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:

1. The parents of a minor child whose rights have not been terminated;

2. Health care surrogate appointed by a Florida court to represent the child; or

3. 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:

1. Anyone designated by the client through a Power of Attorney or Durable Power of Attorney;

2. A medical proxy under Chapter 765, F.S.;

3. Health care surrogate; or

4. 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;

(c) Is not a family home as defined in subsection (5) of this rule; and

(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.

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.