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.

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