What is FCA?

Child Advocacy Blog


Disabled Child Attorney: In Dramatic Shift, AHCA Changes Rules to Help State’s Kids, Parents

To any Florida attorney who fights and sues to protect the rights of and prevent damages to disabled, vulnerable or foster children, the past two years have been tough to watch. Over that time, Florida’s Agency for Health Care Administration has been attempting to balance its budget on the backs of Florida’s Medically Fragile Children and their parents who want to care for them at home by violating the Federal Medicaid Act and chopping the number of hours that they are willing to reimburse parents for medically necessary private duty nurses.

Through their contracted agent, eQ Health Solutions, Inc, AHCA ignores the medical histories and the number of hours these parents have received and are entitled to in attempt to force the parents, many of whom have full time jobs to care for these children — many of whom are on ventilators, have trach tubes to breath and are fed through G-tubes. AHCA ignores the capacities or lack of capacity of many of the parents to assess emergencies and intervene with life saving procedures.

The ground is shifting. The rules are changing. In the Legislature and AHCA itself, change has come, according to this Miami Herald story.

In a recent, groundbreaking move by the state, AHCA revised its rules for “Parental Responsibility for Home Health Services.” According to a recent Agency Alert…

“The Agency for Health Care Administration (AHCA) is in the process of amending current language in the Florida Medicaid Home Health Coverage and Limitations Handbook and the Florida Medicaid Prescribed Pediatric Extended Care (PPEC) Coverage and Limitations Handbook to more accurately describe the process for evaluating parental responsibility when reviewing requests for both private duty nursing and PPEC services for children under the age of 21.

“Effective immediately, when determining the need for Private Duty Nursing (PDN) services, the Agency will not require that parents participate to the fullest extent possible in performing skilled interventions that normally could only be provided by a licensed nurse. The following language should be applied when determining parental responsibility in evaluating the need for PDN services:

If the parents or legal guardians are willing and capable of providing more than activities of daily living (ADL) and instrumental activities of daily living (IADL) care, PDN services can be authorized to supplement the care provided by those parents or legal guardians.

“Medicaid can reimburse PDN services rendered to a recipient whose parent or legal guardian is not available or able to provide ADL and IADL care. Supporting documentation must accompany the prior authorization request in order to substantiate a parent or legal guardian’s inability to participate in the care of the recipient (i.e., work or school schedules and medical documentation). If a parent or legal guardian is unable to provide a documented work schedule, a statement attesting to the work schedule must be presented to eQHealth Solutions when requesting authorization.

“If you have any questions, please contact your local Medicaid area office.”

Leave a Reply