AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.310Targeted Case Management for Children at Risk of Abuse and Neglect
NOTICE 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. 39, No. 240, December 12, 2013 issue of the Florida Administrative Register.
The following changes have been made to the Florida Medicaid Targeted Case Management for Children at Risk of Abuse and Neglect Coverage and Limitations Handbook.
Page 1-3 Provider Agency Certification Criteria
This section will now read:
The CSC or LGE must ensure a provider agency:
- Is under contract to receive funding from the CSC or LGE for 100% of the cost of providing TCM to the target population.
- Is knowledgeable of and in compliance with state and federal statutes, rules, and policies that pertain to this service and the target population.
- Is able to administer case management services to the target population as evidenced by sufficient numbers of managerial staff and TCM supervisors and case managers for children at risk of abuse and neglect.
- Is a community-based provider agency with a demonstrated capability to serve this target population.
- Has the financial management capacity and system to provide documentation of costs.
- Has established linkages with the local network of human services providers, schools, and other resources in the service area.
- Has a quality improvement program with written policies and procedures, which include an active case management peer review process and ongoing recipient and family satisfaction surveys.
- Has established pre-service and in-service training programs that promote the knowledge, skills, and competency of all case managers.
- Has an established credentialing process that will assess and validate the qualifications of all case managers and supervisors of case managers.
- Has the capacity to provide supervision by a qualified practitioner.
- Maintains documentation and programmatic records that include clearly identified TCM for children at risk of abuse and neglect certifications for eligibility, assessments, service plans, and service documentation.
- Cooperates with and participates in monitoring conducted by AHCA and the CSC or LGE.
Page 1-3 Supervisor Certification
In the first sentence, the word management is changed to manager.
Page 1-4 Supervisor Certification Criteria
This section will now read:
A TCM supervisor:
- Is employed by or under contract with a provider agency that has been certified by a CSC or LGE as qualified to provide case management services to the target population.
- Has a minimum of one of the following:
– No change.
– No change.
– No change.
- Has completed all required training and any other training, including periodic retraining.
- Has completed the mandated reporter training that addresses abuse and neglect as outlined in section 39.201, F.S.
- Is enrolled, prior to providing supervision, as a Medicaid-approved case manager.
- Has knowledge of the resources, specific to the identified service area, that are available for children who have been or are at risk of being abused, neglected, or abandoned.
- Is knowledgeable of and in compliance with state and federal statutes, and rules and policies that pertain to this service and target population.
Page 1-5 Case Manager Certification Criteria
This section will now read:
A case manager:
- Is employed by or under contract with a provider agency that has been certified by the CSC or LGE as qualified to provide case management services to the target population.
- Has a minimum of high school diploma or GED with at least one year of experience working with children who have been or are at risk of being abused, neglected, or abandoned.
- Has successfully completed the required CSC-approved training and any other required training, including periodic retraining within required timeframes.
- Has completed the mandated reporter training that addresses abuse and neglect as outlined in Section 39.201, F.S.
- Has knowledge of the resources, specific to the identified service area, that are available for children who have been or are at risk of being abused, neglected, or abandoned.
- Is knowledgeable of and complying with state and federal statutes, and rules and policies that pertain to this service and target population.
- Is certified by the certified provider agency as meeting these requirements.
Page 1-5 Process
In the last paragraph, the word management is changed to manager.
Page 1-6 Supervisor
The word Supervision in the name of the form is changed to Supervisor.
Page 1-6 CSC or LGE
The fifth bullet now reads:
- Having developed policies and procedures to monitor agencies and ensure compliance with regulations, policies, and standards in this handbook.
Page 1-7, the first label will now read:
CSC or LGE, continued
The third and fourth bullets now read:
- Cooperating with and participating in monitoring conducted by AHCA.
- Reimbursing contracted provider agencies for the full cost of services and certifying these expenditures to Medicaid quarterly.
Page 1-7 Provider Agency
In the first bullet, the word management is changed to manager.
Page 1-8 Training
The first paragraph will now read:
Targeted case managers and case manager supervisors must participate in case management training approved by the CSC and LGE.
In the second paragraph, the word management is changed to manager.
Page 2-1 Medical Necessity
The fourth condition will now read:
4.Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide.
Page 2-2 Who Can Receive Services
A second sentence is added after the second bullet and reads:
The eligibility criteria are on the Child Certification, found in the appendices.
Page 2-2 Recipient Certification
The first sentence will now read:
The provider must complete the Child Certification, found in the appendices, within 30 days of a recipient’s initial receipt of a covered service.
Page 2-3 Who Must Provde
In the last paragraph, the word management is changed to manager.
Page 2-4 Supervision
In the first and second paragraphs, the word management is changed to manager.
Page 2-4 Timeframe for Development
The first paragraph will now read:
The assessment must be completed within 45 days from when the recipient receives a covered TCM service for children at risk of abuse and neglect.
Page 2-6 Requirements
The second bullet now reads:
- Be developed within 90 days from when the recipient receives a covered TCM service for children at risk of abuse and neglect.
Page 2-6 Frequency of Review
The first sentence will now read:
The service plan must be reviewed and revised no less frequently than every six months.
Page A-2 Procedure Codes and Fee Schedule
The Maximum Fee is changed to $407.60.
Page B-2 Contractor Certification for Children’s Services Council
Number four will now read:
(4)Agrees to enroll in Medicaid as a case management group provider, with contracted agencies’ case manager supervisors comprising the group membership.
Page C-2 Case Manager Supervisor Certification.
In the first line, the word management is changed to manager.
The last sentence in the first paragraph will now read:
This individual case manager supervisor:
The list is revised as follows:
(1)Is employed by or under contract with a provider agency that has been certified by a children’s services council or local government entity as qualified to provide supervision for case management services to the target population.
(2)Has a minimum of one of the following:
(a) through (c) No change.
(3)No change.
(4)Has completed mandated reporter training that addresses abuse and neglect.
(5)No change.
(6)Is knowledgeable of the resources, specific to the identified service area, that are available for children who are abused, neglected, or abandoned or are at risk for abuse, neglect, or abandonment.
(7)Is knowledgeable of and in compliance with the state and federal statutes, rules, and policies that pertain to this service and target population.
(8)Is hereby certified by the certified provider agency as meeting these requirements.
Page D-2 Case Manager Certification
The last sentence in the first paragraph will now read:
This individual case manager:
The list is revised as follows:
(1)Is employed by or under contract with a provider agency that has been certified by a children’s services council or local government entity as qualified to provide case management services to the target population.
(2)Has a minimum of a high school degree, or equivalent, with a minimum of one year of experience working with children who have been abused, neglected, or abandoned, or are at risk of abuse, neglect, or abandonment.
(3)No change.
(4)Has completed the mandated reporter training that addresses abuse and neglect.
(5)Is knowledgeable of the resources, specific to the identified service area, that are available for children who are abused, neglected, or abandoned or are at risk for abuse, neglect, or abandonment.
(6)Is knowledgeable of and in compliance with the state and federal statutes, rules, and policies that pertain to this service and target population.
(7)Is certified by the certified provider agency as meeting these requirements.
Page E-2 Child Certification
The last signature line will now read:
Case Manager Supervisor.
Page F-2 Provider Agency Certification for Children’s Services Council
The second paragraph and the numbered list will now read:
The agency provider:
(1)Is under contract to receive funding from the CSC or LGE for 100 percent of the cost of providing targeted case management services to the target population.
(2)Is knowledgeable of and in compliance with state and federal statutes, rules, and policies that pertain to this service and the target population.
(3)Is able to administer case management services to the target population as evidenced by sufficient numbers of managerial staff and targeted case manager supervisors and case managers for children at risk of abuse and neglect.
(4)Is a community-based provider agency with a demonstrated capability to serve this target population.
(5)Has the financial management capacity and system to provide documentation of costs.
(6)Has established linkages with the local network of human services providers, schools, and other resources in the service area.
(7)Has a quality improvement program with written policies and procedures, which include an active case management peer review process and ongoing recipient and family satisfaction surveys.
(8)Has established pre-service and in-service training programs that promote the knowledge, skills, and competency of all case managers.
(9)Has an established credentialing process that will assess and validate the qualifications of all case managers and supervisors of case managers.
(10)Has the capacity to provide supervision by a qualified practitioner.
(11)Maintains documentation and programmatic records that include clearly identified targeted case management for children at risk of abuse and neglect certifications for eligibility, assessments, service plans and service documentation.
(12)Cooperates with and participates in monitoring conducted by the Agency for Health Care Administration or its designee and the CSC or LGE.
