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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; defining the term "complete 15
application"; revising timeframes within which the 16
agency must make eligibility determinations for 17
services; lowering the age that a caregiver must be 18
for an individual to be placed in a certain 19
preenrollment category; amending s. 393.0651, F.S.; 20
requiring the agency to provide an individual support 21
plan for each client serv ed by the home and community -22
based services Medicaid waiver program; providing 23
appropriations; requiring the Agency for Persons with 24
Disabilities, in consultation with Agency for Health 25
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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
Care Administration, to jointly develop a 26
comprehensive plan for the a dministration, finance, 27
and delivery of home and community -based services 28
through a new home and community -based services 29
Medicaid waiver program; providing requirements for 30
the waiver program; requiring the Agency for Health 31
Care Administration to submit a specified report to 32
the Governor, the President of the Senate, and the 33
Speaker of the House of Representatives by a specified 34
date; providing an effective date. 35
36
Be It Enacted by the Legislature of the State of Florida: 37
38
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 appli cation 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 inte gration, 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, including, 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, social 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 integrated 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 have the 63
potential to prevent, correct, cure, or reduce the severity of 64
developmental disabiliti es. 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 procedures 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 develop 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 provid e 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 in 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 cris is, 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 agency or its designee must provide a 112
comprehensive assessment. 113
(c) If the agency requests addit ional 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. For purposes of this paragraph, the term "complete 119
application" means an application submitted to the agency which 120
is signed and dated by the applicant or an individual with legal 121
authority to apply for public benefits on behalf of the 122
applicant, is responsive on all parts of the application, an d 123
contains documentation of a diagnosis. 124
2. If the applicant requesting enrollment in the home and 125
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community-based services Medicaid waiver program for individuals 126
with developmental disabilities is deemed to be in crisis as 127
described in paragraph (5)(a) , the agency must make an 128
eligibility determination within 15 calendar days after receipt 129
of a complete application. 130
3. If the applicant meets the criteria specified in 131
paragraph (5)(b), the agency must review and make an eligibility 132
determination as soon as practicable after receipt of a complete 133
application. 134
4. If the application meets the criteria specified in 135
paragraphs (5)(c)-(g), the agency shall make an eligibility 136
determination within 60 days after receipt of a complete 137
application. Any delay s in the eligibility determination process 138
or any tolling of the time standard until certain information or 139
actions have been completed, must be conveyed to the client as 140
soon as such delays are known with a verbal contact to the 141
client or the client's des ignated caregiver and confirmed by a 142
written notice of the delay, the anticipated length of delay, 143
and a contact person for the client. 144
(5) Except as provided in subsections (6) and (7), if a 145
client seeking enrollment in the developmental disabilities ho me 146
and community-based services Medicaid waiver program meets the 147
level of care requirement for an intermediate care facility for 148
individuals with intellectual disabilities pursuant to 42 C.F.R. 149
ss. 435.217(b)(1) and 440.150, the agency must assign the cli ent 150
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to an appropriate preenrollment category pursuant to this 151
subsection and must provide priority to clients waiting for 152
waiver services in the following order: 153
(d) Category 4, which includes, but is not required to be 154
limited to, clients whose caregive rs are 60 70 years of age or 155
older and for whom a caregiver is required but no alternate 156
caregiver is available. 157
158
Within preenrollment categories 3, 4, 5, 6, and 7, the agency 159
shall prioritize clients in the order of the date that the 160
client is determined eligible for waiver services. 161
Section 3. Section 393.0651, Florida Statutes, is amended 162
to read: 163
393.0651 Family or individual support plan. —The agency 164
shall provide directly or contract for the development of a 165
family support plan for children ages 3 to 18 years of age and 166
an individual support plan for each client served by the home 167
and community-based services Medicaid waiver program under s. 168
393.0662. The client, if competent, the client's parent or 169
guardian, or, when appropriate, the client advoc ate, shall be 170
consulted in the development of the plan and shall receive a 171
copy of the plan. Each plan must include the most appropriate, 172
least restrictive, and most cost -beneficial environment for 173
accomplishment of the objectives for client progress and a 174
specification of all services authorized. The plan must include 175
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provisions for the most appropriate level of care for the 176
client. Within the specification of needs and services for each 177
client, when residential care is necessary, the agency shall 178
move toward placement of clients in residential facilities based 179
within the client's community. The ultimate goal of each plan, 180
whenever possible, shall be to enable the client to live a 181
dignified life in the least restrictive setting, be that in the 182
home or in the community. The family or individual support plan 183
must be developed within 60 calendar days after the agency 184
determines the client eligible pursuant to s. 393.065(3). When 185
developing or reviewing the support plan, the waiver support 186
coordinator must infor m the client, the client's parent or 187
guardian, or, when appropriate, the client advocate about the 188
consumer-directed care program under s. 409.221. 189
(1) The agency shall develop and specify by rule the core 190
components of support plans. 191
(2) The family or individual support plan shall be 192
integrated with the individual education plan (IEP) for all 193
clients who are public school students entitled to a free 194
appropriate public education under the Individuals with 195
Disabilities Education Act, I.D.E.A., as amended . The family or 196
individual support plan and IEP must be implemented to maximize 197
the attainment of educational and habilitation goals. 198
(a) If the IEP for a student enrolled in a public school 199
program indicates placement in a public or private residential 200
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program is necessary to provide special education and related 201
services to a client, the local education agency must provide 202
for the costs of that service in accordance with the 203
requirements of the Individuals with Disabilities Education Act, 204
I.D.E.A., as amended. This does not preclude local education 205
agencies and the agency from sharing the residential service 206
costs of students who are clients and require residential 207
placement. 208
(b) For clients who are entering or exiting the school 209
system, an interdepart mental staffing team composed of 210
representatives of the agency and the local school system shall 211
develop a written transitional living and training plan with the 212
participation of the client or with the parent or guardian of 213
the client, or the client advoca te, as appropriate. 214
(3) Each family or individual support plan shall be 215
facilitated through case management designed solely to advance 216
the individual needs of the client. 217
(4) In the development of the family or individual support 218
plan, a client advocat e may be appointed by the support planning 219
team for a client who is a minor or for a client who is not 220
capable of express and informed consent when: 221
(a) The parent or guardian cannot be identified; 222
(b) The whereabouts of the parent or guardian cannot b e 223
discovered; or 224
(c) The state is the only legal representative of the 225
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client. 226
227
Such appointment may not be construed to extend the powers of 228
the client advocate to include any of those powers delegated by 229
law to a legal guardian. 230
(5) The agency shall place a client in the most 231
appropriate and least restrictive, and cost -beneficial, 232
residential facility according to his or her individual support 233
plan. The client, if competent, the client's parent or guardian, 234
or, when appropriate, the client advocate, a nd the administrator 235
of the facility to which placement is proposed shall be 236
consulted in determining the appropriate placement for the 237
client. Considerations for placement shall be made in the 238
following order: 239
(a) Client's own home or the home of a fami ly member or 240
direct service provider. 241
(b) Foster care facility. 242
(c) Group home facility. 243
(d) Intermediate care facility for the developmentally 244
disabled. 245
(e) Other facilities licensed by the agency which offer 246
special programs for people with devel opmental disabilities. 247
(f) Developmental disabilities center. 248
(6) In developing a client's annual family or individual 249
support plan, the individual or family with the assistance of 250
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the support planning team shall identify measurable objectives 251
for client progress and shall specify a time period expected for 252
achievement of each objective. 253
(7) The individual, family, and support coordinator shall 254
review progress in achieving the objectives specified in each 255
client's family or individual support plan, an d shall revise the 256
plan annually, following consultation with the client, if 257
competent, or with the parent or guardian of the client, or, 258
when appropriate, the client advocate. The agency or designated 259
contractor shall annually report in writing to the cli ent, if 260
competent, or to the parent or guardian of the client, or to the 261
client advocate, when appropriate, with respect to the client's 262
habilitative and medical progress. 263
(8) Any client, or any parent of a minor client, or 264
guardian, authorized guardian advocate, or client advocate for a 265
client, who is substantially affected by the client's initial 266
family or individual support plan, or the annual review thereof, 267
shall have the right to file a notice to challenge the decision 268
pursuant to ss. 120.569 and 12 0.57. Notice of such right to 269
appeal shall be included in all support plans provided by the 270
agency. 271
Section 4. For the 2024-2025 fiscal year, the sums of 272
$16,333,475 in recurring funds from the General Revenue Fund and 273
$22,518,748 in recurring funds from the Operations and 274
Maintenance Trust Fund are appropriated in the Home and 275
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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
Community Based Services Waiver categ ory to the Agency for 276
Persons with Disabilities to offer waiver services to the 277
greatest number of individuals permissible under the 278
appropriation from preenrollment categories 3, 4, and 5, 279
including individuals whose caregiver is age 60 or older in 280
category 4, established in s. 393.065, Florida Statutes, as 281
amended by this act. For the 2024 -2025 fiscal year, the sum of 282
$38,852,223 in recurring funds from the Medical Care Trust Fund 283
is appropriated in the Home and Community Based Services Waiver 284
category to the Agency for Health Care Administration to 285
establish budget authority for Medicaid services. 286
Section 5. The Agency for Health Care Administration and 287
the Agency for Persons with Disabilities, in consultation with 288
other stakeholders, shall jointly de velop a comprehensive plan 289
for the administration, finance, and delivery of home and 290
community-based services through a new home and community -based 291
services Medicaid waiver program. The waiver program shall be 292
for clients transitioning into adulthood and shall be designed 293
to prevent future crisis enrollment into the waiver authorized 294
under s. 393.0662, Florida Statutes. The Agency for Health Care 295
Administration is authorized to contract with necessary experts, 296
in consultation with the Agency for Persons wi th Disabilities, 297
to assist in developing the plan. The Agency for Persons with 298
Disabilities, in consultation with the Agency for Health Care 299
Administration, must submit a report to the Governor, the 300
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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
President of the Senate, and the Speaker of the House of 301
Representatives by December 1, 2024, addressing, at a minimum, 302
all of the following: 303
(1) The purpose, rationale, and expected benefits of the 304
new waiver program. 305
(2) The proposed eligibility criteria for clients and 306
service benefit package to be offere d through the waiver 307
program. 308
(3) A proposed implementation plan and timeline, including 309
recommendations for number of clients served by the waiver 310
program at initial implementation, changes over time, and any 311
per-client benefit caps. 312
(4) Proposals for how clients will transition onto and off 313
of the waiver, including, but not limited to, transitions 314
between this waiver and the waiver established under s. 315
393.0662, Florida Statutes. 316
(5) The fiscal impact for the implementation year and 317
projections for the next 5 years, determined on an actuarially -318
sound basis. 319
(6) An analysis of the availability of services that would 320
be offered under the waiver program and recommendations to 321
increase availability of such services, if necessary. 322
(7) A list of all st akeholders, public and private, who 323
were consulted or contacted as part of the waiver program. 324
Section 6. This act shall take effect July 1, 2024. 325