RULE NO: RULE TITLE
65G-11.001: DD Waiver Waitlist Prioritization
65G-11.002: Wait List Prioritization Criteria
65G-11.001 Definitions.
In addition to the terms defined in Section.393.0634, F.S., and for the purpose of this rule chapter, the following terms and phrases shall have the following meanings:
(1) “Agency” is the Agency for Persons with Disabilities (“APD”).
(2) through (5) No change.
(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 and is incorporated by reference in Rule 65G-4.0026, F.A.C.
(7) No change.
(8) “Waiver” is a Home and Community Based Services (HCBS) waiver authorized by 42 U.S.C. 1396n(c) 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. iIn accordance with Section 393.0661(3), F.S. and Rules 65G-4.0026 through 65G-4.0029, F.A.C.
(9) “Wait List Priority Checklist” is the tool completed at the time an eligible individual applies for waiver-funded services and provides 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. The Checklist is hereby incorporated by reference and may be accessed on the APD website at: http://apdcares.org/customers/waitlist/docs/wait-list-categorization-checklist.xls.
Rulemaking Authority Section 393.065(7) FS. Law Implemented Section 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 category criterion, the highest-ranking category will be assigned. If funding is available, the Agency shall offer waiver enrollment to individuals on the wait list 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 receiving waiver services 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 to be provided to the agency, such as Florida Driver’s License, school records, utility bill, housing lease or rental agreement, or employment information.
(3) through (4) No change.
(5) Category 2 includes children who are jointly served by the Agency and the Department of Children and Family Services (“DCF”, also known as 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) No change.
(b) Individuals who are at substantial risk of incarceration or court commitment which is defined 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) No change.
(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 causing 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 12 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) through (g) No change.
(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) through (10) No change.
Rulemaking Authority 393.065(7) FS. Law Implemented Section 393.065(5) FS. History–New________.
65G-11.003 No change.