July 08, 2020
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Senate Bill 1124

Senate Bill sb1124er

CODING: Words stricken are deletions; words underlined are additions.


    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



  1                                 

  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 Health Care

  6         Administration, in consultation with the Agency

  7         for Persons with Disabilities, to seek federal

  8         approval and implement a four-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; authorizing the Agency for Health

13         Care Administration and the Agency for Persons

14         with Disabilities to adopt rules; requiring the

15         Agency for Persons with Disabilities to seek

16         federal waivers and amend contracts in order to

17         implement the waiver system; providing

18         requirements for changes to various services;

19         deleting authorization for the Agency for

20         Health Care Administration to adopt certain

21         emergency rules; providing an effective date.

22  

23  Be It Enacted by the Legislature of the State of Florida:

24  

25         Section 1.  Section 393.0661, Florida Statutes, is

26  amended to read:

27         393.0661  Home and community-based services delivery

28  system; comprehensive redesign.--The Legislature finds that

29  the home and community-based services delivery system for

30  persons with developmental disabilities and the availability

31  of appropriated funds are two of the critical elements in


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    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



 1  making services available. Therefore, it is the intent of the

 2  Legislature that the Agency for Persons with Disabilities

 3  shall develop and implement a comprehensive redesign of the

 4  system.

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

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

 7  necessary to achieve an appropriate rate structure, client

 8  choice within a specified service package, appropriate

 9  assessment strategies, an efficient billing process that

10  contains reconciliation and monitoring components, a redefined

11  role for support coordinators that avoids potential conflicts

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

13  to levels of need.

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

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

16  external vendor or may use support coordinators to complete

17  client assessments if it develops sufficient safeguards and

18  training to ensure ongoing inter-rater reliability.

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

20  Health Care Administration, may contract for the determination

21  of medical necessity and establishment of individual budgets.

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

23  developmental disabilities pursuant to a federally approved

24  waiver shall be reimbursed according to a rate methodology

25  based upon an analysis of the expenditure history and

26  prospective costs of providers participating in the waiver

27  program, or under any other methodology developed by the

28  Agency for Health Care Administration, in consultation with

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

30  Federal Government in accordance with the waiver.

31  


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    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



 1         (3)  The Agency for Health Care Administration, in

 2  consultation with the agency, shall seek federal approval and

 3  implement a four-tiered waiver system to serve clients with

 4  developmental disabilities in the developmental disabilities

 5  and family and supported living waivers. The agency shall

 6  assign all clients receiving services through the

 7  developmental disabilities waiver to a tier based on a valid

 8  assessment instrument, client characteristics, and other

 9  appropriate assessment methods. All services covered under the

10  current developmental disabilities waiver shall be available

11  to all clients in all tiers where appropriate, except as

12  otherwise provided in this subsection or in the General

13  Appropriations Act.

14         (a)  Tier one shall be limited to clients who have

15  service needs that cannot be met in Tier two, three, or four

16  for intensive medical or adaptive needs and that are essential

17  for avoiding institutionalization, or who possess behavioral

18  problems that are exceptional in intensity, duration, or

19  frequency and present a substantial risk of harm to themselves

20  or others.

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

22  needs include a licensed residential facility and greater than

23  5 hours per day in residential habilitation services or

24  clients in supported living who receive greater than 6 hours a

25  day of in-home support services. Total annual expenditures

26  under tier two may not exceed $55,000 per client each year.

27         (c)  Tier three shall include, but is not limited to,

28  clients requiring residential placements, clients in

29  independent or supported living situations, and clients who

30  live in their family home. Total annual expenditures under

31  tier three may not exceed $35,000 per client each year.


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    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



 1         (d)  Tier four is the family and supported living

 2  waiver. Tier four shall include, but is not limited to,

 3  clients in independent or supported living situations and

 4  clients who live in their family home. An increase to the

 5  number of services available to clients in this tier shall not

 6  take effect prior to July 1, 2008. Total annual expenditures

 7  under tier four may not exceed $14,792 per client each year.

 8         (e)  The Agency for Health Care Administration shall

 9  also seek federal approval to provide a consumer-directed

10  option for persons with developmental disabilities which

11  corresponds to the funding levels in each of the waiver tiers.

12  The agency shall implement the four-tiered waiver system

13  beginning with tiers one, three, and four and followed by tier

14  two. The agency and the Agency for Health Care Administration

15  may adopt any rules necessary to administer this subsection.

16         (f)  The agency shall seek federal waivers and amend

17  contracts as necessary to make changes to services defined in

18  federal waiver programs administered by the agency as follows:

19         1.  Supported living coaching services shall not exceed

20  20 hours per month for persons who also receive in-home

21  support services.

22         2.  Limited support coordination services shall be the

23  only type of support coordination service provided to persons

24  under the age of 18 who live in the family home.

25         3.  Personal care assistance services shall be limited

26  to no more than 180 hours per calendar month and shall not

27  include rate modifiers. Additional hours may be authorized

28  only if a substantial change in circumstances occurs for the

29  individual.

30         4.  Residential habilitation services shall be limited

31  to 8 hours per day. Additional hours may be authorized for


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    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



 1  persons who have intensive medical or adaptive needs and if

 2  such hours are essential for avoiding institutionalization, or

 3  for persons who possess behavioral problems that are

 4  exceptional in intensity, duration, or frequency and present a

 5  substantial risk of harming themselves or others. This

 6  restriction shall be in effect until the four-tiered waiver

 7  system is fully implemented.

 8         5.  Chore, nonresidential support services and

 9  homemaker services shall be eliminated. The agency shall

10  expand the definition of in-home support services to enable

11  the provider of the service to include activities previously

12  provided in these eliminated services.

13         6.  Massage therapy and psychological assessment

14  services shall be eliminated.

15         7.  The agency shall conduct supplemental cost plan

16  reviews to verify the medical necessity of authorized services

17  for plans that have increased by more than 8 percent during

18  either of the two preceding fiscal years.

19         8.  The agency shall implement a consolidated

20  residential habilitation rate structure to increase savings to

21  the state through a more cost-effective payment method and

22  establish uniform rates for intensive behavioral residential

23  habilitation services.

24         9.  Pending federal approval, the agency is authorized

25  to extend current support plans for clients receiving services

26  under Medicaid waivers for 1 year beginning July 1, 2007, or

27  from the date approved, whichever is later. Clients who have a

28  substantial change in circumstances which threatens their

29  health and safety may be reassessed during this year in order

30  to determine the necessity for a change in their support plan.

31  


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    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



 1         (3)  Pending the adoption of rate methodologies

 2  pursuant to nonemergency rulemaking under s. 120.54, the

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

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

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

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

 7  such rules shall be exempt from time limitations provided in

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

 9  another emergency rule or the nonemergency adoption of the

10  rate methodology.

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

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

13  Health Care Administration, in consultation with the Agency

14  for Persons with Disabilities, from adjusting fees,

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

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

17  other adjustment necessary to comply with the availability of

18  moneys and any limitations or directions provided for in the

19  General Appropriations Act.

20         (5)  The Agency for Persons with Disabilities shall

21  submit quarterly status reports to the Executive Office of the

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

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

24  its successor regarding the financial status of home and

25  community-based services, including the number of enrolled

26  individuals who are receiving services through one or more

27  programs; the number of individuals who have requested

28  services who are not enrolled but who are receiving services

29  through one or more programs, with a description indicating

30  the programs from which the individual is receiving services;

31  the number of individuals who have refused an offer of


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    ENROLLED

    2007 Legislature                 CS for SB 1124, 1st Engrossed



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

 2  waiting for services; the number of individuals who have

 3  requested services but who are receiving no services; a

 4  frequency distribution indicating the length of time

 5  individuals have been waiting for services; and information

 6  concerning the actual and projected costs compared to the

 7  amount of the appropriation available to the program and any

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

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

10  Administration, indicates that the cost of services is

11  expected to exceed the amount appropriated, the agency shall

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

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

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

15  Fiscal Council or its successor to remain within the amount

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

17  Care Administration to implement the plan so as to remain

18  within the appropriation.

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

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