RULE NO: RULE TITLE
65D-31.004: Functions of Managing Entities
NOTICE OF PROPOSED RULE CHANGES
65D-31.004 Functions of Managing Entities.
(1) System of care development and management. Managing entities must:
(a) Require must ensure that substance abuse and mental health services within their respective geographic areas to be coordinated and developed into an integrated network of assessable services which are and is responsive to the needs of persons in need of service and their families.
(b) Require must ensure substance abuse and mental health services to be are responsive to the needs of the community and community stakeholders including the courts, community agencies, law enforcement, child welfare agencies and others who are reliant on mental health and substance abuse services as essential to their success.
(c) Require the must ensure application of evidence-based practices by network providers through contracting requirements, program development and design, and the provision of training, technical assistance, and quality improvement activities.
(d) Develop effective and formal mechanisms for care management, continuity of care, least restrictive placement, and service coordination as outlined in the Substance Abuse and Mental Health Services Program Managing Entity Performance Contract.
(e) through (2)(a) No change.
(b) The managing entity is required to contract only with agencies which when contracting with providers are to ensure that agencies are qualified and capable of providing quality client services. The managing entity will develop policies, procedures, and practices that require assure that network providers to comply are complying with applicable laws, rules, and regulations, and contract requirements as outlined in the Substance Abuse and Mental Health Services Program Managing Entity Performance Contract.
(c) The managing entity must require that, within available resources, ensure that, within available resources, a comprehensive system of care is available within their respective geographic area which that is accessible, co-occurring competent, and consists of a range of services that is responsive to the needs of persons receiving services and is responsive to the needs of the community.
(3)(a) The managing entity Managing Entity is responsible for the management, accountability, and efficient use of public funds by:
(b) Developing and negotiating rates with its network providers as outlined in the Substance Abuse and Mental Health Services Program Managing Entity Performance Contract. within the parameter established by the Department, the The managing entity may propose alternate payment methodologies to the Department such as case rates, capitation or other forms that demonstrate both accountability and efficiencies.
(c) Allocation of funds to providers as outlined in the Substance Abuse and Mental Health Services Program Managing Entity Performance Contract consistent with departmentally approved allocation methodologies.
(d) No change.
(e) Managing Department funding allocations to ensure that state and federal requirements are met, as outlined in the Substance Abuse and Mental Health Services Program Managing Entity Performance Contract.
(f) Achieving efficiencies by the consolidation of provider operational functions. Examples include, but are not limited to, including, but not limited to, data collection and analysis, administrative efficiencies, and group purchasing.
(g) Reinvesting funds gained by efficiencies into the system of care after achieving departmentally approved reserves and necessary infrastructure development.
(4)(a) The managing entity will participate in the departmental planning process at of the state, regional, and circuit levels.
(b) No change.
(c) A three (3) year managing entity strategic plan is required to be submitted on a schedule that corresponds to the reporting requirements and submission dates outlined in Section 394.75, F.S., State and district substance abuse and mental health plans. departmental statutorily required Substance Abuse and Mental Health Plan.
1. Delete
2. through a. No change
b. Deleted
c. through e. renumbered b. through d. No change.
(5) Data Collection, Analysis, and Reporting
(a) The Department, in collaboration with the managing entities shall design and implement a comprehensive behavioral health management information system based on policies and procedures outlined in the Department’s Pamphlet 155-2, most current version of the pamphlet for. Mental Health and Substance Abuse Measurement and Data, DCF Pamphlet 155-2, effective date, September 1, 2008, 9th Edition, Version 9.1, which is incorporated by reference and is available on the Department’s Web Portal at www.dcf.state.fl.us/mentalhealth/publications/index.shtml. to meet the minimum reporting requirements at the federal, state and local levels as follows: Each managing entity shall develop and maintain a database system, including data from agencies under contract with the managing entity. At the minimum, Tthe managing entity’s database system shall provide information needed not only by the managing entity to address the management and clinical care needs of the local provider networks, but also by the Ddepartment to meet the state and federal data reporting requirements. The Department shall collaborate with managing entities to develop business requirements, which managing entities will use to extract data required at the state and federal levels from their local database systems and to submit these data electronically into the Department’s central database system. Requirements will increase system access to users and ensure timely and accurate information. The Department shall use the central database system to provide non-confidential data accessible to all stakeholders, including managing entities, for planning, monitoring, evaluation, and research purposes.
(b) The managing entity shall have the capability and capacity to submit all the required data electronically into the Substance Abuse and Mental health Information System (SAMHIS). The contractor shall submit these data based on policies and procedures outlined in the Department’s Pamphlet 155-2, most current version of the pamphlet for. Mental Health and Substance Abuse Measurement and Data, DCF Pamphlet 155-2, effective date, September 1, 2008, 9th Edition, Version 9.1. (available on the department’s website,).
(c) No change.
(d) The managing entity shall establish procedures for documenting and reporting service events in such manner as to provide a clear and distinguishable audit trail of each service event submitted into the SAMHIS database. At a minimum, the The audit trail documentation shall include the following: the HIPAA procedure code description; service data and duration; the recipient names and identification number; and the staff names and identification number. Such procedures shall ensure that the Department is not billed for unallowable or more service event units than are eligible for payment.
(e) To be paid by the Department, the managing entity shall use the service event data submitted into the SAMHIS database as the main source for verifying and justifying the service units provided by the contractor and the amount billed to or paid by the Department. The Department shall may deny all or part of the payment if the managing entity fails to comply with this data submission requirements based on policies and procedures outlined in the Department’s Pamphlet 155-2, most current version of the pamphlet for. Mental Health and Substance Abuse Measurement and Data, DCF Pamphlet 155-2, effective date, September 1, 2008, 9th Edition, Version 9.1.
(6) Continuous Quality Improvement.
(a) The managing entity will establish a clearly delineated continuous quality improvement program that includes provides for the meaningful involvement of managing entity personnel, provider organizations, consumers, and stakeholders as outlined in the Substance Abuse and Mental Health Services Program Managing Entity Performance Contract. The program will:
(a) 1. through 2. No change.
3. Measure the overall performance of the managing entity, the system of care, and the performance of participating provider agencies.
4. Deleted
4.5. Require Insure that there are mechanisms that identify performance issues, conduct analysis of performance issues, develop appropriate interventions, and measure the effects of those interventions.
5.6. Review the results of quality assurance reviews, external monitoring, critical incidents, consumer complaints and grievances, and take steps to initiate improvement, including appropriate corrective actions and sanctions.
7. through 8. renumbered 6. through 7. No change.
(b) The managing entity will establish a Quality Assurance Program that, at a minimum, addresses the following areas:
1. Monitoring contracted agencies to insure that the managing entity contract requirements are met.
2. Monitoring provider invoices for accuracy and allowability of the services billed.
3. Monitoring data submitted by contracted providers to insure completeness and accuracy.
4. Establishing an Incident Reporting and notification System that provides timely reporting of adverse incidents.
5. No change.
(7) Peer Review.
(c)(a) The managing entity continuous quality improvement program will include a peer review process among network providers that involves the review of staff member’s professional work clinical, administrative and financial records and by comparing trained and qualified individuals who perform similar tasks.
1.(b) The managing entity will ensure insure that all network providers have participating agencies has a peer review process in place.
2.(c) The managing entity shall may establish a peer review process that reviews network providers’ clinical, administrative and financial records and agency clinical practices provides technical assistance to network providers individuals and agencies in the adoption and use of evidence-based practices.
(7)(8) Utilization Management.
(a) The managing entity will develop a utilization management program that includes: at a minimum
1. through 3. No change.
(8)(9) Technical Assistance and Training
(a) The managing entity will provide technical assistance and training that includes: in a minimum of two areas:
1. through 3. No change
(9)(10) Board Development and Governance
(a) The managing entity will provide board development activities which:
1. through 3. No change
(10) Disaster Planning and Responsiveness
(a) The managing entity will work collaboratively with the Department and take direction from Department staff for any disaster-related preparedness or response activities.
Rule 65D-31.004, F.A.C., incorporates by reference the Department of Children and Families Pamphlet 155-2, Mental Health and Substance Abuse Measurement and Data, effective date, September 1, 2008, 9th Edition, Version 9.1. The following revisions were made to the handbook.
Page 1-3, the reference to “Section 394.9082(6)(j), F.S.”, is replaced with “Section 394.9082(5)(k), F.S.”, and reference to “and the Agency for Health Care Administration (AHCA)” is deleted.
Page 1-9, Section 8. Use of Social Security Number as Person’s Unique Identifier. The first sentence in the second paragraph that reads, “For all agencies, the use of the SSN is mandatory”. This sentence is expanded to read, “For all agencies, the use of the SSN is mandatory based on statutory authority found in Sections 394.78 and 397.321, F.S.”
Rulemaking Authority 394.9082(10) FS. Law Implemented 394.9082 FS. History–New________.