Florida Regulations 65A-2.036: Optional State Supplementation Base Provider Rates and Program Standards
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(1) The Department establishes the base provider rates for specialized living arrangements (the amount the individual is to pay the facility) specified in subsection (4), below, within funds appropriated by the Legislature. Base provider rates may vary depending upon type of specialized living facility and covered services in such facilities.
(2) Within the funds appropriated by the Legislature, Optional State Supplementation (OSS) eligible individuals receive a standard personal needs allowance (PNA), the amount the individual keeps for personal needs. The PNA is established by Legislative proviso language. The individual’s PNA does not vary due to type of specialized living facility and covered services in such facilities.
(3) Optional State Supplementation Program Financial Standards. Optional State Supplementation Program financial standards are subject to Florida legislative appropriations and federal cost-of-living adjustments.
(a) The monthly income eligibility standard for residents of Assisted Living Facilities (ALFs), Adult Family Care Homes (AFCHs) and, except as specified in paragraph (b), below, Mental Health Residential Treatment Facilities (MHRTFs) is $872.40.
(b) The monthly income eligibility standard for residents of MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of Assistive Care Services (ACS), and for individuals with coverage under subsections 65A-2.033(3) and (4), F.A.C., is $979.00.
(c) The personal needs allowance is $54.
(4) Optional State Supplementation Base Provider Rates. Optional State Supplementation base provider rates are subject to Florida legislative appropriations and federal cost-of-living adjustments.
(a) For ALFs, AFCHs and, except as specified in paragraph (b), below, MHRTFs, the monthly base provider rate is $872.40 and is inclusive of room and board only.
(b) For MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of ACS, and for the individuals covered under subsections 65A-2.033(3) and (4), F.A.C., the monthly base provider rate is $979.00 and is inclusive of room, board and personal care.
(5) To calculate the amount of the OSS payment, the base provider rate is added to the standard PNA to determine the individual’s total needs. From this sum, the individual’s gross income, minus the allowable exclusions at Fl. Admin. Code R. 65A-2.035, is subtracted, resulting in the amount of the OSS payment.
(6) Payment for the month of admission to the special living arrangement shall be prorated if the month of admission is the month of application or later. For months other than the month of admission, payment begins the first day of the month.
(7) The monthly income eligibility standards of paragraphs (3)(a) and (b), above, and the base provider rates established at subsection (4) above, shall be increased by the annual cost-of-living adjustment to the federal benefit rate, provided the average state optional supplementation contribution does not increase as a result.
(8) The payment is issued monthly through an automated delivery system.
(9) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.
Rulemaking Authority Florida Statutes § 409.212(7). Law Implemented Florida Statutes § 409.212. History-New 1-1-77, Amended 9-27-79, 10-7-80, 9-29-81, 9-29-82, 10-31-83, 11-28-83, 9-30-84, 10-1-85, Formerly 10C-2.36, Amended 1-1-87, 2-9-88, 11-6-88, 2-16-89, 3-1-90, 1-27-91, 2-19-95, Formerly 10C-2.036, Amended 1-27-99, 12-16-01, 5-14-02, 11-26-18, 6-30-19, 6-11-20, 10-26-21.
(3) Optional State Supplementation Program Financial Standards. Optional State Supplementation Program financial standards are subject to Florida legislative appropriations and federal cost-of-living adjustments.
(a) The monthly income eligibility standard for residents of Assisted Living Facilities (ALFs), Adult Family Care Homes (AFCHs) and, except as specified in paragraph (b), below, Mental Health Residential Treatment Facilities (MHRTFs) is $872.40.
(b) The monthly income eligibility standard for residents of MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of Assistive Care Services (ACS), and for individuals with coverage under subsections 65A-2.033(3) and (4), F.A.C., is $979.00.
(c) The personal needs allowance is $54.
(4) Optional State Supplementation Base Provider Rates. Optional State Supplementation base provider rates are subject to Florida legislative appropriations and federal cost-of-living adjustments.
(a) For ALFs, AFCHs and, except as specified in paragraph (b), below, MHRTFs, the monthly base provider rate is $872.40 and is inclusive of room and board only.
(b) For MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of ACS, and for the individuals covered under subsections 65A-2.033(3) and (4), F.A.C., the monthly base provider rate is $979.00 and is inclusive of room, board and personal care.
(5) To calculate the amount of the OSS payment, the base provider rate is added to the standard PNA to determine the individual’s total needs. From this sum, the individual’s gross income, minus the allowable exclusions at Fl. Admin. Code R. 65A-2.035, is subtracted, resulting in the amount of the OSS payment.
(6) Payment for the month of admission to the special living arrangement shall be prorated if the month of admission is the month of application or later. For months other than the month of admission, payment begins the first day of the month.
(7) The monthly income eligibility standards of paragraphs (3)(a) and (b), above, and the base provider rates established at subsection (4) above, shall be increased by the annual cost-of-living adjustment to the federal benefit rate, provided the average state optional supplementation contribution does not increase as a result.
(8) The payment is issued monthly through an automated delivery system.
(9) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date.
Rulemaking Authority Florida Statutes § 409.212(7). Law Implemented Florida Statutes § 409.212. History-New 1-1-77, Amended 9-27-79, 10-7-80, 9-29-81, 9-29-82, 10-31-83, 11-28-83, 9-30-84, 10-1-85, Formerly 10C-2.36, Amended 1-1-87, 2-9-88, 11-6-88, 2-16-89, 3-1-90, 1-27-91, 2-19-95, Formerly 10C-2.036, Amended 1-27-99, 12-16-01, 5-14-02, 11-26-18, 6-30-19, 6-11-20, 10-26-21.