Florida Senate - 2024                             CS for SB 1758
       By the Committee on Children, Families, and Elder Affairs; and
       Senator Brodeur
       586-02414-24                                          20241758c1
    1                        A bill to be entitled                      
    2         An act relating to individuals with disabilities;
    3         amending s. 393.064, F.S.; revising provisions related
    4         to programs and services provided by the Agency for
    5         Persons with Disabilities; requiring the agency,
    6         within available resources, to offer voluntary
    7         participation care navigation services to clients and
    8         their caregivers at specified times; specifying goals
    9         and requirements for such care navigation services;
   10         specifying requirements for care plans; requiring the
   11         integration of care plans with any individual
   12         education plans of clients; specifying requirements
   13         for such integration; amending s. 393.065, F.S.;
   14         requiring the agency to develop and implement an
   15         online application process; specifying requirements
   16         for the online application process; defining the term
   17         “complete application”; revising timeframes within
   18         which the agency must make eligibility determinations
   19         for services; lowering the age that a caregiver must
   20         be for an individual to be placed in a certain
   21         preenrollment category; amending s. 393.0651, F.S.;
   22         revising which types of clients are eligible for an
   23         individual support plan; clarifying the timeframe
   24         within which a family or individual support plan must
   25         be developed; requiring waiver support coordinators to
   26         inform the client, client’s parent or guardian, or
   27         client’s advocate, as appropriate, of certain
   28         information when developing or reviewing the family or
   29         individual support plan; providing appropriations;
   30         requiring the Agency for Health Care Administration
   31         and the Agency for Persons with Disabilities, in
   32         consultation with other stakeholders, to jointly
   33         develop a comprehensive plan for the administration,
   34         finance, and delivery of home and community-based
   35         services through a new home and community-based
   36         services Medicaid waiver program; providing
   37         requirements for the waiver program; authorizing the
   38         Agency for Health Care Administration to contract with
   39         necessary experts to assist in developing the plan;
   40         requiring the Agency for Health Care Administration to
   41         submit a specified report to the Governor and the
   42         Legislature by a specified date; providing an
   43         effective date.
   45  Be It Enacted by the Legislature of the State of Florida:
   47         Section 1. Section 393.064, Florida Statutes, is amended to
   48  read:
   49         393.064 Care navigation Prevention.—
   50         (1) Within available resources, the agency shall offer to
   51  clients and their caregivers care navigation services for
   52  voluntary participation at the time of application and as part
   53  of any eligibility or renewal review. The goals of care
   54  navigation are to create a seamless network of community
   55  resources and supports for the client and the client’s family as
   56  a whole to support a client in daily living, community
   57  integration, and achievement of individual goals. Care
   58  navigation services must involve assessing client needs and
   59  developing and implementing care plans, including, but not
   60  limited to, connecting a client to resources and supports. At a
   61  minimum, a care plan must address immediate, intermediate, and
   62  long-term needs and goals to promote and increase well-being and
   63  opportunities for education, employment, social engagement,
   64  community integration, and caregiver support. For a client who
   65  is a public school student entitled to a free appropriate public
   66  education under the Individuals with Disabilities Education Act,
   67  I.D.E.A., as amended, the care plan must be integrated with the
   68  student’s individual education plan (IEP). The care plan and IEP
   69  must be implemented to maximize the attainment of educational
   70  and habilitation goals give priority to the development,
   71  planning, and implementation of programs which have the
   72  potential to prevent, correct, cure, or reduce the severity of
   73  developmental disabilities. The agency shall direct an
   74  interagency and interprogram effort for the continued
   75  development of a prevention plan and program. The agency shall
   76  identify, through demonstration projects, through program
   77  evaluation, and through monitoring of programs and projects
   78  conducted outside of the agency, any medical, social, economic,
   79  or educational methods, techniques, or procedures that have the
   80  potential to effectively ameliorate, correct, or cure
   81  developmental disabilities. The agency shall determine the costs
   82  and benefits that would be associated with such prevention
   83  efforts and shall implement, or recommend the implementation of,
   84  those methods, techniques, or procedures which are found likely
   85  to be cost-beneficial.
   86         (2) Prevention Services provided by the agency must shall
   87  include services to high-risk children from 3 to 5 years of age,
   88  and their families, to meet the intent of chapter 411. Except
   89  for services for children from birth to age 3 years which are
   90  the responsibility of the Division of Children’s Medical
   91  Services in the Department of Health or part H of the
   92  Individuals with Disabilities Education Act, such services may
   93  include:
   94         (a) Individual evaluations or assessments necessary to
   95  diagnose a developmental disability or high-risk condition and
   96  to determine appropriate, individual family and support
   97  services.
   98         (b) Early intervention services, including developmental
   99  training and specialized therapies.
  100         (c) Support services, such as respite care, parent
  101  education and training, parent-to-parent counseling, homemaker
  102  services, and other services which allow families to maintain
  103  and provide quality care to children in their homes.
  104         (3) Other agencies of state government shall cooperate with
  105  and assist the agency, within available resources, in
  106  implementing programs which have the potential to prevent, or
  107  reduce the severity of, developmental disabilities and shall
  108  consider the findings and recommendations of the agency in
  109  developing and implementing agency programs and formulating
  110  agency budget requests.
  111         (4) There is created at the developmental disabilities
  112  center in Gainesville a research and education unit. Such unit
  113  shall be named the Raymond C. Philips Research and Education
  114  Unit. The functions of such unit shall include:
  115         (a) Research into the etiology of developmental
  116  disabilities.
  117         (b) Ensuring that new knowledge is rapidly disseminated
  118  throughout the agency.
  119         (c) Diagnosis of unusual conditions and syndromes
  120  associated with developmental disabilities in clients identified
  121  throughout developmental disabilities programs.
  122         (d) Evaluation of families of clients with developmental
  123  disabilities of genetic origin in order to provide them with
  124  genetic counseling aimed at preventing the recurrence of the
  125  disorder in other family members.
  126         (e) Ensuring that health professionals in the developmental
  127  disabilities center at Gainesville have access to information
  128  systems that will allow them to remain updated on newer
  129  knowledge and maintain their postgraduate education standards.
  130         (f) Enhancing staff training for professionals throughout
  131  the agency in the areas of genetics and developmental
  132  disabilities.
  133         Section 2. Subsection (1) and paragraph (d) of subsection
  134  (5) of section 393.065, Florida Statutes, are amended to read:
  135         393.065 Application and eligibility determination.—
  136         (1)(a) The agency shall develop and implement an online
  137  application process that, at a minimum, supports paperless,
  138  electronic application submissions with immediate e-mail
  139  confirmation to each applicant to acknowledge receipt of
  140  application upon submission. The online application system must
  141  allow an applicant to review the status of a submitted
  142  application and respond to provide additional information.
  143         (b) The agency shall maintain access to a printable paper
  144  application on its website and, upon request, must provide an
  145  applicant with a printed paper application. Paper applications
  146  may Application for services shall be submitted made in writing
  147  to the agency, in the region in which the applicant resides.
  148         (c) The agency must shall review each submitted application
  149  in accordance with federal time standards and make an
  150  eligibility determination within 60 days after receipt of the
  151  signed application. If, at the time of the application, an
  152  applicant is requesting enrollment in the home and community
  153  based services Medicaid waiver program for individuals with
  154  developmental disabilities deemed to be in crisis, as described
  155  in paragraph (5)(a), the agency shall complete an eligibility
  156  determination within 45 days after receipt of the signed
  157  application.
  158         1.(a) If the agency determines additional documentation is
  159  necessary to make an eligibility determination, the agency may
  160  request the additional documentation from the applicant.
  161         2.(b) When necessary to definitively identify individual
  162  conditions or needs, the agency or its designee must provide a
  163  comprehensive assessment.
  164         (c) If the agency requests additional documentation from
  165  the applicant or provides or arranges for a comprehensive
  166  assessment, the agency’s eligibility determination must be
  167  completed within 90 days after receipt of the signed
  168  application.
  169         (d)1.For purposes of this paragraph, the term “complete
  170  application” means an application submitted to the agency which
  171  is signed and dated by the applicant or an individual with legal
  172  authority to apply for public benefits on behalf of the
  173  applicant, is responsive on all parts of the application, and
  174  contains documentation of a diagnosis.
  175         2.If the applicant requesting enrollment in the home and
  176  community-based services Medicaid waiver program for individuals
  177  with developmental disabilities is deemed to be in crisis as
  178  described in paragraph (5)(a), the agency must make an
  179  eligibility determination within 15 calendar days after receipt
  180  of a complete application.
  181         3.If the applicant meets the criteria specified in
  182  paragraph (5)(b), the agency must review and make an eligibility
  183  determination as soon as practicable after receipt of a complete
  184  application.
  185         4. If the application meets any of the criteria specified
  186  in paragraphs (5)(c)-(g), the agency shall make an eligibility
  187  determination within 60 days after receipt of a complete
  188  application.
  189         (e)Any delays in the eligibility determination process, or
  190  any tolling of the time standard until certain information or
  191  actions have been completed, must be conveyed to the client as
  192  soon as such delays are known through verbal contact with the
  193  client or the client’s designated caregiver and confirmed by a
  194  written notice of the delay, the anticipated length of delay,
  195  and a contact person for the client.
  196         (5) Except as provided in subsections (6) and (7), if a
  197  client seeking enrollment in the developmental disabilities home
  198  and community-based services Medicaid waiver program meets the
  199  level of care requirement for an intermediate care facility for
  200  individuals with intellectual disabilities pursuant to 42 C.F.R.
  201  ss. 435.217(b)(1) and 440.150, the agency must assign the client
  202  to an appropriate preenrollment category pursuant to this
  203  subsection and must provide priority to clients waiting for
  204  waiver services in the following order:
  205         (d) Category 4, which includes, but is not required to be
  206  limited to, clients whose caregivers are 60 70 years of age or
  207  older and for whom a caregiver is required but no alternate
  208  caregiver is available.
  210  Within preenrollment categories 3, 4, 5, 6, and 7, the agency
  211  shall prioritize clients in the order of the date that the
  212  client is determined eligible for waiver services.
  213         Section 3. Section 393.0651, Florida Statutes, is amended
  214  to read:
  215         393.0651 Family or individual support plan.—The agency
  216  shall provide directly or contract for the development of a
  217  family support plan for children ages 3 to 18 years of age and
  218  an individual support plan for each client served by the home
  219  and community-based services Medicaid waiver program under s.
  220  393.0662. The client, if competent, the client’s parent or
  221  guardian, or, when appropriate, the client advocate, shall be
  222  consulted in the development of the plan and shall receive a
  223  copy of the plan. Each plan must include the most appropriate,
  224  least restrictive, and most cost-beneficial environment for
  225  accomplishment of the objectives for client progress and a
  226  specification of all services authorized. The plan must include
  227  provisions for the most appropriate level of care for the
  228  client. Within the specification of needs and services for each
  229  client, when residential care is necessary, the agency shall
  230  move toward placement of clients in residential facilities based
  231  within the client’s community. The ultimate goal of each plan,
  232  whenever possible, shall be to enable the client to live a
  233  dignified life in the least restrictive setting, be that in the
  234  home or in the community. The family or individual support plan
  235  must be developed within 60 calendar days after the agency
  236  determines the client eligible pursuant to s. 393.065(3).
  237         (1) The agency shall develop and specify by rule the core
  238  components of support plans.
  239         (2) The family or individual support plan shall be
  240  integrated with the individual education plan (IEP) for all
  241  clients who are public school students entitled to a free
  242  appropriate public education under the Individuals with
  243  Disabilities Education Act, I.D.E.A., as amended. The family or
  244  individual support plan and IEP must be implemented to maximize
  245  the attainment of educational and habilitation goals.
  246         (a) If the IEP for a student enrolled in a public school
  247  program indicates placement in a public or private residential
  248  program is necessary to provide special education and related
  249  services to a client, the local education agency must provide
  250  for the costs of that service in accordance with the
  251  requirements of the Individuals with Disabilities Education Act,
  252  I.D.E.A., as amended. This does not preclude local education
  253  agencies and the agency from sharing the residential service
  254  costs of students who are clients and require residential
  255  placement.
  256         (b) For clients who are entering or exiting the school
  257  system, an interdepartmental staffing team composed of
  258  representatives of the agency and the local school system shall
  259  develop a written transitional living and training plan with the
  260  participation of the client or with the parent or guardian of
  261  the client, or the client advocate, as appropriate.
  262         (3) Each family or individual support plan shall be
  263  facilitated through case management designed solely to advance
  264  the individual needs of the client.
  265         (4) In the development of the family or individual support
  266  plan, a client advocate may be appointed by the support planning
  267  team for a client who is a minor or for a client who is not
  268  capable of express and informed consent when:
  269         (a) The parent or guardian cannot be identified;
  270         (b) The whereabouts of the parent or guardian cannot be
  271  discovered; or
  272         (c) The state is the only legal representative of the
  273  client.
  275  Such appointment may not be construed to extend the powers of
  276  the client advocate to include any of those powers delegated by
  277  law to a legal guardian.
  278         (5) The agency shall place a client in the most appropriate
  279  and least restrictive, and cost-beneficial, residential facility
  280  according to his or her individual support plan. The client, if
  281  competent, the client’s parent or guardian, or, when
  282  appropriate, the client advocate, and the administrator of the
  283  facility to which placement is proposed shall be consulted in
  284  determining the appropriate placement for the client.
  285  Considerations for placement shall be made in the following
  286  order:
  287         (a) Client’s own home or the home of a family member or
  288  direct service provider.
  289         (b) Foster care facility.
  290         (c) Group home facility.
  291         (d) Intermediate care facility for the developmentally
  292  disabled.
  293         (e) Other facilities licensed by the agency which offer
  294  special programs for people with developmental disabilities.
  295         (f) Developmental disabilities center.
  296         (6) In developing a client’s annual family or individual
  297  support plan, the individual or family with the assistance of
  298  the support planning team shall identify measurable objectives
  299  for client progress and shall specify a time period expected for
  300  achievement of each objective.
  301         (7) The individual, family, and support coordinator shall
  302  review progress in achieving the objectives specified in each
  303  client’s family or individual support plan, and shall revise the
  304  plan annually, following consultation with the client, if
  305  competent, or with the parent or guardian of the client, or,
  306  when appropriate, the client advocate. The agency or designated
  307  contractor shall annually report in writing to the client, if
  308  competent, or to the parent or guardian of the client, or to the
  309  client advocate, when appropriate, with respect to the client’s
  310  habilitative and medical progress.
  311         (8) Any client, or any parent of a minor client, or
  312  guardian, authorized guardian advocate, or client advocate for a
  313  client, who is substantially affected by the client’s initial
  314  family or individual support plan, or the annual review thereof,
  315  shall have the right to file a notice to challenge the decision
  316  pursuant to ss. 120.569 and 120.57. Notice of such right to
  317  appeal shall be included in all support plans provided by the
  318  agency.
  319         (9)When developing or reviewing a client’s family or
  320  individual support plan, the waiver support coordinator shall
  321  inform the client, the client’s parent or guardian, or, when
  322  appropriate, the client advocate about the consumer-directed
  323  care program established under s. 409.221.
  324         Section 4. For the 2024-2025 fiscal year, the sums of
  325  $16,562,703 in recurring funds from the General Revenue Fund and
  326  $22,289,520 in recurring funds from the Operations and
  327  Maintenance Trust Fund are appropriated in the Home and
  328  Community Based Services Waiver category to the Agency for
  329  Persons with Disabilities to offer waiver services to the
  330  greatest number of individuals permissible under the
  331  appropriation from preenrollment categories 3, 4, and 5,
  332  including individuals whose caregiver is age 60 or older in
  333  category 4, as provided in s. 393.065, Florida Statutes, as
  334  amended by this act.
  335         Section 5. The Agency for Health Care Administration and
  336  the Agency for Persons with Disabilities, in consultation with
  337  other stakeholders, shall jointly develop a comprehensive plan
  338  for the administration, finance, and delivery of home and
  339  community-based services through a new home and community-based
  340  services Medicaid waiver program. The waiver program shall be
  341  for clients transitioning into adulthood and shall be designed
  342  to prevent future crisis enrollment into the waiver program
  343  authorized under s. 393.0662, Florida Statutes. The Agency for
  344  Health Care Administration is authorized to contract with
  345  necessary experts to assist in developing the plan. The Agency
  346  for Health Care Administration must submit a report to the
  347  Governor, the President of the Senate, and the Speaker of the
  348  House of Representatives by December 1, 2024, addressing, at a
  349  minimum, all of the following:
  350         (1)The purpose, rationale, and expected benefits of the
  351  new waiver program.
  352         (2)The proposed eligibility criteria for clients and
  353  service packages to be offered through the new waiver program.
  354         (3)A proposed implementation plan and timeline, including
  355  recommendations for the number of clients to be served by the
  356  new waiver program at initial implementation, changes over time,
  357  and any per-client benefit caps.
  358         (4)Proposals for how clients will transition onto and off
  359  of the new waiver, including, but not limited to, transitions
  360  between this new waiver and the waiver established under s.
  361  393.0662, Florida Statutes.
  362         (5)The fiscal impact for the implementation year and
  363  projections for the subsequent 5 years, determined on an
  364  actuarially sound basis.
  365         (6)An analysis of the availability of services that would
  366  be offered under the new waiver program and recommendations to
  367  increase availability of such services, if necessary.
  368         (7)A list of all stakeholders, public and private, who
  369  were consulted or contacted as part of developing the plan for
  370  the new waiver program.
  371         Section 6. This act shall take effect July 1, 2024.