Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. SB 82
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       Appropriations Subcommittee on Health and Human Services (Bean)
       recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Present subsections (39) through (45) of section
    6  393.063, Florida Statutes, are redesignated as subsections (40)
    7  through (46), respectively, a new subsection (39) is added to
    8  that section, and present subsection (41) of that section is
    9  amended, to read:
   10         393.063 Definitions.—For the purposes of this chapter, the
   11  term:
   12         (39) “Significant additional need” means an additional need
   13  for medically necessary services which would place the health
   14  and safety of the client, the client’s caregiver, or the public
   15  in serious jeopardy if it is not met. The agency may only
   16  provide additional funding after the determination of a client’s
   17  initial allocation amount and after the qualified organization
   18  has documented the availability of nonwaiver resources.
   19         (42)(41) “Support coordinator” means an employee of a
   20  qualified organization pursuant to s. 393.0663 a person who is
   21  designated by the agency to assist individuals and families in
   22  identifying their capacities, needs, and resources, as well as
   23  finding and gaining access to necessary supports and services;
   24  coordinating the delivery of supports and services; advocating
   25  on behalf of the individual and family; maintaining relevant
   26  records; and monitoring and evaluating the delivery of supports
   27  and services to determine the extent to which they meet the
   28  needs and expectations identified by the individual, family, and
   29  others who participated in the development of the support plan.
   30         Section 2. Subsection (2) of section 393.066, Florida
   31  Statutes, is amended to read:
   32         393.066 Community services and treatment.—
   33         (2) Necessary services shall be purchased, rather than
   34  provided directly by the agency, when the purchase of services
   35  is more cost-efficient than providing them directly. All
   36  purchased services must be approved by the agency. As a
   37  condition of payment, persons or entities under contract with
   38  the agency to provide services shall use agency data management
   39  systems to document service provision to clients before billing
   40  and must use the agency data management systems to bill for
   41  services. Contracted persons and entities shall meet the minimum
   42  hardware and software technical requirements established by the
   43  agency for the use of such systems. Such persons or entities
   44  shall also meet any requirements established by the agency for
   45  training and professional development of staff providing direct
   46  services to clients.
   47         Section 3. Section 393.0661, Florida Statutes, is repealed.
   48         Section 4. Section 393.0662, Florida Statutes, is amended
   49  to read:
   50         393.0662 Individual budgets for delivery of home and
   51  community-based services; iBudget system established.—The
   52  Legislature finds that improved financial management of the
   53  existing home and community-based Medicaid waiver program is
   54  necessary to avoid deficits that impede the provision of
   55  services to individuals who are on the waiting list for
   56  enrollment in the program. The Legislature further finds that
   57  clients and their families should have greater flexibility to
   58  choose the services that best allow them to live in their
   59  community within the limits of an established budget. Therefore,
   60  the Legislature intends that the agency, in consultation with
   61  the Agency for Health Care Administration, shall manage the
   62  service delivery system using individual budgets as the basis
   63  for allocating the funds appropriated for the home and
   64  community-based services Medicaid waiver program among eligible
   65  enrolled clients. The service delivery system that uses
   66  individual budgets shall be called the iBudget system.
   67         (1) The agency shall administer an individual budget,
   68  referred to as an iBudget, for each individual served by the
   69  home and community-based services Medicaid waiver program. The
   70  funds appropriated to the agency shall be allocated through the
   71  iBudget system to eligible, Medicaid-enrolled clients. For the
   72  iBudget system, eligible clients shall include individuals with
   73  a developmental disability as defined in s. 393.063. The iBudget
   74  system shall provide for: enhanced client choice within a
   75  specified service package; appropriate assessment strategies; an
   76  efficient consumer budgeting and billing process that includes
   77  reconciliation and monitoring components; a role for support
   78  coordinators that avoids potential conflicts of interest; a
   79  flexible and streamlined service review process; and the
   80  equitable allocation of available funds based on the client’s
   81  level of need, as determined by the allocation methodology.
   82         (a) In developing each client’s iBudget, the agency shall
   83  use the allocation methodology as defined in s. 393.063(4), in
   84  conjunction with an assessment instrument that the agency deems
   85  to be reliable and valid, including, but not limited to, the
   86  agency’s Questionnaire for Situational Information. The
   87  allocation methodology shall determine the amount of funds
   88  allocated to a client’s iBudget.
   89         (b) The agency may authorize additional funding based on a
   90  client having one or more significant additional needs of the
   91  following needs that cannot be accommodated within the funding
   92  determined by the algorithm and having no other resources,
   93  supports, or services available to meet the needs. Such
   94  additional funding may be provided only after the determination
   95  of a client’s initial allocation amount and after the qualified
   96  organization has documented the availability of all nonwaiver
   97  resources. Upon receipt of an incomplete request for significant
   98  additional needs, the agency shall close the request.
   99         (c)The agency shall centralize, within its headquarters
  100  office, medical necessity determinations of requested services
  101  made through the significant additional needs process. The
  102  process must ensure consistent application of medical necessity
  103  criteria. This process must provide opportunities for targeted
  104  training, quality assurance, and inter-rater reliability. need:
  105         1. An extraordinary need that would place the health and
  106  safety of the client, the client’s caregiver, or the public in
  107  immediate, serious jeopardy unless the increase is approved.
  108  However, the presence of an extraordinary need in and of itself
  109  does not warrant authorized funding by the agency. An
  110  extraordinary need may include, but is not limited to:
  111         a. A documented history of significant, potentially life
  112  threatening behaviors, such as recent attempts at suicide,
  113  arson, nonconsensual sexual behavior, or self-injurious behavior
  114  requiring medical attention;
  115         b. A complex medical condition that requires active
  116  intervention by a licensed nurse on an ongoing basis that cannot
  117  be taught or delegated to a nonlicensed person;
  118         c. A chronic comorbid condition. As used in this
  119  subparagraph, the term “comorbid condition” means a medical
  120  condition existing simultaneously but independently with another
  121  medical condition in a patient; or
  122         d. A need for total physical assistance with activities
  123  such as eating, bathing, toileting, grooming, and personal
  124  hygiene.
  125         2. A significant need for one-time or temporary support or
  126  services that, if not provided, would place the health and
  127  safety of the client, the client’s caregiver, or the public in
  128  serious jeopardy. A significant need may include, but is not
  129  limited to, the provision of environmental modifications,
  130  durable medical equipment, services to address the temporary
  131  loss of support from a caregiver, or special services or
  132  treatment for a serious temporary condition when the service or
  133  treatment is expected to ameliorate the underlying condition. As
  134  used in this subparagraph, the term “temporary” means a period
  135  of fewer than 12 continuous months. However, the presence of
  136  such significant need for one-time or temporary supports or
  137  services in and of itself does not warrant authorized funding by
  138  the agency.
  139         3. A significant increase in the need for services after
  140  the beginning of the service plan year that would place the
  141  health and safety of the client, the client’s caregiver, or the
  142  public in serious jeopardy because of substantial changes in the
  143  client’s circumstances, including, but not limited to, permanent
  144  or long-term loss or incapacity of a caregiver, loss of services
  145  authorized under the state Medicaid plan due to a change in age,
  146  or a significant change in medical or functional status which
  147  requires the provision of additional services on a permanent or
  148  long-term basis that cannot be accommodated within the client’s
  149  current iBudget. As used in this subparagraph, the term “long
  150  term” means a period of 12 or more continuous months. However,
  151  such significant increase in need for services of a permanent or
  152  long-term nature in and of itself does not warrant authorized
  153  funding by the agency.
  154         4. A significant need for transportation services to a
  155  waiver-funded adult day training program or to waiver-funded
  156  employment services when such need cannot be accommodated within
  157  a client’s iBudget as determined by the algorithm without
  158  affecting the health and safety of the client, if public
  159  transportation is not an option due to the unique needs of the
  160  client or other transportation resources are not reasonably
  161  available.
  163  The agency shall reserve portions of the appropriation for the
  164  home and community-based services Medicaid waiver program for
  165  adjustments required pursuant to this paragraph and may use the
  166  services of an independent actuary in determining the amount to
  167  be reserved.
  168         (d)(c) A client’s annual expenditures for home and
  169  community-based Medicaid waiver services may not exceed the
  170  limits of his or her iBudget. The total of all clients’
  171  projected annual iBudget expenditures may not exceed the
  172  agency’s appropriation for waiver services.
  173         (2) The Agency for Health Care Administration, in
  174  consultation with the agency, shall seek federal approval to
  175  amend current waivers, request a new waiver, and amend contracts
  176  as necessary to manage the iBudget system, improve services for
  177  eligible and enrolled clients, and improve the delivery of
  178  services through the home and community-based services Medicaid
  179  waiver program and the Consumer-Directed Care Plus Program,
  180  including, but not limited to, enrollees with a dual diagnosis
  181  of a developmental disability and a mental health disorder.
  182         (3) The agency must certify and document within each
  183  client’s cost plan that the a client has used must use all
  184  available services authorized under the state Medicaid plan,
  185  school-based services, private insurance and other benefits, and
  186  any other resources that may be available to the client before
  187  using funds from his or her iBudget to pay for support and
  188  services.
  189         (4) Rates for any or all services established under rules
  190  of the Agency for Health Care Administration must be designated
  191  as the maximum rather than a fixed amount for individuals who
  192  receive an iBudget, except for services specifically identified
  193  in those rules that the agency determines are not appropriate
  194  for negotiation, which may include, but are not limited to,
  195  residential habilitation services.
  196         (5) The agency shall ensure that clients and caregivers
  197  have access to training and education that inform them about the
  198  iBudget system and enhance their ability for self-direction.
  199  Such training and education must be offered in a variety of
  200  formats and, at a minimum, must address the policies and
  201  processes of the iBudget system and the roles and
  202  responsibilities of consumers, caregivers, waiver support
  203  coordinators, providers, and the agency, and must provide
  204  information to help the client make decisions regarding the
  205  iBudget system and examples of support and resources available
  206  in the community.
  207         (6) The agency shall collect data to evaluate the
  208  implementation and outcomes of the iBudget system.
  209         (7) The Agency for Health Care Administration shall seek
  210  federal approval to provide a consumer-directed option for
  211  persons with developmental disabilities. The agency and the
  212  Agency for Health Care Administration may adopt rules necessary
  213  to administer this subsection.
  214         (8)The Agency for Health Care Administration shall seek
  215  federal waivers and amend contracts as necessary to make changes
  216  to services defined in federal waiver programs as follows:
  217         (a) Supported living coaching services may not exceed 20
  218  hours per month for persons who also receive in-home support
  219  services.
  220         (b) Limited support coordination services are the only
  221  support coordination services that may be provided to persons
  222  under the age of 18 who live in the family home.
  223         (c) Personal care assistance services are limited to 180
  224  hours per calendar month and may not include rate modifiers.
  225  Additional hours may be authorized for persons who have
  226  intensive physical, medical, or adaptive needs if such hours
  227  will prevent institutionalization.
  228         (d) Residential habilitation services are limited to 8
  229  hours per day. Additional hours may be authorized for persons
  230  who have intensive medical or adaptive needs and if such hours
  231  will prevent institutionalization, or for persons who possess
  232  behavioral problems that are exceptional in intensity, duration,
  233  or frequency and present a substantial risk of harm to
  234  themselves or others.
  235         (e) The agency shall conduct supplemental cost plan reviews
  236  to verify the medical necessity of authorized services for plans
  237  that have increased by more than 8 percent during either of the
  238  2 preceding fiscal years.
  239         (f) The agency shall implement a consolidated residential
  240  habilitation rate structure to increase savings to the state
  241  through a more cost-effective payment method and establish
  242  uniform rates for intensive behavioral residential habilitation
  243  services.
  244         (g) The geographic differential for Miami-Dade, Broward,
  245  and Palm Beach Counties for residential habilitation services
  246  must be 7.5 percent.
  247         (h) The geographic differential for Monroe County for
  248  residential habilitation services must be 20 percent.
  249         (9) The agency shall collect premiums or cost sharing
  250  pursuant to s. 409.906(13)(c).
  251         (10) This section or any related rule does not prevent or
  252  limit the Agency for Health Care Administration, in consultation
  253  with the agency, from adjusting fees, reimbursement rates,
  254  lengths of stay, number of visits, or number of services, or
  255  from limiting enrollment or making any other adjustment
  256  necessary to comply with the availability of moneys and any
  257  limitations or directions provided in the General Appropriations
  258  Act.
  259         (11)A provider of services rendered to persons with
  260  developmental disabilities pursuant to a federally approved
  261  waiver shall be reimbursed according to a rate methodology based
  262  upon an analysis of the expenditure history and prospective
  263  costs of providers participating in the waiver program, or under
  264  any other methodology developed by the Agency for Health Care
  265  Administration in consultation with the agency and approved by
  266  the Federal Government in accordance with the waiver.
  267         (12) The agency shall submit quarterly status reports to
  268  the Executive Office of the Governor, the chair of the Senate
  269  Appropriations Committee or its successor, and the chair of the
  270  House Appropriations Committee or its successor containing all
  271  of the following information:
  272         (a)The financial status of home and community-based
  273  services, including the number of enrolled individuals receiving
  274  services through one or more programs.
  275         (b)The number of individuals who have requested services
  276  and who are not enrolled but who are receiving services through
  277  one or more programs, with a description indicating the programs
  278  from which the individual is receiving services.
  279         (c)The number of individuals who have refused an offer of
  280  services but who choose to remain on the list of individuals
  281  waiting for services.
  282         (d)The number of individuals who have requested services
  283  but who are receiving no services.
  284         (e)A frequency distribution indicating the length of time
  285  individuals have been waiting for services.
  286         (f)Information concerning the actual and projected costs
  287  compared to the amount of the appropriation available to the
  288  program and any projected surpluses or deficits.
  289         (13)If at any time an analysis by the agency, in
  290  consultation with the Agency for Health Care Administration,
  291  indicates that the cost of services is expected to exceed the
  292  amount appropriated, the agency shall submit a plan in
  293  accordance with subsection (10) to the Executive Office of the
  294  Governor, the chair of the Senate Appropriations Committee or
  295  its successor, and the chair of the House Appropriations
  296  Committee or its successor to remain within the amount
  297  appropriated. The agency shall work with the Agency for Health
  298  Care Administration to implement the plan so as to remain within
  299  the appropriation.
  300         (14) The agency, in consultation with the Agency for Health
  301  Care Administration, shall provide a quarterly reconciliation
  302  report of all home and community-based services waiver
  303  expenditures from the Agency for Health Care Administration’s
  304  claims management system with service utilization from the
  305  Agency for Persons with Disabilities Allocation, Budget, and
  306  Contract Control system. The reconciliation report shall be
  307  submitted to the Governor, the President of the Senate, and the
  308  Speaker of the House of Representatives no later than 30 days
  309  after the close of each quarter.
  310         (15)(7) The agency and the Agency for Health Care
  311  Administration may adopt rules specifying the allocation
  312  algorithm and methodology; criteria and processes for clients to
  313  access reserved funds for significant additional needs
  314  extraordinary needs, temporarily or permanently changed needs,
  315  and one-time needs; and processes and requirements for selection
  316  and review of services, development of support and cost plans,
  317  and management of the iBudget system as needed to administer
  318  this section.
  319         Section 5. Section 393.0663, Florida Statutes, is created
  320  to read:
  321         393.0663 Support coordination; legislative intent;
  322  qualified organizations; agency duties; due process;
  323  rulemaking.—
  324         (1) LEGISLATIVE INTENT.—To enable the state to provide a
  325  systematic approach to service oversight for persons providing
  326  care to individuals with developmental disabilities, it is the
  327  intent of the Legislature that the agency work in collaboration
  328  with relevant stakeholders to ensure that waiver support
  329  coordinators have the knowledge, skills, and abilities necessary
  330  to competently provide services to individuals with
  331  developmental disabilities by requiring all support coordinators
  332  to be employees of a qualified organization.
  334         (a)As used in this section, the term “qualified
  335  organization” means an organization determined by the agency to
  336  meet the requirements of this section and of the Developmental
  337  Disabilities Individual Budgeting Waiver Services Coverage and
  338  Limitations Handbook.
  339         (b)The agency shall use qualified organizations for the
  340  purpose of providing all support coordination services to
  341  iBudget clients in this state. A qualified organization must:
  342         1. Employ four or more support coordinators;
  343         2.Maintain a professional code of ethics and a
  344  disciplinary process that apply to all support coordinators
  345  within the organization;
  346         3.Comply with the agency’s cost containment initiatives;
  347         4.Require support coordinators to ensure client budgets
  348  are linked to levels of need;
  349         5.Require support coordinators to perform all duties and
  350  meet all standards related to support coordination as provided
  351  in the Developmental Disabilities Individual Budgeting Waiver
  352  Services Coverage and Limitations Handbook;
  353         6.Prohibit dual employment of a support coordinator which
  354  adversely impacts the support coordinator’s availability to
  355  clients;
  356         7.Educate clients and families regarding identifying and
  357  preventing abuse, neglect, and exploitation;
  358         8.Instruct clients and families on mandatory reporting
  359  requirements for abuse, neglect, and exploitation;
  360         9.Submit within established timeframes all required
  361  documentation for requests for significant additional needs;
  362         10.Require support coordinators to successfully complete
  363  training and professional development approved by the agency;
  364         11.Require support coordinators to pass a competency-based
  365  assessment established by the agency; and
  366         12.Implement a mentoring program approved by the agency
  367  for support coordinators who have worked as a support
  368  coordinator for less than 12 months.
  369         (3) DUTIES OF THE AGENCY.—The agency shall:
  370         (a)Require all qualified organizations to report to the
  371  agency any violation of ethical or professional conduct by
  372  support coordinators employed by the organization;
  373         (b)Maintain a publicly accessible registry of all support
  374  coordinators, including any history of ethical or disciplinary
  375  violations; and
  376         (c)Impose an immediate moratorium on new client
  377  assignments, impose an administrative fine, require plans of
  378  remediation, and terminate the Medicaid Waiver Services
  379  Agreement of any qualified organization that is noncompliant
  380  with applicable laws or rules.
  381         (4) DUE PROCESS.—Any decision by the agency to take action
  382  against a qualified organization as described in paragraph
  383  (3)(c) is reviewable by the agency. Upon receiving an adverse
  384  determination, the qualified organization may request an
  385  administrative hearing pursuant to ss. 120.569 and 120.57(1)
  386  within 30 days after completing any appeals process established
  387  by the agency.
  388         (5) RULEMAKING.—The agency may adopt rules to implement
  389  this section.
  390         Section 6. Subsection (6) is added to section 400.962,
  391  Florida Statutes, to read:
  392         400.962 License required; license application.—
  393         (6) An applicant that has been granted a certificate-of
  394  need exemption under s. 408.036(3)(o) must also demonstrate and
  395  maintain compliance with the following criteria:
  396         (a)The total number of beds per home within the facility
  397  may not exceed eight, with each resident having his or her own
  398  bedroom and bathroom. Each eight-bed home must be colocated on
  399  the same property with two other eight-bed homes and must serve
  400  individuals with severe maladaptive behaviors and co-occurring
  401  psychiatric diagnoses.
  402         (b)A minimum of 16 beds within the facility must be
  403  designated for individuals with severe maladaptive behaviors who
  404  have been assessed using the Agency for Persons with
  405  Disabilities’ Global Behavioral Service Need Matrix with a score
  406  of at least Level 3 and up to Level 6, or assessed using the
  407  criteria deemed appropriate by the Agency for Health Care
  408  Administration regarding the need for a specialized placement in
  409  an intermediate care facility for the developmentally disabled.
  410         (c)The applicant has not had a facility license denied,
  411  revoked, or suspended within the 36 months preceding the request
  412  for exemption.
  413         (d)The applicant must have at least 10 years of experience
  414  serving individuals with severe maladaptive behaviors in this
  415  state.
  416         (e)The applicant must implement a state-approved staff
  417  training curriculum and monitoring requirements specific to the
  418  individuals whose behaviors require higher intensity, frequency,
  419  and duration of services.
  420         (f)The applicant must make available medical and nursing
  421  services 24 hours per day, 7 days per week.
  422         (g)The applicant must demonstrate a history of using
  423  interventions that are least restrictive and that follow a
  424  behavioral hierarchy.
  425         (h)The applicant must maintain a policy prohibiting the
  426  use of mechanical restraints.
  427         Section 7. Paragraph (o) is added to subsection (3) of
  428  section 408.036, Florida Statutes, to read:
  429         408.036 Projects subject to review; exemptions.—
  430         (3) EXEMPTIONS.—Upon request, the following projects are
  431  subject to exemption from subsection (1):
  432         (o)For a new intermediate care facility for the
  433  developmentally disabled as defined in s. 408.032 which has a
  434  total of 24 beds, comprising three eight-bed homes, for use by
  435  individuals exhibiting severe maladaptive behaviors and co
  436  occurring psychiatric diagnoses requiring increased levels of
  437  behavioral, medical, and therapeutic oversight. The facility
  438  must not have had a license denied, revoked, or suspended within
  439  the 36 months preceding the request for exemption and must have
  440  at least 10 years of experience serving individuals with severe
  441  maladaptive behaviors in this state. The agency may not grant an
  442  additional exemption to a facility that has been granted an
  443  exemption under this paragraph unless the facility has been
  444  licensed and operational for a period of at least 2 years. The
  445  exemption under this paragraph does not require a specific
  446  legislative appropriation.
  447         Section 8. Subsection (15) of section 409.906, Florida
  448  Statutes, is amended to read:
  449         409.906 Optional Medicaid services.—Subject to specific
  450  appropriations, the agency may make payments for services which
  451  are optional to the state under Title XIX of the Social Security
  452  Act and are furnished by Medicaid providers to recipients who
  453  are determined to be eligible on the dates on which the services
  454  were provided. Any optional service that is provided shall be
  455  provided only when medically necessary and in accordance with
  456  state and federal law. Optional services rendered by providers
  457  in mobile units to Medicaid recipients may be restricted or
  458  prohibited by the agency. Nothing in this section shall be
  459  construed to prevent or limit the agency from adjusting fees,
  460  reimbursement rates, lengths of stay, number of visits, or
  461  number of services, or making any other adjustments necessary to
  462  comply with the availability of moneys and any limitations or
  463  directions provided for in the General Appropriations Act or
  464  chapter 216. If necessary to safeguard the state’s systems of
  465  providing services to elderly and disabled persons and subject
  466  to the notice and review provisions of s. 216.177, the Governor
  467  may direct the Agency for Health Care Administration to amend
  468  the Medicaid state plan to delete the optional Medicaid service
  469  known as “Intermediate Care Facilities for the Developmentally
  470  Disabled.” Optional services may include:
  472  DISABLED SERVICES.—The agency may pay for health-related care
  473  and services provided on a 24-hour-a-day basis by a facility
  474  licensed and certified as a Medicaid Intermediate Care Facility
  475  for the Developmentally Disabled, for a recipient who needs such
  476  care because of a developmental disability. Payment shall not
  477  include bed-hold days except in facilities with occupancy rates
  478  of 95 percent or greater. The agency is authorized to seek any
  479  federal waiver approvals to implement this policy. The agency
  480  shall seek federal approval to implement a payment rate for
  481  Medicaid intermediate care facilities serving individuals with
  482  developmental disabilities, severe maladaptive behaviors, severe
  483  maladaptive behaviors and co-occurring complex medical
  484  conditions, or a dual diagnosis of developmental disability and
  485  mental illness.
  486         Section 9. Paragraph (d) of subsection (2) of section
  487  1002.385, Florida Statutes, is amended to read:
  488         1002.385 The Gardiner Scholarship.—
  489         (2) DEFINITIONS.—As used in this section, the term:
  490         (d) “Disability” means, for a 3- or 4-year-old child or for
  491  a student in kindergarten to grade 12, autism spectrum disorder,
  492  as defined in the Diagnostic and Statistical Manual of Mental
  493  Disorders, Fifth Edition, published by the American Psychiatric
  494  Association; cerebral palsy, as defined in s. 393.063(6); Down
  495  syndrome, as defined in s. 393.063(15); an intellectual
  496  disability, as defined in s. 393.063(24); Phelan-McDermid
  497  syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
  498  as defined in s. 393.063(29); spina bifida, as defined in s.
  499  393.063(41) s. 393.063(40); being a high-risk child, as defined
  500  in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
  501  rare diseases which affect patient populations of fewer than
  502  200,000 individuals in the United States, as defined by the
  503  National Organization for Rare Disorders; anaphylaxis; deaf;
  504  visually impaired; traumatic brain injured; hospital or
  505  homebound; or identification as dual sensory impaired, as
  506  defined by rules of the State Board of Education and evidenced
  507  by reports from local school districts. The term “hospital or
  508  homebound” includes a student who has a medically diagnosed
  509  physical or psychiatric condition or illness, as defined by the
  510  state board in rule, and who is confined to the home or hospital
  511  for more than 6 months.
  512         Section 10. This act shall take effect January 1, 2021.
  514  ================= T I T L E  A M E N D M E N T ================
  515  And the title is amended as follows:
  516         Delete everything before the enacting clause
  517  and insert:
  518                        A bill to be entitled                      
  519         An act relating to individuals with disabilities;
  520         amending s. 393.063, F.S.; defining the term
  521         “significant additional need”; revising the definition
  522         of the term “support coordinator”; amending s.
  523         393.066, F.S.; requiring persons and entities under
  524         contract with the Agency for Persons with Disabilities
  525         to use the agency data management systems to bill for
  526         services; repealing s. 393.0661, F.S., relating to the
  527         home and community-based services delivery system;
  528         amending s. 393.0662, F.S.; revising criteria used by
  529         the agency to develop a client’s iBudget; revising
  530         criteria used by the agency to authorize additional
  531         funding for certain clients; requiring the agency to
  532         centralize medical necessity determinations of certain
  533         services; requiring the agency to certify and document
  534         the use of certain services before approving the
  535         expenditure of certain funds; requiring the Agency for
  536         Health Care Administration to seek federal approval to
  537         provide consumer-directed options; authorizing the
  538         Agency for Persons with Disabilities and the Agency
  539         for Health Care Administration to adopt rules;
  540         requiring the Agency for Health Care Administration to
  541         seek federal waivers and amend contracts under certain
  542         conditions; requiring the Agency for Persons with
  543         Disabilities to collect premiums or cost sharing;
  544         providing construction; providing for the
  545         reimbursement of certain providers of services;
  546         requiring the Agency for Persons with Disabilities to
  547         submit quarterly status reports to the Executive
  548         Office of the Governor, the chair of the Senate
  549         Appropriations Committee, and the chair of the House
  550         Appropriations Committee or their successors;
  551         providing requirements for such reports; requiring the
  552         Agency for Persons with Disabilities, in consultation
  553         with the Agency for Health Care Administration, to
  554         submit a certain plan to the Executive Office of the
  555         Governor, the chair of the Senate Appropriations
  556         Committee, and the chair of the House Appropriations
  557         Committee under certain conditions; requiring the
  558         agency to work with the Agency for Health Care
  559         Administration to implement such plan; requiring the
  560         Agency for Persons with Disabilities, in consultation
  561         with the Agency for Health Care Administration, to
  562         provide quarterly reconciliation reports to the
  563         Governor and the Legislature within a specified
  564         timeframe; revising rulemaking authority of the Agency
  565         for Persons with Disabilities and the Agency for
  566         Health Care Administration; creating s. 393.0663,
  567         F.S.; providing legislative intent; defining the term
  568         “qualified organization”; requiring the Agency for
  569         Persons with Disabilities to use qualified
  570         organizations to provide support coordination services
  571         for certain clients; providing requirements for
  572         qualified organizations; providing agency duties;
  573         providing for the review and appeal of certain
  574         decisions made by the agency; authorizing the agency
  575         to adopt rules; amending s. 400.962, F.S.; requiring
  576         certain facilities that have been granted a
  577         certificate-of-need exemption to demonstrate and
  578         maintain compliance with specified criteria; amending
  579         s. 408.036, F.S.; providing an exemption from a
  580         certificate-of-need requirement for certain
  581         intermediate care facilities; prohibiting the Agency
  582         for Health Care Administration from granting an
  583         additional exemption to a facility unless a certain
  584         condition is met; providing that a specific
  585         legislative appropriation is not required for such
  586         exemption; amending s. 409.906, F.S.; requiring the
  587         agency to seek federal approval to implement certain
  588         payment rates; amending s. 1002.385, F.S.; conforming
  589         a cross-reference; providing an effective date.