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Amendment CaShTmL-553850.HTM
    Florida Senate - 2007            PROPOSED COMMITTEE SUBSTITUTE
    Bill No. SB 1124
                        Barcode 553850   Comm: FAV  03/28/2007 11:47 AM       
    603-2145-07
    Proposed Committee Substitute by the Committee on Health and
    Human Services Appropriations
 1                      A bill to be entitled
 2         An act relating to home and community-based
 3         services for persons with developmental
 4         disabilities; amending s. 393.0661, F.S.;
 5         requiring the Agency for Persons with
 6         Disabilities, in consultation with the Agency
 7         for Health Care Administration, to develop and
 8         implement standards for a three-tiered waiver
 9         system for the purpose of serving clients with
10         developmental disabilities; providing
11         requirements and limitations with respect to
12         each tier; requiring the Agency for Persons
13         with Disabilities to seek federal approval as
14         necessary to implement the waiver system;
15         requiring the agency to adopt rules providing
16         eligibility criteria; deleting authorization
17         for the agency to adopt certain emergency
18         rules; providing an effective date.
19  
20  Be It Enacted by the Legislature of the State of Florida:
21  
22         Section 1.  Section 393.0661, Florida Statutes, is
23  amended to read:
24         393.0661  Home and community-based services delivery
25  system; comprehensive redesign.--The Legislature finds that
26  the home and community-based services delivery system for
27  persons with developmental disabilities and the availability
28  of appropriated funds are two of the critical elements in
29  making services available. Therefore, it is the intent of the
30  Legislature that the Agency for Persons with Disabilities
31  shall develop and implement a comprehensive redesign of the
                                  1
    3:35 PM   03/21/07                             s1124p-ha00-pa5

Florida Senate - 2007 PROPOSED COMMITTEE SUBSTITUTE Bill No. SB 1124 Barcode 553850 603-2145-07 1 system. 2 (1) The redesign of the home and community-based 3 services system shall include, at a minimum, all actions 4 necessary to achieve an appropriate rate structure, client 5 choice within a specified service package, appropriate 6 assessment strategies, an efficient billing process that 7 contains reconciliation and monitoring components, a redefined 8 role for support coordinators that avoids potential conflicts 9 of interest, and ensures that family/client budgets are linked 10 to levels of need. 11 (a) The agency shall use an assessment instrument that 12 is reliable and valid. The agency may contract with an 13 external vendor or may use support coordinators to complete 14 client assessments if it develops sufficient safeguards and 15 training to ensure ongoing inter-rater reliability. 16 (b) The agency, with the concurrence of the Agency for 17 Health Care Administration, may contract for the determination 18 of medical necessity and establishment of individual budgets. 19 (2) A provider of services rendered to persons with 20 developmental disabilities pursuant to a federally approved 21 waiver shall be reimbursed according to a rate methodology 22 based upon an analysis of the expenditure history and 23 prospective costs of providers participating in the waiver 24 program, or under any other methodology developed by the 25 Agency for Health Care Administration, in consultation with 26 the Agency for Persons with Disabilities, and approved by the 27 Federal Government in accordance with the waiver. 28 (3) The agency, in consultation with the Agency for 29 Health Care Administration, shall develop and implement 30 standards for a three-tiered waiver system to serve clients 31 with developmental disabilities. 2 3:35 PM 03/21/07 s1124p-ha00-pa5
Florida Senate - 2007 PROPOSED COMMITTEE SUBSTITUTE Bill No. SB 1124 Barcode 553850 603-2145-07 1 (a) Tier one shall be limited to clients whose 2 services are paid under the home and community-based services 3 waiver, whose higher level of service needs are essential to 4 avoid institutionalization, or who possess behavioral concerns 5 that are exceptional in intensity, duration, or frequency and 6 present a substantial risk of harm to themselves or others. 7 (b) Tier two shall be limited to clients whose service 8 needs include some or all of the services available under the 9 family and supported living waiver, plus residential 10 rehabilitation services. Residential rehabilitation services 11 under tier two shall be limited to the number of hours 12 medically necessary, but may not exceed 8 hours per day. Total 13 annual expenditures under this waiver shall be capped at 14 $30,000 per client. Clients served through tier two include, 15 but need not be limited to, clients requiring residential 16 placements. 17 (c) Tier three, the family and supported living 18 waiver, shall include, but need not be limited to, clients in 19 independent or supported living situations or clients who live 20 in their family home. Total annual expenditures under this 21 waiver shall be capped at $14,792 per client. 22 23 The agency, in consultation with the Agency for Health Care 24 Administration, shall seek federal approval as needed to carry 25 out the provisions of this subsection, and the agency may 26 adopt rules providing eligibility criteria and procedures for 27 administering this subsection. 28 (3) Pending the adoption of rate methodologies 29 pursuant to nonemergency rulemaking under s. 120.54, the 30 Agency for Health Care Administration may, at any time, adopt 31 emergency rules under s. 120.54(4) in order to comply with 3 3:35 PM 03/21/07 s1124p-ha00-pa5
Florida Senate - 2007 PROPOSED COMMITTEE SUBSTITUTE Bill No. SB 1124 Barcode 553850 603-2145-07 1 subsection (4). In adopting such emergency rules, the agency 2 need not make the findings required by s. 120.54(4)(a), and 3 such rules shall be exempt from time limitations provided in 4 s. 120.54(4)(c) and shall remain in effect until replaced by 5 another emergency rule or the nonemergency adoption of the 6 rate methodology. 7 (4) Nothing in this section or in any administrative 8 rule shall be construed to prevent or limit the Agency for 9 Health Care Administration, in consultation with the Agency 10 for Persons with Disabilities, from adjusting fees, 11 reimbursement rates, lengths of stay, number of visits, or 12 number of services, or from limiting enrollment, or making any 13 other adjustment necessary to comply with the availability of 14 moneys and any limitations or directions provided for in the 15 General Appropriations Act. 16 (5) The Agency for Persons with Disabilities shall 17 submit quarterly status reports to the Executive Office of the 18 Governor, the chair of the Senate Ways and Means Committee or 19 its successor, and the chair of the House Fiscal Council or 20 its successor regarding the financial status of home and 21 community-based services, including the number of enrolled 22 individuals who are receiving services through one or more 23 programs; the number of individuals who have requested 24 services who are not enrolled but who are receiving services 25 through one or more programs, with a description indicating 26 the programs from which the individual is receiving services; 27 the number of individuals who have refused an offer of 28 services but who choose to remain on the list of individuals 29 waiting for services; the number of individuals who have 30 requested services but who are receiving no services; a 31 frequency distribution indicating the length of time 4 3:35 PM 03/21/07 s1124p-ha00-pa5
Florida Senate - 2007 PROPOSED COMMITTEE SUBSTITUTE Bill No. SB 1124 Barcode 553850 603-2145-07 1 individuals have been waiting for services; and information 2 concerning the actual and projected costs compared to the 3 amount of the appropriation available to the program and any 4 projected surpluses or deficits. If at any time an analysis by 5 the agency, in consultation with the Agency for Health Care 6 Administration, indicates that the cost of services is 7 expected to exceed the amount appropriated, the agency shall 8 submit a plan in accordance with subsection (4) to the 9 Executive Office of the Governor, the chair of Senate Ways and 10 Means Committee or its successor, and the chair of the House 11 Fiscal Council or its successor to remain within the amount 12 appropriated. The agency shall work with the Agency for Health 13 Care Administration to implement the plan so as to remain 14 within the appropriation. 15 Section 2. This act shall take effect July 1, 2007. 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 5 3:35 PM 03/21/07 s1124p-ha00-pa5
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