Florida Senate - 2024 SB 1170 By Senator Bradley 6-01504-24 20241170__ Page 1 of 16 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to the home and community-based 2 services Medicaid waiver program; amending s. 393.065, 3 F.S.; requiring the Agency for Persons with 4 Disabilities to develop and implement an automated, 5 electronic application process for specified services; 6 providing requirements for the application process; 7 requiring the agency to provide an application in a 8 printed form or a portable document format under 9 certain circumstances; deleting the requirement that 10 application for services be made to the agency in the 11 region in which the applicant resides; specifying that 12 applicants meeting specified criteria are deemed to be 13 in crisis regardless of the applicant’s age; requiring 14 the agency to make an eligibility determination for 15 certain applicants within specified timeframes; 16 authorizing the agency to request additional 17 documentation needed to make an eligibility 18 determination; prohibiting such request from 19 preventing or delaying services to the applicant; 20 providing for a comprehensive assessment of an 21 applicant under certain circumstances; requiring the 22 agency to complete its eligibility determination 23 within a specified timeframe after requesting 24 additional documentation from or arranging for a 25 comprehensive assessment of the applicant; requiring 26 the Agency for Persons with Disabilities and the 27 Agency for Health Care Administration to adopt rules 28 and implement certain policies by a specified date; 29

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 2 of 16 CODING: Words stricken are deletions; words underlined are additions. amending s. 393.0662, F.S.; providing requirements for 30 the Agency for Health Care Administration when a 31 client’s iBudget is established; requiring the Agency 32 for Persons with Disabilities to ensure that certain 33 client services commence within a specified timeframe; 34 requiring the Agency for Persons with Disabilities and 35 the Agency for Health Care Administration to adopt 36 rules and implement certain policies by a specified 37 date; amending ss. 393.0651, 409.9127, and 409.9855, 38 F.S.; conforming cross-references; providing an 39 effective date. 40 41 Be It Enacted by the Legislature of the State of Florida: 42 43

Section 1. Present subsections (1) through (12) of

section 44 393.065, Florida Statutes, are redesignated as subsections (2) 45 through (13), respectively, a new subsection (1) is added to 46 that section, and present subsections (1), (5), (6), and (7), 47 paragraph (

a) of present subsection (8), and present subsections 48 (11) and (12) are amended, to read: 49 393.065 Application and eligibility determination.— 50

(1) As part of the agency’s website, the agency shall 51 develop and implement an automated, electronic application 52 process. The application process shall, at a minimum, support: 53 (

a) Electronic submissions. 54 (

b) Automatic processing of each application. 55 (

c) Immediate automatic e-mail confirmation to each 56 applicant with proof of filing along with a date and time stamp. 57 (

d) Upon request, if the applicant does not have access to 58

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 3 of 16 CODING: Words stricken are deletions; words underlined are additions. electronic resources, providing the applicant with the 59 application in printed form or in a portable document format. 60 (2)

(1) Application for services shall be made in writing to 61 the agency, in the region in which the applicant resides. The 62 agency shall review each application and make an eligibility 63 determination within 60 days after receipt of the signed 64 application. If, at the time of the application, an applicant is 65 requesting enrollment in the home and community-based services 66 Medicaid waiver program for individuals with developmental 67 disabilities deemed to be in crisis, as described in paragraph 68 (6)(a) (5)(a), the agency shall complete an eligibility 69 determination within 45 days after receipt of the signed 70 application. 71 (

a) If the agency determines additional documentation is 72 necessary to make an eligibility determination, the agency may 73 request the additional documentation from the applicant. 74 (

b) When necessary to definitively identify individual 75 conditions or needs, the agency or its designee must provide a 76 comprehensive assessment. 77 (

c) If the agency requests additional documentation from 78 the applicant or provides or arranges for a comprehensive 79 assessment, the agency’s eligibility determination must be 80 completed within 90 days after receipt of the signed 81 application. 82 (

d) If the applicant meets the criteria for preenrollment 83 category 2 in paragraph (6)(b), such applicant is deemed to be 84 in crisis and the following is required, regardless of the 85 applicant’s age: 86 1. The agency shall review each application and make an 87

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 4 of 16 CODING: Words stricken are deletions; words underlined are additions. eligibility determination within 5 business days after receipt 88 of the signed application. 89 2. If, at the time of the application, the applicant is 90 requesting enrollment in the home and community-based services 91 Medicaid waiver program for individuals with developmental 92 disabilities deemed to be in crisis, as described in paragraph 93 (6)(a), the agency must complete an eligibility determination 94 within 15 calendar days after receipt of the signed application. 95 3.

If the agency determines additional documentation is 96 necessary to make an eligibility determination, the agency may 97 request additional documentation from the applicant, but such 98 agency request may not prevent or delay services to the 99 applicant. When necessary to definitively identify individual 100 conditions or needs, the agency or its designee must provide a 101 comprehensive assessment. 102 4.

If the agency requests additional documentation from the 103 applicant or provides or arranges for a comprehensive 104 assessment, the agency’s eligibility determination must be 105 completed within 60 calendar days after receipt of the signed 106 application. 107 (6)

(5) Except as provided in subsections (7) and (8) (6) 108 and (7), if a client seeking enrollment in the developmental 109 disabilities home and community-based services Medicaid waiver 110 program meets the level of care requirement for an intermediate 111 care facility for individuals with intellectual disabilities 112 pursuant to 42 C.F.R. ss. 435.217(b)(1) and 440.150, the agency 113 must assign the client to an appropriate preenrollment category 114 pursuant to this subsection and must provide priority to clients 115 waiting for waiver services in the following order: 116

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 5 of 16 CODING: Words stricken are deletions; words underlined are additions. (

a) Category 1, which includes clients deemed to be in 117 crisis as described in rule, must be given first priority in 118 moving from the preenrollment categories to the waiver. 119 (

b) Category 2, which includes clients in the preenrollment 120 categories who are: 121 1. From the child welfare system with an open case in the 122 Department of Children and Families’ statewide automated child 123 welfare information system and who are either: 124 a. Transitioning out of the child welfare system into 125 permanency; or 126 b. At least 18 years but not yet 22 years of age and who 127 need both waiver services and extended foster care services; or 128 2. At least 18 years but not yet 22 years of age and who 129 withdrew consent pursuant to s. 39.6251(5)(

c) to remain in the 130 extended foster care system. 131 For individuals who are at least 18 years but not yet 22 years 132 of age and who are eligible under sub-subparagraph 1.b., the 133 agency must provide waiver services, including residential 134 habilitation, and the community-based care lead agency must fund 135 room and board at the rate established in s. 409.145(3) and 136 provide case management and related services as defined in s. 137 409.986(3)(e). Individuals may receive both waiver services and 138 services under s. 39.6251. Services may not duplicate services 139 available through the Medicaid state plan. 140 (

c) Category 3, which includes, but is not required to be 141 limited to, clients: 142 1. Whose caregiver has a documented condition that is 143 expected to render the caregiver unable to provide care within 144 the next 12 months and for whom a caregiver is required but no 145

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 6 of 16 CODING: Words stricken are deletions; words underlined are additions. alternate caregiver is available; 146 2. At substantial risk of incarceration or court commitment 147 without supports; 148 3. Whose documented behaviors or physical needs place them 149 or their caregiver at risk of serious harm and other supports 150 are not currently available to alleviate the situation; or 151 4.

Who are identified as ready for discharge within the 152 next year from a state mental health hospital or skilled nursing 153 facility and who require a caregiver but for whom no caregiver 154 is available or whose caregiver is unable to provide the care 155 needed. 156 (

d) Category 4, which includes, but is not required to be 157 limited to, clients whose caregivers are 70 years of age or 158 older and for whom a caregiver is required but no alternate 159 caregiver is available. 160 (

e) Category 5, which includes, but is not required to be 161 limited to, clients who are expected to graduate within the next 162 12 months from secondary school and need support to obtain a 163 meaningful day activity, maintain competitive employment, or 164 pursue an accredited program of postsecondary education to which 165 they have been accepted. 166 (

f) Category 6, which includes clients 21 years of age or 167 older who do not meet the criteria for category 1, category 2, 168 category 3, category 4, or category 5. 169 (

g) Category 7, which includes clients younger than 21 170 years of age who do not meet the criteria for category 1, 171 category 2, category 3, or category 4. 172 Within preenrollment categories 3, 4, 5, 6, and 7, the agency 173 shall prioritize clients in the order of the date that the 174

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 7 of 16 CODING: Words stricken are deletions; words underlined are additions. client is determined eligible for waiver services. 175 (7)

(6) The agency must allow an individual who meets the 176 eligibility requirements of subsection (3) (2) to receive home 177 and community-based services in this state if the individual’s 178 parent or legal guardian is an active-duty military 179 servicemember and if, at the time of the servicemember’s 180 transfer to this state, the individual was receiving home and 181 community-based services in another state. 182 (8)

(7) The agency must allow an individual with a diagnosis 183 of Phelan-McDermid syndrome who meets the eligibility 184 requirements of subsection (3) (2) to receive home and 185 community-based services. 186 (9)

(8) Only a client may be eligible for services under the 187 developmental disabilities home and community-based services 188 Medicaid waiver program. For a client to receive services under 189 the developmental disabilities home and community-based services 190 Medicaid waiver program, there must be available funding 191 pursuant to s. 393.0662 or through a legislative appropriation 192 and the client must meet all of the following: 193 (

a) The eligibility requirements of subsection (3) (2), 194 which must be confirmed by the agency. 195 (12)(a)(11)(

a) The agency must provide the following 196 information to all applicants or their parents, legal guardians, 197 or family members: 198 1. A brief overview of the vocational rehabilitation 199 services offered through the Division of Vocational 200 Rehabilitation of the Department of Education, including a 201 hyperlink or website address that provides access to the 202 application for such services; 203

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 8 of 16 CODING: Words stricken are deletions; words underlined are additions. 2. A brief overview of the Florida ABLE program as 204 established under s. 1009.986, including a hyperlink or website 205 address that provides access to the application for establishing 206 an ABLE account as defined in s. 1009.986(2); 207 3.

A brief overview of the supplemental security income 208 benefits and social security disability income benefits 209 available under Title XVI of the Social Security Act, as 210 amended, including a hyperlink or website address that provides 211 access to the application for such benefits; 212 4. A statement indicating that the applicant’s local public 213 school district may provide specialized instructional services, 214 including transition programs, for students with special 215 education needs; 216 5.

A brief overview of programs and services funded through 217 the Florida Center for Students with Unique Abilities, including 218 contact information for each state-approved Florida 219 Postsecondary Comprehensive Transition Program; 220 6. A brief overview of decisionmaking options for 221 individuals with disabilities, guardianship under

chapter 744, 222 and alternatives to guardianship as defined in s. 744.334(1), 223 which may include contact information for organizations that the 224 agency believes would be helpful in assisting with such 225 decisions; 226 7. A brief overview of the referral tools made available 227 through the agency, including a hyperlink or website address 228 that provides access to such tools; and 229 8. A statement indicating that some waiver providers may 230 serve private-pay individuals. 231 (

b) The agency must provide the information required in 232

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 9 of 16 CODING: Words stricken are deletions; words underlined are additions. paragraph (

a) in writing to an applicant or his or her parent, 233 legal guardian, or family member along with a written disclosure 234 statement in substantially the following form: 235 236 DISCLOSURE STATEMENT 237 Each program and service has its own eligibility 238 requirements. By providing the information specified in 239

section 393.065(12)(a) 393.065(11)(a), Florida Statutes, 240 the agency does not guarantee an applicant’s eligibility 241 for or enrollment in any program or service. 242 243 (

c) The agency must also publish the information required 244 in paragraph (

a) and the disclosure statement in paragraph (b) 245 on its website, and must provide that information and statement 246 annually to each client placed in the preenrollment categories 247 or to the parent, legal guardian, or family member of such 248 client. 249 (13)

(12) The agency and the Agency for Health Care 250 Administration: 251 (

a) May adopt rules specifying application procedures, 252 criteria associated with the preenrollment categories, 253 procedures for administering the preenrollment, including tools 254 for prioritizing waiver enrollment within preenrollment 255 categories, and eligibility requirements as needed to administer 256 this section. 257 (

b) By September 29, 2024, shall adopt rules and implement 258 policies to maintain compliance with paragraph (2)(d). 259

Section 2. Subsections (2) and (15) of

section 393.0662, 260 Florida Statutes, are amended to read: 261

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 10 of 16 CODING: Words stricken are deletions; words underlined are additions. 393.0662 Individual budgets for delivery of home and 262 community-based services; iBudget system established.—The 263 Legislature finds that improved financial management of the 264 existing home and community-based Medicaid waiver program is 265 necessary to avoid deficits that impede the provision of 266 services to individuals who are on the waiting list for 267 enrollment in the program.

The Legislature further finds that 268 clients and their families should have greater flexibility to 269 choose the services that best allow them to live in their 270 community within the limits of an established budget. Therefore, 271 the Legislature intends that the agency, in consultation with 272 the Agency for Health Care Administration, shall manage the 273 service delivery system using individual budgets as the basis 274 for allocating the funds appropriated for the home and 275 community-based services Medicaid waiver program among eligible 276 enrolled clients.

The service delivery system that uses 277 individual budgets shall be called the iBudget system. 278

(2) The Agency for Health Care Administration, in 279 consultation with the agency, shall: 280 (

a) Seek federal approval to amend current waivers, request 281 a new waiver, and amend contracts as necessary to manage the 282 iBudget system, improve services for eligible and enrolled 283 clients, and improve the delivery of services through the home 284 and community-based services Medicaid waiver program and the 285 Consumer-Directed Care Plus Program, including, but not limited 286 to, enrollees with a dual diagnosis of a developmental 287 disability and a mental health disorder. 288 (

b) At the time a client’s iBudget is established: 289 1. Educate the client or the caregiver of the client 290

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 11 of 16 CODING: Words stricken are deletions; words underlined are additions. regarding the Consumer-Directed Care Plus Program. 291 2. Provide each client the opportunity to apply for the 292 Consumer-Directed Care Plus Program. 293 (

c) The agency shall, within 14 calendar days after the 294 time of a client’s submission of an application for the 295 Consumer-Directed Care Plus Program, ensure that the client’s 296 Consumer-Directed Care Plus Program services commence and the 297 client is no longer required to access services through the 298 iBudget system. 299

(15) The agency and the Agency for Health Care 300 Administration: 301 (

a) May adopt rules specifying the allocation algorithm and 302 methodology; criteria and processes for clients to access funds 303 for services to meet significant additional needs; and processes 304 and requirements for selection and review of services, 305 development of support and cost plans, and management of the 306 iBudget system as needed to administer this section. 307 (

b) By September 29, 2024, shall adopt rules and implement 308 policies to maintain compliance with paragraph (2)(b). 309

Section

Section 393.0651, Florida Statutes, is amended 310 to read: 311 393.0651 Family or individual support plan.—The agency 312 shall provide directly or contract for the development of a 313 family support plan for children ages 3 to 18 years of age and 314 an individual support plan for each client. The client, if 315 competent, the client’s parent or guardian, or, when 316 appropriate, the client advocate, shall be consulted in the 317 development of the plan and shall receive a copy of the plan. 318 Each plan must include the most appropriate, least restrictive, 319

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 12 of 16 CODING: Words stricken are deletions; words underlined are additions. and most cost-beneficial environment for accomplishment of the 320 objectives for client progress and a specification of all 321 services authorized. The plan must include provisions for the 322 most appropriate level of care for the client. Within the 323 specification of needs and services for each client, when 324 residential care is necessary, the agency shall move toward 325 placement of clients in residential facilities based within the 326 client’s community.

The ultimate goal of each plan, whenever 327 possible, shall be to enable the client to live a dignified life 328 in the least restrictive setting, be that in the home or in the 329 community. The family or individual support plan must be 330 developed within 60 days after the agency determines the client 331 eligible pursuant to s. 393.065(4) s. 393.065(3). 332

(1) The agency shall develop and specify by rule the core 333 components of support plans. 334

(2) The family or individual support plan shall be 335 integrated with the individual education plan (IEP) for all 336 clients who are public school students entitled to a free 337 appropriate public education under the Individuals with 338 Disabilities Education Act, I.D.E.A., as amended. The family or 339 individual support plan and IEP must be implemented to maximize 340 the attainment of educational and habilitation goals. 341 (

a) If the IEP for a student enrolled in a public school 342 program indicates placement in a public or private residential 343 program is necessary to provide special education and related 344 services to a client, the local education agency must provide 345 for the costs of that service in accordance with the 346 requirements of the Individuals with Disabilities Education Act, 347 I.D.E.A., as amended. This does not preclude local education 348

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 13 of 16 CODING: Words stricken are deletions; words underlined are additions. agencies and the agency from sharing the residential service 349 costs of students who are clients and require residential 350 placement. 351 (

b) For clients who are entering or exiting the school 352 system, an interdepartmental staffing team composed of 353 representatives of the agency and the local school system shall 354 develop a written transitional living and training plan with the 355 participation of the client or with the parent or guardian of 356 the client, or the client advocate, as appropriate. 357

(3) Each family or individual support plan shall be 358 facilitated through case management designed solely to advance 359 the individual needs of the client. 360

(4) In the development of the family or individual support 361 plan, a client advocate may be appointed by the support planning 362 team for a client who is a minor or for a client who is not 363 capable of express and informed consent when: 364 (

a) The parent or guardian cannot be identified; 365 (

b) The whereabouts of the parent or guardian cannot be 366 discovered; or 367 (

c) The state is the only legal representative of the 368 client. 369 370 Such appointment may not be construed to extend the powers of 371 the client advocate to include any of those powers delegated by 372 law to a legal guardian. 373

(5) The agency shall place a client in the most appropriate 374 and least restrictive, and cost-beneficial, residential facility 375 according to his or her individual support plan. The client, if 376 competent, the client’s parent or guardian, or, when 377

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 14 of 16 CODING: Words stricken are deletions; words underlined are additions. appropriate, the client advocate, and the administrator of the 378 facility to which placement is proposed shall be consulted in 379 determining the appropriate placement for the client. 380 Considerations for placement shall be made in the following 381 order: 382 (

a) Client’s own home or the home of a family member or 383 direct service provider. 384 (

b) Foster care facility. 385 (

c) Group home facility. 386 (

d) Intermediate care facility for the developmentally 387 disabled. 388 (

e) Other facilities licensed by the agency which offer 389 special programs for people with developmental disabilities. 390 (

f) Developmental disabilities center. 391

(6) In developing a client’s annual family or individual 392 support plan, the individual or family with the assistance of 393 the support planning team shall identify measurable objectives 394 for client progress and shall specify a time period expected for 395 achievement of each objective. 396

(7) The individual, family, and support coordinator shall 397 review progress in achieving the objectives specified in each 398 client’s family or individual support plan, and shall revise the 399 plan annually, following consultation with the client, if 400 competent, or with the parent or guardian of the client, or, 401 when appropriate, the client advocate. The agency or designated 402 contractor shall annually report in writing to the client, if 403 competent, or to the parent or guardian of the client, or to the 404 client advocate, when appropriate, with respect to the client’s 405 habilitative and medical progress. 406

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(8) Any client, or any parent of a minor client, or 407 guardian, authorized guardian advocate, or client advocate for a 408 client, who is substantially affected by the client’s initial 409 family or individual support plan, or the annual review thereof, 410 shall have the right to file a notice to challenge the decision 411 pursuant to ss. 120.569 and 120.57. Notice of such right to 412 appeal shall be included in all support plans provided by the 413 agency. 414

Section 4. Subsection (3) of

section 409.9127, Florida 415 Statutes, is amended to read: 416 409.9127 Preauthorization and concurrent utilization 417 review; conflict-of-interest standards.— 418

(3) The agency shall help the Agency for Persons with 419 Disabilities meet the requirements of s. 393.065(5) s. 420 393.065(4). Only admissions approved pursuant to such 421 assessments are eligible for reimbursement under this chapter. 422

Section 5. Paragraph (

b) of subsection (2) of

section 423 409.9855, Florida Statutes, is amended to read: 424 409.9855 Pilot program for individuals with developmental 425 disabilities.— 426

(2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT.— 427 (

b) The Agency for Persons with Disabilities shall approve 428 a needs assessment methodology to determine functional, 429 behavioral, and physical needs of prospective enrollees. The 430 assessment methodology may be administered by persons who have 431 completed such training as may be offered by the agency. 432 Eligibility to participate in the pilot program is determined 433 based on all of the following criteria: 434 1. Whether the individual is eligible for Medicaid. 435

Florida Senate - 2024 SB 1170 6-01504-24 20241170__ Page 16 of 16 CODING: Words stricken are deletions; words underlined are additions. 2. Whether the individual is 18 years of age or older and 436 is on the waiting list for individual budget waiver services 437 under

chapter 393 and assigned to one of categories 1 through 6 438 as specified in s. 393.065(6) s. 393.065(5). 439 3. Whether the individual resides in a pilot program 440 region. 441

Section 6. This act shall take effect July 1, 2024. 442