(1) Definitions and Intent.
    (a) The service provider shall make a determination of ability to pay in accordance with the sliding fee scale for all individuals seeking substance abuse or mental health services. Payment of fees shall not be a pre-requisite to treatment or the receipt of services. The sliding fee scale shall not apply to services provided under the following Covered Services as defined in Rule 65E-14.021. F.A.C:
    1. Case Management,
    2. Crisis Stabilization, when charging a fee is contraindicated as specified in Florida Statutes § 394.674(2),
    3. Crisis Support/Emergency,
    4. Drop-In/Self Help Centers,
    5. Information and Referral,
    6. Intensive Case Management,
    7. Mental Health Clubhouse Services,
    8. Outreach,
    9. Prevention – Indicated,
    10. Prevention – Selective,
    11. Prevention – Universal Direct,
    12. Prevention – Universal Indirect,
    13. Substance Abuse Inpatient Detoxification; and,
    14. Substance Abuse Outpatient Detoxification.
    (b) It is not the intent of this rule to prohibit or regulate the collection of fees on behalf of an individual from third party payers and commercial insurers such as Workers’ Compensation, TRICARE, Medicaid, or Medicare. However, service providers shall make every reasonable effort to identify and collect benefits from third party payers for services rendered to eligible individuals.
    (c) For the purposes of this rule, household income is defined by I.R.C. §36B(d)(2) (1986), https://www.flrules.org/Gateway/reference.asp?No=Ref-04195, with exceptions pursuant to 42 CFR §435.603(e), October 1, 2012, https://www.flrules.org/Gateway/reference.asp?No=Ref-04196, hereby incorporated by reference, copies of which may be obtained from the Office of Substance Abuse and Mental Health, 1317 Winewood Blvd., Building 6, Tallahassee, Florida 32399-0700.
    (2) General Provisions.
    (a) Each service provider shall develop a sliding fee scale, that is updated annually, in conjunction with the Federal Poverty Guidelines, and applies to individuals receiving services that are paid for by state, federal, or local matching funds.
    (b) The service provider shall request a sliding fee payment from persons not eligible for Medicaid or receiving services ineligible under Medicaid; and whose household income is less than 150 percent of the federal poverty income guidelines in accordance with Florida Statutes § 409.9081 Nominal co-payments for the following substance abuse and mental health services shall apply:
    1. Outpatient treatment services – $3 per day.
    2. Residential treatment services – $2 per day.
    (c) The service provider shall require persons meeting the criteria listed below to contribute to their treatment costs consistent with the provisions of Florida Statutes § 409.212:
    1. Persons who receive optional supplementation payments or are receiving a supplemental security income check,
    2. Persons determined to be eligible for optional supplementation by the department; and,
    3. Persons who meet program eligibility criteria for assisted living facilities, foster care family placements, long-term residential care, or any other special living arrangements.
    (3) Fee Liability Exceptions. The following parties shall not be liable for payment of fees:
    (a) Parents of minors, when the minor has been permanently committed to the department and parental rights have been permanently terminated, or
    (b) Parents of a minor, when the minor has requested and is receiving services without parental consent.
    (4) Uniform Schedule of Discounts and Sliding Fee Scale.
    (a) Each service provider shall develop a uniform schedule of discounts and sliding fee scale, as specified in Section 394.674(4)(a), F.S.
    (b) The uniform schedule of discounts shall be based on household income, financial assets and family size, as declared by the person or the person’s guardian, relative to the family’s percent of poverty level.
    (c) The percent of poverty level shall be calculated by dividing the household income by the U.S. Department of Health and Human Services Annual Update of the Health and Human Services Poverty Guidelines. The poverty guidelines establish poverty income levels for various family sizes.
    (d) The total charges to an individual shall not exceed 5% of gross household income.
    (e) Nothing in this rule shall prevent a service provider from further discounting or writing off charges individually or in the aggregate.
    (f) An individual’s failure to make payment under a provider’s sliding fee scale shall not prevent the individual from receiving services.
Rulemaking Authority 394.493(2), 394.674(4), 394.78(1), 394.9082(3), 397.321(5) FS. Law Implemented 394.493(2), 394.674(3), (4), 394.74(3)(c), 394.9082, 397.431 FS. History-New 7-1-03, Amended 7-27-14.