59A-3.278. Comprehensive Medical Rehabilitation, Psychiatric and Substance Abuse Programs

(1) A hospital establishing comprehensive medical rehabilitation, psychiatric, or substance abuse inpatient programs as a specialty hospital or as a physically and functionally distinct unit within a hospital must apply for licensure of comprehensive medical rehabilitation, psychiatric, or substance abuse beds by submitting a hospital licensure application as specified in subsection 59A-3.066(2). No hospital shall admit patients for the primary purpose of providing comprehensive medical rehabilitation, psychiatric, or substance abuse services unless it has obtained a valid license with the appropriate bed type, and meets the requirements of this section. (2) All rehabilitation, psychiatric, and substance abuse programs provided by hospitals shall provide to the patient: (a) A pre-admission assessment upon referral and an evaluation upon admission; (b) Establishment of goals; (c) Development of a plan of treatment, including discharge planning, in coordination with the referring individual and rehabilitation staff, and after discussion with the patient and family; (d) Regular and frequent assessment, performed on an interdisciplinary basis, of the patient’s condition and progress, and of the results of treatment; (e) Maintenance of treatment and progress records; and, (f) At least a quarterly assessment of the quality and appropriateness of the care provided. (3) When any comprehensive medical rehabilitation activity, psychiatric or substance abuse treatment is provided from outside the hospital, the hospital shall ensure by contract or other enforceable mechanism that such services meet all safety requirements and quality control measures required by the hospital. (4) The scope of services offered, and the relationship of the comprehensive medical rehabilitation, psychiatric or substance abuse program to other hospital units, as well as all supervisory relationships within the program, shall be defined in writing. Responsibility for the performance of clinical services also shall be clearly defined. Delegation of authority within the program shall be specified in job descriptions and in organizational plans. Written policies and procedures to guide the operation of the rehabilitation program shall be developed and reviewed at least annually, revised as necessary, dated to indicate the time of last revision, and enforced. (5) There shall be a current written plan of care for each patient receiving comprehensive medical rehabilitative, psychiatric or substance abuse services. The plan shall state the diagnosis, and problem list when appropriate, pertinent to the rehabilitation or treatment process; precautions necessitated by the patient’s general medical condition or other factors; the short-term and long-term goals of the treatment program; and require monthly or more frequent review of the patient’s progress. The medical record and the written plan shall evidence a team approach, with participation of health care professionals, the patient, and, as appropriate, the patient’s family. The medical record shall document the written instructions given to the patient and the family concerning appropriate care after discharge from the hospital. (6) The comprehensive medical rehabilitation, psychiatric or substance abuse program must have notes and log records that are separately identified from the other admission and discharge records in the hospital in which it is located, and are separately retrievable. (7) A hospital providing inpatient comprehensive medical rehabilitation, psychiatric, or substance abuse programs must provide the services in one or more separate physical locations organized by a single licensed bed type. The beds assigned to the program must be physically separate from and not commingled with other licensed bed types. Comprehensive medical rehabilitation, psychiatric or substance abuse programs and beds may be located on the same floor as other programs or beds. (a) Facilities providing hospital inpatient psychiatric services to patients under the age of 18 must have beds and common areas designated for pediatric patients which cannot be used by adults. (b) Facilities providing hospital inpatient substance abuse services to patients under the age of 18 must have beds and common areas designated for pediatric patients which cannot be used by adults. (c) Facilities providing hospital inpatient psychiatric and/or substance abuse services to patients that are 18 years of age and still attending high school may be admitted to a bed in a room within the child psychiatric unit with other inpatients 14 years of age or older if determined appropriate by a physician who is providing medical direction for the unit. (8) Each hospital providing comprehensive medical rehabilitation, psychiatric, or substance abuse programs must have a protocol in place for the emergency transportation of medically necessary transfers. The protocol shall include transfer to the geographically closest hospital with the service capability, unless another prior arrangement is in place or the geographically closest hospital is at capacity. (9) Information on specifications, operation and maintenance of all equipment used in comprehensive medical rehabilitation, psychiatric, and substance abuse programs shall be maintained. All equipment shall be operated according to manufacturer’s specifications, and a preventive and corrective maintenance program on such equipment shall be conducted and recorded. (10) Psychiatric programs provided by hospitals shall meet the following additional standards: (a) The program, unit, service or similarly titled part shall have medical direction by a physician who is board-certified or board-eligible by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry. A physician with psychiatric postgraduate training and experience who is not board certified or eligible may serve as the medical director if the training and experience is acceptable to the hospital’s governing board via the medical staff committee responsible for appointment and reappointment of medical staff as specified in Rule 59A-3.275, F.A.C. (b) The program, unit, service or similarly titled part shall have a an advanced practice registered nurse certified as a psychiatric nurse, or a registered professional nurse with mental health nursing experience and education acceptable to the psychiatric medical director. This rule does not restrict or limit a person licensed under Chapter 464, F.S., from performing psychiatric services within their scope of practice. (c) Providers of hospital inpatient psychiatric services must also provide outpatient services either directly or through referral to outpatient mental health programs, such as local psychiatrists, local psychologists, community mental health programs, or other local mental health outpatient programs. The referral must be included as part of the patient’s discharge planning and must be documented in the patient’s medical record. (d) All facilities providing hospital inpatient psychiatric services shall have a screening program to assess the most appropriate treatment for the patient. Patients with a dual diagnosis of a psychiatric disorder and substance abuse shall be evaluated to determine the types of treatment needed, the appropriate treatment setting, and, if necessary, the appropriate sequence of treatment for the psychiatric and substance abuse disorders. (e) As appropriate to meet the needs of the patient, hospital inpatient psychiatric services whether provided directly by the hospital or through arrangement must include emergency screening services, pharmacology, individual therapy, and referral services. (11) Substance abuse programs provided by hospitals shall meet the following additional standards: (a) The program, unit, service, or similarly titled part shall have medical direction by a physician who is board- certified or board-eligible in Addiction Medicine, through the American Board of Preventive Medicine or the American Osteopathic Association. (b) The program, unit, service or similarly titled part shall have a registered professional nurse or advanced practice registere nurse qualified in psychiatric or mental health nursing to oversee the nursing operations of the unit. (c) Providers of hospital inpatient substance abuse services must also provide outpatient services, either directly or through referral to outpatient substance abuse programs, such as local psychiatrists, other physicians trained in the treatment of substance abuse disorders, local psychologists, community mental health programs, or other local substance abuse outpatient programs. The referral must be included as part of the patient’s discharge planning and must be documented in the patient’s medical record. (d) Providers of hospital inpatient substance abuse services must have a screening program to assess the most appropriate treatment for the patient. Patients with a dual diagnosis of substance abuse and a psychiatric disorder shall be evaluated to determine the types of treatment needed, the appropriate treatment setting, and, if necessary, the appropriate sequence of treatment for the substance abuse and psychiatric disorders. (e) As appropriate to meet the needs of the patient, hospital inpatient substance abuse services whether provided directly by the hospital or through arrangement must include emergency screening services, treatment planning services, pharmacology, individual therapy, and referral services. (12) Comprehensive medical rehabilitation programs provided by hospitals must include comprehensive medical rehabilitaiton nursing, physical therapy, and occupational therapy. In addition to required services as specified in this chapter, the following services may be provided, directly or by contract as needed: speech pathology and audiology, social services, psychological services, and orthotic and prosthetic services. The responsibility for the medical direction of the comprehensive medical rehabilitation program must be a physician member of the organized medical staff with at least two years of experience in the medical management of inpatients requiring rehabilitation services and is knowledgeable in the comprehensive medical rehabilitation services offered. Unless otherwise permitted by law, comprehensive medical rehabilitation services shall be initiated by a physician. The written request for services shall include reference to the diagnosis or problems for which treatment is planned. Overall supervision and administration of the following specialty comprehensive medical rehabilitation programs may be provided by staff with the following credentials: (a) Physical Therapy – A qualified physical therapist who shall be a graduate of a physical therapy program approved by a nationally recognized accrediting body or have documented equivalent training or experience, and shall meet all current requirements under Chapter 486, F.S. (b) Occupational Therapy – A qualified occupational therapist who shall be a graduate of an occupational therapy program approved by a nationally recognized accrediting body; or shall currently hold certification by the American Occupational Therapy Association as an Occupational Therapist, Registered; or shall have documented equivalent training or experience; and shall meet all current requirements for licensure under Chapter 468, Part III, F.S. (c) Speech Pathology and Audiology – A qualified speech-language pathologist or audiologist who shall meet all current requirements for licensure under Chapter 468, Part I, F.S. (d) Comprehensive Medical Rehabilitation Nursing – A registered nurse or advanced practice registered nurse who shall have documented training in comprehensive medical rehabilitation nursing. This rule does not restrict or limit a person licensed under Chapter 464, F.S., from performing comprehensive medical rehabilitation services within their scope of practice. (e) Vocational or Educational Rehabilitation – A qualified individual who shall be a graduate of vocational rehabilitation program at the graduate level, or have documented equivalent training or experience. (f) Comprehensive Medical Rehabilitation – A qualified physician who shall be a member of the organized professional staff and who is certified, or eligible for examination, either by the American Board of Physical Medicine and Rehabilitation or by a specialty related to comprehensive medical rehabilitation. (13) All comprehensive medical rehabilitation, psychiatric, and substance abuse programs must provide patient discharge data in accordance with section 408.061, F.S. and Chapters 59E-7 and 59B-9, F.A.C.