To create a sliding fee scale for families of children with chronic and serious conditions who do not qualify for Medicaid or Title XXI of the Social Security Act and to implement Chapter 2012-184, L.O.F.

 

DEPARTMENT OF HEALTH
Division of Children’s Medical Services

RULE NO.:RULE TITLE:
64C-2.004Sliding Fee Scale
PURPOSE AND EFFECT: To create a sliding fee scale for families of children with chronic and serious conditions who do not qualify for Medicaid or Title XXI of the Social Security Act and to implement Chapter 2012-184, L.O.F.
SUMMARY: The rule provides guidance for a sliding fee scale that will be used to determine the amount that families shall contribute to participate financially in the cost of care.
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: the cost to implement this rule will be born solely by the CMS area offices and the tasks associated with implementing this rule represent a very limited staff effort beyond current duties. 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: 391.026(18) FS.
LAW IMPLEMENTED: 391.029(3)(a) 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: Rae Hendlin, Children’s Medical Services, Chief of Network Administration, 4052 Bald Cypress Way, Bin #A06, Tallahassee, Florida 32399-1707 or at [e-mail] or [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

64C-2.004              Sliding Fee Scale.

(1) Subject to funding, Children’s Medical Services (CMS) may pay for certain medical services to children with serious health care needs who do not qualify for Medicaid or Title XXI of the Social Security Act.

(2) Semi-annually, families must participate in the cost of care based on the following sliding fee scale:

(a) Families at or under 200 percent of the Federal Poverty Level (FPL) Guidelines pay $0 towards the cost of care;

(b) Families between 201 and 250 percent of the Federal Poverty Level (FPL) Guidelines pay $25 towards the cost of care;

(c) Families between 251 and 300 percent of the Federal Poverty Level (FPL) Guidelines pay $50 towards the cost of care;

(d) Families between 301 and 400 percent of the Federal Poverty Level (FPL) Guidelines pay $150 towards the cost of care;

(e) Families between 401 and 450 percent of the Federal Poverty Level (FPL) Guidelines pay $200 towards the cost of care; and

(f) Families at or over 451 percent of the Federal Poverty Level (FPL) Guidelines pay $250 towards the cost of care.

(3) CMS will calculate the family’s percentage for (2) based on the annual taxable family income and family size.  For purposes of this calculation, CMS will utilize the 2013 Federal Poverty Guidelines for the 48 Contiguous States and the District of Columbia, effective January 24, 2013,  which is hereby incorporated by reference, and may be obtained at: http://aspe.hhs.gov/poverty/13poverty.shtlm or can be found at ___________.

(4) Prior to receiving services covered through CMS, the family must produce documentation that the family has spent the amount indicated above in subsection (2), the sliding fee, towards the cost of care.

(a) The family may submit proof of the amount spent by submitting a receipt, canceled check, credit card statement, provider invoice, or similar documentation, documenting payment has been received. 

(b) Proof of expenditure will only be accepted for any primary care or specialized services that are medically necessary or essential family support services for the enrolled child.

(c) Proof of expenditure of the amount above in subsection (2), the sliding fee, must be submitted every six months to CMS.

Rulemaking Authority 391.026(18) FS. Law Implemented 391.029(3)(a) FS. History-New.

NAME OF PERSON ORIGINATING PROPOSED RULE: Mary Beth Vickers, Division Director, Children’s Medical Services

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 31, 2013
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 20, 2012