Bill Text: FL S1084 | 2023 | Regular Session | Comm Sub

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Pilot Program for Individuals with Developmental Disabilities

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2023-05-05 - Died on Calendar, companion bill(s) passed, see SB 2510 (Ch. 2023-243) [S1084 Detail]

Download: Florida-2023-S1084-Comm_Sub.html

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       Florida Senate - 2023                             CS for SB 1084
       
       
        
       By the Appropriations Committee on Health and Human Services;
       and Senator Trumbull
       
       
       
       
       603-03939-23                                          20231084c1
    1                        A bill to be entitled                      
    2         An act relating to the pilot program for individuals
    3         with developmental disabilities; creating s. 409.9855,
    4         F.S.; requiring the Agency for Health Care
    5         Administration to implement a pilot program for
    6         individuals with developmental disabilities in
    7         specified Statewide Medicaid Managed Care regions to
    8         provide coverage of comprehensive services;
    9         authorizing the agency to seek any federal approval
   10         needed to implement the program; requiring the agency
   11         to submit such request by a specified date; requiring
   12         the agency to administer the pilot program but
   13         delegate specified duties to the Agency for Persons
   14         with Disabilities; requiring the Agency for Health
   15         Care Administration to make payments for comprehensive
   16         services under the pilot program using a managed care
   17         model; providing applicability; requiring the Agency
   18         for Health Care Administration to evaluate the
   19         feasibility of implementing the pilot program
   20         statewide; providing that participation in the pilot
   21         program is voluntary and subject to specific
   22         appropriation; providing construction; requiring the
   23         Agency for Persons with Disabilities to conduct needs
   24         assessments of prospective enrollees; providing
   25         enrollment eligibility requirements; requiring the
   26         Agency for Persons with Disabilities to make offers
   27         for enrollment to eligible individuals within
   28         specified parameters; requiring that individuals
   29         enrolled in the pilot program be afforded an
   30         opportunity to enroll in any appropriate existing
   31         Medicaid waiver program upon cessation of the pilot
   32         program; requiring the Agency for Persons with
   33         Disabilities to adopt rules; requiring participating
   34         plans to cover specified benefits; providing
   35         additional requirements for the provision of benefits
   36         by participating plans under the pilot program;
   37         providing eligibility requirements for plans;
   38         providing a selection process; requiring the agency to
   39         give preference to certain plans; requiring capitated
   40         payments based on a specified methodology; requiring
   41         that the agencies ensure that the methodology be
   42         actuarially sound and reflect specified intent;
   43         requiring that the selected plan comply with specified
   44         provisions; providing that implementation of the
   45         program shall occur concurrently with other specified
   46         services; requiring the Agency for Persons with
   47         Disabilities to conduct certain audits of the selected
   48         plans and, in consultation with the agency, to submit
   49         specified progress reports to the Governor and the
   50         Legislature by specified dates throughout the program
   51         approval and implementation process; providing
   52         requirements for the respective reports; requiring the
   53         Agency for Persons with Disabilities, in consultation
   54         with the Agency for Health Care Administration, to
   55         conduct an evaluation of the pilot program;
   56         authorizing the Agency for Persons with Disabilities
   57         to contract with an independent evaluator to conduct
   58         such evaluation; providing requirements for the
   59         evaluation; requiring the Agency for Persons with
   60         Disabilities to conduct quality assurance monitoring
   61         of the pilot program; requiring the agencies to submit
   62         the results of the evaluation to the Governor and the
   63         Legislature by a specified date; requiring
   64         participating plans to maintain specified provider
   65         capacity limits; requiring participating plans to
   66         consult with the Agency for Persons with Disabilities
   67         before placing a pilot program enrollee in certain
   68         facilities; providing for the future repeal of the
   69         pilot program; amending s. 409.961, F.S.; conforming a
   70         provision to changes made by the act; requiring that
   71         plans selected to participate in the pilot program be
   72         plans awarded a contract as a result of a specified
   73         invitation to negotiate; requiring that the pilot
   74         program be implemented in specified Statewide Medicaid
   75         Managed Care regions; providing an effective date.
   76  
   77         WHEREAS, the mission of the Agency for Persons with
   78  Disabilities is developing community-based programs and services
   79  for individuals with developmental disabilities and working with
   80  private businesses, not-for-profit corporations, units of local
   81  government, and other organizations capable of providing needed
   82  services to clients to promote their living, learning, and
   83  working as part of their communities, and
   84         WHEREAS, the Agency for Persons with Disabilities advances
   85  that mission through the iBudget waiver, which is designed to
   86  promote and maintain the health of eligible individuals with
   87  developmental disabilities, to provide medically necessary
   88  supports and services to delay or prevent institutionalization,
   89  and to foster the principles and appreciation of self
   90  determination, and
   91         WHEREAS, the Legislature intends for a comprehensive and
   92  coordinated service delivery system for individuals with
   93  developmental disabilities which includes all services specified
   94  in ss. 393.066(3), 409.973, and 409.98, Florida Statutes, and
   95  the state’s home and community-based services Medicaid waiver
   96  program, and
   97         WHEREAS, the Legislature further intends that such service
   98  delivery system ensure consumer education and choice, including
   99  choice of provider, location of living setting, location of
  100  services, and scheduling of services and supports; access to
  101  care coordination services; local access to medically necessary
  102  services; coordination of preventative, acute, and long-term
  103  care and home and community-based services; reduction in
  104  unnecessary service utilization; provision of habilitative and
  105  rehabilitative services; and adherence to person-centered
  106  planning as described in 42 C.F.R. s. 441.301(c)(1), and
  107         WHEREAS, Florida continues to look for multiple innovative
  108  pathways to serve individuals with developmental disabilities
  109  and their families, including expanding the continuum of care to
  110  provide a robust and stable system that is a reliable provider
  111  of services for individuals with developmental disabilities to
  112  promote a comprehensive state of thriving in daily living,
  113  community integration, and goal-based achievement, NOW,
  114  THEREFORE,
  115  
  116  Be It Enacted by the Legislature of the State of Florida:
  117  
  118         Section 1. Section 409.9855, Florida Statutes, is created
  119  to read:
  120         409.9855 Pilot program for individuals with developmental
  121  disabilities.—
  122         (1) PILOT PROGRAM IMPLEMENTATION.—
  123         (a) Using a managed care model, the agency shall implement
  124  a pilot program for individuals with developmental disabilities
  125  in Statewide Medicaid Managed Care Regions D and I to provide
  126  coverage of comprehensive services, including community-based
  127  services described in s. 393.066(3) and services currently
  128  included in the state’s federally approved home and community
  129  based services Medicaid waiver program for individuals with
  130  developmental disabilities.
  131         (b) The agency may seek federal approval through an
  132  experimental, pilot, or demonstration project state plan
  133  amendment or Medicaid waiver as necessary to implement the pilot
  134  program, which is intended to provide an additional service
  135  delivery system for individuals with developmental disabilities
  136  in the state Medicaid program using an integrated-care
  137  management model designed to serve Medicaid recipients in the
  138  community. The agency shall submit a request for any federal
  139  approval needed to implement the pilot program by September 1,
  140  2023.
  141         (c) Pursuant to s. 409.963, the agency shall administer the
  142  pilot program, but shall delegate specific duties and
  143  responsibilities for the pilot program to the Agency for Persons
  144  with Disabilities. At a minimum, the Agency for Persons with
  145  Disabilities shall perform the duties specified in this section
  146  and in chapter 393 as they relate to individuals being served by
  147  the community-based services Medicaid waiver program.
  148         (d) The agency shall make payments for comprehensive
  149  services, including community-based services described in s.
  150  393.066(3) and approved through the state’s home and community
  151  based services Medicaid waiver program for individuals with
  152  developmental disabilities, using a managed care model. Unless
  153  otherwise specified, ss. 409.961-409.969 apply to the pilot
  154  program.
  155         (e) The agency shall evaluate the feasibility of statewide
  156  implementation of the capitated managed care model used by the
  157  pilot program to serve individuals with developmental
  158  disabilities.
  159         (2) ELIGIBILITY; VOLUNTARY ENROLLMENT.—
  160         (a) Participation in the pilot program is voluntary and
  161  limited to the maximum number of enrollees specified in the
  162  General Appropriations Act. Eligibility for the pilot program
  163  does not automatically entitle individuals to any other services
  164  under chapter 393.
  165         (b) The Agency for Persons with Disabilities shall conduct
  166  a needs assessment to determine functional, behavioral, and
  167  physical needs of prospective enrollees. Medicaid recipients
  168  identified as meeting all of the following criteria may receive
  169  offers of enrollment into the pilot program:
  170         1. Are 21 years of age or older and are on the waiting list
  171  for iBudget waiver services under chapter 393;
  172         2. Have been assigned to category 3, category 4, category
  173  5, or category 6 as specified in s. 393.065(5); and
  174         3. Reside in a pilot program region.
  175         (c) Notwithstanding any provisions of s. 393.065 to the
  176  contrary and subject to the availability of funds, the Agency
  177  for Persons with Disabilities shall make offers for enrollment
  178  to eligible individuals. Before making enrollment offers, the
  179  agency and the Agency for Persons with Disabilities shall
  180  determine that sufficient funds exist to support additional
  181  enrollment into plans. The Agency for Persons with Disabilities
  182  shall ensure that a statistically valid population is sampled to
  183  participate in the pilot program. The agency shall make
  184  enrollment offers and use clinical eligibility criteria that
  185  ensure that pilot program sites have sufficient diversity of
  186  enrollment to conduct a statistically valid test of the managed
  187  care pilot program within a 3-year timeframe.
  188         (d) Notwithstanding any provisions of s. 393.065 to the
  189  contrary, upon the cessation of the pilot program, individuals
  190  enrolled in the pilot program must be afforded an opportunity to
  191  enroll in any appropriate existing Medicaid waiver program. The
  192  Agency for Persons with Disabilities shall develop rules to
  193  implement this subsection.
  194         (3) PILOT PROGRAM BENEFITS.—
  195         (a) Plans participating in the pilot program must, at a
  196  minimum, cover the following:
  197         1. All benefits included in s. 409.973.
  198         2. All benefits included in s. 409.98.
  199         3. All benefits included in s. 393.066(3), and all of the
  200  following:
  201         a. Adult day training.
  202         b. Behavior analysis services.
  203         c. Behavior assistant services.
  204         d. Companion services.
  205         e. Consumable medical supplies.
  206         f. Dietitian services.
  207         g. Durable medical equipment and supplies.
  208         h. Environmental accessibility adaptations.
  209         i. Occupational therapy.
  210         j. Personal emergency response systems.
  211         k. Personal supports.
  212         l. Physical therapy.
  213         m. Prevocational services.
  214         n. Private duty nursing.
  215         o. Residential habilitation, including the following
  216  levels:
  217         (I) Standard level.
  218         (II) Behavior-focused level.
  219         (III) Intensive-behavior level.
  220         (IV) Enhanced intensive-behavior level.
  221         p. Residential nursing services.
  222         q. Respiratory therapy.
  223         r. Respite care.
  224         s. Skilled nursing.
  225         t. Specialized medical home care.
  226         u. Specialized mental health counseling.
  227         v. Speech therapy.
  228         w. Support coordination.
  229         x. Supported employment.
  230         y. Supported living coaching.
  231         z. Transportation.
  232         (b) All providers of the services listed under paragraph
  233  (a) must meet the provider qualifications outlined in the
  234  Florida Medicaid Developmental Disabilities Individual Budgeting
  235  Waiver Services Coverage and Limitations Handbook as adopted by
  236  reference in rule 59G-13.070, Florida Administrative Code.
  237         (c) Support coordination services must maximize the use of
  238  natural supports and community services before using state
  239  resources.
  240         (d) The plans participating in the pilot program must
  241  provide all categories of benefits through a single, integrated
  242  model of care.
  243         (e) Services must be provided to enrollees in accordance
  244  with an individualized care plan in conjunction with the Agency
  245  for Persons with Disabilities which is evaluated and updated at
  246  least quarterly and as warranted by changes in an enrollee’s
  247  circumstances.
  248         (4) ELIGIBLE PLANS; PLAN SELECTION.—
  249         (a) To be eligible to participate in the pilot program, a
  250  plan must have been awarded a contract to provide long-term care
  251  services pursuant to s. 409.966 as a result of an invitation to
  252  negotiate.
  253         (b) The agency shall select, as provided in s. 287.057(1),
  254  one plan to participate in the pilot program for each of the two
  255  regions. The director of the Agency for Persons with
  256  Disabilities or his or her designee must be a member of the
  257  negotiating team.
  258         1. The invitation to negotiate must specify the criteria
  259  and the relative weight assigned to each criterion that will be
  260  used for determining the acceptability of submitted responses
  261  and guiding the selection of the plans with which the agency and
  262  the Agency for Persons with Disabilities negotiate. In addition
  263  to any other criteria established by the agency and the Agency
  264  for Persons with Disabilities, the agencies shall consider the
  265  following factors in the selection of eligible plans:
  266         a. Experience serving similar populations, including the
  267  plan’s record in achieving specific quality standards with
  268  similar populations.
  269         b. Establishment of community partnerships with providers
  270  which create opportunities for reinvestment in community-based
  271  services.
  272         c. Provision of additional benefits, particularly
  273  behavioral health services, the coordination of dental care, and
  274  other initiatives that improve overall well-being.
  275         d. Provision of and capacity to provide mental health
  276  therapies and analysis designed to meet the needs of individuals
  277  with developmental disabilities.
  278         e. Evidence that an eligible plan has written agreements or
  279  signed contracts or has made substantial progress in
  280  establishing relationships with providers before submitting its
  281  response.
  282         f. Experience in the provision of person-centered planning
  283  as described in 42 C.F.R. s. 441.301(c)(1).
  284         g. Experience in robust provider development programs that
  285  result in increased availability of Medicaid providers to serve
  286  the developmental disabilities community.
  287         2. After negotiations are conducted, the agency shall
  288  select the eligible plans that are determined to be responsive
  289  and provide the best value to the state. Preference must be
  290  given to plans that:
  291         a. Have signed contracts in sufficient numbers to meet the
  292  specific standards established under s. 409.967(2)(c), including
  293  contracts for personal supports, skilled nursing, residential
  294  habilitation, adult day training, mental health services,
  295  respite care, companion services, and supported employment, as
  296  those services are defined in the Florida Medicaid Developmental
  297  Disabilities Individual Budgeting Waiver Services Coverage and
  298  Limitations Handbook as adopted by reference in rule 59G-13.070,
  299  Florida Administrative Code.
  300         b. Have well-defined programs for recognizing patient
  301  centered medical homes and providing increased compensation to
  302  recognized medical homes, as defined by the plan.
  303         c. Have well-defined programs related to person-centered
  304  planning as described in 42 C.F.R. s. 441.301(c)(1).
  305         d. Have robust and innovative programs for provider
  306  development and collaboration with the Agency for Persons with
  307  Disabilities.
  308         (5) CAPITATED PAYMENT.—
  309         (a) The selected plans shall receive capitated per-member,
  310  per-month payments based on a rate-setting methodology developed
  311  specifically for the unique needs of the developmentally
  312  disabled population.
  313         (b) The agency, in coordination with the Agency for Persons
  314  with Disabilities, must ensure that the capitation-rate-setting
  315  methodology for the integrated system is actuarially sound and
  316  reflects the intent to provide individualized, quality care in
  317  the least-restrictive setting.
  318         (c) The agency must include in the dental capitation-rate
  319  setting methodology for the prepaid dental health program
  320  established pursuant to s. 409.973(5) the inclusion of serving
  321  individuals in this population.
  322         (d) The selected plan must comply with s. 409.967(3).
  323         (6) PROGRAM IMPLEMENTATION AND EVALUATION.—
  324         (a) Full implementation of the pilot program shall occur
  325  concurrent to the contracts awarded, pursuant to s. 409.966, for
  326  the provision of managed medical assistance and long-term care
  327  services.
  328         (b) Upon implementation of the program, the Agency for
  329  Persons with Disabilities shall conduct audits of the selected
  330  plans’ implementation of person-centered planning.
  331         (c) The Agency for Persons with Disabilities shall, in
  332  consultation with the agency, submit progress reports to the
  333  Governor, the President of the Senate, and the Speaker of the
  334  House of Representatives upon the federal approval,
  335  implementation, and operation of the pilot program, as follows:
  336         1. By December 31, 2023, a status report on progress made
  337  toward federal approval of the waiver or waiver amendment needed
  338  to implement the pilot program.
  339         2. By December 31, 2024, a status report on progress made
  340  toward full implementation of the pilot program.
  341         3. By December 31, 2025, and annually thereafter, a status
  342  report on the operation of the pilot program, including, but not
  343  limited to, all of the following:
  344         a. Program enrollment, including the number and
  345  demographics of enrollees, statistically reflecting the
  346  diversity of enrollees.
  347         b. Any complaints received.
  348         c. Access to approved services.
  349         (d) The Agency for Persons with Disabilities shall, in
  350  consultation with the agency, conduct an evaluation of specific
  351  measures of access, quality, and costs of the pilot program. The
  352  Agency for Persons with Disabilities may contract with an
  353  independent evaluator to conduct such evaluation. The evaluation
  354  must include assessments of cost savings; consumer education,
  355  choice, and access to services; plans for future capacity and
  356  the enrollment of new Medicaid providers; coordination of care;
  357  person-centered planning and person-centered well-being
  358  outcomes; health and quality-of-life outcomes; and quality of
  359  care by each eligibility category and managed care plan in each
  360  pilot program site. The evaluation must describe any
  361  administrative or legal barriers to the implementation and
  362  operation of the pilot program in each region.
  363         1. The Agency for Persons with Disabilities shall conduct
  364  quality assurance monitoring of the pilot program to include
  365  client satisfaction with services, client health and safety
  366  outcomes, client well-being outcomes, and service delivery in
  367  accordance with the client’s care plan.
  368         2. The Agency for Persons with Disabilities and the agency
  369  shall submit the results of the evaluation to the Governor, the
  370  President of the Senate, and the Speaker of the House of
  371  Representatives by October 1, 2029.
  372         (7) MANAGED CARE PLAN ACCOUNTABILITY.—
  373         (a) In addition to the requirements of ss. 409.967,
  374  409.975, and 409.982, plans participating in the pilot program
  375  must have provider capacity within a maximum travel distance for
  376  clients to services for specialized therapies, adult day
  377  training, and prevocational training, for clients, as follows:
  378         1. For urban areas, 15 miles travel distance for clients;
  379  and
  380         2. For rural areas, 30 miles travel distance for clients.
  381         (b) Plans participating in the pilot program must consult
  382  with the Agency for Persons with Disabilities before placing an
  383  enrollee of the pilot program in a facility licensed by the
  384  Agency for Persons with Disabilities.
  385         (8) REPEAL.—This section shall be repealed October 2, 2029,
  386  after submission of the evaluation pursuant to paragraph (6)(d),
  387  unless reviewed and saved from repeal through reenactment by the
  388  Legislature.
  389         Section 2. Section 409.961, Florida Statutes, is amended to
  390  read:
  391         409.961 Statutory construction; applicability; rules.—It is
  392  the intent of the Legislature that if any conflict exists
  393  between the provisions contained in this part and in other parts
  394  of this chapter, the provisions in this part control. Sections
  395  409.961-9855 409.961-409.985 apply only to the Medicaid managed
  396  medical assistance program, the and long-term care managed care
  397  program, and the pilot program for individuals with
  398  developmental disabilities, as provided in this part. The agency
  399  shall adopt any rules necessary to comply with or administer
  400  this part and all rules necessary to comply with federal
  401  requirements. In addition, the department shall adopt and accept
  402  the transfer of any rules necessary to carry out the
  403  department’s responsibilities for receiving and processing
  404  Medicaid applications and determining Medicaid eligibility and
  405  for ensuring compliance with and administering this part, as
  406  those rules relate to the department’s responsibilities, and any
  407  other provisions related to the department’s responsibility for
  408  the determination of Medicaid eligibility. Contracts with the
  409  agency and a person or entity, including Medicaid providers and
  410  managed care plans, necessary to administer the Medicaid program
  411  are not rules and are not subject to chapter 120.
  412         Section 3. (1) For a plan to be selected to participate in
  413  the pilot program for individuals with developmental
  414  disabilities pursuant to s. 409.9855, Florida Statutes, as
  415  created by this act, the plan must have been awarded a contract
  416  as a result of the invitation to negotiate, ITN-04836, for
  417  Statewide Medicaid Managed Care Program which was issued on
  418  April 11, 2023.
  419         (2) The pilot program for individuals with developmental
  420  disabilities pursuant to s. 409.9855, Florida Statutes, as
  421  created by this act, shall be implemented in Statewide Medicaid
  422  Managed Care Regions D and I, as established by chapter 2022-42,
  423  Laws of Florida.
  424         Section 4. This act shall take effect upon becoming a law.