This information was obtained from Aaron Nangle’ newsletter.  To receive Nangle’s newsletter, visit his website at waiverinfo@aol.com

Emergency Rule Lifted By Rick Scott

Details About How/When Rates Are Restored

Provider Update

The APD emergency rate reduction to provider rates will end at midnight, April 15. Provider rates will return to their March 2011 levels effective Saturday, April 16.

Rates for services provided between April 1 and April 15 will remain at the reduced rate.

To keep from issuing over 150,000 new service authorizations, APD is changing current service authorizations (April 1 – June 30). These service authorizations will have an approved amount based on the reduced rate for services provided between April 1 through April 15 and the old (higher) rate from April 16 through the service authorization end date.

Changed service plans will be available in ABC by close of business Monday, April 18.

Service authorization requests will be submitted to FMMIS the evening of April 18. Service authorizations are anticipated to be available Tuesday, April 19.

Billing is suspended until system changes are complete. APD anticipates that service authorizations will be available to Waiver Support Coordinators on Tuesday, April 19.  WSC must review and distribute these service authorizations. Once a provider has received a service authorization, they may begin billing for April services.

If you have any questions or problems with your service authorization, Area Office staff can answer questions and make corrections to service plans.

Rates

The rate shown on the service authorization will be the old (higher) rate. The approved amount on the service authorization may not be equal to the old rate shown on the service authorization multiplied by the number of units. The service authorization for April may show an amount slightly less than the original rate multiplied by the number of units because of the reduced rate used from April 1 through April 15.

When billing for April, please remember to reduce the amount billed for services provided before April 16.   

Because of the rate change, services (other than monthly) should be billed daily by date in April. Please do not “roll-up” service rates used after April 15 with services provided during the April 1 through April 15 period.

Service Scenarios

The sections below describe how reduced rate service authorizations will be handled to increase the rates.

Service Plans with Approved Amount <= $1.00 or Rate = $0.00 : 

 Service Plans with Approved Amount <= $1.00 or Rate = $0.00 will not be updated by this process.

 Monthly Services (One unit per month billed)

The services below will be handled as follows:

For April,    

The reduced rate will be multiplied by 50% (.5).              

The old rate will be multiplied by 50% (.5).

These two amounts will be added together to get the blended amount for April

Each remaining month (May and June) will be billed at the old rate ($100.00)

New Service Authorization Amount (April-June) 92.50 + 100 + 100 = $292.50

 Example:

Reduced rate = $85, Old rate = $100, 4/1/2011-6/30/2011

For April,

$85 x .5 = $42.50

$100 x .5 = $50

$42.50 + $50 = $92.50 (blended amount for April)

92.50 + 100 + 100 = $292.50 New Service Authorization Amount (April-June)

Monthly Services

Res Hab Basic – Standard

Res Hab Ext 1 – Behavior Focus

Res Hab Ext 1 – Standard

Res Hab Ext 2 – Behavior Focus

Res Hab Ext 2 – Standard

Res Hab Min – Behavior Focus

Res Hab Min – Standard

Res Hab Mod – Behavior Focus

Res Hab Mod – Standard

Support Coordination – Limited

Support Coordination – Full

Support Coordination – Transitional

Support Coordination CDC+ – Limited

Support Coordination CDC+ – Full

 Unit Based Services

The services below will be handled as follows

Calculate number of days between begin date and 4/15/2011 = Reduced rate days (DaysReduced)

Calculate the number of days between 4/16/2011 and service authorization end date = remaining days (DaysRemain)

DaysReduced + DaysRemain = DaysSA

Approved amount / reduced rate = number of units (Units)

Units / DaysSA = units per day (UnitsDay)

UnitsDay * DaysReduced * reduced rate = 4/1/2011-4/15/2011 amount (ReducedAmt)

UnitsDay * DaysRemain * old rate = 4/16/2011-end of service authorization amount (RemainingAmount)

ReducedAmt + RemainingAmount = New Service Authorization Amount

 Example:

Reduced rate = $85, Old rate = $100, Period 4/1/2011-6/30/2011, Amount $8500

4/1/2011 – 4/15/2011 = 15 (DaysReduced)

4/16/2011 – 6/30/2011 = 76 (DaysRemain)

15 + 76 = 91 (DaysSA)

$8500 / $85 = 100 (Units)

100/91 = 1.0989 (UnitsDay)

1.0989 * 15 * $85 = $1401.0975 (ReducedAmt)

1.0989 * 76 * $100 = $8351.64 (RemainingAmount)

$1401.0975 + $8351.64 = $9752.7375 (New Service Authorization Amount)

Unit Based Services

In – Home Supports (Live-In Staff)

Res Hab Basic – Standard – Daily

Res Hab Ext 1 – Standard – Daily

Res Hab Ext 2 – Standard – Daily

Res Hab Min – Standard – Daily

Res Hab Mod – Standard – Daily

Residential Habilitation – (Live In Staff) – Daily

Respite Care – Day

Adult Day Training – Facility Based

Adult Day Training – Off Site

Behavior Analysis Level 1

Behavior Analysis Level 2

Behavior Analysis Level 3

Behavior Assistant Services

Companion

Dietitian Services

In – Home Supports (Awake Staff)

Occupational Therapy

Personal Care Assistance

Physical Therapy

Private Duty Nursing – LPN

Private Duty Nursing – RN

Residential Habilitation – (Quarter Hour)

Residential Nursing Services – LPN

Residential Nursing Services – RN

Respiratory Therapy

Respite Care – Quarter Hour

Skilled Nursing – LPN

Skilled Nursing – RN

Specialized Mental Health – Therapy

Speech Therapy

Supported Employment   Group

Supported Employment – Individual Model

Supported Living Coaching

Services Reduced by a flat 15 percent

The services below will be handled as follows

Calculate number of days between begin date and 4/15/2011 = Reduced rate days (DaysReduced)

Calculate the number of days between 4/16/2011 and service authorization end date = remaining days (DaysRemain)

DaysReduced + DaysRemain = DaysSA

Approved amount / reduced rate = number of units (Units)

Units / DaysSA = units per day (UnitsDay)

Reduced rate / .85 = old rate

UnitsDay * DaysReduced * reduced rate = amount prior to 4/16/2011 (amount 1)

UnitsDay * DaysRemain * old rate = amount after 4/15/2011 (amount 2)

Amount 1 + amount 2 = New Service Authorization Amount

 Example:

Reduced rate = $85, Period 4/1/2011-6/30/2011, Amount $8500

4/1/2011 – 4/15/2011 = 15 (DaysReduced)

4/16/2011 – 6/30/2011 = 76 (DaysRemain)

15 + 76 = 91 (DaysSA)

$8500 / $85 = 100 (Units)

100/91 = 1.0989 (UnitsDay)

$85 / .85 = 100 (old rate)

1.0989 * 15 * $85 = $1401.0975 (ReducedAmt)

1.0989 * 76 * $100 = $8351.64 (RemainingAmount)

$1401.0975 + $8351.64 = $9752.7375 (New Service Authorization Amount)

 Services Reduced by a flat 15 percent

CONSUMABLE MEDICAL SUPPLIES

IN HOME SUPPORTS MONTHLY – S.L.WAIVER

Personal Emergency Response – Service

Res Hab Basic – Behavior Focus

Residential Habilitation – (Day) Intensive Behavior in a Licensed Facility

Special Medical Home Care

Transportation – Mile

Transportation – Month

Transportation – Trip

One time or infrequent services

The services below will be handled as follows:

A list of these service authorizations is being provided to the Area Offices. Changes for these services will be handled manually by the Area Offices

Services

Adult Dental Services

Behavioral Analysis Services Assessment

Durable Medical Equipment

Environmental Accessibility Adaptations

Home Accessibility Assessment

Occupational Therapy Assessment

Personal Emergency Response – Installation

Physical Therapy – Assessment

Respiratory Therapy Assessment

Specialized Mental Health – Assessment

Speech Therapy – Assessment

Special Case for Res Hab Behavior Focus

The services listed below have the same procedure code of either “T2020U6” or “T2023U6” in the Rate table. However Res Hab Basic does not have any given rates as this service comes under services with negotiated rates. The business rule being applied is:

a) Take the pre-April 1 ABC service plan rate (old) and compare it with all the rates available in the old rate table.

 b) If a perfect rate match is found for the procedure code and rate, the matched rate will be used in the current service plan. Otherwise the ABC old service plan rate will be used in the current service plan.

Services

Res Hab Basic – Behavior Focus

Res Hab Min – Behavior Focus

Res Hab Mod – Behavior Focus

Res Hab Ext 2 – Behavior Focus

Res Hab Ext 1 – Behavior Focus – Daily

Res Hab Ext 2 – Behavior Focus – Daily

Res Hab Min – Behavior Focus – Daily

Res Hab Mod – Behavior Focus – Daily

 Problems That Might Occur

One time or infrequent services are being handled manually

Units may not be used on a daily basis so the calculated amount is not correct

Source:  http://apdcares.org/news/news/2011/new-rule.htm

  ______________________________________________________

Message From Aaron Nangle

The aim of win-win negotiation is to find a solution that is acceptable to both parties, and leaves both parties feeling that they’ve won, in some way, after the event.  I don’t believe that has happened  for either party, and that worries me.  Providers and families are very, very thankful to The Governor and to the Legislators for restoring rates, yet they are also  fully aware that there is not enough funding to serve everyone and future cuts are likely. The Governor has made it very clear that APD must stay within its budget, and he has an obligation to tax payers to balance the Florida budget.  

There are about 50,000 people who need services from The Agency For Persons With Disabilities- just over 30,000 are on the waiver and 19,000 on the waiting list.   Historically, the budget has not been enough to provide services for the 30,000 on the waiver.  Furthermore, many people have been waiting for services for five years or more. 

In this crisis, we have come together and worked towards solutions.  We need to continue to do so.  The absolute worst thing we can do is to panic and start blaming each other.  Let’s face it, the money wasn’t wasted on private jets for our workers or exotic retreats, it was spent on medically necessary services. 

In order to balance the APD budget and also serve everyone on the waiting list, people would need to cut their service utilization nearly in half.  In most cases that is an impossible request.  We can not tell people they can only live in their group homes for 182 days per year.  From this experience we have also learned that provider rates can not be cut by 30-40 percent.  The law requires that agencies pay their employees at least minimum wage, and minimum wage is usually not enough to keep dependable, quality, caring providers. 

The second rule of successful negotiation is to understand the wants and needs of the other party.  

http://www.youtube.com/watch?v=yA7nCI1Q8Kg

(video of meeting in the Governor’s office)

We have a lot of work to do.

__________________________________________

Ever Care Adult Care Services LLC,

Is Ready To Help

  We have beds available immediately and are prepared to help anyone in need during these difficult times. Behavior focused adult male, Standard female and male beds are available. Live near the beach, enjoy great daily activities. Contact – Mary Jo, 727-449-7045 or Email: mhscan@aol.com 

 See our website at http://evercareadultservices.com/

______________________________________
 

Call to Advertise your company & be listed on our websites.
We want people to have a true choice.

SupportCoordinators.Com  –  WaiverProvider.Com

FloridaGroupHome.Com  –  FloridaUnites.com

FloridaAutism.org  –  FloridaGuardianship.com

In every negotiation, there are winners and losers.  Perhaps there are other winners yet to be revealed. 

Who wins in Medicaid overhaul? | Top Story | Health News Florida.

FLORIDA UNITED FOR CHOICE –

________________________________________________________________________

WHY INCLUDING THE DEVELOPMENTALLY DISABLED OF FLORIDA INTO AN HMO MODEL IS NOT GOING TO WORK:

*We are fundamentally opposed to the aspect of Medicaid Reform that entrusts the coordination and care of the developmentally disabled of Florida to Health Maintenance Organizations (HMO’s). The current system of identifying, providing, overseeing, and funding of needed supports and services to the disabled of the state involves thousands of private contract HCBS Medicaid Waiver support and service providers who advocate for the needs of their caseloads and strive to get the needs of the developmentally disabled citizens of the State met. These providers work in concert with the state’s Agency for Persons with

Disabilities (APD) playing a significant role in quality assurance and oversight of the system. Surrendering the entire service system over to contracted HMO’s would eliminate choice, eliminate adequate oversight, and it would create a system nearly impossible for a developmentally disabled citizen and/or their family to navigate. Our reasons for opposing an HMO take over of the support and services system for the developmentally disabled of Florida are:

HMO is Not the Model That Best Serves the Developmentally Disabled Population

*There is something fundamentally different about being developmentally disabled versus any other kind of public assistance recipient — HMO is not geared for them.*

  • · Developmentally disabled (“DD”) recipients had absolutely no choice being born with their conditions and situations. They made no mistakes, errors in judgment and the nature of their assistance is hardly ever temporary.
  • · They will need life long care and support from an established cadre of specialized providers knowledgeable in DD issues. This care involves much more than merely medical concerns.
  • · There are social, self-care and self-advocacy issues that are unique to them. Many are non-verbal and nearly all could not successfully understand and navigate an HMO’s 1-800 number access system nor be able to advocate for their own needs effectively against an HMO’s opposition to funding services. Disabled people are easily intimidated and confused. Frequently they are cared for by highly stressed single caregivers. Yet they are lumped together with non-disabled welfare recipients.
  • · 30,000 people with disabilities and their families including over 2.7 million other voting Floridians will be negatively impacted. HMOs and PPNs are based on a medical model not on the special needs of DD consumers.

 

CHOICE

The thousands of service providers in the current system are hired and fired by the recipients of services THEMSELVES.

  • · In other words, the disabled of Florida now have the greatest choice in the freest fair-market system anywhere in the country. They have an independent case manager–a Support Coordinator whom they can hire and fire–whose overriding responsibility is to advocate for their preferences, help them identify their needs, and then assist them in navigating many complex service systems.
  • · When a disabled recipient is unhappy with the service provider (Support Coordinator, Respite provider, Companion, etc.), they can immediately terminate them and then be assisted in interviewing and locating a replacement provider that will best meet their needs.
  • · Going to an HMO model would eliminate this choice-based fair-market model. It would require them to rely on an HMO-funded case manager—a case manager WITHIN the HMO itself to push for support and service approvals and navigate the HMO’s complex requirements for these service approvals. In other words the HMO-funded case manager would be tasked with advocating against his own employer on behalf of the disabled person. This represents a debilitating conflict of interest as the HMO’s essential concern is profit and that case manager works for them. HMO’s have no established history of dealing effectively with this inherent conflict.
  • · A developmentally disabled recipient would essentially go from a model offering thousands of providers to a small handful. Opting for an HMO take-over of services for the developmentally disabled of Florida removes choice for these citizens and needlessly eliminates the highly specialized providers that these disabled individuals have known for years, come to trust, and who have developed an accurate and effective understanding of them and their needs. *This is a process that takes years with this population and equates in many cases to their avoiding institutionalization. Eliminating the independent provider system in favor of approximately 4 HMO’s carving up the state eliminates the current independent advocate provider system. This represents removing independent third party advocacy for the most vulnerable, poor and disabled population of the state.

Fiscal Responsibility:

It is understood that the state is in difficult financial times and that spending must be reduced.

  • · The developmentally disabled of Florida and their caregivers as well as the provider system that works for them understand the need for a sustainable system. The current Agency for Persons with Disabilities

(APD) and HCBS Medicaid Waiver systems afford the state an effective infrastructure to enforce accountability and compress funding when times are tough.

  • · Rather than paying HMO’s a fully-funded contract UP FRONT for five years, the current system allows the state to enact reductions at any time until the economic situation improves. Simply put, the current system allows the Florida state government real, dynamic flexibility. (*You can tear pages out of the

Waiver Services Handbook but keep the book so that when you can you add those pages BACK IN.)

  • · The current ‘Tier system’ places recipients into capped budgets. This is a ready infrastructure that allows you to decrease budgets for individuals receiving services when you have no other choice because of the economic situation. And again, when the budget improves, you can increase the Tier budgets for recipients.
  • · Once in a contract with an HMO you are stuck with that system for 5 years, regardless of how well or poorly the HMO performs. Historical data throughout the history of HMO’s in this country shows it is extremely difficult and costly to recoup funding from them when improprieties are discovered.

________________________________________________________________

Thanks to George Andrews, Medwaiver Support Coordinator, for sending this information:                         

  MANAGED CARE FOR PERSONS WITH DISABILITIES & MEDICAID BENEFICIARIES

Issue:  2.7 million Floridians including 30,000+ APD DD consumers will be required to join an HMO, Preferred Provider Networks (PPN) to receive benefits if Governor Crist doesn’t veto the new managed care bill  This will profoundly impact the quality, quantity and choices of services received. 

Read 66 page Bill:(HB 7223 > reconciled Senate/House version). DD section primarily on page 53 line 1471 to page 57 line 1585. 

Who:   Persons with Developmental Disabilities including Medicaid beneficiaries forced to join private manage care companies. 

When:  Managed Care will be phased in over the next 4 years with some changes 7-1-10. “By January 1, 2014, the agency shall begin implementation of statewide long-term care managed care for persons with developmental disabilities, with full implementation in all regions by October 1, 2015.”(line 1480-83)  House bill was heard in only 1 committee (not health committee) and passed all within 7 days (April 12-19, 2010)

Where:  Scope is the entire State of Florida, instead of continuing the current pilot project to ascertain if it really cuts cost and how if effects quality and availability of services. 

How:  The state will be divided into six regions that HMOs and PPNs will operate the managed care of all 2.7 million FL Medicaid beneficiaries.  The state will pay a monthly fee for each Medicaid beneficiary to the HMOs or PPNs instead of a fee for service.

Why:  HMOs and insurance companies have promoted a radical shift away from fee for service delivery system to a Medicaid managed care model that is privately operated with the promise that it will save the state 3% to 15%.  Additional motivation for this change was the $3 billion shortfall in revenues to meet the overall state budget along with the increasing Medicaid costs.  The problem is that the not so certain savings that were promised by HMOs, these savings will actually be used instead to pay for the HMO profits and administration.  

Impact of Change:  Medicaid beneficiaries such as DD Medicaid Waiver consumers will have less choice in selecting their providers.  Support Coordinators and other providers will be eliminated since HMOs / PPNs will hire their own case managers and decide which new cheaper providers to use.  As a result, quality and quantity of services will most certainly decrease since manage care providers have a vested interest in cutting services to maximize their profits.  If you like HMOs, you may like the change. 30,000 people with disabilities and their families including over 2.7 million other voting Floridians will be negatively impacted.  HMOs and PPNs are based on a medical model not on the special needs of DD consumers.  Over 15,000 persons with disabilities will remain on the wait list.  No impact in reducing the wait. There will also be thousands of people that will likely lose their job once implemented since HMOs and PPNs would employ their own people discarding many of the current providers of care.  Billions of state funded dollars may also leave the State of Florida if any of the new HMOs or PPNs are located outside of the state.  How does this change improve Florida’s economy and jobs?

Action you can take:  Get involved now! Contact Governor Crist.  Call, fax (850) 487-0801  email Charlie.Crist@MyFlorida.com  , or write a letter to Governor Crist @:  Office of Governor Charlie Crist State of Florida The Capitol 400 S. Monroe St. Tallahassee, FL 32399-0001.  In addition to telling him in a polite, respectful manner you are against this mandated managed care change, tell him briefly how it will affect you in a very short example.  (A sample letter is below).   Tell as many elderly and disabled people on Medicaid about this and offer to help them contact Governor Crist to veto.  Be sure to thank the governor for his veto protecting the most vulnerable, poor and disabled in addition to standing on principle of opposing the same legislatively manipulated process this bill took as the teacher Merit pay bill. Managed Care bill: Total time in House =1 week, no notice to 2.7 million beneficiaries,

only 1 committee had input and was clearly an abuse of the intended legislative procedure and process. 

Solution: Governor Crist vetoes bill. If reductions in state programs are still necessary to balance budget, then do take across the board reductions instead of managed care bill.  This bill removes choice and capriciously eliminates providers that have in many cases known for years the beneficiaries and their needs.  Eliminating providers such as support coordinators will be removing independent third party advocacy for the most vulnerable, poor and disabled population without a voice. If governor does not veto, at least require HMOs to respect the choice of DD consumer as to whether keep the current support coordinator and other providers.  This demonstrates respect for choice and some continuity. Or instead increase the scope of the pilot study currently underway or allow more time to study the results of the current pilot project to see if it actually works.

Here is how your State of FL Representative voted on this bill.  (Info provided is subject to change)

                       “A society will be judged on how it treats its weakest members”.

Dear Governor Crist,                 

ISSUE:  House and Senate Bill Related to Medicaid Reform and Implementation of HMO Management of the HCBS Medicaid Waiver  HB 7723

Question:  Should the State be Divided Into Regions Managed by HMO’s and Preferred Provider Networks

ANSWER:  NO!   PLEASE VETO THIS BILL

I realize you have difficult budget decisions to make. But please DO NOT SIGN the Medicaid Reform Bill.

The House and Senate adopted these bills, written largely if not entirely by a lobbyist for one of the HMO’s, without due consideration for the data available from the pilot study of this being conducted in the Miami-Dade area of the state. The reviews from those areas are mixed and hardly conclusive in showing that they improve the quality of life for any of the disabled citizens they are supposed to serve. In fact, there are numerous concerns among a great many recipients of services in those areas regarding the loss of choice and the significant decrease in the quality of services received under the HMO system. These bills were rushed through both the House (introduced in only 1 committee and 1 week later  voted on house floor-does that sound familiar?) and Senate with limited transparency and little deliberation–as if the deals for approval were made well in advance of the readings.   Is this the type of example and values we want to teach our young voters?  The message sent was that the rich and powerful can quickly force a dramatic change on the elderly and disabled without any notice or input from the very people the new law will affect.  

The current system involves the Agency for Persons with Disabilities (APD) playing a significant role in quality assurance and private contract HCBS Medicaid Waiver providers who advocate for the needs of their caseloads working together to get the needs of the developmentally disabled citizens of the state met. It has been working very well and though harsh, the cost containment efforts of this current system are finally showing significant gains while still allowing the State of Florida a good measure of control over the quality of services provided. Surrendering the entire service system over to greedy, profit-hungry HMO entities is NOT the way we want the State of Florida to go. 

If you still are inclined to support this proposal, please first consider increasing the scope of the pilot study currently underway or allow more time to study the results of the current pilot project to see if it actually works.  Make sure this proposal is proved before inflicting this drastic change on more than 30,000 people with disabilities and their families and over 2.7 million other voting Floridians.  There will also be thousands of employees within companies that will likely lose their job once implemented since HMOs and PPNs would employ their own people.  Billions of state funded dollars may also leave the State of Florida if any of the new HMOs or PPNs are located outside of the state.  Will this improve our economy and jobs? 

I am earnestly asking you to VETO the Medicaid Reform Bill and allow the current system with any necessary cost reductions to work. There are NO winners in this bill with the sole exception of HMO’s.

Thank you.

This is an e-mail I received this morning from Richard Stimson, Special Gathering executive director.  It gives a somewhat clearer picture of what and why this new bill is happening.  Below his short note is a notice from Florida Developmental Disabilities Council which we have published earlier.

Hi All:

 I am directing this e-mail mostly at Special Gathering families, but have copied a few others also.  I wanted to make sure you saw this e-mail from the Florida Developmental Disabilities Council about Medicaid Manage Care.

I would advise you to speak to your Support Coordinator about this quickly.  Please understand that it has not been passed yet, but the thinking is that it will pass (well I guess it has passed the house).  I am also concerned that no one is really on top of how this will affect our folks (please note the 5th word in the forwarded e-mail is “SURPRISED.”).  It appears no one knew this was coming.  

This one just feels different than past problems.  No one can question our state and nation have major financial problems.  Often when there has been legislation that concerned us it was a law about developmental disabilities.  This law change really is not about us.  We are just pulled into the changes because our funding stream is now connected to Medicaid (this has not always been true).  The growth in Medicaid cost keeps growing and our state leaders are trying to get the increasing cost under control. 

Just wanted to make sure you have the information.

Blessings,

Richard Stimson


From: Florida Developmental Disabilities Council [mailto:vandab@fddc.org]
Sent: Wednesday, April 14, 2010 9:48 AM
To: specialgathering@yahoo.com
Subject: Capitol Update * Volume 10 * Issue 4

 

 

 

 

Announcement from the

Florida Developmental Disabilities Council

 

 

 

April 14, 2010    Volume 10, Issue

Florida Developmental Disabilities Council, Inc.
124 Marriott Drive, Suite 203, Tallahassee, FL 32301-2981
Phone: (850) 488-4180 / (800) 580-7801 ~ Fax: (850) 922-6702 ~ TDD (850) 488-0956 / (888) 488-8633

http://www.fddc.org/ 

 

                                   Medicaid Managed Care
 
This week everyone was surprised when the House Select Committee on the Economic and Strategic Policy released two major Medicaid Managed Care bills that directly impact people with developmental disabilities. These Medicaid reform bills put all Medicaid services (with few exceptions) under a managed care entity that could be either a Health Maintenance Organization (HMO) or a Provider Services Network (PSN). The key features of the bill, PCB SPCSEP 10-03- (link here) Medicaid Managed Care, include the following:
 
· All purchased Medicaid services will be under managed care. There will be no 

  exceptions or “carve outs”.
· For people with developmental disabilities, this includes all Waiver services, all private
  Intermediate Care Facilities for the Developmentally Disabled (ICF/DD) services, and

  all basic health care services.
· The only services not subject to managed care will be those provided at state-run

  institutions.
· The effective date for HMOs or PSNs to begin delivering services to people with

  developmental disabilities is 2015.
· The state will be divided into six areas with at least two HMOs and one PSN managing

   services in each area.
· The tier system is continued except that a fifth level is added for services provided

   by private ICF/DDs.
· The managed care entity is expected to save 8% of the current cost of care with a

   preferred savings of 15%.
· The savings will be used to pay for the administrative costs (overhead and profits) of

  the HMO or PSN.
· No additional funds can be expected to offset their costs and the waiting list will not

  be initially addressed.
 
The Agency for Persons with Disabilities (APD) functions would be limited to managing the two remaining state institutions, the forensic programs and a small general revenue program. Case management would be provided by the HMO or PSN and independent support coordination would be eliminated.
 
The House, the Select Committee on Economic and Strategic Policy heard its proposed committee Medicaid reform bill on Monday. The Senate Health Regulation Committee will hear the proposal on Wednesday and Thursday. Then the bill would be negotiated between the House and the Senate.
 
The Florida Developmental Disabilities Council will be working with members of the Senate Health Regulation Comittee,and Health and Human Services Appropriations Committee and Senate President Atwater .
 
Our message will be to develop a plan and specialty networks for individuals with developmental disabilities for basic health care needs and pilot the plan in the existing pilot counties.
 
Also we are advocating that the Agency for Persons with Disabilities and the Individual Budget( IBudget) system be used to manage the care provided by the Developmental Disabilities Home and Community Based Waiver.
 
Please call your legislators and let your opinion be heard! 

 

 

 

HB 81 – Relating to Use, Prevention, and Reduction of Seclusion and Restraint on Students with Disabilities in Public Schools
by Hukill Cosponsors: Anderson, Brandenburg, Burgin, Flores, Fresen, Glorioso, Gonzalez, Heller, Hudson, Jenne, Kiar, Llorente, McBurney, Nehr, Pafford, Planas, Porth, Precourt, Sachs, Schenck, Schultz, Schwartz, Skidmore, Soto, Stargel, Steinberg, Tobia, Williams (T), Zapata
Summary
During the PreK-12 Policy Committee on March 25th, HB 81 passed! This marked the first time a bill on guidelines for Restraint and Seclusion had passed a committee. A House Proposed Committee Substitute (PCS) combined this bill with HB 1073(see next bill below). The original bill was laid on Table so from now on we will refer to the combined HB 1073.
 
The Council has taken a supporting the original legislation. Council position    
  
Effective Date: July 1, 2010
Actions

08/20/09 HOUSE Filed
10/01/09 HOUSE Referred to PreK-12 Policy Committee; Health Care Services Policy Committee; PreK-12 Appropriations Committee; Education Policy Council 
03/25/10 HOUSE PCS combines this bill with H 1073; Original bill laid on Table, refer to combined H 1073
Similar Bills
SB 2118 – Relating to Students with Disabilities/Seclusion/Restraint by Gardiner
03/01/10 SENATE Referred to Education Pre-K – 12; Children, Families, and Elder Affairs; Education Pre-K – 12 Appropriations
03/23/10 SENATE Temporarily postponed by Education Pre-K – 12
04/06/10 SENATE Favorable with CS by Education Pre-K – 12; 7 Yeas, 0 Nays 
04/09/10 SENATE Committee Substitute Text (C1) Filed
04/12/10 SENATE Now in Children, Families, and Elder Affairs  
 
 
SB 1166  – Relating to Community Residential Homes by Altman
Co-Sponsors: Storms
Summary
This bill prohibits rules adopted by the Agency for Persons with Disabilities from restricting the number of facilities designated as community residential homes located within a planned residential community. The bill also defines the term “planned residential community” and provides that community residential homes located within a planned residential community may be contiguous to one another and exempt from the 1000 foot rule. The 1000 foot rule states that group homes that have six beds or less may not be within 1000 feet of each other. Position

EFFECTIVE DATE: 07/01/2010.
Actions
01/21/10 SENATE  Referred to Community Affairs; Children, Families, and Elder Affairs
02/16/10 SENATE  Favorable by Community Affairs; 10 Yeas, 0 Nays
03/26/10 SENATE Favorable by Children, Families, and Elder Affairs; 6 Yeas, 0 Nays
03/29/10 SENATE Placed on Calendar, on second reading
Identical Bills

HB 0645 – Relating to Community Residential Homes by Stargel
Actions
01/28/10 HOUSE Referred to Military & Local Affairs Policy Committee; Health Care Services Policy Committee; Economic Development & Community Affairs Policy Council
03/25/10 HOUSE Favorable with CS by Military & Local Affairs Policy Committee; 9 Yeas, 4 Nays
03/30/10 HOUSE Committee Substitute Text (C1) Filed 
04/05/10 HOUSE Reference to Health Care Services Policy Committee Removed; Reference to Health & Family Services Policy Council Added; Remaining references: Health & Family Services Policy Council; Economic Development & Community Affairs Policy Council
04/05/10 HOUSE Now in Health & Family Services Policy Council
04/09/10 HOUSE On Council agenda – Health & Family Services Policy Council, 04/13/10, 9:15 am, 212 K 

 

 

 

SB 1388   – Relating to Intellectual Disabilities by Haridopolos
Summary
This bill amends provisions in statute by substituting the term “intellectual disability” for the term “mental retardation.” The bill revises definitions relating to intermediate care facilities for the developmentally disabled to delete unused terms. The bill also provides that the name Arc of Florida is substituted for the Association for Retarded Citizens. This bill is a “reviser bill”. It provides a directive to theDivision of Statutory Revision.
EFFECTIVE DATE: 07/01/2010.
Committees of Reference
Children, Families, and Elder Affairs, Criminal Justice, Judiciary, Health and Human Services Appropriations
Actions
01/26/10 SENATE  Filed
03/26/10 SENATE Favorable with CS by Children, Families, and Elder Affairs; 6 Yeas, 0 Nays
03/29/10 SENATE Committee Substitute Text (C1) Filed
04/08/10 SENATE On Committee agenda – Criminal Justice, 04/13/10, 9:30 am, 37 S
 
SB 2038 – Relating to Medicaid Buy-in Program/Persons with Disabilities by Crist 
Summary
The bill provided for Medicaid eligibility for certain persons with disabilities under a Medicaid buy-in program, subject to specific federal authorization. The proposed Work Incentive Medicaid Coverage program would continue to offer Medicaid coverage to people with disabilities who are working. Once they enrolled in the program they would have the opportunity to earn more and save more than the allowable limits for regular Medicaid and still retain their health care coverage through the State’s Medicaid Program. The bill requires the Department of Children and Family Services to adopt rules for determining eligibility. The bill also directs the Department of Health to perform all disability determinations. Finally, the bill requires the Agency for Health Care Administration to seek amendments to specified Medicaid waivers for certain persons with disabilities. The Council supports this Council Position   EFFECTIVE DATE: 07/01/2010.
Committees of Reference
Health Regulation, Children, Families, and Elder Affairs, Health and Human Services Appropriations; Policy and Steering Committee on Ways and Means
Actions
02/16/10 SENATE Filed
03/01/10 SENATE Referred to Health Regulation; Children, Families, and Elder Affairs; Health and Human Services Appropriations; Policy & Steering Committee on Ways and Means 03/26/10 SENATE Favorable with CS by Health Regulation; 5 Yeas, 0 Nays
04/07/10 SENATE Favorable by Children, Families and Elder Affairs; 7 Yeas, 0 Nays 
04/08/10 SENATE Now in Health and Human Services Appropriations 
Similar Bills
HB 0837 – Relating to Medicaid Buy-in for Persons with Disabilities by Homan
02/10/10 HOUSE Referred to Health Care Regulation Policy Committee; Health Care Appropriations Committee; Health & Family Services Policy Council
2/10/10 HOUSE Now in Health Care Regulation Policy Committee
 
SB 0214 -Relating to Autism by Ring                             
Summary
This bill requires a physician to refer a minor whose parent suspects the minor has an autism spectrum disorder, cerebral palsy, or Down syndrome to an appropriate specialist for screening, evaluation, or diagnosis. The bill requires health insurers and health maintenance organizations to provide direct access to an appropriate specialist for a diagnosis. The terms “direct access” and “appropriate specialist” are defined in the bill. The bill mandates health insurance policies and health maintenance organization contracts to provide at least three visits per policy year for the screening, evaluation, or diagnosis of autism spectrum disorder, cerebral palsy, or Down syndrome.
EFFECTIVE DATE: 07/01/2010.
Actions                                  
10/05/09 SENATE Filed                               
12/09/09 SENATE Referred to Health Regulation; Banking and Insurance; Policy &  Steering Committee on Ways and Means
03/09/10 SENATE Favorable with CS by Health Regulation; 7 Yeas, 0 Nay
03/11/10 SENATE Committee Substitute Text (C1) Filed                           
03/15/10 SENATE Reference to Governmental Oversight and Accountability added; Remaining references: Banking and Insurance; Governmental Oversight and Accountability; Policy & Steering Committee on Ways and Means
03/24/10 SENATE Favorable with CS by Banking and Insurance; 10 Yeas, 0 Nays
04/06/10 SENATE Favorable with CS by Governmental Oversight and Accountability; 7 Yeas, 1 Nay 
04/07/10 SENATE Committee Substitute Text (C3) Filed
04/09/10 SENATE Now in Policy & Steering Committee on Ways and Means 
Compare
HB 0107 -Relating to Autism by Coley                               
09/11/09 HOUSE Filed
10/12/09 HOUSE Referred to Health Care Regulation Policy Committee; Insurance, Business & Financial Affairs Policy Committee; Government Operations Appropriations Committee; General Government Policy Council
03/22/10 HOUSE Favorable with CS by Health Care Regulation Policy Committee; 10 Yeas, 1 Nay
03/30/10 HOUSE Committee Substitute Text (C1) Filed 
04/05/10 HOUSE Reference to Insurance, Business & Financial Affairs Policy Committee Removed; Remaining References: Government Operations Appropriations Committee; General Government Policy Council
04/09/10 HOUSE Favorable by Government Operations Appropriations Committee; 8 Yeas, 3 Nays
04/09/10 HOUSE Now in General Government Policy Council 

 

 

 

SB 0222  -Relating to Childhood Vaccinations by Ring  
Summary                  
This bill requires a pediatrician or attending physician to discuss the risks, benefits, and alternatives of each vaccination before a child is vaccinated. The bill provides requirements for the administration of certain vaccines required for school entry. Licensed health care providers will be required to provide certain vaccine information statements to parents, legal guardians, and legal representatives before administering certain vaccines to children.

EFFECTIVE DATE: 07/01/2010.     
Actions                      
10/05/09 SENATE Filed                               
12/09/09 SENATE Referred to Health Regulation; Children, Families, and Elder Affairs; Policy & Steering Committee on Ways and Means                                
Similar
HB 0117 -Relating to Childhood Vaccinations by Ambler  
09/15/09 HOUSE Filed
10/12/09 HOUSE Referred to Health Care Regulation Policy Committee; PreK-12 Appropriations Committee; Civil Justice & Courts Policy Committee; Health Care Appropriations Committee 
02/16/10 HOUSE Temporarily postponed by Health Care Regulation Policy Committee
03/01/10 HOUSE Withdrawn prior to introduction   
 
SB 0490 -Relating to Dentistry by Smith                         
Summary
This bill defines the term “public health supervision” and redefines the term “health access settings” to include school-based prevention programs. The bill would authorize dental hygienists to perform certain additional dental hygiene services under public health supervision. The bill provides that certain tasks are remediable and delegable to dental hygienists in certain settings. The bill includes a list of remediable and delegable tasks.

EFFECTIVE DATE: 07/01/2010.
Actions                                  
10/20/09 SENATE Filed                               
12/09/09 SENATE Referred to Health Regulation; Education Pre-K – 12; Health and Human Services Appropriations
Similar                                   
HB 1469 -Relating to Dentistry and Dental Hygiene by Patterson
03/10/10 HOUSE Referred to Health Care Regulation Policy Committee; Health Care Appropriations Committee; Health & Family Services Policy Council
03/10/10 HOUSE Now in Health Care Regulation Policy Committee 

 

 

 

HB 0719 -Relating to Child Care by Zapata                             
Summary
This bill revises provisions relating to standards that child care facilities must meet to obtain and maintain a Gold Seal Quality Care provider designation. The bill requires the Department of Children and Families to notify specified accrediting associations upon adoption of additional or revised Gold Seal Quality Care program standards. This bill also revises minimum age requirements and establishes minimum education standards for child care personnel. Minimum staff credential requirements are redefined. Effective Date: July 1, 2010           
Actions                      
01/19/10 HOUSE Filed                                 
01/28/10 HOUSE Referred to Health Care Services Policy Committee; Health Care Appropriations Committee; Health & Family Services Policy Council                              
01/28/10 HOUSE Now in Health Care Services Policy Committee                         
Similar
SB 1382-Relating to Child Care Facilities by Rich           02/03/10         
02/03/10 SENATE Referred to Children, Families, and Elder Affairs; Health and Human Services Appropriations
03/26/10 SENATE Favorable with CS by Children, Families, and Elder Affairs; 6 Yeas, 0 Nays
03/26/10 SENATE Favorable with CS by Children, Families, and Elder Affairs; 6 Yeas, 0 Nays 
03/29/10 SENATE Committee Substitute Text (C1) Filed
04/01/10 SENATE Now in Health and Human Services Appropriations 
04/08/10 SENATE On Committee agenda – Health and Human Services Appropriations, 04/13/10, 2:45 pm, 110 S            
 
HB 1505-Relating to John M. McKay Scholarships for Students with Disabilities Program by Flores                                             
Summary
This bill revises student eligibility requirements for participation in this scholarship program. It authorizes students who are eligible to enter kindergarten to receive the John M. McKay Scholarship. It provides eligibility requirements for students identified with a developmental delay and authorizes students who were enrolled and reported by a school district for funding during any prior year to receive the scholarship. The bill authorizes the Commissioner of Education to deny, suspend, or revoke a private school’s participation in the program for certain acts or omissions by owner or operator. And finally the bill permits students to receive instruction and services at a site other than the physical location of the private school under specified conditions. Effective Date: July 1, 2010    
Actions                      
03/01/10 HOUSE Filed                                 
03/10/10 HOUSE Referred to PreK-12 Policy Committee; PreK-12 Appropriations Committee; Education Policy Council                                   
03/17/10 HOUSE Favorable with CS by PreK-12 Policy Committee; 12 Yeas, 0 Nays
03/18/10 HOUSE Committee Substitute Text (C1) Filed                             
03/26/10 HOUSE Favorable by PreK-12 Appropriations Committee; 8 Yeas, 0 Nays
 04/07/10 HOUSE Favorable by Education Policy Council; 16 Yeas, 0 Nays
 04/07/10 HOUSE Placed on Calendar, on second reading
Compare
SB 2746 -Relating to Education Programs for Children with Disabilities by Gardiner
03/09/10 SENATE Referred to Education Pre-K – 12; Commerce; Education Pre-K – 12 Appropriations            
04/09/10 SENATE On Committee agenda – Education Pre-K – 12, 04/14/10, 1:00 pm, 301 S
 
SB 2192 -Relating to Prepaid Developmental Disabilities Savings Program Peaden, Jr.       
Summary      
This bill provides for administration and management of the savings program by the Florida Prepaid College Board in conjunction with the Stanley G. Tate Florida Prepaid College Program. The bill provides that the prepaid contract fund and the investment fund shall consist of certain moneys. The bill creates the Prepaid Services for Parents of Children with Developmental Disabilities Study Group. 
Effect of Proposed Changes: The Savings Program provides that the legislature intends:

·The creation of such a program can offer accessibility to services regardless of a family’s income,

  insurance or Medicaid eligibility.
· A program consisting of a prepaid contract plan and an investment plan will allow for advance payment

  of or saving for the costs associated with developmentally disabled children as they age out of the

  education system.
· The prepaid contract plan is to be interchangeable with an advance payment plan of the Stanley G.

  Tate Florida Prepaid College Program.
· The investment plan is to be a supplement or alternative to the prepaid contract plan, which will allow

   funds to be placed in trust to meet future needs.
· The program is to be conducted to maximize program efficiency and effectiveness. 
EFFECTIVE DATE: 07/01/2010.
Actions                                  
02/18/10 SENATE Filed                               
03/01/10 SENATE Referred to Children, Families, and Elder Affairs; Governmental Oversight and Accountability; Finance and Tax; Higher Education Appropriations; Policy & Steering Committee on Ways and Means   
03/18/10 SENATE Favorable with CS by Children, Families, and Elder Affairs; 8 Yeas, 0 Nays 03/22/10 SENATE Committee Substitute Text (C1) Filed
04/09/10 SENATE On Committee agenda – Governmental Oversight and Accountability, 04/14/10, 1:00 pm, 110 S
Identical
HB 1111-Relating to Prepaid Developmental Disabilities Savings Program by Ford                      
03/01/10 HOUSE Referred to Health Care Services Policy Committee; State Universities & Private Colleges Policy Committee; Full Appropriations Council on Education & Economic Development; Health & Family Services Policy Council 

HOUSE Now in Health Care Services Policy Committee   

 

 

 

SB 2200 – Relating to Allocation/Expenditure of State Lottery Revenues by Altman
Summary
This bill requires net proceeds from a scratch-off lottery game to be allocated to the Division of Vocational Rehabilitation in the Department of Education to be distributed to programs offering services to individuals with developmental disabilities. EFFECTIVE DATE: 07/01/2010.
Actions
02/18/10 SENATE Filed
03/01/10 SENATE Referred to Regulated Industries; Education Pre-K – 12; Education Pre-K – 12 Appropriations; Policy & Steering Committee on Ways and Means 
Identical Bills
HB 0943 – Relating to Allocation and Expenditure of State Lottery Revenues by Proctor
02/18/10 HOUSE Referred to PreK-12 Appropriations Committee; Governmental Affairs Policy Committee; Full Appropriations Council on Education & Economic Development
 
 
HB 5303  -Relating to Agency for Persons with Disabilities Health Care Appropriations Committee
Summary
This bill revises provisions relating to order of priority for clients with developmental disabilities waiting for waiver services and extends the date for implementation for certain categories of clients. The bill specifies assessment instruments to be used for delivery of home and community-based services and provides a limit on annual expenditures for clients with certain service needs. The bill directs the agency to eliminate behavior assistance services and reduces the geographic differential for Miami-Dade, Broward, Palm Beach, and Monroe Counties for residential habilitation services. Finally, the bill establishes the iBudget program for delivery of home and community-based services and provides for hearings on Medicaid programs administered by the agency. Effective Date: July 1, 2010  
03/17/10 HOUSE Filed (Formerly Filed PCB HCA3)
03/18/10 HOUSE Referred to Full Appropriations Council on Education & Economic Development
03/23/10 HOUSE Favorable by Full Appropriations Council on Education & Economic Development; 12 Yeas, 6 Nays
03/23/10 HOUSE Placed on Calendar, on second reading
03/23/10 HOUSE Placed on Special Order Calendar for 03/31/10
Compare
SB 1468  Relating to Home and Community-based Services by Peaden, Jr. 
01/27/10 SENATE Filed
02/03/10 SENATE Referred to Health and Human Services Appropriations; Policy & Steering Committee on Ways and Means; Rules 
03/19/10 SENATE Favorable with CS by Health and Human Services Appropriations; 4 Yeas, 2 Nays
03/19/10 SENATE Committee Substitute Text (C1) Filed
03/22/10 SENATE Reference to Rules removed; remaining references: Policy & Steering Committee on Ways and Means 
03/26/10 SENATE Favorable with CS by Policy & Steering Committee on Ways and Means; 16 Yeas, 4 Nays
03/26/10 SENATE Committee Substitute Text (C2) Filed
03/30/10 SENATE Placed on Calendar, on second reading
03/31/10 SENATE Read Second Time; Read Third Time; Passed (Vote: 26 Yeas / 10 Nays)

Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 1 of 8 CHAMBER ACTION

Senate House

.

Representative Grimsley offered the following: 1

2

Amendment (with title amendment) 3

Remove lines 379-384 and insert: 4

(9)(a) The agency, in consultation with the Agency for 5 Health Care Administration, shall establish an individual 6 budget, referred to as an iBudget, demonstration project for 7 each individual served through the Medicaid waiver program in 8 Escambia, Okaloosa, Santa Rosa, and Walton Counties, which 9 comprise area one of the agency. For the purpose of this 10 subsection, the Medicaid waiver program includes the four-tiered 11 waiver system established in subsection (3) or the Consumer 12 Directed Care Plus Medicaid waiver program. The funds 13 appropriated to the agency and used for Medicaid waiver program 14 services to individuals in the demonstration project area shall 15 be allocated through the iBudget system to eligible, Medicaid-16 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 2 of 8

enrolled clients. The iBudget system shall be designed to 17 provide for enhanced client choice within a specified service 18 package, appropriate assessment strategies, an efficient 19 consumer budgeting and billing process that includes 20 reconciliation and monitoring components, a redefined role for 21 support coordinators that avoids potential conflicts of 22 interest, a flexible and streamlined service review process, and 23 a methodology and process that ensure the equitable allocation 24 of available funds to each client based on the client’s level of 25 need, as determined by the variables in the allocation 26 algorithm. 27

1. In developing each client’s iBudget, the agency shall 28 use an allocation algorithm and methodology. The algorithm shall 29 use variables that have been determined by the agency to have a 30 statistically validated relationship to the client’s level of 31 need for services provided through the Medicaid waiver program. 32 The algorithm and methodology may consider individual 33 characteristics, including, but not limited to, a client’s age 34 and living situation, information from a formal assessment 35 instrument that the agency determines is valid and reliable, and 36 information from other assessment processes. 37

2. The allocation methodology shall provide the algorithm 38 that determines the amount of funds allocated to a client’s 39 iBudget. The agency may approve an increase in the amount of 40 funds allocated, as determined by the algorithm, based on the 41 client’s having one or more of the following needs that cannot 42 be accommodated within the funding as determined by the 43 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 3 of 8

algorithm and having no other resources, supports, or services 44 available to meet those needs: 45

a. An extraordinary need that would place the health and 46 safety of the client, the client’s caregiver, or the public in 47 immediate, serious jeopardy unless the increase is approved. An 48 extraordinary need may include, but is not limited to: 49

(I) A documented history of significant, potentially life-50 threatening behaviors, such as recent attempts at suicide, 51 arson, nonconsensual sexual behavior, or self-injurious behavior 52 requiring medical attention; 53

(II) A complex medical condition that requires active 54 intervention by a licensed nurse on an ongoing basis that cannot 55 be taught or delegated to a nonlicensed person; 56

(III) A chronic co-morbid condition. As used in this sub-57 sub-subparagraph, the term “co-morbid condition” means a medical 58 condition existing simultaneously with but independently of 59 another medical condition in a patient; or 60

(IV) A need for total physical assistance with activities 61 such as eating, bathing, toileting, grooming, and personal 62 hygiene. 63

64

However, the presence of an extraordinary need alone does not 65 warrant an increase in the amount of funds allocated to a 66 client’s iBudget as determined by the algorithm. 67

b. A significant need for one-time or temporary support or 68 services that, if not provided, would place the health and 69 safety of the client, the client’s caregiver, or the public in 70 serious jeopardy unless the increase is approved. A significant 71 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 4 of 8

need may include, but is not limited to, the provision of 72 environmental modifications, durable medical equipment, services 73 to address the temporary loss of support from a caregiver, or 74 special services or treatment for a serious temporary condition 75 when the service or treatment is expected to ameliorate the 76 underlying condition. As used in this sub-subparagraph, the term 77 “temporary” means lasting for a period of less than 12 78 consecutive months. However, the presence of such significant 79 need for one-time or temporary support or services alone does 80 not warrant an increase in the amount of funds allocated to a 81 client’s iBudget as determined by the algorithm. 82

c. A significant increase in the need for services after 83 the beginning of the service plan year that would place the 84 health and safety of the client, the client’s caregiver, or the 85 public in serious jeopardy because of substantial changes in the 86 client’s circumstances, including, but not limited to, permanent 87 or long-term loss or incapacity of a caregiver, loss of services 88 authorized under the state Medicaid plan due to a change in age, 89 or a significant change in medical or functional status that 90 requires the provision of additional services on a permanent or 91 long-term basis that cannot be accommodated within the client’s 92 current iBudget. As used in this sub-subparagraph, the term 93 “long-term” means lasting for a period of more than 12 94 continuous months. However, such significant increase in need 95 for services of a permanent or long-term nature alone does not 96 warrant an increase in the amount of funds allocated to a 97 client’s iBudget as determined by the algorithm. 98

99 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 5 of 8

The agency shall reserve portions of the appropriation for the 100 home and community-based services Medicaid waiver program for 101 adjustments required pursuant to this subparagraph and may use 102 the services of an independent actuary in determining the amount 103 of the portions to be reserved. 104

3. A client’s iBudget shall be the total of the amount 105 determined by the algorithm and any additional funding provided 106 under subparagraph 2. A client’s annual expenditures for 107 Medicaid waiver services may not exceed the limits of his or her 108 iBudget. 109

(b) The Agency for Health Care Administration, in 110 consultation with the agency, shall seek federal approval for 111 the iBudget demonstration project and amend current waivers, 112 request a new waiver if appropriate, and amend contracts as 113 necessary to implement the iBudget system to serve eligible, 114 enrolled clients in the demonstration project area through the 115 Medicaid waiver program. 116

(c) The agency shall transition all eligible, enrolled 117 clients in the demonstration project area to the iBudget system. 118 The agency may gradually phase in the iBudget system with full 119 implementation by January 1, 2013. 120

1. The agency shall design the phase-in process to ensure 121 that a client does not experience more than one-half of any 122 expected overall increase or decrease to his or her existing 123 annualized cost plan during the first year that the client is 124 provided an iBudget due solely to the transition to the iBudget 125 system. However, all iBudgets in the demonstration project area 126 must be fully phased in by January 1, 2013. 127 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 6 of 8

(d) A client must use all available services authorized 128 under the state Medicaid plan, school-based services, private 129 insurance and other benefits, and any other resources that may 130 be available to the client before using funds from his or her 131 iBudget to pay for support and services. 132

(e) The service limitations in subparagraphs (3)(f)1., 2., 133 and 3. shall not apply to the iBudget system. 134

(f) Rates for any or all services established under rules 135 of the agency shall be designated as the maximum rather than a 136 fixed amount for individuals who receive an iBudget, except for 137 services specifically identified in those rules that the agency 138 determines are not appropriate for negotiation, which may 139 include, but are not limited to, residential habilitation 140 services. 141

(g) The agency shall ensure that clients and caregivers in 142 the demonstration project area have access to training and 143 education to inform them about the iBudget system and enhance 144 their ability for self-direction. Such training shall be offered 145 in a variety of formats and, at a minimum, shall address the 146 policies and processes of the iBudget system; the roles and 147 responsibilities of consumers, caregivers, waiver support 148 coordinators, providers, and the agency; information available 149 to help the client make decisions regarding the iBudget system; 150 and examples of support and resources available in the 151 community. 152

(h)1. The agency, in consultation with the Agency for 153 Health Care Administration, shall prepare a design plan for the 154 purchase of an evaluation by an independent contractor. The 155 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 7 of 8

design plan to evaluate the iBudget demonstration project shall 156 be submitted to the President of the Senate and the Speaker of 157 the House of Representatives for approval not later than 158 December 31, 2010. 159

2. The agency shall prepare an evaluation that shall 160 include, at a minimum, an analysis of cost savings, cost 161 containment, and budget predictability. In addition, the 162 evaluation shall review the demonstration with regard to 163 consumer education, quality of care, affects on choice of and 164 access to services, and satisfaction of demonstration project 165 participants. The agency shall submit the evaluation report to 166 the Governor, the President of the Senate, and the Speaker of 167 the House of Representatives no later than December 31, 2013. 168

(i) The agency shall adopt rules specifying the allocation 169 algorithm and methodology; criteria and processes for clients to 170 access reserved funds for extraordinary needs, temporarily or 171 permanently changed needs, and one-time needs; and processes and 172 requirements for selection and review of services, development 173 of support and cost plans, and management of the iBudget system 174 as needed to administer this subsection. 175

(10) The agency shall develop a transition plan for 176 recipients who are receiving services in one of the four waiver 177 tiers at the time qualified plans are available in each 178 recipient’s region pursuant to s. 409.989(3) to enroll those 179 recipients in qualified plans. 180

(11) This section expires October 1, 2015. 181

182

183 HOUSE AMENDMENT Bill No. HB 7225 (2010) Amendment No. 311719 Approved For Filing: 4/14/2010 1:57:04 PM Page 8 of 8

—————————————————– 184

T I T L E A M E N D M E N T 185

Between lines 4 and 5, insert: 186

providing for an establishment of an iBudget demonstration 187 project by the Agency for Persons with Disabilities, in 188 consultation with the Agency for Health Care 189 Administration, in specified counties; providing for 190 allocation of funds; providing goals; providing for an 191 allocation algorithm and methodology for development of a 192 client’s iBudget; providing for the seeking of federal 193 approval and waivers; providing for a transition to full 194 implementation; providing for inapplicability of certain 195 service limitations; providing for setting rates; providing 196 for client training and education; providing for 197 evaluation; requiring a report; requiring rulemaking; 198