HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/CS/HB 1271 Individuals with Disabilities
SPONSOR(S): Health & Human Services Committee, Health Care Appropriations Subcommittee, Children,
Families & Seniors Subcommittee, Buchanan
TIED BILLS: IDEN./SIM. BILLS: SB 1758
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY
CHIEF
1) Children, Families & Seniors Subcommittee 15 Y, 0 N, As Lloyd Brazzell
CS
2) Health Care Appropriations Subcommittee 15 Y, 0 N, As Fontaine Clark
CS
3) Health & Human Services Committee 19 Y, 0 N, As Lloyd Calamas
CS
SUMMARY ANALYSIS
The Agency for Persons with Disabilities (APD) provides services to eligible individuals with developmental
disabilities which includes those persons served under a Medicaid Home and Community-Based Services
(HCBS) waiver. The HCBS waiver allows individuals to continue to live in their own homes or in another home-
like setting and avoid institutionalization. Applications submitted to APD using a paper application are reviewed
under statutory deadlines. Most eligible individuals are initially placed on a pre-enrollment list; some can wait
for years before funding is available for waiver enrollment.
CS/CS/CS/HB 1271 enhances the individual’s eligibility and enrollment experience by:
Requiring an online application process;
Specifying the steps or documentation required to submit a “complete” application;
Requiring APD to communicate with applicants about certain application actions; and
Specifying time standards for review and action on eligibility by pre-enrollment category.
The bill expands the iBudget program and improves service delivery by:
Reprioritizing individuals whose caregivers are ages 60-69 higher on the pre-enrollment list;
Creating care navigation to assist individuals waiting for services in accessing community resources;
Limiting APD to developing support plans only for waiver enrollees;
Authorizing funding for waiver enrollment for individuals in pre-enrollment categories 3-5, including
those in category 4 with caregivers aged 60 years of age or older, and any siblings in categories 3-6.
The bill amends the implementation process for the iConnect data system. It makes provider use of the
iConnect system contingent on certain development milestones, and requires APD to establish a process for
provider training and feedback. The bill requires APD to submit an assessment report by December 31, 2024
to the Legislature and Governor on its iConnect data management system, which considers the needs of and
impacts on both the agency and its clients.
The bill requires the Agency for Health Care Administration (AHCA) to contract with experts to, in consultation
with APD, develop a new Medicaid waiver focused on waiver clients transitioning into adulthood. AHCA must
submit its report to the Legislature and Governor by December 1, 2024.
The bill provides an appropriation of $38,852,223 in recurring funds to APD and has no fiscal impact on local
government.
The bill has an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h1271e.HHS
DATE: 2/23/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Agency for Persons with Disabilities
The Agency for Persons with Disabilities (APD) provides services to certain individuals with
developmental disabilities.1 APD supports these individuals and families in living, learning, and working
within their communities by creating multiple pathways to be successful through a variety of social,
medical, behavioral, residential, and therapeutic services. 2
Chapter 393, F.S., provides the authority and guidance to the APD on what programs to develop, who
is eligible, and how to manage those programs within available resources. In s. 393.062, F.S., the
legislative findings and declaration of intent state:
The greatest priority shall be given to the development and implementation of
community-based services that will enable individuals with developmental disabilities to
achieve their greatest potential for independent and productive living, enable them to
live in their own homes or in residences located in their own communities, and permit
them to be diverted or removed from unnecessary institutional placements.
One of the ways in which services are delivered to individuals with developmental disabilities is through
federal waivers, such as the Home and Community Based Services (HCBS) waiver 3. The HCBS
waiver allows individuals to continue to live in their own homes or in another home-like setting and
avoid institutionalization.4 To qualify for this waiver, an individual must meet the standards for
institutional level of care.5
Home and Community Based Waiver Programs
iBudget Florida Program
The APD administers the Medicaid HCBS waiver known as iBudget Florida (iBudget) for individuals
with specified developmental disabilities who also meet Medicaid eligibility requirements. 6 The iBudget
provides home and community-based services and supports to eligible persons with developmental
disabilities living at home or in a home-like setting, with the costs shared with the federal government.
The waiver services are delivered through a fee-for-service (FFS) delivery model, which means that
providers are enrolled and reimbursed for services directly by the Agency for Health Care
Administration (AHCA).
The iBudget program allocates available funding to clients, providing each one with an established
budget with the flexibility to choose from the authorized array of services that best meet their individual
needs within their community.7 Individual waiver support coordinators client assist each client with
determination of his or her unique needs and the coordination of necessary providers to provide those
services.
1
S. 393.062, F.S.
2
Agency for Persons with Disabilities, About Us, available at About Us | APD - Agency for Persons with Disabilities - State of Florida (myflorida.com)
(last visited January 22, 2024).
3
Medicaid.gov, Home and Community Based Services – 1915(c), available at https://www.medicaid.gov/medicaid/home-community-based-
services/home-community-based-services-authorities/home-community-based-services-1915c/index.html (last visited January 22, 2024).
4
Rule 59G-13.080(1), F.A.C.
5
Id.
6
S. 392.00662, F.S.
7
Id.
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Beginning May 2011, APD started a phase-in of the iBudget program statewide completing the final
transition from the old system on July 1, 2013.8 The iBudget uses an algorithm or formula to set each
participant’s funding allocation under the waiver.9 According to APD, over 35,000 enrolled individuals
are currently receiving their services under the iBudget waiver program, and 21,000 individuals are on
the pre-enrollment (wait) list for waiver services (see below).
Consumer Directed Care Plus Program
An individual who is enrolled on the iBudget waiver may elect to receive services through the
Consumer Directed Care Plus Program, or CDC+, Program. The CDC+ Program allows individuals
greater flexibility in the selection of providers and types of services and supports that may be
purchased using the individual’s budget. For instance, under CDC+, an individual and his or her family
can directly hire personal caregivers instead of using a Medicaid-enrolled provider. Like the waiver, a
support coordinator assists the individual and his or her family with the identification of appropriate
services and supports and then makes those selections through the system. However, under CDC+,
this support individual is known as a consultant and has a more limited role. 10
Program Eligibility
To receive services from APD, an individual must be found eligible through a paper application
submission process. Information from the paper application is received at regional offices and is
manually keyed into an electronic client data management system. The application is reviewed for
eligibility based on that information and to identify if additional information is needed. The APD
determines eligibility based on Florida statutes and rules. To be eligible, an individual must:
Demonstrate evidence that one of the following developmental diagnoses manifested itself
before the age of 18 and can reasonably be expected to continue indefinitely:
o Intellectual disability.
o Spina Bifida.
o Cerebral palsy.
o Autism.
o Down syndrome.
o Phelan McDermid syndrome.
o Prader-Willi syndrome. 11
Be domiciled in Florida;12 and
Be at least three years of age.13
The APD must review an application within 60 days depending on individual circumstances and the
documentation received.14 Additional time to work with the applicant may be needed, for example, to
conduct a comprehensive assessment to determine if the individual meets clinical eligibility
requirements.
For an applicant deemed in crisis, APD must expedite the application review to completion within 45
days.15 If additional documentation is needed, APD may pend the application until that information is
provided which would toll the clock until the information was provided by the applicant. Eligible
individuals are either enrolled in the program (provided a slot) or placed on the pre-enrollment list if the
8
The Agency for Persons with Disabilities, Quarterly Report on Agency Services to Floridians with Developmental Disabilities and their Costs: First
Quarter Fiscal Year 2022-23, p.2, November 15, 2022, available at https://apd.myflorida.com/publications/reports/ (last visited January 22, 2024).
9
Id.
10
A support coordinator is defined in s. 393.063(37), F.S. Further responsibilities are also included in the Agency for Health Care Administration,
Consumer Directed Care Plus Program Coverage, Limitations, and Reimbursement Handbook (October 2015), available at
https://apd.myflorida.com/cdcplus/docs/CDC_Plus_Program_Handbook_2015.pdf (last visited January 22, 2024).
11
S. 393.063(11), F.S. and 393.065, F.S.
12
S. 393.063(13), F.S. and 393.065, F.S.
13
Supra, note 2.
14
S. 393.065(1), F.S.
15
Id.
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demand exceeds the available funding.16The APD assigns each waitlisted client to a pre-enrollment
category based on their needs and prioritized in the following decreasing order of priority: 17
Category 1: Clients deemed to be in crisis.
Category 2: Children in the child welfare system at the time of permanency or turning 18.
Category 3: Intensive Needs
Category 4 : Caregiver over the age of 70
Category 5: Transition from School
Category 6: Age 21 and Over
Category 7: Age under 21
Eligible individuals that meet the criteria for Categories 1 or 2 are directly enrolled onto the iBudget
waiver. Currently, there is a higher demand for iBudget services than funding available, which means
individuals who require services are put on the pre-enrollment list based on the categorization of their
needs.
As of December 2023, as the table shows below, over 21,000 individuals were waiting for services, with
approximately 50 percent of those between 25 through 59 years old. 18
iBudget Pre-Enrollment List December 202319
Total
Category Description
Clients
Category 1 Crisis 0
Category 2 Children in welfare system at the time
0
of permanency or turning 18
Category 3 Intensive Needs 210
Category 4 Caregiver over age 70 83
Category 5 Transition from School 20
Category 6 Age 21 and Over 12,809
Category 7 Age under 21 8,464
Grand Total: 21,587
For each client in a pre-enrollment category, APD develops a support plan and sends an annual status
letter. During this annual check-in, APD verifies contact information, provides resources information,
and also provides the family an opportunity to indicate if there are any new unmet needs or other
changes that may impact the individual’s eligibility.20 The APD has recently begun providing care
navigation to these clients, using positions that were repurposed for that effort.
When an individual is deemed eligible for services, the APD must consult with the client, if the client is
competent, if not then the client’s parent or guardian to devise a support plan. For children ages three
to 18 and other individuals, the support plan must include the most appropriate, the least restrictive,
and most cost beneficial environment for the individual’s progress, and have the appropriate
specification for the services authorized.21
iConnect Data Management System
As part of the funding under the federal Centers for Medicare and Medicaid Services (CMS) Home and
Community Based Services Waiver (HCBS), the waiver includes six performance measures and 26
program assurances. The APD must demonstrate compliance on an ongoing basis and each
assurance requires data to be collected, tracked, analyzed, and action taken to remediate problems
16
Rule 65G-1.047, F.A.C. The rule provides that the severity of the crisis is determined by the risk to the health, safety, and w elfare of each applicant
relative to other applicant. Rule 65G-11.004 provides a procedure for determining if a client is considered to be in crisis.
17
S. 363.065(5), F.S.
18
Agency for Persons with Disabilities, 2024 Agency Bill Analysis – HB 1271 (January 8, 2024)(on file with Children, Families & Seniors Subcommittee).
19
Id.
20
Id.
21
S. 393.0651, F.S.
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that are found from any data collection.22 Prior to iConnect and as components are still implemented
now, APD primarily utilizes several disparate and antiquated systems with only automation in only a
small portion of these business and administrative functions and requirements. APD’s support
document for iConnect argued that the necessary automated systems require considerable manual
intervention for maintenance, operations, support, and integration with other systems. In addition, many
of the business functions remain manual processes. The pre iConnect environment was inefficient,
labor intensive, and did not meet the program needs, and does not until fully implemented.23 Many, if
not the majority, of the key program functions identified in the Assumptions and Constraints section of
the Schedule IV-B, are detailed as manual or paper based functions which are employee generated,
not automated by system activity or eligibility functionality.24
A third party vendor, WellSky was selected, through a competitive procurement process, in 2015 for an
to design and implement the existing single client record and Electronic Visit Verification system called
iConnect. The data management system is utilized by both internal APD team members and external
stakeholders, including Waiver