| 1 | The Committee on Future of Florida's Families recommends the |
| 2 | following: |
| 3 |
|
| 4 | Committee Substitute |
| 5 | Remove the entire bill and insert: |
| 6 | A bill to be entitled |
| 7 | An act relating to mental health and vocational |
| 8 | rehabilitation services; creating part VI of chapter 394, |
| 9 | F.S., relating to self-directed and family-directed mental |
| 10 | health and vocational rehabilitation services; providing a |
| 11 | popular name; providing legislative intent; providing for |
| 12 | implementation and expansion; providing definitions; |
| 13 | providing a program for self-directed mental health and |
| 14 | vocational rehabilitation services for adults; providing |
| 15 | eligibility and other program requirements; providing |
| 16 | limitations; providing for statewide and local advisory |
| 17 | councils; providing authority to request certain federal |
| 18 | waivers and to request and use certain grants; providing |
| 19 | for transfer of certain funds; providing for ongoing |
| 20 | review and reports; providing rulemaking and overall |
| 21 | authority; providing for a pilot program for family- |
| 22 | directed mental health treatment and support services for |
| 23 | certain children based on the self-directed care program |
| 24 | for adults; providing eligibility and other pilot program |
| 25 | requirements; providing background screening requirements; |
| 26 | providing rulemaking authority; providing for annual |
| 27 | reports; providing for future repeal of the pilot program; |
| 28 | repealing s. 394.9084, F.S., relating to the pilot project |
| 29 | for client-directed and choice-based adult mental health |
| 30 | services; providing an effective date. |
| 31 |
|
| 32 | Be It Enacted by the Legislature of the State of Florida: |
| 33 |
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| 34 | Section 1. Part VI of chapter 394, Florida Statutes, |
| 35 | consisting of sections 394.9501 and 394.9503, is created to |
| 36 | read: |
| 37 | PART VI |
| 38 | SELF-DIRECTED AND FAMILY-DIRECTED MENTAL HEALTH |
| 39 | AND VOCATIONAL REHABILITATION SERVICES |
| 40 | 394.9501 Self-directed mental health and vocational |
| 41 | rehabilitation services.-- |
| 42 | (1) POPULAR NAME.--This section may be cited by the |
| 43 | popular name the "Florida Self-Directed Care (FloridaSDC) Act." |
| 44 | (2) LEGISLATIVE INTENT.--The Legislature finds that the |
| 45 | experience, courage, and philosophy of the advocates who helped |
| 46 | to initiate the self-directed care pilot for adults with |
| 47 | psychiatric disabilities in Northeast Florida has created a new |
| 48 | modality of care, has increased personal responsibility, and has |
| 49 | empowered individuals. The Legislature finds that many adults |
| 50 | with psychiatric disabilities are able to choose the providers |
| 51 | and services that best help them to achieve recovery from mental |
| 52 | illness. It is the intent of the Legislature to provide adults |
| 53 | with a mental illness and children with or at risk for emotional |
| 54 | disturbances and their families the opportunity to exercise |
| 55 | choice and control in managing their mental health recovery by |
| 56 | offering a program of self-directed care with a wide range of |
| 57 | choices in and control over the purchased mental health care and |
| 58 | vocational rehabilitation services they access. The Legislature |
| 59 | finds that some families of children with or at risk for |
| 60 | emotional disturbances are able to choose the providers and |
| 61 | services best able to assist them in recovery. The Legislature |
| 62 | intends to test the self-directed modality for these families in |
| 63 | a pilot project. |
| 64 | (3) IMPLEMENTATION AND EXPANSION.--The department shall |
| 65 | expand this program as resources become available. The |
| 66 | administrative costs for sites added after July 1, 2004, shall |
| 67 | not be paid from funds appropriated for direct client services. |
| 68 | (4) DEFINITIONS.--As used in this section, the term: |
| 69 | (a) "Adult with a mental illness" means a person who is |
| 70 | age 18 or older and who has a diagnosis or diagnostic impression |
| 71 | of an Axis I or Axis II mental disorder. |
| 72 | (b) "Agency" means the Agency for Health Care |
| 73 | Administration. |
| 74 | (c) "Budget allowance" means the amount of funds made |
| 75 | available to the managing entity on behalf of a participant to |
| 76 | purchase needed mental health treatment, rehabilitation and |
| 77 | enrichment, and vocational rehabilitation services, based on the |
| 78 | results of an assessment of a participant's needs and goals. |
| 79 | (d) "Department" means the Department of Children and |
| 80 | Family Services. |
| 81 | (e) "Division" means the Division of Vocational |
| 82 | Rehabilitation of the Department of Education. |
| 83 | (f) "Freedom account" means an account in which a |
| 84 | participant who receives supplemental security income (SSI) or |
| 85 | social security disability income (SSDI) is permitted to save |
| 86 | funds to assist in achieving independence by reaching |
| 87 | educational and vocational goals. |
| 88 | (g) "Managing entity" means the single organization |
| 89 | approved by the department to provide fiscal intermediary |
| 90 | services and administrative support. |
| 91 | (h) "Participant" means a person who has chosen to |
| 92 | participate in the program, who has met the enrollment |
| 93 | requirements, and who has received a budget allowance. |
| 94 | (i) "Provider" means a person or organization licensed or |
| 95 | otherwise permitted to render services eligible for |
| 96 | reimbursement under this program for which the participant is |
| 97 | not the employer of record. |
| 98 | (j) "Quality advocate" means a mental health professional |
| 99 | who is licensed or eligible for licensure pursuant to chapter |
| 100 | 490 or chapter 491 who manages the delivery of direct services |
| 101 | to participants. |
| 102 | (k) "Recovery coach" means an individual who provides |
| 103 | technical assistance to participants in meeting their |
| 104 | responsibilities under this section. |
| 105 | (l) "Self-determination" means a fiscal mechanism that |
| 106 | gives the individual an opportunity to choose the providers and |
| 107 | services necessary for recovery from a mental illness or an |
| 108 | emotional disturbance. |
| 109 | (5) SELF-DIRECTED CARE.-- |
| 110 | (a) Program established.--The department shall establish |
| 111 | the Florida self-directed care (FloridaSDC) program for adults, |
| 112 | which shall be based on the principles of participant choice and |
| 113 | control. The department shall establish interagency cooperative |
| 114 | agreements and work with the agency, the division, and the |
| 115 | Social Security Administration to implement and administer the |
| 116 | FloridaSDC program. The FloridaSDC program shall give enrolled |
| 117 | persons the opportunity to choose the providers of services and |
| 118 | to direct the delivery of services to best meet their mental |
| 119 | health care and vocational rehabilitation needs. The department |
| 120 | shall operate the direct-services portion of the FloridaSDC |
| 121 | program within the funds appropriated by the Legislature and |
| 122 | other funds obtained through the agency, division, and |
| 123 | department. The FloridaSDC program shall consist of four |
| 124 | subcomponents. A participant must participate in at least one |
| 125 | and may participate in any of the following subcomponents for |
| 126 | which they are eligible: |
| 127 | 1. Department mental health services.--This subcomponent |
| 128 | provides a budget allowance that includes community mental |
| 129 | health outpatient, community support, and case management |
| 130 | services. This budget allowance excludes Florida Assertive |
| 131 | Community Treatment (FACT) services for adults; residential |
| 132 | services; and emergency stabilization services, including crisis |
| 133 | stabilization units, short-term residential treatment, and |
| 134 | inpatient services. The participant must be eligible as provided |
| 135 | in the waiver of s. 1115 of the Social Security Act, 42 U.S.C. |
| 136 | s. 1315. |
| 137 | 2. Agency mental health services.--This subcomponent |
| 138 | includes in the budget allowance Medicaid community mental |
| 139 | health services and mental health targeted case management |
| 140 | services. |
| 141 | 3. Vocational rehabilitation.--This subcomponent includes |
| 142 | funds available for an eligible participant as provided by the |
| 143 | Rehabilitation Act of 1973, as amended. |
| 144 | 4. Social Security Administration.--This subcomponent |
| 145 | includes funds from any social security income program. |
| 146 | (b) Eligibility and enrollment.--To be eligible for |
| 147 | enrollment in the FloridaSDC program, a person must be an adult |
| 148 | with a severe and persistent mental illness who: |
| 149 | 1.a. Receives supplemental security income (SSI), social |
| 150 | security disability income (SSDI), disabled veterans income, or |
| 151 | any other type of disability income due to psychiatric |
| 152 | disability; |
| 153 | b. Receives social security income (SSI) for reasons other |
| 154 | than psychiatric disability; or |
| 155 | c. Does not receive disability income due to psychiatric |
| 156 | disability but has an application in process or has received |
| 157 | such income within the last 5 years. |
| 158 | 2. Is legally competent to direct his or her own affairs. |
| 159 | 3. Is not enrolled in Florida Assertive Community |
| 160 | Treatment (FACT) services. |
| 161 | 4. Lives in the department's district in which the program |
| 162 | he or she participates in is located. |
| 163 | 5. Applies for Medicaid and other income-support programs |
| 164 | for which he or she may qualify. |
| 165 | (c) Participation.--Participation in the FloridaSDC |
| 166 | program is voluntary and participants may disenroll at any time. |
| 167 | Agency and department services shall be available on the first |
| 168 | day of the month after a person disenrolls. |
| 169 | (d) Budget allowances.--Participants enrolled in the |
| 170 | FloridaSDC program shall be given a monthly budget allowance |
| 171 | based on the results of their assessed needs and goals and the |
| 172 | financial resources of the program. Budget allowances shall be |
| 173 | managed on behalf of participants by the managing entity as the |
| 174 | fiscal intermediary. The department, in collaboration with the |
| 175 | statewide advisory council, shall develop purchasing guidelines, |
| 176 | approved by the agency and the division, to assist participants |
| 177 | in using the budget allowance to purchase needed, cost-effective |
| 178 | services. The department shall determine the total amount of |
| 179 | budget allowances available for each site by calculating the |
| 180 | average cost to serve eligible participants during the previous |
| 181 | fiscal year. Individual budget allowances may vary in accordance |
| 182 | with the participants' approved recovery plans. Funding for |
| 183 | budget allowances shall be provided through department funding, |
| 184 | agency funds made available through a waiver of s. 1115 of the |
| 185 | Social Security Act, 42 U.S.C. s. 1315, and division funds. |
| 186 | (e) Services.--The managing entity for the FloridaSDC |
| 187 | program shall use budget allowances to pay for community-based |
| 188 | services that meet the participant's mental health care and |
| 189 | vocational rehabilitation needs based on the individual's |
| 190 | recovery plan goals and that are a cost-efficient use of such |
| 191 | funds. Such funds shall be considered the payer of last resort |
| 192 | and must be coordinated with any other benefits for which the |
| 193 | participant is eligible. |
| 194 | (f) Participant roles and responsibilities.--Participants |
| 195 | in the FloridaSDC program shall choose the providers of |
| 196 | services, as well as when and how the services are provided. The |
| 197 | roles and responsibilities of participants include, but are not |
| 198 | limited to, the following: |
| 199 | 1. Communicating needs, preferences, and expectations |
| 200 | about services being purchased. |
| 201 | 2. Ending the services of an unsatisfactory provider. |
| 202 | 3. Providing the managing entity with all information |
| 203 | necessary for provider payments. |
| 204 | (g) Department roles and responsibilities.--The roles and |
| 205 | responsibilities of the department under the FloridaSDC program |
| 206 | include, but are not limited to, the following: |
| 207 | 1. Establishing standards for approval of the managing |
| 208 | entity. The managing entity may not be a provider of behavioral |
| 209 | health care services or be a managed care organization. |
| 210 | 2. Establishing, in consultation with the agency and the |
| 211 | division, the minimum qualifications for all providers and being |
| 212 | the final arbiter of the fitness of any individual or |
| 213 | organization to be a provider. |
| 214 | 3. Establishing, at the beginning of each fiscal year, the |
| 215 | number of available openings in the program for each district. |
| 216 | (h) Managing entity roles and responsibilities.-- |
| 217 | 1. The roles and responsibilities of the managing entity |
| 218 | under the FloridaSDC program include, but are not limited to, |
| 219 | the following: |
| 220 | a. Providing recordkeeping and fiscal processing services |
| 221 | and providing for an audit by an independent certified public |
| 222 | accountant annually. |
| 223 | b. Retaining the participant-directed care funds in |
| 224 | distinct categories by program subcomponent, processing provider |
| 225 | enrollment information, if any, reviewing records to ensure |
| 226 | correctness, making payments to providers for services, ensuring |
| 227 | timely account activity and balance reporting to participants |
| 228 | and FloridaSDC program staff, and maintaining district-level |
| 229 | FloridaSDC service staff. |
| 230 | c. Contracting recovery coaches who shall provide |
| 231 | training, technical assistance, and support to participants. The |
| 232 | managing entity may not provide direct services to participants |
| 233 | beyond those provided by the recovery coaches and quality |
| 234 | advocates. |
| 235 | d. Establishing a provider network. |
| 236 | e. Providing controls to prevent overspending of budget |
| 237 | allowances and separate accounting for each program |
| 238 | subcomponent, and ensuring that funds expended meet all federal |
| 239 | requirements and purchasing guidelines established by the |
| 240 | department. |
| 241 | f. Maintaining each participant's freedom account under s. |
| 242 | 1110(b) of the Social Security Act. |
| 243 | g. Assessing each participant's mental health care and |
| 244 | vocational rehabilitation needs, helping with the recovery plan, |
| 245 | and providing ongoing support with the recovery plan. |
| 246 | h. Expediting linkages for FloridaSDC participants to |
| 247 | other mental health services not available through the program. |
| 248 | i. Educating each participant about the use of advanced |
| 249 | medical and psychiatric directives. |
| 250 | 2. Employees, board members, or owners of the managing |
| 251 | entity may not serve on boards of mental health care providers |
| 252 | or any other entity that would result in a conflict of interest. |
| 253 | (6) LIMITATIONS.--Participants enrolled in the agency |
| 254 | mental health services subcomponent are excluded from enrollment |
| 255 | in any program that prepays Medicaid community mental health or |
| 256 | mental health targeted case management benefits and may not |
| 257 | access Medicaid reimbursed mental health benefits under a fee- |
| 258 | for-service program. The vocational rehabilitation subcomponent |
| 259 | is contingent upon federal legislation allowing for a |
| 260 | demonstration program that will permit vocational rehabilitation |
| 261 | funds to flow through the managing entity. Participation in the |
| 262 | Social Security Administration subcomponent is contingent upon |
| 263 | federal approval of a demonstration project authorized by a |
| 264 | waiver. |
| 265 | (7) ADVISORY COUNCILS.--Local advisory councils shall |
| 266 | guide the FloridaSDC program in each participating district. |
| 267 | Each local advisory council shall adhere to the intent of the |
| 268 | FloridaSDC program to provide choice and control to |
| 269 | participants. At least 51 percent of the members of the local |
| 270 | advisory councils shall be participants in the FloridaSDC |
| 271 | program. A statewide advisory council of at least five and no |
| 272 | more than nine members shall guide the FloridaSDC program. The |
| 273 | statewide advisory council shall be comprised of local advisory |
| 274 | council members. At least 51 percent of the members of the |
| 275 | statewide advisory council shall be participants in the |
| 276 | FloridaSDC program. The remaining council memberships shall be |
| 277 | comprised of adult family members of individuals who have been |
| 278 | diagnosed with a psychiatric disability. Providers of behavioral |
| 279 | health care services, or their staff, owners, or board members, |
| 280 | are not eligible to serve on any advisory council. Members of |
| 281 | local and statewide advisory councils shall serve without |
| 282 | compensation but are entitled to reimbursement for travel and |
| 283 | per diem expenses pursuant to s. 112.061. The department shall |
| 284 | develop policies and rules regarding appointment, operation, and |
| 285 | terms of memberships for both the state and local advisory |
| 286 | councils. The department shall consider requests and |
| 287 | recommendations from the statewide advisory council for |
| 288 | improvements to the FloridaSDC program. |
| 289 | (8) FEDERAL WAIVERS; GRANTS.-- |
| 290 | (a) The department shall take all necessary action to |
| 291 | ensure state compliance with federal regulations. The agency, in |
| 292 | collaboration with the department, shall seek a waiver of s. |
| 293 | 1115 of the Social Security Act, 42 U.S.C. s. 1315; the |
| 294 | department shall expeditiously seek any available Supplemental |
| 295 | Security Administration (SSA) waivers under s. 1110(b) of the |
| 296 | Social Security Act; and the division, in collaboration with the |
| 297 | department, shall seek federal approval to participate in the |
| 298 | FloridaSDC program. |
| 299 | (b) The department may apply for and use any funds from |
| 300 | private, state, and federal grants provided for self-directed |
| 301 | care, voucher, and self-determination programs, including those |
| 302 | providing substance abuse and mental health care. |
| 303 | (c) The FloridaSDC program may operate while awaiting |
| 304 | approval of federal waivers, but the program may not provide |
| 305 | services for which a waiver is required without first obtaining |
| 306 | approval for that waiver. |
| 307 | (9) FUNDS TRANSFER.--The department, the agency, and the |
| 308 | division may transfer funds as identified in paragraph (5)(a) to |
| 309 | the managing entity. |
| 310 | (10) REVIEWS AND REPORTS.--The department, the agency, and |
| 311 | the division shall each, on an ongoing basis, review and assess |
| 312 | the implementation of the FloridaSDC program. The department |
| 313 | shall implement an evaluation of the program through June 2006. |
| 314 | If the agency obtains a federal waiver, the evaluation shall be |
| 315 | used to demonstrate effectiveness. The evaluation is considered |
| 316 | part of administrative funds and cannot be paid for by service |
| 317 | dollars. Beginning January 31, 2005, the department shall |
| 318 | biannually submit a written report to the chairs of the |
| 319 | appropriate substantive committees of the Legislature that |
| 320 | includes review of the FloridaSDC program by the department, the |
| 321 | agency, and the division and that contains recommendations for |
| 322 | improvements to the program. |
| 323 | (11) RULES.--The department, the agency, and the division |
| 324 | shall have rulemaking authority to implement the provisions of |
| 325 | this section. These rules shall be for the purpose of enhancing |
| 326 | choice in and control over the purchased mental health and |
| 327 | vocational rehabilitative services accessed by FloridaSDC |
| 328 | participants. The statewide advisory council and other |
| 329 | interested stakeholders may participate in the development and |
| 330 | review of such rules prior to their adoption. |
| 331 | (12) AUTHORITY.--The department has final authority on and |
| 332 | responsibility for operation of the FloridaSDC program. |
| 333 | 394.9503 Family-directed care (FloridaFDC) pilot |
| 334 | program.-- |
| 335 | (1) The Department of Children and Family Services shall |
| 336 | develop a family-directed care (FloridaFDC) pilot program in a |
| 337 | district selected by the department. The FloridaFDC pilot |
| 338 | program shall provide mental health treatment and support |
| 339 | services for children who are at risk of emotional disturbance |
| 340 | or who have an emotional disturbance or a serious emotional |
| 341 | disturbance. The FloridaFDC pilot program shall be organized and |
| 342 | operated in the same manner and intent as the self-directed care |
| 343 | (FloridaSDC) program established under s. 394.9501. The |
| 344 | department may use for the FloridaFDC pilot program any funds of |
| 345 | the FloridaSDC program secured from grants provided for |
| 346 | substance abuse and mental health services that are designated |
| 347 | for services to children. |
| 348 | (2) Participants in the FloridaFDC pilot program shall be |
| 349 | children who are at risk of emotional disturbance or who have an |
| 350 | emotional disturbance or a serious emotional disturbance. The |
| 351 | child must be living at home with his or her family or legal |
| 352 | guardian in order to participate in the FloridaFDC pilot |
| 353 | program. |
| 354 | (a) A child at risk of emotional disturbance is a person |
| 355 | under 18 years of age who is currently referred for mental |
| 356 | health treatment in a program for students with emotional |
| 357 | disabilities in accordance with the Individuals with |
| 358 | Disabilities Education Act and for whom there are strong |
| 359 | clinical indicators that in the near future such child will |
| 360 | require treatment and care from the public mental health care |
| 361 | system. |
| 362 | (b) A child with an emotional disturbance is a person |
| 363 | under 18 years of age who meets one of the following criteria: |
| 364 | 1. Has a diagnosis listed in the Diagnostic and |
| 365 | Statistical Manual of the American Psychiatric Association and a |
| 366 | Children's Global Assessment Scale score of 51-60. |
| 367 | 2. Is currently classified as a student with an emotional |
| 368 | disturbance by a local school district. |
| 369 | (c) A child with a serious emotional disturbance is a |
| 370 | person under 18 years of age who meets one of the following |
| 371 | criteria: |
| 372 | 1. Has a diagnosis of schizophrenia or other psychotic |
| 373 | disorder, major depression, mood disorder, or personality |
| 374 | disorder. |
| 375 | 2. Has a diagnosis listed in the Diagnostic and |
| 376 | Statistical Manual of the American Psychiatric Association and a |
| 377 | Children's Global Assessment Scale score of 50 or below. |
| 378 | 3. Is currently classified as a student with a serious |
| 379 | emotional disturbance by a local school district. |
| 380 | 4. Is currently receiving supplemental security income |
| 381 | (SSI) benefits for a psychiatric disability. |
| 382 | (3) The following children are not eligible to participate |
| 383 | in the FloridaFDC pilot program: |
| 384 | (a) Children who are in the custody of the Department of |
| 385 | Children and Family Services. |
| 386 | (b) Children with a primary diagnosis of developmental |
| 387 | disability, pervasive developmental disorder, substance abuse, |
| 388 | communication disorder, learning disorder, or autism. |
| 389 | (4) All persons who render care to children under this |
| 390 | section must comply with the requirements of chapter 435. For |
| 391 | purposes of this section, a person who has undergone screening, |
| 392 | who is qualified for employment under this section and |
| 393 | applicable rules, and who has not been unemployed for more than |
| 394 | 180 days following such screening is not required to be |
| 395 | rescreened. Such person must attest under penalty of perjury to |
| 396 | not having been convicted of a disqualifying offense since |
| 397 | completing such screening. |
| 398 | (5) The Department of Children and Family Services, the |
| 399 | Agency for Health Care Administration, and the Division of |
| 400 | Vocational Rehabilitation of the Department of Education shall |
| 401 | have rulemaking authority to implement the provisions of this |
| 402 | section. These rules shall be for the purpose of enhancing |
| 403 | choice in and control over the purchased mental health and |
| 404 | vocational rehabilitative services received by FloridaFDC pilot |
| 405 | program participants. The statewide advisory council created |
| 406 | under s. 394.9501 and other interested stakeholders may |
| 407 | participate in the development and review of such rules prior to |
| 408 | their adoption. |
| 409 | (6) The Department of Children and Family Services shall |
| 410 | submit a report concerning the progress of the FloridaFDC pilot |
| 411 | program to the appropriate legislative committees by December 1 |
| 412 | of each year of the pilot program. |
| 413 | (7) This section is repealed July 1, 2008. |
| 414 | Section 2. Section 394.9084, Florida Statutes, is |
| 415 | repealed. |
| 416 | Section 3. This act shall take effect July 1, 2004. |