Signed by Governor Ron DeSantis

Vote Smart's Synopsis:

Vote to pass a bill that amends the Medicaid Program for disabled individuals, including the requirements for eligibility.

Highlights:

• Defines “significant additional need” as an additional need for medically necessary services that would place the health and safety of the client, the client’s caregiver, or the public is in serious jeopardy if it is not met, and specifies that the term shall not exclude services for an additional need that the client requires in order to remain in the least restrictive setting including employment services and transportation services  (Sec. 1).

• Authorizes additional funding to be made to an individual after the initial allocation amount is determined and after the qualified organization has documented the availability of all nonwaiver resources (Sec. 1).

• Requires the Agency for Health Care Administration to seek federal approval and waivers to amend contracts that provide consumer-directed options for individuals with developmental disabilities and centralize within its headquarters medical necessity determinations for requested services made through the significant additional needs process (Sec. 1).

• Amends the requirements for the agency to make changes to services defined under a federal waiver program as follows, including, but not limited to (Sec. 4):

• Supported living coaching services not to exceed 20 hours per month for individuals who also receive in-home support services;

• Limited support coordination services are the only support coordination services that may be provided to individuals under that age of 18 who live in the family home;

• Personal care assistance services are limited to 180 hours per calendar month and may not include rate modifiers unless additional hours have been authorized for individuals with intensive physical, medical, or adaptive needs if such hours will prevent institutionalization; and

• Residential habilitation services are limited to 8 hours per day unless additional hours have been authorized for individuals with intensive medical or adaptive needs.

• Specifies that nothing in this act shall prevent or limit the agency for Health Care Administration in consultation with the agency, from adjusting fees, reimbursement rates, lengths of stay, number of visits, number of services, from limiting enrollment, or making any other adjustment necessary to comply with the availability of funds (Sec. 4).

• Requires the agency to submit a quarterly status report to the executive office of the Governor that contains the following information (Sec. 4):

• The financial status of home and community-based services, including the number of enrolled individuals receiving services through one or more programs;

• The number of individuals who have requested services but are not enrolled to receive services through the aforementioned programs;

• The number of individuals who have refused an offer of services but who choose to remain on the list of individuals waiting for services;

• The number of individuals who have requested services but who are receiving no services;

• A frequency distribution indicating the length of time individuals have been waiting for services; and

• Information concerning the actual and projected costs compared to the amount of the appropriation available to the program and any projected surplus or deficits.

• Requires the Agency for Health Care Administration to submit a plan to the House Appropriations Committee if the costs of services are expected to exceed the appropriated amount that brings costs down to remain within the appropriated amount (Sec. 4).

• Defines a “qualified organization” as an organization determined by the agency to meet the requirements of this act and the section of the Developmental Disabilities Individual Budgeting Waiver Services Coverage and Limitations Handbook (Sec. 5).

• Requires all qualified organizations report to the agency any violation of ethical or professional conduct by support coordinators employed by the organization (Sec. 5).

• Requires intermediate care facility for the developmentally disabled have a total of 24 beds that shall be split into 3 individual 8-bed homes for use by individuals exhibiting severe maladaptive behaviors and co-occurring psychiatric diagnosis requiring increased levels of behavioral, medical, and therapeutic oversight (Sec. 7).

• Requires the agency to seek federal approval to implement a payment rate for Medicaid intermediate care facilities serving individuals with developmental disabilities, severe maladaptive behaviors, severe maladaptive behaviors, and co-occurring complex medical conditions (Sec. 8).

Full Bill Text