The Department intends to amend Chapter 65A-1.7141, F.A.C., to remove unnecessary provisions and increase the personal needs allowance for residents in institutional settings.

 

DEPARTMENT OF CHILDREN AND FAMILIES

Economic Self-Sufficiency Program

RULE NO.:RULE TITLE:

65A-1.7141SSI-Related Medicaid Post Eligibility Treatment of Income

PURPOSE AND EFFECT: The Department intends to amend Chapter 65A-1.7141, F.A.C., to remove unnecessary provisions and increase the personal needs allowance for residents in institutional settings.

SUMMARY: The personal needs allowance will be increased from $105 to $130. Provisions regarding the Cystic Fibrosis waiver will be removed.

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: The Department used a checklist to conduct an economic analysis and determine if there is an adverse impact or regulatory costs associated with this rule that exceeds the criteria in section 120.541(2)(a), F.S. Based upon this analysis, the Department has determined that the proposed rule is not expected to require legislative ratification.

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

RULEMAKING AUTHORITY: 409.919, 409.961 FS.

LAW IMPLEMENTED: 409.902, 409.903, 409.904, 409.906, 409.919, 409.961, 409.063 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: Jodi Abramowitz. Jodi can be reached at [phone] or [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

65A-1.7141 SSI-Related Medicaid Post Eligibility Treatment of Income.

After an individual is determined eligible for Hospice, Institutional Care Program (ICP), Program of All-Inclusive Care for the Elderly (PACE), Cystic Fibrosis waiver, Individual Budgeting (iBudget), or Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) Program, the Department determines the individual’s patient responsibility. “Patient responsibility” is the amount the Agency for Health Care Administration (AHCA) must reduce its payments to a medical institution and intermediate care facility or payments for home and community based services provided to an individual towards their cost of care. Patient responsibility is based on the amount of income remaining after the following deductions are applied pursuant to 42 CFR §435.725 and 42 CFR §435.726. This process is called “post eligibility treatment of income.”

(1) For institutional care services and Hospice, the following deductions are applied to the individual’s income to determine patient responsibility in the following order:

(a) A Personal Needs Allowance (PNA) of $130 $105. Individuals residing in medical institutions and intermediate care facilities shall have $130 $105 of their monthly income protected for their personal need allowance.

(b) through (h) No change.

(i) Uncovered medical expense deduction. The following policy will be applied in considering medical deductions for institutionalized individuals and individuals receiving HCBS services to calculate the amount allowed for the uncovered medical expense deduction:

1. For institutionalized persons or residents of medical institutions and intermediate care facilities, the deduction includes:

a. No change.

b. For other incurred medical expenses, the expense must be for a medical or remedial care service and be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2) 59G-1.010(166), F.A.C., and be recognized in state law. For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be the amount of the deduction, not to exceed the maximum payment or fee recognized by Medicare, commercial payors, or any other third party payor, for the same or similar item, care, or service.

2. through 5. No change.

(2) For the Program of All-Inclusive Care for the Elderly (PACE), the following deductions are applied to the individual’s income to determine patient responsibility:

(a) A deduction is made for the PNA based on the individual’s living arrangement as follows:

1. through 2. No change.

3. For an individual residing in a nursing home, the PNA is $130 $105.

(b) No change.

(c) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

1. The service or item claimed as a deduction from the individual’s income must be a medical or remedial care service, be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2) 59G-1.010(166), F.A.C., be recognized in state law, and have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

2. through 4. No change.

(d) No change.

(3) For the Cystic Fibrosis waiver, the following deductions are applied to the individual’s income to determine patient responsibility in accordance with 42 CFR §435.726:

(a) A deduction is made for PNA in an amount that is equal to 300% of the FBR.

(b) A spousal deduction equal to the SSI standard FBR minus the spouse’s monthly income is allowed when the spouse is residing in the community.

(c) A deduction for the family at the Temporary Cash Assistance consolidated need standard (CNS).

(d) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

1. The service or item claimed as a deduction from the individuals income must be a medical or remedial care service, be medically necessary as specified in subsection 59G-1.010(166), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

2. For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be used as the deduction not to exceed the maximum payment or fee recognized by Medicare, commercial payers or any other third party payer for the same or similar item, care, or service.

3. Other resident health insurance policies will be treated as first payor and the beneficiary will have to demonstrate that the other insurance has not or will not cover the expense.

4. The medical or remedial care expenses that were incurred as the result of imposition of a transfer of assets penalty is limited to zero.

(4) For the iBudget Florida waiver, the following deductions are applied to the individual’s income to determine patient responsibility in accordance with 42 CFR §435.726:

(a) through (c) No change.

(d) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

1. The service or item claimed as a deduction from the individual’s individuals income must not be a medical or remedial care service, be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2) 59G-1.010(166), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

2. through 4. No change.

(5) For the Statewide Medicaid Managed Care Long-Term Care Program, the following deductions are applied to the individual’s income to determine patient responsibility in accordance with 42 CFR §435.726:

(a) through (b) No change.

(c) A deduction for incurred medical or remedial care expenses not subject to payment by a third party, and subject to the following reasonable limits:

1. The service or item claimed as a deduction from the individual’s individuals income must be a medical or remedial care service, be medically necessary as specified in the Florida Medicaid Definitions Policy, incorporated by reference in subsection 59G-1.010(2) 59G-1.010(166), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

2. through 4. No change.

Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919, 409.961, 409.063 FS. History–New 5-29-05, 8-12-15, Amended_____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Vonsenita Tranquille

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Mike Carroll

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: July 23, 2018

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 27, 2018