Florida Senate - 2025 COMMITTEE AMENDMENT
Bill No. SB 1050
Ì643234ÆÎ643234
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/03/2025 .
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The Committee on Children, Families, and Elder Affairs (Bradley)
recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Subsection (14) of section 393.0662, Florida
6 Statutes, is amended to read:
7 393.0662 Individual budgets for delivery of home and
8 community-based services; iBudget system established.—The
9 Legislature finds that improved financial management of the
10 existing home and community-based Medicaid waiver program is
11 necessary to avoid deficits that impede the provision of
12 services to individuals who are on the waiting list for
13 enrollment in the program. The Legislature further finds that
14 clients and their families should have greater flexibility to
15 choose the services that best allow them to live in their
16 community within the limits of an established budget. Therefore,
17 the Legislature intends that the agency, in consultation with
18 the Agency for Health Care Administration, shall manage the
19 service delivery system using individual budgets as the basis
20 for allocating the funds appropriated for the home and
21 community-based services Medicaid waiver program among eligible
22 enrolled clients. The service delivery system that uses
23 individual budgets shall be called the iBudget system.
24 (14)(a) The agency, in consultation with the Agency for
25 Health Care Administration, shall provide a quarterly
26 reconciliation report of all home and community-based services
27 waiver expenditures from the Agency for Health Care
28 Administration’s claims management system with service
29 utilization from the Agency for Persons with Disabilities
30 Allocation, Budget, and Contract Control system. The
31 reconciliation report must be submitted to the Governor, the
32 President of the Senate, and the Speaker of the House of
33 Representatives no later than 30 days after the close of each
34 quarter.
35 (b) The agency shall post its quarterly reconciliation
36 reports on its website, in a conspicuous location, no later than
37 5 days after submitting the reports as required in this
38 subsection.
39 Section 2. Subsection (12) of section 393.065, Florida
40 Statutes, is renumbered as subsection (13), paragraph (a) of
41 subsection (1), paragraph (b) of subsection (5), and subsection
42 (10) are amended, and a new subsection (12) is added to that
43 section, to read:
44 393.065 Application and eligibility determination.—
45 (1)(a) The agency shall develop and implement an online
46 application process that, at a minimum, supports paperless,
47 electronic application submissions with immediate e-mail
48 confirmation to each applicant to acknowledge receipt of
49 application upon submission. The online application system must
50 allow an applicant to review the status of a submitted
51 application and respond to provide additional information. The
52 online application must allow an applicant to apply for crisis
53 enrollment.
54 (5) Except as provided in subsections (6) and (7), if a
55 client seeking enrollment in the developmental disabilities home
56 and community-based services Medicaid waiver program meets the
57 level of care requirement for an intermediate care facility for
58 individuals with intellectual disabilities pursuant to 42 C.F.R.
59 ss. 435.217(b)(1) and 440.150, the agency must assign the client
60 to an appropriate preenrollment category pursuant to this
61 subsection and must provide priority to clients waiting for
62 waiver services in the following order:
63 (b) Category 2, which includes clients in the preenrollment
64 categories who are:
65 1. From the child welfare system with an open case in the
66 Department of Children and Families’ statewide automated child
67 welfare information system and who are either:
68 a. Transitioning out of the child welfare system into
69 permanency; or
70 b. At least 18 years but not yet 22 years of age and who
71 need both waiver services and extended foster care services; or
72 2. At least 18 years but not yet 22 years of age and who
73 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the
74 extended foster care system.
75
76 For individuals who are at least 18 years but not yet 22 years
77 of age and who are eligible under sub-subparagraph 1.b., the
78 agency must provide waiver services, including residential
79 habilitation, and must actively participate in transition
80 planning activities, including, but not limited to,
81 individualized service coordination, case management support,
82 and ensuring continuity of care pursuant to s. 39.6035. The
83 community-based care lead agency must fund room and board at the
84 rate established in s. 409.145(3) and provide case management
85 and related services as defined in s. 409.986(3)(e). Individuals
86 may receive both waiver services and services under s. 39.6251.
87 Services may not duplicate services available through the
88 Medicaid state plan.
89
90 Within preenrollment categories 3, 4, 5, 6, and 7, the agency
91 shall prioritize clients in the order of the date that the
92 client is determined eligible for waiver services.
93 (10) The client, the client’s guardian, or the client’s
94 family must ensure that accurate, up-to-date contact information
95 is provided to the agency at all times. Notwithstanding s.
96 393.0651, the agency must send an annual letter requesting
97 updated information from the client, the client’s guardian, or
98 the client’s family. The agency must remove from the
99 preenrollment categories any individual who cannot be located
100 using the contact information provided to the agency, fails to
101 meet eligibility requirements, or becomes domiciled outside the
102 state.
103 (12) To ensure transparency and timely access to
104 information, the agency shall post on its website in a
105 conspicuous location the total number of individuals in each
106 priority category. The posted numbers shall reflect the current
107 status of the preenrollment priority list and shall be updated
108 at least every 5 days.
109 Section 3. Section 393.0664, Florida Statutes, is created
110 to read:
111 393.0664 Adult Pathways Home and Community-based Services
112 Medicaid waiver program.—
113 (1) PROGRAM IMPLEMENTATION.—
114 (a) The agency shall implement the Adult Pathways Home and
115 Community-based Services Medicaid waiver program using a fee
116 for-service model with an annual per-person funding cap to
117 address the needs of clients with developmental disabilities as
118 they transition into adulthood and achieve greater independence
119 throughout their lifetimes.
120 (b) The program is created to establish an additional
121 pathway to provide necessary supports and services to clients
122 and contain costs by maximizing the use of natural supports and
123 community partnerships before turning to state resources to meet
124 the needs of clients at the earliest possible time to prevent
125 care crises and to positively influence outcomes relating to
126 client health, safety, and well-being.
127 (c) The agency, in partnership with the Agency for Health
128 Care Administration, may seek federal approval through a state
129 plan amendment or Medicaid waiver as necessary to implement the
130 program. The Agency for Health Care Administration shall submit
131 a request for any federal approval needed to implement the
132 program by October 1, 2025.
133 (2) VOLUNTARY ENROLLMENT; ELIGIBILITY; DISENROLLMENT.—
134 (a) Participation in the program is voluntary and limited
135 to the maximum number of enrollees authorized in the General
136 Appropriations Act.
137 (b) The agency shall approve a needs assessment methodology
138 to determine functional, behavioral, and physical needs of
139 prospective enrollees. The assessment methodology may be
140 administered only by persons who have completed any training
141 required by the agency for such purpose. If required, the agency
142 must offer any such training.
143 (c) To participate in the program, a client must meet all
144 of the following criteria:
145 1. Be eligible for Medicaid.
146 2. Be eligible for a preenrollment category for Medicaid
147 waiver services as provided in s. 393.065(5).
148 3. Be 18 to 28 years of age at the time of enrollment and
149 have attained a high school diploma or the equivalent.
150 4. Meet the level of care required for home and community
151 based services as identified in the federal approval for the
152 program.
153 (d) Enrollees may remain on the Adult Pathways waiver until
154 the age of 32.
155 (e) Participation in the program does not affect the status
156 of current clients of the home and community-based services
157 Medicaid waiver program under s. 393.0662 unless a client, or
158 his or her legal representative, voluntarily disenrolls from
159 that program.
160 (f) Enrollees who voluntarily disenroll from the program
161 must be allowed to return to the most appropriate preenrollment
162 category for services under s. 393.065 based on a current needs
163 assessment and the preenrollment category criteria.
164 (3) ADULT PATHWAYS WAIVER SERVICES.—
165 (a) The agency shall authorize covered services as
166 specified in the Medicaid waiver which are medically necessary,
167 including, but not limited to, any of the following:
168 1. Adult day training.
169 2. Companion services.
170 3. Employment services.
171 4. Personal supports.
172 5. Prevocational services.
173 6. Supported living coaching.
174 7. Transportation.
175 8. Care Coordination.
176 (b) Services must be provided to enrollees in accordance
177 with an individualized care plan, which must be evaluated and
178 updated at least annually and as often as warranted by changes
179 in the enrollee’s circumstances.
180 (4) PROGRAM ADMINISTRATION AND EVALUATION.—
181 (a) The agency shall begin enrollment upon federal approval
182 of the Medicaid waiver, with coverage for enrollees becoming
183 effective upon authorization and availability of sufficient
184 state and federal funding and resources.
185 (b) This section and any rules adopted pursuant thereto may
186 not be construed to prevent or limit the agency, in consultation
187 with the Agency for Health Care Administration, from adjusting
188 fees, reimbursement rates, lengths of stay, number of visits, or
189 number of services; limiting enrollment; or making any other
190 adjustment necessary based upon funding and any limitations
191 imposed or directions provided in the General Appropriations
192 Act.
193 (c) The agency, in consultation with the Agency for Health
194 Care Administration, shall submit progress reports to the
195 Governor, the President of the Senate, and the Speaker of the
196 House of Representatives upon federal approval of the Medicaid
197 waiver and throughout implementation of the program under the
198 waiver. By July 1, 2026, the Agency for Persons with
199 Disabilities shall submit a progress report on the
200 administration of the program, including, but not limited to,
201 all of the following:
202 1. The number of enrollees in the program and other
203 pertinent information on enrollment.
204 2. Service use.
205 3. Average cost per enrollee.
206 4. Outcomes and performance reporting relating to health,
207 safety, and well-being of enrollees.
208 Section 4. Section 393.502, Florida Statutes, is amended to
209 read:
210 393.502 Family care councils.—
211 (1) CREATION AND PURPOSE OF STATEWIDE FAMILY CARE COUNCIL.
212 There shall be established and located within each service area
213 of the agency a family care council.
214 (a) The Statewide Family Care Council is established to
215 connect local family care councils and facilitate direct
216 communication between local councils and the agency, with the
217 goal of enhancing the quality of and access to resources and
218 supports for individuals with developmental disabilities and
219 their families.
220 (b) The statewide council shall:
221 1. Review annual reports, policy proposals, and program
222 recommendations submitted by the local family care councils.
223 2. Advise the agency on statewide policies, programs, and
224 service delivery improvements based on the collective
225 recommendations of the local councils.
226 3. Identify systemic barriers to the effective delivery of
227 services and recommend solutions to address such barriers.
228 4. Foster collaboration and the sharing of best practices
229 and available resources among local family care councils to
230 improve service delivery across regions.
231 5. Submit an annual report no later than December 1 of each
232 year to the Governor, the President of the Senate, the Speaker
233 of the House of Representatives, and the agency. The report
234 shall include a summary of local council findings, policy
235 recommendations, and an assessment of the agency’s actions in
236 response to previous recommendations of the local councils.
237 (c) The agency shall provide a written response within 60
238 days after receipt, including a detailed action plan outlining
239 steps taken or planned to address recommendations. The response
240 must specify whether recommendations will be implemented and
241 provide a timeline for implementation or include justification
242 if recommendations are not adopted.
243 (2) STATEWIDE FAMILY CARE COUNCIL MEMBERSHIP.—
244 (a) The statewide council shall consist of the following
245 members appointed by the Governor:
246 1. One representative from each of the local family care
247 councils, who must be a resident of the area served by that
248 local council. Among these representatives must be at least one
249 individual who is receiving waiver services from the agency
250 under s. 393.065 and at least one individual who is assigned to
251 a preenrollment category for waiver services under s. 393.065.
252 2. One individual representing an advocacy organization
253 representing individuals with disabilities.
254 3. One representative of a public or private entity that
255 provides services to individuals with developmental disabilities
256 that does not have a Medicaid wavier service contract with the
257 agency.
258 (b) Employees of the agency or the Agency for Health Care
259 Administration are not eligible to serve on the statewide
260 council.
261 (3) STATEWIDE FAMILY CARE COUNCIL TERMS; VACANCIES.—
262 (a) Statewide council members shall be initially appointed
263 to staggered 2 and 4 year terms, with subsequent terms of 4
264 years. Members may be reappointed to one additional consecutive
265 term.
266 (b) A member who has served two consecutive terms shall not
267 be eligible to serve again until at least 12 months have elapsed
268 since ending service on the statewide council.
269 (c) Upon expiration of a term or in the case of any other
270 vacancy, the statewide council shall, by majority vote,
271 recommend to the Governor for appointment at least one person
272 for each vacancy.
273 1. The Governor shall make an appointment within 45 days
274 after receiving a recommendation from the statewide council. If
275 the Governor fails to make an appointment for a member under
276 subsection (2), the chair of the local council may appoint a
277 member meeting the requirements of subsection (2) to act as the
278 statewide council representative for that local council until
279 the Governor makes an appointment.
280 2. If no member of a local council is willing and able to
281 serve on the statewide council, the Governor shall appoint an
282 individual from another local council to serve on the statewide
283 council.
284 (4) STATEWIDE FAMILY CARE COUNCIL MEETINGS; ORGANIZATION.
285 The statewide council shall meet at least quarterly. The council
286 meetings may be held in person or via teleconference or other
287 electronic means.
288 (a) The Governor shall appoint the initial chair from among
289 the members of the statewide council. Subsequent chairs shall be
290 elected annually by a majority vote of the council.
291 (b) Members of the statewide council shall serve without
292 compensation but may be reimbursed for per diem and travel
293 expenses pursuant to s. 112.061.
294 (c) A majority of the members of the statewide council
295 shall constitute a quorum.
296 (5) LOCAL FAMILY CARE COUNCILS.—There is established and
297 located within each service area of the agency a local family
298 care council to work constructively with the agency, advise the
299 agency on local needs, identify gaps in services, and advocate
300 for individuals with developmental disabilities and their
301 families.
302 (6) LOCAL FAMILY CARE COUNCIL DUTIES.—The local family care
303 councils shall:
304 (a) Assist in providing information and conducting outreach
305 to individuals with developmental disabilities and their
306 families.
307 (b) Convene family listening sessions at least twice a year
308 to gather input on local service delivery challenges.
309 (c) Hold a public forum every 6 months to solicit public
310 feedback concerning actions taken by the local family councils.
311 (d) Share information with other local family care
312 councils.
313 (e) Identify policy issues relevant to the community and
314 family support system in the region.
315 (f) Submit to the Statewide Family Care Council, no later
316 than September 1 of each year, an annual report detailing
317 proposed policy changes, program recommendations, and identified
318 service delivery challenges within its region.
319 (7)(2) LOCAL FAMILY CARE COUNCIL MEMBERSHIP.—
320 (a) Each local family care council shall consist of at
321 least 10 and no more than 15 members recommended by a majority
322 vote of the local family care council and appointed by the
323 Governor.
324 (b) At least three of the members of the council shall be
325 individuals receiving or waiting to receive services from the
326 agency. One such member shall be an individual who has been
327 receiving services within the 4 years before the date of
328 recommendation. The remainder of the council members shall be
329 parents, grandparents, guardians, or siblings of individuals who
330 have developmental disabilities and qualify for services
331 pursuant to this chapter. For a grandparent to be a council
332 member, the grandchild’s parent or legal guardian must consent
333 to the appointment and report the consent to the agency.
334 (c) A person who is currently serving on another board or
335 council of the agency may not be appointed to a local family
336 care council.
337 (d) Employees of the agency or the Agency for Health Care
338 Administration are not eligible to serve on a local family care
339 council.
340 (e) Persons related by consanguinity or affinity within the
341 third degree shall not serve on the same local family care
342 council at the same time.
343 (f) A chair for the council shall be chosen by the council
344 members to serve for 1 year. A person may not serve no more than
345 four 1-year terms as chair.
346 (8)(3) LOCAL FAMILY CARE COUNCIL TERMS; VACANCIES.—
347 (a) Local family council members shall be appointed for a
348 3-year terms term, except as provided in subsection (11) (8),
349 and may be reappointed to one additional term.
350 (b) A member who has served two consecutive terms shall not
351 be eligible to serve again until 12 months have elapsed since
352 ending his or her service on the local council.
353 (c)1. Upon expiration of a term or in the case of any other
354 vacancy, the local council shall, by majority vote, recommend to
355 the Governor for appointment a person for each vacancy based on
356 recommendations received from the family-led nominating
357 committee described in paragraph (9)(a).
358 2. The Governor shall make an appointment within 45 days
359 after receiving a recommendation. If the Governor fails to make
360 an appointment within 45 days the local council shall, by
361 majority vote, may select an interim appointment for each
362 vacancy from the panel of candidates recommended by the family
363 led nominating committee.
364 (9)(4) LOCAL FAMILY CARE COUNCIL COMMITTEE APPOINTMENTS.—
365 (a) The chair of each local family care council shall
366 create, and appoint individuals receiving or waiting to receive
367 services from the agency and their relatives, to serve on a
368 family-led nominating committee. Members of the family-led
369 nominating council need not be members of the local council. The
370 family-led nominating committee shall nominate candidates for
371 vacant positions on the local family council.
372 (b) The chair of the local family care council may appoint
373 persons to serve on additional council committees. Such persons
374 may include current members of the council and former members of
375 the council and persons not eligible to serve on the council.
376 (5) TRAINING.—
377 (a) The agency, in consultation with the local councils,
378 shall establish a training program for local family care council
379 members. Each local area shall provide the training program when
380 new persons are appointed to the local council and at other
381 times as the secretary deems necessary.
382 (b) The training shall assist the council members to
383 understand the laws, rules, and policies applicable to their
384 duties and responsibilities.
385 (c) All persons appointed to a local council must complete
386 this training within 90 days after their appointment. A person
387 who fails to meet this requirement shall be considered to have
388 resigned from the council.
389 (10)(6) LOCAL FAMILY CARE COUNCIL MEETINGS.—Local council
390 members shall serve on a voluntary basis without payment for
391 their services but shall be reimbursed for per diem and travel
392 expenses as provided for in s. 112.061. Local councils The
393 council shall meet at least six times per year. Meetings may be
394 held in person or by teleconference or other electronic means.
395 (7) PURPOSE.—The purpose of the local family care councils
396 shall be to advise the agency, to develop a plan for the
397 delivery of family support services within the local area, and
398 to monitor the implementation and effectiveness of services and
399 support provided under the plan. The primary functions of the
400 local family care councils shall be to:
401 (a) Assist in providing information and outreach to
402 families.
403 (b) Review the effectiveness of service programs and make
404 recommendations with respect to program implementation.
405 (c) Advise the agency with respect to policy issues
406 relevant to the community and family support system in the local
407 area.
408 (d) Meet and share information with other local family care
409 councils.
410 (11)(8) NEW LOCAL FAMILY CARE COUNCILS.—When a local family
411 care council is established for the first time in a local area,
412 the Governor shall appoint the first four council members, who
413 shall serve 3-year terms. These members shall submit to the
414 Governor, within 90 days after their appointment,
415 recommendations for at least six additional members, selected by
416 majority vote.
417 (12)(9) FUNDING; FINANCIAL REVIEW.—The statewide and local
418 family care councils council may apply for, receive, and accept
419 grants, gifts, donations, bequests, and other payments from any
420 public or private entity or person. Each local council is
421 subject to an annual financial review by staff assigned by the
422 agency. Each local council shall exercise care and prudence in
423 the expenditure of funds. The local family care councils shall
424 comply with state expenditure requirements.
425 (13) TRAINING.—
426 (a) The agency, in consultation with the statewide and
427 local councils, shall establish and provide a training program
428 for council members.
429 (b) The training shall assist the council members to
430 understand the laws, rules, and policies applicable to their
431 duties and responsibilities.
432 (c) All persons newly appointed to the statewide or a local
433 council must complete this training within 90 days after their
434 appointment. A person who fails to meet this requirement is
435 considered to have resigned from the council. The agency may
436 make additional training available to council members.
437 (14) DUTIES.—The agency shall publish on its website all
438 annual reports submitted by the local care councils and the
439 Statewide Family Care Council within 15 days after receipt of
440 such reports in a designated and easily accessible section of
441 the website.
442 (15) ADMINISTRATIVE SUPPORT.—The agency shall provide
443 administrative support to the statewide council and local
444 councils, including, but not limited to, staff assistance and
445 meeting facilities, within existing resources.
446 Section 5. Subsections (1), (2), (3), and (6) of section
447 409.9855, Florida Statutes, are amended to read:
448 409.9855 Pilot program for individuals with developmental
449 disabilities.—
450 (1) PILOT PROGRAM IMPLEMENTATION.—
451 (a) Using a managed care model, The agency shall implement
452 a pilot program for individuals with developmental disabilities
453 in Statewide Medicaid Managed Care Regions D and I to provide
454 coverage of comprehensive services using a managed care model.
455 The agency may seek federal approval through a state plan
456 amendment or Medicaid waiver as necessary to implement the pilot
457 program.
458 (b) The agency shall administer the pilot program pursuant
459 to s. 409.903 and as a component of the Statewide Medicaid
460 Managed Care model established by this section. Unless otherwise
461 specified, ss. 409.961-409.969 apply to the pilot program. The
462 agency may seek federal approval through a state plan amendment
463 or Medicaid waiver as necessary to implement the pilot program.
464 The agency shall submit a request for any federal approval
465 needed to implement the pilot program by September 1, 2023.
466 (c) Pursuant to s. 409.963, the agency shall administer the
467 pilot program in consultation with the Agency for Persons with
468 Disabilities.
469 (c)(d) The agency shall make capitated payments to managed
470 care organizations for comprehensive coverage, including managed
471 medical assistance benefits and long-term care under this part
472 and community-based services described in s. 393.066(3) and
473 approved through the state’s home and community-based services
474 Medicaid waiver program for individuals with developmental
475 disabilities. Unless otherwise specified, ss. 409.961-409.969
476 apply to the pilot program.
477 (e) The agency shall evaluate the feasibility of statewide
478 implementation of the capitated managed care model used by the
479 pilot program to serve individuals with developmental
480 disabilities.
481 (2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT.—
482 (a) Participation in the pilot program is voluntary and
483 limited to the maximum number of enrollees specified in the
484 General Appropriations Act.
485 (b) To be eligible for enrollment in the pilot program, an
486 individual must:
487 (b) The Agency for Persons with Disabilities shall approve
488 a needs assessment methodology to determine functional,
489 behavioral, and physical needs of prospective enrollees. The
490 assessment methodology may be administered by persons who have
491 completed such training as may be offered by the agency.
492 Eligibility to participate in the pilot program is determined
493 based on all of the following criteria:
494 1. Be Medicaid eligible.
495 1. Whether the individual is eligible for Medicaid.
496 2. Be Whether the individual is 18 years of age or older.
497 3.Have a developmental disability as defined in s. 393.063.
498 4. Be placed in any preenrollment category for individual
499 budget waiver services under chapter 393 and reside in Statewide
500 Medicaid Managed Care Regions D or I; effective October 1, 2025,
501 be placed in any preenrollment category for individual budget
502 waiver services under chapter 393 regardless of region; or,
503 effective July 1, 2026, be enrolled in the individual budget
504 waiver services program under chapter 393 or in the long-term
505 care managed care program under this part regardless of region
506 and is on the waiting list for individual budget waiver services
507 under chapter 393 and assigned to one of categories 1 through 6
508 as specified in s. 393.065(5).
509 3. Whether the individual resides in a pilot program
510 region.
511 (c) The agency shall enroll individuals in the pilot
512 program based on verification that the individual has met the
513 criteria in paragraph (b).
514 1. The Agency for Persons with Disabilities shall transmit
515 to the agency weekly data files of clients enrolled in the
516 Medicaid home and community-based services waiver program under
517 chapter 393 and clients in preenrollment categories pursuant to
518 s. 393.065. The agency shall maintain a record of individuals
519 with developmental disabilities who may be eligible for the
520 pilot program using this data, Medicaid enrollment data
521 transmitted by the Department of Children and Families, and any
522 available collateral data.
523 2. The agency shall determine and administer the process
524 for enrollment. A needs assessment conducted by the Agency for
525 Persons with Disabilities is not required for enrollment. The
526 agency shall notify individuals with developmental disabilities
527 of the opportunity to voluntarily enroll in the pilot program
528 and explain the benefits available through the pilot program,
529 the process for enrollment, and the procedures for
530 disenrollment, including the requirement for continued coverage
531 after disenrollment pursuant to paragraph (d).
532 3. The agency shall provide a call center staffed by agents
533 trained to assist individuals with developmental disabilities
534 and their families in learning about and enrolling in the pilot
535 program.
536 4. The agency shall coordinate with the Department of
537 Children and Families and the Agency for Persons with
538 Disabilities to develop partnerships with community-based
539 organizations to disseminate information about the pilot program
540 to providers of covered services and potential enrollees.
541 (d) Notwithstanding any provisions of s. 393.065 to the
542 contrary, an enrollee must be afforded an opportunity to enroll
543 in any appropriate existing Medicaid waiver program if any of
544 the following conditions occur:
545 1. At any point during the operation of the pilot program,
546 an enrollee declares an intent to voluntarily disenroll,
547 provided that he or she has been covered for the entire previous
548 plan year by the pilot program.
549 2. The agency determines the enrollee has a good cause
550 reason to disenroll.
551 3. The pilot program ceases to operate.
552
553 Such enrollees must receive an individualized transition plan to
554 assist him or her in accessing sufficient services and supports
555 for the enrollee’s safety, well-being, and continuity of care.
556 (3) PILOT PROGRAM BENEFITS.—
557 (a) Plans participating in the pilot program must, at a
558 minimum, cover the following:
559 1. All benefits included in s. 409.973.
560 2. All benefits included in s. 409.98.
561 3. All benefits included in s. 393.066(3).
562 4. Any additional benefits negotiated by the agency
563 pursuant to paragraph (4)(b), and all of the following:
564 a. Adult day training.
565 b. Behavior analysis services.
566 c. Behavior assistant services.
567 d. Companion services.
568 e. Consumable medical supplies.
569 f. Dietitian services.
570 g. Durable medical equipment and supplies.
571 h. Environmental accessibility adaptations.
572 i. Occupational therapy.
573 j. Personal emergency response systems.
574 k. Personal supports.
575 l. Physical therapy.
576 m. Prevocational services.
577 n. Private duty nursing.
578 o. Residential habilitation, including the following
579 levels:
580 (I) Standard level.
581 (II) Behavior-focused level.
582 (III) Intensive-behavior level.
583 (IV) Enhanced intensive-behavior level.
584 p. Residential nursing services.
585 q. Respiratory therapy.
586 r. Respite care.
587 s. Skilled nursing.
588 t. Specialized medical home care.
589 u. Specialized mental health counseling.
590 v. Speech therapy.
591 w. Support coordination.
592 x. Supported employment.
593 y. Supported living coaching.
594 z. Transportation.
595 (b) All providers of the benefits services listed under
596 paragraph (a) must meet the provider qualifications established
597 by the agency for the Medicaid long-term care managed care
598 program under this section. If no such qualifications apply to a
599 specific benefit or provider type, the provider must meet the
600 provider qualifications established by the Agency for Persons
601 with Disabilities for the individual budget waiver services
602 program under chapter 393 outlined in the Florida Medicaid
603 Developmental Disabilities Individual Budgeting Waiver Services
604 Coverage and Limitations Handbook as adopted by reference in
605 rule 59G-13.070, Florida Administrative Code.
606 (c) Support coordination services must maximize the use of
607 natural supports and community partnerships.
608 (d) The plans participating in the pilot program must
609 provide all categories of benefits through a single, integrated
610 model of care.
611 (e) Participating plans must provide benefits services must
612 be provided to enrollees in accordance with an individualized
613 care plan which is evaluated and updated at least quarterly and
614 as warranted by changes in an enrollee’s circumstances.
615 Participating plans must conduct an individualized assessment of
616 each enrollee within 5 days after enrollment to determine the
617 enrollee’s functional, behavioral, and physical needs. The
618 assessment method or instrument must be approved by the agency.
619 (f) Participating plans must offer a consumer-directed
620 services option in accordance with s. 409.221.
621 (6) PROGRAM IMPLEMENTATION AND EVALUATION.—
622 (a) The agency shall conduct monitoring and evaluations and
623 require corrective actions or payment of penalties as may be
624 necessary to secure compliance with contractual requirements,
625 consistent with its obligations under this section, including,
626 but not limited to, compliance with provider network standards,
627 financial accountability, performance standards, health care
628 quality improvement systems, and program integrity select
629 participating plans and begin enrollment no later than January
630 31, 2024, with coverage for enrollees becoming effective upon
631 authorization and availability of sufficient state and federal
632 resources.
633 (b) Upon implementation of the program, the agency, in
634 consultation with the Agency for Persons with Disabilities,
635 shall conduct audits of the selected plans’ implementation of
636 person-centered planning.
637 (b)(c) The agency, in consultation with the Agency for
638 Persons with Disabilities, shall submit progress reports to the
639 Governor, the President of the Senate, and the Speaker of the
640 House of Representatives upon the federal approval,
641 implementation, and operation of the pilot program, as follows:
642 1. By August 30, 2025 December 31, 2023, a status report on
643 progress made toward federal approval of the waiver or waiver
644 amendment needed to implement the pilot program.
645 2. By December 31, 2025 2024, a status report on
646 implementation of the pilot program.
647 3. By December 31, 2025, and annually thereafter, a status
648 report on the operation of the pilot program, including, but not
649 limited to, all of the following:
650 a. Program enrollment, including the number and
651 demographics of enrollees.
652 b. Any complaints received.
653 c. Access to approved services.
654 (c)(d) The agency, in consultation with the Agency for
655 Persons with Disabilities, shall establish specific measures of
656 access, quality, and costs of the pilot program. The agency may
657 contract with an independent evaluator to conduct such
658 evaluation. The evaluation must include assessments of cost
659 savings; consumer education, choice, and access to services;
660 plans for future capacity and the enrollment of new Medicaid
661 providers; coordination of care; person-centered planning and
662 person-centered well-being outcomes; health and quality-of-life
663 outcomes; and quality of care by each eligibility category and
664 managed care plan in each pilot program site. The evaluation
665 must describe any administrative or legal barriers to the
666 implementation and operation of the pilot program in each
667 region.
668 1. The agency, in consultation with the Agency for Persons
669 with Disabilities, shall conduct quality assurance monitoring of
670 the pilot program to include client satisfaction with services,
671 client health and safety outcomes, client well-being outcomes,
672 and service delivery in accordance with the client’s care plan.
673 2. The agency shall submit the results of the evaluation to
674 the Governor, the President of the Senate, and the Speaker of
675 the House of Representatives by October 1, 2029.
676 Section 6. This act shall take effect July 1, 2025.
677
678 ================= T I T L E A M E N D M E N T ================
679 And the title is amended as follows:
680 Delete everything before the enacting clause
681 and insert:
682 A bill to be entitled
683 An act relating to services for individuals with
684 developmental disabilities; amending s. 393.0662,
685 F.S.; requiring the Agency for Persons with
686 Disabilities to post its quarterly reconciliation
687 reports on its website within a specified timeframe;
688 amending s. 393.065, F.S.; providing a requirement for
689 the online application system to allow an applicant to
690 apply for crisis enrollment; removing a requirement
691 for the agency to remove certain individuals from the
692 preenrollment categories under certain circumstances;
693 requiring the agency to participate in transition
694 planning activities and to post the total number of
695 individuals in each priority category on its website;
696 creating s. 393.0664, F.S.; requiring the agency to
697 implement a specified Medicaid waiver program to
698 address the needs of certain clients; providing the
699 purpose of the program; authorizing the agency, in
700 partnership with the Agency for Health Care
701 Administration, to seek federal approval through a
702 state plan amendment or Medicaid waiver to implement
703 the program by a specified date; providing voluntary
704 enrollment, eligibility, and disenrollment
705 requirements; requiring the agency to approve a needs
706 assessment methodology; providing that only persons
707 trained by the agency may administer the methodology;
708 requiring the agency to offer such training; requiring
709 the agency to authorize certain covered services
710 specified in the Medicaid waiver; providing
711 requirements for such services; requiring the agency
712 to begin enrollment in the program upon federal
713 approval; providing construction; requiring the
714 agency, in consultation with the Agency for Health
715 Care Administration, to submit progress reports to the
716 Governor and the Legislature upon federal approval and
717 throughout implementation of the program; requiring
718 the agency to submit, by a specified date, a progress
719 report on the administration of the program;
720 specifying requirements for the report; amending s.
721 393.502, F.S.; establishing the Statewide Family Care
722 Council; providing for the purpose, membership, and
723 duties of the council; requiring local family care
724 councils to report to the statewide council policy
725 changes and program recommendations in an annual
726 report; providing for appointment of council members;
727 providing for the creation of family-led nominating
728 committees; providing duties of the agency relating to
729 the statewide council and local councils; amending s.
730 409.9855, F.S.; revising implementation and
731 eligibility requirements of the pilot program for
732 individuals with developmental disabilities; requiring
733 the Agency for Persons with Disabilities to transmit
734 to the Agency for Health Care Administration weekly
735 data files of specified clients; requiring the Agency
736 for Health Care Administration to provide a call
737 center for specified purposes and to coordinate with
738 the Department of Children and Families and the Agency
739 for Persons with Disabilities to disseminate
740 information about the pilot program; revising pilot
741 program benefits; revising provider qualifications;
742 requiring participating plans to conduct an
743 individualized assessment of each enrollee within a
744 specified timeframe for certain purposes and to offer
745 certain services to such enrollees; requiring the
746 Agency for Health Care Administration to conduct
747 monitoring and evaluations and require corrective
748 actions or payment of penalties under certain
749 circumstances; removing coordination requirements for
750 the agency when submitting certain reports,
751 establishing specified measures, and conducting
752 quality assurance monitoring of the pilot program;
753 revising dates for submitting certain status reports;
754 providing an effective date.