65G-4.0026: Tier Waivers
PURPOSE AND EFFECT: To set a 45-day time limit for the Agency to review tier eligibility when a client requests additional services on the basis of a significant change in circumstances or on the basis that the change is necessary to avoid institutionalization and the requested services cause the clients cost plan to be over the current tier expenditure cap.
SUBJECT AREA TO BE ADDRESSED: Client requests for additional waiver services that cause the clients cost plan to be over the tier expenditure cap.
SPECIFIC AUTHORITY: 393.0661(3) FS.
LAW IMPLEMENTED: 393.0661(3) FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE NOTICED IN THE NEXT AVAILABLE FLORIDA ADMINISTRATIVE WEEKLY.
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: Marc Ito, Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399, (850)922-4556, marc_ito@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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Marc Ito, Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399, (850)922-4556, marc_ito@apd.state.fl.us
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
65G-4.0026 Tier Waivers.
(1) through (4) No change.
(5) Upon a client’s request submitted by the waiver support coordinator, tThe Agency will review a client’s tier eligibility when a client has a significant change in circumstance or condition that impacts on the client’s health, safety, or welfare or when a change in the client’s plan of care is required to avoid institutionalization. The information identifying and documenting a significant change in circumstance or condition that necessitates additional or different services must be submitted by the client’s Waiver Support Coordinator to the appropriate Agency Area office for determination. The agency shall determine whether the client is eligible for a different tier revision of the tier assignment is necessary when the additional service has been determined medically necessary approved through the prior service authorization process.
(a) If a client has submitted a request pursuant to this subsection, the agency shall determine whether the client is eligible for a different tier within forty-five days of the agency’s receiving notice of either of the following events,
1. An additional service is determined medically necessary through the prior service authorization process and such additional service causes the client’s cost plan to be over the client’s current tier cap; or
2. An additional service is determined medically necessary through the prior service authorization process and such additional service is not available under the client’s current tier.
(b) The 45-day time limit in paragraph (a) shall not apply when unusual circumstances make it difficult or impossible for the agency to comply with the 45-day time limit. “Unusual circumstances” means an administrative or other emergency beyond the agency’s control, but does not mean any delay caused by the agency’s administrative procedures.
(6) through (7) No change.
Rulemaking Authority 393.0661(3) FS. Law Implemented 393.0661(3) FS. History–New 3-7-10, Amended_________.