April 10, 2020
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Bill No. 7047
Amendment No. 350751
Senate House

1Representative(s) Galvano offered the following:
3     Amendment (with title amendment)
4     Between lines 392 and 393, insert:
5     Section 6.  Paragraph (c) is added to subsection (1) of
6section 393.0661, Florida Statutes, to read:
7     393.0661  Home and community-based services delivery
8system; comprehensive redesign.--The Legislature finds that the
9home and community-based services delivery system for persons
10with developmental disabilities and the availability of
11appropriated funds are two of the critical elements in making
12services available. Therefore, it is the intent of the
13Legislature that the Agency for Persons with Disabilities shall
14develop and implement a comprehensive redesign of the system.
15     (1)  The redesign of the home and community-based services
16system shall include, at a minimum, all actions necessary to
17achieve an appropriate rate structure, client choice within a
18specified service package, appropriate assessment strategies, an
19efficient billing process that contains reconciliation and
20monitoring components, a redefined role for support coordinators
21that avoids potential conflicts of interest, and ensures that
22family/client budgets are linked to levels of need.
23     (c)  By December 1, 2007, the Agency for Persons with
24Disabilities, in consultation with the Agency for Health Care
25Administration, shall create a model service delivery system
26pilot project for persons with developmental disabilities who
27receive services under the developmental disabilities waiver
28program administered by the Agency for Persons with
29Disabilities. Persons with developmental disabilities who
30receive services under the family and supported living waiver
31program or the consumer-directed care plus waiver program
32administered by the Agency for Persons with Disabilities may
33also be included in the system if the agency determines that
34such inclusion is feasible and will improve coordination of care
35and management of costs. The system must transfer and combine
36all services funded by Medicaid waiver programs and services
37funded only by the state, including room and board and supported
38living payments, for individuals who participate in the system.
39The pilot project shall document increased client outcomes that
40are known to be associated with a valid needs assessment of the
41level of need of the client, rate setting based on the level of
42need, and encouragement of the use of community-centered
43services and supports. The pilot project shall implement strong
44utilization control, such as capped rates, in order to ensure
45predictable and controlled annual costs. Medicaid service
46delivery, including, but not limited to, service authorization,
47care management, and monitoring shall be managed locally through
48the area office of the Agency for Persons with Disabilities in
49order to encourage provider development. Support coordination
50services shall be available to individuals participating in the
51pilot program.
52     1.  The Legislature intends that the service delivery
53system provide recipients in Medicaid waiver programs with a
54coordinated system of services, increased cost predictability,
55and a stabilized rate of increase in Medicaid expenditures while
57     a.  Consumer choice.
58     b.  Opportunities for consumer-directed services.
59     c.  Access to medically necessary services.
60     d.  Coordination of community-based services.
61     e.  Reductions in the unnecessary use of services.
62     2.  The Agency for Persons with Disabilities shall
63implement the system on a pilot basis in Area 1 and may conduct
64a similar pilot in an urban area of the Agency for Persons with
65Disabilities, in consultation with the Agency for Health Care
66Administration. After completion of the development phase of the
67system, attainment of necessary federal approval, selection of
68qualified providers, and rate setting, the Agency for Persons
69with Disabilities shall delegate administration of the system to
70the administrator of the agency's local area office. The Agency
71for Persons with Disabilities shall set standards for qualified
72providers and provide quality assurance, monitoring oversight,
73and other duties necessary for the system. The enrollment of
74Medicaid waiver recipients into the system in pilot areas shall
75be mandatory.
76     3.  The local area office shall administer the pilot
77program and shall be responsible for ensuring that the costs of
78the program do not exceed the amount of funds allocated for the
79program. The agency area administrator shall also:
80     a.  Identify the needs of the recipients using a
81standardized assessment process approved by the agency.
82     b.  Allow a recipient to select any provider that has been
83qualified by the agency, provided that the service offered by
84the provider is appropriate to meet the needs of the recipient.
85     c.  Make a good faith effort to select qualified providers
86currently providing Medicaid waiver services for the agency in
87the pilot area.
88     d.  Develop and use a service provider qualification system
89approved by the agency that describes the quality of care
90standards that providers of service to persons with
91developmental disabilities must meet in order to provide
92services within the pilot area.
93     e.  Exclude, when feasible, chronically poor-performing
94providers and facilities as determined by the agency.
95     f.  Demonstrate a quality assurance system and a
96performance improvement system that are satisfactory to the
98     4.  The agency must ensure that the rate-setting
99methodology for the system reflects the intent to provide
100quality care in the least restrictive setting appropriate for
101the recipient and provide for choice by the recipient. The
102agency may choose to limit financial risk for the pilot area
103operating the system to cover high-cost recipients or to address
104the catastrophic care needs of recipients enrolled in the
106     5.  Within 24 months after implementation, the agency shall
107contract for a comprehensive evaluation of the system. The
108evaluation must include assessments of cost savings, cost-
109effectiveness, recipient outcomes, consumer choice, access to
110services, coordination of care, and quality of care. The
111evaluation shall include, but not be limited to, an assessment
112of the following aspects:
113     a.  A study of the funding patterns of the cost-prediction
114methodology before and after implementation of the pilot
116     b.  A study of the service utilization patterns of the
117cost-prediction methodology before and after implementation of
118the pilot program;
119     c.  The accuracy of the cost-prediction methodology in
120explaining and predicting funding levels for individuals
121receiving each of the three waivers in the pilot areas;
122     d.  The accuracy of the cost-prediction methodology and a
123plan for dealing with cases involving individuals with the
124highest and lowest support needs and funding levels;
125     e.  A survey of consumer satisfaction regarding consumer
126choice, scope of services, and proposed funding levels generated
127by the cost-prediction methodology in the pilot areas;
128     f.  The applicability of the cost-prediction  methodology
129to explain and predict funding levels for all individuals
130receiving the waivers;
131     g.  The robustness of the cost-prediction methodology to
132withstand appeals and grievances; and
133     h.  A systematic comparison of the outcomes in both pilot
134areas and the different models that are demonstrated.
135     6.  Each pilot area shall form an advisory committee that
136includes representatives from the stakeholder community,
137including persons with disabilities, family members of persons
138with disabilities, members of disability advocacy groups, and
139representatives of program service providers to provide feedback
140and monitor the implementation of the pilot program on at least
141a quarterly basis.
142     7.  The Agency for Persons with Disabilities shall form an
143advisory committee that includes representatives from the
144stakeholder community, including persons with disabilities,
145family members of persons with disabilities, members of
146disability advocacy groups, and representatives of program
147service providers to provide feedback and monitor the
148implementation of the pilot program from a statewide
150     8.  The advisory committees shall submit reports evaluating
151the progress of the pilot programs to the President of the
152Senate and the Speaker of the House of Representatives on a
153quarterly basis.
154     9.  The agency shall submit a report that describes the
155administrative or legal barriers to the implementation and
156operation of the system, including recommendations regarding
157statewide expansion of the system and a recommendation for the
158model service delivery system to be implemented statewide, to
159the Governor, the President of the Senate, and the Speaker of
160the House of Representatives no later than December 31, 2008.
161     10.  The agency, in coordination with the Agency for Health
162Care Administration, may seek federal waivers or Medicaid state
163plan amendments and adopt rules as necessary to administer the
164system on a pilot basis. The agency must receive specific
165authorization from the Legislature prior to expanding beyond the
166pilot areas designated for the implementation of this system.
167Further expansion of this pilot project requires approval by the
170======= T I T L E  A M E N D M E N T =======
171     Remove line(s) 16 and insert:
172anesthesiologist assistant; amending s. 393.0661, F.S.;
173requiring the Agency for Persons with Disabilities, in
174consultation with the Agency for Health Care Administration, to
175implement federal waivers to create a model service delivery
176system pilot project for Medicaid recipients with developmental
177disabilities; providing legislative intent; providing for
178implementation of the system on a pilot basis in certain areas
179of the state; providing for administration of the system by the
180Agency for Persons with Disabilities; providing requirements for
181selection of service providers to operate the system; providing
182for mandatory enrollment in pilot areas; requiring an evaluation
183of the system; providing for the formation of local and
184statewide advisory committees; requiring the committees to
185submit quarterly reports to the Legislature; requiring the
186agency to submit a report to the Governor and Legislature;
187authorizing the agency to seek federal waivers or Medicaid state
188plan amendments and adopt rules; requiring the agency to receive
189specific authorization from the Legislature before expanding the
190system; providing an effective date.

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