First-Day Notice of the Right to Report Complaints, Abuse, and Medicaid Fraud

This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1.

This policy makes sure that every client of Sample Agency, LLC (the "Agency"), and the client's family or representative where appropriate, knows from the first day of services how to report a complaint to AHCA, abuse, neglect or exploitation to the Florida Abuse Hotline, and suspected Medicaid fraud, in the words and with the numbers Florida law requires.

This policy applies to every client, whether the Agency holds a home health agency license (NSHHA) or a homemaker and companion registration (HMC). Section 408.810(5), F.S., binds every "licensee," and s. 408.803(8), F.S., defines "license" to include "any permit, registration, certificate, or license issued by the agency"; s. 400.509(2), F.S., applies all of Part II of chapter 408 to registrants. It applies to every client regardless of payment source, including clients who do not receive Medicaid.

For the purposes of this policy:

Section 408.810(5)(a), F.S., provides: "On or before the first day services are provided to a client, a licensee must inform the client and his or her immediate family or representative, if appropriate, of the right to report:" complaints, abusive, neglectful or exploitative practices, and Medicaid fraud. The Agency gives this notice on Form FL-HC-CR-02-A, with the statutory words and the current statewide toll-free numbers, to every client on or before the first day of services, explains it, and keeps the client's signed acknowledgment in the client record. Staff never discourage a client or anyone else from making any of these reports.

The statute prescribes the words of each statement. The Agency's notice prints them with the current number and does not reword them. Table 1 shows the statutory wording and the wording on the Agency's notice.

Each number must be provided "in a manner that is clearly legible" (s. 408.810(5)(a)1.-3.). The Agency's notice also lists other ways to report (AHCA's online complaint form, the Florida Abuse Hotline's online and fax routes, and 911 in an emergency), below the three statements and never in place of them.

For the Medicaid fraud item, the statute also requires "An agency-written description of Medicaid fraud" (s. 408.810(5)(a)3., F.S.). In Part II of chapter 408, "agency" means AHCA (s. 408.803(1), F.S.), so the description is AHCA's own text. The Administrator obtains AHCA's description and attaches it to Form FL-HC-CR-02-A, without changes. The Agency does not write its own version inside quotation marks or present its words as AHCA's. Below AHCA's description, the form may carry a short plain-language explanation that is clearly labeled as the Agency's explanation. The Administrator checks at each review of this policy that the attached description is AHCA's current text.

The notice is given as follows.

1. The intake coordinator prepares Form FL-HC-CR-02-A with the start-of-service documents (Policy FL-HC-ADM-01): the service agreement, the client rights notice (Form FL-HC-CR-01-A) and, for adults, the advance directive information (Form FL-HC-CR-04-A).
2. On or before the first day services are provided, the intake coordinator, or if services start before an intake visit the first staff member to visit, gives the form to the client and, if appropriate, to the client's immediate family or representative.
3. The staff member reads or explains each statement, points out the numbers, and explains that the client may call at any time, without telling the Agency first, and that no one at the Agency will be upset or treat the client differently for calling.
4. The client or representative signs and dates the acknowledgment on the form; the staff member signs as the person who gave the notice. If the client declines to sign, the staff member writes "declined to sign," the date and his or her own name.
5. A copy of the form stays in the client's home, with the client's other Agency papers. The signed original goes in the client record the same day or, if given at a first visit, is brought to the office by the next business day (Agency's own standard).
6. If the first day of services passes without a signed acknowledgment, the office tells the Administrator, who arranges for the notice to be given at the next visit and records why it was late. Services are not refused because of a late notice, but the Agency treats the delay as a compliance failure under Policy FL-HC-QA-01.

As the Agency's own standards:

• The three statements are printed in at least 14-point type, one under the other, on the first page of Form FL-HC-CR-02-A.
• The Spanish version of the form shows the English statements exactly as the statute requires, followed by a faithful Spanish translation of each one, with the same numbers.
• For any other language, a qualified interpreter reads and explains the notice (Policy FL-HC-CR-03), and the interpreter's name or identification number is recorded on Form FL-HC-CR-03-A.
• For a client who is blind or has low vision, staff read the notice aloud and offer larger print; for a client who is deaf or hard of hearing, staff give the written notice and use a qualified sign language interpreter or other auxiliary aid when needed, and point out the Florida Relay Service (711) and the TTY numbers on the form.
• For a client with a cognitive impairment, staff explain the notice to the client as far as the client can understand and give it also to the representative or family.

As the Agency's own standard, a copy of the three statements in English and Spanish is posted in the Agency's office where visitors can read it, is printed in the client information packet, and, if the Agency has a website, is shown on it. These copies are in addition to, and never in place of, the individual notice given to each client.

The statute provides: "The agency shall publish a minimum of a 90-day advance notice of a change in the toll-free telephone numbers." (s. 408.810(5)(a), F.S.) The Administrator checks the three numbers against AHCA's published numbers at each review of this policy and whenever AHCA announces a change. When a number changes, the Administrator replaces Form FL-HC-CR-02-A and the posted copies before the change takes effect and, as the Agency's own standard, gives every current client the updated notice at the next visit, with a new signed acknowledgment.

Staff support a client who wants to report, and never discourage, delay or question it.

• If a client asks for help to call AHCA, the Florida Abuse Hotline or the Medicaid fraud line, staff help dial the number or find the online form, and give the client privacy for the call.
• Staff tell the office that the client wished to make a report only if the client agrees. The Agency does not ask the client what was reported.
• A staff member who personally suspects abuse, neglect or exploitation does not wait for the client: "Any person ... who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited must immediately report such knowledge or suspicion to the central abuse hotline." (s. 415.1034(1)(a), F.S.) Suspected abuse of a child is reported to the same hotline (s. 39.201(1), F.S.). See Policy FL-HC-ANE-01.
• A staff member who suspects Medicaid fraud, including by the Agency, reports it to the Medicaid fraud line (1-888-419-3456) or under Policy FL-HC-ETH-02, without fear of retaliation.
• No staff member retaliates against, or treats less favorably, a client or family member who has made or may make a report (Agency's own standard).

Accountability under this policy is allocated as follows.

The signed Form FL-HC-CR-02-A, or the record that the client declined to sign, is kept in the client record for the periods in Policy FL-HC-RM-01 (for a licensed agency, 3 years following termination of services, s. 400.491(2), F.S.; Medicaid records, 5 years after the date services were furnished, s. 409.913(9), F.S.). The Administrator keeps each superseded version of the form, with the dates it was in use.

As the Agency's own standard, the quarterly record review (Policy FL-HC-QA-01) checks, for every record in the sample, that the acknowledgment is signed and dated on or before the first day of services and that the form in use carries the current numbers and AHCA's description of Medicaid fraud. Any late or missing notice is corrected and recorded.

All staff learn at orientation (Policy FL-HC-HR-06) what the notice says, why it must be given on or before the first day, and that they must never discourage a report. Intake staff and any staff member who may open services practice giving the notice, including in Spanish and with an interpreter. Staff are retrained when the form or the numbers change.

This policy implements the following authorities.

• s. 408.810(5), F.S., Minimum licensure requirements: notice of the right to report
• s. 408.803(1), (6), (8), F.S., Definitions of "agency," "client" and "license"
• s. 400.509(2), F.S., Part II of chapter 408 applies to registrants
• s. 415.1034(1)(a), F.S., Mandatory reporting of abuse, neglect or exploitation of vulnerable adults
• s. 39.201(1), F.S., Mandatory reports of child abuse, abandonment or neglect
• s. 409.913, F.S., Oversight of the integrity of the Medicaid program

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Agency, LLC. The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a statute or rule cited in Section 15 is amended, the amendment is recorded in this table and a new version of this policy is issued.