Current through Reg. 50, No. 187; September 24, 2024
(1)
Subject to funding availability, the Agency will accept oral or written
requests for crisis enrollment in a HCBS waiver by the applicant or the
applicant's family, guardian, guardian advocate, or support
coordinator.
(2) The applicant or
applicant's representative shall request crisis enrollment through the Area
Office in the service area where the applicant resides. The Agency may not
enroll an applicant on the waiver unless the Agency has determined that the
applicant has a developmental disability, as defined in Section
393.063(9),
F.S., and also meets the following waiver eligibility requirements listed in
the Handbook, Chapter 2 "Requirements to Receive Services":
(a) The recipient's intelligence quotient
(IQ) is 59 or less, or
(b) The
recipient's IQ is 60-69 inclusive and the recipient has a secondary
handicapping condition that includes:
1.
Cerebral palsy, spina bifida, Prader-Willi syndrome, epilepsy, autism,
or
2. Ambulation, sensory, chronic
health, and behavioral problems;
(c) The recipient's IQ is 60-69 inclusive and
the recipient has severe functional limitations in at least three of the
following major life activities:
1.
Self-care,
2. Learning,
3. Mobility,
4. Self-direction,
5. Understanding and use of
language,
6. Capacity for
independent living, or
(d) The recipient is eligible under a primary
disability of autism, cerebral palsy, spina bifida, or Prader-Willi syndrome
and the condition results in substantial functional limitations in three or
more major life activities listed in paragraph (c), above.
(3) The Area Office will collect pertinent
information and supporting documentation relevant to a crisis determination and
conduct a preliminary assessment based on the crisis status criteria specified
in Rule 65G-1.047, F.A.C.
(a) If the Area Office concludes that the
applicant does not meet crisis status or that the services needed are available
from other agencies or programs or covered by other third-party payors, the
Area Office will deny the crisis enrollment request and provide written
notification of the denial to the applicant or applicant's
representative.
(b) If the Area
Office concludes that the applicant may meet crisis status and does not have
access to insurance, other agencies or programs for needed services, or
concludes that programs in which the applicant is participating cannot meet the
applicant's service needs, the Area Office will submit its initial assessment
and supporting documentation to the Central Office for review and final
determination of whether the applicant meets crisis status. The applicant or
the applicant's representative may, upon request, review the initial assessment
and supporting documentation to ensure that all necessary information is
included.
(4) The Central
Office will notify the Area Offices of deadlines for submission of crisis
enrollment requests to the Central Office for periodic review. Following review
of the submissions, the Central Office will notify the Area Office whether it
has approved or denied each submission. The Area Office is responsible for
notifying the applicant or applicant's representative of the Central Office's
final crisis determination.
(a) APPROVAL.
1. If funding is available and the applicant
is approved for crisis enrollment, the applicant will be offered placement on
the FSL waiver, unless that waiver cannot reasonably meet the applicant's
specific service needs for addressing the crisis. In such instances, the person
will be offered placement on the DD waiver. In determining the appropriate
waiver placement, the Central Office will consider the availability of services
necessary to resolve the crisis situation that are not provided under the FSL
waiver, including the need for residential habilitation services, nursing
services beyond the coverage provided through the Medicaid State Plan, or
placement in a residential facility.
2. After the Central Office determines the
appropriate waiver placement, the Area Office will provide written notice of
placement to the applicant or applicant's representative. If the applicant is
not already a client of the Agency or is not already on a preenrollement
category, the Agency will provide a full determination of the applicant's
eligibility for services within 45 days of the crisis eligibility
determination, as provided in Section
393.065(2),
F.S. Eligibility for Medicaid waiver services is contingent upon eligibility
for the state Medicaid services, such as Supplemental Security Income (SSI),
MEDS-AD, or TANF provided by the Department of Children and Families, as
required by the Handbook, Chapter 2, "Requirements to Receive Services." If the
applicant is not enrolled in a state Medicaid program, the Area Office will
refer the applicant to the local Department of Children and Families for
submission of a Request for Assistance (RFA). If the applicant is deemed
eligible for state Medicaid, the Area Office will complete the waiver
enrollment. If the applicant is not Medicaid-eligible, the Area office will
rescind the approval for crisis enrollment on the Medicaid
waiver.
(b) DENIAL. The
Area Office will notify the applicant or applicant's representative in writing
of a denial of crisis enrollment. If the Agency denied the application based on
lack of documentation and additional documentation becomes available, or a
change in the applicant's situation may affect the applicant's status for
crisis determination, the applicant may reapply to the Area Office for crisis
consideration.
Rulemaking Authority
393.501(1),
393.065 FS. Law Implemented
393.065.
New 9-19-07, Formerly
65G-1.046.
