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 the Joint Administrative Procedures Committee and during the public hearing process.
59G-13.080(9). The subsection used both commas and semicolons to separate the names of the authorized Home and Community-Based Waiver programs. We replaced the commas separating the names of the waivers with semicolons. The subsection now reads, “(9) Home and Community-Based Services Waiver Programs. The following are authorized HCB services waivers: Adult Cystic Fibrosis Waiver; Adult Day Health Waiver; Aged and Disabled Adult Waiver; Alzheimer’s Disease Waiver; Assisted Living for the Elderly Waiver; Channeling Waiver; Consumer-Directed Care Waiver; Developmental Disabilities Waiver; Family Supported Living Waiver; Familial Dysautonomia Waiver; Model Waiver; Project AIDS Care Waiver; and Traumatic Brain Injury and Spinal Cord Injury Waiver.”
59G-13.080(10)(b). We revised the first sentence to read, “The Agency contracts with the organized health care delivery system for the provision of these services to enrolled recipients.” The following revisions were made to the list of services: 7. We deleted “Homemaker and” so the service reads, “Personal Care Services”; 8. We deleted “Housekeeping/” so the service reads, “Chore Services”; we added, “9. In Home Counseling”; we renumbered 9 through 17 to 10 through 18; and we added, “19. Special Medical Equipment and 20. Special Medical Supplies”; and we renumbered 18. and 19. to 21. and 22.
59G-13.080(10)(c). In the second sentence, we corrected the rule citations to read, “59G-4.290 and 59G-4.180.”
59G-13.080(10)(d). Provider enrollment is no longer accomplished through the contract procurement process as set forth in Chapter 287, F.S., and Chapter 13A-1, F.A.C. (transferred to Chapter 60A-1.045). We revised the sentence to read, “Provider enrollment is coordinated by the Channeling provider.”
59G-13.080(10)(e). In the first sentence, we deleted “with a year-end cost settlement.” In the third sentence, we changed “agreement” to “contract.” We deleted the last sentence, which read, “The final amount paid shall not exceed the amount that would have been paid, on an aggregate basis, by Medicaid under fee-for-service for institutional care provided to a demographically similar population of recipients.”
59G-13.080(11)(c)2. We corrected the abbreviation for the Children’s Multidisciplinary Assessment Team to CMAT.
Rule 59G-13.083 incorporates by reference the Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, July 2007. The following revisions were made to the handbook.
On page 1-3, Direct Provider Billing, third paragraph; page 1-10, Purpose of This Handbook, second paragraph; page 1-15, Provider Responsibility Regarding HIPAA Requirements, second note, last sentence; page 2-9, Claim Form, second sentence; and page 3-2, Billing Procedures, first paragraph, last sentence, and the fourth paragraph, second sentence, we changed the date that the Non-Institutional 081 claim form will be replaced by the CMS-1500 claim form from March 1, 2008 to July 1, 2008.
Page 1-39, Projected Service Outcomes. We deleted the third bullet, which read, “Recipients in supported living live in homes occupied by no more than two other recipients with developmental disabilities and in areas in which persons with disabilities account for no more than 10 percent of the houses or 10 percent of the units in an apartment complex, unless otherwise waived by APD.”
Page 2-9, Cost Plan. Under examples of a significant change, we added “or” after the semicolon at the end of the second sentence.
Page 2-24, Behavioral Assistant Services, Description. In the first paragraph, last sentence, we corrected the rule citation to read, “65G-4.009.”
Page 2-52, Personal Care Assistance, Description. We added the following sentence at the end of the paragraph, “Personal care assistance may not be used as a substitute for a meaningful day activity.” Under Limitations, in the third sentence, we deleted, “up to 300 hours a month or 1200 quarter hour units a month, if they have intensive physical, medical or adaptive needs and such hours are essential for avoiding institutionalization.” We revised the sentence to read, “A recipient having intensive physical, medical, or adaptive needs meeting the requirements for the intense level of personal care assistance, who needs additional hours over 180 to maintain their health and medical status, may request additional hours of personal care assistance services.”
Page 2-53, Personal Care Assistance, Limitations, continued. In the first paragraph, after the second sentence, we added, “Standard and moderate level needs for the service cannot exceed 180 hours or 720 quarter hour units of the service per month.” In the second bullet, we changed the third sentence from, “Additional hours a month, not to exceed 300 hours or 1200 quarter hour units of the service per month may be requested for intensive physical, medical or adaptive needs when the hours are essential to avoiding institutionalization,” to read, “Additional hours a month over the 180 hour limit may be requested for intensive physical, medical or adaptive needs when the hours are essential to maintain the recipient’s health and medical status.” We added a fourth sentence to read, “Additional hours a month over the 180 hour limit may be requested for intensive physical, medical or adaptive needs when the hours are essential to maintain the recipient’s health and medical status. 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.”
Page 2-57, Physical Therapy, Limitations, and page 2-87, Speech Therapy, Documentation Requirements. In the last sentence of the Note, we corrected the rule citation in which the Florida Medicaid Therapy Services Coverage and Limitations Handbook is incorporated by reference to read, “59G-4.320.”
Page 2-65, Minimum Staffing Requirements for Standard and Behavior Focus Residential Habilitation Services Provided in a Licensed Facility. In the first sentence, after “providers of”, we added, “standard and behavior focus.” After the second sentence, we added, “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.”
In the second paragraph, we revised the Direct Care Staff Hours per Person per 24 Hour Day to read, “Basic Level = 2 hours per day or 14 hours per week; Minimal Level = 5 hours per day or 35 hours per week; Moderate Level = 8 hours per day or 56 hours per week; Extensive 1 Level = 10 hours per day or 70 hours per week; Extensive 2 Level = 14 hours per day or 98 hours per week.”
In the third paragraph, we added a fourth sentence that reads, “The number of all available staff hours is multiplied by seven to establish a weekly minimum total.”
In the fourth paragraph, we revised the first sentence to read, “6 recipients X 8 direct care staff hours per person per 24 hour day = 48 available direct care staff hours per day, or 336 available direct care staff hours per week.”
We moved the last paragraph to page 2-66.
Page 2-66, Minimum Staffing Requirements for Standard and Behavior Focus Residential Habilitation Services Provided in a Licensed Facility, continued. We added to the end of last sentence, “and to optimize coverage on the weekends and holidays.”
Page 2-107, Supported Living Coaching, Description. In the first paragraph, second sentence, after “These services,” we added, “are provided by qualified supported living coaches to a recipient residing in a living setting meeting the requirements set forth in Rule 65G-5.004, F.A.C., and.” In the last paragraph, after Core Assurance, we added, “Chapter 59G-5, F.A.C.”
Page 1-108, Supported Living Coaching, Limitations. In the fourth paragraph, we revised the second sentence to read, “The homes of recipients receiving supported living coaching services shall meet requirements set forth in Rule 65G-5.004, F.A.C.” We deleted, “account for no more than ten percent of the housing in the smallest identifiable geographical area in which the homes are located, which may be a city block, subdivision, neighborhood, apartment complex or mobile home park. The recipient’s home shall be scattered, noncontiguous, and dispersed throughout that area. Waiver requests, regarding the density requirements can be submitted in writing to APD.” In the fifth paragraph, second sentence, we added, “However,” before “recipients.”
Page 3-1, Procedure Codes. In the first paragraph, we deleted, “The codes are part of the standard code set described in the Physician’s Current Procedure Terminology (CPT) book. Please refer to the CPT book for complete descriptions of the standard codes. CPT codes and descriptions are copyrighted 2007 by the American Medical Association. All rights reserved.” This information is also in the second paragraph, where it is applicable. It had been erroneously repeated in the first paragraph.
