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2.14 MEDICAL SERVICES GUIDANCE

Federal law mandates that a state must not use TANF funds to provide medical services and the term "medical services" does not include pregnancy family planning services. The material provided in this section relies not only on the statutory language but also on the discussion in the preamble to the final TANF regulations of issues related to domestic violence, substance abuse treatment, and mental health treatment.

Purpose: The purpose of this section is to provide clarification as to what services are considered "medical services" under Florida's TANF Program and, therefore not allowable for TANF funding.

General: In general, medical services include treatment to alleviate or remedy a health or medical condition, the provision of which requires a license to practice a medical profession in Florida. Medical services would generally include those services covered by the Medicaid program. However, the fact that a service is potentially reimbursable by Medicaid does not automatically mean that it is a medical service. Activities by medical professionals that are related to assessment or which are vocational in nature may not be medical services. This section provides guidance on these issues.

Guidelines: The following services are not medical services for purposes of TANF (and the differentiation of medical vs. non-medical services for TANF is not intended to apply to any other program or funding source): 1. Pre-pregnancy family planning. These activities are not considered medical services due to an explicit statutory exception (section 408(a) (6) of the Social Security Act, as amended). 2. Case management (whether or not reimbursable under Medicaid as targeted case management). As used here, case management includes the development of individualized case plans, family case plans, employability plans, etc., the provision or brokering for services found in the case plan, and the process of monitoring progress toward case goals. Case management also may include assessment of recipient needs, identification of barriers to achievement of goals, and the periodic review of such plans.

NOTE: If an activity such as case management is Medicaid reimbursable and an allowable expense under TANF, it is never permissible to bill both funding sources for the same expenditure. 3. Assessment activities related to a TANF purpose. Assessment activities related to a TANF purpose are generally not considered medical services and are allowable activities under TANF. Examples of assessment activities that are not medical services may include vocational assessment by a health professional to determine what work activities are appropriate. For example, a pre-employment physical examination that does not include treatment is not a medical service. An assessment by a health professional acting as a member of a Child Protection Team as to whether a child could safely remain in his or her own home is not a