This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1271e.HHS
DATE: 2/23/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/CS/HB 1271 Individuals with Disabilities
SPONSOR(S): Health & Human Services Committee, Health Care Appropriations Subcommittee, Children,
Families & Seniors Subcommittee, Buchanan
TIED BILLS: IDEN./SIM. BILLS: SB 1758
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Children, Families & Seniors Subcommittee 15 Y, 0 N, As
CS
Lloyd Brazzell
2) Health Care Appropriations Subcommittee 15 Y, 0 N, As
CS
Fontaine Clark
3) Health & Human Services Committee 19 Y, 0 N, As
CS
Lloyd Calamas
SUMMARY ANALYSIS
The Agency for Persons with Disabilities (APD) provides services to eligible individuals with developmental
disabilities which includes those persons served under a Medicaid Home and Community-Based Services
(HCBS) waiver. The HCBS waiver allows individuals to continue to live in their own homes or in another home-
like setting and avoid institutionalization. Applications submitted to APD using a paper application are reviewed
under statutory deadlines. Most eligible individuals are initially placed on a pre-enrollment list; some can wait
for years before funding is available for waiver enrollment.
CS/CS/CS/HB 1271 enhances the individual’s eligibility and enrollment experience by:
Requiring an online application process;
Specifying the steps or documentation required to submit a “complete” application;
Requiring APD to communicate with applicants about certain application actions; and
Specifying time standards for review and action on eligibility by pre-enrollment category.
The bill expands the iBudget program and improves service delivery by:
Reprioritizing individuals whose caregivers are ages 60-69 higher on the pre-enrollment list;
Creating care navigation to assist individuals waiting for services in accessing community resources;
Limiting APD to developing support plans only for waiver enrollees;
Authorizing funding for waiver enrollment for individuals in pre-enrollment categories 3-5, including
those in category 4 with caregivers aged 60 years of age or older, and any siblings in categories 3-6.
The bill amends the implementation process for the iConnect data system. It makes provider use of the
iConnect system contingent on certain development milestones, and requires APD to establish a process for
provider training and feedback. The bill requires APD to submit an assessment report by December 31, 2024
to the Legislature and Governor on its iConnect data management system, which considers the needs of and
impacts on both the agency and its clients.
The bill requires the Agency for Health Care Administration (AHCA) to contract with experts to, in consultation
with APD, develop a new Medicaid waiver focused on waiver clients transitioning into adulthood. AHCA must
submit its report to the Legislature and Governor by December 1, 2024.
The bill provides an appropriation of $38,852,223 in recurring funds to APD and has no fiscal impact on local
government.
The bill has an effective date of July 1, 2024. STORAGE NAME: h1271e.HHS PAGE: 2
DATE: 2/23/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Agency for Persons with Disabilities
The Agency for Persons with Disabilities (APD) provides services to certain individuals with
developmental disabilities.
1
APD supports these individuals and families in living, learning, and working
within their communities by creating multiple pathways to be successful through a variety of social,
medical, behavioral, residential, and therapeutic services.
2
Chapter 393, F.S., provides the authority and guidance to the APD on what programs to develop, who
is eligible, and how to manage those programs within available resources. In s. 393.062, F.S., the
legislative findings and declaration of intent state:
The greatest priority shall be given to the development and implementation of
community-based services that will enable individuals with developmental disabilities to
achieve their greatest potential for independent and productive living, enable them to
live in their own homes or in residences located in their own communities, and permit
them to be diverted or removed from unnecessary institutional placements.
One of the ways in which services are delivered to individuals with developmental disabilities is through
federal waivers, such as the Home and Community Based Services (HCBS) waiver
3
. The HCBS
waiver allows individuals to continue to live in their own homes or in another home-like setting and
avoid institutionalization.
4
To qualify for this waiver, an individual must meet the standards for
institutional level of care.
5
Home and Community Based Waiver Programs
iBudget Florida Program
The APD administers the Medicaid HCBS waiver known as iBudget Florida (iBudget) for individuals
with specified developmental disabilities who also meet Medicaid eligibility requirements.
6
The iBudget
provides home and community-based services and supports to eligible persons with developmental
disabilities living at home or in a home-like setting, with the costs shared with the federal government.
The waiver services are delivered through a fee-for-service (FFS) delivery model, which means that
providers are enrolled and reimbursed for services directly by the Agency for Health Care
Administration (AHCA).
The iBudget program allocates available funding to clients, providing each one with an established
budget with the flexibility to choose from the authorized array of services that best meet their individual
needs within their community.
7
Individual waiver support coordinators client assist each client with
determination of his or her unique needs and the coordination of necessary providers to provide those
services.
1
S. 393.062, F.S.
2
Agency for Persons with Disabilities, About Us, available at About Us | APD - Agency for Persons with Disabilities - State of Florida (myflorida.com)
(last visited January 22, 2024).
3
Medicaid.gov, Home and Community Based Services – 1915(c), available at https://www.medicaid.gov/medicaid/home-community-based-
services/home-community-based-services-authorities/home-community-based-services-1915c/index.html (last visited January 22, 2024).
4
Rule 59G-13.080(1), F.A.C.
5
Id.
6
S. 392.00662, F.S.
7
Id. STORAGE NAME: h1271e.HHS PAGE: 3
DATE: 2/23/2024
Beginning May 2011, APD started a phase-in of the iBudget program statewide completing the final
transition from the old system on July 1, 2013.
8
The iBudget uses an algorithm or formula to set each
participant’s funding allocation under the waiver.
9
According to APD, over 35,000 enrolled individuals
are currently receiving their services under the iBudget waiver program, and 21,000 individuals are on
the pre-enrollment (wait) list for waiver services (see below).
Consumer Directed Care Plus Program
An individual who is enrolled on the iBudget waiver may elect to receive services through the
Consumer Directed Care Plus Program, or CDC+, Program. The CDC+ Program allows individuals
greater flexibility in the selection of providers and types of services and supports that may be
purchased using the individual’s budget. For instance, under CDC+, an individual and his or her family
can directly hire personal caregivers instead of using a Medicaid-enrolled provider. Like the waiver, a
support coordinator assists the individual and his or her family with the identification of appropriate
services and supports and then makes those selections through the system. However, under CDC+,
this support individual is known as a consultant and has a more limited role.
10
Program Eligibility
To receive services from APD, an individual must be found eligible through a paper application
submission process. Information from the paper application is received at regional offices and is
manually keyed into an electronic client data management system. The application is reviewed for
eligibility based on that information and to identify if additional information is needed. The APD
determines eligibility based on Florida statutes and rules. To be eligible, an individual must:
Demonstrate evidence that one of the following developmental diagnoses manifested itself
before the age of 18 and can reasonably be expected to continue indefinitely:
o Intellectual disability.
o Spina Bifida.
o Cerebral palsy.
o Autism.
o Down syndrome.
o Phelan McDermid syndrome.
o Prader-Willi syndrome.
11
Be domiciled in Florida;
12
and
Be at least three years of age.
13
The APD must review an application within 60 days depending on individual circumstances and the
documentation received.
14
Additional time to work with the applicant may be needed, for example, to
conduct a comprehensive assessment to determine if the individual meets clinical eligibility
requirements.
For an applicant deemed in crisis, APD must expedite the application review to completion within 45
days.
15
If additional documentation is needed, APD may pend the application until that information is
provided which would toll the clock until the information was provided by the applicant. Eligible
individuals are either enrolled in the program (provided a slot) or placed on the pre-enrollment list if the
8
The Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities and their Costs: First
Quarter Fiscal Year 2022-23, p.2, November 15, 2022, available at https://apd.myflorida.com/publications/reports/ (last visited January 22, 2024).
9
Id.
10
A support coordinator is defined in s. 393.063(37), F.S. Further responsibilities are also included in the Agency for Health Care Administration,
Consumer Directed Care Plus Program Coverage, Limitations, and Reimbursement Handbook (October 2015), available at
https://apd.myflorida.com/cdcplus/docs/CDC_Plus_Program_Handbook_2015.pdf (last visited January 22, 2024).
11
S. 393.063(11), F.S. and 393.065, F.S.
12
S. 393.063(13), F.S. and 393.065, F.S.
13
Supra, note 2.
14
S. 393.065(1), F.S.
15
Id. STORAGE NAME: h1271e.HHS PAGE: 4
DATE: 2/23/2024
demand exceeds the available funding.
16
The APD assigns each waitlisted client to a pre-enrollment
category based on their needs and prioritized in the following decreasing order of priority:
17
Category 1: Clients deemed to be in crisis.
Category 2: Children in the child welfare system at the time of permanency or turning 18.
Category 3: Intensive Needs
Category 4 : Caregiver over the age of 70
Category 5: Transition from School
Category 6: Age 21 and Over
Category 7: Age under 21
Eligible individuals that meet the criteria for Categories 1 or 2 are directly enrolled onto the iBudget
waiver. Currently, there is a higher demand for iBudget services than funding available, which means
individuals who require services are put on the pre-enrollment list based on the categorization of their
needs.
As of December 2023, as the table shows below, over 21,000 individuals were waiting for services, with
approximately 50 percent of those between 25 through 59 years old.
18
iBudget Pre-Enrollment List December 2023
19
Category Description
Total
Clients
Category 1 Crisis 0
Category 2 Children in welfare system at the time
of permanency or turning 18
0
Category 3 Intensive Needs 210
Category 4 Caregiver over age 70 83
Category 5 Transition from School 20
Category 6 Age 21 and Over 12,809
Category 7 Age under 21 8,464
Grand Total: 21,587
For each client in a pre-enrollment category, APD develops a support plan and sends an annual status
letter. During this annual check-in, APD verifies contact information, provides resources information,
and also provides the family an opportunity to indicate if there are any new unmet needs or other
changes that may impact the individual’s eligibility.
20
The APD has recently begun providing care
navigation to these clients, using positions that were repurposed for that effort.
When an individual is deemed eligible for services, the APD must consult with the client, if the client is
competent, if not then the client’s parent or guardian to devise a support plan. For children ages three
to 18 and other individuals, the support plan must include the most appropriate, the least restrictive,
and most cost beneficial environment for the individual’s progress, and have the appropriate
specification for the services authorized.
21
iConnect Data Management System
As part of the funding under the federal Centers for Medicare and Medicaid Services (CMS) Home and
Community Based Services Waiver (HCBS), the waiver includes six performance measures and 26
program assurances. The APD must demonstrate compliance on an ongoing basis and each
assurance requires data to be collected, tracked, analyzed, and action taken to remediate problems
16
Rule 65G-1.047, F.A.C. The rule provides that the severity of the crisis is determined by the risk to the health, safety, and w elfare of each applicant
relative to other applicant. Rule 65G-11.004 provides a procedure for determining if a client is considered to be in crisis.
17
S. 363.065(5), F.S.
18
Agency for Persons with Disabilities, 2024 Agency Bill Analysis – HB 1271 (January 8, 2024)(on file with Children, Families & Seniors Subcommittee).
19
Id.
20
Id.
21
S. 393.0651, F.S. STORAGE NAME: h1271e.HHS PAGE: 5
DATE: 2/23/2024
that are found from any data collection.
22
Prior to iConnect and as components are still implemented
now, APD primarily utilizes several disparate and antiquated systems with only automation in only a
small portion of these business and administrative functions and requirements. APD’s support
document for iConnect argued that the necessary automated systems require considerable manual
intervention for maintenance, operations, support, and integration with other systems. In addition, many
of the business functions remain manual processes. The pre iConnect environment was inefficient,
labor intensive, and did not meet the program needs, and does not until fully implemented.
23
Many, if
not the majority, of the key program functions identified in the Assumptions and Constraints section of
the Schedule IV-B, are detailed as manual or paper based functions which are employee generated,
not automated by system activity or eligibility functionality.
24
A third party vendor, WellSky was selected, through a competitive procurement process, in 2015 for an
to design and implement the existing single client record and Electronic Visit Verification system called
iConnect. The data management system is utilized by both internal APD team members and external
stakeholders, including Waiver Support Coordinators and other APD providers.
25
For example, a provider or agency owner creates an account on iConnect and receives notice of
individuals that have been found eligible for their services, which services, the approval date for
services, plus all of the identifying information needed on the eligible client.
26
A provider or agency
looking for a schedule of available clients in iConnect would encounter a screen similar to the one
presented below.
27
After completion of a service, the agency or provider would also electronically verify
provider participation via iConnect and to assist with any remaining provider or agency payments.
Currently, clients and caregivers do not have access to information on iConnect. An access date for a
client or parent and guardian portal on the APD portal is not yet publicly listed, but is a component of
the agency’s final rollout of the iConnect system.
28
Additionally, as part of its Frequently Asked
Questions, the site says that as the launch date approaches, the agency will determine what will be the
best way to disseminate information which is identified as appropriate for release.
29
During 2023, APD and WellSky hosted Town Hall meetings around the state. According to those
presentations, APD and WellSky has a number of anticipated improvements that were anticipated for
completion by the end of 2023 or are planned for 2024.
30
22
Agency for Persons with Disabilities, 2024-2025 State Fiscal Year Schedule IV-B Business Case for iConnect System, (September 15, 2023),
available at http://floridafiscalportal.state.fl.us/Document.aspx?ID=26106&DocType=PDF (last visited February 23, 2024).
23
Id.
24
Id.
25
Agency for Persons with Disabilities and WellSky, APD iConnect (Townhall Webinar, December 4, 2023), presentation available at
https://apd.myflorida.com/waiver/iconnect/docs/Townhall%20Presentation%2006282023%20with%20Screenshotrevised12042023.pdf (last visited
February 23, 2024).
26
Agency for Persons with Disabilities, APD iConnect – Provider Tips and Tricks – the Basics (Oct. 29, 2020), available at Provider Tips and Tricks
Guide Oct 29 2020.pdf (myflorida.com) (last visited February 23, 2024).
27
Id.
28
Agency for Persons with Disabilities, APD iConnect FAQs, available at https://apd.myflorida.com/waiver/iconnect/faq/consumers/qa1.htm (last visited
February 23, 2024).
29
Id.
30
Supra, note 25. STORAGE NAME: h1271e.HHS PAGE: 6
DATE: 2/23/2024
The Florida Unique Abilities Partner Program
The Florida Unique Abilities Partner Program (program) recognizes businesses that employ individuals
who have disabilities and businesses that establish organizations that support independence for
individuals with disabilities. In 2016, HB 7003 mandated the Florida Department of Economic
Opportunity (DEO) to create and manage the program, which was part of a larger initiative under the
Employment First Act designed to prioritize the employment of individuals with disabilities and to
change the employment system to better integrate these individuals into the workforce.
31
The department commenced rulemaking and adopted Rule 73B-4.001, F.A.C., to establish the
application and eligibility for a designation process as part of its implementation plan. The rule was
finalized in December 2016 by the Department of Economic Opportunity and has not been modified.
The program allows for a designation as a Florida Unique Abilities Partner based on achievement in at
least one of the following:
Employment of Individuals who have a disability.
Contributions to local or national disability organizations.
Contributions to, or the establishment of, a program that contributes to the independence of
individuals who have a disability.
32
To qualify, a business must demonstrate a commitment to providing career and financial opportunities
to individuals with unique abilities and to assisting organizations that support them who meet one or
more of these criteria above.
33
An interested business completes a simple application and, if approved,
a partner will receive name recognition on the Florida Unique Abilities Partner Program website, special
designation in the Employ Florida Marketplace (if not currently listed), the Florida Unique Abilities
31
Ch. Law 2016-3, §8; s. 413.801, F.S.
32
Id.
33
Florida Department of Commerce, Florida Unique Abilities Partner Program, available at https://www.floridajobs.org/unique-abilities-partner-program
(last visited February 23, 2024). 2023 2024
Plan Rule Enhancements
Incorporate legislative changes
New Provider Application
New & Renewal via iConnect
Winter 2024
Intermediate Care Facility Transitions
& Residential Planning
Residential referrals for consumers
seeking group home placement
Monthly Monitoring
Complete form via iConnect
Winter 2024
Life Skills Development Services
Request & Track supported employment
services for their consumers
Background Screening Roster Violations
& Arrest Notifications
Communicate with providers via iConnect
Spring 2024
Provider Administrative Actions
(Expansions and Terminations)
Process actions within system
Quality Assurance
Review report & support remediation plans
via iConnect
Spring 2024
Behavioral Services
Complete & submit monthly reports via
iConnect
Worker Portal
Worker-friendly; complete assessments,
forms
Spring 2024
Provider Service Level Designations
Request designations thru iConnect
Source:
APD iConnect/SkyWell TownHalls (2023)
APD Planned Updgrades to iConnect STORAGE NAME: h1271e.HHS PAGE: 7
DATE: 2/23/2024
Partner logo for commercial use, and a window display. Applications are usually considered and a
decision made within 30 days.
34
The 2023 current partners list includes 197 partners throughout Florida with the majority of the partners
concentrated in a dozen counties.
35
# COUNTY PARTNERS
1 Leon 48
2 Brevard 12
3 Hillsborough 12
4 Orange 11
5 Duval 10
6 Broward 9
7 Miami-Dade 9
8 Palm Beach 9
9 Volusia 7
10 Lee 6
11 Pinellas 6
12 Seminole 5
TOTAL: 144
The program is again under the Department of Commerce umbrella and in the most recent annual
report for 2022, 301 total applications have been received since program inception with 187 annual
certifications and three new certifications awarded.
36
Effects of the Bill
Care Navigators
The bill authorizes APD to offer clients and their caregivers care navigation services within available
resources at the time of application and as part of any eligibility or renewal review. A care navigator
would assist the client and the client’s family with navigating the systems and accessing services,
supports, and available resources to meet an individual non-waiver enrolled client’s needs, as well as
identifying and addressing any barriers preventing individuals from accomplishing their goals. The care
navigator would also connect individuals to supports and services in a timely manner and address
immediate or critical needs to stabilize the individual seeking assistance before the individual reaches a
crisis point.
Under s. 393.064, F.S., a care navigator would be involved in activities such as assessing client needs,
developing care plans, and connecting individuals to resources that address the individual’s immediate,
intermediate, and long-term needs, goals leading to increased opportunities in education, employment,
social engagement, community integration, and caregiver support.
For an individual who is also a public school student, the student’s Individuals with Disabilities
Education Act (I.D.E.A.) plan, as amended, would also be incorporated into the care plan.
Online Application
34
Id.
35
Florida Department of Commerce, Florida Unique Abilities Partner Program, available at https://flcom.my.salesforce-sites.com/uap/partnerList (last
visited February 23, 2024).
36
Florida Commerce Annual Report 2023, Florida Unique Abilities Partner Program, p. 18, available online at https://floridajobs.org/docs/default-
source/reports-and-legislation/floridacommerce-annual-report-2023.pdf?sfvrsn=51d55db0_2 (last visited February 23, 2024). STORAGE NAME: h1271e.HHS PAGE: 8
DATE: 2/23/2024
The bill modernizes the application and eligibility processes at APD to incorporate a requirement for an
online application, identify the federal time standards for eligibility review and processing, specify the
steps for a complete application, and provide specificity for eligibility determination time standards.
With only a paper application currently available, the bill requires APD to implement an online
application process and system that meets certain minimum requirements, including directives to:
Create and maintain a paperless, electronic application.
Maintain access to a printable, paper application on the APD website.
Provide paper applications upon request.
Designate a central or regional address for submission of paper applications via regular U.S.
mail or via confidential fax.
Provide immediate confirmation of receipt in the same manner as application was submitted,
unless the applicant has designated otherwise.
For those individuals seeking enrollment in the HCBS waiver program who identify as being in crisis, the
APD must make an eligibility determination in an expedited manner of 15 calendar days after receipt of
a completed application. To be considered a completed application, the application must:
Include a signature and date by the applicant or someone with legal authority to apply for public
benefits on behalf of the applicant.
Be responsive on all parts of the application.
Contain documentation of a diagnosis.
For individuals with developmental disabilities who meet the criteria in s. 393.065(5)(b), F.S., which are
children who are in the child welfare system (Category 2 on the pre-enrollment list), the APD must make
eligibility determinations as soon as practicable. For the remaining categories under s. 393.065, F.S.,
the bill requires an eligibility determination standard of 60 days after receipt of a complete application.
The APD may toll the clock on the 60 day time period if documentation is missing; however, APD must
convey this delay to the client verbally as soon as the action is taken and follow up with a written
confirmation which details the anticipated length of the delay and a contact person for the client to reach
should he or she have questions.
The bill amends the individual support plan requirement in s. 393.0651, F.S., to limit that requirement to
only individuals served by the current iBudget waiver. The bill adds a time standard of 60 calendar days
after an APD eligibility determination for the development of the individual support plan and a
requirement that the waiver support coordinator specifically inform the client, the client’s parent or
guardian about the CDC+ program. This will ensure that individuals eligible for CBC+ are informed about
the opportunity.
Category 4 Eligibility
The potential number of eligible individuals on the pre-enrollment wait list from Category 4 increases
with the reduction of the minimum qualifying age of the caregiver from age 70 or older to age 60 or
older. For those waiver individuals for whom a caregiver is necessary or for whom caregiver is older but
not yet 70 and there is no alternate caregiver available, the age modification will deepen the pool of
possible recipients in the higher priority category. The adjustment also hastens the movement of
additional individuals from category 6 up to category 5, and may allow waiver services to potentially
reach these clients sooner.
Additional individuals having the opportunity to remain at home with a caregiver or in a home-like setting
reduce the likelihood of the individual needing to move to future non-home like or institutional-level care,
or at least may prolong the action. Nationally, the number of individuals and the percentage of
individuals with disabilities in state-run institutional care has dropped significantly from a high count of
194,650 individuals in 1975 to 18,807 in 2017.
37
Only a quarter of individuals with disabilities in 2017
37
Larson, S.A., Butterw orth, J., Winsor, J., Tanis, S., Lulinski, A., and Smith, J. (2021). 30 years of Community Living for individuals w ith intellectual
and/or developmental disabilities (1987- 2017). Washington, DC: Administration for Community Living, U.S. Department of Health and Human Services,
available at https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/30%20Years%207-13-21.pdf (last visited February 23,
2024). STORAGE NAME: h1271e.HHS PAGE: 9
DATE: 2/23/2024
who also received some kind of supports
38
lived in a group setting of any kind, meaning an individual not
living on their own, with a family member, or a host or foster family.
39
With more individuals with
disabilities living almost independently or living on their own with the significant assistance of a
caregiver, recognizing the importance of an aging parent, family member, or caregiver may be the
individual’s key to independence.
New HCBS Waiver Plan
The AHCA, APD, and other stakeholders are directed to develop a comprehensive plan for the
administration, finance, and delivery of a HCBS Medicaid waiver program focused on successfully
transitioning waiver clients into adulthood and proactively preventing crisis situations. The AHCA is
authorized to contract with the necessary experts, in consultation with APD, to develop and submit the
plan to the Governor, the President of the Senate, and the Speaker of the House of Representatives by
December 1, 2024. The report must specifically address, at a minimum:
The purpose, rationale, and expected benefits of the new waiver program.
The proposed eligibility criteria for clients and the service benefit package to be offered through
the waiver.
A proposed implementation plan and timeline, including the recommended number of clients to
be served at implementation and at different program intervals.
Proposals for how clients may transition off and on the program and between other designated
waiver programs.
The fiscal impact of the program for the implementation year and over the next five fiscal years,
determined on an actuarially sound basis.
An analysis of the availability of the services that would be offered under the waiver program
and recommendations for how to increase access, if necessary.
A list of participating stakeholders, public and private, involved in or consulted about the
proposed waiver program.
iConnect Data Management System
The bill addresses iConnect functionality and required usage of the system by APD providers.
The bill requires iConnect to allow providers to electronically transmit all required information to iConnect
in an industry standard format, and exempts agency contracted providers from using iConnect for
information management until iConnect is fully functional for such electronic transmission. However,
providers must use the system for electronic visit verification (EVV) as required by the APD. Providers
are also exempted from iConnect training, except as is needed for EVV-related usage.
APD shall, at a minimum, provide enhanced technical assistance and host feedback and listening
sessions with service providers to plan for future system enhancements.
The bill requires APD to submit a report to the Governor and Legislature by December 31, 2024. The
report is to assess the functionality of the data management system, considering the needs of and
impacts on APD and other users, and provide options and associated costs for achieving sufficient
functionality.
The effective date of the bill is July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amends s. 393.064; F.S.; Care navigation.
Section 2: Amends s. 393.065, F.S.; Application and eligibility determination.
38
The term “supports” generally refers to the financial, social, educational, physical, and other resources that the state or federal government or a private
entity made provide to an individual w ith an intellectual or developmental disability to aid that individual w ith acts of everyday living as w ell as other
activities, as designated by the source.
39
Supra, note 34. STORAGE NAME: h1271e.HHS PAGE: 10
DATE: 2/23/2024
Section 3: Amends s. 393.0651, F.S.; Family or individual support plan.
Section 4: Provides an appropriation.
Section 5: Creates an unnumbered section of law, related to a report.
Section 6: Type two transfer from the Department of Commerce.
Section 7: Amends s. 20.60, F.S.; Department of Commerce.
Section 8: Amends s. 413.891, F.S.; Florida Unique Abilities Partner Program.
Section 9: Provides an effective date of July 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The bill appropriates a recurring total of $38,852,223 ($16,562,703 from the General Revenue Fund
and $22,289,520 the Operations and Maintenance Trust Fund) to expand HCBS waiver services to
additional clients.
The bill requires the agency to implement an electronic application process. The agency indicates a
cost of between $1,750,000 to $1,850,000 to develop the system, based upon the level of
sophistication desired. Total implementation may take longer than a year.
40
Based on a review of
historical reversions, the agency has sufficient existing resources to begin system development
during FY 2024-25. APD can submit a Legislative Budget Request for the following year to request
the additional resources needed to complete the system and for recurring maintenance needs.
The bill requires APD to collaborate with AHCA and other stakeholders to develop a plan for the
administration, finance, and delivery of a new HCBS Medicaid waiver. The new program will
transition clients into adulthood by offering services to prevent crisis situations. The House
proposed General Appropriations Act for FY 2024-25 provides $800,000 for actuarial services to
determine appropriate capitation rates for the newly-created program.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
The bill does not appear to affect local governments.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Those individuals enrolled on the waiver under the bill will receive additional supports and services.
The number of individuals who will be enrolled on the waiver under the bill is unknown, as under the
iBudget waiver the specific budget for each individual is determined after enrollment.Providers of
services to these individuals will have increased workload and revenue.
D. FISCAL COMMENTS:
None.
40
Supra, Note 2. STORAGE NAME: h1271e.HHS PAGE: 11
DATE: 2/23/2024
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
APD has sufficient rule-making authority in current law to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On January 24, 2024, the Children, Families, and Seniors Subcommittee adopted two amendments and
reported the bill favorably as a committee substitute. The amendments:
Define the term “complete application,” which means an application that:
o Has been signed and dated,
o Is responsive on all parts, and
o Contains documentation of a diagnosis.
Identify APD as responsible for the report on the waiver study, and require AHCA to consult APD
when hiring any experts to assist with the study.
On January 29, 2024, the Health Care Appropriations Subcommittee adopted one amendment that
modifies the appropriation funding sources to reflect the most recently adopted Federal Medical Assistance
Percentage (FMAP). The total appropriation amount of $38,852,223 does not change; rather, the amounts
from the General Revenue Fund and the Operations and Maintenance Trust Fund are updated for the
FMAP fund split.
On February 22, 2024, the Health and Human Services Committee adopted four amendments and
reported the bill favorably as a committee substitute. The amendments:
Include individuals in category 6 who have a sibling in categories 3-6 among the group eligible for
iBudget enrollment under the bill.
Tasks AHCA, rather than APD, with submission of the report to the Governor, the Speaker of the
House of Representatives, Senate President, and relevant fiscal and policy committees of both
chambers on the new waiver plan.
Exempts providers from requirements to use the APD iConnect system for data management, and
to receive training on iConnect use for that purpose, under certain conditions.
Requires providers to use iConnect for electronic visit verification and receive training, if mandated.
Requires APD to provide technical assistance and host feedback and listening sessions for
enhancements on a future system.
Requires a report to the Legislature on iConnect functionality with options and associated costs for
achieving sufficient functionality.
Requires a Type 2 transfer of the Unique Abilities Partner Program from the Department of
Commerce to APD effective October 1, 2024.
The analysis is drafted to the bill as amended and passed by the Health and Human Services Committee.