The Department proposes to amend the existing rules.

DEPARTMENT OF HEALTH
Division of Family Health Services

RULE NO: RULE TITLE
64F-18.002: Definitions
64F-18.003: Procedure
PURPOSE AND EFFECT: The Department proposes to amend the existing rules.
SUMMARY: This rule is being amended to add definitions, update Insulin Distribution Program application form, and provide additional information on eligibility determination.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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: 385.204 FS.
LAW IMPLEMENTED: 385.204 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Sarah Cawthon, Department of Health, 4052 Bald Cypress Way, Bin A-13, Tallahassee, Florida 32399

THE FULL TEXT OF THE PROPOSED RULE IS:

64F-18.002  Definitions.

(1) “Bona fide resident” means a person living in Florida with the intent to remain. as evidenced by self-declaration

(2) “Current prescription” means a prescription written by a licensed health care practitioner who is authorized by law to prescribe medicine within 3 months of application and effective for up to no more than 6 12 months after it is written.  The prescription must be written by a licensed health care practitioner authorized by law to prescribe medicine and include the following information:

(a) Person’s name (printed or typed);

(b) Person’s date of birth;

(c) Physician’s state license number;

(d) Physician’s name (printed or typed);

(e) Physician’s phone number;

(f) Date of prescription;

(g) Type of insulin to be issued;

(h) Medication dosage;

(i) Amount of medication to be issued at each visit – up to a three month supply;

(j) Whether and how many refills are allowed.

(3) “Designated agent” means any pharmacy that has entered into a written agreement with a county health department to provide insulin to approved insulin distribution program participants.

(4) “Family” means one or more persons living in one dwelling place who are related by blood, marriage, law or conception. A single adult, over 18, living with relatives is considered to be a separate family.

(5)(4) “Federal poverty guidelines” mean the poverty guidelines defined by subsection 64F-16.001(7), F.A.C.

(6) “Gross family income” means the sum of income available to a family at the time of application.  Gross family income is based on all income to be earned or received or anticipated to be earned or received in a current month.  Gross family income does not include Supplemental Security Income (SSI) or any income received by the SSI eligibile individual(s) and any income received by the minor sibling(s) of the eligible individual(s). Gross family income includes the following:

(a) Wages and salary;

(b) Child support;

(c) Alimony;

(d) Unemployment compensation;

(e) Worker’s compensation for lost income;

(f) Veteran’s pension;

(g) Social Security;

(h) Pension or annuities;

(i) Dividends, interest on savings, stocks or bonds;

(j) Income from estates or trusts;

(k) Net rental income or royalties;

(l) Net income from self-employment;

(m) Contributions;

(n) Public assistance or welfare payments;

(o) Cash amounts received or withdrawn from any source including savings, investments, trust accounts and other resources which are readily available to the family;

(p) Other case income.

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

(8)(5) “Self declaration” means a written statement regarding assets, insurance coverage, income, family size and or residency made by a person applying for the insulin distribution program services. Self-declaration does not include any documentation other than the signature of the person making the statement. The self-declaration statement that the department requires under this chapter shall include a signed acknowledgement by the applicant that the statement is true at the time it is made and that the applicant understands that the county health department provider shall have the option of verifying the information provided statement.

(9) “Verification” means to confirm the accuracy of information through sources other than the self-declaration statement of the individual that originally supplied the information.

Specific Authority 385.204 FS. Law Implemented 385.204 FS. History–New 12-19-00, Amended__________.

 

64F-18.003 Procedure.

(1) A person wishing to participate in the insulin distribution program can obtain an application from any county health department. The application is form number DH2105, 3/07, 10/00, “Insulin Distribution Program Application Form” which is incorporated herein by reference. A copy of this form can be obtained from any local county health department or its designated agent.

(2) Every 12 months a client must submit a completed application to the county health department or designated agent of the department who will approve the application based upon the following criteria:

(a) The applicant must be a bona fide Florida resident;

(b) The applicant must be unable to pay for insulin because the applicant:

1. Is uninsured, or lacking insurance that provides coverage for would reimburse the applicant for insulin, and

2. Has a net family income at or below 100% of Federal poverty guidelines, and

3. Has no more than $2,500 per family in private funds, bank accounts or assets other than their homestead to defray the cost.

(c) The applicant must submit a current prescription for insulin.; and

(d) The applicant must self-declare assets, insurance coverage, family size and residency.

(e) The applicant must sign a statement of income, specifying all gross income available to the applicant and the number of people dependent upon that income. The statement shall include a signed acknowledgement that the statement is true at the time it is made and that the person making the statement understands that the CHD will attempt to verify the statement.

(3) The county health department will verify the applicant’s income as follows:

(a) Verification may be made by telephone, in written form, or by face to face contact. Verification does not require written documentation to confirm an applicant’s statement. Verification can include:

1. A statement from a government agency which attests to the applicant’s financial status.

2. A statement from the applicant’s or family member’s employer.

3. Pay stubs for four consecutive weeks.

4. A statement from a source providing unearned income to the applicant or family unit.

(b) If the CHD is unable to verify wages paid or an employer will not verify wages paid, the statement provided by applicant may be accepted as accurate.

(c) If the applicant declares zero income, the CHD may require the applicant to describe in detail their living circumstances and how they obtain basic necessities such as food, shelter, clothing, medical care, and transportation.

(4) The county health department has authority to make the final determinations of eligibility for the insulin distribution program.

(5)(d) If the Department of Health’s pharmaceutical budget permits, applicants or current insulin distribution program clients with a net family income of 101-200% of Federal poverty guidelines that meet the requirements in paragraph (2)(a) and subparagraph (2)(b)1. and 3. above will be eligible for the insulin distribution program or to continue in the program and receive insulin at reduced cost based on a sliding fee scale as set forth in Chapter 64F-16, F.A.C.

(6)(e) If an otherwise unqualified applicant, as defined above, is temporarily without current financial resources to purchase insulin, the county health department may provide a one month supply of insulin to this applicant once annually.

(7)(3) If at any time the applicant experiences a change in status, which could affect his or her eligibility, the applicant must report this change to the county health department within thirty days of this change.

(8)(4) The county health department will assist clients receiving insulin through this program, who become or are found to be ineligible, in locating another source of insulin. The county health department will continue to provide insulin to the client until another source can be found for up to 1 year after the determination of ineligibility.

(9)(5) County health departments or their designated agents will maintain records regarding their dispensing of insulin under this program for five years. These records shall include a copy of the Insulin Distribution Program Application Form and a copy of the applicant’s prescriptions for insulin.

Specific Authority 385.204 FS. Law Implemented 385.204 FS. History–New 12-19-00, Amended_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Sarah Cawthon
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Tammie Johnson
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: October 1, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: October 5, 2007