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Amendment CaShTmL-302602.HTM
    Florida Senate - 2007           CONFERENCE COMMITTEE AMENDMENT
    Bill No. CS for SB 1124
                        Barcode 302602
                            CHAMBER ACTION
              Senate                               House
                                   .                    
                                   .                    
 1                                 .         AD         
                                   .         05/03/2007 17:29:53
 2                                 .                    
                                   .                    
 3         Floor: AD/2R            .                    
       05/03/2007 02:13 PM         .                    
 4  ______________________________________________________________
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 8  
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10  ______________________________________________________________
11  The Conference Committee on CS for SB 1124 recommended the
12  following amendment:
13  
14         Conference Committee Amendment (with title amendment) 
15         Delete everything after the enacting clause
16  
17  and insert:  
18         Section 1.  Section 393.0661, Florida Statutes, is
19  amended to read:
20         393.0661  Home and community-based services delivery
21  system; comprehensive redesign.--The Legislature finds that
22  the home and community-based services delivery system for
23  persons with developmental disabilities and the availability
24  of appropriated funds are two of the critical elements in
25  making services available. Therefore, it is the intent of the
26  Legislature that the Agency for Persons with Disabilities
27  shall develop and implement a comprehensive redesign of the
28  system.
29         (1)  The redesign of the home and community-based
30  services system shall include, at a minimum, all actions
31  necessary to achieve an appropriate rate structure, client
                                  1
    10:20 PM   04/29/07                                c1124c1d-05

Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 choice within a specified service package, appropriate 2 assessment strategies, an efficient billing process that 3 contains reconciliation and monitoring components, a redefined 4 role for support coordinators that avoids potential conflicts 5 of interest, and ensures that family/client budgets are linked 6 to levels of need. 7 (a) The agency shall use an assessment instrument that 8 is reliable and valid. The agency may contract with an 9 external vendor or may use support coordinators to complete 10 client assessments if it develops sufficient safeguards and 11 training to ensure ongoing inter-rater reliability. 12 (b) The agency, with the concurrence of the Agency for 13 Health Care Administration, may contract for the determination 14 of medical necessity and establishment of individual budgets. 15 (2) A provider of services rendered to persons with 16 developmental disabilities pursuant to a federally approved 17 waiver shall be reimbursed according to a rate methodology 18 based upon an analysis of the expenditure history and 19 prospective costs of providers participating in the waiver 20 program, or under any other methodology developed by the 21 Agency for Health Care Administration, in consultation with 22 the Agency for Persons with Disabilities, and approved by the 23 Federal Government in accordance with the waiver. 24 (3) The Agency for Health Care Administration, in 25 consultation with the agency, shall seek federal approval and 26 implement a four-tiered waiver system to serve clients with 27 developmental disabilities in the developmental disabilities 28 and family and supported living waivers. The agency shall 29 assign all clients receiving services through the 30 developmental disabilities waiver to a tier based on a valid 31 assessment instrument, client characteristics, and other 2 10:20 PM 04/29/07 c1124c1d-05
Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 appropriate assessment methods. All services covered under the 2 current developmental disabilities waiver shall be available 3 to all clients in all tiers where appropriate, except as 4 otherwise provided in this subsection or in the General 5 Appropriations Act. 6 (a) Tier one shall be limited to clients who have 7 service needs that cannot be met in Tier two, three, or four 8 for intensive medical or adaptive needs and that are essential 9 for avoiding institutionalization, or who possess behavioral 10 problems that are exceptional in intensity, duration, or 11 frequency and present a substantial risk of harm to themselves 12 or others. 13 (b) Tier two shall be limited to clients whose service 14 needs include a licensed residential facility and greater than 15 5 hours per day in residential habilitation services or 16 clients in supported living who receive greater than 6 hours a 17 day of in-home support services. Total annual expenditures 18 under tier two may not exceed $55,000 per client each year. 19 (c) Tier three shall include, but is not limited to, 20 clients requiring residential placements, clients in 21 independent or supported living situations, and clients who 22 live in their family home. Total annual expenditures under 23 tier three may not exceed $35,000 per client each year. 24 (d) Tier four is the family and supported living 25 waiver. Tier four shall include, but is not limited to, 26 clients in independent or supported living situations and 27 clients who live in their family home. An increase to the 28 number of services available to clients in this tier shall not 29 take effect prior to July 1, 2008. Total annual expenditures 30 under tier four may not exceed $14,792 per client each year. 31 (e) The Agency for Health Care Administration shall 3 10:20 PM 04/29/07 c1124c1d-05
Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 also seek federal approval to provide a consumer-directed 2 option for persons with developmental disabilities which 3 corresponds to the funding levels in each of the waiver tiers. 4 The agency shall implement the four-tiered waiver system 5 beginning with tiers one, three, and four and followed by tier 6 two. The agency and the Agency for Health Care Administration 7 may adopt any rules necessary to administer this subsection. 8 (f) The agency shall seek federal waivers and amend 9 contracts as necessary to make changes to services defined in 10 federal waiver programs administered by the agency as follows: 11 1. Supported living coaching services shall not exceed 12 20 hours per month for persons who also receive in-home 13 support services. 14 2. Limited support coordination services shall be the 15 only type of support coordination service provided to persons 16 under the age of 18 who live in the family home. 17 3. Personal care assistance services shall be limited 18 to no more than 180 hours per calendar month and shall not 19 include rate modifiers. Additional hours may be authorized 20 only if a substantial change in circumstances occurs for the 21 individual. 22 4. Residential habilitation services shall be limited 23 to 8 hours per day. Additional hours may be authorized for 24 persons who have intensive medical or adaptive needs and if 25 such hours are essential for avoiding institutionalization, or 26 for persons who possess behavioral problems that are 27 exceptional in intensity, duration, or frequency and present a 28 substantial risk of harming themselves or others. This 29 restriction shall be in effect until the four-tiered waiver 30 system is fully implemented. 31 5. Chore, nonresidential support services and 4 10:20 PM 04/29/07 c1124c1d-05
Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 homemaker services shall be eliminated. The agency shall 2 expand the definition of in-home support services to enable 3 the provider of the service to include activities previously 4 provided in these eliminated services. 5 6. Massage therapy and psychological assessment 6 services shall be eliminated. 7 7. The agency shall conduct supplemental cost plan 8 reviews to verify the medical necessity of authorized services 9 for plans that have increased by more than 8 percent during 10 either of the two preceding fiscal years. 11 8. The agency shall implement a consolidated 12 residential habilitation rate structure to increase savings to 13 the state through a more cost-effective payment method and 14 establish uniform rates for intensive behavioral residential 15 habilitation services. 16 9. Pending federal approval, the agency is authorized 17 to extend current support plans for clients receiving services 18 under Medicaid waivers for 1 year beginning July 1, 2007, or 19 from the date approved, whichever is later. Clients who have a 20 substantial change in circumstances which threatens their 21 health and safety may be reassessed during this year in order 22 to determine the necessity for a change in their support plan. 23 (3) Pending the adoption of rate methodologies 24 pursuant to nonemergency rulemaking under s. 120.54, the 25 Agency for Health Care Administration may, at any time, adopt 26 emergency rules under s. 120.54(4) in order to comply with 27 subsection (4). In adopting such emergency rules, the agency 28 need not make the findings required by s. 120.54(4)(a), and 29 such rules shall be exempt from time limitations provided in 30 s. 120.54(4)(c) and shall remain in effect until replaced by 31 another emergency rule or the nonemergency adoption of the 5 10:20 PM 04/29/07 c1124c1d-05
Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 rate methodology. 2 (4) Nothing in this section or in any administrative 3 rule shall be construed to prevent or limit the Agency for 4 Health Care Administration, in consultation with the Agency 5 for Persons with Disabilities, from adjusting fees, 6 reimbursement rates, lengths of stay, number of visits, or 7 number of services, or from limiting enrollment, or making any 8 other adjustment necessary to comply with the availability of 9 moneys and any limitations or directions provided for in the 10 General Appropriations Act. 11 (5) The Agency for Persons with Disabilities shall 12 submit quarterly status reports to the Executive Office of the 13 Governor, the chair of the Senate Ways and Means Committee or 14 its successor, and the chair of the House Fiscal Council or 15 its successor regarding the financial status of home and 16 community-based services, including the number of enrolled 17 individuals who are receiving services through one or more 18 programs; the number of individuals who have requested 19 services who are not enrolled but who are receiving services 20 through one or more programs, with a description indicating 21 the programs from which the individual is receiving services; 22 the number of individuals who have refused an offer of 23 services but who choose to remain on the list of individuals 24 waiting for services; the number of individuals who have 25 requested services but who are receiving no services; a 26 frequency distribution indicating the length of time 27 individuals have been waiting for services; and information 28 concerning the actual and projected costs compared to the 29 amount of the appropriation available to the program and any 30 projected surpluses or deficits. If at any time an analysis by 31 the agency, in consultation with the Agency for Health Care 6 10:20 PM 04/29/07 c1124c1d-05
Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 Administration, indicates that the cost of services is 2 expected to exceed the amount appropriated, the agency shall 3 submit a plan in accordance with subsection (4) to the 4 Executive Office of the Governor, the chair of Senate Ways and 5 Means Committee or its successor, and the chair of the House 6 Fiscal Council or its successor to remain within the amount 7 appropriated. The agency shall work with the Agency for Health 8 Care Administration to implement the plan so as to remain 9 within the appropriation. 10 Section 2. This act shall take effect July 1, 2007. 11 12 13 ================ T I T L E A M E N D M E N T =============== 14 And the title is amended as follows: 15 Delete everything before the enacting clause 16 17 and insert: 18 A bill to be entitled 19 An act relating to home and community-based 20 services for persons with developmental 21 disabilities; amending s. 393.0661, F.S.; 22 requiring the Agency for Health Care 23 Administration, in consultation with the Agency 24 for Persons with Disabilities, to seek federal 25 approval and implement a four-tiered waiver 26 system for the purpose of serving clients with 27 developmental disabilities; providing 28 requirements and limitations with respect to 29 each tier; authorizing the Agency for Health 30 Care Administration and the Agency for Persons 31 with Disabilities to adopt rules; requiring the 7 10:20 PM 04/29/07 c1124c1d-05
Florida Senate - 2007 CONFERENCE COMMITTEE AMENDMENT Bill No. CS for SB 1124 Barcode 302602 1 Agency for Persons with Disabilities to seek 2 federal waivers and amend contracts in order to 3 implement the waiver system; providing 4 requirements for changes to various services; 5 deleting authorization for the Agency for 6 Health Care Administration to adopt certain 7 emergency rules; providing an effective date. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 8 10:20 PM 04/29/07 c1124c1d-05
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