This rulemaking is intended to eliminate language that is not required by statute and to clarify fees and eligibility requirements for the Epilepsy Services Program.

 

DEPARTMENT OF HEALTH

Division of Family Health Services

RULE NOS.:RULE TITLES:

64F-9.001Definitions

64F-9.002 Eligibility for ESP Services

64F-9.003Individual Action Plans (IAP)

64F-9.004Prevention Program Activities

64F-9.005ESP Reporting Requirements

PURPOSE AND EFFECT:  This rulemaking is intended to eliminate language that is not required by statute and to clarify fees and eligibility requirements for the Epilepsy Services Program.

SUMMARY: The Department proposes to eliminate language in the rule that is not required by statute, and to clarify the eligibility requirements for the services provided by the Epilepsy Services Program, which include case management, medical services, and prevention and education services. The rulemaking also provides how fees shall be assessed for program services.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on the SERC checklist, this rulemaking will not have an adverse impact or regulatory costs in excess of $1 million within five years as established in s.120.541(2)(a), F.S.

Any person who wishes to provide information regarding the statement of estimated regulatory costs, or to provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 385.207(4) FS.

LAW IMPLEMENTED: 385.207 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS:  Shamarial Roberson, Bureau of Chronic Disease, 2585 Merchants Row Blvd., Bin #A-18, Tallahassee, FL 32399, [phone], Ext. 3815 or [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64F-9.001 Definitions.

For the purpose of this chapter, the following definitions will apply: The following words and phrases shall have the following meanings for the purpose of this rule.

(1) “Assets” means certificates of deposits, savings accounts, checking accounts, bonds, stocks, and money market accounts.

(2)(1) “Epilepsy Services Program (ESP)” means a program that provides both case management, medical services, and epilepsy prevention and education services according to s. 385.207, F.S.

(3) “Case Management” means obtaining information from a person to develop a plan of care that identifies the client’s needs, goals, and treatment objectives; and coordinating medical and other services.

(4) “Medical Services” means procedures and tests provided, based on available funding, to diagnose and control epilepsy.

(5) “Prevention and Education Services” means activities to increase community understanding and awareness of epilepsy and effective methods for epilepsy prevention and early detection.

(2) “ESP Client” means a person who is both a resident of Florida and who either:

(a) Is suspected to have epilepsy and has applied to the ESP provider for case management services under this program within a given contract year; or

(b) Is an ESP client, enrolled in a prior year, of the provider and is receiving continuing case management services as defined above; or

(c) Has a confirmed diagnosis of epilepsy and is receiving case management services as defined above.

(3) “Family” means one or more persons living in one dwelling place who are related by blood, marriage, law or conception. A pregnant woman and her unborn child or children are considered to be two or more family members. A single adult, over 18, living with relatives is considered to be a separate family for income eligibility determination purposes. If the dwelling place includes more than one family or more than one unrelated individual, the poverty guidelines are applied separately to each family or unrelated individual and not the dwelling place as a whole.

(4) “Gross Family Income” means the sum of income available to a family at the time of application. Gross family income shall be based on all income to be earned or received or anticipated to be earned or received in the current month. Providers are permitted to request income for up to 12 months prior to the date of application if the income received in the current month is not representative of the family’s gross income due to seasonal employment and if it is to the client’s benefit to do so. Income shall include the following:

(a) Wages and salary;

(b) Child support;

(c) Alimony;

(d) Unemployment compensation;

(e) Workers’s compensation;

(f) Veteran's pension;

(g) Social Security;

(h) Pensions or annuities;

(i) Dividends, interest on savings or bonds;

(j) Income from estates or trusts;

(k) Net rental income or royalties; and

(l) Net income from self employment;

(m) Contributions; and

(n) AFDC.

(5) “Individualized Action Plan (IAP)” is an individualized plan relating to the client's needs, goals, and expected outcomes to the services and responsibilities of the provider.

(6) “Net Family Income” means gross family income minus the standard work related, child care and child support deductions as used in determining presumptive eligibility for Medicaid.

(7) “Significant Other” means anyone who is recognized by the client or the courts as having a key role in the client's life such as a care giver, companion, guardian or foster parent.

(8) “Sliding Fee Scale” means a scale of charges which are less than the full cost of the service that clients shall be charged for ESP services.  The fee scale for these services shall progress in increments of 20 percent of the full cost of services for those clients between 100 and 200 percent of the most current poverty guidelines published by the Federal Office of Management and Budget.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 402.166, 402.165, 402.167, 39 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.003, Amended                            .

 

64F-9.002 Eligibility and Fees for ESP Services

(1) To be eligible for case management, a person must:

(a) Be a Florida resident, as evidenced by a valid Florida driver’s license or identification card; a current utility bill in the person’s name including a Florida address; a current Florida voter registration card; or a current record of registration certificate from a Florida school (K-12); and

(b) Be diagnosed with epiliepsy or have had a seizure or suspected seizure and require services to diagnose epilepsy.

(2) To be eligible for medical services, a person must meet the eligibilitly criteria for case managment in subsection (1), have no insurance or other medical service coverage, and have assets less than $2,500.

(3) All persons in Florida are eligible for prevention and education services.

(4) Fees:

(a) No fees shall be assessed for case management or prevention and education services.

(b) Persons with net family incomes between 101 and 200 percent of the Health and Human Services Poverty Guidelines for the 48 Contiguous States and the District of Columbia (Poverty Guidelines), as published in the January 25, 2016, rendition of the Federal Register, incorporated by reference and available at http://flrules.Gateway/reference.asp?No=Ref-####, or https://aspe.hhs/poverty-guidelines, shall be charged a fee for medical services on a sliding scale based on the following increments:

1. Persons with incomes at or below 100 percent of the Poverty Guidelines shall pay no fee.

2. Persons with incomes at 101 to 199 percent of the Poverty Guidelines shall pay 17 percent of the full fee.

3. Persons with incomes at 120 to 139 percemt of the Poverty Guidelines shall pay 33 percent of the full fee.

4. Persons with incomes at 140 to 159 percent of the Poverty Guidelines shall pay 50 percent of the full fee.

5. Persons with incomes at 160 to 179 percent of the Poverty Guidelines shall pay 67 percent of the full fee.

6. Persons with incomes at 180 to 199 percent of the Poverty Guidelines shall pay 83 percent of the full fee.

7. Persons with incomes at or above 200 percent of the Poverty Guidelines shall pay the full fee.

(1) Income Eligibility.

(a) Sliding Fee Scale. Persons with net family incomes from 100 to 200 percent of the OMB poverty guidelines shall be charged a fee on a sliding scale based on 20 percent increments as published by the State Health Office.

(b) Administrative, Gate and Flat Fees. Administrative, gate, and flat fees are not to be charged to any client receiving ESP services from a county health department or their subcontractors.

(c) Fee Exemption. Clients of county health departments and their subcontractors shall not be charged any fee for ESP services as defined in this policy if they have a net family income below 100% of poverty. The poverty guidelines are defined by the Federal Office of Management and Budget (OMB). The poverty guidelines will be updated on an annual basis.

(d) Waiver of Fees. County health departments and their subcontractors have the discretion of reducing or waiving fees in situations where a person with an income at or above 100 percent of poverty is unable to pay.

(e) Limitation of Income Eligibility. No eligibility limits shall be established for epilepsy case management services.

(2) Liability for Fees:

(a) All clients who are enrolled, or become enrolled, in Medicaid and all clients with a net family income below 100 percent of the most current poverty guidelines published by the Federal Office of Management and Budget (OMB) shall be eligible for services provided by the ESP at no charge.

(b) When the net family income is between 100 and 200 percent of the federal OMB poverty income guidelines the client would be responsible for payment of a portion of the provider's cost of the services provided based upon a sliding fee schedule.

(c) When the net family income is at or above 200 percent of the federal OMB poverty income guidelines the client would be responsible for 100% of the provider's cost of services.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 39, 402.33 FS. History–New 11-1-92, Amended 5-5-94, 4-29-96, Formerly 10D-117.004, Amended                            .

 

64F-9.003 Individual Action Plan (IAP).

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 402.33 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.006, Repealed                            .

 

64F-9.004 Prevention Program Activities.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.011, Repealed.

 

64F-9.005 ESP Reporting Requirements.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.014, Repealed.

 

64F-9.004 Prevention Program Activities.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.011, Repealed              .

 

64F-9.005 ESP Reporting Requirements.

Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.014, Repealed              .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Shamarial Roberson

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Celeste Philip, MD, MPH, Surgeon General and Secretary

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 17, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: April 6, 2016