Florida Regulations 65-6.022: Fee Review Procedures
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(1) A client or responsible party may request a review of the fee if they do not agree with the assessment.
(2) The Regional Managing Director or Facility Administrator shall appoint, at a minimum, three members to a review committee. The Regional Managing Director or Facility Administrator may appoint a designee to approve the decisions of the committee.
(3) The client or responsible party must notify the department, in writing, of his request for review of the fee assessed, and must submit any receipts, tax records, bills, certified statements or other documentation needed to substantiate the request for a review of the fee.
(a) If the request, with the required documentation, is submitted to the department within three months of the date shown on the Notice of Maintenance Fee to be Charged, depending upon the committee’s recommendation, the fee may be changed retroactive to the first month for which fees were assessed.
(b) If the request, with the required documentation, is submitted later than three months after the date shown on the Notice of Maintenance Fee to be Charged, depending upon the committee’s recommendation, the fee may be adjusted retroactively to the month in which the request was received.
(4) The department shall inform persons requesting a review of the fee assessed of the criteria used to evaluate such requests, as follows:
(a) Each member of a family unit, including the client, is entitled to receive the benefits of an equitable share of the family’s income.
(b) The fee assessed shall not cause the family to be unable to purchase directly medical or dental treatment or other services prescribed in the client’s habilitation, rehabilitation, or treatment plan.
(c) The department shall not be expected to accept payment for residential services which is less than the cost of caring for the client at home, except for a family with insufficient income to meet basic needs.
(d) A client or responsible party shall not expect to increase his net worth by diverting income to savings or investment in preference to reimbursing the department for the fee assessed.
(e) The payment of the assessed fee shall not force the family members remaining at home to live on an income which would qualify them for public assistance.
(f) Resources available for payment of the assessed fee for residential services shall not be diverted for expenditures which would not be possible if the client lived at home.
(g) The fee assessed shall not cause the family to be unable to visit or otherwise be actively involved in the rehabilitation of the client.
(5) The review committee shall notify the client or responsible party of the date and time his request will be reviewed.
(6) Fee waivers or reductions may be granted to allow a client in residential care to accumulate funds from benefit payments or other sources in accordance with discharge plans, or plans to prepare for independent living. The client, or the client’s direct service worker shall submit the request in writing and provide a justification for the request.
(7) The review committee, by majority vote, shall recommend to the Regional Managing Director or designee, or Facility Administrator or designee, whether a fee reduction or waiver shall be granted. This recommendation shall be made within 30 days of receipt of the request, with the required documentation.
(8) If the committee recommends that a fee waiver or reduction is justified, the committee shall recommend an effective date in accordance with paragraph 65-6.022(3)(a) or (b), F.A.C. The committee may also recommend that the fee waiver or reduction be granted for a specified, limited period of time.
(9) If the Regional Managing Director or designee, or Facility Administrator or designee, denies the request for a fee waiver or reduction, the client or responsible party shall be informed of his right to appeal the decision pursuant to the provisions of chapter 120, F.S.
(10) The Regional Managing Director or designee, or Facility Administrator or designee, shall notify the requesting party, in writing, within ten days of the decision.
Rulemaking Authority Florida Statutes § 402.33(7). Law Implemented Florida Statutes § 402.33. History-New 1-23-85, Formerly 10-6.22, 10-6.022, Amended 11-26-18.
Terms Used In Florida Regulations 65-6.022
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
(3) The client or responsible party must notify the department, in writing, of his request for review of the fee assessed, and must submit any receipts, tax records, bills, certified statements or other documentation needed to substantiate the request for a review of the fee.
(a) If the request, with the required documentation, is submitted to the department within three months of the date shown on the Notice of Maintenance Fee to be Charged, depending upon the committee’s recommendation, the fee may be changed retroactive to the first month for which fees were assessed.
(b) If the request, with the required documentation, is submitted later than three months after the date shown on the Notice of Maintenance Fee to be Charged, depending upon the committee’s recommendation, the fee may be adjusted retroactively to the month in which the request was received.
(4) The department shall inform persons requesting a review of the fee assessed of the criteria used to evaluate such requests, as follows:
(a) Each member of a family unit, including the client, is entitled to receive the benefits of an equitable share of the family’s income.
(b) The fee assessed shall not cause the family to be unable to purchase directly medical or dental treatment or other services prescribed in the client’s habilitation, rehabilitation, or treatment plan.
(c) The department shall not be expected to accept payment for residential services which is less than the cost of caring for the client at home, except for a family with insufficient income to meet basic needs.
(d) A client or responsible party shall not expect to increase his net worth by diverting income to savings or investment in preference to reimbursing the department for the fee assessed.
(e) The payment of the assessed fee shall not force the family members remaining at home to live on an income which would qualify them for public assistance.
(f) Resources available for payment of the assessed fee for residential services shall not be diverted for expenditures which would not be possible if the client lived at home.
(g) The fee assessed shall not cause the family to be unable to visit or otherwise be actively involved in the rehabilitation of the client.
(5) The review committee shall notify the client or responsible party of the date and time his request will be reviewed.
(6) Fee waivers or reductions may be granted to allow a client in residential care to accumulate funds from benefit payments or other sources in accordance with discharge plans, or plans to prepare for independent living. The client, or the client’s direct service worker shall submit the request in writing and provide a justification for the request.
(7) The review committee, by majority vote, shall recommend to the Regional Managing Director or designee, or Facility Administrator or designee, whether a fee reduction or waiver shall be granted. This recommendation shall be made within 30 days of receipt of the request, with the required documentation.
(8) If the committee recommends that a fee waiver or reduction is justified, the committee shall recommend an effective date in accordance with paragraph 65-6.022(3)(a) or (b), F.A.C. The committee may also recommend that the fee waiver or reduction be granted for a specified, limited period of time.
(9) If the Regional Managing Director or designee, or Facility Administrator or designee, denies the request for a fee waiver or reduction, the client or responsible party shall be informed of his right to appeal the decision pursuant to the provisions of chapter 120, F.S.
(10) The Regional Managing Director or designee, or Facility Administrator or designee, shall notify the requesting party, in writing, within ten days of the decision.
Rulemaking Authority Florida Statutes § 402.33(7). Law Implemented Florida Statutes § 402.33. History-New 1-23-85, Formerly 10-6.22, 10-6.022, Amended 11-26-18.