| 1 | Representative Zapata offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 |
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| 6 | Section 1. Subsection (1) of section 393.23, Florida |
| 7 | Statutes, is amended to read: |
| 8 | 393.23 Developmental disabilities centers; trust |
| 9 | accounts.--All receipts from the operation of canteens, vending |
| 10 | machines, hobby shops, sheltered workshops, activity centers, |
| 11 | farming projects, and other like activities operated in a |
| 12 | developmental disabilities center, and moneys donated to the |
| 13 | center, must be deposited in a trust account in any bank, credit |
| 14 | union, or savings and loan association authorized by the State |
| 15 | Treasury as a qualified depository to do business in this state, |
| 16 | if the moneys are available on demand. |
| 17 | (1) Moneys in the trust account must be expended for the |
| 18 | benefit, education, or and welfare of clients. However, if |
| 19 | specified, moneys that are donated to the center must be |
| 20 | expended in accordance with the intentions of the donor. Trust |
| 21 | account money may not be used for the benefit of employees of |
| 22 | the agency or to pay the wages of such employees. The welfare of |
| 23 | the clients includes the expenditure of funds for the purchase |
| 24 | of items for resale at canteens or vending machines, and for the |
| 25 | establishment of, maintenance of, and operation of canteens, |
| 26 | hobby shops, recreational or entertainment facilities, sheltered |
| 27 | workshops, activity centers, farming projects, or other like |
| 28 | facilities or programs established at the center for the benefit |
| 29 | of clients. |
| 30 | Section 2. Subsection (3) of section 393.0661, Florida |
| 31 | Statutes, is amended to read: |
| 32 | 393.0661 Home and community-based services delivery |
| 33 | system; comprehensive redesign.--The Legislature finds that the |
| 34 | home and community-based services delivery system for persons |
| 35 | with developmental disabilities and the availability of |
| 36 | appropriated funds are two of the critical elements in making |
| 37 | services available. Therefore, it is the intent of the |
| 38 | Legislature that the Agency for Persons with Disabilities shall |
| 39 | develop and implement a comprehensive redesign of the system. |
| 40 | (3) The Agency for Health Care Administration, in |
| 41 | consultation with the agency, shall seek federal approval and |
| 42 | implement a four-tiered waiver system to serve clients with |
| 43 | developmental disabilities in the developmental disabilities and |
| 44 | family and supported living waivers. The agency shall assign all |
| 45 | clients receiving services through the developmental |
| 46 | disabilities waiver to a tier based on a valid assessment |
| 47 | instrument, client characteristics, and other appropriate |
| 48 | assessment methods. All services covered under the current |
| 49 | developmental disabilities waiver shall be available to all |
| 50 | clients in all tiers where appropriate, except as otherwise |
| 51 | provided in this subsection or in the General Appropriations |
| 52 | Act. |
| 53 | (a) Tier one shall be limited to clients who have service |
| 54 | needs that cannot be met in tier two, three, or four for |
| 55 | intensive medical or adaptive needs and that are essential for |
| 56 | avoiding institutionalization, or who possess behavioral |
| 57 | problems that are exceptional in intensity, duration, or |
| 58 | frequency and present a substantial risk of harm to themselves |
| 59 | or others. |
| 60 | (b) Tier two shall be limited to clients whose service |
| 61 | needs include a licensed residential facility and who are |
| 62 | authorized to receive a moderate level of support for standard |
| 63 | residential habilitation services or a minimal level of support |
| 64 | for behavior focus residential habilitation services or clients |
| 65 | in supported living who receive greater than 6 hours a day of |
| 66 | in-home support services. Total annual expenditures under tier |
| 67 | two may not exceed $55,000 per client each year. |
| 68 | (c) Tier three shall include, but is not limited to, |
| 69 | clients requiring residential placements, clients in independent |
| 70 | or supported living situations, and clients who live in their |
| 71 | family home. Total annual expenditures under tier three may not |
| 72 | exceed $35,000 per client each year. |
| 73 | (d) Tier four is the family and supported living waiver. |
| 74 | Tier four shall include, but is not limited to, clients in |
| 75 | independent or supported living situations and clients who live |
| 76 | in their family home. An increase to the number of services |
| 77 | available to clients in this tier shall not take effect prior to |
| 78 | July 1, 2009. Total annual expenditures under tier four may not |
| 79 | exceed $14,792 per client each year. |
| 80 | (e) The Agency for Health Care Administration shall also |
| 81 | seek federal approval to provide a consumer-directed option for |
| 82 | persons with developmental disabilities which corresponds to the |
| 83 | funding levels in each of the waiver tiers. The agency shall |
| 84 | implement the four-tiered waiver system beginning with tiers |
| 85 | one, three, and four and followed by tier two. The agency and |
| 86 | the Agency for Health Care Administration may adopt any rules |
| 87 | necessary to administer this subsection. |
| 88 | (f) The agency shall seek federal waivers and amend |
| 89 | contracts as necessary to make changes to services defined in |
| 90 | federal waiver programs administered by the agency as follows: |
| 91 | 1. Supported living coaching services shall not exceed 20 |
| 92 | hours per month for persons who also receive in-home support |
| 93 | services. |
| 94 | 2. Limited support coordination services shall be the only |
| 95 | type of support coordination service provided to persons under |
| 96 | the age of 18 who live in the family home. |
| 97 | 3. Personal care assistance services shall be limited to |
| 98 | no more than 180 hours per calendar month and shall not include |
| 99 | rate modifiers. Additional hours may be authorized for persons |
| 100 | who have intensive physical, medical, or adaptive needs if such |
| 101 | hours are essential for avoiding institutionalization. |
| 102 | 4. Residential habilitation services shall be limited to 8 |
| 103 | hours per day. Additional hours may be authorized for persons |
| 104 | who have intensive medical or adaptive needs and if such hours |
| 105 | are essential for avoiding institutionalization, or for persons |
| 106 | who possess behavioral problems that are exceptional in |
| 107 | intensity, duration, or frequency and present a substantial risk |
| 108 | of harming themselves or others. This restriction shall be in |
| 109 | effect until the four-tiered waiver system is fully implemented. |
| 110 | 5. Chore services, nonresidential support services, and |
| 111 | homemaker services shall be eliminated. The agency shall expand |
| 112 | the definition of in-home support services to enable the |
| 113 | provider of the service to include activities previously |
| 114 | provided in these eliminated services. |
| 115 | 6. Massage therapy, medication review, and psychological |
| 116 | assessment services shall be eliminated. |
| 117 | 7. The agency shall conduct supplemental cost plan reviews |
| 118 | to verify the medical necessity of authorized services for plans |
| 119 | that have increased by more than 8 percent during either of the |
| 120 | 2 preceding fiscal years. |
| 121 | 8. The agency shall implement a consolidated residential |
| 122 | habilitation rate structure to increase savings to the state |
| 123 | through a more cost-effective payment method and establish |
| 124 | uniform rates for intensive behavioral residential habilitation |
| 125 | services. |
| 126 | 9. Pending federal approval, the agency is authorized to |
| 127 | extend current support plans for clients receiving services |
| 128 | under Medicaid waivers for 1 year beginning July 1, 2007, or |
| 129 | from the date approved, whichever is later. Clients who have a |
| 130 | substantial change in circumstances which threatens their health |
| 131 | and safety may be reassessed during this year in order to |
| 132 | determine the necessity for a change in their support plan. |
| 133 | 10. The agency shall eliminate redundancies and |
| 134 | duplications between in-home support services, companion |
| 135 | services, personal care services, and supported living coaching |
| 136 | by limiting or consolidating the services. |
| 137 | 11. The agency shall reduce the intensity and frequency of |
| 138 | supported employment services to individuals in stable |
| 139 | employment situations who have a documented history of at least |
| 140 | 3 years' employment with the same company or in the same |
| 141 | industry. |
| 142 | Section 3. Effective upon this act becoming a law, |
| 143 | subsection (6) of section 393.0661, Florida Statutes, is amended |
| 144 | to read: |
| 145 | 393.0661 Home and community-based services delivery |
| 146 | system; comprehensive redesign.--The Legislature finds that the |
| 147 | home and community-based services delivery system for persons |
| 148 | with developmental disabilities and the availability of |
| 149 | appropriated funds are two of the critical elements in making |
| 150 | services available. Therefore, it is the intent of the |
| 151 | Legislature that the Agency for Persons with Disabilities shall |
| 152 | develop and implement a comprehensive redesign of the system. |
| 153 | (6) Effective January 1, 2009, and except as otherwise |
| 154 | provided in this section, an individual served by the home and |
| 155 | community-based services waiver or the family and supported |
| 156 | living waiver funded through the Agency for Persons with |
| 157 | Disabilities shall have his or her cost plan adjusted to reflect |
| 158 | the amount of expenditures for the previous state fiscal year |
| 159 | plus 5 percent if such amount is less than the individual's |
| 160 | existing cost plan. The Agency for Persons with Disabilities |
| 161 | shall use actual paid claims for services provided during the |
| 162 | previous fiscal year that are submitted by October 31 to |
| 163 | calculate the revised cost plan amount. If an individual was not |
| 164 | served for the entire previous state fiscal year or there was |
| 165 | any single change in the cost plan amount of more than 5 percent |
| 166 | during the previous state fiscal year, the agency shall set the |
| 167 | cost plan amount at an estimated annualized expenditure amount |
| 168 | plus 5 percent. The agency shall estimate the annualized |
| 169 | expenditure amount by calculating the average of monthly |
| 170 | expenditures, beginning in the fourth month after the individual |
| 171 | enrolled or the cost plan was changed by more than 5 percent and |
| 172 | ending with August 31, 2008, and multiplying the average by 12. |
| 173 | In the event that at least 3 months of actual expenditure data |
| 174 | are not available to estimate annualized expenditures, the |
| 175 | agency may not rebase a cost plan pursuant to this subsection. |
| 176 | This subsection expires June 30, 2009, unless reenacted by the |
| 177 | Legislature before that date. |
| 178 | Section 4. Except as otherwise expressly provided in this |
| 179 | act, this act shall take effect July 1, 2009. |
| 180 |
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| 181 |
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| 182 | ----------------------------------------------------- |
| 183 | T I T L E A M E N D M E N T |
| 184 | Remove the entire title and insert: |
| 185 | A bill to be entitled |
| 186 | An act relating to the Agency for Persons with |
| 187 | Disabilities; amending s. 393.23, F.S.; revising purposes |
| 188 | of expenditures of moneys deposited in the trust accounts |
| 189 | of developmental disabilities centers; amending s. |
| 190 | 393.0661, F.S.; revising provisions relating to services |
| 191 | provided to certain clients with developmental |
| 192 | disabilities served under the four-tiered waiver system; |
| 193 | revising provisions relating to the calculation of |
| 194 | annualized expenditures; deleting future review and repeal |
| 195 | of s. 393.0661(6), F.S., relating to cost plans for |
| 196 | individuals served by the home and community-based |
| 197 | services waiver or the family and supported living waiver |
| 198 | funded through the Agency for Persons with Disabilities; |
| 199 | providing effective dates. |