Provider Requirements and Service Limitations
From The May 2010 Florida Medicaid Provider Handbook
Respite - Requirements To Receive
Respite care is a service that provides supportive care and supervision to a recipient when the primary caregiver is unable to perform these duties due to a planned brief absence, an emergency absence or when the caregiver is available, but temporarily physically unable to care for or supervise the recipient for a brief period.
Respite care service providers are not reimbursed separately for transportation and travel cost. These costs are integral components of respite care services and are included in the basic fee.
Respite care services are limited to the amount, duration, and scope of the service described on the recipient’s support plan and current approved cost plan. The amount of respite services are determined individually and limited to no more than thirty days per year, (720 hours) per recipient.
Reimbursement* and monitoring documentation to be maintained by the provider:
- *Copy of claim(s) submitted for payment; and
- *Service log.
The provider must submit a copy of service log, monthly, to the waiver support coordinator.
If the provider plans to transport the recipient in his private vehicle, at the time of enrollment the provider must be able to show proof of: 1) a valid driver’s license; 2) car registration, and 3) insurance. Subsequent to enrollment, the provider is responsible for keeping this documentation up-to-date.
*Indicates reimbursement documentation.
Place of Service:
This service may be provided in the recipient’s own home, family home or foster home. The recipient may also go to a licensed group, foster home, or assisted living facility to receive the service. Overnight respite care can be provided only in the recipient’s own home, family home, licensed foster home, group home or ALF. This service cannot be provided in the provider’s home.
Recipients living in licensed group homes are not eligible to receive respite care services.
Relatives who live outside the recipient’s home and are enrolled as Medicaid waiver providers may provide respite care services and be reimbursed for the services. The relative must meet the same qualifications as other providers of the same service. With regard to relatives providing this service, safeguards must be taken to ensure 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. An example of a valid reason may be a general lack of enrolled providers due to the rural setting.
Most recipients who require respite care services do not need the services of a registered or licensed practical nurse. Nurses should only be employed to perform this service when the recipient has a complex medical condition. If a nurse provides this service, a prescription will be necessary.
Providers of respite services must use the published stepped quarter hour rate for the service or the daily rate if respite services are provided for ten or more hours a day. The provider must bill for only those hours of direct contact with the recipient(s). The respite rate shall be determined based on from one to three recipients in the home receiving the service. Respite services provided in a licensed residential facility will be billed at the ratio of 1:1 in the stepped rate for the service.
Respite Care Services Provider Requirements
Providers of respite care services may be licensed residential facilities, licensed home health or hospice agencies, licensed nurse registries, or agencies that specialize in services for recipients with developmental disabilities.
Independent vendors may also provide this service. Independent vendors and employees of agencies may be registered or licensed practical nurses or persons at least 18 years of age with one year of experience working in a medical, psychiatric, nursing or child care setting or working with recipients with developmental disabilities. College, vocational or technical training equal to 30 semester hours, 45 quarter hours or 720 classroom hours may substitute for the required experience.
Independent vendors, who are not nurses, are not required to be licensed, certified, or registered if they bill for and are reimbursed only for services personally rendered.
Nurses who render respite care services as independent vendors shall be licensed in accordance with Chapter 464, F.S.
Proof of training in the areas of Cardiopulmonary Resuscitation (CPR), HIV/AIDS and infection control is required within 30 days of initially providing respite care services. Proof of annual or required updated training shall be maintained on file for review.
The provider is responsible for all training requirements outlined in the Core Assurances.
Note: Refer to Appendix A for provider training requirements.