Florida Senate - 2020              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 82
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to individuals with disabilities;
    3         amending s. 393.063, F.S.; defining the term
    4         “significant additional need”; revising the definition
    5         of the term “support coordinator”; amending s.
    6         393.066, F.S.; requiring persons and entities under
    7         contract with the Agency for Persons with Disabilities
    8         to use the agency data management systems to bill for
    9         services; repealing s. 393.0661, F.S., relating to the
   10         home and community-based services delivery system;
   11         amending s. 393.0662, F.S.; revising criteria used by
   12         the agency to develop a client’s iBudget; revising
   13         criteria used by the agency to authorize additional
   14         funding for certain clients; requiring the agency to
   15         centralize medical necessity determinations of certain
   16         services; requiring the agency to certify and document
   17         the use of certain services before approving the
   18         expenditure of certain funds; requiring the Agency for
   19         Health Care Administration to seek federal approval to
   20         provide consumer-directed options; authorizing the
   21         Agency for Persons with Disabilities and the Agency
   22         for Health Care Administration to adopt rules;
   23         requiring the Agency for Health Care Administration to
   24         seek federal waivers and amend contracts under certain
   25         conditions; requiring the Agency for Persons with
   26         Disabilities to collect premiums or cost sharing;
   27         providing construction; providing for the
   28         reimbursement of certain providers of services;
   29         requiring the Agency for Persons with Disabilities to
   30         submit quarterly status reports to the Executive
   31         Office of the Governor, the chair of the Senate
   32         Appropriations Committee, and the chair of the House
   33         Appropriations Committee or their successors;
   34         providing requirements for such reports; requiring the
   35         Agency for Persons with Disabilities, in consultation
   36         with the Agency for Health Care Administration, to
   37         submit a certain plan to the Executive Office of the
   38         Governor, the chair of the Senate Appropriations
   39         Committee, and the chair of the House Appropriations
   40         Committee under certain conditions; requiring the
   41         agency to work with the Agency for Health Care
   42         Administration to implement such plan; requiring the
   43         Agency for Persons with Disabilities, in consultation
   44         with the Agency for Health Care Administration, to
   45         provide quarterly reconciliation reports to the
   46         Governor and the Legislature within a specified
   47         timeframe; revising rulemaking authority of the Agency
   48         for Persons with Disabilities and the Agency for
   49         Health Care Administration; creating s. 393.0663,
   50         F.S.; providing legislative intent; defining the term
   51         “qualified organization”; requiring the Agency for
   52         Persons with Disabilities to use qualified
   53         organizations to provide support coordination services
   54         for certain clients; providing requirements for
   55         qualified organizations; providing agency duties;
   56         providing for the review and appeal of certain
   57         decisions made by the agency; authorizing the agency
   58         to adopt rules; amending s. 400.962, F.S.; requiring
   59         certain facilities that have been granted a
   60         certificate-of-need exemption to demonstrate and
   61         maintain compliance with specified criteria; amending
   62         s. 408.036, F.S.; providing an exemption from a
   63         certificate-of-need requirement for certain
   64         intermediate care facilities; prohibiting the Agency
   65         for Health Care Administration from granting an
   66         additional exemption to a facility unless a certain
   67         condition is met; providing that a specific
   68         legislative appropriation is not required for such
   69         exemption; amending s. 409.906, F.S.; requiring the
   70         agency to seek federal approval to implement certain
   71         payment rates; amending s. 1002.385, F.S.; conforming
   72         a cross-reference; providing an effective date.
   74  Be It Enacted by the Legislature of the State of Florida:
   76         Section 1. Present subsections (39) through (45) of section
   77  393.063, Florida Statutes, are redesignated as subsections (40)
   78  through (46), respectively, a new subsection (39) is added to
   79  that section, and present subsection (41) of that section is
   80  amended, to read:
   81         393.063 Definitions.—For the purposes of this chapter, the
   82  term:
   83         (39) “Significant additional need” means an additional need
   84  for medically necessary services which would place the health
   85  and safety of the client, the client’s caregiver, or the public
   86  in serious jeopardy if it is not met. The agency may only
   87  provide additional funding after the determination of a client’s
   88  initial allocation amount and after the qualified organization
   89  has documented the availability of nonwaiver resources.
   90         (42)(41) “Support coordinator” means an employee of a
   91  qualified organization pursuant to s. 393.0663 a person who is
   92  designated by the agency to assist individuals and families in
   93  identifying their capacities, needs, and resources, as well as
   94  finding and gaining access to necessary supports and services;
   95  coordinating the delivery of supports and services; advocating
   96  on behalf of the individual and family; maintaining relevant
   97  records; and monitoring and evaluating the delivery of supports
   98  and services to determine the extent to which they meet the
   99  needs and expectations identified by the individual, family, and
  100  others who participated in the development of the support plan.
  101         Section 2. Subsection (2) of section 393.066, Florida
  102  Statutes, is amended to read:
  103         393.066 Community services and treatment.—
  104         (2) Necessary services shall be purchased, rather than
  105  provided directly by the agency, when the purchase of services
  106  is more cost-efficient than providing them directly. All
  107  purchased services must be approved by the agency. As a
  108  condition of payment, persons or entities under contract with
  109  the agency to provide services shall use agency data management
  110  systems to document service provision to clients before billing
  111  and must use the agency data management systems to bill for
  112  services. Contracted persons and entities shall meet the minimum
  113  hardware and software technical requirements established by the
  114  agency for the use of such systems. Such persons or entities
  115  shall also meet any requirements established by the agency for
  116  training and professional development of staff providing direct
  117  services to clients.
  118         Section 3. Section 393.0661, Florida Statutes, is repealed.
  119         Section 4. Section 393.0662, Florida Statutes, is amended
  120  to read:
  121         393.0662 Individual budgets for delivery of home and
  122  community-based services; iBudget system established.—The
  123  Legislature finds that improved financial management of the
  124  existing home and community-based Medicaid waiver program is
  125  necessary to avoid deficits that impede the provision of
  126  services to individuals who are on the waiting list for
  127  enrollment in the program. The Legislature further finds that
  128  clients and their families should have greater flexibility to
  129  choose the services that best allow them to live in their
  130  community within the limits of an established budget. Therefore,
  131  the Legislature intends that the agency, in consultation with
  132  the Agency for Health Care Administration, shall manage the
  133  service delivery system using individual budgets as the basis
  134  for allocating the funds appropriated for the home and
  135  community-based services Medicaid waiver program among eligible
  136  enrolled clients. The service delivery system that uses
  137  individual budgets shall be called the iBudget system.
  138         (1) The agency shall administer an individual budget,
  139  referred to as an iBudget, for each individual served by the
  140  home and community-based services Medicaid waiver program. The
  141  funds appropriated to the agency shall be allocated through the
  142  iBudget system to eligible, Medicaid-enrolled clients. For the
  143  iBudget system, eligible clients shall include individuals with
  144  a developmental disability as defined in s. 393.063. The iBudget
  145  system shall provide for: enhanced client choice within a
  146  specified service package; appropriate assessment strategies; an
  147  efficient consumer budgeting and billing process that includes
  148  reconciliation and monitoring components; a role for support
  149  coordinators that avoids potential conflicts of interest; a
  150  flexible and streamlined service review process; and the
  151  equitable allocation of available funds based on the client’s
  152  level of need, as determined by the allocation methodology.
  153         (a) In developing each client’s iBudget, the agency shall
  154  use the allocation methodology as defined in s. 393.063(4), in
  155  conjunction with an assessment instrument that the agency deems
  156  to be reliable and valid, including, but not limited to, the
  157  agency’s Questionnaire for Situational Information. The
  158  allocation methodology shall determine the amount of funds
  159  allocated to a client’s iBudget.
  160         (b) The agency may authorize additional funding based on a
  161  client having one or more significant additional needs of the
  162  following needs that cannot be accommodated within the funding
  163  determined by the algorithm and having no other resources,
  164  supports, or services available to meet the needs. Such
  165  additional funding may be provided only after the determination
  166  of a client’s initial allocation amount and after the qualified
  167  organization has documented the availability of all nonwaiver
  168  resources. Upon receipt of an incomplete request for significant
  169  additional needs, the agency shall close the request.
  170         (c)The agency shall centralize, within its headquarters
  171  office, medical necessity determinations of requested services
  172  made through the significant additional needs process. The
  173  process must ensure consistent application of medical necessity
  174  criteria. This process must provide opportunities for targeted
  175  training, quality assurance, and inter-rater reliability. need:
  176         1. An extraordinary need that would place the health and
  177  safety of the client, the client’s caregiver, or the public in
  178  immediate, serious jeopardy unless the increase is approved.
  179  However, the presence of an extraordinary need in and of itself
  180  does not warrant authorized funding by the agency. An
  181  extraordinary need may include, but is not limited to:
  182         a. A documented history of significant, potentially life
  183  threatening behaviors, such as recent attempts at suicide,
  184  arson, nonconsensual sexual behavior, or self-injurious behavior
  185  requiring medical attention;
  186         b. A complex medical condition that requires active
  187  intervention by a licensed nurse on an ongoing basis that cannot
  188  be taught or delegated to a nonlicensed person;
  189         c. A chronic comorbid condition. As used in this
  190  subparagraph, the term “comorbid condition” means a medical
  191  condition existing simultaneously but independently with another
  192  medical condition in a patient; or
  193         d. A need for total physical assistance with activities
  194  such as eating, bathing, toileting, grooming, and personal
  195  hygiene.
  196         2. A significant need for one-time or temporary support or
  197  services that, if not provided, would place the health and
  198  safety of the client, the client’s caregiver, or the public in
  199  serious jeopardy. A significant need may include, but is not
  200  limited to, the provision of environmental modifications,
  201  durable medical equipment, services to address the temporary
  202  loss of support from a caregiver, or special services or
  203  treatment for a serious temporary condition when the service or
  204  treatment is expected to ameliorate the underlying condition. As
  205  used in this subparagraph, the term “temporary” means a period
  206  of fewer than 12 continuous months. However, the presence of
  207  such significant need for one-time or temporary supports or
  208  services in and of itself does not warrant authorized funding by
  209  the agency.
  210         3. A significant increase in the need for services after
  211  the beginning of the service plan year that would place the
  212  health and safety of the client, the client’s caregiver, or the
  213  public in serious jeopardy because of substantial changes in the
  214  client’s circumstances, including, but not limited to, permanent
  215  or long-term loss or incapacity of a caregiver, loss of services
  216  authorized under the state Medicaid plan due to a change in age,
  217  or a significant change in medical or functional status which
  218  requires the provision of additional services on a permanent or
  219  long-term basis that cannot be accommodated within the client’s
  220  current iBudget. As used in this subparagraph, the term “long
  221  term” means a period of 12 or more continuous months. However,
  222  such significant increase in need for services of a permanent or
  223  long-term nature in and of itself does not warrant authorized
  224  funding by the agency.
  225         4. A significant need for transportation services to a
  226  waiver-funded adult day training program or to waiver-funded
  227  employment services when such need cannot be accommodated within
  228  a client’s iBudget as determined by the algorithm without
  229  affecting the health and safety of the client, if public
  230  transportation is not an option due to the unique needs of the
  231  client or other transportation resources are not reasonably
  232  available.
  234         The agency shall reserve portions of the appropriation for
  235  the home and community-based services Medicaid waiver program
  236  for adjustments required pursuant to this paragraph and may use
  237  the services of an independent actuary in determining the amount
  238  to be reserved.
  239         (d)(c) A client’s annual expenditures for home and
  240  community-based Medicaid waiver services may not exceed the
  241  limits of his or her iBudget. The total of all clients’
  242  projected annual iBudget expenditures may not exceed the
  243  agency’s appropriation for waiver services.
  244         (2) The Agency for Health Care Administration, in
  245  consultation with the agency, shall seek federal approval to
  246  amend current waivers, request a new waiver, and amend contracts
  247  as necessary to manage the iBudget system, improve services for
  248  eligible and enrolled clients, and improve the delivery of
  249  services through the home and community-based services Medicaid
  250  waiver program and the Consumer-Directed Care Plus Program,
  251  including, but not limited to, enrollees with a dual diagnosis
  252  of a developmental disability and a mental health disorder.
  253         (3) The agency must certify and document within each
  254  client’s cost plan that the a client has used must use all
  255  available services authorized under the state Medicaid plan,
  256  school-based services, private insurance and other benefits, and
  257  any other resources that may be available to the client before
  258  using funds from his or her iBudget to pay for support and
  259  services.
  260         (4) Rates for any or all services established under rules
  261  of the Agency for Health Care Administration must be designated
  262  as the maximum rather than a fixed amount for individuals who
  263  receive an iBudget, except for services specifically identified
  264  in those rules that the agency determines are not appropriate
  265  for negotiation, which may include, but are not limited to,
  266  residential habilitation services.
  267         (5) The agency shall ensure that clients and caregivers
  268  have access to training and education that inform them about the
  269  iBudget system and enhance their ability for self-direction.
  270  Such training and education must be offered in a variety of
  271  formats and, at a minimum, must address the policies and
  272  processes of the iBudget system and the roles and
  273  responsibilities of consumers, caregivers, waiver support
  274  coordinators, providers, and the agency, and must provide
  275  information to help the client make decisions regarding the
  276  iBudget system and examples of support and resources available
  277  in the community.
  278         (6) The agency shall collect data to evaluate the
  279  implementation and outcomes of the iBudget system.
  280         (7) The Agency for Health Care Administration shall seek
  281  federal approval to provide a consumer-directed option for
  282  persons with developmental disabilities. The agency and the
  283  Agency for Health Care Administration may adopt rules necessary
  284  to administer this subsection.
  285         (8)The Agency for Health Care Administration shall seek
  286  federal waivers and amend contracts as necessary to make changes
  287  to services defined in federal waiver programs as follows:
  288         (a) Supported living coaching services may not exceed 20
  289  hours per month for persons who also receive in-home support
  290  services.
  291         (b) Limited support coordination services are the only
  292  support coordination services that may be provided to persons
  293  under the age of 18 who live in the family home.
  294         (c) Personal care assistance services are limited to 180
  295  hours per calendar month and may not include rate modifiers.
  296  Additional hours may be authorized for persons who have
  297  intensive physical, medical, or adaptive needs if such hours
  298  will prevent institutionalization.
  299         (d) Residential habilitation services are limited to 8
  300  hours per day. Additional hours may be authorized for persons
  301  who have intensive medical or adaptive needs and if such hours
  302  will prevent institutionalization, or for persons who possess
  303  behavioral problems that are exceptional in intensity, duration,
  304  or frequency and present a substantial risk of harm to
  305  themselves or others.
  306         (e) The agency shall conduct supplemental cost plan reviews
  307  to verify the medical necessity of authorized services for plans
  308  that have increased by more than 8 percent during either of the
  309  2 preceding fiscal years.
  310         (f) The agency shall implement a consolidated residential
  311  habilitation rate structure to increase savings to the state
  312  through a more cost-effective payment method and establish
  313  uniform rates for intensive behavioral residential habilitation
  314  services.
  315         (g) The geographic differential for Miami-Dade, Broward,
  316  and Palm Beach Counties for residential habilitation services
  317  must be 7.5 percent.
  318         (h) The geographic differential for Monroe County for
  319  residential habilitation services must be 20 percent.
  320         (9) The agency shall collect premiums or cost sharing
  321  pursuant to s. 409.906(13)(c).
  322         (10) This section or any related rule does not prevent or
  323  limit the Agency for Health Care Administration, in consultation
  324  with the agency, from adjusting fees, reimbursement rates,
  325  lengths of stay, number of visits, or number of services, or
  326  from limiting enrollment or making any other adjustment
  327  necessary to comply with the availability of moneys and any
  328  limitations or directions provided in the General Appropriations
  329  Act.
  330         (11)A provider of services rendered to persons with
  331  developmental disabilities pursuant to a federally approved
  332  waiver shall be reimbursed according to a rate methodology based
  333  upon an analysis of the expenditure history and prospective
  334  costs of providers participating in the waiver program, or under
  335  any other methodology developed by the Agency for Health Care
  336  Administration in consultation with the agency and approved by
  337  the Federal Government in accordance with the waiver.
  338         (12) The agency shall submit quarterly status reports to
  339  the Executive Office of the Governor, the chair of the Senate
  340  Appropriations Committee or its successor, and the chair of the
  341  House Appropriations Committee or its successor containing all
  342  of the following information:
  343         (a)The financial status of home and community-based
  344  services, including the number of enrolled individuals receiving
  345  services through one or more programs.
  346         (b)The number of individuals who have requested services
  347  and who are not enrolled but who are receiving services through
  348  one or more programs, with a description indicating the programs
  349  from which the individual is receiving services.
  350         (c)The number of individuals who have refused an offer of
  351  services but who choose to remain on the list of individuals
  352  waiting for services.
  353         (d)The number of individuals who have requested services
  354  but who are receiving no services.
  355         (e)A frequency distribution indicating the length of time
  356  individuals have been waiting for services.
  357         (f)Information concerning the actual and projected costs
  358  compared to the amount of the appropriation available to the
  359  program and any projected surpluses or deficits.
  360         (13)If at any time an analysis by the agency, in
  361  consultation with the Agency for Health Care Administration,
  362  indicates that the cost of services is expected to exceed the
  363  amount appropriated, the agency shall submit a plan in
  364  accordance with subsection (10) to the Executive Office of the
  365  Governor, the chair of the Senate Appropriations Committee or
  366  its successor, and the chair of the House Appropriations
  367  Committee or its successor to remain within the amount
  368  appropriated. The agency shall work with the Agency for Health
  369  Care Administration to implement the plan so as to remain within
  370  the appropriation.
  371         (14) The agency, in consultation with the Agency for Health
  372  Care Administration, shall provide a quarterly reconciliation
  373  report of all home and community-based services waiver
  374  expenditures from the Agency for Health Care Administration’s
  375  claims management system with service utilization from the
  376  Agency for Persons with Disabilities Allocation, Budget, and
  377  Contract Control system. The reconciliation report shall be
  378  submitted to the Governor, the President of the Senate, and the
  379  Speaker of the House of Representatives no later than 30 days
  380  after the close of each quarter.
  381         (15)(7) The agency and the Agency for Health Care
  382  Administration may adopt rules specifying the allocation
  383  algorithm and methodology; criteria and processes for clients to
  384  access reserved funds for significant additional needs
  385  extraordinary needs, temporarily or permanently changed needs,
  386  and one-time needs; and processes and requirements for selection
  387  and review of services, development of support and cost plans,
  388  and management of the iBudget system as needed to administer
  389  this section.
  390         Section 5. Section 393.0663, Florida Statutes, is created
  391  to read:
  392         393.0663 Support coordination; legislative intent;
  393  qualified organizations; agency duties; due process;
  394  rulemaking.—
  395         (1) LEGISLATIVE INTENT.—To enable the state to provide a
  396  systematic approach to service oversight for persons providing
  397  care to individuals with developmental disabilities, it is the
  398  intent of the Legislature that the agency work in collaboration
  399  with relevant stakeholders to ensure that waiver support
  400  coordinators have the knowledge, skills, and abilities necessary
  401  to competently provide services to individuals with
  402  developmental disabilities by requiring all support coordinators
  403  to be employees of a qualified organization.
  405         (a)As used in this section, the term “qualified
  406  organization” means an organization determined by the agency to
  407  meet the requirements of this section and of the Developmental
  408  Disabilities Individual Budgeting Waiver Services Coverage and
  409  Limitations Handbook.
  410         (b)The agency shall use qualified organizations for the
  411  purpose of providing all support coordination services to
  412  iBudget clients in this state. A qualified organization must:
  413         1. Employ four or more support coordinators;
  414         2.Maintain a professional code of ethics and a
  415  disciplinary process that apply to all support coordinators
  416  within the organization;
  417         3.Comply with the agency’s cost containment initiatives;
  418         4.Require support coordinators to ensure client budgets
  419  are linked to levels of need;
  420         5.Require support coordinators to perform all duties and
  421  meet all standards related to support coordination as provided
  422  in the Developmental Disabilities Individual Budgeting Waiver
  423  Services Coverage and Limitations Handbook;
  424         6.Prohibit dual employment of a support coordinator if the
  425  dual employment adversely impacts the support coordinator’s
  426  availability to clients;
  427         7.Educate clients and families regarding identifying and
  428  preventing abuse, neglect, and exploitation;
  429         8.Instruct clients and families on mandatory reporting
  430  requirements for abuse, neglect, and exploitation;
  431         9.Submit within established timeframes all required
  432  documentation for requests for significant additional needs;
  433         10.Require support coordinators to successfully complete
  434  training and professional development approved by the agency;
  435         11.Require support coordinators to pass a competency-based
  436  assessment established by the agency; and
  437         12.Implement a mentoring program approved by the agency
  438  for support coordinators who have worked as a support
  439  coordinator for less than 12 months.
  440         (3) DUTIES OF THE AGENCY.—The agency shall:
  441         (a)Require all qualified organizations to report to the
  442  agency any violation of ethical or professional conduct by
  443  support coordinators employed by the organization;
  444         (b)Maintain a publicly accessible registry of all support
  445  coordinators, including any history of ethical or disciplinary
  446  violations; and
  447         (c)Impose an immediate moratorium on new client
  448  assignments, impose an administrative fine, require plans of
  449  remediation, and terminate the Medicaid Waiver Services
  450  Agreement of any qualified organization that is noncompliant
  451  with applicable laws or rules.
  452         (4) DUE PROCESS.—Any decision by the agency to take action
  453  against a qualified organization as described in paragraph
  454  (3)(c) is reviewable by the agency. Upon receiving an adverse
  455  determination, the qualified organization may request an
  456  administrative hearing pursuant to ss. 120.569 and 120.57(1)
  457  within 30 days after completing any appeals process established
  458  by the agency.
  459         (5) RULEMAKING.—The agency may adopt rules to implement
  460  this section.
  461         Section 6. Subsection (6) is added to section 400.962,
  462  Florida Statutes, to read:
  463         400.962 License required; license application.—
  464         (6) An applicant that has been granted a certificate-of
  465  need exemption under s. 408.036(3)(o) must also demonstrate and
  466  maintain compliance with the following criteria:
  467         (a)The total number of beds per home within the facility
  468  may not exceed eight, with each resident having his or her own
  469  bedroom and bathroom. Each eight-bed home must be colocated on
  470  the same property with two other eight-bed homes and must serve
  471  individuals with severe maladaptive behaviors and co-occurring
  472  psychiatric diagnoses.
  473         (b)A minimum of 16 beds within the facility must be
  474  designated for individuals with severe maladaptive behaviors who
  475  have been assessed using the Agency for Persons with
  476  Disabilities’ Global Behavioral Service Need Matrix with a score
  477  of at least Level 3 and up to Level 6, or assessed using the
  478  criteria deemed appropriate by the Agency for Health Care
  479  Administration regarding the need for a specialized placement in
  480  an intermediate care facility for the developmentally disabled.
  481         (c)The applicant has not had a facility license denied,
  482  revoked, or suspended within the 36 months preceding the request
  483  for exemption.
  484         (d)The applicant must have at least 10 years of experience
  485  serving individuals with severe maladaptive behaviors in this
  486  state.
  487         (e)The applicant must implement a state-approved staff
  488  training curriculum and monitoring requirements specific to the
  489  individuals whose behaviors require higher intensity, frequency,
  490  and duration of services.
  491         (f)The applicant must make available medical and nursing
  492  services 24 hours per day, 7 days per week.
  493         (g)The applicant must demonstrate a history of using
  494  interventions that are least restrictive and that follow a
  495  behavioral hierarchy.
  496         (h)The applicant must maintain a policy prohibiting the
  497  use of mechanical restraints.
  498         Section 7. Paragraph (o) is added to subsection (3) of
  499  section 408.036, Florida Statutes, to read:
  500         408.036 Projects subject to review; exemptions.—
  501         (3) EXEMPTIONS.—Upon request, the following projects are
  502  subject to exemption from subsection (1):
  503         (o)For a new intermediate care facility for the
  504  developmentally disabled as defined in s. 408.032 which has a
  505  total of 24 beds, comprising three eight-bed homes, for use by
  506  individuals exhibiting severe maladaptive behaviors and co
  507  occurring psychiatric diagnoses requiring increased levels of
  508  behavioral, medical, and therapeutic oversight. The facility
  509  must not have had a license denied, revoked, or suspended within
  510  the 36 months preceding the request for exemption and must have
  511  at least 10 years of experience serving individuals with severe
  512  maladaptive behaviors in this state. The agency may not grant an
  513  additional exemption to a facility that has been granted an
  514  exemption under this paragraph unless the facility has been
  515  licensed and operational for a period of at least 2 years. The
  516  exemption under this paragraph does not require a specific
  517  legislative appropriation.
  518         Section 8. Subsection (15) of section 409.906, Florida
  519  Statutes, is amended to read:
  520         409.906 Optional Medicaid services.—Subject to specific
  521  appropriations, the agency may make payments for services which
  522  are optional to the state under Title XIX of the Social Security
  523  Act and are furnished by Medicaid providers to recipients who
  524  are determined to be eligible on the dates on which the services
  525  were provided. Any optional service that is provided shall be
  526  provided only when medically necessary and in accordance with
  527  state and federal law. Optional services rendered by providers
  528  in mobile units to Medicaid recipients may be restricted or
  529  prohibited by the agency. Nothing in this section shall be
  530  construed to prevent or limit the agency from adjusting fees,
  531  reimbursement rates, lengths of stay, number of visits, or
  532  number of services, or making any other adjustments necessary to
  533  comply with the availability of moneys and any limitations or
  534  directions provided for in the General Appropriations Act or
  535  chapter 216. If necessary to safeguard the state’s systems of
  536  providing services to elderly and disabled persons and subject
  537  to the notice and review provisions of s. 216.177, the Governor
  538  may direct the Agency for Health Care Administration to amend
  539  the Medicaid state plan to delete the optional Medicaid service
  540  known as “Intermediate Care Facilities for the Developmentally
  541  Disabled.” Optional services may include:
  543  DISABLED SERVICES.—The agency may pay for health-related care
  544  and services provided on a 24-hour-a-day basis by a facility
  545  licensed and certified as a Medicaid Intermediate Care Facility
  546  for the Developmentally Disabled, for a recipient who needs such
  547  care because of a developmental disability. Payment shall not
  548  include bed-hold days except in facilities with occupancy rates
  549  of 95 percent or greater. The agency is authorized to seek any
  550  federal waiver approvals to implement this policy. The agency
  551  shall seek federal approval to implement a payment rate for
  552  Medicaid intermediate care facilities serving individuals with
  553  developmental disabilities, severe maladaptive behaviors, severe
  554  maladaptive behaviors and co-occurring complex medical
  555  conditions, or a dual diagnosis of developmental disability and
  556  mental illness.
  557         Section 9. Paragraph (d) of subsection (2) of section
  558  1002.385, Florida Statutes, is amended to read:
  559         1002.385 The Gardiner Scholarship.—
  560         (2) DEFINITIONS.—As used in this section, the term:
  561         (d) “Disability” means, for a 3- or 4-year-old child or for
  562  a student in kindergarten to grade 12, autism spectrum disorder,
  563  as defined in the Diagnostic and Statistical Manual of Mental
  564  Disorders, Fifth Edition, published by the American Psychiatric
  565  Association; cerebral palsy, as defined in s. 393.063(6); Down
  566  syndrome, as defined in s. 393.063(15); an intellectual
  567  disability, as defined in s. 393.063(24); Phelan-McDermid
  568  syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
  569  as defined in s. 393.063(29); spina bifida, as defined in s.
  570  393.063(41) s. 393.063(40); being a high-risk child, as defined
  571  in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
  572  rare diseases which affect patient populations of fewer than
  573  200,000 individuals in the United States, as defined by the
  574  National Organization for Rare Disorders; anaphylaxis; deaf;
  575  visually impaired; traumatic brain injured; hospital or
  576  homebound; or identification as dual sensory impaired, as
  577  defined by rules of the State Board of Education and evidenced
  578  by reports from local school districts. The term “hospital or
  579  homebound” includes a student who has a medically diagnosed
  580  physical or psychiatric condition or illness, as defined by the
  581  state board in rule, and who is confined to the home or hospital
  582  for more than 6 months.
  583         Section 10. This act shall take effect January 1, 2021.