HB 0727

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

CODING: Words stricken are deletions; words underlined are additions.