65G-11.001: DD Waiver Waitlist Prioritization
65G-11.002: Wait List Prioritization Criteria
65G-11.003: Wait List Prioritization Procedure
PURPOSE AND EFFECT: The purpose of this proposed rulemaking is to provide specific rule language to implement the prioritizing of the waitlist for enrollment on the Developmental Disabilities Home and Community Based Services Waivers. This rule is required to implement statutory language to Chapter 393, F.S., adopted during the 2009 Florida Legislative session.
SUMMARY: This rule describes the categories for the waitlist for waiver services as required by Florida Statute 393.065(5). Included in the rule is the documentation needed from individuals and the process the Agency will use to make the waitlist prioritization assignment.
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: 393.065(7) FS.
LAW IMPLEMENTED: 393.065(5) FS.
A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: June 9, 2010, 3:00 p.m. – 5:00 p.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: Denise Arnold, Agency for Persons with Disabilities, 4030 Esplanade Way, Room 301, Tallahassee, Florida 32399, (850)488-3673. 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: Denise Arnold, Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399, (850)488-3673
THE FULL TEXT OF THE PROPOSED RULE IS:
65G-11.001 Definitions.
In addition to the terms defined in Section 393.064, F.S., and for the purpose of this rule, the following terms and phrases shall have the following meanings:
(1) “Agency” is the Agency for Persons with Disabilities.
(2) “Area Office” is the local office responsible for management one of the Agency’s service areas.
(3) “Caregiver” is defined as the person who provides personal care, supervision, training or housing to an individual and who is not paid by APD to perform these tasks. For purposes of this rule, a caregiver is defined as a parent stepparent, grandparent, sibling, spouse or other relative or friend living in the same residence as the individual. Further, the caregiver must be a resident of the State of Florida for a minimum of 12 consecutive months and may not be receiving monetary compensation for the caregiver duties.
(4) “Central Office” is the Agency’s headquarters located at 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399-0950, main telephone number (850)488-4257.
(5) “Crisis Enrollment” is the waiver enrollment of an eligible individual to a Home and Community Based Services Waiver, in accordance with Rule 65G-1.046, F.A.C.
(6) Questionnaire for Situational Information (QSI)” is the agency approved assessment that assesses a person’s need for level of support in areas of community living, functional, behavioral and physical health. The assessment is completed every three years and is updated as the needs and life circumstances of the individual changes. The QSI is administered by trained and certified agency staff.
(7) “Waitlist” is the prioritized list maintained by the APD Central Office of Persons with Disabilities that have been determined eligible for APD services and eligible to receive waiver services when funding is available.
(8) “Waiver” is a Home and Community Based Services (HCBS) waiver authorized by 42 U.S.C. 1396n© of the federal Social Security Act and Section 409.906, F.S., that provides Medicaid funding for home and community based services to eligible persons with developmental disabilities who are eligible for Agency services and who live at home or in a home-like setting. The Agency currently operates four HCBS waivers: Tier One, Two, Three and Four. In accordance with Section 393.0661(3), Florida Statutes and Rules 65G-4.0026 through 65G-4.0029, Florida Administrative Code.
(9) “Wait list Priority Checklist” is the tool completed at the time an eligible individual applies for waiver-funded services and consists of an indication of the category that the individual will be placed on the wait list. This checklist identifies services needed and current services received and requests information about the individual’s current and short-term life situation, condition and circumstances. The checklist is reviewed on an annual basis and is updated when the Agency is notified that the individual’s needs and circumstances have changed.
Rulemaking Authority 393.065(7) FS. Law Implemented 393.065(5) FS. History–New________.
65G-11.002 Wait List Prioritization Criteria.
(1) In accordance with Chapter 393, F.S., beginning July 1, 2010, the Agency will assign a category of priority for the wait list by collecting information about the individual’s needs and the status of the individual’s caregiver if applicable. If an individual meets the criteria for more than one criterion, the highest-ranking category will be assigned. If funding is available, the Agency shall offer waiver enrollment to individuals on the waitlist in the order of the categories, category 1 being the top category. Within each category, the date the individual was determined eligible for the wait list shall be determine the order for waive documentation provided to the agency, such as, Florida Driver’s License, school records, utility bill, housing lease or rental agreements, employment information.
(2) Determination of residency of the caregiver for 12 consecutive months shall be determined by documentation provided to the agency, such as Florida Driver’s License, school records, utility bill, housing lease or rental agreement, employment information.
(3) If a backup caregiver is available, the name, relationship and age of the backup caregiver must be provided.
(4) Category 1 includes individuals determined to meet the crisis criteria specified in Rule 65G-1.047, F.A.C. The process for crisis determination will follow the requirements outlined in Rule 65G-1.046, F.A.C.
(a) Individuals whose situation has reached a crisis may request a crisis application be completed by the area office. In addition to the requirements of Chapter 65G-1, F.A.C., the following shall apply:
(b) A temporary placement in jail is not considered a form of housing and therefore will not exclude the individual from the definition of homeless. Additionally an individual that is within 90 days of discharge from an institutional setting and does not have an acceptable home or residential situation in place shall be considered in Category 1.
(5) Category 2 includes children who are jointly served by the Agency and the Department of Children and Families in the Child Welfare program. A monthly data match between the two agencies identifies these individuals. DCF may bring to the attention of APD any child in need of critical services with an open case with the Department of Children and Families in the Child Welfare program, rather than wait for the data match. If the youth is still on the wait list for APD services at the age of 18 when they age-out of foster care, the youth will remain under Category 2 until they begin receiving services, unless they are deemed homeless and qualify under Category 1.
(6) Category 3 includes the following individuals:
(a) Individuals for whom the caregiver has a condition or circumstance that is expected to render the caregiver unable to provide care within the next twelve months and other caregivers are unable, unwilling or unavailable to provide care. The evaluation of the caregiver’s condition or circumstance should consider the level of care necessitated by the client’s needs and the caregiver’s ability to provide that level of care. The condition or circumstance that renders the caregiver unable must be documented by a physician’s statement if it is a medical condition and must explain the reason the current caregiver can no longer provide the individual’s care. Circumstances that are not medical in nature must be described and signed by the caregiver and notarized. This documentation will be provided to the Area Office for a determination of eligibility for Category 3.
(b) Individuals who are at substantial risk of incarceration or court commitment as defined by unlawful activity by the individual that has required the intervention of local or state law enforcement even if the unlawful activity did not result in an arrest or criminal charges. Documentation is required to include a summary of incidents in which the individual has engaged in dangerous behavior, has past history of involvement with the court system or law enforcement, is currently involved with the court system or law enforcement, multiple arrests, incarceration in jail, prison or admission to the mentally retarded defendant program.
(c) This category includes individuals who are currently incarcerated and are expected to be released within 12 months. Documentation for placing an individual in the priority category includes copies of any past court commitments, documentation from law enforcement, and court ordered competency evaluations. Documentation must include: 1) a summary of incidents in which the individual has engaged in dangerous behavior, has past history of involvement with the court system or law enforcement, is currently involved with the court system or law enforcement, multiple arrests, incarceration in jail, prison or admission to the mentally retarded defendant program, and 2) copies of any past court commitments, documentation from law enforcement, and court ordered competent evaluations.
(d) Individuals whose behaviors or physical needs place them or their caregiver at risk or harm within the next 12 months, and for whom no other supports are currently available to meet their needs. In such cases, the individual will provide documentation of behaviors that are causing the risk or potential harm or the physical needs that are present and the medical treatment provided to the individual or to others because of the individual’s behavioral or physical issues. Documentation of behaviors or physical needs that are casing the risk or potential harm and the medical treatment provided to the individual or to others because of the individual’s behaviors or physical needs must be provided. Documentation of the frequency, intensity and duration of behavioral incidents and an explanation of behavioral interventions that have used must also be provided.
(e) Individuals who are identified by the facility as ready for discharge from a state mental health hospital, intermediate care facility for the developmentally disabled, a skilled nursing facility, correctional facility, or a secure forensic facility within the next twelve months. There must be evidence that without the provision of waiver-funded services, these individuals will be at risk of readmission to an institution due to a lack of available caregiver or a lack of appropriate or available services. Documentation for this category must include a discharge summary from the facility that indicates the individual is ready for discharge or no longer meets the criteria for the level of care required by the facility and the status of available caregivers for the individual. Documentation that there are no other resources or services available other than waiver services to meet the individuals needs must be provided.
(f) Individuals receiving Voluntary Protective Services (VPS) or requesting DCF assistance to prevent their child from entering foster care. The parents or caregivers shall provide documentation from the applicable agencies or departments confirming this information
(g) In reviewing the caregiver’s ability to provide, care the Agency shall consider the reliability and long-term commitment of the caregiver in order to ensure continuity of care. Additionally, the caregiver’s responsibility for other minors under their care shall be considered.
(7) Category 4 includes individuals whose primary caregiver is age 70 years of age or older and no other alternate caregiver is available, willing or able to provide support. Additionally, other government or community resources are not available to provide assistance for the caregiver. Documentation of the date of birth of the primary caregiver must be provided as well as documentation that the individual needs a caregiver and no other caregiver is available is required. The Agency shall include a review of the caregiver’s ability to provide the level of support the individual needs and not just consider the age of the caregiver. The health of the caregiver(s) will be considered. Additionally the age of both parents who are providing care giving shall be considered and if one is able to provide the care then the individual will not be considered for Category 4.
(8) Category 5 includes individuals who are expected to graduate from secondary school within the next 12 months, individuals who have received a special diploma and need the support available through waiver funded services to obtain or maintain competitive employment, or individuals who have applied for and been accepted to an accredited institution for postsecondary education. Documentation of the individual’s graduation is required as well as documentation that there are no other resources available, other than waiver funded services to provide the individual with the support to obtain or maintain a job.
(9) Category 6 includes individuals who are age 21 years of age older and do not meet the criteria for any other category. Documentation of this category is obtained through verification of the individual’s date of birth and verification that documentation does not qualify the individual for any other category. The Agency shall provide short term services to these individuals through the use of Social Services Block Grant funding as allocated by the legislature, These services shall not duplicate any services required by other state agencies or departments and shall only be provided when other community resources are not available.
(10) Category 7 includes those individuals who are younger than 21 years of age and who do not meet the criteria for any other category. Documentation of this category is obtained through verification of the individual’s date of birth and absence of any documentation that places an individual into another category. The Agency shall provide short-term services to these individuals using Social Services Block Grant funding as allocated by the legislature. These services shall not duplicate any services required by other state agencies or departments and shall only be provided when other community resources are not available. Prevention and early intervention services that are critical to the child’s developmental growth shall be a high priority for services from the Agency as well as support to the parents or caregivers to maintain the child in the family home.
Rulemaking Authority 393.065(7) FS. Law Implemented 393.065(5) FS. History–New________.
65G-11.003 Wait list Prioritization Procedure.
(1) The Agency shall assign the wait list categories to each individual on the wait list upon adoption of this rule by using information from the current needs assessment and the Questionnaire for Situational Information (QSI), version 4.0, and the Wait list Prioritization Checklist. Additionally, the Agency will also request information about: 1) identification of the current caregiver, 2) demographic information of the caregiver, 3) medical circumstances or other circumstances of the caregiver that prevent the caregiver from providing care, and 4) the availability of other caregiver.
(2) The Agency will notify each individual/guardian on the wait list in writing of the individual’s assigned wait list category and eligibility determination date. The individual/guardian may submit documentation to the area office if there is a need for the category assignment to be reconsidered. Upon review of the information provided, the Agency will notify the individual in writing within 15 working days, of the reconsideration decision.
(3) At any time during the year, the individual can request a revaluation to move to another category by submitting to the area office a written request with the required documentation as specified for each category.
(4) The individual, family or guardian must ensure that accurate address and phone contact information is provided to the area staff and must notify the area office at any time this information changes.
(5) Individuals will be removed from the wait list and the individual’s Agency record will be closed if the individual: becomes domiciled in another state,
(a) Becomes ineligible for APD and the waiver, or
(b) Cannot be contacted or located over a two month period using the information provided to the area office staff, The individual can reapply for APD services at any time.
(6) The Agency shall provide regular communication to the individuals on the wait list and their parents/guardians/family members regarding possible resources in the community or other government programs, and the ongoing activities of the Agency.
Rulemaking Authority 393.065(7) FS. Law Implemented 393.065(5) FS. History–New________.