Opinion ID: 75587
Heading Depth: 4
Heading Rank: 2

Heading: Defendants Adopt the Status Tracking Survey

Text: After entry of the final judgment, defendants designed and adopted what they deemed a “uniform assessment instrument,” known as the Florida Status Tracking Survey, to determine which applicants for ICF/DD services satisfy the medical necessity standard. Under the Status Tracking Survey defendants evaluate applicants for ICF/DD services to determine if their “level of need” indicates that they require “continuous active treatment” so that ICF/DD services are “medically necessary.” The Status Tracking Survey was designed in part to evaluate an applicants’ level of need for ICF/DD services in three categories: daily functioning, behavioral risk, and physical/medical status. Those individuals who score a sufficiently high level of need are deemed to require 24-hour care for severe medical, behavioral, and functional deficits. The purpose of the Status Tracking Survey was explained during the show cause hearing by Dr. Ray Foster, who consulted with the State in developing it: In terms of taking a look at the [Status Tracking Survey], its purpose. . . is really to identify individuals who are at higher Levels of Need for assistance, support, intervention, service, supervision, the kinds of things that you would need in your daily life day to day, to help you eat and dress and function and get around, to take care of behaviors that would pos[e] a risk to yourself or someone else and to take care of health conditions that would require special treatment or extended periods of monitoring or supervision in some way. . . . [I]n the end the 11 decision you have to come down to is whether or not, based on this person’s characteristics and levels of need, are they high enough? Are they substantial enough? Are they enduring enough to require the top ended service that we can deliver in our State. That is really the purpose of this tool. The new eligibility criteria contained in the Status Tracking Survey were not subject to notice and comment rulemaking and they have never been published. 3. Defendants Develop the Two-Step Review Process Determining that an applicant has an appropriate level of need is only part of the first of two steps in defendants’ revised eligibility determination process. Under the first step, after an applicant submits an initial request for services, defendants determine both whether the applicant is Medicaid eligible and, using the Status Tracking Survey, whether the applicant is eligible to receive ICF/DD services, i.e., whether such services are medically necessary. If the applicant is determined to be eligible, defendants then schedule an interview with the applicant to discuss alternative services, such as home and community-based waiver services, to ensure that the applicant actually does want ICF/DD services. 7 Eligible applicants who do want ICF/DD services are placed on a waiting list. 7 In the Home and Community Based Services Waiver Act, Title XIX of the Social Security Act, 42 U.S.C. § 1396n(c), Congress has authorized certain persons with developmental disabilities to receive Medicaid services in a community setting rather than in an institutional facility. As a result, certain individuals who would qualify for ICF/DD placement may instead elect to remain in their homes. See id. 12 Under defendants’ revised two-step review process, they have 90 days from the date the applicant is put on the waiting list after re-affirming the initial request for services to place that applicant in an ICF/DD facility. See Florida Medicaid Plan, Attachment 3.1-A(15)(2) 4. Defendants Apply the Status Tracking Survey and the Two-Step Review Process Utilizing their revised criteria and admissions practices, defendants began evaluating the level of need of the 600 individuals they had previously identified to the district court as requiring ICF/DD services, plus an additional 34 individuals who were subsequently identified as potentially eligible candidates. Defendants reviewed the files of these individuals using a uniform screening instrument (not the Status Tracking Survey) that measured three indicators of eligibility: 1) Medicaid eligibility; 2) a request for ICF/DD placement; and 3) a preliminary indication that the individuals were likely to need active treatment. Of the individuals screened, only 285 were identified for further evaluation. Most of the 285 individuals8 who were identified as likely to meet the criteria for ICF/DD services were further reviewed using the Status Tracking Survey to evaluate their level of need. Of those individuals, 208 were identified as 8 Nineteen of the 285 individuals were unavailable due to circumstances beyond the control of the defendants. 13 having a level of need of 4, or 5, which was required at that time to support a finding of medical necessity.9 Those 208 individuals were subsequently interviewed to determine whether they wanted ICF/DD placement or whether they would prefer home and community-based waiver services. According to defendants, of the 208 individuals, only 10 people requested ICF/DD placement after the interviews. Thus, by application of the new eligibility criteria and the revised two-step review process, the defendants reduced their initial estimate of “eligible” individuals awaiting ICF/DD services from 634 to 10.