Florida Senate - 2025 CS for CS for SB 1050
By the Committees on Appropriations; and Children, Families, and
Elder Affairs; and Senator Bradley
576-03824-25 20251050c2
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 provide a list of all qualified
6 organizations located within the region in which the
7 client resides and to post its quarterly
8 reconciliation reports on its website within a
9 specified timeframe; amending s. 393.065, F.S.;
10 requiring that online applications include an
11 application for crisis enrollment; requiring the
12 agency to participate in transition planning
13 activities and to post the total number of individuals
14 in each priority category on its website; reordering
15 and amending s. 393.502, F.S.; establishing the
16 Statewide Family Care Council; providing for the
17 purpose, membership, and duties of the council;
18 providing for appointment of local council members;
19 providing for the creation of family-led nominating
20 committees; requiring local family care councils to
21 report to the statewide council policy changes and
22 program recommendations in an annual report; providing
23 duties of the agency relating to the statewide council
24 and local councils; amending s. 409.972, F.S.;
25 requiring certain Medicaid-eligible persons to take
26 certain actions before enrollment; prohibiting the
27 agency from automatically enrolling such persons;
28 amending s. 409.9855, F.S.; revising implementation
29 and eligibility requirements of the pilot program for
30 individuals with developmental disabilities; providing
31 for a method of voluntarily choosing to enroll in the
32 pilot program; requiring the agency to transmit to the
33 Agency for Health Care Administration weekly data
34 files of specified clients; requiring the Agency for
35 Health Care Administration to provide a call center
36 for specified purposes and to coordinate with the
37 Department of Children and Families and the Agency for
38 Persons with Disabilities to disseminate information
39 about the pilot program; revising pilot program
40 benefits; revising provider qualifications; requiring
41 participating plans to conduct an individualized
42 assessment of each enrollee within a specified
43 timeframe for certain purposes and to offer certain
44 services to such enrollees; requiring the Agency for
45 Health Care Administration to conduct monitoring and
46 evaluations and require corrective actions or payment
47 of penalties under certain circumstances; deleting
48 coordination requirements for the agency when
49 submitting certain reports, establishing specified
50 measures, and conducting quality assurance monitoring
51 of the pilot program; revising the dates by which the
52 Agency for Persons with Disabilities shall submit
53 progress reports to the Governor and Legislature;
54 requiring the Agency for Persons with Disabilities to
55 contract for a specified study and provide to the
56 Governor and the Legislature a specified report by
57 specified date; providing an effective date.
58
59 Be It Enacted by the Legislature of the State of Florida:
60
61 Section 1. Subsections (5) and (14) of section 393.0662,
62 Florida Statutes, are amended to read:
63 393.0662 Individual budgets for delivery of home and
64 community-based services; iBudget system established.—The
65 Legislature finds that improved financial management of the
66 existing home and community-based Medicaid waiver program is
67 necessary to avoid deficits that impede the provision of
68 services to individuals who are on the waiting list for
69 enrollment in the program. The Legislature further finds that
70 clients and their families should have greater flexibility to
71 choose the services that best allow them to live in their
72 community within the limits of an established budget. Therefore,
73 the Legislature intends that the agency, in consultation with
74 the Agency for Health Care Administration, shall manage the
75 service delivery system using individual budgets as the basis
76 for allocating the funds appropriated for the home and
77 community-based services Medicaid waiver program among eligible
78 enrolled clients. The service delivery system that uses
79 individual budgets shall be called the iBudget system.
80 (5) The agency shall ensure that clients and caregivers
81 have access to training and education that inform them about the
82 iBudget system and enhance their ability for self-direction.
83 Such training and education must be offered in a variety of
84 formats and, at a minimum, must address the policies and
85 processes of the iBudget system and the roles and
86 responsibilities of consumers, caregivers, waiver support
87 coordinators, providers, and the agency, and must provide
88 information to help the client make decisions regarding the
89 iBudget system and examples of support and resources available
90 in the community. The agency shall, within 5 days after
91 enrollment, provide the client with a comprehensive and current
92 written list of all qualified organizations located within the
93 region in which the client resides.
94 (14)(a) The agency, in consultation with the Agency for
95 Health Care Administration, shall provide a quarterly
96 reconciliation report of all home and community-based services
97 waiver expenditures from the Agency for Health Care
98 Administration’s claims management system with service
99 utilization from the Agency for Persons with Disabilities
100 Allocation, Budget, and Contract Control system. The
101 reconciliation report must be submitted to the Governor, the
102 President of the Senate, and the Speaker of the House of
103 Representatives no later than 30 days after the close of each
104 quarter.
105 (b) The agency shall post its quarterly reconciliation
106 reports on its website, in a conspicuous location, no later than
107 5 days after submitting the reports as required in this
108 subsection.
109 Section 2. Present subsection (12) of section 393.065,
110 Florida Statutes, is redesignated as subsection (13), a new
111 subsection (12) is added to that section, and paragraph (a) of
112 subsection (1), paragraph (b) of subsection (5), and subsection
113 (10) of that section are amended, to read:
114 393.065 Application and eligibility determination.—
115 (1)(a) The agency shall develop and implement an online
116 application process that, at a minimum, supports paperless,
117 electronic application submissions with immediate e-mail
118 confirmation to each applicant to acknowledge receipt of
119 application upon submission. The online application system must
120 allow an applicant to review the status of a submitted
121 application and respond to provide additional information. The
122 online application must allow an applicant to apply for crisis
123 enrollment.
124 (5) Except as provided in subsections (6) and (7), if a
125 client seeking enrollment in the developmental disabilities home
126 and community-based services Medicaid waiver program meets the
127 level of care requirement for an intermediate care facility for
128 individuals with intellectual disabilities pursuant to 42 C.F.R.
129 ss. 435.217(b)(1) and 440.150, the agency must assign the client
130 to an appropriate preenrollment category pursuant to this
131 subsection and must provide priority to clients waiting for
132 waiver services in the following order:
133 (b) Category 2, which includes clients in the preenrollment
134 categories who are:
135 1. From the child welfare system with an open case in the
136 Department of Children and Families’ statewide automated child
137 welfare information system and who are either:
138 a. Transitioning out of the child welfare system into
139 permanency; or
140 b. At least 18 years but not yet 22 years of age and who
141 need both waiver services and extended foster care services; or
142 2. At least 18 years but not yet 22 years of age and who
143 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the
144 extended foster care system.
145
146 For individuals who are at least 18 years but not yet 22 years
147 of age and who are eligible under sub-subparagraph 1.b., the
148 agency must provide waiver services, including residential
149 habilitation, and must actively participate in transition
150 planning activities, including, but not limited to,
151 individualized service coordination, case management support,
152 and ensuring continuity of care pursuant to s. 39.6035. The
153 community-based care lead agency must fund room and board at the
154 rate established in s. 409.145(3) and provide case management
155 and related services as defined in s. 409.986(3)(e). Individuals
156 may receive both waiver services and services under s. 39.6251.
157 Services may not duplicate services available through the
158 Medicaid state plan.
159
160 Within preenrollment categories 3, 4, 5, 6, and 7, the agency
161 shall prioritize clients in the order of the date that the
162 client is determined eligible for waiver services.
163 (10) The client, the client’s guardian, or the client’s
164 family must ensure that accurate, up-to-date contact information
165 is provided to the agency at all times. Notwithstanding s.
166 393.0651, the agency must send an annual letter requesting
167 updated information from the client, the client’s guardian, or
168 the client’s family. The agency must remove from the
169 preenrollment categories any individual who cannot be located
170 using the contact information provided to the agency, fails to
171 meet eligibility requirements, or becomes domiciled outside the
172 state.
173 (12) To ensure transparency and timely access to
174 information, the agency shall post on its website in a
175 conspicuous location the total number of individuals in each
176 priority category by county of residence. The posted numbers
177 shall reflect the current status of the preenrollment priority
178 list and shall be updated at least every 5 days.
179 Section 3. Section 393.502, Florida Statutes, is reordered
180 and amended to read:
181 393.502 Family care councils.—
182 (1) CREATION AND PURPOSE OF STATEWIDE FAMILY CARE COUNCIL.
183 There shall be established and located within each service area
184 of the agency a family care council.
185 (a) The Statewide Family Care Council is established to
186 connect local family care councils and facilitate direct
187 communication between local councils and the agency, with the
188 goal of enhancing the quality of and access to resources and
189 supports for individuals with developmental disabilities and
190 their families.
191 (b) The statewide council shall:
192 1. Review annual reports, policy proposals, and program
193 recommendations submitted by the local family care councils.
194 2. Advise the agency on statewide policies, programs, and
195 service delivery improvements based on the collective
196 recommendations of the local councils.
197 3. Identify systemic barriers to the effective delivery of
198 services and recommend solutions to address such barriers.
199 4. Foster collaboration and the sharing of best practices
200 and available resources among local family care councils to
201 improve service delivery across regions.
202 5. Submit an annual report no later than December 1 of each
203 year to the Governor, the President of the Senate, the Speaker
204 of the House of Representatives, and the agency. The report must
205 include a summary of local council findings, policy
206 recommendations, and an assessment of the agency’s actions in
207 response to previous recommendations of the local councils.
208 (c) The agency shall provide a written response within 60
209 days after receipt, including a detailed action plan outlining
210 steps taken or planned to address recommendations. The response
211 must specify whether recommendations will be implemented and
212 provide a timeline for implementation or include justification
213 if recommendations are not adopted.
214 (2) STATEWIDE FAMILY CARE COUNCIL MEMBERSHIP.—
215 (a) The statewide council shall be composed of the
216 following members appointed by the Governor:
217 1. One representative from each of the local family care
218 councils, who must be a resident of the area served by that
219 local council. Among these representatives must be at least one
220 individual who is receiving waiver services from the agency
221 under s. 393.065 and at least one individual who is assigned to
222 a preenrollment category for waiver services under s. 393.065.
223 2. One representative of an advocacy organization
224 representing individuals with disabilities.
225 3. One representative of a public or private entity that
226 provides services to individuals with developmental disabilities
227 that does not have a Medicaid waiver service contract with the
228 agency.
229 (b) Employees of the agency or the Agency for Health Care
230 Administration are not eligible to serve on the statewide
231 council.
232 (3) STATEWIDE FAMILY CARE COUNCIL TERMS; VACANCIES.—
233 (a) Statewide council members shall be initially appointed
234 to staggered 2- and 4-year terms, with subsequent terms of 4
235 years. Members may be reappointed to one additional consecutive
236 term.
237 (b) A member who has served two consecutive terms is not
238 eligible to serve again until at least 12 months have elapsed
239 since ending service on the statewide council.
240 (c) Upon expiration of a term or in the case of any other
241 vacancy, the statewide council shall, by majority vote,
242 recommend to the Governor for appointment at least one person
243 for each vacancy.
244 1. The Governor shall make an appointment within 45 days
245 after receiving a recommendation from the statewide council. If
246 the Governor fails to make an appointment for a member under
247 subsection (2), the chair of the local council may appoint a
248 member meeting the requirements of subsection (2) to act as the
249 statewide council representative for that local council until
250 the Governor makes an appointment.
251 2. If no member of a local council is willing and able to
252 serve on the statewide council, the Governor shall appoint an
253 individual from another local council to serve on the statewide
254 council.
255 (4) STATEWIDE FAMILY CARE COUNCIL MEETINGS; ORGANIZATION.
256 The statewide council shall meet at least quarterly. The council
257 meetings may be held in person or through teleconference or
258 other electronic means.
259 (a) The Governor shall appoint the initial chair from among
260 the members of the statewide council. Subsequent chairs shall be
261 elected annually by a majority vote of the council.
262 (b) Members of the statewide council shall serve without
263 compensation but may be reimbursed for per diem and travel
264 expenses pursuant to s. 112.061.
265 (c) A majority of the members of the statewide council
266 constitutes a quorum.
267 (5) LOCAL FAMILY CARE COUNCILS.—There is established and
268 located within each service area of the agency a local family
269 care council to work constructively with the agency, advise the
270 agency on local needs, identify gaps in services, and advocate
271 for individuals with developmental disabilities and their
272 families.
273 (6) LOCAL FAMILY CARE COUNCIL DUTIES.—The local family care
274 councils shall:
275 (a) Assist in providing information and conducting outreach
276 to individuals with developmental disabilities and their
277 families.
278 (b) Convene family listening sessions at least twice a year
279 to gather input on local service delivery challenges.
280 (c) Hold a public forum every 6 months to solicit public
281 feedback concerning actions taken by the local family councils.
282 (d) Share information with other local family care
283 councils.
284 (e) Identify policy issues relevant to the community and
285 family support system in the region.
286 (f) Submit to the Statewide Family Care Council, no later
287 than September 1 of each year, an annual report detailing
288 proposed policy changes, program recommendations, and identified
289 service delivery challenges within its region.
290 (7)(2) LOCAL FAMILY CARE COUNCIL MEMBERSHIP.—
291 (a) Each local family care council shall consist of at
292 least 10 and no more than 15 members recommended by a majority
293 vote of the local family care council and appointed by the
294 Governor.
295 (b) At least three of the members of the council shall be
296 individuals receiving or waiting to receive services from the
297 agency. One such member shall be an individual who has been
298 receiving services within the 4 years before the date of
299 recommendation. The remainder of the council members shall be
300 parents, grandparents, guardians, or siblings of individuals who
301 have developmental disabilities and qualify for services
302 pursuant to this chapter. For a grandparent to be a council
303 member, the grandchild’s parent or legal guardian must consent
304 to the appointment and report the consent to the agency.
305 (c) A person who is currently serving on another board or
306 council of the agency may not be appointed to a local family
307 care council.
308 (d) Employees of the agency or the Agency for Health Care
309 Administration are not eligible to serve on a local family care
310 council.
311 (e) Persons related by consanguinity or affinity within the
312 third degree may shall not serve on the same local family care
313 council at the same time.
314 (f) A chair for the council shall be chosen by the council
315 members to serve for 1 year. A person may not serve no more than
316 four 1-year terms as chair.
317 (8)(3) LOCAL FAMILY CARE COUNCIL TERMS; VACANCIES.—
318 (a) Local family council members shall be appointed for a
319 3-year terms term, except as provided in subsection (11) (8),
320 and may be reappointed to one additional term.
321 (b) A member who has served two consecutive terms is shall
322 not be eligible to serve again until 12 months have elapsed
323 since ending his or her service on the local council.
324 (c)1. Upon expiration of a term or in the case of any other
325 vacancy, the local council shall, by majority vote, recommend to
326 the Governor for appointment a person for each vacancy based on
327 recommendations received from the family-led nominating
328 committee described in paragraph (9)(a).
329 2. The Governor shall make an appointment within 45 days
330 after receiving a recommendation. If the Governor fails to make
331 an appointment within 45 days, the local council shall, by
332 majority vote, select an interim appointment for each vacancy
333 from the panel of candidates recommended by the family-led
334 nominating committee.
335 (9)(4) LOCAL FAMILY CARE COUNCIL COMMITTEE APPOINTMENTS.—
336 (a) The chair of each local family care council shall
337 create, and appoint individuals receiving or waiting to receive
338 services from the agency and their relatives, to serve on a
339 family-led nominating committee. Members of the family-led
340 nominating council need not be members of the local council. The
341 family-led nominating committee shall nominate candidates for
342 vacant positions on the local family council.
343 (b) The chair of the local family care council may appoint
344 persons to serve on additional council committees. Such persons
345 may include current members of the council and former members of
346 the council and persons not eligible to serve on the council.
347 (13)(5) TRAINING.—
348 (a) The agency, in consultation with the statewide and
349 local councils, shall establish and provide a training program
350 for local family care council members. Each local area shall
351 provide the training program when new persons are appointed to
352 the local council and at other times as the secretary deems
353 necessary.
354 (b) The training shall assist the council members to
355 understand the laws, rules, and policies applicable to their
356 duties and responsibilities.
357 (c) All persons newly appointed to the statewide or a local
358 council must complete this training within 90 days after their
359 appointment. A person who fails to meet this requirement is
360 shall be considered to have resigned from the council. The
361 agency may make additional training available to council
362 members.
363 (10)(6) LOCAL FAMILY CARE COUNCIL MEETINGS.—Local council
364 members shall serve on a voluntary basis without payment for
365 their services but shall be reimbursed for per diem and travel
366 expenses as provided for in s. 112.061. Local councils The
367 council shall meet at least six times per year. Meetings may be
368 held in person or by teleconference or other electronic means.
369 (7) PURPOSE.—The purpose of the local family care councils
370 shall be to advise the agency, to develop a plan for the
371 delivery of family support services within the local area, and
372 to monitor the implementation and effectiveness of services and
373 support provided under the plan. The primary functions of the
374 local family care councils shall be to:
375 (a) Assist in providing information and outreach to
376 families.
377 (b) Review the effectiveness of service programs and make
378 recommendations with respect to program implementation.
379 (c) Advise the agency with respect to policy issues
380 relevant to the community and family support system in the local
381 area.
382 (d) Meet and share information with other local family care
383 councils.
384 (11)(8) NEW LOCAL FAMILY CARE COUNCILS.—When a local family
385 care council is established for the first time in a local area,
386 the Governor shall appoint the first four council members, who
387 shall serve 3-year terms. These members shall submit to the
388 Governor, within 90 days after their appointment,
389 recommendations for at least six additional members, selected by
390 majority vote.
391 (12)(9) FUNDING; FINANCIAL REVIEW.—The statewide and local
392 family care councils council may apply for, receive, and accept
393 grants, gifts, donations, bequests, and other payments from any
394 public or private entity or person. Each local council is
395 subject to an annual financial review by staff assigned by the
396 agency. Each local council shall exercise care and prudence in
397 the expenditure of funds. The local family care councils shall
398 comply with state expenditure requirements.
399 (14) DUTIES.—The agency shall publish on its website all
400 annual reports submitted by the local family care councils and
401 the Statewide Family Care Council within 15 days after receipt
402 of such reports in a designated and easily accessible section of
403 the website.
404 (15) ADMINISTRATIVE SUPPORT.—The agency shall provide
405 administrative support to the statewide council and local
406 councils, including, but not limited to, staff assistance and
407 meeting facilities, within existing resources.
408 Section 4. Subsection (1) of section 409.972, Florida
409 Statutes, is amended to read:
410 409.972 Mandatory and voluntary enrollment.—
411 (1) The following Medicaid-eligible persons listed in
412 paragraphs (a)-(g) are exempt from mandatory managed care
413 enrollment required by s. 409.965, and may voluntarily choose to
414 participate in the managed medical assistance program. These
415 eligible persons must make an affirmative choice before any
416 enrollment action by the agency. The agency may not
417 automatically enroll these eligible persons.:
418 (a) Medicaid recipients who have other creditable health
419 care coverage, excluding Medicare.
420 (b) Medicaid recipients residing in residential commitment
421 facilities operated through the Department of Juvenile Justice
422 or a treatment facility as defined in s. 394.455.
423 (c) Persons eligible for refugee assistance.
424 (d) Medicaid recipients who are residents of a
425 developmental disability center, including Sunland Center in
426 Marianna and Tacachale in Gainesville.
427 (e) Medicaid recipients enrolled in the home and community
428 based services waiver pursuant to chapter 393, and Medicaid
429 recipients waiting for waiver services.
430 (f) Medicaid recipients residing in a group home facility
431 licensed under chapter 393.
432 (g) Children receiving services in a prescribed pediatric
433 extended care center.
434 Section 5. Subsections (1), (2), (3), and (6) of section
435 409.9855, Florida Statutes, are amended to read:
436 409.9855 Pilot program for individuals with developmental
437 disabilities.—
438 (1) PILOT PROGRAM IMPLEMENTATION.—
439 (a) Using a managed care model, The agency shall implement
440 a pilot program for individuals with developmental disabilities
441 in Statewide Medicaid Managed Care Regions D and I to provide
442 coverage of comprehensive services using a managed care model.
443 The agency may seek federal approval through a state plan
444 amendment or Medicaid waiver as necessary to implement the pilot
445 program.
446 (b) The agency shall administer the pilot program pursuant
447 to s. 409.963 and as a component of the Statewide Medicaid
448 Managed Care model established by this part. Unless otherwise
449 specified, ss. 409.961-409.969 apply to the pilot program. The
450 agency may seek federal approval through a state plan amendment
451 or Medicaid waiver as necessary to implement the pilot program.
452 The agency shall submit a request for any federal approval
453 needed to implement the pilot program by September 1, 2023.
454 (c) Pursuant to s. 409.963, the agency shall administer the
455 pilot program in consultation with the Agency for Persons with
456 Disabilities.
457 (d) The agency shall make capitated payments to managed
458 care organizations for comprehensive coverage, including managed
459 medical assistance benefits and long-term care under this part
460 and community-based services described in s. 393.066(3) and
461 approved through the state’s home and community-based services
462 Medicaid waiver program for individuals with developmental
463 disabilities. Unless otherwise specified, ss. 409.961-409.969
464 apply to the pilot program.
465 (e) The agency shall evaluate the feasibility of statewide
466 implementation of the capitated managed care model used by the
467 pilot program to serve individuals with developmental
468 disabilities.
469 (2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT.—
470 (a) Participation in the pilot program is voluntary and
471 limited to the maximum number of enrollees specified in the
472 General Appropriations Act. An individual must make an
473 affirmative choice before any enrollment action by the agency.
474 The agency may not automatically enroll eligible individuals.
475 (b) To be eligible for enrollment in the pilot program, an
476 individual must The Agency for Persons with Disabilities shall
477 approve a needs assessment methodology to determine functional,
478 behavioral, and physical needs of prospective enrollees. The
479 assessment methodology may be administered by persons who have
480 completed such training as may be offered by the agency.
481 Eligibility to participate in the pilot program is determined
482 based on all of the following criteria:
483 1. Be Medicaid eligible Whether the individual is eligible
484 for Medicaid.
485 2. Be Whether the individual is 18 years of age or older.
486 3. Have a developmental disability as defined in s.
487 393.063.
488 4. Be placed in any preenrollment category for individual
489 budget waiver services under chapter 393 and reside in Statewide
490 Medicaid Managed Care Regions D or I; effective October 1, 2025,
491 be placed in any preenrollment category for individual budget
492 waiver services under chapter 393, regardless of region; or,
493 effective July 1, 2026, be enrolled in the individual budget
494 waiver services program under chapter 393 or in the long-term
495 care managed care program under this part, regardless of region
496 and is on the waiting list for individual budget waiver services
497 under chapter 393 and assigned to one of categories 1 through 6
498 as specified in s. 393.065(5).
499 3. Whether the individual resides in a pilot program
500 region.
501 (c) The agency shall enroll individuals in the pilot
502 program based on verification that the individual has met the
503 criteria in paragraph (b).
504 1. The Agency for Persons with Disabilities shall transmit
505 to the agency weekly data files of clients enrolled in the
506 Medicaid home and community-based services waiver program under
507 chapter 393 and clients in preenrollment categories pursuant to
508 s. 393.065. The agency shall maintain a record of individuals
509 with developmental disabilities who may be eligible for the
510 pilot program using this data, Medicaid enrollment data
511 transmitted by the Department of Children and Families, and any
512 available collateral data.
513 2. The agency shall determine and administer the process
514 for enrollment. A needs assessment conducted by the Agency for
515 Persons with Disabilities is not required for enrollment. The
516 agency shall notify individuals with developmental disabilities
517 of the opportunity to voluntarily enroll in the pilot program
518 and explain the benefits available through the pilot program,
519 the process for enrollment, and the procedures for
520 disenrollment, including the requirement for continued coverage
521 after disenrollment pursuant to paragraph (d).
522 3. The agency shall provide a call center staffed by agents
523 trained to assist individuals with developmental disabilities
524 and their families in learning about and enrolling in the pilot
525 program.
526 4. The agency shall coordinate with the Department of
527 Children and Families and the Agency for Persons with
528 Disabilities to develop partnerships with community-based
529 organizations to disseminate information about the pilot program
530 to providers of covered services and potential enrollees.
531 (d) Notwithstanding any provisions of s. 393.065 to the
532 contrary, an enrollee must be afforded an opportunity to enroll
533 in any appropriate existing Medicaid waiver program if any of
534 the following conditions occur:
535 1. At any point during the operation of the pilot program,
536 an enrollee declares an intent to voluntarily disenroll,
537 provided that he or she has been covered for the entire previous
538 plan year by the pilot program.
539 2. The agency determines the enrollee has a good cause
540 reason to disenroll.
541 3. The pilot program ceases to operate.
542
543 Such enrollees must receive an individualized transition plan to
544 assist him or her in accessing sufficient services and supports
545 for the enrollee’s safety, well-being, and continuity of care.
546 (3) PILOT PROGRAM BENEFITS.—
547 (a) Plans participating in the pilot program must, at a
548 minimum, cover the following:
549 1. All benefits included in s. 409.973.
550 2. All benefits included in s. 409.98.
551 3. All benefits included in s. 393.066(3).
552 4. Any additional benefits negotiated by the agency
553 pursuant to paragraph (4)(b), and all of the following:
554 a. Adult day training.
555 b. Behavior analysis services.
556 c. Behavior assistant services.
557 d. Companion services.
558 e. Consumable medical supplies.
559 f. Dietitian services.
560 g. Durable medical equipment and supplies.
561 h. Environmental accessibility adaptations.
562 i. Occupational therapy.
563 j. Personal emergency response systems.
564 k. Personal supports.
565 l. Physical therapy.
566 m. Prevocational services.
567 n. Private duty nursing.
568 o. Residential habilitation, including the following
569 levels:
570 (I) Standard level.
571 (II) Behavior-focused level.
572 (III) Intensive-behavior level.
573 (IV) Enhanced intensive-behavior level.
574 p. Residential nursing services.
575 q. Respiratory therapy.
576 r. Respite care.
577 s. Skilled nursing.
578 t. Specialized medical home care.
579 u. Specialized mental health counseling.
580 v. Speech therapy.
581 w. Support coordination.
582 x. Supported employment.
583 y. Supported living coaching.
584 z. Transportation.
585 (b) All providers of the benefits services listed under
586 paragraph (a) must meet the provider qualifications established
587 by the agency for the Medicaid long-term care managed care
588 program under this section. If no such qualifications apply to a
589 specific benefit or provider type, the provider must meet the
590 provider qualifications established by the Agency for Persons
591 with Disabilities for the individual budget waiver services
592 program under chapter 393 outlined in the Florida Medicaid
593 Developmental Disabilities Individual Budgeting Waiver Services
594 Coverage and Limitations Handbook as adopted by reference in
595 rule 59G-13.070, Florida Administrative Code.
596 (c) Support coordination services must maximize the use of
597 natural supports and community partnerships.
598 (d) The plans participating in the pilot program must
599 provide all categories of benefits through a single, integrated
600 model of care.
601 (e) Participating plans must provide benefits services must
602 be provided to enrollees in accordance with an individualized
603 care plan which is evaluated and updated at least quarterly and
604 as warranted by changes in an enrollee’s circumstances.
605 Participating plans must conduct an individualized assessment of
606 each enrollee within 5 days after enrollment to determine the
607 enrollee’s functional, behavioral, and physical needs. The
608 assessment method or instrument must be approved by the agency.
609 (f) Participating plans must offer a consumer-directed
610 services option in accordance with s. 409.221.
611 (6) PROGRAM IMPLEMENTATION AND EVALUATION.—
612 (a) The agency shall conduct monitoring and evaluations and
613 require corrective actions or payment of penalties as may be
614 necessary to secure compliance with contractual requirements,
615 consistent with its obligations under this section, including,
616 but not limited to, compliance with provider network standards,
617 financial accountability, performance standards, health care
618 quality improvement systems, and program integrity select
619 participating plans and begin enrollment no later than January
620 31, 2024, with coverage for enrollees becoming effective upon
621 authorization and availability of sufficient state and federal
622 resources.
623 (b) Upon implementation of the program, the agency, in
624 consultation with the Agency for Persons with Disabilities,
625 shall conduct audits of the selected plans’ implementation of
626 person-centered planning.
627 (b)(c) The agency, in consultation with the Agency for
628 Persons with Disabilities, shall submit progress reports to the
629 Governor, the President of the Senate, and the Speaker of the
630 House of Representatives upon the federal approval,
631 implementation, and operation of the pilot program, as follows:
632 1. By August 30, 2025 December 31, 2023, a status report on
633 progress made toward federal approval of the waiver or waiver
634 amendment needed to implement the pilot program.
635 2. By December 31, 2025 2024, a status report on
636 implementation of the pilot program.
637 3. By December 31, 2025, and annually thereafter, a status
638 report on the operation of the pilot program, including, but not
639 limited to, all of the following:
640 a. Program enrollment, including the number and
641 demographics of enrollees.
642 b. Any complaints received.
643 c. Access to approved services.
644 (c)(d) The agency, in consultation with the Agency for
645 Persons with Disabilities, shall establish specific measures of
646 access, quality, and costs of the pilot program. The agency may
647 contract with an independent evaluator to conduct such
648 evaluation. The evaluation must include assessments of cost
649 savings; consumer education, choice, and access to services;
650 plans for future capacity and the enrollment of new Medicaid
651 providers; coordination of care; person-centered planning and
652 person-centered well-being outcomes; health and quality-of-life
653 outcomes; and quality of care by each eligibility category and
654 managed care plan in each pilot program site. The evaluation
655 must describe any administrative or legal barriers to the
656 implementation and operation of the pilot program in each
657 region.
658 1. The agency, in consultation with the Agency for Persons
659 with Disabilities, shall conduct quality assurance monitoring of
660 the pilot program to include client satisfaction with services,
661 client health and safety outcomes, client well-being outcomes,
662 and service delivery in accordance with the client’s care plan.
663 2. The agency shall submit the results of the evaluation to
664 the Governor, the President of the Senate, and the Speaker of
665 the House of Representatives by October 1, 2029.
666 Section 6. (1) The Agency for Persons with Disabilities
667 shall contract for a study to review, evaluate, and identify
668 recommendations regarding the algorithm required under s.
669 393.0662, Florida Statutes. The individual contractor must
670 possess, or, if the contractor is a firm, must include at least
671 one lead team member who possesses, a doctorate in statistics
672 and advanced knowledge of the development and selection of
673 multiple linear regression models. The study must, at a minimum,
674 assess the performance of the current algorithm used by the
675 agency and determine whether a different algorithm would better
676 meet the requirements of that section. In conducting this
677 assessment and determination, at a minimum, the study must also
678 review the fit of recent expenditure data to the current
679 algorithm, determine and refine dependent and independent
680 variables, develop and apply a method for identifying and
681 removing outliers, develop alternative algorithms using multiple
682 linear regression, test the accuracy and reliability of the
683 algorithms, provide recommendations for improving accuracy and
684 reliability, recommend an algorithm for use by the agency,
685 assess the robustness of the recommended algorithm, and provide
686 suggestions for improving any recommended alternative algorithm,
687 if appropriate. The study must also consider whether any waiver
688 services that are not currently funded through the algorithm can
689 be funded through the current algorithm or an alternative
690 algorithm, and the impact of doing so on that algorithm’s fit
691 and effectiveness. The study must present for any recommended
692 alternative algorithm, at a minimum, the estimated number and
693 percent of waiver enrollees who would require supplemental
694 funding under s. 393.0662(1)(b), Florida Statutes, compared to
695 the current algorithm; and the number and percent of waiver
696 enrollees whose budgets are estimated to increase or decrease,
697 categorized by level of increase or decrease, age, living
698 setting, and current total individual budget amount.
699 (2) The agency shall report to the Governor, the President
700 of the Senate, and the Speaker of the House of Representatives
701 findings and recommendations by November 15, 2025.
702 Section 7. This act shall take effect July 1, 2025.