Florida Senate - 2023 SB 1594 By Senator Brodeur 10-01012-23 20231594__ 1 A bill to be entitled 2 An act relating to services for persons with 3 disabilities; amending s. 393.065, F.S.; revising 4 provisions related to the application for services for 5 persons with disabilities; revising timeframes within 6 which the Agency for Persons with Disabilities must 7 make certain eligibility determinations; requiring the 8 agency to request additional documentation from 9 applicants if it determines such documentation is 10 necessary to make an eligibility determination; 11 specifying requirements for the agencys eligibility 12 determinations; revising procedures for admissions to 13 intermediate care facilities for the developmentally 14 disabled; requiring the agency to assign certain 15 clients to a waiting list; revising provisions related 16 to the prioritization of clients waiting for certain 17 waiver services; requiring the agency to place certain 18 clients on an agency registration list; providing that 19 only agency clients are eligible for certain services; 20 specifying eligibility criteria for such services; 21 amending s. 393.0651, F.S.; conforming provisions to 22 changes made by the act; providing an effective date. 23 24 Be It Enacted by the Legislature of the State of Florida: 25 26 Section 1.Section 393.065, Florida Statutes, is amended to 27 read: 28 393.065Application and eligibility determination. 29 (1)Application for services must shall be made in writing 30 to the agency, in the region service area in which the applicant 31 resides. The agency shall review each application and make an 32 eligibility determination applicant for eligibility within 45 33 days after the date the application is signed for children under 34 6 years of age and within 60 days after receipt of the signed 35 application. If an applicant is requesting enrollment in the 36 home and community-based services (HCBS) Medicaid waiver program 37 for a person with developmental disabilities due to crisis, as 38 specified in paragraph (5)(a), at the time of the application, 39 the agency must complete an eligibility determination within 45 40 days after receipt of the signed application. 41 (a)If the agency determines additional documentation is 42 necessary to make a proper determination on an applicants 43 eligibility, the agency must request the necessary documentation 44 from the applicant the date the application is signed for all 45 other applicants. 46 (b)When necessary to definitively identify individual 47 conditions or needs, the agency shall provide a comprehensive 48 assessment. 49 (c)If the agency requests additional documentation from an 50 applicant or provides a comprehensive assessment, the agencys 51 eligibility determination must be completed within 90 days after 52 receipt of the signed application. 53 (2)To be eligible for services under this chapter, the 54 agencys eligibility determination must find the applicant has 55 satisfied all procedural requirements and eligibility criteria 56 found in rule, which must include, but need not be limited to, 57 the requirement that the applicant have a developmental 58 disability and be domiciled in Florida Only applicants whose 59 domicile is in Florida are eligible for services. Information 60 accumulated by other agencies, including professional reports 61 and collateral data, must shall be considered in this process 62 when available. 63 (2)In order to provide immediate services or crisis 64 intervention to applicants, the agency shall arrange for 65 emergency eligibility determination, with a full eligibility 66 review to be accomplished within 45 days of the emergency 67 eligibility determination. 68 (3)The agency shall notify each applicant, in writing, of 69 its eligibility determination decision. Any applicant or client 70 determined by the agency to be ineligible for services has the 71 right to appeal this decision pursuant to ss. 120.569 and 72 120.57. 73 (4)Any admission to an intermediate care facility for the 74 developmentally disabled must be authorized by the agency. As 75 part of the authorization, the agency, or its designee, shall 76 conduct an assessment, including an assessment of medical 77 necessity and level of reimbursement The agency shall assess the 78 level of need and medical necessity for prospective residents of 79 intermediate care facilities for the developmentally disabled. 80 The agency may enter into an agreement with the Department of 81 Elderly Affairs for its Comprehensive Assessment and Review for 82 Long-Term-Care Services (CARES) program to conduct assessments 83 to determine the level of need and medical necessity for long 84 term-care services under this chapter. To the extent permissible 85 under federal law, the assessments shall be funded under Title 86 XIX of the Social Security Act. 87 (5)The agency shall assign any client that meets the level 88 of care requirement for an intermediate care facility for 89 individuals with intellectual disabilities pursuant to 42 C.F.R. 90 s. 435.217(b)(1) and 42 C.F.R. s. 440.150 to a waiting list, and 91 shall provide priority to clients waiting for waiver services in 92 the following order: 93 (a)Category 1, which includes clients deemed to be in 94 crisis as described in rule, shall be given first priority in 95 moving from the waiting list to the waiver. 96 (b)Category 2, which includes individuals on the waiting 97 list who are: 98 1.From the child welfare system with an open case in the 99 Department of Children and Families statewide automated child 100 welfare information system and who are either: 101 a.Transitioning out of the child welfare system at the 102 finalization of an adoption, a reunification with family 103 members, a permanent placement with a relative, or a 104 guardianship with a nonrelative; or 105 b.At least 18 years but not yet 22 years of age and who 106 need both waiver services and extended foster care services; or 107 2.At least 18 years but not yet 22 years of age and who 108 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the 109 extended foster care system. 110 111 For individuals who are at least 18 years but not yet 22 years 112 of age and who are eligible under sub-subparagraph 1.b., the 113 agency shall provide waiver services, including residential 114 habilitation, and the community-based care lead agency shall 115 fund room and board at the rate established in s. 409.145(3) and 116 provide case management and related services as defined in s. 117 409.986(3)(e). Individuals may receive both waiver services and 118 services under s. 39.6251. Services may not duplicate services 119 available through the Medicaid state plan. 120 (c)Category 3, which includes, but is not required to be 121 limited to, clients: 122 1.Whose caregiver has a documented condition that is 123 expected to render the caregiver unable to provide care within 124 the next 12 months and for whom a caregiver is required but no 125 alternate caregiver is available; 126 2.At substantial risk of incarceration or court commitment 127 without supports; 128 3.Whose documented behaviors or physical needs place them 129 or their caregiver at risk of serious harm and other supports 130 are not currently available to alleviate the situation; or 131 4.Who are identified as ready for discharge within the 132 next year from a state mental health hospital or skilled nursing 133 facility and who require a caregiver but for whom no caregiver 134 is available or whose caregiver is unable to provide the care 135 needed. 136 (d)Category 4, which includes, but is not required to be 137 limited to, clients whose caregivers are 70 years of age or 138 older and for whom a caregiver is required but no alternate 139 caregiver is available. 140 (e)Category 5, which includes, but is not required to be 141 limited to, clients who are expected to graduate within the next 142 12 months from secondary school and need support to obtain a 143 meaningful day activity, maintain competitive employment, or 144 pursue an accredited program of postsecondary education to which 145 they have been accepted. 146 (f)Category 6, which includes clients 21 years of age or 147 older who do not meet the criteria for category 1, category 2, 148 category 3, category 4, or category 5. 149 (g)Category 7, which includes clients younger than 21 150 years of age who do not meet the criteria for category 1, 151 category 2, category 3, or category 4. 152 (6)Within categories 3, 4, 5, and 6, and 7, the agency 153 shall maintain a waiting list of clients placed in the order of 154 the date that the client is determined eligible for waiver 155 services. 156 (7)The agency shall place on an agency registration list 157 any client who meets the level of care requirement for an 158 intermediate care facility for individuals with intellectual 159 disabilities pursuant to 42 C.F.R. s. 435.217(b)(1) and 42 160 C.F.R. s. 440.150 and is: 161 (a)Younger than 21 years of age, requesting but not 162 receiving waiver services, and not assigned to category 1, 163 category 2, category 3, category 4, or category 5; or 164 (b)An adult that resides in an institutional setting, 165 including, but not limited to, a penal institution, an 166 intermediate care facility for the developmentally disabled, a 167 mental health hospital, a nursing home, or a forensic facility 168 run by the agency pursuant to chapter 916. 169 (8)(6)The agency shall allow an individual who meets the 170 eligibility requirements of subsection (2) subsection (1) to 171 receive home and community-based services in this state if the 172 individuals parent or legal guardian is an active-duty military 173 servicemember and if, at the time of the servicemembers 174 transfer to this state, the individual was receiving home and 175 community-based services in another state. 176 (9)(7)The agency shall allow an individual with a 177 diagnosis of Phelan-McDermid syndrome who meets the eligibility 178 requirements of subsection (2) subsection (1) to receive home 179 and community-based services. 180 (10)Only a client may be eligible for services under the 181 HCBS Medicaid waiver program. To receive services under the HCBS 182 Medicaid waiver program, there must be available funding 183 pursuant to s. 393.0662 or other legislative appropriation, and 184 a client must: 185 (a)Meet the eligibility criteria as provided in subsection 186 (2), which must be confirmed by the agency; 187 (b)Be eligible for the state Medicaid program under Title 188 XIX of the Social Security Act or the Supplemental Security 189 Income program; 190 (c)Meet the level of care requirements for an intermediate 191 care facility for individuals with intellectual disabilities 192 pursuant to 42 C.F.R. s. 435.217(b)(1) and 42 C.F.R. s. 440.150; 193 and 194 (d)Meet the requirements set forth in the approved federal 195 waiver authorized under s. 1915(c) of the Social Security Act 196 and 42 C.F.R. s. 441.302. 197 (11)(8)Agency action that selects individuals to receive 198 waiver services pursuant to this section does not establish a 199 right to a hearing or an administrative proceeding under chapter 200 120 for individuals remaining on the waiting list. 201 (12)(9)The client, the clients guardian, or the clients 202 family must ensure that accurate, up-to-date contact information 203 is provided to the agency at all times. Notwithstanding s. 204 393.0651, the agency shall send an annual letter requesting 205 updated information from the client, the clients guardian, or 206 the clients family. The agency shall remove from the waiting 207 list any individual who cannot be located using the contact 208 information provided to the agency, fails to meet eligibility 209 requirements, or becomes domiciled outside the state. 210 (13)(a)(10)(a)The agency shall provide the following 211 information to all applicants or their parents, legal guardians, 212 or family members: 213 1.A brief overview of the vocational rehabilitation 214 services offered through the Division of Vocational 215 Rehabilitation of the Department of Education, including a 216 hyperlink or website address that provides access to the 217 application for such services; 218 2.A brief overview of the Florida ABLE program as 219 established under s. 1009.986, including a hyperlink or website 220 address that provides access to the application for establishing 221 an ABLE account as defined in s. 1009.986(2); 222 3.A brief overview of the supplemental security income 223 benefits and social security disability income benefits 224 available under Title XVI of the Social Security Act, as 225 amended, including a hyperlink or website address that provides 226 access to the application for such benefits; 227 4.A statement indicating that the applicants local public 228 school district may provide specialized instructional services, 229 including transition programs, for students with special 230 education needs; 231 5.A brief overview of programs and services funded through 232 the Florida Center for Students with Unique Abilities, including 233 contact information for each state-approved Florida 234 Postsecondary Comprehensive Transition Program; 235 6.A brief overview of decisionmaking options for 236 individuals with disabilities, guardianship under chapter 744, 237 and alternatives to guardianship as defined in s. 744.334(1), 238 which may include contact information for organizations that the 239 agency believes would be helpful in assisting with such 240 decisions; 241 7.A brief overview of the referral tools made available 242 through the agency, including a hyperlink or website address 243 that provides access to such tools; and 244 8.A statement indicating that some waiver providers may 245 serve private-pay individuals. 246 (b)The agency must provide the information required in 247 paragraph (a) in writing to an applicant or his or her parent, 248 legal guardian, or family member along with a written disclosure 249 statement in substantially the following form: 250 251 DISCLOSURE STATEMENT 252 253 Each program and service has its own eligibility requirements. 254 By providing the information specified in section 395.065(13)(a) 255 393.065(10)(a), Florida Statutes, the agency does not guarantee 256 an applicants eligibility for or enrollment in any program or 257 service. 258 (c)The agency shall also publish the information required 259 in paragraph (a) and the disclosure statement in paragraph (b) 260 on its website, and shall provide that information and statement 261 annually to each applicant placed on the waiting list or to the 262 parent, legal guardian, or family member of such applicant. 263 (14)(11)The agency and the Agency for Health Care 264 Administration may adopt rules specifying application 265 procedures, criteria associated with the waiting list 266 categories, procedures for administering the waiting list, 267 including tools for prioritizing waiver enrollment within 268 categories, and eligibility criteria as needed to administer 269 this section. 270 Section 2.Section 393.0651, Florida Statutes, is amended 271 to read: 272 393.0651Family or individual support plan.The agency 273 shall provide directly or contract for the development of a 274 family support plan for children ages 3 to 18 years of age and 275 an individual support plan for each client. The client, if 276 competent, the clients parent or guardian, or, when 277 appropriate, the client advocate, shall be consulted in the 278 development of the plan and shall receive a copy of the plan. 279 Each plan must include the most appropriate, least restrictive, 280 and most cost-beneficial environment for accomplishment of the 281 objectives for client progress and a specification of all 282 services authorized. The plan must include provisions for the 283 most appropriate level of care for the client. Within the 284 specification of needs and services for each client, when 285 residential care is necessary, the agency shall move toward 286 placement of clients in residential facilities based within the 287 clients community. The ultimate goal of each plan, whenever 288 possible, shall be to enable the client to live a dignified life 289 in the least restrictive setting, be that in the home or in the 290 community. For children under 6 years of age, The family or 291 individual support plan shall be developed within the timeframes 292 45-day application period as specified in s. 393.065(1); for all 293 applicants 6 years of age or older, the family or individual 294 support plan shall be developed within the 60-day period as 295 specified in that subsection. 296 (1)The agency shall develop and specify by rule the core 297 components of support plans. 298 (2)The family or individual support plan shall be 299 integrated with the individual education plan (IEP) for all 300 clients who are public school students entitled to a free 301 appropriate public education under the Individuals with 302 Disabilities Education Act, I.D.E.A., as amended. The family or 303 individual support plan and IEP shall be implemented to maximize 304 the attainment of educational and habilitation goals. 305 (a)If the IEP for a student enrolled in a public school 306 program indicates placement in a public or private residential 307 program is necessary to provide special education and related 308 services to a client, the local education agency shall provide 309 for the costs of that service in accordance with the 310 requirements of the Individuals with Disabilities Education Act, 311 I.D.E.A., as amended. This shall not preclude local education 312 agencies and the agency from sharing the residential service 313 costs of students who are clients and require residential 314 placement. 315 (b)For clients who are entering or exiting the school 316 system, an interdepartmental staffing team composed of 317 representatives of the agency and the local school system shall 318 develop a written transitional living and training plan with the 319 participation of the client or with the parent or guardian of 320 the client, or the client advocate, as appropriate. 321 (3)Each family or individual support plan shall be 322 facilitated through case management designed solely to advance 323 the individual needs of the client. 324 (4)In the development of the family or individual support 325 plan, a client advocate may be appointed by the support planning 326 team for a client who is a minor or for a client who is not 327 capable of express and informed consent when: 328 (a)The parent or guardian cannot be identified; 329 (b)The whereabouts of the parent or guardian cannot be 330 discovered; or 331 (c)The state is the only legal representative of the 332 client. 333 334 Such appointment shall not be construed to extend the powers of 335 the client advocate to include any of those powers delegated by 336 law to a legal guardian. 337 (5)The agency shall place a client in the most appropriate 338 and least restrictive, and cost-beneficial, residential facility 339 according to his or her individual support plan. The client, if 340 competent, the clients parent or guardian, or, when 341 appropriate, the client advocate, and the administrator of the 342 facility to which placement is proposed shall be consulted in 343 determining the appropriate placement for the client. 344 Considerations for placement shall be made in the following 345 order: 346 (a)Clients own home or the home of a family member or 347 direct service provider. 348 (b)Foster care facility. 349 (c)Group home facility. 350 (d)Intermediate care facility for the developmentally 351 disabled. 352 (e)Other facilities licensed by the agency which offer 353 special programs for people with developmental disabilities. 354 (f)Developmental disabilities center. 355 (6)In developing a clients annual family or individual 356 support plan, the individual or family with the assistance of 357 the support planning team shall identify measurable objectives 358 for client progress and shall specify a time period expected for 359 achievement of each objective. 360 (7)The individual, family, and support coordinator shall 361 review progress in achieving the objectives specified in each 362 clients family or individual support plan, and shall revise the 363 plan annually, following consultation with the client, if 364 competent, or with the parent or guardian of the client, or, 365 when appropriate, the client advocate. The agency or designated 366 contractor shall annually report in writing to the client, if 367 competent, or to the parent or guardian of the client, or to the 368 client advocate, when appropriate, with respect to the clients 369 habilitative and medical progress. 370 (8)Any client, or any parent of a minor client, or 371 guardian, authorized guardian advocate, or client advocate for a 372 client, who is substantially affected by the clients initial 373 family or individual support plan, or the annual review thereof, 374 shall have the right to file a notice to challenge the decision 375 pursuant to ss. 120.569 and 120.57. Notice of such right to 376 appeal shall be included in all support plans provided by the 377 agency. 378 Section 3.This act shall take effect July 1, 2023.