The rule amendments clarify and update language regarding provider terminations, reductions, or suspensions of services to clients by providers and clarify standards regarding retaliatory conduct.

 

DEPARTMENT OF CHILDREN AND FAMILIES

Agency for Persons with Disabilities

RULE NOS.:RULE TITLES:

65G-3.001Definitions

65G-3.002Criteria for Admissions and Services

65G-3.003Rules for Reduction of Services by the Provider

65G-3.004Rules for Suspension of Services by the Provider

65G-3.005Rules for Termination of Servies by the Provider

65G-3.006Retaliatory Conduct

PURPOSE AND EFFECT: The rule amendments clarify and update language regarding provider terminations, reductions, or suspensions of services to clients by providers and clarify standards regarding retaliatory conduct.

SUMMARY: The rule amendments clarify and update language regarding provider terminations, reductions, or suspensions of services to clients by providers and clarify standards regarding retaliatory conduct.

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: Because this rule does not have an adverse impact on small business and will not likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule, the rule is not expected to require legislative ratification. The rule does not have an adverse impact on small business and is not likely to increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule because the rule simply clarifies the requirements of incident reporting that were previously in place.

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: 393.125(2), 393.501(1), FS.

LAW IMPLEMENTED: 393.125(2), 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: Danielle Thompson, Senior Attorney, Agency for Persons with Disabilities, [e-mail], [phone]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

Substantial rewording of Rule 65G-3.001, F.A.C. follows. See Florida Administrative Code for current text.

65G-3.001  Definitions.

(1) “Contract” means a formal written agreement between the provider and Agency and includes Medicaid Waiver Services Agreement.

(2) “Discrimination” means the unjust or prejudicial treatment of different categories of people.

(3) “Individual Representative” is defined in Rule 65G-4.0213(13), F.A.C.

(4) “Provider” means any individual, program, or facility that receives payment for the care, treatment, training, residence or habilitation of persons with developmental disabilities. A provider does not include:

(a) A spouse, family member or guardian with whom a person with developmental disabilities resides;

(b) A provider covered under the provisions of Part VIII of Chapter 400, F.S.; or

(c) Individuals or entities providing services to clients through the CDC+ program pursuant to ss. 393.066, and 409.221, F.S., and the rules of the Agency.

(5) “Reduction” means a decrease in the frequency, duration or intensity in the level of services, initiated by a non-residential provider that is not a result of faded or prescribed reductions that are part of service planning.

(6) “Retaliatory Conduct” means negative action against a client or client’s individual representative motivated by the desire to punish the client or the client’s individual representative.

(7) “Suspension” means an involuntary and temporary break in services in a non-residential program initiated by the provider. Suspension does not mean a break of services to a client by a service provider due to the unavailability of funds to the provider by the Agency.

(8) “Termination” means the involuntary, permanent discharge or discontinuation of services in a  program by the provider when such action is not included as part of the service planning process. Termination does not mean a discontinuation of services to a client by a service provider due to the unavailability of funds to the provider by the Agency.

(9)  “Regional Office” means the Agency local office responsible for managing a specific geographical region.

Rulemaking Authority 393.125(2) F.S. Law Implemented 393.0651, 393.067, 393.125(2) F.S. History–New 12-10-91, Amended ____________, Formerly 10F-8.026, 65B-8.026.

 

65G-3.002 Criteria for Admissions and Services.

Rulemaking Authority 393.125(2) F.S. Law Implemented 393.125(2) F.S. History–New 12-10-91, Formerly 10F-8.028, 65B-8.028, Repealed ___________.

 

65G-3.003 Rules for Reduction of Services by the Provider.

Rulemaking Authority 393.125(2) F.S. Law Implemented 393.125(2) F.S. History–New 12-10-91, Formerly 10F-8.029, 65B-8.029, Repealed ___________.

 

65G-3.004 Rules for Suspension of Services by the Provider.

Rulemaking Authority 393.125(2) F.S. Law Implemented 393.125(2), 120 F.S. History–New 12-10-91, Amended 5-19-93, Formerly 10F-8.030, 65B-8.030, Repealed __________.

 

Substantial rewording of Rule 65G-3.005, F.A.C. follows. See Florida Administrative Code for present text.

65G-3.005 Rules for Termination, Reduction, or Suspension of Services by the Provider.

(1) TERMINATIONS AND REDUCTIONS

(a) If a provider determines that he or she must terminate or reduce services the provider gives to a client, the provider shall send written notice of intent to terminate or reduce services to the client and their individual representative by certified mail or electronic mail. The provider shall send the required notice to the Regional Office and Support Coordinator via electronic mail.

1. The provider may not terminate or reduce services until at least thirty calendar days after the receipt of the notification by the client, individual representative, Regional Office, and Support Coordinator.

2. If the client is not on the iBudget Waiver pursuant to s. 393.0662, F.S., notification is only required to be given by the provider to the Regional Office, the client and the client’s individual’s representative. 

(b) Upon receipt of the notice from the provider, the Support Coordinator shall:

1. Evaluate the circumstances that led to the proposed termination or reduction,

2. Determine what actions, if any, should be taken to resolve the situation,

3. Immediately assist the client or the client’s individual representative in locating an alternate provider if resolution is not acceptable to the client or provider or otherwise not possible, and

4. Update the client’s support plan, cost plan and relevant service authorizations accordingly. 

(c) At the request of the client or the client’s individual representative, the Support Coordinator shall arrange a meeting with the provider and the client or the client’s individual representative, to offer any recommendations to  the client and the provider in an effort to resolve the concerns that led to the issuance of the notice of intent to terminate or reduce service. The meeting must be arranged within five (5) calendar days of the client’s or the individual representative’s request for the meeting.

(d) The Support Coordinator shall contact the Regional Office immediately if the client and the client’s individual representative need assistance in locating an alternate provider at least 25 days prior to the effective date of termination or reduction in services. The Regional Office will assist the client and the client’s individual representative in meeting the client’s needs.

(e) If the termination is for services provided in a licensed residential facility, the Regional Office shall immediately work with the client’s Support Coordinator to assist the client or the client’s individual representative in choosing an alternate place to live before the date of termination.

(f) If the client or the client’s individual representative selects an individual or entity to render the services who is not qualified to be that client’s provider, the Regional Office shall issue a notice to deny  the client’s selection of provider choice within 30 calendar days of the client’s notification to the Regional Office. The notice shall identify:

1. Any alternate providers or service options for the client that the Agency has determined are readily available;

2. The reason the Agency is denying the client’s selection of provider choice;

3. The specific statute or regulation supporting the denial; and

4. An explanation of the client’s administrative hearing rights pursuant to ss. 393.125, 120.569, and 120.57, F.S.

(2) SUSPENSIONS

(a) Emergency Suspension: A service provider may immediately suspend services provided to a client in a non-residential program when the behavior of the client constitutes an immediate danger to health, safety, or welfare of the client, another recipient of the provider’s services, the provider, or a third party.  If a service provider immediately suspends a client’s services for this reason, the provider shall give written notice of immediate suspension to the client, the client’s individual representative, the client’s Support Coordinator, and Regional Office at the time of the suspension or immediately thereafter, detailing reasons for the suspension. 

(b) Other Suspension: A service provider may immediately suspend services provided to a client in a non-residential program when the client’s behavior interferes with services provided to other recipients of the provider’s services.  If a service provider initiates a suspension for this reason, the service provider shall provide written notice of immediate suspension from a non-residential program to the client, the client’s individual representative, the client’s Support Coordinator, and the Regional Office at the time of the suspension or immeiately thereafter, detailing reasons for the suspension.

1. This type of suspension shall not exceed 3 service days. 

2. If the client is not on the iBudget Waiver pursuant to s. 393.0662, F.S., notification is only required to be given by the provider to the Regional Office, the client and the client’s individual’s representative. 

(c) The Support Coordinator shall ensure that appropriate service coverage is available during the time of suspension and update the support plan, cost plan, and relevant service authorizations accordingly. The Support Coordinator shall contact the Regional office immediately if assistance is needed in securing alternate services or providers. The Regional Office will assist the client and the client’s individual representative in meeting the client’s needs.

(3) This rule does not apply to fading or other reduction of care set forth in the client’s plan of care.

Rulemaking Authority 393.125(2) F.S. Law Implemented 393.125(2) F.S. History–New 12-10-91, Amended 5-19-93, ______________, Formerly 10F-8.031, 65B-8.031.

 

Substantial rewording of Rule 65G-3.006, F.A.C. follows. See Florida Administrative Code for present text.

65G-3.006 Discrimination and Retaliatory Conduct.

(1) Service providers are prohibited from:

(a) Taking any action that qualifies as illegal discrimination against any client receiving services in the receipt of those services. 

(b) Prejudicing the future provision of appropriate services when the client or the client’s individual representative attempts to advocate with the Agency, a government entity, or advocacy organization for desired services.  Providing factual information regarding a client that is pertinent to ensure the safety, health, and welfare of the client and third parties shall not be considered “prejudicing the future provision of appropriate services.”

(c) Taking any action that qualifies as retaliatory conduct againt a client or the client’s individual representative if either has complained about the service provider to the Agency, a governmental entity or  advocacy organization, or any other individual or entity.

(2) In cases where retaliatory  illegal discriminatory conduct, or factual information is withheld by the service provider, as described within this section, is determined by the Agency, the Agency, at its discretion, may initiate action against the service provider’s license, contract with the Agency, or Medicaid Waiver Services Agreement, in accordance with the provisions of applicable state law and administrative rules.

Rulemaking Authority 393.125(2) F.S. Law Implemented 393.125(2) F.S. History–New 12-10-91, Amended 5-19-93, _____________, Formerly 10F-8.033, 65B-8.033

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Danielle Thompson, Senior Attorney, Agency for Persons with Disabilities, [e-mail], [phone]

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Barbara Palmer

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 20, 2019

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 25, 2018