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A bill to be entitled

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An act relating to the Florida Self-Directed Care program;

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amending s. 394.9084, F.S.; providing for the expansion of

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the program to all districts of the Department of Children

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and Family Services; defining the term "fiscal

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intermediary"; providing for the duties of the

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intermediary; deleting an obsolete provision; requiring an

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evaluation of the program by the Office of Program Policy

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Analysis and Government Accountability by a certain date;

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revising the evaluation criteria; abrogating the

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expiration date of the program; providing an effective

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date.

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

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     Section 1.  Section 394.9084, Florida Statutes, is amended

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to read:

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     394.9084 Florida Self-Directed Care program.--

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

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cooperation with the Agency for Health Care Administration, may

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provide develop a client-directed and choice-based Florida Self-

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Directed Care program, in all department pilot project in

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district 4 and three other districts to provide mental health

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treatment and support services to adults who have a serious

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mental illness. The department may also develop and implement a

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client-directed and choice-based pilot project in one district to

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provide mental health treatment and support services for children

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with a serious emotional disturbance who live at home. If

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established, any staff who work with children must be screened

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under s. 435.04. The department projects shall implement a

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payment mechanism model in which each participant client controls

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

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treatment and support services. The department shall establish

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interagency cooperative agreements and work with the agency, the

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Division of Vocational Rehabilitation, and the Social Security

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Administration to implement and administer the Florida Self-

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Directed Care program.

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     (2)  To be eligible for enrollment in the Florida Self-

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Directed Care program, a person must be an adult with a severe

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and persistent mental illness.

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

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subcomponents:

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     (a)  Department mental health services, which include

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community mental health outpatient, community support, and case

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management services funded through the department. This

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subcomponent excludes Florida Assertive Community Treatment

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

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stabilization services, including crisis stabilization units,

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short-term residential treatment, and inpatient services.

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     (b)  Agency mental health services, which include community

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mental health services and mental health targeted case management

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services reimbursed by Medicaid.

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     (c)  Vocational rehabilitation, which includes funds

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available for an eligible participant as provided by the

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

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     (d)  Social Security Administration.

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     (4) A fiscal intermediary The managing entity shall pay for

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the cost-efficient community-based services the participant

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selects to meet his or her mental health care and vocational

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rehabilitation needs and goals as identified on his or her

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recovery plan. For purposes of this section, the term "fiscal

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intermediary" means an entity approved by the department which

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helps the participant manage his or her budget allowance, retains

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the funds, processes employment information, if any, and tax

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information, reviews records to ensure correctness, and writes

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paychecks to providers.

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

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ensure state compliance with federal regulations.

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     (a) The agency, in collaboration with the department, shall

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seek federal Medicaid waivers;, and the department shall

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expeditiously seek any available Supplemental Security

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

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Security Act; and the division, in collaboration with the

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department, shall seek federal approval to participate in the

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Florida Self-Directed Care program. No later than June 30, 2005,

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the department, agency, and division shall amend and update their

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strategic and state plans to reflect participation in the

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projects, including intent to seek federal approval to provide

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cashout options for eligible services for participants in the

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projects.

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

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private, state, and federal grants provided for self-directed

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care, voucher, and self-determination programs, including those

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providing substance abuse and mental health care.

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

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transfer funds to the fiscal intermediary managing entity.

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     (7) The department, the agency, and the division are

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authorized to adopt rules to administer shall have rulemaking

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authority to implement the provisions of this section. These

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rules shall be for the purpose of enhancing choice in and control

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over the purchased mental health and vocational rehabilitative

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services accessed by Florida Self-Directed Care participants.

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

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memorandum of agreement to delineate management roles for

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operation of the Florida Self-Directed Care program.

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     (9) By June 30, 2009, the Office of Program Policy Analysis

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and Government Accountability shall evaluate the effectiveness

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the department, the agency, and the division shall each, on an

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ongoing basis, review and assess the implementation of the

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Florida Self-Directed Care program. The evaluation shall include

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an assessment of participant choice and access to services, cost

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savings, coordination and quality of care, adherence to

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principles of self-directed care, barriers to implementation,

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progress toward statewide expansion of the program, and

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recommendations for improvement in the program.

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     (a) The department will implement an evaluation of the

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program and will include recommendations for improvements in the

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program.

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

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program participants and nonparticipants:

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     1. Re-hospitalization rates.

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     2. Levels of satisfaction.

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     3. Service utilization rates.

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     4. Residential stability.

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     5. Levels of community integration and interaction.

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     (c) The evaluation must evaluate adherence to the Centers

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for Medicare and Medicaid self-direction requirements, including:

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     1. Person-centered planning.

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     2. Individual budgets.

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     3. Availability of independently brokered services from

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recovery coaches and quality advocates.

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

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     5. Participant safety and program incident management

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planning.

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     6. An independently mediated grievance process.

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     (d) The evaluation must assess the economic self-

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sufficiency of the program participants, including the number of

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Individual Development Accounts.

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     (e) The evaluation must assess any adverse incidents

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resulting from the Florida Self-Directed Care, including consumer

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grievances, conflicts of interest, and patterns of self-referral

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by licensed professions.

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

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the evaluation. If the agency and the department obtain a federal

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waiver, the evaluation will be used to determine effectiveness.

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     (10) This section expires July 1, 2008.

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     Section 2.  This act shall take effect upon becoming a law.