implemented, and resolved within 45 days of the filing of the grievance or appeal; and,
All protocols developed or adopted by the Lead Agency for the provision, monitoring and reporting of services, are being followed by its network members and subcontracted Providers of Behavioral Health Services.

(5) Continuity. Lead Agencies shall ensure continuity and coordination of services throughout their Behavioral Health Care Network in order to improve access and quality of care for enrolled children by:

(a) Coordinating available services within and without the Lead Agency’s Behavioral Health Network;

(b) Sharing and exchanging information across all levels of care and all behavioral health providers, to the extent authorized by the child and the family and allowed under state statute and federal regulation;

(c) Developing written policies and procedures approved by the department to ensure that enrolled children and their families receive timely access to and follow-up with appropriate behavioral health providers, including a psychiatrist for medication management and psychiatric assessment;

(d) Developing written policies and procedures approved by the department in conjunction with Children’s Medical Services to ensure that enrolled children receive continuity and coordination of behavioral health services with general medical care;

(e) Developing written policies and procedures approved by the department to ensure continuity of services for children being disenrolled by the network as well as children being received or transferred to and from out-of-network providers upon entry into service and disenrollment is accomplished without disruption of services to the child; and,

(f) Developing written policies and procedures approved by the department to ensure prior authorization for all urgent and routine care provided outside of any contracted or subcontracted out-of network arrangement. These policies and procedures shall include provisions for the enrolled child’s access to and payment for Behavioral Health Services provided out-of-network.

(6) Out-of-Network Service Utilization. The Lead Agency shall make available its approved policies in accessing out-of-network coverage and ensure all children and their families are aware of its written policies and procedures governing out-of-network service utilization. The Lead Agency shall provide enrollees identification card and outreach materials, the telephone number that an enrolled child and out-of-network provider may call for information about covered service.

(7) The Lead Agency shall ensure that enrolled children and their families are advised that with the exception of emergency services the Lead Agency shall not be liable for the cost of out-of-network services the child accesses that are available through its Behavioral Health Care Network in which the child is enrolled unless specifically authorized by the Lead Agency.

(8) Emergency Out-of-Network Service Utilization. A Provider of Behavioral Health Services shall not require prior authorization for the provision of Emergency Behavioral Health Care to an enrolled child.

(a) The Lead Agency shall not be responsible for payment of services delivered after twenty-four hours of the authorization of admission unless the Lead Agency has specifically authorized the delivery of such services.

(b) The Lead Agency shall reimburse out-of-network providers for properly completed and submitted claims for Emergency Behavioral Health Care provided that such claims are submitted within 90 days of the date of service. The Lead Agency shall adjudicate such claim within 60 days of receipt. A claim shall be considered properly completed and submitted when the following occurs:

The claim documents psychiatric admission for the treatment of Emergency Behavioral Health Care as defined in subsection 65E-11.002(12), F.A.C., and includes the date of admission, reason for admission, location of the treatment facility, duration of service noted, and any Behavioral Health Services authorized by the referring Lead Agency.
The claim includes documentation of the out-of-network provider’s notification to the Lead Agency of the presenting child receipt of services within 24 hours of learning the child’s identity or its attempts to notify the Lead Agency of the child presenting for Emergency Behavioral Health Care and the circumstances that precluded its attempts to notify the Lead Agency; and,
Charges mutually agreed to by the Lead Agency and the provider within 60 days after submittal of the claim.

(9) The Lead Agency shall be liable for charges for Emergency Behavioral Health Care pursuant to the provisions of Section 394.451, F.S., the “The Florida Mental Health Act” also known as “The Baker Act.” with regard to admissions and assessments with reimbursement to the treating facility not to exceed the Medicaid approved rate for Baker Act admissions and assessments.

(10) Lead Agencies shall be responsible for the management of the enrollment pool which shall include the application of screenings and assessments to potential entrants to the pool and the conducting of reverification screenings among existing enrolled children. The costs of such services shall be borne by the Lead Agency.

(11) Service Delivery Location. All Behavioral Health Services shall be accessible in a setting which is located no further than a thirty (30) minute typical drive time from the residence of the enrolled child accessing the care.

(12) Exceptions to the drive-time provision shall be made by the Behavioral Health Network Coordinator to address the lack of specialty providers or other service constraints existing in rural areas.

(13) Service Times. Providers of Behavioral Health Services shall at a minimum, be available during normal business hours to provide direct services to children and to carry out activities related to clinical administration and shall comply with the following service standards:

(a) Emergency Behavioral Health Care shall be unrestricted and directly accessible to the enrolled child, twenty-four (24) hours a day and seven (7) days a week.

(b) Urgent Care as defined in subsection 65E-11.002(27), F.A.C., shall be evaluated and delivered within twenty-four (24) hours.

(14) Records and Documentation. Providers of Behavioral Health Services shall maintain written service documentation to support each service rendered on behalf of the enrolled child. Service documentation must contain all of the following:

(a) Recipient’s name;

(b) Date the service was rendered;

(d) Identification of the setting in which service was rendered;

(e) Reference to the treatment plan goal and objectives for which service is being provided;

(f) Description of the specific service rendered, including the specific intervention;

(g) Updates regarding the recipient’s progress toward meeting goals and objectives identified in the treatment plan; and,

(h) Original signature, credential and functional title of the person providing the service.

History

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

Chapter 65E-12 PUBLIC MENTAL HEALTH CRISIS STABILIZATION UNITS AND SHORT-TERM RESIDENTIAL TREATMENT PROGRAMS

Fla. Admin. Code R. 65E-12.103 Definitions

(1) “Advanced Registered Nurse Practitioner” or “ARNP” means any person licensed under Section 464.012, F.S., to practice professional nursing and is certified in advanced or specialized nursing practice.

(2) “Advisory or Governing Board” means a formally constituted group of citizens that advises or directs a program regarding policy. A community facility that is a part of a community mental health center may use the center’s board for policy advice or policy direction.

(3) “Agency” means the Agency for Health Care Administration.

(4) “Consultant Pharmacist” means a licensed pharmacist, as defined in Chapter 465, F.S.

(5) Crisis Stabilization Unit” or “CSU” means a program as defined in Section 394.67, F.S.

(6) “Department” means the Department of Children and Families.

(7) “Direct Care Staff” means staff who have direct contact with and are responsible for the care of individuals receiving services and specified treatment and rehabilitative activities, as specified in policies and procedures, under the supervision of a mental health professional or registered nurse.

(8) “Discharge Plan” means a written plan describing continuity of care for an individual following discharge from the CSU or SRT, including recommended services, supports, and setting where the individual will reside. The discharge planning process begins at the time of admission and involves the individual and their family, case manager, and other individuals or service providers, as appropriate.

(9) “Emergency Screening” means a process in which an individual receives a preliminary determination of the type, extent, and immediacy, of his or her treatment needs.

(10) “Individual” or “Individual Receiving Services” means an individual who either voluntarily seeks admission or for whom involuntary admission is sought under Section 394.463, F.S., and who receives screening, evaluation, or treatment services from an entity that is operated, funded, or regulated by the department.

(11) “Licensed Practical Nurse” means any person who is licensed to practice practical nursing under Chapter 464, F.S.

(12) “Mental Health Professional” means a psychiatrist, psychiatric nurse, clinical psychologist, marriage and family therapist, mental health counselor, or clinical social worker, as defined in Section 394.455, F.S.

(13) “Nursing Assessment” means a general evaluation, begun immediately upon admission and completed within 24 hours, conducted by a registered nurse. It is not intended to serve as the physical examination required under Section 394.459, F.S., unless it is performed as a physical examination by an ARNP.

(14) “Peer Review” means the review of a staff member’s professional work by comparably trained and qualified individuals performing similar tasks.

(15) “Physical Examination” means an evaluation performed by a licensed physician or by an ARNP under the supervision of a licensed physician, or by a physician assistant.

(16) “Physician” means a person who is licensed under Chapter 458 or 459, F.S.

(17) “Physician Assistant” or “PA” means a person who is licensed to perform medical services delegated by a supervising physician under Chapter 458 or 459, F.S.

(18) “Policies and Procedures” means written standards, methods, and guidelines that govern the operation of the program, assure compliance with these rules and applicable statutes, and ensure the coordinated delivery of quality acute care treatment services that are designed to improve treatment outcomes.

(19) “Psychiatrist” means a person who is licensed under Chapter 458 or 459, F.S., and as defined in Section 394.455, F.S.

(20) “Quality Assurance” means a process, including peer review and utilization review, designed to evaluate the quality of care of a program and to promote efficient and effective screening, evaluation, and treatment services. Crisis stabilization units and SRTs that are a part of a community mental health center, as defined in Section 394.907, F.S., may be included in that organization’s quality assurance program.

(21) “Receiving Facility” means a public or private facility designated as defined in Section 394.455, F.S.

(22) “Registered Nurse” means any person who is licensed to practice professional nursing under Chapter 464, F.S.

(23) “Rehabilitative Services” means services and supports that are collaborative, person-directed, and individualized to promote recovery, full community integration, and improved quality of life for an individual diagnosed with any mental health condition impairing his or her ability to lead a meaningful life. These services help an individual develop skills and access resources needed to increase his or her capacity to be successful and satisfied in the living, working, learning, and social environments of his or her choice.

(24) “Restraint” as defined in Section 394.455, F.S.

(25) “Seclusion” as defined in Section 394.455, F.S.

(26) Service Plan” means a written statement of the long-term view, goals, and objectives to be achieved with the individual receiving services and the means for attaining those objectives.

(27) “Short-term Residential Treatment Program” or “SRT” means a state-supported acute care residential alternative service that operates 24 hours per day, 7 days per week and is typically of 90 days or less in duration, and which is an integrated part of a designated public receiving facility and receiving state mental health funds under the authority of Chapter 394, F.S. The purpose of an SRT is to provide intensive short-term treatment to individuals who are temporarily in need of a 24-hour-a-day structured therapeutic setting in a less restrictive, but longer-stay alternative to hospitalization.

(28) “Treatment” means the clinical care of an individual who has been determined to have a mental illness.

(29) “Usable Client Space” means the sum, in gross square feet, of all rooms, interior wall to interior wall, that are part of a CSU or SRT. Mechanical and electrical rooms, administrative and staff offices, screening areas, nurses’ stations, visitor and reception areas, crawl spaces, and attic spaces, are excluded.

(30) “Utilization Review” means the process of using predefined criteria to evaluate the necessity and appropriateness of services and allocated resources to ensure that a program’s services are necessary, cost-efficient, and effectively provided.

History

Rulemaking Authority 394.879(1), 394.907(8) FS. Law Implemented 394.455, 394.459, 394.463, 394.67, 394.875, 394.907 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.103, Amended 9-1-98, 4-8-18.

Fla. Admin. Code R. 65E-12.104 Licensing Procedure

(1) Every entity operating as a CSU or SRT is required to obtain a license from the agency unless specifically excluded from licensure under the provisions of Section 394.875, F.S. All applicants for licensure must comply with the requirements of Chapter 394, Parts I and IV, F.S., Chapter 408, Part II, F.S., and Chapter 59A-35, F.A.C.

(2) Accredited Programs. CSUs and SRTs which are accredited by The Joint Commission (TJC), Council on Accreditation (COA) or Commission on Accreditation of Rehabilitation Facilities (CARF) shall provide proof of accreditation as required by Section 394.741, F.S. Application for licensure by accredited programs does not preclude monitoring by the department, the agency and fire marshal, and compliance with the provisions of rule Chapter 65E-12, F.A.C.

(3) Liability Insurance Coverage.

(a) Applicants shall provide proof of professional liability insurance coverage from an authorized insurer in an amount not less than $300,000 per occurrence with a minimum annual aggregate of not less than $1,000,000.

(b) Applicants shall provide proof of general liability insurance coverage from an authorized insurer in an amount not less than $300,000 per occurrence with a minimum annual aggregate of not less than $1,000,000.

(4) A license issued by the agency shall be posted in a conspicuous place on the premises and shall state the type of service to be performed by the licensee and the maximum bed capacity of the CSU or SRT.

(5) Certification of Authorized Beds. The agency shall issue a license certifying the number of authorized beds and available appropriation for each facility as determined by the department based upon existing need, geographic considerations, and available resources. The department formula, ten CSU beds per 100,000 general population, may be used as a guideline.

(6) Program Closure. If a licensee voluntarily closes a facility licensed under this rule, the licensee shall notify the agency, the department, and the managing entity under contract with the department, in writing, at least 30 days prior to such closure. The CSU or SRT that is closing, with the assistance of the managing entity under contract with the department, shall attempt to relocate each individual receiving services, with the individual’s lawful consent, to another CSU or SRT along with their clinical records and files. The licensee shall notify the agency, the department, and the managing entity under contract with the department, where the clinical records and files of previously discharged individuals are and where they will be stored for the legally required period.

History

Rulemaking Authority 394.876, 394.879(1) FS. Law Implemented 394.741, 394.875, 394.876 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.104, Amended 9-1-98, 4-8-18.

Fla. Admin. Code R. 65E-12.105 Minimum Staffing Standards

(1) Each facility shall designate an individual who is responsible for the overall management and operation of a CSU or SRT and whose qualifications and duties are defined in the individual’s job description. The job description shall ensure that other job responsibilities will not impede the operation and administration of the CSU or SRT. The occupant of this position shall possess experience in acute mental health and hold at least a bachelor’s degree in the human services field or be a registered nurse.

(2)(a) Every CSU and SRT shall have at least one psychiatrist as primary medical coverage as defined in Section 394.455(24), F.S. Back-up coverage may be a physician who will consult with the psychiatrist. The psychiatrist or physician shall be on call 24-hours-a-day and will make daily rounds. Counties of less than 50,000 population may utilize a licensed physician for on-call activities and daily rounds as long as the physician has postgraduate training and experience in diagnosis and treatment of mental and nervous disorders.

(b) The psychiatrist shall be responsible for the development of general medical policies, prescription of medications, and medical treatment of persons receiving services. Each person shall be provided medical or psychiatric services as considered appropriate and such services shall be recorded by the physician or psychiatrist in the clinical record.

(3) Sufficient numbers and types of qualified staff shall be on duty and available at all times to provide necessary and adequate safety and care. The program policies and procedures shall define the types and numbers of clinical and managerial staff needed to provide persons with treatment services in a safe and therapeutic environment.

(4) At least one registered nurse shall be on duty 24-hours-a-day, 7-days-a-week.

(5) At no time shall the minimum on-site available nursing coverage and mental health treatment staff be less than the following for shifts from 7:00 a.m. until 11:00 p.m. to assure the appropriate handling and administration of medication and the completion of nursing assessments:

Number of Beds

Registered Nurses

Mental Health Treatment Staff

CSU

SRT

CSU

SRT

1-10

11-20

21-30

*Licensed Practical Nurse may substitute for one registered nurse.

(6) At no time shall on-site available nursing coverage and mental health treatment staff be less than the following for both CSUs and SRTs for shifts from 11:00 p.m. until 7:00 a.m. to assure the appropriate handling and administration of medication and the completion of nursing assessments:

Number of Beds

Registered Nurses

Mental Health Treatment Staff

1-10

11-20

21-30

(7) A person with a minimum of a master’s degree in psychology, social work, psychiatric nursing, counseling education, or mental health counseling, and has received clinical training, shall regularly provide staff consultation and treatment services to the CSU and SRT as described in the facility’s policies and procedures.

(8) Rehabilitative services shall be made available to the SRT.

(9) Emergency Screening Staff.

(a) The following requirement shall apply to all persons who assume emergency screening responsibilities after the effective date of this rule. Staff who have the responsibility of conducting emergency screening for possible admission to the CSU shall have a master’s degree in psychology, social work, counseling education, mental health counseling, psychiatric nursing; or be a registered nurse; or be a person with a bachelor’s degree, in a human services field, with a minimum of 1 year of work experience in a mental health related field.

(b) All emergency screeners assuming emergency screening responsibilities after the effective date of this rule shall complete a course in emergency screening prior to or within 3 months of assuming emergency screening responsibilities. This course shall include 12 contact hours of training in emergency screening, including clinical assessment, mental status examination, crisis intervention, Baker Act admission criteria, and the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised, Washington, DC, American Psychiatric Association, 1994, which is incorporated by reference and may be obtained from the American Psychiatric Association, 1400 K Street, N.W., Washington, DC 20005. Completion of the training course shall be documented. Persons who deliver training curriculum for emergency screening shall be mental health professionals, physicians, or mental health counselors licensed under Chapter 491, F.S., or under the supervision of a mental health professional, physician, or mental health counselor.

(c) Face-to-face consultation shall be available from a mental health professional or a mental health counselor licensed under Chapter 491, F.S., at all times for newly employed emergency screeners who have not completed the required training. They shall also receive intensive supervision and on the job training until successful completion of the training course.

(d) Emergency screeners shall, at all times, be under the supervision of a mental health professional or a mental health counselor licensed under Chapter 491, F.S. The extent and type of supervision provided to emergency screeners shall be specified in the CSU’s policy and procedures manual.

(e) All emergency screening staff shall have 10 documented contact hours of relevant staff development and training each calendar year.

(f) The CSU will include a training plan in their policy and procedures manual that will reinforce the initial training curriculum and be responsive to their quality assurance findings.

(g) Personnel comprising the minimum CSU staff, as specified in Rule 65E-12.105, F.A.C., shall not function as emergency screeners at the same time as working on the CSU.

(10) Each CSU and SRT shall develop policies and procedures to ensure adequate minimum staffing. These policies shall address double shifting, use of temporary registered nurses, use of regular part-time registered nurses and licensed practical nurses. Policies shall ensure that nursing staff are not used in dual capacity or in ancillary areas which compromise minimum unit staffing requirements, except as expressly provided for by this rule.

History

Rulemaking Authority 394.879(1), (2) FS. Law Implemented 394.455, 394.879 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.105, Amended 9-1-98.

Fla. Admin. Code R. 65E-12.106 Common Minimum Program Standards

(1) Advisory or Governing Board. The CSU or SRT shall have either a formally constituted advisory or governing board for the CSU or SRT or operate under a provider board which has ultimate authority for establishing policy and overseeing the operation of the CSU or SRT. The board shall operate under a mission statement and a set of bylaws governing its operation.

(a) Selection and Terms of Office. If an advisory or governing board exists, the method of selection of members and terms shall be specified in the corporate bylaws of the corporation. The membership of such an advisory or governing board shall include broad representation from the professional disciplines and the community, including a consumer and a consumer’s family member, and shall meet quarterly.

(b) Records. Records of the CSU or SRT with an advisory or governing board shall include the name, address, and terms of office of members; written minutes of meetings; attendance; and specific recommendations or decisions of the board.

(2) Personnel Policies. Personnel policies shall be made available in writing to all personnel. Policies shall include rules governing the ethical conduct of staff and volunteers, rights and confidentiality of information regarding individuals receiving services.

(a) Performance Evaluation of Staff. An annual performance evaluation of all personnel shall be conducted. The program shall provide for the signature of the employee acknowledging receipt of the evaluation.

(b) Personnel Records. Records on all employees and volunteers shall be maintained by the CSU or SRT. Each employee record, available for employee review shall contain:

The employee’s current job description with minimum qualifications for the position;
The employment application or resume with evidence that references were checked prior to employment;
The employee’s annual evaluations;
A copy of the employee’s professional license, if applicable;
A receipt indicating that the employee has been trained and understands program policies and procedures, patient rights as stated in Section 394.459, F.S., ethical conduct, and confidentiality of information regarding individuals receiving services;
Documentation that the employee has been trained and understands the legal mandate under Section 415.103, F.S., to report suspected abuse and neglect as well as the use of the Florida Abuse Hotline; and,
Documentation that the employee or volunteer has been fingerprinted and screened, if appropriate, in accordance with Section 394.4572, F.S.
Documentation of training as required by Section 381.0035, F.S., for all non-licensed staff.

(c) Fingerprint Screening. All personnel, as defined in Section 394.4572, F.S. shall be screened in accordance with Sections 394.4572 and 408.809, F.S. Each CSU and SRT shall maintain fingerprint screening records as follows:

A current list which identifies, by position title, all positions which require fingerprint screening.
A continuously updated record of all active personnel which identifies for each person his position title, date of hire, and the date of the most recent fingerprint screening.

(3) Staff Development and Training. Each CSU and SRT shall provide staff development and training for all facility staff, including part-time, temporary, and volunteers, and shall develop policies and procedures for implementing these activities. Policies and procedures shall be reviewed annually. There shall be a qualified and experienced staff person responsible for staff development and training who is, under the supervision of, or receives consultation from, a mental health professional licensed under Chapter 491, F.S. All staff development and training activities shall be documented and shall include activity or course title; number of contact hours; instructor’s name; credentials; and, date. The participation of each employee shall be documented in accordance with systemic procedures either in the employee’s personnel file or staff development and training file. Attendance at professional workshops and conferences should also be documented accordingly.

(4) Financial Records. Financial records that identify all income by source, and report all expenditures by category, shall be maintained in a manner consistent with Chapter 65E-14, F.A.C.

(5) Confidentiality and Clinical Records. Every CSU and SRT shall maintain a record on each individual receiving services, assuring that records and identifying information are maintained in a confidential manner, and securing valid lawful consent prior to the release of information in accordance with Section 394.4615, F.S. Clinical records may be stored on paper, magnetic material, film, or other media, including electronic storage. All staff shall receive training as part of staff orientation, with at least a triennial update on file, regarding the effective maintenance of confidentiality of clinical records, including electronic records. It shall be emphasized that confidentiality includes oral discussions regarding individuals receiving services inside and outside the CSU or SRT and shall be discussed as part of employee training.

(a) Clinical Record System. Each CSU and SRT shall have policies and procedures, in accordance with Section 394.4615, F.S., for a clinical record system. The clinical record is the focal point of treatment documentation and is a legal document. Entries placed in the clinical record to document the individual’s progress or facility’s actions must be objective, legible, accurate, dated, timed when appropriate, and authenticated with the writer’s signature, title, and discipline. Electronic signatures, as defined in Chapter 668, Part I, F.S., are permissable. The clinical record shall be organized and maintained for easy access. Clinical record services shall be the responsibility of an individual who has demonstrated competence and training or experience in clinical record management. Adequate space shall be provided for the storage and retrieval of the records. The records shall be kept secure from unauthorized access, and each program shall adopt policies and procedures which regulate and control access to and use of clinical records.

(b) Record Retention and Disposition. An individual’s complete clinical record shall be retained for a minimum period of 6 years following discharge. If any litigation claim, negotiation, audit, or other action involving the records has been started before the expiration of the six-year period, the records shall be retained until completion of the action and resolution of all issues which arise from such actions.

(c) Content of Clinical Records. The required signature of treatment personnel shall be original as opposed to the facsimile. The required signature of treatment personnel shall be original as opposed to the facsimile. Policies and procedures shall require the clinical record to clearly document the extent of progress toward short-term objectives and long-term view. Clinical record documentation for each order or treatment decision shall include its respective basis or justification, actions taken, description of behaviors or response, and staff evaluation of the impact of the treatment on the individual’s progress. Clinical records shall contain:

The name and address of the individual receiving services;
Name, address, and telephone number of guardian, representatives, or others as specified by the individual receiving services;
The source of referral and relevant referral information;
Intake interview and initial physical assessment;
The signed and dated informed consent for treatment as mandated under Sections 394.459(3) and 394.4615, F.S.;
Documentation of orientation to program and program rules;
The medical history and physical examination report with diagnosis;
The report of the mental status examination and psychosocial, psychological, nursing, rehabilitation, nutritional, and mental health assessments as appropriate;
The original service plan developed, dated and signed by the individual receiving services and treatment staff. The plan shall contain short-term treatment objectives that relate to crisis stabilization and the description and frequency of services to be provided;
The signed and dated service plan reassessments and reviews;
Examination, diagnosis and progress notes by physician, psychiatric nurses, treatment staff and other mental health professionals that relate to the service plan objectives;
Laboratory and radiology results, if applicable;
Documentation of seclusion or restraint observations, if utilized;
A record of all contacts with medical and other services;
A record of medical treatment and administration of medication, if administered;
An original or original copy of all physician or psychiatric nurse medication and treatment orders;
Signed consent for the release of information, if information is released;
An individualized discharge plan;
Forms CF-MH 3042a, CF-MH 3042b, and CF-MH 3084, as appropriate;
A current, originally authorized CF-MH 3084, Feb 2005, “Baker Act Service Eligibility,” which is incorporated herein by reference for all individuals receiving services and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-08945 and from the department’s website at https://eds.myflfamilies.com/DCFFormsInternet/Search/DCFFormSearch.aspx; and,
If the individual receiving services has a community case manager, documentation of contacts between the community case manager and CSU or SRT staff and the person receiving service.

(6) Consent to Treatment. Any CSU or SRT rendering treatment for mental illness to any individual, pursuant to Chapter 394, F.S., and Chapter 65E-5, F.A.C., shall have on file a valid and signed informed consent for treatment. Forms CF-MH 3042a, “General Authorization for Treatment Except Psychotropic Medications,” Feb 05 and CF-MH 3042b, “Specific Authorization for Psychotropic Medications,” Feb 05, or substantially similar forms, may be used. Forms CF-MH 3042a and 3042b are incorporated by reference and are available at http://www.flrules.org/Gateway/reference.asp?No=Ref-09031 and http://www.flrules.org/Gateway/reference.asp?No=Ref-090312, respectively, and from the department’s website at https://eds.myflfamilies.com/DCFFormsInternet/Search/DCFFormSearch.aspx.

(7) Admission and Discharge Criteria. Each CSU and SRT shall develop and utilize policies and procedures pursuant to Chapter 394, F.S., for the intake, screening, admission, referral, disposition, and notification of the individual or their guardians, representatives, or others as specified by the individual seeking treatment. There shall be adequate intake procedures to ensure that individuals being received from an emergency room, agency, facility, or other referral source shall have all the required paperwork and documentation for admission. If an individual has a case manager, the case manager shall be notified and shall provide appropriate information and participate in the development of the discharge plan. Individuals receiving services, guardians, or others as specified by the individual receiving services shall be informed of their eligibility or ineligibility status for publicly funded CSU or SRT services, either at admission or shortly thereafter.

(a) Admissions Criteria. All persons admitted shall meet the criteria defined under Section 394.455(28), 394.4625, or 394.463, F.S.

(b) Supervisory Clinical Review. The program policies and procedures shall specify administrative procedures for the ongoing review of clinical decisions regarding admission, treatment, and disposition. This shall include staffings, individual supervision, and record reviews.

(c) Orientation to Program and Abuse Reporting. Each CSU and SRT shall conduct and document an orientation session with each individual receiving services, guardians, and others as specified by the individual receiving services, regarding admission and discharge standards, rules, procedures, activities and concepts of the program. A written copy of the above shall be provided to individuals receiving services and their guardians. Individuals receiving services shall be informed in writing of rights, protection standards, possible searches and seizures, in-house grievance protocol, function of the human rights advocacy committee and current procedures for reporting abuse, neglect, or exploitation to the Abuse Hotline as required by Section 415.1034, F.S. Programs shall not discourage or prevent anyone from contacting the Abuse Hotline.

(8) Protection of Individuals Receiving Services. Unless abridged by a court of law, the rights of individuals who are admitted to CSU and SRT programs shall be assured as mandated under Chapter 394, Part I, F.S., and Chapter 65E-5, F.A.C. Each CSU and SRT shall be operated in a manner that protects the individual’s rights, life, and physical safety while receiving evaluation and treatment. In addition to all rights granted under Chapter 394, Part I, F.S., individuals receiving services shall be:

(a) Assigned a primary therapist or counselor; and,

(b) Assured that any search or seizure is carried out in a manner consistent with program policies and procedures to ensure safety and security and is consistent with therapeutic practices.

Searches and Seizures. Whenever there is a reason to believe that the security of a facility or the health of anyone is endangered or that contraband or objects which are illegal to possess are present on the premises, a search of an individual’s room, locker, or possessions shall be conducted if authorized by the program director or designee, as defined in program policies and procedures.
Presence of Individual. Whenever feasible, the individual receiving services shall be present during a search.
Absence of Individual. When it is impossible for the individual to be physically present during the search, they shall be given prompt written notice of the search and of any article confiscated.
Documentation. Written reports of all searches shall be documented in the individual’s clinical record. A written inventory of items confiscated shall be forwarded to the program director or designee.

(c) Facility policy shall prohibit any retaliation or reprisal against either the individual or against staff for reporting suspected abuse, neglect or exploitation, or violations of the individual’s rights. A copy of this facility policy shall be posted in a common area and provided to individuals receiving services upon request.

(9) Quality Assurance Program. Every CSU and SRT shall comply with the requirements of Section 394.907, F.S.

(a) Inclusions. Every CSU and SRT shall have, or be an active part of, an established multidisciplinary quality assurance program and develop a written plan which addresses the minimum guidelines to ensure a comprehensive integrated review of all programs, practices, and facility services, including the following: facilities safety and maintenance; care and treatment practices; resource utilization review; peer review; infection control; records review; maintenance of clinical records; pharmaceutical review; professional and clinical practices; curriculum, training and staff development; and incidents with appropriate policies and procedures. The quality assurance program must include:

Composition of quality assurance review committees and subcommittees, purpose, scope, and objectives of the quality assurance committee and each subcommittee, frequency of meetings, minutes of meetings, and documentation of meetings;
Procedures to ensure selection of both difficult and randomly selected cases for review;
Procedures to be followed in reviewing cases and incident reports;
Criteria and standards used in the review process and procedures for their development;
Procedures to be followed to assure dissemination of the results and verification of corrective action;
Tracking capability of incident reports, pertinent issues and actions; and,
Procedures for measuring and documenting progress and outcome of individuals receiving services.

(b) Process. The quality assurance program shall conduct two separate complementary review processes on a monthly basis to include peer review and utilization review. The effects of the peer and utilization reviews shall ensure the following.

The admission is necessary and appropriate.
The services are the least restrictive means of intervention.
Rights are being protected.
Family or significant others are involved in the treatment and discharge planning process as much as feasible with the consent of the individual receiving services.
The service plan is comprehensive, relative to the full range of the needs of the individual receiving services at the CSU or SRT.
Minimal standards for clinical records and consent to treatment are being met as required by subsections 65E-12.106(5) and (6), F.A.C., of this rule.
Medication is prescribed and administered appropriately. All medication errors shall be reported under the CSU or SRT’s incident reporting system and subject to internal review by the quality assurance program.
There has been appropriate handling of medical emergencies.
Special treatment procedures, for example, seclusion and restraints, emergency treatment orders, and medical emergencies, are conducted according to facility policy.
High risk situations and special cases are reviewed within 24 hours. These shall include suicide attempts, death, serious injury, violence, sexual assaults, and abuse of any individual.
All incident reports are reviewed by the facility director within 3 working days.
The length of stay is supported by clinical documentation.
Supportive services are ordered and obtained as needed.
Continuity of care is provided through care coordination activities.
Delay in receiving services is minimal.

(c) The quality assurance committee shall submit a quarterly report to the CSU or SRT director and board of directors for their review and appropriate action.

(10) Critical Incident Reporting.

(a) Every CSU and SRT shall develop policies and procedures for submitting critical incidents into the Department’s statewide designated electronic system specific to critical incident reporting.

(b) Every CSU and SRT shall report critical events within one (1) business day of the incident occurring.

Adult Death. An individual 18 years old or older whose life terminates:

a. While receiving services, or

b. When it is known that an adult died within thirty (30) days of discharge from a CSU or SRT.

c. The final classification of an adult’s death is determined by the medical examiner. In the interim, the manner of death shall be reported as one of the following:

(I) Accident. A death due to the unintended actions of one’s self or another.

(II) Homicide. A death due to the deliberate actions of another.

(III) Natural Expected. A death that occurs, because of, or from complications of, a diagnosed illness for which the prognosis is terminal.

(IV) Natural Unexpected. A sudden death that was not anticipated and is attributed to an underlying disease either known or unknown prior to the death.

(V) Suicide. The intentional and voluntary taking of one’s own life.

(VI) Undetermined. The manner of death has not yet been determined.

(VII) Unknown. The manner of death was not identified or made known.

Child Arrest. The arrest of a child.
Child Death. An individual who is less than 18 years of age whose life terminates:

a. While receiving services, or

b. When it is known that a child died within 30 days of discharge from a CSU or SRT;

c. The final classification of a child’s death is determined by the medical examiner. In the interim, the manner of death will be reported as one of the following:

(I) Accident. A death due to the unintended actions of one’s self or another.

(II) Homicide. A death due to the deliberate actions of another.

(III) Natural Expected. A death that occurs, because of, or from complications of, a diagnosed illness for which the prognosis is terminal.

(IV) Natural Unexpected. A sudden death that was not anticipated and is attributed to an underlying disease either known or unknown prior to the death.

(V) Suicide. The intentional and voluntary taking of one’s own life.

(VI) Undetermined. The manner of death has not yet been determined.

(VII) Unknown. The manner of death was not identified or made known.

Child-on-Child Sexual Abuse. Any sexual behavior between children less than 18 years of age which occurs without consent, without equality, or because of coercion.
Elopement. An unauthorized absence of any individual.
Employee Arrest. The arrest of an employee for a civil or criminal offense.
Employee Misconduct. Work-related conduct or activity of an employee that results in potential liability for the Department or the Agency for Health Care Administration (Agency); death or harm to an individual receiving services; abuse, neglect or exploitation of an individual receiving services; or which results in a violation of statute, rule, regulation, or policy. This includes falsification of records; failure to report suspected abuse or neglect; contract mismanagement; or improper commitment or expenditure of state funds.
Missing Child. When the whereabouts of a child in the custody of the Department are unknown and attempts to locate the child have been unsuccessful.
Security Incident – Unintentional. An unintentional action or event that results in compromised data confidentiality, a danger to the physical safety of personnel, property, or technology resources; misuse of state property or technology resources; or, denial of use of property or technology resources. This excludes instances of compromised information of individuals in treatment.
Sexual Abuse/Sexual Battery. Any unsolicited or non-consensual sexual activity by one individual receiving services to another individual receiving services; or, sexual activity by a service provider employee or other person to an individual receiving services, or an individual receiving services to an employee regardless of the consent of the individual receiving services. This may include sexual battery, as defined in Chapter 794, F.S.
Significant Injury to Individuals in Treatment. Any severe bodily trauma received by an individual in a CSU or SRT that requires immediate medical or surgical evaluation or treatment in a hospital emergency department to address and prevent permanent damage or loss of life.
Significant Injury to Staff. Any serious bodily trauma received by a staff member as result of a work-related activity that requires immediate medical or surgical evaluation or treatment in a hospital emergency department to prevent permanent damage or loss of life.
Suicide Attempt. A potentially lethal act which reflects an attempt by an individual to cause his or her own death as determined by a licensed mental health professional or other licensed healthcare professional.
Other. Any major event not previously identified as a reportable critical incident but has, or is likely to have, a significant impact on individuals receiving services, on the Department, or on the Agency, such as:

a. Human acts that jeopardize the health, safety, or welfare of individuals receiving services, such as kidnapping, riot, or hostage situation;

b. Bomb or biological/chemical threat of harm to personnel or property involving an explosive device or biological/chemical agent received in person, by telephone, in writing, via mail, electronically, or otherwise;

c. Theft, vandalism, damage, fire, sabotage, or destruction of state or private property of significant value or importance;

d. Death of an employee or visitor while on the grounds of the CSU or SRT;

e. Significant injury of a visitor while on the grounds of the CSU or SRT that requires immediate medical or surgical evaluation or treatment in a hospital emergency department to prevent permanent damage or loss of life, or

f. Events regarding individuals receiving services or providers that have led to or may lead to media reports.

All public and private designated Baker Act receiving facilities and all SRTs shall develop policies and procedures for reporting seclusion and restraint events into the statewide designated electronic system specific to seclusion and restraints.

(11) Data. Every CSU and SRT shall participate in reporting data as mandated under Section 394.461, F.S.

(12) Health and Safety.

(a) Disaster Preparedness.

Each CSU and SRT shall have, or operate under, a safety committee with a safety director or officer who is familiar with the applicable local, state, federal and National Fire Protection Association safety standards. The committee’s functions may be performed by an already existing committee with related interests and responsibilities.
Each CSU and SRT shall have, or be a part of, a written internal and external disaster plan, developed with the assistance of qualified fire, safety and other experts.

a. The plan and fire safety manual shall identify the availability of fire protection services and provide for the following:

(I) Use of the fire alarm;

(II) Transmission of the alarm to the fire department;

(III) Response to the alarm;

(IV) Isolation of the fire;

(V) Evacuation of the fire area or facility utilizing posted evacuation routes;

(VI) Preparation of the residents and building for evacuation;

(VII) Fire extinguishment;

(VIII) Descriptive procedures for the operation and maintenance of fire equipment;

(IX) Procedures for staff training and the provision of monthly fire drills rotated so that all shifts have at least one fire drill quarterly;

(X) Documentation of monthly and periodic professional inspections of equipment; and,

(XI) Provision for annual review and revision of the fire safety manual and plan.

b. The plan shall be made available to all facility staff and posted in appropriate areas within the facility.

c. There shall be records indicating the nature of disaster training and orientation programs offered to staff.

(b) Fire Safety. CSUs and SRTs must comply with all federal and local fire safety standards. Local fire codes which are more stringent standards, or add additional requirements, shall take precedent over the minimum requirements set forth in this rule.

(d) Health and Sanitation.

Appropriate health and sanitation inspections shall be obtained before occupying any new physical facility or addition. A report of the most recent inspections must be on file and accessible to authorized individuals.
Hot and cold running water under pressure shall be readily available in all washing, bathing and food preparation areas. Hot water in areas used by individuals being served shall be at least 100 degrees Fahrenheit but not exceed 120 degrees Fahrenheit.
Garbage, Trash and Rubbish Disposal.

a. All garbage, trash, and rubbish from residential areas shall be collected daily and taken to storage facilities. Garbage shall be removed from storage facilities frequently enough to prevent a potential health hazard or at least twice per week. Wet garbage shall be collected and stored in impervious, leak proof, fly tight containers pending disposal. All containers, storage areas and surrounding premises shall be kept clean and free of vermin.

b. If public or contract garbage collection service is available, the facility shall subscribe to these services unless the volume makes on-site disposal feasible. If garbage and trash are disposed of on premises, the method of disposal shall not create sanitary nuisance conditions. Facilities must comply with the Florida Department of Health’s garbage, trash, and rubbish disposal requirements, as stated in Chapter 62-701, F.A.C.

(13) Food Services.

(a) At least three nutritious meals per day and nutritional snacks, shall be provided each individual receiving services. No more than 14 hours may elapse between the end of an evening meal and the beginning of a morning meal. Special diets shall be provided when an individual requires it. Under no circumstance may food be withheld for disciplinary reasons. Menus shall be reviewed and approved in advance at least quarterly by a Florida registered dietitian.

(b) For food service areas with a capacity of 13 or more individuals, facilities must comply with the Florida Department of Health’s food service requirements, as stated in Chapter 64E-11, F.A.C.

(c) Third Party Food Service. When food service is provided by a third party, the provider must comply with the Florida Department of Health’s food service requirements, as stated in Chapter 64E-11, F.A.C. There shall be a formal contract between the facility and provider containing assurances that the provider will meet all food service and dietary standards imposed by this rule. Sanitation reports and food service establishment inspection reports shall be on file in the facility.

(14) Housekeeping and Maintenance. Every CSU and SRT shall have housekeeping and maintenance standards which meet the following criteria:

(a) Facilities shall be clean, in good repair, and free of hazards such as cracks in floors, walls, or ceilings; warped or loose boards, tile, linoleum, hand rails or railings; broken window panes; and any similar type hazard.

(b) The interior and exterior of the building shall be clean and in good repair. Loose, cracked or peeling wallpaper or paint shall be promptly replaced or repaired to provide a satisfactory finish.

(c) All furniture and furnishings shall be clean and in good repair, and contribute to creating a therapeutic environment.

(d) An adequate supply of linen shall be maintained to provide clean and sanitary conditions for each individual at all times.

(e) Mattresses and pillows shall have fire retardant covers or similar protection for fire safety and sanitation purposes.

(15) Compliance with Statutes and Rules. The program director or administrator shall ensure that the program complies with Chapter 394, F.S., and Chapters 65E-5, 65E-12, and 65E-14, F.A.C.

(16) Register of Individuals and Census. An admission and discharge logbook shall be maintained which lists individuals admitted sequentially by name with identifying information about each including age, race, sex, county of residence, disposition, and the actual location to which the individual was discharged or transferred. A daily census record shall be maintained which includes the name of individuals on the unit and on authorized pass. This may be maintained electronically, but shall be easily accessible to all relevant facility staff and administrators.

(17) Pharmaceutical Services.

(a) Every CSU and SRT must handle, dispense or administer drugs in accordance with the Department of Health’s Rule Chapter 65E-16, F.A.C.

(b) The professional services of a consultant pharmacist shall be used in the delivery of pharmaceutical services. Standards, policies and procedures shall be established by the consultant pharmacist for the control and accountability of all drugs kept at the program.

(18) Emergency Medical Services. Every CSU or SRT shall have written policies and procedures for handling medical emergency cases which may arise subsequent to an individual’s admission. All staff shall be familiar with the policies and procedures.

(a) Emergency Treatment Orders. Policies and procedures shall be written to address the use of emergency treatment orders as specified in Section 394.459, F.S., and Chapter 65E-5, F.A.C. They shall address the following:

Emergency treatment orders shall be initiated only upon direct order of a physician or psychiatrist;
The clinical justification shall be documented in the clinical record; and,
The use of standing, pro re nata (PRN), or routine orders for emergency treatment orders is prohibited.

(b) Cardiopulmonary Resuscitation and Choke Relief. All nurses and direct service staff shall be trained to practice basic cardiopulmonary resuscitation (CPR) and choke relief technique at employment or within 6 months of employment and have a refresher course at least every 2 years. There shall be one person on the premises at all times who is CPR certified and proficient in choke relief techniques. Training shall be documented in the personnel record of the employee. Consent for referral and the disclosure of vital information is not required in life-threatening situations.

(c) Medical Kit and Emergency Information. A physician, psychiatrist, consultant pharmacist, and registered nurse, designated by the program director or administrator, shall select drugs and ancillary equipment to be included in an emergency medical kit. The kit shall be maintained at the program and safeguarded in accordance with laws and regulations pertaining to the specific items included. A list of emergency programs and poison centers shall be maintained near a telephone for easy access by all staff.

(19) Protection of Individuals Receiving Services.

(a) Unauthorized Entry or Exit. Each CSU and SRT shall have policies and procedures regarding unauthorized entry to or exit from the unit.

(b) Control of potentially injurious items.

Policies and procedures shall prohibit the transmittal onto or carrying onto the unit sharps, flammables, toxins, weapons, caustic chemicals, rope, or other items potentially injurious to individuals on the unit.
Therapeutic activity materials shall also exclude similarly potentially hazardous items such as bats, paddles, mallets, knives, ropes, cords, wire clothes hangers, wire, sharp pointed scissors, luggage straps, and sticks.
Housekeeping supplies and chemicals shall, whenever practical, be non-toxic or non-caustic. The unit shall implement procedures to avoid access by individuals receiving services during use or storage.
Nursing and medical supplies including drugs, sharps, and breakables shall be safeguarded from access by individuals receiving services through storage, use, and disposal processes.

(c) Use of Restraint or Seclusion. Each CSU and SRT shall develop and maintain detailed policies and procedures for the use of seclusion and restraint. Such policies and procedures shall be readily available to CSU and SRT staff, individuals served, guardians, and others as specified by the individual.

(d) Suicide Precaution.

Suicide precaution is for the protection of individuals who have been assessed to be potentially suicidal and require a higher level of supervision.
The modification or removal of suicide precautions shall require clinical justification determined by an assessment and shall be specified by the attending physician or psychiatric nurse and documented in the clinical record. A registered nurse, clinical psychologist or other mental health professional may initiate suicide precautions prior to obtaining a psychiaric nurse’s, physician’s or psychiatrist’s order, but in all instances must obtain an order within 1 hour of initiating the precautions. Telephone orders shall be reviewed and signed by a psychiatric nurse or physician within 24 hours of their initiation.
Each CSU shall develop policies and procedures for implementing suicide precautions addressing: assessment, staffing, levels of observation and documentation. Policies and procedures shall require constant visual observation of individuals clinically determined to be actively suicidal.

(e) Other high risk behaviors, such as elopement and assaultive behavior, shall be addressed in the CSU and SRT policies and procedures.

(20) Nursing Services.

(a) Medical Prescription. Registered nurses shall ensure that each psychiaric nurse’s, physician’s, or psychiatrist’s orders are followed. When a determination is made that the orders have not been followed or were refused by the individual being served, the psychiaric nurse, physician or psychiatrist shall be notified within 24 hours. The registered nurse or nursing service shall substantiate this action through documentation in the individual’s clinical record.

(b) Nursing Standards. Each CSU and SRT shall develop and maintain a standard manual of nursing services which shall address medications, treatments, diet, personal hygiene care and grooming, clean bed linens and environment, and protection from infection.

(21) Continuity of Care. Upon admission, all individuals receiving services, in both a CSU and SRT shall be assessed for the need of case management services. If determined to need case management services, the individual shall be linked to a case manager in the community.

(22) Children. Every CSU and SRT which serves individuals under 18 years of age shall define, in policies and procedures, the services and supervision to be provided to the children. Minors under the age of 14 years shall not be admitted to a bed in a room or ward with an adult. They may share common areas with an adult only when under direct visual observation by unit staff. This shall be reviewed and documented on a daily basis.

(23) Collocation.

(a) Collocation means the operation of CSU and SRT, or CSU and substance abuse detoxification services from a common nurses’ station without treatment system integration. It may result in the administration of those services by the same organization and the sharing of common services, such as housekeeping, maintenance and professional services. A CSU shall be separated and secured by locked doors from the SRT and detoxification units.

(b) Whenever a CSU is collocated with an SRT or substance abuse detoxification unit there shall be no compromise in CSU standards. In all instances, whenever there is a conflict between CSU rules and SRT, substance abuse rules, the more restrictive rules shall apply.

(c) Individuals receiving CSU, SRT, and detoxification services shall not commingle or share a common space unless individually authorized by a physician’s, psychiatrist’s, or psychiatric nurse’s written order to participate in specific treatment and evaluation activities on other units as specified in the individual’s service plan. Service plan documentation shall include: type of activity, supervision, frequency of activity, and duration of each activity session.

(d) Collocation Staffing Requirements. CSU and SRT, or CSU and detoxification staff may be shared if the individual served-staff ratio is not violated and the health, safety and welfare of the individual is not jeopardized. When services are collocated and staff resources are shared, the staffing pattern shall be the more restrictive as required by this rule, based on the combined total number of beds. When the combined number of beds exceeds 30, nursing and direct service staff shall not be shared.

(24) Passes.

(a) A psychiaric nurse’s or physician’s order shall be written in accordance with unit policies and procedures specifying each occasion that an individual receiving services is permitted off unit and consistent with the service plan.

(b) Each written order shall specify: the clinical basis for the order; the necessity and purpose of the order; the level of supervision while off the unit; the staff designated responsible for the individual receiving services; and the authorized time of departure and return deadline which cannot exceed 24 hours for CSUs and 48 hours for SRTs.

(25) Smoking. Each CSU and SRT shall designate smoking areas or declare the facility non-smoking and shall post signs to so indicate. Areas frequented by smokers and non-smokers shall not be designated a smoking area. The facility shall ensure the operation of adequate smoke evacuation mechanisms to maintain a healthful air quality throughout.

(26) Personal Items. Individuals receiving services in CSUs and SRTs are entitled to wear their own clothing except when this right is restricted for safety. This restriction must be fully justified in the clinical record. Policies and procedures shall be developed which describe the utilization of special clothing, or describe unit restrictions concerning other potentially hazardous personal articles, such as sharps and ingestibles.

(27) Universal Infection Control. Each CSU and SRT shall develop and implement policies and procedures for universal infection control and prevention to protect people from blood and body fluid borne disease. Specific procedures shall include management of individuals who potentially have infectious diseases, such as Hepatitis B, Human Immunodeficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), or other infectious diseases. These procedures shall include: isolation, specific infection control techniques, availability of proper equipment, proper disposal of potentially infected waste, transfer, and the release of confidential information to select unit medical and direct care staff on a need-to-know basis. Any testing for HIV must be done in accordance with the Department of Health’s requirements as stated in Chapter 64D-2, F.A.C. Policies and procedures shall be regularly updated to include information provided by the department, the Department of Health, and the Center for Disease Control. All biohazardous waste must be handled and disposed in accordance with the Department of Health’s requirements as stated in Chapter 64E-16, F.A.C.

(28) HIV and AIDS Education Requirements. Each CSU and SRT must meet the Department of Health’s requirements for HIV and AIDS education pursuant to Section 381.0035, F.S., for each employee and individual receiving services and maintain records of such training.

(29) Unit operating policy and procedure manuals shall be organized and maintained for easy access and reference and available to all facility staff at all times. The CSU and SRT shall have a copy of Chapter 394, F.S., Chapters 65E-5 and 65E-12, F.A.C., on the unit available to all staff and individuals receiving services at all times.

(30) CSUs and SRTs shall ensure that the unit’s licensed professionals and other unit staff function together under a set of written reciprocal unit protocols. These protocols shall establish the sequence of activities to be performed, designate authorized or responsible personnel, and establish standards for the accuracy, completion, and comprehensiveness of activities.

History

Rulemaking Authority 394.457, 394.46715, 394.879(1), 394.907(8) FS. Law Implemented 394.455, 394.457, 394.4572, 394.459, 394.4615, 394.463, 394.77, 394.875, 394.879, 394.907 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.106, Amended 9-1-98, 10-4-00, 4-8-18.

Fla. Admin. Code R. 65E-12.107 Minimum Standards for Crisis Stabilization Units (CSUs)

In addition to Rules 65E-12.104, 65E-12.105, and 65E-12.106, F.A.C., above, these standards apply to CSU programs.

(1) Emergency Screening. All persons who apply for admission pursuant to Section 394.4625, F.S., or for whom involuntary examination is initiated pursuant to Section 394.463, F.S., shall be assessed by the CSU or by the emergency services unit of the public receiving facility. Each receiving facility shall provide emergency screening services on a 24-hours-a-day, 7-days-a-week basis and shall have policies and procedures for identifying individuals at high risk. No person can be detained for more than 12 hours without being admitted or released. Everyone for whom involuntary examination is initiated pursuant to Section 394.463, F.S., shall receive a face-to-face examination by a physician or clinical psychologist prior to release. The examination shall include a psychiatric evaluation, including a mental status examination, or a psychological status report.

(a) Unit policies and procedures shall be written concerning the detainment of persons who are awaiting an involuntary examination and disposition. These procedures shall address protection from harm, and the prevention of departure from the unit prior to the examination.

(b) Referral. Individuals referred, or to be referred, to a receiving facility under Chapter 394, Part I, F.S., who also require treatment for an acute physical condition shall be delivered and, if appropriate, admitted to an emergency medical or inpatient service for health care until medically cleared and stabilized to meet the CSU’s medical criteria as prescribed in its policies and procedures. Medical clearance shall be documented in the clinical record.

(c) Paying Fees. Individuals who can pay for services and who wish to be admitted to a private hospital facility authorized to provide services under Chapter 394, Part I, F.S., may be referred without prior examination by the receiving facility.

(2) Admission.

(a) All persons admitted to a CSU shall be admitted pursuant to Chapter 394, Part I, F.S., and Chapter 65E-5, F.A.C. Each CSU shall provide admission services on a 24-hours-a-day, 7-days-a-week basis.

(b) Initial Assessment.

Upon admission to the CSU an emotional and behavioral assessment as specified in subsection (d), below, shall be made based on facility program policy and procedures. This assessment shall be made by a mental health professional, registered nurse, or other unit staff under the supervision of a mental health professional. The consultation of a physician, psychiatrist, or clinical psychologist shall be available to the CSU staff for purposes of assisting in this assessment. Examination and disposition of a person who has been admitted involuntarily shall be in accordance with the provisions of Section 394.463, F.S.
All persons admitted to a CSU shall be provided a nursing assessment, begun at time of admission and completed within 24 hours, by a registered nurse as part of the assessment process.

(c) Physical Examination. All persons admitted to a CSU shall be provided a physical examination within 24 hours of admission, based on program policies and procedures. The physical examination shall include a complete medical history and documentation of significant medical problems. It shall contain specific descriptive terms and not the phrase, “within normal limits.” General findings shall be written in the clinical records within 24 hours.

(d) Emotional and Behavioral Assessment. For everyone admitted to a CSU an emotional and behavioral assessment shall be completed within 72 hours and entered into the clinical record. The assessment shall be made by a mental health professional or other unit staff under the supervision of a mental health professional. The assessment shall include the following.

A history of previous emotional, behavioral, and substance abuse problems and treatment.
A social assessment to include a determination of the need for participation of family members or significant others in the individual’s treatment; the social, peer-group, and environmental setting from which the person comes; family circumstances; current living situation; employment history; social, ethnic, cultural factors; and childhood history.
A direct psychiatric evaluation to be completed by a physician or psychiatrist to include a mental status examination which includes behavioral descriptions, including symptoms, not summary conclusions, and concise evaluation of cognitive functioning. A diagnosis, made by the physician or psychiatrist, shall be recorded in the clinical record, with a minimum of Axes I, II, and III, from the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Washington, DC, American Psychiatric Association, 1987, which is incorporated by reference and may be obtained from the American Psychiatric Association, 1400 K Street, N.W., Washington, DC 20005.

(e) Laboratory Work. Laboratory work and other diagnostic procedures deemed necessary shall be performed as ordered by the physician or psychiatrist.

(3) Medical Care.

(a) The development of medical care policies and procedures shall be the responsibility of the psychiatrist or physician. The policies and procedures for medical care shall include the procedures that may be initiated by a registered nurse in order to alleviate a life threatening situation. Medication or medical treatment shall be administered upon direct order from a physician or psychiatrist, and orders for medications and treatments shall be written and signed by the physician or psychiatrist.

(b) There shall be no standing orders for any medication used primarily for the treatment of mental illness.

(c) Every order given by telephone shall be received and recorded immediately only by a registered nurse with the physician’s or psychiatrist’s name, and signed by the physician or psychiatrist within 24 hours. Such telephone orders shall include a progress note that an order was made by telephone, the content of the order, justification, time and date.

(d) Physical, medical and nursing care standards shall provide for continuity and follow-up of acute medical problems.

(4) Service Implementation Plan. A service implementation plan shall be initiated by the service plan manager with documented input from the person receiving services and signed by the person receiving services, the responsible physician, psychiatrist, or a staff member privileged by policies and procedures within 24 hours of the individual’s admission. The CSU shall develop a service implementation plan that has objectives and action steps written for the person in behavioral terms. The objectives shall be related directly to one or more goals in the person’s comprehensive service plan, if there is one. The plan shall be fully developed within 5 days of admission and must contain short-term treatment objectives stated in behavioral terms relative to the long-term view and goals in the comprehensive service plan, if there is one, an aftercare plan, and a description of the type and frequency of services to be provided in relation to treatment objectives. A copy of the service implementation plan shall be provided to the person receiving services and his guardian as provided for by law.

(5) Required CSU Services.

(a) Each CSU shall provide the following services on a 24-hour-a-day, 7-days-a-week basis:

Emergency reception,
Evaluation,
Observation,
Crisis counseling,
Therapeutic activities, including recreational, educational, and social, whose intent is to involve the individual in reality-oriented events and interpersonal interactions shall be provided 3-hours-a-day, 7-days-a-week, with participation and non-participation documented in the individual’s clinical record; and,
Referral to other service components of a mental health agency, a private care facility, or another appropriate care agency.

(b) Routine Activities. Basic routine activities for persons admitted to a CSU shall be delineated in program policies and procedures which shall be available to all personnel. The daily activities shall be planned to provide a consistent, well structured, yet flexible, framework for daily living and shall be periodically reviewed and revised as the needs of individuals or the group change. Basic daily routine shall be coordinated with special requirements of the service implementation plan. A schedule of daily activities shall be posted or otherwise available to all persons receiving services.

(c) Off premises activities by two or more persons being served are not permitted except in cases as documented in the individual’s clinical record pursuant to subsection 65E-12.106(24), of this rule.

(d) Continuity of Care.

Discharge Preparation. Prior to discharge or departure from the CSU, the staff with the consent of the person receiving services shall work with the individual’s support system including family, friends, employers and case manager, as appropriate, to assure that all efforts are made to prepare the individual for returning to a less restrictive setting.
Referral Services. All CSUs shall develop and maintain written referral agreements.

(e) Referral to Hospital Inpatient Care. The CSU shall have access to a hospital inpatient unit to assure that individuals being referred are admitted as soon as necessary.

(f) Transportation. The CSU shall provide or have access to transportation to a hospital inpatient unit on an emergency basis when necessary.

(g) Laboratory and Radiology Services.

Requirement. The CSU shall provide or contract with licensed laboratory and radiology services commensurate with the needs of the persons receiving services.

a. Emergency. Provision shall be made for the availability of emergency laboratory and radiology services 24-hours-a-day, 7-days-a-week, including holidays.

b. Orders. All laboratory tests and radiology services shall be ordered by a physician or psychiatrist.

c. Records. All laboratory and radiology reports shall be filed in the clinical record.

d. Specimens. The CSU shall have written policies and procedures governing the collection, preservation and transportation of specimens to assure adequate stability of specimens.

Contracts. When the CSU depends on an outside laboratory or radiology clinic for services, there shall be a written contract detailing the conditions, procedures and availability of work performed. The contract shall be reviewed and approved by the CSU director or administrator.

(6) Space. Each person receiving services shall be provided a minimum of 175 square feet of usable client space within the CSU. Bedrooms shall be spacious and attractive, and activity rooms or space shall be provided.

(7) Locked Doors. CSU facilities shall be locked to provide reasonable control over access to and egress from the unit and emergency reception areas. When individuals are moved to other areas, the pathways shall also be locked or have adequate control provisions to prevent elopement. Such controlled passageways shall include access to the emergency reception area, unit proper, off unit doorways, and recreational areas. All unit door locks shall employ a common key for rapid access in emergency situations with quick releasing or single-turn mechanisms.

History

Rulemaking Authority 394.457(5), 394.879(1), (2) FS. Law Implemented 394.459(2), 394.463, 394.465, 394.875, 394.879(1) FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.107, Amended 9-1-98.

Fla. Admin. Code R. 65E-12.108 Minimum Standards for Short-Term Residential Treatment Programs (SRT)

In addition to Rules 65E-12.104, 65E-12.105, and 65E-12.106, F.A.C., above, these standards apply to SRT programs.

(1) Admission Criteria.

(a) Referral Required. People may be admitted to an SRT only following a psychiatric or psychological evaluation and referral from a CSU, inpatient unit, or a designated public or private receiving facility.

(b) Admission. All individuals shall be admitted pursuant to Chapter 394, Part I, F.S., and Chapter 65E-5, F.A.C., and only on the order of a physician or psychiatrist.

(2) Nursing Assessment and Physical Examination. All persons shall be given a nursing assessment and shall be given a physical examination within 24 hours of admission. The physical examination shall include a complete medical history and documentation of significant medical problems. It must contain specific descriptive terms and not the phrase, “within normal limits.” If the person received a physical examination at an inpatient program or CSU prior to transfer to the SRT, no further physical examination will be necessary unless clinically indicated or it does not meet the requirements of this section. General findings must be written in the individual's clinical record within 24 hours.

(3) Emotional and Behavioral Assessment. For all individuals who are admitted to an SRT an emotional and behavioral assessment shall be completed and entered into the individual’s clinical record within 72 hours. The assessment shall be made by a mental health professional or other unit staff under the supervision of a mental health professional. If the individual received an assessment at an inpatient program or CSU prior to transfer to the SRT, another assessment is not required unless clinically necessary or it does not meet the requirements of this section. The assessment shall include the following.

(a) A history of previous emotional, behavioral, and substance abuse problems and treatment.

(b) A social assessment to include a determination of the need for participation of family members or significant others in the person’s treatment; the social, peer group, and environmental setting from which the person comes; family circumstances; current living situation; employment history; social, ethnic, cultural factors; and childhood history.

(c) A direct psychiatric evaluation to be completed by a physician or psychiatrist to include a mental status examination which includes behavioral descriptions, including symptoms, not summary conclusions, and concise evaluation of cognitive functioning. A diagnosis, made by the physician or psychiatrist, shall be recorded in the individual’s clinical record, with a minimum of Axes I, II, and III, from the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised, Washington, DC, American Psychiatric Association, 1994.

(d) When indicated, a psychological assessment including intellectual, projective, and personality testing. The assessment shall also include specifications of the behaviors that will be demonstrated in order for the individual to return to a less restrictive setting and recommended intervention strategies.

(e) When indicated, other functional evaluations of language, self-care, and social-affective and visual-motor functioning.

(4) Medical Care.

(b) There shall be no standing orders for any medication used primarily for the treatment of mental illness.

(5) Comprehensive Service and Implementation Plans. At the time of admission to the SRT the previously completed comprehensive service plan shall be reviewed and revised as needed with the person’s service plan manager. The SRT shall develop a service implementation plan which has objectives and action steps written for the person in behavioral terms. The objectives shall be related directly to one or more goals in the person’s comprehensive service plan. The service implementation plan shall be initiated with documented input from the person receiving services and signed by the responsible physician or psychiatrist or a staff member privileged by policies and procedures within 24 hours of admission. The service implementation plan shall be fully developed within 5 days of admission and must contain short-term treatment objectives stated in behavioral terms, relative to the long-term view and goals in the comprehensive service plan, and a description of the type and frequency of services to be provided in relation to treatment objectives. The plan shall be reviewed and updated at least every 30 days. A copy of the plan shall be signed by and provided to the individual and his guardian as provided by law. A new aftercare plan shall be developed prior to discharge from the SRT.

(6) Previous Record. For individuals who enter the SRT as a continuation of care, transfer from an inpatient program or CSU, the previously completed intake interview, physical examination, medication log, progress notes, discharge or aftercare plan, and forms under Chapter 65E-5, F.A.C., shall be made a part of the SRT clinical record.

(7) Required SRT Services.

(a) Services. Each SRT shall provide the following services on a 24-hour-a-day, 7-day-a-week basis:

Twenty-four hour supervision,
Individual, group, and family counseling services directed toward alleviating the crisis or symptomatic behavior which required admission to an SRT,
Medical or psychiatric treatment,
Social and recreational activities, inside and outside the context of the facility,
Referral to other less restrictive, nonresidential treatment services, when appropriate. Each SRT shall have access to the CSU, if one exists in the area, and to hospital emergency services in the event of a crisis that cannot be managed within the facility; and,
Each SRT shall provide or have access to transportation in order to accomplish emergency transfers and to meet the service needs of persons served.

(b) Routine Activities. Basic routine activities for persons admitted to an SRT shall be delineated in program policies and procedures which shall be available to all personnel. The daily activities shall be planned to provide a consistent, well structured, yet flexible, framework for daily living and shall be periodically reviewed and revised as the needs of individuals or the group change. Basic daily routine shall be coordinated with special requirements of each service implementation plan. A schedule of daily activities shall be posted or otherwise available to all persons receiving services.

Requirement. Every SRT shall provide or contract for licensed laboratory services commensurate with the individual’s needs.

a. Emergency. Provision shall be made for the availability of emergency licensed laboratory services on a 24-hour-a-day, 7-day-a-week basis including holidays.

b. Orders. All laboratory tests and services shall be ordered by a physician or psychiatrist.

c. Record. All laboratory reports shall be filed in the individual's clinical record.

d. Specimens. Each SRT shall have written policies and procedures governing the collection, preservation and transportation of specimens to assure adequate stability of specimens.

Contracts. Where the SRT depends on an outside laboratory for services, there shall be a written contract detailing the conditions, procedures and availability of work performed. The contract shall be reviewed and approved by the SRT director or administrator.

(d) Continuity of Care.

Discharge Preparation. Prior to discharge or departure from the SRT, the staff with the individual’s consent shall work with the individual’s support system including family, friends, employers and case manager, as appropriate, to assure that all efforts are made to prepare the individual for returning to a less restrictive setting.
Referral Services. All SRT facilities shall develop and maintain written referral agreements.

(e) Each SRT shall have access to a hospital inpatient unit to assure that referred persons are admitted as soon as necessary.

(8) Space. Each person receiving services shall be provided a minimum of 175 square feet of usable client space within the SRT. Bedrooms shall be spacious and attractive, and activity rooms or space shall be provided.

(9) Access and Egress. Each SRT shall provide reasonable control over access to and egress from the unit and recreational area.

History

Rulemaking Authority 394.879(1), (2) FS. Law Implemented 394.875 FS. History–New 2-27-86, Amended 7-14-92, Formerly 10E-12.108, Amended 9-1-98.

Fla. Admin. Code R. 65E-12.109 Minimum Construction Standards for New CSU and SRT Facilities Initially Licensed After July 14, 1993

(1) General Provisions.

(a) Construction Requirements.

New facility construction and additions, refurbishing, renovations and alterations to existing facilities shall comply with the following codes and standards:

a. The building codes described in Rule 9B-3.047, F.A.C.,

b. The fire codes contained in Chapter 59A-3, F.A.C., as described in the National Fire Protection Association (N.F.P.A.) 101, Chapters 12 and 13, Special Definitions, as applicable to limited health care facilities, which is included by reference in Chapter 59A-3, F.A.C.,

c. The accessibility by handicapped persons standards in Chapter 553, Part V, F.S.; and,

d. The federal Americans with Disabilities Act as referenced in Chapter 59A-3, F.A.C.

Modernization or Renovation. Any alteration, or any installation of new equipment, shall be accomplished, as nearly as practical, in conformance with the requirements for new construction. Alterations shall not diminish the level of safety or usable client space below that which exists prior to the alteration. Life safety features which do not meet the requirements for existing buildings shall not be further diminished. Life safety features in excess of those required for new construction are not required to be maintained. In no case shall the resulting life safety be less than that required for existing buildings.
Sewage, including liquid wastes from cleaning operations, shall be disposed of in a public sewage system or other approved sewage system in accordance with Chapters 381 and 403, F.S.
All sanitary facilities shall comply with the requirements of Chapter 64E-10, F.A.C.
All plumbing shall comply with the requirements of Chapter 9B-51, F.A.C., Plumbing, or with the plumbing code legally applicable to the area where the facility is located.
The water supply must be adequate, of safe and sanitary quality and from an approved source in accordance with Chapter 381, F.S., and Chapter 64E-4, F.A.C.
Appropriate health and sanitation inspections and a Certificate of Occupancy shall be obtained before occupying any new facility or addition. A report of the most recent inspections must be on file and accessible to authorized individuals.
No unsprinkled building classification as defined in the 1985 Standard Building Code, as incorporated by reference in Chapter 59A-3, F.A.C., is allowed.
All facilities shall be protected throughout by an approved automatic sprinkler and smoke detection system to include a smoke detector in every bedroom. Provision must be made for automatic emergency forces notification.
Surge protection in compliance with the National Electric Code Article 280, as incorporated by reference in Chapter 59A-3, F.A.C., shall be installed to protect each service entrance equipment and have integral visual indication of surge protector failure. Additional surge protection shall be provided for all low voltage and power connections to all electronic equipment and conductors entering or exiting the building and other life safety systems equipment such as fire alarm, telephone, and nurse call. Protection shall be in accordance with appropriate IEEE standards for the type of equipment being protected.

(b) Overall Functional Design.

The CSU or SRT shall be designed to provide a locked perimeter around a living unit and fenced exercise area within which individuals can reside 24-hours-a-day in an environment designed to minimize potential for injury. The CSU or SRT structure shall be single story ground level facility. These facilities shall have separate off-unit reception and administration areas which may also be locked. Service corridors and pathways to other non-unit activities shall not be through the locked CSU or SRT unit.
The walls throughout all client areas of the CSU or SRT shall either be concrete block or a double layer of gypsum wallboard or three-quarter inch think plaster or metal lath to minimize maintenance of the facility. The general architecture of the unit shall provide for optimal line-of-sight observation from the nurses’ station throughout the unit, minimizing hidden spots and blind corners.
The CSU or SRT shall be designed to create a pleasant functional therapeutic environment throughout, by the use of sunlight, colors, designs, textures, and furnishings. The design shall achieve a secure unit which looks more residential than institutional in its construction and furnishings, while incorporating substantial safety considerations throughout.
The CSU or SRT shall be designed in order that the general unit be divided into a close observation area and a general observation area based upon the need for frequent physical proximity, singular observation of individuals, and lowered stimulation levels. These areas do not need physical separation; for example, they may be the left and right sides of the unit.

a. Close Observation Area. This area shall include persons brought onto the CSU or SRT needing initial observation or restraints, individualized observation, and lowered stimulation levels, all of which require the frequent physical proximity of nurses. This area shall be directly adjacent to the primary unit doorway and nurses’ station. The immediately adjacent rooms shall be used for single occupancy and restraint or seclusion. These rooms shall be remote from routine high activity areas and corridors.

b. General Observation Area. This shall include areas where persons routinely congregate or walk through such as multi-occupant bedrooms, activity rooms, smoking areas, dining room and routine traffic corridors, or pathways. The dining and activity areas shall be directly observable, or under constant staff supervision, but may be a greater distance from the nurses’ station.

All areas of CSUs and SRTs shall be ventilated by central, ducted supply and return forced air systems. Toilets, bathrooms and soiled function rooms shall be mechanically exhausted to the outside. Ventilation units shall distribute tempered heated or cooled air to all spaces and shall supply outside air in the quantity of either the sum of all exhausts or 20 cfm per person whichever is greater. The quality of all exhausts must match the intake volume of all outside air. Supply, exhaust, and return fans shall run continuously while the building is occupied. Areas in which smoking is permitted shall be well vented by at least 35 cfm per person to the outside in order to minimize smoke diffusion throughout the unit.
All doors opening directly onto the unit from non-client rooms or office areas shall be equipped with locksets which are key released to leave the client area and permit unobstructed return to the client area. Door closures are required to deny persons receiving services accidental unsupervised access to the contents of staff offices, janitorial closets, and mechanical areas.
Corridors shall ensure maximum clear distances by recessing water fountains and fire extinguishers, or placing them in alcoves. Corridors in client areas must be at least a six foot clear width; non-client areas must be at least 44 inches minimum clear width. Corridor ceilings shall be a minimum height of seven feet six inches.
Hot and cold running water under pressure shall be readily available in all washing, bathing, food preparation, and food handling areas. Hot water in client areas shall be at least 100 degrees Fahrenheit, but not exceed 120 degrees Fahrenheit.
The minimum size for doors shall be no less than three feet wide and six feet eight inches high. Areas accessible to persons with physical disabilities shall comply with applicable codes and standards.
Since glass fragments are a safety hazard throughout the unit, the use of glass shall be minimal.
All television sets must be securely fastened.
Door closures shall not be utilized in unobserved client areas.
All CSUs and SRTs equipped with electronic locks on internal doors or egress doors shall ensure that such locks have manual common key mechanical override that will operate in the event of a power failure or fire. Egress pathways and doors shall be locked as provided for in Life Safety Code, National Fire Protection Association (N.F.P.A.) 101, Chapter 12, as incorporated by reference in Chapter 59A-3, F.A.C.
CSUs and SRTs with electronic or magnetic door locks or other fundamental operational components which are electric shall have either: a battery back-up system rated for facility emergency power draw and capable of sustaining door locks and emergency operations for a minimum period of 6 hours; or an emergency generator with transfer switch with a battery pack back-up system capable of operating for 2 hours at facility emergency power draw level.
The use of door vision panels and windows shall minimize the opportunity for isolation of staff or persons served in unobserved areas. This does not include privacy provisions such as bathrooms and bedrooms.

(2) Uniform Specifications.

(a) Design shall ensure that each person receiving services in a CSU or SRT is provided a minimum of 175 square feet of usable client space.

(b) Tamper-resistant screws shall be used to protect electrical switches and outlets throughout the facility in all areas accessible to persons receiving services. Lighting fixtures shall be tamper-proof type throughout the facility in all areas accessible to persons receiving services.

(c) All electrical switches and outlets in wet areas shall be ground-fault protected with a remote breaker switch. Tamper-proof, safety type duplex outlets shall be used in all areas accessible to persons receiving services.

(d) Air ducts shall be covered with a perforated type metal grill, not residential louvered grills, throughout the unit in all areas accessible to persons receiving services.

(e) All hose bibs shall be equipped with a vacuum breaker device.

(f) The unit shall have a minimum of one drinking fountain.

(g) Ceiling height in bedrooms, activity areas, and bathrooms shall be at least nine feet.

(h) The operation of all perimeter locks shall ensure reasonable control over both access and egress.

(3) Administration and Public Areas.

(a) Waiting rooms shall have an adjacent rest room which is designed to accommodate persons with physical disabilities.

(b) The entrance shall be grade-level, sheltered from inclement weather and accessible to persons with physical disabilities.

(c) The lobby shall include a drinking fountain and space for clerical personnel. Private interview space for emergency screening of voluntary persons shall be adjacent to the lobby.

(4) Emergency Screening Area For CSUs.

(a) This shall be a locked area in which law enforcement admissions may be received. This area shall not be wholly isolated visually from the CSU to provide safety for emergency screening personnel who may become isolated in this area. This area shall provide for medical clearance, emergency screening, bathroom facilities, and other activities which may be necessary.

(b) A separate entrance shall be provided directly to emergency screening areas and examination rooms for law enforcement personnel. It shall have a driveway where a law enforcement vehicle can pull immediately adjacent to the building before transferring a person through the separate entrance to the emergency screening area. The law enforcement entrance shall also have a lock box where the law enforcement officer can lock his weapons during such time as he is in the facility.

(c) A separate bathroom with supervised shower area shall be located so that all persons being admitted may be showered before being admitted to the residential section of the unit.

(5) Seclusion Rooms.

(a) Each CSU shall have a minimum of two seclusion rooms that shall share a common vestibule with a bathroom off the vestibule area. Each SRT shall have at least one seclusion room. Seclusion rooms shall be free of sharp edges or corners and be strongly constructed to withstand repeated physical assaults. Walls shall be either concrete block or double layered to provide resistance and be smooth. The ceilings shall be nine feet in clear height, hard-coated, and lighting fixtures recessed and tamper-proof. Lighting fixtures shall be nonbreakable, preferably Lexan, and shall be installed with tamper-proof screws, as shall any other items in the seclusion rooms. The seclusion room door shall be heavy wood or metal at least 36 inches in width and shall open outward. The door frame shall be heavy steel and shall be thoroughly bolted into the wall and cemented in.

(b) At least one seclusion room in the CSU shall have a sturdily constructed bed, without sharp edges and bolted to the floor. A bed in the SRT seclusion room is optional; however, if present, the bed shall meet the same requirements as specified for the CSU. Its placement in the room shall provide adequate space for staff to apply restraints and not assist individuals in tampering with the lights, smoke detectors, cameras, or other items that may be in the ceiling of the room. There shall be a rheostat control mechanism outside the room to adjust the illumination of the light in the seclusion room.

(c) The floor and walls, up to a height of three feet, shall be coated with an impermeable finish to resist penetration of body fluids. One seclusion room shall have a floor drain. A hose bib shall be in a readily adjacent area such as a bathroom.

(d) There shall be a vision panel in the door of the seclusion room, no larger than eight inches by eight inches, which provides a view of the entire room. This vision panel shall be Lexan or other suitably strong material and it shall be securely mounted in the door. Provisions shall be made to ensure privacy from the public and other persons receiving services while providing easy access for staff observation.

(e) Seclusion rooms shall be a minimum of 70 square feet and a minimum room dimension of nine feet.

(f) Fire sprinkler heads shall be ceiling mounted and either recessed or flush mounted type without a looped spray dispersal head.

(g) A voice activated and switchable emergency calling system for monitoring persons receiving services shall be provided in each seclusion room.

(h) Each seclusion room shall have an electronic visual monitoring system capable of viewing the entire room and be monitored from the nurses’ station.

(6) Janitor’s Closet.

(a) A janitor’s closet shall be on the unit. It shall contain a floor receptor for mop water and provide space for mop bucket, brooms, and other minimal items. Caustic and other dangerous chemicals shall not be stored in this closet.

(b) This closet shall have an automatic door closer and have automatic relocking type lock.

(7) Bathrooms.

(a) Access to a bathroom shall not be through another person’s bedroom. Bathrooms shall provide space, in addition to bathing, for dry clothes and changing of clothes and for observation staff. The shower head shall be recessed or have a smooth curve from which items cannot be hung. There shall be no overhead rod, privacy stall supports, protrusions, or fixtures capable of carrying more than 40 pounds of weight. The ceiling shall be hard coated. Sprinkler heads shall be either recessed or a flush mounted type dispersal head. The toilet shall be a flushometer-type, not residential with water tank and cover. Toilets shall be of heavy duty construction securely fastened to the floor and have seats with locking nuts. Secure cleanout access shall be provided for the toilet to clean out plugs and pipes. Floor drains in bathroom areas shall be of sufficient size that they cannot be plugged by standing on them.

(b) Mirrors shall not be common glass. A polycarbonate mirror, fully secured, and flat-mounted to the wall is required. Polished metal mirrors shall not be permitted.

(d) Bathroom fixtures, shower, lavatory, and toilet shall be readily accessible from a common area. If not accessible from a common area, they will be deemed to be available only to the occupants of directly adjoining bedroom or bedrooms.

(e) Each CSU and SRT shall have a bathroom of sufficient size for use by persons with physical disabilities. It shall include toilet, lavatory, shower, and safety grab bars for shower and toilet.

(f) The facility shall have a minimum ratio of one shower for each eight persons receiving services and one toilet and lavatory for each six persons receiving services. Individual shower stalls and dressing areas shall be provided. The use of gang showers is prohibited.

(8) Nurses’ Station.

(a) The nurses’ station shall be positioned so that the unit may be under constant direct visual surveillance. Charting and records areas shall be located in the rear of the nurses’ station, and not in a separate area, so that staff on duty can readily observe the client areas. A bathroom shall be nearby for staff use. The nurses’ station, if separated from client areas, shall utilize either Lexan or safety wire glass for enclosure to above counter top level. If not enclosed the counter top shall be at least 18 inches in width.

(b) Thirty is the maximum number of beds which may be served by a common nurses’ station in collocated units, as described in subsection 65E-12.106(23), of this rule.

(c) The nurses’ station, which functions as the primary control center, shall have necessary electronic assistance such as camera monitors and intercoms in more remote areas where persons may become isolated. Areas warranting visual and auditory monitoring includes remote entrance or egress doors, isolated hallways, after hours law enforcement entrance, emergency screening area, and fenced recreational yard.

(9) Medication Room. The medication room shall be located near the nurses’ station. The medication room shall have a sink, refrigerator, locked storage, and facilities for dispensing medication. Security against unauthorized access must be assured. The refrigerator shall store medications and clean materials only.

(10) Examination Room. A suitable examination room shall be provided for physical examinations, nursing assessments, and other related medical activities. It shall include a sink for handwashing.

(11) Bedrooms.

(a) Ceilings shall be non-accessible to prohibit persons receiving services from entering attic spaces or having access to overhead pipes and beams. Light switches and electrical outlets shall be secured with non-tamper type screws. When feasible each bedroom shall have a window, operable by staff, with an exterior view. Window sills shall not exceed a height of 36 inches above floor level and should incorporate protective screens or Lexan type material to prevent direct access to glass surfaces. There should be no overhead protrusions available for hanging in excess of 40 pounds weight.

(b) Beds and other heavy furniture suitable for barricading the door shall be secured to the floor or walls.

(c) Multiple occupant bedrooms shall be limited to a maximum of four occupants and shall be a minimum size of 60 square feet per bed with no less than a 30 inch separation between beds. Single occupant bedrooms shall be a minimum of 80 square feet.

(d) Bedroom doors shall be a minimum of 36 inches wide.

(12) Kitchen and Nourishment Preparation Area.

(a) Preparation or food handling areas shall have water and plumbing fixtures suitable for cleaning dining utensils. The requirements for nourishment preparation areas is less than that of kitchens due to the minimal scale of operations for these areas. If these areas are accessible to persons receiving services, they should include appropriate safety considerations for sharp and other dangerous instruments and the elimination of hot surfaces. Space shall be provided for disposal of wet garbage. Refrigeration and freezer space shall be provided in these areas for the carry-over of a minimum amount of perishable food.

(b) Kitchens shall comply with Chapter 64E-11, F.A.C., Food Preparation and Sanitation Requirements, as well as the 1985 National Fire Protection Association, Section 101, Chapters 12 and 13, Fire Safety Requirements as incorporated by reference in Chapter 59A-3, F.A.C. Kitchens shall be designed with flow-through type operation where food arriving is immediately placed into dry storage or freezer units without walking through food preparation areas. The flow-through type system would provide for the preparation of food, serving and dishes returned with garbage and waste going out to an adjacent dumpster and can-wash with water collection curbing and drain. A concrete pad shall be provided for the trash dumpster and garbage truck entrance.

(c) Kitchens shall be equipped with fire-suppression hoods and through-wall grease laden air evacuation and ventilation systems. All electrical outlets shall be ground-faulted. If meals are to be served via an open area, directly from the kitchen, this area shall have a fire-rated steel retractable overhead door type mechanism to continue the firewall protection around the kitchen area. Kitchens shall have heat detectors rather than smoke sensors.

(d) External to the kitchen, and outside the waste exit door, there shall be a curbed slop sink for mops and dirty kitchen water with an immediately accessible hose bib and drain. This area shall be external to the kitchen area, but immediately adjacent to it, to provide ready disposal of waste water as well as for the removal of cleaning items from the kitchen when they are not in use.

(e) There shall be a large food storage pantry in or adjacent to the kitchen.

(f) Facilities utilizing off-site kitchens for food preparation shall have an on-site food reception, warming, and holding area of sufficient size and with sufficient equipment to warm and hold food for each meal served. Required space shall include provision for proper disposal or holding of used implements and disposal of wet garbage in accordance with Chapter 64E-11, F.A.C.

(13) Dining Area. Each CSU or SRT shall have an attractive dining area on the unit. Seating capacity shall reflect the licensed capacity of the entire CSU or SRT, although residents may eat or be served in shifts during daily operations. Individual, rather than bench seating, shall be used for easy floor cleaning.

(14) Unit Laundry Facilities.

(a) Provision shall be made for the storage of soiled laundry in an adjacent, isolated, fire-resistant area.

(b) Each CSU or SRT shall have a personal laundry room which shall incorporate a flow-through design in which dirty laundry enters, is sorted, placed in the washer, dried, folded and moved out without crossing clean laundry with dirty laundry. CSUs and SRTs shall have a small washer and dryer for immediate unit needs and to wash clothes. These washing and drying units shall be equipped to sanitize clothes as a preventive measure of infection control.

(c) The soiled laundry room shall have a locked door equipped with automatic door closer to restrict access to cleaning chemicals. The soiled laundry room air shall be exhausted outside the facility.

(15) Clean Laundry Room.

(a) A separate space shall be provided for clean laundry capable of storing an adequate supply of laundry for the size of the CSU or SRT. The laundry closet shall have a locked door to prevent access to these items by persons receiving services.

(b) Items stored on the top shelf shall provide an 18 inch clear space from sprinkler heads so as to not block dispersal of water.

(16) Fenced Recreational Area.

(a) CSUs and SRTs shall have a no less than six foot high fenced, out-of-doors area where persons receiving services may have access to fresh air and exercise. It must provide privacy for persons receiving services otherwise exposed to public view. This area shall be constructed to retain persons inside the area and minimize elopements from the area, although it is not a secure area.

(b) The fenced area shall provide some shaded area where persons receiving services may be out of doors without being in direct sunlight or may receive sunlight as they desire. The enclosing fences shall have an exit gate which is located away from the building as a secondary egress from the fenced area, for use in fire situations, or access by lawn maintenance equipment. The gate shall be provided with a lock which is readily accessible from both sides. The area of this fenced enclosure shall be at least 1,100 square feet including an activity area having dimensions of not less than 20 feet by 40 feet.

(c) Objects shall not be placed near the fence to provide a ready step ladder over the fence and, if fabric fencing is used, the horizontal bracing used for corners shall be outside the fabric to preclude its use as an escape ladder step. The fenced area shall be designed, without blind corners, to be readily visible by one staff member standing in a central location. If desired, the fence may be topped with a 45 degree inward slanting restraining type wire. The use of barbed wire and other sharp injurious materials, however, is prohibited.

(d) This area, as all other primary fire exit routes, shall have egress lighting which is connected to the power side of the facility electrical panel so that in the event of a fire and electrical panel disconnect, the exit and congregation areas would still have lighting.

(17) Multi-Purpose Room. In addition to open, on-unit floor space, each CSU and SRT shall have an accessible multipurpose room for group activities of at least 180 square feet. This area may be the dining area.

(18) Furnishings.

(a) CSU and SRT furniture shall be durably constructed for heavy wear and use. Furniture shall not be readily throwable. Furnishings shall have a flame resistant rating.

(b) Hollow-based type furniture shall not be used as they provide ready concealment of contraband items such as medications, sharps, wires, or cords.

(d) Bedroom furniture shall provide limited storage space since individuals stay a short period of time and personal supplies are limited.

(e) Within the above constraints, furniture shall contribute to the appearance of a residential rather than institutional environment.

(19) Off Unit Storage Areas.

(a) Each CSU and SRT shall have appropriate storage, in non-client areas, for operating supplies and materials.

(b) Adjacent non-client area storage for personal belongings must be a minimum of eight cubic feet for each person receiving services.

History

Rulemaking Authority 394.879(1), (2) FS. Law Implemented 394.875 FS. History–New 7-14-92, Formerly 10E-12.109, Amended 9-1-98.

Fla. Admin. Code R. 65E-12.110 Integrated Crisis Stabilization Unit and Addictions Receiving Facility Services

(1) General Provisions.

(a) All the requirements for licensure and operation as a Crisis Stabilization Unit (CSU) that are otherwise required by Chapters 65E-12 and 65E-5, F.A.C., shall apply, except as provided for in this rule.

(b) The requirements for licensure and operation as an addictions receiving facility (ARF) that are otherwise required by Chapter 65D-30, F.A.C., shall not apply except as provided for in this rule.

(c) This rule applies both to integrated adult Crisis Stabilization Unit (CSU) and addictions receiving facility (ARF) services (as described in Section 394.4612, F.S. and hereafter referred to as “adult CSU/ARFs”; and to children’s Crisis Stabilization Unit (CSU) and addictions receiving facility (ARF) services, as described in Section 394.499, F.S., and hereafter referred to as “children’s CSU/ARFs.” Adult CSU/ARFs and children’s CSU/ARFs may hereafter collectively be referred to as “CSU/ARFs.”

(2) Eligibility Criteria.

(a) Adult CSU/ARFs shall serve individuals 18 years of age and older who present with a serious and acute mental illness or substance abuse impairment, or with co-occuring mental illness and substance abuse disorders.

(b) Children’s CSU/ARFs shall serve individuals under 18 years of age who present with a serious and acute mental illness or substance abuse impairment, or with co-occuring mental illness and substance abuse disorders.

(c) If an individual is admitted to a children’s CSU/ARF while under 18 years of age and attains the age of 18 years while receiving services at the facility, the facility may continue to provide services to the individual until the individual is discharged.

(d) CSU/ARFs shall admit any individual who would otherwise be eligible for admission to a CSU under Chapter 394, F.S. or to an ARF under Chapter 397, F.S.

(3) Clinical Procedures.

(a) CSU/ARFs shall provide integrated CSU and ARF services within the same facility, and shall provide services to each individual based upon their particular needs. This may include an emphasis on services that are typically provided in either an ARF or a CSU, as determined from the initial screening and assessment and subsequent screening of each individual.

(b) Commingling (or sharing of common space) among CSU/ARF service recipients may be permitted, regardless of the service recipients’ diagnoses, types of treatment, or reasons for admission.

(c) Service recipients requiring close medical observation, as determined by the medical staff, must be visible and readily accessible to nursing staff 24 hours per day, seven days per week.

(d) The use of medication-assisted and methadone maintenance treatment for substance abuse in CSU/ARFs must meet the requirements of Rule 65D-30.014, F.A.C.

(e) Service recipients in a CSU/ARF must receive a physical examination within 24 hours of admission. This examination must meet the requirements of a physical health assessment as specified in subsection 65D-30.004(14), F.A.C., except that, with regard to service recipients who have been determined not to require substance abuse treatment, specific requirements of the examination may be waived in accordance with a medical protocol approved by the medical director.

(f) Service recipients in a CSU/ARF must receive a behavioral and psychosocial assessment meeting the requirements of paragraph 65E-12.107(2)(d) and subsection 65D-30.004(14), F.A.C., within 24 hours of admission.

(g) CSU/ARFs must provide all services required of CSUs (as specified in subsection 65E-12.107(5), F.A.C.), and all services required of ARFs (as specified in subsection 65D-30.005(2), F.A.C.).

(h) A registered nurse shall ensure that emergency medical services are provided immediately in a CSU/ARF in accordance with the medical protocols established by the medical director. Such protocols shall include provisions to ensure that new arrivals are promptly assessed for symptoms of substance abuse intoxication and are given prompt medical care and attention. In addition, protocols shall be implemented to ensure that monitoring of psychiatric medication is provided, and that general health care needs are met.

(i) Development of a discharge plan shall commence upon admission. The plan shall include information on the need for continuation of prescribed psychotropic medications and other prescribed medications, including opioid or other addiction treatment medications, and continuing care appointments for treatment and support services, including medication and case management, and shall be based upon the particular needs of the individual. If the discharge is delayed, the CSU/ARF shall notify the outpatient or continuing care service provider and shall document continued service planning. With the express and informed consent of the individual receiving services, discharge planning shall include input from the individual’s support system, including, but not limited to, family members and friends.

(j) Prescriptions for psychotropic medications shall be provided to each adult upon discharge, and to the legal guardian of each minor upon discharge to cover the intervening days until the first scheduled outpatient appointment. Discharge planning shall address the availability of and access to prescription medication in the community.

(k) The medical director shall develop protocols specifying the circumstances under which blood and urine samples shall be taken for laboratory testing, including drug screening.

(4) Staffing Requirements.

(a) Staff shall meet the training requirements of Rule 65E-5.330 and subsection 65D-30.004(31), F.A.C., as a prerequisite to providing services.

(b) Within the training requirements of Rule 65E-5.330 and subsection 65D-30.004(31), F.A.C., staff shall receive substance abuse training from qualified professionals. The term “qualified professional” has the same meaning as in Section 397.311(26), F.S. The training must include the etiology and characteristics of substance abuse, common street drugs and means of use, motivational stages, and principles of recovery and relapse.

(c) A CSU/ARF shall have a medical director licensed under Chapter 458 or 459, F.S., who is responsible for overseeing all medical services delivered at the facility.

(d) The staff of a CSU/ARF shall include a qualified professional as defined in Section 397.311(26), F.S. A qualified professional shall be available on-call 24 hours per day, seven days per week. A qualified professional shall be on-site daily for a minimum of 40 hours per week total. The provider’s operating procedures shall include a description of those circumstances requiring the qualified professional to be onsite.

(e) Emergency screeners shall meet the requirements of subsections 65D-30.005(7) and 65E-5.400(5), F.A.C.

(f) CSU/ARFs shall meet the staff and supervision requirements of subsections 65D-30.005(12)-(13), F.A.C.

(g) CSU/ARFs shall comply with subsection 65D-30.004(33), F.A.C., which limits the tasks that may be performed by certain types of staff members.

(5) Operational, Administrative, and Financing Requirements.

(a) Licensure and Designation. A facility may operate as a CSU/ARF if it meets the following requirements:

The facility is licensed as a CSU by the Agency for Health Care Administration (hereafter referred to as the “Agency”) under Chapter 394, F.S., and Chapter 65E-12, F.A.C.,
The facility is designated as a Baker Act receiving facility by the Department under Chapter 394, F.S., and Chapter 65E-5, F.A.C.; and,
The facility is designated and licensed as an ARF by the Department under Chapter 397, F.S., and Chapter 65D-30, F.A.C.

(b) Unit Operating Policies and Procedures. Uniform policies and procedures and forms that provide for the integrated operation of CSU/ARF services shall be developed and utilized. This shall include policies and procedures in accordance with the provisions set forth in Rules 65E-12.105, 65E-12.106, and 65E-12.107, F.A.C. These procedures shall include provisions that address use of the Baker Act and the Marchman Act in accordance with the individual’s diagnosis. The unit’s operating policies and procedures shall be subject to the approval of the organization’s medical director and advisory governing board.

(c) CSU/ARFs shall report critical incidents to the Department according to Department of Children and Families Operating Procedure No. 215-6, January 10, 2012, http://www.flrules.org/Gateway/reference.asp?No=Ref-01266, which is incorporated herein by reference and is available at http://www.dcf.state.fl.us/admin/publications/cfops/215%20Safety%20(CFOP%20215-XX)/CFOP%20215-6,%20Incident%20Reporting%20and%20Analysis%20System%20(IRAS).pdf.

(d) CSU/ARFs shall report seclusion and restraint events to the Department as described in Department of Children and Families Pamphlet 155-2, Chapter 14, August 1, 2011, http://www.flrules.org/Gateway/reference.asp?No=Ref-01267, which is incorporated herein by reference and is available at http://www.dcf.state.fl.us/programs/samh/publications/c14v10.pdf. This reporting shall be done electronically using the Department’s web-based application, located at https://samh-prod.dcf.state.fl.us/samh/, either directly via the data input screens or indirectly via the File Transfer Protocol batch process. Facilities shall report seclusion and restraint events on a monthly basis.

(e) In those cases where an individual receiving services from a CSU/ARF needs to be transported to other services, the provider shall arrange for such transportation.

(f) CSU/ARFs that house both men and women must provide separate bedrooms for each gender.

(g) When a CSU/ARF releases an involuntary client held under the Marchman Act, notice shall be given to the court.

(h) CSU/ARFs should be aware of the requirements of 42 Code of Federal Regulations, Part 2 related to case records and other identifying information for individuals reflecting a substance abuse diagnosis. The Department and the Agency shall have access to confidential records, as needed, to conduct monitoring visits, surveys, complaint investigations, and other required site visits.

(i) In those instances where case records are maintained electronically, a staff identifier code shall be acceptable in lieu of a signature. Documentation within case records shall not be deleted. Amendments or marked through changes shall be initialed and dated by the individual making such changes.

(j) A CSU/ARF shall develop a uniform case record system regarding the content and format of case records.

(k) Each CSU/ARF shall develop a written Universal Infection Control plan which shall apply to all staff, volunteers, and to all individuals receiving services, and shall be reviewed and approved by the medical director. The CSU/ARF shall conduct screening and a risk assessment for infectious diseases for each individual who is determined to be substance abuse impaired, as required by Rules 65D-30.004 and 65E-5.180, F.A.C. All infection control activities shall be documented.

(6) Investigation of Complaints.

(a) Each CSU/ARF shall develop a written policy and procedure regarding complaints as required by subsection 65E-5.180(6), F.A.C. This policy must be posted conspicuously in an area of the facility routinely used by all service recipients.

(b) Complaints received by the Department or by the Agency may be jointly investigated.

History

Rulemaking Authority 394.4612, 394.499 FS. Law Implemented 394.4612, 394.499 FS. History–New 8-28-03. Amended 6-27-12.

Chapter 65E-14 COMMUNITY SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES - FINANCIAL RULES

Fla. Admin. Code R. 65E-14.001 Applicability

(1) This chapter applies to all Substance Abuse and Mental Health (SAMH)-Funded Entities as defined in paragraph (2)(s), of this rule, when providing services using community substance abuse and mental health funds appropriated by the Legislature to the Department of Children and Families (Department) through the Community Substance Abuse and Mental Health Services budget entity.

(2) Definitions.

(a) “Acquisition cost” of an item means the net invoice price of the item including the cost of modifications, attachments, accessories, or auxiliary apparatus necessary to make the equipment usable for the purpose for which it was acquired, subject to the following special considerations:

An item’s acquisition cost may include ancillary costs related to the acquisition; such as installation, transportation, taxes, duty or transit insurance, if the organization’s standard accounting practice identifies such ancillary charges as acquisition costs.
If an item is purchased by trading in another item, the acquisition cost shall include the amount received for trade in plus any additional outlay.
The acquisition cost of an item of real property shall include the net price for purchase, construction or fabrication of the property; and shall exclude the cost of rental, alterations or renovations to the property.

(b) “Adult Family Members of the Household” means persons 18 years or older who are related by birth, marriage, or adoption and who live together in the same household.

(c) “Approved budget” means a budget, including any revised budget, which has been approved by the contractor’s or subcontractor’s governing body and, where required, the department or Managing Entity.

(d) “Audit” means a single or program-specific audit in accordance with 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, (January 1, 2014), http://www.flrules.org/Gateway/reference.asp?No=Ref-06630, herein incorporated by reference, as specified in subsection 65E-14.003(1), F.A.C., and Section 215.97, F.S.

(e) “Client Fees” means compensation received by a service provider for services rendered to a specific individual from any source of funds, including local, state, federal and private sources.

(f) “Covered Service” means a grouping of services that are similar in time, intensity, and function, and whose cost is generally the same.

(g) “Equipment” means fixtures and other tangible personal property of a non-consumable and nonexpendable nature, the value of which is $5,000 or more and the normal expected life of which is one year or more; and hardback-covered bound books that are circulated to students or the general public, the value or cost of which is $25 or more, and hardback-covered bound books, the value or cost of which is $250 or more; and intangible data processing applications and/or computer software, regardless of its value. The value of donated equipment shall be based upon the item’s market value at the time of donation.

(h) “Facility” means land and buildings or any portion thereof, equipment, individually or collectively, or any other tangible capital asset, wherever located, and whether owned or leased by the organization.

(i) “First Party Payer” means the individual receiving services.

(j) “Individual,” means a person of any age who receives substance abuse or mental health services from an entity subject to the provisions of this chapter. For the purposes of this chapter, “individual” has the same meaning as “client,” “patient” or “person” as used throughout chapter 394 or 397, F.S.

(k) “Matching” means the value of third-party funds and in-kind contributions and resources received, expended and identified by a service provider operating under a contract with the department or a service provider operating under a subcontract with a Managing Entity to defray an amount established by statute or funding source of allowable costs of operating SAMH-funded programs pursuant to this chapter.

(l) “Ownership costs” means those costs incurred in relation to ownership of real and tangible personal property, including allowable interest, depreciation, taxes, insurance and normal maintenance.

(m) “Plan of care” means a plan developed by the service provider and the person served which delineates goals for the person served and the services to be provided to meet those goals. This includes, but is not limited to, recovery plans, service plans, treatment plans, and case management plans.

(n) “Program income” means income earned by a service provider for activities where part of the cost of those activities is paid for by the department. Program Income does not include:

Revenues raised by a government contractor under its governing powers, such as taxes, special assessments, levies, fines, and fees, or
Tuition and related fees received by an institution of higher education for a regularly offered course taught by an employee of the SAMH-Funded Entity.

(o) “Programs” mean the Adult Substance Abuse, Children’s Substance Abuse, Adult Mental Health, and Children’s Mental Health programs administered by the Department of Children and Families.

(p) “Real property” means land, building, appurtenances thereto, fixtures and fixed equipment, structures, including additions, replacements, major repairs and renovations to real property which materially improve or change its functional use.

(q) “Regional plan” means the combination of all substance abuse and mental health plans applicable to districts within each region as approved by the department’s SAMH regional administrator and governing bodies in accordance with section 394.75, F.S.

(r) “Related party” means an entity’s business affiliates, officers and directors and their family members; employees; investors whose investments are accounted for by the equity method; employee benefit trusts that are managed by or under the trusteeship of the entity’s board or management; and parties with which the entity may deal if one party controls or can significantly influence the management or operating policies of the other to an extent that one of the parties would be prevented from fully pursuing its own separate interest.

(s) “Substance Abuse and Mental Health (SAMH)-Funded Entity” means an entity under contract with the department or subcontracting with a department contractor, which receives public funds legislatively appropriated to the department to provide community substance abuse or mental health services. This definition specifically includes behavioral health Managing Entities as defined in section 394.9082, F.S., service providers operating under a contract with the department, and service providers operating under a subcontract with a Managing Entity.

(t) “Second Party Payer” or “Responsible Party” means any person legally responsible for the financial support of the individual receiving services, and may include parents of a minor, a spouse, a guardian, representative payee or trustee in a fiduciary capacity for handling benefit payments, trusts and estates established or received for the financial support of the individual served.

(u) “Service Provider” as defined in Section 394.455 or 397.311, F.S.

(v) “Sliding Fee Scale” means a schedule of fees for identified services based on a uniform schedule of discounts deducted from a service provider’s established client charges pursuant to section 394.674(4)(a), F.S.

(w) “Supplies” means all tangible personal property other than “equipment” as defined in this chapter.

(x) “Third-party in-kind contribution” means property or services which benefit a state-supported service program or project, and which are contributed by non-state and federal third parties without charge to the SAMH-Funded Entity.

(y) “Third Party Payer” means commercial insurers such as workers’ compensation, TRICARE, Medicare, Health Maintenance Organizations, Managed Care Organizations, or other payers liable, to the extent that they are required by contract or law, to participate in the cost of providing services to a specific individual.

History

Rulemaking Authority 394.74, 394.78(1), 394.9082(3), 397.321(5) FS. Law Implemented 394.74, 394.77, 394.9082, 397.481 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.01, Amended 7-29-96, Formerly 10E-14.001, Amended 7-1-03, 12-14-03, 1-2-05, 7-27-14, 4-27-16, 1-31-23.

Fla. Admin. Code R. 65E-14.002 Retention and Access Requirements for Records

This rule applies to all financial and programmatic records, supporting documents, statistical records, and other records of SAMH-Funded Entities which are necessary to document expenditures, income and assets of the entity.

(1) Length of Retention Period.

(a) Except as provided in paragraph (1)(b) of this rule, records shall be retained for a minimum of six years, or longer if required by law, from the starting date specified in subsection (2) of this rule.

(b) If any litigation claim, negotiation, audit, or other action involving the records has been started before the expiration of the six-year period, the records shall be retained until completion of the action and resolution of all issues which arise from such actions.

(2) Starting Date of Retention Period.

(a) Except as specified in paragraph (2)(b) of this rule, the retention period starts 90 days after the end of the contract period.

(b) The retention period for equipment and property records starts from the date of the equipment’s or property’s disposition or replacement.

(3) Access to Records.

(a) The department, any other state agency, the Florida Attorney General, the Florida Auditor General, the United States Department of Health and Human Services, the Comptroller of the United States, or any of their authorized representatives shall have the right of access to any books, documents, papers, or other records of a SAMH-Funded Entity which are pertinent to the organization’s use of substance abuse and mental health funds in order to make audits, examinations, excerpts, or transcripts.

(b) The rights of access in this rule shall not be limited to the required retention period, but shall last as long as the records are retained.

(4) Restrictions on Public Access. Unless required by federal or state statutes, a SAMH-Funded Entity may not impose subcontract terms which conflict with access to records as specified in subsection (3) of this rule. Representatives of the organizations requiring access shall be identified with official documentation.

History

Rulemaking Authority 394.78(1), 394.9082(3) FS. Law Implemented 394.9082 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.02, 10E-14.002, Amended 1-2-05, 7-27-14.

Fla. Admin. Code R. 65E-14.003 Audits of SAMH-Funded Entities

(1) SAMH-Funded Entities shall engage an independent auditor to perform an annual single program or program-specific audit in accordance with section 215.97, F.S., and 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, as incorporated by reference in Rule 65E-14.001, F.A.C. When a financial audit is required to be performed by an independent auditor pursuant to 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, as incorporated by reference in rule 65E-14.001, F.A.C., the audit package shall contain the documents listed in paragraphs (1)(a)-(d), which are hereby incorporated by reference. Copies of these documents may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

(a) CF-MH 1034, July 2014, Schedule of State Earnings with Instructions. https://www.flrules.org/Gateway/reference.asp?No=Ref-04187. This schedule identifies eligible local match to determine if requirements are met and computes amounts due to the department.

(b) CF-MH 1035, July 2014, Schedule of Related Party Transaction Adjustments https://www.flrules.org/Gateway/reference.asp?No=Ref-04203. This schedule indicates, by Covered Service, required related party transaction adjustments.

(c) CF-MH 1037, July 2014, Actual Expenses and Revenues Schedule with Instructions. https://www.flrules.org/Gateway/reference.asp?No=Ref-04189. This schedule displays expenditures by line-item category and revenues by source for each program and Covered Service funded with state substance abuse and mental health program appropriations. The schedule also identifies expenditures by line-item category and revenues by source for all other Covered Services as a group, for all other programs as a group, and for administrative and support functions, and displays totals for the agency as a whole.

(d) CF-MH 1036, July 2014, Schedule of Bed-Day Availability Payments with Instructions https://www.flrules.org/Gateway/reference.asp?No=Ref-04188. This schedule ensures that bed-days paid for by the department on the basis of availability were not also paid for by a third-party contract or funds from a local government or another state agency for services that include bed-day availability or utilization. Programs that do not utilize availability based payment methodology are not required to submit this form.

(2) The schedules in subsection (1) of this rule, shall be based on revenues and expenditures recorded during the state’s fiscal year and shall be prepared in accordance with Generally Accepted Accounting Principles.

(3) When 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, as incorporated by reference in rule 65E-14.001, F.A.C., does not require an audit by an independent auditor, the SAMH-Funded Entity’s chief financial officer shall prepare the schedules required in subsection (1) of this rule. If no chief financial officer exists, the entity’s executive director shall prepare the required schedules.

(4) Service providers under subcontract with a Managing Entity shall submit all schedules listed in subsection (1) of this rule, to the Managing Entity within 180 days after the end of the state’s fiscal year or within 180 days of the end of the entity’s funding period, whichever occurs sooner.

(5) Managing Entities and any other entities under direct contract with the department shall submit the schedules listed in paragraphs (1)(a) and (b) of this rule, and copies of all schedules listed in paragraphs (1)(c) and (d) of this rule, prepared by the service providers under a Managing Entity subcontract. Managing Entities shall submit these schedules to the department annually within 180 days after the end of the state’s fiscal year or within 180 days after the end of the entity’s funding period, whichever occurs sooner.

(6) The department shall notify the SAMH-Funded Entity by certified mail, return receipt requested, of the amounts due the department resulting from an audit. Payment is due within 30 days after the date of receipt.

History

Rulemaking Authority 394.74, 394.78(1), (3), (5), 394.9082(3) FS. Law Implemented 394.74, 394.76(5), 394.77, 394.78(3), 394.9082 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.03, Amended 7-29-96, Formerly 10E-14.003, Amended 7-1-03, 12-14-03, 7-27-14, 4-27-16.

Fla. Admin. Code R. 65E-14.004 Program Income

History

Rulemaking Authority 394.77, 394.78(1), 397.321(5) FS. Law Implemented 394.66(9), 394.77, 397.481 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.04, Amended 7-29-96, Formerly 10E-14.004, Amended 7-1-03, Repealed 7-27-14.

Fla. Admin. Code R. 65E-14.005 Matching

This rule contains standards for Service Providers to satisfy State requirements for matching.

(1) Allowable for Matching. With the exceptions listed in subsection (2) of this rule, matching requirements may be satisfied by any or all of the following:

(a) Allowable costs supported by non-State or Federal grants incurred by the service provider during the effective funding period;

(b) The value of third-party funds and in-kind contributions applicable to the matching requirement period; and,

(2) Unallowable for Matching. The following costs and expenditures may not be used to satisfy the match requirement.

(a) Costs paid for by another State, Federal or other governmental agency contract or grant except as provided by State or Federal statute;

(b) Costs or third-party funds and in-kind contributions that are used to satisfy a matching requirement of another State contract or Federal grant;

(d) Expenditures for services not related to the Covered Services for substance abuse and mental health services specified in rule 65E-14.021, F.A.C.;

(e) Unallowable costs specified in 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, as incorporated by reference in rule 65E-14.001, F.A.C.; and,

(f) Income from sale of printed material, food, and books purchased with State funds.

(3) Not Requiring Matching. The following services and funds do not require local match:

(a) Deinstitutionalization projects, which are defined as adult mental health programs in the following Covered Services as defined in rule 65E-14.021, F.A.C.:

Case Management,
Drop-In/Self Help Centers,
Florida Assertive Community Treatment (FACT) Teams,
Intensive Case Management,
Mental Health Clubhouse Services,
Recovery Support,
Residential Levels I, II, III and IV,
Room and Board with Supervision Levels I, II, and III,
Short-term Residential Treatment, except those acute care continuum programs supported with Baker Act funds and operated by a public receiving facility; and,
Supportive Housing/Living.

(b) Services funded under Children’s Mental Health (100435) and Purchased Residential Treatment Services (102780) appropriation categories.

(d) The amount of Substance Abuse General Revenue funding in special categories 100618 and 100420, as determined by the following calculations:

For the most recent 12-month period available, calculate the number of clients served by the service provider that present with primary, secondary, or tertiary alcohol or drug problems as specified in the substance abuse enrollment and admission data in the department’s Mental Health and Substance Abuse data system.
From the data, count the total number of persons presenting with alcohol as a primary, secondary, or tertiary problem.
Divide the total number of persons presenting by the number of clients served to arrive at the percentage of alcohol clients served.
Subtract the percentage of alcohol clients served from 1.00 to arrive at the percentage of drug abuse clients served.
Multiply the percentage of drug abuse clients served by the total amount of General Revenue substance abuse funds in the contract to arrive at the amount that does not require match.

(4) Calculating the Total Match Amount.

(a) Add the amounts from paragraphs (3)(a), (b), (c), and subparagraph (3)(d)5., in this rule, together and subtract that total from the total amount of the contract.

(b) Divide the result in paragraph (4)(a), in this rule, by 3 to arrive at the total match amount required.

(c) Records. Costs and third-party funds and in-kind contributions counting towards satisfying a matching requirement must be verifiable from the service provider’s records. These records must show how the value placed on third-party in-kind contributions was derived.

(5) Special Standards for Third-party In-kind Contributions.

(a) Third-party in-kind contributions shall conform to allowable cost provisions to satisfy a matching requirement.

(b) When a third-party in-kind contribution is made at a reduced charge, the service provider’s records must provide documentation as specified in paragraph (5)(d) of this rule, to verify that portion of the cost donated.

(c) The values placed on third-party in-kind contributions for matching purposes shall conform to other appropriate sections of this rule.

(d) Documentation of in-kind contributions. All third-party in-kind contributions must be documented. The following standards will be applied to all claims for in-kind match:

Service. A statement from the employer of the person who provided the donated service detailing the nature of the service, basis for computing cost of those services, dates and number of hours the services were provided and certification that the services were provided and certification that the services were not and will not be paid for by the service provider but were donated at no charge. This statement shall be prepared on the letterhead stationery of the donor and signed by the chief executive officer of that organization.
Volunteers. A statement from the volunteer certifying that required services were performed for the service provider free of charge and the minimum training and experience requirements were met for the service performed. Time logs shall be prepared and signed by the volunteer. In addition, a schedule shall be prepared by the service provider which indicates the basis for establishing the value of these services.
Supplies. A statement from the person or organization donating the supplies detailing the description, condition and value of the supplies and a certification that the donor was not and will not be paid for the supplies. This statement shall be on the letterhead stationery of the donor. If no letterhead is available, the statement shall include the name, address and telephone number of the donor, and signed by a responsible party of that organization.
Use of equipment. A signed statement from the owner of the equipment detailing the description of the loaned equipment, responsibilities for repairs, maintenance and insurance, beginning and ending dates of the use of the equipment; the valuation of the use of the equipment and a certification that no payment has been or will be received for the use of the equipment. This statement shall be on the owner’s letterhead stationery.
Use of building or space. A signed statement from the owner of the property, building or space detailing the description of the property; dimensions; times available and used; responsibilities for repairs, maintenance, insurance, utilities and janitorial services; the valuation of the use of the property and a certification that no payment has been or will be received for the use of the property. This statement shall be on the owner’s letterhead stationery.

(6) Valuation of Donated and Volunteer Services.

(a) Donated Services. When an employer other than the service provider furnishes free of charge the services of an employee in the employee’s normal time of work, the services shall be valued at the employee’s regular rate of pay including the employee’s fringe benefits. If the service provider does not have those employees performing similar work, the rates shall be consistent with those ordinarily paid by other employers for similar work in the same labor market.

(b) Volunteer Services. When, at the discretion of the service provider, volunteer services are used as local match, the individual must meet the training and experience requirement of employees placed in similar positions. These services are only allowable up to a maximum of ten percent of the contracted dollars inclusive of the required match. Time logs and all other required documentation must be available for audit purposes.

If a third party donates supplies, the contribution shall be valued at the market value of the supplies at the time of donation.
If a third party donates the use of equipment or space, but retains title, the contribution shall be valued at the fair rental rate of the equipment or space.

(d) Valuation of donated equipment, building, and land. The fair market value at the time of donation of the equipment, building or land may be counted as matching. In all cases, the approval may be given only if purchase of the equipment, building or land would be approved as an allowable cost.

(7) Appraisal of Real Property. It will be necessary to establish the market value of land or a building or the fair rental rate of land or of space in a building. In cases where there is a dispute between the department and a service provider regarding the value of land or a building, or the fair rental rate of land or a building, the department shall require that the market value or fair rental rate be established by a certified real property appraiser and that the value or rate be certified by a responsible official of the party to which the property or its use is donated. The appraisal needs to include the appraiser’s estimate of the remaining useful life of the property.

(8) Service providers are responsible for meeting matching requirements for substance abuse and mental health funds, as specified in chapter 394, part IV, F.S., based on the total amount of contracted or subcontracted funds.

History

Rulemaking Authority 394.74, 394.9082(3) FS. Law Implemented 394.74, 394.76, 394.9082 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.05, 10E-14.005, Amended 7-1-03, 12-14-03, 1-2-05, 7-27-14, 4-27-16.

Fla. Admin. Code R. 65E-14.006 Valuation of Donated and Volunteer Services

History

Rulemaking Authority 394.76, 397.03 FS. Law Implemented 394.76, 397.03 FS. History–New 2-23-84, Amended 2-25-85, Formerly 10E-14.06, 10E-14.006, Repealed 7-27-14.

Fla. Admin. Code R. 65E-14.007 Appraisal of Real Property

History

Rulemaking Authority 394.74, 397.321(5) FS. Law Implemented 394.74, 397.481 FS. History–New 2-23-83, Formerly 10E-14.07, Amended 7-29-96, Formerly 10E-14.007, Amended 9-17-97, 7-1-03, Repealed 7-27-14.

Fla. Admin. Code R. 65E-14.010 Property

(1) This rule applies to items of real property, equipment, supplies and to items of intellectual property as defined in sections 815.03(10) and 815.03(11), F.S., which are acquired with State support. To be considered acquired with State support, some or all of the items’ acquisition cost must be both:

(a) An allowable cost within the SAMH-Funded Entity’s Line Item Operating Budget; and,

(b) Either directly supported by substance abuse and mental health funds or included in the SAMH-Funded Entity’s match requirement valuation in compliance with rule 65E-14.005, F.A.C.

(2) If a SAMH-funded entity acquires, remodels, constructs, improves or expands real property with State support, the department shall be entitled to recover an amount bearing the same ratio as determined by contract, subcontract or other funding agreement to the current value of the property. This right shall remain for twenty years after the acquisition, remodeling, construction, improvement or expansion is completed.

(3) This rule does not apply to:

(a) Property for which only depreciation or interest is charged, or

(b) Property donated entirely as a third-party in-kind contribution and not used toward satisfying a matching requirement.

(4) SAMH-Funded Entities may follow their own property management policies and procedures provided such policies and procedures observe the requirements of this rule.

(5) Title to Real Property, Equipment, and Supplies. Subject to the obligations and conditions set forth in this rule, title to real property, equipment, supplies and intellectual property acquired with State support shall vest, upon acquisition, in the SAMH-Funded Entity unless otherwise specified in terms of the contract or subcontract.

(6) Real Property. Property subject to this rule shall be subject to the following requirements, in addition to any other requirements imposed by contract or subcontract terms:

(a) Use.

So long as the property is owned by the same SAMH-Funded Entity or its successor in law, it must be used for the originally authorized purpose for a period of twenty years or for as long as specifically authorized for that purpose, whichever is less.
If the property is no longer needed for the authorized purpose in less than 20 years, the SAMH-Funded Entity may request approval from the department to use the property for alternative purposes. Allowable alternative purposes shall be limited to:

a. Services, programs or projects supported by other State contracts; and,

b. Activities not supported by other State contracts but having purposes consistent with the original authorized purpose.

The department shall no longer have a claim to property held by the same SAMH-Funded Entity for the original or an approved alternative purpose after twenty years.

(b) Transfer of Title. A SAMH-Funded Entity may request department approval to transfer title to an eligible third party for continued use for authorized purposes in accordance with paragraph (6)(a) of this rule. If approved, the terms of the transfer shall provide that the transferee shall assume all the rights and obligations of the transferor set forth in this rule or in other contract or subcontract terms.

(c) Disposition. When the real property is no longer to be used as provided in paragraphs (6)(a) and (b) of this rule, the SAMH-Funded Entity shall either:

Sell the property and pay the department an amount computed by multiplying the State’s share of the property times the proceeds from sale, after deducting actual and reasonable expenses related to the sale, including repairs, if needed, from the sale’s proceeds, or
Retain title to the property and pay the department an amount computed by multiplying the fair market value of the property by the State’s share of the property.

(7) Real Property Records and Management.

(a) Real property records shall be maintained accurately and shall include the following minimum requirements:

A legal description of the property including any physical location address, building situated thereon as well as any other improvement,
Identification of the contract, subcontract or other funding agreement under which the recipient acquired the property and the authorized purpose for which the property will be used,
The information needed to calculate the State’s share of the property,
Acquisition date and all elements of the cost of the property,
Condition of the property at acquisition; and,
The date information in subparagraphs (7)(a)1. through 5. of this rule, was reported to the department.

(b) A control system and maintenance procedures shall be in effect to prevent damage or loss of the property. Any loss or damage shall be investigated and fully documented.

(c) Where property is to be sold and the State is entitled to all or part of the proceeds, the department shall establish procedures for the conduct of the sale.

(8) Equipment and Supplies.

(a) Use of Equipment: A SAMH-Funded Entity shall use any equipment acquired with State support in the program for which it was acquired. In the event equipment is no longer needed for the original program, the SAMH-Funded Entity shall request department approval to use the equipment, if needed, in other programs currently or previously sponsored by the department.

(b) The useful life of equipment shall be determined at the time of its acquisition and be specified in contract, subcontract or other funding document. In case of a sale or transfer of the purchased equipment, the department shall be entitled to recover the same ratio to the then value of the item for the period of time specified as useful life. The department will have no interest in the item beyond the period of time specified as useful life.

(c) Use by Other Entities. When the SAMH-Funded Entity can no longer use the equipment as required by paragraph (6)(a), of this rule, it may request department approval to make the item available to other entities for use in programs currently or previously sponsored by the department.

(9) Replacement of Equipment.

(a) A SAMH-Funded Entity may exchange equipment for replacement items if needed. If the original item is sold or included as a trade-in for the replacement item, any proceeds realized shall be applied to the acquisition cost of the replacement item and the transaction shall be one which a prudent person would make in like circumstances.

(b) If the replacement cost includes an additional outlay which is charged as a cost to either State funds or match requirement, the replacement item shall be subject to the same property requirements or exemptions applicable to the original item.

(10) Disposition of Equipment. When original or replacement equipment is no longer to be used in programs currently or previously sponsored by the department, a SAMH-Funded Entity shall dispose of the item as follows:

(a) The entity may retain or sell the item and shall notify the department in advance of such actions.

If the item is retained, the department shall have a right to an amount calculated by multiplying the current market value by the State’s share of the item.
If the item is sold, the department shall have a right to an amount calculated by multiplying the proceeds from the sale by the State’s share of the item. Expenses related to actual and reasonable expenses related to the sale, not to exceed fifteen percent of the total sale proceeds, may be deducted from the amount otherwise due the department. When the State is entitled to all or part of the proceeds, the department shall establish procedures for the conduct of the sale.

(b) Equipment management requirements. Until disposition takes place, a SAMH-Funded Entity shall comply with the following minimum requirements for managing equipment and any replacement items.

Property records shall be maintained accurately. For each item, the records shall include:

a. A description of the item including the manufacturer’s model number, if any,

b. An identification number, such as the manufacturer’s serial number,

c. Identification of the contract, subcontract or other funding agreement under which the entity acquired the item,

d. The information needed to calculate the State’s share of the item,

e. Acquisition date and unit acquisition cost,

f. Location, use, and condition of the item; and,

g. The date information in sub-subparagraphs (10)(b)1.a. through f. of this rule, was reported to the department.

A SAMH-Funded Entity shall conduct a physical inventory of equipment and reconcile the results with the property records at least once each State fiscal year to verify the existence, current utilization, and continued need for the item. The SAMH-Funded Entity shall investigate and determine the causes of any differences between the physical inventory and quantities in the accounting records. The SAMH-Funded Entity shall submit a copy of the annual inventory to the Managing Entity or department as appropriate, along with any disposition records, within 30 days after completion of the inventory.
A SAMH-Funded Entity shall implement a control system and maintenance procedures to prevent loss, damage, or theft of equipment. The SAMH-Funded Entity shall investigate and fully document any loss, damage, or theft.

(11) Unused Supplies.

(a) This section applies to supplies acquired with State support which have not been used in the program for which they were acquired at the time State support for the program is terminated for any reason.

(b) The SAMH-Funded Entity shall notify the department of the quantity, type and fair market value of unused supplies. If the unused supplies exceed $1,000 in total aggregate fair market value and are not needed for any other program funded by the department, the SAMH-Funded Entity may either retain or sell the supplies, and shall credit the State as follows:

Retained supplies. The credit is computed by multiplying the State’s share of the supplies by their current market value.
Sold supplies. The credit is computed by multiplying the State’s share of the supplies by the proceeds from any sale. Expenses related to actual and reasonable expenses related to the sale, not to exceed fifteen percent of the total sale proceeds, may be deducted from the amount otherwise due the department.

(12) Valuation of the State’s Share. Several sections of this rule require a valuation of the State’s share of real property, equipment, supplies or intellectual property acquired with state support. The following methods determine the valuation:

(a) The State’s share of real property equals the amount of State support used to acquire property under a contract, subcontract or other funding agreement, divided by the total acquisition cost of the property. The State’s share is expressed as a percentage. For the purposes of this rule, “costs under a contract, subcontract or other funding agreement” means only allowable costs which are either supported by the funding document or counted towards satisfying an included match requirement. Notwithstanding any conflicting standards in rule 65E-14.005, F.A.C., the value of third-party in kind contributions may not be included in the valuation of the State’s share.

(b) Replacement equipment. The State’s share of replacement equipment is:

Step 1. Determine the State’s share of the equipment replaced. Divide the amount of State support used to acquire the replacement equipment by the total acquisition cost of the replacement equipment. The total is expressed as a percentage.
Step 2. Determine the percentage of the replacement equipment’s cost that was covered by the amount received for trade-in or the sales proceeds from the equipment replaced.
Step 3. Multiply the step 1 percentage by the step 2 percentage.
Step 4. If an additional outlay for the replacement equipment was charged as a cost either to State funds or to required matching funds, calculate the State’s share attributable to that additional outlay as explained. Add that additional percentage to the step 3 percentage.

(13) Copyrights.

(a) Works Under Contracts. Unless otherwise provided by the terms of the contract, a SAMH-Funded Entity may copyright or permit others to copyright, any appropriately copyrightable material developed specifically for or in the course of contract or subcontract performance.

(b) State of Florida Rights. If any copyrightable material is developed specifically for or in the course of contract or subcontract performance, the State of Florida shall have a royalty-free, nonexclusive, and irrevocable right to reproduce, publish, or otherwise use, and to authorize others to use the work for state government purposes. A contractor awarding a subcontract may reserve a similar right for itself with respect to copyrightable material developed.

History

Rulemaking Authority 273.055, 394.74(1) 394.78(1), 394.9082(3) FS. Law Implemented 273.055, 394.74(2)(c), 394.78(5) FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.10, 10E-14.010, Amended 7-27-14.

Fla. Admin. Code R. 65E-14.012 Contract Closeout, Suspension, and Termination

History

Rulemaking Authority 394.74 FS. Law Implemented 394.74 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.12, 10E-14.012, Repealed 7-31-12.

Fla. Admin. Code R. 65E-14.014 SAMH-Funded Entity Responsibilities

(1) Each Managing Entity shall develop and implement a Care Coordination Policy applicable to its subcontracted service providers. Care Coordination policies and practices shall assure eligibility for services, the appropriateness of services, and the need for services. Care Coordination includes fiscal accountability as described in this rule. The Care Coordination Policy shall:

(a) Specify methods that shall be used to reduce, manage, and eliminate waitlists for services;

(b) Promote increased planning, use, and delivery of services to all individuals receiving services, including those with co-occurring substance abuse disorders and mental illnesses;

(c) Ensure access to and use of clinically appropriate services using screening, assessment and placement tools designed to identify appropriate level and intensity of care for an individual within a continuum of services;

(d) Promote the use of service outcome data to achieve desired outcomes;

(e) Include a methodology to ensure that people are served at the clinically indicated least restrictive level of care, and are diverted from higher levels of care when clinically indicated; and,

(f) Monitor and implement system changes to promote efficiencies.

(2) The service provider shall assist clients who may be eligible for Medicaid or other benefit programs to:

(a) Complete the program’s application process;

(b) Assist with required eligibility documentation; and,

(3) SAMH-Funded Entities shall not bill the department for services provided to:

(a) Individuals who have third party insurance coverage when the services provided are paid under the insurance plan, or

(b) Recipients of Medicaid, or another publically funded health benefits assistance program, when the services provided are paid by said program.

(4) SAMH-Funded Entities may bill the department if services are provided to individuals who have lost Medicaid, or another publicly funded health benefits assistance program coverage for any reason during the period of non-coverage subject to the sliding fee scale requirements in rule 65E-14.018, F.A.C.

(5) In all subcontracts with service providers, a Managing Entity shall specify:

(a) Procedures under which financial transactions and service provision are to be documented with sufficient clarity and detail to support audit compliance under Generally Accepted Accounting Principles;

(b) The type of services purchased and a description of the manner in which the services are to be provided;

(d) The billing and payment mechanism; third party billings and fee collection procedures which prevent duplicate payments for services provided;

(e) Documentation of the performance of billed services;

(f) The duration of the subcontract; and,

(g) The mechanism by which any overpayment will be recovered.

(6) A SAMH-Funded Entity shall refund to the department any amount paid for:

(a) Ineligible services;

(b) Services to individuals which exceed the standards set forth under subsections (3) and (4) in this rule;

(d) Undocumented services;

(e) Services provided to a Medicaid-eligible individual prior to becoming a Medicaid recipient when those services are subsequently covered under a retroactive Medicaid reimbursement determination; and,

(f) Any amount owed because of a violation of contract or rules.

(7) The review and approval of contracts or subcontracts by the department or by a Managing Entity shall not diminish the responsibility for each SAMH-Funded Entity to perform in accordance with all rules in chapter 65E-14, F.A.C.

(8) Financial monitoring of service providers shall include a review of a representative sample of individual recipient records for each type of service provided. Monitoring shall include verification of the following:

(a) That billing adequately reflects the contracted dollar amounts for each service provided;

(b) Compliance with provision of services to eligible persons per priority population criteria as defined in section 394.674, F.S., and financial eligibility criteria specified in subsection (3) of this rule; and,

(c) Verification that the number of service units purchased equals service event data reported to the Managing Entity and the department’s service event data reporting system.

History

Rulemaking Authority 394.78(1), (5), 394.9082(3) FS. Law Implemented 394.78(5), 394.9082 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.14, Amended 7-29-96, Formerly 10E-14.014, Amended 8-17-97, 7-1-03, 7-27-14.

Fla. Admin. Code R. 65E-14.016 Transactions Resulting in Additional Cost to the Program

(1) Transactions between a SAMH-Funded Entity and a related party that appear to result, as determined by the department on the basis of the standards in subsection (3) of this rule, in additional cost to the program shall be reimbursed to the SAMH-Funded Entity in an amount equal to the eligible cost which would have been allowed had no related party been involved. Any cost in excess of what would have been allowable by the department shall be disallowed.

(2) If the department determines on the basis of the standards in subsection (3) of this rule, related party involvement has caused an increase in cost, the department shall have access to the financial records of the related party in order to determine the allowable cost of the transaction. If the department is not allowed full and unrestricted access to the records of the related party, all payments to the related party questioned by the department shall be disallowed.

(3) The following related party transactions shall be reviewed by the department for compliance with Generally Accepted Accounting Principles:

(a) Transactions between a SAMH-Funded Entity and related party who have common ownership or control.

(b) The existence of a related party primarily for the benefit or purpose of a SAMH-Funded Entity. Primary benefit or purpose is defined to be when fifty percent or more of the gross revenues of the related party are received from or for the SAMH-Funded Entity or fifty percent of the expenditures of the related party are made to or for the benefit of the SAMH-Funded Entity. The department shall carefully review the documentation provided in all such situations before making a decision. The final determination shall rest with the department.

(c) If real or personal property has ever been transferred between a related party and a SAMH-Funded Entity, reimbursement for the use of the property transferred shall not exceed the lower of fair market value or actual cost to the transferor.

(d) If a related party leases property to a SAMH-Funded Entity and subsequently makes a cash or in-kind donation to the lessee, the department shall disallow any amount that exceeds the lower of the market value lease cost or the ownership costs of the related party.

(e) A SAMH-Funded Entity which leases property or delivers services to another SAMH-Funded Entity shall do so at cost. The cost incurred shall be reasonable and delivered at the lowest available cost for the service. The lowest available cost shall be documented by evidence that the SAMH-Funded Entity solicited services from other entities and selected the lowest cost available. Documentation for the decision shall be maintained by the SAMH-Funded Entity for review by the department.

(f) If a SAMH-Funded Entity loans money to any other party and subsequently leases property or buys services from the same party, the SAMH-Funded Entity and the second party shall be deemed to be related parties.

(g) If a SAMH-Funded Entity leases property from a related party, any cost in excess of fair market value shall be considered an unallowable cost.

(h) Space donated by a related party in a building previously owned by a SAMH-Funded Entity or by a related party who exists primarily for the benefit of the SAMH-Funded entity shall be valued for match and reimbursable cost purposes at the fair market value of the space.

History

Rulemaking Authority 394.78(1), 394.9082(3) FS. Law Implemented 394.78(3), 394.9082 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.16, 10E-14.016, Amended 7-1-03, 7-27-14.

Fla. Admin. Code R. 65E-14.017 Cost Principles

(1) Applicability. The following principles shall apply to all SAMH-Funded Entities unless otherwise specified.

(2) For contracts or subcontracts, these principles shall be used in determining the costs of work performed, identifying the appropriate use of state funds and local matching funds, and accounting for the expenditure of such funds.

(3) All SAMH-Funded Entities shall use the accounting standards established by 2 C.F.R. §§200.0-.521, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, as incorporated by reference in rule 65E-14.001, F.A.C., to account for the expenditure of funds.

(4) All SAMH-Funded Entities contracting directly with the department shall also report actual expenditure data on a monthly basis to the department according to the reporting requirements and templates included in the terms of each entity’s contract.

History

Rulemaking Authority 394.78(1), 394.9082(3) FS. Law Implemented 394.74, 394.77, 394.78(1), 394.9082 FS. History–New 2-23-83, Amended 2-25-85, Formerly 10E-14.17, Amended 7-29-96, Formerly 10E-14.017, Amended 9-17-97, 7-1-03, 7-27-14, 4-27-16.

Fla. Admin. Code R. 65E-14.018 Sliding Fee Scale

(1) Definitions and Intent.

(a) The service provider shall make a determination of ability to pay in accordance with the sliding fee scale for all individuals seeking substance abuse or mental health services. Payment of fees shall not be a pre-requisite to treatment or the receipt of services. The sliding fee scale shall not apply to services provided under the following Covered Services as defined in rule 65E-14.021, F.A.C:

Case Management,
Crisis Stabilization, when charging a fee is contraindicated as specified in section 394.674(2), F.S.,
Crisis Support/Emergency,
Drop-In/Self Help Centers,
Information and Referral,
Intensive Case Management,
Mental Health Clubhouse Services,
Outreach,
Prevention – Indicated,
Prevention – Selective,
Prevention – Universal Direct,
Prevention – Universal Indirect,
Substance Abuse Inpatient Detoxification; and,
Substance Abuse Outpatient Detoxification.

(b) It is not the intent of this rule to prohibit or regulate the collection of fees on behalf of an individual from third party payers and commercial insurers such as Workers’ Compensation, TRICARE, Medicaid, or Medicare. However, service providers shall make every reasonable effort to identify and collect benefits from third party payers for services rendered to eligible individuals.

(c) For the purposes of this rule, household income is defined by I.R.C. §36B(d)(2) (1986), https://www.flrules.org/Gateway/reference.asp?No=Ref-04195, with exceptions pursuant to 42 CFR §435.603(e), October 1, 2012, https://www.flrules.org/Gateway/reference.asp?No=Ref-04196, hereby incorporated by reference, copies of which may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

(2) General Provisions.

(a) Each service provider shall develop a sliding fee scale, that is updated annually, in conjunction with the Federal Poverty Guidelines, and applies to individuals receiving services that are paid for by state, federal, or local matching funds.

(b) The service provider shall request a sliding fee payment from persons not eligible for Medicaid or receiving services ineligible under Medicaid; and whose household income is less than 150 percent of the federal poverty income guidelines in accordance with section 409.9081, F.S. Nominal co-payments for the following substance abuse and mental health services shall apply:

Outpatient treatment services – $3 per day.
Residential treatment services – $2 per day.

(c) The service provider shall require persons meeting the criteria listed below to contribute to their treatment costs consistent with the provisions of section 409.212, F.S.:

Persons who receive optional supplementation payments or are receiving a supplemental security income check,
Persons determined to be eligible for optional supplementation by the department; and,
Persons who meet program eligibility criteria for assisted living facilities, foster care family placements, long-term residential care, or any other special living arrangements.

(3) Fee Liability Exceptions. The following parties shall not be liable for payment of fees:

(a) Parents of minors, when the minor has been permanently committed to the department and parental rights have been permanently terminated, or

(b) Parents of a minor, when the minor has requested and is receiving services without parental consent.

(4) Uniform Schedule of Discounts and Sliding Fee Scale.

(a) Each service provider shall develop a uniform schedule of discounts and sliding fee scale, as specified in section 394.674(4)(a), F.S.

(b) The uniform schedule of discounts shall be based on household income, financial assets and family size, as declared by the person or the person’s guardian, relative to the family’s percent of poverty level.

(c) The percent of poverty level shall be calculated by dividing the household income by the U.S. Department of Health and Human Services Annual Update of the Health and Human Services Poverty Guidelines. The poverty guidelines establish poverty income levels for various family sizes.

(d) The total charges to an individual shall not exceed 5% of gross household income.

(e) Nothing in this rule shall prevent a service provider from further discounting or writing off charges individually or in the aggregate.

(f) An individual’s failure to make payment under a provider’s sliding fee scale shall not prevent the individual from receiving services.

History

Rulemaking Authority 394.493(2), 394.674(4), 394.78(1), 394.9082(3), 397.321(5) FS. Law Implemented 394.493(2), 394.674(3), (4), 394.74(3)(c), 394.9082, 397.431 FS. History–New 7-1-03, Amended 7-27-14.

Fla. Admin. Code R. 65E-14.019 Methods of Paying for Services

(1) When purchasing substance abuse and mental health services pursuant to rule 65E-14.021, F.A.C., the department or a Managing Entity shall use one or a combination of the payment methodologies provided for in subsection 65E-14.019(2), F.A.C. Each contract or subcontract shall specify the payment methodology or methodologies to be used.

(2) Pursuant to section 394.74(2)(b), F.S., the following payment methodologies may be negotiated for use in a contract or subcontract:

(a) Fee-for-service rate: a method of making payment for services, based on a negotiated schedule of fees set by contract or subcontract.

(b) Case rate: a negotiated payment for a clinically-defined episode of care for an individual served, based on a contractually defined for package of services to be delivered within a defined period of time.

(c) Capitation rate: a negotiated monthly fee that is paid for an enrolled individual, whether or not the individual receives the services in that time period.

(d) Cost reimbursement: This payment methodology may be used to reimburse for operational start-up costs for new services; for specific service contracts when required by statute, grant or funding source; or for specific fixed capital outlay projects appropriated by the legislature.

(3) All supporting documentation shall comply with the Department of Financial Services Reference Guide for State Expenditures, February 2011, https://www.flrules.org/Gateway/reference.asp?No=Ref-04201, which is hereby incorporated by reference, a copy of which may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

(4) All contracts and subcontracts, regardless of payment methodology, shall comply with any requirements which are conditions of the receipt of state or federal grant funds as specified in the contract or subcontract.

History

Rulemaking Authority 394.74(2), 394.78(1), (5), 394.9082(3) FS. Law Implemented 394.74(2), 394.76(4), 394.78(1), (5), 394.9082 FS. History–New 7-1-03, Amended 12-14-03, 7-27-14.

Fla. Admin. Code R. 65E-14.020 Cost Reimbursement Method of Payment

(1) This rule establishes requirements applicable to service providers under direct contract with the department or service providers under subcontracts with a Managing Entity regarding the implementation of a cost reimbursement method of payment for substance abuse and mental health services.

(2) Required Fiscal Reports. If a contract or subcontract with a service provider requires a cost reimbursement method of payment, the service provider shall prepare and submit a CF-MH 1038, July 2014, Line Item Operating Budget With Instructions, https://www.flrules.org/Gateway/reference.asp?No=Ref-04190, which is hereby incorporated by reference, to the department or Managing Entity, as appropriate, for approval no later than 90 days before the next state fiscal year.

(3) If there is a change in funding level for any service provider, the CF-MH 1038 shall be revised and approved prior to amending the entity’s contract or subcontract.

(4) Once approved by the department or Managing Entity, the CF-MH 1038 shall be finalized and incorporated into the service contract or subcontract.

(5) Report of Expenditures and Request for Payment or Advance. The service provider shall request payment by preparing and submitting form CF-MH 1040, July 2014, Cost Reimbursement Report of Expenditures and Request for Payment or Advance, https://www.flrules.org/Gateway/reference.asp?No=Ref-04191, which is hereby incorporated by reference. This form shall show actual, allowable expenditures by line-item category or negotiated rates for reimbursement. Requests for payment shall be based on and cannot exceed the amounts specified in the line-item budget and shall be for the purposes specified in the budget narrative.

(6) For cost reimbursement contracts or subcontracts, program income shall be retained by the service provider and used in accordance with the approved Line Item Operating Budget.

(7) All forms incorporated by reference in this rule may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.

History

Rulemaking Authority 394.78(1), (5), 394.9082(3), 397.321(5) FS. Law Implemented 394.74(2)(c), (3)(d), (4), 394.78(1), (5), 394.9082, 397.321(10) FS. History–New 7-1-03, Amended 12-14-03, 7-27-14.

Fla. Admin. Code R. 65E-14.021 Schedule of Covered Services

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,

(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:

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.

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.

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.

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.

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.
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.
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:

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.

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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
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).

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1. of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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).

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,

Programs – Community Mental Health.
Measurement Standard: Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III), of this rule.
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.

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.

Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health.
Measurement Standard –Day, as defined in sub-sub-subparagraph (3)(a)3.a.(I) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(I) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
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.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
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.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Non-direct staff hour as defined in subparagraph (3)(a)2. of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Number of Enrolled Participants, notwithstanding the requirements of paragraph (3)(a) of this rule.
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.

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.

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.

Programs – Community Substance Abuse
Measurement Standard: Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1., of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Cumulative allowable expenses reported in actual dollars expended, notwithstanding the requirements of paragraph (3)(a) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(I) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard –Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard –Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(I) of this rule.
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.

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.
Programs – Community Substance Abuse.
Measurement Standard – Dosage, as defined in sub-subparagraph (3)(a)4.a. of this rule.
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.

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.
Programs – Community Mental Health.
Measurement Standard –Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Non-Direct Staff Hour, as defined in subparagraph (3)(a)2. of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
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.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Non-Direct Staff Hour, as defined in subparagraph (3)(a)2. of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Non-Direct Staff Hour, as defined in subparagraph (3)(a)2. of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Non-Direct Staff Hour, as defined in subparagraph (3)(a)2. of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard –Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard –Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Day, as defined in sub-sub-subparagraph (3)(a)3.a.(II), of this rule.
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.

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.
Programs – Community Mental Health.
Measurement Standard –Day, as defined in sub-sub-subparagraph (3)(a)3.a.(I) of this rule.
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.

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.
Programs – Community Substance Abuse.
Measurement Standard –Day, as defined in sub-sub-subparagraph (3)(a)3.a.(I) of this rule.
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.

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.
Programs – Community Substance Abuse.
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.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard – Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(III) of this rule.
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.

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.
Programs – Community Mental Health and Community Substance Abuse.
Measurement Standard –Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
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).

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.
Programs – Community Substance Abuse.
Measurement Standard –Direct Staff Hour, as defined in sub-sub-subparagraph (3)(a)1.a.(II) of this rule.
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.

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.

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.
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.

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.
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.
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.

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.

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.

A service provider shall not invoice for any Covered Services paid for under any other contract or from any other source.
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.

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.

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.
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.

History

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. History–New 7-1-03, Amended 12-14-03, 1-2-05, 7-27-14, 6-28-15, 4-27-16, 3-5-23.

Fla. Admin. Code R. 65E-14.022 Data Requirements

History

Rulemaking Authority 394.78(1), 397.321(5) FS. Law Implemented 394.66(9), 394.74(3)(e), 394.77, 397.321(3)(c), (10) FS. History–New 7-1-03, Amended 12-14-03., 1-2-05, Repealed 9-3-14.

Chapter 65E-15 CONTINUITY OF CARE CASE MANAGEMENT

Fla. Admin. Code R. 65E-15.021 Definitions

History

Rulemaking Authority 394.457(5), 394.78(1) FS. Law Implemented 394.455, 394.4573, 394.67 FS. History–New 4-20-89, Amended 11-17-93, 6-9-96, Formerly 10E-15.021, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.031 Priority Clients

History

Rulemaking Authority 394.457(5), 394.78(1) FS. Law Implemented 394.4573, 394.66, 394.74(3), 394.75, 394.76(2) FS. History–New 4-20-89, Formerly 10E-15.031, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.032 Intensive Case Management Team Services

History

Rulemaking Authority 394.457(5), 394.78(1) FS. Law Implemented 394.4573, 394.66, 394.74(3) FS. History–New 11-17-93, Formerly 10E-15.032, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.041 Case Status

History

Rulemaking Authority 394.457, 394.78(1) FS. Law Implemented 394.4573, 394.66, 394.74(3) FS. History–New 4-20-89, Amended 6-9-96, Formerly 10E-15.041, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.051 Case Management

History

Rulemaking Authority 394.457(5), 394.78(1), 916.20(1) FS. Law Implemented 394.4573(1), 394.66, 394.74(3), 394.75, 916.17(2) FS. History–New 4-20-89, Amended 11-17-93, 6-9-96, Formerly 10E-15.051, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.071 State Treatment Facility and Case Management Activities

History

Rulemaking Authority 394.457 FS. Law Implemented 394.4573 FS. History–New 4-20-89, Amended 6-9-96, Formerly 10E-15.071, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.081 Case Management Record

History

Rulemaking Authority 394.457(5), 394.78(1) FS. Law Implemented 394.4573(2), 394.66, 394.75, 394.78 FS. History–New 4-20-89, Amended 6-9-96, Formerly 10E-15.081, Repealed 2-23-16.

Fla. Admin. Code R. 65E-15.111 Systems Management

History

Rulemaking Authority 394.457(2), 394.78(1) FS. Law Implemented 394.4573, 394.66, 394.907 FS. History–New 4-20-89, Formerly 10E-15.111, Repealed 2-23-16.

Chapter 65E-16 INDIGENT PSYCHIATRIC MEDICATION PROGRAM

Fla. Admin. Code R. 65E-16.001 Definitions

(1) “IPMP” or “the Program” means the Indigent Psychiatric Medication Program.

(2) “IPMP/FSH Warehouse” means a physical space located on the campus of Florida State Hospital (FSH) at Chattahoochee, Florida. This space is reserved for receiving, storing, and shipping IPMP psychiatric medications.

(3) “Managing Entity” means a corporation as defined in Section 394.9082(2)(e), F.S.

(4) “Provider” means an agency that contracts with a Managing Entity to provide substance abuse and mental health services in accordance with Chapters 394 and 397, F.S.

(5) “Psychiatric Medication” means any drug prescribed with the primary intent to stabilize or improve mood, mental status, symptoms of behavioral health disorders, mental health or substance use disorders. The medications include the following major categories:

(a) Antipsychotics;

(b) Antidepressants;

(d) Mood stabilizers;

(e) Cerebral or psychomotor stimulants;

(f) Beta blockers,

(g) Anticonvulsants,

(h) Cognition enhancers, and

(i) Opiate blockers.

History

Rulemaking Authority 394.676(2) FS. Law Implemented 394.676 FS. History–New 9-19-19.

Fla. Admin. Code R. 65E-16.002 Individual Eligibility Criteria

To be eligible for the Program, individuals must meet the following clinical and financial eligibility criteria.

(1) To meet the clinical criteria, individuals:

(a) Must be a member of at least one (1) of the Department’s priority populations, as defined in Section 394.674(1), F.S.; and

(b) Must not currently be admitted to a state mental health treatment facility, an inpatient psychiatric hospital, or a crisis stabilization unit.

(2) To meet the financial eligibility criteria, individuals:

(a) Must have a net family income at or below 150 percent of the Federal Poverty Income Guidelines, as published annually in the Federal Register; and

(b) Must lack third-party insurance, including Medicaid, or other funding sources for psychotropic medications.

If individuals have third party insurance for psychiatric medications but the prescribed medication is not covered or not authorized, they may receive IPMP psychiatric medications until the prescribed medication is covered or authorized by the third-party insurer.

History

Rulemaking Authority 394.676(2) FS. Law Implemented 394.676 FS. History–New 9-19-19.

Fla. Admin. Code R. 65E-16.003 Provider Requirements

(1) To participate in the IPMP program, providers must be under contract with a Managing Entity.

(2) The provider must operate a licensed pharmacy or subcontract with a licensed pharmacy.

(3) Providers shall submit the following information to the IPMP/FSH Warehouse and Managing Entity to enroll in the IPMP program:

(a) The provider’s IPMP contact information, including name, email, and phone number;

(b) The name of the person authorized by the provider to approve the Supply Requisition; and

(c) A copy of the pharmacy license(s) from the provider, or the provider’s subcontracted pharmacy. Copies of the license(s) and the permit issued must be maintained in accordance with the Department of Health’s requirements specified in Section 499.012(1)(d), F.S.

(4) IPMP providers shall ensure that the information in subsection (3) is updated annually and provided to the IPMP/Warehouse and to the Managing Entity with the first medication order of the fiscal year.

History

Rulemaking Authority 394.676(2) FS. Law Implemented 394.676 FS. History–New 9-19-19.

Fla. Admin. Code R. 65E-16.004 Sanctions

(1) If an IPMP provider is not in compliance with the requirements in Chapter 65E-16 F.A.C. and Chapters 465 and 499, Part I, F.S., and the violation does not present a threat to the health, safety, or welfare of an individual or the public, the Department shall:

(a) Provide a notice of noncompliance to the provider as the first enforcement action taken; and

(b) Require a corrective action plan from the Managing Entity and the IPMP provider within 10 business days from receipt of the notice of noncompliance. The severity of the noncompliance may affect the period of time allowed for correction, but in no event shall the corrective action period exceed 90 days.

(2) When the violation does present a threat to the health, safety, or welfare of an individual or the public:

(a) The Department will require a corrective action plan from the Managing Entity and the IPMP provider within 10 business days from receipt of the notice of noncompliance. The corrective action plan must include a procedure to ensure that individuals who participate in IPMP continue to have access to psychiatric medications; and

(b) The Department will impose an immediate moratorium on IPMP prescriptions; and

(3) Notice of the moratorium shall be posted and visible to the public at the location of the provider until the action is lifted.

(4) Each Managing Entity will terminate participation of an IPMP provider from this Program for:

(a) False representation or omission of information relevant to approving a provider to participate in the Program.

(b) An intentional or negligent act materially affecting the health or safety of an individual receiving IPMP services from the provider.

(5) If an IPMP provider’s contract is terminated for cause by the Managing Entity, or if the provider is terminated from participation in the Program, the IPMP provider is barred from submitting any request to participate in this Program to the Managing Entity for a period of one (1) year after the termination.

History

Rulemaking Authority 394.676(2) FS. Law Implemented 394.676 FS. History–New 9-19-19.

Chapter 65E-20 FORENSIC CLIENT SERVICES ACT REGULATION

Fla. Admin. Code R. 65E-20.002 Definitions

(1) “Advanced Practice Registered Nurse” as defined in Section 464.003(3), F.S.

(2) “Commitment” means a court ordered involuntary hospitalization or placement of a forensic client according to the procedures of this act. It does not include voluntary admission of any client.

(3) “Individual” means a person with a mental illness who has been charged with a felony offense or acquitted of a felony offense by reason of insanity and is being served in a forensic facility. The term is synonymous with “defendant,” “client,” “patient,” or “resident.”

(4) “Personal Safety Plan” means a plan regarding strategies that the individual identifies as being helpful in avoiding a crisis. The plan also lists identified triggers that may signal or lead to agitation or distress.

(5) “Physician” means a medical practitioner licensed under Chapter 458 or 459, F.S., who has experience in the diagnosis and treatment of mental and nervous disorders.

(6) “Recovery Plan” means a written plan developed by the individual and his or her recovery team to facilitate achievement of the individual's recovery goals. This plan is based on assessment data, identifying the individual’s clinical, rehabilitative and activity service needs, the strategy for meeting those needs, documented treatment goals and objectives, and documented progress in meeting specified goals and objectives.

(7) “Recovery Team” means a group of individuals with specific responsibilities identified on the recovery plan who support and facilitate an individual’s recovery process.

(8) “Restraint” means as defined in Section 916.106(15), F.S.

(9) “Seclusion” means as defined in Section 916.106(16), F.S.

(10) “Seclusion and Restraint Oversight Committee” means a group of individuals at an agency or facility that monitors the use of seclusion and restraint at the facility. The purpose of this committee is to assist in the reduction of seclusion and restraint use at the agency or facility.

(11) “Treatment” means mental health services which are provided to individuals, individually or in groups, including: counseling, supportive therapy, psychotherapeutic medication, intensive psychotherapy, or any other accepted therapeutic process.

(12) “Walking Restraint” means a type of restraint device that allows an individual limited mobility but still prevents harm to self or others. It is intended as a less restrictive form of restraint.

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.106, 916.106(15), (16) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.002, Amended 1-28-10, 1-5-21.

Fla. Admin. Code R. 65E-20.003 Rights of Individuals

In addition to those rights enumerated in Section 916.107, F.S., every forensic client is entitled to the following:

(1) Right to Individual Dignity.

(a) Freedom from neglect or abuse;

(b) Safe living conditions and protection from harm;

(d) The opportunity to be outdoors and to participate in physical exercise at regular intervals, in the absence of medical or security considerations.

(2) Right to Treatment.

(a) Within existing resources, the Department and contracted providers shall not deny or delay mental health services to any forensic client under any circumstances, except where allowed by law.

(b) Forensic clients committed pursuant to Chapter 916, F.S., shall be given within 24 hours of admission, and at least annually thereafter, a physical examination by a licensed physician or other health practitioner as authorized by law. In the event of refusal of the examination by the client, the procedures for emergency treatment shall apply.

(c) If a forensic client has been adjudicated incompetent under the provisions of Chapter 744, F.S., a copy of the client’s individualized treatment or rehabilitation plan shall be provided to the legal guardian within 30 calendar days of the client’s admission.

(d) Every reasonable effort shall be made to communicate treatment information to the client in a language the client understands. Reasonable effort means the use of auxillary aids or services, certified interpreters, and translators.

(3) Right to Express and Informed Consent.

(a) Informed Consent.

Upon admission to a forensic facility, a client, or the person authorized to provide consent for treatment on behalf of the client, shall be asked to sign an “Informed Consent for Psychotherapeutic Medication,” CF 1630, Jul 2014, which is incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12506. The signed authorization form establishes express and informed consent.
The facility shall not administer psychotherapeutic medication until the required authorization form is signed, except in those cases where emergency treatment is ordered by a physician as provided in Section 916.107(3), F.S.

(b) Specialized Consent Requirements and Procedures.

In each separate instance where surgical procedures require the use of a general anesthetic, special written consent shall be obtained, prior to performing the procedure, from the client or the person legally authorized to provide consent if the client is a minor or has been declared incompetent under the provisions of Chapter 744, F.S.
In each separate instance where electroconvulsive treatment is to be used, pursuant to Section 458.325, F.S., there must be specific written informed consent from the client, or the person legally authorized to provide consent if the client is a minor or has been declared incompetent under the provisions of Chapter 744, F.S, prior to performing the procedure by using the “Authorization for Electroconvulsive Treatment for a Resident of a State Mental Health Treatment Facility,” CF-MH 3057F, Jul 2008, which is incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12505.
The provision of psychosurgical or electroconvulsive treatment requires the written concurrence of a second, nonattending physician pursuant to Section 458.325, F.S.
Written consent for routine nonpsychiatric medical procedures or treatment shall be received from the client or the person legally authorized to provide consent on behalf of the client.
Any authorization for treatment given by an administrator of a forensic facility or his designated representative pursuant to Section 916.107(3)(b), F.S., shall be clearly documented in the client’s clinical record and the client’s guardian, if applicable, and next of kin shall be notified.

(4) The Right to Communication, Abuse Reporting, and Visits.

(a) Communication.

Every forensic client shall be allowed to receive correspondence and may send an unlimited number of letters.

a. Each facility shall provide stationery and writing implements for indigent forensic clients, and shall pay postage on up to three outgoing pieces of correspondence each week.

b. The term “correspondence” shall not include parcels or packages. Forensic facilities shall develop policies and procedures to provide for the inspection of parcels or packages, and for the removal of contraband items for health or security reasons prior to the contents being given to the client, and shall include a system in which items removed as contraband are inventoried, notification given to the client of what was removed and why, as well as a process to either store the contraband material at the facility, or arrange to have it picked up or mailed to a person designated by the client or, in cases of contraband, transferred to the appropriate law enforcement agency.

Upon admission, a forensic facility shall advise clients of the facility of rules governing written and verbal communications, including telephone calls and visitation between clients and others outside the facility.
A forensic client’s right to communicate shall not be restricted as a means of discipline, punishment, or to serve only the convenience of facility staff.

(b) Abuse Reporting.

All facilities providing mental health services, pursuant to Chapter 916, F.S., shall provide for the reporting of abuse in accordance with the provisions of Chapter 415, F.S., “Protection from Abuse, Neglect, and Exploitation.”
Each forensic facility as defined in Chapter 916, F.S., shall provide:

a. A verbal and written explanation to each client of the procedures for reporting an alleged abuse,

b. Client access to a telephone for the purpose of reporting an alleged abuse, which should be immediate for all clients except those in seclusion or restraints, in which case access should be as soon as is practical, but in no event shall exceed 4 hours from the time the client requests access to the telephone to report an alleged abuse; and,

c. The posting, in plain view, of:

I. A copy of the abuse reporting procedure,

II. The telephone number of the abuse registry.

All forensic facilities shall maintain verification that all staff understand and are aware of the abuse reporting procedures as a condition of employment.

(5) The Right to Vote in Public Elections.

(a) Any forensic client not disqualified by law, and meeting the legal age and residency requirements of the state, shall be assisted in registering to vote and in voting if he so requests.

(b) A client who is properly registered to vote in a county other than the county of placement shall be assisted in making application for an absentee ballot in that county if he so requests. A client who is not registered to vote shall be assisted in registering in the county of his permanent residence, if he so requests.

(c) If a client requests assistance in voting, registering, or in getting information about voting requirements, staff at the facility shall assist him in obtaining the information.

(6) The Right to Confidentiality of a Forensic Client’s Clinical Record.

(a) The clinical record of every forensic client is confidential and shall be clearly indicated as such. Other than the exceptions noted in Section 916.107(8), F.S., and as implemented below, information may only be released when the client or his guardian, if a minor or adjudged incompetent under the provisions of Chapter 744, F.S., signs an “Authorization for Release of Information” CF-MH 3044, Dec 2020, which is incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12504. This authorization must contain the name of the person or agency to whom the information is to be released, the purpose of the release, and the time period within which the authorization is valid.

(b) Information received on a privileged and confidential basis from third parties, other than an Department treatment facility or Florida community provider, shall be restricted from release when the administrator determines that the information would adversely affect the client’s treatment or violate the rights of another person. Every record which is released shall indicate where third party privileged and confidential records were withheld.

(c) When a clinical record, or any part thereof, is released to any person or agency for any purpose, each page, or part thereof, shall be marked as follows: “Confidential and Privileged Information for Professional Use Only.”

(d) All forensic clients have the right of reasonable access to their own medical records on a continuing basis, except for privileged and confidential records from third party sources. The right of reasonable access shall be clarified through written policies maintained by each facility. A client’s attorney shall have access to records upon written authorization from the client.

(e) If a request is made by a parent or legal guardian for the client’s recovery treatment plan, or current physical and mental condition, the request shall be made in writing and signed.

(f) Whenever a forensic client has declared an intention to harm others, any notification to law enforcement, pursuant to Section 394.4615, F.S., shall be done by the facility administrator or the facility adminstrator’s designee, and shall be documented in the client’s clinical record.

(7) The Right to Be Informed.

(a) All forensic clients have the right to timely and meaningful information about their rights. Each client shall be informed of his rights as a forensic client in a forensic facility at the time of admission.

(b) Each forensic facility shall post in a conspicuous place or places a list of all forensic client rightsand, upon request, make available the list translated into another language.

(c) Each forensic facility shall maintain on the premises of the treatment site, an up-to-date copy of Chapter 916, F.S., and an up-to-date copy of these rules, and shall have these documents available for inspection upon the request of a client, the client’s representative, the client’s guardian, friends or relatives of the client.

History

Rulemaking Authority 916.1093 FS. Law Implemented 916.107 FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.003, Amended 1-28-10, 1-5-21.

Fla. Admin. Code R. 65E-20.004 The Right to Treatment

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(2) FS. History–New 9-29-86, Formerly 10E-20.004, Repealed 1-5-21.

Fla. Admin. Code R. 65E-20.005 The Right to Express and Informed Consent

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(3) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.005, Amended 9-29-98, Repealed 1-5-21.

Fla. Admin. Code R. 65E-20.006 The Right to Communication, Abuse Reporting and Visits

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(5) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.006, Repealed 1-5-21.

Fla. Admin. Code R. 65E-20.007 The Right to Vote in Public Elections

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(7) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.007, Repealed 1-5-21.

Fla. Admin. Code R. 65E-20.008 The Right to Confidentiality of a Forensic Client’s Clinical Record

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(8) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.008, Repealed 1-5-21.

Fla. Admin. Code R. 65E-20.009 The Right to Be Informed

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107 FS. History–New 9-29-86, Formerly 10E-20.009, Repealed 1-5-21.

Fla. Admin. Code R. 65E-20.010 Transportation

(1) Department forensic clients shall be transported separately from Department of Corrections felons who are being transported to and from correctional facilities.

(2) All transportation provided shall be consistent with the needs of clients and the condition of clients being transported, as specified by the sending facility. Any company contracting with the governing board of a county to transport forensic clients shall comply with requirements to ensure the safety and dignity of the client. Such requirements shall be specified in the contract and shall include, but not be limited to the following:

(a) All transport vehicles will be equipped with a type 1A10BC fire extinguisher, seat belts, and two-way communication radio.

(b) Staff having the responsibility for transporting clients shall be trained, experienced, and otherwise qualified to transport mentally ill persons. This training shall include, but not be limited to, the training approved by the department for law enforcement officers involved with the care and handling of clients under Chapter 394, F.S.

(d) Staff members transporting forensic clients shall not wear firearms in the vehicle.

(e) The length of time for transporting clients shall not exceed 12 hours per day.

(f) Rest stops shall be made at regular intervals during the transporting of clients.

(g) Clients shall be dressed in appropriate seasonal attire.

(h) Nutritious meals shall be provided at appropriate times during the transporting of clients.

(i) Physical restraints, such as canvas cuffs, shall be used only when necessary to protect the clients from injury to themselves or others.

(j) All staff members who accompany clients shall have knowledge of techniques in handling volatile clients.

(k) Any driver of a vehicle used in transporting mental health clients shall have a valid Florida Class E (non-commercial) license when operating a vehicle designed to transport 15 or fewer individuals including the driver. The Class C commercial license will be needed when operating a vehicle with a Gross Vehicle Weight Rating of less than 26,001 pounds designed to transport more than 15 persons including the driver. When passengers are transported in a vehicle with a Gross Vehicle Weight Rating of 26,001 pounds or more a Class B commerical license with a Passenger endorsement will be needed. All drivers will be responsible for ensuring they have the appropriate licenses and endorsements.

(l) Any vehicle used in transporting clients shall be maintained and operated in accordance with chapter 916, F.S., and in a manner that protects the clients’ rights, dignity, and physical safety.

(m) The number of persons in any vehicle used in transporting clients shall not exceed the manufacturer’s recommended seating capacity.

(n) Any unusual incidents occurring during the client transport process shall be reported immediately upon arrival at the treatment facility to the sheriff’s department, the originating receiving or treatment facility, if applicable, and the governing board of the county.

(o) The transport company shall ensure the confidentiality of the transport record.

(p) Civil patients committed under Part I of Chapter 394, F.S., and forensic clients committed under Chapter 916, F.S., who are assigned to reside in secure facilities, shall be transported separately. Forensic clients who reside in civil facilities may be transported with civil patients.

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(10) FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.010, Amended 9-29-98, 11-29-12.

Fla. Admin. Code R. 65E-20.011 Receipt of Commitment Orders and Required Documentation

(1) Commitment orders pertaining to any person committed to the Department of Children and Families pursuant to the provisions of Chapter 916, F.S., shall be sent to the Department of Children and Families for review and determination of an appropriate facility placement for the client. The order shall be accompanied by documentation specified in Florida Rules of Criminal Procedure 3.212 and 3.217. The complete commitment package shall be sent to one of the following addresses:

For mentally ill forensic clients, the perferred method is to send via email to DCF.Adult.Forensic.Admissions@myflfamilies.com. Alternatively, packets can be mailed to:

Forensic Admission Coordinator,

Department of Children and Families/SAMH

1317 Winewood Boulevard, Building 6

Tallahassee, FL 32399-0700

(850)487-3471

For developmentally disabled forensic clients, the preferred method is to send via email to APD.Forensic.Admissions@apdcares.org.

Alternatively, packets can be mailed to:

APD Forensic Admissions

4030 Esplanade Way

Tallahassee, FL 32399-0950

(850)414-7592

Upon receipt of each commitment package the Department shall review the package for completeness.

(a) If complete, the date of receipt shall be recorded. The statutory 15 day period set forth in Section 916.107(1)(a), F.S., will commence on this day.

(b) If the package is incomplete, the appropriate authority will be notified of the missing items and advised that the official date of receipt of the commitment package will be delayed until all missing items are received.

(2) Clients are scheduled for admission based on date of receipt of complete commitment package. Upon notification by the Department of the availability of a bed and date of assignment, the committing county will be responsible for arranging transportation.

(3) Admissions at state forensic facilities are accepted Monday through Thursday from 8:00 a.m. through 3:00 p.m., and Fridays from 8:00 a.m. through 1:00 p.m. No weekend or holiday admissions are accepted.

(4) Assignment of a forensic client for admission to a civil mental health treatment facility shall be done according to procedures established by the Department. Prior to the assignment to a civil facility, that facility must be contacted and approval obtained. A forensic client who is dangerous or is a serious escape risk shall not be assigned to a civil facility.

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107 FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.011, Amended 11-29-12, 1-5-21.

Fla. Admin. Code R. 65E-20.012 Admission to a Forensic Facility

(1) Forensic facilities shall admit forensic clients who are:

(a) Assigned and scheduled for admission by the appropriate Forensic Admissions Office; and

(b) Accompanied by an Order of Commitment and other documentation, as specified in Florida Rules of Criminal Procedure 3.212 and 3.217, which shall be used by facility staff in making their initial evaluation and in instituting appropriate treatment quickly.

(2) Facility staff shall review the accompanying documentation for completeness.

(3) In any case where a client who is not assigned to a particular facility and scheduled for admission arrives at a facility, facility staff shall notify the Forensic Admissions Office and the Facility Administrator to determine available options.

(4) A physical examination shall be conducted on the day of arrival of the client at a forensic facility. Any apparently recent injuries noted shall be reported to the administrator of the county jail sending the forensic client. Photographs of injuries shall be taken as evidence.

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.13, 916.15 FS. History–New 9-29-86, Amended 7-1-96, Formerly 10E-20.012, Amended 9-29-98, 1-5-21.

Fla. Admin. Code R. 65E-20.013 Contraband Control

(1) At the time of admission, the transporting officers shall remain with the client until the forensic facility accepts custody of the client.

(a) The transporting officers shall surrender any firearm, deadly weapon or contraband item to the facility security staff upon entering the facility grounds.

(b) The transporting officers shall transfer the client’s property, including money, valuables and personal effects, to the facility staff.

(2) At the time of admission, facility security staff shall examine and inventory the client’s personal effects for contraband and items as determined by statute, Departmental rule, or by the administrator of the facility, and designated by written institutional policy to be hazardous to the welfare of the residents or the operation of the facility. Security staff shall confiscate and appropriately dispose of such contraband, and provide the client with a receipt for the confiscated items.

(3) All employees and visitors are subject to a search of their possessions and person when on the grounds of a forensic facility. Searches of the person under this section may include inspection of the possessions carried by the person, removal of shoes, a pat-down body search, and searches by electronic methods. In any case, where a pat-down body search is authorized, such search shall be conducted by an individual of the same sex as the person searched, and all other persons present shall also be of the same sex.

(a) Employees shall be informed that their failure to allow the search to be conducted may result in disciplinary action.

(b) Visitors shall be informed that their failure to allow the search to be conducted will result in their expulsion from the facility and its grounds.

(4) Strip searches and cavity searches of clients in a forensic facility may be authorized by the facility administrator pursuant to written institutional policy based on the rules set forth below.

(a) Strip Searches.

Definition: a body search in which all clothing is removed and the entire body is visually checked, including hair, ears, mouth with dentures to be removed, armpits, hands, pubic region, between toes, soles of the feet, arms, and inner portions of legs.
Strip searches must be done in the area where the acts of disrobing and being searched cannot be viewed by other clients and employees not involved in the search.
Staff conducting or observing the strip search shall be of the same sex as the person being searched.
The strip search shall be observed by another staff member who is of the same sex as the person being searched. A supervisor shall instruct the staff conducting the search as to the requirements of this policy, and shall ensure that this policy is followed.

(b) Cavity Searches.

Definition: a body search in which physical rather than visual inspection of bodily orifices is made. The bodily orifices include mouth, ears, nostrils, vagina and rectum.
Cavity searches are only to be conducted in extreme cases, where reasonable belief exists that the person has contraband upon his or her person which may be contained in a bodily orifice.
A cavity search will only be conducted by a physician. A registered nurse must be present continuously during the search. Either the doctor or the nurse must be of the same sex as the client being searched.
Cavity searches must be done in an area where the search cannot be viewed by other clients or employees not involved in the search.
In addition to the physician and nurse, one or more employees of the same sex as the client may be present during the search if necessary for security or to make the search possible.

(5) Searches of the client’s living area may be made whenever it is deemed necessary to insure the safety and security of the facility and when there is reason to believe that contraband is present.

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.107(10), 916.1085 FS. History–New 9-29-86, Formerly 10E-20.013.

Fla. Admin. Code R. 65E-20.014 Seclusion and Restraint for Emergency Behavior Management Purposes

(1) General Standards.

(a) Each facility will provide a therapeutic milieu that supports a culture of recovery, individual empowerment, and responsibility. Each individual will have a voice in determining his or her treatment options. Treatment will foster trusting relationships and partnerships for safety between staff and individuals. Facility staff will be particularly sensitive to individuals with a history of trauma and use trauma informed care.

(b) The health and safety of the individual shall be the primary concern at all times.

(c) Seclusion or restraint shall be employed only in emergency situations when necessary to prevent an individual from seriously injuring self or others, and less restrictive techniques have been tried and failed, or it has been clinically determined that the danger is of such immediacy that less restrictive techniques cannot be safely applied.

(d) There is a high prevalence of past traumatic experience among individuals who receive mental health services. The response to trauma can include intense fear and helplessness, a reduced ability to cope, and an increased risk to exacerbate or develop a range of mental health and other medical conditions. The experience of being placed in seclusion or being restrained is potentially traumatizing. Seclusion and restraint practices shall be guided by the following principles of trauma-informed care: assessing trauma histories and symptoms; recognizing culture and practices that are re-traumatizing; processing the impact of a seclusion or restraint with the individual; and addressing staff training needs to improve knowledge and sensitivity.

(e) When an individual demonstrates a need for immediate medical attention in the course of an episode of seclusion or restraint, the seclusion or restraint shall be discontinued and immediate medical attention shall be obtained.

(f) Individuals will not be restrained in a prone position. Prone containment will be used only when required by the immediate situation to prevent imminent serious harm to the individual or others. To reduce the risk of positional asphyxiation, the individual will be repositioned as quickly as possible.

(g) Responders will pay close attention to the respiratory function of the individual during containment and restraint. All staff involved will observe the individual’s respiration, coloring, and other possible signs of distress and immediately respond if the individual appears to be in distress. Responding to the individual’s distress may include repositioning the individual, discontinuing the seclusion or restraint, or summoning medical attention.

(h) Objects shall not be placed over an individual’s face. In situations where precautions need to be taken to protect staff, staff may wear protective gear.

(i) Unless necessary to prevent serious injury, an individual’s hands shall not be secured behind the back during containment or restraint.

(j) The use of walking restraints is prohibited except for purposes of off-unit transportation and may only be used under direct observation of staff who have been trained for this purpose. Direct observation means that staff maintains continual visual contact of the individual and remains within close physical proximity to the individual at all times.

(k) The individual shall be released from seclusion or restraint as soon as he or she is no longer an imminent danger to self or others.

(l) Seclusion or restraint use shall not be based solely on a history of dangerous behavior or history of seclusion or restraint use. Dangerous behaviors include those behaviors that jeopardize the physical safety of oneself or others.

(m) Seclusion and restraint may not be used simultaneously for children less than 18 years of age. For adults age 18 and over, simultaneous seclusion and restraint is only permitted if the individual is continually monitored face-to-face by an assigned, trained staff member or if the individual is continually monitored by trained staff using both audio and video equipment. Staff providing this monitoring must be in close proximity to the individual.

(n) An individual who is restrained must not be located in areas subject to view by individuals other than involved staff or where exposed to potential injury by other individuals. This does not apply to individuals in walking restraints.

(o) Each facility utilizing seclusion or restraint procedures shall establish and utilize a Seclusion and Restraint Oversight Committee. Members of the Committee shall include, but is not limited to, the facility administrator/designee, medical staff, quality assurance staff, and a peer specialist or advocate, if employed by the facility or otherwise available. If a peer specialist or advocate is not employed by the facility, an external peer specialist or advocate may be appointed.

(2) Staff Training. Staff must be trained during orientation and subsequently at least annually. Prior to using seclusion or restraint, staff will demonstrate specific knowledge of, or relevant competency in, the following areas:

(a) Employing strategies designed to reduce confrontation and to calm and comfort people, including the development and use of a personal safety plan;

(b) Using nonphysical intervention skills as well as body control and physical management techniques to ensure safety;

(c) Observing for and responding to signs of physical and psychological distress during the seclusion or restraint event;

(d) Applying restraint devices safely;

(e) Monitoring the physical and psychological well-being of the individual who is restrained or secluded, including, but not limited to: respiratory and circulatory status, skin integrity, vital signs, and any special requirements specified by facility policy associated with the one hour face-to-face evaluation;

(f) Identifying the specific behavioral changes that indicate restraint or seclusion is no longer necessary;

(g) Using first aid techniques; and,

(h) Being certified in the use of cardiopulmonary resuscitation (CPR), including required periodic recertification. The frequency of training for cardiopulmonary resuscitation will be in accordance with CPR certification requirements and facility policy.

(3) Prior to the Implementation of Seclusion or Restraint.

(a) Prior intervention shall include individualized therapeutic actions identified in a personal safety plan that address individual triggers leading to psychiatric crisis. Recommended form CF-MH 3124, Feb. 05, “Personal Safety Plan,” which is incorporated herein by reference, may be used for the purpose of guiding individualized techniques. Recommended form CF-MH 3124 is available at http://www.flrules.org/Gateway/reference.asp?No=Ref-12487 and may also be accessed from the Department’s website at “http://www.dcf.state.fl.us/mental health/laws.”

(b) Prior interventions should include verbal de-escalation, calming strategies, and environmental changes to reduce identified triggers. Non physical interventions must be the first choice unless safety issues require the use of physical intervention.

(c) A personal safety plan shall be completed upon admission and at least every 12 months thereafter and filed in the individual’s clinical record.

The personal safety plan shall be reviewed by the recovery team, and updated if necessary, after each incident of seclusion or restraint;
Specific intervention techniques from the personal safety plan that are offered or used prior to a seclusion or restraint event shall be documented in the individual’s clinical record after each use of seclusion or restraint; and
All staff shall be aware of and have ready access to each individual’s personal safety plan.

(d) Contraindications to the use of specific seclusion or restraint techniques due to medical conditions shall be documented in the individual’s clinical record as part of the individual’s admission and subsequent physical examination or psychiatric evaluation. Staff shall be informed of any contraindications as determined by the physician or Advanced Practice Registered Nurse (APRN) and shall utilize other techniques as indicated on the individual’s personal safety plan.

(4) Implementation of Seclusion or Restraint.

(a) A registered nurse or highest-level staff member, as specified by written facility policy, who is immediately available and who is trained in seclusion and restraint procedures may initiate seclusion or restraint in an emergency when danger to self or others is imminent.

(b) An order for seclusion or restraint must be obtained from the physician, APRN, or Physician’s Assistant (PA), if permitted by the facility to order seclusion and restraint and stated within their professional protocol. The treating physician must be consulted if the seclusion or restraint was ordered by another physician.

(c) The individual must be seen face-to-face by a physician or APRN within one hour after initiation of seclusion or restraint. The face-to-face exam may be delegated to a Registered Nurse (RN) or PA if authorized by the facility and the individual has been trained in seclusion and restraint procedures as described in subsection (2). The staff member conducting the face-to-face examination shall evaluate or review, and document the following within one hour:

The individual’s immediate situation;
The individual’s reaction to the intervention;
The individual’s medical and behavioral condition;
The individual’s medication orders, including an assessment of the need to modify such orders during the period of seclusion or restraint. If the face-to-face exam is completed by the RN or PA, the RN or PA shall consult with the physician or APRN regarding the need to modify the resident’s medication orders;
The need or lack of need to elevate the individual’s head and torso during restraint;
Whether the risks associated with the use of seclusion or restraint are significantly less than not using seclusion or restraint; and;
The need to continue or terminate the intervention.

(d) A licensed psychologist may only conduct the behavioral assessment portion of the face-to-face exam indicated in subparagraph (4)(c)3., if authorized by the facility and trained in seclusion and restraint procedures as described in subsection (2). If the face-to-face evaluation is conducted by a trained Registered Nurse or physician assistant, the attending physician who is responsible for the care of the individual must be consulted after the evaluation is completed.

(e) Documentation of the face-to-face examination described in subparagraphs (4)(c)1.-7., including the time and date completed, shall be included in the individual’s clinical record.

(f) Each written order for seclusion or restraint is limited to four hours for adults, age 18 and over; and two hours for youth age 9 through 17. A seclusion or restraint order may be renewed every two hours for youth and every four hours for adults, after consultation and review by a physician, APRN, or PA in person, or by telephone with a Registered Nurse who has physically observed and evaluated the individual. The order may only be renewed for up to a total of 24 hours. When the order has expired after 24 hours, a physician, APRN, or PA must see and assess the individual before seclusion or restraint can be re-ordered. The results of this assessment must be documented. Seclusion or restraint use exceeding 24 hours requires the notification of the facility administrator or the facility administrator’s designee.

(g) Once seclusion or restraint has been terminated, a new order and subsequent assessments are required to place the individual back into seclusion or restraint as indicated in subsection (4), of this rule.

(h) Each seclusion or restraint order must be signed within 24 hours of the initiation of seclusion or restraint.

(i) The seclusion or restraint order shall include the specific behavior prompting the use of seclusion or restraint, the time limit for seclusion or restraint, and the behavior necessary for the individual’s release. Additionally, for restraint, the order shall contain the type of restraint ordered and the positioning of the individual, including possibly elevating the individual’s head for respiratory and other medical safety considerations. Consideration shall be given to the individual’s age, physical fragility, and physical disability when ordering restraint type.

(j) An order for seclusion or restraint shall not be issued as a standing order or on an as-needed basis.

(k) In order to protect all individuals served by a facility, each individual shall be searched for contraband before or immediately after being placed into seclusion or restraints.

(l) The individual shall be clothed appropriately for the current temperature and at no time shall an individual be placed in seclusion or restraint in a nude or semi-nude state.

(m) For youth under the age of 18, the facility must notify the parent(s) or legal guardian(s) of the individual who has been restrained or placed in seclusion within 24 hours after the initiation of each seclusion or restraint event. This notification must be documented in the individual’s clinical record, including the date and time of notification and the name of the staff person providing the notification.

(n) Every secluded or restrained individual shall be informed of the behavior that resulted in the seclusion or restraint and the behavior and the criteria necessary for release. Release criteria shall reflect that the individual is not an imminent danger to self or others.

(o) For each use of seclusion or restraint, the following information shall be documented in the individual’s clinical record:

The emergency situation resulting in the seclusion or restraint event;
Alternatives or other less restrictive interventions attempted, or the clinical determination that less restrictive techniques could not be safely applied;
The name and title of the staff member initiating the seclusion or restraint; the date/time of initiation and release;
The individual’s response to seclusion or restraint, including the rationale for continued use of the intervention; and
The individual was informed of the behavior that resulted in the seclusion or restraint and the criteria necessary for release.

(5) During Seclusion or Restraint Use.

(a) When restraint is initiated, except for walking/transport restraint, nursing staff shall see and assess the individual no later than 15 minutes after initiation and at least every hour thereafter. The assessment shall include checking the individual’s circulation and respiration, including vital signs (pulse and respiratory rate at a minimum).

(b) The individual who is secluded shall be observed by trained staff every 15 minutes. At least one observation an hour will be conducted by a nurse.

(c) Restrained individuals must have continuous observation by trained staff. Documentation of the resident’s condition will occur at least every 15 minutes.

(d) Monitoring the physical and psychological well-being of the individual who is secluded or restrained shall include but is not limited to: respiratory and circulatory status; signs of injury; vital signs; skin integrity; behavioral observations; verbal interactions; and any special requirements specified by facility policies. This monitoring shall be conducted by trained staff as required in subsection (2).

(e) During each period of seclusion or restraint, the individual must be offered opportunities to drink and toilet as requested. In addition, the individual who is restrained must be offered opportunities to have range of motion at least every two hours to promote comfort. Each facility shall have written policies and procedures specifying the frequency of providing drink, toileting, checking of body positioning to avoid traumatizing an individual, and retaining the individual’s maximum degree of dignity and comfort during the use of bodily control and physical management techniques.

(f) Documentation of the observations and the staff person’s name shall be recorded at the time the observation takes place.

(6) Release from Seclusion or Restraint and Post-Release Activities.

(a) Release from seclusion or restraint shall occur as soon as the individual no longer appears or reports to present an imminent danger to self or others. Upon release from seclusion or restraint, the individual’s physical condition shall be observed, evaluated, and documented by trained staff. Documentation shall also include the name and title of the staff releasing the individual and the date and time of release.

(b) After a seclusion or restraint event, a debriefing process shall take place to decrease the likelihood of a future seclusion or restraint event for the individual and to provide support.

A review of the incident with the individual who was secluded or restrained. The individual shall be given the opportunity to process the seclusion or restraint event as soon as possible but no longer than within 24 hours of release. This debriefing discussion shall take place between the individual and either the recovery team or another preferred staff member. This review shall address the incident within the framework of the individual’s life history and mental health issues. It shall assess the impact of the event on the individual and help the individual identify and expand coping mechanisms to avoid the use of seclusion or restraint in the future. The discussion will include constructive coping techniques for the future. A summary of this review should be documented in the individual’s clinical record.
A review of the incident with all staff involved in the event and supervisors or administrators. This review shall be conducted as soon as possible after the event but no longer than within 24 hours of release and shall address: the circumstances leading to the event; the nature of de-escalation efforts; alternatives to seclusion and restraint attempted; staff response to the incident; and ways to effectively support the individual’s constructive coping in the future and avoid the need for future seclusion or restraint. The outcomes of this review shall be documented by the facility for purposes of continuous performance improvement and monitoring. The review findings will be forwarded to the Seclusion and Restraint Oversight Committee.
Support for other individuals served and staff, as needed, to return the unit to a therapeutic milieu.

(d) Within two working days after any use of seclusion or restraint, the recovery team shall meet and review the circumstances preceding the event and review the individual’s recovery plan and personal safety plan to determine whether any changes are needed in order to prevent the further use of seclusion or restraint. The individual who was secluded or restrained shall be provided an opportunity to participate in this meeting. The recovery team shall also assess the impact the event had on the individual and provide any counseling, services, or treatment that may be necessary. The recovery team shall analyze the individual’s clinical record for trends or patterns relating to conditions, events, or the presence of other persons immediately before or upon the onset of the behavior warranting the seclusion or restraint, and upon the individual’s release from seclusion or restraint. The recovery team shall review the effectiveness of the emergency intervention and develop more appropriate therapeutic interventions. Documentation of this review shall be placed in the individual’s clinical record.

(e) If an individual has had multiple seclusion or restraint events, the recovery team shall conduct a thorough clinical review, including a medication review, to determine if any changes to the recovery plan or overall treatment and services are needed.

(f) The Seclusion and Restraint Oversight Committee shall conduct at least weekly reviews of each use of seclusion and restraint event. The Committee shall also monitor patterns of use, for the purpose of ensuring least restrictive approaches are utilized, to prevent or reduce the frequency and duration of use.

(7) Reporting.

(a) All civil and forensic state mental health treatment facilities serving individuals committed pursuant to Chapter 916, F.S., are required to report each seclusion and restraint event to the Department of Children and Families. This reporting shall be done electronically using the Department’s web-based application, either directly via the data input screens, or indirectly via the File Transfer Protocol batch process. The required reporting elements include: provider tax identification number; individual’s social security number and identification number; date and time the seclusion or restraint event was initiated; discipline of the individual ordering the seclusion or restraint; discipline of the individual implementing the seclusion or restraint; reason seclusion or restraint was initiated; type of restraint used; whether significant injuries were sustained by the individual; and date and time seclusion or restraint was terminated. Facilities shall report seclusion and restraint events to the Department on a monthly basis. Events that result in death or significant injury, either to a staff member or individual, shall be reported to the Department’s web-based system as required by the Department. The purpose of collecting protected health information, such as social security number, is to uniquely identify each person served for treatment, payment, and health care operation as authorized by the HIPAA privacy and security standards, as referenced in 45 CFR 164.506.

(b) All facilities that are subject to the Conditions of Participation for Hospitals, 42 Code of Federal Regulations, part 482, under the Centers for Medicare and Medicaid Services (CMS), must report to CMS any death that occurs in the following circumstances:

While an individual is restrained or secluded,
Within 24 hours after release from seclusion or restraint, or
Within one week after seclusion or restraint, where it is reasonable to assume that use of the seclusion or restraint contributed directly or indirectly to the individual’s death.

Each death described in paragraph (7)(b), shall be reported to CMS by telephone no later than the close of business the next business day following knowledge of the individuals’ death. A report shall simultaneously be submitted to the Director of Mental Health/Designee in the Mental Health Program Office Headquarters in Tallahassee, FL. The address is: 1317 Winewood Blvd., Tallahassee, FL 32399-0700. Facilities that are not required to report these deaths to CMS shall report the death to the Director of Mental Health/Designee in the Mental Health Program Office Headquarters at the address above.

(c) The Department shall collect and review the data on a monthly basis. The Director of Mental Health shall be informed of any deaths or significant injuries related to seclusion or restraint, and significant trends regarding seclusion and restraint use.

(8) Nothing herein shall affect the ability of emergency medical technicians, paramedics or physicians, or any person acting under the direct medical supervision of a physician to provide examination or treatment of incapacitated individuals in accordance with Section 401.445, F.S.

History

Rulemaking Authority 916.1093(2) FS. Law Implemented 916.105(4), 916.107(4)(b), 916.1093(2) FS. History–New 1-28-10, Amended 1-5-21.

Chapter 65E-25 SEXUALLY VIOLENT PREDATOR PROGRAM

Fla. Admin. Code R. 65E-25.001 Assessment and Evaluation Procedures

(1) There shall be an initial assessment of every person referred to the Department of Children and Families (Department) for possible commitment as a sexually violent predator. The initial assessment shall consist of a record review by no fewer than two licensed psychologists or psychiatrists or one licensed psychologist and one licensed psychiatrist with experience in or relevant to the evaluation or treatment of persons with mental abnormalities, as defined in Section 394.912(5), F.S. Records reviewed shall, at a minimum, consist of the person’s criminal and institutional background and treatment history provided with the referral by the Department of Corrections, Department of Juvenile Justice, or the Department pursuant to Section 394.913(2), F.S.

(2)(a) A clinical evaluation shall be conducted on persons who may meet the statutory criteria for commitment as sexually violent predators as determined by the initial assessment. At least one licensed psychologist or psychiatrist with experience in or relevant to the evaluation or treatment of persons with mental abnormalities shall perform a clinical evaluation which shall include, at a minimum, a review of all records considered during the initial assessment and a personal interview of the person if the person consents to the interview. The psychologist(s) or psychiatrist(s) who perform the clinical evaluation shall be different from the psychologist(s) or psychiatrist(s) who conducted the initial assessment.

(b) The evaluator’s clinical opinion shall be the product of clinical judgement guided by the application of assessment instruments helpful in the prediction of sexual offender recidivism. Each clinical evaluation shall include the use of an actuarial tool, when applicable. The clinical evaluation shall result in a written report that addresses, at a minimum, whether the person suffers from a mental abnormality or personality disorder that makes the person likely to engage in acts of sexual violence if not confined in a secure facility for long-term control, care, and treatment.

(3) The multidisciplinary team shall consist of:

(a) The licensed psychologist(s) or psychiatrist(s) who conducted the initial assessment or who reviewed the complete assessment and evaluation file; and

(b) The licensed psychologist(s) or psychiatrist(s) who performed the clinical evaluation.

(4) The department must recommend that the state attorney file a petition for civil commitment if at least two members of the multidisciplinary team determine that the person meets the definition of a sexually violent predator.

(5) The Department’s recommendation to the state attorney of whether or not to file a petition shall be based upon the multidisciplinary team report. In the event the Department or a member of the multidisciplinary team receives additional information concerning a person after the recommendation is provided to the state attorney, the Department must provide the additional information to all the members of the multidisciplinary team. Each member of the team must review the additional information alters his or her conclusion as to whether or not the person meets commitment criteria. If the conclusion of the multidisciplinary team is revised as a result of the additional information, the Department will submit a revised recommendation to the state attorney.

History

Rulemaking Authority 394.930 FS. Law Implemented 394.913, 394.9135 FS. History–New 10-7-01, Amended 4-19-21.

Fla. Admin. Code R. 65E-25.002 Education and Training Requirements for Multidisciplinary Team Members

Multidisciplinary team members must be licensed psychologists or psychiatrists with a minimum of one year’s experience in the assessment or treatment of sex offenders. The Department may accept other relevant experience in lieu of the one year of sex offender assessment or treatment experience. In determining whether to accept other experience in lieu of one year of sex offender assessment and treatment, the Department will consider the forensic experience and training the potential team member has in the assessment or treatment of individuals who offend sexually. Multidisciplinary team members must earn a minimum of 24 hours of continuing education credit biannually in the assessment or treatment of sex offenders.

History

Rulemaking Authority 394.930 FS. Law Implemented 394.913, 394.930 FS. History–New 10-7-01, Amended 4-19-21.

Fla. Admin. Code R. 65E-25.003 Criteria for Recommendation that Involuntary Civil Commitment Petition be Filed

(1) In order for the multidisciplinary team to conclude a person meets criteria for civil commitment, the person’s history must include specific clinically-relevant information which suggests the person:

(a) Has a propensity to engage in acts of sexual violence defined as sexually violent offenses in Section 394.912, F.S.;

(b) Is likely to commit future sexually violent offenses if not confined in a secure residential facility; and

(c) Is likely to commit future sexually violent offenses if returned to the community without having received long-term treatment and care.

(2) In determining whether the criteria in subsection (1), are met, the clinical evaluation(s) prepared by the multidisciplinary team members must address the following factors, if present:

(a) Self reported intention or desire to commit a sexually violent offense;

(b) Recent behavior suggestive of sexually violent offending;

(d) Behavior or self-reported evidence of sexual deviance or personality disorder;

(e) Victims of sexual behaviors;

(f) Predatory behavior;

(g) Physical force or threats in the course of a sexually violent offense;

(h) Abduction or attempted abduction of a child unknown to the offender; and

(i) Other factors determined to be clinically significant to a person’s risk to reoffend.

(3) A person will not be considered to meet the criteria for involuntary civil commitment as a sexually violent predator if the person’s propensity to commit sexually violent offenses is wholly attributable to a “mental illness” as defined in Section 394.455, F.S.

(4) A person will not be considered to meet the criteria for involuntary civil commitment as a sexually violent predator if the person’s propensity to commit sexually violent offenses is wholly attributable to “intellectual disability” or “autism” as defined in Section 393.063, F.S.

History

Rulemaking Authority 394.930 FS. Law Implemented 394.913, 394.9135, 394.930 FS. History–New 10-7-01, Amended 8-7-14, 4-19-21.

Fla. Admin. Code R. 65E-25.004 Designation of Secure Facilities

The secure facilities to be utilized by the department for the control, care and treatment of persons detained or committed under Sections 394.910-.931, F.S., are the Florida Civil Commitment Center at 13619 S.E. Hwy. 70, Arcadia, FL 34266, and the South Bay Sexually Violent Predator Detainee Unit at 600 US Hwy. 27 South, South Bay, FL 33493.

History

Rulemaking Authority 394.930 FS. Law Implemented 394.914, 394.9151, 394.917 FS. History–New 10-7-01.

Fla. Admin. Code R. 65E-25.005 Basic Treatment Plan Components

(1) The treatment program for persons involuntarily committed to the Department shall be a cognitive-behavioral therapy and relapse prevention program tailored to meet the needs of each committed person. Each committed person must receive a comprehensive assessment that will permit the development of an individualized treatment plan.

(2) The treatment program shall consist of a series of hierarchically advancing stages of treatment and rehabilitation. The program must afford group and, where indicated, individual counseling directed toward sex offender-specific issues, as well as substance abuse and general psychological issues. In addition to structured counseling activities, the program must offer vocational therapy and therapeutic recreational activities.

(3) The treatment program may utilize phallometric and polygraphic assessment to assist in measuring treatment progress.

(4) Where medically and therapeutically appropriate, the treatment program may offer, on a voluntary basis, pharmacological treatment designed to reduce deviant sexual impulses.

(5) At least annually, each committed person shall have his treatment plan and progress reviewed by the primary treating clinician and the clinical director or his or her licensed psychologist/psychiatrist designee. A status report shall be prepared and included in the clinical file, with notation of any adjustments made in the person’s treatment plan as a result of the review.

History

Rulemaking Authority 394.930 FS. Law Implemented 394.930 FS. History–New 10-7-01, Amended 4-19-21.

Fla. Admin. Code R. 65E-25.006 Notification of Examination

(1) Prior to conducting a personal interview of a potential sexually violent predator, the person to be interviewed must be informed of the following:

(a) That the person is the subject of a clinical evaluation which, together with review of pertinent records, will enable the State to formulate an opinion as to whether the person meets statutory criteria as a sexually violent predator;

(b) That the person may decline to be interviewed and, that if declined, the clinical evaluation will consist of a record review only; and

(c) That the evaluation will result in a written report that will be considered by the State in reaching a determination as to whether to recommend to the state attorney that an involuntary commitment petition be filed.

(2) The person will be provided with a consent form to sign indicating an understanding of the information provided pursuant to subsection (1).

(a) If the person refuses to sign the consent form, the evaluator should so indicate on the written statement and sign and date it.

(b) In the event that it is not practicable to provide the person the consent form and obtain a signature, the evaluator should so indicate on the consent form with a brief explanation of why the consent form could not be provided and sign and date it.

History

Rulemaking Authority 394.930 FS. Law Implemented 394.913, 394.9155, 394.930 FS. History–New 10-7-01, Amended 4-19-21.

Chapter 65E-26 SUBSTANCE ABUSE AND MENTAL HEALTH PRIORITY POPULATIONS AND SERVICES

Fla. Admin. Code R. 65E-26.001 Applicability

This chapter establishes standards for identifying individuals who are eligible for publicly funded substance abuse and mental health services and for enrolling these individuals into the department’s priority populations as referenced in Section 394.674, F.S.

History

Rulemaking Authority 394.674(4) FS. Law Implemented 394.674 FS. History–New 3-8-12.

Fla. Admin. Code R. 65E-26.002 Enrollment and Eligibility Requirements

(1) To be eligible for substance abuse and mental health services funded by the Department of Children and Families (DCF), an individual must be enrolled in one of the department’s priority populations as referenced in Section 394.674, F.S.

(2) To meet this enrollment requirement, the provider must submit enrollment data and service event data in the department’s database system as follows:

(a) Every service event funded by the department must have a corresponding enrollment record showing the priority population of the person served.

(b) Service event records funded by the department that do not have corresponding enrollment records will not be accepted in the department’s database system.

(3) Each service provider under contract with the Department of Children and Families (DCF) to provide substance abuse and/or mental health services must establish written policies and procedures describing the process for enrolling eligible persons into the department’s priority populations, and for reporting enrollment data elements into the department’s database system. The enrollment data elements include the following: Contractor federal tax identification (ID); Department of Children and Family Services (DCF) contract number; provider federal tax identification (ID); provider site; client social security number; client date of birth; client evaluation purpose; client evaluation date; program area; results from an evidence-based clinical assessment instrument; primary mental health (MH) diagnosis (ICD-9); primary substance abuse (SA) diagnosis (ICD-9); Baker Act status; commitment status; competency status; Marchman Act status; mental health prognosis status; health status; psychiatric disability income; annual family income; activities of daily living status; residential status; referral status; evidence of mental health problem; dependency/criminal status; children global assessment scale (CGAS) score; functional assessment rating score; indication of risk factor for emotional disturbance; history of intravenous use; primary substance abuse problem; secondary substance abuse problem; tertiary substance abuse problem; pregnancy status; number of dependents; family size; employment status; postpartum status; number of arrests; criminal justice involvement status; juvenile justice involvement status; prevention program involvement status; child welfare involvement status; drug court status; and veteran status.

(4) For eligible persons who meet the department’s priority population criteria and who are admitted into the service provider agency to receive these services, the provider must do the following.

(a) Enroll the person into the most appropriate priority population at the time of admission.

(b) Collect and submit the enrollment data element(s) as part of the “initial admission” record reported in the department’s database system.

(c) Review the enrollment record of each active client as part of the ongoing case review process to determine if the person’s priority population criteria have changed and, if necessary, re-enrolled the person as follows:

Re-enroll the person in the most appropriate priority population to reflect the change.
Collect and submit the enrollment data element(s) as part of the “priority population update” record reported in the department’s database system. This record shall include only the key fields and the required enrollment data elements.

(5) For eligible persons who meet the department’s priority population criteria but are not admitted into the provider agency because these persons are seen on a brief emergency basis and are immediately discharged or because needed services are unavailable within the provider agency, the provider must also:

(a) Enroll the person into the most appropriate priority population at the time of admission; and,

(b) Collect and submit the enrollment data element(s) as part of the “immediate discharge” record reported in the department’s database system.

(6) For eligible persons who do not meet the above conditions in subsections 65E-26.002(4) and (5), F.A.C., the providers may, but are not required to, collect and submit the admission records or immediate discharge records in the department’s database system.

History

Rulemaking Authority 394.674(4) FS. Law Implemented 394.674 FS. History–New 3-8-12.

Division 65I Office on Homelessness

Chapter 65I-1 EMERGENCY FINANCIAL ASSISTANCE FOR HOUSING PROGRAM

Fla. Admin. Code R. 65I-1.001 Definitions

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 7-15-93, Formerly 10C-33.003, Amended 2-16-00, Formerly 65A-33.003, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.002 Eligibility Factors Other Than Income

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 7-15-93, Formerly 10C-33.004, Amended 2-16-00, Formerly 65A-33.004, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.003 Determination of Eligibility Based on Income

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Formerly 10C-33.005, Amended 2-16-00, Formerly 65A-33.005, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.004 Income

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Formerly 10C-33.006, Amended 2-16-00, Formerly 65A-33.006, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.005 Verification

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.007, Amended 2-16-00, Formerly 65A-33.007, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.006 Program Administration

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.008, Amended 2-16-00, Formerly 65A-33.008, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.007 Eligible Payments

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, Formerly 10C-33.009, Formerly 65A-33.009, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.008 Ineligible Payments

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Formerly 10C-33.010, Formerly 65A-33.010, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Fla. Admin. Code R. 65I-1.009 Type and Amount of Assistance

History

Rulemaking Authority 414.45, 420.622 FS. Law Implemented 414.16 FS. History–New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.011, Amended 2-16-00, Formerly 65A-33.011, Repealed by Chapter 2013-74, Laws of Florida 7-1-13.

Division 65F Refugee Services

Chapter 65F-1 Unaccompanied Refugee Minors

Fla. Admin. Code R. 65F-1.001 Definitions

(1) “Child welfare services,” as used in this rule, means foster care and all related services and benefits available to children in Florida’s foster care and to young adults who remain qualified for independent living transition services.

(2) “Unaccompanied refugee minor” means an unaccompanied minor, as defined in 45 C.F.R. §400.111, who has met the federal eligibility standards for placement into the Unaccompanied Refugee Minor Program (URMP). Only unaccompanied refugee minors are eligible for child welfare services through the URMP.

(3) “Unaccompanied Refugee Minor Program” (URMP) means the federally funded and state administered program under 45 C.F.R. Parts 400 and 401 and Section 402.86, F.S., established to secure custody over an unaccompanied refugee minor and to provide the same range of child welfare services available to other children and young adults in Florida.

History

Rulemaking Authority 402.86(2) FS. Law Implemented 402.86(1) FS. History‒New 9-24-13.

Fla. Admin. Code R. 65F-1.002 Provision of Child Welfare Services

Unaccompanied refugee minors are eligible, within the meaning of 45 C.F.R. §400.116(a), for the same range of child welfare services and according to the same standards as are provided to other children and young adults in Florida’s foster care. Allowable child welfare services may include foster care maintenance payments, medical assistance, support services, services identified in the State’s plans under titles IV-B and IV-E of the Social Security Act; services permissible under title XX of the Social Security Act; and expenditures incurred in establishing legal responsibility. Time an unaccompanied refugee minor spends in custody of the U.S. Department of Health and Human Services’ Office of Refugee Resettlement shall be considered time spent in foster care for purposes of receiving child welfare services including, but not limited to, services and benefits described in Section 409.1451, F.S.

History

Rulemaking Authority 402.86(2) FS. Law Implemented 402.86(1) FS. History‒New 9-24-13.

Division 65D Substance Abuse Program

Chapter 65D-30 SUBSTANCE ABUSE SERVICES OFFICE

Fla. Admin. Code R. 65D-30.001 Title

These rules shall be known as the licensure standards for “Substance Abuse Services.”

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397 FS. History–New 5-25-00, Amended 4-3-03.

Fla. Admin. Code R. 65D-30.002 Definitions

(1) “Abbreviated Treatment Plan” means a shorter version of a treatment plan that is developed immediately following placement in an addictions receiving facility or detoxification component and is designed to expedite planning of services typically provided to individuals placed in those components.

(2) “Accreditation” means the process by which a provider satisfies specific nationally accepted administrative, clinical, medical, and facility standards applied by an accrediting organization that has been approved by the department.

(3) “Aftercare” means structured services provided to individuals who have completed an episode of treatment in a component and who are in need of continued observation and support to maintain recovery.

(4) “Ancillary Services” as defined in Section 397.311, F.S.

(5) “Assessment” means a process used to determine the type and severity of an individual’s substance use problem and includes a psychosocial assessment and, depending upon the component, a physical health assessment.

(6) “Authorized Agent of the Department” as defined in Section 397.311, F.S.

(7) “Best Practice” means the combination of specific treatments, related services, organizational and administrative principles, core competencies, or social values designed to most effectively benefit the individuals served. Best Practices also include evidence-based practice, which is subject to scientific evaluation for effectiveness and efficacy. Best Practice standards may be established by entities such as the Substance Abuse and Mental Health Services Administration, national trade associations, accrediting organizations recognized by the Department, or comparable authorities in substance use treatment.

(8) “Business Day” means a day in which the Department’s Office of Substance Abuse and Mental Health is operating for business Monday through Friday between 8:00 a.m. and 5:00 p.m. (Eastern Standard Time).

(9) “Case Management” means services provided to or on behalf of an individual in order to assess his or her needs, plan or arrange services, coordinate service providers, link the service system to an individual, monitor service delivery, and evaluate the effect of the services received.

(10) “Certification” means a designation earned by an individual or organization demonstrating core competency in a practice area related to substance use prevention, treatment, or recovery support, awarded by a Department-recognized credentialing entity.

(11) “Change or Transfer in Ownership” means, in addition to Section 397.407(6), F.S.;

(a) An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or

(b) An event in which greater than 50 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is publicly traded on a recognized stock exchange.

(12) “Clinical Record” means all parts of the record required to be maintained that are provided to an individual and includes all clinical records, assessments, financial and legal agreements and consents, progress notes, charts, admission and discharge data, clinical services, clinical summaries, individual therapy notes, group therapy notes, family therapy notes, and other information recorded by the facility staff, which pertains to the individual’s treatment.

(13) “Clinical Services,” for the purposes of this rule chapter, means services such as screening, assessment, level of care determination, treatment planning, and counseling.

(14) “Clinical Staff” means employees, independent contractors, and volunteers of a provider who are responsible for providing clinical services to individuals.

(15) “Clinical Summary,” as used in the context of these rules, means a written statement summarizing the results of the psychosocial assessment relative to the perceived condition of the individual and a further statement of possible service needs based on the individual’s condition.

(16) “Clinical Supervisor” as defined in Section 397.311, F.S.

(17) “Competency and Ability of Applicant” means a determination that an applicant for a license under Chapter 397, F.S., is able or unable to demonstrate, through a background check on education and employment history, the capability of providing substance abuse services in accordance with applicable laws and regulations.

(18) “Component” or “Service Component” as defined in Section 397.311, F.S. Each service component, except for Aftercare, is defined in Section 397.311(26), F.S. Aftercare is defined above.

(19) “Co-occurring Disorder” means a diagnosis of a substance use disorder and a concurrent diagnosis of a mental health disorder.

(20) “Counseling” means the process, conducted in a facility licensed under Chapter 397, F.S., of engaging an individual and his/her support system (i.e., family, significant other, etc.), as indicated, in a discussion of issues associated with the individual’s substance use and other co-occurring conditions in an effort to work toward a constructive resolution of those problems and ultimately toward recovery. For the purposes of this rule chapter, therapy is considered a type of counseling.

(21) “Counselor” means a member of the clinical staff, working in a facility licensed under Chapter 397, F.S., whose duties primarily consist of conducting and documenting services such as counseling, psycho-educational groups, psychosocial assessment, and treatment planning.

(22) “Court Ordered” means the result of an order issued by a court requiring an individual’s participation in a licensed component of a provider under the following authority:

(a) Civil involuntary as provided under Sections 397.6811 and 397.693, F.S.;

(b) Treatment of individuals with substance use disorders in licensed secure facilities as provided under Section 397.702, F.S.; and

(23) “Credentialing entity” as defined in Section 397.311, F.S.

(24) “Crisis Intervention” means emergency psychological care aimed at assisting individuals in a crisis situation to restore equilibrium to their biopsychosocial functioning and to minimize the potential for psychological trauma. This includes the methods used to offer immediate, short-term help to individuals who experience an event that produces emotional, mental, physical, and behavioral distress or problems.

(25) “Detoxification Protocol” means a detailed plan of the medical protocol for the detoxification treatment or procedure. This includes the type of medication, dosage, administration, and components of treatment other than medication.

(26) “Diagnostic Criteria” means prevailing standards which are used to determine an individual’s mental and physical condition relative to their need for substance use services, such as those which are described in the current Diagnostic and Statistical Manual of Mental Disorders.

(27) “Diagnostic Services” means services that are provided to individuals who have been assessed as having special needs and that will assist in their recovery such as educational tests, psychometric tests and evaluation, psychological and psychiatric evaluation and testing, and specific medical tests.

(28) “Direct Care Staff” means employees, independent contractors, and volunteers of a provider who provide direct services to individuals.

(29) “Direct Services” means services that are provided by employees or volunteers who have contact or who interact with individuals receiving services.

(30) “Discharge Summary” means a written narrative of the individual’s treatment record describing the individual’s accomplishments and challenges during treatment, reasons for discharge, and recommendations for further services.

(31) “Financial Ability” means a provider’s ability to secure and maintain the necessary financial resources to provide services to individuals in compliance with required standards.

(32) “Indicated Prevention Services” has the same meaning as provided for the same term in subsection 65E-14.021(4), F.A.C.

(33) “Inmate Substance Abuse Programs,” include substance abuse services provided within facilities housing only inmates and operated by or under contract with the Department of Corrections.

(34) “Initial Treatment Plan” means a preliminary, written plan of goals and objectives intended to inform the individual of service expectations and to prepare the individual for service provision.

(35) “Intervention Plan” means a written plan of goals and objectives to be achieved by an individual who is involved in intervention services.

(36) “Licensed Bed Capacity” means the total bed capacity of addictions receiving facilities, residential detoxification facilities, and residential facilities.

(37) “Licensing Fee” means revenue collected by the department from a provider required to be licensed under Section 397.407, F.S.

(38) “Medical Consultant” means a physician licensed under Chapter 458 or 459, F.S., or an advanced practice registered nurse licensed under Chapter 464, F.S., or a physician assistant, who has an agreement with a licensed provider to be available to consult on any medical services required by individuals involved in those licensed components.

(39) “Medical Director” means a physician licensed under Chapter 458 or 459, F.S., who has been designated to oversee all medical services of a provider and has been given the authority and responsibility for medical care delivered by a provider.

(40) “Medical History” means information on the individual’s past and present general physical health, including the effect of substance use on the individual’s health.

(41) “Medical Maintenance” means special clinical protocols that permit extending the amount of consecutive take-home methadone provided to individuals who are involved in medication-assisted treatment for opioid addiction and who qualify through a special exemption from the Department for participation under these protocols. Medical maintenance may be either partial (13 consecutive take-home doses) or full (27 consecutive take-home doses).

(42) “Medication Observation Record” or “MOR” means the chart maintained for each individual which records medication that is self-administered by an individual.

(43) “Methadone Medication-Assisted Treatment Sponsor” means a representative of a methadone medication-assisted treatment provider who is responsible for its operation and who assumes responsibility for all its employees and volunteers, including all practitioners, agents, or other persons providing services at the provider.

(44) “Mobile Methadone Medication Assisted Treatment Unit” means a vehicle lawfully used at a location other than the providers site.

(45) “Nursing Physical Screen” means a procedure for taking an individual’s medical history and vital signs and recording any general impressions of an individual’s current physical condition, general body functions, and current medical problems.

(46) “Nursing Support Staff” means persons who assist Registered Nurses and Licensed Practical Nurses in carrying out their duties, but who are not licensed nurses.

(47) “Operating Procedures” means written policies and procedures governing the organization and operation of a provider that include methods of implementation and accountability.

(48) “Organizational Capability” means a provider’s ability to implement written operating procedures in conformance with required standards.

(49) “Overlay” means a component operated within facilities not owned or operated by a provider.

(50) “Owner” means the owner of record of a licensed facility that has an enforceable claim or title to an asset or property and is recognized as such by law.

(51) “Peer Specialist” as defined in Section 397.311, F.S.

(52) “Physical Examination” means a medical evaluation of the individual’s current physical condition.

(53) “Physical Health Assessment” means a series of services that are provided to evaluate an individual’s medical history and present physical condition and include a medical history, a nursing physical screen, a physical examination, laboratory tests, tests for contagious diseases, and other related diagnostic tests.

(54) “Placement” means the process used to determine individual admission to, continued stay in, and transfer or discharge from a component in accordance with specific criteria.

(55) “Prevention Plan” means a plan of goals to be achieved by an individual or family involved in structured indicated prevention activities on a regularly scheduled basis.

(56) “Primary Counselor” means the provider’s staff who has primary responsibility for delivering and coordinating clinical services for specific individuals in treatment.

(57) “Private Practice,” as used in these rules, means a sole proprietorship, an individual or individuals using shared office space, or other business entity, required to be licensed under Chapter 397, F.S.

(58) “Privately Funded Provider” means a provider which relies solely on private funding sources.

(59) “Program Office” means the specific office of the Department identified as the single state authority for substance abuse.

(60) “Progress Notes” means written entries made in the clinical record that specify the intervention provided, and document progress or lack thereof toward meeting treatment plan objectives, and which generally address the provision of services, the individual’s response to those services, and significant events.

(61) “Protective Factors” means those conditions that inhibit, reduce, or protect against the probability of the occurrence of drug use or abuse.

(62) “Provider” or “Service Provider” as defined in Section 397.311, F.S.

(63) “Psychosocial Assessment” means a series of evaluative measures designed to identify the behavioral and social factors involved in substance abuse and its symptoms, and is used in the determination of placement and the development of the treatment plan.

(64) “Publicly Funded Provider” means a provider that receives funds directly from the department, Medicaid, or another public agency or is a state agency or local government agency.

(65) “Qualified Designee” or “Qualified Medical Designee” means a licensed medical health professional practicing within the scope of their training, education, and competence and identified by the Medical Director and in the provider’s written medical protocols for the delegation of certain medical services, in accordance with Rule 65D-30.004, F.A.C.

(66) “Qualified Professional” as defined in Section 397.311, F.S.

(67) “Quality Assurance” means a formal method of evaluating the quality of care rendered by a provider and is used to promote and maintain an efficient and effective service delivery system. Quality assurance includes the use of a quality improvement process to prevent problems from occurring so that corrective efforts are not required.

(68) “Recovery Residence” as defined in Section 397.311, F.S.

(69) “Regional Substance Abuse and Mental Health Office” or “Regional Office” means a local Substance Abuse and Mental Health Program office of the Department.

(70) “Resident” means an individual receiving treatment for a substance use disorder or co-occurring substance use and mental health disorders within a structured, non-hospital, live-in environment.

(71) “Restraint” as defined in Section 394.455(42), F.S.

(72) “Risk Factors” means those conditions affecting a group, individual, or defined geographic area that increase the likelihood of a substance use or substance abuse problem.

(73) “Seclusion” as defined in Section 394.455(43), F.S.

(74) “Selective Prevention Services” has the same meaning as provided for the same term in subsection 65E-14.021(4), F.A.C.

(75) “Services” means assistance that is provided to individuals and their support system (i.e., family, significant other, etc.), as indicated, in their efforts to reduce or eliminate substance use free, such as counseling, treatment planning, vocational activities, educational training, and recreational activities.

(76) “Site” means a physical location with multiple buildings, units, or structures on the same property where licensed service components are provided.

(77) “Stabilization” as defined in Section 397.311, F.S.

(78) “Substantial Noncompliance” means an applicant or licensee that has not met all requirements as outlined in statute or Chapter 65D-30, and has not corrected all cited violations.

(79) “Summary Note” means a written record of the progress made by individuals involved in intervention services and indicated prevention services.

(80) “Supportive Counseling” means a form of counseling that is primarily intended to provide information and motivation to individuals.

(81) “Telehealth” as defined in Section 456.47(1)(a), F.S.

(82) “Transfer Summary” means a written justification of the circumstances of the transfer of an individual from one (1) component to another or from one (1) provider to another.

(83) “Treatment” or “Clinical Treatment” as defined in Section 397.311, F.S.

(84) “Treatment Plan” as defined in Section 397.311, F.S.

(85) “Universal Direct Prevention Services” has the same meaning as provided for the same term in subsection 65E-14.021(4), F.A.C.

(86) “Verbal De-escalation” means approved non-physical techniques and procedures used to manage a potentially aggressive situation and prevent it from escalating into physical aggression.

(87) “Written Communication” or “In Writing” means a form of either electronic or postal communication.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.311, 397.321(1), 397.410 FS. History–New 5-25-00, Amended 4-3-03, 12-12-05, 8-29-19, 6-19-23, 10-20-24, 10-16-25.

Fla. Admin. Code R. 65D-30.003 Department Licensing and Regulatory Standards

(1) Licensing.

(a) License Required. All substance abuse components, as defined in Rule 65D-30.002, F.A.C., must be provided by persons or entities that are licensed by the Department pursuant to Section 397.401, F.S., unless otherwise exempt from licensing under Section 397.4012, F.S., prior to initiating the provision of services.

(b) Licenses Issued by Site. The Department shall electronically issue one license for all service components offered by a provider at each site. A license is valid only for the specific service component(s) listed for the specific site identified on the license. Each site listed on the license shall reflect the license status for that site. The provider shall print the most recent version of the license and display a copy in the facility. One (1) license is required where all facilities are maintained on the same premises and operated under the same management.

For the purposes of paragraph (b), living arrangements utilized for individuals of day or night treatment with community housing do not constitute facilities or separate premises.

(2) Mandatory Accreditation.

(a) In accordance with Section 397.403(3), F.S., providers shall achieve accreditation by an accrediting organization recognized by the Department, as discussed in Rule 65D-30.0031, F.A.C. Accreditation is required for all clinical treatment services and for each location services are offered. Accreditation cannot be attained without a Department issued license for substance abuse treatment services.

(b) Applicants for licensure and licensed service providers must meet current best practice standards related to the licensable service components of the accrediting organization. When a provider who has attained accreditation is in noncompliance with accrediting standards, the provider must notify the Department within 10 days. A copy of the Quality Assurance plan and proof of corrected areas must be submitted to the Department upon request.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), 397.403, 397.410 FS. History–New 5-25-00, Amended 4-3-03, 12-12-05, 8-29-19, 10-20-24.

Fla. Admin. Code R. 65D-30.0031 Certifications and Recognitions Required by Statute

(1) Department Recognition of Accrediting Organizations.

(a) The Department shall recognize one (1) or more professional credentialing entities as an accrediting organization for persons providing substance use treatment, prevention, and recovery support services. A list of Department recognized accrediting organizations can be found at the following link: https://www.myflfamilies.com/services/licensing/samh.

(b) Accrediting organizations that desire Department recognition shall submit a request in writing to Department. The Department shall respond in writing to the organization’s chief executive officer denying or granting recognition. An organization must meet the following criteria in order to be granted recognition by the Department.

The accrediting organization shall have fees and practice standards which apply to substance use services. These standards shall incorporate administrative, clinical, medical, support, and environmental management standards.
The accrediting organization shall have written procedures detailing the survey and accreditation process.
The accrediting organization shall submit evidence of three (3) years of experience functioning as an accreditation organization for substance use services.
For the purposes of this rule, a service provider must hold a valid license for each service component type prior to seeking accreditation for substance use treatment services, as defined in Rule 65D-30.002, F.A.C.
The provider must submit the accrediting survey report to the Department.

(2) Department Recognition of Credentialing Entities.

(a) The Department shall recognize one (1) or more professional credentialing entities as a certifying organization for addiction professionals. A list of Department recognized credentialing organizations can be found at the following link: https://www.myflfamilies.com/services/licensing/samh. An organization that desires recognition by the Department as a certifying organization for addiction professionals shall request such approval in writing from the Department. Organizations seeking approval shall be:

A non-profit and governed by a Board of Directors representative of the population it intends to certify;
Include specific requirements which applicants must meet to become certified and to maintain certification;
Establish core competencies, certification standards, and examination instruments according to nationally recognized certification and psychometric standards;
Require annual continuing education units to ensure addiction treatment, prevention, or recovery support subject matter content is current;
Require applicants and certificants to adhere to a professional code of ethics and disciplinary process;
Conduct investigations into allegations of professional misconduct; and
Maintain a web-based public-access database of certificants’ status, including ethical violation history.

(b) The Department shall recognize one (1) or more credentialing entities as a certifying organization for recovery residences who meets all requirements of Section 397.487, F.S. A list of Department recognized credentialing entities can be found at the following link: https://www.myflfamilies.com/services/licensing/samh. An organization that desires recognition by the Department as a certifying organization for recovery residences shall request such approval in writing from the Department.

(c) The Department shall recognize one (1) or more credentialing entities as a certifying organization for peer specialists, in accordance with Section 397.417, F.S. A list of Department recognized credentialing organizations for peer specialists can be found at the following link: https://www.myflfamilies.com/services/licensing/samh. An organization that desires recognition by the Department as a certifying organization for peer specialists shall request such approval in writing from the Department. Organizations seeking approval must demonstrate compliance with the following nationally recognized standards for developing and administering professional certification programs to certify peer specialists:

Core competencies required for certification of an individual as a peer specialist that include:

a. Advocacy,

b. Mentoring,

c. Recovery support,

d. Cultural and linguistic competence,

e. Motivational interviewing,

f. Vicarious trauma/Self-care,

g. Professional responsibility, and

h. Group facilitation skills.

Certification guidelines and requirements, including training requirements;
Ability to screen applicants;
Capacity to administer exams for certification at proctored test-taking sites, including policies for special accommodations in compliance with the Americans with Disabilities Act;
Established code of ethics;
Policies and procedures for investigation of complaints and corrective action against a certified peer specialist, which may include suspension and revocation of certification, and appeals;
Procedures for continuing education requirements for, and a process for, biennial certification renewal; and
Publicly available fee schedule and payment process for costs associated with certification, exam, recertification, and continuing education units.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), (15), 397.403, 397.417, 397.4871 FS. History–New 8-29-19, Amended 3-30-23, 10-20-24.

Fla. Admin. Code R. 65D-30.0032 Display of Licenses

(1) Display of Licenses. The most recent version of the provider’s license shall be displayed in a conspicuous, publicly accessible place within each facility.

(2) A license is valid only for the provider, location(s), service component, and type for which the license is issued.

(3) Licenses shall exhibit the name under which the provider conducts business.

(4) Marketing or advertising materials shall use the legal entity’s name registered with the Division of Corporations, and any reference to a service component must use the name of the licensed service component as defined in Section 397.311(26), F.S. and Rule 65D-30.002, F.A.C.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), 397.407, 397.410 FS. History–New 8-29-19, Amended 10-20-24.

Fla. Admin. Code R. 65D-30.0033 License Types

(1) Probationary License.

(a) Conditions Permitting Issuance. A probationary license is issued to a new applicant upon completion of all applicable requirements. For providers with existing licensed component(s), an amended license will be issued to the provider with the newly added service component under a probationary status.

(b) If all licensure requirements are not met after issuing of a probationary status, a regular status will not be issued.

(c) Special Requirements Regarding Probationary Status. The following special requirements apply regarding new applicants:

A new applicant shall refrain from providing non-exempt services until a probationary status is issued;
New applicants that lease or purchase any real property during the application process do so at their own risk. Such lease or purchase does not obligate the Department to approve the applicant for licensing; and
In instances where an applicant fails to admit individuals for services during the initial probationary period, the Department shall not issue a regular status, even where other standards have been met. If an applicant continues to pursue licensure, the applicant must reapply and pay the associated fees.

(d) Issuing New Licenses. All licenses issued to a provider shall have the same expiration dates; any additional licenses that are issued to the provider will carry the same expiration date as provider’s existing regular licenses.

(e) Methadone Medication Assisted Treatment for Opioid Use Disorder Addiction Provider Components. A methadone medication assisted treatment for opioid use disorder for addiction provider shall not initiate methadone medication assisted treatment during the probationary period, until SAMHSA provisional certification and DEA registration has been issued.

(2) Regular License.

(a) A regular status is valid for a period of 12 months from the date of issuance.

(b) If a regular status replaces a probationary status, the regular status shall be valid for a period of 12 months from the date the probationary status was issued if there are no other licenses issued to the provider.

(c) When a provider has an existing regular status, the regular status replacing a probationary status will carry the same expiration date as the provider’s existing license.

(d) When a regular status replaces an interim status, the anniversary date of the regular status shall not change.

(3) Interim License.

(a) Conditions Permitting Issuance. An interim status will replace a regular status for a period not to exceed 90 days, where the Department finds that any one (1) of the following conditions exist.

1.The provider is in substantial noncompliance with licensing standards.

The provider has failed to provide proof of compliance with local fire, safety, or health requirements.
The provider is involved in license suspension or revocation proceedings.

All components within a facility that are affected shall be listed on the interim license.

(b) Reissuing an Interim Status. The Department may reissue an interim status for an additional 90 days at the end of the initial 90-day period in the case of extreme hardship. Extreme hardship is defined as an inability to reach full compliance that cannot be attributed to the provider.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), 397.407, 397.410 FS. History–New 8-29-19, Amended 11-22-22, 10-20-24.

Fla. Admin. Code R. 65D-30.0034 Change in Status of License

(1) Changing the Status of Licenses. Changes to a provider’s license shall be permitted under the following circumstances:

(a) If adding a new component to an existing licensed site, the Department will issue an amended license which shall indicate a probationary status for the specific location and component. Once the provider has satisfied the requirements for a regular status, the Department shall reissue a license to reflect the newly added component.

(b) Once the provider has satisfied the requirements of a regular status for that specific site, the Department will reissue a license to reflect a regular status for that location.

(c) A provider’s current license shall be amended when a component at a specific site is discontinued. In such cases, the provider shall destroy its current license only after receipt of an amended license.

(d) Whenever there is a change in a provider’s licensed bed capacity, the provider shall notify the Department within 24 hours of the change. The Department shall issue an amended license.

(e) When there is a change in a provider’s status regarding accreditation, the provider shall notify the Department in writing within two business days of such change.

(f) Any change in the name of a facility that remains under the same ownership and management shall be submitted in writing to the Department within 30 days prior to the effective date of the change. Upon receipt of the notification, the Department will issue a replacement license listing the correct facility name.

(2) License Non-transferable. In addition to Section 397.407(6), F.S., an acquisition of a majority of ownership shall require the submission of a new application for each site affected. A change in ownership of less than a majority of the ownership interest in a licensed entity only requires submittal of a Level 2 background check. All owners shall be screened according to the level 2 screening requirements of Chapter 435, F.S.

(a) Licenses are not transferable:

Where an individual, a legal entity or an organizational entity, acquires an already licensed provider or site as described herein; or
Where a provider relocates or the address where services are rendered changes.

(b) Submitting Applications. A completed “Application for Licensing to Provide Substance Abuse Treatment Services,” CF-MH Form 4024, incorporated by reference in Rule 65D-30.0036, F.A.C., shall be submitted to the Department at least 30 days prior to acquisition or relocation. In lieu of the paper “Application for Licensure to Provide Substance Use Services,” the applicant may complete an on-line process through the Department’s statewide electronic system specific to licensure, which can be accessed at http://www.myflfamilies.com/service-programs/substance-abuse/licensure-regulation.

Acquisition. An entity shall submit an Application for Licensing to Provide Substance Abuse Treatment Services to the Department 30 days prior to a change in controlling ownership as defined in this rule of the licensed provider or of the contractual management entity. Failure to register the provider and submit an application 30 days prior to a change will result in the invalidation of the provider’s license or site, provided that the change in ownership occurs, effective the date of the action changing the control of ownership or management. In addition to the application, online application or CF-MH Form 4024, the applicant shall be required to submit all items as required in Rule 65D-30.0036, F.A.C. When the application is considered complete, the Department shall issue a probationary license.
Relocation. In addition to an Application for Licensing to Provide Substance Abuse Treatment Services, if there is no change in the provider’s services, the provider shall only be required to provide proof of general liability insurance coverage and compliance with local fire and safety standards established by the State Fire Marshal, health codes, appropriate zoning, and occupational license. If there is a change in the provider’s services, the provider shall be required to submit all items as required in Rule 65D-30.0036, F.A.C. In this latter case, when the Department determines the application to be complete, the Department shall issue a probationary license. A regular license will not be issued if relocating during a probationary period, and the applicant must re-apply.
Temporary Relocation. A provider may temporarily relocate services when an evacuation is necessary in order to protect the health, safety, and welfare of individual’s being served.

a. Information on the emergency circumstances requiring temporary relocation of services and options to transfer individuals to another provider shall be made available to individuals in treatment, prior to any emergency action taken by the provider, and acknowledgement of the information shall be documented in the clinical record. The provider shall discharge individuals who can be safely discharged.

b. The provider must notify the Department by phone or electronic mail within two business days of relocation.

c. If the temporary relocation exceeds 30 business days, prior approval is required by Department. The provider shall submit a written request to the Department, including justification for the temporary relocation, the beginning and ending dates of the temporary relocation, and a plan for the transfer of any individuals to other providers. The regional office shall approve written requests containing the required information. The regional office shall send a written approval or denial to the provider.

d. During temporary relocation, a provider must deliver or arrange for appropriate care and services to all individuals.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), 397.403, 397.407, 397.410 FS. History–New 8-29-19, Amended 10-20-24.

Fla. Admin. Code R. 65D-30.0035 Required Fees

(1) Licensing Fees. Applicants for a license to operate a licensed service component shall be required to pay a fee upon submitting an application to the regional office. The fees paid by privately-funded providers shall exceed fees paid by publicly-funded providers, as required in Section 397.407(1), F.S. The fee schedules are listed by component as follows:

Publicly-Funded Providers

Service Component

Fee ($)

Addictions Receiving Facility (Adult)

325

Addictions Receiving Facility (Juvenile)

325

Outpatient Methadone Detoxification

325

Inpatient Methadone Detoxification

325

Outpatient Detoxification

325

Inpatient Detoxification

325

Intensive Inpatient Treatment

325

Residential Treatment I

300

Residential Treatment II

300

Residential Treatment III

300

Residential Treatment IV

300

Day or Night Treatment with Community Housing

250

Day or Night Treatment

250

Intensive Outpatient Treatment

250

Outpatient Treatment

250

Methadone Medication-Assisted Treatment for Opioid Addiction

350

Aftercare

200

General Intervention

200

Treatment Alternatives for Safer Communities

200

Employee Assistance Program

200

Case Management

200

Prevention Indicated

200

Prevention Selective

200

Prevention Universal Direct

200

Applications to provide overlay services or medication assisted treatment mobile units should be accompanied by the fee equal to the amount of the licensure fee for the relative service component(s).

Relocation Fee – The relocation fee is based on the fee charged for the component(s) being relocated. The relocation fee will be waived if due to a natural disaster.

Privately-Funded Providers

Service Component

Fee ($)

Addictions Receiving Facility (Adult)

375

Addictions Receiving Facility (Juvenile)

375

Outpatient Methadone Detoxification

375

Inpatient Methadone Detoxification

375

Outpatient Detoxification

375

Inpatient Detoxification

375

Intensive Inpatient Treatment

350

Residential Treatment I

350

Residential Treatment II

350

Residential Treatment III

350

Residential Treatment IV

350

Day or Night Treatment with Community Housing

300

Day or Night Treatment

300

Intensive Outpatient Treatment

300

Outpatient Treatment

300

Methadone Medication-Assisted Treatment for Opioid Addiction

400

Aftercare

250

General Intervention

250

Treatment Alternatives for Safer Communities

250

Employee Assistance Program

250

Case Management

250

Prevention Indicated

250

Prevention Selective

250

Prevention Universal Direct

250

Applications to provide overlay services or medication assisted treatment mobile units should be accompanied by the fee equal to the amount of the licensure fee for the relative service component(s).

Relocation Fee – The relocation fee is based on the fee charged for the component(s) being relocated. The relocation fee will be waived if due to a natural disaster.

(2) The licensure fee must be included with all applications as required in Section 397.407, F.S.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), 397.407 FS. History–New 8-29-19, Amended 10-16-25.

Fla. Admin. Code R. 65D-30.0036 Licensure Application and Renewal

(1) Application for Licensing. Applications for any license described in this rule chapter shall be submitted initially and annually thereafter to the Department along with the required licensing fee. A renewal application is subject to the provisions of s. 397.407(8). Applications for renewal submitted less than 60, but more than 30 calendar days, prior to the expiration of the regular license, will be processed. Late fees will be applied to all renewal applications submitted after 60 days. If the application for renewal is not received by the Department prior to the expiration of the regular license, the application will be returned to the applicant, including any fees. In addition to requirements pursuant to Section 397.403, F.S., and unless otherwise specified, all applications for licensure shall include the following:

(a) A standard application for licensing, using CF-MH Form 4024, (August 2025), titled “Application for Licensing to Provide Substance Abuse Treatment Services,” which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18474. In lieu of a standard application, the applicant may complete an online process through the Department’s statewide electronic system specific to licensure, which can be accessed at https://www.myflfamilies.com/services/licensing/samh.

(b) Written proof of compliance for all licensed facilities, including community housing, with local health, fire and safety inspections;

(c) Information on the competency and ability of the applicant, chief executive officer, chief financial officers, and clinical supervisors to carry out the requirements of these rules, including education, previous employment history, and list of references.

(d) A financial audit or review conducted by a certified accountant must be completed within the last 12 months of the calendar year showing proof of the applicant’s financial ability and organizational capability to operate. Providers that are accredited according to the provisions of s. 394.741, F.S. by a Department recognized accrediting organizations and Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, the Department of Management Services, or the Department of Juvenile Justice are exempt from this requirement;

(e) Proof of professional liability and general liability coverage. (Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, or the Department of Juvenile Justice are exempt from this requirement) Professional liability insurance coverage shall be in an amount not less than $250,000 per claim, with a minimum annual aggregate of not less than $750,000;

(f) Confirmation of completion of basic HIV/AIDS education requirements pursuant to Section 381.0035, F.S., for renewal applications;

(g) If delivering services through telehealth, detailed procedures outlining the equipment and implementation plan for services shall be included. Providers utilizing telehealth must implement technical written policies and procedures for telehealth systems that comply with the Health Insurance Portability and Accountability Act privacy regulations, and applicable state and federal laws that pertain to patient privacy. Policies and procedures must also address the technical safeguards required by Title 45, Code of Federal Regulations, Section 164.312, where applicable. All staff shall have a working knowledge of the substance use operating procedures; and

(h) The Drug Enforcement Administration registration for all physicians.

(2) Items listed in paragraphs (1)(a)-(h) must accompany the application for a license and shall be maintained.

(a) Renewal applicants shall submit item (1)(a)-(h) along with the licensure application. However, regarding items in paragraph (1)(c), only new applicants or where there is a change in chief executive officer, chief financial officers, or clinical supervisors shall submit this information with the application. All documents attached to the application, including items listed in paragraphs (1)(a)-(h) for renewal applicants, shall be made available for review at the provider facility. Documents attached to the application, including items listed in paragraphs (1)(a)-(h) that expire during the licensure period shall be renewed by the provider prior to the expiration date.

(b) The provider shall notify the Department prior to the expiration date if the provider will cease operation and not renew the license. Providers must be accredited by a Department-approved accrediting entity.

(3) Once the application is determined to meet licensure requirements, a methadone medication assisted treatment for opioid use disorder addiction provider shall be issued a probationary license while awaiting verification of certification from the Substance Abuse and Mental Health Services Administration (SAMHSA) and registration with the Drug Enforcement Agency (DEA). Upon receipt of the SAMHSA certification, DEA registration, and an approved probationary Department inspection, the Department will issue the provider a regular license to provide methadone medication assisted treatment for opioid use disorder treatment.

(4) Upon notification of a change in ownership of a methadone medication assisted treatment for opioid use disorder addiction provider, the provider shall submit the DEA Form 223 Certificate of Registration, which shall be kept with the original DEA Certificate of Registration until the expiration date. The provider must submit proof of notification from SAMHSA based upon all other compliance actions.

(5) Nonresponsive applicant. If certified mail sent to the provider’s address of record, mailing address if applicable, is returned as unclaimed or undeliverable, the Department will send a copy of the letter by regular mail to the provider’s address of record, or mailing address if applicable, with a copy to the applicant’s address if different from the provider. The applicant must respond to the request within 21 days of the date of the letter sent by regular mail. If timely response is not received, the application will be denied.

(6) Inspections of Accredited Providers. In addition to conducting licensing inspections every three (3) years, the Department has the right to conduct inspections of accredited providers in accordance with Section 394.741(6) and 397.411, F.S., in cases where any of the following conditions exist:

(a) The accredited provider or component of the provider fails to submit the accreditation report and any corrective action plan related to its accreditation upon request by the Department;

(b) The provider or component of the provider has not received or has not maintained accreditation as provided for in subsection (7) of this rule;

(c) The Department’s investigation of complaints results in findings of one (1) or more violations of the licensing standards of any accredited component; or

(d) The Department has concerns regarding the health, safety or welfare of individuals served.

(7) Determination of Accreditation. Providers shall submit a copy of the accreditation survey report to the Department annually. The Department shall review the report and confirm that accreditation has been awarded for the applicable components. If the survey report indicates that the provider or any components of the provider have been issued provisional or conditional accreditation, the Department shall conduct a licensing inspection as permitted in subsection (6) of this rule.

History

Rulemaking Authority 397.321(5), 397.4014 FS. Law Implemented 397.321(6), 397.4014, 397.403, 397.407, 397.410, 397.411 FS. History–New 8-29-19, Amended 11-22-22, 1-1-24, 10-20-24, 10-16-25, Technical Change 3-18-26.

Fla. Admin. Code R. 65D-30.0037 Department Licensing Procedures

(1) Department Licensing Procedures.

(a) Application Process. The Department shall process all new and renewal applications for licensing and shall notify both new and renewal applicants in writing within 30 business days of receipt of the application that it is complete or incomplete. Where an application is incomplete, the Department shall specify in writing to the applicant the items that are needed to complete the application. Following receipt of the Department’s response, the applicant shall have 10 business days to submit the required information to the Department. If the applicant needs additional time to submit the required information, it may request such additional time within five business days of the deadline for submitting the information. Within five business days of receipt of the request, the Department shall approve the request for up to an additional 30 business days. Any renewal applicant that fails to meet these deadlines shall be assessed an additional fee equal to the late fee provided for in Section 397.407(3), F.S., $100 per licensed component for each specific location. If the applicant is seeking a new license and fails to meet these deadlines, the application, excluding all fees, shall be returned to the applicant unprocessed.

(b) Licensing Inspection. The Department may conduct announced or unannounced on-site licensing inspections pursuant to Section 397.411, F.S.

(c) Notifying Providers Regarding Disposition on Licensing. In the case of new and renewal applications, the Department shall give written notice to the applicant as required in Section 120.60(3), F.S., that the Department has granted or denied its application for a license. In the case of new applicants, this shall occur within the 90-day period following receipt of the completed application. In the case of renewal applicants, this shall occur prior to expiration of the current license.

(d) Distribution of Licenses and Notices. For new and renewal applications, the Department shall send providers a written, signed license along with the written notice as described in subparagraph 4 of this section. Additionally, any adverse action by the Department (e.g., issuance of an interim license, license suspension, denial, revocation, fine or moratorium) shall be accompanied by notice of the right of appeal as required by Chapter 120, F.S.

(2) Closing a Licensed Provider. Pursuant to Chapter 120, F.S., providers shall notify the Department in writing at least 90 days prior to ceasing operation. The provider, with the Department’s assistance, shall attempt to place all individuals being served in need of care with other providers along with their clinical records and files. The provider shall notify the Department where the clinical records and files of previously discharged individuals are and where they will be stored for the legally required period. A service provider may not engage in patient brokering as established in Section 397.55(2), F.S.

(3) Approval of Overlay Services.

(a) Qualifying as Overlay Services. A provider that is licensed under Chapter 397, F.S., to provide day or night treatment, intensive outpatient treatment, outpatient treatment, aftercare, or intervention is permitted to deliver those component services at locations which are leased or owned by an organization other than the provider, but not by another provider. The aforementioned component services may be delivered under the authority of the provider’s current regular license for that component service so that the alternate location will not require a license. To qualify, overlay services shall be provided on a regular or routine basis over time, at an agreed upon location.

(b) Procedure for Approving Overlay Services.

The provider shall submit a request to provide overlay services and applicable fee to the Department, including:

a. A description of the services to be provided;

b. The manner in which services will be provided;

c. The number of days each week and the number of hours each day each service will be provided;

d. How services will be supervised; and

e. The location of the services.

The Department shall notify the provider within 30 business days of receipt of the request to provide overlay services of its decision to approve or deny the request and, in the case of denial, reasons for denying the request in accordance with subparagraph 3.
The Department shall deny the request to provide overlay services if it determines that the provider did not address the specific items in subparagraph 1., or is currently operating under less than a regular license.
In cases where the request to provide overlay services is approved, the Department shall clearly specify the licensed component that will be provided as overlay.

Services delivered at the alternate site must correspond directly to those permitted under the provider’s current license.
Information on each individual involved in an overlay service must be maintained in a manner that complies with current licensing requirements.
Overlay services are subject to all requirements of the corresponding level of licensure and are subject to inspection by the Department.
Overlay services may only be provided at the locations specified by the Department in the approval letter.

(4) Licensing of Department of Juvenile Justice Commitment Programs and Detention Facilities. In instances where substance use services are provided within Juvenile Justice Commitment Programs and detention facilities, such services may be provided in accordance with any one (1) of the four (4) conditions described below:

(a) The services must be provided for the appropriate licensable service component as defined in subsection 65D-30.002(17), F.A.C.;

(b) The services must be provided by employees of a service provider licensed under Chapter 397, F.S.;

(c) The services must be provided by employees of the commitment program or detention facility who are qualified professionals licensed under Chapter 458, 459, 490 or 491, F.S.; or

(d) The services must be provided by an individual who is an independent contractor who is licensed under Chapter 458, 459, 490 or 491, F.S.

(5) Licensing of Department of Corrections Inmate Substance Abuse Programs. Inmate substance abuse services shall be provided within inmate facilities operated by or under contract with the Department of Corrections, or Department of Management Services, as specifically provided for in these rules. The inmate facility is licensed under Chapter 397, F.S., in accordance with the requirements in Rule 65D-30.004, F.A.C., and the appropriate component under Rule 65D-30.007, 65D-30.009, 65D-30.0091, 65D-30.010, 65D-30.011, 65D-30.012 or 65D-30.013, F.A.C.

History

Rulemaking Authority 397.321(5) FS. Law Implemented 397.321(6), 397.4014, 397.403, 397.407, 397.410 FS. History–New 8-29-19, Amended 10-20-24.

Fla. Admin. Code R. 65D-30.0038 Violations; Imposition of Administrative Fines; Grounds

(1) The Department shall classify violations of chapter 397, F.S. and chapter 65D-30, F.A.C. in accordance with sections 397.410(2) and 397.411(7), F.S. Violations shall be classified on the written notice as follows:

(a) A class I violation is subject to an administrative fine of $400 for an isolated deficiency, $600 for a patterned deficiency, and $800 for a widespread deficiency.

(b) A class II violation is subject to an administrative fine of $300 for an isolated deficiency, $500 for a patterned deficiency, and $700 for a widespread deficiency.

(c) A class III violation is subject to an administrative fine of $200 for an isolated deficiency, $400 for a patterned deficiency, and $600 for a widespread deficiency.

(d) A class IV violation is subject to an administrative fine of $100 for an isolated, patterned, or widespread deficiency.

(2) The Department shall impose an administrative fine for the following unclassified violations. The amount of the administrative fine shall be $100 for each violation per day, beginning on the day the violation was identified by the Department.

(a) Failure to submit required incident reports;

(b) Failing to inform the Department of a change in ownership within the specified timeframe in accordance with Rule 65D-30.0034, F.A.C.; and

(3) Administrative fines for Class III and IV violations will not be assessed if the violations are corrected within the time specified in the corrective action plan (CAP). When the violation is not corrected by the date specified in the CAP, the fine shall be assessed.

(4) The facility must submit a written CAP to the Department within seven calendar days from the date of receipt of the inspection. The CAP must be signed by the executive director or designee of the provider.

(a) The CAP shall include the following:

Identify the violation;
The actions the facility will take to correct each of the violations identified;
The date by which the violation shall be corrected; and
The actions the facility will take to ensure the violation identified does not occur again.

(b) Unless a date is directed or extended by the Department, the date to resolve the violation shall not exceed 30 days from the inspection completion date.

(5) The Department will reject any proposed corrective action plan that fails to identify all the information described in subsection (4) of this rule or reflects a plan of action that does not address the violation(s). If the Department rejects a proposed corrective action plan, the Department shall notify the provider in writing of the reasons for rejection and require the provider to submit an amended corrective action plan addressing the deficiency or deficiencies within five calendar days of receipt of the Department’s notice rejecting the corrective action plan. Failure to submit a CAP that is sufficient for Department approval within 30 days of the inspection completion date shall be considered an unclassified violation and be subject to administrative fines as described in subsection (2) of this rule.

(6) The Department may deny, suspend, or revoke a license pursuant to s. 397.415, F.S. A license will not be renewed if a licensee has not paid all previously owed fines to the Department.

History

Rulemaking Authority 397.321(5), 397.410(2) FS. Law Implemented 397.410, 397.411 397.415, 397.4104, 397.4873 FS. History–New 8-29-19, Amended 9-4-23.

Fla. Admin. Code R. 65D-30.004 Common Licensing Standards

(1) Operating Procedures. Providers shall demonstrate organizational capability required by Section 397.403(1), F.S., through a written, indexed system of policies and procedures that are descriptive of services, and the population served. Administrative and clinical services must align with current best practices as defined in subsection 65D-30.002(7), F.A.C. All staff shall have a working knowledge of the operating procedures. These operating procedures shall be submitted with new applications and applications for new components to be available for review by the Department at any time.

(2) Quality Improvement. Providers shall have a quality improvement program which complies with the requirements established in Section 397.4103, F.S., and which ensures the use of a continuous quality improvement process.

(3) Provider Governance and Management.

(a) Governing Board. Any provider that applies for a license, shall be a legally constituted entity. Providers that are government-based and providers that are for-profit and not-for-profit, as defined in Section 397.311, F.S., shall have a governing board that shall set policy for the provider. The governing board shall maintain a record of all meetings where business is conducted relative to provider operations. These records shall be available for review by the Department.

(b) Insurance Coverage. Regarding to liability insurance coverage, providers shall assess the potential risks associated with the delivery of services to determine the amount of coverage necessary and shall purchase policies accordingly.

(c) Chief Executive Officer. A chief executive officer shall be appointed. If the entity is operated by a governing board, the governing board shall appoint a chief executive officer. The qualifications and experience required for the position of chief executive officer shall be defined in the provider’s operating procedures. Documentation shall be available from the governing board providing evidence that a background screening has been completed in accordance with Chapters 397 and 435, F.S., and there is no evidence of a disqualifying offense. Providers shall notify the regional office in writing within 24 hours when a new chief executive officer is appointed.

(d) Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of subsection (3).

(4) Personnel Policies. Personnel policies shall clearly address recruitment and selection of prospective employees, promotion and termination of staff, code of ethical conduct, sexual harassment, confidentiality of individual records, attendance and leave, employee grievance, non-discrimination, abuse reporting procedures, and the orientation of staff to the agency’s universal infection control procedures. The code of ethical conduct shall prohibit employees and volunteers from engaging in sexual activity with individuals receiving services for a minimum of two (2) years after the last professional contact with the individual. Providers shall also have a drug-free workplace policy for employees and prospective employees.

(a) Personnel Records. Records on all personnel shall be maintained. Each personnel record shall contain:

The individual’s current job description with minimum qualifications for the position and documentation that the staff meets the minimum qualifications outlined in the job description;
The employment application or resume;
The employee’s annual performance appraisal;
A document signed and dated by the employee indicating that the employee received new staff orientation and understand the personnel policies and the programs operating policies and procedures;
A verified or certified copy of degrees, licenses, or certificates of each employee;
Documentation of employee screening as required in paragraph (b); and
Documentation of required staff training.
Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of subparagraph (a)7.

(b) Background Screening Requirements.

Providers shall ensure compliance with background screening in accordance with Section 397.4073, F.S.
Providers shall ensure that peer specialists are screened in accordance with Section 397.417, F.S.
Individuals subject to screening in this subsection shall be re-screened within five (5) years from the date of their last screening results and every five (5) years thereafter. At the time of the initial screening, and with every re-screening, an Attestation of Good Moral Character, form CF 1649, (June 2025), which is incorporated by reference and available at http://flrules.org/Gateway/reference.asp?No=Ref-18473, shall be submitted by individuals who are subject to level 2 background screenings.
Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of subparagraph 3., unless the service provider personnel have direct contact with unmarried inmates under the age of 18 or with inmates who are intellectually disabled, pursuant to Section 397.4073(1)(e), F.S.

(c) A person who is disqualified pursuant to the background screening conducted in paragraph (4)(b) of this rule may request an exemption from disqualification pursuant to Section 435.07, F.S. or, if applicable, Section 397.4073(4)(b), F.S.

(d) Employment History and Reference Checks. The chief executive officer or designee, such as human resources staff, shall assess employment history and reference checks for each employee who has direct contact with children receiving services or intellectually disabled adults receiving services.

(5) Standards of Conduct. Providers shall establish written rules of conduct for individuals. Each individual receiving services shall be given rules of conduct during orientation to be reviewed, signed and dated.

(6) Medical Director. Providers licensed to operate addictions receiving facilities, detoxification, intensive inpatient treatment, residential treatment, and methadone and medication-assisted treatment for opioid use disorder shall have a medical director. Providers shall designate a medical director who shall oversee all medical services. The medical director’s responsibilities shall be clearly described.

(a) The Medical Director shall have overall responsibility for the following:

Medical services provided by the program;
Oversight of the development and revision of medical policies, including:

a. The means for the detection and referral of health problems through medical surveillance and regular examination;

b. Implementation of medical orders regarding treatment of medical conditions;

c. Reporting of communicable diseases and infections in accordance with federal and state laws;

d. Procedures and ongoing training for routine medical care, specialized services, specialized medications, and medical and psychiatric emergency care;

Collaborative supervision with the clinical supervisor of non-medical staff in the provision of substance use disorder services; and
Supervision of medical staff in the performance of medical services.

(b) The Medical Director must meet at least twice a year with the risk management and quality assurance program of the facility to review incident reports, grievances, and complaints to identify and implement processes to reduce clinical risks and safety hazards. This process shall be documented in the risk management and quality assurance committee meeting minutes. When the Medical Director is the attending physician of an individual receiving services, they shall participate in the development of the treatment plan.

(c) The Department shall utilize the following methodology for determining the maximum number of individuals a medical director may serve pursuant to Section 397.410(1)(c)5., F.S.:

Component

Average Length of Stay (LOS) in Days

Total Service Time over LOS

Work Days

Work Days per LOS

Hours worked per LOS (Work Days x Work Days per LOS)

Calculation (Time in LOS/Total Service Time)

Total Case Load

Inpatient Detoxification

4 days

1.0 hour*

8 hours

4 days

32 hours

32 /1 hour

32 individuals

Outpatient Detoxification

5 days

1.2 hours*

8 hours

5 days

40 hours

40/1.2 hours

33 individuals

Residential Level I

19 days

1 hour**

8 hours

15 days

120 hours

120/1 hour

120 individuals

Residential Level II

41 days

1.75 hours**

8 hours

30 days

240 hours

240/1.75

137 individuals

Residential Level III

54 days

2.25 hours**

8 hours

40 days

320 hours

320/2.25

142 individuals

Residential Level IV

42 days

1.75 hours**

8 hours

30 days

240 hours

240/1.75

137 individuals

Medication and Methadone Maintenance

1,030 days

3.25 hours***

8 hours

709 days

5,672 hours

5,672/3.25

1,745 individuals

*Service Times: New Patient Visit (30 minutes), Daily Follow-up (10 minutes)

**Service Times: New Patient Visit (30 minutes), Weekly Follow-up (15 minutes)

***Service Times: New Patient Visit (30 minutes), Quarterly Follow-up (15 minutes)

(d) A medical director may not serve in that capacity for more than a maximum of the indicated number of individuals for the treatment types listed below:

Addiction receiving facilities, inpatient detoxification, and intensive impatient providers – a cumulative total of 32 individuals at any given time.
Outpatient detoxification – a cumulative total of 33 individuals at any given time.
Residential treatment (level 1) – a cumulative total of 120 individuals at any given time.
Residential treatment (level 2) – a cumulative total of 137 individuals at any given time.
Residential treatment (level 3) – a cumulative total of 142 individuals at any given time.
Residential treatment (level 4) – a cumulative total of 137 individuals at any given time.
Methadone medication-assisted treatment for opioid use disorder – a cumulative total of 1,745 individuals at any given time.

(e) Providers licensed for multiple service components shall ensure compliance with this medical director standard by applying the percentage of time dedicated to each service component to the Department’s methodology for maximum individuals served. This information shall be submitted with the application for licensure and updated at the time of any licensure renewal. The provider shall be responsible for providing documentation to support the case load maximum upon request.

(f) A provider may not operate without a medical director on staff at any time. When a medical director is not available, the medical director shall ensure that a qualified physician who is available is designated. Upon the departure of a medical director, an interim medical director shall be appointed. The provider shall notify the regional office in writing within 24 hours when there is a change in the medical director, provide proof that the new or interim medical director holds a current license in the state of Florida, and is free of administrative action(s) against their license.

(g) In cases where a provider operates treatment components that are not identified in this subsection, the provider shall have access to a physician, physician assistant, or APRN through a written agreement who will be available to consult on any medical services required by individuals involved in those components. Physicians, physician assistants, or APRN’s serving as a medical consultant shall adhere to all requirements and restrictions as described for medical directors in this chapter.

(h) A medical director or medical consultant in violation of any of the requirements set forth in Chapter 65D-30, F.A.C., or Chapter 397, F.S., is permanently barred from being employed by or contracting with a service provider licensed under Chapter 65D-30, F.A.C.

(7) Medical Services.

(a) Written Medical Provisions. For components identified in subsection 65D-30.004(6), F.A.C., each physician working with a provider shall establish written protocols for the provision of medical services pursuant to Chapters 458 and 459, F.S., and for managing medication according to medical and pharmacy standards, pursuant to Chapter 465, F.S. Such protocols will be implemented only after written approval by the chief executive officer and medical director.

(b) The medical protocols shall also include:

The manner in which certain medical functions may be delegated to appropriate licensed practitioners in those instances where these practitioners are utilized as part of the clinical staff;
Issuing orders; and
Signing and countersigning results of physical health assessments;
Procedures shall be documented for the administration of medication by a qualified medical professional as authorized by their scope of practice.

(c) Supervision of self-administration of medication may be provided, including at the community housing location, under the following conditions:

A secure, locked storage for medications must be maintained;
Individuals must receive prescription medication in accordance to the prescriptions of appropriate licensed practitioners, as required by law;
Supervision of self-administration of medication must be provided by trained personnel in accordance with paragraph 65D-30.0046(1)(f), F.A.C. of this chapter.
A record of all instances of supervision of self-administration of medication shall be maintained in a medication observation record, to include the date, time, and dosage in accordance to the prescription. The personnel who witnessed the self-administration of the medication shall sign and date the medication observation record.

(d) All medical protocols shall be reviewed and approved by the medical director and chief executive officer on an annual basis and shall be available for review by the Department.

(e) Emergency Medical Services. All licensed providers shall describe the manner in which medical emergencies shall be addressed.

(f) Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of subsection (7).

(8) State Approval Regarding Prescription Medication. In instances where the provider utilizes prescription medication, medications shall be purchased, handled, dispensed, administered, and stored in compliance with the State of Florida Board of Pharmacy requirements for facilities and in accordance with Chapter 465, F.S. This shall be implemented in consultation with a state-licensed consultant pharmacist and approved by the medical director. The provider shall ensure that policies implementing this subsection are reviewed and signed and dated annually by a state-licensed consultant pharmacist.

(a) All providers purchasing, dispensing, handling, administering, storing, or observing self-administration of medications shall adhere to best practices, state and federal regulations.

(b) Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of subsection (8).

(9) Universal Infection Control. Providers licensed to operate addictions receiving facilities, detoxification, intensive inpatient treatment, residential treatment, day or night treatment with community housing, day or night treatment, intensive outpatient treatment, outpatient treatment, and medication-assisted treatment for opioid addiction shall implement an exposure control plan and universal infection control services.

(a) Plan for Exposure Control.

A written plan for exposure control regarding infectious diseases shall be developed and shall apply to all staff, volunteers, and individuals receiving services. The plan shall be initially approved and reviewed annually by the medical director or consulting physician. The plan shall be in compliance with Chapters 381 and 384, F.S., and in accordance with the Department of Health’s requirements as stated in Chapters 64D-2 and 64D-3, F.A.C. The plan shall be signed and dated by the medical director or consulting physician as required by this paragraph.
The plan shall be consistent with the protocols and facility standards published in the Federal Centers for Disease Control and Prevention Guidelines and Recommendations for Infectious Diseases.

(b) Required Services. The following Universal Infection Control Services shall be provided:

Risk assessment and screening individuals for both high-risk behavior and symptoms of communicable disease as well as actions to be taken on behalf of individuals identified as high-risk and individuals known to have an infectious disease;
HIV and TB testing and HIV pre-test and post-test counseling to high-risk individuals, provided directly or through referral to other healthcare providers which can offer the services; and
Reporting of communicable diseases to the Department of Health in accordance with Sections 381.0031 and 384.25, F.S.

(c) Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of subsection (9).

(10) Universal Infection Control Education Requirements for Employees and Individuals. Providers shall meet the educational requirements for HIV and AIDS pursuant to Section 381.0035, F.S., and all infection prevention and control educational activities shall be documented. Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, or the Department of Management Services, and Juvenile Justice Commitment Programs and detention facilities operated by the Department of Juvenile Justice, are exempt from the requirements of this subsection.

(11) Meals. Providers licensed to operate addictions receiving facilities, inpatient detoxification, intensive inpatient treatment, and residential treatment shall provide at least three (3) meals per calendar day. In addition, at least one (1) snack shall be provided each day. Providers licensed to operate day or night treatment with community housing and day or night treatment, the provider shall make arrangements to serve a meal to individuals involved in services a minimum of five (5) hours at any one time. Individuals with special dietary needs shall be reasonably accommodated. Under no circumstances may food be withheld for disciplinary reasons. The provider shall document and ensure that nutrition and dietary plans are reviewed and approved by a dietitian/nutritionist licensed under Section 468.509, F.S., at least annually. If the provider contracts with a third party for food services, a copy of the provider’s contract with the company and the company’s current health inspection shall be provided to the Department upon application and renewal. Inmate Substance Abuse Programs operated by or under contract with the Department of Corrections, the Department of Juvenile Justice, or the Department of Management Services are exempt from the requirements of this subsection but shall provide such services as required in the policies, standards, and contractual conditions established by the respective department.

(12) Verbal De-escalation. Providers licensed to operate all components except for universal direct prevention services shall have written policies and procedures of the specific verbal de-escalation technique(s) to be used. Direct care staff shall be trained in verbal de-escalation techniques as required in paragraph 65D-30.0046(1)(b), F.A.C. The provider shall provide proof to the Department that affected staff have completed training in those techniques.

(13) Compulsory School Attendance for Minors. Providers which admit juveniles between the ages of 6 and 16 shall comply with Chapter 1003, Part III, F.S., entitled School Attendance.

(14) Data. Providers shall report data to the department pursuant to Section 397.321(3)(c), F.S.

(15) Special In-Residence Requirements. Service providers housing individuals for treatment shall only furnish beds to individuals admitted for substance use treatment for the specific level of care for which the individuals meet criteria. Providers that house males and females together within the same facility shall provide separate sleeping arrangements for these individuals and must have at least one staff member present at all times. Providers which serve adults in the same facility as persons under 18 years of age shall ensure individual safety with one-on-one supervision, separate bedrooms, and programming according to age. Providers, aside from Juvenile Justice Commitment Programs and detention facilities operated by or under contract with the Department of Juvenile Justice, shall not collocate children or adolescents with adults. Admitted seventeen-year-olds who turn 18 while completing treatment shall be allowed to stay only if it is clinically indicated, there is one-on-one supervision, and they have separate bedrooms.

(16) Reporting of Abuse, Neglect, and Deaths. Providers shall adhere to the statutory requirements for reporting abuse, neglect, and deaths of children under Chapter 39, F.S., and of adults under Sections 415.1034 and 397.501(7)(c), F.S.

(17) Critical Incident Reporting pursuant to Section 397.4103(2)(f), F.S.

(a) Every provider shall develop policies and procedures for submitting critical incidents into the Department’s statewide designated electronic system specific to critical incident reporting.

(b) Every provider shall report the following critical incidents within 24 hours of the incident occurring.

Adult Death. An individual 18 years old or older whose life terminates:

a. While receiving services; or

b. When it is known that an adult died within thirty (30) days of discharge from a program.