The purpose of the proposed rule amendments is to update Rule Chapter 58C-1, F.A.C., to reflect current statutory language, policies, and procedures; to add language regarding confidentiality and disclosure of information; and to delete references ...

DEPARTMENT OF ELDER AFFAIRS
Community Care for the Elderly

RULE NO: RULE TITLE
58C-1.001: Definitions
58C-1.002: Eligibility
58C-1.003: Administration
58C-1.004: Application Procedures
58C-1.005: Provider Requirements
58C-1.007: Contributions and Donations
58C-1.008: Program Forms
58C-1.009: Confidentiality and Disclosure of Information
PURPOSE AND EFFECT: The purpose of the proposed rule amendments is to update Rule Chapter 58C-1, F.A.C., to reflect current statutory language, policies, and procedures; to add language regarding confidentiality and disclosure of information; and to delete references to the Department of Elder Affairs Program and Services Manual, July 1994 and revised November 1994, which is incorporated by reference in this rule chapter.
SUMMARY: The proposed rule amendments include definitions used in this rule chapter; eligibility for Community Care for the Elderly (CCE) services; administration of the CCE program; application process; provider requirements under the CCE program; contributions and donations; program forms; and the addition of language regarding confidentiality, disclosure of information and record retention procedures.
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: 430.08 FS.
LAW IMPLEMENTED: 430.03, 430.04, 430.202, 430.203, 430.205, 430.207 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: June 18, 2008, 9:30 a.m. – 11:00 a.m. EST.
PLACE: Department of Elder Affairs, 4040 Esplanade Way, Conference Room 225F, Tallahassee, FL 32399-7000
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 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Avenue, Tallahassee, FL 32399-7000; Telephone number [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: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Avenue, Tallahassee, FL 32399-7000; Telephone number [phone]; Email address [e-mail]. A copy of the proposed rule amendments and the form incorporated by reference is included on the department’s Web site at http://elderaffairs.state.fl.us/, under the heading DOEA Rulemaking, Administration of the Community Care for the Elderly Program

THE FULL TEXT OF THE PROPOSED RULE IS:

58C-1.001 Definitions.

The following terms are defined in this rule chapter As used in this chapter:

(1) “AGING OUT CLIENTS”: Individuals reaching 60 years of age who are being transitioned from the Department of Children and Families Services Community Care for Disabled Adults or Home Care For Disabled Adults services to the department’s community-based services. Adult Day Care means a social program which assures that a protective environment and preventive, remedial, and restorative services are provided to functionally impaired adults in need of such care.

(a) Adult Day Health Care means an organized day program of therapeutic, social and health activities and services provided to functionally impaired adults for the purpose of restoring or maintaining optimal capacity of self care.

(2) ASSESSMENT INSTRUMENT: The tool prescribed in the contract between the department and the AAAs, the AAAs and the lead agencies, and the lead agencies and the service providers for use in determining a client’s level of functioning, existing resources, service needs, and priority for services. Area Agency on Aging (AAA) means the agency designated by the Department in a planning and service area defined by the Department to develop and administer the area plan for a comprehensive and coordinated system of services for older persons.

(3) CONTRACTOR: The department, area agency on aging, lead agency or any other agency that initiates a contract with a contracting agency as described in Section 430.203(4), F.S. Area Plan (Plan of Action) means a plan developed by an Area Agency on Aging for a comprehensive and coordinated service delivery system in its planning and service area in accordance with 42 U.S.C. 3001 et seq., Older Americans Act of 1965, as amended, on a uniform area plan format prescribed by the State Unit on Aging. This plan identifies such funding resources as: the Older Americans Act (OAA), Community Care for the Elderly (CCE), and other funds; and sets forth measurable objectives; and, identifies the planning, coordination, evaluation activities to be undertaken for the period. The area plan is developed and submitted by the Area Agency on Aging and submitted to the State Unit on Aging. Annual updates of the area plan are required.

(4) Case/Care Plan means a plan which specifies the ongoing services prescribed for a CCE client to meet the needs identified in the comprehensive assessment. The care plan shall specify the estimated duration, desired frequency, problem statements, and scope of the services to be provided. It shall identify the provider agency, organization or person(s) responsible for providing the service(s). It shall also identify non-traditional providers such as families, churches, private agencies and neighbors. The care plan shall include a listing of desired outcomes agreed to with the client or caregiver where client is incapacitated. The case plan shall be signed by the case manager and the client.

(5) Case Management means a client centered series of activities which includes planning, arrangement for, and coordination of community based services for an eligible Community Care for the Elderly client. Case Management is an approved service, even when delivered in the absence of other services. Case management includes intake and referral, travel time related to the client’s case, a comprehensive client assessment, development of an individualized care plan with planned client outcomes, and follow-up contacts for the purpose of monitoring the client’s situation and to assure timely, effective delivery of service.

(6) Chore Service means the performance of house or yard tasks including seasonal cleaning, essential errands, yard work, lifting and moving, and simple household repairs for eligible persons who are unable to do these tasks for themselves because of frailty or other disabling conditions.

(7) Comprehensive Assessment means an assessment which records an individual’s physical health status, ability to perform activities of daily living, existing social support including individual client preferences and mental functioning.

(8) Community means a geographic area designated by the Area Agency on Aging after considering the needs, the availability and delivery pattern of local services, and natural boundaries of neighborhoods. A community can be a county, a portion of a county, or two or three counties.

(9) Core Service means services limited to adult day care, chore service, counseling, emergency home repair, health maintenance service, home delivered meals, homemaker services, information, medical transportation services, mini-day care, referral, and respite care.

(10) Counseling means an interactive process, on a one-to-one or group basis, wherein a person is provided direct guidance and assistance in the utilization of needed health, mental health, financial, and social services, and help in coping with personal problems through the establishment of a supportive relationship. Counseling may include the purchase of professional mental health and financial management counseling services.

(11) Emergency Alert Response Service means a community based electronic surveillance service system established to monitor the frail homebound elderly by means of an electronic communication link with a response center which will alert and dispatch properly qualified assistance to the client in need on a 24 hour, seven days a week basis.

(12) Emergency Home Repair means assistance in obtaining critical repairs or alterations to correct deficiencies or situations identified as a barrier to the eligible person’s health, safety, or ability to perform activities of daily living or as an impediment to the delivery of services to that eligible person.

(13) Health Maintenance Services means those routine health services necessary to help maintain the health of a functionally impaired elderly person, but shall be limited to medical therapeutic services, nonmedical prevention services, personal care services, home health aide services, home nursing services, and emergency response systems.

(14) Home Delivered Meals means a nutritionally sound meal that meets one-third of the current daily recommended dietary allowance serviced in the home to a homebound older person.

(15) Home Health Aide Service means health or medically oriented tasks provided to an eligible individual in his residence by a home health aide. The home health aide must be employed by a licensed home health agency and supervised by a licensed health professional who is an employee or contractor of the home health agency, in accordance with Chapter 59A-8, F.A.C. This service must be prescribed by a physician or nurse practitioner licensed in the State of Florida.

(16) Home Nursing Service means part-time or intermittent nursing care administered to an individual by a licensed practical nurse, registered nurse, or advanced registered nurse practitioner, in the individual’s place of residence, pursuant to a plan of care approved by a licensed physician and in accordance with Sections 400.462(6), 400.464(5)(a), 410.0241, and Chapter 464, F.S. Home nursing service must be provided through a licensed home health agency.

(17) Homemaker Service means the accomplishment of specific home management duties including housekeeping, meal planning and preparation, shopping assistance, and routine household activities by a trained homemaker.

(18) Information means responding to an inquiry from a person, or on behalf of a person, regarding resources and available services.

(19) Medical Therapeutic Service means those corrective or rehabilitative services which are prescribed or administered by a physician or other health care professional in accordance with Sections 400.462(6), 400.464(5)(a), 410.0241 and Chapter 464, F.S. Such services are designed to assist the functionally impaired older person to maintain or regain sufficient functional skills to live independently in his or her place of residence and include physical, occupational, respiratory, hearing disorder or speech-language

therapy. Medical therapeutic services must be provided through a licensed home health agency.

(20) Medical Transportation Services means the provision of rides and/or escort services to and from medical services. Medical services are defined as visits to physicians, dentists, psychiatrists, physical therapists, clinics, hospitals, mental health centers, or any similar facility or service provider. The service can include intermediate stops to fill prescriptions and buy medical supplies in conjunction with such visits.

(21) Mini-Day Care means a program providing for supervised care in a private home, licensed adult congregate living facility, or adult family care home for up to five impaired persons for a portion of a 24 hour day. A meal and snacks and social and recreational activities are included as part of the service.

(22) Personal Care Services means those non-medically oriented tasks provided by a personal care worker to assist the functionally impaired elderly person with bathing, dressing, ambulation, housekeeping, supervision, emotional security, eating, supervision of self-administered medications and assistance with securing health care from appropriate sources. Personal Care Services shall be provided with the supervision of a nurse licensed under Chapter 464, F.S.

(23) Referral means activity wherein a person’s needs are determined and the person is directed to a particular resource(s). Contact with the resource(s) is made for the person. Follow-up is conducted with the client and referral agency to determine whether the service was received.

(24) Respite Care means a service to provide supervision, companionship, or personal care, to a functionally impaired older person for a specified period of time. The purpose of the service is to maintain the quality of care to the client for a sustained period of time through temporary, intermittent relief of the primary caregiver.

(25) Service Provider means an individual, group or organization that is awarded a subgrant or contract from the Department, lead agency or an Area Agency on Aging to provide core or other services under the Area Agency on Aging Community Care for the Elderly Application plan.

Specific Authority 410.021-.029, 430.08 FS., ch. 80-101, s. 10, ch. 91-115, s. 10, Laws of Fla. Law Implemented 410.021-.029, 430.03(6), 430.04, 430.203 FS., ch. 91-115, s. 10, Laws of Fla. History–New 12-23-81, Formerly 10A-11.02, 10A-11.002, Amended 3-28-95,_________.

 

58C-1.002 Eligibility.

To be eligible for Community Care for the Elderly services, a pPersons must be who meet the following criteria are eligible for CCE core services:

(1) Shall be Aage 60 or over; and

(2) Shall be Ffunctionally impaired pursuant to Section 430.203(7), F.S., as determined by through an the initial comprehensive assessment and at least an annual reassessment using the form incorporated by reference in paragraph 58A-1.010(1)(b), F.A.C. shall be reassessed at least annually;

(2) Priority shall be given to those persons who are assessed to be at risk of placement in an institution or who are abused, neglected or exploited.

Specific Authority 410.021-.029, 430.08 FS., ch. 80-181, s. 10, ch. 91-115, s. 10, Laws of Fla. Law Implemented 410.023(4), 410.0241(6), 430.03(6), 430.04, 430.202,430.203 FS., ch. 91-115, s. 10, Laws of Fla. History–New 3-11-81, Formerly 10A-10.02, 10A-10.002, Amended 3-28-95, ________.

 

58C-1.003 Administration.

(1) The dDepartment shall plan, develop, and coordinate a statewide program to carry out its responsibilities under the Community Care for the Elderly program administer directly or through an Area Agency on Aging, at least one community care service system in each planning and service area where practical.

(2)(a) The AAA Area Agency on Aging, under contract with the department, shall responsibilities include:

(a) Comply with State of Florida procedures regarding solicitation and execution of contracts with service providers; and

1. Plan for and approve funds for community care service systems;

2. Submit annually to the Department Community Care for the Elderly Contract Module Sections of the Area Plan;

(b)3. Designate lead agencies and aAdminister the Community Care for the Elderly pProgram in accordance with its contract with the department. the Department of Elder Affairs Programs and Service Manual, dated July 1994 and revised November 1994, available in the Office of the Department Secretary and at each Area Agency on Aging, and herein incorporated by reference;

4. Administer Community Care for the Elderly contracts;

5. Cooperate with lead agencies to determine core services to be funded;

6. Designate lead agencies;

7. Advertise funds available for lead agencies and core services;

8. Provide technical assistance to lead agency applicants;

9. Require annual submission of Service Provider Application, DOEA Form #218, dated September 1994, available in the Office of the Secretary and herein incorporated by reference, for funding of current lead agency and core service providers utilizing applications provided by the Department;

10. Notify applicants of acceptability of applications and any further action;

11. Assess applicant’s ability to be a lead agency and provide core services and case management as well as ability to sub-contract, if applicant indicates plans to do so;

12. Provide the Department with review copies of applications;

13. Assess fiscal management capabilities;

14. Monitor the lead agencies’ case management capabilities;

15. Assess availability of ten percent match for lead agency budget; match is the minimum funding necessary for the support of project operations and includes in-kind or cash contributions;

16. Contract for lead agency and core services according to manuals, rules and contract procedures of the Department. The lead agency shall provide case management and shall subcontract or directly provide core services;

17. Monitor and evaluate contracts programmatically and fiscally;

18. Make payments to contractors;

19. Provide for in-service training for lead agencies at least once a year;

20. Establish procedures for appeals regarding contracts for lead agencies and core services and for appeals regarding denial, reduction or termination of core services and assessed contributions. Criteria are to assure a timely response and identify how appeals are handled and the time limitations involved;

21. Assure that procedures for appeals regarding denial of core services, reduction of core services, or termination of core services are followed by each lead agency.

(3)(b) Lead aAgenciesy shall responsibilities include: provide, directly or through subcontracts, case management and core services; maintain client and program records; and provide reports as specified in their contracts with the AAAs.

1. Coordinate services for functionally impaired elderly;

2. Provide case management;

3. Provide or sub-contract for at least four core services;

4. Compile community care statistics as required by the Department;

5. Monitor its sub-contracts following standards set by the Department and as identified in the Department of Elder Affairs Programs and Services Manual, dated July 1994 and revised November 1994, available in the Office of the Department Secretary and at each Area Agency on Aging, and herein incorporated by reference;

6. Make payments to sub-contractors for core services;

7. Collect contributions and donations for core services provided according to Rule 58C-1.007, F.A.C.;

8. Utilize services provided by recipients of core services in lieu of contributions;

9. Locate in a multi-service senior center when practicable;

10. Provide for in-service training for staff including volunteers and core service contractors at least once a year;

11. Accept contributions, gifts and grants to carry out a community care service system;

12. Maximize use of volunteers to provide core services to functionally impaired elderly persons;

13. Demonstrate innovative approaches to program management, staff training, and service delivery that impact on cost avoidance, cost effectiveness and program efficiency;

14. Follow procedures established by the contracting agency for appeals regarding denial, reduction or termination of core services to clients and for appeals regarding contracts for core services.

15. Ensure that quality services are delivered in a timely manner to eligible individuals.

16. Case managers shall ensure that all other resources have been utilized prior to approving the provision of services with Community Care for the Elderly funds.

17. All agencies receiving Community Care for the Elderly funds shall maintain client, fiscal, and program records and provide reports as specified by the Department of Elder Affairs Programs and Services Manual, dated July 1994 and revised November 1994, available in the Office of the Department Secretary and at each Area Agency on Aging, and herein incorporated by reference.

Specific Authority 410.021-.029, 430.08 FS., ch. 80-181, s. 10, ch. 91-115, s. 10, Laws of Fla. Law Implemented 410.024, 410.0241, 430.03(6), 430.04, 430.202, 430.203, 430.204, 430.205 FS., ch. 91-115, s. 10, Laws of Fla. History–New 3-11-81, Formerly 10A-10.03, 10A-10.003, Amended 3-28-95,_________.

 

58C-1.004 Application Procedures.

Application procedures for a Community Care for the Elderly lead agency and core service provider shall be accomplished through a competitive bid process.

(1) Prior to advertising for the lead agency, each Area Agency on Aging, shall review the results of the most current aging needs assessment and waiting lists for services in each service area in order to determine the area of the planning and service area most in need of core services and which core services are most needed.

(2) Existing Community Care for the Elderly lead agencies and core service providers shall submit a service provider application each year in order to be considered for refunding. The Service Provider Application is DOEA Form #218, dated September 1994, available in the Office of the Department Secretary, and herein incorporated by reference.

(3) Standards for approval of applications.

(a) Prior to contracting with any lead agency, the Area Agency on Aging administering the program shall assess the applicant’s or provider agency’s ability to meet lead agency or service provider requirements as contained in Rule 58C-1.005, F.A.C.

(b) Applications which are properly and completely prepared according to the instructions provided will be approved for contracts subject to the availability of State and local resources in sufficient amounts to assure that cash outlays can be met.

(c) The contracting agency which funds and administers Community Care for the Elderly shall review all applications and determine which applications are approved for funding. The approved agency must demonstrate sound fiscal management in accordance with generally accepted accounting principles and be capable of providing core services, case management and coordination of services.

(d) The lead agency and any of its core service providers will provide a minimum of ten percent of the funding necessary to support the program. Cash or in-kind resources may be used to meet this matching requirement.

(4) Contracting and Financial Management Procedures. Contracts between the department, the Area Agency on Aging, lead agency or core service providers shall follow departmental contracting and financial management procedures.

Specific Authority 430.08 FS. Law Implemented 430.03, 430.04, 430,203(9), 430.204, 430.205 FS. History–New 3-11-81, Formerly 10A-10.04, 10A-10.004, Amended 3-28-95, 10-30-05,________.

 

58C-1.005 Service Provider Requirements.

All service providers must provide services in accordance shall comply with the requirements in their contracts with the contractor the Department of Elder Affairs Programs and Services Manual, dated July 1994 and revised November 1994, available in the Office of the Department Secretary and at each Area Agency on Aging, and herein incorporated by reference.

Specific Authority 410.021-.029, 430.08 FS., ch. 80-181, s. 10, ch. 91-115, s. 10, Laws of Fla. Law Implemented 410.024-.0241, 430.03(6), 430.04, 430.204, 430.205 FS., ch.91-115, s. 10, Laws of Fla. History–New 3-11-81, Formerly 10A-10.05, 10A-10.005, Amended 3-28-95,________.

 

58C-1.007 Co-payments and Contributions and Donations.

(1) Contracting agencies that enter into a contract to provide services under the Community Care for the Elderly program Lead agencies are responsible for collection of co-payments and contributions and donations from clients receiving recipients of Community Care for the Elderly core services.

(2) The contracting agency must determine Once an applicant is deemed eligible (Ref. Rule 58C-1.002, F.A.C.), a determination shall be made as to a dollar amount that the applicant must be assessed for those services based on an overall ability to pay. Partial payments may also be assessed.

(3) Pursuant to Section 430.204(8), F.S., co-payments must be determined using the fee schedule established in DOEA Form CoPay, Co-Pay Schedule, July 2008. The form is hereby incorporated by reference and available from the Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399-7000. If it is readily apparent, after completion of the Department of Elder Affairs Programs and Services Manual assessed contribution work sheet, that the applicant is not able to afford a partial or total contribution towards payment for services, further inquiry as to the applicant’s income level is unnecessary. Included within this category is an applicant whose monthly expenses are such that a contribution would be punitive. In these situations, service providers may continue to request voluntary contributions or donations.

(4) The case manager shall request information from the applicant, his or her spouse, relative or guardian in order to establish a contribution assesment.

Specific Authority 410.021-.029, 430.08 FS., ch. 80-181, s. 10, ch. 91-115, s. 10, Laws of Fla. Law Implemented 410.024(8), 430.03(6), 430.04, 430.204(8) 430.06(2)(c)13. FS., ch. 91-115, s. 10., Laws of Fla. History–New 3-11-81, Formerly 10A-10.07, 10A-10.007, Amended 3-28-95,_________.

 

58C-1.008 Program Forms.

The following forms shall be used for programs regulated by this chapter, are hereby incorporated by reference in Rule 58A-1.010, F.A.C. In addition, a care plan must be developed that meets the criteria established in subsection (3) of that rule. and are available in the Office of the Secretary and at each Area Agency on Aging:

(1) For purposes of assessment:

(a) DOEA Form 701A, Prioritization Form, July, 2000.

(b) DOEA Form 701B, Assessment Instrument, July, 2000.

(c) DOEA Form 701C, Congregate Meals Form, July, 2000.

(2) For purposes of completing forms listed in subsection (1): DOEA Form 701D, Assessment Instructions (701A, 701B, 701C), July, 2000.

(3) For purposes of documenting planned services of care: DOEA Forms 203A, Care Plan, and 203B, instructions dated July, 2001.

Specific Authority 430.08, 430.203-.205 FS. Law Implemented 430.203, 430.205 430.201-.207 FS. History–New 8-20-00, Amended 8-6-01, ________.

 

58C-1.009 Confidentiality, Disclosure of Information, and Retention of Records.

(1) Contracting agencies that enter into a contract to provide services under the Community Care for the Elderly program shall collect, maintain, and exchange information about applicants applying for services and clients receiving services only to the extent it is necessary to administer the programs covered under this agreement in accordance with the Health Insurance Portability and Accountability Act (HIPPA) of 1996.

(2) The contracting agency shall retain all client records, financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to each agreement and/or contract for a period of at least five (5) years after termination of the agreement(s).

(a) If an audit has been initiated and audit findings have not been resolved at the end of five (five) years, the records shall be retained at least until resolution of the audit findings.

(b) These records may be subject to additional retention requirements set by law.

(3) Persons duly authorized by the department shall have full access and the right to examine or duplicate any of said records and documents during the stated retention period or as long as records are retained, whichever is later.

Specific Authority 430.08 FS. Law Implemented 430.207 FS. History–New ________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Jim Crochet
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: E. Douglas Beach, Ph.D., Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 09, 2008
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: June 24, 2005