Florida Regulations 65G-13.002: Individual and Family Supports (IFS) Procedure
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(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 Fl. Admin. Code R. 65G-13.003, 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 Fl. Admin. Code R. 65G-13.003, 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. History-New 8-28-16, Amended 12-25-22.
Terms Used In Florida Regulations 65G-13.002
- Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
(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 Fl. Admin. Code R. 65G-13.003, 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 Fl. Admin. Code R. 65G-13.003, 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. History-New 8-28-16, Amended 12-25-22.