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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 home and community -based services 2
Medicaid waiver program; amending s. 393.065, F.S.; 3
requiring the Agency for Persons with Disabilities to 4
develop and implement an automated, electronic 5
application process for specified services; providing 6
requirements for the application process; requiring 7
the agency to provide an application in a printed form 8
or a portable document format under certain 9
circumstances; requiring the agency to make an 10
eligibility determination in a specified amount of 11
time for certain persons; authorizing the agency to 12
request additional documentation under certain 13
circumstances; providing requirements for such 14
request; requiring rulemaking; amending s. 393.0662, 15
F.S.; providing requirements for the Agency for Health 16
Care Administration when a client's iBudget is 17
established; requiring the agency within a specified 18
time period to ensure certain services that a client 19
has applied for have begun; requiring rulemaking; 20
amending ss. 393.0651, 409.9127, and s. 409.9855, 21
F.S.; conforming provisions to changes made by the 22
act; providing an effective date. 23
24
Be It Enacted by the Legislature of the State of Florida: 25
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26
Section 1. Subsections (1) through (12) of section 27
393.065, Florida Statutes, are renumbered as subsections (2) 28
through (13), respectively, present subsections (1), (5), (6), 29
and (7), paragraph (a) of present subsection (8), and present 30
subsections (11) and (12) are ame nded, and a new subsection (1) 31
is added to that section, to read: 32
393.065 Application and eligibility determination. — 33
(1) As part of the agency's website, the agency shall 34
develop and implement an automated, electronic application 35
process. The applicat ion process shall, at a minimum, support: 36
(a) Electronic submissions. 37
(b) Automatic processing of each application. 38
(c) Immediate automatic e -mail confirmation to each 39
applicant with proof of filing along with a date and time stamp. 40
(d) Upon request, if the applicant does not have access to 41
electronic resources, the agency providing the applicant with 42
the application in printed form or in a portable document 43
format. 44
(2)(1) Application for services shall be made in writing to 45
the agency, in the regi on in which the applicant resides. The 46
agency shall review each application and make an eligibility 47
determination within 60 days after receipt of the signed 48
application. If, at the time of the application, an applicant is 49
requesting enrollment in the home and community-based services 50
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Medicaid waiver program for individuals with developmental 51
disabilities deemed to be in crisis, as described in paragraph 52
(6)(a) (5)(a), the agency shall complete an eligibility 53
determination within 45 days after receipt of the signed 54
application. 55
(a) If the agency determines additional documentation is 56
necessary to make an eligibility determination, the agency may 57
request the additional documentation from the applicant. 58
(b) When necessary to definitively identify individual 59
conditions or needs, the agency or its designee must provide a 60
comprehensive assessment. 61
(c) If the agency requests additional documentation from 62
the applicant or provides or arranges for a comprehensive 63
assessment, the agency's eligibility determinatio n must be 64
completed within 90 days after receipt of the signed 65
application. 66
(d) If the applicant meets the criteria in paragraph 67
(7)(b), such applicant shall be deemed in crisis and the 68
following shall be required, regardless of age: 69
1. The agency shall review each application and make an 70
eligibility determination within 5 business days after receipt 71
of the signed application. 72
2. If, at the time of the application, the applicant is 73
requesting enrollment in the home and community -based services 74
Medicaid waiver program for individuals with developmental 75
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disabilities deemed to be in crisis, as described in paragraph 76
(7)(a), the agency shall complete an eligibility determination 77
within 15 calendar days after receipt of the signed application. 78
3. If the agency determines additional documentation is 79
necessary to make an eligibility determination, the agency may 80
request additional documentation from the applicant, but such 81
agency request may not prevent or delay services to the 82
applicant. When necessa ry to definitively identify individual 83
conditions or needs, the agency or its designee must provide a 84
comprehensive assessment. 85
4. If the agency requests additional documentation from 86
the applicant or provides or arranges for a comprehensive 87
assessment, the agency's eligibility determination must be 88
completed within 60 calendar days after receipt of the signed 89
application. 90
(6)(5) Except as provided in subsections (7) and (8) (6) 91
and (7), if a client seeking enrollment in the developmental 92
disabilities home and community-based services Medicaid waiver 93
program meets the level of care requirement for an intermediate 94
care facility for individuals with intellectual disabilities 95
pursuant to 42 C.F.R. ss. 435.217(b)(1) and 440.150, the agency 96
must assign the client to an appropriate preenrollment category 97
pursuant to this subsection and must provide priority to clients 98
waiting for waiver services in the following order: 99
(a) Category 1, which includes clients deemed to be in 100
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crisis as described in rule, must be given first priority in 101
moving from the preenrollment categories to the waiver. 102
(b) Category 2, which includes clients in the 103
preenrollment categories who are: 104
1. From the child welfare system with an open case in the 105
Department of Children and Famili es' statewide automated child 106
welfare information system and who are either: 107
a. Transitioning out of the child welfare system into 108
permanency; or 109
b. At least 18 years but not yet 22 years of age and who 110
need both waiver services and extended foster car e services; or 111
2. At least 18 years but not yet 22 years of age and who 112
withdrew consent pursuant to s. 39.6251(5)(c) to remain in the 113
extended foster care system. 114
For individuals who are at least 18 years but not yet 22 years 115
of age and who are eligible under sub-subparagraph 1.b., the 116
agency must provide waiver services, including residential 117
habilitation, and the community -based care lead agency must fund 118
room and board at the rate established in s. 409.145(3) and 119
provide case management and related se rvices as defined in s. 120
409.986(3)(e). Individuals may receive both waiver services and 121
services under s. 39.6251. Services may not duplicate services 122
available through the Medicaid state plan. 123
(c) Category 3, which includes, but is not required to be 124
limited to, clients: 125
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1. Whose caregiver has a documented condition that is 126
expected to render the caregiver unable to provide care within 127
the next 12 months and for whom a caregiver is required but no 128
alternate caregiver is available; 129
2. At substantial r isk of incarceration or court 130
commitment without supports; 131
3. Whose documented behaviors or physical needs place them 132
or their caregiver at risk of serious harm and other supports 133
are not currently available to alleviate the situation; or 134
4. Who are identified as ready for discharge within the 135
next year from a state mental health hospital or skilled nursing 136
facility and who require a caregiver but for whom no caregiver 137
is available or whose caregiver is unable to provide the care 138
needed. 139
(d) Category 4, which includes, but is not required to be 140
limited to, clients whose caregivers are 70 years of age or 141
older and for whom a caregiver is required but no alternate 142
caregiver is available. 143
(e) Category 5, which includes, but is not required to be 144
limited to, clients who are expected to graduate within the next 145
12 months from secondary school and need support to obtain a 146
meaningful day activity, maintain competitive employment, or 147
pursue an accredited program of postsecondary education to which 148
they have been accepted. 149
(f) Category 6, which includes clients 21 years of age or 150
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older who do not meet the criteria for category 1, category 2, 151
category 3, category 4, or category 5. 152
(g) Category 7, which includes clients younger than 21 153
years of age who do not meet the criteria for category 1, 154
category 2, category 3, or category 4. 155
Within preenrollment categories 3, 4, 5, 6, and 7, the agency 156
shall prioritize clients in the order of the date that the 157
client is determined eligible for waiver services. 158
(7)(6) The agency must allow an individual who meets the 159
eligibility requirements of subsection (3) (2) to receive home 160
and community-based services in this state if the individual's 161
parent or legal guardian is an active -duty military 162
servicemember and if, at the time of the servicemember's 163
transfer to this state, the individual was receiving home and 164
community-based services in another state. 165
(8)(7) The agency must allow an individual with a 166
diagnosis of Phelan-McDermid syndrome who meets the eligibility 167
requirements of subsection (3) (2) to receive home and 168
community-based services. 169
(9)(8) Only a client may be eligible for services under 170
the developmental disabilities home and community -based services 171
Medicaid waiver program. For a client to receive services u nder 172
the developmental disabilities home and community -based services 173
Medicaid waiver program, there must be available funding 174
pursuant to s. 393.0662 or through a legislative appropriation 175
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and the client must meet all of the following: 176
(a) The eligibility requirements of subsection (3) (2), 177
which must be confirmed by the agency. 178
(12)(a)(11)(a) The agency must provide the following 179
information to all applicants or their parents, legal guardians, 180
or family members: 181
1. A brief overview of the vocational rehabilitation 182
services offered through the Division of Vocational 183
Rehabilitation of the Department of Education, including a 184
hyperlink or website address that provides access to the 185
application for such services; 186
2. A brief overview of the Florida ABLE program as 187
established under s. 1009.986, including a hyperlink or website 188
address that provides access to the application for establishing 189
an ABLE account as defined in s. 1009.986(2); 190
3. A brief overview of the supplemental security income 191
benefits and social security disability income benefits 192
available under Title XVI of the Social Security Act, as 193
amended, including a hyperlink or website address that provides 194
access to the application for such benefits; 195
4. A statement indicating that the applicant's local 196
public school district may provide specialized instructional 197
services, including transition programs, for students with 198
special education needs; 199
5. A brief overview of programs and services funded 200
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through the Florida Center for Students with Unique Abilities, 201
including contact information for each state -approved Florida 202
Postsecondary Comprehensive Transition Program; 203
6. A brief overview of decisionmaking options for 204
individuals with disabilities, gua rdianship under chapter 744, 205
and alternatives to guardianship as defined in s. 744.334(1), 206
which may include contact information for organizations that the 207
agency believes would be helpful in assisting with such 208
decisions; 209
7. A brief overview of the refe rral tools made available 210
through the agency, including a hyperlink or website address 211
that provides access to such tools; and 212
8. A statement indicating that some waiver providers may 213
serve private-pay individuals. 214
(b) The agency must provide the infor mation required in 215
paragraph (a) in writing to an applicant or his or her parent, 216
legal guardian, or family member along with a written disclosure 217
statement in substantially the following form: 218
219
DISCLOSURE STATEMENT 220
Each program and service has its own el igibility 221
requirements. By providing the information specified in 222
section 393.065(12)(a) 393.065(11)(a), Florida Statutes, 223
the agency does not guarantee an applicant's eligibility 224
for or enrollment in any program or service. 225
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226
(c) The agency must also pub lish the information required 227
in paragraph (a) and the disclosure statement in paragraph (b) 228
on its website, and must provide that information and statement 229
annually to each client placed in the preenrollment categories 230
or to the parent, legal guardian, or family member of such 231
client. 232
(13)(12) The agency and the Agency for Health Care 233
Administration: 234
(a) May adopt rules specifying application procedures, 235
criteria associated with the preenrollment categories, 236
procedures for administering the preenrollme nt, including tools 237
for prioritizing waiver enrollment within preenrollment 238
categories, and eligibility requirements as needed to administer 239
this section. 240
(b) By September 29, 2024, adopt rules and implement 241
policies to maintain compliance with paragraph (2)(d). 242
Section 2. Subsections (2) and (15) of section 393.0662, 243
Florida Statutes, are amended to read: 244
393.0662 Individual budgets for delivery of home and 245
community-based services; iBudget system established. —The 246
Legislature finds that improved fi nancial management of the 247
existing home and community -based Medicaid waiver program is 248
necessary to avoid deficits that impede the provision of 249
services to individuals who are on the waiting list for 250
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enrollment in the program. The Legislature further finds that 251
clients and their families should have greater flexibility to 252
choose the services that best allow them to live in their 253
community within the limits of an established budget. Therefore, 254
the Legislature intends that the agency, in consultation with 255
the Agency for Health Care Administration, shall manage the 256
service delivery system using individual budgets as the basis 257
for allocating the funds appropriated for the home and 258
community-based services Medicaid waiver program among eligible 259
enrolled clients. The service delivery system that uses 260
individual budgets shall be called the iBudget system. 261
(2) The Agency for Health Care Administration, in 262
consultation with the agency, shall : 263
(a) Seek federal approval to amend current waivers, 264
request a new waiver , and amend contracts as necessary to manage 265
the iBudget system, improve services for eligible and enrolled 266
clients, and improve the delivery of services through the home 267
and community-based services Medicaid waiver program and the 268
Consumer-Directed Care Plus Program, including, but not limited 269
to, enrollees with a dual diagnosis of a developmental 270
disability and a mental health disorder. 271
(b) At the time a client's iBudget is established: 272
1. Educate the client or the caregiver of the client 273
regarding the Consumer-Directed Care Plus Program. 274
2. Provide each client the opportunity to apply for the 275
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Consumer-Directed Care Plus Program. 276
(c) The agency shall, within 14 calendar days after the 277
time of a client's submission for Consumer -Directed Care Plus 278
Program, ensure that the client's Consumer -Directed Care Plus 279
Program services begin and the client is no longer required to 280
go through iBudget. 281
(15) The agency and the Agency for Health Care 282
Administration: 283
(a) May adopt rules specifying the allocatio n algorithm 284
and methodology; criteria and processes for clients to access 285
funds for services to meet significant additional needs; and 286
processes and requirements for selection and review of services, 287
development of support and cost plans, and management of the 288
iBudget system as needed to administer this section. 289
(b) By September 29, 2024, adopt rules and implement 290
policies to maintain compliance with paragraph (2)(b). 291
Section 3. Section 393.0651, Florida Statutes, is amended 292
to read: 293
393.0651 Family or individual support plan. —The agency 294
shall provide directly or contract for the development of a 295
family support plan for children ages 3 to 18 years of age and 296
an individual support plan for each client. The client, if 297
competent, the client's parent or guardian, or, when 298
appropriate, the client advocate, shall be consulted in the 299
development of the plan and shall receive a copy of the plan. 300
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Each plan must include the most appropriate, least restrictive, 301
and most cost-beneficial environment for accomplish ment of the 302
objectives for client progress and a specification of all 303
services authorized. The plan must include provisions for the 304
most appropriate level of care for the client. Within the 305
specification of needs and services for each client, when 306
residential care is necessary, the agency shall move toward 307
placement of clients in residential facilities based within the 308
client's community. The ultimate goal of each plan, whenever 309
possible, shall be to enable the client to live a dignified life 310
in the least restrictive setting, be that in the home or in the 311
community. The family or individual support plan must be 312
developed within 60 days after the agency determines the client 313
eligible pursuant to s. 393.065(4) s. 393.065(3). 314
(1) The agency shall develop and specify by rule the core 315
components of support plans. 316
(2) The family or individual support plan shall be 317
integrated with the individual education plan (IEP) for all 318
clients who are public school students entitled to a fr ee 319
appropriate public education under the Individuals with 320
Disabilities Education Act, I.D.E.A., as amended. The family or 321
individual support plan and IEP must be implemented to maximize 322
the attainment of educational and habilitation goals. 323
(a) If the IEP for a student enrolled in a public school 324
program indicates placement in a public or private residential 325
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program is necessary to provide special education and related 326
services to a client, the local education agency must provide 327
for the costs of that ser vice in accordance with the 328
requirements of the Individuals with Disabilities Education Act, 329
I.D.E.A., as amended. This does not preclude local education 330
agencies and the agency from sharing the residential service 331
costs of students who are clients and req uire residential 332
placement. 333
(b) For clients who are entering or exiting the school 334
system, an interdepartmental staffing team composed of 335
representatives of the agency and the local school system shall 336
develop a written transitional living and training p lan with the 337
participation of the client or with the parent or guardian of 338
the client, or the client advocate, as appropriate. 339
(3) Each family or individual support plan shall be 340
facilitated through case management designed solely to advance 341
the individual needs of the client. 342
(4) In the development of the family or individual support 343
plan, a client advocate may be appointed by the support planning 344
team for a client who is a minor or for a client who is not 345
capable of express and informed consent when: 346
(a) The parent or guardian cannot be identified; 347
(b) The whereabouts of the parent or guardian cannot be 348
discovered; or 349
(c) The state is the only legal representative of the 350
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client. 351
352
Such appointment may not be construed to extend the powers of 353
the client advocate to include any of those powers delegated by 354
law to a legal guardian. 355
(5) The agency shall place a client in the most 356
appropriate and least restrictive, and cost -beneficial, 357
residential facility according to his or her individual support 358
plan. The client, if competent, the client's parent or guardian, 359
or, when appropriate, the client advocate, and the administrator 360
of the facility to which placement is proposed shall be 361
consulted in determining the appropriate placement for the 362
client. Considerations for placement shall be made in the 363
following order: 364
(a) Client's own home or the home of a family member or 365
direct service provider. 366
(b) Foster care facility. 367
(c) Group home facility. 368
(d) Intermediate care facility for the developmentally 369
disabled. 370
(e) Other facilities licensed by the agency which offer 371
special programs for people with developmental disabilities. 372
(f) Developmental disabilities center. 373
(6) In developing a client's annual family or individual 374
support plan, the individu al or family with the assistance of 375
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the support planning team shall identify measurable objectives 376
for client progress and shall specify a time period expected for 377
achievement of each objective. 378
(7) The individual, family, and support coordinator shall 379
review progress in achieving the objectives specified in each 380
client's family or individual support plan, and shall revise the 381
plan annually, following consultation with the client, if 382
competent, or with the parent or guardian of the client, or, 383
when appropriate, the client advocate. The agency or designated 384
contractor shall annually report in writing to the client, if 385
competent, or to the parent or guardian of the client, or to the 386
client advocate, when appropriate, with respect to the client's 387
habilitative and medical progress. 388
(8) Any client, or any parent of a minor client, or 389
guardian, authorized guardian advocate, or client advocate for a 390
client, who is substantially affected by the client's initial 391
family or individual support plan, or the annual rev iew thereof, 392
shall have the right to file a notice to challenge the decision 393
pursuant to ss. 120.569 and 120.57. Notice of such right to 394
appeal shall be included in all support plans provided by the 395
agency. 396
Section 4. Subsection (3) of section 409.9127 , Florida 397
Statutes, is amended to read: 398
409.9127 Preauthorization and concurrent utilization 399
review; conflict-of-interest standards.— 400
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(3) The agency shall help the Agency for Persons with 401
Disabilities meet the requirements of s. 393.065(5) s. 402
393.065(4). Only admissions approved pursuant to such 403
assessments are eligible for reimbursement under this chapter. 404
Section 5. Paragraphs (b) and (d) of subsection (2) of 405
section 409.9855, Florida Statutes, are amended to read: 406
409.9855 Pilot program for ind ividuals with developmental 407
disabilities.— 408
(2) ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT. — 409
(b) The Agency for Persons with Disabilities shall approve 410
a needs assessment methodology to determine functional, 411
behavioral, and physical needs of prosp ective enrollees. The 412
assessment methodology may be administered by persons who have 413
completed such training as may be offered by the agency. 414
Eligibility to participate in the pilot program is determined 415
based on all of the following criteria: 416
1. Whether the individual is eligible for Medicaid. 417
2. Whether the individual is 18 years of age or older and 418
is on the waiting list for individual budget waiver services 419
under chapter 393 and assigned to one of categories 1 through 6 420
as specified in s. 393.065(6) s. 393.065(5). 421
3. Whether the individual resides in a pilot program 422
region. 423
(d) Notwithstanding any provisions of s. 393.065 to the 424
contrary, an enrollee must be afforded an opportunity to enroll 425
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in any appropriate existing Medicaid waiver program if any of 426
the following conditions occur: 427
1. At any point during the operation of the pilot program, 428
an enrollee declares an intent to voluntarily disenroll, 429
provided that he or she has been covered for the entire previous 430
plan year by the pilot program. 431
2. The agency determines the enrollee has a good cause 432
reason to disenroll. 433
3. The pilot program ceases to operate. 434
435
Such enrollees must receive an individualized transition plan to 436
assist him or her in accessing sufficient services and supports 437
for the enrollee's safety, well -being, and continuity of care. 438
Section 6. This act shall take effect July 1, 2024. 439