FLORIDA CHECKLIST
Fla. Admin. Code Ann. R. 65E-4.016 provides the following – 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. Any facility licensed as a residential treatment facility under this rule must sustain a 60-day average or greater length of stay of residents, except as specifically provided for in Section 394.875(11), F.S. Any facility providing primarily clinical residential services, either during an urgent care episode or during the 90 days following such an episode shall not be licensable under this rule. Residential treatment facilities that primarily provide treatment for eating disorders, weight loss programs, substance abuse or other specialty psychiatric treatment program are excluded from licensure under this rule.
(3) Licensure Procedure. Every RTF must be licensed annually by AHCA unless specifically excluded from licensure under the provisions of subsection 394.875(5), 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 subsection 65E-4.016(4), F.A.C., may be licensed as one facility under the following circumstances:
1. Such buildings are not separated by another building, part of a building or buildings used for other purposes; and
2. 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) Original License – New construction, new operation or change of licensed operator. Applicants for an original license shall submit a completed AHCA Form, 3180-5003 Feb. 96, “Crisis Stabilization Unit, Short-Term Residential Treatment Facility and Residential Treatment Facility Licensure Application” effective February, 1996, which is incorporated by reference and provided by AHCA. The following supplemental information must be attached to the application:
1. 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, based minimally on the criteria in subsection 65E-4.016(4), F.A.C., that are applicable to the level of RTF for which the licensure application is being submitted.
2. Table of Organization, including all management levels between the RTF and the governing board.
3. Resume of the RTF manager.
4. Fiscal information, including a balance sheet and a statement projecting revenues, expenses, taxes, extraordinary items and other credits and charges for the licensure year.
5. 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.
6. Copy of current fire safety inspection certificate.
7. Copy of current health inspection certificate.
8. For Level I and II facilities, a signed statement from the appropriate government official that the facility has met applicable local zoning requirements.
9. Proof of current JCAHO accreditation, if applicable.
(d) A newly developing facility will be provided a 90-day probationary license after the completed application has been verified for compliance with Rule 65E-4.016, F.A.C. The probationary period may be extended for an additional 90 days if the applicant has substantially complied with the requirements for licensure, and if action has been initiated to satisfy all of these requirements.
(e) Renewal License.
1. An applicant for renewal of a license shall apply to AHCA no later than 90 days before expiration of the current license.
2. Applicants for renewal of a license to operate a facility shall submit an application that meets the requirements of paragraph 65E-4.016(3)(a), F.A.C.
(f) License Fee. An annual non-refundable license fee shall be submitted with the application for licensure. The fee shall be reasonably calculated annually to cover the cost of regulation. The formula for calculating this fee is the cost of Office of Health Facility Regulation positions for the process of surveying crisis stabilization units, short-term residential treatment facilities, and residential treatment facilities for licensure divided by the total number of crisis stabilization units, short-term residential treatment facilities, and residential treatment facility beds times the number of beds in the facility applying for licensure.
(g) The license, AHCA Form 3180-5001 Feb. 96, effective February, 1996, which is incorporated by reference, 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, 7 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.
1. 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.
2. Staffing Pattern. Level IA facilities must maintain a minimum of 1-10 staff to resident ratio with never less than 2 staff on the premises at all times. There must be 24 hours per day, 7 days per week nursing supervision, provided minimally by a licensed practical nurse under the direction of an on-call licensed physician 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, 7 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.
1. 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.
2. 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, 7 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.
1. 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.
2. 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 4 or more residents who have attained most of the skills required for independent living and require minimal staff support.
1. 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.
2. Staffing Pattern. Level IV facilities may have less than 24 hours per day, 7 days per week on-premises supervision; however, on-call staff must be available at all times. Staff shall have a minimum of weekly on-premises contact with residents.
(f) Level V. A Level V facility provides a semi-independent, minimally structured apartment setting for 1 to 4 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 apartments on this level that are operated by a service provider, regardless of location, shall be considered the premises of the facility.
1. 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.
2. Staffing Pattern. Level V facilities may have less than 24 hours per day, 7 days per week on-premises staff; however, on-call staff must be available at all times. Staff shall have a minimum of weekly on-premises contact with residents.
(5) Program Reviews, Evaluations and Consultations.
(a) Representatives of the Alcohol, Drug Abuse and Mental Health Program Office; AHCA; and District Alcohol, Drug Abuse and Mental Health Program Office; shall provide consultation and conduct annual reviews and evaluations, or more as necessary, of all RTFs to determine compliance with rules and standards.
(b) RTFs shall afford representatives of the Alcohol, Drug Abuse and Mental Health Program Office; AHCA; and District Alcohol, Drug Abuse and Mental Health Program Offices; access to the facility and the documentation necessary for conducting the reviews required to determine compliance with this rule and all other applicable rules and statutes.
KANSAS Legal Requirements
Article 22 – Licensing of Psychiatric Hospitals; Funding of Community Mental Health Centers and
Facilities for the Mentally Retarded and Facilities for Handicapped Persons
30-22-1 Scope. (a) These rules and regulations shall apply to the licensing of psychiatric
hospitals as authorized by K.S.A. 75-3307b, as amended, and shall apply to the setting of
standards, the inspection of such hospitals, and the withdrawal of licenses for cause.
(b) Terms used herein shall have the same meaning as defined in the “act for obtaining
treatment for a mentally ill person,” K.S.A. 59-2901 through 59-2941, as amended. (Authorized by
and implementing K.S.A. 75-3307b; effective, E-70-16, Feb. 13, 1970; effective Jan. 1, 1971;
amended Feb. 15, 1977; amended May 1, 1979; amended Oct. 28, 1991.)
30-22-2 Principles to be considered in approval of application for licensing, renewal of
license, or revoking of license. The following principles shall be considered in the inspection of
the applying psychiatric hospital:
(a) The quality of the services offered by the applying agency is determined by professional
standards, and the selection of the services as to kind and extent can only be determined by the
governing authority usually based upon the will of the community, the nature of the community
problems, and the depth of community resources (acting together with the professional
considerations).
(b) The applying agency shall be a growing, developing, social organization with different stages
of differentiation and versatility dependent upon the specific local internal and community forces
acting at a given point in time.
(c) Services of the applying agency may be offered to the mentally ill, the mentally retarded,
persons under specific or unusual stress, or handicapped persons. Services may include those
listed below offered either in an inpatient, residential setting, or an outpatient, neighborhood, or
home setting.
(1) Diagnosis, evaluation, treatment, and restoration of mentally disordered or handicapped
persons to an optimal level of functioning.
(2) Day care, training, education, sheltered employment necessary to improve an individual’s
maximum abilities leading toward total rehabilitation.
(3) Consultative and educational services to schools, courts, health and welfare and social
agencies, both public and private.
(4) Training for students entering the mental health and retardation professions and continuing
in-service training of mental health and retardation professionals and adjunctive personnel.
(5) Recruitment, training, and supervision of volunteer workers in the mental health related
activities of the community.
(6) Informational activities directed toward the general population.
(7) Research.
(8) Interventions in society purposely directed to reduce stresses to the individual or to the
community as a whole, which stresses contribute to the incidence of mental illness or mental
retardation.
(9) Client information and referral, counseling, follow along, protective and other social and
socio-legal services, transportation, residential and transitional centers, and recreation services,
all geared toward the handicapped individuals, their families and the general public.
(d) The applying agency shall acknowledge the dignity and protect the rights of all persons
within its authority to direct or regulate both personnel and clientele.
(e) The applying agency shall have an ethical and competent staff, and the recruitment practices
shall provide measures to insure the hiring of personnel with these characteristics.
(f) The applying agency shall make provisions to cooperate with other community agencies
within the scope of its resources and the skills of its personnel, and within its capacities to
respond to the community needs.
(g) The applying agency shall keep accurate, current, and adequate client and administrative
records, and shall submit reports derived from such records as required by the licensing agency
to carry out these licensing procedures.
(h) The applying agency shall have written policies and procedures covering operation of the
agency, including a written policy on how the agency is related to the statewide mental health
planning effort.
(i) The applying agency shall provide a physical plant which is a safe and wholesome
environment fit to enhance the program.
(j) The applying agency shall plan the program and physical plant to be accessible to clientele in
point of view of time, location, and transportation. (Authorized by and implementing K.S.A. 75-
3307b; effective, E-70-16, Feb. 13, 1970; effective Jan. 1, 1971; amended Jan. 1, 1974; amended
May 1, 1975; amended Feb. 15, 1977; amended May 1, 1979; amended Oct. 28, 1991.)
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