The Department proposes to amend the existing language in this chapter.

DEPARTMENT OF HEALTH
Division of Family Health Services

Rule No.: RULE TITLE
64F-9.001: Definitions
64F-9.002: Eligibility for ESP Services
64F-9.003: Individual Action Plan (IAP)
64F-9.004: Prevention Program Activities
64F-9.005: ESP Reporting Requirements
64F-9.006: ESP Antiepileptic Drug Program (ADP)
PURPOSE AND EFFECT: The Department proposes to amend the existing language in this chapter.
SUMMARY: Each rule was updated to recognize changes in definitions or terminology and modifying the eligibility and enrollment process.
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: 385.207(4) FS.
LAW IMPLEMENTED: 385.207 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Nikita Wiggins, 4052 Bald Cypress Way, Bin #A-18, Tallahassee, Florida 32399

THE FULL TEXT OF THE PROPOSED RULE IS:

(Substantial rewording of Rule 64F-9.001 follows. See Florida Administrative Code for present text):

64F-9.001 Epilepsy Services Program (ESP) – Definitions.

The following words and phrases shall have the following meanings for the purpose of this rule.

(1) “Antiepileptic Drug Program (ADP)” means a program administered by the Department of Health to promote and assist with the continued development and expansion of programs for required pharmaceuticals which will have a positive effect in the care and treatment of persons with epilepsy. Authority is given under Sections 385.207(2)(a), Florida Statutes. Eligibility for this program is subject to availability of funds. Eligible persons are able to receive up to a three month supply of his or her prescribed medication.

(2) “Direct client services” means providing case management, medical follow-up, coordinating laboratory and other testing services (EEG, MRI and CT Scan) as well as vocational assistance and psychological care as needed to epilepsy clients or ESP clients.

(3) “Epilepsy Services Program (ESP)” means a program that provides direct client services, prevention and education services according to Section 385.207, F.S., to improve access to health care services for Florida’s citizens living with epilepsy.

(4) “ESP Client” means a person who is both a resident of Florida and who either:

(a) Is suspected to have a seizure disorder or epilepsy and has applied for direct client services; or

(b) Has a confirmed diagnosis of epilepsy and is receiving direct client services.

(5) “Family” means one or more persons living in one dwelling place who are related by blood, marriage, law or conception. A pregnant woman and her unborn child or children are considered to be two or more family members. A single adult, over 18, living with relatives is considered to be a separate family for income eligibility determination purposes. If the dwelling place includes more than one family or more than one unrelated individual, the poverty guidelines are applied separately to each family or unrelated individual and not the dwelling place as a whole.

(6) “Gross Family Income” means the sum of gross income available to a family at the time of application. Gross family income shall be based on all gross income to be earned, unearned, received or anticipated to be earned or received in the current month. Gross family income does not include Supplemental Social Security Income (SSI) or any other received by the SSI eligible individual(s) and any income received by the minor sibling(s) of the eligible individual(s). Providers are permitted to request income for up to 12 months prior to the date of application if the income received in the current month is not representative of the family’s gross income due to seasonal employment and if it is to the client's benefit to do so. Income shall include the following:

(a) Wages, salary and self-employment income;

(b) Child support received;

(c) Alimony received;

(d) Unemployment compensation;

(e) Worker’s compensation;

(f) Veteran's pension;

(g) Social Security;

(h) Pensions or annuities;

(i) Dividends, interest on savings or bonds;

(j) Income from estates or trusts;

(k) Net rental income or royalties;

(l) Net income from self employment;

(m) Contributions; and

(n) TANF.

(7) “Net Income” means gross family income minus Federal Tax Withholdings, Social Security and Medicare deductions.

(8) “Plan of Care (POC)” is an individualized plan relating to the client’s needs, goals, and expected outcomes to the services and responsibilities of the provider A POC is created during the intake process and is updated as necessary. The POC is reviewed at least annually to assure the client is on target with the stated goals and objectives.

(9) “Provider” means an organization or individual providing services or commodities to ESP clients in accordance with the terms of a Department of Health contract.

(10) “Poverty Guidelines” The guidelines are a simplified version of the federal poverty threshold used for administrative purposes to establish income ranges of the sliding fee scale to determine financial eligibility for medical services. The guidelines are updated annually based on the increased in the Consumer Price Index as show in the Federal Registrar by the United States Department of Health and Human Services.

(11) “Sliding Fee Scale” means a scale of charges which are less than the full cost of the service that clients shall be charged for ESP services. The fee scale for these services shall progress in increments of the full cost of services for those clients between 100 and 200 percent of the most current poverty guidelines published by the United States Department of Health and Human Services.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.003, Amended________.

 

(Substantial rewording of Rule 64F-9.002 follows. See Florida Administrative Code for present text):

64F-9.002 Epilepsy Services Program (ESP) – Scope of Services Eligibility for ESP Services.

The ESP includes the following statewide programs:

(1) Direct Client Services: A program to improve access, provide care and assistance to persons with epilepsy through the delivery of a comprehensive range of services that will have a positive effect on the quality of life. Services include case management, medical service referrals, coordinating laboratory and other testing services such as EEG, CT Scan and MRI, vocational assistance and psychological care as needed.

(2) Prevention and Education: A program to reduce the stigma associated with epilepsy, increase knowledge and understanding of epilepsy. Services include awareness activities, educational seminars, and presentations to various groups to promote the early recognition, treatment, and prevention of epilepsy.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.006, Amended________.

 

(Substantial rewording of Rule 64F-9.003 follows. See Florida Administrative Code for present text):

64F-9.003 Epilepsy Services Program (ESP) – Direct Client Services Administration Individual Action Plan.

(1) Eligibility: Subject to the availability of funds, an individual is eligible for the ESP – Direct Client Services Program if:

(a) He or she is a Florida resident;

Proof of Florida residency can include any of the following:

1. Florida driver’s license or identification card;

2. Local utility bill (electric, gas, landline phone);

3. Voter registration card; or

4. Local school record (K-12) or registration certificate.

(b) Has or is suspected of having a seizure disorder or epilepsy. Diagnosis must be confirmed within 30 days of application for persons suspected of having a seizure disorder or epilepsy.; and

(c) He or she completes the following forms:

Application for services, DOH #----, 11/10.

Financial Worksheet, DOH #----, 11/10.

Both forms are incorporated by reference and are available by writing to: 4052 Bald Cypress Way, Bin #A-18, Tallahassee, Florida 32399 or at the following website: www.doh.state.fl.us/family/epilepsy/index.html.

(2) A client’s eligibility is determined annually.

(3) An individual shall be ineligible for the ESP program if he or she does not meet the aforementioned criteria in subsection 64F-9.003(1), F.A.C.

(4) Fee Assessment: Fees will only be assessed for direct client services excluding case management services. The fee shall be assessed using the total gross family income, the approved sliding fee schedule, and the financial worksheet. Providers must review proof of income for all adults in the family.

(a) All clients who are enrolled, or become enrolled, in Medicaid and all clients with a gross family income below 100 percent of the most current poverty guidelines published by United States Department of Health and Human Services and incorporated by reference and available at http://aspe.hhs.gov/poverty/ shall be eligible for medical services provided by the ESP at no charge.

(b) When the gross family income is between 100 and 200 percent of the poverty income guidelines the client will be responsible for payment of a portion of the provider's cost of the medical services provided based upon a sliding fee scale or schedule. The sliding scale will be applied as follows:

1. Persons with incomes at or below 100 percent of the poverty guidelines shall pay no fee.

2. Persons with incomes at 101 to 119 percent of the poverty guidelines shall pay 17 percent of the full fee.

3. Persons with incomes at 120 to 139 percent of the poverty guidelines shall pay 33 percent of the full fee.

4. Persons with incomes at 140 to 159 percent of the poverty guidelines shall pay 50 percent of the full fee.

5. Persons with incomes at 160 to 179 percent of the poverty guidelines shall pay 67 percent of the full fee.

6. Persons with incomes at 180 to 199 percent of the poverty guidelines shall pay 83 percent of the full fee.

(c) When the gross family income is at or above 200 percent of the federal poverty income guidelines the client will be responsible for 100 percent (%) of the provider's cost of services.

(5) Disenrollment: An ESP client may be disenrolled for any of the following reasons below:

(a) The ESP client does not have a confirmed diagnosis of having a seizure disorder or epilepsy within 30 days of application.

(b) The ESP client no longer meets one of the eligibility requirements in Rule 64F-9.003, F.A.C.

(c) The ESP client does not agree and/or comply with the developed POC.

(d) The ESP client does not pay fee(s) for medical service and is unwilling to agree to a payment plan.

(e) The ESP client does not provide or complete information as requested by the provider.

(f) The ESP client is repeatedly belligerent and displays confrontational behavior towards staff.

(g) The ESP client is no longer in need of services.

(h) The ESP client request closure of their case file.

(i) The ESP client has not received services in the past 12 months.

(j) Lack of funding.

(6) Prior to disenrollment, the ESP client will receive no less than 30 days notification, in writing, of the decision to disenroll. Applicants may re-apply 30 days after receipt of notice provided the reason for disenrollment has been resolved.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 402.33 FS. History–New 11-1-92, Amended 5-5-94, 4-29-96, Formerly 10D-117.004, Amended________.

 

(Substantial rewording of Rule 64F-9.004 follows. See Florida Administrative Code for present text):

64F-9.004 ESP – Prevention and Education Services Prevention Program Activities.

Epilepsy Services Program (ESP) will disseminate information statewide through education and awareness activities to promote the early recognition, treatment, prevention and reduce stigma associated with epilepsy. Persons with epilepsy and their families, professionals and the general public will receive education. There are no eligibility requirements for participation in prevention and education services.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.011, Amended________.

 

(Substantial rewording of Rule 64F-9.005 follows. See Florida Administrative Code for present text):

64F-9.005 ESP Reporting Requirements.

A provider shall submit properly completed quarterly reports outlining the number of clients served and outcomes reached, as well as the number of education presentations and awareness activities conducted. The reports will be compiled and delivered to the Department of Health within 15 days of the end of the quarter being reported. Failure to submit reports as required will result in invoices for payment being withheld until reports are submitted.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.011, Amended________.

 

(Substantial rewording of Rule 64F-9.006 follows. See Florida Administrative Code for present text):

64F-9.006 ESP Antiepileptic Drug Program (ADP).

(1) Eligibility is subject to the availability of funds. An individual is eligible for the ADP Program if:

(a) He or she is a bona-fide Florida Resident;

(b) He or she has a diagnosis of epilepsy;

(c) He or she completes an Epilepsy Medication Request, DOH#--- , 11/10. A copy may be obtained by writing: 4052 Bald Cypress Way, Bin A-18, Tallahassee, Florida 32399 or accessing www.state.fl.us/family/epilepsy/index.html;

(d) He or she provides a current prescription for epilepsy medications. The prescription may either be written on the Epilepsy Medication Request form or provided separately and attached to the form;

(e) He or she is uninsured or is lacking insurance that covers epilepsy medications;

(f) He or she has a gross family income at or below 100 percent (%) of the poverty guidelines. If the applicants dwelling place includes more than one family or more than one unrelated individual, the poverty guidelines shall be applied to each family or unrelated individual and not the dwelling place as a whole; and

(g) He or she has no more than $2,500 in private funds, bank accounts, or assets other than a homestead.

(2) Disenrollment: A client may be disenrolled if:

(a) The client appears to be Medicaid eligible, or in the case of a minor the parent or guardian, and the client has been advised by the County Health Department (CHD) that he or she has three months to pursue Medicaid eligibility;

(b) Services have been provided by the CHD during the three month processing period and

(c) At the end of the period, the client has not presented evidence to the CHD showing he or she has pursued Medicaid eligibility; or

(d) Lack of funding.

(3) If the CHD has not been shown evidence that the client has pursued Medicaid eligibility, the CHD has the authority to discontinue services at the end of the three month period except for those services available to clients without income limitations as specified in Rule 64F-16.008, F.A.C.

(4) If the CHD decides to reduce or withhold services due to limitations in resources, the CHD will give clients 30 days written notice prior to disenrollment.

Rulemaking Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Nikita Wiggins
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: State Surgeon General, Ana M. Viamonte Ros, M.D., M.P.H.
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 17, 2010
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: December 17, 2010