Bill Text: FL S1990 | 2012 | Regular Session | Introduced
Bill Title: Developmental Disabilities
Spectrum: Committee Bill
Status: (Failed) 2012-03-09 - Died in Conference Committee, companion bill(s) passed, see HB 5001 (Ch. [S1990 Detail]
Download: Florida-2012-S1990-Introduced.html
Florida Senate - 2012 SB 1990 By the Committee on Budget 576-03466-12 20121990__ 1 A bill to be entitled 2 An act relating to developmental disabilities; 3 amending s. 393.063, F.S.; redefining the term 4 “support coordinator”; amending s. 393.0661, F.S.; 5 requiring that the Agency for Persons with 6 Disabilities review a waiver support coordinator’s 7 performance to ensure that the support coordinator 8 meets or exceeds criteria established by the agency; 9 providing responsibilities of the support coordinator; 10 providing that the waiver is the funding source of 11 last resort for client services; requiring that the 12 agency’s area offices conduct and manage the provider 13 agreements with the waiver support coordinators and 14 the performance reviews; providing criteria for 15 evaluating a support coordinator’s performance; 16 authorizing the agency to recognize superior 17 performance by exempting a waiver support coordinator 18 from annual quality assurance reviews or other 19 mechanisms established by the agency; authorizing the 20 agency to issue sanctions for poor performance; 21 authorizing the agency to adopt rules; conforming a 22 cross-reference; amending s. 393.0662, F.S.; 23 conforming provisions to changes made by the act; 24 providing that funds appropriated to the agency shall 25 be allocated through the iBudget system to eligible, 26 Medicaid-enrolled clients who have a developmental 27 disability and not only Down syndrome; providing that 28 a client has the flexibility to determine the type, 29 amount, frequency, duration, and scope of the services 30 on his or her cost plan if certain criteria are met; 31 requiring that the agency determine the client’s 32 initial iBudget amount; requiring that the area office 33 review the amount of funding needed to address the 34 each client’s extraordinary needs in order to 35 determine the medical necessity for each service in 36 the amount, duration, frequency, intensity, and scope 37 that meets the client’s needs; requiring that the 38 agency to consider certain factors of the individual 39 which may affect the level of services needed; 40 requiring that the client’s medical necessity review 41 include a comparison of client’s algorithm allocation, 42 cost plan, and extraordinary needs; providing certain 43 requirements for an client’s initial annualized 44 iBudget amount; authorizing increases to an client’s 45 initial iBudget amount under certain circumstances 46 during specified fiscal years; deleting a provision 47 regarding the phasing-in process of the iBudget 48 system; requiring a client to use all available 49 nonwaiver services before using funds from his or her 50 iBudget to pay for support and services; creating s. 51 393.28, F.S.; requiring that the agency adopt and 52 enforce certain sanitation standards to protect 53 individuals served in facilities licensed or regulated 54 by the agency; requiring that the agency inspect or 55 contract for the inspection of those facilities; 56 authorizing the agency to adopt rules; requiring that 57 the agency defer to certain preexisting standards if 58 rules are not adopted; authorizing the agency to 59 consult with the Department of Health, the Agency for 60 Health Care Administration, the Department of Business 61 and Professional Regulation, and the Department of 62 Agriculture and Consumer Services concerning 63 procedures related to the storage, preparation, 64 serving, or display of food and procedures related to 65 the detection and prevention of diseases caused by 66 certain factors in the environment; authorizing the 67 agency to impose sanctions against certain 68 establishments or operators for violation of sanitary 69 standards; authorizing the agency to contract with 70 another entity for food service protection and 71 inspection services; providing an effective date. 72 73 Be It Enacted by the Legislature of the State of Florida: 74 75 Section 1. Subsection (37) of section 393.063, Florida 76 Statutes, is amended to read: 77 393.063 Definitions.—For the purposes of this chapter, the 78 term: 79 (37) “Support coordinator” means a person who is 80 contracting withdesignated bythe agency to assist clients 81individualsand families in identifying their capacities, needs, 82 and resources, as well as finding and gaining access to 83 necessary supports and services; locating or developing 84 employment opportunities; coordinating the delivery of supports 85 and services; advocating on behalf of the clientindividualand 86 family; maintaining relevant records; and monitoring and 87 evaluating the delivery of supports and services to determine 88 the extent to which they meet the needsand expectations89 identified by the clientindividual, family, and others who 90 participated in the development of the support plan. 91 Section 2. Present subsections (8), (9), and (10) of 92 section 393.0661, Florida Statutes, are redesignated as 93 subsections (9), (10), and (11), respectively, present 94 subsection (9) is amended, and a new subsection (8) is added to 95 that section, to read: 96 393.0661 Home and community-based services delivery system; 97 comprehensive redesign.—The Legislature finds that the home and 98 community-based services delivery system for persons with 99 developmental disabilities and the availability of appropriated 100 funds are two of the critical elements in making services 101 available. Therefore, it is the intent of the Legislature that 102 the Agency for Persons with Disabilities shall develop and 103 implement a comprehensive redesign of the system. 104 (8) In determining whether to continue a Medicaid waiver 105 provider agreement for support coordinator services, the agency 106 shall review the performance of the waiver support coordinator 107 to ensure that the support coordinator meets or exceeds the 108 criteria established by the agency. The support coordinator is 109 responsible for assisting the client in meeting his or her 110 service needs through nonwaiver resources, as well as through 111 the client’s budget allocation or cost plan under the waiver. 112 The waiver is the funding source of last resort for client 113 services. The agency’s area offices shall conduct and manage the 114 provider agreements with the waiver support coordinators and the 115 performance reviews. 116 (a) Criteria for evaluating a support coordinator’s 117 performance must include, but are not limited to: 118 1. The protection of the health and safety of clients. 119 2. The assistance provided to clients in obtaining 120 employment and pursuing other meaningful activities. 121 3. The assistance provided to clients in accessing services 122 that allow them to live in their community. 123 4. The use of family resources. 124 5. The use of private resources. 125 6. The use of community resources. 126 7. The use of charitable resources. 127 8. The use of volunteer resources. 128 9. The use of services from other governmental entities. 129 10. The overall outcome in securing nonwaiver resources. 130 11. The cost-effective use of waiver resources. 131 12. The coordination of all available resources to ensure 132 that clients’ outcomes are met. 133 (b) The agency may recognize consistently superior 134 performance by exempting a waiver support coordinator from 135 annual quality assurance reviews or other mechanisms established 136 by the agency. The agency may issue sanctions for poor 137 performance, including, but not limited to, a reduction in 138 caseload size, recoupment or other financial penalties, and 139 termination of the waiver support coordinator’s provider 140 agreement. The agency may adopt rules to administer this 141 subsection. 142 (10)(9)The Agency for Persons with Disabilities shall 143 submit quarterly status reports to the Executive Office of the 144 Governor, the chair of the Senate Ways and Means Committee or 145 its successor, and the chair of the House Fiscal Council or its 146 successor regarding the financial status of home and community 147 based services, including the number of enrolled individuals who 148 are receiving services through one or more programs; the number 149 of individuals who have requested services who are not enrolled 150 but who are receiving services through one or more programs, 151 with a description indicating the programs from which the 152 individual is receiving services; the number of individuals who 153 have refused an offer of services but who choose to remain on 154 the list of individuals waiting for services; the number of 155 individuals who have requested services but who are receiving no 156 services; a frequency distribution indicating the length of time 157 individuals have been waiting for services; and information 158 concerning the actual and projected costs compared to the amount 159 of the appropriation available to the program and any projected 160 surpluses or deficits. If at any time an analysis by the agency, 161 in consultation with the Agency for Health Care Administration, 162 indicates that the cost of services is expected to exceed the 163 amount appropriated, the agency shall submit a plan in 164 accordance with subsection (9)(8)to the Executive Office of 165 the Governor, the chair of the Senate Ways and Means Committee 166 or its successor, and the chair of the House Fiscal Council or 167 its successor to remain within the amount appropriated. The 168 agency shall work with the Agency for Health Care Administration 169 to implement the plan so as to remain within the appropriation. 170 Section 3. Section 393.0662, Florida Statutes, is amended 171 to read: 172 393.0662 Individual budgets for delivery of home and 173 community-based services; iBudget system established.—The 174 Legislature finds that improved financial management of the 175 existing home and community-basedMedicaidwaiver program is 176 necessary to avoid deficits that impede the provision of 177 services to individuals who are on the waiting list for 178 enrollment in the program. The Legislature further finds that 179 clients and their families should have greater flexibility to 180 choose the services that best allow them to live in their 181 community within the limits of an established budget. Therefore, 182 the Legislature intends that the agency, in consultation with 183 the Agency for Health Care Administration, develop and implement 184 a comprehensive redesign of the service delivery system using 185 individual budgets as the basis for allocating the funds 186 appropriated for thehome and community-based services Medicaid187 waiver program among eligible enrolled clients. The service 188 delivery system that uses individual budgets shall be called the 189 iBudget system. 190 (1) The agency shall establish an individual budget, to be 191 referred to as an iBudget, for each clientindividualserved by 192 the home and community-based servicesMedicaidwaiver program. 193 The funds appropriated to the agency shall be allocated through 194 the iBudget system to eligible, Medicaid-enrolled clients who 195 have. For the iBudget system, eligible clients shall include196individuals with a diagnosis of Down syndrome ora developmental 197 disabilityas defined in s.393.063. The iBudget system shall be 198 designed to provide for: enhanced client choice within a 199 specified service package; appropriate assessment strategies; an 200 efficient consumer budgeting and billing process that includes 201 reconciliation and monitoring components; a redefined role for 202 support coordinators whichthatavoids potential conflicts of 203 interest; a flexible and streamlined service review process; and 204 a methodology and process that ensures the equitable allocation 205 of available funds to each client based on the client’s level of 206 need, as determined by the variables in the allocation 207 algorithm. 208 (2)(a)In developing each client’s iBudget, the agency 209 shall use an allocation algorithm and methodology. 210 (a) The algorithm shall use variables that have been 211 determined by the agency to have a statistically validated 212 relationship to the client’s level of need for services provided 213 through thehome and community-based services Medicaidwaiver 214 program. The algorithmand methodologymay consider individual 215 characteristics, including, but not limited to, a client’s age 216 and living situation, information from a formal assessment 217 instrument that the agency determines is valid and reliable, and 218 information from other assessment processes. 219 (b) The allocation methodology shall provide the algorithm 220 that determines the amount of funds allocated to a client’s 221 iBudget. The agency may approve an increase in the amountof222fundsallocated, as determinedby the algorithm, based on the 223 client having one or more of the following needs that cannot be 224 accommodated within thefunding as determined by thealgorithm 225 allocation and having no other resources, supports, or services 226 available to meet such needsthe need: 227 1. An extraordinary need that would place the health and 228 safety of the client, the client’s caregiver, or the public in 229 immediate, serious jeopardy unless the increase is approved. An 230 extraordinary need may include, but is not limited to: 231 a. A documented history of significant, potentially life 232 threatening behaviors, such as recent attempts at suicide, 233 arson, nonconsensual sexual behavior, or self-injurious behavior 234 requiring medical attention; 235 b. A complex medical condition that requires active 236 intervention by a licensed nurse on an ongoing basis that cannot 237 be taught or delegated to a nonlicensed person; 238 c. A chronic comorbid condition. As used in this 239 subparagraph, the term “comorbid condition” means a medical 240 condition existing simultaneously but independently with another 241 medical condition in a patient; or 242 d. A need for total physical assistance with activities 243 such as eating, bathing, toileting, grooming, and personal 244 hygiene. 245 246 However, the presence of an extraordinary need alone does not 247 warrant an increase in the amount of funds allocated to a 248 client’s iBudget as determined by the algorithm. 249 2. A significant need for one-time or temporary support or 250 services that, if not provided, would place the health and 251 safety of the client, the client’s caregiver, or the public in 252 serious jeopardy, unless the increase is approved. A significant 253 need may include, but is not limited to, the provision of 254 environmental modifications, durable medical equipment, services 255 to address the temporary loss of support from a caregiver, or 256 special services or treatment for a serious temporary condition 257 when the service or treatment is expected to ameliorate the 258 underlying condition. As used in this subparagraph, the term 259 “temporary” means lessa period of fewerthan 12 continuous 260 months. However, the presence of such significant need for one 261 time or temporary supports or services alone does not warrant an 262 increase in the amount of funds allocated to a client’s iBudget 263 as determined by the algorithm. 264 3. A significant increase in the need for services after 265 the beginning of the service plan year whichthatwould place 266 the health and safety of the client, the client’s caregiver, or 267 the public in serious jeopardy because of substantial changes in 268 the client’s circumstances, including, but not limited to, 269 permanent or long-term loss or incapacity of a caregiver, loss 270 of services authorized under the state Medicaid plan due to a 271 change in age, or a significant change in medical or functional 272 status which requires the provision of additional services on a 273 permanent or long-term basis whichthatcannot be accommodated 274 within the client’s current iBudget. As used in this 275 subparagraph, the term “long-term” meansa period of12 or more 276 continuous months. However, such significant increase in need 277 for services of a permanent or long-term nature alone does not 278 warrant an increase in the amount of funds allocated to a 279 client’s iBudget as determined by the algorithm. 280 281 The agency shall reserve portions of the appropriation for the 282home and community-based services Medicaidwaiver program for 283 adjustments required pursuant to this paragraph and may use the 284 services of an independent actuary in determining the amount of 285 the portions to be reserved. 286 (c) A client’s iBudget shall be the total of the amount 287 determined by the algorithm and any additional funding provided 288 pursuant to paragraph (b). 289 (d) A client shall have the flexibility to determine the 290 type, amount, frequency, duration, and scope of the services on 291 his or her cost plan if the agency determines that such services 292 meet his or her health and safety needs, meet the requirements 293 contained in the Coverage and Limitations Handbook for each 294 service included on the cost plan, and comply with the other 295 requirements of this section. 296 (e) A client’s annual expenditures forhome and community297based services Medicaidwaiver services may not exceed the 298 limits of his or her iBudget. The total of all clients’ 299 projected annual iBudget expenditures may not exceed the 300 agency’s appropriation for waiver services. 301 (3)(2)The Agency for Health Care Administration, in 302 consultation with the agency, shall seek federal approval to 303 amend current waivers, request a new waiver, and amend contracts 304 as necessary to implement the iBudget system to serve eligible, 305 enrolled clients through the home and community-based services 306 Medicaid waiver program and the Consumer-Directed Care Plus 307 Program. 308 (4)(3)The agency shall transition all eligible, enrolled 309 clients to the iBudget system. The agency may gradually phase in 310 the iBudget system. 311 (a) During the transition, the agency shall determine an 312 client’s initial iBudget amount by comparing the client’s 313 algorithm allocation to the client’s current annual cost plan 314 and the client’s extraordinary needs. The client’s algorithm 315 allocation is the amount determined by the algorithm, adjusted 316 to the agency’s appropriation and any set-asides determined 317 necessary by the agency, including, but not limited to, funding 318 for individuals who have extraordinary needs as delineated in 319 paragraph (2)(b). The area office shall review the amount of 320 funding needed to address the each client’s extraordinary needs 321 in order to determine the medical necessity for each service in 322 the amount, duration, frequency, intensity, and scope that meets 323 the client’s needs. The agency shall consider the client’s 324 characteristics based on a needs assessment as well as the 325 client’s living setting, availability of natural supports, 326 family circumstances, and other factors that may affect the 327 level of service needed. 328 (b) The client’s medical-necessity review must include a 329 comparison of the following: 330 1. If the client’s algorithm allocation is greater than the 331 individual cost plan, the client’s initial iBudget shall be 332 equal to the total cost plan amount. 333 2. If the client’s algorithm allocation is less than the 334 client’s cost plan but is greater than the amount for the 335 client’s extraordinary needs, the client’s initial iBudget shall 336 be equal to the algorithm allocation. 337 3. If the client’s algorithm allocation is less than the 338 amount for the client’s extraordinary needs, the client’s 339 initial iBudget shall be equal to the amount for the client’s 340 extraordinary needs. 341 342 The client’s initial annualized iBudget amount may not be less 343 than 50 percent of that client’s existing annualized cost plan. 344 If the client’s initial iBudget is less than the client’s 345 current cost plan, and is within $1,000 of the current cost 346 plan, the agency may adjust the iBudget to equal the cost plan 347 amount. 348 (c) During the 2011-2012 and 2012-2013 fiscal years, 349 increases to an client’s initial iBudget amount may be granted 350 only if a significant change in circumstances has occurred and 351 if the criteria for extraordinary needs as described in 352 paragraph (2)(b) are met. 353 (d)(a)While the agency phases in the iBudget system, the 354 agency may continue to serve eligible, enrolled clients under 355 the four-tiered waiver system established under s. 393.065 while 356 those clients await transitioning to the iBudget system. 357(b) The agency shall design the phase-in process to ensure358that a client does not experience more than one-half of any359expected overall increase or decrease to his or her existing360annualized cost plan during the first year that the client is361provided an iBudget due solely to the transition to the iBudget362system.363 (5)(4)A client must use all available nonwaiver services 364authorized under the state Medicaid plan, school-based services,365private insurance and other benefits, and any other resources366 that may be available to the client before using funds from his 367 or her iBudget to pay for support and services. 368 (6)(5)The service limitations in s. 393.0661(3)(f)1., 2., 369 and 3. do not apply to the iBudget system. 370 (7)(6)Rates for any or all services established under 371 rules of the Agency for Health Care Administration mustshallbe 372 designated as the maximum rather than a fixed amount for clients 373individualswho receive an iBudget, except for services 374 specifically identified in those rules that the agency 375 determines are not appropriate for negotiation, which may 376 include, but are not limited to, residential habilitation 377 services. 378 (8)(7)The agency shall ensure that clients and caregivers 379 have access to training and education that informsto inform380 them about the iBudget system and enhancesenhancetheir ability 381 for self-direction. Such training must be providedshall be382offeredin a variety of formats and, at a minimum, mustshall383 address the policies and processes of the iBudget system; the 384 roles and responsibilities of consumers, caregivers, waiver 385 support coordinators, providers, and the agency; information 386 that is available to help the client make decisions regarding 387 the iBudget system; and examples of nonwaiversupport and388 resources that may be available in the community. 389 (9)(8)The agency shall collect data to evaluate the 390 implementation and outcomes of the iBudget system. 391 (10)(9)The agency and the Agency for Health Care 392 Administration may adopt rules specifying the allocation 393 algorithm and methodology; criteria and processes that allowfor394 clients to access reserved funds for extraordinary needs, 395 temporarily or permanently changed needs, and one-time needs; 396 and processes and requirements for the selection and review of 397 services, development of support and cost plans, and management 398 of the iBudget system as needed to administer this section. 399 Section 4. Section 393.28, Florida Statutes, is created to 400 read: 401 393.28 Food service and environmental health protection and 402 inspection.— 403 (1) AUTHORITY.— 404 (a) The Agency for Persons with Disabilities shall adopt 405 and enforce sanitation standards related to food-borne illnesses 406 and environmental sanitation hazards to ensure the protection of 407 individuals served in facilities licensed or regulated by the 408 agency under s. 393.067 by inspecting or contracting for the 409 inspection of those facilities. 410 (b) The agency may develop rules to administer this 411 section. In the absence of rules, the agency shall defer to 412 preexisting standards related to environmental health 413 inspections of group care facilities as described in s. 381.006, 414 preexisting standards related to food service establishments as 415 described in s. 381.0072, and the rules relevant to these 416 provisions. 417 (c) Rules under this section may provide additional or 418 alternative standards to those referenced in paragraph (b), and 419 may include sanitation requirements for the storage, 420 preparation, and serving of food, as well as sanitation 421 requirements to detect and prevent disease caused by natural and 422 manmade factors in the environment. 423 (2) CONSULTATION.—The agency may consult with the 424 Department of Health, the Agency for Health Care Administration, 425 the Department of Business and Professional Regulation, and the 426 Department of Agriculture and Consumer Services concerning 427 procedures related to the storage, preparation, serving, or 428 display of food and procedures related to the detection and 429 prevention of diseases caused by natural and manmade factors in 430 the environment. 431 (3) LICENSING SANCTIONS; PROCEDURES.—The agency may impose 432 sanctions pursuant to s. 393.0673 against any establishment or 433 operator licensed under s. 393.067 for violations of sanitary 434 standards. 435 (4) CONTRACTING.—The agency may contract with another 436 entity for the provision of food service protection and 437 inspection services. 438 Section 5. This act shall take effect July 1, 2012.