Florida Senate - 2020 SB 82
By Senator Bean
4-01661A-20 202082__
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 certify and document the use of certain services
16 before approving the expenditure of certain funds;
17 requiring the Agency for Health Care Administration to
18 seek federal approval to provide consumer-directed
19 options; authorizing the Agency for Persons with
20 Disabilities and the Agency for Health Care
21 Administration to adopt rules; requiring the Agency
22 for Health Care Administration to seek federal waivers
23 and amend contracts under certain conditions;
24 requiring the Agency for Persons with Disabilities to
25 collect premiums or cost sharing; providing
26 construction; providing for the reimbursement of
27 certain providers of services; requiring the Agency
28 for Persons with Disabilities to submit quarterly
29 status reports to the Governor, the chair of the
30 Senate Appropriations Committee, and the chair of the
31 House Appropriations Committee; requiring the Agency
32 for Persons with Disabilities, in consultation with
33 the Agency for Health Care Administration, to submit a
34 certain plan to the Governor, the chair of the Senate
35 Appropriations Committee, and the chair of the House
36 Appropriations Committee under certain conditions;
37 requiring the Agency for Persons with Disabilities, in
38 consultation with the Agency for Health Care
39 Administration, to provide quarterly reconciliation
40 reports to the Governor and the Legislature within a
41 specified timeframe; revising rulemaking authority of
42 the Agency for Persons with Disabilities and the
43 Agency for Health Care Administration; creating s.
44 393.0663, F.S.; requiring the Agency for Persons with
45 Disabilities to competitively procure qualified
46 organizations to provide support coordination
47 services; requiring such procurement to be initiated
48 on a specified date; providing requirements for
49 contracts awarded by the agency; amending s. 409.906,
50 F.S.; requiring the Agency for Health Care
51 Administration to contract with an external vendor for
52 certain medical necessity determinations; requiring
53 the Agency for Persons with Disabilities to seek
54 federal approval to implement certain payment rates;
55 amending ss. 409.968 and 1002.385, F.S.; conforming
56 cross-references; providing an effective date.
57
58 Be It Enacted by the Legislature of the State of Florida:
59
60 Section 1. Present subsections (39) through (45) of section
61 393.063, Florida Statutes, are redesignated as subsections (40)
62 through (46), respectively, a new subsection (39) is added to
63 that section, and present subsection (41) of that section is
64 amended, to read:
65 393.063 Definitions.—For the purposes of this chapter, the
66 term:
67 (39) “Significant additional need” means a medically
68 necessary need for a service increase arising after the
69 beginning of the service plan year which would place the health
70 and safety of the client, the client’s caregiver, or the public
71 in serious jeopardy.
72 (42)(41) “Support coordinator” means an employee of a
73 qualified organization pursuant to s. 393.0663 a person who is
74 designated by the agency to assist individuals and families in
75 identifying their capacities, needs, and resources, as well as
76 finding and gaining access to necessary supports and services;
77 coordinating the delivery of supports and services; advocating
78 on behalf of the individual and family; maintaining relevant
79 records; and monitoring and evaluating the delivery of supports
80 and services to determine the extent to which they meet the
81 needs and expectations identified by the individual, family, and
82 others who participated in the development of the support plan.
83 Section 2. Subsection (2) of section 393.066, Florida
84 Statutes, is amended to read:
85 393.066 Community services and treatment.—
86 (2) Necessary services shall be purchased, rather than
87 provided directly by the agency, when the purchase of services
88 is more cost-efficient than providing them directly. All
89 purchased services must be approved by the agency. As a
90 condition of payment, persons or entities under contract with
91 the agency to provide services shall use agency data management
92 systems to document service provision to clients before billing
93 and must use the agency data management systems to bill for
94 services. Contracted persons and entities shall meet the minimum
95 hardware and software technical requirements established by the
96 agency for the use of such systems. Such persons or entities
97 shall also meet any requirements established by the agency for
98 training and professional development of staff providing direct
99 services to clients.
100 Section 3. Section 393.0661, Florida Statutes, is repealed.
101 Section 4. Section 393.0662, Florida Statutes, is amended
102 to read:
103 393.0662 Individual budgets for delivery of home and
104 community-based services; iBudget system established.—The
105 Legislature finds that improved financial management of the
106 existing home and community-based Medicaid waiver program is
107 necessary to avoid deficits that impede the provision of
108 services to individuals who are on the waiting list for
109 enrollment in the program. The Legislature further finds that
110 clients and their families should have greater flexibility to
111 choose the services that best allow them to live in their
112 community within the limits of an established budget. Therefore,
113 the Legislature intends that the agency, in consultation with
114 the Agency for Health Care Administration, shall manage the
115 service delivery system using individual budgets as the basis
116 for allocating the funds appropriated for the home and
117 community-based services Medicaid waiver program among eligible
118 enrolled clients. The service delivery system that uses
119 individual budgets shall be called the iBudget system.
120 (1) The agency shall administer an individual budget,
121 referred to as an iBudget, for each individual served by the
122 home and community-based services Medicaid waiver program. The
123 funds appropriated to the agency shall be allocated through the
124 iBudget system to eligible, Medicaid-enrolled clients. For the
125 iBudget system, eligible clients shall include individuals with
126 a developmental disability as defined in s. 393.063. The iBudget
127 system shall provide for: enhanced client choice within a
128 specified service package; appropriate assessment strategies; an
129 efficient consumer budgeting and billing process that includes
130 reconciliation and monitoring components; a role for support
131 coordinators that avoids potential conflicts of interest; a
132 flexible and streamlined service review process; and the
133 equitable allocation of available funds based on the client’s
134 level of need, as determined by the allocation methodology.
135 (a) In developing each client’s iBudget, the agency shall
136 use the allocation methodology as defined in s. 393.063(4), in
137 conjunction with an assessment instrument that the agency deems
138 to be reliable and valid, including, but not limited to, the
139 agency’s Questionnaire for Situational Information. The
140 allocation methodology shall determine the amount of funds
141 allocated to a client’s iBudget.
142 (b) The agency may authorize additional funding based on a
143 client having one or more significant additional needs of the
144 following needs that cannot be accommodated within the funding
145 determined by the algorithm and having no other resources,
146 supports, or services available to meet the needs. Such
147 additional funding may be provided only after the determination
148 of a client’s initial allocation amount and after the agency has
149 certified and documented the use of all available resources
150 under the Medicaid state plan as described in subsection (2).
151 need:
152 1. An extraordinary need that would place the health and
153 safety of the client, the client’s caregiver, or the public in
154 immediate, serious jeopardy unless the increase is approved.
155 However, the presence of an extraordinary need in and of itself
156 does not warrant authorized funding by the agency. An
157 extraordinary need may include, but is not limited to:
158 a. A documented history of significant, potentially life
159 threatening behaviors, such as recent attempts at suicide,
160 arson, nonconsensual sexual behavior, or self-injurious behavior
161 requiring medical attention;
162 b. A complex medical condition that requires active
163 intervention by a licensed nurse on an ongoing basis that cannot
164 be taught or delegated to a nonlicensed person;
165 c. A chronic comorbid condition. As used in this
166 subparagraph, the term “comorbid condition” means a medical
167 condition existing simultaneously but independently with another
168 medical condition in a patient; or
169 d. A need for total physical assistance with activities
170 such as eating, bathing, toileting, grooming, and personal
171 hygiene.
172 2. A significant need for one-time or temporary support or
173 services that, if not provided, would place the health and
174 safety of the client, the client’s caregiver, or the public in
175 serious jeopardy. A significant need may include, but is not
176 limited to, the provision of environmental modifications,
177 durable medical equipment, services to address the temporary
178 loss of support from a caregiver, or special services or
179 treatment for a serious temporary condition when the service or
180 treatment is expected to ameliorate the underlying condition. As
181 used in this subparagraph, the term “temporary” means a period
182 of fewer than 12 continuous months. However, the presence of
183 such significant need for one-time or temporary supports or
184 services in and of itself does not warrant authorized funding by
185 the agency.
186 3. A significant increase in the need for services after
187 the beginning of the service plan year that would place the
188 health and safety of the client, the client’s caregiver, or the
189 public in serious jeopardy because of substantial changes in the
190 client’s circumstances, including, but not limited to, permanent
191 or long-term loss or incapacity of a caregiver, loss of services
192 authorized under the state Medicaid plan due to a change in age,
193 or a significant change in medical or functional status which
194 requires the provision of additional services on a permanent or
195 long-term basis that cannot be accommodated within the client’s
196 current iBudget. As used in this subparagraph, the term “long
197 term” means a period of 12 or more continuous months. However,
198 such significant increase in need for services of a permanent or
199 long-term nature in and of itself does not warrant authorized
200 funding by the agency.
201 4. A significant need for transportation services to a
202 waiver-funded adult day training program or to waiver-funded
203 employment services when such need cannot be accommodated within
204 a client’s iBudget as determined by the algorithm without
205 affecting the health and safety of the client, if public
206 transportation is not an option due to the unique needs of the
207 client or other transportation resources are not reasonably
208 available.
209
210 The agency shall reserve portions of the appropriation for the
211 home and community-based services Medicaid waiver program for
212 adjustments required pursuant to this paragraph and may use the
213 services of an independent actuary in determining the amount to
214 be reserved.
215 (c) A client’s annual expenditures for home and community
216 based Medicaid waiver services may not exceed the limits of his
217 or her iBudget. The total of all clients’ projected annual
218 iBudget expenditures may not exceed the agency’s appropriation
219 for waiver services.
220 (2) The Agency for Health Care Administration, in
221 consultation with the agency, shall seek federal approval to
222 amend current waivers, request a new waiver, and amend contracts
223 as necessary to manage the iBudget system, improve services for
224 eligible and enrolled clients, and improve the delivery of
225 services through the home and community-based services Medicaid
226 waiver program and the Consumer-Directed Care Plus Program,
227 including, but not limited to, enrollees with a dual diagnosis
228 of a developmental disability and a mental health disorder.
229 (3) The agency must certify and document within each
230 client’s cost plan that the a client has used must use all
231 available services authorized under the state Medicaid plan,
232 school-based services, private insurance and other benefits, and
233 any other resources that may be available to the client before
234 using funds from his or her iBudget to pay for support, and
235 services, and any significant additional needs as determined by
236 a qualified organization contracted pursuant to s.
237 409.906(13)(c).
238 (4) Rates for any or all services established under rules
239 of the Agency for Health Care Administration must be designated
240 as the maximum rather than a fixed amount for individuals who
241 receive an iBudget, except for services specifically identified
242 in those rules that the agency determines are not appropriate
243 for negotiation, which may include, but are not limited to,
244 residential habilitation services.
245 (5) The agency shall ensure that clients and caregivers
246 have access to training and education that inform them about the
247 iBudget system and enhance their ability for self-direction.
248 Such training and education must be offered in a variety of
249 formats and, at a minimum, must address the policies and
250 processes of the iBudget system and the roles and
251 responsibilities of consumers, caregivers, waiver support
252 coordinators, providers, and the agency, and must provide
253 information to help the client make decisions regarding the
254 iBudget system and examples of support and resources available
255 in the community.
256 (6) The agency shall collect data to evaluate the
257 implementation and outcomes of the iBudget system.
258 (7) The Agency for Health Care Administration shall seek
259 federal approval to provide a consumer-directed option for
260 persons with developmental disabilities. The agency and the
261 Agency for Health Care Administration may adopt rules necessary
262 to administer this subsection.
263 (8) The Agency for Health Care Administration shall seek
264 federal waivers and amend contracts as necessary to make changes
265 to services defined in federal waiver programs as follows:
266 (a) Supported living coaching services may not exceed 20
267 hours per month for persons who also receive in-home support
268 services.
269 (b) Limited support coordination services are the only type
270 of support coordination services which may be provided to
271 persons under the age of 18 who live in the family home.
272 (c) Personal care assistance services are limited to 180
273 hours per calendar month and may not include rate modifiers.
274 Additional hours may be authorized for persons who have
275 intensive physical, medical, or adaptive needs if such hours are
276 essential for avoiding institutionalization.
277 (d) Residential habilitation services are limited to 8
278 hours per day. Additional hours may be authorized for persons
279 who have intensive medical or adaptive needs and if such hours
280 are essential for avoiding institutionalization, or for persons
281 who possess behavioral problems that are exceptional in
282 intensity, duration, or frequency and present a substantial risk
283 of harming themselves or others.
284 (e) The agency shall conduct supplemental cost plan reviews
285 to verify the medical necessity of authorized services for plans
286 that have increased by more than 8 percent during either of the
287 2 preceding fiscal years.
288 (f) The agency shall implement a consolidated residential
289 habilitation rate structure to increase savings to the state
290 through a more cost-effective payment method and establish
291 uniform rates for intensive behavioral residential habilitation
292 services.
293 (g) The geographic differential for Miami-Dade, Broward,
294 and Palm Beach Counties for residential habilitation services
295 must be 7.5 percent.
296 (h) The geographic differential for Monroe County for
297 residential habilitation services must be 20 percent.
298 (9) The agency shall collect premiums or cost sharing
299 pursuant to s. 409.906(13)(c).
300 (10) This section or any related rule does not prevent or
301 limit the Agency for Health Care Administration, in consultation
302 with the agency, from adjusting fees, reimbursement rates,
303 lengths of stay, number of visits, or number of services, or
304 from limiting enrollment or making any other adjustment
305 necessary to comply with the availability of moneys and any
306 limitations or directions provided in the General Appropriations
307 Act.
308 (11) A provider of services rendered to persons with
309 developmental disabilities pursuant to a federally approved
310 waiver shall be reimbursed according to a rate methodology based
311 upon an analysis of the expenditure history and prospective
312 costs of providers participating in the waiver program, or under
313 any other methodology developed by the Agency for Health Care
314 Administration, in consultation with the agency, and approved by
315 the Federal Government in accordance with the waiver.
316 (12) The agency shall submit quarterly status reports to
317 the Executive Office of the Governor, the chair of the Senate
318 Appropriations Committee or its successor, and the chair of the
319 House Appropriations Committee or its successor containing all
320 of the following information:
321 (a) The financial status of home and community-based
322 services, including the number of enrolled individuals who are
323 receiving services through one or more programs.
324 (b) The number of individuals who have requested services
325 who are not enrolled but who are receiving services through one
326 or more programs, with a description indicating the programs
327 from which the individual is receiving services.
328 (c) The number of individuals who have refused an offer of
329 services but who choose to remain on the list of individuals
330 waiting for services.
331 (d) The number of individuals who have requested services
332 but who are receiving no services.
333 (e) A frequency distribution indicating the length of time
334 individuals have been waiting for services.
335 (f) Information concerning the actual and projected costs
336 compared to the amount of the appropriation available to the
337 program and any projected surpluses or deficits.
338 (13) If at any time an analysis by the agency, in
339 consultation with the Agency for Health Care Administration,
340 indicates that the cost of services is expected to exceed the
341 amount appropriated, the agency shall submit a plan in
342 accordance with subsection (10) to the Executive Office of the
343 Governor, the chair of the Senate Appropriations Committee or
344 its successor, and the chair of the House Appropriations
345 Committee or its successor to remain within the amount
346 appropriated. The agency shall work with the Agency for Health
347 Care Administration to implement the plan so as to remain within
348 the appropriation.
349 (14) The agency, in consultation with the Agency for Health
350 Care Administration, shall provide a quarterly reconciliation
351 report of all home and community-based services waiver
352 expenditures from the Agency for Health Care Administration’s
353 claims management system with service utilization from the
354 Agency for Persons with Disabilities Allocation, Budget, and
355 Contract Control system. The reconciliation report shall be
356 submitted to the Governor, the President of the Senate, and the
357 Speaker of the House of Representatives no later than 30 days
358 after the close of each quarter.
359 (15)(7) The agency and the Agency for Health Care
360 Administration may adopt rules specifying the allocation
361 algorithm and methodology; criteria and processes for clients to
362 access reserved funds for significant additional needs
363 extraordinary needs, temporarily or permanently changed needs,
364 and one-time needs; and processes and requirements for selection
365 and review of services, development of support and cost plans,
366 and management of the iBudget system as needed to administer
367 this section.
368 Section 5. Section 393.0663, Florida Statutes, is created
369 to read:
370 393.0663 Waiver support coordination services.—The agency
371 shall competitively procure two or more qualified organizations
372 to provide support coordination services. In awarding a contract
373 to a qualified organization, the agency shall take into account
374 price, quality, and accessibility to these services. The agency
375 shall initiate procurement on October 1, 2020.
376 (1) The contract must include provisions requiring
377 compliance with agency cost-containment initiatives.
378 (2) The contract must require support coordinators to
379 ensure client budgets are linked to levels of need.
380 (3) The contract must require support coordinators to avoid
381 potential conflicts of interest.
382 (4) The contract must require the organization to perform
383 all duties and meet all standards related to support
384 coordination as provided in the Developmental Disabilities
385 Waiver Services Coverage and Limitations Handbook.
386 (5) The contract shall be 3 years in duration. Following
387 the initial 3-year period, the contract may be renewed annually
388 for 3 consecutive years and may not exceed 1 year in duration.
389 (6) The contract may provide for support coordination
390 services statewide or by agency region, at the discretion of the
391 agency.
392 Section 6. Present paragraphs (c) and (d) of subsection
393 (13) of section 409.906, Florida Statutes, are redesignated as
394 paragraphs (d) and (e), respectively, a new paragraph (c) is
395 added to that subsection, and subsection (15) of that section is
396 amended, to read:
397 409.906 Optional Medicaid services.—Subject to specific
398 appropriations, the agency may make payments for services which
399 are optional to the state under Title XIX of the Social Security
400 Act and are furnished by Medicaid providers to recipients who
401 are determined to be eligible on the dates on which the services
402 were provided. Any optional service that is provided shall be
403 provided only when medically necessary and in accordance with
404 state and federal law. Optional services rendered by providers
405 in mobile units to Medicaid recipients may be restricted or
406 prohibited by the agency. Nothing in this section shall be
407 construed to prevent or limit the agency from adjusting fees,
408 reimbursement rates, lengths of stay, number of visits, or
409 number of services, or making any other adjustments necessary to
410 comply with the availability of moneys and any limitations or
411 directions provided for in the General Appropriations Act or
412 chapter 216. If necessary to safeguard the state’s systems of
413 providing services to elderly and disabled persons and subject
414 to the notice and review provisions of s. 216.177, the Governor
415 may direct the Agency for Health Care Administration to amend
416 the Medicaid state plan to delete the optional Medicaid service
417 known as “Intermediate Care Facilities for the Developmentally
418 Disabled.” Optional services may include:
419 (13) HOME AND COMMUNITY-BASED SERVICES.—
420 (c) The agency shall competitively procure a qualified
421 organization to perform medical necessity determinations of
422 significant additional needs requests, as defined in s. 393.063.
423 (15) INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY
424 DISABLED SERVICES.—The agency may pay for health-related care
425 and services provided on a 24-hour-a-day basis by a facility
426 licensed and certified as a Medicaid Intermediate Care Facility
427 for the Developmentally Disabled, for a recipient who needs such
428 care because of a developmental disability. Payment shall not
429 include bed-hold days except in facilities with occupancy rates
430 of 95 percent or greater. The agency is authorized to seek any
431 federal waiver approvals to implement this policy. The agency
432 shall seek federal approval to implement a payment rate for
433 Medicaid intermediate care facilities serving individuals with
434 developmental disabilities, severe maladaptive behaviors, severe
435 maladaptive behaviors and co-occurring complex medical
436 conditions, or a dual diagnosis of developmental disability and
437 mental illness.
438 Section 7. Paragraph (a) of subsection (4) of section
439 409.968, Florida Statutes, is amended to read:
440 409.968 Managed care plan payments.—
441 (4)(a) Subject to a specific appropriation and federal
442 approval under s. 409.906(13)(e) s. 409.906(13)(d), the agency
443 shall establish a payment methodology to fund managed care plans
444 for flexible services for persons with severe mental illness and
445 substance use disorders, including, but not limited to,
446 temporary housing assistance. A managed care plan eligible for
447 these payments must do all of the following:
448 1. Participate as a specialty plan for severe mental
449 illness or substance use disorders or participate in counties
450 designated by the General Appropriations Act;
451 2. Include providers of behavioral health services pursuant
452 to chapters 394 and 397 in the managed care plan’s provider
453 network; and
454 3. Document a capability to provide housing assistance
455 through agreements with housing providers, relationships with
456 local housing coalitions, and other appropriate arrangements.
457 Section 8. Paragraph (d) of subsection (2) of section
458 1002.385, Florida Statutes, is amended to read:
459 1002.385 The Gardiner Scholarship.—
460 (2) DEFINITIONS.—As used in this section, the term:
461 (d) “Disability” means, for a 3- or 4-year-old child or for
462 a student in kindergarten to grade 12, autism spectrum disorder,
463 as defined in the Diagnostic and Statistical Manual of Mental
464 Disorders, Fifth Edition, published by the American Psychiatric
465 Association; cerebral palsy, as defined in s. 393.063(6); Down
466 syndrome, as defined in s. 393.063(15); an intellectual
467 disability, as defined in s. 393.063(24); Phelan-McDermid
468 syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
469 as defined in s. 393.063(29); spina bifida, as defined in s.
470 393.063(41) s. 393.063(40); being a high-risk child, as defined
471 in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
472 rare diseases which affect patient populations of fewer than
473 200,000 individuals in the United States, as defined by the
474 National Organization for Rare Disorders; anaphylaxis; deaf;
475 visually impaired; traumatic brain injured; hospital or
476 homebound; or identification as dual sensory impaired, as
477 defined by rules of the State Board of Education and evidenced
478 by reports from local school districts. The term “hospital or
479 homebound” includes a student who has a medically diagnosed
480 physical or psychiatric condition or illness, as defined by the
481 state board in rule, and who is confined to the home or hospital
482 for more than 6 months.
483 Section 9. This act shall take effect July 1, 2020.