Florida Senate - 2020                               CS for SB 82
       By the Committee on Appropriations; and Senator Bean
       576-04295-20                                            202082c1
    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 and the chairs of the Senate
   32         Appropriations Committee and the House Appropriations
   33         Committee or their successor committees; providing
   34         requirements for such reports; requiring the Agency
   35         for Persons with Disabilities, in consultation with
   36         the Agency for Health Care Administration, to submit a
   37         certain plan to the Executive Office of the Governor,
   38         the chair of the Senate Appropriations Committee, and
   39         the chair of the House Appropriations Committee under
   40         certain conditions; requiring the agency to work with
   41         the Agency for Health Care Administration to implement
   42         such plan; requiring the Agency for Persons with
   43         Disabilities, in consultation with the Agency for
   44         Health Care Administration, to provide quarterly
   45         reconciliation reports to the Governor and the
   46         Legislature within a specified timeframe; revising
   47         rulemaking authority of the Agency for Persons with
   48         Disabilities and the Agency for Health Care
   49         Administration; creating s. 393.0663, F.S.; providing
   50         legislative intent; defining the term “qualified
   51         organization”; requiring the Agency for Persons with
   52         Disabilities to use qualified organizations to provide
   53         support coordination services for certain clients;
   54         providing requirements for qualified organizations;
   55         providing agency duties; providing for the review and
   56         appeal of certain decisions made by the agency;
   57         authorizing the agency to adopt rules; amending s.
   58         400.962, F.S.; requiring certain facilities that have
   59         been granted a certificate-of-need exemption to
   60         demonstrate and maintain compliance with specified
   61         criteria; amending s. 408.036, F.S.; providing an
   62         exemption from a certificate-of-need requirement for
   63         certain intermediate care facilities; prohibiting the
   64         Agency for Health Care Administration from granting an
   65         additional exemption to a facility unless a certain
   66         condition is met; providing that a specific
   67         legislative appropriation is not required for such
   68         exemption; amending s. 409.906, F.S.; requiring the
   69         agency to seek federal approval to implement certain
   70         payment rates; amending s. 1002.385, F.S.; conforming
   71         a cross-reference; providing an effective date.
   73  Be It Enacted by the Legislature of the State of Florida:
   75         Section 1. Present subsections (39) through (45) of section
   76  393.063, Florida Statutes, are redesignated as subsections (40)
   77  through (46), respectively, a new subsection (39) is added to
   78  that section, and present subsection (41) of that section is
   79  amended, to read:
   80         393.063 Definitions.—For the purposes of this chapter, the
   81  term:
   82         (39) “Significant additional need” means an additional need
   83  for medically necessary services which would place the health
   84  and safety of the client, the client’s caregiver, or the public
   85  in serious jeopardy if it is not met. The term does not exclude
   86  services for an additional need that the client requires in
   87  order to remain in the least restrictive setting, including, but
   88  not limited to, employment services and transportation services.
   89  The agency may provide additional funding only after the
   90  determination of a client’s initial allocation amount and after
   91  the qualified organization has documented the availability of
   92  nonwaiver resources.
   93         (42)(41) “Support coordinator” means an employee of a
   94  qualified organization as provided in s. 393.0663 a person who
   95  is designated by the agency to assist individuals and families
   96  in identifying their capacities, needs, and resources, as well
   97  as finding and gaining access to necessary supports and
   98  services; coordinating the delivery of supports and services;
   99  advocating on behalf of the individual and family; maintaining
  100  relevant records; and monitoring and evaluating the delivery of
  101  supports and services to determine the extent to which they meet
  102  the needs and expectations identified by the individual, family,
  103  and others who participated in the development of the support
  104  plan.
  105         Section 2. Subsection (2) of section 393.066, Florida
  106  Statutes, is amended to read:
  107         393.066 Community services and treatment.—
  108         (2) Necessary services shall be purchased, rather than
  109  provided directly by the agency, when the purchase of services
  110  is more cost-efficient than providing them directly. All
  111  purchased services must be approved by the agency. As a
  112  condition of payment and before billing, persons or entities
  113  under contract with the agency to provide services shall use
  114  agency data management systems to document service provision to
  115  clients shall use such systems to bill for services. Contracted
  116  persons and entities shall meet the minimum hardware and
  117  software technical requirements established by the agency for
  118  the use of such systems. Such persons or entities shall also
  119  meet any requirements established by the agency for training and
  120  professional development of staff providing direct services to
  121  clients.
  122         Section 3. Section 393.0661, Florida Statutes, is repealed.
  123         Section 4. Section 393.0662, Florida Statutes, is amended
  124  to read:
  125         393.0662 Individual budgets for delivery of home and
  126  community-based services; iBudget system established.—The
  127  Legislature finds that improved financial management of the
  128  existing home and community-based Medicaid waiver program is
  129  necessary to avoid deficits that impede the provision of
  130  services to individuals who are on the waiting list for
  131  enrollment in the program. The Legislature further finds that
  132  clients and their families should have greater flexibility to
  133  choose the services that best allow them to live in their
  134  community within the limits of an established budget. Therefore,
  135  the Legislature intends that the agency, in consultation with
  136  the Agency for Health Care Administration, shall manage the
  137  service delivery system using individual budgets as the basis
  138  for allocating the funds appropriated for the home and
  139  community-based services Medicaid waiver program among eligible
  140  enrolled clients. The service delivery system that uses
  141  individual budgets shall be called the iBudget system.
  142         (1) The agency shall administer an individual budget,
  143  referred to as an iBudget, for each individual served by the
  144  home and community-based services Medicaid waiver program. The
  145  funds appropriated to the agency shall be allocated through the
  146  iBudget system to eligible, Medicaid-enrolled clients. For the
  147  iBudget system, eligible clients shall include individuals with
  148  a developmental disability as defined in s. 393.063. The iBudget
  149  system shall provide for: enhanced client choice within a
  150  specified service package; appropriate assessment strategies; an
  151  efficient consumer budgeting and billing process that includes
  152  reconciliation and monitoring components; a role for support
  153  coordinators that avoids potential conflicts of interest; a
  154  flexible and streamlined service review process; and the
  155  equitable allocation of available funds based on the client’s
  156  level of need, as determined by the allocation methodology.
  157         (a) In developing each client’s iBudget, the agency shall
  158  use the allocation methodology as defined in s. 393.063(4), in
  159  conjunction with an assessment instrument that the agency deems
  160  to be reliable and valid, including, but not limited to, the
  161  agency’s Questionnaire for Situational Information. The
  162  allocation methodology shall determine the amount of funds
  163  allocated to a client’s iBudget.
  164         (b) The agency may authorize additional funding based on a
  165  client having one or more significant additional needs of the
  166  following needs that cannot be accommodated within the funding
  167  determined by the algorithm and having no other resources,
  168  supports, or services available to meet the needs. Such
  169  additional funding may be provided only after the determination
  170  of a client’s initial allocation amount and after the qualified
  171  organization has documented the availability of all nonwaiver
  172  resources. Upon receipt of an incomplete request for services to
  173  meet significant additional needs, the agency shall close the
  174  request.
  175         (c)The agency shall centralize, within its headquarters,
  176  medical necessity determinations for requested services made
  177  through the significant additional needs process. The process
  178  must ensure consistent application of medical necessity
  179  criteria. This process must provide opportunities for targeted
  180  training, quality assurance, and inter-rater reliability. need:
  181         1. An extraordinary need that would place the health and
  182  safety of the client, the client’s caregiver, or the public in
  183  immediate, serious jeopardy unless the increase is approved.
  184  However, the presence of an extraordinary need in and of itself
  185  does not warrant authorized funding by the agency. An
  186  extraordinary need may include, but is not limited to:
  187         a. A documented history of significant, potentially life
  188  threatening behaviors, such as recent attempts at suicide,
  189  arson, nonconsensual sexual behavior, or self-injurious behavior
  190  requiring medical attention;
  191         b. A complex medical condition that requires active
  192  intervention by a licensed nurse on an ongoing basis that cannot
  193  be taught or delegated to a nonlicensed person;
  194         c. A chronic comorbid condition. As used in this
  195  subparagraph, the term “comorbid condition” means a medical
  196  condition existing simultaneously but independently with another
  197  medical condition in a patient; or
  198         d. A need for total physical assistance with activities
  199  such as eating, bathing, toileting, grooming, and personal
  200  hygiene.
  201         2. A significant need for one-time or temporary support or
  202  services that, if not provided, would place the health and
  203  safety of the client, the client’s caregiver, or the public in
  204  serious jeopardy. A significant need may include, but is not
  205  limited to, the provision of environmental modifications,
  206  durable medical equipment, services to address the temporary
  207  loss of support from a caregiver, or special services or
  208  treatment for a serious temporary condition when the service or
  209  treatment is expected to ameliorate the underlying condition. As
  210  used in this subparagraph, the term “temporary” means a period
  211  of fewer than 12 continuous months. However, the presence of
  212  such significant need for one-time or temporary supports or
  213  services in and of itself does not warrant authorized funding by
  214  the agency.
  215         3. A significant increase in the need for services after
  216  the beginning of the service plan year that would place the
  217  health and safety of the client, the client’s caregiver, or the
  218  public in serious jeopardy because of substantial changes in the
  219  client’s circumstances, including, but not limited to, permanent
  220  or long-term loss or incapacity of a caregiver, loss of services
  221  authorized under the state Medicaid plan due to a change in age,
  222  or a significant change in medical or functional status which
  223  requires the provision of additional services on a permanent or
  224  long-term basis that cannot be accommodated within the client’s
  225  current iBudget. As used in this subparagraph, the term “long
  226  term” means a period of 12 or more continuous months. However,
  227  such significant increase in need for services of a permanent or
  228  long-term nature in and of itself does not warrant authorized
  229  funding by the agency.
  230         4. A significant need for transportation services to a
  231  waiver-funded adult day training program or to waiver-funded
  232  employment services when such need cannot be accommodated within
  233  a client’s iBudget as determined by the algorithm without
  234  affecting the health and safety of the client, if public
  235  transportation is not an option due to the unique needs of the
  236  client or other transportation resources are not reasonably
  237  available.
  239         The agency shall reserve portions of the appropriation for
  240  the home and community-based services Medicaid waiver program
  241  for adjustments required pursuant to this paragraph and may use
  242  the services of an independent actuary in determining the amount
  243  to be reserved.
  244         (d)(c) A client’s annual expenditures for home and
  245  community-based Medicaid waiver services may not exceed the
  246  limits of his or her iBudget. The total of all clients’
  247  projected annual iBudget expenditures may not exceed the
  248  agency’s appropriation for waiver services.
  249         (2) The Agency for Health Care Administration, in
  250  consultation with the agency, shall seek federal approval to
  251  amend current waivers, request a new waiver, and amend contracts
  252  as necessary to manage the iBudget system, improve services for
  253  eligible and enrolled clients, and improve the delivery of
  254  services through the home and community-based services Medicaid
  255  waiver program and the Consumer-Directed Care Plus Program,
  256  including, but not limited to, enrollees with a dual diagnosis
  257  of a developmental disability and a mental health disorder.
  258         (3) The agency must certify and document within each
  259  client’s cost plan that the a client has used must use all
  260  available services authorized under the state Medicaid plan,
  261  school-based services, private insurance and other benefits, and
  262  any other resources that may be available to the client before
  263  using funds from his or her iBudget to pay for support and
  264  services.
  265         (4) Rates for any or all services established under rules
  266  of the Agency for Health Care Administration must be designated
  267  as the maximum rather than a fixed amount for individuals who
  268  receive an iBudget, except for services specifically identified
  269  in those rules that the agency determines are not appropriate
  270  for negotiation, which may include, but are not limited to,
  271  residential habilitation services.
  272         (5) The agency shall ensure that clients and caregivers
  273  have access to training and education that inform them about the
  274  iBudget system and enhance their ability for self-direction.
  275  Such training and education must be offered in a variety of
  276  formats and, at a minimum, must address the policies and
  277  processes of the iBudget system and the roles and
  278  responsibilities of consumers, caregivers, waiver support
  279  coordinators, providers, and the agency, and must provide
  280  information to help the client make decisions regarding the
  281  iBudget system and examples of support and resources available
  282  in the community.
  283         (6) The agency shall collect data to evaluate the
  284  implementation and outcomes of the iBudget system.
  285         (7) The Agency for Health Care Administration shall seek
  286  federal approval to provide a consumer-directed option for
  287  persons with developmental disabilities. The agency and the
  288  Agency for Health Care Administration may adopt rules necessary
  289  to administer this subsection.
  290         (8)The Agency for Health Care Administration shall seek
  291  federal waivers and amend contracts as necessary to make changes
  292  to services defined in federal waiver programs, as follows:
  293         (a) Supported living coaching services may not exceed 20
  294  hours per month for persons who also receive in-home support
  295  services.
  296         (b) Limited support coordination services are the only
  297  support coordination services that may be provided to persons
  298  under the age of 18 who live in the family home.
  299         (c) Personal care assistance services are limited to 180
  300  hours per calendar month and may not include rate modifiers.
  301  Additional hours may be authorized for persons who have
  302  intensive physical, medical, or adaptive needs, if such hours
  303  will prevent institutionalization.
  304         (d) Residential habilitation services are limited to 8
  305  hours per day. Additional hours may be authorized for persons
  306  who have intensive medical or adaptive needs and if such hours
  307  will prevent institutionalization, or for persons who have
  308  behavioral problems that are exceptional in intensity, duration,
  309  or frequency and who present a substantial risk of harm to
  310  themselves or others.
  311         (e) The agency shall conduct supplemental cost plan reviews
  312  to verify the medical necessity of authorized services for plans
  313  that have increased by more than 8 percent during either of the
  314  2 preceding fiscal years.
  315         (f) The agency shall implement a consolidated residential
  316  habilitation rate structure to increase savings to the state
  317  through a more cost-effective payment method and establish
  318  uniform rates for intensive behavioral residential habilitation
  319  services.
  320         (g) The geographic differential for Miami-Dade, Broward,
  321  and Palm Beach Counties for residential habilitation services is
  322  7.5 percent.
  323         (h) The geographic differential for Monroe County for
  324  residential habilitation services is 20 percent.
  325         (9) The agency shall collect premiums or cost sharing
  326  pursuant to s. 409.906(13)(c).
  327         (10) This section or any related rule does not prevent or
  328  limit the Agency for Health Care Administration, in consultation
  329  with the agency, from adjusting fees, reimbursement rates,
  330  lengths of stay, number of visits, or number of services, or
  331  from limiting enrollment or making any other adjustment
  332  necessary to comply with the availability of moneys and any
  333  limitations or directions provided in the General Appropriations
  334  Act.
  335         (11)A provider of services rendered to persons with
  336  developmental disabilities pursuant to a federally approved
  337  waiver must be reimbursed according to a rate methodology based
  338  upon an analysis of the expenditure history and prospective
  339  costs of providers participating in the waiver program, or under
  340  any other methodology developed by the Agency for Health Care
  341  Administration in consultation with the agency and approved by
  342  the Federal Government in accordance with the waiver.
  343         (12) The agency shall submit quarterly status reports to
  344  the Executive Office of the Governor, the chair of the Senate
  345  Appropriations Committee or its successor, and the chair of the
  346  House Appropriations Committee or its successor which contain
  347  all of the following information:
  348         (a)The financial status of home and community-based
  349  services, including the number of enrolled individuals receiving
  350  services through one or more programs.
  351         (b)The number of individuals who have requested services
  352  and who are not enrolled but who are receiving services through
  353  one or more programs, with a description indicating the programs
  354  under which the individual is receiving services.
  355         (c)The number of individuals who have refused an offer of
  356  services but who choose to remain on the list of individuals
  357  waiting for services.
  358         (d)The number of individuals who have requested services
  359  but who are receiving no services.
  360         (e)A frequency distribution indicating the length of time
  361  individuals have been waiting for services.
  362         (f)Information concerning the actual and projected costs
  363  compared to the amount of the appropriation available to the
  364  program and any projected surpluses or deficits.
  365         (13)If at any time an analysis by the agency, in
  366  consultation with the Agency for Health Care Administration,
  367  indicates that the cost of services is expected to exceed the
  368  amount appropriated, the agency shall submit a plan in
  369  accordance with subsection (10) to the Executive Office of the
  370  Governor, the chair of the Senate Appropriations Committee or
  371  its successor committee, and the chair of the House
  372  Appropriations Committee or its successor committee to remain
  373  within the amount appropriated. The agency shall work with the
  374  Agency for Health Care Administration to implement the plan so
  375  as to remain within the appropriation.
  376         (14) The agency, in consultation with the Agency for Health
  377  Care Administration, shall provide a quarterly reconciliation
  378  report of all home and community-based services waiver
  379  expenditures from the Agency for Health Care Administration’s
  380  claims management system with service utilization from the
  381  Agency for Persons with Disabilities Allocation, Budget, and
  382  Contract Control system. The reconciliation report must be
  383  submitted to the Governor, the President of the Senate, and the
  384  Speaker of the House of Representatives no later than 30 days
  385  after the close of each quarter.
  386         (15)(7) The agency and the Agency for Health Care
  387  Administration may adopt rules specifying the allocation
  388  algorithm and methodology; criteria and processes for clients to
  389  access reserved funds for services to meet significant
  390  additional needs extraordinary needs, temporarily or permanently
  391  changed needs, and one-time needs; and processes and
  392  requirements for selection and review of services, development
  393  of support and cost plans, and management of the iBudget system
  394  as needed to administer this section.
  395         Section 5. Section 393.0663, Florida Statutes, is created
  396  to read:
  397         393.0663 Support coordination; legislative intent;
  398  qualified organizations; agency duties; due process;
  399  rulemaking.—
  400         (1) LEGISLATIVE INTENT.—To enable the state to provide a
  401  systematic approach to service oversight for persons providing
  402  care to individuals with developmental disabilities, it is the
  403  intent of the Legislature that the agency work in collaboration
  404  with relevant stakeholders to ensure that waiver support
  405  coordinators have the knowledge, skills, and abilities necessary
  406  to competently provide services to individuals with
  407  developmental disabilities by requiring all support coordinators
  408  to be employees of a qualified organization.
  410         (a)As used in this section, the term “qualified
  411  organization” means an organization determined by the agency to
  412  meet the requirements of this section and of the Developmental
  413  Disabilities Individual Budgeting Waiver Services Coverage and
  414  Limitations Handbook.
  415         (b)The agency shall use qualified organizations for the
  416  purpose of providing all support coordination services to
  417  iBudget clients in this state. In order to be qualified, an
  418  organization must:
  419         1. Employ four or more support coordinators;
  420         2.Maintain a professional code of ethics and a
  421  disciplinary process that apply to all support coordinators
  422  within the organization;
  423         3.Comply with the agency’s cost containment initiatives;
  424         4.Require support coordinators to ensure that client
  425  budgets are linked to levels of need;
  426         5.Require support coordinators to perform all duties and
  427  meet all standards related to support coordination as provided
  428  in the Developmental Disabilities Individual Budgeting Waiver
  429  Services Coverage and Limitations Handbook;
  430         6.Prohibit dual employment of a support coordinator if the
  431  dual employment adversely impacts the support coordinator’s
  432  availability to clients;
  433         7.Educate clients and families regarding identifying and
  434  preventing abuse, neglect, and exploitation;
  435         8.Instruct clients and families on mandatory reporting
  436  requirements for abuse, neglect, and exploitation;
  437         9.Submit within established timeframes all required
  438  documentation for requests for significant additional needs;
  439         10.Require support coordinators to successfully complete
  440  training and professional development approved by the agency;
  441         11.Require support coordinators to pass a competency-based
  442  assessment established by the agency; and
  443         12.Implement a mentoring program approved by the agency
  444  for support coordinators who have worked as a support
  445  coordinator for less than 12 months.
  446         (3) DUTIES OF THE AGENCY.—The agency shall:
  447         (a)Require all qualified organizations to report to the
  448  agency any violation of ethical or professional conduct by
  449  support coordinators employed by the organization;
  450         (b)Maintain a publicly accessible registry of all support
  451  coordinators, including any history of ethical or disciplinary
  452  violations; and
  453         (c)Impose an immediate moratorium on new client
  454  assignments, impose an administrative fine, require plans of
  455  remediation, and terminate the Medicaid Waiver Services
  456  Agreement of any qualified organization that is noncompliant
  457  with applicable laws or rules.
  458         (4) DUE PROCESS.—Any decision by the agency to take action
  459  against a qualified organization as described in paragraph
  460  (3)(c) is reviewable by the agency. Upon receiving an adverse
  461  determination, the qualified organization may request an
  462  administrative hearing pursuant to ss. 120.569 and 120.57(1)
  463  within 30 days after completing any appeals process established
  464  by the agency.
  465         (5) RULEMAKING.—The agency may adopt rules to implement
  466  this section.
  467         Section 6. Subsection (6) is added to section 400.962,
  468  Florida Statutes, to read:
  469         400.962 License required; license application.—
  470         (6) An applicant that has been granted a certificate-of
  471  need exemption under s. 408.036(3)(o) must also demonstrate and
  472  maintain compliance with the following requirements:
  473         (a)The total number of beds per home within the facility
  474  may not exceed eight, with each resident having his or her own
  475  bedroom and bathroom. Each eight-bed home must be colocated on
  476  the same property with two other eight-bed homes and must serve
  477  individuals with severe maladaptive behaviors and co-occurring
  478  psychiatric diagnoses.
  479         (b)A minimum of 16 beds within the facility must be
  480  designated for individuals with severe maladaptive behaviors who
  481  have been assessed using the Agency for Persons with
  482  Disabilities’ Global Behavioral Service Need Matrix with a score
  483  of at least Level 3 and up to Level 6, or assessed using the
  484  criteria deemed appropriate by the Agency for Health Care
  485  Administration regarding the need for a specialized placement in
  486  an intermediate care facility for the developmentally disabled.
  487         (c)The applicant may not have had a facility license
  488  denied, revoked, or suspended within the 36 months preceding the
  489  request for exemption.
  490         (d)The applicant must have had at least 10 years of
  491  experience serving individuals with severe maladaptive behaviors
  492  in this state.
  493         (e)The applicant must have implemented a state-approved
  494  staff training curriculum and monitoring requirements specific
  495  to the individuals whose behaviors require higher intensity,
  496  frequency, and duration of services.
  497         (f)The applicant must make available medical and nursing
  498  services 24 hours per day, 7 days per week.
  499         (g)The applicant must demonstrate a history of using
  500  interventions that are least restrictive and that follow a
  501  behavioral hierarchy.
  502         (h)The applicant must maintain a policy prohibiting the
  503  use of mechanical restraints.
  504         Section 7. Paragraph (o) is added to subsection (3) of
  505  section 408.036, Florida Statutes, to read:
  506         408.036 Projects subject to review; exemptions.—
  507         (3) EXEMPTIONS.—Upon request, the following projects are
  508  subject to exemption from subsection (1):
  509         (o)For a new intermediate care facility for the
  510  developmentally disabled as defined in s. 408.032 which has a
  511  total of 24 beds, comprising three eight-bed homes, for use by
  512  individuals exhibiting severe maladaptive behaviors and co
  513  occurring psychiatric diagnoses requiring increased levels of
  514  behavioral, medical, and therapeutic oversight. The facility
  515  must not have had a license denied, revoked, or suspended within
  516  the 36 months preceding the request for exemption and must have
  517  at least 10 years of experience serving individuals with severe
  518  maladaptive behaviors in this state. The agency may not grant an
  519  additional exemption to a facility that has been granted an
  520  exemption under this paragraph unless the facility has been
  521  licensed and operational for a period of at least 2 years. The
  522  exemption under this paragraph does not require a specific
  523  legislative appropriation.
  524         Section 8. Subsection (15) of section 409.906, Florida
  525  Statutes, is amended to read:
  526         409.906 Optional Medicaid services.—Subject to specific
  527  appropriations, the agency may make payments for services which
  528  are optional to the state under Title XIX of the Social Security
  529  Act and are furnished by Medicaid providers to recipients who
  530  are determined to be eligible on the dates on which the services
  531  were provided. Any optional service that is provided shall be
  532  provided only when medically necessary and in accordance with
  533  state and federal law. Optional services rendered by providers
  534  in mobile units to Medicaid recipients may be restricted or
  535  prohibited by the agency. Nothing in this section shall be
  536  construed to prevent or limit the agency from adjusting fees,
  537  reimbursement rates, lengths of stay, number of visits, or
  538  number of services, or making any other adjustments necessary to
  539  comply with the availability of moneys and any limitations or
  540  directions provided for in the General Appropriations Act or
  541  chapter 216. If necessary to safeguard the state’s systems of
  542  providing services to elderly and disabled persons and subject
  543  to the notice and review provisions of s. 216.177, the Governor
  544  may direct the Agency for Health Care Administration to amend
  545  the Medicaid state plan to delete the optional Medicaid service
  546  known as “Intermediate Care Facilities for the Developmentally
  547  Disabled.” Optional services may include:
  549  DISABLED SERVICES.—The agency may pay for health-related care
  550  and services provided on a 24-hour-a-day basis by a facility
  551  licensed and certified as a Medicaid Intermediate Care Facility
  552  for the Developmentally Disabled, for a recipient who needs such
  553  care because of a developmental disability. Payment shall not
  554  include bed-hold days except in facilities with occupancy rates
  555  of 95 percent or greater. The agency is authorized to seek any
  556  federal waiver approvals to implement this policy. The agency
  557  shall seek federal approval to implement a payment rate for
  558  Medicaid intermediate care facilities serving individuals with
  559  developmental disabilities, severe maladaptive behaviors, severe
  560  maladaptive behaviors and co-occurring complex medical
  561  conditions, or a dual diagnosis of developmental disability and
  562  mental illness.
  563         Section 9. Paragraph (d) of subsection (2) of section
  564  1002.385, Florida Statutes, is amended to read:
  565         1002.385 The Gardiner Scholarship.—
  566         (2) DEFINITIONS.—As used in this section, the term:
  567         (d) “Disability” means, for a 3- or 4-year-old child or for
  568  a student in kindergarten to grade 12, autism spectrum disorder,
  569  as defined in the Diagnostic and Statistical Manual of Mental
  570  Disorders, Fifth Edition, published by the American Psychiatric
  571  Association; cerebral palsy, as defined in s. 393.063(6); Down
  572  syndrome, as defined in s. 393.063(15); an intellectual
  573  disability, as defined in s. 393.063(24); Phelan-McDermid
  574  syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
  575  as defined in s. 393.063(29); spina bifida, as defined in s.
  576  393.063(41) s. 393.063(40); being a high-risk child, as defined
  577  in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
  578  rare diseases which affect patient populations of fewer than
  579  200,000 individuals in the United States, as defined by the
  580  National Organization for Rare Disorders; anaphylaxis; deaf;
  581  visually impaired; traumatic brain injured; hospital or
  582  homebound; or identification as dual sensory impaired, as
  583  defined by rules of the State Board of Education and evidenced
  584  by reports from local school districts. The term “hospital or
  585  homebound” includes a student who has a medically diagnosed
  586  physical or psychiatric condition or illness, as defined by the
  587  state board in rule, and who is confined to the home or hospital
  588  for more than 6 months.
  589         Section 10. This act shall take effect July 1, 2021.