Senate Bill sb2894er

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    2004 Legislature          CS for CS for SB 2894, 1st Engrossed



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  2         An act relating to mental health and vocational

  3         rehabilitation services; amending s. 394.9084,

  4         F.S.; providing for implementation and

  5         expansion of a program for self-directed mental

  6         health and vocational rehabilitation services

  7         for adults; authorizing the development and

  8         implementation of a pilot project for children;

  9         providing eligibility and other program

10         requirements; providing limitations; providing

11         authority to request certain federal waivers

12         and to request and use certain grants;

13         providing for transfer of certain funds;

14         providing for ongoing review and reports;

15         providing rulemaking and overall authority;

16         revising an expiration date; providing an

17         effective date.

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19  Be It Enacted by the Legislature of the State of Florida:

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21         Section 1.  Section 394.9084, Florida Statutes, is

22  amended to read:

23         394.9084  Florida Self-Directed Care Pilot project;

24  client-directed and choice-based adult mental health

25  services.--

26         (1)  The Department of Children and Family Services, in

27  cooperation with the Agency for Health Care Administration,

28  may shall develop a client-directed and choice-based pilot

29  project in district 4 and three other districts to provide

30  mental health treatment and support services to adults who

31  have a serious mental illness. The department may also develop


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    2004 Legislature          CS for CS for SB 2894, 1st Engrossed



 1  and implement a client-directed and choice-based pilot project

 2  in one district to provide mental health treatment and support

 3  services for children with a serious emotional disturbance who

 4  live at home. If established, any staff who work with children

 5  must be screened under s. 435.04. The projects project shall

 6  implement test a payment model in which each client controls

 7  the money that is available for that client's mental health

 8  treatment and support services. The department shall establish

 9  interagency cooperative agreements and work with the agency,

10  the division, and the Social Security Administration to

11  implement and administer the Florida Self-Directed Care

12  program.

13         (2)  To be eligible for enrollment in the Florida

14  Self-Directed Care program, a person must be an adult with a

15  severe and persistent mental illness.

16         (3)  The Florida Self-Directed Care program has four

17  subcomponents:

18         (a)  Department mental health services, which include

19  community mental health outpatient, community support, and

20  case management services funded through the department. This

21  subcomponent excludes Florida Assertive Community Treatment

22  (FACT) services for adults; residential services; and

23  emergency stabilization services, including crisis

24  stabilization units, short-term residential treatment, and

25  inpatient services.

26         (b)  Agency mental health services, which include

27  community mental health services and mental health targeted

28  case management services reimbursed by Medicaid.

29         (c)  Vocational rehabilitation, which includes funds

30  available for an eligible participant as provided by the

31  Rehabilitation Act of 1973, 29 U.S.C. chapter 16, as amended.


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 1         (d)  Social Security Administration.

 2         (4)  The managing entity shall pay for the

 3  cost-efficient community-based services the participant

 4  selects to meet his or her mental health care and vocational

 5  rehabilitation needs and goals as identified on his or her

 6  recovery plan.

 7         (5)(a)  The department shall take all necessary action

 8  to ensure state compliance with federal regulations. The

 9  agency, in collaboration with the department, shall seek

10  federal Medicaid waivers, and the department shall

11  expeditiously seek any available Supplemental Security

12  Administration waivers under s. 1110(b) of the federal Social

13  Security Act; and the division, in collaboration with the

14  department, shall seek federal approval to participate in the

15  Florida Self Directed Care program. No later than June 30,

16  2005, the department, agency, and division shall amend and

17  update their strategic and state plans to reflect

18  participation in the projects, including intent to seek

19  federal approval to provide cashout options for eligible

20  services for participants in the projects.

21         (b)  The department may apply for and use any funds

22  from private, state, and federal grants provided for

23  self-directed care, voucher, and self-determination programs,

24  including those providing substance abuse and mental health

25  care.

26         (6)  The department, the agency, and the division may

27  transfer funds to the managing entity.

28         (7)  The department, the agency, and the division shall

29  have rulemaking authority to implement the provisions of this

30  section. These rules shall be for the purpose of enhancing

31  choice in and control over the purchased mental health and


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 1  vocational rehabilitative services accessed by Florida Self

 2  Directed Care participants.

 3         (8)  The department and the agency will complete a

 4  memorandum of agreement to delineate management roles for

 5  operation of the Florida Self Directed Care program.

 6         (9)  The department, the agency, and the division shall

 7  each, on an ongoing basis, review and assess the

 8  implementation of the Florida Self Directed Care program.

 9         (a)  The department will implement an evaluation of the

10  program and will include recommendations for improvements in

11  the program.

12         (b)  At a minimum, the evaluation must compare between

13  program participants and nonparticipants:

14         1.  Re-hospitalization rates.

15         2.  Levels of satisfaction.

16         3.  Service utilization rates.

17         4.  Residential stability.

18         5.  Levels of community integration and interaction.

19         (c)  The evaluation must evaluate adherence to the

20  Centers for Medicare and Medicaid self-direction requirements,

21  including:

22         1.  Person-centered planning.

23         2.  Individual budgets.

24         3.  Availability of independently brokered services

25  from recovery coaches and quality advocates.

26         4.  Access to the program by all who are eligible to

27  enroll.

28         5.  Participant safety and program incident management

29  planning.

30         6.  An independently mediated grievance process.

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 1         (d)  The evaluation must assess the economic

 2  self-sufficiency of the program participants, including the

 3  number of Individual Development Accounts.

 4         (e)  The evaluation must assess any adverse incidents

 5  resulting from the Florida Self Directed Care, including

 6  consumer grievances, conflicts of interest, and patterns of

 7  self-referral by licensed professions.

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 9  The department is authorized to spend up to $100,000 to pay

10  for the evaluation. If the agency and the department obtain a

11  federal waiver, the evaluation will be used to determine

12  effectiveness. The project shall be evaluated by an

13  independent entity whose evaluation must include an assessment

14  of:

15         (a)  The criteria for selecting adult mental health

16  clients with serious mental illness eligible for participation

17  in the project.

18         (b)  The duties and responsibilities of the care

19  coordinator.

20         (c)  The accessibility and quality of services provided

21  under the project by available community-based providers

22  selected by the client, compared to those services that are

23  available without the project.

24         (d)  The input by the clients in the development of

25  treatment plans compared to other clients not participating in

26  the project.

27         (e)  The achievement of individual treatment goals or

28  outcome measures established for each client participating in

29  the project compared to other mental health clients.

30         (f)  Any demonstrated improvements or cost savings in

31  the delivery of community-based mental health treatment and


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    2004 Legislature          CS for CS for SB 2894, 1st Engrossed



 1  support services, including an explanation of the analyses

 2  used in determining cost savings.

 3         (g)  All monitoring and oversight conducted by the

 4  Department of Children and Family Services or the Agency for

 5  Health Care Administration.

 6         (h)  Any existing or appointed local advisory group

 7  assisting in the design and implementation of the project.

 8         (2)  The Department of Children and Family Services

 9  shall submit a report concerning the progress of the project

10  to the appropriate legislative committees by December 1, 2002,

11  and December 1, 2003.

12         (10)(3)  This section expires July 1, 2008 2004.

13         Section 2.  This act shall take effect July 1, 2004.

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