65A-2.022 Rights and Responsibilities. (1) Any individual has the right to apply for Optional State Supplementation (OSS) and, if found eligible according to these rules and Section 409.212, F.S., to receive an established monthly payment. Individuals residing in Assisted Living Facilities (ALF) and Adult Family Care Homes (AFCH) are eligible to receive OSS payments to assist with the cost of room and board. Individuals residing in facilities covered by subsection 65A-2.032(7), F.A.C., and within the coverage groups specified in subsections 65A-2.033(1) through (4), F.A.C., are also eligible to receive OSS payments. Additionally, individuals residing in Mental Health Residential Treatment Facilities (MHRTFs) enrolled as qualified Medicaid providers of Assistive Care Services (ACS) with the Agency for Health Care Administration (AHCA) are eligible to receive OSS payments to assist with room and board. Individuals residing in MHRTFs that are not enrolled as qualified Medicaid providers of ACS by AHCA, under subsections 65A-2.033(3) and (4), F.A.C., are eligible for OSS payments that are inclusive of room, board and personal care. The individual’s use of the personal needs allowance is not restricted. (2) An authorized representative as defined in subsection 65A-1.203(9), F.A.C., may be designated to act on behalf of the individual in any matter pertaining to the individual’s OSS eligibility. Designation may be made by the individual, or a person knowledgeable of the individual’s affairs may be self-designated as the individual’s representative. The authorized representative may be identified on the Appointment of a Designated Representative, CF-ES 2505, 07/2013, HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-03155" http://www.flrules.org/Gateway/reference.asp?No=Ref-03155, incorporated by reference. The following non-English versions of the Appointment of a Designated Representative form are incorporated by reference: CF-ES 2505H (Creole), 07/2013, available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13629" http://www.flrules.org/Gateway/reference.asp?No=Ref-13629, and CF-ES 2505S (Spanish), 07/2013, available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13630" http://www.flrules.org/Gateway/reference.asp?No=Ref-13630. (3) The individual is responsible for providing all facts necessary to establish initial and continuing eligibility. The individual is also responsible to notify the Department of any changes in circumstances that could affect their eligibility within ten days of the date of the change. (4) The Department is responsible for determining eligibilty within the required time standard in accordance with subsections 65A-2.023(1) and (2), F.A.C., equitable treatment in accordance with Rules 65A-1.204 and 65A-2.031, F.A.C., and timely notification in accordance with subsection 65A-2.023(2), F.A.C., of any decision regarding an individual’s payment or eligibility status. (5) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.22, 10C-2.022, Amended 12-16-01, 5-14-02, 10-2-13, 10-26-21.

65A-2.023 Application and Determination of Eligibility. (1) An individual applying to receive an Optional State Supplementation (OSS) payment must submit an ACCESS Florida Application, CF-ES 2337, 08/2016, incorporated by reference in Rule 65A-1.205, F.A.C. Once the completed, dated and signed application is received, and date stamped as received by the Department, the application process begins. (2) Applications are processed and the eligibility decision is made in accordance with the standards in Rule 65A-1.205, F.A.C., with the exception that the ACCESS Florida Application is the application for the OSS Program. The individual is notified of the eligibility decision by a Notice of Case Action, CF-ES 2235, 02/2012, HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-01205" http://www.flrules.org/Gateway/reference.asp?No=Ref-01205, incorporated by reference. The following non-English versions of the Notice of Case Action are incorporated by reference: CF-ES 2235H (Creole), 02/2012, available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13627" http://www.flrules.org/Gateway/reference.asp?No=Ref-13627, and CF-ES 2235S (Spanish), 02/2012, available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13628" http://www.flrules.org/Gateway/reference.asp?No=Ref-13628. (3) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.23, Amended 2-9-88, Formerly 10C-2.023, Amended 12-16-01, 6-4-12, 10-26-21.

65A-2.024 Determination of Continued Eligibility. (1) The individual receiving Optional State Supplementation (OSS) must notify the Department of changes in circumstances as indicated in subsection 65A-2.022(3), F.A.C. The Department, in cooperation with the individual, must redetermine the individual’s eligibility for continued assistance at least annually. (2) Individuals who do not cooperate with the Department by providing required information or documentation shall have their case terminated, as continuing eligibility cannot be established. (3) If an individual leaves the special living arrangement for a period of 30 consecutive days, the individual is no longer eligible for continued OSS benefits and must reapply in order for their eligibility to be determined. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Amended 10-7-80, Formerly 10C-2.24, 10C-2.024, Amended 12-16-01.

65A-2.031 Advance Notice: Written Ten Day Advance Notice. (1) Written notification must be given or mailed to an individual receiving Optional State Supplementation ten days in advance of action to terminate or reduce the payment. (2) Exception. Conformity to ten day advance notice is waived in the following situations, but written notification must be given or mailed to the individual or their authorized representative prior to the effective date of the action: (a) When termination is due to death; (b) When an individual or their authorized representative requests termination or reduction of assistance in writing; (c) When the Department is unable to locate an individual as evidenced by the return of a letter of a recent date, with an indication that the letter could not be delivered due to no forwarding address, and no further information for locating the individual is available; (d) When an administrative or fair hearing has been denied, the benefits that were continued without reduction pending the outcome of the hearing may be reduced with no advance notice of adverse action to the individual, or (e) When systems transactions fail to reduce or terminate assistance correctly and notice has previously been given. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.31, 10C-2.031, Amended 12-16-01.

65A-2.032 Optional State Supplementation Eligibility Criteria. (1) An eligible individual must be age 65 or older, or age 18 or older and blind or disabled as defined by Title XVI of the Social Security Act (SSA). Federal disability criteria are found at 20 C.F.R. §§416 et seq. (2) An eligible individual must be living in the state of Florida with the intent to remain. (3) An eligible individual must be a United States citizen or a qualified noncitizen as defined in 8 U.S.C. §1641(b). (4) An eligible individual must have income within standards established by the Department in subsection 65A-2.036(3), F.A.C. (5) An eligible individual must have assets within SSA Title XVI standards for Supplemental Security Income (SSI). (6) An individual must apply for and seek a determination of eligibility for all other monetary benefits for which they may be entitled or otherwise potentially eligible as required by 20 C.F.R. §416.210 for the SSI Program and by 42 C.F.R. §435.608 for the Medicaid Program. (7) An eligible individual must be living in a licensed Assisted Living Facility as defined in Section 429.02(5), F.S.; a licensed Adult Family Care Home as defined in Section 429.65(2), F.S.; or a licensed Mental Health Residential Treatment Facility as defined in Section 394.67(23), F.S. Additionally, the facility must meet the individual’s needs based on objective medical and social evaluations and care plans, in accordance with Chapter 59A-36, 59A-37 or 65E-4, F.A.C., respectively. (8) Pursuant to Section 429.67(8), F.S., the Department of Children and Families will refer residents who receive Optional State Supplementation (OSS) to adult family care homes by providing the resident with the Adult Family Care Home Referral Notice, CF-ES 2202, 08/2009, incorporated by reference and available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13625" http://www.flrules.org/Gateway/reference.asp?No=Ref-13625. The following non-English versions of the Adult Family Care Home Referral Notice are incorporated by reference: CF-ES 2202H (Creole), 08/2009, available at HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13625" http://www.flrules.org/Gateway/reference.asp?No=Ref-13625, and CF-ES 2202S (Spanish), 08/2009, HYPERLINK "http://www.flrules.org/Gateway/reference.asp?No=Ref-13626" http://www.flrules.org/Gateway/reference.asp?No=Ref-13626. (9) When appropriated OSS funding is insufficient to meet fiscal demands, a proportional reduction will be applied to OSS payments, but shall not affect maintenance of effort required per 42 U.S.C. §1382g. (10) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date. Rulemaking Authority 409.212(7), 429.67(8) FS. Law Implemented 409.212, 429.67(8) FS. History–New 1-1-77, Amended 9-29-81, 10-31-83, Formerly 10C-2.32, Amended 9-30-86, Formerly 10C-2.032, Amended 12-16-01, 2-25-10, 10-26-21.

65A-2.033 Optional State Supplementation Coverage Groups. To be determined eligible for Optional State Supplementation (OSS), an individual must qualify under one of the following coverage groups. (1) The individual must be eligible for and receiving a check from the Supplemental Security Income (SSI) Program administered by the Social Security Administration. The Department accepts receipt of SSI as meeting all factors of OSS eligibility criteria in Rule 65A-2.032, F.A.C., except age and placement need as specified in subsections 65A-2.032(1) and (7), F.A.C., which must be verified by Department staff. (2) The individual must meet all SSI and OSS eligibility criteria, except for income which must be equal to or less than the OSS income standard established by the Department. These individuals must meet eligibility criteria in Rule 65A-2.032, F.A.C. (3) The individual must have been eligible for and receiving Aid to the Aged, Blind or Disabled from the state as of December 1973. This federally mandated coverage group did not qualify for the same level of benefits under SSI in 1974. For this coverage group, the special living facility criteria at subsection 65A-2.032(7), F.A.C., does not apply. (4) The individual must: reside in an Assisted Living Facility or Mental Health Residential Treatment Facility; have been eligible for and receiving OSS payments for August 2001; have become ineligible for OSS as of September 2001 solely because their income exceeds the applicable OSS income standard of $609.40; and, not be categorically eligible for full Medicaid benefits as of September 2001. Additionally, in regard to an Adult Family Care Home (AFCH), the individual must: reside in an AFCH; have been eligible for and receiving OSS payment for December 2001; have become ineligible for OSS as of January 2002, solely because their income exceeds the applicable OSS income standard of $623.40; and, not be categorically eligible for full Medicaid benefits as of January 2002. As long as the individual continues to meet all OSS eligibility criteria and the income standard test in paragraph 65A-2.036(3)(b), F.A.C., they will remain eligible for payment under the provider rates in paragraph 65A-2.036(4)(b), F.A.C. Once an OSS recipient no longer meets all OSS eligibility criteria or the income standard in paragraph 65A-2.036(3)(b), F.A.C., they will no longer be eligible under this coverage group. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.33, Amended 9-30-86, 2-9-88, Formerly 10C-2.033, Amended 12-16-01, 5-14-02.

65A-2.035 Income Calculation. (1) To be determined eligible for Optional State Supplementation, an individual must not have gross monthly income, after the following exclusions, in excess of Department standards, as found in subsection 65A-2.036(3), F.A.C.: (a) Gross income, less an earned income exclusion of $65 plus one-half of the remaining earned income; (b) Other federal exclusions to the individual’s income; and, (c) Additional exclusions provided by Section 409.212(5), F.S. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Amended 9-29-82, Formerly 10C-2.35, Amended 1-27-91, Formerly 10C-2.035, Amended 12-16-01.

65A-2.036 Optional State Supplementation Base Provider Rates and Program Standards. (1) The Department establishes the base provider rates for specialized living arrangements (the amount the individual is to pay the facility) specified in subsection (4), below, within funds appropriated by the Legislature. Base provider rates may vary depending upon type of specialized living facility and covered services in such facilities. (2) Within the funds appropriated by the Legislature, Optional State Supplementation (OSS) eligible individuals receive a standard personal needs allowance (PNA), the amount the individual keeps for personal needs. The PNA is established by Legislative proviso language. The individual’s PNA does not vary due to type of specialized living facility and covered services in such facilities. (3) Optional State Supplementation Program Financial Standards. Optional State Supplementation Program financial standards are subject to Florida legislative appropriations and federal cost-of-living adjustments. (a) The monthly income eligibility standard for residents of Assisted Living Facilities (ALFs), Adult Family Care Homes (AFCHs) and, except as specified in paragraph (b), below, Mental Health Residential Treatment Facilities (MHRTFs) is $1,045.40. (b) The monthly income eligibility standard for residents of MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of Assistive Care Services (ACS), and for individuals with coverage under subsections 65A-2.033(3) and (4), F.A.C., is $1,152.00. (c) The personal needs allowance is $160.00. (4) Optional State Supplementation Base Provider Rates. Optional State Supplementation base provider rates are subject to Florida legislative appropriations and federal cost-of-living adjustments. (a) For ALFs, AFCHs and, except as specified in paragraph (b), below, MHRTFs, the monthly base provider rate is $991.40 and is inclusive of room and board only. (b) For MHRTFs that do not meet the criteria for enrollment as qualified Medicaid providers of ACS, and for the individuals covered under subsections 65A-2.033(3) and (4), F.A.C., the monthly base provider rate is $1,152.00 and is inclusive of room, board and personal care. (5) To calculate the amount of the OSS payment, the base provider rate is added to the standard PNA to determine the individual’s total needs. From this sum, the individual’s gross income, minus the allowable exclusions at Rule 65A-2.035, F.A.C., is subtracted, resulting in the amount of the OSS payment. (6) Payment for the month of admission to the special living arrangement shall be prorated if the month of admission is the month of application or later. For months other than the month of admission, payment begins the first day of the month. (7) The monthly income eligibility standards of paragraphs (3)(a) and (b), above, and the base provider rates established at subsection (4) above, shall be increased by the annual cost-of-living adjustment to the federal benefit rate, provided the average state optional supplementation contribution does not increase as a result. (8) The payment is issued monthly through an automated delivery system. (9) This rule will be reviewed and repealed, modified, or renewed through the rulemaking process five years from the effective date. Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Amended 9-27-79, 10-7-80, 9-29-81, 9-29-82, 10-31-83, 11-28-83, 9-30-84, 10-1-85, Formerly 10C-2.36, Amended 1-1-87, 2-9-88, 11-6-88, 2-16-89, 3-1-90, 1-27-91, 2-19-95, Formerly 10C-2.036, Amended 1-27-99, 12-16-01, 5-14-02, 11-26-18, 6-30-19, 6-11-20, 10-26-21, 6-24-25.