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Document Citation: 58N-1.009, F.A.C.
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FLORIDA ADMINISTRATIVE CODE
TITLE 58 DEPARTMENT OF ELDER AFFAIRS
58N DIVISION OF STATEWIDE COMMUNITY BASED SERVICES
CHAPTER 58N-1 LONG-TERM CARE COMMUNITY DIVERSION PROJECTS
Date:
08/31/2009
Document:
58N-1.009 Care and Service Standards.
(1) Medicaid Waiver Services: The provider must provide all Medicaid waiver services in accordance with its contract with the department.
(2) Case Management. Case management services must be provided by case managers directly employed by the diversion provider and cannot be a subcontracted service.
(a) Case managers must meet at least one of the following qualifications:
1. Have a Bachelor's Degree from an accredited college or university in social work, sociology, psychology, gerontology or human services related field; or
2. Have a Bachelor's Degree from a college or university and have at least two (2) years of case management experience; or
3. Be a registered nurse licensed to practice in the state; or
4. Be a licensed practical nurse licensed to practice in the state with three (3) years of geriatric or related experience.
(b) In addition to any other training required, the diversion provider must ensure that case managers annually attend and complete the following training:
1. Abuse, neglect, and exploitation training specifically involving the elderly;
2. Four (4) hours of in-service training on issues affecting the frail elderly; and
3. Alzheimer's disease and related disorders annual continuing education training from a qualified individual or entity, focusing on newly developed topics in the field.
(c) Case managers must have one face-to-face visit with each participant at least every ninety (90) calendar days from the date of enrollment.
(d) The case manager must make the necessary emergency plans or other shelter arrangements with the participant or representative during the enrollment orientation process.
1. The emergency plan must include arrangements for emergency supplies, transportation to the emergency location, and assistance in the coordination of emergency services with the participant's family or other shelter arrangements.
2. The participant must be provided with the diversion provider's emergency contact number.
3. The case manager must review and update the participant's emergency/disaster plan with the participant or representative at least annually.
(e) The diversion provider may employ case aides to assist case managers.
1. Case aide services include assistance with:
a. Implementing plans of care by arranging and verifying the services provided by the subcontractors;
b. Obtaining access to appointments and other services as prescribed in the plans of care; and
c. Arranging linkages between providers and participants.
3. Case aide services do not include:
a. Developing plans of care;
b. Conducting assessments or reassessments; or
c. Participating directly with assessing participant health status, medical follow-up or discharge planning.
(3) Care Planning:
(a) Each participant must have a care plan. The care plan is the tool used by the case manager to document a participant's assessed needs, desired outcomes, and services to be provided. The care plan is a plan of action, developed with the participation of the case manager, the program participant, the participant's caregiver or representative, and to the extent possible, the participant's health care provider. It is designed to assist the case manager in the overall management of the participant's care.
1. At each face-to-face visit, the participant or representative and case manager must review the care plan and make changes, if necessary, to meet the participant's continuing needs. The participant or representative and case manager must acknowledge in writing that the care plan was reviewed and changes to the care plan were agreed upon, if applicable.
2. At any time a significant change is indicated, the participant or representative and case manager must acknowledge the change in writing. A significant change is defined as any deterioration or improvement in the participant's mental, physical or social condition that would require an adjustment in his or her care plan. A significant change could result in an increase or decrease in services, depending upon the outcome.
3. The participant or representative must receive a signed and dated copy of the care plan or care plan summary.
(b) All changes in services in the care plan must be documented in the participant's file.
(4) Emergency/Disaster Plan and Plan for Continuity of Operations.
(a) The diversion provider must submit an emergency/disaster plan to the department no later than April 30th of each year. The plan must include a list of names and contact information for members of the provider's disaster and emergency management team.
(b) The diversion provider must submit annually a continuity of operations plan (COOP). The plan must include:
1. Risk assessment of the physical and operational environment, the information technology that supports that environment and an analysis of the potential impact a disaster, emergency or other significant business interruption would have on critical functions in service delivery.
2. Procedure for the maintenance of communications, security controls and continued protection of confidential data and information contained in both electronic and hard copy formats, including alternate sites for facility operations, data operations and related functions.
3. Notification protocol for initiation of the plan and for continued communications between essential staff, stakeholders, the department and participants, including a regularly updated list of names and functions of essential emergency team members.
4. A recovery strategy to include restoration of normal operations and systems and notification protocol for staff, participants, other stakeholders and the department throughout the recovery process.
5. Annual schedule for training in emergency procedures for essential team members and staff, and inspection and testing of facilities and equipment both on-site and alternate or back-up facilities or equipment.
(5) Disenrollments:
(a) In order to disenroll a participant from the diversion program, the diversion provider must follow the requirements outlined in its contract with the department.
(b) Upon notification of a participant's death, the diversion provider must disenroll the participant and void any claims for the months following the participant's death. The diversion provider must notify the local offices of the Comprehensive Assessment and Review for Long-Term Care Services (CARES) and Department of Children and Family Services.
(c) The diversion provider must submit a copy of voluntary disenrollments to the local CARES office. In addition, the provider must submit all disenrollment transactions to the Medicaid fiscal agent via electronic submission or other method as set forth in its contract with the department.
(d) The CARES office must not accept disenrollment forms from anyone other than the participant's current diversion provider.
(e) The current diversion provider must continue to provide services to the participant until the documented effective date of disenrollment.
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