| 1 | A bill to be entitled |
| 2 | An act relating to the Agency for Persons with |
| 3 | Disabilities; amending s. 393.0661, F.S.; revising |
| 4 | provisions relating to certain clients with developmental |
| 5 | disabilities served under the four-tiered waiver system; |
| 6 | providing for residential habilitation services; |
| 7 | establishing geographic differential payments for Miami- |
| 8 | Dade, Broward, Palm Beach, and Monroe Counties; providing |
| 9 | effective dates for applicable payments; providing for |
| 10 | rebasing cost plans based on actual expenditures for |
| 11 | individuals served by home and community-based services or |
| 12 | family and supported living waiver programs; extending the |
| 13 | effective date for the provision of certain services; |
| 14 | providing for future review and repeal of certain |
| 15 | provisions; amending s. 393.071, F.S.; providing for |
| 16 | deposit of client fees into the agency's Operations and |
| 17 | Maintenance Trust Fund; amending s. 393.125, F.S.; |
| 18 | granting certain persons the right to request a hearing to |
| 19 | review agency decisions; providing an effective date. |
| 20 |
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| 21 | Be It Enacted by the Legislature of the State of Florida: |
| 22 |
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| 23 | Section 1. Subsection (4) of section 393.0661, Florida |
| 24 | Statutes, is renumbered as subsection (7), paragraphs (b) and |
| 25 | (d) of subsection (3) are amended, present subsection (5) is |
| 26 | renumbered as subsection (8) and amended, and new subsections |
| 27 | (4), (5), and (6) are added to that section, to read: |
| 28 | 393.0661 Home and community-based services delivery |
| 29 | system; comprehensive redesign.--The Legislature finds that the |
| 30 | home and community-based services delivery system for persons |
| 31 | with developmental disabilities and the availability of |
| 32 | appropriated funds are two of the critical elements in making |
| 33 | services available. Therefore, it is the intent of the |
| 34 | Legislature that the Agency for Persons with Disabilities shall |
| 35 | develop and implement a comprehensive redesign of the system. |
| 36 | (3) The Agency for Health Care Administration, in |
| 37 | consultation with the agency, shall seek federal approval and |
| 38 | implement a four-tiered waiver system to serve clients with |
| 39 | developmental disabilities in the developmental disabilities and |
| 40 | family and supported living waivers. The agency shall assign all |
| 41 | clients receiving services through the developmental |
| 42 | disabilities waiver to a tier based on a valid assessment |
| 43 | instrument, client characteristics, and other appropriate |
| 44 | assessment methods. All services covered under the current |
| 45 | developmental disabilities waiver shall be available to all |
| 46 | clients in all tiers where appropriate, except as otherwise |
| 47 | provided in this subsection or in the General Appropriations |
| 48 | Act. |
| 49 | (b) Tier two shall be limited to clients whose service |
| 50 | needs include a licensed residential facility and who are |
| 51 | authorized to receive a moderate level of support for standard |
| 52 | residential habilitation services or a minimal level of support |
| 53 | for behavior focus greater than 5 hours per day in residential |
| 54 | habilitation services or clients in supported living who receive |
| 55 | greater than 6 hours a day of in-home support services. Total |
| 56 | annual expenditures under tier two may not exceed $55,000 per |
| 57 | client each year. |
| 58 | (d) Tier four is the family and supported living waiver. |
| 59 | Tier four shall include, but is not limited to, clients in |
| 60 | independent or supported living situations and clients who live |
| 61 | in their family home. An increase to the number of services |
| 62 | available to clients in this tier shall not take effect prior to |
| 63 | July 1, 2009 2008. Total annual expenditures under tier four may |
| 64 | not exceed $14,792 per client each year. |
| 65 | (4) Effective July 1, 2008, the geographic differential |
| 66 | for Miami-Dade, Broward, and Palm Beach Counties for residential |
| 67 | habilitation services shall be 7.5 percent. Effective July 1, |
| 68 | 2009, the geographic differential for Miami-Dade, Broward, and |
| 69 | Palm Beach Counties for residential habilitation services shall |
| 70 | be 4.5 percent. |
| 71 | (5) Effective July 1, 2008, the geographic differential |
| 72 | for Monroe County for residential habilitation services shall be |
| 73 | 20 percent. Effective July 1, 2009, the geographic differential |
| 74 | for Monroe County for residential habilitation services shall be |
| 75 | 15 percent. Effective July 1, 2010, the geographic differential |
| 76 | for Monroe County for residential habilitation services shall be |
| 77 | 10 percent. |
| 78 | (6) Effective January 1, 2009, and except as otherwise |
| 79 | provided in this section, an individual served by the home and |
| 80 | community-based services waiver or the family and supported |
| 81 | living waiver funded through the Agency for Persons with |
| 82 | Disabilities may have his or her cost plan adjusted to reflect |
| 83 | the amount of expenditures for the previous state fiscal year |
| 84 | plus 5 percent if such amount is less than the individual's |
| 85 | existing cost plan. The Agency for Persons with Disabilities |
| 86 | shall use actual paid claims for services provided during the |
| 87 | previous fiscal year that are submitted by October 31 to |
| 88 | calculate the revised cost plan amount. If an individual was not |
| 89 | served for the entire previous state fiscal year or there was |
| 90 | any single change in the cost plan amount of more than 5 percent |
| 91 | during the previous state fiscal year, the agency shall set the |
| 92 | cost plan amount at an estimated annualized expenditure amount |
| 93 | plus 5 percent. The agency shall estimate the annualized |
| 94 | expenditure amount by calculating the average of monthly |
| 95 | expenditures, beginning in the fourth month after the individual |
| 96 | enrolled or the cost plan was changed by more than 5 percent and |
| 97 | ending with August 31, 2008, and multiplying the average by 12. |
| 98 | In the event that at least 3 months of actual expenditure data |
| 99 | are not available to estimate annualized expenditures, the |
| 100 | agency may not rebase a cost plan pursuant to this subsection. |
| 101 | This subsection expires June 30, 2009, unless reenacted by the |
| 102 | Legislature before that date. |
| 103 | (8)(5) The Agency for Persons with Disabilities shall |
| 104 | submit quarterly status reports to the Executive Office of the |
| 105 | Governor, the chair of the Senate Ways and Means Committee or |
| 106 | its successor, and the chair of the House Fiscal Council or its |
| 107 | successor regarding the financial status of home and community- |
| 108 | based services, including the number of enrolled individuals who |
| 109 | are receiving services through one or more programs; the number |
| 110 | of individuals who have requested services who are not enrolled |
| 111 | but who are receiving services through one or more programs, |
| 112 | with a description indicating the programs from which the |
| 113 | individual is receiving services; the number of individuals who |
| 114 | have refused an offer of services but who choose to remain on |
| 115 | the list of individuals waiting for services; the number of |
| 116 | individuals who have requested services but who are receiving no |
| 117 | services; a frequency distribution indicating the length of time |
| 118 | individuals have been waiting for services; and information |
| 119 | concerning the actual and projected costs compared to the amount |
| 120 | of the appropriation available to the program and any projected |
| 121 | surpluses or deficits. If at any time an analysis by the agency, |
| 122 | in consultation with the Agency for Health Care Administration, |
| 123 | indicates that the cost of services is expected to exceed the |
| 124 | amount appropriated, the agency shall submit a plan in |
| 125 | accordance with subsection (7) (4) to the Executive Office of |
| 126 | the Governor, the chair of the Senate Ways and Means Committee |
| 127 | or its successor, and the chair of the House Fiscal Council or |
| 128 | its successor to remain within the amount appropriated. The |
| 129 | agency shall work with the Agency for Health Care Administration |
| 130 | to implement the plan so as to remain within the appropriation. |
| 131 | Section 2. Section 393.071, Florida Statutes, is amended |
| 132 | to read: |
| 133 | 393.071 Client fees.--The agency shall charge fees for |
| 134 | services provided to clients in accordance with s. 402.33. All |
| 135 | funds collected pursuant to this section shall be deposited in |
| 136 | the Operations and Maintenance Trust Fund. |
| 137 | Section 3. Subsection (1) of section 393.125, Florida |
| 138 | Statutes, is amended to read: |
| 139 | 393.125 Hearing rights.-- |
| 140 | (1) REVIEW OF AGENCY DECISIONS.-- |
| 141 | (a) For Medicaid programs administered by the agency, any |
| 142 | developmental services applicant or client, or his or her |
| 143 | parent, guardian, guardian advocate, or authorized |
| 144 | representative, may request a hearing in accordance with federal |
| 145 | Medicaid law and rules and shall request such a hearing pursuant |
| 146 | to ss. 120.569 and 120.57. These hearings shall be provided by |
| 147 | the Department of Children and Family Services pursuant to s. |
| 148 | 409.285 and shall follow procedures consistent with applicable |
| 149 | federal Medicaid law and rules. |
| 150 | (b)(a) Any other developmental services applicant or |
| 151 | client, or his or her parent, guardian, guardian advocate, or |
| 152 | authorized representative, who has any substantial interest |
| 153 | determined by the agency, has the right to request an |
| 154 | administrative hearing pursuant to ss. 120.569 and 120.57, which |
| 155 | hearing shall be conducted pursuant to s. 120.57(1), (2), or |
| 156 | (3). |
| 157 | (b) Notice of the right to an administrative hearing shall |
| 158 | be given, both verbally and in writing, to the applicant or |
| 159 | client, and his or her parent, guardian, guardian advocate, or |
| 160 | authorized representative, at the same time that the agency |
| 161 | gives the applicant or client notice of the agency's action. The |
| 162 | notice shall be given, both verbally and in writing, in the |
| 163 | language of the client or applicant and in English. |
| 164 | (c) A request for a hearing under this section shall be |
| 165 | made to the agency, in writing, within 30 days of the |
| 166 | applicant's or client's receipt of the notice. |
| 167 | Section 4. This act shall take effect July 1, 2008. |