Florida Senate - 2020 CS for SB 82
By the Committee on Appropriations; and Senator Bean
576-04295-20 202082c1
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 and the chairs of the Senate
32 Appropriations Committee and the House Appropriations
33 Committee or their successor committees; providing
34 requirements for such reports; requiring the Agency
35 for Persons with Disabilities, in consultation with
36 the Agency for Health Care Administration, to submit a
37 certain plan to the Executive Office of the Governor,
38 the chair of the Senate Appropriations Committee, and
39 the chair of the House Appropriations Committee under
40 certain conditions; requiring the agency to work with
41 the Agency for Health Care Administration to implement
42 such plan; requiring the Agency for Persons with
43 Disabilities, in consultation with the Agency for
44 Health Care Administration, to provide quarterly
45 reconciliation reports to the Governor and the
46 Legislature within a specified timeframe; revising
47 rulemaking authority of the Agency for Persons with
48 Disabilities and the Agency for Health Care
49 Administration; creating s. 393.0663, F.S.; providing
50 legislative intent; defining the term “qualified
51 organization”; requiring the Agency for Persons with
52 Disabilities to use qualified organizations to provide
53 support coordination services for certain clients;
54 providing requirements for qualified organizations;
55 providing agency duties; providing for the review and
56 appeal of certain decisions made by the agency;
57 authorizing the agency to adopt rules; amending s.
58 400.962, F.S.; requiring certain facilities that have
59 been granted a certificate-of-need exemption to
60 demonstrate and maintain compliance with specified
61 criteria; amending s. 408.036, F.S.; providing an
62 exemption from a certificate-of-need requirement for
63 certain intermediate care facilities; prohibiting the
64 Agency for Health Care Administration from granting an
65 additional exemption to a facility unless a certain
66 condition is met; providing that a specific
67 legislative appropriation is not required for such
68 exemption; amending s. 409.906, F.S.; requiring the
69 agency to seek federal approval to implement certain
70 payment rates; amending s. 1002.385, F.S.; conforming
71 a cross-reference; providing an effective date.
72
73 Be It Enacted by the Legislature of the State of Florida:
74
75 Section 1. Present subsections (39) through (45) of section
76 393.063, Florida Statutes, are redesignated as subsections (40)
77 through (46), respectively, a new subsection (39) is added to
78 that section, and present subsection (41) of that section is
79 amended, to read:
80 393.063 Definitions.—For the purposes of this chapter, the
81 term:
82 (39) “Significant additional need” means an additional need
83 for medically necessary services which would place the health
84 and safety of the client, the client’s caregiver, or the public
85 in serious jeopardy if it is not met. The term does not exclude
86 services for an additional need that the client requires in
87 order to remain in the least restrictive setting, including, but
88 not limited to, employment services and transportation services.
89 The agency may provide additional funding only after the
90 determination of a client’s initial allocation amount and after
91 the qualified organization has documented the availability of
92 nonwaiver resources.
93 (42)(41) “Support coordinator” means an employee of a
94 qualified organization as provided in s. 393.0663 a person who
95 is designated by the agency to assist individuals and families
96 in identifying their capacities, needs, and resources, as well
97 as finding and gaining access to necessary supports and
98 services; coordinating the delivery of supports and services;
99 advocating on behalf of the individual and family; maintaining
100 relevant records; and monitoring and evaluating the delivery of
101 supports and services to determine the extent to which they meet
102 the needs and expectations identified by the individual, family,
103 and others who participated in the development of the support
104 plan.
105 Section 2. Subsection (2) of section 393.066, Florida
106 Statutes, is amended to read:
107 393.066 Community services and treatment.—
108 (2) Necessary services shall be purchased, rather than
109 provided directly by the agency, when the purchase of services
110 is more cost-efficient than providing them directly. All
111 purchased services must be approved by the agency. As a
112 condition of payment and before billing, persons or entities
113 under contract with the agency to provide services shall use
114 agency data management systems to document service provision to
115 clients shall use such systems to bill for services. Contracted
116 persons and entities shall meet the minimum hardware and
117 software technical requirements established by the agency for
118 the use of such systems. Such persons or entities shall also
119 meet any requirements established by the agency for training and
120 professional development of staff providing direct services to
121 clients.
122 Section 3. Section 393.0661, Florida Statutes, is repealed.
123 Section 4. Section 393.0662, Florida Statutes, is amended
124 to read:
125 393.0662 Individual budgets for delivery of home and
126 community-based services; iBudget system established.—The
127 Legislature finds that improved financial management of the
128 existing home and community-based Medicaid waiver program is
129 necessary to avoid deficits that impede the provision of
130 services to individuals who are on the waiting list for
131 enrollment in the program. The Legislature further finds that
132 clients and their families should have greater flexibility to
133 choose the services that best allow them to live in their
134 community within the limits of an established budget. Therefore,
135 the Legislature intends that the agency, in consultation with
136 the Agency for Health Care Administration, shall manage the
137 service delivery system using individual budgets as the basis
138 for allocating the funds appropriated for the home and
139 community-based services Medicaid waiver program among eligible
140 enrolled clients. The service delivery system that uses
141 individual budgets shall be called the iBudget system.
142 (1) The agency shall administer an individual budget,
143 referred to as an iBudget, for each individual served by the
144 home and community-based services Medicaid waiver program. The
145 funds appropriated to the agency shall be allocated through the
146 iBudget system to eligible, Medicaid-enrolled clients. For the
147 iBudget system, eligible clients shall include individuals with
148 a developmental disability as defined in s. 393.063. The iBudget
149 system shall provide for: enhanced client choice within a
150 specified service package; appropriate assessment strategies; an
151 efficient consumer budgeting and billing process that includes
152 reconciliation and monitoring components; a role for support
153 coordinators that avoids potential conflicts of interest; a
154 flexible and streamlined service review process; and the
155 equitable allocation of available funds based on the client’s
156 level of need, as determined by the allocation methodology.
157 (a) In developing each client’s iBudget, the agency shall
158 use the allocation methodology as defined in s. 393.063(4), in
159 conjunction with an assessment instrument that the agency deems
160 to be reliable and valid, including, but not limited to, the
161 agency’s Questionnaire for Situational Information. The
162 allocation methodology shall determine the amount of funds
163 allocated to a client’s iBudget.
164 (b) The agency may authorize additional funding based on a
165 client having one or more significant additional needs of the
166 following needs that cannot be accommodated within the funding
167 determined by the algorithm and having no other resources,
168 supports, or services available to meet the needs. Such
169 additional funding may be provided only after the determination
170 of a client’s initial allocation amount and after the qualified
171 organization has documented the availability of all nonwaiver
172 resources. Upon receipt of an incomplete request for services to
173 meet significant additional needs, the agency shall close the
174 request.
175 (c) The agency shall centralize, within its headquarters,
176 medical necessity determinations for requested services made
177 through the significant additional needs process. The process
178 must ensure consistent application of medical necessity
179 criteria. This process must provide opportunities for targeted
180 training, quality assurance, and inter-rater reliability. need:
181 1. An extraordinary need that would place the health and
182 safety of the client, the client’s caregiver, or the public in
183 immediate, serious jeopardy unless the increase is approved.
184 However, the presence of an extraordinary need in and of itself
185 does not warrant authorized funding by the agency. An
186 extraordinary need may include, but is not limited to:
187 a. A documented history of significant, potentially life
188 threatening behaviors, such as recent attempts at suicide,
189 arson, nonconsensual sexual behavior, or self-injurious behavior
190 requiring medical attention;
191 b. A complex medical condition that requires active
192 intervention by a licensed nurse on an ongoing basis that cannot
193 be taught or delegated to a nonlicensed person;
194 c. A chronic comorbid condition. As used in this
195 subparagraph, the term “comorbid condition” means a medical
196 condition existing simultaneously but independently with another
197 medical condition in a patient; or
198 d. A need for total physical assistance with activities
199 such as eating, bathing, toileting, grooming, and personal
200 hygiene.
201 2. A significant need for one-time or temporary support or
202 services that, if not provided, would place the health and
203 safety of the client, the client’s caregiver, or the public in
204 serious jeopardy. A significant need may include, but is not
205 limited to, the provision of environmental modifications,
206 durable medical equipment, services to address the temporary
207 loss of support from a caregiver, or special services or
208 treatment for a serious temporary condition when the service or
209 treatment is expected to ameliorate the underlying condition. As
210 used in this subparagraph, the term “temporary” means a period
211 of fewer than 12 continuous months. However, the presence of
212 such significant need for one-time or temporary supports or
213 services in and of itself does not warrant authorized funding by
214 the agency.
215 3. A significant increase in the need for services after
216 the beginning of the service plan year that would place the
217 health and safety of the client, the client’s caregiver, or the
218 public in serious jeopardy because of substantial changes in the
219 client’s circumstances, including, but not limited to, permanent
220 or long-term loss or incapacity of a caregiver, loss of services
221 authorized under the state Medicaid plan due to a change in age,
222 or a significant change in medical or functional status which
223 requires the provision of additional services on a permanent or
224 long-term basis that cannot be accommodated within the client’s
225 current iBudget. As used in this subparagraph, the term “long
226 term” means a period of 12 or more continuous months. However,
227 such significant increase in need for services of a permanent or
228 long-term nature in and of itself does not warrant authorized
229 funding by the agency.
230 4. A significant need for transportation services to a
231 waiver-funded adult day training program or to waiver-funded
232 employment services when such need cannot be accommodated within
233 a client’s iBudget as determined by the algorithm without
234 affecting the health and safety of the client, if public
235 transportation is not an option due to the unique needs of the
236 client or other transportation resources are not reasonably
237 available.
238
239 The agency shall reserve portions of the appropriation for
240 the home and community-based services Medicaid waiver program
241 for adjustments required pursuant to this paragraph and may use
242 the services of an independent actuary in determining the amount
243 to be reserved.
244 (d)(c) A client’s annual expenditures for home and
245 community-based Medicaid waiver services may not exceed the
246 limits of his or her iBudget. The total of all clients’
247 projected annual iBudget expenditures may not exceed the
248 agency’s appropriation for waiver services.
249 (2) The Agency for Health Care Administration, in
250 consultation with the agency, shall seek federal approval to
251 amend current waivers, request a new waiver, and amend contracts
252 as necessary to manage the iBudget system, improve services for
253 eligible and enrolled clients, and improve the delivery of
254 services through the home and community-based services Medicaid
255 waiver program and the Consumer-Directed Care Plus Program,
256 including, but not limited to, enrollees with a dual diagnosis
257 of a developmental disability and a mental health disorder.
258 (3) The agency must certify and document within each
259 client’s cost plan that the a client has used must use all
260 available services authorized under the state Medicaid plan,
261 school-based services, private insurance and other benefits, and
262 any other resources that may be available to the client before
263 using funds from his or her iBudget to pay for support and
264 services.
265 (4) Rates for any or all services established under rules
266 of the Agency for Health Care Administration must be designated
267 as the maximum rather than a fixed amount for individuals who
268 receive an iBudget, except for services specifically identified
269 in those rules that the agency determines are not appropriate
270 for negotiation, which may include, but are not limited to,
271 residential habilitation services.
272 (5) The agency shall ensure that clients and caregivers
273 have access to training and education that inform them about the
274 iBudget system and enhance their ability for self-direction.
275 Such training and education must be offered in a variety of
276 formats and, at a minimum, must address the policies and
277 processes of the iBudget system and the roles and
278 responsibilities of consumers, caregivers, waiver support
279 coordinators, providers, and the agency, and must provide
280 information to help the client make decisions regarding the
281 iBudget system and examples of support and resources available
282 in the community.
283 (6) The agency shall collect data to evaluate the
284 implementation and outcomes of the iBudget system.
285 (7) The Agency for Health Care Administration shall seek
286 federal approval to provide a consumer-directed option for
287 persons with developmental disabilities. The agency and the
288 Agency for Health Care Administration may adopt rules necessary
289 to administer this subsection.
290 (8) The Agency for Health Care Administration shall seek
291 federal waivers and amend contracts as necessary to make changes
292 to services defined in federal waiver programs, as follows:
293 (a) Supported living coaching services may not exceed 20
294 hours per month for persons who also receive in-home support
295 services.
296 (b) Limited support coordination services are the only
297 support coordination services that may be provided to persons
298 under the age of 18 who live in the family home.
299 (c) Personal care assistance services are limited to 180
300 hours per calendar month and may not include rate modifiers.
301 Additional hours may be authorized for persons who have
302 intensive physical, medical, or adaptive needs, if such hours
303 will prevent institutionalization.
304 (d) Residential habilitation services are limited to 8
305 hours per day. Additional hours may be authorized for persons
306 who have intensive medical or adaptive needs and if such hours
307 will prevent institutionalization, or for persons who have
308 behavioral problems that are exceptional in intensity, duration,
309 or frequency and who present a substantial risk of harm to
310 themselves or others.
311 (e) The agency shall conduct supplemental cost plan reviews
312 to verify the medical necessity of authorized services for plans
313 that have increased by more than 8 percent during either of the
314 2 preceding fiscal years.
315 (f) The agency shall implement a consolidated residential
316 habilitation rate structure to increase savings to the state
317 through a more cost-effective payment method and establish
318 uniform rates for intensive behavioral residential habilitation
319 services.
320 (g) The geographic differential for Miami-Dade, Broward,
321 and Palm Beach Counties for residential habilitation services is
322 7.5 percent.
323 (h) The geographic differential for Monroe County for
324 residential habilitation services is 20 percent.
325 (9) The agency shall collect premiums or cost sharing
326 pursuant to s. 409.906(13)(c).
327 (10) This section or any related rule does not prevent or
328 limit the Agency for Health Care Administration, in consultation
329 with the agency, from adjusting fees, reimbursement rates,
330 lengths of stay, number of visits, or number of services, or
331 from limiting enrollment or making any other adjustment
332 necessary to comply with the availability of moneys and any
333 limitations or directions provided in the General Appropriations
334 Act.
335 (11) A provider of services rendered to persons with
336 developmental disabilities pursuant to a federally approved
337 waiver must be reimbursed according to a rate methodology based
338 upon an analysis of the expenditure history and prospective
339 costs of providers participating in the waiver program, or under
340 any other methodology developed by the Agency for Health Care
341 Administration in consultation with the agency and approved by
342 the Federal Government in accordance with the waiver.
343 (12) The agency shall submit quarterly status reports to
344 the Executive Office of the Governor, the chair of the Senate
345 Appropriations Committee or its successor, and the chair of the
346 House Appropriations Committee or its successor which contain
347 all of the following information:
348 (a) The financial status of home and community-based
349 services, including the number of enrolled individuals receiving
350 services through one or more programs.
351 (b) The number of individuals who have requested services
352 and who are not enrolled but who are receiving services through
353 one or more programs, with a description indicating the programs
354 under which the individual is receiving services.
355 (c) The number of individuals who have refused an offer of
356 services but who choose to remain on the list of individuals
357 waiting for services.
358 (d) The number of individuals who have requested services
359 but who are receiving no services.
360 (e) A frequency distribution indicating the length of time
361 individuals have been waiting for services.
362 (f) Information concerning the actual and projected costs
363 compared to the amount of the appropriation available to the
364 program and any projected surpluses or deficits.
365 (13) If at any time an analysis by the agency, in
366 consultation with the Agency for Health Care Administration,
367 indicates that the cost of services is expected to exceed the
368 amount appropriated, the agency shall submit a plan in
369 accordance with subsection (10) to the Executive Office of the
370 Governor, the chair of the Senate Appropriations Committee or
371 its successor committee, and the chair of the House
372 Appropriations Committee or its successor committee to remain
373 within the amount appropriated. The agency shall work with the
374 Agency for Health Care Administration to implement the plan so
375 as to remain within the appropriation.
376 (14) The agency, in consultation with the Agency for Health
377 Care Administration, shall provide a quarterly reconciliation
378 report of all home and community-based services waiver
379 expenditures from the Agency for Health Care Administration’s
380 claims management system with service utilization from the
381 Agency for Persons with Disabilities Allocation, Budget, and
382 Contract Control system. The reconciliation report must be
383 submitted to the Governor, the President of the Senate, and the
384 Speaker of the House of Representatives no later than 30 days
385 after the close of each quarter.
386 (15)(7) The agency and the Agency for Health Care
387 Administration may adopt rules specifying the allocation
388 algorithm and methodology; criteria and processes for clients to
389 access reserved funds for services to meet significant
390 additional needs extraordinary needs, temporarily or permanently
391 changed needs, and one-time needs; and processes and
392 requirements for selection and review of services, development
393 of support and cost plans, and management of the iBudget system
394 as needed to administer this section.
395 Section 5. Section 393.0663, Florida Statutes, is created
396 to read:
397 393.0663 Support coordination; legislative intent;
398 qualified organizations; agency duties; due process;
399 rulemaking.—
400 (1) LEGISLATIVE INTENT.—To enable the state to provide a
401 systematic approach to service oversight for persons providing
402 care to individuals with developmental disabilities, it is the
403 intent of the Legislature that the agency work in collaboration
404 with relevant stakeholders to ensure that waiver support
405 coordinators have the knowledge, skills, and abilities necessary
406 to competently provide services to individuals with
407 developmental disabilities by requiring all support coordinators
408 to be employees of a qualified organization.
409 (2) QUALIFIED ORGANIZATIONS.—
410 (a) As used in this section, the term “qualified
411 organization” means an organization determined by the agency to
412 meet the requirements of this section and of the Developmental
413 Disabilities Individual Budgeting Waiver Services Coverage and
414 Limitations Handbook.
415 (b) The agency shall use qualified organizations for the
416 purpose of providing all support coordination services to
417 iBudget clients in this state. In order to be qualified, an
418 organization must:
419 1. Employ four or more support coordinators;
420 2. Maintain a professional code of ethics and a
421 disciplinary process that apply to all support coordinators
422 within the organization;
423 3. Comply with the agency’s cost containment initiatives;
424 4. Require support coordinators to ensure that client
425 budgets are linked to levels of need;
426 5. Require support coordinators to perform all duties and
427 meet all standards related to support coordination as provided
428 in the Developmental Disabilities Individual Budgeting Waiver
429 Services Coverage and Limitations Handbook;
430 6. Prohibit dual employment of a support coordinator if the
431 dual employment adversely impacts the support coordinator’s
432 availability to clients;
433 7. Educate clients and families regarding identifying and
434 preventing abuse, neglect, and exploitation;
435 8. Instruct clients and families on mandatory reporting
436 requirements for abuse, neglect, and exploitation;
437 9. Submit within established timeframes all required
438 documentation for requests for significant additional needs;
439 10. Require support coordinators to successfully complete
440 training and professional development approved by the agency;
441 11. Require support coordinators to pass a competency-based
442 assessment established by the agency; and
443 12. Implement a mentoring program approved by the agency
444 for support coordinators who have worked as a support
445 coordinator for less than 12 months.
446 (3) DUTIES OF THE AGENCY.—The agency shall:
447 (a) Require all qualified organizations to report to the
448 agency any violation of ethical or professional conduct by
449 support coordinators employed by the organization;
450 (b) Maintain a publicly accessible registry of all support
451 coordinators, including any history of ethical or disciplinary
452 violations; and
453 (c) Impose an immediate moratorium on new client
454 assignments, impose an administrative fine, require plans of
455 remediation, and terminate the Medicaid Waiver Services
456 Agreement of any qualified organization that is noncompliant
457 with applicable laws or rules.
458 (4) DUE PROCESS.—Any decision by the agency to take action
459 against a qualified organization as described in paragraph
460 (3)(c) is reviewable by the agency. Upon receiving an adverse
461 determination, the qualified organization may request an
462 administrative hearing pursuant to ss. 120.569 and 120.57(1)
463 within 30 days after completing any appeals process established
464 by the agency.
465 (5) RULEMAKING.—The agency may adopt rules to implement
466 this section.
467 Section 6. Subsection (6) is added to section 400.962,
468 Florida Statutes, to read:
469 400.962 License required; license application.—
470 (6) An applicant that has been granted a certificate-of
471 need exemption under s. 408.036(3)(o) must also demonstrate and
472 maintain compliance with the following requirements:
473 (a) The total number of beds per home within the facility
474 may not exceed eight, with each resident having his or her own
475 bedroom and bathroom. Each eight-bed home must be colocated on
476 the same property with two other eight-bed homes and must serve
477 individuals with severe maladaptive behaviors and co-occurring
478 psychiatric diagnoses.
479 (b) A minimum of 16 beds within the facility must be
480 designated for individuals with severe maladaptive behaviors who
481 have been assessed using the Agency for Persons with
482 Disabilities’ Global Behavioral Service Need Matrix with a score
483 of at least Level 3 and up to Level 6, or assessed using the
484 criteria deemed appropriate by the Agency for Health Care
485 Administration regarding the need for a specialized placement in
486 an intermediate care facility for the developmentally disabled.
487 (c) The applicant may not have had a facility license
488 denied, revoked, or suspended within the 36 months preceding the
489 request for exemption.
490 (d) The applicant must have had at least 10 years of
491 experience serving individuals with severe maladaptive behaviors
492 in this state.
493 (e) The applicant must have implemented a state-approved
494 staff training curriculum and monitoring requirements specific
495 to the individuals whose behaviors require higher intensity,
496 frequency, and duration of services.
497 (f) The applicant must make available medical and nursing
498 services 24 hours per day, 7 days per week.
499 (g) The applicant must demonstrate a history of using
500 interventions that are least restrictive and that follow a
501 behavioral hierarchy.
502 (h) The applicant must maintain a policy prohibiting the
503 use of mechanical restraints.
504 Section 7. Paragraph (o) is added to subsection (3) of
505 section 408.036, Florida Statutes, to read:
506 408.036 Projects subject to review; exemptions.—
507 (3) EXEMPTIONS.—Upon request, the following projects are
508 subject to exemption from subsection (1):
509 (o) For a new intermediate care facility for the
510 developmentally disabled as defined in s. 408.032 which has a
511 total of 24 beds, comprising three eight-bed homes, for use by
512 individuals exhibiting severe maladaptive behaviors and co
513 occurring psychiatric diagnoses requiring increased levels of
514 behavioral, medical, and therapeutic oversight. The facility
515 must not have had a license denied, revoked, or suspended within
516 the 36 months preceding the request for exemption and must have
517 at least 10 years of experience serving individuals with severe
518 maladaptive behaviors in this state. The agency may not grant an
519 additional exemption to a facility that has been granted an
520 exemption under this paragraph unless the facility has been
521 licensed and operational for a period of at least 2 years. The
522 exemption under this paragraph does not require a specific
523 legislative appropriation.
524 Section 8. Subsection (15) of section 409.906, Florida
525 Statutes, is amended to read:
526 409.906 Optional Medicaid services.—Subject to specific
527 appropriations, the agency may make payments for services which
528 are optional to the state under Title XIX of the Social Security
529 Act and are furnished by Medicaid providers to recipients who
530 are determined to be eligible on the dates on which the services
531 were provided. Any optional service that is provided shall be
532 provided only when medically necessary and in accordance with
533 state and federal law. Optional services rendered by providers
534 in mobile units to Medicaid recipients may be restricted or
535 prohibited by the agency. Nothing in this section shall be
536 construed to prevent or limit the agency from adjusting fees,
537 reimbursement rates, lengths of stay, number of visits, or
538 number of services, or making any other adjustments necessary to
539 comply with the availability of moneys and any limitations or
540 directions provided for in the General Appropriations Act or
541 chapter 216. If necessary to safeguard the state’s systems of
542 providing services to elderly and disabled persons and subject
543 to the notice and review provisions of s. 216.177, the Governor
544 may direct the Agency for Health Care Administration to amend
545 the Medicaid state plan to delete the optional Medicaid service
546 known as “Intermediate Care Facilities for the Developmentally
547 Disabled.” Optional services may include:
548 (15) INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY
549 DISABLED SERVICES.—The agency may pay for health-related care
550 and services provided on a 24-hour-a-day basis by a facility
551 licensed and certified as a Medicaid Intermediate Care Facility
552 for the Developmentally Disabled, for a recipient who needs such
553 care because of a developmental disability. Payment shall not
554 include bed-hold days except in facilities with occupancy rates
555 of 95 percent or greater. The agency is authorized to seek any
556 federal waiver approvals to implement this policy. The agency
557 shall seek federal approval to implement a payment rate for
558 Medicaid intermediate care facilities serving individuals with
559 developmental disabilities, severe maladaptive behaviors, severe
560 maladaptive behaviors and co-occurring complex medical
561 conditions, or a dual diagnosis of developmental disability and
562 mental illness.
563 Section 9. Paragraph (d) of subsection (2) of section
564 1002.385, Florida Statutes, is amended to read:
565 1002.385 The Gardiner Scholarship.—
566 (2) DEFINITIONS.—As used in this section, the term:
567 (d) “Disability” means, for a 3- or 4-year-old child or for
568 a student in kindergarten to grade 12, autism spectrum disorder,
569 as defined in the Diagnostic and Statistical Manual of Mental
570 Disorders, Fifth Edition, published by the American Psychiatric
571 Association; cerebral palsy, as defined in s. 393.063(6); Down
572 syndrome, as defined in s. 393.063(15); an intellectual
573 disability, as defined in s. 393.063(24); Phelan-McDermid
574 syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
575 as defined in s. 393.063(29); spina bifida, as defined in s.
576 393.063(41) s. 393.063(40); being a high-risk child, as defined
577 in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
578 rare diseases which affect patient populations of fewer than
579 200,000 individuals in the United States, as defined by the
580 National Organization for Rare Disorders; anaphylaxis; deaf;
581 visually impaired; traumatic brain injured; hospital or
582 homebound; or identification as dual sensory impaired, as
583 defined by rules of the State Board of Education and evidenced
584 by reports from local school districts. The term “hospital or
585 homebound” includes a student who has a medically diagnosed
586 physical or psychiatric condition or illness, as defined by the
587 state board in rule, and who is confined to the home or hospital
588 for more than 6 months.
589 Section 10. This act shall take effect July 1, 2021.