65G-2.016: Residential Fee Collection
PURPOSE AND EFFECT: The purpose of this new rule is to allow for the equitable collection of third party benefits from clients that receive funds in excess of their person needs allowance and room and board payments. This rule will have the effect of reducing excessive and unnecessary payments to clients or their representative payees, and will help to prevent clients from being disqualified from Medicaid due to the availability of excess funding.
SUMMARY: This rule provides for the payment of an adult client's room and board in a licensed residential facility and allows the agency to assess a fee upon third-party benefits that an adult client receives in excess of his or her personal needs allowance and room and board costs.
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:
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: 393.501(1), 402.33 FS.
LAW IMPLEMENTED: 402.33 FS.
A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: February 3, 2012, 9:00 a.m. – 11:00 a.m.
PLACE: Agency for Persons with Disabilities, 4030 Esplanade Way, Room 301, Tallahassee, Florida 32399
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 7 days before the workshop/meeting by contacting: Fran Blanton, Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 335, Tallahassee, Florida 32399, (850)922-4204, fran_blanton@apd.state.fl.us. 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: Fran Blanton, Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 335, Tallahassee, Florida 32399, (850)922-4204, fran_blanton@apd.state.fl.us
THE FULL TEXT OF THE PROPOSED RULE IS:
65G-2.016 Residential Fee Collection.
(1) This rule applies to all clients, as defined in Section 393.063, Florida Statutes, who are eighteen years of age or older, who receive residential habilitation services, and who live in a foster care facility, group home facility, residential habilitation center, or comprehensive transitional education program, licensed pursuant to Section 393.067, Florida Statutes.
(2) Definitions. For the purposes of this operating procedure, the following terms shall be defined as follows:
(a) Agency. As defined in Section 393.063, F.S., the term means the Agency for Persons with Disabilities.
(b) Client. As defined in Section 393.063, F.S., the term means any person determined eligible by the agency for services under Chapter 393, F.S.
(b) Personal Needs Allowance. A portion of the third party benefit payment that must be set aside and used for the direct benefit of the client.
(c) Residential Habilitation. Supervision and specific training activities that assist the client to acquire, maintain or improve skills related to activities of daily living. The service focuses on personal hygiene skills such as bathing and oral hygiene; homemaking skills such as food preparation, vacuuming and laundry; and on social and adaptive skills that enable the client to reside in the community. This training is provided in accordance with a formal implementation plan, developed with direction from the client and reflects the client’s goal(s) from their current support plan.
(d) Room and Board Payment. Reimbursement to the operators of facilities or programs licensed pursuant to Section 393.067, Florida Statutes, to cover the cost of providing food and shelter to Agency clients (who also receive residential habilitation services) in accordance with Chapter 65G-2 of the Florida Administrative Code.
(e) Third party benefits. As defined in Section 402.33, F.S., the term means moneys received by or owing to a client or responsible party because of the client’s need for or receipt of services such as those provided by the agency. This term includes, but is not limited to, Medicare payments, workers’ compensation, and Supplemental Security Income.
(3) Room and Board Payment Rates. Providers serving clients who receive residential habilitation services within a facility licensed pursuant to Section 393.067, Florida Statutes, will receive a room and board payment which is dependent upon the amount of third party benefits the client receives.
(4) Payments to Providers:
(a) The room and board payment is calculated by subtracting a personal needs allowance ($93.58 per month) from the client’s third party monthly benefit. The room and board ($543.42) payment is then subtracted from the remaining benefit amount. If the third party benefit minus the client’s personal needs allowance and room and board amount exceeds $637, the balance less federal exceptions shall be subject to the provisions in subsection (5) below.
(b) For clients receiving residential habilitation services in a facility licensed pursuant to Section 393.067, Florida Statutes, whose monthly third party benefits minus the personal needs allowance are less than $543.42, the provider will receive a room and board payment equal to the difference between $543.42 and the amount the client receives from third party benefits.
(5) Fees assessed:
(a) For clients receiving residential habilitation services in a facility licensed pursuant to Section 393.067, Florida Statutes, whose monthly third party benefits minus the personal needs allowance are greater than $543.42, the client or client’s representative payee must send a payment to Agency for Persons with Disabilities that is equal to the difference between the total amount of monthly third party benefits that the client received and the total cost of the room and board payments plus the client’s personal allowance ($637.00).
(b) Payments made pursuant to paragraph (5)(a) must be sent to the local APD area office by the 15th day of the month after receipt of the third party benefit payments. If the 15th of the month falls on a weekend or national holiday, then the payment due date will be the next business day immediately thereafter. Checks or money orders should be made payable to Agency for Persons with Disabilities (or APD). Individuals or organizations serving as the representative payees for third party benefit payments should submit a single check or money order to the Agency each month.
(c) Clients or representative payees for clients may include federally approved exemptions or deductions in the calculation of the fees assessed pursuant to this subsection.
(6) Mandatory Monthly Reports to the Agency.
(a) Every client or representative payee for a client, including a facility or program licensed pursuant to Section 393.067, Florida Statutes, must report to the appropriate APD area office by the 15th day of the month. The report must include a calculation for each client that includes:
a. The total third party benefit payments that the client receives;
b. The amount to be subtracted from the client’s third-party benefits for payment of the client’s room and board and for the client’s personal needs allowances;
c. Each individual federally approved deduction or exemption that the client has included in the calculation; and
d. The total amount owed to the provider pursuant to subsection (4) of this rule or the total amount of the fee assessed pursuant to subsection (5) of this rule.
(b) If the monthly report described in this subsection indicates that a fee should be assessed to the client’s third party benefits pursuant to subsection (5) of this rule, the client or representative payee for the client must also include a payment of the assessed fee with the monthly report.
(c) If the 15th day of the month falls on a weekend or national holiday, then the payment due date will be the next business day immediately thereafter.
(7) Review of Assessed Fees.
(a) Substantially affected individuals may request a review the fees assessed upon their third party benefit payments by submitting a request for review to the applicable area office in writing.
(b) If the substantially affected individuals still disagree with the fees assessed upon their third party benefit payments after their request for review, they may request an administrative hearing pursuant to Section 393.125, Florida Statutes.
Rulemaking Authority 393.501(1), 402.33 FS. Law Implemented 402.33 FS. History–New_________.