Definitions, Rules for Termination, Reduction, or Suspension of Services by the Provider, Discrimination and Retaliatory Conduct
DEPARTMENT OF CHILDREN AND FAMILIES
Agency for Persons with Disabilities
RULE NOS.:RULE TITLES:
65G-3.001Definitions
65G-3.005Rules for Termination, Reduction, or Suspension of Services by the Provider
65G-3.006Discrimination and Retaliatory Conduct
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. 45 No. 42, March 1, 2019 issue of the Florida Administrative Register.
65G-3.001 Definitions.
(1) through (2) No change.
(3) “Fading”is the planned reduction in a client’s level of service over a specified period of time, which is determined by the client’s identified progress and needs identified based on medical necessity. This planned reduction must be documented in the client’s records which may include but is not limited to the client’s plans of care, support plan, cost plan, provider documentation, or Agency determinations.
(4)(3) “Individual Representative” is defined in Rule 65G-4.0213(13), F.A.C.
(5)(4) “Provider” means any individual, program, or facility that receives payment for the care, treatment, training, residence or habilitation of persons with developmental disabilities. A provider does not include:
(a) A spouse, family member or guardian with whom a person with developmental disabilities resides;
(b) A provider covered under the provisions of Part VIII of Chapter 400, F.S.; or
(c) Individuals or entities providing services to clients through the Consumer Directed Care Plus CDC+ program pursuant to ss. 393.066, and 409.221, F.S., and the rules of the Agency.
(6)(5) “Reduction” means a decrease in the frequency, duration or intensity in the level of services, initiated by a non-residential provider that is not a result of faded or prescribed reductions that are part of service planning.
(7)(6) “Retaliatory Conduct” means negative action against a client or client’s individual representative motivated by the desire to punish the client or the client’s individual representative.
(8)(7) “Suspension” means an involuntary and temporary break in services in a non-residential program initiated by the provider. Suspension does not mean a break of services to a client by a service provider due to the unavailability of funds to the provider by the Agency.
(9)(8) “Termination” means the involuntary, permanent discharge or discontinuation of services in a program by the provider when such action is not included as part of the service planning process. Termination does not mean a discontinuation of services to a client by a service provider due to the unavailability of funds to the provider by the Agency.
(10)(9) “Regional Office” means the Agency local office responsible for managing a specific geographical region.
Rulemaking Authority 393.501(1), 393.125(2) F.S. Law Implemented 393.0651, 393.067, 393.125(2) F.S. History–New 12-10-91, Amended ____________, Formerly 10F-8.026, 65B-8.026.
65G-3.005 Rules for Termination, Reduction, or Suspension of Services by the Provider.
(1) TERMINATIONS AND REDUCTIONS
(a) through (e) No change.
(f) If the client or the client’s individual representative selects an individual or entity to render the services who is not qualified to be that client’s provider, the Regional Office shall issue a notice to deny the client’s selection of provider choice within 30 calendar days of the client’s notification to the Regional Office. The notice shall identify:
1. Any alternate providers or service options for the client that the Agency has determined are readily available;
2. The reason the Agency is denying the client’s selection of provider choice;
3. The specific statute or rule regulation supporting the denial; and
4. An explanation of the client’s administrative hearing rights pursuant to ss. 393.125, 120.569, and 120.57, F.S.
(2) SUSPENSIONS
(a) Emergency Suspension: A service provider may immediately suspend services provided to a client in a non-residential program when the behavior of the client constitutes an immediate danger to health, safety, or welfare of the client, another recipient of the provider’s services, the provider, or a third party. If a service provider immediately suspends a client’s services for this reason, the provider shall give written notice of immediate suspension to the client, the client’s individual representative, the client’s Support Coordinator, and Regional Office at the time of the suspension or immediately thereafter, detailing reasons for the suspension.
(b) Other Suspension: A service provider may immediately suspend services provided to a client in a non-residential program when the client’s behavior interferes with services provided to other recipients of the provider’s services. If a service provider initiates a suspension for this reason, the service provider shall provide written notice of immediate suspension from a non-residential program to the client, the client’s individual representative, the client’s Support Coordinator, and the Regional Office at the time of the suspension or immeiately thereafter, detailing reasons for the suspension.
1. This type of suspension shall not exceed 3 service days.
2. If the client is not on the iBudget Waiver pursuant to s. 393.0662, F.S., notification is only required to be given by the provider to the Regional Office, the client and the client’s individual’s representative.
(c) The Support Coordinator shall ensure that appropriate service coverage is available during the time of suspension and update the support plan, cost plan, and relevant service authorizations accordingly. The Support Coordinator shall contact the Regional office the day the Support Coordinator receives notice of the suspension immediately if assistance is needed in securing alternate services or providers. The Regional Office will assist the client and the client’s individual representative in meeting the client’s needs.
(3) This rule does not apply to fading or other reduction of care set forth in the client’s plan of care.
Rulemaking Authority 393.501(1),393.125(2) F.S. Law Implemented 393.125(2) F.S. History–New 12-10-91, Amended 5-19-93, ______________, Formerly 10F-8.031, 65B-8.031.
65G-3.006 Discrimination and Retaliatory Conduct.
(1) no change.
(2) In cases where the Agency has determined the provider has engaged in retaliatory conduct, illegal discriminatory conduct, or withheld factual information is withheld by the service provider, as described within this section, is determined by the Agency, the Agency, at its discretion, may initiate action against the service provider’s license, pursuant to Chapter 65G-2, F.A.C., or any contract with the Agency, including the or Medicaid Waiver Services Agreement, in accordance with the provisions of applicable state law and administrative rules.
Rulemaking Authority 393.501(1), 393.125(2) F.S. Law Implemented 393.125(2) F.S. History–New 12-10-91, Amended 5-19-93, _____________, Formerly 10F-8.033, 65B-8.033
