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Florida House Bill H0831

Florida 2023 Regular Session

Florida House Bill H0831 Compare Versions

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1010 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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1414 A bill to be entitled 1
15-An act relating to the pilot program for individuals 2
16-with developmental disabilities; creating s. 409.9855, 3
15+An act relating to Medicaid recipients with 2
16+developmental disabilities; creating s. 409.9812, 3
1717 F.S.; requiring the Agency for Health Care 4
18-Administration to implement a pilot program for 5
19-individuals with developmental disabilities in 6
20-specified Statewide Medicaid Managed Care regions to 7
21-provide coverage of comprehensive services; 8
22-authorizing the agency to s eek federal approval as 9
23-needed to implement the program; requiring the agency 10
24-to submit a request for federal approval by a 11
25-specified date; requiring the agency to administer the 12
26-pilot program in consultation with the Agency for 13
27-Persons with Disabilities; requiring the Agency for 14
28-Health Care Administration to make specified payments 15
29-to certain organizations for comprehensive services 16
30-for individuals with developmental disabilities; 17
31-providing applicability; requiring the agency to 18
32-evaluate the feasibility of implementing a statewide 19
33-capitated managed care model used by the pilot program 20
34-for certain individuals; providing that participation 21
35-in the pilot program is voluntary and subject to 22
36-specific appropriation; requiring the Agency for 23
37-Persons with Disabiliti es to approve a needs 24
38-assessment methodology to determine certain needs for 25
18+Administration to select a qualified long-term care 5
19+plan to implement the Integrated Plan for Persons with 6
20+Developmental Disabilities Pilot Program in Miami -Dade 7
21+County; providing the pilot program's purpose; 8
22+providing the benefits covered by the pilot program; 9
23+providing that participation in the pilot program is 10
24+voluntary and limited to a specified number of 11
25+enrollees; providing potential participants; providing 12
26+payment to the selected plan; providing requirements 13
27+for the plan; providing requirements for financial 14
28+reports; providing that the plan's pretax income may 15
29+be subject to certain requirements; providing 16
30+requirements for services; requiring agency contract 17
31+for independent evaluation of the plan performance; 18
32+requiring presentation of such evaluation results to 19
33+the Legislature by a specified date; providing an 20
34+effective date. 21
35+ 22
36+Be It Enacted by the Legislature of the State of Florida: 23
37+ 24
38+ Section 1. Section 409.9812, Florida Statutes, is created 25
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4747 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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51-prospective enrollees; providing program enrollment 26
52-eligibility requirements; requiring that enrollees be 27
53-afforded an opportunity to enroll in any appropriate 28
54-existing Medicaid wai ver program under certain 29
55-circumstances; requiring participating plans to cover 30
56-specified benefits; providing requirements for 31
57-providers of services; providing eligibility 32
58-requirements for plans; providing a selection process; 33
59-requiring the Agency for Heal th Care Administration to 34
60-give preference to certain plans; requiring that plan 35
61-payments be based on rates specifically developed for 36
62-a certain population; requiring the agency to ensure 37
63-that the rate be actuarially sound; requiring that the 38
64-revenues and expenditures of the selected plan be 39
65-included in specified reporting and regulatory 40
66-requirements; requiring the agency to select 41
67-participating plans and begin enrollment by a 42
68-specified date; requiring the agency, in consultation 43
69-with the Agency for Persons with Disabilities, to 44
70-conduct certain audits of the selected plans' 45
71-implementation of person -centered planning and to 46
72-submit specified progress reports to the Governor and 47
73-the Legislature by specified dates throughout the 48
74-program approval and implementatio n process; providing 49
75-requirements for the respective reports; requiring the 50
51+to read: 26
52+ 409.9812 Integrated Plan for Persons with Developmental 27
53+Disabilities Pilot Program.— 28
54+ (1) The agency shall select a single qualified long -term 29
55+care plan to implement the Integrated Plan for Persons with 30
56+Developmental Disabilities Pilot Program in Miami -Dade County. 31
57+The purpose of the pilot program is to provide coverage for 32
58+comprehensive services for Medicaid recipients who have a 33
59+developmental disability, as defined in s. 393.063. The 34
60+comprehensive services coverage includes the benefits described 35
61+in s. 409.973, the community services described in s. 36
62+393.066(3), and the long-term care plan benefits described in s. 37
63+409.98. 38
64+ (2) Participation in the pilot program is voluntary and 39
65+limited to the maximum number of enrollees specified in the 40
66+General Appropriations Act. Potential participants will be 41
67+identified from individual s on the waiting list for the 42
68+Individual Budget (iBudget) Waiver services. 43
69+ (3) The selected qualified long -term care plan will be 44
70+paid a risk-adjusted capitation rate. The plan must: 45
71+ (a) Be a provider service network whose owners include 46
72+licensed health care providers with experience serving iBudget 47
73+Waiver recipients. 48
74+ (b) Provide all categories of benefits through a single, 49
75+integrated model of care. 50
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8484 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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88-Agency for Health Care Administration, in consultation 51
89-with the Agency for Persons with Disabilities, to 52
90-conduct an evaluation of the pilot program; 53
91-authorizing the Agency for Heal th Care Administration 54
92-to contract with an independent evaluator to conduct 55
93-such evaluation; providing requirements for the 56
94-evaluation; requiring the Agency for Health Care 57
95-Administration, in consultation with the Agency for 58
96-Persons with Disabilities, to c onduct quality 59
97-assurance monitoring of the pilot program; requiring 60
98-the Agency for Health Care Administration to submit 61
99-the results of the evaluation to the Governor and the 62
100-Legislature by a specified date; providing an 63
101-effective date. 64
102- 65
103-Be It Enacted by the Legislature of the State of Florida: 66
104- 67
105- Section 1. Section 409.9855, Florida Statutes, is created 68
106-to read: 69
107- 409.9855 Pilot program for individuals with developmental 70
108-disabilities.— 71
109- (1) PILOT PROGRAM IMPLEMENTATION. — 72
110- (a) Using a managed care mo del, the agency shall implement 73
111-a pilot program for individuals with developmental disabilities 74
112-in Statewide Medicaid Managed Care Regions D and I to provide 75
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121-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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125-coverage of comprehensive services. 76
126- (b) The agency may seek federal approval through a state 77
127-plan amendment or Medicaid waiver as necessary to implement the 78
128-pilot program. The agency shall submit a request for any federal 79
129-approval needed to implement the pilot program by September 1, 80
130-2023. 81
131- (c) Pursuant to s. 409.963, the agency shall administer 82
132-the pilot program in consultation with the Agency for Persons 83
133-with Disabilities. 84
134- (d) The agency shall make capitated payments to managed 85
135-care organizations for comprehensive coverage, including 86
136-community-based services described in s. 393.066(3) and approve d 87
137-through the state's home and community -based services Medicaid 88
138-waiver program for individuals with developmental disabilities. 89
139-Unless otherwise specified, ss. 409.961 -409.969 apply to the 90
140-pilot program. 91
141- (e) The agency shall evaluate the feasibility of statewide 92
142-implementation of the capitated managed care model used by the 93
143-pilot program to serve individuals with developmental 94
144-disabilities. 95
145- (2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT. — 96
146- (a) Participation in the pilot program is voluntary and 97
147-limited to the maximum number of enrollees specified in the 98
148-General Appropriations Act. 99
149- (b) The Agency for Persons with Disabilities shall approve 100
150-
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158-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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162-a needs assessment methodology to determine functional, 101
163-behavioral, and physical needs of prospective enrol lees. The 102
164-assessment methodology may be administered by persons who have 103
165-completed such training as may be offered by the agency. 104
166-Eligibility to participate in the pilot program is determined 105
167-based on all of the following criteria: 106
168- 1. Whether the individ ual is eligible for Medicaid. 107
169- 2. Whether the individual is 18 years of age or older and 108
170-is on the waiting list for individual budget waiver services 109
171-under chapter 393 and assigned to one of categories 1 through 6 110
172-as specified in s. 393.065(5). 111
173- 3. Whether the individual resides in a pilot program 112
174-region. 113
175- (c) The agency shall enroll individuals in the pilot 114
176-program based on verification that the individual has met the 115
177-criteria in paragraph (b). 116
178- (d) Notwithstanding any provisions of s. 393.065 to the 117
179-contrary, an enrollee must be afforded an opportunity to enroll 118
180-in any appropriate existing Medicaid waiver program if any of 119
181-the following conditions occur: 120
182- 1. At any point during the operation of the pilot program, 121
183-an enrollee declares an inten t to voluntarily disenroll, 122
184-provided that he or she has been covered for the entire previous 123
185-plan year by the pilot program. 124
186- 2. The agency determines the enrollee has a good cause 125
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195-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199-reason to disenroll. 126
200- 3. The pilot program ceases to operate. 127
201- 128
202-Such enrollees must receive an individualized transition plan to 129
203-assist him or her in accessing sufficient services and supports 130
204-for the enrollee's safety, well -being, and continuity of care. 131
205- (3) PILOT PROGRAM BENEFITS. — 132
206- (a) Plans participating in the pilot prog ram must, at a 133
207-minimum, cover the following: 134
208- 1. All benefits included in s. 409.973. 135
209- 2. All benefits included in s. 409.98. 136
210- 3. All benefits included in s. 393.066(3), and all of the 137
211-following: 138
212- a. Adult day training. 139
213- b. Behavior analysis services. 140
214- c. Behavior assistant services. 141
215- d. Companion services. 142
216- e. Consumable medical supplies. 143
217- f. Dietitian services. 144
218- g. Durable medical equipment and supplies. 145
219- h. Environmental accessibility adaptations. 146
220- i. Occupational therapy. 147
221- j. Personal emergency response systems. 148
222- k. Personal supports. 149
223- l. Physical therapy. 150
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232-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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236- m. Prevocational services. 151
237- n. Private duty nursing. 152
238- o. Residential habilitation, including the following 153
239-levels: 154
240- (I) Standard level. 155
241- (II) Behavior-focused level. 156
242- (III) Intensive-behavior level. 157
243- (IV) Enhanced intensive -behavior level. 158
244- p. Residential nursing services. 159
245- q. Respiratory therapy. 160
246- r. Respite care. 161
247- s. Skilled nursing. 162
248- t. Specialized medical home care. 163
249- u. Specialized mental health counseling. 164
250- v. Speech therapy. 165
251- w. Support coordination. 166
252- x. Supported employment. 167
253- y. Supported living coaching. 168
254- z. Transportation. 169
255- (b) All providers of the services listed under paragraph 170
256-(a) must meet the provider qualifications outlined in the 171
257-Florida Medicaid Developmental Disabilities Individual Budgeting 172
258-Waiver Services Coverage and Limitations Handbook as adopted by 173
259-reference in rule 59G -13.070, Florida Administrative Code. 174
260- (c) Support coordination services must maximize the use of 175
261-
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269-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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271-
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273-natural supports and comm unity partnerships. 176
274- (d) The plans participating in the pilot program must 177
275-provide all categories of benefits through a single, integrated 178
276-model of care. 179
277- (e) Services must be provided to enrollees in accordance 180
278-with an individualized care plan which is evaluated and updated 181
279-at least quarterly and as warranted by changes in an enrollee's 182
280-circumstances. 183
281- (4) ELIGIBLE PLANS; PLAN SELECTION. — 184
282- (a) To be eligible to participate in the pilot program, a 185
283-plan must have been awarded a contract to provide long -term care 186
284-services pursuant to s. 409.981 as a result of an invitation to 187
285-negotiate. 188
286- (b) The agency shall select, as provided in s. 287.057(1), 189
287-one plan to participate in the pilot program for each of the two 190
288-regions. The director of the Agency for Person s with 191
289-Disabilities or his or her designee must be a member of the 192
290-negotiating team. 193
291- 1. The invitation to negotiate must specify the criteria 194
292-and the relative weight assigned to each criterion that will be 195
293-used for determining the acceptability of submit ted responses 196
294-and guiding the selection of the plans with which the agency and 197
295-the Agency for Persons with Disabilities negotiate. In addition 198
296-to any other criteria established by the agency, in consultation 199
297-with the Agency for Persons with Disabilities, t he agency shall 200
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306-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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310-consider the following factors in the selection of eligible 201
311-plans: 202
312- a. Experience serving similar populations, including the 203
313-plan's record in achieving specific quality standards with 204
314-similar populations. 205
315- b. Establishment of community pa rtnerships with providers 206
316-which create opportunities for reinvestment in community -based 207
317-services. 208
318- c. Provision of additional benefits, particularly 209
319-behavioral health services, the coordination of dental care, and 210
320-other initiatives that improve overall w ell-being. 211
321- d. Provision of and capacity to provide mental health 212
322-therapies and analysis designed to meet the needs of individuals 213
323-with developmental disabilities. 214
324- e. Evidence that an eligible plan has written agreements 215
325-or signed contracts or has made substantial progress in 216
326-establishing relationships with providers before submitting its 217
327-response. 218
328- f. Experience in the provision of person -centered planning 219
329-as described in 42 C.F.R. s. 441.301(c)(1). 220
330- g. Experience in robust provider development programs that 221
331-result in increased availability of Medicaid providers to serve 222
332-the developmental disabilities community. 223
333- 2. After negotiations are conducted, the agency shall 224
334-select the eligible plans that are determined to be responsive 225
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343-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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347-and provide the best value to the state. Preference must be 226
348-given to plans that: 227
349- a. Have signed contracts in sufficient numbers to meet the 228
350-specific standards established under s. 409.967(2)(c), including 229
351-contracts for person al supports, skilled nursing, residential 230
352-habilitation, adult day training, mental health services, 231
353-respite care, companion services, and supported employment, as 232
354-those services are defined in the Florida Medicaid Developmental 233
355-Disabilities Individual Budg eting Waiver Services Coverage and 234
356-Limitations Handbook as adopted by reference in rule 59G -13.070, 235
357-Florida Administrative Code. 236
358- b. Have well-defined programs for recognizing patient -237
359-centered medical homes and providing increased compensation to 238
360-recognized medical homes, as defined by the plan. 239
361- c. Have well-defined programs related to person -centered 240
362-planning as described in 42 C.F.R. s. 441.301(c)(1). 241
363- d. Have robust and innovative programs for provider 242
364-development and collaboration with the Agency fo r Persons with 243
365-Disabilities. 244
366- (5) PAYMENT.— 245
367- (a) The selected plans must receive a per -member, per-246
368-month payment based on a rate developed specifically for the 247
369-unique needs of the developmentally disabled population. 248
370- (b) The agency must ensure that the rate for the 249
371-integrated system is actuarially sound. 250
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380-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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384- (c) The revenues and expenditures of the selected plan 251
385-which are associated with the implementation of the pilot 252
386-program must be included in the reporting and regulatory 253
387-requirements established in s. 409.967(3). 254
388- (6) PROGRAM IMPLEMENTATION AND EVALUATION. — 255
389- (a) The agency shall select participating plans and begin 256
390-enrollment no later than January, 2024. 257
391- (b) Upon implementation of the program, the agency, in 258
392-consultation with the Agency for Person s with Disabilities, 259
393-shall conduct audits of the selected plans' implementation of 260
394-person-centered planning. 261
395- (c) The agency, in consultation with the Agency for 262
396-Persons with Disabilities, shall submit progress reports to the 263
397-Governor, the President of th e Senate, and the Speaker of the 264
398-House of Representatives upon the federal approval, 265
399-implementation, and operation of the pilot program, as follows: 266
400- 1. By December 31, 2023, a status report on progress made 267
401-toward federal approval of the waiver or waiver amendment needed 268
402-to implement the pilot program. 269
403- 2. By December 31, 2024, a status report on implementation 270
404-of the pilot program. 271
405- 3. By December 31, 2025, and annually thereafter, a status 272
406-report on the operation of the pilot program, including, but not 273
407-limited to, all of the following: 274
408- a. Program enrollment, including the number and 275
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417-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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421-demographics of enrollees. 276
422- b. Any complaints received. 277
423- c. Access to approved services. 278
424- (d) The agency, in consultation with the Agency for 279
425-Persons with Disabilities, shall establish specific measures of 280
426-access, quality, and costs of the pilot program. The agency may 281
427-contract with an independent evaluator to conduct such 282
428-evaluation. The evaluation must inc lude assessments of cost 283
429-savings; consumer education, choice, and access to services; 284
430-plans for future capacity and the enrollment of new Medicaid 285
431-providers; coordination of care; person -centered planning and 286
432-person-centered well-being outcomes; health and quality-of-life 287
433-outcomes; and quality of care by each eligibility category and 288
434-managed care plan in each pilot program site. The evaluation 289
435-must describe any administrative or legal barriers to the 290
436-implementation and operation of the pilot program in each 291
437-region. 292
438- 1. The agency, in consultation with the Agency for Persons 293
439-with Disabilities, shall conduct quality assurance monitoring of 294
440-the pilot program to include client satisfaction with services, 295
441-client health and safety outcomes, client well -being outcomes, 296
442-and service delivery in accordance with the client's care plan. 297
443- 2. The agency shall submit the results of the evaluation 298
444-to the Governor, the President of the Senate, and the Speaker of 299
445-the House of Representatives by October 1, 2029. 300
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454-F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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458- Section 2. This act shall take effect upon becoming a law. 301
88+ (4) Periodic financial reports from the selected qualified 51
89+long-term care plan must document revenues and expenditures 52
90+related to the pilot program. The plan's pretax income may be 53
91+subject to the income sharing ratios established in s. 54
92+409.967(3)(f). 55
93+ (5) The selected qualified long -term care plan's services 56
94+must be provided to enrollees in accordance wi th an 57
95+individualized care plan that is evaluated and updated at least 58
96+quarterly or as warranted by changes in conditions and 59
97+circumstances. 60
98+ (6) The agency shall contract for an independent 61
99+evaluation of the performance of the selected qualified long -62
100+term care plan based on specific measures of access, quality, 63
101+and cost. The results of the evaluation shall be presented to 64
102+the Legislature by October 31, 2024. 65
103+ Section 2. This act shall take effect July 1, 2023. 66