Documentation Requirements.......................................................................................2-8

Consumable Medical Supplies .................................................................................... 2-24

DS Waiver Provider

Applicant

Enrollment

DS Waiver provider applicants must meet specific qualifications and

requirements before becoming eligible to provide DS waiver services. In

addition, provider applicants must possess a high degree of ethical

principles and have no adverse history with the Department of Children

and Families, the Agency for Health Care Administration, or any other

regulatory agency that causes the Agency or Department to question

whether the health, safety and welfare of a waiver participant would be

jeopardized during the delivery of an approved waiver service.

Medicaid DS waiver providers must:

Developmental Disabilities District Office, to enroll as a DS waiver

provider;

in Chapter 1 of this handbook;

and

Department.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

1-10 July 2002

DS Waiver Provider

Background

Screening

Requirements

Applicants must comply with the requirements of a level 2 screening in

accordance with section 435.04, F.S. Compliance with this requirement may

be accomplished through one of two ways:

Applicants must submit the DCF fingerprinting card, an affidavit of good

moral character, a caretaker information sheet and a check for $32.00

(made payable to DCF) to the department for processing. If the

applicant had a screening within 12 months of the time of application

and can provide a copy of the report, then the applicant does not need

to repeat the screening. The results of this screening will be submitted

with the Medicaid enrollment application in lieu of the Medicaid

fingerprint card and check for $39.

Applicants must submit the Medicaid fingerprint card, the enrollment

application and a check for $39 (made payable to the Medicaid fiscal

agent, ACS State Healthcare) to ACS for processing.

Screening is performed at the time of enrollment and every five years

thereafter. It is the responsibility of the applicant/provider to insure this

request for screening or re-screening is submitted for processing in a timely

manner.

Determination of

Eligibility for

Certification

The District Office determines if the provider applicant meets the

qualifications and requirements for enrollment as a waiver provider. Any

individual or agency desiring to enroll in Medicaid as a DS waiver provider

shall submit an application for enrollment to the District Office. This

handbook provides detailed information on each service available through

the waiver, including provider qualifications, limitations, and required

documentation. If you are considering becoming a provider, please carefully

review each service you wish to provide before completing a waiver provider

application. The application for enrollment consists of a Medicaid Provider

Enrollment Application and a DS Waiver Provider Application.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 1-11

Determination of

Eligibility for

Certification,

continued

The DS Waiver Provider Application includes a Medicaid Waiver Services

Agreement, Core Assurances and Developmental Services Waiver Services

Coverage and Limitations handbook. All DS Waiver provider applicants must

agree to comply with requirements found in the Developmental Disabilities

Medicaid Waiver Services Agreement and attached Core Assurances, as well

as service specific requirements specified in this handbook (incorporated by

reference into the Core Assurances) as a condition of enrollment.

The Medicaid forms in the application packet and payment for the background

screening if required (i.e., if not completed under Chapter 393, F.S.,

requirements) from the provider applicant along with a certificate of eligibility,

are then forwarded to the Central Office for further processing. The Medicaid

fiscal agent (ACS) completes final processing and enrollment.

The District Office receives verification from the Central Office when the

provider applicant is enrolled in Medicaid as a waiver provider. The District

Office then sends the provider a certificate indicating their status as a

Medicaid enrolled DS waiver provider.

Prior to July 1, 2001, agency and solo provider applicants may have received

certificates from the District Office prior to completion of Medicaid enrollment.

Effective July 1, 2001, eligibility for agency and solo providers to provide

services will be established when the Medicaid enrollment is completed.

When an applicant for enrollment in the waiver has been determined eligible,

passed necessary background screening requirements, and is enrolled in

Medicaid, the Department will issue a certificate of eligibility. This certificate

will list the waiver services the applicant is eligible to provide and the effective

date of Medicaid enrollment with the assigned Medicaid Provider number.

Once the certificate of eligibility is received, the provider may render waiver

services and receive reimbursement for those services from Medicaid. No

waiver-reimbursed service may be rendered until the provider receives

notification of his or her enrollment in Medicaid.

For information regarding how to become a waiver service provider, contact

the District Office in your area.

All providers are required to participate in the direct deposit program for

Medicaid payments and must have an active savings or checking account.

Note: Refer to Chapter 2 of the Medicaid Provider Reimbursement Handbook

Non-Institutional 081, for information concerning general Medicaid provider

qualifications and refer to Appendices B, C, D and E for additional

information.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

1-12 July 2002

Agencies Wishing

to Provide Multiple

Services

Agency providers that specialize in services to beneficiaries who have a

developmental disability may apply and be approved eligible to provide

additional services if they employ staff who meet the qualifications for that

service. For example, an agency that serves beneficiaries with a

developmental disability that is certified to provide supported living coaching

services may also provide non-residential support services.

Special Requirements for Support Coordination Providers

All waiver support coordinators, including solo providers or support

coordinators employed by agency providers, shall be determined eligible by a

District Office and individually enrolled in the Medicaid program as individual

treating providers, prior to providing waiver services and billing Medicaid.

Support coordinators will have their eligibility date established at the date the

District Office receives a complete application and the background screening

from the Florida Department of Law Enforcement (FDLE) is returned with no

record or no disqualifying offense.

When the individual waiver support coordinator completes and submits an

application with fingerprint card to the District and a local level background

screening has been completed by F.D.L.E. and returned with no record or

disqualifying offence, the District will determine the applicant eligible to

conduct an unsupervised face-to-face visit or to have unsupervised contact

with a beneficiary, pending the results of a level two background screening.

If the local background screening is returned and indicates a record or

disqualifying offence, the applicant may not provide services until the level

two background screening is complete, returned and eligibility is approved.

However, if the applicant’s certificate of eligibility is denied for any reason the

applicant cannot perform any waiver services with or without the supervision

of an enrolled waiver support coordinator.

For applicants who are employed at the time of application and intend to

remain in the current employment, the application must include a statement

addressing a plan for dual employment. The plan should address the type of

employment held at the time of the application, the total number of hours

involved in that employment on a weekly basis, a plan for the manner in

which the applicant may be contacted by beneficiaries receiving services

during the hours employed in the other job, and how conflicting priorities,

emergencies and meetings will be handled. The plan shall also address any

long-range plan for reducing or terminating the other employment, should he

or she assume a full waiver caseload.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 1-13

Special Requirements

for Support

Coordination

Providers, continued

The District Office shall approve the applicant’s dual employment plan as

part of the waiver enrollment process. If it is determined that the applicant

cannot be available to meet the needs of beneficiaries on their caseload,

the application may be denied. In no instance may dual employment

include the provision of services to beneficiaries with developmental

disabilities (other than within a case management or support coordination

function).

Specific support coordination responsibilities are specified in the Core

Assurances and must be signed by the provider prior to receiving a

certificate of eligibility from the District Office.

Family Members

Enrolled as DS Waiver

Providers

Under no circumstances may a relative provide support coordination to

their family member. However, relatives not legally responsible for the

care of the beneficiary may provide services such as respite, personal

care or transportation. In those limited situations, the relative must meet

the same qualifications as other providers of the same waiver service.

Controls must be in place to insure that the payment is made to the

relative as a provider only in return for specific services rendered and

there is adequate justification as to why the relative is the provider of care.

The reason a relative is chosen for the provider shall also be documented.

Reasons for using a relative may include lack of other available providers

in a rural area or the ability to meet specific scheduling of a beneficiary

that other providers can’t meet. Convenience to the beneficiary, caregiver

or family alone is not adequate justification. Parents of minors, spouses,

guardians and guardian advocates of waiver participants are specifically

excluded from payment for any services provided to their child, spouse or

beneficiary served.

Statewide Enrollment All DS waiver providers are enrolled on a statewide basis unless they

indicate a geographic preference on the DS Waiver Application or the

District Office restricts enrollment to specified geographic areas. DS

waiver providers may be restricted to the provision of services within

specific geographic areas based on a lack of provider capacity sufficient to

meet projected service needs, concerns regarding the provider’s quality of

care or other issues that may negatively impact beneficiaries, as

determined by the District Office.

Note: Refer to Appendix E for contact information.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

1-14 July 2002

Freedom of Choice The waiver is designed around beneficiary choice. Accordingly,

beneficiaries served through the waiver may select among enrolled,

qualified service providers and may change providers at any time. Once a

beneficiary has an approved cost plan, the funds allocated to that support

plan follow the beneficiary. Within the funds allocated in the support plan,

the beneficiary is free to change enrolled, qualified providers as desired to

meet the goals and objectives set out in the support plan.

Provider Qualifications Providers of consumable medical supplies include home health or

hospice agencies, pharmacies, medical supply companies, durable

medical equipment suppliers and vendors such as discount stores and

department stores.

Independent vendors may also provide these services.

Home health agencies and durable medical equipment companies must

provide a bond, letter of credit or other collateral at the time of application,

unless the agency has been a Medicaid enrolled provider for at least one

year prior to the date it applies to become a waiver provider and has had

no sanctions imposed by Medicaid, or any regulatory body.

Home health and hospice agencies shall be licensed by the Agency for

Health Care Administration in accordance with Chapter 400, Part IV or

Part VI, F.S.

Pharmacies shall hold a permit to operate, issued by the Department of

Health, in accordance with Chapter 465, F.S.

Medical supply companies and durable medical equipment suppliers,

shall hold local occupational licenses or permits, in accordance with

Chapter 205, F.S., and shall be currently licensed by the Agency for

Health Care Administration.

Retail stores shall hold local occupational licenses or permits, in

accordance with Chapter 205, F.S.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

Provider Qualifications Providers of durable medical equipment (DME) include home health or

hospice agencies, pharmacies, medical supply companies, durable

medical equipment suppliers and vendors such as discount stores and

department stores.

In accordance with rule 59G-4.070, F.A.C., to enroll as a Medicaid

provider, a DME and medical supply entity must meet the following

criteria:

provide documentation from the city or county authority that no

licensure is required;

Board of Orthotics and Prosthetics, if providing orthotics and

prosthetic devices.

In accordance with Code of Federal Regulations (C.F.R.) Part 440.70,

providers will be in compliance with all applicable laws relating to

qualifications or licensure. In accordance with Chapter 205, F.S.,

independent vendors, Assistive Technology Suppliers and Assistive

Technology Practitioners certified by the Rehabilitation Engineering and

Assistive Technology Society of North America (RESNA) may also

provide these services.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 1-21

Provider Qualifications,

continued

In accordance with Chapter 400.935, F.S., and Chapter 409.919, F.S.,

home health agencies and durable medical equipment companies must

provide a bond, letter of credit or other collateral at the time of

application, unless the agency has been a Medicaid enrolled provider for

at least one year prior to the date it applies to become a waiver provider

and has had no sanctions imposed by Medicaid, or any other regulatory

body.

Home health and hospice agencies shall be licensed by the Agency for

Health Care Administration, in accordance with Chapter 400, Part IV or

Part VI, F.S.

Pharmacies shall hold a permit to operate issued by the Department of

Health, in accordance with Chapter 400, F.S. Medical supply companies

and durable medical equipment suppliers shall hold local occupational

licenses or permits, in accordance with Chapter 205, F.S., and be

currently licensed by the Agency for Health Care Administration.

Retail stores shall hold local occupational licenses or permits, in

accordance with Chapter 205, F.S.

Developmental Services Waiver Services

Covered Services, Limitations And Exclusions

Introduction This chapter describes the services covered under the Medicaid

Developmental Services (DS) waiver program. It also describes the

requirements for service provision, service limitations and exclusions.

This chapter contains:

TOPIC PAGE

Requirements To Receive Services 2-2

Documentation Requirements 2-8

Definitions 2-9

Adult Day Training 2-14

Adult Dental Services 2-17

Behavior Analysis Services 2-19

Behavior Assistant Services 2-20

Chore Services 2-21

Companion Services 2-22

Consumable Medical Supplies 2-24

Dietitian Services 2-27

Durable Medical Equipment and Supplies 2-29

Environmental Accessibility Adaptations 2-36

Homemaker Services 2-41

In-Home Support Services 2-42

Medication Review 2-43

Non-Residential Support Services 2-45

Occupational Therapy 2-47

Personal Care Assistance 2-48

Personal Emergency Response Systems 2-52

In This Chapter

Physical Therapy 2-53

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-2 July 2002

Private Duty Nursing 2-55

Psychological Assessment 2-56

Residential Habilitation Services 2-57

Residential Nursing Services 2-59

Respiratory Therapy 2-60

Respite Care 2-62

Skilled Nursing 2-63

Special Medical Home Care 2-64

Specialized Mental Health Services 2-66

Speech Therapy 2-67

Support Coordination 2-69

Supported Employment 2-81

Supported Living Coaching 2-85

Therapeutic Massage 2-90

Transportation 2-92

In This Chapter,

continued

Who Can Receive

Services?

Participants in the waiver must meet the eligibility requirements of the

Developmental Disabilities Program, in accordance with Chapter 393, F.S.

must meet the level of care criteria for placement in an Intermediate Care

Facility for the Developmentally Disabled (ICF/DD), and must be eligible for

Medicaid under one of a variety of categories described in the Medicaid

Provider Reimbursement handbook, Non-Institutional 081.

Note: Refer to Appendix D for contact information and Appendix F for

beneficiary application and eligibility determination.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-3

Medicaid

Eligibility

Beneficiaries who are not already eligible for Medicaid benefits through

Supplemental Security Income (SSI), MEDS-AD, or TANF at the time they

apply for DS waiver services must complete, or have a designated

representative complete, and submit a Request for Assistance (RFA) to the

local Department of Children and Families.

Note: Refer to Chapter 3 of the Medicaid Provider Reimbursement

handbook, Non-Institutional 081, for information on verifying beneficiary

eligibility. Refer to Appendix D for contact information.

Level of Care

Requirements

Beneficiaries who are eligible for Medicaid benefits must also meet all of the

following conditions to be eligible for enrollment in the waiver:

Disabilities Program eligibility requirements, in accordance with Chapter

393, F.S.

secondary handicapping condition, that includes cerebral palsy, spina

bifida, Prader-Willi syndrome, epilepsy, autism, or ambulation, sensory,

chronic health, and behavioral problems, or the beneficiaries IQ is 60-69

inclusive and the beneficiary has severe functional limitations in at least

three major life activities including self-care, learning, mobility, selfdirection,

understanding and use of language, and capacity for

independent living (Secondary disability = 6 in the ABC system.); or

palsy, spina bifida, or Prader-Willi syndrome. In addition, the condition

must result in substantial functional limitations in three or more major life

activities, including self-care, learning, mobility, self-direction,

understanding and use of language, and capacity for independent living.

(Secondary disability = 6 in the ABC system.)

necessary.

community-based supports and services.

DS waiver services shall not be reimbursed when the date of service is prior

to the beneficiary’s enrollment into the DS Waiver.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-4 July 2002

Beneficiary

Enrollment Onto

the DS Waiver

Once Medicaid and the waiver eligibility requirements are met, the District

Office reviews the beneficiaries request for home and community-based

supports and services. That office will determine if: 1) a waiver vacancy is

available; 2) sufficient funding is available to meet the beneficiary’s needs;

and, 3) the beneficiary can be safely maintained in the community. The

determination will be made in accordance with legislatively appropriated

funding and established annual priorities.

The Central Office maintains the statewide list of all beneficiaries determined

eligible and waiting for waiver services.

of the following conditions exist:

program;

eligibility for Medicaid benefits and this loss is expected to extend for a

lengthy period;

Intermediate Care Facility for the Developmentally Disabled (ICF/DD); or

Note: Refer to Appendix F for complete beneficiary application and eligibility

determination, waiting list information, crisis information, and enrollment into

the DS Wavier.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-5

Medical

Necessity

Waiver services shall only be provided when the service or item is medically

necessary. Chapter 59G-1.010(166), (a), and (c) of the F.A.C. defines

medical necessity as:

allied care, goods or services furnished or ordered must meet the following

conditions:

disability, or to alleviate severe pain;

diagnosis of the illness or injury under treatment, and not in excess of

the patient’s needs;

as defined by the Medicaid program and not be experimental or

investigational;

which no equally effective and more conservative or less costly

treatment is available statewide; and,

the beneficiary, the beneficiary’s caretaker, or the provider.

(c) The fact that a provider has prescribed, recommended, or approved

medical or allied care, goods or services does not, in itself, make such care,

goods or services medically necessary, or a medical necessity, or a covered

service.

Medical

Necessity

Determinations

An appropriate, qualified professional shall make the determination that the

standards for medical necessity set forth in 59G-1.010 (166), (a) and (c),

F.A.C., are met, and that the requested item meets the service definition, as

contained in the approved DS waiver. The request shall also be reviewed by

the Department’s Medical Director or consulting physician, for the same

purpose. This additional review will typically only be necessary if the District

does not have an appropriate physician available to review the request.

When a requested service or item is determined to be medically necessary, it

shall be approved. If sufficient information is not available to determine that

the service or item is medically necessary, a written request for more

information will be sent to the waiver support coordinator and

beneficiary/family/guardian. If it is determined that the service is not

medically necessary (i.e., the request does not conform to the standards set

forth in 59G-1.010 (166)(a), and (c) F.A.C.), a written denial of the service

and notice of due process will be sent to the beneficiary/family/guardian and

copied to the waiver support coordinator. A Medicaid beneficiary may appeal

decisions by the District Office by requesting a Medicaid Fair Hearing, in

accordance with Chapter 42, 431.200 of the Code of Federal Regulations.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-6 July 2002

Medical

Necessity

Determinations,

continued

A prescription for a service or item, which has general utility or that, is

generally available to the public does not change the character of the item for

coverage purposes under the waiver. It is the general use and not the

specific use that governs coverage.

Note: Refer to definitions for additional information.

Service

Authorization

Requirements

The services described in this handbook represent all approved services that

may be purchased for a beneficiary participating in the DS waiver who needs

the service to reach an outcome described on the support plan. In order for a

beneficiary to receive a service it must be identified on a beneficiaries

support plan and cost plan (also known as the plan of care) and be approved

by the District Office before the service may be provided. Providers of DS

Waiver services are limited to the amount, duration and scope of the services

described on the beneficiaries support plan and current approved cost plan.

Availability of

Other Coverage

Sources

Supports and services are developed and delivered in natural community

settings. Additionally, the supports and services authorized under the waiver

should be used to supplement the supports already provided by family,

friends, neighbors, and the community. Replacement of such natural and

free supports with government-funded services is contrary to the intent of the

waiver program. State and federal funds are the means of last resort and

only utilized when a family or community support is unavailable or while a

support is being developed. Only by involving the beneficiary in community

inclusive supports and experiences, can full integration into community life be

accomplished.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-7

Availability of

Other Coverage

Sources,

continued

When a service must be purchased, those available under the Medicaid

State Plan must be utilized before accessing services through the waiver.

The waiver cannot supplant or replace a benefit available through Medicaid

State Plan services. It is a federal requirement to access state plan coverage

before the provision of waiver services. As stated in section 4442.3, State

Medicaid Manual:

To obtain specific information about Medicaid State Plan coverage, refer to

the Medicaid Coverage and Limitation handbook for the particular service.

Handbooks can be downloaded from the Medicaid fiscal agent web site

http://floridamedicaid.acsinc.com, select Provider Support, select handbooks.

Note: Refer to Appendix D for contact information.

Service Delivery

Timelines

Beneficiaries currently enrolled on the waiver will be provided with those

services that have been determined to be medically necessary with

reasonable promptness. The Developmental Disabilities Program will make

reasonable efforts to provide those waiver services for which a determination

of medical necessity has been made within 90 days of the date of the

beneficiary’s enrollment on the waiver, or request, to the extent that sufficient

provider capacity exists.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-8 July 2002

Introduction DS waiver services are based on beneficiary needs that are documented in

an approved plan of care. The plan of care includes the support plan and

approved cost plan. A person cannot receive Medicaid waiver services until

he or she is determined eligible and is enrolled in the appropriate waiver

program.

Medicaid will only reimburse for waiver services that are specifically

identified in the approved plan of care by service type, frequency and

duration and for which there is sufficient documentation supporting the

provision of a service to the beneficiary.

General Service

Documentation

Requirements

Documentation is a written record that supports the fact that a service has

been rendered. When a service is rendered, the provider must document

the service and file the documentation appropriately before requesting

reimbursement. Appropriate documentation is required in order to receive

payment. All documentation must be dated and signed by the individual

rendering the service. Progress notes that are co-signed by support

coordinator supervisors are acceptable for waiver support coordinators

whose application has been submitted to the District Office and approved for

enrollment while they are waiting for enrollment notification from the

Department. An updated Support Plan and Cost Plan are submitted, at a

minimum, annually to the District Office.

A list of the documentation that is required for each service is included in

section of each service for a detailed listing of documentation that must be

submitted for reimbursement, and documentation that must be kept on file by

the provider for monitoring and review purposes.

this handbook for a description of each type of documentation. For the

purpose of efficiency, the required elements of the following documentation

may be combined on one form:

It is the responsibility of each service provider to understand and comply with

all documentation requirements. Questions regarding further clarification

about these requirements should be directed to the District Office.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-9

Annual Report A written report documenting the beneficiary’s progress toward their support

plan goal(s) for the year, as required in Chapter 393, F.S.

Annual Satisfaction

Survey

A survey of beneficiaries that addresses his or her satisfaction with service

delivery and the extent to which the beneficiaries desired outcomes have been

achieved, as specified in the core assurances and as described in Chapter 65B -

11.008, F.A.C., for providers of supported living coaching services.

Behavior Analysis

Services Plan

A written plan that includes a description of the specific behaviors to be

changed, intervention procedures to be used, data to be collected, training for

caregivers, and a monitoring schedule to be followed by the behavior analysis

services provider. This plan should be clearly written in language that is easily

understood by other service providers.

Bi-weekly Contact

Log

Every two weeks a recording of contacts required for beneficiaries

receiving Supported Employment. Contacts may be either at the job site

or another setting.

Central Record or

Provider File of a

Beneficiary

A file (or a series of continuation files) kept by the provider in which the following

documentation must be recorded, stored and made available for review:

parental or guardian contact data, permission forms, and results of

assessments, evaluations, and medical and medication information;

written authorization of services, and implementation plans, as required;

and,

specified in the Developmental Services Waiver Services Coverage and

Limitations handbook, that are related to the service and support activities

identified in the implementation plan.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-10 July 2002

Community

Integrated Settings

Local settings that are not limited to, or segregated settings for, beneficiaries

with developmental disabilities, and that possess the following characteristics:

generic local community resources utilized by other people without disabilities

and settings which promote direct personal interaction with others with or

without developmental disabilities.

Cost Plan The form used by the Waiver Support Coordinator listing all services requested

by the beneficiary on the support plan, regardless of funding source, and the

anticipated cost of each waiver service. The department’s District Office must

approve the cost plan prior to service provision. Each time a beneficiary’s

support plan is amended to increase or add services, the cost plan too must be

amended and approved, as described above, in order for the service to be

initiated. A support plan and cost plan must be updated for each beneficiary

enrolled on the waiver at least annually, during the annual support planning

process to reflect current needs and situations. Cost plan forms are available

from the District Office.

Note: Refer to Appendix E for contact information.

Daily Attendance

Log

A listing of the beneficiaries and the days of the month. For each day the

beneficiary participated in the service, the date is checked (v) or marked with an

"X". This log is called a "trip log" for transportation services.

Daily Progress Note Daily (on days service was rendered) notes of the beneficiary’s progress

towards achieving his or her support plan goals for the period being billed or the

summary describing the treatment or training provided to the beneficiary or task

supports a goal on his support plan to learn how to cook.)

Data Displays Graphed data of target and replacement behaviors.

Dietary Management

Plan

A nutritional plan based on an assessment that includes current weight, height,

usual weight, body measurements, results of laboratory tests useful in

establishing current nutritional status, possible symptoms of or contributors to

malnutrition, appetite, dysphasia (difficulty swallowing), odynophagia (pain on

swallowing), correlation between drug therapy and appetite, chronic digestive

conditions, current dietary practices, vitamins, herbal supplements, food

preferences, and hydration status. The plan should address problems based on

the assessment and establish targets for weight, nutritional intake, food texture

and consistency, fluid and caloric intake.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-11

Florida Status

Tracking Survey

(FSTS)

The FSTS is a questionnaire, designed to obtain and provide information about

a beneficiary with developmental disabilities, which is used to develop the

beneficiary’s supports and services. The FSTS aids in the support planning

process. Following the instructions provided by the Department, this survey is

initially completed and updated annually by the beneficiary’s waiver support

coordinator.

Home Accessibility

Assessment

An assessment conducted by a Rehabilitation Engineer or other certified

professional that determines the medically necessary physical adaptations to a

beneficiary’s home to permit accessibility when adaptations are in excess of

$3,500. This assessment must also be used to determine appropriateness of

ceiling tracking systems and may be used for determination of appropriate van

modifications.

Implementation Plan A plan developed with direction from the beneficiary, which includes information

from the beneficiaries current support plan, and other pertinent sources. The

specific areas of training and strategies to meet support plan goal(s) for each

beneficiary will be addressed in the beneficiaries implementation plan. Training

objectives appropriate to the beneficiaries programs and services may also be

included in the implementation plan. At a minimum, the implementation plan will

include:

plan goal(s).

progress in achieving the support plan goal(s). The information from this

assessment will be used to update and modify the plan, as needed, to

ensure that progress toward goal achievement is attained.

The implementation plan will be developed, at a minimum, within 30 days of the

initiation of the new service, or within 30 calendar days of the service

authorization effective date for continuation of services and annually thereafter.

A copy of the implementation plan, approved by the beneficiary, shall be

furnished to the beneficiary, guardian and to the waiver support coordinator at

the end of this 30-day period. The progress toward achieving the goal(s)

identified on the implementation plan shall be documented in daily progress

notes or monthly summaries, as specified in each service description. Data

supporting the beneficiaries progress, or lack thereof, summarized in the

monthly summary shall be available for review.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-12 July 2002

Beneficiary Nursing

Assessment

A detailed assessment that includes height, weight, blood pressure, allergies,

medications, a comprehensive evaluation of mental status, physical status,

neurological, respiratory, cardiovascular, gastro- intestinal, reproductive and

musculoskeletal systems, nursing diagnosis, and recommendations for nursing

interventions.

Invoice A list of the approved service(s) or procedure(s) rendered or item(s) purchased,

rate and units. The provider’s name, address, provider number and the

appropriate service code must appear on the form. When billing for equipment

or supplies, include brand name, model number, size, and any attachments

needed. The service provider may send a copy of catalog pages.

Medicaid Waiver

Services Agreement

The Developmental Disabilities Program Medicaid Waiver Services Agreement

means the agreement between DCF Developmental Disabilities Program and

providers of waiver services, which consists of form CF-DS 3064, the Core

Assurances for providers of Medicaid Home and Community-Based Waiver

Services Programs, and documents specifying rates. Specific service

requirements, as defined in the Developmental Services Waiver Services

Coverage and Limitations handbook, are incorporated into the agreement by

reference. All providers must complete this agreement to provide services to

beneficiaries enrolled in the Developmental Services Home and Community-

Based Services Waiver Program.

Note: Refer to Appendices B and C for additional information.

Medication Review A review that contains recommendations for changes in medications, and is

provided by the consultant pharmacist to the beneficiary (or family or legal

guardian ) and the prescribing physician. Follow-up by the consultant

pharmacist with the prescribing physician shall be provided . In addition, the

consultant pharmacist shall provide written guidelines and information for use by

the beneficiary and their caregivers, about medication administration and other

interventions specific to the beneficiary’s needs designed to improve the

therapeutic outcome of currently prescribed medications.

Monthly Nutritional

Status Report

A report that reflects the beneficiary’s progress toward meeting targets in their

Dietary Management Plan. Weight gains or losses should be reported as well as

any recommended dietary adjustments.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-13

Monthly Summary A summary note of the month’s activities indicating the beneficiary’s progress

toward achieving their support plan goals for the month billed.

to cook because he wants to move into his own apartment.)

For Residential Nursing Services, the monthly summary must include details

such as health risk indicators, information about medication, treatments, doctor’s

appointments and anything else of significance regarding the beneficiary’s

health.

Prescription Instructions written by a physician. A copy of the prescription is needed prior to

requesting funding for medical services or certain medical equipment or supplies

and is kept in the beneficiary’s central file. The original prescription for an

individual medical service is maintained in the medical service provider’s file

with a copy maintained in the beneficiary’s central file.

Service Log Includes times and dates service was rendered with a detailed list of the

activities performed on each visit.

Solo Provider An enrolled provider who personally renders waiver services directly to

beneficiaries and does not employ others to render waiver services.

Supported Living

Log

Written documentation of the dates, times and summary of the supports

provided during contact with the beneficiary, as described in Chapter 65B-

11.014, F.A.C.

Treatment Plan A written plan developed by a provider of Specialized Mental Health Services.

The treatment plan must be provided to the waiver support coordinator with the

first full month’s billing and every six months thereafter.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-14 July 2002

Description Day training programs for adults are training services intended to support the

participation of beneficiaries in daily, valued routines of the community. For

adults this may include work-like settings that do not meet the definition of

supported employment.

Description Consumable medical supplies are those non-durable supplies and items that

enable beneficiaries to increase their ability to perform activities of daily living.

Consumable medical supplies are of limited usage and must be replaced on a

frequent basis. Supplies covered under the Developmental Services Home

and Community-Based Services waiver must meet all of the following

conditions: a) be related to a beneficiaries specific medical condition, b) not be

provided by any other program, c) be the most cost-beneficial means of

meeting the beneficiaries need, and d) not primarily for the convenience of the

beneficiary, caregiver, or family. Consumable medical supplies covered by the

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-25

Limitations Consumable Medical Supplies will not duplicate supplies provided by the

Medicaid State Plan. Refer to the Medicaid Durable Medical Equipment -

Medical Supplies Coverage and Limitations handbook for additional

information on Medicaid State Plan coverage. Supplies not available under

the Medicaid State Plan, or available in insufficient quantity to meet the needs

of the beneficiary, may be purchased by the waiver. All supplies shall have

direct medical or remedial benefit to the beneficiary and are related to the

beneficiary’s developmental disability.

If multiple vendors are enrolled to provide this service, the beneficiary shall be

encouraged to select from among the eligible vendors based on an item’s

availability, quality and best price. No more than ten items per day may be

purchased.

Consumable medical supplies covered by the DS waiver are listed below.

Some items have specific requirements or limitations.

1. Diapers, including pull-ups, adult diapers or adult disposable briefs.

2. Wipes.

3. Disposable gloves, when a beneficiary requires personal care that

exposes the caregiver to body fluids. Latex-free gloves will be authorized

when the beneficiaries or the caregiver’s physician certifies that the

beneficiary or caregiver has a latex allergy or that there is a probable

expectation that the beneficiary or caregiver may have a latex allergy (i.e.,

beneficiaries with spina-bifida).

4. Surgical masks, when prescribed by a physician and are:

a. Worn by a beneficiary with a compromised immune system as a

protection from infectious disease; or

b. Worn by a caregiver who must provide a treatment that requires strict,

sterile procedure in which they are trained to provide care to a

beneficiary who has a compromised immune system and who must be

protected at all cost from exposure to any airborne organisms or

substances. The physician must renew the prescription quarterly.

5. Disposable or washable bed/chair pads and adult sized bibs.

6. Ensure, or other food supplements, when determined necessary by a

licensed dietitian. Beneficiaries that require nutritional supplements must

have a dietitian’s assessment documenting such need. The assessment

shall include documentation of weight fluctuation. Total parenteral

nutrition (TPN) is available through the Medicaid pharmacy program.

7. Feeding tubes and supplies, not covered by Medicaid and prescribed by

a physician. Excludes supplies for a beneficiary who qualifies for food

supplements under the Medicaid pharmacy program or Medicare

program.

8. Dressings, not covered by Medicaid, required for a caregiver to change

wet to dry dressing over surgical wounds or pressure ulcers, and

prescribed by a physician.

9. Hearing aid batteries, cords and routine maintenance and cleaning

prescribed by an audiologist.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-26 July 2002

Limitations, continued 10. Bowel management supplies purchased under the waiver are limited to

$150.00 every 3 months. These supplies include laxatives, suppositories

and enemas determined necessary for bowel management by the

beneficiary’s physician.

Items not contained on this list, that meet the definition of consumable medical

supplies, may be approved through exception by the Department. To request

an exception, a physician must prescribe the item. The statement from the

physician, must delineate how the item is medically necessary, how it’s directly

related to the beneficiary’s developmental disability, and without which the

beneficiary can not continue to reside in the community or in his or her current

placement.

The request will be reviewed by the District’s physician or nurse to determine

compliance with the standards for medical necessity set forth in 59G-1.010

(166), F.A.C., and to determine whether the requested item fairly meets the

service definition. The Developmental Disabilities Medical Director shall also

review the request for the same purpose. This additional review will typically

only be necessary if the District does not have an appropriate physician

available to review the request. A recommendation will be made to the District

for approval or denial.

Consumable medical supplies must be directly and specifically related to the

beneficiary’s disability. Items of general use, such as: toothbrushes,

toothpaste, toothpicks, floss, deodorant, feminine hygiene supplies, bath soap,

lotions, razors, shaving cream, mouthwash, shampoo, cream rinse, tissues,

aspirin, Tylenol, Benadryl, nasal spray, creams, ointments, vapor rub, powder,

over-the-counter antihistamines, decongestants and cough syrups, clothing,

etc., are not covered. Supplies for investigational or experimental use are not

covered.

A prescription submitted for supplies, diets, over-the-counter medications,

vitamins, herbs, etc. which has general utility or is generally available to the

general population without a prescription, does not change the character of the

item for purposes of coverage in this category. For example, a physical

therapist, occupational therapist or physician recommending or prescribing

items like Tylenol, Ginko Biloba, vitamins, gluten-free foods, cotton balls or Qtips,

does not convert that item from general utility items to consumable

medical supplies covered under the HCBS Waiver. Items covered in this

category generally include only those items that are specifically designed for a

medical purpose, and are not used by the general public or other general utility

uses. It is the general character and not specific use of the item that governs

for purposes of coverage under this category.

Consumable medical supplies are approved for a year at a time. Supplies may

be ordered for 3 months at a time.

The waiver does not allow for payment or reimbursement of co-payments for

consumable medical supplies covered by third party insurance.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-27

Documentation

Requirements

For reimbursement purposes, the provider must submit:

1. An invoice listing the supplies purchased.

For monitoring review purposes, the provider must have, at a minimum:

1. A copy of the invoices listing the supplies purchased for the period being

reviewed; and

2. The original prescription for the supply (if prescribed).

Note: Refer to the definition section for additional information.

Special

Considerations

Educational supplies are not consumable medical supplies and are not covered

by the waiver. These supplies are expected to be furnished by the local school

system. Beneficiaries or their family members shall not be reimbursed for

consumable medical supplies they purchase.

Description Dietitian services are those services prescribed by a physician that are

necessary to maintain or improve the overall physical health of a beneficiary.

The services include assessing the nutritional status and needs of a

beneficiary; recommending an appropriate dietary regimen, nutrition support

and nutrient intake; and providing counseling and education to the beneficiary,

family, direct service staff and food service staff. The services may also include

the development and oversight of nutritional care systems that promote a

person’s optimal health.

Limitations A beneficiary shall receive no more than 12 units of these services per day. A

unit is defined as a 15 minute time period or portion thereof.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-28 July 2002

Limitations,

continued

A rehabilitation engineer or other certified professional may be reimbursed

under home accessibility assessment to assess the appropriateness of

any van conversion including identification of an appropriate lift system.

2. Wheelchair carrier, for the back of the car. Limited to one carrier for a fiveyear

period.

3. Wheelchairs, to the extent that they are medically necessary and not

covered by Medicaid State Plan. A physician must prescribe the specific

item. Coverage in this category will typically only be provided when the

following criteria are met:

a. The beneficiary has a customized power wheelchair funded through

Medicare or Medicaid, which is used as their primary mode of

ambulation, or the beneficiary is ambulatory, but has a documented

medical condition that prevents walking for sufficient lengths of time to

go about his or her daily activities, for example cardiac insufficiency or

emphysema. This condition must be documented by a physician and

include a statement addressing how the beneficiary is limited in

normal daily activities by the condition;

b. The beneficiary needs a manual wheelchair to facilitate movement

within their own home, and to enable them to be safely transported in

an automobile. It must be documented that the vehicle does not have

a lift or that the beneficiaries primary chair, if applicable, cannot be

collapsed to fit into a trunk or on a wheelchair carrier;

c. The requested wheelchair is the most cost-beneficial device, meeting

the needs of the beneficiary.

d. The wheelchair covered by this service is a standard (manual)

wheelchair and not intended for a beneficiary who cannot use a

standard chair for any length of time without adaptation.

If the beneficiary usually uses a customized wheelchair, but needs a

standard wheelchair to transfer to an automobile that does not have a

lift or around the home to avoid the need for accessibility adaptations,

an additional second (standard) wheelchair should be considered.

Any adaptive wheelchair, including a customized power wheelchair is

covered through Medicaid State Plan.

Only one manual wheelchair may be purchased in a five-year period.

The waiver will not fund the purchase of both a manual wheelchair

and a stroller in a five-year period. Excluded from coverage are

wheelchairs requested to facilitate recreational activities such as

beach wheelchairs, sports wheelchairs or wheelchairs that are not the

most cost- beneficial way to meet the needs of the beneficiary.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-31

Limitations,

continued

4. Strollers, subject to the same criteria and limitations for wheelchairs, as

stated above, except reimbursement for a stroller will be limited to $1,200.

Only one stroller or manual wheelchair can be purchased in any five-year

period. As a cost-effective alternative the base unit for an adaptive car

seat, could be covered in lieu of a stand-alone stroller unit.

5. Portable ramps, when the beneficiary requires access to more than one

non-accessible structure.

6. Patient Lift, hydraulic or electric with seat or sling, when the beneficiary

requires the assistance of more than one person to transfer between a

bed, a chair, wheelchair or commode. One lift every eight years. Limited

to adults. Cost not to exceed $2,000.

7. A ceiling lift requires a home accessibility assessment by a rehabilitation

engineer or appropriate professional to insure the structural integrity of the

home to support the ceiling lift and track system. When this system is

requested it must be documented that it is the most cost-effective means

of meeting the beneficiary’s need and the specific item selected does not

exceed the medically necessary needs of the individual. Medical

necessity is usually limited to necessary access to an individual bedroom

and bath. Only one system will be allowed for any individual. If after at

least five years, the individual moves, it will be determined if the most

cost-efficient means to meet the individuals need is by moving the current

system or purchasing a new system if still required by the individual. A

new assessment and determination must be made. Cost may not exceed

$10,000.

8. Adaptive car seat, for beneficiaries being transported in the family vehicle

and who cannot use the standard restraint system or can no longer fit into

a standard child’s car seat. The seat must be prescribed by a physical

therapist that will determine that the beneficiary cannot use standard

restraint devices or car seats. The physical therapist will identify

appropriate equipment for the beneficiary. Adaptive car seats are limited

to one per beneficiary every three years and cost no more than $1,000.

9. Bidet, limited to beneficiaries who are able to transfer onto commodes

independently, but whose physical disability limits or prevents thorough

cleaning. This item requires a prescription by a physician and assessment

by a physical or occupational therapist to determine that the beneficiary

can use the item independently. The bidet and installation must cost no

more than $1,000.

10. Single room air conditioner, when there is a documented medical reason

for the beneficiaries need to maintain a constant external temperature.

Conditions for which a single room air conditioner may be appropriate

include congestive heart failure, severe cardiac disease, COPD

(emphysema), or damage or disease of the hypothalamus. Only one

single room air conditioner (maximum of 250 square feet capacity) will be

approved per beneficiary for a five-year period. The air conditioning unit

must cost no more than $300.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-32 July 2002

Limitations,

continued

11. Single room air purifier, when there is a documented medical reason for

the equipment. The documentation necessary for this equipment would

be a prescription from a pulmonologist along with a medical statement

explaining the medical diagnosis, the reason why the equipment is

necessary and the expected outcome of the treatment. Conditions for

which a single room air purifier may be appropriate include severe asthma

with documented sensitivity to indoor airborne particles, chronic

obstructive pulmonary disease, emphysema or pulmonary dysplasia. The

air purifier unit must cost no more than $250. Only one air purifier unit will

be approved per beneficiary for a five-year period.

12. Adaptive switches and buttons to operate equipment, communication

devices, environmental controls, such as heat, air conditioning, and lights,

for a beneficiary living alone or who is alone without a caregiver for a

major portion of the day. Excluded are adaptive switches or buttons to

control devices intended for entertainment, employment, or education.

13. Adaptive door openers and locks for beneficiaries living alone or who are

alone for substantial portions of the day or night and have a need to be

able to open, close or lock the door and cannot do so without special

adaptation.

14. Environmental safety devices limited to door alarms, anti-scald device,

and grab bars for the bathroom.

15. Bath or shower chair when medically indicated and not covered through

the Medicaid State Plan. Coverage is limited to the most cost-beneficial

item necessary to meet the beneficiary’s need for bathing. Items that

exceed the basic needs of the beneficiary are not covered.

16. Adaptive eating devices, including adaptive plates, bowls, cups, drinking

glasses, and eating utensils, that are prescribed by a physical therapist,

occupational therapist or Rehabilitation Engineering and Assistive

Technology Society of North America (RESNA) certified provider.

Adaptive bathing aids, to facilitate independence, as prescribed by a

physical, occupational therapist, or RESNA certified provider.

17. Picture communication boards and pocket charts, selected and prescribed

by a speech therapist.

18. Gait belts for safety during transfers and ambulation, and transfer boards.

19. Egg crate padding for a bed, when medically indicated and prescribed by

a physician.

20. Hypoallergenic covers for mattress and pillows, ordered by a physician,

who documents necessity based upon severe allergic reaction to airborne

irritants.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-33

Limitations,

continued

21. Generators, may be covered for a beneficiary when:

a. The beneficiary is ventilator-dependent;

b. The beneficiary requires daily use of oxygen via a concentrator;

c. The beneficiary requires continuous, 24-hour total parenteral nutrition

via an electric pump;

d. The beneficiary requires continuous, 24-hour infusion of total nutritional

formula through a jejunostomy or gastrostomy tube via an electric pump;

or,

e. The beneficiary requires continuous, 24-hour infusion of medication via

an electric pump.

The size of the generator is limited to the wattage necessary to provide

power to the essential life-sustaining equipment. When a generator is

requested, it must be documented that the specific model identified is the

most cost-beneficial and meets, but does not exceed the beneficiary’s

need. One generator per beneficiary may be purchased per 10-year period.

22. Bolsters/pillows/wedges, necessary for positioning, prescribed by a

physical or occupational therapist.

23. Therapy mat, prescribed by a physical therapist when a beneficiary is

involved in a home-therapy program designed by a therapist and carried

out by the family or caregiver in the person’s own or family home.

24. Pulse oximeters may be purchased for beneficiaries with respiratory or

cardiac disease, who use supplemental oxygen on a continuous or

intermitted basis. This equipment must be prescribed by the beneficiary’s

pulmonologist, cardiologist or primary care physician.

Items not contained on this list, meeting the definition of durable medical

equipment, may be approved through exception by the Department. To

request an exception, a physician must prescribe the item. The statement

from the physician, must delineate how the item is medically necessary, how it

is directly related to the beneficiary’s developmental disability, without which

the beneficiary can not continue to reside in the community or in their current

placement. The request will be reviewed by an appropriate, qualified

professional to determine whether the standards for medical necessity set

forth in Chapter 59G-1.010 (166), F.A.C., are met, and to determine whether

the requested item fairly meets the service definition. The Developmental

Disabilities Medical Director shall also review the request, for the same

purpose. This additional review will typically only be necessary if the District

does not have an appropriate physician available to review the request. A

recommendation will be made to the District for approval or denial.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-34 July 2002

Limitations,

continued

If multiple vendors are enrolled to provide this service, the beneficiary shall

select from among all eligible vendors based on the item’s availability, quality

and best price. No more than five items per day may be purchased.

A prescription submitted for a piece of equipment, which has general utility or

is generally used for physical fitness or personal recreational choice, does not

change the character of the equipment for purposes of coverage in this

category. For example, a physical therapist, occupational therapist or

physician recommending or prescribing a stationary bicycle or hot tub, does

not covert that item from personal fitness or recreational choice equipment to

durable medical equipment covered under the HCBS Waiver. Items covered

in this category generally include those specifically designed for a medical

purpose, and are not used by the general public for physical fitness purposes,

recreational purposes, or other general utility uses. It is the general character

and not the specific use of the equipment that determines its purpose, for

coverage under this category.

Items usually found or used in a physician’s office, therapist’s office, hospitals,

rehabilitation centers, clinics or treatment centers, or items designed for use

by a physician or trained medical personnel are not covered. This includes

items such as prone or supine standers, gait trainers, activity streamers,

vestibular equipment, paraffin machines/baths, therapy balls, etc. Also

excluded; are experimental equipment, weighted vests and other weighted

items used for the treatment of autism, facilitated communication, hearing and

vision systems, institutional type equipment, investigational equipment, items

used for cosmetic purposes, personal comfort, convenience or general

sanitation items, or routine and first aid items.

Documentation

Requirements

Items for diversional or entertainment purposes are not covered. Items that

would normally be available to any child (or adult) and would ordinarily be

provided by families, are also excluded. Such items include, but are not

limited to; crayons, coloring books, other books, games, toys, videotapes, CD

players, radios, cassette players, tape recorders, television, VCRs, cameras,

film, computers and software, exercise equipment (i.e., treadmill, exercise

bike), indoor and outdoor play equipment (i.e, swing sets, slides, bicycles,

tricycles (including adaptive types), trampolines, play houses, merry-gorounds,

etc, and furniture or appliances. Items that are considered family

recreational choices are also not covered (i.e, air conditioning for campers,

swimming pools, decks, spas, patios, hot tubs, etc.). The above examples do

not represent an exhaustive list of all items not covered through the waiver.

For reimbursement purposes, the provider must submit:

1. An invoice (prior to processing the invoice for payment the beneficiaries

waiver support coordinator must document that the equipment was

received and it works according to the manufacturer’s description, either

by conducting a site visit or obtaining verbal verification from the

beneficiary/family).

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

July 2002 2-35

Documentation

Requirements,

continued

For monitoring review purposes, the provider must have, at a minimum:

1. A copy of the invoices listing the equipment provided for the period being

reviewed; and

2. The original prescription for the equipment (if prescribed by a physician).

Note: Refer to the defi nition section for additional information.

Special

Considerations

Beneficiaries and their family members shall not be reimbursed for equipment

they purchase.

Any durable medical equipment must be determined to be cost-beneficial.

Once the most reasonable alternative has been identified and specifications

developed, three competitive bids must be obtained for all items $1,000 and

over, to determine the most economical option. If three bids cannot be

obtained it must be documented to show what efforts were made to secure the

three bids and explain why less were obtained. For items under $1,000, one

bid is required as long as it can be demonstrated that the bid is consistent with

local market value.

The DS waiver shall not provide durable medical equipment that is available

for purchase through the Medicaid State Plan. Medicaid often covers like

equipment, but not the specific brand requested. When this occurs, the

beneficiary is limited to the Medicaid covered device. The lack of coverage for

a specific brand name is not a medically necessary justification for waiver

purchase. Only the equipment that is not covered through the Medicaid State

Plan, or in a sufficient quantity to meet the needs of the beneficiary, may be

purchased by the DS waiver, and then only consistent with what is described

above. All equipment shall have direct medical or remedial benefit to the

beneficiary, shall be related to the beneficiary’s developmental disability and

shall be necessary to prevent institutionalization. Assessment and

recommendation of appropriateness by a licensed physician, physical

therapist or occupational therapist may be required.

In accordance with Chapter 393.13, F.S., totally enclosed cribs and barred

enclosures are considered restraints and are not covered under the waiver.

Strollers and wheelchairs, when used for restraint, are also not covered.

Note: Refer to the Definition Section for additional information regarding

prescriptions.

Developmental Services Waiver Services Florida Medicaid Coverage and Limitations

2-36 July 2002