This rulemaking is necessitated by changes to section 766.1115, F.S., by deleting unnecessary or redundant language, incorporating required reference materials, and clarifying existing requirements.

 

DEPARTMENT OF HEALTH

Division of Health Access and Tobacco

RULE NOS.:RULE TITLES:

64I-2.001Definitions.

64I-2.002Client Eligibility.

64I-2.003Patient Selection and Referral.

64I-2.004Volunteer Provider Eligibility.

64I-2.005Contract Requirements.

64I-2.006Covered Services.

64I-2.009Annual Report.

PURPOSE AND EFFECT: This rulemaking is necessitated by changes to section 766.1115, F.S., by deleting unnecessary or redundant language, incorporating required reference materials, and clarifying existing requirements.

SUMMARY: Rule 64I-2.001, F.A.C. is being amended to remove definitions clearly stated in statute, remove unnecessary language and correct an obsolete program reference. Rule 64I-2.002, F.A.C. is being amended to eliminate language clearly stated in statute, add language allowing providers to determine and approve client eligibility in accordance with recent statutory changes, update references to the Training Guide and the Financial Eligibility form, and incorporate the Patient Referral form. Rule 64I-2.003, F.A.C. is being repealed to remove language no longer authorized by statute. Rule 64I-2.004, F.A.C. is being amended to clarify existing requirements, incorporate the contract, DH 1029, and eliminate unnecessary language. Rule 64I-2.005, F.A.C. is being repealed to remove redundant language. Rule 64I-2.006, F.A.C. is being repealed to comply with recent changes to the statute. Rule 64I-2.009, F.A.C. is being amended to clarify existing requirements and eliminate unnecessary language.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on the SERC checklist, this rulemaking will not have an adverse impact or regulatory costs in excess of $1 million within five years as established in Section 120.541(2)(a), F.S.

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.

RULEMAKING AUTHORITY: 766.1115(11) FS.

LAW IMPLEMENTED: 766.1115 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Duane Ashe, Administrator, Health Resources and Access Section, 4052 Bald Cypress Way, Bin C15, Tallahassee, FL 32399

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64I-2.001 Definitions.

For the purpose of this rule chapter, the following definitions will apply:

(1) “Adverse incident”: as defined in Section 395.0197(5), F.S.

(2) “Corporate medical group” means a corporation for profit established under the provisions of Chapter 607, F.S., or a corporation not for profit established under the provisions of Chapter 617, F.S.

(3) “Emergency medical condition”: as defined in Section 395.002(9), F.S.

(4) renumbered (1) No change.

(2)(5) “Gross family income” means the sum of income available to a family at the time of application. Gross family income shall be based on all income earned or received in the last four (4) weeks. Income shall not include Supplemental Security Income (SSI), income from trusts fully funded by SSI payments, and Temporary Cash Assistance (TCA) to Needy Families (TANF). Gross family iIncome shall include but not be limited to the following:

(a) wWages and salary,.

(b) cChild support,.

(c) aAlimony,.

(d) uUnemployment compensation,.

(e) wWorker’s compensation,.

(f) vVeteran’s pension,.

(g) sSocial security.

(h) pPensions and annuities,.

(i) dDividends and interest on savings, stocks, and bonds,.

(j) iIncome from estates and trusts,.

(k) nNet rental income or royalties,.

(l) nNet income from self employment,.

(m) and cContributions.

(3)(6) “Net family income” means gross family income minus the standard work related, child care, and child support deductions as used in determining presumptive eligibility for Medicaid expansion as designated by the Omnibus Budget Reconciliation Act 1986.

(4)(7) “Verification” means to confirm the accuracy of information through sources other than the self declaratory statement of the individual originally supplying the information. Verification may be by telephone, in written form, or by face-to-face contact. Verification does not require written documentation to confirm an applicant’s statement. Examples of verification include:

(a) A statement from a state or federal agency which attests to the applicant’s financial status.

(b) A statement from the applicant’s or family member’s employer.

(c) Pay stubs for four consecutive weeks.

(d) A statement from a source providing unearned income to the applicant or family unit.

(8) renumbered (5) No change.

(9) “Health care provider or provider” includes: a full-time student enrolled in an accredited program that prepares the student to be a health care provider licensed under Chapter 458, 459, 460, 461, 464, or 467, F.S. The student must perform duties under the supervision and license of a health care provider who is contracted under the Volunteer Health Care Provider Program and is practicing in the student’s area of study.

(10) “Volunteer corporation” means a not for profit corporation, consisting of its employees and volunteers, established under the provisions of Chapter 617, F.S., for the purpose of providing volunteer health care under contract with a governmental contractor, and thereby qualifying its employees and volunteers for sovereign immunity pursuant to Section 766.1115, F.S.

Rulemaking Specific Authority 766.1115(11)(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.002, Amended 4-11-06, Formerly 64F-11.001, Amended                            .

 

64I-2.002 Client Eligibility.

(1) The governmental contractor or the provider will determine and approve client eligibility based on one of the following three eligibility groups:

(a) through (b) No change.

(c) Individuals who are clients of the department, that volunteer to participate in the program, and who meet the program income eligibility requirements when the appropriate health care is not available through the department.

(2) In order to be eligible, an individual shall not have medical or dental care insurance coverage for the illness, injury, or condition for which medical or dental care is sought.

(3) The governmental contractor will establish an eligibility limit not to exceed 200 percent of the poverty level.

(3)(4) The governmental contractor or provider is responsible for determining if applicants meet the eligibility criteria as established in the Department of Health Client/Patient Eligibility and Referral Process Training Guide, DH 1032G (12/14 02/06), as incorporated herein by reference and available at______, for participation in the Volunteer Health Care Provider Program. A copy of the Client Eligibility and Referral Process Training Guide can be obtained through the department’s Volunteer Health Services Program.

(4)(5) Applicants shall furnish to the governmental contractor or provider information regarding the gross family income for the family unit, child care expenses, and child support payments. The applicant’s self declaration of income and expenses is acceptable for eligibility determination, and shall be documented on the Volunteer Health Care Provider Program Financial Eligibility form, DH 1032E, (12/14 07/05), which is incorporated by reference and available at        . The governmental contractor or provider may verify income and expenses for the four week period prior to the date of application. Additional verification for the preceding 12 month period may be requested if the income for the four week period is not representative of the family income and the additional information is in the best interest of the applicant. A copy of the Financial Eligibility form can be obtained through the department’s Volunteer Health Services Program.

(5)(6) The governmental contractor or provider shall use net family income to determine eligibility.

(6) An applicant shall not be referred to a health care provider until the governmental contractor or provider determines the individual to be eligible and provides the applicant with a completed patient referral form. The Patient Referral Form, DH 1032, (12/14), is incorporated by reference and available at         .

Rulemaking Specific Authority 766.1115(11)(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.003, Amended 4-11-06, Formerly 64F-11.002, Amended                    .

 

64I-2.003 Patient Selection and Referral.

Rulemaking Specific Authority 766.1115(11)(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.004, Amended 4-11-06, Formerly 64F-11.003, Repealed             .

 

64I-2.004 Volunteer Provider Eligibility.

(1) In order to participate in this program, a health care provider shall comply with the following:

(a) Have a current valid Florida health professional license or authorization to practice or operate under Florida law Statutes or Florida Administrative Code.

(b) Sign the Volunteer Health Care Provider Programa contract, DH 1029 (12/14), with the governmental contractor. The contract is hereby incorporated by reference and available at                            .

(c) Not be under obligations, probation, or restrictions with the Department of Health or any Florida licensing authority. If obligations are assigned after the provider has participated in the program, then the governmental contractor will determine contract status of the provider.

(d) through (e) No change.

(f) Accept for treatment only patients that have been quailfied as eligible and who have a completed referral form, which is incorporated in Rule 64I-2.002(6).

(2) No change.

Rulemaking Specific Authority 766.1115(11)(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.005, Amended 4-11-06, Formerly 64F-11.004, Amended                            .

 

64I-2.005 Contract Requirements.

Rulemaking Specific Authority 766.1115(11)(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.006 Amended 4-11-06, Formerly 64F-11.005, Repealed                            .

 

64I-2.006 Covered Services.

Rulemaking Specific Authority 766.1115(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.007, Amended 4-11-06, Formerly 64F-11.006, Repealed                            .

 

64I-2.009 Annual Report.

(1) Each governmental contractor and provider, by August 31 of each year, shall submit to the Department of Health Director of the Volunteer Health Services Program information required to prepare the annual report to the Legislature as specified in Section 766.1115(8), F.S., including, but not limited to,

(2) The report period shall be July 1 to June 30.

(3) The governmental contractor shall include in the report participating clinics and organizations, the number of providers, the number of patients, the number of patient visits patient encounters, and the value of services and donations rendered from July 1 to June 30.

Rulemaking Specific Authority 766.1115(11)(10) FS. Law Implemented 766.1115 FS. History–New 1-20-93, Formerly 10D-122.012, Amended 4-11-06, Formerly 64F-11.009, Amended                  .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Duane A. Ashe, Administrator, Health Resources and Access Section

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: John H. Armstrong, MD, FACS, Surgeon General and Secretary

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 5, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 16, 2014