Current through Reg. 50, No. 187; September 24, 2024
(1) Requesting IFS.
(a) A request for IFS can be made orally or
in writing to the appropriate Agency regional office by a client, client's
legal representative, or client's support coordinator. IFS can also be
initiated by the Agency.
(b) A
request for IFS must include:
1. The name and
address of the client for whom IFS is being requested;
2. If the requester is different than the
client, the name, contact information, and relationship with the client of the
individual submitting the IFS request;
3. A description of the specific need to be
addressed by the requested IFS service(s);
4. Documentation that demonstrates the
specific need to be addressed by the requested IFS service(s); and
5. An explanation of the efforts taken to
address those needs through other funding sources and natural
supports.
(2)
Within 30 calendar days of receipt of a request for IFS, the Agency will
approve, partially approve, deny, reduce, terminate, or request additional
documentation to supplement the request. If additional documentation or
information is requested, the deadline for the Agency's response shall be
extended to 60 calendar days following the receipt of the original request for
IFS.
(a) If the Agency requests additional
documentation:
1. The requester shall either:
a. Provide the requested documentation or
information within 10 calendar days of the date of the written notice;
or
b. notify the Agency in writing
that the individual requesting IFS wishes the Agency to render its decision
based upon the documentation and information provided with the initial
request.
2. If the Agency
does not receive the requested additional information, the Agency will make a
determination of the request for IFS based on the information
available.
(3)
Prior to authorizing the use of IFS, the support coordinator or, if the client
is not enrolled on the Waiver, the Agency, shall assist the client with
exploring alternative funding and service(s) options for which the individual
may be eligible to receive in accordance with subsection
65G-13.003(3),
F.A.C.
(a) If alternative funding and/or
service(s) options are available or become available, the Agency shall
partially approve, deny, reduce, or terminate the request for IFS to the extent
not covered from the alternative funding and/or service(s).
(b) The support coordinator shall document in
iConnect the alternative options that were explored.
(4) Approval for IFS.
(a) IFS funds can only be encumbered for the
current fiscal year.
(b) IFS will
not be approved retroactively, except in limited circumstances:
1. To correct an administrative error;
or
2. On a case-by-case basis to
consider a health and safety risk to the client or emergency
situations.
(c) The
regional office shall only approve IFS for clients who meet the IFS eligibility
criteria described in Rule
65G-13.003, F.A.C., and the
Agency has available funds.
(5) IFS shall not be approved for goods or
services if the client:
(a) Requested and was
denied the same goods or services provided under the Medicaid State Plan and/or
the Waiver under the same or substantially similar circumstances;
and/or
(b) Is in the process of
disputing a denial or termination pertaining to the same goods or services
under the Medicaid State Plan and/or the Waiver.
(6) Denial or Partial Approval of IFS.
(a) If the regional office concludes that the
client's request does not meet or only partially meets the IFS criteria
described in Rule 65G-13.003, F.A.C., the regional
office shall deny, reduce, partially approve, or terminate the IFS request and
provide written notification of the denial to the client or client's legal
representative within the timeframe established in subsection (2) of this
rule.
(b) If the Agency denies or
partially approves a request for IFS based on lack of documentation and
additional documentation subsequently becomes available, or there is a change
in the client's situation, client may submit a new request for IFS, at any
time, to the regional office.
(c)
The Agency shall not authorize the use of IFS that exceed the appropriation
amount. Unavailability of funds is sufficient reason to deny a request for
IFS.
(7) Reduction or
Termination of IFS. If any time after an approval of IFS the agency determines
that a client does not meet all the eligibility requirements, the Agency may
reduce or terminate the benefit by providing written notification to the client
or client's legal representative.
(8) Anytime IFS are denied, partially
approved, reduced, or terminated, the client shall have the right to request an
administrative hearing pursuant to Sections
393.125(1)(b),
120.569 and
120.57, F.S., within 30 calendar
days of receipt of notification.
(9) This rule shall be reviewed, and if
necessary, renewed through the rulemaking process five years from the effective
date.
Rulemaking Authority
393.066(8),
393.0663,
393.501(1) FS.
Law Implemented 393.063,
393.066,
393.0663 FS.
New 8-28-16, Amended
12-25-22.
