AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO: RULE TITLE
59G-13.080: Home and Community-Based Services Waivers
59G-13.083: Developmental Disabilities Waiver ServicesNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 34, No. 6, February 8, 2008 issue of the Florida Administrative Weekly.
These changes are in response to comments received from and during the public hearing process.
Subsection 59G-13.080(3). In the first sentence, we updated the reference to “Health Care Financing Administration” to its current title, “Centers for Medicare and Medicaid Services.” The sentence now reads, “Home and Community-Based (HCB) Waiver Services are those Medicaid services approved by the Centers for Medicare and Medicaid Services under the authority of Section 1915(c) of the Social Security Act.”
Subsection 59G-13.080(15). We renumbered the subsection from (15) to (12) and undeleted the rule text. We added information on where the handbooks can be obtained to the last sentence. The subsection now reads, “(12) Assistive Care Services and Assisted Living for the Elderly Waiver. All Assistive Care Services and Assisted Living for the Elderly Waiver providers must comply with the provisions of the Florida Medicaid Assistive Care Services and Assisted Living for the Elderly Waiver Coverage and Limitations Handbook, July 2001, which is incorporated by reference and available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-Florida.com. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies are available by calling the Provider Contact Center at (800)289-7799 and selecting Option 7.”
Subsection 59G-13.083(2). In the first sentence, we corrected the reference to the reimbursement handbook from the Florida Medicaid Provider Reimbursement Handbook, Non-Institutional 081, incorporated by reference in Rule 59G-13.001, F.A.C., to the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, incorporated by reference in Rule 59G-4.001, F.A.C. We updated the website and phone number where the handbooks can be obtained. The rule text now reads, “All developmental disabilities waiver services providers enrolled in the Medicaid program must be in compliance with the Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, July 2007, incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated by reference in Rule 59G-4.001, F.A.C. Both handbooks are available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Provider Contact Center at (800)289-7799 and selecting Option 7.”
Rule 59G-13.083, F.A.C., incorporates by reference the Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, July 2007. The following revisions were made to the handbook.
Page 2-53, Personal Care Assistance, Limitations, second bullet. We have replaced, “Services will not be provided during routine sleep hours unless there is documentation from the recipient’s physician that night-time services are required and the duties to be performed by the PCA provider are clearly delineated.” Replaced with, “Any recipient who requires PCA services between 10:00 p.m. and 6:00 a.m. shall provide documentation from a physician stating that PCA services are medically necessary during this time. The support plan shall also explain the duties that a PCA provider will perform between the hours of 10:00 p.m. and 6:00 a.m.”
Page 2-65, Residential Habilitation Services, Minimum Staffing Requirements for Standard and Behavior Focus Residential Habilitation Services Provided in a Licensed Facility, table of hours. We have revised the table of hours and calculation explanation, to read,
“Providers of standard and behavior focus residential habilitation services shall provide a minimum level of staffing consistent with the minimum Direct Care Level of Staffing Hours per Person per 24 Hour Day or Hours per Week as identified in the table below. Staffing ratios shall be established by the provider using the available total minimum Direct Care Staff Hours per Person per 24 Hour Day hours consistent with the support and training needs of recipients receiving residential habilitation services for functional, behavioral or physical needs. The provider will meet the minimum staffing levels on a per day basis for each home, or shall provide the required staffing over a seven day period for each home to accommodate for absences from the home and to establish optimal coverage on weekends. Providers of residential habilitation services and their employees shall provide sufficient staffing and staff ratios while delivering these services to meet individual needs and provide appropriate levels of training and supervision for recipients of the service consistent with the table shown below:
Direct Care Staff Hours per Person per 24 Hour Day or 7 day week:
Level of DisabilityLevel of Direct Care Staffing
_______________Hours per 24 hour DayHours per Week
Basic Level214
Minimal428
Moderate Level642
Extensive 1 Level856
Extensive 2 Level1177
Hours counted must be provided by direct care staff or by other staff, who are providing direct care or direct time spent on client training, intervention or supervision. Provider compliance with direct care staffing levels for residential habilitation services substantiates Medicaid billing requirements only; other provisions of this Handbook remain fully applicable to all providers.
Calculating Available Minimum Direct Care Staff Hours per Person per 24 Hour Day or 7 day Week for the provision of Standard and Behavior Focus Residential Habilitation Services:
To determine minimum required staffing for each level of support for residential habilitation services, the minimum direct care staff hours per person per 24 hour day authorized for recipients receiving residential habilitation services are multiplied by the number of recipients receiving the service at that level in the home setting. All available staff hours per level are totaled to obtain a daily minimum total number of staff hours. The resulting total is then divided by 8 hours of staff work time to produce an FTE level per day. The number of all available staff hours is multiplied by seven to establish a weekly minimum total. For example: The calculation below is for six recipients receiving the service and living in the same home, all authorized at the Moderate Level of Supports. The minimum number of direct care staff hours per person per 24 hour day for the moderate level is 6 hours. The calculation is as follows:
6 recipients X 6 direct care staff hours per person per 24 hour day = 36 available direct care staff hours per day, or 252 available direct care staff hours per week. 36 direct care staff hours per day divided by an 8 hour staff working day = 4.5 Full Time Equivalents (FTEs) per day for minimum residential habilitation direct care staffing purposes.
Minimum staffing requirements for Intensive Behavioral Residential Habilitation services shall be determined at the time the rate for the service is established. Minimum staffing for Live-In Residential Habilitation services is determined by the rate ratio authorized for the home.
Example of the application of 4.5 staff FTEs at the Moderate Level as calculated above: The 4.5 FTEs generated using the calculation above may be used to establish an average staffing pattern for standard or behavior focus residential habilitation providers and their employees of 1.5 staff per 8 hour shift over a 24 hour period. If recipients are engaged in the receipt of other services during a period of time during the day, the residential habilitation provider may modify the staffing pattern to maximize staff during the time that recipients are in the home and receiving the service, and to optimize coverage on the weekends and holidays.”
