HB 5111

1
A bill to be entitled
2An act relating to the Agency for Persons with
3Disabilities; amending s. 393.23, F.S.; revising purposes
4of expenditures of moneys deposited in the trust accounts
5of developmental disabilities centers; amending s.
6393.0661, F.S.; revising provisions relating to services
7provided to certain clients with developmental
8disabilities served under the four-tiered waiver system;
9revising provisions relating to the calculation of
10annualized expenditures; deleting future review and repeal
11of s. 393.0661(6), F.S., relating to cost plans for
12individuals served by the home and community-based
13services waiver or the family and supported living waiver
14funded through the Agency for Persons with Disabilities;
15providing effective dates.
16
17Be It Enacted by the Legislature of the State of Florida:
18
19     Section 1.  Subsection (1) of section 393.23, Florida
20Statutes, is amended to read:
21     393.23  Developmental disabilities centers; trust
22accounts.--All receipts from the operation of canteens, vending
23machines, hobby shops, sheltered workshops, activity centers,
24farming projects, and other like activities operated in a
25developmental disabilities center, and moneys donated to the
26center, must be deposited in a trust account in any bank, credit
27union, or savings and loan association authorized by the State
28Treasury as a qualified depository to do business in this state,
29if the moneys are available on demand.
30     (1)  Moneys in the trust account must be expended for the
31benefit, education, or and welfare of clients. However, if
32specified, moneys that are donated to the center must be
33expended in accordance with the intentions of the donor. Trust
34account money may not be used for the benefit of employees of
35the agency or to pay the wages of such employees. The welfare of
36the clients includes the expenditure of funds for the purchase
37of items for resale at canteens or vending machines, and for the
38establishment of, maintenance of, and operation of canteens,
39hobby shops, recreational or entertainment facilities, sheltered
40workshops, activity centers, farming projects, or other like
41facilities or programs established at the center for the benefit
42of clients.
43     Section 2.  Subsection (3) of section 393.0661, Florida
44Statutes, is amended to read:
45     393.0661  Home and community-based services delivery
46system; comprehensive redesign.--The Legislature finds that the
47home and community-based services delivery system for persons
48with developmental disabilities and the availability of
49appropriated funds are two of the critical elements in making
50services available. Therefore, it is the intent of the
51Legislature that the Agency for Persons with Disabilities shall
52develop and implement a comprehensive redesign of the system.
53     (3)  The Agency for Health Care Administration, in
54consultation with the agency, shall seek federal approval and
55implement a four-tiered waiver system to serve clients with
56developmental disabilities in the developmental disabilities and
57family and supported living waivers. The agency shall assign all
58clients receiving services through the developmental
59disabilities waiver to a tier based on a valid assessment
60instrument, client characteristics, and other appropriate
61assessment methods. All services covered under the current
62developmental disabilities waiver shall be available to all
63clients in all tiers where appropriate, except as otherwise
64provided in this subsection or in the General Appropriations
65Act.
66     (a)  Tier one shall be limited to clients who have service
67needs that cannot be met in tier two, three, or four for
68intensive medical or adaptive needs and that are essential for
69avoiding institutionalization, or who possess behavioral
70problems that are exceptional in intensity, duration, or
71frequency and present a substantial risk of harm to themselves
72or others.
73     (b)  Tier two shall be limited to clients whose service
74needs include a licensed residential facility and who are
75authorized to receive a moderate level of support for standard
76residential habilitation services or a minimal level of support
77for behavior focus residential habilitation services or clients
78in supported living who receive greater than 6 hours a day of
79in-home support services. Total annual expenditures under tier
80two may not exceed $55,000 per client each year.
81     (c)  Tier three shall include, but is not limited to,
82clients requiring residential placements, clients in independent
83or supported living situations, and clients who live in their
84family home. Total annual expenditures under tier three may not
85exceed $35,000 per client each year.
86     (d)  Tier four is the family and supported living waiver.
87Tier four shall include, but is not limited to, clients in
88independent or supported living situations and clients who live
89in their family home. An increase to the number of services
90available to clients in this tier shall not take effect prior to
91July 1, 2009. Total annual expenditures under tier four may not
92exceed $14,792 per client each year.
93     (e)  The Agency for Health Care Administration shall also
94seek federal approval to provide a consumer-directed option for
95persons with developmental disabilities which corresponds to the
96funding levels in each of the waiver tiers. The agency shall
97implement the four-tiered waiver system beginning with tiers
98one, three, and four and followed by tier two. The agency and
99the Agency for Health Care Administration may adopt any rules
100necessary to administer this subsection.
101     (f)  The agency shall seek federal waivers and amend
102contracts as necessary to make changes to services defined in
103federal waiver programs administered by the agency as follows:
104     1.  Supported living coaching services shall not exceed 20
105hours per month for persons who also receive in-home support
106services.
107     2.  Limited support coordination services shall be the only
108type of support coordination service provided to persons under
109the age of 18 who live in the family home.
110     3.  Personal care assistance services shall be limited to
111no more than 180 hours per calendar month and shall not include
112rate modifiers. Additional hours may be authorized for persons
113who have intensive physical, medical, or adaptive needs if such
114hours are essential for avoiding institutionalization.
115     4.  Residential habilitation services shall be limited to 8
116hours per day. Additional hours may be authorized for persons
117who have intensive medical or adaptive needs and if such hours
118are essential for avoiding institutionalization, or for persons
119who possess behavioral problems that are exceptional in
120intensity, duration, or frequency and present a substantial risk
121of harming themselves or others. This restriction shall be in
122effect until the four-tiered waiver system is fully implemented.
123     5.  Chore services, nonresidential support services, and
124homemaker services shall be eliminated. The agency shall expand
125the definition of in-home support services to enable the
126provider of the service to include activities previously
127provided in these eliminated services.
128     6.  Massage therapy, medication review, and psychological
129assessment services shall be eliminated.
130     7.  The agency shall conduct supplemental cost plan reviews
131to verify the medical necessity of authorized services for plans
132that have increased by more than 8 percent during either of the
1332 preceding fiscal years.
134     8.  The agency shall implement a consolidated residential
135habilitation rate structure to increase savings to the state
136through a more cost-effective payment method and establish
137uniform rates for intensive behavioral residential habilitation
138services.
139     9.  Pending federal approval, the agency is authorized to
140extend current support plans for clients receiving services
141under Medicaid waivers for 1 year beginning July 1, 2007, or
142from the date approved, whichever is later. Clients who have a
143substantial change in circumstances which threatens their health
144and safety may be reassessed during this year in order to
145determine the necessity for a change in their support plan.
146     10.  The agency shall eliminate redundancies and
147duplications between in-home support services, companion
148services, personal care services, and supported living coaching
149by limiting or consolidating the services.
150     11.  The agency shall reduce the intensity and frequency of
151supported employment services to individuals in stable
152employment situations who have a documented history of at least
1533 years' employment with the same company or in the same
154industry.
155     Section 3.  Effective upon this act becoming a law,
156subsection (6) of section 393.0661, Florida Statutes, is amended
157to read:
158     393.0661  Home and community-based services delivery
159system; comprehensive redesign.--The Legislature finds that the
160home and community-based services delivery system for persons
161with developmental disabilities and the availability of
162appropriated funds are two of the critical elements in making
163services available. Therefore, it is the intent of the
164Legislature that the Agency for Persons with Disabilities shall
165develop and implement a comprehensive redesign of the system.
166     (6)  Effective January 1, 2009, and except as otherwise
167provided in this section, an individual served by the home and
168community-based services waiver or the family and supported
169living waiver funded through the Agency for Persons with
170Disabilities shall have his or her cost plan adjusted to reflect
171the amount of expenditures for the previous state fiscal year
172plus 5 percent if such amount is less than the individual's
173existing cost plan. The Agency for Persons with Disabilities
174shall use actual paid claims for services provided during the
175previous fiscal year that are submitted by October 31 to
176calculate the revised cost plan amount. If an individual was not
177served for the entire previous state fiscal year or there was
178any single change in the cost plan amount of more than 5 percent
179during the previous state fiscal year, the agency shall set the
180cost plan amount at an estimated annualized expenditure amount
181plus 5 percent. The agency shall estimate the annualized
182expenditure amount by calculating the average of monthly
183expenditures, beginning in the fourth month after the individual
184enrolled or the cost plan was changed by more than 5 percent and
185ending with August 31, 2008, and multiplying the average by 12.
186In the event that at least 3 months of actual expenditure data
187are not available to estimate annualized expenditures, the
188agency may not rebase a cost plan pursuant to this subsection.
189This subsection expires June 30, 2009, unless reenacted by the
190Legislature before that date.
191     Section 4.  Except as otherwise expressly provided in this
192act, this act shall take effect July 1, 2009.


CODING: Words stricken are deletions; words underlined are additions.