The Department of Health, Brain and Spinal Cord Injury Program is proposing revisions to its current rules and proposing three additional rules under Chapter 64I, F.A.C. The purpose of the proposed revisions and new rules is to the clarify and add ...

DEPARTMENT OF HEALTH
Division of Health Access and Tobacco

RULE NO: RULE TITLE
64I-1.001: Definitions
64I-1.002: Services
64I-1.003: Order of Selection
64I-1.004: Scope of Services
64I-1.005: Transitional Living Facility (TLF) Service Requirements
PURPOSE AND EFFECT: The Department of Health, Brain and Spinal Cord Injury Program is proposing revisions to its current rules and proposing three additional rules under Chapter 64I, F.A.C. The purpose of the proposed revisions and new rules is to the clarify and add statute and rule definitions; address eligibility for and closure from the program; define services of the program; develop an order of selection; and to define services provided by a transitional living facility and requirements they must meet prior to providing services.
SUMMARY: Proposed changes to Rule 64I-1.001, F.A.C., will provide clear and understandable definitions of terms used in Sections 381.73-.79, F.S., and Rules 64I-1.001-1.004, F.A.C. In addition, technical revisions to the rule are proposed to capitalize defined terms, use established statutory abbreviations, and to correct the name of the program. Proposed changes to Rule 64I-1.002, F.A.C., will eliminate language relating to services and will focus on eligibility for and closure from the Brain and Spinal Cord Injury Program. The proposed changes will assist the program in closing individuals’ cases that should be served by the state vocational rehabilitation program and will assist the program in determining eligibility for individuals who have previously received services from the program. Proposed Rule 64I-1.003, F.A.C., will define to whom services can be provided by the Department. In addition, the proposed rule will clearly define what services the Department will not provide. Department staff will have specific guidelines on determining what services can be purchased and who is eligible to receive them. Services will only be provided to individuals who have been determined eligible for the program and to applicants only to the extent necessary to determine eligibility. In addition, the Department will not purchase specific services for individuals being served by the Department. Proposed Rule 64I-1.004, F.A.C., will develop an order of selection in the event the Department is unable to purchase services for all eligible individuals due to budget shortfall. The proposed rule also ensures that all eligible individuals will continue to receive case management services in the event the Department is unable to purchase services. Proposed Rule 64I-1.005, F.A.C., requires that transitional living facilities will serve only those individuals who have sustained a brain or spinal cord injury as defined by Section 381.745, F.S., and sets forth requirements a transitional living facility must meet prior to providing services. Transitional living facilities must satisfactorily receive designation from the Brain and Spinal Cord Injury Program after undergoing a survey. In addition, transitional living facilities must obtain accreditation from the Commission on Accreditation of Rehabilitation Facilities.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: These rules do not impact small businesses (less than 200 employees), therefore a statement of estimated regulatory cost is not applicable.
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.
SPECIFIC AUTHORITY: 381.011 FS.
LAW IMPLEMENTED: 381.75, 381.76, 381.79, 400.805 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Tuesday, February 16, 2010, 1:30 p.m.
PLACE: Department of Health, 4025 Esplanade Way, Room 301, Tallahassee, FL 32311
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Suzanne Kelly, Department of Health, Brain and Spinal Cord Injury Program, 4052 Bald Cypress Way, Tallahassee, Florida 32399; telephone: [phone]; Email address: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Michael Greif, Department of Health, Office of the General Counsel, 4052 Bald Cypress Way, Tallahassee, Florida 32399; telephone: [phone], extension 2027; Email address: [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

64I-1.001 Definitions.

(1) Definitions for terms used in Sections 381.739-.79, F.S., and Rules 64I-1.001-1.004, F.A.C., this rule, consistent with Section 381.745, F.S.

(a) Appropriate Level of Functioning in the Community: Maintaining oneself in a Ccommunity of one’s informed choosing by performing all activities of daily living, independently, or with support, but without the need for Sservices. A particular level of functioning in the Community is not an Appropriate Level of Functioning in the Community if the underlying activities of daily living:

1. Cannot be safely performed in a manner that is consistent with the Eligible Individual’s limitations; or

2. Are not financially supportable for the foreseeable future.

(b) No change.

(c) Legal Resident: An individual person who currently lives in Florida, has the present intent to remain in Florida indefinitely, and has lawful permanent presence in the United States of America.

(d) Medically Stable: The Aapplicant’s mental and physical health are sufficiently stable so that BSCIP can make a determination as to whether the Aapplicant is otherwise eligible for the General Program.

(e) No change.

(f) Reintegration into the Community: Maintaining oneself in a Ccommunity by performing all activities of daily living, independently, or with support, but without the need for Sservices.

(g) Unable to Provide Services for all Eligible Individuals: The General Program is unable to purchase Services within three months of the scheduled time for each such Service for each Eligible Individual due to budget shortfall.

(2) Additional definitions for terms used in Rules 64I-1.001-1.004, F.A.C. this rule, consistent with Section 381.745, F.S.

(a) Applicant: An individual person requesting determination of eligibility for the General Program.

(b) Community: A location no more restrictive than an assisted living facility licensed under Ch. Chapter 400, Pt. Part III, F.S.

(c) Eligible Individual Person: An individual person determined eligible for the General Program.

(d) Equipment: For purposes of Section 381.79(1)(b), F.S., means personal property not required to be titled under state law and does not include fixtures to real property except as modifications to a residence.

(e)(d) General Program: The program for which eligibility is determined under Section 381.76, F.S.

(f)(e) Glasgow Coma Scale Score (Glasgow): The neurological assessment developed by G. Teasdale and B. Jennett Jennitte in “Assessment of Coma and Impaired Consciousness: A Practical Scale,” Lancet 1974; 22: 81-84. A copy of the Glasgow may be obtained from the Department of Health, Brain and Spinal Cord Injury Prevention Program, 4052 Bald Cypress Way, Bin C-25, Tallahassee, Florida 32399-1744 and which is incorporated herein by reference.

(g)(f) Rancho Los Amigos Scale, revised (Rancho): A cognitive functioning scale to determine the level or severity of a brain injury based on observations of the patient’s response to external stimuli. Original Scale co-authored by Chris Hagen, Ph.D., Danese Malkmus, M.A., Patricia Durham, M.A., Communication Disorders Service, Rancho Los Amigos Hospital, 1972. Revised 11/15/74 by Danese Malkmus, M.A., and Kathryn Stenderup, O.T.R. Revised scale 1997 by Chris Hagen. A copy of the Rancho may be obtained from the Department of Health, Brain and Spinal Cord Injury Prevention Program, 4052 Bald Cypress Way, Bin #C25, Tallahassee, Florida 32399-1744 and which is incorporated herein by reference.

(h)(g) Services: Services provided by the General Program.

Rulemaking Specific Authority 381.0011 FS. Law Implemented 381.76 FS. History–New 5-9-05, Amended 10-31-05,________.

 

64I-1.002 Ineligibility, Eligibility and Closure Services.

(1) An Applicant shall be determined ineligible for the General Program if the Applicant: All Services must be directed specifically to an individual applicant or eligible person by prior authorization of BSCIP.

(a) Is determined eligible for the state vocational rehabilitational program funded under the Rehabilitation Act of 1973, as amended;

(b) Does not require Services to achieve Reintegration into the Community;

(c) Is below Rancho 4 or otherwise is not reasonably expected to achieve Reintegration into the Community through Services; or

(d) Is otherwise categorically ineligible under the statutory criteria.

(2) An Eligible Individual’s case shall be closed if the Eligible Individual is: Services can be delivered to an applicant only to the extent necessary to determine eligibility for the General Program; and does not include:

(a) Determined eligible for the state vocational rehabilitational program funded under the Rehabilitation Act of 1973, as amended; Upgrading, replacement or maintenance of a durable medical device;

(b) At an Appropriate Level of Functioning in the Community; or Funding for consumables (those items for which the very act of using destroys their further use), except in support of services, and then only during a twenty four (24) month period beginning with the first time such funding is authorized;

(c) Not reasonably expected to return to an Appropriate Level of Functioning in the Community through Services. Change in circumstances not directly related to the applicant or eligible person’s brain or spinal cord injury and capable of repetition throughout the life of the applicant or eligible person. Examples of changes in circumstances capable of repetition include moving to another location, obtaining a vehicle or, except in the case of a person below the age of eighteen, the loss of a caregiver; or

(d) Any that require approval under federal law, such as human subject research.

(3) Prior closure does not prevent an individual from becoming an Applicant. The applicant shall be determined ineligible for the General Program if the applicant:

(a) Is determined eligible for and has an approved individual plan for employment from the state vocational rehabilitation program funded under the Rehabilitation Act of 1973, as amended;

(b) Does not require services to achieve reintegration into the community;

(c) Is below Rancho 4 or otherwise is not reasonably expected to achieve reintegration into the community through services; or

(d) Is otherwise categorically ineligible under the statutory criteria.

(4) Applicants previously closed under paragraph (2)(b) for not more than twelve months prior to again becoming an Applicant shall be: The eligible person’s case shall be closed if the eligible person is:

(a) Presumed to satisfy Section 381.76(1)(a)-(d), F.S.; and Determined eligible for and has an approved individual plan for employment from the state vocational rehabilitation program funded under the Rehabilitation Act of 1973, as amended, except that such case shall remain open solely for case management if such is required;

(b) Presumed to satisfy Section 381.76(1)(e), F.S., if the specific required Services: Is at an appropriate level of functioning in the community; or

1. Are needed to achieve an Appropriate Level of Functioning in the Community;

2. Were not provided previously; and

3. Are not available or in sufficient supply from any other resource.

(c) Is not reasonably expected to return to an appropriate level of functioning in the community through services.

(5) Previous closure under paragraph (3)(b) or (4)(b) above does not prevent an individual from becoming an applicant.

Rulemaking Specific Authority 381.0011 FS. Law Implemented 381.76 FS. History–New 10-31-05, Amended________.

 

64I-1.003 Services.

(1) All Services must be directed specifically to an individual Applicant or Eligible Individual by prior authorization of the General Program.

(2) Services can be delivered for an Applicant only to the extent necessary to determine eligibility for the General Program and for an Eligible Individual only to the extent necessary to achieve 1.002(2) closure.

(3) Services do not include:

(a) Upgrading, replacement or maintenance of a durable medical device;

(b) Funding for consumables (those items for which the very act of using destroys their further use), except in support of Services, and then for no more than twenty four (24) months beginning with the first time such funding is authorized;

(c) Any required by a change in circumstances not directly related to the Applicant or Eligible Individual’s brain or spinal cord injury and capable of repetition throughout their life. Examples of changes in circumstances capable of repetition include moving to another location, obtaining a vehicle or, except in the case of an individual below the age of eighteen, the loss of a caregiver; or

(d) Any requiring approval under federal law, such as human subject research.

Rulemaking Authority 381.0011 FS. Law Implemented 381.79 FS. History–New________.

 

64I-1.004 Order of Selection.

(1) Should the General Program be Unable to Provide Services for all Eligible Individuals, all Eligible Individuals shall continue to receive case coordination regarding Services not requiring authorization under Section 381.79(1)(a), F.S.

(2) Eligible Individuals shall receive Services requiring authorization under Section 381.79(1)(a), F.S., in the following order. Should the General Program be Unable to Provide Services requiring authorization under Section 381.79(1)(a), F.S., to all Eligible Individuals within any of categories (a)-(d), individuals within that category and all remaining Eligible Individuals shall be served under paragraph (e):

(a) Within 1 week of expected completion of the last scheduled Service before 1.002(a) or 1.002(b) closure.

(b) Within 2 weeks of expected completion of the last scheduled Service before 1.002(a) or 1.002(b) closure.

(c) Within 3 weeks of expected completion of the last scheduled Service before 1.002(a) or 1.002(b) closure.

(d) Within 4 weeks of expected completion of the last scheduled Service before 1.002(a) or 1.002(b) closure.

(e) The remainder, in order from greatest to least risk of institutionalization, as determined by the General Program using the Home and Community-Based Medicaid Waiver Prioritization Screening Instrument, April 2006, as referenced in Rule 59G-13.130, F.A.C.

Rulemaking Authority 381.0011 FS. Law Implemented 381.76 FS. History–New________.

 

64I-1.005 Transitional Living Facility (TLF) Services.

(1) Services:

(a) No entity can deliver TLF services without complying with this rule and before receiving a TLF license from the Agency for Health Care Administration under Section 400.805, Ch. 59A-17, F.A.C.;

(b) TLF services are solely for persons who have sustained brain or spinal cord injury as defined in Section 381.745, F.S.;

(c) TLF services do not include services as an appropriate discharge site;

(d) No entity can deliver services as a TLF before requesting and satisfactorily undergoing a Brain and Spinal Cord Injury Program survey using the Transitional Living Facility Survey Report – Brain Injury Plan and Transitional Living Facility Survey Report – Spinal Cord Injury Plan Standards and Criteria for Transitional Living Facilities, respectively, DH Forms DH-BSC 1008, 7/09 and 1009, 7/09. These forms are incorporated by reference and copies are available from the Department. Copies of these forms and requests for Brain and Spinal Cord Injury Program survey may be made by contacting the Brain and Spinal Cord Injury Program via: mail at 4052 Bald Cypress Way, Bin C-25, Tallahassee, FL 32399-1744 or telephone [phone] or toll-free [phone]. Copies of the form may also be obtained at http://www.doh.state.fl.us/demo/BrainSC/Facilities/ReviewInstruments.htm.

(e) No entity can deliver services as a TLF except upon obtaining and maintaining Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation for actions taken or intended to be taken under a TLF license. CARF may be reached via: the internet www.carf.org; telephone, [phone] or toll-free [phone] voice; fax, [phone]; and by mail CARF-CCAC, 1730 Rhode Island Avenue N.W., Suite 209, Washington, DC 20036, USA.

Rulemaking Authority 381.0011 FS. Law Implemented 381.75, 400.805 FS. History–New________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Thom DeLilla, Bureau Chief, Brain and Spinal Cord Injury Program
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Ana M. Viamonte Ros, M.D., M.P.H., State Surgeon General
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 6, 2010
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: August 15, 2008, September 26, 2008 and June 26, 2009