Fla. Admin. Code Ann. R. 65G-14.0041 - Qualified Organization Duties and Responsibilities - Code of Ethics

Current through Reg. 48, No. 66; April 5, 2022

(1) Each Qualified Organization must develop, maintain, and enforce a professional code of ethics applicable to all Support Coordinators within the organization. Failure to develop, maintain, or enforce a professional code of ethics shall constitute grounds for the Agency to deny approval of or take disciplinary action against the Qualified Organization.
(2) The code of ethics must include:
(a) Provisions addressing how the Qualified Organization will prevent and avoid actual and perceived conflicts of interest among its Support Coordinators, which must prohibit each Support Coordinator from:
1. Being the legal representative, applying to be the legal representative, or being affiliated with an organization or person who is the legal representative of a client served by the Qualified Organization;
2. Being the legal representative or representative payee for any benefits received by a client served by the Qualified Organization nor assume control of a client's finances or assume possession of a client's checkbook, investments, or cash;
3. Rendering support coordination services to a client who is a family member;
4. Unduly influencing paid services on behalf of a client from a service provider who is a family member of the Support Coordinator or any employee of the Qualified Organization;
5. Providing any waiver service other than support coordination and CDC+ consultant services;
6. Being a subsidiary of or being directly or indirectly controlled by persons or organizations providing waiver services within the state of Florida, other than support coordination and related administrative activities to clients who receive services from the Agency;
7. Requesting or receiving financial compensation from family members of clients; and
8. Providing assistance to a client on completion of the Support Coordinator Client Satisfaction Survey.
(b) Provisions mandating every Support Coordinator to promote client choice as described in the iBudget Handbook, including freedom to direct service planning and choose a provider from all available providers;
(c) Provisions addressing how the Qualified Organization will ensure that clients' rights under section 393.13, F.S. are protected, including reporting known or suspected abuse, neglect, exploitation, and sexual misconduct;
(d) Provisions encouraging fairness, integrity, and civility, including providing honest and accurate information verbally and in writing, being available for clients, timely responding to communications from clients and Agency staff, and cooperating and collaborating with others involved in client care;
(e) Provisions requiring Support Coordinators to counsel clients and, if applicable, the client's legal representative regarding covered services and that covered services will only be approved if they are individualized, specific, consistent with the client's needs, and not in excess of the client's needs;
(f) Provisions requiring Support Coordinators to explore all services available through local, state, and federal government and non-government programs or services, including the Medicaid State Plan; school-based services; private insurance; natural supports; and community supports, prior to requesting Waiver funds on behalf of the client, which may be evidenced by denial letters, coverage policies, case notes, and other documentation;
(g) Provisions requiring Support Coordinators to only pursue Waiver services for clients that the Support Coordinator believes address the capacities, needs, and resources of their clients and are not available through other resources or funding sources, which the Support Coordinator must indicate on the Verification of Available Services Form incorporated by reference in Rule 65G-4.0213, F.A.C.;
(h) Provisions requiring confidentiality and privacy of client information;
(i) Provisions prohibiting Support Coordinators from misrepresenting their affiliation with the Agency; and
(j) Provisions addressing Support Coordinator duties and responsibilities described in Chapter 393, F.S. and the iBudget Handbook, including:
1. Ensuring Significant Additional Needs requests are complete and accurate when submitted;
2. Assisting clients and, if applicable, legal representatives obtain services through the Medicaid state plan;
3. Participating in meetings required by the Agency;
4. Participating in meetings coordinating services on behalf of the client;
5. Assisting clients and, if applicable, their legal representative with the process for addressing client complaints and grievances regarding possible service delivery issues;
6. Coordinating in the preparation and planning for natural disasters, including ensuring each client has a personal disaster plan and monitoring the status of each client, including providing information on available resources during and after a natural disaster; and
7. Updating service authorizations in iConnect to reflect the current, approved level of service(s) and providing the updated service authorizations to providers.
(3) The Qualified Organization must make the approved code of ethics available to all its employed Support Coordinators and must review the code of ethics to each client or, if applicable, client's legal representative on an annual basis or immediately upon request.
(4) Upon discovering that a Support Coordinator has violated the code of ethics, the Qualified Organization must send a report to the Agency as described in 65G-14.003, F.A.C.
(5) This Rule shall be reviewed, and if necessary, renewed through the rulemaking process five years from the effective date.

Notes

Fla. Admin. Code Ann. R. 65G-14.0041

Rulemaking Authority 393.0663(5), 393.501(1) F.S. Law Implemented 393.0662, 393.0663(2)-(3), 393.063 F.S.

Adopted by Florida Register Volume 47, Number 031, February 16, 2021 effective 7/1/2021.

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