Aged and Disabled Adult Waiver Services, Aged and Disabled Adult Waiver Services Procedure Codes and Fee Schedule

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-13.030: Aged and Disabled Adult Waiver Services
59G-13.031: Aged and Disabled Adult Waiver Services Procedure Codes and Fee Schedule

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. 36 No. 2, January 15, 2010 issue of the Florida Administrative Weekly.

The following revisions were made to the Notice of Proposed Rule text.

59G-13.030 Aged and Disabled Adult Waiver Services.

(1) through (3) No change.

(a) Appendix A contains the Adult Services Client Assessment, CF-AA 3019, PDF 10/2005, eight pages. DOEA Assessment Instrument, DOEA Form 701B, September 2008 and DCF Assessment Instrument, CF-AA Form 3019, PDF 10/2005. The latter form is available at the Department of Children and Families website at http://www.dcf.state.fl.us/DCFForms/Search/DCFFormSearch.aspx.

(b) Appendix B contains the Medical Certification for Nursing Facility/Home and Community Based Services Form, AHCA-MedServ Form 3008, May 2009.

(c) Appendix C contains Informed Consent Form AHCA-Med-Serv Form 2040, May 2009.

(d)(b) Appendix D contains the Notification of Level of Care, DOEA-CARES form Form 603 (Revised March 2003), one page. The form is mailed to the provider by the Department of Elder Affairs, CARES Unit.

(e)(c) Appendix E contains the Aged and Disabled Adult Services Waiver Agreement of Expectations, AHCA-Med Serv Form 033, May 2009, two pages. The form is available by photocopying it from the handbook.

(f) Appendix F contains Hospice Forms: Notice of Hospice Election Waiver, AHCA Form 5000-29, October 2003; Cooperative Agreement for a Hospice and Medicaid Waiver Enrolled Recipient, AHCA Form 5000-30, October 2003; Attachment to Cooperative Agreement for a Hospice and Medicaid Waiver Enrolled Recipients, AHCA Form 5000-30A, October 2003.

(g)(d) Appendix G contains the Request for Approval of Care Plan Services Increase, CF-AA 1116, PDF 05/2004, two pages. The form is available from the Department of Children and Families website at http://www.dcf.state.fl.us/DCFForms/Search/DCFFormSearch.aspx.

(h)(e) Appendix H contains the Aged/Disabled Adult Waiver Aging Out Plan of Care, AHCA-Med Serv Form 047, May 2009, five pages. The form is available by photocopying it from the handbook.

Rulemaking Authority 409.919 FS. Law Implemented 409.906, 409.907, 409.908, 409.912 FS. History–New 6-1-05, Amended 4-17-06,_________.

 

The purpose of the amendment to Rule 59G-13.030, F.A.C., is to incorporate by reference the revised Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook, May 2009. The following revisions have been made to the handbook.

Page 1-4 AAAs and Medicaid Waiver Specialists. Fifth paragraph is changed to read as follows: “The AAAs shall follow policies and procedures regarding recipient enrollment into the A/DA Waiver Program and “wait list” policies and procedures for those individuals on the “wait list.” The “wait list” shall be available for review by AHCA; DCF, Adult Protective Services; and DOEA.”

Page 1-5 DCF’s Spending Authority. First paragraph is changed to read as follows: “DCF’s Adult Protective Services Headquarters Program Office manages the budgetary authority for disabled adults ages 18 to 59 served by the A/DA waiver.”

Page 1-6

Case Management Agency Requirements.

First paragraph is changed to read as follows: “To provide A/DA waiver case management services, the entity must have one of the following unless case management is provided by DCF staff:”

Second bullet is changed to read as follows: “A referral agreement and contract with the Department of Children and Families (DCF).”

After “General Case Management Provider Qualifications” Insert: “Transition Case Management. Transition Case Management services can be provided to Medicaid eligible individuals who reside in a nursing facility and wish to transition into a less restrictive environment within the community. This service can be used to assess, evaluate, plan, and coordinate the services needed by a potential nursing home transition candidate. Transition case management services can be provided to Medicaid eligible individuals who have resided in a nursing facility for at least 60 consecutive days before their discharge from the nursing facility. The enrolled case management provider may bill for a time period no greater than 180 consecutive days (6 months) prior to discharge, and is not authorized to bill for transition case management services provided until after the individual is discharged from the nursing facility and is actively enrolled in the waiver. After discharge from the nursing facility and enrollment in the waiver, transition case management services end and regular waiver case management services can begin. If an individual is not discharged from the nursing facility, the case management provider will not be authorized to bill for transition case management services.

The provider qualifications and the reimbursement rate for Transition Case Management will remain the same as currently provided by case management services under the waiver.”

Page 1-8

Adult Companion Providers.

Fifth bullet is changed to read as follows: “A home health agency licensed under Chapter 400, Part III, F.S.”

Sixth bullet is changed to read as follows: “A home health agency licensed under Chapter 400, Part III, F.S. that meets federal conditions of Medicare participation under 42 CFR 484;”

Page 1-9

Case Aide Providers.

First paragraph is changed to read as follows: “To provide A/DA waiver case aide services, providers must have one of the following unless case aides are provided by DCF staff:”

Second bullet is changed to read as follows: “A referral agreement and contract with the Department of Children and Families (DCF).”

Page 1-10 Consumable Medical Supply providers. Fifth bullet is changed to read as follows: “HME providers licensed in accordance with Chapter 400, Part VII, F.S., if the HME provider supplies products that require recipient training and enrolled as a Medicaid Durable Medical Equipment provider.”

Page 1-14 Specialized Medical Equipment and Supply Providers. Fifth bullet is changed to read as follows: “HME providers with an occupational license issued in accordance with Chapter 205, F.S. and have an HME license issued in accordance with Chapter 400, Part VII, F.S., if the HME provides supplies requiring recipient training. Enrolled as a Medicaid Durable Medical Equipment provider.”

Page 1-17 Referral Agreement. Paragraph is changed to read as follows: “Every A/DA waiver service provider must maintain a current executed referral agreement or memorandum of agreement with the AAA or case management agency. The Department of Children & Families’ Adult Protective Services offices maintain referral agreements or memorandum of agreement with the A/DA waiver service providers. The executed referral agreement or memorandum of agreement must be on file with the AAA or case management agency before any A/DA waiver service is provided. Failure to comply with this A/DA waiver provider responsibility can result in AHCA recouping any payments made for services provided prior to the executed referral agreement or memorandum of agreement being placed on file.”

Page 2-5

Request for Level of Care. Second paragraph is changed to read as follows: “Note: See Appendix B in this handbook for a copy of the Medical Certification for Nursing Facility/Home and Community Based Services Form (MCNF/HCBS), AHCA-Med Serv Form 3008.The form is available on the DOEA website at http://elderaffairs.state.fl.us/english/cares.php.”

Informed Consent Form. Second paragraph is changed to read as follows: “Note: See Appendix C for a copy of the Informed Consent Form, AHCA Med-Serv Form 2040 in English and Spanish. The form is available on the DOEA website at http://elderaffairs.state.fl.us/english/cares.php.”

Page 2-7 Recipient Enrollment into the Waiver. Last paragraph is changed to read as follows: “Enrollment into the waiver for individuals 18 to 59 years old is determined by the Florida Department of Children and Families, Adult Protective Services Programs’ Region Offices. A listing of the District Offices and the telephone numbers are available on this website: http://www.dcf.state.fl.us/as/”

Page 2-8 A/DA Waiting List. Last paragraph is changed to read as follows: “The A/DA waiting list for the 18 to 59 year old disabled adult population of the waiver is maintained at the Florida Department of Children and Families, Adult Protective Services Program Office.”

Page 2-10 Choice of Case Manager. Paragraph is changed to read as follows: “Recipients have a right to select the case management provider or case manager of their choice. In the absence of a selection by the recipient or authorized representative, the case management agency may assign a case manager. The recipient or authorized representative may make a different selection at a later date after the initial selection.”

Page 2-11 Case Manager Responsibilities. Eighth bullet is changed to read as follows: “Review and update the plan of care every three (3) months to ensure the appropriate services are provided at the level needed by the recipient;”

Page 2-13 Covered Services. Ninth bullet is changed to read as follows: “The three (3) month and twelve (12) month reviews and updates to the recipient’s plan of care;”

Page 2-15 Case Narrative Requirements. Following fifth paragraph, insert new paragraph as follows: “For monthly telephone contact, the narrative must reflect the case manager’s monitoring of client changes and the receipt and satisfaction with services;”

Page 2-17. Plan of Care Document. Paragraph is changed to read as follows: “The plan of care document must contain the following elements: 1) Client name and Medicaid identification number; 2) Case management agency name and Medicaid provider identification number; 3) Client’s assessed service needs; 4) Types, units, frequency and duration of planned waiver and non-waiver services; 5) The provider and associated costs of each planned service; 6) Initiation, revision and termination dates of the care plan; 7) An acknowledgement that the client or client’s representative is involved in the development of the care; and 8) Client or representative and case manager signatures and date of signatures.”

Page 2-20

Plan of Care Implementation and Review. The fourth bullet is changed to read as follows: “Reviewing the plan of care with the recipient or caregiver face-to-face every three (3) months to determine if the recipient’s needs continue to be met. The plan of care may need to be reviewed more frequently depending on changes in the recipient’s condition or living situation. The necessity for reviews conducted more frequently than the three-month review must be justified in the narrative.”

Increasing and Decreasing Service Authorizations. Last paragraph is changed to read as follows: “For changes or increases in services for the disabled adult population of the waiver to be effective the case manager must submit a completed Request for Service Increase Form, CF-AA 1116, pdf. May 2004, for processing through the DCF, Adult Protective Services Region Program Office.”

Page 2-21 Annual Assessment. First paragraph is changed to read as follows: “A/DA waiver recipients must receive a complete assessment at least annually. If changes in the recipient’s condition warrant a complete update assessment, an assessment should be done based on circumstances and need.”

Page 2-22

Termination of Enrollment. Eighth bullet is changed to read as follows: “The recipient no longer meets the defined level of care criteria for Intermediate I or Intermediate II as stated in Rule 59G-4.180, F.A.C.; or”

Case Manager Responsibilities Regarding Termination. Second bullet is changed to read as follows: “Notify the DCF Region Office;”

Page 2-27 Service Limitations. Following second bullet, insert new bullet as follows: “Adult companions may not drive the recipient in their car or the recipient’s car but may accompany the recipient on public transportation, by taxi, or on Medicaid transportation.”

Page 2-28 Service Limitations. Fourth bullet is changed to read as follows: “Authorization of ten hours per day requires extensive written justification.”

Page 2-34 Incontinence Supplies. Last paragraph is removed from the text as follows: “Note: See the Adult and Disabled Waiver Disposable Incontinence Medical Supplies Fee Schedule and Quality Standards for Briefs and Diapers available on 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 Fee Schedules. They are incorporated by reference in Rule 59G-13.032, F.A.C.”

Page 2-35

Service Limitations-Consumable Medical Supplies.

Fifth bullet is changed to read as follows: “See the Aged and Disabled Adult Services Waiver Procedure Codes and Fee Schedule.”

Last paragraph is removed from the text as follows: “Note: The Aged and Disabled Adult Services Fee Schedule and the Adult and Disabled Waiver Disposable Incontinence Medical Supplies Fee Schedule are available on 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 Fee Schedules. Aged and Disabled Adult Services Fee Schedule is incorporated by reference in Rule 59G-13.031, F.A.C.; and the Adult and Disabled Waiver Disposable Incontinence Medical Supplies Fee Schedule is incorporated by reference in Rule 59G-13.032, F.A.C.”

Page 2-36

Service Exclusions. Paragraph is changed to read as follows: “A/DA waiver funds may not be utilized for Consumable Medical Supplies available under the Florida Medicaid Durable Medical Equipment and Medical Supply Services Program, unless the supplies that are available under the Medicaid Durable Medical Equipment and Medical Supply Services Program are unable to meet the physician-ordered specifications. A copy of the completed Prior Authorization form PAO1 07/2008, denying or approving the request, must be in the case record for each requested DME service.”

Page 2-46 Service Exclusions. Last paragraph is removed from the text as follows: “Note: The Fee Schedule is available on 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 Fee Schedules. It is incorporated by reference in Rule 59G-13.031, F.A.C.”

Page 2-55 Service Limitations. Fourth bullet is changed to read as follows: “See the Aged and Disabled Adult Services Waiver Procedure Codes and Fee Schedule, for the maximum units of service and the maximum reimbursement per unit. Although this service may be authorized for up to four hours per day, such an authorization would be unusual and requires extensive documentation.”

Page 4-2 The header at the top of this page has been corrected to read “Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook.”

Page 4-4 The header at the top of this page has been corrected to read “Aged and Disabled Adult Waiver Services Coverage and Limitations Handbook.”

The purpose of the amendment to Rule 59G-13.031, F.A.C., is to incorporate by reference the revised Aged and Disabled Adult Waiver Fee Schedule, May 2009. The following information was added to the fee schedule.

AGED AND DISABLED ADULT SERVICES WAIVER

FEE SCHEDULE

 

T2024

U2

TRANSITION CASE MANAGEMENT

$11.25 per 15-minute unit

80 units (20 hours) per six (6) month transition period ($900 maximum)