The purpose of the proposed rule amendments is to update Rule Chapter 58H-1, F.A.C., to reflect current statutory language, policies, and procedures; to add language regarding confidentiality and disclosure of information; and to delete references ...

 

DEPARTMENT OF ELDER AFFAIRS
Home Care for the Elderly

RULE NO: RULE TITLE
58H-1.001: Purpose
58H-1.002: Definitions
58H-1.003: Administration
58H-1.004: Access to the Program
58H-1.005: Client Functional and Financial Eligibility
58H-1.006: Caregiver Requirements
58H-1.007: Dwelling Requirements
58H-1.008: Appeal Proceedings
58H-1.009: Program Forms
58H-1.010: Confidentiality and Disclosure Information
PURPOSE AND EFFECT: The purpose of the proposed rule amendments is to update Rule Chapter 58H-1, F.A.C., to reflect current statutory language, policies, and procedures; to add language regarding confidentiality and disclosure of information; and to delete references to the Department of Elder Affairs Programs and Services Manual, July 1994 and revised November 1994, which is incorporated by reference in this rule chapter.
SUMMARY: The proposed rule amendments include the purpose of the Home Care for the Elderly (HCE) program; definitions used in this rule chapter; administration of the HCE program; HCE program access; HCE program eligibility; caregiver requirements; dwelling requirements; grievance procedures; program forms; and the addition of language regarding confidentiality, disclosure of information and record retention procedures.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 430.08, 430.603 FS.
LAW IMPLEMENTED: 430.601-.608 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: June 18, 2008, 9:30 a.m. – 11:00 a.m., EST.
PLACE: Department of Elder Affairs, 40540 Esplanade Way, Conference Room 225F, Tallahassee, FL 32399-7000
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, FL 32399-7000; Telephone number [phone]; Email address [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, FL 32399-7000; Telephone number [phone]; Email address [e-mail]. A copy of the proposed rule amendments is available on the department Web site at http://elderaffairs.state.fl.us/, under the heading DOEA Rulemaking, Administration of the Home Care for the Elderly Program

THE FULL TEXT OF THE PROPOSED RULE IS:

58H-1.001 Purpose.

The purpose of these rules is to provide a framework for the Department of Elder Affairs (DOEA) to administer Sections 430.601-.608, F.S. The Home Care for the Elderly (HCE) pProgram provides rules encourage the provision of care for the elderly in family-type living arrangements in private homes as an alternative to and prevention of premature or inappropriate institutionalization by providing assistance through financial subsidies and support services to encourage and assist those individuals who live with and willing to provide care for frail elderly individuals in family-type arrangements in private homes on a not for profit basis.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.601-.606 FS. History–New 1-1-96, Amended ________.

 

58H-1.002 Definitions.

The following terms are defined in the rule chapter are in addition to definitions found in Sections 430.602 and 430.203(1) and (9), F.S.:

(1) ASSESSMENT INSTRUMENT: The tool prescribed by the area agency on aging in its contract with the case management agency for use in determining the client’s level of functioning, existing resources, service needs, and priority for services. ACTIVITIES OF DAILY LIVING (ADL) are functions and tasks for self care, such as ambulating, bathing, dressing, eating, grooming, and other personal care activities.

(2) BASIC SUBSIDY: is Aa monthly payment made to the caregiver for support and health maintenance, to assist with the cost of housing, food, clothing, medical and dental services, and incidentals, which are not covered by Medicare, Medicaid and other insurance.

(3) CARE PLAN means a plan which specifies the ongoing services prescribed for a Home Care for the Elderly client to meet the needs identified in the comprehensive assessment. The care plan shall specify the estimated duration, desired frequency, problem statements, and scope of the services to be provided. The care plan shall identify the caregiver, provider agency, or other organization responsible for providing the service(s). The care plan shall include a listing of desired outcomes agreed to with the client and caregiver. The care plan shall be developed, signed and dated by the case manager, the client, and caregiver.

(3)(4) CAREGIVER: is Aan adult person(s), age 18 or above, who applies and is approved by the case management Lead aAgency to provide care to 3 or fewer elderly persons client(s) in the private residence of the client or caregiver on a non-profit basis.

(5) CASE MANAGEMENT is a client centered series of activities which includes planning, arrangement for and coordination of community-based services for an eligible client. Case Management is a service which may be delivered in the absence of other services. Case Management activities include intake and referral, comprehensive assessment and reassessment, development of a care plan with planned client outcomes, assistance in helping clients to obtain community resources, follow-up contacts for the purpose of monitoring client progress to assure effective delivery of services, and travel time related to the client’s case.

(4) CASE MANAGEMENT AGENCY: The Community Care for the Elderly lead agency or other agency under contract with an area agency on aging (AAA) to provide case management services.

(5)(6) DWELLING: means Aa family-type home that serves as the primary residence of the client and or caregiver.

(7) HOME CARE CLIENT means an individual who meets all eligibility requirements for this program, and who without home care supportive services could require placement in an institution or nursing home.

(6)(8) SERVICE PROVIDER: means Aa Community Care for the Elderly lLead aAgency that is awarded a contract to provide case management and other services under the Home Care for the Elderly pProgram.

(7)(9) SPECIAL SUBSIDY: means Aa flexible payment based on actual cost that is has been pre-authorized on the care plan by the Lead Agency cCase mManager to purchase any specialized medical or health care services, supplies or equipment, which are required to maintain the health and well-being of the elderly person. The special subsidy This supplement is separate from and may be utilized in addition to the basic subsidy.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.603, 430.605 430.601-.606 FS. History–New 1-1-96, Amended________.

 

58H-1.003 Program Administration.

The Home Care for the Elderly Program shall be administered directly by the Department through an Area Agency on Aging located within a Planning and Service Area.

(1) The Department of Elder Affairs shall, plan, develop, and coordinate a statewide program to carry out its responsibilities under the Home Care for the Elderly statutes, including entering into contracts with area agencies on aging for the provision of HCE services within the designated planning and service area. The Department’s responsibilities include:

(a) Coordinating statewide activities necessary to carry out the provisions of the Home Care for the Elderly law;

(b) Developing program policies and plans;

(c) Setting service standards and rates;

(d) Providing for program development and quality through monitoring, technical assistance, staff development and training, and evaluation activities; and

(e) Contracting with the Area Agency on Aging for provision of Home Care for the Elderly services.

(2) The area agencies on aging shall comply with the following requirements in regards to carrying out its responsibilities under the Home Care for the Elderly program: Area Agency on Aging’s responsibilities include:

(a) State of Florida procedures regarding solicitation and execution of contracts with service providers; and

(b)(a) Terms and conditions of its contract with the department. Administering the Home Care for the Elderly Program in accordance with the Department of Elder Affairs Programs and Services Manual dated July 1994, revised January 1996, and the Division of Administration Policy Memorandum A0016, dated December 1995, available in the Office of the Department Secretary and at each Area Agency on Aging, and herein incorporated by reference;

(b) Administering the Home Care for the Elderly contracts with Community Care for the Elderly Lead Agencies;

(c) Contracting with the Lead Agency for provision of Home Care for the Elderly Case Management;

(d) Providing information regarding available subsidy funding;

(e) Providing technical assistance to Lead Agencies;

(f) Requiring Lead Agencies to annually submit the Service Provider Application, (DOEA Form 218, September 1994, revised October 1, 1995, available in the Office of the Secretary and herein incorporated by reference) for funding of current Lead Agency to provide Home Care for the Elderly;

(g) Providing the Department with review copies of applications;

(h) Monitoring Lead Agencies’ programmatic and fiscal capabilities;

(i) Making Home Care for the Elderly basic and special subsidy payments after verification schedules have been reviewed;

(j) Reconciling client data input in Department’s Client Information and Registration Tracking System from the Lead Agency and any fiscal verification schedules before making basic or special subsidy payments or Lead Agency Case Management payment;

(k) Compiling program statistics required by the Department;

(l) Providing for in-service training for Lead Agencies at least once a year;

(m) Having and implementing procedures and time frames for appeals regarding contracts for Lead Agencies and for appeals regarding denial, reduction or termination of services to clients pursuant to Rule 58H-1.008, F.A.C.; and

(n) Hearing appeals not resolved at the Lead Agency.

(3) The case management Lead aAgency shall responsibilities include:

(a) Determineing eligibility for the Home Care for the Elderly pProgram using the assessment instrument form incorporated by reference in paragraph 58A-1.010(1)(b), F.A.C. for functionally impaired and financially eligible elderly;

(b) Provideing case management services as applicable and specified in accordance with its contract with the area agency on aging;

(c) Determining the amount of the basic subsidy derived from DOEA Form H-001, Home Care for the Elderly Basic Subsidy Chart, July 2008, hereby incorporated by reference and available from the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida, 32399-7000 Coordinating services; and

(d) Compiling program statistics as required by the Department;

(e) Determining basic and special subsidy payments to caregivers as required;

(f) Entering data on clients in Department’s Client and Information Tracking System monthly;

(g) Providing for in-service training for staff including volunteers at least once a year;

(h) Accepting contributions, gifts and grants to carry out services;

(i) Maximizing use of volunteers to provide services to functionally impaired elderly persons;

(j) Having and implementing procedures and time frames for appeals regarding denial, reduction or termination of services to clients pursuant to Rule 58H-1.008, F.A.C.;

(k) Ensuring that quality services are delivered in a timely manner to eligible individuals; and,

(d)(l) Maintaining client, fiscal, and program records and provide reports as specified in its contract with the area agency on aging by the Department of Elder Affairs Programs and Services Manual, dated July 1994 and revised January 1996, and the Division of Administration Policy Memorandum A0016, dated December 1995, available in the Office of the Department Secretary and at each Area Agency on Aging, and herein incorporated by reference.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.603, 430.605, 430.606 430.60-.606 FS. History–New 1-1-96, Amended ________.

 

58H-1.004 Access to the Program.

(1) Requests for the Home Care for the Elderly pProgram services may be initiated by the applicant potential home care client or the applicant’s caregiver on behalf of the client.

(2) The service provider shall not arrange for recruitment and matching of potential providers and recipients to facilitate admittance to the Home Care for the Elderly Program between two unrelated or unfamiliar parties.

(3) The application process shall include:

(a) Client assessment and determination of functional and financial eligibility.

(b) Caregiver eligibility, including an assessment of the home.

(2)(4) The application process must be completed as specified in the case management agency’s contract with the area agency on aging by the Department’s Programs and Services Manual.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.603, 430.606 430.601-.606 FS. History–New 1-1-96, Amended ________.

 

58H-1.005 Client Functional and Financial Eligibility.

(1) To be eligible for the Home Care for the Elderly pProgram, an applicant must:

(a) Be age 60 or older; and

(b) Be a current resident of the State of Florida with the intent to remain in the state Have completed on their behalf, an Intake and Comprehensive Uniform Client Assessment, DOEA Form 111A and B, Feb. 1992, for Home Care for the Elderly services; and

(c) Meet the criteria for functional and financial eligibility set forth under subparagraphs 1. through 5. below:.

1. Be Shall have been assessed and determined to be at risk of nursing home placement based on the comprehensive uniform client assessment instrument pursuant to paragraph 58H-1.003(3)(a), F.A.C.; and

2. Have Shall self-declared their income and assets which do not cannot exceed the Institutional Care Program (ICP) limits set forth in DOEA Form H-001, incorporated by reference in paragraph paragraph 58H-1.003(3)(c), F.A.C.; used under Medicaid for eligibility for nursing home care or;

3. Receive Shall be a recipient of Supplemental Security Income (SSI); or;

4. Receive benefits as a Shall be a recipient of Medicaid for the Aged or Disabled (Meds AD), or Qualified Medicare Beneficiary (QMB), or as a Special Low Income Medicare Beneficiary (SLMB); and

5. Shall Hhave an approved caregiver who meets the caregiver requirements pursuant to Rule 58H-1.006, F.A.C., and the dwelling requirements pursuant to Rule 58H-1.007, F.A.C.

(2) Once eligibility has been determined, the caregiver and client will be notified of their eligibility status for the Home Care for the Elderly Program.

(a) A Care Plan specifying the services and the amount of monthly basic subsidy, and if authorized, special subsidy for which the client has been determined eligible, will be signed and dated by the caregiver, client and the case manager.

(b) Subsidy payment shall be based on the financial status of the client receiving care.

(3) If determined ineligible, the client and caregiver shall be notified of their right to an appeal.

Specific Authority 430.08, 430.603 430.403 FS. Law Implemented 430.603, 430.606 430.601-.606 FS. History–New 1-1-96, Amended ________.

 

58H-1.006 Caregiver Requirements.

(1) Caregivers shall meet the following requirements as specified in the case management agency’s contract with the area agency on aging. A caregiver in the Home Care for the Elderly Program shall:

(a) Be a mature adult, age 18 or above, capable of providing a family type living environment and willing to accept the responsibility for the social, physical and emotional needs of the home care client;

(b) Be a relative or friend who has been accepted by the client as surrogate family or is a responsible adult with whom the client has made an arrangement to provide home care services;

(c) Be willing to accept the responsibility for the social, physical and emotional needs of the recipient.

(d)(c) Be physically present to provide supervision and to assist in arrangement of services for the client;

(e)(d) Maintain the residential dwelling free of conditions that pose an immediate threat to the life, safety, health and well being of the home care client pursuant to Rule 58H-1.007, F.A.C.; and

(f)(e) Be without record of conviction of abuse, neglect or exploitation of another older person, adult or child; shall not have been the perpetrator in a confirmed report of abuse, neglect or exploitation of another person by the Abuse Registry or other investigation process; and shall be willing to sign a statement which certifies that they are without record of conviction or have not been a perpetrator in a proposed confirmed or confirmed report of abuse, neglect or exploitation of another person by the Abuse Registry or other investigative process and grants written authorization to the Lead Agency to check the Abuse Registry through the Florida Department of HRS. The Lead Agency may grant an exemption from this disqualification following the procedures outlined in the DOEA Programs and Services Manual.

(2) The case management agency may exempt a caregiver from certain requirements as specified in its contract with the area agency on aging.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.603 430.601-.606 FS. History–New 1-1-96, Amended ________.

 

58H-1.007 Dwelling Requirements.

(1) The dwelling must comply with safety, fire, and sanitation standards as described in the case management agency’s contract with the area agency on aging the Department’s Programs and Services Manual, Chapter II-3, Client Assessment, Section G.

(2) When a home is determined not to meet the standards set forth for the Home Care for the Elderly pProgram, the applicant, must client, or caregiver shall be notified in writing.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.603, 430.604 430.601-.606 FS. History–New 1-1-96, Amended_________.

 

58H-1.008 Appeal Proceedings.

(1) Applicants shall be advised of the right to and the process of requesting an appeal. Appeals may be initiated in reference to application denial or any action which would terminate, suspend or reduce services received.

(2) Appeals must be reviewed and heard by the Lead Agency first.

(3) Written notification of the determination and right to an appeal shall be sent from the Lead Agency to the applicant.

(4) If resolution is not reached after an appeal hearing at the Lead Agency, the applicant may request the appeal be forwarded to the Area Agency on Aging.

(5) Upon request and receipt of the appeal from the Lead Agency, the Area Agency on Aging shall review and hear the appeal.

(6) The Area Agency on Aging shall provide written notification of determination to the applicant and the Lead Agency.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.601-.606 FS. History–New 1-1-96, Repealed________.

 

58H-1.009 Program Forms.

The following forms shall be used for programs regulated by this chapter, are hereby incorporated by reference in Rule 58A-1.010, F.A.C. In addition, the development of a care plan must meet the criteria established in subsection (3) of that rule. and are available in the Office of the Secretary and at each Area Agency on Aging:

(1) For purposes of assessment:

(a) DOEA Form 701A, Prioritization Form, July, 2000.

(b) DOEA Form 701B, Assessment Instrument, July, 2000.

(c) DOEA Form 701C, Congregate Meals Form, July, 2000.

(2) For purposes of completing forms listed in subsection (1): DOEA Form 701D, Assessment Instructions (701A, 701B, 701C), July, 2000.

(3) For purposes of documenting planned services of care: DOEA Forms 203A, Care Plan, and 203B, instructions dated July, 2001.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.603, 430.606 430.601-.608 FS. History–New 8-20-00, Amended 8-6-01, ________.

 

58H-1.010 Confidentiality and Disclosure Information.

(1) Case management agencies contracting with the area agency on aging to provide services under the HCE shall collect, maintain, and exchange information about applicants applying for services and clients receiving services only to the extent it is necessary to administer the programs covered under this agreement in accordance with the Health Insurance Portability and Accountability Act (HIPPA) of 1996.

(2) The case management agency shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to each agreement and/or contract for a period of at least five (5) years after termination of the agreement(s).

(a) If an audit has been initiated and audit findings have not been resolved at the end of five (five) years, the records shall be retained at least until resolution of the audit findings.

(b) These records may be subject to additional retention requirements set by law.

(3) Persons duly authorized by the department shall have full access and the right to examine or duplicate any of said records and documents during said retention period or as long as records are retained, whichever is later.

Specific Authority 430.08, 430.603 FS. Law Implemented 430.608 FS. History–New________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Jim Crochet
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: E. Douglas Beach, Ph.D., Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 9, 2008
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: June 25, 2005