Bill Text: FL S1468 | 2010 | Regular Session | Comm Sub
Bill Title: Home and Community-based Services [WPSC]
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2010-04-30 - Died in Senate, companion bill(s) passed, see HB 5303 (Ch. 2010-157) [S1468 Detail]
Download: Florida-2010-S1468-Comm_Sub.html
Florida Senate - 2010 CS for CS for SB 1468 By the Policy and Steering Committee on Ways and Means; the Committee on Health and Human Services Appropriations; and Senator Peaden 576-03798A-10 20101468c2 1 A bill to be entitled 2 An act relating to home and community-based services; 3 amending s. 393.0661, F.S.; reducing the annual 4 maximum expenditure to each client assigned by the 5 Agency for Persons With Disabilities to tier one, tier 6 two, tier three, and tier four level services; 7 eliminating behavior assistant services in certain 8 group homes as a deliverable service to eligible 9 clients; creating s. 393.0662, F.S.; establishing the 10 iBudget program for the delivery of home and 11 community-based services; providing for amendment of 12 current contracts to implement the iBudget system; 13 providing for the phasing in of the program; requiring 14 clients to use certain resources before using funds 15 from their iBudget; requiring the agency to provide 16 training for clients and evaluate and adopt rules with 17 respect to the iBudget system; providing a contingent 18 effective date. 19 20 Be It Enacted by the Legislature of the State of Florida: 21 22 Section 1. Paragraphs (a), (b), (c), (d), and (f) of 23 subsection (3) of section 393.0661, Florida Statutes, are 24 amended to read: 25 393.0661 Home and community-based services delivery system; 26 comprehensive redesign.—The Legislature finds that the home and 27 community-based services delivery system for persons with 28 developmental disabilities and the availability of appropriated 29 funds are two of the critical elements in making services 30 available. Therefore, it is the intent of the Legislature that 31 the Agency for Persons with Disabilities shall develop and 32 implement a comprehensive redesign of the system. 33 (3) The Agency for Health Care Administration, in 34 consultation with the agency, shall seek federal approval and 35 implement a four-tiered waiver system to serve eligible clients 36 through the developmental disabilities and family and supported 37 living waivers. The agency shall assign all clients receiving 38 services through the developmental disabilities waiver to a tier 39 based on a valid assessment instrument, client characteristics, 40 and other appropriate assessment methods. 41 (a) Tier one is limited to clients who have service needs 42 that cannot be met in tier two, three, or four for intensive 43 medical or adaptive needs and that are essential for avoiding 44 institutionalization, or who possess behavioral problems that 45 are exceptional in intensity, duration, or frequency and present 46 a substantial risk of harm to themselves or others. Total annual 47 expenditures under tier one may not exceed $120,000 per client 48 each year. 49 (b) Tier two is limited to clients whose service needs 50 include a licensed residential facility and who are authorized 51 to receive a moderate level of support for standard residential 52 habilitation services or a minimal level of support for behavior 53 focus residential habilitation services, or clients in supported 54 living who receive more than 6 hours a day of in-home support 55 services. Total annual expenditures under tier two may not 56 exceed $49,500$55,000per client each year. 57 (c) Tier three includes, but is not limited to, clients 58 requiring residential placements, clients in independent or 59 supported living situations, and clients who live in their 60 family home. Total annual expenditures under tier three may not 61 exceed $31,500$35,000per client each year. 62 (d) Tier four is the family and supported living waiver and 63 includes, but is not limited to, clients in independent or 64 supported living situations and clients who live in their family 65 home. Total annual expenditures under tier four may not exceed 66 $13,313$14,792per client each year. 67 (f) The agency shall seek federal waivers and amend 68 contracts as necessary to make changes to services defined in 69 federal waiver programs administered by the agency as follows: 70 1. Supported living coaching services may not exceed 20 71 hours per month for persons who also receive in-home support 72 services. 73 2. Limited support coordination services is the only type 74 of support coordination service that may be provided to persons 75 under the age of 18 who live in the family home. 76 3. Personal care assistance services are limited to 180 77 hours per calendar month and may not include rate modifiers. 78 Additional hours may be authorized for persons who have 79 intensive physical, medical, or adaptive needs if such hours are 80 essential for avoiding institutionalization. 81 4. Residential habilitation services are limited to 8 hours 82 per day. Additional hours may be authorized for persons who have 83 intensive medical or adaptive needs and if such hours are 84 essential for avoiding institutionalization, or for persons who 85 possess behavioral problems that are exceptional in intensity, 86 duration, or frequency and present a substantial risk of harming 87 themselves or others. This restriction shall be in effect until 88 the four-tiered waiver system is fully implemented. 89 5. Chore services, nonresidential support services, and 90 homemaker services are eliminated. The agency shall expand the 91 definition of in-home support services to allow the service 92 provider to include activities previously provided in these 93 eliminated services. 94 6. Massage therapy, medication review, behavior assistant 95 services provided in a standard or behavior-focus group home, 96 and psychological assessment services are eliminated. 97 7. The agency shall conduct supplemental cost plan reviews 98 to verify the medical necessity of authorized services for plans 99 that have increased by more than 8 percent during either of the 100 2 preceding fiscal years. 101 8. The agency shall implement a consolidated residential 102 habilitation rate structure to increase savings to the state 103 through a more cost-effective payment method and establish 104 uniform rates for intensive behavioral residential habilitation 105 services. 106 9. Pending federal approval, the agency may extend current 107 support plans for clients receiving services under Medicaid 108 waivers for 1 year beginning July 1, 2007, or from the date 109 approved, whichever is later. Clients who have a substantial 110 change in circumstances which threatens their health and safety 111 may be reassessed during this year in order to determine the 112 necessity for a change in their support plan. 113 10. The agency shall develop a plan to eliminate 114 redundancies and duplications between in-home support services, 115 companion services, personal care services, and supported living 116 coaching by limiting or consolidating such services. 117 11. The agency shall develop a plan to reduce the intensity 118 and frequency of supported employment services to clients in 119 stable employment situations who have a documented history of at 120 least 3 years’ employment with the same company or in the same 121 industry. 122 Section 2. Section 393.0662, Florida Statutes, is created 123 to read: 124 393.0662 Individual budgets for delivery of home and 125 community-based services; iBudget system established.—The 126 Legislature finds that improved financial management of the 127 existing home and community-based Medicaid waiver program is 128 necessary to avoid deficits that impede the provision of 129 services to individuals who are on the waiting list for 130 enrollment in the program. The Legislature further finds that 131 clients and their families should have greater flexibility to 132 choose the services that best allow them to live in their 133 community within the limits of an established budget. Therefore, 134 the Legislature intends that the agency, in consultation with 135 the Agency for Health Care Administration, develop and implement 136 a comprehensive redesign of the service delivery system using 137 individual budgets as the basis for allocating the funds 138 appropriated for the home and community-based services Medicaid 139 waiver program among eligible enrolled clients. The service 140 delivery system that uses individual budgets shall be called the 141 iBudget system. 142 (1) The agency shall establish an individual budget, 143 referred to as an iBudget, for each individual served by the 144 home and community-based services Medicaid waiver program. The 145 funds appropriated to the agency shall be allocated through the 146 iBudget system to eligible, Medicaid-enrolled clients. The 147 iBudget system shall be designed to provide for: enhanced client 148 choice within a specified service package; appropriate 149 assessment strategies; an efficient consumer budgeting and 150 billing process that includes reconciliation and monitoring 151 components; a redefined role for support coordinators which 152 avoids potential conflicts of interest; a flexible and 153 streamlined service review process; and a methodology and 154 process that ensures the equitable allocation of available funds 155 to each client based on the client’s level of need, as 156 determined by the variables in the allocation algorithm. 157 (a) In developing each client’s iBudget, the agency shall 158 use an allocation algorithm and methodology. The algorithm shall 159 use variables that have been determined by the agency to have a 160 statistically validated relationship to the client’s level of 161 need for services provided through the home and community-based 162 services Medicaid waiver program. The algorithm and methodology 163 may consider individual characteristics, including, but not 164 limited to, a client’s age and living situation, information 165 from a formal assessment instrument that the agency determines 166 is valid and reliable, and information from other assessment 167 processes. 168 (b) The allocation methodology shall provide the algorithm 169 that determines the amount of funds allocated to a client’s 170 iBudget. The agency may approve an increase in the amount of 171 funds allocated, as determined by the algorithm, based on the 172 client having: 173 1. An extraordinary need that would place the health and 174 safety of the client, the client’s caregiver, or the public in 175 immediate, serious jeopardy unless the increase is approved. An 176 extraordinary need may include, but is not limited to: 177 a. A documented history of significant, potentially life 178 threatening behaviors, such as recent attempts at suicide, 179 arson, nonconsensual sexual behavior, or self-injurious behavior 180 requiring medical attention; 181 b. A complex medical condition that requires active 182 intervention by a licensed nurse on an ongoing basis which 183 cannot be taught or delegated to a nonlicensed person; 184 c. A chronic co-morbid condition. As used in this 185 subparagraph, the term “co-morbid condition” means a medical 186 condition existing simultaneously but independently along with 187 another medical condition in a patient; or 188 d. A need for total physical assistance with activities 189 such as eating, bathing, toileting, grooming, and personal 190 hygiene. 191 192 However, the presence of an extraordinary need alone does not 193 warrant an increase in the amount of funds allocated to a 194 client’s iBudget as determined by the algorithm. 195 2. A significant need for one-time or temporary support or 196 services that, if not provided, would place the health and 197 safety of the client, the client’s caregiver, or the public in 198 serious jeopardy, unless the increase, as determined by the 199 total of the algorithm and any adjustments based on 200 subparagraphs 1. and 3., is approved. A significant need may 201 include, but is not limited to, the provision of environmental 202 modifications, durable medical equipment, services to address 203 the temporary loss of support from a caregiver, or special 204 services or treatment for a serious temporary condition when the 205 service or treatment is expected to ameliorate the underlying 206 condition. As used in this subparagraph, the term “temporary” 207 means a period of less than 12 continuous months. 208 3. A significant increase in the need for services after 209 the beginning of the service plan year which would place the 210 health and safety of the client, the client’s caregiver, or the 211 public in serious jeopardy because of substantial changes in the 212 client’s circumstances, including, but not limited to, permanent 213 or long-term loss or incapacity of a caregiver, loss of services 214 authorized under the state Medicaid plan due to a change in age, 215 or a significant change in medical or functional status which 216 requires the provision of additional services on a permanent or 217 long-term basis and which cannot be accommodated within the 218 client’s current iBudget. As used in this subparagraph, the term 219 “long-term” means a period of 12 or more continuous months. 220 221 The agency shall reserve portions of the appropriation for the 222 home and community-based services Medicaid waiver program for 223 adjustments required pursuant to this paragraph and may use the 224 services of an independent actuary in determining the amount of 225 the portions to be reserved. 226 (c) A client’s iBudget shall be the total of the amount 227 determined by the algorithm and any additional funding provided 228 pursuant to paragraph (b). A client’s annual expenditures for 229 home and community-based services Medicaid waiver services may 230 not exceed the limits of his or her iBudget. The total of a 231 client’s projected annual iBudget expenditures may not exceed 232 the agency’s appropriation for waiver services. 233 (2) The Agency for Health Care Administration, in 234 consultation with the agency, shall seek federal approval to 235 amend current waivers, request a new waiver, and amend contracts 236 as necessary to implement the iBudget system to serve eligible, 237 enrolled clients through the home and community-based services 238 Medicaid waiver program and the Consumer-Directed Care Plus 239 Program. 240 (3) The agency shall provide for the transition of all 241 eligible, enrolled clients to the iBudget system. The agency may 242 gradually phase in the iBudget system. 243 (a) While the agency phases in the iBudget system, the 244 agency may continue to serve eligible, enrolled clients under 245 the four-tiered waiver system established under s. 393.065 while 246 those clients await the transition to the iBudget system. 247 (b) The agency shall design the phase-in process to ensure 248 that a client does not experience more than one-half of any 249 expected overall increase or decrease to his or her existing 250 annualized cost plan during the first year that the client is 251 provided an iBudget due solely to the transition to the iBudget 252 system. 253 (4) A client must use all available services authorized 254 under the state Medicaid plan, school-based services, private 255 insurance, and other benefits and use any other resources that 256 are available to the client before using funds from his or her 257 iBudget to pay for support and services. 258 (5) Rates for any or all services established under rules 259 of the Agency for Health Care Administration shall be designated 260 as the maximum rather than a fixed amount for individuals who 261 receive an iBudget, except for services specifically identified 262 in those rules which the agency determines are not appropriate 263 for negotiation, including, but not limited to, residential 264 habilitation services. 265 (6) The agency shall ensure that clients and caregivers 266 have access to training and education to inform them about the 267 iBudget system and enhance their ability for self-direction. 268 Such training shall be offered in a variety of formats and, at a 269 minimum, shall address the policies and processes of the iBudget 270 system; the roles and responsibilities of consumers, caregivers, 271 waiver support coordinators, providers, and the agency; 272 information available to help the client make decisions 273 regarding the iBudget system; and examples of support and 274 resources available in the community. 275 (7) The agency shall collect data to evaluate the 276 implementation and outcomes of the iBudget system. 277 (8) The agency and the Agency for Health Care 278 Administration may adopt rules specifying the allocation 279 algorithm and methodology; criteria and processes for clients to 280 access reserved funds for extraordinary needs, temporarily or 281 permanently changed needs, and one-time needs; and processes and 282 requirements for selection and review of services, development 283 of support and cost plans, and management of the iBudget system 284 as needed to administer this section. 285 Section 3. This act shall take effect July 1, 2010; 286 however, the amendments to s. 393.0661(3)(b), (c), (d), and 287 (f)6., Florida Statutes, made by this act do not take effect if 288 federal law extends the enhanced Federal Medicaid Assistance 289 Percentage rate, as provided under the American Reinvestment and 290 Recovery Act (Pub. L. No. 111-5), from December 31, 2010, 291 through June 30, 2011.
