64F-9.001: Definitions
64F-9.002: Eligibility for ESP Services
64F-9.003: Individual Action Plan (IAP)
64F-9.004: Prevention Program Activities
64F-9.005: ESP Reporting Requirements
PURPOSE AND EFFECT: The Department proposes to amend the existing language in this chapter.
SUMMARY: Each rule was updated to recognize changes in definitions or terminology and modifying the eligibility and enrollment process.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: A Statement of Estimated Regulatory Cost was prepared and changes to the rules have no effects on the costs related to the rules.
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: 385.207(4) FS.
LAW IMPLEMENTED: 385.207 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: Melba Hawkins-Littles, 4052 Bald Cypress Way, Bin A-18, Tallahassee, Florida 32399
THE FULL TEXT OF THE PROPOSED RULE IS:
(Substantial rewording of Rule 64F-9.001 follows. See Florida Administrative Code for present text.)
64F-9.001 Definitions.
The following words and phrases shall have the following meanings for the purpose of this rule.
(1) “Epilepsy Services Program (ESP)” means a program that provides direct client services, prevention and education services according to Section 385.207, F.S., to improve access to health care services for Florida’s citizens living with epilepsy.
(2) “ESP Client” means a person who is both a resident of Florida and who either:
(a) Is suspected to have a seizure disorder or epilepsy and has applied for direct client services; or
(b) Is an ESP client, enrolled in a prior year, and is receiving continuing case management services as defined above; or
(c) Has a confirmed diagnosis of epilepsy and is receiving direct client services.
(3) “Family” means one or more persons living in one dwelling place who are related by blood, marriage, law or conception. A pregnant woman and her unborn child or children are considered to be two or more family members. A single adult, over 18, living with relatives is considered to be a separate family for income eligibility determination purposes. If the dwelling place includes more than one family or more than one unrelated individual, the poverty guidelines are applied separately to each family or unrelated individual and not the dwelling place as a whole.
(4) “Gross Family Income” means the sum of gross income available to a family at the time of application. Gross family income shall be based on all gross income to be earned, unearned, received or anticipated to be earned or received in the current month. Providers are permitted to request income for up to 12 months prior to the date of application if the income received in the current month is not representative of the family’s gross income due to seasonal employment and if it is to the client's benefit to do so. Income shall include the following:
(a) Wages, salary and self-employment income;
(b) Child support received;
(c) Alimony received;
(d) Unemployment compensation;
(e) Worker’s compensation;
(f) Veteran’s pension;
(g) Social Security;
(h) Pensions or annuities;
(i) Dividends, interest on savings or bonds;
(j) Income from estates or trusts;
(k) Net rental income or royalties;
(l) Net income from self employment;
(m) Contributions; and
(n) Temporary Assistance for Needy Families (TANF)
(5) “Net Income” means gross family income minus Federal Tax Withholdings, Social Security and Medicare deductions.
(6) “Plan of Care (POC)” is an individualized plan relating to the client’s needs, goals, and expected outcomes to the services. A POC is created during the intake process and is updated as necessary. The POC is reviewed at least annually to assure the client is on target with the stated goals and objectives.
(7) “Provider” an organization or individual providing services or commodities to the department or its assignee in accordance with the terms of a contract.
(8) “Poverty Guidelines” The guidelines are a simplified version of the federal poverty threshold used for administrative purposes to establish income ranges of the sliding fee scale to determine financial eligibility for medical services. The guidelines are updated annually based on the increase in the Consumer Price Index as shown in the Federal Registrar by the Department of Health and Human Services. The Program Eligibility Annual Income Guidelines as disseminated by the Department of Health are used to determine eligibility for the ESP and Antiepileptic Drug Program and are based on gross income.
(9) “Sliding Fee Scale” means a scale of charges which are less than the full cost of the service that clients shall be charged for ESP services. The fee scale for these services shall progress in increments of the full cost of services for those clients between 100 and 200 percent of the most current poverty guidelines published by the Federal Office of Management and Budget.
Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 402.166, 402.165, 402.167, 39 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.003, Amended________.
(Substantial rewording of Rule 64F-9.002 follows. See Florida Administrative Code for present text)
64F-9.002 Scope of Services Eligibility for ESP Services.
The ESP includes the following programs:
(1) Direct Client Services: A statewide program will be maintained to improve access, provide care and assistance to persons with epilepsy through the delivery of a comprehensive range of services that will have a positive effect on the quality of life. Services include client guidance, eligibility determination, case management, and service referrals.
(2) Prevention and Education: A statewide prevention and education program will be maintained to reduce the stigma associated with epilepsy, increase knowledge and understanding of epilepsy. Services include awareness activities, educational seminars, and presentations to various target groups to promote the early recognition, treatment, and prevention of epilepsy.
Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 402.33 FS. History–New 11-1-92, Amended 5-5-94, 4-29-96, Formerly 10D-117.006, Amended________.
(Substantial rewording of Rule 64F-9.003 follows. See Florida Administrative Code for present text)
64F-9.003 Direct Client Services Administration Individual Action Plan (IAP).
(1) Eligibility: An individual is eligible for the ESP – Direct Client Services Program if:
(a) He or she is a Florida resident;
(b) He or she is diagnosed or suspected of having a seizure disorder or epilepsy; and
(c) He or she cooperates in establishing eligibility, including providing the information necessary to complete the Application for Services Form and the Financial Worksheet.
The provider determines that the individual has met all eligibility criteria and assesses the eligibility of clients annually. An individual shall be ineligible and not enrolled in the ESP program if he or she does not meet the aforementioned criteria.
(2) Enrollment: If eligible for the ESP program, the provider shall enroll the individual as an ESP client in the program and will complete, distribute and discuss the following forms:
(a) Application for service;
(b) Financial worksheet;
(c) Client Right and Responsibilities;
(d) Grievance Form;
(e) Health Insurance Portability and Accountability Act (HIPAA) forms.
(3) Fee Assessment: There are no fees established for epilepsy case management services. Fees will be assessed for other direct client services, such as, medical services and Anti-Epileptic Drug Program. The fee shall be assessed using the total gross family income, the approved sliding fee schedule, and the financial worksheet. Providers must review proof of income for all adults in the household.
(a) All clients who are enrolled, or become enrolled, in Medicaid and all clients with a gross family income below 100 percent of the most current poverty guidelines published by the Federal Office of Management and Budget (OMB) shall be eligible for medical services provided by the ESP at no charge.
(b) When the gross family income is between 100 and 200 percent of the federal OMB poverty income guidelines the client would be responsible for payment of a portion of the provider's cost of the medical services provided based upon a sliding fee schedule.
(c) When the gross family income is at or above 200 percent of the federal OMB poverty income guidelines the client would be responsible for 100% of the provider’s cost of services.
(4) Waiver of Charges:
(a) CHD directors/administrators and their subcontractors have the authority to reduce or waive charges in situations where a person with an income above 100 percent of poverty is unable to pay.
(b) Clients may request a review of their fee charge on the basis that they have severe, unusual, and unavoidable expenses or obligations that substantially reduce their ability to pay and which warrant special consideration.
(c) Clients requesting special consideration must be able to submit receipts, tax records, bills, or certified statements that document their need for special consideration.
(5) Plan of Care (POC): Providers shall complete a Plan of Care (POC) with each ESP client. The POC is developed and implemented at the time of intake and it is reviewed at least annually to assure the client is on target with the stated goals and objectives.
(a) Purpose of the POC: The purpose of the POC is to identify an ESP client’s needs, delineate action to meet these needs and serve as the basis for case management.
(b) POC Development: The plan is based upon observations, self declaration, interviews, and progress reports. All client needs must be identified regardless of availability of resources.
(c) POC Goals: Goals will be specific, measurable, attainable, and will be developed in accordance with client’s consent.
(d) POC Core: At a minimum, providers will develop core goals for each of the following basic needs:
1. Epilepsy Medical Care and Treatment,
2. Epilepsy Education,
3. Overall Health Needs,
4. Financial Situation,
5. Transportation Needs,
6. Confidentiality: Relatives and friends may be informed of the POC only if the ESP client/legal guardian gives consent.
(6) Disenrollment: The provider may disenroll a client for any of the following reasons below:
(a) The ESP client no longer meets one of the eligibility requirements in Rule 64F-9.003, F.A.C.
(b) The ESP client does not agree and/or comply with the developed POC.
(c) The ESP client does not pay fee(s) for medical service and is unwilling to agree to a payment plan.
(d) The ESP client does not provide or complete information as requested by the provider.
(e) The ESP client is repeatedly billigerent and displays confrontational behavior towards staff.
(f) The ESP client is no longer in need of services.
(g) The ESP client request closure of their case file.
(h) The ESP client has not received services in the past 12 months.
Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207, 39, 402.33 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.006, Amended________.
(Substantial rewording of Rule 64F-9.004 follows. See Florida Administrative Code for present text)
64F-9.004 Epilepsy Services Program Prevention and Education Services Prevention Program Activities.
Epilepsy Services Program (ESP) will disseminate information through education and awareness activities to promote the early recognition, treatment, prevention and reduce stigma associated with epilepsy. The provider will ensure that epilepsy education awareness and prevention services are provided in all of Florida’s 67 counties through a network of statewide providers serving local communities. Persons with epilepsy and their families, professionals and the general public will receive education. There are no eligibility requirements for participation in activities.
Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.011, Amended________.
(Substantial rewording of Rule 64F-9.005 follows. See Florida Administrative Code for present text)
64F-9.005 Epilepsy Services Program ESP Reporting Requirements.
An annual report of services provided outlining the number of clients served, outcome reached and expenses incurred will be compiled and delivered to the Department of Health within 60 days of the end of the contract year.
Rulemaking Specific Authority 385.207(4) FS. Law Implemented 385.207 FS. History–New 11-1-92, Amended 4-29-96, Formerly 10D-117.014, Amended________.