RULE NO: RULE TITLE
59G-13.083: Developmental Disabilities Waiver Services
The purpose of the amendment to Rule 59G-13.083, F.A.C., is to incorporate by reference the revised Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, May 2010. The following revisions have been made to the handbook.
Page 1-17: Adult Dental Services Provider Requirements, Provider Qualifications. Second paragraph has been changed to read:
Unlicensed dental interns and dental students of university based dental programs may provide services under the general supervision of a licensed dentist but cannot act as a treating provider or bill Medicaid for covered services. The licensed supervising dentist of the facility acts as the treating provider of a covered service. A dentist who has a teaching permit issued by the Florida Board of Dentistry as outlined in Section 466.002, F.S., may also act as the treating provider of a covered service. The facility may bill Medicaid for covered services.
Page 1-18: Behavior Analysis Provider Requirements, Provider Qualifications. Level 3 has been changed to read:
Board or Florida Certified Assistant Behavior Analyst or a Florida Certified Behavior Analyst with bachelors or high school diploma, regardless of experience.
Page 1-20: Companion Provider Requirements, Provider Qualifications. First paragraph has been changed to read:
Providers of companion services may be home health or hospice agencies licensed in accordance with Chapter 400, Parts III and IV, F.S. If providing this service as an agency or group provider, using more than one employee to provide companion services and billing for their services, the provider must be registered as a sitter or companion provider in accordance with Section 400.509, F.S. if not licensed as a home health agency or a hospice.
Page 1-22: Durable Medical Equipment Provider Requirements, Provider Qualifications. Second paragraph has been changed to read:
In accordance with 42 C.F.R. 440.70, part providers must be in compliance with all applicable laws relating to qualifications or licensure.
Page 1-22: Durable Medical Equipment Provider Requirements, Provider Qualifications, fifth paragraph has been changed to read:
Pharmacies shall hold a permit to operate issued in accordance with Chapter 465, F.S. Medical supply companies and durable medical equipment suppliers shall hold local occupational licenses or permits, in accordance with Chapter 400, Part VII, F.S.
Page 1-22: Durable Medical Equipment Provider Requirements, Provider Qualifications, sixth paragraph has been deleted.
Page 1-31: Respite Care Services Provider Requirements, Provider Qualifications. Third paragraph has been changed to read:
Independent vendors, who are not nurses, are not required to be licensed, certified, or registered if they bill for and are reimbursed only for services personally rendered.
Page 2-11: Definitions, Implementation Plan. Second paragraph has been changed to read:
The implementation plan will be developed, at a minimum, within 30 days of the initiation of the new service, or within 30 calendar days of the support plan effective date for continuation of services and annually thereafter. A copy of the implementation plan, approved by the recipient, shall be furnished to the recipient, guardian and to the waiver support coordinator at the end of this 30-day period. The progress toward achieving the goal(s) identified on the implementation plan shall be documented in daily progress notes or quarterly summaries, as specified in each service description. Data supporting the recipient’s progress or lack thereof, summarized in the quarterly summary shall be available for review.
Page 2-12: Definitions, Monthly Summary. Deleted
Page 2-13: Definitions, Quarterly Summary, The following has been added to the text to read:
A written summary of the quarter’s activities indicating the recipient’s progress toward achieving support plan goals for the services billed in that quarter.
For residential nursing services, the quarterly summary must include details such as health risk indicators, information about medication, treatments, doctor’s appointments and anything else of significance regarding the recipient’s health.
Page 2-13: Definitions, Service Log. The text has been changed to read:
A form used to document service delivery. The service log shall include the recipient’s name and Medicaid ID number. The log shall include the date, time, duration of the service, and summary of services provided.
Page 2-13: Definitions, Supported Living Log, has been changed to read:
Written documentation of the dates, times and summary of the supports provided during contact with the recipient, as described in Rule 65G-5.012, F.A.C.
Page 2-24: Behavior Analysis Services, Description. A third paragraph has been added to read:
Delivery of behavioral services is a complex process that includes provision of services directly to the recipient, at times, or others supporting the recipient in his or her presence, as well as services required to assess, plan and train others without the recipient present. Examples of services provided to the recipient to caregivers, staff or other providers while the recipient is present include: analog functional analysis, observation of the recipient for descriptive functional assessment, observations of and feedback regarding interactions of caregivers, staff or other providers with the recipient, modeling procedures with the recipient for caregivers, staff, or other providers, probing new procedures with the recipient, and direct training to the recipient (typically with caregivers, staff, or other providers present). In addition, services required to support behavior analysis services, may include: behavior plan development, graphing and analysis of data, behavior plan revision, training staff, caregivers or other providers (recipient not present), consultation to other professionals, Local Review Committee presentation, and treatment team meeting (with or without recipient present). The latter support services may not be reimbursed in excess of 25 percent of the total units for the cost plan year.
Page 2-26: Behavior Analysis Services, Documentation Requirements. The last item has been changed to read:
*Dated evidence of LRC reviews and recommendations specific to target behaviors and the behavior plan, when the procedures and behaviors meet criteria for review and approval in accordance with Rule 65G-4.010, F.A.C.
Page 2-47: Durable Medical Equipment and Supplies, Special Considerations. The last paragraph has been changed to read:
In accordance with Section 393.13, F.S., totally enclosed cribs and barred enclosures are considered restraints and are not covered under the waiver. Strollers and wheelchairs, when used for restraint as defined in Rule 65G-8.001, F.A.C., are also not covered.
Page 2-70: Residential Habilitation Services, Documentation Requirements, reimbursement and monitoring documentation. Item number five has been changed to read:
LRC review and approval dates and recommendations made specific to the plan and review schedules for the plan as indicated in Rules 65G-4.009 and 65G-4.010, F.A.C. for individuals residing in licensed behavior focus or intensive behavior homes; and
Page 2-70: Residential Habilitation Services, Documentation Requirements. Documentation to be sent to the waiver support coordinator, item number four has been changed to read:
LRC review dates and recommendations made specific to the plan and review schedules for the plan as indicated in Rules 65G-4.009 and 65G-4.010, F.A.C., for individuals residing in licensed behavior focus and intensive behavior homes; and
Page 2-76: Residential Habilitation Services, Residential Habilitation with a Behavioral Focus. First paragraph has been changed to read:
In order for the provider to receive a residential habilitation with a behavioral focus rate for a recipient based on the Provider Rate Table, the provider must meet the specified staff qualifications for the service, and the recipient must exhibit the characteristics listed below. This rate level shall be approved only when it has been determined through use of the APD-approved assessment by a certified behavior analyst and the support planning process that a recipient requires residential habilitation services with a behavioral focus. The need for residential habilitation with a behavioral focus and the rate for the service shall be identified on the recipient’s support and cost plan and on the authorization for service submitted to the provider by the recipient’s support coordinator. Service authorization shall be based on established need and re-evaluated at least annually while the recipient is receiving the services. The provider must document evidence of continued need as well as evidence that the services are assisting the service provider in meeting the needs of the recipient so that transition to less restrictive services may be possible.
Page 2-77: Residential Habilitation Services, Intensive Behavioral Residential Habilitation. First paragraph has been changed to read:
Intensive behavioral residential habilitation rates for a recipient must be approved and authorized through the prior service authorization process performed by the APD or an agent of the APD. Authorization shall require review by at least one board certified behavior analyst or a Florida certified behavior analyst with expanded privileges who holds a master’s degree with a primary emphasis in applied behavior analysis. The review process shall include evaluation of the proposed rates for the service being sought. Authorized rates for this service may vary across providers and recipients based on the specific service needs of the recipient. Service authorization shall occur prior to service delivery, for new services, within 30-days of the adoption of this rule for existing services and at least annually while the recipient is receiving the service. The provider must meet provider qualifications for this level of service. Further, the following recipient characteristics and service characteristics must be met in order to receive an intense behavioral residential habilitation rate. Service authorization shall be based on established need and re-evaluated at least annually while the recipient is receiving the services. The provider must document evidence of continued need as well as evidence that the service is assisting in meeting the needs so that transition to less restrictive services may be possible.
Page 2-102: Support Coordination, Support and Service Planning Requirements. First paragraph has been changed to read:
A copy of support plan information, pertinent to the provider, and an approved service authorization will also be provided to other providers of services to authorize and initiate service delivery by the effective date of the approved support and cost plans. Through conversations with the recipient, those who know the recipient well, and through review of the service vendor’s documentation, the waiver support coordinator monitors the recipient’s involvement in purchased services to determine if the activities meet the recipient’s expectations. The waiver support coordinator will determine that these services are age and culturally appropriate; address the need for which they are intended; and provide appropriate challenges, motivation and experiences to meet the recipient’s identified goals.
Page 2-122: Transportation, Description. Fifth paragraph has been changed to read:
Fifteen passenger vehicles that are not lift-equipped shall not carry more than ten passengers at any given time and shall reference the National Highway Transportation Safety Board guidelines for loading such vehicles.
Page 3-4: Reimbursement Information, Limitations, first paragraph has been changed to read:
Providers may not bill for service when a recipient is not in attendance, except as noted in the description section of that service.
APPENDIX A
Page A-8: 2.0 Program Requirements, paragraph E. has been amended to read:
The provider agrees, within the mission and scope of the service(s) offered, to assist people in their achievement of personal goals, choice, social inclusion, relationships, rights, dignity and respect, health, environment, security and satisfaction.
Page A-8: 2.0 Program Requirements, Paragraph F. has been changed to read:
The provider agrees to participate in and support the individually determined outcome process for each recipient. The provider will also use the recommendations from the person-centered review process to: (1) implement person-centered supports and services; (2) enhance service delivery in a manner that supports the achievement of individually determined outcomes; and (3) make improvements in the provider’s service delivery system.
Page A-9: 2.1 Required Training. Paragraph E. has been changed to read:
The Medicaid Waiver Services Agreement and its Attachments. The Developmental Disabilities Waiver Services Coverage and Limitations Handbook and its appendices, and the use of personal goals to establish a person-centered approach to service delivery;
Page A-10: 3.0 Administrative Policies, Procedures, and Practices. Section B, first paragraph was deleted, paragraphs 2.-8. renumbered 1.-7. and item six was changed to read:
The provider’s grievance procedures, as outlined in section 3.9 of this document;
Page A-11: 3.1 Self-Assessment. Paragraph is changed to read:
Each agency or group provider, or solo or individual provider furnishing specific services referenced in 3.0 above shall perform an annual self-assessment to determine the effectiveness of services being offered and the provider’s compliance with requirements identified in this agreement and the Developmental Disabilities Waiver Services Coverage and Limitations Handbook. This annual assessment will assist the provider to determine, within the realm and scope of the service(s) that is provided, the extent to which the provider is developing and maintaining person-centered processes that will assist recipients in the achievement of personal goals, choice, social inclusion, relationships, rights, dignity and respect, health, environment, security and satisfaction. At a minimum, the provider’s self-assessment survey will include a combination of: a) records review; b) interviews to determine the extent to which provider actions support the achievement of personal goals identified by recipients receiving services; and c) annual recipient satisfaction surveys. The provider, as part of the self-assessment process, develops a Quality Improvement Plan addressing the areas in need of improvement.