Bill Text: FL S1170 | 2024 | Regular Session | Introduced
Bill Title: Home and Community-based Services Medicaid Waiver Program
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2024-03-08 - Died in Children, Families, and Elder Affairs [S1170 Detail]
Download: Florida-2024-S1170-Introduced.html
Florida Senate - 2024 SB 1170
By Senator Bradley
6-01504-24 20241170__
1 A bill to be entitled
2 An act relating to the home and community-based
3 services Medicaid waiver program; amending s. 393.065,
4 F.S.; requiring the Agency for Persons with
5 Disabilities to develop and implement an automated,
6 electronic application process for specified services;
7 providing requirements for the application process;
8 requiring the agency to provide an application in a
9 printed form or a portable document format under
10 certain circumstances; deleting the requirement that
11 application for services be made to the agency in the
12 region in which the applicant resides; specifying that
13 applicants meeting specified criteria are deemed to be
14 in crisis regardless of the applicant’s age; requiring
15 the agency to make an eligibility determination for
16 certain applicants within specified timeframes;
17 authorizing the agency to request additional
18 documentation needed to make an eligibility
19 determination; prohibiting such request from
20 preventing or delaying services to the applicant;
21 providing for a comprehensive assessment of an
22 applicant under certain circumstances; requiring the
23 agency to complete its eligibility determination
24 within a specified timeframe after requesting
25 additional documentation from or arranging for a
26 comprehensive assessment of the applicant; requiring
27 the Agency for Persons with Disabilities and the
28 Agency for Health Care Administration to adopt rules
29 and implement certain policies by a specified date;
30 amending s. 393.0662, F.S.; providing requirements for
31 the Agency for Health Care Administration when a
32 client’s iBudget is established; requiring the Agency
33 for Persons with Disabilities to ensure that certain
34 client services commence within a specified timeframe;
35 requiring the Agency for Persons with Disabilities and
36 the Agency for Health Care Administration to adopt
37 rules and implement certain policies by a specified
38 date; amending ss. 393.0651, 409.9127, and 409.9855,
39 F.S.; conforming cross-references; providing an
40 effective date.
41
42 Be It Enacted by the Legislature of the State of Florida:
43
44 Section 1. Present subsections (1) through (12) of section
45 393.065, Florida Statutes, are redesignated as subsections (2)
46 through (13), respectively, a new subsection (1) is added to
47 that section, and present subsections (1), (5), (6), and (7),
48 paragraph (a) of present subsection (8), and present subsections
49 (11) and (12) are amended, to read:
50 393.065 Application and eligibility determination.—
51 (1) As part of the agency’s website, the agency shall
52 develop and implement an automated, electronic application
53 process. The application process shall, at a minimum, support:
54 (a) Electronic submissions.
55 (b) Automatic processing of each application.
56 (c) Immediate automatic e-mail confirmation to each
57 applicant with proof of filing along with a date and time stamp.
58 (d) Upon request, if the applicant does not have access to
59 electronic resources, providing the applicant with the
60 application in printed form or in a portable document format.
61 (2)(1) Application for services shall be made in writing to
62 the agency, in the region in which the applicant resides. The
63 agency shall review each application and make an eligibility
64 determination within 60 days after receipt of the signed
65 application. If, at the time of the application, an applicant is
66 requesting enrollment in the home and community-based services
67 Medicaid waiver program for individuals with developmental
68 disabilities deemed to be in crisis, as described in paragraph
69 (6)(a) (5)(a), the agency shall complete an eligibility
70 determination within 45 days after receipt of the signed
71 application.
72 (a) If the agency determines additional documentation is
73 necessary to make an eligibility determination, the agency may
74 request the additional documentation from the applicant.
75 (b) When necessary to definitively identify individual
76 conditions or needs, the agency or its designee must provide a
77 comprehensive assessment.
78 (c) If the agency requests additional documentation from
79 the applicant or provides or arranges for a comprehensive
80 assessment, the agency’s eligibility determination must be
81 completed within 90 days after receipt of the signed
82 application.
83 (d) If the applicant meets the criteria for preenrollment
84 category 2 in paragraph (6)(b), such applicant is deemed to be
85 in crisis and the following is required, regardless of the
86 applicant’s age:
87 1. The agency shall review each application and make an
88 eligibility determination within 5 business days after receipt
89 of the signed application.
90 2. If, at the time of the application, the applicant is
91 requesting enrollment in the home and community-based services
92 Medicaid waiver program for individuals with developmental
93 disabilities deemed to be in crisis, as described in paragraph
94 (6)(a), the agency must complete an eligibility determination
95 within 15 calendar days after receipt of the signed application.
96 3. If the agency determines additional documentation is
97 necessary to make an eligibility determination, the agency may
98 request additional documentation from the applicant, but such
99 agency request may not prevent or delay services to the
100 applicant. When necessary to definitively identify individual
101 conditions or needs, the agency or its designee must provide a
102 comprehensive assessment.
103 4. If the agency requests additional documentation from the
104 applicant or provides or arranges for a comprehensive
105 assessment, the agency’s eligibility determination must be
106 completed within 60 calendar days after receipt of the signed
107 application.
108 (6)(5) Except as provided in subsections (7) and (8) (6)
109 and (7), if a client seeking enrollment in the developmental
110 disabilities home and community-based services Medicaid waiver
111 program meets the level of care requirement for an intermediate
112 care facility for individuals with intellectual disabilities
113 pursuant to 42 C.F.R. ss. 435.217(b)(1) and 440.150, the agency
114 must assign the client to an appropriate preenrollment category
115 pursuant to this subsection and must provide priority to clients
116 waiting for waiver services in the following order:
117 (a) Category 1, which includes clients deemed to be in
118 crisis as described in rule, must be given first priority in
119 moving from the preenrollment categories to the waiver.
120 (b) Category 2, which includes clients in the preenrollment
121 categories who are:
122 1. From the child welfare system with an open case in the
123 Department of Children and Families’ statewide automated child
124 welfare information system and who are either:
125 a. Transitioning out of the child welfare system into
126 permanency; or
127 b. At least 18 years but not yet 22 years of age and who
128 need both waiver services and extended foster care services; or
129 2. At least 18 years but not yet 22 years of age and who
130 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the
131 extended foster care system.
132 For individuals who are at least 18 years but not yet 22 years
133 of age and who are eligible under sub-subparagraph 1.b., the
134 agency must provide waiver services, including residential
135 habilitation, and the community-based care lead agency must fund
136 room and board at the rate established in s. 409.145(3) and
137 provide case management and related services as defined in s.
138 409.986(3)(e). Individuals may receive both waiver services and
139 services under s. 39.6251. Services may not duplicate services
140 available through the Medicaid state plan.
141 (c) Category 3, which includes, but is not required to be
142 limited to, clients:
143 1. Whose caregiver has a documented condition that is
144 expected to render the caregiver unable to provide care within
145 the next 12 months and for whom a caregiver is required but no
146 alternate caregiver is available;
147 2. At substantial risk of incarceration or court commitment
148 without supports;
149 3. Whose documented behaviors or physical needs place them
150 or their caregiver at risk of serious harm and other supports
151 are not currently available to alleviate the situation; or
152 4. Who are identified as ready for discharge within the
153 next year from a state mental health hospital or skilled nursing
154 facility and who require a caregiver but for whom no caregiver
155 is available or whose caregiver is unable to provide the care
156 needed.
157 (d) Category 4, which includes, but is not required to be
158 limited to, clients whose caregivers are 70 years of age or
159 older and for whom a caregiver is required but no alternate
160 caregiver is available.
161 (e) Category 5, which includes, but is not required to be
162 limited to, clients who are expected to graduate within the next
163 12 months from secondary school and need support to obtain a
164 meaningful day activity, maintain competitive employment, or
165 pursue an accredited program of postsecondary education to which
166 they have been accepted.
167 (f) Category 6, which includes clients 21 years of age or
168 older who do not meet the criteria for category 1, category 2,
169 category 3, category 4, or category 5.
170 (g) Category 7, which includes clients younger than 21
171 years of age who do not meet the criteria for category 1,
172 category 2, category 3, or category 4.
173 Within preenrollment categories 3, 4, 5, 6, and 7, the agency
174 shall prioritize clients in the order of the date that the
175 client is determined eligible for waiver services.
176 (7)(6) The agency must allow an individual who meets the
177 eligibility requirements of subsection (3) (2) to receive home
178 and community-based services in this state if the individual’s
179 parent or legal guardian is an active-duty military
180 servicemember and if, at the time of the servicemember’s
181 transfer to this state, the individual was receiving home and
182 community-based services in another state.
183 (8)(7) The agency must allow an individual with a diagnosis
184 of Phelan-McDermid syndrome who meets the eligibility
185 requirements of subsection (3) (2) to receive home and
186 community-based services.
187 (9)(8) Only a client may be eligible for services under the
188 developmental disabilities home and community-based services
189 Medicaid waiver program. For a client to receive services under
190 the developmental disabilities home and community-based services
191 Medicaid waiver program, there must be available funding
192 pursuant to s. 393.0662 or through a legislative appropriation
193 and the client must meet all of the following:
194 (a) The eligibility requirements of subsection (3) (2),
195 which must be confirmed by the agency.
196 (12)(a)(11)(a) The agency must provide the following
197 information to all applicants or their parents, legal guardians,
198 or family members:
199 1. A brief overview of the vocational rehabilitation
200 services offered through the Division of Vocational
201 Rehabilitation of the Department of Education, including a
202 hyperlink or website address that provides access to the
203 application for such services;
204 2. A brief overview of the Florida ABLE program as
205 established under s. 1009.986, including a hyperlink or website
206 address that provides access to the application for establishing
207 an ABLE account as defined in s. 1009.986(2);
208 3. A brief overview of the supplemental security income
209 benefits and social security disability income benefits
210 available under Title XVI of the Social Security Act, as
211 amended, including a hyperlink or website address that provides
212 access to the application for such benefits;
213 4. A statement indicating that the applicant’s local public
214 school district may provide specialized instructional services,
215 including transition programs, for students with special
216 education needs;
217 5. A brief overview of programs and services funded through
218 the Florida Center for Students with Unique Abilities, including
219 contact information for each state-approved Florida
220 Postsecondary Comprehensive Transition Program;
221 6. A brief overview of decisionmaking options for
222 individuals with disabilities, guardianship under chapter 744,
223 and alternatives to guardianship as defined in s. 744.334(1),
224 which may include contact information for organizations that the
225 agency believes would be helpful in assisting with such
226 decisions;
227 7. A brief overview of the referral tools made available
228 through the agency, including a hyperlink or website address
229 that provides access to such tools; and
230 8. A statement indicating that some waiver providers may
231 serve private-pay individuals.
232 (b) The agency must provide the information required in
233 paragraph (a) in writing to an applicant or his or her parent,
234 legal guardian, or family member along with a written disclosure
235 statement in substantially the following form:
236
237 DISCLOSURE STATEMENT
238 Each program and service has its own eligibility
239 requirements. By providing the information specified in
240 section 393.065(12)(a) 393.065(11)(a), Florida Statutes,
241 the agency does not guarantee an applicant’s eligibility
242 for or enrollment in any program or service.
243
244 (c) The agency must also publish the information required
245 in paragraph (a) and the disclosure statement in paragraph (b)
246 on its website, and must provide that information and statement
247 annually to each client placed in the preenrollment categories
248 or to the parent, legal guardian, or family member of such
249 client.
250 (13)(12) The agency and the Agency for Health Care
251 Administration:
252 (a) May adopt rules specifying application procedures,
253 criteria associated with the preenrollment categories,
254 procedures for administering the preenrollment, including tools
255 for prioritizing waiver enrollment within preenrollment
256 categories, and eligibility requirements as needed to administer
257 this section.
258 (b) By September 29, 2024, shall adopt rules and implement
259 policies to maintain compliance with paragraph (2)(d).
260 Section 2. Subsections (2) and (15) of section 393.0662,
261 Florida Statutes, are amended to read:
262 393.0662 Individual budgets for delivery of home and
263 community-based services; iBudget system established.—The
264 Legislature finds that improved financial management of the
265 existing home and community-based Medicaid waiver program is
266 necessary to avoid deficits that impede the provision of
267 services to individuals who are on the waiting list for
268 enrollment in the program. The Legislature further finds that
269 clients and their families should have greater flexibility to
270 choose the services that best allow them to live in their
271 community within the limits of an established budget. Therefore,
272 the Legislature intends that the agency, in consultation with
273 the Agency for Health Care Administration, shall manage the
274 service delivery system using individual budgets as the basis
275 for allocating the funds appropriated for the home and
276 community-based services Medicaid waiver program among eligible
277 enrolled clients. The service delivery system that uses
278 individual budgets shall be called the iBudget system.
279 (2) The Agency for Health Care Administration, in
280 consultation with the agency, shall:
281 (a) Seek federal approval to amend current waivers, request
282 a new waiver, and amend contracts as necessary to manage the
283 iBudget system, improve services for eligible and enrolled
284 clients, and improve the delivery of services through the home
285 and community-based services Medicaid waiver program and the
286 Consumer-Directed Care Plus Program, including, but not limited
287 to, enrollees with a dual diagnosis of a developmental
288 disability and a mental health disorder.
289 (b) At the time a client’s iBudget is established:
290 1. Educate the client or the caregiver of the client
291 regarding the Consumer-Directed Care Plus Program.
292 2. Provide each client the opportunity to apply for the
293 Consumer-Directed Care Plus Program.
294 (c) The agency shall, within 14 calendar days after the
295 time of a client’s submission of an application for the
296 Consumer-Directed Care Plus Program, ensure that the client’s
297 Consumer-Directed Care Plus Program services commence and the
298 client is no longer required to access services through the
299 iBudget system.
300 (15) The agency and the Agency for Health Care
301 Administration:
302 (a) May adopt rules specifying the allocation algorithm and
303 methodology; criteria and processes for clients to access funds
304 for services to meet significant additional needs; and processes
305 and requirements for selection and review of services,
306 development of support and cost plans, and management of the
307 iBudget system as needed to administer this section.
308 (b) By September 29, 2024, shall adopt rules and implement
309 policies to maintain compliance with paragraph (2)(b).
310 Section 3. Section 393.0651, Florida Statutes, is amended
311 to read:
312 393.0651 Family or individual support plan.—The agency
313 shall provide directly or contract for the development of a
314 family support plan for children ages 3 to 18 years of age and
315 an individual support plan for each client. The client, if
316 competent, the client’s parent or guardian, or, when
317 appropriate, the client advocate, shall be consulted in the
318 development of the plan and shall receive a copy of the plan.
319 Each plan must include the most appropriate, least restrictive,
320 and most cost-beneficial environment for accomplishment of the
321 objectives for client progress and a specification of all
322 services authorized. The plan must include provisions for the
323 most appropriate level of care for the client. Within the
324 specification of needs and services for each client, when
325 residential care is necessary, the agency shall move toward
326 placement of clients in residential facilities based within the
327 client’s community. The ultimate goal of each plan, whenever
328 possible, shall be to enable the client to live a dignified life
329 in the least restrictive setting, be that in the home or in the
330 community. The family or individual support plan must be
331 developed within 60 days after the agency determines the client
332 eligible pursuant to s. 393.065(4) s. 393.065(3).
333 (1) The agency shall develop and specify by rule the core
334 components of support plans.
335 (2) The family or individual support plan shall be
336 integrated with the individual education plan (IEP) for all
337 clients who are public school students entitled to a free
338 appropriate public education under the Individuals with
339 Disabilities Education Act, I.D.E.A., as amended. The family or
340 individual support plan and IEP must be implemented to maximize
341 the attainment of educational and habilitation goals.
342 (a) If the IEP for a student enrolled in a public school
343 program indicates placement in a public or private residential
344 program is necessary to provide special education and related
345 services to a client, the local education agency must provide
346 for the costs of that service in accordance with the
347 requirements of the Individuals with Disabilities Education Act,
348 I.D.E.A., as amended. This does not preclude local education
349 agencies and the agency from sharing the residential service
350 costs of students who are clients and require residential
351 placement.
352 (b) For clients who are entering or exiting the school
353 system, an interdepartmental staffing team composed of
354 representatives of the agency and the local school system shall
355 develop a written transitional living and training plan with the
356 participation of the client or with the parent or guardian of
357 the client, or the client advocate, as appropriate.
358 (3) Each family or individual support plan shall be
359 facilitated through case management designed solely to advance
360 the individual needs of the client.
361 (4) In the development of the family or individual support
362 plan, a client advocate may be appointed by the support planning
363 team for a client who is a minor or for a client who is not
364 capable of express and informed consent when:
365 (a) The parent or guardian cannot be identified;
366 (b) The whereabouts of the parent or guardian cannot be
367 discovered; or
368 (c) The state is the only legal representative of the
369 client.
370
371 Such appointment may not be construed to extend the powers of
372 the client advocate to include any of those powers delegated by
373 law to a legal guardian.
374 (5) The agency shall place a client in the most appropriate
375 and least restrictive, and cost-beneficial, residential facility
376 according to his or her individual support plan. The client, if
377 competent, the client’s parent or guardian, or, when
378 appropriate, the client advocate, and the administrator of the
379 facility to which placement is proposed shall be consulted in
380 determining the appropriate placement for the client.
381 Considerations for placement shall be made in the following
382 order:
383 (a) Client’s own home or the home of a family member or
384 direct service provider.
385 (b) Foster care facility.
386 (c) Group home facility.
387 (d) Intermediate care facility for the developmentally
388 disabled.
389 (e) Other facilities licensed by the agency which offer
390 special programs for people with developmental disabilities.
391 (f) Developmental disabilities center.
392 (6) In developing a client’s annual family or individual
393 support plan, the individual or family with the assistance of
394 the support planning team shall identify measurable objectives
395 for client progress and shall specify a time period expected for
396 achievement of each objective.
397 (7) The individual, family, and support coordinator shall
398 review progress in achieving the objectives specified in each
399 client’s family or individual support plan, and shall revise the
400 plan annually, following consultation with the client, if
401 competent, or with the parent or guardian of the client, or,
402 when appropriate, the client advocate. The agency or designated
403 contractor shall annually report in writing to the client, if
404 competent, or to the parent or guardian of the client, or to the
405 client advocate, when appropriate, with respect to the client’s
406 habilitative and medical progress.
407 (8) Any client, or any parent of a minor client, or
408 guardian, authorized guardian advocate, or client advocate for a
409 client, who is substantially affected by the client’s initial
410 family or individual support plan, or the annual review thereof,
411 shall have the right to file a notice to challenge the decision
412 pursuant to ss. 120.569 and 120.57. Notice of such right to
413 appeal shall be included in all support plans provided by the
414 agency.
415 Section 4. Subsection (3) of section 409.9127, Florida
416 Statutes, is amended to read:
417 409.9127 Preauthorization and concurrent utilization
418 review; conflict-of-interest standards.—
419 (3) The agency shall help the Agency for Persons with
420 Disabilities meet the requirements of s. 393.065(5) s.
421 393.065(4). Only admissions approved pursuant to such
422 assessments are eligible for reimbursement under this chapter.
423 Section 5. Paragraph (b) of subsection (2) of section
424 409.9855, Florida Statutes, is amended to read:
425 409.9855 Pilot program for individuals with developmental
426 disabilities.—
427 (2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT.—
428 (b) The Agency for Persons with Disabilities shall approve
429 a needs assessment methodology to determine functional,
430 behavioral, and physical needs of prospective enrollees. The
431 assessment methodology may be administered by persons who have
432 completed such training as may be offered by the agency.
433 Eligibility to participate in the pilot program is determined
434 based on all of the following criteria:
435 1. Whether the individual is eligible for Medicaid.
436 2. Whether the individual is 18 years of age or older and
437 is on the waiting list for individual budget waiver services
438 under chapter 393 and assigned to one of categories 1 through 6
439 as specified in s. 393.065(6) s. 393.065(5).
440 3. Whether the individual resides in a pilot program
441 region.
442 Section 6. This act shall take effect July 1, 2024.
