HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 1 of 13
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
A bill to be entitled 1
An act relating to the pilot program for individuals 2
with developmental disabilities; creating s. 409.9855, 3
F.S.; requiring the Agency for Health Care 4
Administration to implement a pilot program for 5
individuals with developmental disabilities in 6
specified Statewide Medicaid Managed Care regions to 7
provide coverage of comprehensive services; 8
authorizing the agency to s eek federal approval as 9
needed to implement the program; requiring the agency 10
to submit a request for federal approval by a 11
specified date; requiring the agency to administer the 12
pilot program in consultation with the Agency for 13
Persons with Disabilities; requiring the Agency for 14
Health Care Administration to make specified payments 15
to certain organizations for comprehensive services 16
for individuals with developmental disabilities; 17
providing applicability; requiring the agency to 18
evaluate the feasibility of implementing a statewide 19
capitated managed care model used by the pilot program 20
for certain individuals; providing that participation 21
in the pilot program is voluntary and subject to 22
specific appropriation; requiring the Agency for 23
Persons with Disabiliti es to approve a needs 24
assessment methodology to determine certain needs for 25
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 2 of 13
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
prospective enrollees; providing program enrollment 26
eligibility requirements; requiring that enrollees be 27
afforded an opportunity to enroll in any appropriate 28
existing Medicaid wai ver program under certain 29
circumstances; requiring participating plans to cover 30
specified benefits; providing requirements for 31
providers of services; providing eligibility 32
requirements for plans; providing a selection process; 33
requiring the Agency for Heal th Care Administration to 34
give preference to certain plans; requiring that plan 35
payments be based on rates specifically developed for 36
a certain population; requiring the agency to ensure 37
that the rate be actuarially sound; requiring that the 38
revenues and expenditures of the selected plan be 39
included in specified reporting and regulatory 40
requirements; requiring the agency to select 41
participating plans and begin enrollment by a 42
specified date; requiring the agency, in consultation 43
with the Agency for Persons with Disabilities, to 44
conduct certain audits of the selected plans' 45
implementation of person -centered planning and to 46
submit specified progress reports to the Governor and 47
the Legislature by specified dates throughout the 48
program approval and implementatio n process; providing 49
requirements for the respective reports; requiring the 50
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 3 of 13
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
Agency for Health Care Administration, in consultation 51
with the Agency for Persons with Disabilities, to 52
conduct an evaluation of the pilot program; 53
authorizing the Agency for Heal th Care Administration 54
to contract with an independent evaluator to conduct 55
such evaluation; providing requirements for the 56
evaluation; requiring the Agency for Health Care 57
Administration, in consultation with the Agency for 58
Persons with Disabilities, to c onduct quality 59
assurance monitoring of the pilot program; requiring 60
the Agency for Health Care Administration to submit 61
the results of the evaluation to the Governor and the 62
Legislature by a specified date; providing an 63
effective date. 64
65
Be It Enacted by the Legislature of the State of Florida: 66
67
Section 1. Section 409.9855, Florida Statutes, is created 68
to read: 69
409.9855 Pilot program for individuals with developmental 70
disabilities.— 71
(1) PILOT PROGRAM IMPLEMENTATION. — 72
(a) Using a managed care mo del, the agency shall implement 73
a pilot program for individuals with developmental disabilities 74
in Statewide Medicaid Managed Care Regions D and I to provide 75
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 4 of 13
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
coverage of comprehensive services. 76
(b) The agency may seek federal approval through a state 77
plan amendment or Medicaid waiver as necessary to implement the 78
pilot program. The agency shall submit a request for any federal 79
approval needed to implement the pilot program by September 1, 80
2023. 81
(c) Pursuant to s. 409.963, the agency shall administer 82
the pilot program in consultation with the Agency for Persons 83
with Disabilities. 84
(d) The agency shall make capitated payments to managed 85
care organizations for comprehensive coverage, including 86
community-based services described in s. 393.066(3) and approve d 87
through the state's home and community -based services Medicaid 88
waiver program for individuals with developmental disabilities. 89
Unless otherwise specified, ss. 409.961 -409.969 apply to the 90
pilot program. 91
(e) The agency shall evaluate the feasibility of statewide 92
implementation of the capitated managed care model used by the 93
pilot program to serve individuals with developmental 94
disabilities. 95
(2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT. — 96
(a) Participation in the pilot program is voluntary and 97
limited to the maximum number of enrollees specified in the 98
General Appropriations Act. 99
(b) The Agency for Persons with Disabilities shall approve 100
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 5 of 13
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
a needs assessment methodology to determine functional, 101
behavioral, and physical needs of prospective enrol lees. The 102
assessment methodology may be administered by persons who have 103
completed such training as may be offered by the agency. 104
Eligibility to participate in the pilot program is determined 105
based on all of the following criteria: 106
1. Whether the individ ual is eligible for Medicaid. 107
2. Whether the individual is 18 years of age or older and 108
is on the waiting list for individual budget waiver services 109
under chapter 393 and assigned to one of categories 1 through 6 110
as specified in s. 393.065(5). 111
3. Whether the individual resides in a pilot program 112
region. 113
(c) The agency shall enroll individuals in the pilot 114
program based on verification that the individual has met the 115
criteria in paragraph (b). 116
(d) Notwithstanding any provisions of s. 393.065 to the 117
contrary, an enrollee must be afforded an opportunity to enroll 118
in any appropriate existing Medicaid waiver program if any of 119
the following conditions occur: 120
1. At any point during the operation of the pilot program, 121
an enrollee declares an inten t to voluntarily disenroll, 122
provided that he or she has been covered for the entire previous 123
plan year by the pilot program. 124
2. The agency determines the enrollee has a good cause 125
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 6 of 13
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
reason to disenroll. 126
3. The pilot program ceases to operate. 127
128
Such enrollees must receive an individualized transition plan to 129
assist him or her in accessing sufficient services and supports 130
for the enrollee's safety, well -being, and continuity of care. 131
(3) PILOT PROGRAM BENEFITS. — 132
(a) Plans participating in the pilot prog ram must, at a 133
minimum, cover the following: 134
1. All benefits included in s. 409.973. 135
2. All benefits included in s. 409.98. 136
3. All benefits included in s. 393.066(3), and all of the 137
following: 138
a. Adult day training. 139
b. Behavior analysis services. 140
c. Behavior assistant services. 141
d. Companion services. 142
e. Consumable medical supplies. 143
f. Dietitian services. 144
g. Durable medical equipment and supplies. 145
h. Environmental accessibility adaptations. 146
i. Occupational therapy. 147
j. Personal emergency response systems. 148
k. Personal supports. 149
l. Physical therapy. 150
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 7 of 13
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
m. Prevocational services. 151
n. Private duty nursing. 152
o. Residential habilitation, including the following 153
levels: 154
(I) Standard level. 155
(II) Behavior-focused level. 156
(III) Intensive-behavior level. 157
(IV) Enhanced intensive -behavior level. 158
p. Residential nursing services. 159
q. Respiratory therapy. 160
r. Respite care. 161
s. Skilled nursing. 162
t. Specialized medical home care. 163
u. Specialized mental health counseling. 164
v. Speech therapy. 165
w. Support coordination. 166
x. Supported employment. 167
y. Supported living coaching. 168
z. Transportation. 169
(b) All providers of the services listed under paragraph 170
(a) must meet the provider qualifications outlined in the 171
Florida Medicaid Developmental Disabilities Individual Budgeting 172
Waiver Services Coverage and Limitations Handbook as adopted by 173
reference in rule 59G -13.070, Florida Administrative Code. 174
(c) Support coordination services must maximize the use of 175
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 8 of 13
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
natural supports and comm unity partnerships. 176
(d) The plans participating in the pilot program must 177
provide all categories of benefits through a single, integrated 178
model of care. 179
(e) Services must be provided to enrollees in accordance 180
with an individualized care plan which is evaluated and updated 181
at least quarterly and as warranted by changes in an enrollee's 182
circumstances. 183
(4) ELIGIBLE PLANS; PLAN SELECTION. — 184
(a) To be eligible to participate in the pilot program, a 185
plan must have been awarded a contract to provide long -term care 186
services pursuant to s. 409.981 as a result of an invitation to 187
negotiate. 188
(b) The agency shall select, as provided in s. 287.057(1), 189
one plan to participate in the pilot program for each of the two 190
regions. The director of the Agency for Person s with 191
Disabilities or his or her designee must be a member of the 192
negotiating team. 193
1. The invitation to negotiate must specify the criteria 194
and the relative weight assigned to each criterion that will be 195
used for determining the acceptability of submit ted responses 196
and guiding the selection of the plans with which the agency and 197
the Agency for Persons with Disabilities negotiate. In addition 198
to any other criteria established by the agency, in consultation 199
with the Agency for Persons with Disabilities, t he agency shall 200
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 9 of 13
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
consider the following factors in the selection of eligible 201
plans: 202
a. Experience serving similar populations, including the 203
plan's record in achieving specific quality standards with 204
similar populations. 205
b. Establishment of community pa rtnerships with providers 206
which create opportunities for reinvestment in community -based 207
services. 208
c. Provision of additional benefits, particularly 209
behavioral health services, the coordination of dental care, and 210
other initiatives that improve overall w ell-being. 211
d. Provision of and capacity to provide mental health 212
therapies and analysis designed to meet the needs of individuals 213
with developmental disabilities. 214
e. Evidence that an eligible plan has written agreements 215
or signed contracts or has made substantial progress in 216
establishing relationships with providers before submitting its 217
response. 218
f. Experience in the provision of person -centered planning 219
as described in 42 C.F.R. s. 441.301(c)(1). 220
g. Experience in robust provider development programs that 221
result in increased availability of Medicaid providers to serve 222
the developmental disabilities community. 223
2. After negotiations are conducted, the agency shall 224
select the eligible plans that are determined to be responsive 225
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 10 of 13
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
and provide the best value to the state. Preference must be 226
given to plans that: 227
a. Have signed contracts in sufficient numbers to meet the 228
specific standards established under s. 409.967(2)(c), including 229
contracts for person al supports, skilled nursing, residential 230
habilitation, adult day training, mental health services, 231
respite care, companion services, and supported employment, as 232
those services are defined in the Florida Medicaid Developmental 233
Disabilities Individual Budg eting Waiver Services Coverage and 234
Limitations Handbook as adopted by reference in rule 59G -13.070, 235
Florida Administrative Code. 236
b. Have well-defined programs for recognizing patient -237
centered medical homes and providing increased compensation to 238
recognized medical homes, as defined by the plan. 239
c. Have well-defined programs related to person -centered 240
planning as described in 42 C.F.R. s. 441.301(c)(1). 241
d. Have robust and innovative programs for provider 242
development and collaboration with the Agency fo r Persons with 243
Disabilities. 244
(5) PAYMENT.— 245
(a) The selected plans must receive a per -member, per-246
month payment based on a rate developed specifically for the 247
unique needs of the developmentally disabled population. 248
(b) The agency must ensure that the rate for the 249
integrated system is actuarially sound. 250
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 11 of 13
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
(c) The revenues and expenditures of the selected plan 251
which are associated with the implementation of the pilot 252
program must be included in the reporting and regulatory 253
requirements established in s. 409.967(3). 254
(6) PROGRAM IMPLEMENTATION AND EVALUATION. — 255
(a) The agency shall select participating plans and begin 256
enrollment no later than January, 2024. 257
(b) Upon implementation of the program, the agency, in 258
consultation with the Agency for Person s with Disabilities, 259
shall conduct audits of the selected plans' implementation of 260
person-centered planning. 261
(c) The agency, in consultation with the Agency for 262
Persons with Disabilities, shall submit progress reports to the 263
Governor, the President of th e Senate, and the Speaker of the 264
House of Representatives upon the federal approval, 265
implementation, and operation of the pilot program, as follows: 266
1. By December 31, 2023, a status report on progress made 267
toward federal approval of the waiver or waiver amendment needed 268
to implement the pilot program. 269
2. By December 31, 2024, a status report on implementation 270
of the pilot program. 271
3. By December 31, 2025, and annually thereafter, a status 272
report on the operation of the pilot program, including, but not 273
limited to, all of the following: 274
a. Program enrollment, including the number and 275
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 12 of 13
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
demographics of enrollees. 276
b. Any complaints received. 277
c. Access to approved services. 278
(d) The agency, in consultation with the Agency for 279
Persons with Disabilities, shall establish specific measures of 280
access, quality, and costs of the pilot program. The agency may 281
contract with an independent evaluator to conduct such 282
evaluation. The evaluation must inc lude assessments of cost 283
savings; consumer education, choice, and access to services; 284
plans for future capacity and the enrollment of new Medicaid 285
providers; coordination of care; person -centered planning and 286
person-centered well-being outcomes; health and quality-of-life 287
outcomes; and quality of care by each eligibility category and 288
managed care plan in each pilot program site. The evaluation 289
must describe any administrative or legal barriers to the 290
implementation and operation of the pilot program in each 291
region. 292
1. The agency, in consultation with the Agency for Persons 293
with Disabilities, shall conduct quality assurance monitoring of 294
the pilot program to include client satisfaction with services, 295
client health and safety outcomes, client well -being outcomes, 296
and service delivery in accordance with the client's care plan. 297
2. The agency shall submit the results of the evaluation 298
to the Governor, the President of the Senate, and the Speaker of 299
the House of Representatives by October 1, 2029. 300
HB 831, Engrossed 1 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0831-01-e1
Page 13 of 13
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
Section 2. This act shall take effect upon becoming a law. 301