HB 1271 2024
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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 individuals with disabilities; 2
amending s. 393.064, F.S.; requiring the Agency for 3
Persons with Disabilities to offer voluntary 4
participation care navigation services to certain 5
persons under certain circumstances; providing goals 6
and requirements for care navigation services; 7
amending s. 393.065, F.S.; requiring the agency to 8
develop and implement an electronic application 9
process; requiring the agency to maintain a printable 10
paper application on its website and, upon request, 11
provide a printed paper application to an applicant; 12
requiring the agency to provide applicants with 13
specified information upon receipt of an application 14
for services; revising timeframes within which the 15
agency must make eligibility determinations for 16
services; lowering the age that a caregiver must be 17
for an individual to be placed in a certain 18
preenrollment category; amending s. 393.0651, F.S.; 19
requiring the agency to provide an individual support 20
plan for each client served by the home and community -21
based services Medicaid waiver program; providing 22
appropriations; requiring the Agency for Health Care 23
Administration and the Agency for Persons with 24
Disabilities, in consultation with other stakeholders, 25
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to jointly develop a comprehensive plan for the 26
administration, finance, and delivery of home and 27
community-based services through a new home and 28
community-based services Medicaid waiver program; 29
providing requirements for the waiver program; 30
requiring the Agency for Health Care Administration to 31
submit a specified report to the Governor, the 32
President of the Senate, and the Speaker of the House 33
of Representatives by a specified date; providing an 34
effective date. 35
36
Be It Enacted by the Legislature of the State of Florida: 37
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Section 1. Subsection (1) of section 393.064, Florida 39
Statutes, is amended to read: 40
393.064 Care navigation Prevention.— 41
(1) Within available resources, the agency must offer to 42
clients and their caregivers, care navigation services for 43
voluntary participation at time of application and as part of 44
any eligibility or renewal review. The goals of care navigation 45
are to create a seamless network of community resources and 46
supports for the client and the client's family as a whole to 47
support a client in daily living, community integration, and 48
achievement of individual goals. Care navigation services shall 49
involve assessing client needs, developing care plans, and 50
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implementing care plans, i ncluding, but not limited to, 51
connecting a client to resources and supports. At a minimum, a 52
care plan shall address immediate, intermediate, and long term 53
needs and goals to promote and increase well -being and 54
opportunities for education, employment, soci al engagement, 55
community integration, and caregiver support. For a client who 56
is a public school student entitled to a free appropriate public 57
education under the Individuals with Disabilities Education Act, 58
I.D.E.A., as amended, the care plan shall be int egrated with the 59
student's individual education plan (IEP). The care plan and IEP 60
must be implemented to maximize the attainment of educational 61
and habilitation goals shall give priority to the development, 62
planning, and implementation of programs which ha ve the 63
potential to prevent, correct, cure, or reduce the severity of 64
developmental disabilities. The agency shall direct an 65
interagency and interprogram effort for the continued 66
development of a prevention plan and program. The agency shall 67
identify, through demonstration projects, through program 68
evaluation, and through monitoring of programs and projects 69
conducted outside of the agency, any medical, social, economic, 70
or educational methods, techniques, or procedures that have the 71
potential to effectively ameliorate, correct, or cure 72
developmental disabilities. The agency shall determine the costs 73
and benefits that would be associated with such prevention 74
efforts and shall implement, or recommend the implementation of, 75
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those methods, techniques, or procedu res which are found likely 76
to be cost-beneficial. 77
Section 2. Subsection (1) and paragraph (d) of subsection 78
(5) of section 393.065, Florida Statutes, are amended to read: 79
393.065 Application and eligibility determination. — 80
(1)(a) The agency shall d evelop and implement an online 81
application process that, at a minimum, supports paperless 82
electronic application submissions with immediate e -mail 83
confirmation to each applicant to acknowledge receipt of 84
application upon submission. 85
(b) The agency shall maintain access to a printable paper 86
application on its website and, upon request, must provide an 87
applicant with a printed paper application. Paper applications 88
may Application for services shall be submitted made in writing 89
to the agency, in the region i n which the applicant resides , 90
sent to a central or regional address via regular United States 91
mail, or faxed to a central or regional confidential fax number. 92
All applications, regardless of manner of submission, must be 93
acknowledged as received, with an immediate receipt confirmation 94
in the same manner as the application had been received unless 95
the applicant has designated an alternative, preferred 96
communication method on the submitted application . 97
(c) The agency must shall review each submitted 98
application in accordance with federal time standards. and make 99
an eligibility determination within 60 days after receipt of the 100
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signed application. If, at the time of the application, an 101
applicant is requesting enrollment in the home and community -102
based services Medicaid waiver program for individuals with 103
developmental disabilities deemed to be in crisis, as described 104
in paragraph (5)(a), the agency shall complete an eligibility 105
determination within 45 days after receipt of the signed 106
application. 107
1.(a) If the agency determines additional documentation is 108
necessary to make an eligibility determination, the agency may 109
request the additional documentation from the applicant. 110
2.(b) When necessary to definitively identify individual 111
conditions or needs, the agen cy or its designee must provide a 112
comprehensive assessment. 113
(c) If the agency requests additional documentation from 114
the applicant or provides or arranges for a comprehensive 115
assessment, the agency's eligibility determination must be 116
completed within 90 days after receipt of the signed 117
application. 118
(d)1. If the applicant requesting enrollment in the home 119
and community-based services Medicaid waiver program for 120
individuals with developmental disabilities is deemed to be in 121
crisis as described in paragrap h (5)(a), the agency must make an 122
eligibility determination within 15 calendar days after receipt 123
of a complete application. 124
2. If the applicant meets the criteria specified in 125
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paragraph (5)(b), the agency must review and make an eligibility 126
determination as soon as practicable after receipt of a complete 127
application. 128
3. If the application meets the criteria specified in 129
paragraphs (5)(c)-(g), the agency shall make an eligibility 130
determination within 60 days after receipt of a complete 131
application. Any delays in the eligibility determination process 132
or any tolling of the time standard until certain information or 133
actions have been completed, must be conveyed to the client as 134
soon as such delays are known with a verbal contact to the 135
client or the client's designated caregiver and confirmed by a 136
written notice of the delay, the anticipated length of delay, 137
and a contact person for the client. 138
(5) Except as provided in subsections (6) and (7), if a 139
client seeking enrollment in the developmenta l disabilities home 140
and community-based services Medicaid waiver program meets the 141
level of care requirement for an intermediate care facility for 142
individuals with intellectual disabilities pursuant to 42 C.F.R. 143
ss. 435.217(b)(1) and 440.150, the agency mu st assign the client 144
to an appropriate preenrollment category pursuant to this 145
subsection and must provide priority to clients waiting for 146
waiver services in the following order: 147
(d) Category 4, which includes, but is not required to be 148
limited to, clients whose caregivers are 60 70 years of age or 149
older and for whom a caregiver is required but no alternate 150
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caregiver is available. 151
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Within preenrollment categories 3, 4, 5, 6, and 7, the agency 153
shall prioritize clients in the order of the date that the 154
client is determined eligible for waiver services. 155
Section 3. Section 393.0651, Florida Statutes, is amended 156
to read: 157
393.0651 Family or individual support plan. —The agency 158
shall provide directly or contract for the development of a 159
family support plan f or children ages 3 to 18 years of age and 160
an individual support plan for each client served by the home 161
and community-based services Medicaid waiver program under s. 162
393.0662. The client, if competent, the client's parent or 163
guardian, or, when appropriate, the client advocate, shall be 164
consulted in the development of the plan and shall receive a 165
copy of the plan. Each plan must include the most appropriate, 166
least restrictive, and most cost -beneficial environment for 167
accomplishment of the objectives for clie nt progress and a 168
specification of all services authorized. The plan must include 169
provisions for the most appropriate level of care for the 170
client. Within the specification of needs and services for each 171
client, when residential care is necessary, the agen cy shall 172
move toward placement of clients in residential facilities based 173
within the client's community. The ultimate goal of each plan, 174
whenever possible, shall be to enable the client to live a 175
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dignified life in the least restrictive setting, be that in the 176
home or in the community. The family or individual support plan 177
must be developed within 60 calendar days after the agency 178
determines the client eligible pursuant to s. 393.065(3). When 179
developing or reviewing the support plan, the waiver support 180
coordinator must inform the client, the client's parent or 181
guardian, or, when appropriate, the client advocate about the 182
consumer-directed care program under s. 409.221. 183
(1) The agency shall develop and specify by rule the core 184
components of support plans. 185
(2) The family or individual support plan shall be 186
integrated with the individual education plan (IEP) for all 187
clients who are public school students entitled to a free 188
appropriate public education under the Individuals with 189
Disabilities Education Act, I.D .E.A., as amended. The family or 190
individual support plan and IEP must be implemented to maximize 191
the attainment of educational and habilitation goals. 192
(a) If the IEP for a student enrolled in a public school 193
program indicates placement in a public or pri vate residential 194
program is necessary to provide special education and related 195
services to a client, the local education agency must provide 196
for the costs of that service in accordance with the 197
requirements of the Individuals with Disabilities Education Ac t, 198
I.D.E.A., as amended. This does not preclude local education 199
agencies and the agency from sharing the residential service 200
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costs of students who are clients and require residential 201
placement. 202
(b) For clients who are entering or exiting the school 203
system, an interdepartmental staffing team composed of 204
representatives of the agency and the local school system shall 205
develop a written transitional living and training plan with the 206
participation of the client or with the parent or guardian of 207
the client, or the client advocate, as appropriate. 208
(3) Each family or individual support plan shall be 209
facilitated through case management designed solely to advance 210
the individual needs of the client. 211
(4) In the development of the family or individual support 212
plan, a client advocate may be appointed by the support planning 213
team for a client who is a minor or for a client who is not 214
capable of express and informed consent when: 215
(a) The parent or guardian cannot be identified; 216
(b) The whereabouts of the parent or guardian cannot be 217
discovered; or 218
(c) The state is the only legal representative of the 219
client. 220
221
Such appointment may not be construed to extend the powers of 222
the client advocate to include any of those powers delegated by 223
law to a legal guardian. 224
(5) The agency shall place a client in the most 225
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appropriate and least restrictive, and cost -beneficial, 226
residential facility according to his or her individual support 227
plan. The client, if competent, the client's parent or guardian, 228
or, when appropriate, the c lient advocate, and the administrator 229
of the facility to which placement is proposed shall be 230
consulted in determining the appropriate placement for the 231
client. Considerations for placement shall be made in the 232
following order: 233
(a) Client's own home or t he home of a family member or 234
direct service provider. 235
(b) Foster care facility. 236
(c) Group home facility. 237
(d) Intermediate care facility for the developmentally 238
disabled. 239
(e) Other facilities licensed by the agency which offer 240
special programs for people with developmental disabilities. 241
(f) Developmental disabilities center. 242
(6) In developing a client's annual family or individual 243
support plan, the individual or family with the assistance of 244
the support planning team shall identify measurable ob jectives 245
for client progress and shall specify a time period expected for 246
achievement of each objective. 247
(7) The individual, family, and support coordinator shall 248
review progress in achieving the objectives specified in each 249
client's family or individual support plan, and shall revise the 250
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plan annually, following consultation with the client, if 251
competent, or with the parent or guardian of the client, or, 252
when appropriate, the client advocate. The agency or designated 253
contractor shall annually report in w riting to the client, if 254
competent, or to the parent or guardian of the client, or to the 255
client advocate, when appropriate, with respect to the client's 256
habilitative and medical progress. 257
(8) Any client, or any parent of a minor client, or 258
guardian, authorized guardian advocate, or client advocate for a 259
client, who is substantially affected by the client's initial 260
family or individual support plan, or the annual review thereof, 261
shall have the right to file a notice to challenge the decision 262
pursuant to ss. 120.569 and 120.57. Notice of such right to 263
appeal shall be included in all support plans provided by the 264
agency. 265
Section 4. For the 2024-2025 fiscal year, the sums of 266
$16,333,475 in recurring funds from the General Revenue Fund and 267
$22,518,748 in recurring funds from the Operations and 268
Maintenance Trust Fund are appropriated in the Home and 269
Community Based Services Waiver category to the Agency for 270
Persons with Disabilities to offer waiver services to the 271
greatest number of individua ls permissible under the 272
appropriation from preenrollment categories 3, 4, and 5, 273
including individuals whose caregiver is age 60 or older in 274
category 4, established in s. 393.065, Florida Statutes, as 275
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amended by this act. For the 2024 -2025 fiscal year, th e sum of 276
$38,852,223 in recurring funds from the Medical Care Trust Fund 277
is appropriated in the Home and Community Based Services Waiver 278
category to the Agency for Health Care Administration to 279
establish budget authority for Medicaid services. 280
Section 5. The Agency for Health Care Administration and 281
the Agency for Persons with Disabilities, in consultation with 282
other stakeholders, shall jointly develop a comprehensive plan 283
for the administration, finance, and delivery of home and 284
community-based services through a new home and community -based 285
services Medicaid waiver program. The waiver program shall be 286
for clients transitioning into adulthood and shall be designed 287
to prevent future crisis enrollment into the waiver authorized 288
under s. 393.0662, Florida Statutes. The Agency for Health Care 289
Administration is authorized to contract with necessary experts 290
to assist in developing the plan. The Agency for Health Care 291
Administration must submit a report to the Governor, the 292
President of the Senate, and the Spea ker of the House of 293
Representatives by December 1, 2024, addressing, at a minimum, 294
all of the following: 295
(1) The purpose, rationale, and expected benefits of the 296
new waiver program. 297
(2) The proposed eligibility criteria for clients and 298
service benefit package to be offered through the waiver 299
program. 300
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(3) A proposed implementation plan and timeline, including 301
recommendations for number of clients served by the waiver 302
program at initial implementation, changes over time, and any 303
per-client benefit caps. 304
(4) Proposals for how clients will transition onto and off 305
of the waiver, including, but not limited to, transitions 306
between this waiver and the waiver established under s. 307
393.0662, Florida Statutes. 308
(5) The fiscal impact for the implementation year and 309
projections for the next 5 years, determined on an actuarially -310
sound basis. 311
(6) An analysis of the availability of services that would 312
be offered under the waiver program and recommendations to 313
increase availability of such services, if necessary. 314
(7) A list of all stakeholders, public and private, who 315
were consulted or contacted as part of the waiver program. 316
Section 6. This act shall take effect July 1, 2024. 317