AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.193Statewide Medicaid Managed Care Long-term Care Waiver Program Prioritization and Enrollment
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. 47 No. 43, March 4, 2021 issue of the Florida Administrative Register.
59G-4.193 Statewide Medicaid Managed Care Long-term Care Waiver Program Prioritization and Enrollment.
(1) No change.
(2) No change.
(a) Adult Protective Services High Risk Referral – Individuals age 60 or older who are determined by Department of Children and Families Adult Protective Services to be victims of abuse, neglect, or exploitation, who need immediate services to prevent further harm.
(a) (b) Aging Out – When an individual who is enrolled in the Department of Children and Families’ (DCF) Community Care for Disabled Adults or Home Care for Disabled Adults program reaches the maximum age for the program and is referred for screening and prioritization for the LTC program.
(b) (c) Authorized Representative – As defined in section 409.962, Florida Statutes (F.S.).
(c) (d) Enrollment – When the Agency for Health Care Administration (AHCA) places a recipient in a Florida Medicaid managed care plan.
(d) (e) High Priority Rank – Number Automatically generated number indicating an individual’s assessed need for LTC services and placement on the wait list, based on priority ranks of 3 and above in accordance with section (3)(b) of this rule., 4, 5, 6, 7, and 8.
(e) (f) Imminent Risk – When individuals living in their home or a community setting meet all of the following:
1. Through 3. No change
(f) (g) Low Priority Rank – Number Automatically generated number indicating an individual’s assessed need for LTC services, based on priority ranks of 1 or 2.
(g) (h) Priority Rank – Number Automatically generated number indicating an individual’s assessed need for LTC services and to determine placement on the wait list, based on the priority score.
(h) (i) Priority Score – Automatically generated number based on a Department of Elder Affairs’ (DOEA) screening completed in accordance with rule 58A-1.010, Florida Administrative Code (F.A.C.).
(i) (j) Rescreening – As defined in section 409.962, F.S.
(j) (k) Screening – As defined in section 409.962, F.S.
(k) (l) Significant Change – As defined in section 409.962, F.S.
(l) (m) Wait List – A list maintained by DOEA of individuals who have been screened and assigned a high priority rank by an Aging and Disability Resource Center (ADRC).
(3) No change.
(a) Through (d) No change.
1. For individuals with a high priority rank, notification of wait list placement.
1. 2. The individual’s priority rank.
2. 3. Contact information for the ADRCs.
3. 4. Instructions for requesting an administrative fair hearing in accordance with Title 42, Code of Federal Regulations (CFR), Section 431, Subpart E, section 409.285, F.S., and Rule 65-2.042, F.A.C.
4. 5. Instructions for requesting a copy of the completed screening tool, which includes the priority score.
5. 6. Instructions for requesting a rescreening. The individual, or their authorized representative, may request a rescreening due to a significant change.
6. For individuals with a high priority rank, notification of wait list placement.
7. No change.
(e) Through (j) No change.
(4) The following Iindividuals may bypass the screening and wait list process to enroll in the LTC program in accordance with section409.979, F.S. if all other LTC managed care program eligibility requirements are met:
a. A Medicaid recipient who is 18, 19, or 20 years of age who has a chronic debilitating disease or condition of one or more physiological or organ systems which generally make the individual dependent upon 24-hour-per-day medical, nursing, or health supervision or intervention.
b. An individual who is referred by the Department of Children and Families pursuant to sections 415.101-415.113, F.S., as high risk and who is placed in an assisted living facility temporarily funded by the Department of Children and Families.
c. An individual who is 18 years of age or older who has been diagnosed with Cystic Fibrosis and who has a hospital level of care.
(5) Through (6) No change.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409. 978, 409.979 FS. History–New 12-8-16,__________.
