Florida Regulations 65-6.016: Income and Benefits Subject to Fee Assessment
Current as of: 2024 | Check for updates
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The cost of services, as defined in subsection 65-6.010(4), F.A.C., is the maximum amount which a payor shall be charged, unless ordered by a court. Payment of fees shall not be a prerequisite to receiving services.
(1) First and second party payors shall be charged a fee not in excess of their ability to pay, according to the procedures described in Fl. Admin. Code R. 65-6.019 The maximum amount which may be charged is the cost of service, unless otherwise ordered by a court, less:
(a) Third party reimbursements received by the department for services provided to the client; and,
(b) In the case of residential care services, benefit payments applied to the cost of residential care.
(2) Benefit payments designated for the care and maintenance of clients, less a personal allowance, shall be applied to the cost of residential care.
(a) Representative payees, other than the department, shall be billed for benefit payments, and for any retroactive benefits received applicable to periods during which the client was in residential care.
(b) A responsible party who is liable for fees based on his income, and who is also a representative payee, shall be billed for the fee based on income, and for the amount of the benefit payment to be applied to the cost of service.
(c) If a client or representative payee receiving the benefit payments fails to pay the amount billed, the department shall request the payor of benefits to have the department designated as representative payee of the benefits.
(3) If a responsible party remarries, a step-parent’s income shall not be subject to fee assessment. However, the number of dependents used in determining ability to pay shall be in proportion to the responsible party’s contribution to total family income.
(4) If a client is receiving residential and non-residential services, the primary fee shall be the fee for residential services. A fee for non-residential services shall be charged only if the ability to pay for residential services exceeds the residential service fee. In this instance, the fee for non-residential services is the lower of the service fees or the difference between ability to pay for residential services less the residential service fee.
Rulemaking Authority Florida Statutes § 402.33(2). Law Implemented Florida Statutes § 402.33. History-New 1-23-85, Formerly 10-6.16, Amended 1-27-86, 3-29-89, 4-27-93, Formerly 10-6.016.
(1) First and second party payors shall be charged a fee not in excess of their ability to pay, according to the procedures described in Fl. Admin. Code R. 65-6.019 The maximum amount which may be charged is the cost of service, unless otherwise ordered by a court, less:
(a) Third party reimbursements received by the department for services provided to the client; and,
(b) In the case of residential care services, benefit payments applied to the cost of residential care.
(2) Benefit payments designated for the care and maintenance of clients, less a personal allowance, shall be applied to the cost of residential care.
(a) Representative payees, other than the department, shall be billed for benefit payments, and for any retroactive benefits received applicable to periods during which the client was in residential care.
(b) A responsible party who is liable for fees based on his income, and who is also a representative payee, shall be billed for the fee based on income, and for the amount of the benefit payment to be applied to the cost of service.
(c) If a client or representative payee receiving the benefit payments fails to pay the amount billed, the department shall request the payor of benefits to have the department designated as representative payee of the benefits.
(3) If a responsible party remarries, a step-parent’s income shall not be subject to fee assessment. However, the number of dependents used in determining ability to pay shall be in proportion to the responsible party’s contribution to total family income.
(4) If a client is receiving residential and non-residential services, the primary fee shall be the fee for residential services. A fee for non-residential services shall be charged only if the ability to pay for residential services exceeds the residential service fee. In this instance, the fee for non-residential services is the lower of the service fees or the difference between ability to pay for residential services less the residential service fee.
Rulemaking Authority Florida Statutes § 402.33(2). Law Implemented Florida Statutes § 402.33. History-New 1-23-85, Formerly 10-6.16, Amended 1-27-86, 3-29-89, 4-27-93, Formerly 10-6.016.