65G-13.003. Individual and Family Supports Criteria

(1) IFS may only be approved for clients when community-based services are medically necessary to prevent institutionalization under Section 393.066(3), F.S., which may include the use of IFS to avert a crisis as described in Section 393.065(5)(a), F.S. and Division 65G, F.A.C.

(2) Clients enrolled on the Waiver must not receive IFS services that are the same or substantially the same as the services offered on the Waiver, except for:

(a) A client approved for and actively enrolling onto the Waiver, the client shall demonstrate imminent serious jeopardy prior to Waiver enrollment. The provision of IFS shall only be approved to directly address the imminent serious jeopardy and must end on the effective date upon commencement of Waiver services that addresses the imminent serious jeopardy. The utilization of IFS will be reviewed on the 90th day from the date the client applied for enrollment onto the Waiver for clients who have not yet enrolled onto the Waiver by the 90th day.

(b) A client with a pending Significant Additional Need (“SAN”) request, as described in Rule 65G-4.0218, F.A.C., that is in imminent serious jeopardy and the IFS directly addresses the need for which the SAN has been requested. For IFS approved under this paragraph, the IFS must terminate:

1. Upon denial of the SAN request; or

2. After approval of the SAN request and upon commencement of the waiver service(s) for which the SAN has been requested.

(3) In order for a client to receive a specific IFS service, the service must not be offered or available by any other resource. Other resources include, but are not limited to:

(a) Medicaid State Plan;

(b) The Waiver, except as provided for in subsection (3) of this rule;

(c) Natural supports;

(d) Other agencies or programs; and

(e) Other paid supports, such as Medicare or private insurance.

(4) The following services are allowable under IFS:

(a) Adult day training, as defined in Section 393.063, F.S.;

(b) Employment and pre-vocational services;

(c) Family care services;

(d) Guardian advocate referrals, as described in Section 393.12, F.S.;

(e) Medical and dental services, which include but are not limited to nursing services, consumable medical supplies, durable medical equipment, medical evaluations, and dental services;

(f) Parent training;

(g) Personal care services, as defined in Section 393.063, F.S.;

(h) Recreation;

(i) Residential facility services;

(j) Respite services, as defined in Section 393.063, F.S.;

(k) Social services;

(l) Specialized therapies;

(m) Supporting living services;

(n) Transportation; and

(o) Other habilitative and rehabilitative services.

(5) Non-allowable IFS services include but are not limited to the following:

(a) Home repairs;

(b) Installation or maintenance of spas or swimming pools;

(c) Constructing, erecting, or maintaining fences;

(d) Restraint devices;

(e) Satellite or cable television services or the purchase of a television;

(f) Vacation travel or accommodations;

(g) Aesthetic home improvements;

(h) Contractor services;

(i) Any portion of the principal or interest of a mortgage payment;

(j) Property taxes;

(k) Premiums for life, auto, medical/health, renter’s, or homeowner’s insurance;

(l) Loans, debts, or credit card payments;

(m) Personal spending funds or savings accounts;

(n) Alcohol or nicotine products or supplies;

(o) Alimony payments, child support payments, or any payments that are not for the direct benefit of the client;

(p) Purchase or replacement of major appliances such as refrigerators, stoves, dishwasher, or washer/dryer;

(q) General repair and maintenance of property, such as repair of major appliances and heating, ventilation, and air conditioning systems;

(r) Computing devices, such as computers and tablet personal computers;

(s) Telephones for persons in the family home or a licensed facility;

(t) Second telephone line in person’s own home;

(u) Court costs, lawyer fees, traffic tickets, or fines;

(v) Recreational items or expenses related to events and activities that a client attends that do not address an assessed need of the client;

(w) Capital improvements to property;

(x) Fees related to legal guardianship and legal guardianship reports;

(y) Supporting or subsidizing any other person living in the client’s household; and

(z) Covering or replacing supports or services that are allowable under the Medicaid State Plan, the Waiver, or any other governmental program after the client has been determined eligible for the Medicaid State Plan, the Waiver, or other governmental program.

(6) This rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

Rulemaking Authority 393.065, 393.066(8), 393.0663, 393.501(1) FS. Law Implemented 393.063, 393.065, 393.066, 393.0663 FS. History–New 8-28-16, Amended 12-25-22.