Senate Bill sb2894
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Florida Senate - 2004 SB 2894
By Senator Webster
9-1683A-04 See HB
1 A bill to be entitled
2 An act relating to mental health and vocational
3 rehabilitation services; creating part VI of
4 chapter 394, F.S., relating to self-directed
5 and family-directed mental health and
6 vocational rehabilitation services for adults
7 and piloting family-directed mental health
8 treatment and support services for certain
9 children; providing a popular name; providing
10 legislative intent; providing definitions;
11 providing a program for self-directed mental
12 health and vocational rehabilitation services
13 for adults; providing eligibility and other
14 program requirements; providing for statewide
15 and local advisory councils; providing
16 authority to request certain federal waivers
17 and to request and use certain grants;
18 providing for transfer of certain funds;
19 providing for ongoing review and reports;
20 providing rulemaking authority; providing for a
21 pilot program for family-directed mental health
22 treatment and support services for certain
23 children based on the self-directed care
24 program for adults; providing eligibility and
25 other pilot program requirements; providing
26 background screening requirements; providing
27 rulemaking authority; providing for annual
28 reports; providing for future repeal of the
29 pilot program; repealing s. 394.9084, F.S.,
30 relating to the pilot project for
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Florida Senate - 2004 SB 2894
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1 client-directed and choice-based adult mental
2 health services; providing an effective date.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Part VI of chapter 394, Florida Statutes,
7 consisting of sections 394.9501 and 394.9503, is created to
8 read:
9 PART VI
10 SELF-DIRECTED AND FAMILY-DIRECTED MENTAL HEALTH
11 AND VOCATIONAL REHABILITATION SERVICES
12 394.9501 Self-directed mental health and vocational
13 rehabilitation services.--
14 (1) POPULAR NAME.--This section may be cited by the
15 popular name the "Florida Self-Directed Care (FloridaSDC)
16 Act."
17 (2) LEGISLATIVE INTENT.--The Legislature embraces the
18 grassroots philosophy of the self-directed care pilot for
19 adults with psychiatric disabilities in Northeast Florida and
20 supports this intent. The Legislature finds that the intent is
21 to give individuals with psychiatric disabilities the
22 opportunity to select the providers and services that the
23 individual deems necessary to achieve recovery from a mental
24 illness. The Legislature finds that this intent is
25 accomplished through the creation of a specific mechanism for
26 providing needed services for adults with serious and
27 persistent mental illnesses and children with or at risk for
28 emotional disturbances. The Legislature finds that this
29 opportunity is based upon well-established models of
30 self-determination for other populations of individuals with
31 disabilities. It is the intent of the Legislature to provide
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Florida Senate - 2004 SB 2894
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1 adults with serious and persistent mental illnesses and
2 children with or at risk for emotional disturbances and their
3 families enrolled in self-directed care a wide range of
4 choices in and control over the purchased mental health care
5 and vocational rehabilitation services they receive.
6 (3) DEFINITIONS.--As used in this section, the term:
7 (a) "Agency" means the Agency for Health Care
8 Administration.
9 (b) "Budget allowance" means the amount of funds made
10 available to a fiscal intermediary on behalf of a participant
11 to purchase needed mental health treatment, rehabilitation and
12 enrichment, and vocational rehabilitation services, based on
13 the results of a needs assessment.
14 (c) "Department" means the Department of Children and
15 Family Services.
16 (d) "Division" means the Division of Vocational
17 Rehabilitation of the Department of Education.
18 (e) "Fiscal intermediary" means an entity approved by
19 the department that helps the participant manage his or her
20 budget allowances.
21 (f) "Freedom account" means an account under which the
22 Social Security Administration would permit supplemental
23 security income (SSI) eligible individuals to save funds that
24 will assist them in achieving independence by reaching their
25 educational and vocational goals.
26 (g) "Participant" means a person who has chosen to
27 participate in the program, who has met the enrollment
28 requirements, and who has received approved budget allowances.
29 (h) "Provider" means a person or organization licensed
30 or otherwise permitted to render services eligible for
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Florida Senate - 2004 SB 2894
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1 reimbursement under this program for which the participant is
2 not the employer of record.
3 (i) "Quality advocate" means licensed professional
4 clinical staff who manage the delivery of direct participant
5 services.
6 (j) "Recovery coach" means an individual who provides
7 technical assistance to participants in meeting their
8 responsibilities under this section.
9 (k) "Self-determination" refers to a fiscal mechanism
10 that provides the individual an opportunity for freedom of
11 choice in determining the providers and services necessary for
12 recovery from a psychiatric disability or an emotional
13 disturbance.
14 (4) SELF-DIRECTED CARE.--
15 (a) Program established.--The department shall
16 establish the self-directed care (FloridaSDC) program for
17 adults, which shall be based on the principles of participant
18 choice and control. The department shall establish interagency
19 cooperative agreements with and shall work with the agency,
20 the division, and the Social Security Administration to
21 implement and administer the FloridaSDC program. The
22 FloridaSDC program shall provide enrolled persons the
23 opportunity to choose the providers of services and to direct
24 the delivery of services to best meet their mental health care
25 and vocational rehabilitation needs. The department shall
26 operate the direct services portion of the FloridaSDC program
27 within the funds appropriated by the Legislature for direct
28 services and other funds obtained through the agency,
29 division, and department. Any expansion of the FloridaSDC
30 program beyond enrollment levels in state fiscal year
31 2003-2004 is contingent upon appropriations for administrative
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Florida Senate - 2004 SB 2894
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1 costs incurred by participating state agencies and for
2 increased fiscal intermediary capacity. Funds for the
3 operation of the fiscal intermediary shall not be paid from
4 appropriations specified for direct participant services. The
5 FloridaSDC program shall consist of four subcomponents.
6 Participants may participate in any subcomponent for which
7 they are eligible. At a minimum, a participant must choose to
8 participate in one of the following subcomponents:
9 1. Department mental health.--This subcomponent
10 includes participant access to an allowance equal to community
11 mental health outpatient services, community support services,
12 and case management services. Self-directed care services
13 exclude Florida Assertive Community Treatment (FACT) services,
14 only for adults; residential services; and emergency
15 stabilization services, including crisis stabilization units,
16 short-term residential treatment, and inpatient services.
17 2. Agency mental health.--Under this subcomponent the
18 agency shall apply for a waiver of s. 1115 of the Social
19 Security Act, 42 U.S.C. s. 1315, to use Medicaid funds for
20 self-directed mental health care. Services included in the
21 budget allowance are those contained in the Medicaid Community
22 Mental Health Services and Mental Health Targeted Case
23 Management Services handbooks. Participants enrolled in this
24 subcomponent shall be excluded from enrollment in any program
25 that prepays Medicaid Community Mental Health or Mental Health
26 Targeted Case Management benefits or to access such benefits
27 under a fee-for-service program.
28 3. Vocational rehabilitation.--Under this subcomponent
29 participation is contingent upon federal legislation allowing
30 for a demonstration program that will permit vocational
31 rehabilitation funds to flow through the fiscal intermediary.
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Florida Senate - 2004 SB 2894
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1 4. Social Security Administration.--Under this
2 subcomponent the department shall apply, under s. 1110(b) of
3 the Social Security Act, to conduct a demonstration that shall
4 test whether the modification of certain SSI program rules
5 fosters greater self-sufficiency among SSI beneficiaries
6 participating in the FloridaSDC program.
7 (b) Eligibility and enrollment.--
8 1. The people who shall be the focus of the FloridaSDC
9 program are adults with severe and persistent mental illness.
10 An adult with a severe and persistent mental illness means a
11 person who is age 18 or older, who has a diagnosis or
12 diagnostic impression of an Axis I or Axis II mental disorder,
13 and who meets one of the following criteria:
14 a. Receives supplemental security income (SSI) due to
15 psychiatric disability.
16 b. Receives social security disability income (SSDI)
17 due to psychiatric disability.
18 c. Receives disabled veterans income due to
19 psychiatric disability.
20 d. Receives any other type of disability income due to
21 psychiatric disability.
22 e. Receives social security income (SSI) for reasons
23 other than psychiatric disability and does not need, is unable
24 to apply, or declines to apply for disability income.
25 f. Does not receive disability income due to
26 psychiatric disability, but has an application in process or
27 has received such income within the last 5 years.
28 g. Is legally competent to direct his or her own
29 affairs.
30 h. Is not enrolled in Florida Assertive Community
31 Treatment (FACT) services.
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Florida Senate - 2004 SB 2894
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1 2. Participants in the FloridaSDC program must live in
2 the district or subdistrict in which the program they
3 participate in is located.
4 3. Additional eligibility requirements to participate
5 in the FloridaSDC program are as follows:
6 a. To be eligible to participate in the agency mental
7 health subcomponent, the individual must be eligible for
8 Medicaid as defined in the waiver of s. 1115 of the Social
9 Security Act, 42 U.S.C. s. 1315.
10 b. To be eligible to participate in the vocational
11 rehabilitation subcomponent, the individual must be eligible
12 as defined by the Rehabilitation Act of 1973, as amended.
13 4. Participation in the FloridaSDC program is
14 voluntary. Individuals who wish to disenroll may do so at any
15 time. Upon disenrollment, the individual shall have access to
16 mental health services for which he or she is eligible, based
17 on the level of need. A participant's disenrollment from the
18 agency mental health subcomponent will be effective the
19 beginning of the month subsequent to his or her disenrollment
20 decision.
21 (c) Budget allowances.--Budget allowances shall be
22 managed on behalf of participants by a fiscal intermediary
23 approved by the department. Budget allowances for any funding
24 from the department shall be based on the average cost to
25 provide the services described in subparagraph (4)(a)1. to an
26 individual with a serious and persistent mental illness in the
27 district or subdistrict of service for the previous fiscal
28 year. This methodology shall be used for budgeting purposes on
29 an aggregate level. Individual budget allowances may vary in
30 accordance with the participants' approved recovery plans. The
31 total of the budget allowances must not exceed the total
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Florida Senate - 2004 SB 2894
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1 budget for the FloridaSDC program. These allowances shall be
2 transferred from the department to the fiscal intermediary for
3 mental health services provided to participants. The
4 department shall develop purchasing guidelines to assist
5 participants in using the budget allowances to purchase
6 needed, cost-effective mental health and vocational
7 rehabilitation services. Funding for budget allowances shall
8 be provided through department funding, agency funds obtained
9 through any waiver of s. 1115 of the Social Security Act, 42
10 U.S.C. s. 1315, or division funds.
11 (d) Services.--The fiscal intermediary shall use
12 budget allowances only to pay for community-based services
13 that meet the participant's mental health care and vocational
14 rehabilitation needs based on the individual's recovery plan
15 and that are a cost-efficient use of such funds. Such funds
16 shall not be used to supplant services available to the
17 individual through other state and federal funding sources.
18 The department, in collaboration with the statewide advisory
19 council, the agency, and the division, shall develop
20 purchasing requirements that meet state and federal
21 regulations.
22 (e) Participant roles and
23 responsibilities.--Participants shall choose the providers of
24 services, as well as when and how the services are provided.
25 The roles and responsibilities of participants include, but
26 are not limited to, the following:
27 1. Communicating needs, preferences, and expectations
28 about services being purchased.
29 2. Ending the services of an unsatisfactory provider.
30 3. Providing the fiscal intermediary with all
31 information necessary for provider payments.
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Florida Senate - 2004 SB 2894
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1 (f) Department roles and responsibilities.--The roles
2 and responsibilities of the department include, but are not
3 limited to, the following:
4 1. Establishing standards for approval of the fiscal
5 intermediary and approving the fiscal intermediary. The fiscal
6 intermediary may not be a provider of behavioral health care
7 services or be a managed care organization.
8 2. Establishing, in consultation with the agency and
9 the division, the minimum qualifications for all providers and
10 being the final arbiter of the fitness of any individual or
11 organization to be a provider.
12 3. Establishing, at the beginning of each fiscal year,
13 the number of available openings in the program for each
14 district.
15 (g) Fiscal intermediary roles and responsibilities.--
16 1. The roles and responsibilities of the fiscal
17 intermediary include, but are not limited to, the following:
18 a. Providing recordkeeping and fiscal processing
19 services and providing for an audit by an independent
20 certified public accountant annually.
21 b. Retaining the participant-directed care funds in
22 distinct categories by program subcomponent, processing
23 provider enrollment information, if any, reviewing records to
24 ensure correctness, making payments to providers for services,
25 ensuring timely account activity and balance reporting to
26 participants and FloridaSDC program staff, and maintaining
27 district-level FloridaSDC service staff.
28 c. Employing recovery coaches who shall provide
29 training, technical assistance, and support to participants.
30 The fiscal intermediary may not provide direct services to
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Florida Senate - 2004 SB 2894
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1 participants beyond those provided by the recovery coaches and
2 quality advocates.
3 d. Establishing controls to prevent overspending of
4 budget allowances and separate accounting for each program
5 subcomponent, and ensuring that funds expended meet all
6 federal requirements and purchasing guidelines established by
7 the department.
8 e. Maintaining the participant's freedom account under
9 s. 1110(b) of the Social Security Act.
10 f. Assessing each participant's mental health care and
11 vocational rehabilitation needs, helping with the recovery
12 plan, and providing ongoing support with the service plan.
13 g. Expediting linkages for FloridaSDC participants to
14 other mental health services not available through the
15 program.
16 h. Educating each participant about the use of
17 advanced medical and psychiatric directives.
18 2. Employees, board members, or owners of the fiscal
19 intermediary may not serve on boards of mental health care
20 providers or any other entity that would result in conflict of
21 interest.
22 (5) ADVISORY COUNCILS.--A statewide advisory council
23 shall guide the FloridaSDC program. The statewide advisory
24 council shall be comprised of local advisory council members.
25 Local advisory councils shall guide the FloridaSDC program in
26 each participating district. Each local advisory council shall
27 adhere to the intent of the FloridaSDC program. The department
28 shall develop policies and rules regarding appointment,
29 operation, and terms of memberships for both the state and
30 local advisory councils. At least 51 percent of state and
31 local advisory council members shall be participants of the
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Florida Senate - 2004 SB 2894
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1 FloridaSDC program. The remaining 49 percent of the council
2 memberships shall be comprised of family members of
3 participants of the FloridaSDC program and other interested
4 parties. Providers of behavioral health care services, or
5 their staff, owners, or board members, are not eligible to
6 serve on any advisory council. Although the statewide and
7 local advisory councils will not have financial management
8 responsibility for the FloridaSDC program, each council shall
9 function as a stakeholder in each program in which it is
10 involved. The department shall consider requests and
11 recommendations from the statewide advisory council for
12 improvements to the FloridaSDC program. Members of local and
13 statewide advisory councils shall serve without compensation
14 but are entitled to reimbursement for travel and per diem
15 expenses pursuant to s. 112.061. The department has final
16 authority on and responsibility for operation of the
17 FloridaSDC program.
18 (6) FEDERAL WAIVERS; GRANTS.--
19 (a) The department shall take all necessary action to
20 ensure state compliance with federal regulations. The agency,
21 in collaboration with the department, shall seek a waiver of
22 s. 1115 of the Social Security Act, 42 U.S.C. s. 1315; the
23 department shall expeditiously seek any available Supplemental
24 Security Administration (SSA) waivers under s. 1110(b) of the
25 Social Security Act; and the division, in collaboration with
26 the department, shall seek federal approval to participate in
27 the FloridaSDC program.
28 (b) The department may apply for and use any funds
29 from private, state, and federal grants provided for
30 self-directed care, voucher, and self-determination programs,
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1 including those providing substance abuse and mental health
2 care.
3 (c) The approval of all waivers is not required for
4 implementation and operation of the FloridaSDC program, but
5 the program may not provide services for which a waiver is
6 required without first obtaining approval for that waiver.
7 (7) FUNDS TRANSFER.--The department, the agency, and
8 the division may transfer funds as identified in paragraph
9 (4)(a) to the fiscal intermediary.
10 (8) REVIEWS AND REPORTS.--The department, the agency,
11 and the division shall each, on an ongoing basis, review and
12 assess the implementation of the FloridaSDC program. Beginning
13 January 31, 2005, the department shall biannually submit a
14 written report to the chairs of the appropriate substantive
15 committees of the Legislature that includes review of the
16 FloridaSDC program by the department, the agency, and the
17 division and that contains recommendations for improvements to
18 the program.
19 (9) RULES.--The department, the agency, and the
20 division shall have rulemaking authority to implement the
21 provisions of this section. These rules shall be for the
22 purpose of enhancing choice in and control over the purchased
23 mental health and vocational rehabilitative services received
24 by FloridaSDC participants. The statewide advisory council and
25 other interested stakeholders may participate in the
26 development and review of such rules prior to their adoption.
27 394.9503 Family-directed care (FloridaFDC) pilot
28 program.--
29 (1) The Department of Children and Family Services
30 shall develop a family-directed care (FloridaFDC) pilot
31 program in a district selected by the department. The
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Florida Senate - 2004 SB 2894
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1 FloridaFDC pilot program shall provide mental health treatment
2 and support services for children who are at risk of emotional
3 disturbance or who have an emotional disturbance or a serious
4 emotional disturbance. The FloridaFDC pilot program shall be
5 organized and operated in the same manner as the self-directed
6 care (FloridaSDC) program established under s. 394.9501. The
7 department may use for the FloridaFDC pilot program any funds
8 of the FloridaSDC program secured from grants provided for
9 substance abuse and mental health services that are restricted
10 to services for children.
11 (2) Participants in the FloridaFDC pilot program shall
12 be children who are at risk of emotional disturbance or who
13 have an emotional disturbance or a serious emotional
14 disturbance. The child must be living at home with his or her
15 family or legal guardian in order to participate in the
16 FloridaFDC pilot program.
17 (a) A child at risk of emotional disturbance is a
18 person under 18 years of age who is currently referred for
19 mental health treatment in a program for students with
20 emotional disabilities in accordance with the Individuals with
21 Disabilities Education Act and for whom there are strong
22 clinical indicators that in the near future such child will
23 require treatment and care from the public mental health care
24 system.
25 (b) A child with an emotional disturbance means a
26 person under 18 years of age who meets one of the following
27 criteria:
28 1. Has a diagnosis listed in the Diagnostic and
29 Statistical Manual of the American Psychiatric Association and
30 a Children's Global Assessment Scale score of 51-60.
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1 2. Is currently classified as a student with an
2 emotional disturbance by a local school district.
3 (c) A child with a serious emotional disturbance is a
4 person under 18 years of age who meets one of the following
5 criteria:
6 1. Has a diagnosis of schizophrenia or other psychotic
7 disorder, major depression, mood disorder, or personality
8 disorder.
9 2. Has a diagnosis listed in the Diagnostic and
10 Statistical Manual of the American Psychiatric Association and
11 a Children's Global Assessment Scale score of 50 or below.
12 3. Is currently classified as a student with serious
13 emotional disturbance by a local school district.
14 4. Is currently receiving supplemental security income
15 (SSI) benefits for a psychiatric disability.
16 (3) The following children are not eligible to
17 participate in the FloridaFDC pilot program:
18 (a) Children who are in the custody of the Department
19 of Children and Family Services.
20 (b) Children with a primary diagnosis of developmental
21 disability, pervasive developmental disorder, substance abuse,
22 communication disorder, learning disorder, or autism.
23 (4) All persons who render care to children under this
24 section must comply with the requirements of s. 435.05 and
25 shall be excluded from employment pursuant to s. 435.06.
26 Persons excluded from employment may request an exemption from
27 disqualification, as provided in s. 435.07. Persons not
28 subject to certification or professional licensure may request
29 an exemption from the Department of Children and Family
30 Services. In considering a request for an exemption, the
31 department shall comply with the provisions of s. 435.07. For
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Florida Senate - 2004 SB 2894
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1 purposes of this section, a person who has undergone
2 screening, who is qualified for employment under this section
3 and applicable rules, and who has not been unemployed for more
4 than 180 days following such screening is not required to be
5 rescreened. Such person must attest under penalty of perjury
6 to not having been convicted of a disqualifying offense since
7 completing such screening.
8 (5) The Department of Children and Family Services,
9 the Agency for Health Care Administration, and the Division of
10 Vocational Rehabilitation of the Department of Education shall
11 have rulemaking authority to implement the provisions of this
12 section. These rules shall be for the purpose of enhancing
13 choice in and control over the purchased mental health and
14 vocational rehabilitative services received by FloridaFDC
15 pilot program participants. The statewide advisory council
16 created under s. 394.9501 and other interested stakeholders
17 may participate in the development and review of such rules
18 prior to their adoption.
19 (6) The Department of Children and Family Services
20 shall submit a report concerning the progress of the
21 FloridaFDC pilot program to the appropriate legislative
22 committees by December 1 of each year of the pilot program.
23 (7) This section is repealed July 1, 2008.
24 Section 2. Section 394.9084, Florida Statutes, is
25 repealed.
26 Section 3. This act shall take effect July 1, 2004.
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