Florida Senate - 2020 PROPOSED COMMITTEE SUBSTITUTE
Bill No. SB 82
Ì796252-Î796252
576-02732A-20
Proposed Committee Substitute by the Committee on Appropriations
(Appropriations Subcommittee on Health and Human Services)
1 A bill to be entitled
2 An act relating to individuals with disabilities;
3 amending s. 393.063, F.S.; defining the term
4 “significant additional need”; revising the definition
5 of the term “support coordinator”; amending s.
6 393.066, F.S.; requiring persons and entities under
7 contract with the Agency for Persons with Disabilities
8 to use the agency data management systems to bill for
9 services; repealing s. 393.0661, F.S., relating to the
10 home and community-based services delivery system;
11 amending s. 393.0662, F.S.; revising criteria used by
12 the agency to develop a client’s iBudget; revising
13 criteria used by the agency to authorize additional
14 funding for certain clients; requiring the agency to
15 centralize medical necessity determinations of certain
16 services; requiring the agency to certify and document
17 the use of certain services before approving the
18 expenditure of certain funds; requiring the Agency for
19 Health Care Administration to seek federal approval to
20 provide consumer-directed options; authorizing the
21 Agency for Persons with Disabilities and the Agency
22 for Health Care Administration to adopt rules;
23 requiring the Agency for Health Care Administration to
24 seek federal waivers and amend contracts under certain
25 conditions; requiring the Agency for Persons with
26 Disabilities to collect premiums or cost sharing;
27 providing construction; providing for the
28 reimbursement of certain providers of services;
29 requiring the Agency for Persons with Disabilities to
30 submit quarterly status reports to the Executive
31 Office of the Governor, the chair of the Senate
32 Appropriations Committee, and the chair of the House
33 Appropriations Committee or their successors;
34 providing requirements for such reports; requiring the
35 Agency for Persons with Disabilities, in consultation
36 with the Agency for Health Care Administration, to
37 submit a certain plan to the Executive Office of the
38 Governor, the chair of the Senate Appropriations
39 Committee, and the chair of the House Appropriations
40 Committee under certain conditions; requiring the
41 agency to work with the Agency for Health Care
42 Administration to implement such plan; requiring the
43 Agency for Persons with Disabilities, in consultation
44 with the Agency for Health Care Administration, to
45 provide quarterly reconciliation reports to the
46 Governor and the Legislature within a specified
47 timeframe; revising rulemaking authority of the Agency
48 for Persons with Disabilities and the Agency for
49 Health Care Administration; creating s. 393.0663,
50 F.S.; providing legislative intent; defining the term
51 “qualified organization”; requiring the Agency for
52 Persons with Disabilities to use qualified
53 organizations to provide support coordination services
54 for certain clients; providing requirements for
55 qualified organizations; providing agency duties;
56 providing for the review and appeal of certain
57 decisions made by the agency; authorizing the agency
58 to adopt rules; amending s. 400.962, F.S.; requiring
59 certain facilities that have been granted a
60 certificate-of-need exemption to demonstrate and
61 maintain compliance with specified criteria; amending
62 s. 408.036, F.S.; providing an exemption from a
63 certificate-of-need requirement for certain
64 intermediate care facilities; prohibiting the Agency
65 for Health Care Administration from granting an
66 additional exemption to a facility unless a certain
67 condition is met; providing that a specific
68 legislative appropriation is not required for such
69 exemption; amending s. 409.906, F.S.; requiring the
70 agency to seek federal approval to implement certain
71 payment rates; amending s. 1002.385, F.S.; conforming
72 a cross-reference; providing an effective date.
73
74 Be It Enacted by the Legislature of the State of Florida:
75
76 Section 1. Present subsections (39) through (45) of section
77 393.063, Florida Statutes, are redesignated as subsections (40)
78 through (46), respectively, a new subsection (39) is added to
79 that section, and present subsection (41) of that section is
80 amended, to read:
81 393.063 Definitions.—For the purposes of this chapter, the
82 term:
83 (39) “Significant additional need” means an additional need
84 for medically necessary services which would place the health
85 and safety of the client, the client’s caregiver, or the public
86 in serious jeopardy if it is not met. The agency may only
87 provide additional funding after the determination of a client’s
88 initial allocation amount and after the qualified organization
89 has documented the availability of nonwaiver resources.
90 (42)(41) “Support coordinator” means an employee of a
91 qualified organization pursuant to s. 393.0663 a person who is
92 designated by the agency to assist individuals and families in
93 identifying their capacities, needs, and resources, as well as
94 finding and gaining access to necessary supports and services;
95 coordinating the delivery of supports and services; advocating
96 on behalf of the individual and family; maintaining relevant
97 records; and monitoring and evaluating the delivery of supports
98 and services to determine the extent to which they meet the
99 needs and expectations identified by the individual, family, and
100 others who participated in the development of the support plan.
101 Section 2. Subsection (2) of section 393.066, Florida
102 Statutes, is amended to read:
103 393.066 Community services and treatment.—
104 (2) Necessary services shall be purchased, rather than
105 provided directly by the agency, when the purchase of services
106 is more cost-efficient than providing them directly. All
107 purchased services must be approved by the agency. As a
108 condition of payment, persons or entities under contract with
109 the agency to provide services shall use agency data management
110 systems to document service provision to clients before billing
111 and must use the agency data management systems to bill for
112 services. Contracted persons and entities shall meet the minimum
113 hardware and software technical requirements established by the
114 agency for the use of such systems. Such persons or entities
115 shall also meet any requirements established by the agency for
116 training and professional development of staff providing direct
117 services to clients.
118 Section 3. Section 393.0661, Florida Statutes, is repealed.
119 Section 4. Section 393.0662, Florida Statutes, is amended
120 to read:
121 393.0662 Individual budgets for delivery of home and
122 community-based services; iBudget system established.—The
123 Legislature finds that improved financial management of the
124 existing home and community-based Medicaid waiver program is
125 necessary to avoid deficits that impede the provision of
126 services to individuals who are on the waiting list for
127 enrollment in the program. The Legislature further finds that
128 clients and their families should have greater flexibility to
129 choose the services that best allow them to live in their
130 community within the limits of an established budget. Therefore,
131 the Legislature intends that the agency, in consultation with
132 the Agency for Health Care Administration, shall manage the
133 service delivery system using individual budgets as the basis
134 for allocating the funds appropriated for the home and
135 community-based services Medicaid waiver program among eligible
136 enrolled clients. The service delivery system that uses
137 individual budgets shall be called the iBudget system.
138 (1) The agency shall administer an individual budget,
139 referred to as an iBudget, for each individual served by the
140 home and community-based services Medicaid waiver program. The
141 funds appropriated to the agency shall be allocated through the
142 iBudget system to eligible, Medicaid-enrolled clients. For the
143 iBudget system, eligible clients shall include individuals with
144 a developmental disability as defined in s. 393.063. The iBudget
145 system shall provide for: enhanced client choice within a
146 specified service package; appropriate assessment strategies; an
147 efficient consumer budgeting and billing process that includes
148 reconciliation and monitoring components; a role for support
149 coordinators that avoids potential conflicts of interest; a
150 flexible and streamlined service review process; and the
151 equitable allocation of available funds based on the client’s
152 level of need, as determined by the allocation methodology.
153 (a) In developing each client’s iBudget, the agency shall
154 use the allocation methodology as defined in s. 393.063(4), in
155 conjunction with an assessment instrument that the agency deems
156 to be reliable and valid, including, but not limited to, the
157 agency’s Questionnaire for Situational Information. The
158 allocation methodology shall determine the amount of funds
159 allocated to a client’s iBudget.
160 (b) The agency may authorize additional funding based on a
161 client having one or more significant additional needs of the
162 following needs that cannot be accommodated within the funding
163 determined by the algorithm and having no other resources,
164 supports, or services available to meet the needs. Such
165 additional funding may be provided only after the determination
166 of a client’s initial allocation amount and after the qualified
167 organization has documented the availability of all nonwaiver
168 resources. Upon receipt of an incomplete request for significant
169 additional needs, the agency shall close the request.
170 (c) The agency shall centralize, within its headquarters
171 office, medical necessity determinations of requested services
172 made through the significant additional needs process. The
173 process must ensure consistent application of medical necessity
174 criteria. This process must provide opportunities for targeted
175 training, quality assurance, and inter-rater reliability. need:
176 1. An extraordinary need that would place the health and
177 safety of the client, the client’s caregiver, or the public in
178 immediate, serious jeopardy unless the increase is approved.
179 However, the presence of an extraordinary need in and of itself
180 does not warrant authorized funding by the agency. An
181 extraordinary need may include, but is not limited to:
182 a. A documented history of significant, potentially life
183 threatening behaviors, such as recent attempts at suicide,
184 arson, nonconsensual sexual behavior, or self-injurious behavior
185 requiring medical attention;
186 b. A complex medical condition that requires active
187 intervention by a licensed nurse on an ongoing basis that cannot
188 be taught or delegated to a nonlicensed person;
189 c. A chronic comorbid condition. As used in this
190 subparagraph, the term “comorbid condition” means a medical
191 condition existing simultaneously but independently with another
192 medical condition in a patient; or
193 d. A need for total physical assistance with activities
194 such as eating, bathing, toileting, grooming, and personal
195 hygiene.
196 2. A significant need for one-time or temporary support or
197 services that, if not provided, would place the health and
198 safety of the client, the client’s caregiver, or the public in
199 serious jeopardy. A significant need may include, but is not
200 limited to, the provision of environmental modifications,
201 durable medical equipment, services to address the temporary
202 loss of support from a caregiver, or special services or
203 treatment for a serious temporary condition when the service or
204 treatment is expected to ameliorate the underlying condition. As
205 used in this subparagraph, the term “temporary” means a period
206 of fewer than 12 continuous months. However, the presence of
207 such significant need for one-time or temporary supports or
208 services in and of itself does not warrant authorized funding by
209 the agency.
210 3. A significant increase in the need for services after
211 the beginning of the service plan year that would place the
212 health and safety of the client, the client’s caregiver, or the
213 public in serious jeopardy because of substantial changes in the
214 client’s circumstances, including, but not limited to, permanent
215 or long-term loss or incapacity of a caregiver, loss of services
216 authorized under the state Medicaid plan due to a change in age,
217 or a significant change in medical or functional status which
218 requires the provision of additional services on a permanent or
219 long-term basis that cannot be accommodated within the client’s
220 current iBudget. As used in this subparagraph, the term “long
221 term” means a period of 12 or more continuous months. However,
222 such significant increase in need for services of a permanent or
223 long-term nature in and of itself does not warrant authorized
224 funding by the agency.
225 4. A significant need for transportation services to a
226 waiver-funded adult day training program or to waiver-funded
227 employment services when such need cannot be accommodated within
228 a client’s iBudget as determined by the algorithm without
229 affecting the health and safety of the client, if public
230 transportation is not an option due to the unique needs of the
231 client or other transportation resources are not reasonably
232 available.
233
234 The agency shall reserve portions of the appropriation for
235 the home and community-based services Medicaid waiver program
236 for adjustments required pursuant to this paragraph and may use
237 the services of an independent actuary in determining the amount
238 to be reserved.
239 (d)(c) A client’s annual expenditures for home and
240 community-based Medicaid waiver services may not exceed the
241 limits of his or her iBudget. The total of all clients’
242 projected annual iBudget expenditures may not exceed the
243 agency’s appropriation for waiver services.
244 (2) The Agency for Health Care Administration, in
245 consultation with the agency, shall seek federal approval to
246 amend current waivers, request a new waiver, and amend contracts
247 as necessary to manage the iBudget system, improve services for
248 eligible and enrolled clients, and improve the delivery of
249 services through the home and community-based services Medicaid
250 waiver program and the Consumer-Directed Care Plus Program,
251 including, but not limited to, enrollees with a dual diagnosis
252 of a developmental disability and a mental health disorder.
253 (3) The agency must certify and document within each
254 client’s cost plan that the a client has used must use all
255 available services authorized under the state Medicaid plan,
256 school-based services, private insurance and other benefits, and
257 any other resources that may be available to the client before
258 using funds from his or her iBudget to pay for support and
259 services.
260 (4) Rates for any or all services established under rules
261 of the Agency for Health Care Administration must be designated
262 as the maximum rather than a fixed amount for individuals who
263 receive an iBudget, except for services specifically identified
264 in those rules that the agency determines are not appropriate
265 for negotiation, which may include, but are not limited to,
266 residential habilitation services.
267 (5) The agency shall ensure that clients and caregivers
268 have access to training and education that inform them about the
269 iBudget system and enhance their ability for self-direction.
270 Such training and education must be offered in a variety of
271 formats and, at a minimum, must address the policies and
272 processes of the iBudget system and the roles and
273 responsibilities of consumers, caregivers, waiver support
274 coordinators, providers, and the agency, and must provide
275 information to help the client make decisions regarding the
276 iBudget system and examples of support and resources available
277 in the community.
278 (6) The agency shall collect data to evaluate the
279 implementation and outcomes of the iBudget system.
280 (7) The Agency for Health Care Administration shall seek
281 federal approval to provide a consumer-directed option for
282 persons with developmental disabilities. The agency and the
283 Agency for Health Care Administration may adopt rules necessary
284 to administer this subsection.
285 (8) The Agency for Health Care Administration shall seek
286 federal waivers and amend contracts as necessary to make changes
287 to services defined in federal waiver programs as follows:
288 (a) Supported living coaching services may not exceed 20
289 hours per month for persons who also receive in-home support
290 services.
291 (b) Limited support coordination services are the only
292 support coordination services that may be provided to persons
293 under the age of 18 who live in the family home.
294 (c) Personal care assistance services are limited to 180
295 hours per calendar month and may not include rate modifiers.
296 Additional hours may be authorized for persons who have
297 intensive physical, medical, or adaptive needs if such hours
298 will prevent institutionalization.
299 (d) Residential habilitation services are limited to 8
300 hours per day. Additional hours may be authorized for persons
301 who have intensive medical or adaptive needs and if such hours
302 will prevent institutionalization, or for persons who possess
303 behavioral problems that are exceptional in intensity, duration,
304 or frequency and present a substantial risk of harm to
305 themselves or others.
306 (e) The agency shall conduct supplemental cost plan reviews
307 to verify the medical necessity of authorized services for plans
308 that have increased by more than 8 percent during either of the
309 2 preceding fiscal years.
310 (f) The agency shall implement a consolidated residential
311 habilitation rate structure to increase savings to the state
312 through a more cost-effective payment method and establish
313 uniform rates for intensive behavioral residential habilitation
314 services.
315 (g) The geographic differential for Miami-Dade, Broward,
316 and Palm Beach Counties for residential habilitation services
317 must be 7.5 percent.
318 (h) The geographic differential for Monroe County for
319 residential habilitation services must be 20 percent.
320 (9) The agency shall collect premiums or cost sharing
321 pursuant to s. 409.906(13)(c).
322 (10) This section or any related rule does not prevent or
323 limit the Agency for Health Care Administration, in consultation
324 with the agency, from adjusting fees, reimbursement rates,
325 lengths of stay, number of visits, or number of services, or
326 from limiting enrollment or making any other adjustment
327 necessary to comply with the availability of moneys and any
328 limitations or directions provided in the General Appropriations
329 Act.
330 (11) A provider of services rendered to persons with
331 developmental disabilities pursuant to a federally approved
332 waiver shall be reimbursed according to a rate methodology based
333 upon an analysis of the expenditure history and prospective
334 costs of providers participating in the waiver program, or under
335 any other methodology developed by the Agency for Health Care
336 Administration in consultation with the agency and approved by
337 the Federal Government in accordance with the waiver.
338 (12) The agency shall submit quarterly status reports to
339 the Executive Office of the Governor, the chair of the Senate
340 Appropriations Committee or its successor, and the chair of the
341 House Appropriations Committee or its successor containing all
342 of the following information:
343 (a) The financial status of home and community-based
344 services, including the number of enrolled individuals receiving
345 services through one or more programs.
346 (b) The number of individuals who have requested services
347 and who are not enrolled but who are receiving services through
348 one or more programs, with a description indicating the programs
349 from which the individual is receiving services.
350 (c) The number of individuals who have refused an offer of
351 services but who choose to remain on the list of individuals
352 waiting for services.
353 (d) The number of individuals who have requested services
354 but who are receiving no services.
355 (e) A frequency distribution indicating the length of time
356 individuals have been waiting for services.
357 (f) Information concerning the actual and projected costs
358 compared to the amount of the appropriation available to the
359 program and any projected surpluses or deficits.
360 (13) If at any time an analysis by the agency, in
361 consultation with the Agency for Health Care Administration,
362 indicates that the cost of services is expected to exceed the
363 amount appropriated, the agency shall submit a plan in
364 accordance with subsection (10) to the Executive Office of the
365 Governor, the chair of the Senate Appropriations Committee or
366 its successor, and the chair of the House Appropriations
367 Committee or its successor to remain within the amount
368 appropriated. The agency shall work with the Agency for Health
369 Care Administration to implement the plan so as to remain within
370 the appropriation.
371 (14) The agency, in consultation with the Agency for Health
372 Care Administration, shall provide a quarterly reconciliation
373 report of all home and community-based services waiver
374 expenditures from the Agency for Health Care Administration’s
375 claims management system with service utilization from the
376 Agency for Persons with Disabilities Allocation, Budget, and
377 Contract Control system. The reconciliation report shall be
378 submitted to the Governor, the President of the Senate, and the
379 Speaker of the House of Representatives no later than 30 days
380 after the close of each quarter.
381 (15)(7) The agency and the Agency for Health Care
382 Administration may adopt rules specifying the allocation
383 algorithm and methodology; criteria and processes for clients to
384 access reserved funds for significant additional needs
385 extraordinary needs, temporarily or permanently changed needs,
386 and one-time needs; and processes and requirements for selection
387 and review of services, development of support and cost plans,
388 and management of the iBudget system as needed to administer
389 this section.
390 Section 5. Section 393.0663, Florida Statutes, is created
391 to read:
392 393.0663 Support coordination; legislative intent;
393 qualified organizations; agency duties; due process;
394 rulemaking.—
395 (1) LEGISLATIVE INTENT.—To enable the state to provide a
396 systematic approach to service oversight for persons providing
397 care to individuals with developmental disabilities, it is the
398 intent of the Legislature that the agency work in collaboration
399 with relevant stakeholders to ensure that waiver support
400 coordinators have the knowledge, skills, and abilities necessary
401 to competently provide services to individuals with
402 developmental disabilities by requiring all support coordinators
403 to be employees of a qualified organization.
404 (2) QUALIFIED ORGANIZATIONS.—
405 (a) As used in this section, the term “qualified
406 organization” means an organization determined by the agency to
407 meet the requirements of this section and of the Developmental
408 Disabilities Individual Budgeting Waiver Services Coverage and
409 Limitations Handbook.
410 (b) The agency shall use qualified organizations for the
411 purpose of providing all support coordination services to
412 iBudget clients in this state. A qualified organization must:
413 1. Employ four or more support coordinators;
414 2. Maintain a professional code of ethics and a
415 disciplinary process that apply to all support coordinators
416 within the organization;
417 3. Comply with the agency’s cost containment initiatives;
418 4. Require support coordinators to ensure client budgets
419 are linked to levels of need;
420 5. Require support coordinators to perform all duties and
421 meet all standards related to support coordination as provided
422 in the Developmental Disabilities Individual Budgeting Waiver
423 Services Coverage and Limitations Handbook;
424 6. Prohibit dual employment of a support coordinator if the
425 dual employment adversely impacts the support coordinator’s
426 availability to clients;
427 7. Educate clients and families regarding identifying and
428 preventing abuse, neglect, and exploitation;
429 8. Instruct clients and families on mandatory reporting
430 requirements for abuse, neglect, and exploitation;
431 9. Submit within established timeframes all required
432 documentation for requests for significant additional needs;
433 10. Require support coordinators to successfully complete
434 training and professional development approved by the agency;
435 11. Require support coordinators to pass a competency-based
436 assessment established by the agency; and
437 12. Implement a mentoring program approved by the agency
438 for support coordinators who have worked as a support
439 coordinator for less than 12 months.
440 (3) DUTIES OF THE AGENCY.—The agency shall:
441 (a) Require all qualified organizations to report to the
442 agency any violation of ethical or professional conduct by
443 support coordinators employed by the organization;
444 (b) Maintain a publicly accessible registry of all support
445 coordinators, including any history of ethical or disciplinary
446 violations; and
447 (c) Impose an immediate moratorium on new client
448 assignments, impose an administrative fine, require plans of
449 remediation, and terminate the Medicaid Waiver Services
450 Agreement of any qualified organization that is noncompliant
451 with applicable laws or rules.
452 (4) DUE PROCESS.—Any decision by the agency to take action
453 against a qualified organization as described in paragraph
454 (3)(c) is reviewable by the agency. Upon receiving an adverse
455 determination, the qualified organization may request an
456 administrative hearing pursuant to ss. 120.569 and 120.57(1)
457 within 30 days after completing any appeals process established
458 by the agency.
459 (5) RULEMAKING.—The agency may adopt rules to implement
460 this section.
461 Section 6. Subsection (6) is added to section 400.962,
462 Florida Statutes, to read:
463 400.962 License required; license application.—
464 (6) An applicant that has been granted a certificate-of
465 need exemption under s. 408.036(3)(o) must also demonstrate and
466 maintain compliance with the following criteria:
467 (a) The total number of beds per home within the facility
468 may not exceed eight, with each resident having his or her own
469 bedroom and bathroom. Each eight-bed home must be colocated on
470 the same property with two other eight-bed homes and must serve
471 individuals with severe maladaptive behaviors and co-occurring
472 psychiatric diagnoses.
473 (b) A minimum of 16 beds within the facility must be
474 designated for individuals with severe maladaptive behaviors who
475 have been assessed using the Agency for Persons with
476 Disabilities’ Global Behavioral Service Need Matrix with a score
477 of at least Level 3 and up to Level 6, or assessed using the
478 criteria deemed appropriate by the Agency for Health Care
479 Administration regarding the need for a specialized placement in
480 an intermediate care facility for the developmentally disabled.
481 (c) The applicant has not had a facility license denied,
482 revoked, or suspended within the 36 months preceding the request
483 for exemption.
484 (d) The applicant must have at least 10 years of experience
485 serving individuals with severe maladaptive behaviors in this
486 state.
487 (e) The applicant must implement a state-approved staff
488 training curriculum and monitoring requirements specific to the
489 individuals whose behaviors require higher intensity, frequency,
490 and duration of services.
491 (f) The applicant must make available medical and nursing
492 services 24 hours per day, 7 days per week.
493 (g) The applicant must demonstrate a history of using
494 interventions that are least restrictive and that follow a
495 behavioral hierarchy.
496 (h) The applicant must maintain a policy prohibiting the
497 use of mechanical restraints.
498 Section 7. Paragraph (o) is added to subsection (3) of
499 section 408.036, Florida Statutes, to read:
500 408.036 Projects subject to review; exemptions.—
501 (3) EXEMPTIONS.—Upon request, the following projects are
502 subject to exemption from subsection (1):
503 (o) For a new intermediate care facility for the
504 developmentally disabled as defined in s. 408.032 which has a
505 total of 24 beds, comprising three eight-bed homes, for use by
506 individuals exhibiting severe maladaptive behaviors and co
507 occurring psychiatric diagnoses requiring increased levels of
508 behavioral, medical, and therapeutic oversight. The facility
509 must not have had a license denied, revoked, or suspended within
510 the 36 months preceding the request for exemption and must have
511 at least 10 years of experience serving individuals with severe
512 maladaptive behaviors in this state. The agency may not grant an
513 additional exemption to a facility that has been granted an
514 exemption under this paragraph unless the facility has been
515 licensed and operational for a period of at least 2 years. The
516 exemption under this paragraph does not require a specific
517 legislative appropriation.
518 Section 8. Subsection (15) of section 409.906, Florida
519 Statutes, is amended to read:
520 409.906 Optional Medicaid services.—Subject to specific
521 appropriations, the agency may make payments for services which
522 are optional to the state under Title XIX of the Social Security
523 Act and are furnished by Medicaid providers to recipients who
524 are determined to be eligible on the dates on which the services
525 were provided. Any optional service that is provided shall be
526 provided only when medically necessary and in accordance with
527 state and federal law. Optional services rendered by providers
528 in mobile units to Medicaid recipients may be restricted or
529 prohibited by the agency. Nothing in this section shall be
530 construed to prevent or limit the agency from adjusting fees,
531 reimbursement rates, lengths of stay, number of visits, or
532 number of services, or making any other adjustments necessary to
533 comply with the availability of moneys and any limitations or
534 directions provided for in the General Appropriations Act or
535 chapter 216. If necessary to safeguard the state’s systems of
536 providing services to elderly and disabled persons and subject
537 to the notice and review provisions of s. 216.177, the Governor
538 may direct the Agency for Health Care Administration to amend
539 the Medicaid state plan to delete the optional Medicaid service
540 known as “Intermediate Care Facilities for the Developmentally
541 Disabled.” Optional services may include:
542 (15) INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY
543 DISABLED SERVICES.—The agency may pay for health-related care
544 and services provided on a 24-hour-a-day basis by a facility
545 licensed and certified as a Medicaid Intermediate Care Facility
546 for the Developmentally Disabled, for a recipient who needs such
547 care because of a developmental disability. Payment shall not
548 include bed-hold days except in facilities with occupancy rates
549 of 95 percent or greater. The agency is authorized to seek any
550 federal waiver approvals to implement this policy. The agency
551 shall seek federal approval to implement a payment rate for
552 Medicaid intermediate care facilities serving individuals with
553 developmental disabilities, severe maladaptive behaviors, severe
554 maladaptive behaviors and co-occurring complex medical
555 conditions, or a dual diagnosis of developmental disability and
556 mental illness.
557 Section 9. Paragraph (d) of subsection (2) of section
558 1002.385, Florida Statutes, is amended to read:
559 1002.385 The Gardiner Scholarship.—
560 (2) DEFINITIONS.—As used in this section, the term:
561 (d) “Disability” means, for a 3- or 4-year-old child or for
562 a student in kindergarten to grade 12, autism spectrum disorder,
563 as defined in the Diagnostic and Statistical Manual of Mental
564 Disorders, Fifth Edition, published by the American Psychiatric
565 Association; cerebral palsy, as defined in s. 393.063(6); Down
566 syndrome, as defined in s. 393.063(15); an intellectual
567 disability, as defined in s. 393.063(24); Phelan-McDermid
568 syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
569 as defined in s. 393.063(29); spina bifida, as defined in s.
570 393.063(41) s. 393.063(40); being a high-risk child, as defined
571 in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
572 rare diseases which affect patient populations of fewer than
573 200,000 individuals in the United States, as defined by the
574 National Organization for Rare Disorders; anaphylaxis; deaf;
575 visually impaired; traumatic brain injured; hospital or
576 homebound; or identification as dual sensory impaired, as
577 defined by rules of the State Board of Education and evidenced
578 by reports from local school districts. The term “hospital or
579 homebound” includes a student who has a medically diagnosed
580 physical or psychiatric condition or illness, as defined by the
581 state board in rule, and who is confined to the home or hospital
582 for more than 6 months.
583 Section 10. This act shall take effect January 1, 2021.