After making community-based care a priority for people with developmental and intellectual disabilities, lawmakers are moving forward with bills that would make it easier for providers to open institutions.
Members of the House Health Care Appropriations Subcommittee on Tuesday unanimously approved a measure (HB 1163) that would allow providers to build institutions to house people with developmental disabilities without first having to obtain approval from the state through the “certificate of need” regulatory process.
The bill wouldn’t cap the number of new institutions that could be built nor is there an expiration date on the exemption.
Bill sponsor Colleen Burton, R-Lakeland, said the proposal is intended to provide more options for people with developmental disabilities who have severe maladaptive behaviors and co-occurring psychiatric diagnoses and for the parents who care for them after the October 2018 closing of a facility known as Carlton Palms.
The Mount Dora facility had 190 residents and was closed by the state Agency for Persons with Disabilities because of abuse.
“I think the best place for everybody, if possible, is to stay in the community,” Burton told The News Service of Florida following the meeting. “These are small facilities. It's not a large institution. And the parameters about how they are operated and what has to happen there are well thought out and in line with what we do today.”
But Olivia Babis, public policy analyst for Disability Rights Florida, which advocates for people with disabilities, has concerns about the proposal and said her group has been trying to connect with Burton and Sen. Gayle Harrell, a Stuart Republican who is sponsoring the Senate version (SB1344).
Instead of providing additional options to people, Babis worries that the newly built institutions may become the only option. Especially for people who live in rural areas and, Babis said, don’t have access to alternatives, such as six-bed behavioral group homes that can offer similar services or home- and community-based services.
And while the new facilities allowed under the bills would be smaller than institutions in the past and would have private bedrooms and bathrooms for residents, Babis said they still are institutions.
“It’s how they conceptualize institutions,” she said, noting that the new facilities wouldn’t have rows of bunk beds for residents or cramped spaces. “They aren’t thinking about having their lives directed by someone else. This is about to what degree you control your own life.”
To qualify for the certificate-of-need exemption, a provider couldn’t have had a license revoked, suspended or denied within the previous three years. Moreover, the provider would need at least 10 years of experience serving people with severe maladaptive behaviors.
The bills also would mandate that to obtain the exemption, providers would build institutions --- known as intermediate care facilities for people with developmental disabilities, or ICFDDs --- that have three eight-bed homes on a campus. The homes would be required to have private bedrooms and bathrooms. Medical and nursing care must be provided around the clock, and at least 16 of the beds must be dedicated to people who have severe maladaptive behaviors.
According to a legislative staff analysis, as many as 661 people enrolled in the Medicaid home- and community-based services program known as iBudget would qualify for placement in the new facilities.
The move to increase the number of institutions comes at a time when lawmakers are wrestling with the costs of caring for people with developmental disabilities in the iBudget program, which is known as a Medicaid “waiver” program. In the iBudget program, people are given stipends to pay for the services they need to live in the community.
Conversely, institutional care is paid for by the traditional Medicaid program.
Agency for Persons with Disabilities Director Barbara Palmer told The News Service of Florida that she is “open-minded” about the bills.
“Do I think that people should be in their homes? Absolutely. That should be the No. 1 place we try to keep them. But when things change in people's lives, there have to be other choices, and we’ve been limited in this state,” she said.
With care in the facilities funded by Medicaid, the state has required them to be subject to certificates of need. The Legislature also has been required to include specific budget appropriations to fund any new beds. In addition to permanently deleting the requirement for so-called CONs, the bills would eliminate the requirement that lawmakers include specific appropriations to fund new beds.
A House staff analysis indicates that “ICFDD services cost more than home- and community-based services.”
Burton and Harrell maintain that any provider who meets the qualifications could open a new ICFDD, but lobbyists for the Florida Association of Rehabilitation Facilities, Inc. acknowledged Sunrise Community, Inc., a non-profit organization headquartered in Miami, is spearheading the legislation.
Attempts to contact Sunrise were unsuccessful.
Sunrise in 2018 submitted a CON application to the state Agency for Health Care Administration to open a new intermediate care facility for people with developmental disabilities in what’s known as Region 6, which includes Hardee, Highlands, Hillsborough, Manatee and Polk counties. The application shows it was an $8.1 million project.
Suzanne Sewell, president and CEO of Florida Association of Rehabilitation Facilities, Inc., said 94 percent of the money the state annually spends caring for people with developmental disabilities is targeted toward the iBudget and home- and community-based services, a policy her association agrees with.
But Sewell said new institutional beds are necessary. Her group, which represents the institutional providers, conducted a survey in 2018 that showed there were 59 individuals with severe maladaptive behaviors who were denied placement in ICFDDs.
“The kind of facility outlined in this legislation would have been an answer to prayers for these families,” she told members of the Senate Health and Human Services Appropriations Subcommittee this month.
