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Services for Individuals under 18 Years Old
Statewide Inpatient Psychiatric Program (SIPP) services are provided in an intensive residential setting and include: crisis intervention; bio-social and or psychiatric evaluation; close monitoring by staff; medication management; individual, family, and group therapy; and connection to community based services. These services are expected to be relatively short termed (less than six-months). Youth must have a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis other than substance abuse, developmental disability, or autism. The youth must be expected to benefit from residential treatment and a less restrictive setting is not available. All referrals must be approved by the Circuit Substance Abuse and Mental Health (SAMH) Program Office. SIPP is a Medicaid Waiver program.
There are six-circuits in Florida serving 67 counties and eleven Statewide Inpatient Psychiatric Programs (SIPPs) serving the needs of Florida’s youth:
Southern
Jackson Memorial Hospital
Southeast
Alternate Family Care
Sun Coast
Manatee Palms Youth Services
Central
University Behavioral Center
Devereux
Northeast
Ten Broeck
Daniel Memorial
Northwest
Meridian/Lakeview
Devereux
The State of Florida contact person is Barbara Butler-Moore, Operation Management Consultant. Ms. Butler-Moore makes final decisions about the appropriateness of this placement for a youth, oversees the program operation, and handles requests for proposals and consumer complaints. Individuals who have any questions about the SIPP program or a complaint, should contact Ms. Butler-Moore at 1-850-410-0566 or by email at .(JavaScript must be enabled to view this email address).
A designated staff person in the local Department of Children and Families (DCF) District Substance Abuse and Mental Health (SAMH) office completes referrals to the Statewide Inpatient Psychiatric Program (SIPP). The parent, guardian, or family member will be told the availability of treatment programs in their area. The youth and the youth’s responsible party will be able to tour the facility and receive an assessment from the provider to determine if all parties involved agree that this is an acceptable course of action. Once the SAMH staff, the youth, responsible party, and the provider determine that admission is appropriate, the SIPP provider will contact the state utilization management contractor for prior authorization of the admission. Then scheduled admission is discussed.
Each provider will supply:
The youth will be given the choice of enrolled providers in his/her area and will be encouraged to select the closest one to his/her residence. Special needs populations will be accommodated.
The Statewide Inpatient Psychiatric Programs (SIPPs) offer the following services:
Whenever the Department denies a request for service, the youth has the right to exercise a formal appeal process mandated under federal law. The process commences with a file review but can go as far as a formal hearing known as a “fair hearing”.
How to Request Reconsideration of the Denial
The youth, legal guardian, attending physician or provider has the right to request a formal reconsideration of any denial of services. The formal reconsideration must be made in writing to the Agency for Healthcare Administration’s (AHCA’s) utilization management contractor within forty (40) calendar days of the date of the notice of initial determination. The date of notice is the date of the letter plus five additional days for mailing. The medical records must be submitted with the request for reconsideration.
The Process for Reviewing the Reconsideration
Upon receipt of the request, a board-certified psychiatrist, not involved in the initial determination, will review all submitted documentation and render a determination within thirty days of receipt. If the second psychiatrist agrees with the original determination, the decision is upheld and the reconsideration process is completed. If the second psychiatrist reverses the original adverse determination, the case is overturned and the reconsideration process is complete.
The Utilization Manager contractor will approve written notification of the reconsideration determination within thirty (30) working days of the dated receipt.
The written request for reconsideration must be sent to Florida’s current Utilization Manager First Health Services of Florida, Inc. at:
Florida Division
Reconsideration Unit
First Health Services of Florida, Inc.
4300 Cox Road
Glen Allen, VA 23060
How to Request a Fair Hearing
After the reconsideration process, a youth can exercise his/her right to appeal the determination further by submitting a request for a fair hearing. A fair hearing is a formal process that allows each party a forum to present witnesses and evidence in support of their positions on provision of services that are at issue. A request for a Fair hearing must be sent to the:
Department of Children and Families
Office of Public Assistance Appeal Hearings
1317 Winewood Boulevard, Building 1, Room 309
Tallahassee, Florida 32399-0700
The youth’s access to quality medical services must, at a minimum, not be adversely affected by a 1915 (b) (4) waiver program. A waiver must ensure an adequate amount of services during reasonable time periods and within reasonable geographic distance from the residence of the individual enrolled under the waiver. Furthermore, access to emergency services and family planning services must not be restricted.
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