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         409.9855Pilot 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  409.961-409.9855 409.961-409.985 apply only to the Medicaid
  402  managed medical assistance program, the and long-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.