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Senate Bill 1124

Senate Bill sb1124c1

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2007                           CS for SB 1124

    By the Committee on Health and Human Services Appropriations;
    and Senator Peaden




    603-2262-07

  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  

                                  1

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    Florida Senate - 2007                           CS for SB 1124
    603-2262-07




 1  shall develop and implement a comprehensive redesign of the

 2  system.

 3         (1)  The redesign of the home and community-based

 4  services system shall include, at a minimum, all actions

 5  necessary to achieve an appropriate rate structure, client

 6  choice within a specified service package, appropriate

 7  assessment strategies, an efficient billing process that

 8  contains reconciliation and monitoring components, a redefined

 9  role for support coordinators that avoids potential conflicts

10  of interest, and ensures that family/client budgets are linked

11  to levels of need.

12         (a)  The agency shall use an assessment instrument that

13  is reliable and valid. The agency may contract with an

14  external vendor or may use support coordinators to complete

15  client assessments if it develops sufficient safeguards and

16  training to ensure ongoing inter-rater reliability.

17         (b)  The agency, with the concurrence of the Agency for

18  Health Care Administration, may contract for the determination

19  of medical necessity and establishment of individual budgets.

20         (2)  A provider of services rendered to persons with

21  developmental disabilities pursuant to a federally approved

22  waiver shall be reimbursed according to a rate methodology

23  based upon an analysis of the expenditure history and

24  prospective costs of providers participating in the waiver

25  program, or under any other methodology developed by the

26  Agency for Health Care Administration, in consultation with

27  the Agency for Persons with Disabilities, and approved by the

28  Federal Government in accordance with the waiver.

29         (3)  The agency, in consultation with the Agency for

30  Health Care Administration, shall develop and implement

31  

                                  2

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    Florida Senate - 2007                           CS for SB 1124
    603-2262-07




 1  standards for a three-tiered waiver system to serve clients

 2  with developmental disabilities.

 3         (a)  Tier one shall be limited to clients whose

 4  services are paid under the home and community-based services

 5  waiver, whose higher level of service needs are essential to

 6  avoid institutionalization, or who possess behavioral concerns

 7  that are exceptional in intensity, duration, or frequency and

 8  present a substantial risk of harm to themselves or others.

 9         (b)  Tier two shall be limited to clients whose service

10  needs are paid under the home and community-based waiver.

11  However, residential habilitation services under tier two

12  shall be limited to the number of hours medically necessary,

13  but may not exceed 8 hours per day. Personal care assistance

14  services shall be limited to the number of hours medically

15  necessary, but may not exceed 150 hours per calendar month.

16  Total annual expenditures under this waiver shall be capped at

17  $30,000 per client. Clients served through tier two include,

18  but need not be limited to, clients requiring residential

19  placements. All clients receiving services through the home

20  and community-based waiver on March 1, 2007, shall be moved to

21  tier two, with the exception of clients who:

22         1.  Have service needs that exceed $30,000 for

23  intensive medical or adaptive needs and that are essential for

24  avoiding institutionalization; or

25         2.  Possess behavioral concerns that are exceptional in

26  intensity, duration, or frequency and present a substantial

27  risk of harm to themselves or others.

28         (c)  Tier three, the family and supported living

29  waiver, shall include, but need not be limited to, clients in

30  independent or supported living situations or clients who live

31  

                                  3

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    Florida Senate - 2007                           CS for SB 1124
    603-2262-07




 1  in their family home. Total annual expenditures under this

 2  waiver shall be capped at $14,792 per client.

 3  

 4  The agency, in consultation with the Agency for Health Care

 5  Administration, shall seek federal approval as needed to carry

 6  out the provisions of this subsection, including placing

 7  limitations or restrictions on the home and community-based

 8  waiver. The agency may adopt rules providing for eligibility

 9  criteria, rate modifications, and procedures for administering

10  this subsection.

11         (3)  Pending the adoption of rate methodologies

12  pursuant to nonemergency rulemaking under s. 120.54, the

13  Agency for Health Care Administration may, at any time, adopt

14  emergency rules under s. 120.54(4) in order to comply with

15  subsection (4). In adopting such emergency rules, the agency

16  need not make the findings required by s. 120.54(4)(a), and

17  such rules shall be exempt from time limitations provided in

18  s. 120.54(4)(c) and shall remain in effect until replaced by

19  another emergency rule or the nonemergency adoption of the

20  rate methodology.

21         (4)  Nothing in this section or in any administrative

22  rule shall be construed to prevent or limit the Agency for

23  Health Care Administration, in consultation with the Agency

24  for Persons with Disabilities, from adjusting fees,

25  reimbursement rates, lengths of stay, number of visits, or

26  number of services, or from limiting enrollment, or making any

27  other adjustment necessary to comply with the availability of

28  moneys and any limitations or directions provided for in the

29  General Appropriations Act.

30         (5)  The Agency for Persons with Disabilities shall

31  submit quarterly status reports to the Executive Office of the

                                  4

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    Florida Senate - 2007                           CS for SB 1124
    603-2262-07




 1  Governor, the chair of the Senate Ways and Means Committee or

 2  its successor, and the chair of the House Fiscal Council or

 3  its successor regarding the financial status of home and

 4  community-based services, including the number of enrolled

 5  individuals who are receiving services through one or more

 6  programs; the number of individuals who have requested

 7  services who are not enrolled but who are receiving services

 8  through one or more programs, with a description indicating

 9  the programs from which the individual is receiving services;

10  the number of individuals who have refused an offer of

11  services but who choose to remain on the list of individuals

12  waiting for services; the number of individuals who have

13  requested services but who are receiving no services; a

14  frequency distribution indicating the length of time

15  individuals have been waiting for services; and information

16  concerning the actual and projected costs compared to the

17  amount of the appropriation available to the program and any

18  projected surpluses or deficits. If at any time an analysis by

19  the agency, in consultation with the Agency for Health Care

20  Administration, indicates that the cost of services is

21  expected to exceed the amount appropriated, the agency shall

22  submit a plan in accordance with subsection (4) to the

23  Executive Office of the Governor, the chair of Senate Ways and

24  Means Committee or its successor, and the chair of the House

25  Fiscal Council or its successor to remain within the amount

26  appropriated. The agency shall work with the Agency for Health

27  Care Administration to implement the plan so as to remain

28  within the appropriation.

29         Section 2.  This act shall take effect July 1, 2007.

30  

31  

                                  5

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    Florida Senate - 2007                           CS for SB 1124
    603-2262-07




 1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 2                         Senate Bill 1124

 3                                 

 4  Requires the Agency for Persons with Disabilities (APD) in
    consultation with the Agency for Health Care Administration
 5  (AHCA) to develop standards for a three-tiered waiver system.

 6  Tier one will be limited to clients who:

 7       o    have service needs that exceed $30,000 for intensive
              medical or adaptive needs and that are essential to
 8            avoid institutionalization; or

 9       o    possess behavioral concerns that are exceptional in
              intensity, duration, or frequency, and present a
10            substantial risk of harm to themselves or others.
              Services will not be capped, but must be medically
11            necessary. This tier is similar to the current HCBS
              waiver.
12  
    Tier two will be similar to the current HCBS waiver. The
13  residential rehabilitation services per client will be capped
    at 8 hours per day and personal care services will be capped
14  at 150 hours per calendar month.  The total annual expenditure
    per client will be capped at $30,000. All clients receiving
15  services through the HCBS Waiver on March 1, 2007 will be
    moved to tier two except clients who:
16  
         o    have service needs that exceed $30,000 for intensive
17            medical or adaptive needs and that are essential to
              avoid institutionalization; or
18  
         o    possess behavioral concerns that are exceptional in
19            intensity, duration, or frequency, and present a
              substantial risk of harm to themselves or others.
20  
    Tier three will be the current family and supported living
21  waiver with total annual expenditures capped at $14,792 per
    client.
22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  6

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