Florida Senate - 2023 CS for CS for SB 1084 By the Committee on Fiscal Policy; the Appropriations Committee on Health and Human Services; and Senator Trumbull 594-04306-23 20231084c2 1 A bill to be entitled 2 An act relating to the pilot program for individuals 3 with developmental disabilities; creating s. 409.9855, 4 F.S.; requiring the Agency for Health Care 5 Administration to implement a pilot program for 6 individuals with developmental disabilities residing 7 in specified Statewide Medicaid Managed Care regions 8 to provide coverage of comprehensive services; 9 authorizing the agency to seek federal approval as 10 needed to implement the program; requiring the agency 11 to submit such request by a specified date; requiring 12 the agency to administer the pilot program but 13 delegate specified duties to the Agency for Persons 14 with Disabilities; requiring the Agency for Health 15 Care Administration to make payments for comprehensive 16 services under the pilot program using a managed care 17 model; providing applicability; requiring the Agency 18 for Health Care Administration to evaluate the 19 feasibility of implementing the pilot program 20 statewide; providing that participation in the pilot 21 program is voluntary and subject to specific 22 appropriation; providing construction; requiring the 23 Agency for Persons with Disabilities to approve a 24 needs assessment methodology for prospective 25 enrollees; providing enrollment eligibility 26 requirements; requiring the Agency for Health Care 27 Administration, in consultation with the Agency for 28 Persons with Disabilities, to make offers for 29 enrollment to eligible individuals within specified 30 parameters; requiring that enrollees be afforded an 31 opportunity to enroll in any appropriate existing 32 Medicaid waiver program under certain circumstances; 33 requiring the Agency for Persons with Disabilities to 34 adopt certain rules; requiring participating plans to 35 cover specified benefits; providing additional 36 requirements for the provision of benefits by 37 participating plans under the pilot program; providing 38 eligibility requirements for plans; providing a 39 selection process; requiring the Agency for Health 40 Care Administration to give preference to certain 41 plans; requiring that plan payments be based on rates 42 specifically developed for a certain population; 43 requiring the Agency for Health Care Administration to 44 ensure that the rate be actuarially sound; requiring 45 that the revenues and expenditures of the selected 46 plan be included in specified reporting and regulatory 47 requirements; providing that implementation of the 48 program shall occur concurrently with other specified 49 services; requiring the Agency for Health Care 50 Administration, in consultation with the Agency for 51 Persons with Disabilities, to conduct certain audits 52 of the selected plans and submit specified progress 53 reports to the Governor and the Legislature by 54 specified dates throughout the program approval and 55 implementation process; providing requirements for the 56 respective reports; requiring the Agency for Health 57 Care Administration, in consultation with the Agency 58 for Persons with Disabilities, to conduct an 59 evaluation of the pilot program; authorizing the 60 Agency for Health Care Administration to contract with 61 an independent evaluator to conduct such evaluation; 62 providing requirements for the evaluation; requiring 63 the Agency for Health Care Administration, in 64 consultation with the Agency for Persons with 65 Disabilities, to conduct quality assurance monitoring 66 of the pilot program; requiring the Agency for Health 67 Care Administration to submit the results of the 68 evaluation to the Governor and the Legislature by a 69 specified date; requiring participating plans to 70 maintain specified provider capacity limits; requiring 71 participating plans to consult with the Agency for 72 Persons with Disabilities before placing a pilot 73 program enrollee in certain group homes; providing for 74 the future repeal of the pilot program; amending s. 75 409.961, F.S.; conforming a provision to changes made 76 by the act; requiring that plans selected to 77 participate in the pilot program be plans awarded a 78 contract as a result of a specified invitation to 79 negotiate; requiring that the pilot program be 80 implemented in specified Statewide Medicaid Managed 81 Care regions; providing an effective date. 82 83 84 WHEREAS, the mission of the Agency for Persons with 85 Disabilities is developing community-based programs and services 86 for individuals with developmental disabilities and working with 87 private businesses, not-for-profit corporations, units of local 88 government, and other organizations capable of providing needed 89 services to clients to promote their living, learning, and 90 working as part of their communities, and 91 WHEREAS, the Agency for Persons with Disabilities advances 92 that mission through the iBudget waiver, which is designed to 93 promote and maintain the health of eligible individuals with 94 developmental disabilities, to provide medically necessary 95 supports and services to delay or prevent institutionalization, 96 and to foster the principles and appreciation of self 97 determination, and 98 WHEREAS, the Legislature intends for a comprehensive and 99 coordinated service delivery system for individuals with 100 developmental disabilities which includes all services specified 101 in ss. 393.066(3), 409.973, and 409.98, Florida Statutes, and 102 the state’s home and community-based services Medicaid waiver 103 program, and 104 WHEREAS, the Legislature further intends that such service 105 delivery system ensure consumer education and choice, including 106 choice of provider, location of living setting, location of 107 services, and scheduling of services and supports; access to 108 care coordination services; local access to medically necessary 109 services; coordination of preventative, acute, and long-term 110 care and home and community-based services; reduction in 111 unnecessary service utilization; provision of habilitative and 112 rehabilitative services; and adherence to person-centered 113 planning as described in 42 C.F.R. s. 441.301(c)(1), and 114 WHEREAS, Florida continues to look for multiple innovative 115 pathways to serve individuals with developmental disabilities 116 and their families, including expanding the continuum of care to 117 provide a robust and stable system that is a reliable provider 118 of services for individuals with developmental disabilities to 119 promote a comprehensive state of thriving in daily living, 120 community integration, and goal-based achievement, NOW, 121 THEREFORE, 122 123 Be It Enacted by the Legislature of the State of Florida: 124 125 Section 1. Section 409.9855, Florida Statutes, is created 126 to read: 127 409.9855 Pilot program for individuals with developmental 128 disabilities.— 129 (1) PILOT PROGRAM IMPLEMENTATION.— 130 (a) Using a managed care model, the agency shall implement 131 a pilot program for individuals with developmental disabilities 132 residing in Statewide Medicaid Managed Care Regions D and I to 133 provide coverage of comprehensive services. 134 (b) The agency may seek federal approval through a state 135 plan amendment or Medicaid waiver as necessary to implement the 136 pilot program. The agency shall submit a request for any federal 137 approval needed to implement the pilot program by September 1, 138 2023. 139 (c) Pursuant to s. 409.963, the agency shall administer the 140 pilot program but shall delegate specific duties and 141 responsibilities for the pilot program to the Agency for Persons 142 with Disabilities. 143 (d) The agency shall make payments for comprehensive 144 services, including community-based services described in s. 145 393.066(3) and approved through the state’s home and community 146 based services Medicaid waiver program for individuals with 147 developmental disabilities, using a managed care model. Unless 148 otherwise specified, ss. 409.961-409.969 apply to the pilot 149 program. 150 (e) The agency shall evaluate the feasibility of statewide 151 implementation of the capitated managed care model used by the 152 pilot program to serve individuals with developmental 153 disabilities. 154 (2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT.— 155 (a) Participation in the pilot program is voluntary and 156 limited to the maximum number of enrollees specified in the 157 General Appropriations Act. Enrollment in the pilot program does 158 not automatically entitle individuals to any other services 159 under chapter 393. 160 (b) The Agency for Persons with Disabilities shall approve 161 a needs assessment methodology to determine functional, 162 behavioral, and physical needs of prospective enrollees. This 163 assessment methodology may be administered by persons who have 164 completed such training as may be offered by the agency. 165 Eligibility to participate in the pilot program is determined 166 based on all of the following criteria: 167 1. Whether the individual is eligible for Medicaid. 168 2. Whether the individual is 18 years of age or older and 169 is on the waiting list for iBudget waiver services under chapter 170 393 and assigned to one of categories 1 through 6 as specified 171 in s. 393.065(5). 172 3. Whether the individual resides in a pilot program 173 region. 174 (c) Notwithstanding any provisions of s. 393.065 to the 175 contrary and subject to the availability of funds, the agency, 176 in consultation with the Agency for Persons with Disabilities, 177 shall make offers for enrollment to eligible individuals. Before 178 making enrollment offers, the agency shall determine that 179 sufficient funds exist to support additional enrollment into 180 plans. The agency, in consultation with the Agency for Persons 181 with Disabilities, shall ensure that a statistically valid 182 population is sampled to participate in the pilot program. The 183 agency shall make enrollment offers and use clinical eligibility 184 criteria that ensure that pilot program sites have sufficient 185 diversity of enrollment to conduct a statistically valid test of 186 the managed care pilot program within a 3-year timeframe. 187 (d) Notwithstanding any provisions of s. 393.065 to the 188 contrary, an enrollee must be afforded an opportunity to enroll 189 in any appropriate existing Medicaid waiver program if any of 190 the following conditions occur: 191 1. At any point during the operation of the pilot program, 192 an enrollee declares an intent to voluntarily disenroll, 193 provided that he or she has been covered for the entire previous 194 plan year by the pilot program. 195 2. At any point during the operation of the pilot program, 196 the plan does not have sufficient enrollees to appropriately 197 provide adequate services to its enrollees. 198 3. The pilot program ceases to operate. 199 200 The Agency for Persons with Disabilities shall develop rules to 201 implement this subsection to ensure that an enrollee receives an 202 individualized transition plan to assist him or her in accessing 203 sufficient services and supports for the enrollee’s safety, 204 well-being, and continuity of care. 205 (3) PILOT PROGRAM BENEFITS.— 206 (a) Plans participating in the pilot program must, at a 207 minimum, cover the following: 208 1. All benefits included in s. 409.973. 209 2. All benefits included in s. 409.98. 210 3. All benefits included in s. 393.066(3), and all of the 211 following: 212 a. Adult day training. 213 b. Behavior analysis services. 214 c. Behavior assistant services. 215 d. Companion services. 216 e. Consumable medical supplies. 217 f. Dietitian services. 218 g. Durable medical equipment and supplies. 219 h. Environmental accessibility adaptations. 220 i. Occupational therapy. 221 j. Personal emergency response systems. 222 k. Personal supports. 223 l. Physical therapy. 224 m. Prevocational services. 225 n. Private duty nursing. 226 o. Residential habilitation, including the following 227 levels: 228 (I) Standard level. 229 (II) Behavior-focused level. 230 (III) Intensive-behavior level. 231 (IV) Enhanced intensive-behavior level. 232 p. Residential nursing services. 233 q. Respiratory therapy. 234 r. Respite care. 235 s. Skilled nursing. 236 t. Specialized medical home care. 237 u. Specialized mental health counseling. 238 v. Speech therapy. 239 w. Support coordination. 240 x. Supported employment. 241 y. Supported living coaching. 242 z. Transportation. 243 (b) All providers of the services listed under paragraph 244 (a) must meet the provider qualifications outlined in the 245 Florida Medicaid Developmental Disabilities Individual Budgeting 246 Waiver Services Coverage and Limitations Handbook as adopted by 247 reference in rule 59G-13.070, Florida Administrative Code. 248 (c) Support coordination services must maximize the use of 249 natural supports and community partnerships. 250 (d) The plans participating in the pilot program must 251 provide all categories of benefits through a single, integrated 252 model of care. 253 (e) Services must be provided to enrollees in accordance 254 with an individualized care plan in consultation with the Agency 255 for Persons with Disabilities which is evaluated and updated at 256 least quarterly and as warranted by changes in an enrollee’s 257 circumstances. 258 (4) ELIGIBLE PLANS; PLAN SELECTION.— 259 (a) To be eligible to participate in the pilot program, a 260 plan must have been awarded a contract to provide long-term care 261 services pursuant to s. 409.981 as a result of an invitation to 262 negotiate. 263 (b) The agency shall select, as provided in s. 287.057(1), 264 one plan to participate in the pilot program for each of the two 265 regions. The director of the Agency for Persons with 266 Disabilities or his or her designee must be a member of the 267 negotiating team. 268 1. The invitation to negotiate must specify the criteria 269 and the relative weight assigned to each criterion that will be 270 used for determining the acceptability of submitted responses 271 and guiding the selection of the plans with which the agency and 272 the Agency for Persons with Disabilities negotiate. In addition 273 to any other criteria established by the agency, in consultation 274 with the Agency for Persons with Disabilities, the agency shall 275 consider the following factors in the selection of eligible 276 plans: 277 a. Experience serving similar populations, including the 278 plan’s record of achieving specific quality standards with 279 similar populations. 280 b. Establishment of community partnerships with providers 281 which create opportunities for reinvestment in community-based 282 services. 283 c. Provision of additional benefits, particularly 284 behavioral health services, the coordination of dental care, and 285 other initiatives that improve overall well-being. 286 d. Provision of and capacity to provide mental health 287 therapies and analysis designed to meet the needs of individuals 288 with developmental disabilities. 289 e. Evidence that an eligible plan has written agreements or 290 signed contracts or has made substantial progress in 291 establishing relationships with providers before submitting its 292 response. 293 f. Experience in the provision of person-centered planning 294 as described in 42 C.F.R. s. 441.301(c)(1). 295 g. Experience in robust provider development programs that 296 result in increased availability of Medicaid providers to serve 297 the developmental disabilities community. 298 2. After negotiations are conducted, the agency shall 299 select the eligible plans that are determined to be responsive 300 and provide the best value to the state. Preference must be 301 given to plans that: 302 a. Have signed contracts in sufficient numbers to meet the 303 specific standards established under s. 409.967(2)(c), including 304 contracts for personal supports, skilled nursing, residential 305 habilitation, adult day training, mental health services, 306 respite care, companion services, and supported employment, as 307 those services are defined in the Florida Medicaid Developmental 308 Disabilities Individual Budgeting Waiver Services Coverage and 309 Limitations Handbook as adopted by reference in rule 59G-13.070, 310 Florida Administrative Code. 311 b. Have well-defined programs for recognizing patient 312 centered medical homes and providing increased compensation to 313 recognized medical homes, as defined by the plan. 314 c. Have well-defined programs related to person-centered 315 planning as described in 42 C.F.R. s. 441.301(c)(1). 316 d. Have robust and innovative programs for provider 317 development and collaboration with the Agency for Persons with 318 Disabilities. 319 (5) PAYMENT.— 320 (a) The selected plans must receive a per-member, per-month 321 payment based on a rate developed specifically for the unique 322 needs of the developmentally disabled population. 323 (b) The agency must ensure that the rate for the integrated 324 system is actuarially sound. 325 (c) The revenues and expenditures of the selected plan 326 which are associated with the implementation of the pilot 327 program must be included in the reporting and regulatory 328 requirements established in s. 409.967(3). 329 (6) PROGRAM IMPLEMENTATION AND EVALUATION.— 330 (a) Full implementation of the pilot program shall occur 331 concurrent to the contracts awarded, pursuant to s. 409.966, for 332 the provision of managed medical assistance and long-term care 333 services. 334 (b) Upon implementation of the program, the agency, in 335 consultation with the Agency for Persons with Disabilities, 336 shall conduct audits of the selected plans’ implementation of 337 person-centered planning. 338 (c) The agency, in consultation with the Agency for Persons 339 with Disabilities, shall submit progress reports to the 340 Governor, the President of the Senate, and the Speaker of the 341 House of Representatives upon the federal approval, 342 implementation, and operation of the pilot program, as follows: 343 1. By December 31, 2023, a status report on progress made 344 toward federal approval of the waiver or waiver amendment needed 345 to implement the pilot program. 346 2. By December 31, 2024, a status report on progress made 347 toward full implementation of the pilot program. 348 3. By December 31, 2025, and annually thereafter, a status 349 report on the operation of the pilot program, including, but not 350 limited to, all of the following: 351 a. Program enrollment, including the number and 352 demographics of enrollees, statistically reflecting the 353 diversity of enrollees. 354 b. Any complaints received. 355 c. Access to approved services. 356 (d) The agency, in consultation with the Agency for Persons 357 with Disabilities, shall establish specific measures of access, 358 quality, and costs of the pilot program. The agency may contract 359 with an independent evaluator to conduct such evaluation. The 360 evaluation must include assessments of cost savings; consumer 361 education, choice, and access to services; plans for future 362 capacity and the enrollment of new Medicaid providers; 363 coordination of care; person-centered planning and person 364 centered well-being outcomes; health and quality-of-life 365 outcomes; and quality of care by each eligibility category and 366 managed care plan in each pilot program site. The evaluation 367 must describe any administrative or legal barriers to the 368 implementation and operation of the pilot program in each 369 region. 370 1. The agency, in consultation with the Agency for Persons 371 with Disabilities, shall conduct quality assurance monitoring of 372 the pilot program to include client satisfaction with services, 373 client health and safety outcomes, client well-being outcomes, 374 and service delivery in accordance with the client’s care plan. 375 2. The agency shall submit the results of the evaluation to 376 the Governor, the President of the Senate, and the Speaker of 377 the House of Representatives by October 1, 2029. 378 (7) MANAGED CARE PLAN ACCOUNTABILITY.— 379 (a) In addition to the requirements of ss. 409.967, 380 409.975, and 409.982, plans participating in the pilot program 381 must have provider capacity within a maximum travel distance for 382 clients to services for specialized therapies, adult day 383 training, and prevocational training, for clients, as follows: 384 1. For urban areas, 15 miles travel distance for clients; 385 and 386 2. For rural areas, 30 miles travel distance for clients. 387 (b) Plans participating in the pilot program must consult 388 with the Agency for Persons with Disabilities before placing an 389 enrollee of the pilot program in a group home licensed by the 390 Agency for Persons with Disabilities. 391 (8) REPEAL.—This section shall be repealed October 2, 2029, 392 after submission of the evaluation pursuant to paragraph (6)(d), 393 unless reviewed and saved from repeal through reenactment by the 394 Legislature. 395 Section 2. Section 409.961, Florida Statutes, is amended to 396 read: 397 409.961 Statutory construction; applicability; rules.—It is 398 the intent of the Legislature that if any conflict exists 399 between the provisions contained in this part and in other parts 400 of this chapter, the provisions in this part control. Sections 401 409.961-409.9855409.961-409.985apply only to the Medicaid 402 managed medical assistance program, theandlong-term care 403 managed care program, and the pilot program for individuals with 404 developmental disabilities, as provided in this part. The agency 405 shall adopt any rules necessary to comply with or administer 406 this part and all rules necessary to comply with federal 407 requirements. In addition, the department shall adopt and accept 408 the transfer of any rules necessary to carry out the 409 department’s responsibilities for receiving and processing 410 Medicaid applications and determining Medicaid eligibility and 411 for ensuring compliance with and administering this part, as 412 those rules relate to the department’s responsibilities, and any 413 other provisions related to the department’s responsibility for 414 the determination of Medicaid eligibility. Contracts with the 415 agency and a person or entity, including Medicaid providers and 416 managed care plans, necessary to administer the Medicaid program 417 are not rules and are not subject to chapter 120. 418 Section 3. (1) For a plan to be selected to participate in 419 the pilot program for individuals with developmental 420 disabilities pursuant to s. 409.9855, Florida Statutes, as 421 created by this act, the plan must have been awarded a contract 422 as a result of the invitation to negotiate, ITN-04836, for 423 Statewide Medicaid Managed Care Program which was issued on 424 April 11, 2023. 425 (2) The pilot program for individuals with developmental 426 disabilities pursuant to s. 409.9855, Florida Statutes, as 427 created by this act, shall be implemented in Statewide Medicaid 428 Managed Care Regions D and I. 429 Section 4. This act shall take effect upon becoming a law.