Florida Regulations 64C-2.004: Safety Net Program Sliding Fee Scale
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(1) The Safety Net Program is a program through Children’s Medical Services (CMS) that, subject to funding, may pay for certain medical services to children with chronic and serious health care needs who do not qualify for Medicaid or Title XXI of the Social Security Act.
(a) Children eligible for assistance using these funds must be uninsured, or insured but not covered for medically necessary services, or unable to access services due to lack of providers or lack of financial resources regardless of insurance status.
(b) The department may serve children on a first-come, first-serve basis until the appropriated funds are fully obligated.
(c) Receiving services through the Safety Net Program does not constitute an entitlement for coverage or services when funds appropriated for this purpose are exhausted.
(2) Semi-annually, families must participate in the cost of care based on the following sliding fee scale:
(a) Families at or under 200 percent of the Federal Poverty Level (FPL) Guidelines pay $0.00 towards the cost of care;
(b) Families between 201 and 250 percent of the Federal Poverty Level (FPL) Guidelines pay $25.00 towards the cost of care;
(c) Families between 251 and 300 percent of the Federal Poverty Level (FPL) Guidelines pay $50.00 towards the cost of care;
(d) Families between 301 and 400 percent of the Federal Poverty Level (FPL) Guidelines pay $150.00 towards the cost of care;
(e) Families between 401 and 450 percent of the Federal Poverty Level (FPL) Guidelines pay $200.00 towards the cost of care; and,
(f) Families at or over 451 percent of the Federal Poverty Level (FPL) Guidelines pay $250.00 towards the cost of care.
(3) CMS will calculate the family’s percentage for subsection (2), based on the annual taxable family income and family size. For purposes of this calculation, CMS will utilize the 2017 Federal Poverty Guidelines for the 48 Contiguous States and the District of Columbia (effective January 31, 2017), which is incorporated by reference, and may be obtained at https://www.federalregister.gov/documents/2017/01/31/2017-02076/annual-update-of-the-hhs-poverty-guidelines, or http://www.flrules.org/Gateway/reference.asp?No=Ref-08121.
(4) Prior to receiving services covered through CMS, the family must produce documentation that the family has spent the amount indicated above in subsection (2), the sliding fee, towards the cost of care.
(a) The family may submit proof of the amount spent by submitting a receipt, canceled check, credit card statement, provider invoice, or similar documentation, documenting payment has been received.
(b) Proof of expenditure will only be accepted for any primary care or specialized services that are medically necessary or essential family support services for the enrolled child.
(c) Proof of expenditure of the amount above in subsection (2), the sliding fee, must be submitted every six months to CMS.
Rulemaking Authority Florida Statutes § 391.026(18). Law Implemented 391.029(3)(a), 391.0315 FS. History—New 5-15-13, Amended 5-11-17.
Terms Used In Florida Regulations 64C-2.004
- Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
(b) The department may serve children on a first-come, first-serve basis until the appropriated funds are fully obligated.
(c) Receiving services through the Safety Net Program does not constitute an entitlement for coverage or services when funds appropriated for this purpose are exhausted.
(2) Semi-annually, families must participate in the cost of care based on the following sliding fee scale:
(a) Families at or under 200 percent of the Federal Poverty Level (FPL) Guidelines pay $0.00 towards the cost of care;
(b) Families between 201 and 250 percent of the Federal Poverty Level (FPL) Guidelines pay $25.00 towards the cost of care;
(c) Families between 251 and 300 percent of the Federal Poverty Level (FPL) Guidelines pay $50.00 towards the cost of care;
(d) Families between 301 and 400 percent of the Federal Poverty Level (FPL) Guidelines pay $150.00 towards the cost of care;
(e) Families between 401 and 450 percent of the Federal Poverty Level (FPL) Guidelines pay $200.00 towards the cost of care; and,
(f) Families at or over 451 percent of the Federal Poverty Level (FPL) Guidelines pay $250.00 towards the cost of care.
(3) CMS will calculate the family’s percentage for subsection (2), based on the annual taxable family income and family size. For purposes of this calculation, CMS will utilize the 2017 Federal Poverty Guidelines for the 48 Contiguous States and the District of Columbia (effective January 31, 2017), which is incorporated by reference, and may be obtained at https://www.federalregister.gov/documents/2017/01/31/2017-02076/annual-update-of-the-hhs-poverty-guidelines, or http://www.flrules.org/Gateway/reference.asp?No=Ref-08121.
(4) Prior to receiving services covered through CMS, the family must produce documentation that the family has spent the amount indicated above in subsection (2), the sliding fee, towards the cost of care.
(a) The family may submit proof of the amount spent by submitting a receipt, canceled check, credit card statement, provider invoice, or similar documentation, documenting payment has been received.
(b) Proof of expenditure will only be accepted for any primary care or specialized services that are medically necessary or essential family support services for the enrolled child.
(c) Proof of expenditure of the amount above in subsection (2), the sliding fee, must be submitted every six months to CMS.
Rulemaking Authority Florida Statutes § 391.026(18). Law Implemented 391.029(3)(a), 391.0315 FS. History—New 5-15-13, Amended 5-11-17.