Florida Senate - 2024                        COMMITTEE AMENDMENT
       Bill No. SB 1758
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  01/23/2024           .                                

       The Committee on Children, Families, and Elder Affairs (Brodeur)
       recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 393.064, Florida Statutes, is amended to
    6  read:
    7         393.064 Care navigation Prevention.—
    8         (1) Within available resources, the agency shall offer to
    9  clients and their caregivers care navigation services for
   10  voluntary participation at the time of application and as part
   11  of any eligibility or renewal review. The goals of care
   12  navigation are to create a seamless network of community
   13  resources and supports for the client and the client’s family as
   14  a whole to support a client in daily living, community
   15  integration, and achievement of individual goals. Care
   16  navigation services must involve assessing client needs and
   17  developing and implementing care plans, including, but not
   18  limited to, connecting a client to resources and supports. At a
   19  minimum, a care plan must address immediate, intermediate, and
   20  long-term needs and goals to promote and increase well-being and
   21  opportunities for education, employment, social engagement,
   22  community integration, and caregiver support. For a client who
   23  is a public school student entitled to a free appropriate public
   24  education under the Individuals with Disabilities Education Act,
   25  I.D.E.A., as amended, the care plan must be integrated with the
   26  student’s individual education plan (IEP). The care plan and IEP
   27  must be implemented to maximize the attainment of educational
   28  and habilitation goals give priority to the development,
   29  planning, and implementation of programs which have the
   30  potential to prevent, correct, cure, or reduce the severity of
   31  developmental disabilities. The agency shall direct an
   32  interagency and interprogram effort for the continued
   33  development of a prevention plan and program. The agency shall
   34  identify, through demonstration projects, through program
   35  evaluation, and through monitoring of programs and projects
   36  conducted outside of the agency, any medical, social, economic,
   37  or educational methods, techniques, or procedures that have the
   38  potential to effectively ameliorate, correct, or cure
   39  developmental disabilities. The agency shall determine the costs
   40  and benefits that would be associated with such prevention
   41  efforts and shall implement, or recommend the implementation of,
   42  those methods, techniques, or procedures which are found likely
   43  to be cost-beneficial.
   44         (2) Prevention Services provided by the agency must shall
   45  include services to high-risk children from 3 to 5 years of age,
   46  and their families, to meet the intent of chapter 411. Except
   47  for services for children from birth to age 3 years which are
   48  the responsibility of the Division of Children’s Medical
   49  Services in the Department of Health or part H of the
   50  Individuals with Disabilities Education Act, such services may
   51  include:
   52         (a) Individual evaluations or assessments necessary to
   53  diagnose a developmental disability or high-risk condition and
   54  to determine appropriate, individual family and support
   55  services.
   56         (b) Early intervention services, including developmental
   57  training and specialized therapies.
   58         (c) Support services, such as respite care, parent
   59  education and training, parent-to-parent counseling, homemaker
   60  services, and other services which allow families to maintain
   61  and provide quality care to children in their homes.
   62         (3) Other agencies of state government shall cooperate with
   63  and assist the agency, within available resources, in
   64  implementing programs which have the potential to prevent, or
   65  reduce the severity of, developmental disabilities and shall
   66  consider the findings and recommendations of the agency in
   67  developing and implementing agency programs and formulating
   68  agency budget requests.
   69         (4) There is created at the developmental disabilities
   70  center in Gainesville a research and education unit. Such unit
   71  shall be named the Raymond C. Philips Research and Education
   72  Unit. The functions of such unit shall include:
   73         (a) Research into the etiology of developmental
   74  disabilities.
   75         (b) Ensuring that new knowledge is rapidly disseminated
   76  throughout the agency.
   77         (c) Diagnosis of unusual conditions and syndromes
   78  associated with developmental disabilities in clients identified
   79  throughout developmental disabilities programs.
   80         (d) Evaluation of families of clients with developmental
   81  disabilities of genetic origin in order to provide them with
   82  genetic counseling aimed at preventing the recurrence of the
   83  disorder in other family members.
   84         (e) Ensuring that health professionals in the developmental
   85  disabilities center at Gainesville have access to information
   86  systems that will allow them to remain updated on newer
   87  knowledge and maintain their postgraduate education standards.
   88         (f) Enhancing staff training for professionals throughout
   89  the agency in the areas of genetics and developmental
   90  disabilities.
   91         Section 2. Subsection (1) and paragraph (d) of subsection
   92  (5) of section 393.065, Florida Statutes, are amended to read:
   93         393.065 Application and eligibility determination.—
   94         (1)(a) The agency shall develop and implement an online
   95  application process that, at a minimum, supports paperless,
   96  electronic application submissions with immediate e-mail
   97  confirmation to each applicant to acknowledge receipt of
   98  application upon submission. The online application system must
   99  allow an applicant to review the status of a submitted
  100  application and respond to provide additional information.
  101         (b) The agency shall maintain access to a printable paper
  102  application on its website and, upon request, must provide an
  103  applicant with a printed paper application. Paper applications
  104  may Application for services shall be submitted made in writing
  105  to the agency, in the region in which the applicant resides.
  106         (c) The agency must shall review each submitted application
  107  in accordance with federal time standards and make an
  108  eligibility determination within 60 days after receipt of the
  109  signed application. If, at the time of the application, an
  110  applicant is requesting enrollment in the home and community
  111  based services Medicaid waiver program for individuals with
  112  developmental disabilities deemed to be in crisis, as described
  113  in paragraph (5)(a), the agency shall complete an eligibility
  114  determination within 45 days after receipt of the signed
  115  application.
  116         1.(a) If the agency determines additional documentation is
  117  necessary to make an eligibility determination, the agency may
  118  request the additional documentation from the applicant.
  119         2.(b) When necessary to definitively identify individual
  120  conditions or needs, the agency or its designee must provide a
  121  comprehensive assessment.
  122         (c) If the agency requests additional documentation from
  123  the applicant or provides or arranges for a comprehensive
  124  assessment, the agency’s eligibility determination must be
  125  completed within 90 days after receipt of the signed
  126  application.
  127         (d)1.For purposes of this paragraph, the term “complete
  128  application” means an application submitted to the agency which
  129  is signed and dated by the applicant or an individual with legal
  130  authority to apply for public benefits on behalf of the
  131  applicant, is responsive on all parts of the application, and
  132  contains documentation of a diagnosis.
  133         2.If the applicant requesting enrollment in the home and
  134  community-based services Medicaid waiver program for individuals
  135  with developmental disabilities is deemed to be in crisis as
  136  described in paragraph (5)(a), the agency must make an
  137  eligibility determination within 15 calendar days after receipt
  138  of a complete application.
  139         3.If the applicant meets the criteria specified in
  140  paragraph (5)(b), the agency must review and make an eligibility
  141  determination as soon as practicable after receipt of a complete
  142  application.
  143         4. If the application meets any of the criteria specified
  144  in paragraphs (5)(c)-(g), the agency shall make an eligibility
  145  determination within 60 days after receipt of a complete
  146  application.
  147         (e)Any delays in the eligibility determination process, or
  148  any tolling of the time standard until certain information or
  149  actions have been completed, must be conveyed to the client as
  150  soon as such delays are known through verbal contact with the
  151  client or the client’s designated caregiver and confirmed by a
  152  written notice of the delay, the anticipated length of delay,
  153  and a contact person for the client.
  154         (5) Except as provided in subsections (6) and (7), if a
  155  client seeking enrollment in the developmental disabilities home
  156  and community-based services Medicaid waiver program meets the
  157  level of care requirement for an intermediate care facility for
  158  individuals with intellectual disabilities pursuant to 42 C.F.R.
  159  ss. 435.217(b)(1) and 440.150, the agency must assign the client
  160  to an appropriate preenrollment category pursuant to this
  161  subsection and must provide priority to clients waiting for
  162  waiver services in the following order:
  163         (d) Category 4, which includes, but is not required to be
  164  limited to, clients whose caregivers are 60 70 years of age or
  165  older and for whom a caregiver is required but no alternate
  166  caregiver is available.
  168  Within preenrollment categories 3, 4, 5, 6, and 7, the agency
  169  shall prioritize clients in the order of the date that the
  170  client is determined eligible for waiver services.
  171         Section 3. Section 393.0651, Florida Statutes, is amended
  172  to read:
  173         393.0651 Family or individual support plan.—The agency
  174  shall provide directly or contract for the development of a
  175  family support plan for children ages 3 to 18 years of age and
  176  an individual support plan for each client served by the home
  177  and community-based services Medicaid waiver program under s.
  178  393.0662. The client, if competent, the client’s parent or
  179  guardian, or, when appropriate, the client advocate, shall be
  180  consulted in the development of the plan and shall receive a
  181  copy of the plan. Each plan must include the most appropriate,
  182  least restrictive, and most cost-beneficial environment for
  183  accomplishment of the objectives for client progress and a
  184  specification of all services authorized. The plan must include
  185  provisions for the most appropriate level of care for the
  186  client. Within the specification of needs and services for each
  187  client, when residential care is necessary, the agency shall
  188  move toward placement of clients in residential facilities based
  189  within the client’s community. The ultimate goal of each plan,
  190  whenever possible, shall be to enable the client to live a
  191  dignified life in the least restrictive setting, be that in the
  192  home or in the community. The family or individual support plan
  193  must be developed within 60 calendar days after the agency
  194  determines the client eligible pursuant to s. 393.065(3).
  195         (1) The agency shall develop and specify by rule the core
  196  components of support plans.
  197         (2) The family or individual support plan shall be
  198  integrated with the individual education plan (IEP) for all
  199  clients who are public school students entitled to a free
  200  appropriate public education under the Individuals with
  201  Disabilities Education Act, I.D.E.A., as amended. The family or
  202  individual support plan and IEP must be implemented to maximize
  203  the attainment of educational and habilitation goals.
  204         (a) If the IEP for a student enrolled in a public school
  205  program indicates placement in a public or private residential
  206  program is necessary to provide special education and related
  207  services to a client, the local education agency must provide
  208  for the costs of that service in accordance with the
  209  requirements of the Individuals with Disabilities Education Act,
  210  I.D.E.A., as amended. This does not preclude local education
  211  agencies and the agency from sharing the residential service
  212  costs of students who are clients and require residential
  213  placement.
  214         (b) For clients who are entering or exiting the school
  215  system, an interdepartmental staffing team composed of
  216  representatives of the agency and the local school system shall
  217  develop a written transitional living and training plan with the
  218  participation of the client or with the parent or guardian of
  219  the client, or the client advocate, as appropriate.
  220         (3) Each family or individual support plan shall be
  221  facilitated through case management designed solely to advance
  222  the individual needs of the client.
  223         (4) In the development of the family or individual support
  224  plan, a client advocate may be appointed by the support planning
  225  team for a client who is a minor or for a client who is not
  226  capable of express and informed consent when:
  227         (a) The parent or guardian cannot be identified;
  228         (b) The whereabouts of the parent or guardian cannot be
  229  discovered; or
  230         (c) The state is the only legal representative of the
  231  client.
  233  Such appointment may not be construed to extend the powers of
  234  the client advocate to include any of those powers delegated by
  235  law to a legal guardian.
  236         (5) The agency shall place a client in the most appropriate
  237  and least restrictive, and cost-beneficial, residential facility
  238  according to his or her individual support plan. The client, if
  239  competent, the client’s parent or guardian, or, when
  240  appropriate, the client advocate, and the administrator of the
  241  facility to which placement is proposed shall be consulted in
  242  determining the appropriate placement for the client.
  243  Considerations for placement shall be made in the following
  244  order:
  245         (a) Client’s own home or the home of a family member or
  246  direct service provider.
  247         (b) Foster care facility.
  248         (c) Group home facility.
  249         (d) Intermediate care facility for the developmentally
  250  disabled.
  251         (e) Other facilities licensed by the agency which offer
  252  special programs for people with developmental disabilities.
  253         (f) Developmental disabilities center.
  254         (6) In developing a client’s annual family or individual
  255  support plan, the individual or family with the assistance of
  256  the support planning team shall identify measurable objectives
  257  for client progress and shall specify a time period expected for
  258  achievement of each objective.
  259         (7) The individual, family, and support coordinator shall
  260  review progress in achieving the objectives specified in each
  261  client’s family or individual support plan, and shall revise the
  262  plan annually, following consultation with the client, if
  263  competent, or with the parent or guardian of the client, or,
  264  when appropriate, the client advocate. The agency or designated
  265  contractor shall annually report in writing to the client, if
  266  competent, or to the parent or guardian of the client, or to the
  267  client advocate, when appropriate, with respect to the client’s
  268  habilitative and medical progress.
  269         (8) Any client, or any parent of a minor client, or
  270  guardian, authorized guardian advocate, or client advocate for a
  271  client, who is substantially affected by the client’s initial
  272  family or individual support plan, or the annual review thereof,
  273  shall have the right to file a notice to challenge the decision
  274  pursuant to ss. 120.569 and 120.57. Notice of such right to
  275  appeal shall be included in all support plans provided by the
  276  agency.
  277         (9)When developing or reviewing a client’s family or
  278  individual support plan, the waiver support coordinator shall
  279  inform the client, the client’s parent or guardian, or, when
  280  appropriate, the client advocate about the consumer-directed
  281  care program established under s. 409.221.
  282         Section 4. For the 2024-2025 fiscal year, the sum of
  283  $16,562,703 in recurring funds from the General Revenue Fund and
  284  $22,289,520 in recurring funds from the Operations and
  285  Maintenance Trust Fund are appropriated in the Home and
  286  Community Based Services Waiver category to the Agency for
  287  Persons with Disabilities to offer waiver services to the
  288  greatest number of individuals permissible under the
  289  appropriation from preenrollment categories 3, 4, and 5,
  290  including individuals whose caregiver is age 60 or older in
  291  category 4, as provided in s. 393.065, Florida Statutes, as
  292  amended by this act.
  293         Section 5. The Agency for Health Care Administration and
  294  the Agency for Persons with Disabilities, in consultation with
  295  other stakeholders, shall jointly develop a comprehensive plan
  296  for the administration, finance, and delivery of home and
  297  community-based services through a new home and community-based
  298  services Medicaid waiver program. The waiver program shall be
  299  for clients transitioning into adulthood and shall be designed
  300  to prevent future crisis enrollment into the waiver program
  301  authorized under s. 393.0662, Florida Statutes. The Agency for
  302  Health Care Administration is authorized to contract with
  303  necessary experts to assist in developing the plan. The Agency
  304  for Health Care Administration must submit a report to the
  305  Governor, the President of the Senate, and the Speaker of the
  306  House of Representatives by December 1, 2024, addressing, at a
  307  minimum, all of the following:
  308         (1)The purpose, rationale, and expected benefits of the
  309  new waiver program.
  310         (2)The proposed eligibility criteria for clients and
  311  service packages to be offered through the new waiver program.
  312         (3)A proposed implementation plan and timeline, including
  313  recommendations for the number of clients to be served by the
  314  new waiver program at initial implementation, changes over time,
  315  and any per-client benefit caps.
  316         (4)Proposals for how clients will transition onto and off
  317  of the new waiver, including, but not limited to, transitions
  318  between this new waiver and the waiver established under s.
  319  393.0662, Florida Statutes.
  320         (5)The fiscal impact for the implementation year and
  321  projections for the subsequent 5 years, determined on an
  322  actuarially sound basis.
  323         (6)An analysis of the availability of services that would
  324  be offered under the new waiver program and recommendations to
  325  increase availability of such services, if necessary.
  326         (7)A list of all stakeholders, public and private, who
  327  were consulted or contacted as part of developing the plan for
  328  the new waiver program.
  329         Section 6. This act shall take effect July 1, 2024.
  331  ================= T I T L E  A M E N D M E N T ================
  332  And the title is amended as follows:
  333         Delete everything before the enacting clause
  334  and insert:
  335                        A bill to be entitled                      
  336         An act relating to individuals with disabilities;
  337         amending s. 393.064, F.S.; revising provisions related
  338         to programs and services provided by the Agency for
  339         Persons with Disabilities; requiring the agency,
  340         within available resources, to offer voluntary
  341         participation care navigation services to clients and
  342         their caregivers at specified times; specifying goals
  343         and requirements for such care navigation services;
  344         specifying requirements for care plans; requiring the
  345         integration of care plans with any individual
  346         education plans of clients; specifying requirements
  347         for such integration; amending s. 393.065, F.S.;
  348         requiring the agency to develop and implement an
  349         online application process; specifying requirements
  350         for the online application process; defining the term
  351         “complete application”; revising timeframes within
  352         which the agency must make eligibility determinations
  353         for services; lowering the age that a caregiver must
  354         be for an individual to be placed in a certain
  355         preenrollment category; amending s. 393.0651, F.S.;
  356         revising which types of clients are eligible for an
  357         individual support plan; clarifying the timeframe
  358         within which a family or individual support plan must
  359         be developed; requiring waiver support coordinators to
  360         inform the client, client’s parent or guardian, or
  361         client’s advocate, as appropriate, of certain
  362         information when developing or reviewing the family or
  363         individual support plan; providing appropriations;
  364         requiring the Agency for Health Care Administration
  365         and the Agency for Persons with Disabilities, in
  366         consultation with other stakeholders, to jointly
  367         develop a comprehensive plan for the administration,
  368         finance, and delivery of home and community-based
  369         services through a new home and community-based
  370         services Medicaid waiver program; providing
  371         requirements for the waiver program; authorizing the
  372         Agency for Health Care Administration to contract with
  373         necessary experts to assist in developing the plan;
  374         requiring the Agency for Health Care Administration to
  375         submit a specified report to the Governor and the
  376         Legislature by a specified date; providing an
  377         effective date.