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Florida Senate - 2025 CS for CS for SB 1050 By the Committees on Appropriations; and Children, Families, and Elder Affairs; and Senator Bradley 576-03824-25 20251050c2 1 A bill to be entitled 2 An act relating to services for individuals with 3 developmental disabilities; amending s. 393.0662, 4 F.S.; requiring the Agency for Persons with 5 Disabilities to provide a list of all qualified 6 organizations located within the region in which the 7 client resides and to post its quarterly 8 reconciliation reports on its website within a 9 specified timeframe; amending s. 393.065, F.S.; 10 requiring that online applications include an 11 application for crisis enrollment; requiring the 12 agency to participate in transition planning 13 activities and to post the total number of individuals 14 in each priority category on its website; reordering 15 and amending s. 393.502, F.S.; establishing the 16 Statewide Family Care Council; providing for the 17 purpose, membership, and duties of the council; 18 providing for appointment of local council members; 19 providing for the creation of family-led nominating 20 committees; requiring local family care councils to 21 report to the statewide council policy changes and 22 program recommendations in an annual report; providing 23 duties of the agency relating to the statewide council 24 and local councils; amending s. 409.972, F.S.; 25 requiring certain Medicaid-eligible persons to take 26 certain actions before enrollment; prohibiting the 27 agency from automatically enrolling such persons; 28 amending s. 409.9855, F.S.; revising implementation 29 and eligibility requirements of the pilot program for 30 individuals with developmental disabilities; providing 31 for a method of voluntarily choosing to enroll in the 32 pilot program; requiring the agency to transmit to the 33 Agency for Health Care Administration weekly data 34 files of specified clients; requiring the Agency for 35 Health Care Administration to provide a call center 36 for specified purposes and to coordinate with the 37 Department of Children and Families and the Agency for 38 Persons with Disabilities to disseminate information 39 about the pilot program; revising pilot program 40 benefits; revising provider qualifications; requiring 41 participating plans to conduct an individualized 42 assessment of each enrollee within a specified 43 timeframe for certain purposes and to offer certain 44 services to such enrollees; requiring the Agency for 45 Health Care Administration to conduct monitoring and 46 evaluations and require corrective actions or payment 47 of penalties under certain circumstances; deleting 48 coordination requirements for the agency when 49 submitting certain reports, establishing specified 50 measures, and conducting quality assurance monitoring 51 of the pilot program; revising the dates by which the 52 Agency for Persons with Disabilities shall submit 53 progress reports to the Governor and Legislature; 54 requiring the Agency for Persons with Disabilities to 55 contract for a specified study and provide to the 56 Governor and the Legislature a specified report by 57 specified date; providing an effective date. 58 59 Be It Enacted by the Legislature of the State of Florida: 60 61 Section 1.Subsections (5) and (14) of section 393.0662, 62 Florida Statutes, are amended to read: 63 393.0662Individual budgets for delivery of home and 64 community-based services; iBudget system established.The 65 Legislature finds that improved financial management of the 66 existing home and community-based Medicaid waiver program is 67 necessary to avoid deficits that impede the provision of 68 services to individuals who are on the waiting list for 69 enrollment in the program. The Legislature further finds that 70 clients and their families should have greater flexibility to 71 choose the services that best allow them to live in their 72 community within the limits of an established budget. Therefore, 73 the Legislature intends that the agency, in consultation with 74 the Agency for Health Care Administration, shall manage the 75 service delivery system using individual budgets as the basis 76 for allocating the funds appropriated for the home and 77 community-based services Medicaid waiver program among eligible 78 enrolled clients. The service delivery system that uses 79 individual budgets shall be called the iBudget system. 80 (5)The agency shall ensure that clients and caregivers 81 have access to training and education that inform them about the 82 iBudget system and enhance their ability for self-direction. 83 Such training and education must be offered in a variety of 84 formats and, at a minimum, must address the policies and 85 processes of the iBudget system and the roles and 86 responsibilities of consumers, caregivers, waiver support 87 coordinators, providers, and the agency, and must provide 88 information to help the client make decisions regarding the 89 iBudget system and examples of support and resources available 90 in the community. The agency shall, within 5 days after 91 enrollment, provide the client with a comprehensive and current 92 written list of all qualified organizations located within the 93 region in which the client resides. 94 (14)(a)The agency, in consultation with the Agency for 95 Health Care Administration, shall provide a quarterly 96 reconciliation report of all home and community-based services 97 waiver expenditures from the Agency for Health Care 98 Administrations claims management system with service 99 utilization from the Agency for Persons with Disabilities 100 Allocation, Budget, and Contract Control system. The 101 reconciliation report must be submitted to the Governor, the 102 President of the Senate, and the Speaker of the House of 103 Representatives no later than 30 days after the close of each 104 quarter. 105 (b)The agency shall post its quarterly reconciliation 106 reports on its website, in a conspicuous location, no later than 107 5 days after submitting the reports as required in this 108 subsection. 109 Section 2.Present subsection (12) of section 393.065, 110 Florida Statutes, is redesignated as subsection (13), a new 111 subsection (12) is added to that section, and paragraph (a) of 112 subsection (1), paragraph (b) of subsection (5), and subsection 113 (10) of that section are amended, to read: 114 393.065Application and eligibility determination. 115 (1)(a)The agency shall develop and implement an online 116 application process that, at a minimum, supports paperless, 117 electronic application submissions with immediate e-mail 118 confirmation to each applicant to acknowledge receipt of 119 application upon submission. The online application system must 120 allow an applicant to review the status of a submitted 121 application and respond to provide additional information. The 122 online application must allow an applicant to apply for crisis 123 enrollment. 124 (5)Except as provided in subsections (6) and (7), if a 125 client seeking enrollment in the developmental disabilities home 126 and community-based services Medicaid waiver program meets the 127 level of care requirement for an intermediate care facility for 128 individuals with intellectual disabilities pursuant to 42 C.F.R. 129 ss. 435.217(b)(1) and 440.150, the agency must assign the client 130 to an appropriate preenrollment category pursuant to this 131 subsection and must provide priority to clients waiting for 132 waiver services in the following order: 133 (b)Category 2, which includes clients in the preenrollment 134 categories who are: 135 1.From the child welfare system with an open case in the 136 Department of Children and Families statewide automated child 137 welfare information system and who are either: 138 a.Transitioning out of the child welfare system into 139 permanency; or 140 b.At least 18 years but not yet 22 years of age and who 141 need both waiver services and extended foster care services; or 142 2.At least 18 years but not yet 22 years of age and who 143 withdrew consent pursuant to s. 39.6251(5)(c) to remain in the 144 extended foster care system. 145 146 For individuals who are at least 18 years but not yet 22 years 147 of age and who are eligible under sub-subparagraph 1.b., the 148 agency must provide waiver services, including residential 149 habilitation, and must actively participate in transition 150 planning activities, including, but not limited to, 151 individualized service coordination, case management support, 152 and ensuring continuity of care pursuant to s. 39.6035. The 153 community-based care lead agency must fund room and board at the 154 rate established in s. 409.145(3) and provide case management 155 and related services as defined in s. 409.986(3)(e). Individuals 156 may receive both waiver services and services under s. 39.6251. 157 Services may not duplicate services available through the 158 Medicaid state plan. 159 160 Within preenrollment categories 3, 4, 5, 6, and 7, the agency 161 shall prioritize clients in the order of the date that the 162 client is determined eligible for waiver services. 163 (10)The client, the clients guardian, or the clients 164 family must ensure that accurate, up-to-date contact information 165 is provided to the agency at all times. Notwithstanding s. 166 393.0651, the agency must send an annual letter requesting 167 updated information from the client, the clients guardian, or 168 the clients family. The agency must remove from the 169 preenrollment categories any individual who cannot be located 170 using the contact information provided to the agency, fails to 171 meet eligibility requirements, or becomes domiciled outside the 172 state. 173 (12)To ensure transparency and timely access to 174 information, the agency shall post on its website in a 175 conspicuous location the total number of individuals in each 176 priority category by county of residence. The posted numbers 177 shall reflect the current status of the preenrollment priority 178 list and shall be updated at least every 5 days. 179 Section 3.Section 393.502, Florida Statutes, is reordered 180 and amended to read: 181 393.502Family care councils. 182 (1)CREATION AND PURPOSE OF STATEWIDE FAMILY CARE COUNCIL. 183 There shall be established and located within each service area 184 of the agency a family care council. 185 (a)The Statewide Family Care Council is established to 186 connect local family care councils and facilitate direct 187 communication between local councils and the agency, with the 188 goal of enhancing the quality of and access to resources and 189 supports for individuals with developmental disabilities and 190 their families. 191 (b)The statewide council shall: 192 1.Review annual reports, policy proposals, and program 193 recommendations submitted by the local family care councils. 194 2.Advise the agency on statewide policies, programs, and 195 service delivery improvements based on the collective 196 recommendations of the local councils. 197 3.Identify systemic barriers to the effective delivery of 198 services and recommend solutions to address such barriers. 199 4.Foster collaboration and the sharing of best practices 200 and available resources among local family care councils to 201 improve service delivery across regions. 202 5.Submit an annual report no later than December 1 of each 203 year to the Governor, the President of the Senate, the Speaker 204 of the House of Representatives, and the agency. The report must 205 include a summary of local council findings, policy 206 recommendations, and an assessment of the agencys actions in 207 response to previous recommendations of the local councils. 208 (c)The agency shall provide a written response within 60 209 days after receipt, including a detailed action plan outlining 210 steps taken or planned to address recommendations. The response 211 must specify whether recommendations will be implemented and 212 provide a timeline for implementation or include justification 213 if recommendations are not adopted. 214 (2)STATEWIDE FAMILY CARE COUNCIL MEMBERSHIP. 215 (a)The statewide council shall be composed of the 216 following members appointed by the Governor: 217 1.One representative from each of the local family care 218 councils, who must be a resident of the area served by that 219 local council. Among these representatives must be at least one 220 individual who is receiving waiver services from the agency 221 under s. 393.065 and at least one individual who is assigned to 222 a preenrollment category for waiver services under s. 393.065. 223 2.One representative of an advocacy organization 224 representing individuals with disabilities. 225 3.One representative of a public or private entity that 226 provides services to individuals with developmental disabilities 227 that does not have a Medicaid waiver service contract with the 228 agency. 229 (b)Employees of the agency or the Agency for Health Care 230 Administration are not eligible to serve on the statewide 231 council. 232 (3)STATEWIDE FAMILY CARE COUNCIL TERMS; VACANCIES. 233 (a)Statewide council members shall be initially appointed 234 to staggered 2- and 4-year terms, with subsequent terms of 4 235 years. Members may be reappointed to one additional consecutive 236 term. 237 (b)A member who has served two consecutive terms is not 238 eligible to serve again until at least 12 months have elapsed 239 since ending service on the statewide council. 240 (c)Upon expiration of a term or in the case of any other 241 vacancy, the statewide council shall, by majority vote, 242 recommend to the Governor for appointment at least one person 243 for each vacancy. 244 1.The Governor shall make an appointment within 45 days 245 after receiving a recommendation from the statewide council. If 246 the Governor fails to make an appointment for a member under 247 subsection (2), the chair of the local council may appoint a 248 member meeting the requirements of subsection (2) to act as the 249 statewide council representative for that local council until 250 the Governor makes an appointment. 251 2.If no member of a local council is willing and able to 252 serve on the statewide council, the Governor shall appoint an 253 individual from another local council to serve on the statewide 254 council. 255 (4)STATEWIDE FAMILY CARE COUNCIL MEETINGS; ORGANIZATION. 256 The statewide council shall meet at least quarterly. The council 257 meetings may be held in person or through teleconference or 258 other electronic means. 259 (a)The Governor shall appoint the initial chair from among 260 the members of the statewide council. Subsequent chairs shall be 261 elected annually by a majority vote of the council. 262 (b)Members of the statewide council shall serve without 263 compensation but may be reimbursed for per diem and travel 264 expenses pursuant to s. 112.061. 265 (c)A majority of the members of the statewide council 266 constitutes a quorum. 267 (5)LOCAL FAMILY CARE COUNCILS.There is established and 268 located within each service area of the agency a local family 269 care council to work constructively with the agency, advise the 270 agency on local needs, identify gaps in services, and advocate 271 for individuals with developmental disabilities and their 272 families. 273 (6)LOCAL FAMILY CARE COUNCIL DUTIES.The local family care 274 councils shall: 275 (a)Assist in providing information and conducting outreach 276 to individuals with developmental disabilities and their 277 families. 278 (b)Convene family listening sessions at least twice a year 279 to gather input on local service delivery challenges. 280 (c)Hold a public forum every 6 months to solicit public 281 feedback concerning actions taken by the local family councils. 282 (d)Share information with other local family care 283 councils. 284 (e)Identify policy issues relevant to the community and 285 family support system in the region. 286 (f)Submit to the Statewide Family Care Council, no later 287 than September 1 of each year, an annual report detailing 288 proposed policy changes, program recommendations, and identified 289 service delivery challenges within its region. 290 (7)(2)LOCAL FAMILY CARE COUNCIL MEMBERSHIP. 291 (a)Each local family care council shall consist of at 292 least 10 and no more than 15 members recommended by a majority 293 vote of the local family care council and appointed by the 294 Governor. 295 (b)At least three of the members of the council shall be 296 individuals receiving or waiting to receive services from the 297 agency. One such member shall be an individual who has been 298 receiving services within the 4 years before the date of 299 recommendation. The remainder of the council members shall be 300 parents, grandparents, guardians, or siblings of individuals who 301 have developmental disabilities and qualify for services 302 pursuant to this chapter. For a grandparent to be a council 303 member, the grandchilds parent or legal guardian must consent 304 to the appointment and report the consent to the agency. 305 (c)A person who is currently serving on another board or 306 council of the agency may not be appointed to a local family 307 care council. 308 (d)Employees of the agency or the Agency for Health Care 309 Administration are not eligible to serve on a local family care 310 council. 311 (e)Persons related by consanguinity or affinity within the 312 third degree may shall not serve on the same local family care 313 council at the same time. 314 (f)A chair for the council shall be chosen by the council 315 members to serve for 1 year. A person may not serve no more than 316 four 1-year terms as chair. 317 (8)(3)LOCAL FAMILY CARE COUNCIL TERMS; VACANCIES. 318 (a)Local family council members shall be appointed for a 319 3-year terms term, except as provided in subsection (11) (8), 320 and may be reappointed to one additional term. 321 (b)A member who has served two consecutive terms is shall 322 not be eligible to serve again until 12 months have elapsed 323 since ending his or her service on the local council. 324 (c)1.Upon expiration of a term or in the case of any other 325 vacancy, the local council shall, by majority vote, recommend to 326 the Governor for appointment a person for each vacancy based on 327 recommendations received from the family-led nominating 328 committee described in paragraph (9)(a). 329 2.The Governor shall make an appointment within 45 days 330 after receiving a recommendation. If the Governor fails to make 331 an appointment within 45 days, the local council shall, by 332 majority vote, select an interim appointment for each vacancy 333 from the panel of candidates recommended by the family-led 334 nominating committee. 335 (9)(4)LOCAL FAMILY CARE COUNCIL COMMITTEE APPOINTMENTS. 336 (a)The chair of each local family care council shall 337 create, and appoint individuals receiving or waiting to receive 338 services from the agency and their relatives, to serve on a 339 family-led nominating committee. Members of the family-led 340 nominating council need not be members of the local council. The 341 family-led nominating committee shall nominate candidates for 342 vacant positions on the local family council. 343 (b)The chair of the local family care council may appoint 344 persons to serve on additional council committees. Such persons 345 may include current members of the council and former members of 346 the council and persons not eligible to serve on the council. 347 (13)(5)TRAINING. 348 (a)The agency, in consultation with the statewide and 349 local councils, shall establish and provide a training program 350 for local family care council members. Each local area shall 351 provide the training program when new persons are appointed to 352 the local council and at other times as the secretary deems 353 necessary. 354 (b)The training shall assist the council members to 355 understand the laws, rules, and policies applicable to their 356 duties and responsibilities. 357 (c)All persons newly appointed to the statewide or a local 358 council must complete this training within 90 days after their 359 appointment. A person who fails to meet this requirement is 360 shall be considered to have resigned from the council. The 361 agency may make additional training available to council 362 members. 363 (10)(6)LOCAL FAMILY CARE COUNCIL MEETINGS.Local council 364 members shall serve on a voluntary basis without payment for 365 their services but shall be reimbursed for per diem and travel 366 expenses as provided for in s. 112.061. Local councils The 367 council shall meet at least six times per year. Meetings may be 368 held in person or by teleconference or other electronic means. 369 (7)PURPOSE.The purpose of the local family care councils 370 shall be to advise the agency, to develop a plan for the 371 delivery of family support services within the local area, and 372 to monitor the implementation and effectiveness of services and 373 support provided under the plan. The primary functions of the 374 local family care councils shall be to: 375 (a)Assist in providing information and outreach to 376 families. 377 (b)Review the effectiveness of service programs and make 378 recommendations with respect to program implementation. 379 (c)Advise the agency with respect to policy issues 380 relevant to the community and family support system in the local 381 area. 382 (d)Meet and share information with other local family care 383 councils. 384 (11)(8)NEW LOCAL FAMILY CARE COUNCILS.When a local family 385 care council is established for the first time in a local area, 386 the Governor shall appoint the first four council members, who 387 shall serve 3-year terms. These members shall submit to the 388 Governor, within 90 days after their appointment, 389 recommendations for at least six additional members, selected by 390 majority vote. 391 (12)(9)FUNDING; FINANCIAL REVIEW.The statewide and local 392 family care councils council may apply for, receive, and accept 393 grants, gifts, donations, bequests, and other payments from any 394 public or private entity or person. Each local council is 395 subject to an annual financial review by staff assigned by the 396 agency. Each local council shall exercise care and prudence in 397 the expenditure of funds. The local family care councils shall 398 comply with state expenditure requirements. 399 (14)DUTIES.The agency shall publish on its website all 400 annual reports submitted by the local family care councils and 401 the Statewide Family Care Council within 15 days after receipt 402 of such reports in a designated and easily accessible section of 403 the website. 404 (15)ADMINISTRATIVE SUPPORT.The agency shall provide 405 administrative support to the statewide council and local 406 councils, including, but not limited to, staff assistance and 407 meeting facilities, within existing resources. 408 Section 4.Subsection (1) of section 409.972, Florida 409 Statutes, is amended to read: 410 409.972Mandatory and voluntary enrollment. 411 (1)The following Medicaid-eligible persons listed in 412 paragraphs (a)-(g) are exempt from mandatory managed care 413 enrollment required by s. 409.965, and may voluntarily choose to 414 participate in the managed medical assistance program. These 415 eligible persons must make an affirmative choice before any 416 enrollment action by the agency. The agency may not 417 automatically enroll these eligible persons.: 418 (a)Medicaid recipients who have other creditable health 419 care coverage, excluding Medicare. 420 (b)Medicaid recipients residing in residential commitment 421 facilities operated through the Department of Juvenile Justice 422 or a treatment facility as defined in s. 394.455. 423 (c)Persons eligible for refugee assistance. 424 (d)Medicaid recipients who are residents of a 425 developmental disability center, including Sunland Center in 426 Marianna and Tacachale in Gainesville. 427 (e)Medicaid recipients enrolled in the home and community 428 based services waiver pursuant to chapter 393, and Medicaid 429 recipients waiting for waiver services. 430 (f)Medicaid recipients residing in a group home facility 431 licensed under chapter 393. 432 (g)Children receiving services in a prescribed pediatric 433 extended care center. 434 Section 5.Subsections (1), (2), (3), and (6) of section 435 409.9855, Florida Statutes, are amended to read: 436 409.9855Pilot program for individuals with developmental 437 disabilities. 438 (1)PILOT PROGRAM IMPLEMENTATION. 439 (a)Using a managed care model, The agency shall implement 440 a pilot program for individuals with developmental disabilities 441 in Statewide Medicaid Managed Care Regions D and I to provide 442 coverage of comprehensive services using a managed care model. 443 The agency may seek federal approval through a state plan 444 amendment or Medicaid waiver as necessary to implement the pilot 445 program. 446 (b)The agency shall administer the pilot program pursuant 447 to s. 409.963 and as a component of the Statewide Medicaid 448 Managed Care model established by this part. Unless otherwise 449 specified, ss. 409.961-409.969 apply to the pilot program. The 450 agency may seek federal approval through a state plan amendment 451 or Medicaid waiver as necessary to implement the pilot program. 452 The agency shall submit a request for any federal approval 453 needed to implement the pilot program by September 1, 2023. 454 (c)Pursuant to s. 409.963, the agency shall administer the 455 pilot program in consultation with the Agency for Persons with 456 Disabilities. 457 (d)The agency shall make capitated payments to managed 458 care organizations for comprehensive coverage, including managed 459 medical assistance benefits and long-term care under this part 460 and community-based services described in s. 393.066(3) and 461 approved through the states home and community-based services 462 Medicaid waiver program for individuals with developmental 463 disabilities. Unless otherwise specified, ss. 409.961-409.969 464 apply to the pilot program. 465 (e)The agency shall evaluate the feasibility of statewide 466 implementation of the capitated managed care model used by the 467 pilot program to serve individuals with developmental 468 disabilities. 469 (2)ELIGIBILITY; VOLUNTARY ENROLLMENT; DISENROLLMENT. 470 (a)Participation in the pilot program is voluntary and 471 limited to the maximum number of enrollees specified in the 472 General Appropriations Act. An individual must make an 473 affirmative choice before any enrollment action by the agency. 474 The agency may not automatically enroll eligible individuals. 475 (b)To be eligible for enrollment in the pilot program, an 476 individual must The Agency for Persons with Disabilities shall 477 approve a needs assessment methodology to determine functional, 478 behavioral, and physical needs of prospective enrollees. The 479 assessment methodology may be administered by persons who have 480 completed such training as may be offered by the agency. 481 Eligibility to participate in the pilot program is determined 482 based on all of the following criteria: 483 1.Be Medicaid eligible Whether the individual is eligible 484 for Medicaid. 485 2.Be Whether the individual is 18 years of age or older. 486 3.Have a developmental disability as defined in s. 487 393.063. 488 4.Be placed in any preenrollment category for individual 489 budget waiver services under chapter 393 and reside in Statewide 490 Medicaid Managed Care Regions D or I; effective October 1, 2025, 491 be placed in any preenrollment category for individual budget 492 waiver services under chapter 393, regardless of region; or, 493 effective July 1, 2026, be enrolled in the individual budget 494 waiver services program under chapter 393 or in the long-term 495 care managed care program under this part, regardless of region 496 and is on the waiting list for individual budget waiver services 497 under chapter 393 and assigned to one of categories 1 through 6 498 as specified in s. 393.065(5). 499 3.Whether the individual resides in a pilot program 500 region. 501 (c)The agency shall enroll individuals in the pilot 502 program based on verification that the individual has met the 503 criteria in paragraph (b). 504 1.The Agency for Persons with Disabilities shall transmit 505 to the agency weekly data files of clients enrolled in the 506 Medicaid home and community-based services waiver program under 507 chapter 393 and clients in preenrollment categories pursuant to 508 s. 393.065. The agency shall maintain a record of individuals 509 with developmental disabilities who may be eligible for the 510 pilot program using this data, Medicaid enrollment data 511 transmitted by the Department of Children and Families, and any 512 available collateral data. 513 2.The agency shall determine and administer the process 514 for enrollment. A needs assessment conducted by the Agency for 515 Persons with Disabilities is not required for enrollment. The 516 agency shall notify individuals with developmental disabilities 517 of the opportunity to voluntarily enroll in the pilot program 518 and explain the benefits available through the pilot program, 519 the process for enrollment, and the procedures for 520 disenrollment, including the requirement for continued coverage 521 after disenrollment pursuant to paragraph (d). 522 3.The agency shall provide a call center staffed by agents 523 trained to assist individuals with developmental disabilities 524 and their families in learning about and enrolling in the pilot 525 program. 526 4.The agency shall coordinate with the Department of 527 Children and Families and the Agency for Persons with 528 Disabilities to develop partnerships with community-based 529 organizations to disseminate information about the pilot program 530 to providers of covered services and potential enrollees. 531 (d)Notwithstanding any provisions of s. 393.065 to the 532 contrary, an enrollee must be afforded an opportunity to enroll 533 in any appropriate existing Medicaid waiver program if any of 534 the following conditions occur: 535 1.At any point during the operation of the pilot program, 536 an enrollee declares an intent to voluntarily disenroll, 537 provided that he or she has been covered for the entire previous 538 plan year by the pilot program. 539 2.The agency determines the enrollee has a good cause 540 reason to disenroll. 541 3.The pilot program ceases to operate. 542 543 Such enrollees must receive an individualized transition plan to 544 assist him or her in accessing sufficient services and supports 545 for the enrollees safety, well-being, and continuity of care. 546 (3)PILOT PROGRAM BENEFITS. 547 (a)Plans participating in the pilot program must, at a 548 minimum, cover the following: 549 1.All benefits included in s. 409.973. 550 2.All benefits included in s. 409.98. 551 3.All benefits included in s. 393.066(3). 552 4.Any additional benefits negotiated by the agency 553 pursuant to paragraph (4)(b), and all of the following: 554 a.Adult day training. 555 b.Behavior analysis services. 556 c.Behavior assistant services. 557 d.Companion services. 558 e.Consumable medical supplies. 559 f.Dietitian services. 560 g.Durable medical equipment and supplies. 561 h.Environmental accessibility adaptations. 562 i.Occupational therapy. 563 j.Personal emergency response systems. 564 k.Personal supports. 565 l.Physical therapy. 566 m.Prevocational services. 567 n.Private duty nursing. 568 o.Residential habilitation, including the following 569 levels: 570 (I)Standard level. 571 (II)Behavior-focused level. 572 (III)Intensive-behavior level. 573 (IV)Enhanced intensive-behavior level. 574 p.Residential nursing services. 575 q.Respiratory therapy. 576 r.Respite care. 577 s.Skilled nursing. 578 t.Specialized medical home care. 579 u.Specialized mental health counseling. 580 v.Speech therapy. 581 w.Support coordination. 582 x.Supported employment. 583 y.Supported living coaching. 584 z.Transportation. 585 (b)All providers of the benefits services listed under 586 paragraph (a) must meet the provider qualifications established 587 by the agency for the Medicaid long-term care managed care 588 program under this section. If no such qualifications apply to a 589 specific benefit or provider type, the provider must meet the 590 provider qualifications established by the Agency for Persons 591 with Disabilities for the individual budget waiver services 592 program under chapter 393 outlined in the Florida Medicaid 593 Developmental Disabilities Individual Budgeting Waiver Services 594 Coverage and Limitations Handbook as adopted by reference in 595 rule 59G-13.070, Florida Administrative Code. 596 (c)Support coordination services must maximize the use of 597 natural supports and community partnerships. 598 (d)The plans participating in the pilot program must 599 provide all categories of benefits through a single, integrated 600 model of care. 601 (e)Participating plans must provide benefits services must 602 be provided to enrollees in accordance with an individualized 603 care plan which is evaluated and updated at least quarterly and 604 as warranted by changes in an enrollees circumstances. 605 Participating plans must conduct an individualized assessment of 606 each enrollee within 5 days after enrollment to determine the 607 enrollees functional, behavioral, and physical needs. The 608 assessment method or instrument must be approved by the agency. 609 (f)Participating plans must offer a consumer-directed 610 services option in accordance with s. 409.221. 611 (6)PROGRAM IMPLEMENTATION AND EVALUATION. 612 (a)The agency shall conduct monitoring and evaluations and 613 require corrective actions or payment of penalties as may be 614 necessary to secure compliance with contractual requirements, 615 consistent with its obligations under this section, including, 616 but not limited to, compliance with provider network standards, 617 financial accountability, performance standards, health care 618 quality improvement systems, and program integrity select 619 participating plans and begin enrollment no later than January 620 31, 2024, with coverage for enrollees becoming effective upon 621 authorization and availability of sufficient state and federal 622 resources. 623 (b)Upon implementation of the program, the agency, in 624 consultation with the Agency for Persons with Disabilities, 625 shall conduct audits of the selected plans implementation of 626 person-centered planning. 627 (b)(c)The agency, in consultation with the Agency for 628 Persons with Disabilities, shall submit progress reports to the 629 Governor, the President of the Senate, and the Speaker of the 630 House of Representatives upon the federal approval, 631 implementation, and operation of the pilot program, as follows: 632 1.By August 30, 2025 December 31, 2023, a status report on 633 progress made toward federal approval of the waiver or waiver 634 amendment needed to implement the pilot program. 635 2.By December 31, 2025 2024, a status report on 636 implementation of the pilot program. 637 3.By December 31, 2025, and annually thereafter, a status 638 report on the operation of the pilot program, including, but not 639 limited to, all of the following: 640 a.Program enrollment, including the number and 641 demographics of enrollees. 642 b.Any complaints received. 643 c.Access to approved services. 644 (c)(d)The agency, in consultation with the Agency for 645 Persons with Disabilities, shall establish specific measures of 646 access, quality, and costs of the pilot program. The agency may 647 contract with an independent evaluator to conduct such 648 evaluation. The evaluation must include assessments of cost 649 savings; consumer education, choice, and access to services; 650 plans for future capacity and the enrollment of new Medicaid 651 providers; coordination of care; person-centered planning and 652 person-centered well-being outcomes; health and quality-of-life 653 outcomes; and quality of care by each eligibility category and 654 managed care plan in each pilot program site. The evaluation 655 must describe any administrative or legal barriers to the 656 implementation and operation of the pilot program in each 657 region. 658 1.The agency, in consultation with the Agency for Persons 659 with Disabilities, shall conduct quality assurance monitoring of 660 the pilot program to include client satisfaction with services, 661 client health and safety outcomes, client well-being outcomes, 662 and service delivery in accordance with the clients care plan. 663 2.The agency shall submit the results of the evaluation to 664 the Governor, the President of the Senate, and the Speaker of 665 the House of Representatives by October 1, 2029. 666 Section 6.(1)The Agency for Persons with Disabilities 667 shall contract for a study to review, evaluate, and identify 668 recommendations regarding the algorithm required under s. 669 393.0662, Florida Statutes. The individual contractor must 670 possess, or, if the contractor is a firm, must include at least 671 one lead team member who possesses, a doctorate in statistics 672 and advanced knowledge of the development and selection of 673 multiple linear regression models. The study must, at a minimum, 674 assess the performance of the current algorithm used by the 675 agency and determine whether a different algorithm would better 676 meet the requirements of that section. In conducting this 677 assessment and determination, at a minimum, the study must also 678 review the fit of recent expenditure data to the current 679 algorithm, determine and refine dependent and independent 680 variables, develop and apply a method for identifying and 681 removing outliers, develop alternative algorithms using multiple 682 linear regression, test the accuracy and reliability of the 683 algorithms, provide recommendations for improving accuracy and 684 reliability, recommend an algorithm for use by the agency, 685 assess the robustness of the recommended algorithm, and provide 686 suggestions for improving any recommended alternative algorithm, 687 if appropriate. The study must also consider whether any waiver 688 services that are not currently funded through the algorithm can 689 be funded through the current algorithm or an alternative 690 algorithm, and the impact of doing so on that algorithms fit 691 and effectiveness. The study must present for any recommended 692 alternative algorithm, at a minimum, the estimated number and 693 percent of waiver enrollees who would require supplemental 694 funding under s. 393.0662(1)(b), Florida Statutes, compared to 695 the current algorithm; and the number and percent of waiver 696 enrollees whose budgets are estimated to increase or decrease, 697 categorized by level of increase or decrease, age, living 698 setting, and current total individual budget amount. 699 (2)The agency shall report to the Governor, the President 700 of the Senate, and the Speaker of the House of Representatives 701 findings and recommendations by November 15, 2025. 702 Section 7.This act shall take effect July 1, 2025.
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