CS for SB 82                                     First Engrossed
    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; limiting the
   64         number of such exemptions the Agency for Health Care
   65         Administration may grant; providing that a specific
   66         legislative appropriation is not required for such
   67         exemption; amending s. 409.906, F.S.; requiring the
   68         agency to seek federal approval to implement certain
   69         payment rates; amending s. 1002.385, F.S.; conforming
   70         a cross-reference; providing an effective date.
   72  Be It Enacted by the Legislature of the State of Florida:
   74         Section 1. Present subsections (39) through (45) of section
   75  393.063, Florida Statutes, are redesignated as subsections (40)
   76  through (46), respectively, a new subsection (39) is added to
   77  that section, and present subsection (41) of that section is
   78  amended, to read:
   79         393.063 Definitions.—For the purposes of this chapter, the
   80  term:
   81         (39) “Significant additional need” means an additional need
   82  for medically necessary services which would place the health
   83  and safety of the client, the client’s caregiver, or the public
   84  in serious jeopardy if it is not met. The term does not exclude
   85  services for an additional need that the client requires in
   86  order to remain in the least restrictive setting, including, but
   87  not limited to, employment services and transportation services.
   88  The agency may provide additional funding only after the
   89  determination of a client’s initial allocation amount and after
   90  the qualified organization has documented the availability of
   91  nonwaiver resources.
   92         (42)(41) “Support coordinator” means an employee of a
   93  qualified organization as provided in s. 393.0663 a person who
   94  is designated by the agency to assist individuals and families
   95  in identifying their capacities, needs, and resources, as well
   96  as finding and gaining access to necessary supports and
   97  services; coordinating the delivery of supports and services;
   98  advocating on behalf of the individual and family; maintaining
   99  relevant records; and monitoring and evaluating the delivery of
  100  supports and services to determine the extent to which they meet
  101  the needs and expectations identified by the individual, family,
  102  and others who participated in the development of the support
  103  plan.
  104         Section 2. Subsection (2) of section 393.066, Florida
  105  Statutes, is amended to read:
  106         393.066 Community services and treatment.—
  107         (2) Necessary services shall be purchased, rather than
  108  provided directly by the agency, when the purchase of services
  109  is more cost-efficient than providing them directly. All
  110  purchased services must be approved by the agency. As a
  111  condition of payment and before billing, persons or entities
  112  under contract with the agency to provide services shall use
  113  agency data management systems to document service provision to
  114  clients shall use such systems to bill for services. Contracted
  115  persons and entities shall meet the minimum hardware and
  116  software technical requirements established by the agency for
  117  the use of such systems. Such persons or entities shall also
  118  meet any requirements established by the agency for training and
  119  professional development of staff providing direct services to
  120  clients.
  121         Section 3. Section 393.0661, Florida Statutes, is repealed.
  122         Section 4. Section 393.0662, Florida Statutes, is amended
  123  to read:
  124         393.0662 Individual budgets for delivery of home and
  125  community-based services; iBudget system established.—The
  126  Legislature finds that improved financial management of the
  127  existing home and community-based Medicaid waiver program is
  128  necessary to avoid deficits that impede the provision of
  129  services to individuals who are on the waiting list for
  130  enrollment in the program. The Legislature further finds that
  131  clients and their families should have greater flexibility to
  132  choose the services that best allow them to live in their
  133  community within the limits of an established budget. Therefore,
  134  the Legislature intends that the agency, in consultation with
  135  the Agency for Health Care Administration, shall manage the
  136  service delivery system using individual budgets as the basis
  137  for allocating the funds appropriated for the home and
  138  community-based services Medicaid waiver program among eligible
  139  enrolled clients. The service delivery system that uses
  140  individual budgets shall be called the iBudget system.
  141         (1) The agency shall administer an individual budget,
  142  referred to as an iBudget, for each individual served by the
  143  home and community-based services Medicaid waiver program. The
  144  funds appropriated to the agency shall be allocated through the
  145  iBudget system to eligible, Medicaid-enrolled clients. For the
  146  iBudget system, eligible clients shall include individuals with
  147  a developmental disability as defined in s. 393.063. The iBudget
  148  system shall provide for: enhanced client choice within a
  149  specified service package; appropriate assessment strategies; an
  150  efficient consumer budgeting and billing process that includes
  151  reconciliation and monitoring components; a role for support
  152  coordinators that avoids potential conflicts of interest; a
  153  flexible and streamlined service review process; and the
  154  equitable allocation of available funds based on the client’s
  155  level of need, as determined by the allocation methodology.
  156         (a) In developing each client’s iBudget, the agency shall
  157  use the allocation methodology as defined in s. 393.063(4), in
  158  conjunction with an assessment instrument that the agency deems
  159  to be reliable and valid, including, but not limited to, the
  160  agency’s Questionnaire for Situational Information. The
  161  allocation methodology shall determine the amount of funds
  162  allocated to a client’s iBudget.
  163         (b) The agency may authorize additional funding based on a
  164  client having one or more significant additional needs of the
  165  following needs that cannot be accommodated within the funding
  166  determined by the algorithm and having no other resources,
  167  supports, or services available to meet the needs. Such
  168  additional funding may be provided only after the determination
  169  of a client’s initial allocation amount and after the qualified
  170  organization has documented the availability of all nonwaiver
  171  resources. Upon receipt of an incomplete request for services to
  172  meet significant additional needs, the agency shall close the
  173  request.
  174         (c)The agency shall centralize, within its headquarters,
  175  medical necessity determinations for requested services made
  176  through the significant additional needs process. The process
  177  must ensure consistent application of medical necessity
  178  criteria. This process must provide opportunities for targeted
  179  training, quality assurance, and inter-rater reliability. need:
  180         1. An extraordinary need that would place the health and
  181  safety of the client, the client’s caregiver, or the public in
  182  immediate, serious jeopardy unless the increase is approved.
  183  However, the presence of an extraordinary need in and of itself
  184  does not warrant authorized funding by the agency. An
  185  extraordinary need may include, but is not limited to:
  186         a. A documented history of significant, potentially life
  187  threatening behaviors, such as recent attempts at suicide,
  188  arson, nonconsensual sexual behavior, or self-injurious behavior
  189  requiring medical attention;
  190         b. A complex medical condition that requires active
  191  intervention by a licensed nurse on an ongoing basis that cannot
  192  be taught or delegated to a nonlicensed person;
  193         c. A chronic comorbid condition. As used in this
  194  subparagraph, the term “comorbid condition” means a medical
  195  condition existing simultaneously but independently with another
  196  medical condition in a patient; or
  197         d. A need for total physical assistance with activities
  198  such as eating, bathing, toileting, grooming, and personal
  199  hygiene.
  200         2. A significant need for one-time or temporary support or
  201  services that, if not provided, would place the health and
  202  safety of the client, the client’s caregiver, or the public in
  203  serious jeopardy. A significant need may include, but is not
  204  limited to, the provision of environmental modifications,
  205  durable medical equipment, services to address the temporary
  206  loss of support from a caregiver, or special services or
  207  treatment for a serious temporary condition when the service or
  208  treatment is expected to ameliorate the underlying condition. As
  209  used in this subparagraph, the term “temporary” means a period
  210  of fewer than 12 continuous months. However, the presence of
  211  such significant need for one-time or temporary supports or
  212  services in and of itself does not warrant authorized funding by
  213  the agency.
  214         3. A significant increase in the need for services after
  215  the beginning of the service plan year that would place the
  216  health and safety of the client, the client’s caregiver, or the
  217  public in serious jeopardy because of substantial changes in the
  218  client’s circumstances, including, but not limited to, permanent
  219  or long-term loss or incapacity of a caregiver, loss of services
  220  authorized under the state Medicaid plan due to a change in age,
  221  or a significant change in medical or functional status which
  222  requires the provision of additional services on a permanent or
  223  long-term basis that cannot be accommodated within the client’s
  224  current iBudget. As used in this subparagraph, the term “long
  225  term” means a period of 12 or more continuous months. However,
  226  such significant increase in need for services of a permanent or
  227  long-term nature in and of itself does not warrant authorized
  228  funding by the agency.
  229         4. A significant need for transportation services to a
  230  waiver-funded adult day training program or to waiver-funded
  231  employment services when such need cannot be accommodated within
  232  a client’s iBudget as determined by the algorithm without
  233  affecting the health and safety of the client, if public
  234  transportation is not an option due to the unique needs of the
  235  client or other transportation resources are not reasonably
  236  available.
  238         The agency shall reserve portions of the appropriation for
  239  the home and community-based services Medicaid waiver program
  240  for adjustments required pursuant to this paragraph and may use
  241  the services of an independent actuary in determining the amount
  242  to be reserved.
  243         (d)(c) A client’s annual expenditures for home and
  244  community-based Medicaid waiver services may not exceed the
  245  limits of his or her iBudget. The total of all clients’
  246  projected annual iBudget expenditures may not exceed the
  247  agency’s appropriation for waiver services.
  248         (2) The Agency for Health Care Administration, in
  249  consultation with the agency, shall seek federal approval to
  250  amend current waivers, request a new waiver, and amend contracts
  251  as necessary to manage the iBudget system, improve services for
  252  eligible and enrolled clients, and improve the delivery of
  253  services through the home and community-based services Medicaid
  254  waiver program and the Consumer-Directed Care Plus Program,
  255  including, but not limited to, enrollees with a dual diagnosis
  256  of a developmental disability and a mental health disorder.
  257         (3) The agency must certify and document within each
  258  client’s cost plan that the a client has used must use all
  259  available services authorized under the state Medicaid plan,
  260  school-based services, private insurance and other benefits, and
  261  any other resources that may be available to the client before
  262  using funds from his or her iBudget to pay for support and
  263  services.
  264         (4) Rates for any or all services established under rules
  265  of the Agency for Health Care Administration must be designated
  266  as the maximum rather than a fixed amount for individuals who
  267  receive an iBudget, except for services specifically identified
  268  in those rules that the agency determines are not appropriate
  269  for negotiation, which may include, but are not limited to,
  270  residential habilitation services.
  271         (5) The agency shall ensure that clients and caregivers
  272  have access to training and education that inform them about the
  273  iBudget system and enhance their ability for self-direction.
  274  Such training and education must be offered in a variety of
  275  formats and, at a minimum, must address the policies and
  276  processes of the iBudget system and the roles and
  277  responsibilities of consumers, caregivers, waiver support
  278  coordinators, providers, and the agency, and must provide
  279  information to help the client make decisions regarding the
  280  iBudget system and examples of support and resources available
  281  in the community.
  282         (6) The agency shall collect data to evaluate the
  283  implementation and outcomes of the iBudget system.
  284         (7) The Agency for Health Care Administration shall seek
  285  federal approval to provide a consumer-directed option for
  286  persons with developmental disabilities. The agency and the
  287  Agency for Health Care Administration may adopt rules necessary
  288  to administer this subsection.
  289         (8)The Agency for Health Care Administration shall seek
  290  federal waivers and amend contracts as necessary to make changes
  291  to services defined in federal waiver programs, as follows:
  292         (a) Supported living coaching services may not exceed 20
  293  hours per month for persons who also receive in-home support
  294  services.
  295         (b) Limited support coordination services are the only
  296  support coordination services that may be provided to persons
  297  under the age of 18 who live in the family home.
  298         (c) Personal care assistance services are limited to 180
  299  hours per calendar month and may not include rate modifiers.
  300  Additional hours may be authorized for persons who have
  301  intensive physical, medical, or adaptive needs, if such hours
  302  will prevent institutionalization.
  303         (d) Residential habilitation services are limited to 8
  304  hours per day. Additional hours may be authorized for persons
  305  who have intensive medical or adaptive needs and if such hours
  306  will prevent institutionalization, or for persons who have
  307  behavioral problems that are exceptional in intensity, duration,
  308  or frequency and who present a substantial risk of harm to
  309  themselves or others.
  310         (e) The agency shall conduct supplemental cost plan reviews
  311  to verify the medical necessity of authorized services for plans
  312  that have increased by more than 8 percent during either of the
  313  2 preceding fiscal years.
  314         (f) The agency shall implement a consolidated residential
  315  habilitation rate structure to increase savings to the state
  316  through a more cost-effective payment method and establish
  317  uniform rates for intensive behavioral residential habilitation
  318  services.
  319         (g) The geographic differential for Miami-Dade, Broward,
  320  and Palm Beach Counties for residential habilitation services is
  321  7.5 percent.
  322         (h) The geographic differential for Monroe County for
  323  residential habilitation services is 20 percent.
  324         (9) The agency shall collect premiums or cost sharing
  325  pursuant to s. 409.906(13)(c).
  326         (10) This section or any related rule does not prevent or
  327  limit the Agency for Health Care Administration, in consultation
  328  with the agency, from adjusting fees, reimbursement rates,
  329  lengths of stay, number of visits, or number of services, or
  330  from limiting enrollment or making any other adjustment
  331  necessary to comply with the availability of moneys and any
  332  limitations or directions provided in the General Appropriations
  333  Act.
  334         (11)A provider of services rendered to persons with
  335  developmental disabilities pursuant to a federally approved
  336  waiver must be reimbursed according to a rate methodology based
  337  upon an analysis of the expenditure history and prospective
  338  costs of providers participating in the waiver program, or under
  339  any other methodology developed by the Agency for Health Care
  340  Administration in consultation with the agency and approved by
  341  the Federal Government in accordance with the waiver.
  342         (12) The agency shall submit quarterly status reports to
  343  the Executive Office of the Governor, the chair of the Senate
  344  Appropriations Committee or its successor, and the chair of the
  345  House Appropriations Committee or its successor which contain
  346  all of the following information:
  347         (a)The financial status of home and community-based
  348  services, including the number of enrolled individuals receiving
  349  services through one or more programs.
  350         (b)The number of individuals who have requested services
  351  and who are not enrolled but who are receiving services through
  352  one or more programs, with a description indicating the programs
  353  under which the individual is receiving services.
  354         (c)The number of individuals who have refused an offer of
  355  services but who choose to remain on the list of individuals
  356  waiting for services.
  357         (d)The number of individuals who have requested services
  358  but who are receiving no services.
  359         (e)A frequency distribution indicating the length of time
  360  individuals have been waiting for services.
  361         (f)Information concerning the actual and projected costs
  362  compared to the amount of the appropriation available to the
  363  program and any projected surpluses or deficits.
  364         (13)If at any time an analysis by the agency, in
  365  consultation with the Agency for Health Care Administration,
  366  indicates that the cost of services is expected to exceed the
  367  amount appropriated, the agency shall submit a plan in
  368  accordance with subsection (10) to the Executive Office of the
  369  Governor, the chair of the Senate Appropriations Committee or
  370  its successor committee, and the chair of the House
  371  Appropriations Committee or its successor committee to remain
  372  within the amount appropriated. The agency shall work with the
  373  Agency for Health Care Administration to implement the plan so
  374  as to remain within the appropriation.
  375         (14) The agency, in consultation with the Agency for Health
  376  Care Administration, shall provide a quarterly reconciliation
  377  report of all home and community-based services waiver
  378  expenditures from the Agency for Health Care Administration’s
  379  claims management system with service utilization from the
  380  Agency for Persons with Disabilities Allocation, Budget, and
  381  Contract Control system. The reconciliation report must be
  382  submitted to the Governor, the President of the Senate, and the
  383  Speaker of the House of Representatives no later than 30 days
  384  after the close of each quarter.
  385         (15)(7) The agency and the Agency for Health Care
  386  Administration may adopt rules specifying the allocation
  387  algorithm and methodology; criteria and processes for clients to
  388  access reserved funds for services to meet significant
  389  additional needs extraordinary needs, temporarily or permanently
  390  changed needs, and one-time needs; and processes and
  391  requirements for selection and review of services, development
  392  of support and cost plans, and management of the iBudget system
  393  as needed to administer this section.
  394         Section 5. Section 393.0663, Florida Statutes, is created
  395  to read:
  396         393.0663 Support coordination; legislative intent;
  397  qualified organizations; agency duties; due process;
  398  rulemaking.—
  399         (1) LEGISLATIVE INTENT.—To enable the state to provide a
  400  systematic approach to service oversight for persons providing
  401  care to individuals with developmental disabilities, it is the
  402  intent of the Legislature that the agency work in collaboration
  403  with relevant stakeholders to ensure that waiver support
  404  coordinators have the knowledge, skills, and abilities necessary
  405  to competently provide services to individuals with
  406  developmental disabilities by requiring all support coordinators
  407  to be employees of a qualified organization.
  409         (a)As used in this section, the term “qualified
  410  organization” means an organization determined by the agency to
  411  meet the requirements of this section and of the Developmental
  412  Disabilities Individual Budgeting Waiver Services Coverage and
  413  Limitations Handbook.
  414         (b)The agency shall use qualified organizations for the
  415  purpose of providing all support coordination services to
  416  iBudget clients in this state. In order to be qualified, an
  417  organization must:
  418         1. Employ four or more support coordinators;
  419         2.Maintain a professional code of ethics and a
  420  disciplinary process that apply to all support coordinators
  421  within the organization;
  422         3.Comply with the agency’s cost containment initiatives;
  423         4.Require support coordinators to ensure that client
  424  budgets are linked to levels of need;
  425         5.Require support coordinators to perform all duties and
  426  meet all standards related to support coordination as provided
  427  in the Developmental Disabilities Individual Budgeting Waiver
  428  Services Coverage and Limitations Handbook;
  429         6.Prohibit dual employment of a support coordinator if the
  430  dual employment adversely impacts the support coordinator’s
  431  availability to clients;
  432         7.Educate clients and families regarding identifying and
  433  preventing abuse, neglect, and exploitation;
  434         8.Instruct clients and families on mandatory reporting
  435  requirements for abuse, neglect, and exploitation;
  436         9.Submit within established timeframes all required
  437  documentation for requests for significant additional needs;
  438         10.Require support coordinators to successfully complete
  439  training and professional development approved by the agency;
  440         11.Require support coordinators to pass a competency-based
  441  assessment established by the agency; and
  442         12.Implement a mentoring program approved by the agency
  443  for support coordinators who have worked as a support
  444  coordinator for less than 12 months.
  445         (3) DUTIES OF THE AGENCY.—The agency shall:
  446         (a)Require all qualified organizations to report to the
  447  agency any violation of ethical or professional conduct by
  448  support coordinators employed by the organization;
  449         (b)Maintain a publicly accessible registry of all support
  450  coordinators, including any history of ethical or disciplinary
  451  violations; and
  452         (c)Impose an immediate moratorium on new client
  453  assignments, impose an administrative fine, require plans of
  454  remediation, and terminate the Medicaid Waiver Services
  455  Agreement of any qualified organization that is noncompliant
  456  with applicable laws or rules.
  457         (4) DUE PROCESS.—Any decision by the agency to take action
  458  against a qualified organization as described in paragraph
  459  (3)(c) is reviewable by the agency. Upon receiving an adverse
  460  determination, the qualified organization may request an
  461  administrative hearing pursuant to ss. 120.569 and 120.57(1)
  462  within 30 days after completing any appeals process established
  463  by the agency.
  464         (5) RULEMAKING.—The agency may adopt rules to implement
  465  this section.
  466         Section 6. Subsection (6) is added to section 400.962,
  467  Florida Statutes, to read:
  468         400.962 License required; license application.—
  469         (6) An applicant that has been granted a certificate-of
  470  need exemption under s. 408.036(3)(o) must also demonstrate and
  471  maintain compliance with the following criteria:
  472         (a) The total number of beds per home within the facility
  473  may not exceed eight, with each resident having his or her own
  474  bedroom and bathroom. Each eight-bed home must be colocated on
  475  the same property with two other eight-bed homes and must serve
  476  individuals with severe maladaptive behaviors and co-occurring
  477  psychiatric diagnoses.
  478         (b) A minimum of 16 beds within the facility must be
  479  designated for individuals with severe maladaptive behaviors who
  480  have been assessed using the Agency for Persons with
  481  Disabilities’ Global Behavioral Service Need Matrix with a score
  482  of at least Level 4 and up to Level 6, or assessed using the
  483  criteria deemed appropriate by the Agency for Health Care
  484  Administration regarding the need for a specialized placement in
  485  an intermediate care facility for the developmentally disabled.
  486         (c) The applicant has not had a facility license denied,
  487  revoked, or suspended within the 36 months preceding the request
  488  for exemption.
  489         (d) The applicant must have at least 10 years of experience
  490  serving individuals with severe maladaptive behaviors in the
  491  state.
  492         (e) The applicant must implement a state-approved staff
  493  training curriculum and monitoring requirements specific to the
  494  individuals whose behaviors require higher intensity, frequency,
  495  and duration of services.
  496         (f) The applicant must make available medical and nursing
  497  services 24 hours per day, 7 days per week.
  498         (g) The applicant must demonstrate a history of using
  499  interventions that are least restrictive and that follow a
  500  behavioral hierarchy.
  501         (h) The applicant must maintain a policy prohibiting the
  502  use of mechanical restraints.
  503         Section 7. Paragraph (o) is added to subsection (3) of
  504  section 408.036, Florida Statutes, to read:
  505         408.036 Projects subject to review; exemptions.—
  506         (3) EXEMPTIONS.—Upon request, the following projects are
  507  subject to exemption from subsection (1):
  508         (o) For a new intermediate care facility for the
  509  developmentally disabled as defined in s. 408.032 which has a
  510  total of 24 beds, comprising three eight-bed homes, for use by
  511  individuals exhibiting severe maladaptive behaviors and co
  512  occurring psychiatric diagnoses requiring increased levels of
  513  behavioral, medical, and therapeutic oversight. The applicant
  514  must not have had a license denied, revoked, or suspended within
  515  the 36 months preceding the request for exemption and must have
  516  at least 10 years of experience serving individuals with severe
  517  maladaptive behaviors in this state. The agency may grant no
  518  more than three exemptions under this paragraph.
  519         1. An exemption under this paragraph does not require a
  520  specific legislative appropriation.
  521         2. An exemption under this paragraph terminates 18 months
  522  after the date of issuance unless the exemption holder has
  523  commenced construction. The agency shall monitor the progress of
  524  the holder of the certificate of exemption in meeting the
  525  timetable for project development specified in the application
  526  for exemption. The agency shall extend the timeframe for a
  527  project if the exemption holder demonstrates to the satisfaction
  528  of the agency that good-faith commencement of the project is
  529  being delayed by litigation or by governmental action or
  530  inaction with respect to regulations or permitting precluding
  531  commencement of the project.
  532         3. This paragraph and subsection (6) of s. 400.962 are
  533  repealed July 1, 2022, unless reviewed and saved from repeal by
  534  the Legislature.
  535         Section 8. Subsection (15) of section 409.906, Florida
  536  Statutes, is amended to read:
  537         409.906 Optional Medicaid services.—Subject to specific
  538  appropriations, the agency may make payments for services which
  539  are optional to the state under Title XIX of the Social Security
  540  Act and are furnished by Medicaid providers to recipients who
  541  are determined to be eligible on the dates on which the services
  542  were provided. Any optional service that is provided shall be
  543  provided only when medically necessary and in accordance with
  544  state and federal law. Optional services rendered by providers
  545  in mobile units to Medicaid recipients may be restricted or
  546  prohibited by the agency. Nothing in this section shall be
  547  construed to prevent or limit the agency from adjusting fees,
  548  reimbursement rates, lengths of stay, number of visits, or
  549  number of services, or making any other adjustments necessary to
  550  comply with the availability of moneys and any limitations or
  551  directions provided for in the General Appropriations Act or
  552  chapter 216. If necessary to safeguard the state’s systems of
  553  providing services to elderly and disabled persons and subject
  554  to the notice and review provisions of s. 216.177, the Governor
  555  may direct the Agency for Health Care Administration to amend
  556  the Medicaid state plan to delete the optional Medicaid service
  557  known as “Intermediate Care Facilities for the Developmentally
  558  Disabled.” Optional services may include:
  560  DISABLED SERVICES.—The agency may pay for health-related care
  561  and services provided on a 24-hour-a-day basis by a facility
  562  licensed and certified as a Medicaid Intermediate Care Facility
  563  for the Developmentally Disabled, for a recipient who needs such
  564  care because of a developmental disability. Payment shall not
  565  include bed-hold days except in facilities with occupancy rates
  566  of 95 percent or greater. The agency is authorized to seek any
  567  federal waiver approvals to implement this policy. The agency
  568  shall seek federal approval to implement a payment rate for
  569  Medicaid intermediate care facilities serving individuals with
  570  developmental disabilities, severe maladaptive behaviors, severe
  571  maladaptive behaviors and co-occurring complex medical
  572  conditions, or a dual diagnosis of developmental disability and
  573  mental illness.
  574         Section 9. Paragraph (d) of subsection (2) of section
  575  1002.385, Florida Statutes, is amended to read:
  576         1002.385 The Gardiner Scholarship.—
  577         (2) DEFINITIONS.—As used in this section, the term:
  578         (d) “Disability” means, for a 3- or 4-year-old child or for
  579  a student in kindergarten to grade 12, autism spectrum disorder,
  580  as defined in the Diagnostic and Statistical Manual of Mental
  581  Disorders, Fifth Edition, published by the American Psychiatric
  582  Association; cerebral palsy, as defined in s. 393.063(6); Down
  583  syndrome, as defined in s. 393.063(15); an intellectual
  584  disability, as defined in s. 393.063(24); Phelan-McDermid
  585  syndrome, as defined in s. 393.063(28); Prader-Willi syndrome,
  586  as defined in s. 393.063(29); spina bifida, as defined in s.
  587  393.063(41) s. 393.063(40); being a high-risk child, as defined
  588  in s. 393.063(23)(a); muscular dystrophy; Williams syndrome;
  589  rare diseases which affect patient populations of fewer than
  590  200,000 individuals in the United States, as defined by the
  591  National Organization for Rare Disorders; anaphylaxis; deaf;
  592  visually impaired; traumatic brain injured; hospital or
  593  homebound; or identification as dual sensory impaired, as
  594  defined by rules of the State Board of Education and evidenced
  595  by reports from local school districts. The term “hospital or
  596  homebound” includes a student who has a medically diagnosed
  597  physical or psychiatric condition or illness, as defined by the
  598  state board in rule, and who is confined to the home or hospital
  599  for more than 6 months.
  600         Section 10. This act shall take effect July 1, 2021.