Florida Senate - 2025 CS for SB 1050
By the Committee on Children, Families, and Elder Affairs; and
Senator Bradley
586-03168-25 20251050c1
1 A bill to be entitled
2 An act relating to services for individuals with
3 developmental disabilities; amending s. 393.0662,
4 F.S.; requiring the Agency for Persons with
5 Disabilities to post its quarterly reconciliation
6 reports on its website within a specified timeframe;
7 amending s. 393.065, F.S.; providing a requirement for
8 the online application system to allow an applicant to
9 apply for crisis enrollment; removing a requirement
10 for the agency to remove certain individuals from the
11 preenrollment categories under certain circumstances;
12 requiring the agency to participate in transition
13 planning activities and to post the total number of
14 individuals in each priority category on its website;
15 creating s. 393.0664, F.S.; requiring the agency to
16 implement a specified Medicaid waiver program to
17 address the needs of certain clients; providing the
18 purpose of the program; authorizing the agency, in
19 partnership with the Agency for Health Care
20 Administration, to seek federal approval through a
21 state plan amendment or Medicaid waiver to implement
22 the program by a specified date; providing voluntary
23 enrollment, eligibility, and disenrollment
24 requirements; requiring the agency to approve a needs
25 assessment methodology; providing that only persons
26 trained by the agency may administer the methodology;
27 requiring the agency to offer such training; requiring
28 the agency to authorize certain covered services
29 specified in the Medicaid waiver; providing
30 requirements for such services; requiring the agency
31 to begin enrollment in the program upon federal
32 approval; providing construction; requiring the
33 agency, in consultation with the Agency for Health
34 Care Administration, to submit progress reports to the
35 Governor and the Legislature upon federal approval and
36 throughout implementation of the program; requiring
37 the agency to submit, by a specified date, a progress
38 report on the administration of the program;
39 specifying requirements for the report; amending s.
40 393.502, F.S.; establishing the Statewide Family Care
41 Council; providing for the purpose, membership, and
42 duties of the council; requiring local family care
43 councils to report to the statewide council policy
44 changes and program recommendations in an annual
45 report; providing for appointment of council members;
46 providing for the creation of family-led nominating
47 committees; providing duties of the agency relating to
48 the statewide council and local councils; amending s.
49 409.9855, F.S.; revising implementation and
50 eligibility requirements of the pilot program for
51 individuals with developmental disabilities; requiring
52 the Agency for Persons with Disabilities to transmit
53 to the Agency for Health Care Administration weekly
54 data files of specified clients; requiring the Agency
55 for Health Care Administration to provide a call
56 center for specified purposes and to coordinate with
57 the Department of Children and Families and the Agency
58 for Persons with Disabilities to disseminate
59 information about the pilot program; revising pilot
60 program benefits; revising provider qualifications;
61 requiring participating plans to conduct an
62 individualized assessment of each enrollee within a
63 specified timeframe for certain purposes and to offer
64 certain services to such enrollees; requiring the
65 Agency for Health Care Administration to conduct
66 monitoring and evaluations and require corrective
67 actions or payment of penalties under certain
68 circumstances; removing coordination requirements for
69 the agency when submitting certain reports,
70 establishing specified measures, and conducting
71 quality assurance monitoring of the pilot program;
72 revising dates for submitting certain status reports;
73 providing an effective date.
74
75 Be It Enacted by the Legislature of the State of Florida:
76
77 Section 1. Subsection (14) of section 393.0662, Florida
78 Statutes, is amended to read:
79 393.0662 Individual budgets for delivery of home and
80 community-based services; iBudget system established.—The
81 Legislature finds that improved financial management of the
82 existing home and community-based Medicaid waiver program is
83 necessary to avoid deficits that impede the provision of
84 services to individuals who are on the waiting list for
85 enrollment in the program. The Legislature further finds that
86 clients and their families should have greater flexibility to
87 choose the services that best allow them to live in their
88 community within the limits of an established budget. Therefore,
89 the Legislature intends that the agency, in consultation with
90 the Agency for Health Care Administration, shall manage the
91 service delivery system using individual budgets as the basis
92 for allocating the funds appropriated for the home and
93 community-based services Medicaid waiver program among eligible
94 enrolled clients. The service delivery system that uses
95 individual budgets shall be called the iBudget system.
96 (14)(a) The agency, in consultation with the Agency for
97 Health Care Administration, shall provide a quarterly
98 reconciliation report of all home and community-based services
99 waiver expenditures from the Agency for Health Care
100 Administration’s claims management system with service
101 utilization from the Agency for Persons with Disabilities
102 Allocation, Budget, and Contract Control system. The
103 reconciliation report must be submitted to the Governor, the
104 President of the Senate, and the Speaker of the House of
105 Representatives no later than 30 days after the close of each
106 quarter.
107 (b) The agency shall post its quarterly reconciliation
108 reports on its website, in a conspicuous location, no later than
109 5 days after submitting the reports as required in this
110 subsection.
111 Section 2. Present subsection (12) of section 393.065,
112 Florida Statutes, is redesignated as subsection (13), paragraph
113 (a) of subsection (1), paragraph (b) of subsection (5), and
114 subsection (10) of that section are amended, and a new
115 subsection (12) is added to that section, to read:
116 393.065 Application and eligibility determination.—
117 (1)(a) The agency shall develop and implement an online
118 application process that, at a minimum, supports paperless,
119 electronic application submissions with immediate e-mail
120 confirmation to each applicant to acknowledge receipt of
121 application upon submission. The online application system must
122 allow an applicant to review the status of a submitted
123 application and respond to provide additional information. The
124 online application must allow an applicant to apply for crisis
125 enrollment.
126 (5) Except as provided in subsections (6) and (7), if a
127 client seeking enrollment in the developmental disabilities home
128 and community-based services Medicaid waiver program meets the
129 level of care requirement for an intermediate care facility for
130 individuals with intellectual disabilities pursuant to 42 C.F.R.
131 ss. 435.217(b)(1) and 440.150, the agency must assign the client
132 to an appropriate preenrollment category pursuant to this
133 subsection and must provide priority to clients waiting for
134 waiver services in the following order:
135 (b) Category 2, which includes clients in the preenrollment
136 categories who are:
137 1. From the child welfare system with an open case in the
138 Department of Children and Families’ statewide automated child
139 welfare information system and who are either:
140 a. Transitioning out of the child welfare system into
141 permanency; or
142 b. At least 18 years but not yet 22 years of age and who
143 need both waiver services and extended foster care services; or
144 2. At least 18 years but not yet 22 years of age and who
145 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the
146 extended foster care system.
147
148 For individuals who are at least 18 years but not yet 22 years
149 of age and who are eligible under sub-subparagraph 1.b., the
150 agency must provide waiver services, including residential
151 habilitation, and must actively participate in transition
152 planning activities, including, but not limited to,
153 individualized service coordination, case management support,
154 and ensuring continuity of care pursuant to s. 39.6035. The
155 community-based care lead agency must fund room and board at the
156 rate established in s. 409.145(3) and provide case management
157 and related services as defined in s. 409.986(3)(e). Individuals
158 may receive both waiver services and services under s. 39.6251.
159 Services may not duplicate services available through the
160 Medicaid state plan.
161
162 Within preenrollment categories 3, 4, 5, 6, and 7, the agency
163 shall prioritize clients in the order of the date that the
164 client is determined eligible for waiver services.
165 (10) The client, the client’s guardian, or the client’s
166 family must ensure that accurate, up-to-date contact information
167 is provided to the agency at all times. Notwithstanding s.
168 393.0651, the agency must send an annual letter requesting
169 updated information from the client, the client’s guardian, or
170 the client’s family. The agency must remove from the
171 preenrollment categories any individual who cannot be located
172 using the contact information provided to the agency, fails to
173 meet eligibility requirements, or becomes domiciled outside the
174 state.
175 (12) To ensure transparency and timely access to
176 information, the agency shall post on its website in a
177 conspicuous location the total number of individuals in each
178 priority category. The posted numbers shall reflect the current
179 status of the preenrollment priority list and shall be updated
180 at least every 5 days.
181 Section 3. Section 393.0664, Florida Statutes, is created
182 to read:
183 393.0664 Adult Pathways Home and Community-based Services
184 Medicaid waiver program.—
185 (1) PROGRAM IMPLEMENTATION.—
186 (a) The agency shall implement the Adult Pathways Home and
187 Community-based Services Medicaid waiver program using a fee
188 for-service model with an annual per-person funding cap to
189 address the needs of clients with developmental disabilities as
190 they transition into adulthood and achieve greater independence
191 throughout their lifetimes.
192 (b) The program is created to establish an additional
193 pathway to provide necessary supports and services to clients
194 and contain costs by maximizing the use of natural supports and
195 community partnerships before turning to state resources to meet
196 the needs of clients at the earliest possible time to prevent
197 care crises and to positively influence outcomes relating to
198 client health, safety, and well-being.
199 (c) The agency, in partnership with the Agency for Health
200 Care Administration, may seek federal approval through a state
201 plan amendment or Medicaid waiver as necessary to implement the
202 program. The Agency for Health Care Administration shall submit
203 a request for any federal approval needed to implement the
204 program by October 1, 2025.
205 (2) VOLUNTARY ENROLLMENT; ELIGIBILITY; DISENROLLMENT.—
206 (a) Participation in the program is voluntary and limited
207 to the maximum number of enrollees authorized in the General
208 Appropriations Act.
209 (b) The agency shall approve a needs assessment methodology
210 to determine functional, behavioral, and physical needs of
211 prospective enrollees. The assessment methodology may be
212 administered only by persons who have completed any training
213 required by the agency for such purpose. If required, the agency
214 must offer any such training.
215 (c) To participate in the program, a client must meet all
216 of the following criteria:
217 1. Be eligible for Medicaid.
218 2. Be eligible for a preenrollment category for Medicaid
219 waiver services as provided in s. 393.065(5).
220 3. Be 18 to 28 years of age at the time of enrollment and
221 have attained a high school diploma or the equivalent.
222 4. Meet the level of care required for home and community
223 based services as identified in the federal approval for the
224 program.
225 (d) Enrollees may remain on the Adult Pathways waiver until
226 the age of 32.
227 (e) Participation in the program does not affect the status
228 of current clients of the home and community-based services
229 Medicaid waiver program under s. 393.0662 unless a client, or
230 his or her legal representative, voluntarily disenrolls from
231 that program.
232 (f) Enrollees who voluntarily disenroll from the program
233 must be allowed to return to the most appropriate preenrollment
234 category for services under s. 393.065 based on a current needs
235 assessment and the preenrollment category criteria.
236 (3) ADULT PATHWAYS WAIVER SERVICES.—
237 (a) The agency shall authorize covered services as
238 specified in the Medicaid waiver which are medically necessary,
239 including, but not limited to, any of the following:
240 1. Adult day training.
241 2. Companion services.
242 3. Employment services.
243 4. Personal supports.
244 5. Prevocational services.
245 6. Supported living coaching.
246 7. Transportation.
247 8. Care Coordination.
248 (b) Services must be provided to enrollees in accordance
249 with an individualized care plan, which must be evaluated and
250 updated at least annually and as often as warranted by changes
251 in the enrollee’s circumstances.
252 (4) PROGRAM ADMINISTRATION AND EVALUATION.—
253 (a) The agency shall begin enrollment upon federal approval
254 of the Medicaid waiver, with coverage for enrollees becoming
255 effective upon authorization and availability of sufficient
256 state and federal funding and resources.
257 (b) This section and any rules adopted pursuant thereto may
258 not be construed to prevent or limit the agency, in consultation
259 with the Agency for Health Care Administration, from adjusting
260 fees, reimbursement rates, lengths of stay, number of visits, or
261 number of services; limiting enrollment; or making any other
262 adjustment necessary based upon funding and any limitations
263 imposed or directions provided in the General Appropriations
264 Act.
265 (c) The agency, in consultation with the Agency for Health
266 Care Administration, shall submit progress reports to the
267 Governor, the President of the Senate, and the Speaker of the
268 House of Representatives upon federal approval of the Medicaid
269 waiver and throughout implementation of the program under the
270 waiver. By July 1, 2026, the Agency for Persons with
271 Disabilities shall submit a progress report on the
272 administration of the program, including, but not limited to,
273 all of the following:
274 1. The number of enrollees in the program and other
275 pertinent information on enrollment.
276 2. Service use.
277 3. Average cost per enrollee.
278 4. Outcomes and performance reporting relating to health,
279 safety, and well-being of enrollees.
280 Section 4. Section 393.502, Florida Statutes, is amended to
281 read:
282 393.502 Family care councils.—
283 (1) CREATION AND PURPOSE OF STATEWIDE FAMILY CARE COUNCIL.
284 There shall be established and located within each service area
285 of the agency a family care council.
286 (a) The Statewide Family Care Council is established to
287 connect local family care councils and facilitate direct
288 communication between local councils and the agency, with the
289 goal of enhancing the quality of and access to resources and
290 supports for individuals with developmental disabilities and
291 their families.
292 (b) The statewide council shall:
293 1. Review annual reports, policy proposals, and program
294 recommendations submitted by the local family care councils.
295 2. Advise the agency on statewide policies, programs, and
296 service delivery improvements based on the collective
297 recommendations of the local councils.
298 3. Identify systemic barriers to the effective delivery of
299 services and recommend solutions to address such barriers.
300 4. Foster collaboration and the sharing of best practices
301 and available resources among local family care councils to
302 improve service delivery across regions.
303 5. Submit an annual report no later than December 1 of each
304 year to the Governor, the President of the Senate, the Speaker
305 of the House of Representatives, and the agency. The report
306 shall include a summary of local council findings, policy
307 recommendations, and an assessment of the agency’s actions in
308 response to previous recommendations of the local councils.
309 (c) The agency shall provide a written response within 60
310 days after receipt, including a detailed action plan outlining
311 steps taken or planned to address recommendations. The response
312 must specify whether recommendations will be implemented and
313 provide a timeline for implementation or include justification
314 if recommendations are not adopted.
315 (2) STATEWIDE FAMILY CARE COUNCIL MEMBERSHIP.—
316 (a) The statewide council shall consist of the following
317 members appointed by the Governor:
318 1. One representative from each of the local family care
319 councils, who must be a resident of the area served by that
320 local council. Among these representatives must be at least one
321 individual who is receiving waiver services from the agency
322 under s. 393.065 and at least one individual who is assigned to
323 a preenrollment category for waiver services under s. 393.065.
324 2. One individual representing an advocacy organization
325 representing individuals with disabilities.
326 3. One representative of a public or private entity that
327 provides services to individuals with developmental disabilities
328 that does not have a Medicaid waiver service contract with the
329 agency.
330 (b) Employees of the agency or the Agency for Health Care
331 Administration are not eligible to serve on the statewide
332 council.
333 (3) STATEWIDE FAMILY CARE COUNCIL TERMS; VACANCIES.—
334 (a) Statewide council members shall be initially appointed
335 to staggered 2- and 4-year terms, with subsequent terms of 4
336 years. Members may be reappointed to one additional consecutive
337 term.
338 (b) A member who has served two consecutive terms shall not
339 be eligible to serve again until at least 12 months have elapsed
340 since ending service on the statewide council.
341 (c) Upon expiration of a term or in the case of any other
342 vacancy, the statewide council shall, by majority vote,
343 recommend to the Governor for appointment at least one person
344 for each vacancy.
345 1. The Governor shall make an appointment within 45 days
346 after receiving a recommendation from the statewide council. If
347 the Governor fails to make an appointment for a member under
348 subsection (2), the chair of the local council may appoint a
349 member meeting the requirements of subsection (2) to act as the
350 statewide council representative for that local council until
351 the Governor makes an appointment.
352 2. If no member of a local council is willing and able to
353 serve on the statewide council, the Governor shall appoint an
354 individual from another local council to serve on the statewide
355 council.
356 (4) STATEWIDE FAMILY CARE COUNCIL MEETINGS; ORGANIZATION.
357 The statewide council shall meet at least quarterly. The council
358 meetings may be held in person or via teleconference or other
359 electronic means.
360 (a) The Governor shall appoint the initial chair from among
361 the members of the statewide council. Subsequent chairs shall be
362 elected annually by a majority vote of the council.
363 (b) Members of the statewide council shall serve without
364 compensation but may be reimbursed for per diem and travel
365 expenses pursuant to s. 112.061.
366 (c) A majority of the members of the statewide council
367 shall constitute a quorum.
368 (5) LOCAL FAMILY CARE COUNCILS.—There is established and
369 located within each service area of the agency a local family
370 care council to work constructively with the agency, advise the
371 agency on local needs, identify gaps in services, and advocate
372 for individuals with developmental disabilities and their
373 families.
374 (6) LOCAL FAMILY CARE COUNCIL DUTIES.—The local family care
375 councils shall:
376 (a) Assist in providing information and conducting outreach
377 to individuals with developmental disabilities and their
378 families.
379 (b) Convene family listening sessions at least twice a year
380 to gather input on local service delivery challenges.
381 (c) Hold a public forum every 6 months to solicit public
382 feedback concerning actions taken by the local family councils.
383 (d) Share information with other local family care
384 councils.
385 (e) Identify policy issues relevant to the community and
386 family support system in the region.
387 (f) Submit to the Statewide Family Care Council, no later
388 than September 1 of each year, an annual report detailing
389 proposed policy changes, program recommendations, and identified
390 service delivery challenges within its region.
391 (7)(2) LOCAL FAMILY CARE COUNCIL MEMBERSHIP.—
392 (a) Each local family care council shall consist of at
393 least 10 and no more than 15 members recommended by a majority
394 vote of the local family care council and appointed by the
395 Governor.
396 (b) At least three of the members of the council shall be
397 individuals receiving or waiting to receive services from the
398 agency. One such member shall be an individual who has been
399 receiving services within the 4 years before the date of
400 recommendation. The remainder of the council members shall be
401 parents, grandparents, guardians, or siblings of individuals who
402 have developmental disabilities and qualify for services
403 pursuant to this chapter. For a grandparent to be a council
404 member, the grandchild’s parent or legal guardian must consent
405 to the appointment and report the consent to the agency.
406 (c) A person who is currently serving on another board or
407 council of the agency may not be appointed to a local family
408 care council.
409 (d) Employees of the agency or the Agency for Health Care
410 Administration are not eligible to serve on a local family care
411 council.
412 (e) Persons related by consanguinity or affinity within the
413 third degree shall not serve on the same local family care
414 council at the same time.
415 (f) A chair for the council shall be chosen by the council
416 members to serve for 1 year. A person may not serve no more than
417 four 1-year terms as chair.
418 (8)(3) LOCAL FAMILY CARE COUNCIL TERMS; VACANCIES.—
419 (a) Local family council members shall be appointed for a
420 3-year terms term, except as provided in subsection (11) (8),
421 and may be reappointed to one additional term.
422 (b) A member who has served two consecutive terms shall not
423 be eligible to serve again until 12 months have elapsed since
424 ending his or her service on the local council.
425 (c)1. Upon expiration of a term or in the case of any other
426 vacancy, the local council shall, by majority vote, recommend to
427 the Governor for appointment a person for each vacancy based on
428 recommendations received from the family-led nominating
429 committee described in paragraph (9)(a).
430 2. The Governor shall make an appointment within 45 days
431 after receiving a recommendation. If the Governor fails to make
432 an appointment within 45 days the local council shall, by
433 majority vote, may select an interim appointment for each
434 vacancy from the panel of candidates recommended by the family
435 led nominating committee.
436 (9)(4) LOCAL FAMILY CARE COUNCIL COMMITTEE APPOINTMENTS.—
437 (a) The chair of each local family care council shall
438 create, and appoint individuals receiving or waiting to receive
439 services from the agency and their relatives, to serve on a
440 family-led nominating committee. Members of the family-led
441 nominating council need not be members of the local council. The
442 family-led nominating committee shall nominate candidates for
443 vacant positions on the local family council.
444 (b) The chair of the local family care council may appoint
445 persons to serve on additional council committees. Such persons
446 may include current members of the council and former members of
447 the council and persons not eligible to serve on the council.
448 (5) TRAINING.—
449 (a) The agency, in consultation with the local councils,
450 shall establish a training program for local family care council
451 members. Each local area shall provide the training program when
452 new persons are appointed to the local council and at other
453 times as the secretary deems necessary.
454 (b) The training shall assist the council members to
455 understand the laws, rules, and policies applicable to their
456 duties and responsibilities.
457 (c) All persons appointed to a local council must complete
458 this training within 90 days after their appointment. A person
459 who fails to meet this requirement shall be considered to have
460 resigned from the council.
461 (10)(6) LOCAL FAMILY CARE COUNCIL MEETINGS.—Local council
462 members shall serve on a voluntary basis without payment for
463 their services but shall be reimbursed for per diem and travel
464 expenses as provided for in s. 112.061. Local councils The
465 council shall meet at least six times per year. Meetings may be
466 held in person or by teleconference or other electronic means.
467 (7) PURPOSE.—The purpose of the local family care councils
468 shall be to advise the agency, to develop a plan for the
469 delivery of family support services within the local area, and
470 to monitor the implementation and effectiveness of services and
471 support provided under the plan. The primary functions of the
472 local family care councils shall be to:
473 (a) Assist in providing information and outreach to
474 families.
475 (b) Review the effectiveness of service programs and make
476 recommendations with respect to program implementation.
477 (c) Advise the agency with respect to policy issues
478 relevant to the community and family support system in the local
479 area.
480 (d) Meet and share information with other local family care
481 councils.
482 (11)(8) NEW LOCAL FAMILY CARE COUNCILS.—When a local family
483 care council is established for the first time in a local area,
484 the Governor shall appoint the first four council members, who
485 shall serve 3-year terms. These members shall submit to the
486 Governor, within 90 days after their appointment,
487 recommendations for at least six additional members, selected by
488 majority vote.
489 (12)(9) FUNDING; FINANCIAL REVIEW.—The statewide and local
490 family care councils council may apply for, receive, and accept
491 grants, gifts, donations, bequests, and other payments from any
492 public or private entity or person. Each local council is
493 subject to an annual financial review by staff assigned by the
494 agency. Each local council shall exercise care and prudence in
495 the expenditure of funds. The local family care councils shall
496 comply with state expenditure requirements.
497 (13) TRAINING.—
498 (a) The agency, in consultation with the statewide and
499 local councils, shall establish and provide a training program
500 for council members.
501 (b) The training shall assist the council members to
502 understand the laws, rules, and policies applicable to their
503 duties and responsibilities.
504 (c) All persons newly appointed to the statewide or a local
505 council must complete this training within 90 days after their
506 appointment. A person who fails to meet this requirement is
507 considered to have resigned from the council. The agency may
508 make additional training available to council members.
509 (14) DUTIES.—The agency shall publish on its website all
510 annual reports submitted by the local care councils and the
511 Statewide Family Care Council within 15 days after receipt of
512 such reports in a designated and easily accessible section of
513 the website.
514 (15) ADMINISTRATIVE SUPPORT.—The agency shall provide
515 administrative support to the statewide council and local
516 councils, including, but not limited to, staff assistance and
517 meeting facilities, within existing resources.
518 Section 5. Subsections (1), (2), (3), and (6) of section
519 409.9855, Florida Statutes, are amended to read:
520 409.9855 Pilot program for individuals with developmental
521 disabilities.—
522 (1) PILOT PROGRAM IMPLEMENTATION.—
523 (a) Using a managed care model, The agency shall implement
524 a pilot program for individuals with developmental disabilities
525 in Statewide Medicaid Managed Care Regions D and I to provide
526 coverage of comprehensive services using a managed care model.
527 The agency may seek federal approval through a state plan
528 amendment or Medicaid waiver as necessary to implement the pilot
529 program.
530 (b) The agency shall administer the pilot program pursuant
531 to s. 409.903 and as a component of the Statewide Medicaid
532 Managed Care model established by this section. Unless otherwise
533 specified, ss. 409.961-409.969 apply to the pilot program. The
534 agency may seek federal approval through a state plan amendment
535 or Medicaid waiver as necessary to implement the pilot program.
536 The agency shall submit a request for any federal approval
537 needed to implement the pilot program by September 1, 2023.
538 (c) Pursuant to s. 409.963, the agency shall administer the
539 pilot program in consultation with the Agency for Persons with
540 Disabilities.
541 (d) The agency shall make capitated payments to managed
542 care organizations for comprehensive coverage, including managed
543 medical assistance benefits and long-term care under this part
544 and community-based services described in s. 393.066(3) and
545 approved through the state’s home and community-based services
546 Medicaid waiver program for individuals with developmental
547 disabilities. Unless otherwise specified, ss. 409.961-409.969
548 apply to the pilot program.
549 (e) The agency shall evaluate the feasibility of statewide
550 implementation of the capitated managed care model used by the
551 pilot program to serve individuals with developmental
552 disabilities.
553 (2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT.—
554 (a) Participation in the pilot program is voluntary and
555 limited to the maximum number of enrollees specified in the
556 General Appropriations Act.
557 (b) To be eligible for enrollment in the pilot program, an
558 individual must The Agency for Persons with Disabilities shall
559 approve a needs assessment methodology to determine functional,
560 behavioral, and physical needs of prospective enrollees. The
561 assessment methodology may be administered by persons who have
562 completed such training as may be offered by the agency.
563 Eligibility to participate in the pilot program is determined
564 based on all of the following criteria:
565 1. Be Medicaid eligible Whether the individual is eligible
566 for Medicaid.
567 2. Be Whether the individual is 18 years of age or older.
568 3. Have a developmental disability as defined in s.
569 393.063.
570 4. Be placed in any preenrollment category for individual
571 budget waiver services under chapter 393 and reside in Statewide
572 Medicaid Managed Care Regions D or I; effective October 1, 2025,
573 be placed in any preenrollment category for individual budget
574 waiver services under chapter 393, regardless of region; or,
575 effective July 1, 2026, be enrolled in the individual budget
576 waiver services program under chapter 393 or in the long-term
577 care managed care program under this part, regardless of region
578 and is on the waiting list for individual budget waiver services
579 under chapter 393 and assigned to one of categories 1 through 6
580 as specified in s. 393.065(5).
581 3. Whether the individual resides in a pilot program
582 region.
583 (c) The agency shall enroll individuals in the pilot
584 program based on verification that the individual has met the
585 criteria in paragraph (b).
586 1. The Agency for Persons with Disabilities shall transmit
587 to the agency weekly data files of clients enrolled in the
588 Medicaid home and community-based services waiver program under
589 chapter 393 and clients in preenrollment categories pursuant to
590 s. 393.065. The agency shall maintain a record of individuals
591 with developmental disabilities who may be eligible for the
592 pilot program using this data, Medicaid enrollment data
593 transmitted by the Department of Children and Families, and any
594 available collateral data.
595 2. The agency shall determine and administer the process
596 for enrollment. A needs assessment conducted by the Agency for
597 Persons with Disabilities is not required for enrollment. The
598 agency shall notify individuals with developmental disabilities
599 of the opportunity to voluntarily enroll in the pilot program
600 and explain the benefits available through the pilot program,
601 the process for enrollment, and the procedures for
602 disenrollment, including the requirement for continued coverage
603 after disenrollment pursuant to paragraph (d).
604 3. The agency shall provide a call center staffed by agents
605 trained to assist individuals with developmental disabilities
606 and their families in learning about and enrolling in the pilot
607 program.
608 4. The agency shall coordinate with the Department of
609 Children and Families and the Agency for Persons with
610 Disabilities to develop partnerships with community-based
611 organizations to disseminate information about the pilot program
612 to providers of covered services and potential enrollees.
613 (d) Notwithstanding any provisions of s. 393.065 to the
614 contrary, an enrollee must be afforded an opportunity to enroll
615 in any appropriate existing Medicaid waiver program if any of
616 the following conditions occur:
617 1. At any point during the operation of the pilot program,
618 an enrollee declares an intent to voluntarily disenroll,
619 provided that he or she has been covered for the entire previous
620 plan year by the pilot program.
621 2. The agency determines the enrollee has a good cause
622 reason to disenroll.
623 3. The pilot program ceases to operate.
624
625 Such enrollees must receive an individualized transition plan to
626 assist him or her in accessing sufficient services and supports
627 for the enrollee’s safety, well-being, and continuity of care.
628 (3) PILOT PROGRAM BENEFITS.—
629 (a) Plans participating in the pilot program must, at a
630 minimum, cover the following:
631 1. All benefits included in s. 409.973.
632 2. All benefits included in s. 409.98.
633 3. All benefits included in s. 393.066(3).
634 4. Any additional benefits negotiated by the agency
635 pursuant to paragraph (4)(b), and all of the following:
636 a. Adult day training.
637 b. Behavior analysis services.
638 c. Behavior assistant services.
639 d. Companion services.
640 e. Consumable medical supplies.
641 f. Dietitian services.
642 g. Durable medical equipment and supplies.
643 h. Environmental accessibility adaptations.
644 i. Occupational therapy.
645 j. Personal emergency response systems.
646 k. Personal supports.
647 l. Physical therapy.
648 m. Prevocational services.
649 n. Private duty nursing.
650 o. Residential habilitation, including the following
651 levels:
652 (I) Standard level.
653 (II) Behavior-focused level.
654 (III) Intensive-behavior level.
655 (IV) Enhanced intensive-behavior level.
656 p. Residential nursing services.
657 q. Respiratory therapy.
658 r. Respite care.
659 s. Skilled nursing.
660 t. Specialized medical home care.
661 u. Specialized mental health counseling.
662 v. Speech therapy.
663 w. Support coordination.
664 x. Supported employment.
665 y. Supported living coaching.
666 z. Transportation.
667 (b) All providers of the benefits services listed under
668 paragraph (a) must meet the provider qualifications established
669 by the agency for the Medicaid long-term care managed care
670 program under this section. If no such qualifications apply to a
671 specific benefit or provider type, the provider must meet the
672 provider qualifications established by the Agency for Persons
673 with Disabilities for the individual budget waiver services
674 program under chapter 393 outlined in the Florida Medicaid
675 Developmental Disabilities Individual Budgeting Waiver Services
676 Coverage and Limitations Handbook as adopted by reference in
677 rule 59G-13.070, Florida Administrative Code.
678 (c) Support coordination services must maximize the use of
679 natural supports and community partnerships.
680 (d) The plans participating in the pilot program must
681 provide all categories of benefits through a single, integrated
682 model of care.
683 (e) Participating plans must provide benefits services must
684 be provided to enrollees in accordance with an individualized
685 care plan which is evaluated and updated at least quarterly and
686 as warranted by changes in an enrollee’s circumstances.
687 Participating plans must conduct an individualized assessment of
688 each enrollee within 5 days after enrollment to determine the
689 enrollee’s functional, behavioral, and physical needs. The
690 assessment method or instrument must be approved by the agency.
691 (f) Participating plans must offer a consumer-directed
692 services option in accordance with s. 409.221.
693 (6) PROGRAM IMPLEMENTATION AND EVALUATION.—
694 (a) The agency shall conduct monitoring and evaluations and
695 require corrective actions or payment of penalties as may be
696 necessary to secure compliance with contractual requirements,
697 consistent with its obligations under this section, including,
698 but not limited to, compliance with provider network standards,
699 financial accountability, performance standards, health care
700 quality improvement systems, and program integrity select
701 participating plans and begin enrollment no later than January
702 31, 2024, with coverage for enrollees becoming effective upon
703 authorization and availability of sufficient state and federal
704 resources.
705 (b) Upon implementation of the program, the agency, in
706 consultation with the Agency for Persons with Disabilities,
707 shall conduct audits of the selected plans’ implementation of
708 person-centered planning.
709 (c) The agency, in consultation with the Agency for Persons
710 with Disabilities, shall submit progress reports to the
711 Governor, the President of the Senate, and the Speaker of the
712 House of Representatives upon the federal approval,
713 implementation, and operation of the pilot program, as follows:
714 1. By August 30, 2025 December 31, 2023, a status report on
715 progress made toward federal approval of the waiver or waiver
716 amendment needed to implement the pilot program.
717 2. By December 31, 2025 2024, a status report on
718 implementation of the pilot program.
719 3. By December 31, 2025, and annually thereafter, a status
720 report on the operation of the pilot program, including, but not
721 limited to, all of the following:
722 a. Program enrollment, including the number and
723 demographics of enrollees.
724 b. Any complaints received.
725 c. Access to approved services.
726 (c)(d) The agency, in consultation with the Agency for
727 Persons with Disabilities, shall establish specific measures of
728 access, quality, and costs of the pilot program. The agency may
729 contract with an independent evaluator to conduct such
730 evaluation. The evaluation must include assessments of cost
731 savings; consumer education, choice, and access to services;
732 plans for future capacity and the enrollment of new Medicaid
733 providers; coordination of care; person-centered planning and
734 person-centered well-being outcomes; health and quality-of-life
735 outcomes; and quality of care by each eligibility category and
736 managed care plan in each pilot program site. The evaluation
737 must describe any administrative or legal barriers to the
738 implementation and operation of the pilot program in each
739 region.
740 1. The agency, in consultation with the Agency for Persons
741 with Disabilities, shall conduct quality assurance monitoring of
742 the pilot program to include client satisfaction with services,
743 client health and safety outcomes, client well-being outcomes,
744 and service delivery in accordance with the client’s care plan.
745 2. The agency shall submit the results of the evaluation to
746 the Governor, the President of the Senate, and the Speaker of
747 the House of Representatives by October 1, 2029.
748 Section 6. This act shall take effect July 1, 2025.