Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. SB 7054
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/15/2016           .                                

       Appropriations Subcommittee on Health and Human Services (Sobel)
       recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 393.063, Florida Statutes, is reordered
    6  and amended to read:
    7         393.063 Definitions.—For the purposes of this chapter, the
    8  term:
    9         (2)(1) “Agency” means the Agency for Persons with
   10  Disabilities.
   11         (1)(2) “Adult day training” means training services that
   12  which take place in a nonresidential setting, separate from the
   13  home or facility in which the client resides, and; are intended
   14  to support the participation of clients in daily, meaningful,
   15  and valued routines of the community. Such training; and may be
   16  provided in include work-like settings that do not meet the
   17  definition of supported employment.
   18         (3) “Algorithm” means the mathematical formula used by the
   19  agency to calculate a budget amount for clients using variables
   20  that have statistically validated relationships to clients’
   21  needs for services provided by the home and community-based
   22  Medicaid waiver program.
   23         (4) “Allocation methodology” means the process used to
   24  determine a client’s iBudget by summing the amount generated by
   25  the algorithm and, if applicable, any funding authorized by the
   26  agency for the client pursuant to s. 393.0662(1)(b).
   27         (5)(3) “Autism” means a pervasive, neurologically based
   28  developmental disability of extended duration which causes
   29  severe learning, communication, and behavior disorders with age
   30  of onset during infancy or childhood. Individuals with autism
   31  exhibit impairment in reciprocal social interaction, impairment
   32  in verbal and nonverbal communication and imaginative ability,
   33  and a markedly restricted repertoire of activities and
   34  interests.
   35         (6)(4) “Cerebral palsy” means a group of disabling symptoms
   36  of extended duration which results from damage to the developing
   37  brain that may occur before, during, or after birth and that
   38  results in the loss or impairment of control over voluntary
   39  muscles. For the purposes of this definition, cerebral palsy
   40  does not include those symptoms or impairments resulting solely
   41  from a stroke.
   42         (7)(5) “Client” means any person determined eligible by the
   43  agency for services under this chapter.
   44         (8)(6) “Client advocate” means a friend or relative of the
   45  client, or of the client’s immediate family, who advocates for
   46  the best interests of the client in any proceedings under this
   47  chapter in which the client or his or her family has the right
   48  or duty to participate.
   49         (9)(7) “Comprehensive assessment” means the process used to
   50  determine eligibility for services under this chapter.
   51         (10)(8) “Comprehensive transitional education program”
   52  means the program established in s. 393.18.
   53         (12)(9) “Developmental disability” means a disorder or
   54  syndrome that is attributable to intellectual disability,
   55  cerebral palsy, autism, spina bifida, Down syndrome, or Prader
   56  Willi syndrome; that manifests before the age of 18; and that
   57  constitutes a substantial handicap that can reasonably be
   58  expected to continue indefinitely.
   59         (11)(10) “Developmental disabilities center” means a state
   60  owned and state-operated facility, formerly known as a “Sunland
   61  Center,” providing for the care, habilitation, and
   62  rehabilitation of clients with developmental disabilities.
   63         (13)(11) “Direct service provider” means a person 18 years
   64  of age or older who has direct face-to-face contact with a
   65  client while providing services to the client or has access to a
   66  client’s living areas or to a client’s funds or personal
   67  property.
   68         (14)(12) “Domicile” means the place where a client legally
   69  resides and, which place is his or her permanent home. Domicile
   70  may be established as provided in s. 222.17. Domicile may not be
   71  established in Florida by a minor who has no parent domiciled in
   72  Florida, or by a minor who has no legal guardian domiciled in
   73  Florida, or by any alien not classified as a resident alien.
   74         (15)(13) “Down syndrome” means a disorder caused by the
   75  presence of an extra chromosome 21.
   76         (16)(14) “Express and informed consent” means consent
   77  voluntarily given in writing with sufficient knowledge and
   78  comprehension of the subject matter to enable the person giving
   79  consent to make a knowing decision without any element of force,
   80  fraud, deceit, duress, or other form of constraint or coercion.
   81         (17)(15) “Family care program” means the program
   82  established in s. 393.068.
   83         (18)(16) “Foster care facility” means a residential
   84  facility licensed under this chapter which provides a family
   85  living environment including supervision and care necessary to
   86  meet the physical, emotional, and social needs of its residents.
   87  The capacity of such a facility may not be more than three
   88  residents.
   89         (19)(17) “Group home facility” means a residential facility
   90  licensed under this chapter which provides a family living
   91  environment including supervision and care necessary to meet the
   92  physical, emotional, and social needs of its residents. The
   93  capacity of such a facility shall be at least 4 but not more
   94  than 15 residents.
   95         (20) “Guardian” has the same meaning as in s. 744.102.
   96         (21)(18) “Guardian advocate” means a person appointed by a
   97  written order of the court to represent a person with
   98  developmental disabilities under s. 393.12.
   99         (22)(19) “Habilitation” means the process by which a client
  100  is assisted in acquiring and maintaining to acquire and maintain
  101  those life skills that which enable the client to cope more
  102  effectively with the demands of his or her condition and
  103  environment and to raise the level of his or her physical,
  104  mental, and social efficiency. The term It includes, but is not
  105  limited to, programs of formal structured education and
  106  treatment.
  107         (23)(20) “High-risk child” means, for the purposes of this
  108  chapter, a child from 3 to 5 years of age with one or more of
  109  the following characteristics:
  110         (a) A developmental delay in cognition, language, or
  111  physical development.
  112         (b) A child surviving a catastrophic infectious or
  113  traumatic illness known to be associated with developmental
  114  delay, when funds are specifically appropriated.
  115         (c) A child with a parent or guardian with developmental
  116  disabilities who requires assistance in meeting the child’s
  117  developmental needs.
  118         (d) A child who has a physical or genetic anomaly
  119  associated with developmental disability.
  120         (24)(21) “Intellectual disability” means significantly
  121  subaverage general intellectual functioning existing
  122  concurrently with deficits in adaptive behavior which manifests
  123  before the age of 18 and can reasonably be expected to continue
  124  indefinitely. For the purposes of this definition, the term:
  125         (a) “Adaptive behavior” means the effectiveness or degree
  126  with which an individual meets the standards of personal
  127  independence and social responsibility expected of his or her
  128  age, cultural group, and community.
  129         (b) “Significantly subaverage general intellectual
  130  functioning” means performance that is two or more standard
  131  deviations from the mean score on a standardized intelligence
  132  test specified in the rules of the agency.
  134  For purposes of the application of the criminal laws and
  135  procedural rules of this state to matters relating to pretrial,
  136  trial, sentencing, and any matters relating to the imposition
  137  and execution of the death penalty, the terms “intellectual
  138  disability” or “intellectually disabled” are interchangeable
  139  with and have the same meaning as the terms “mental retardation”
  140  or “retardation” and “mentally retarded” as defined in this
  141  section before July 1, 2013.
  142         (25)(22) “Intermediate care facility for the
  143  developmentally disabled” or “ICF/DD” means a residential
  144  facility licensed and certified under part VIII of chapter 400.
  145         (26)(23) “Medical/dental services” means medically
  146  necessary services that are provided or ordered for a client by
  147  a person licensed under chapter 458, chapter 459, or chapter
  148  466. Such services may include, but are not limited to,
  149  prescription drugs, specialized therapies, nursing supervision,
  150  hospitalization, dietary services, prosthetic devices, surgery,
  151  specialized equipment and supplies, adaptive equipment, and
  152  other services as required to prevent or alleviate a medical or
  153  dental condition.
  154         (27)(24) “Personal care services” means individual
  155  assistance with or supervision of essential activities of daily
  156  living for self-care, including ambulation, bathing, dressing,
  157  eating, grooming, and toileting, and other similar services that
  158  are incidental to the care furnished and essential to the
  159  health, safety, and welfare of the client if no one else is
  160  available to perform those services.
  161         (28)(25) “Prader-Willi syndrome” means an inherited
  162  condition typified by neonatal hypotonia with failure to thrive,
  163  hyperphagia or an excessive drive to eat which leads to obesity
  164  usually at 18 to 36 months of age, mild to moderate intellectual
  165  disability, hypogonadism, short stature, mild facial
  166  dysmorphism, and a characteristic neurobehavior.
  167         (29)(26) “Relative” means an individual who is connected by
  168  affinity or consanguinity to the client and who is 18 years of
  169  age or older.
  170         (30)(27) “Resident” means a person who has a developmental
  171  disability and resides at a residential facility, whether or not
  172  such person is a client of the agency.
  173         (31)(28) “Residential facility” means a facility providing
  174  room and board and personal care for persons who have
  175  developmental disabilities.
  176         (32)(29) “Residential habilitation” means supervision and
  177  training with the acquisition, retention, or improvement in
  178  skills related to activities of daily living, such as personal
  179  hygiene skills, homemaking skills, and the social and adaptive
  180  skills necessary to enable the individual to reside in the
  181  community.
  182         (33)(30) “Residential habilitation center” means a
  183  community residential facility licensed under this chapter which
  184  provides habilitation services. The capacity of such a facility
  185  may not be fewer than nine residents. After October 1, 1989, new
  186  residential habilitation centers may not be licensed and the
  187  licensed capacity for any existing residential habilitation
  188  center may not be increased.
  189         (34)(31) “Respite service” means appropriate, short-term,
  190  temporary care that is provided to a person who has a
  191  developmental disability in order to meet the planned or
  192  emergency needs of the person or the family or other direct
  193  service provider.
  194         (35)(32) “Restraint” means a physical device, method, or
  195  drug used to control dangerous behavior.
  196         (a) A physical restraint is any manual method or physical
  197  or mechanical device, material, or equipment attached or
  198  adjacent to an individual’s body so that he or she cannot easily
  199  remove the restraint and which restricts freedom of movement or
  200  normal access to one’s body.
  201         (b) A drug used as a restraint is a medication used to
  202  control the person’s behavior or to restrict his or her freedom
  203  of movement and is not a standard treatment for the person’s
  204  medical or psychiatric condition. Physically holding a person
  205  during a procedure to forcibly administer psychotropic
  206  medication is a physical restraint.
  207         (c) Restraint does not include physical devices, such as
  208  orthopedically prescribed appliances, surgical dressings and
  209  bandages, supportive body bands, or other physical holding
  210  necessary for routine physical examinations and tests; for
  211  purposes of orthopedic, surgical, or other similar medical
  212  treatment; to provide support for the achievement of functional
  213  body position or proper balance; or to protect a person from
  214  falling out of bed.
  215         (36)(33) “Seclusion” means the involuntary isolation of a
  216  person in a room or area from which the person is prevented from
  217  leaving. The prevention may be by physical barrier or by a staff
  218  member who is acting in a manner, or who is physically situated,
  219  so as to prevent the person from leaving the room or area. For
  220  the purposes of this chapter, the term does not mean isolation
  221  due to the medical condition or symptoms of the person.
  222         (37)(34) “Self-determination” means an individual’s freedom
  223  to exercise the same rights as all other citizens, authority to
  224  exercise control over funds needed for one’s own support,
  225  including prioritizing these funds when necessary,
  226  responsibility for the wise use of public funds, and self
  227  advocacy to speak and advocate for oneself in order to gain
  228  independence and ensure that individuals with a developmental
  229  disability are treated equally.
  230         (38)(35) “Specialized therapies” means those treatments or
  231  activities prescribed by and provided by an appropriately
  232  trained, licensed, or certified professional or staff person and
  233  may include, but are not limited to, physical therapy, speech
  234  therapy, respiratory therapy, occupational therapy, behavior
  235  therapy, physical management services, and related specialized
  236  equipment and supplies.
  237         (39)(36) “Spina bifida” means, for purposes of this
  238  chapter, a person with a medical diagnosis of spina bifida
  239  cystica or myelomeningocele.
  240         (40)(37) “Support coordinator” means a person who is
  241  designated by the agency to assist individuals and families in
  242  identifying their capacities, needs, and resources, as well as
  243  finding and gaining access to necessary supports and services;
  244  coordinating the delivery of supports and services; advocating
  245  on behalf of the individual and family; maintaining relevant
  246  records; and monitoring and evaluating the delivery of supports
  247  and services to determine the extent to which they meet the
  248  needs and expectations identified by the individual, family, and
  249  others who participated in the development of the support plan.
  250         (41)(38) “Supported employment” means employment located or
  251  provided in an integrated work setting, with earnings paid on a
  252  commensurate wage basis, and for which continued support is
  253  needed for job maintenance.
  254         (42)(39) “Supported living” means a category of
  255  individually determined services designed and coordinated in
  256  such a manner as to provide assistance to adult clients who
  257  require ongoing supports to live as independently as possible in
  258  their own homes, to be integrated into the community, and to
  259  participate in community life to the fullest extent possible.
  260         (43)(40) “Training” means a planned approach to assisting a
  261  client to attain or maintain his or her maximum potential and
  262  includes services ranging from sensory stimulation to
  263  instruction in skills for independent living and employment.
  264         (44)(41) “Treatment” means the prevention, amelioration, or
  265  cure of a client’s physical and mental disabilities or
  266  illnesses.
  267         Section 2. Section 393.0641, Florida Statutes, is repealed.
  268         Section 3. Present subsections (6) and (7) of section
  269  393.065, Florida Statutes, are redesignated as subsections (7)
  270  and (9), respectively, subsections (3) and (5) and present
  271  subsections (6) and (7) of that section are amended, and new
  272  subsections (6) and (8) are added to that section, to read:
  273         393.065 Application and eligibility determination.—
  274         (3) The agency shall notify each applicant, in writing, of
  275  its eligibility decision. Any applicant determined by the agency
  276  to be ineligible for developmental services has the right to
  277  appeal this decision pursuant to ss. 120.569 and 120.57.
  278         (5) Except as otherwise directed by law, beginning July 1,
  279  2010, The agency shall assign and provide priority to clients
  280  waiting for waiver services in the following order:
  281         (a) Category 1, which includes clients deemed to be in
  282  crisis as described in rule, shall be given first priority in
  283  moving from the waiting list to the waiver.
  284         (b) Category 2, which includes clients on the waiting
  285  children on the wait list who are:
  286         1. From the child welfare system with an open case in the
  287  Department of Children and Families’ statewide automated child
  288  welfare information system and who are:
  289         a. Transitioning out of the child welfare system at the
  290  finalization of an adoption, a reunification with a family
  291  member, a permanent placement with a relative, or a guardianship
  292  with a nonrelative; or
  293         b. At least 18 years old, but not yet 22 years old, and who
  294  need both waiver services and extended foster care services; or
  295         2. At least 18 years old, but not yet 22 years old, and who
  296  withdrew consent pursuant to s. 39.6251(5)(c) to remain in
  297  extended foster care.
  299  For clients who are eligible under sub-subparagraph 1.b., the
  300  agency shall provide waiver services, including residential
  301  habilitation, and the community-based care lead agency shall
  302  fund room and board at the rates established in s. 409.145(4)
  303  and provide case management and related services as defined in
  304  s. 409.986(3)(e). Such clients may receive both waiver services
  305  and services under s. 39.6251 which may not duplicate services
  306  available through the Medicaid state plan.
  307         (c) Category 3, which includes, but is not required to be
  308  limited to, clients:
  309         1. Whose caregiver has a documented condition that is
  310  expected to render the caregiver unable to provide care within
  311  the next 12 months and for whom a caregiver is required but no
  312  alternate caregiver is available;
  313         2. At substantial risk of incarceration or court commitment
  314  without supports;
  315         3. Whose documented behaviors or physical needs place them
  316  or their caregiver at risk of serious harm and other supports
  317  are not currently available to alleviate the situation; or
  318         4. Who are identified as ready for discharge within the
  319  next year from a state mental health hospital or skilled nursing
  320  facility and who require a caregiver but for whom no caregiver
  321  is available, or whose caregiver cannot provide the care needed.
  322         (d) Category 4, which includes, but is not required to be
  323  limited to, clients whose caregivers are 70 years of age or
  324  older and for whom a caregiver is required but no alternate
  325  caregiver is available.
  326         (e) Category 5, which includes, but is not required to be
  327  limited to, clients who are expected to graduate within the next
  328  12 months from secondary school and need support to obtain a
  329  meaningful day activity, or maintain competitive employment, or
  330  to pursue an accredited program of postsecondary education to
  331  which they have been accepted.
  332         (f) Category 6, which includes clients 21 years of age or
  333  older who do not meet the criteria for category 1, category 2,
  334  category 3, category 4, or category 5.
  335         (g) Category 7, which includes clients younger than 21
  336  years of age who do not meet the criteria for category 1,
  337  category 2, category 3, or category 4.
  339  Within categories 3, 4, 5, 6, and 7, the agency shall maintain a
  340  waiting wait list of clients placed in the order of the date
  341  that the client is determined eligible for waiver services.
  342         (6) The agency shall allow an individual who meets the
  343  eligibility requirements pursuant to subsection (1) to receive
  344  home and community-based services in this state if the
  345  individual’s parent or legal guardian is an active duty military
  346  servicemember and if at the time of the servicemember’s transfer
  347  to this state, the individual was receiving home and community
  348  based services in another state.
  349         (7)(6) The client, the client’s guardian, or the client’s
  350  family must ensure that accurate, up-to-date contact information
  351  is provided to the agency at all times. Notwithstanding s.
  352  393.0651, the agency shall send an annual letter requesting
  353  updated information from the client, the client’s guardian, or
  354  the client’s family. The agency shall remove from the waiting
  355  wait list any individual who cannot be located using the contact
  356  information provided to the agency, fails to meet eligibility
  357  requirements, or becomes domiciled outside the state.
  358         (8) Agency action that selects individuals to receive
  359  waiver services pursuant to this section does not establish a
  360  right to a hearing or an administrative proceeding under chapter
  361  120 for individuals remaining on the waiting list.
  362         (9)(7) The agency and the Agency for Health Care
  363  Administration may adopt rules specifying application
  364  procedures, criteria associated with the waiting list wait-list
  365  categories, procedures for administering the waiting wait list,
  366  including tools for prioritizing waiver enrollment within
  367  categories, and eligibility criteria as needed to administer
  368  this section.
  369         Section 4. Subsection (2) of section 393.066, Florida
  370  Statutes, is amended to read:
  371         393.066 Community services and treatment.—
  372         (2) Necessary All services needed shall be purchased,
  373  rather than instead of provided directly by the agency, when the
  374  purchase of services such arrangement is more cost-efficient
  375  than providing them having those services provided directly. All
  376  purchased services must be approved by the agency. Persons or
  377  entities under contract with the agency to provide services
  378  shall use agency data management systems to document service
  379  provision to clients. Contracted persons and entities shall meet
  380  the minimum hardware and software technical requirements
  381  established by the agency for the use of such systems. Such
  382  persons or entities shall also meet any requirements established
  383  by the agency for training and professional development of staff
  384  providing direct services to clients.
  385         Section 5. Section 393.0662, Florida Statutes, is amended
  386  to read:
  387         393.0662 Individual budgets for delivery of home and
  388  community-based services; iBudget system established.—The
  389  Legislature finds that improved financial management of the
  390  existing home and community-based Medicaid waiver program is
  391  necessary to avoid deficits that impede the provision of
  392  services to individuals who are on the waiting list for
  393  enrollment in the program. The Legislature further finds that
  394  clients and their families should have greater flexibility to
  395  choose the services that best allow them to live in their
  396  community within the limits of an established budget. Therefore,
  397  the Legislature intends that the agency, in consultation with
  398  the Agency for Health Care Administration, shall manage develop
  399  and implement a comprehensive redesign of the service delivery
  400  system using individual budgets as the basis for allocating the
  401  funds appropriated for the home and community-based services
  402  Medicaid waiver program among eligible enrolled clients. The
  403  service delivery system that uses individual budgets shall be
  404  called the iBudget system.
  405         (1) The agency shall administer establish an individual
  406  budget, referred to as an iBudget, for each individual served by
  407  the home and community-based services Medicaid waiver program.
  408  The funds appropriated to the agency shall be allocated through
  409  the iBudget system to eligible, Medicaid-enrolled clients. For
  410  the iBudget system, eligible clients shall include individuals
  411  with a diagnosis of Down syndrome or a developmental disability
  412  as defined in s. 393.063. The iBudget system shall be designed
  413  to provide for: enhanced client choice within a specified
  414  service package; appropriate assessment strategies; an efficient
  415  consumer budgeting and billing process that includes
  416  reconciliation and monitoring components; a redefined role for
  417  support coordinators which that avoids potential conflicts of
  418  interest; a flexible and streamlined service review process; and
  419  a methodology and process that ensures the equitable allocation
  420  of available funds to each client based on the client’s level of
  421  need, as determined by the variables in the allocation
  422  algorithm.
  423         (a) In developing each client’s iBudget, the agency shall
  424  use the an allocation algorithm and methodology as defined in s.
  425  393.063(4). The algorithm shall use variables that have been
  426  determined by the agency to have a statistically validated
  427  relationship to the client’s level of need for services provided
  428  through the home and community-based services Medicaid waiver
  429  program. The algorithm and methodology may consider individual
  430  characteristics, including, but not limited to, a client’s age
  431  and living situation, information from a formal assessment
  432  instrument that the agency determines is valid and reliable, and
  433  information from other assessment processes.
  434         (b) The allocation methodology shall determine provide the
  435  algorithm that determines the amount of funds allocated to a
  436  client’s iBudget.
  437         (c) The agency may authorize funding approve an increase in
  438  the amount of funds allocated, as determined by the algorithm,
  439  based on a the client having one or more of the following needs
  440  that cannot be accommodated within the funding as determined by
  441  the algorithm and having no other resources, supports, or
  442  services available to meet the need:
  443         1. An extraordinary need that would place the health and
  444  safety of the client, the client’s caregiver, or the public in
  445  immediate, serious jeopardy unless the increase is approved.
  446  However, the presence of an extraordinary need in and of itself
  447  does not warrant authorized funding by the agency. An
  448  extraordinary need may include, but is not limited to:
  449         a. The loss of or a change in the client’s caregiver
  450  arrangement or a documented need based on a medical, behavioral,
  451  or psychological assessment;
  452         b.a. A documented history of significant, potentially life
  453  threatening behaviors, such as recent attempts at suicide,
  454  arson, nonconsensual sexual behavior, or self-injurious behavior
  455  requiring medical attention;
  456         c.b. A complex medical condition that requires active
  457  intervention by a licensed nurse on an ongoing basis that cannot
  458  be taught or delegated to a nonlicensed person;
  459         d.c. A chronic comorbid condition. As used in this
  460  subparagraph, the term “comorbid condition” means a medical
  461  condition existing simultaneously but independently with another
  462  medical condition in a patient; or
  463         e.d. A need for total physical assistance with activities
  464  such as eating, bathing, toileting, grooming, and personal
  465  hygiene.
  467  However, the presence of an extraordinary need alone does not
  468  warrant an increase in the amount of funds allocated to a
  469  client’s iBudget as determined by the algorithm.
  470         2. A significant need for one-time or temporary support or
  471  services that, if not provided, would place the health and
  472  safety of the client, the client’s caregiver, or the public in
  473  serious jeopardy, unless the increase is approved. A significant
  474  need may include, but is not limited to, the provision of
  475  environmental modifications, durable medical equipment, services
  476  to address the temporary loss of support from a caregiver, or
  477  special services or treatment for a serious temporary condition
  478  when the service or treatment is expected to ameliorate the
  479  underlying condition. As used in this subparagraph, the term
  480  “temporary” means a period of fewer than 12 continuous months.
  481  However, the presence of such significant need for one-time or
  482  temporary supports or services alone does not in and of itself
  483  warrant authorized funding by the agency an increase in the
  484  amount of funds allocated to a client’s iBudget as determined by
  485  the algorithm.
  486         3. A significant increase in the need for services after
  487  the beginning of the service plan year which that would place
  488  the health and safety of the client, the client’s caregiver, or
  489  the public in serious jeopardy because of substantial changes in
  490  the client’s circumstances, including, but not limited to,
  491  permanent or long-term loss or incapacity of a caregiver, loss
  492  of services authorized under the state Medicaid plan due to a
  493  change in age, or a significant change in medical or functional
  494  status which requires the provision of additional services on a
  495  permanent or long-term basis that cannot be accommodated within
  496  the client’s current iBudget. As used in this subparagraph, the
  497  term “long-term” means a period of 12 or more continuous months.
  498  However, such significant increase in need for services of a
  499  permanent or long-term nature alone does not in and of itself
  500  warrant authorized funding by the agency warrant an increase in
  501  the amount of funds allocated to a client’s iBudget as
  502  determined by the algorithm.
  503         4. A significant need for transportation services to a
  504  waiver-funded adult day training program or to waiver-funded
  505  employment services when such need cannot be accommodated within
  506  a client’s iBudget as determined by the algorithm without
  507  affecting the health and safety of the client, if public
  508  transportation is not an option due to the unique needs of the
  509  client or other transportation resources are not reasonably
  510  available.
  512  The agency shall reserve portions of the appropriation for the
  513  home and community-based services Medicaid waiver program for
  514  adjustments required pursuant to this paragraph and may use the
  515  services of an independent actuary in determining the amount of
  516  the portions to be reserved.
  517         (d)(c)A client’s iBudget shall be the total of the amount
  518  determined by the algorithm and any additional funding provided
  519  pursuant to paragraph (b). A client’s annual expenditures for
  520  home and community-based services Medicaid waiver services may
  521  not exceed the limits of his or her iBudget. The total of all
  522  clients’ projected annual iBudget expenditures may not exceed
  523  the agency’s appropriation for waiver services.
  524         (2) The Agency for Health Care Administration, in
  525  consultation with the agency, shall seek federal approval to
  526  amend current waivers, request a new waiver, and amend contracts
  527  as necessary to manage the iBudget system, to improve services
  528  for eligible and enrolled clients, and to improve the delivery
  529  of services implement the iBudget system to serve eligible,
  530  enrolled clients through the home and community-based services
  531  Medicaid waiver program and the Consumer-Directed Care Plus
  532  Program.
  533         (3) The agency shall transition all eligible, enrolled
  534  clients to the iBudget system. The agency may gradually phase in
  535  the iBudget system.
  536         (a) While the agency phases in the iBudget system, the
  537  agency may continue to serve eligible, enrolled clients under
  538  the four-tiered waiver system established under s. 393.065 while
  539  those clients await transitioning to the iBudget system.
  540         (b) The agency shall design the phase-in process to ensure
  541  that a client does not experience more than one-half of any
  542  expected overall increase or decrease to his or her existing
  543  annualized cost plan during the first year that the client is
  544  provided an iBudget due solely to the transition to the iBudget
  545  system.
  546         (3)(4) A client must use all available services authorized
  547  under the state Medicaid plan, school-based services, private
  548  insurance and other benefits, and any other resources that may
  549  be available to the client before using funds from his or her
  550  iBudget to pay for support and services.
  551         (4)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
  552  and 3. do not apply to the iBudget system.
  553         (5)(6) Rates for any or all services established under
  554  rules of the Agency for Health Care Administration must shall be
  555  designated as the maximum rather than a fixed amount for
  556  individuals who receive an iBudget, except for services
  557  specifically identified in those rules that the agency
  558  determines are not appropriate for negotiation, which may
  559  include, but are not limited to, residential habilitation
  560  services.
  561         (6)(7) The agency shall ensure that clients and caregivers
  562  have access to training and education that to inform them about
  563  the iBudget system and enhance their ability for self-direction.
  564  Such training and education must shall be offered in a variety
  565  of formats; and at a minimum, must shall address the policies
  566  and processes of the iBudget system and; the roles and
  567  responsibilities of consumers, caregivers, waiver support
  568  coordinators, providers, and the agency; must provide;
  569  information available to help the client make decisions
  570  regarding the iBudget system; and must provide examples of
  571  support and resources available in the community.
  572         (7)(8) The agency shall collect data to evaluate the
  573  implementation and outcomes of the iBudget system.
  574         (8)(9) The agency and the Agency for Health Care
  575  Administration may adopt rules specifying the allocation
  576  algorithm and methodology; criteria and processes for clients to
  577  access reserved funds for extraordinary needs, temporarily or
  578  permanently changed needs, and one-time needs; and processes and
  579  requirements for selection and review of services, development
  580  of support and cost plans, and management of the iBudget system
  581  as needed to administer this section.
  582         Section 6. Section 393.0679, Florida Statutes, is created
  583  to read:
  584         393.0679 Utilization review.—The agency shall conduct
  585  utilization review activities in intermediate care facilities
  586  for individuals with developmental disabilities, both public and
  587  private, as necessary to meet the requirements of the approved
  588  Medicaid state plan and federal law, and such facilities shall
  589  comply with any requests for information and documentation made
  590  by the agency and permit any agency inspections in connection
  591  with such activities.
  592         Section 7. Subsection (1), paragraphs (a) and (b) of
  593  subsection (4), paragraphs (b), (e), (f), (g), and (h) of
  594  subsection (5), subsection (6), paragraph (d) of subsection (7),
  595  subsection (10), and paragraph (b) of subsection (12) of section
  596  393.11, Florida Statutes, are amended, and subsection (14) is
  597  added to that section, to read:
  598         393.11 Involuntary admission to residential services.—
  599         (1) JURISDICTION.—If a person has an intellectual
  600  disability or autism and requires involuntary admission to
  601  residential services provided by the agency, the circuit court
  602  of the county in which the person resides has jurisdiction to
  603  conduct a hearing and enter an order involuntarily admitting the
  604  person in order for the person to receive the care, treatment,
  605  habilitation, and rehabilitation that the person needs. For the
  606  purpose of identifying intellectual disability or autism,
  607  diagnostic capability shall be established by the agency. Except
  608  as otherwise specified, the proceedings under this section are
  609  governed by the Florida Rules of Civil Procedure.
  610         (4) AGENCY PARTICIPATION.—
  611         (a) Upon receiving the petition, the court shall
  612  immediately order the developmental services program of the
  613  agency to examine the person being considered for involuntary
  614  admission to residential services.
  615         (b) Following examination, the agency shall file a written
  616  report with the court at least 10 working days before the date
  617  of the hearing. The report must be served on the petitioner, the
  618  person who has the intellectual disability or autism, and the
  619  person’s attorney at the time the report is filed with the
  620  court.
  621         (5) EXAMINING COMMITTEE.—
  622         (b) The court shall appoint at least three disinterested
  623  experts who have demonstrated to the court an expertise in the
  624  diagnosis, evaluation, and treatment of persons who have
  625  intellectual disabilities or autism. The committee must include
  626  at least one licensed and qualified physician, one licensed and
  627  qualified psychologist, and one qualified professional who, at a
  628  minimum, has a master’s degree in social work, special
  629  education, or vocational rehabilitation counseling, to examine
  630  the person and to testify at the hearing on the involuntary
  631  admission to residential services.
  632         (e) The committee shall prepare a written report for the
  633  court. The report must explicitly document the extent that the
  634  person meets the criteria for involuntary admission. The report,
  635  and expert testimony, must include, but not be limited to:
  636         1. The degree of the person’s intellectual disability or
  637  autism and whether, using diagnostic capabilities established by
  638  the agency, the person is eligible for agency services;
  639         2. Whether, because of the person’s degree of intellectual
  640  disability or autism, the person:
  641         a. Lacks sufficient capacity to give express and informed
  642  consent to a voluntary application for services pursuant to s.
  643  393.065 and lacks basic survival and self-care skills to such a
  644  degree that close supervision and habilitation in a residential
  645  setting are necessary and, if not provided, would result in a
  646  threat of substantial harm to the person’s well-being; or
  647         b. Lacks basic survival and self-care skills to such a
  648  degree that close supervision and habilitation in a residential
  649  setting is necessary and if not provided would result in a real
  650  and present threat of substantial harm to the person’s well
  651  being; or
  652         b.c. Is likely to physically injure others if allowed to
  653  remain at liberty.
  654         3. The purpose to be served by residential care;
  655         4. A recommendation on the type of residential placement
  656  which would be the most appropriate and least restrictive for
  657  the person; and
  658         5. The appropriate care, habilitation, and treatment.
  659         (f) The committee shall file the report with the court at
  660  least 10 working days before the date of the hearing. The report
  661  must be served on the petitioner, the person who has the
  662  intellectual disability or autism, the person’s attorney at the
  663  time the report is filed with the court, and the agency.
  664         (g) Members of the examining committee shall receive a
  665  reasonable fee to be determined by the court. The fees shall be
  666  paid from the general revenue fund of the county in which the
  667  person who has the intellectual disability or autism resided
  668  when the petition was filed.
  669         (h) The agency shall develop and prescribe by rule one or
  670  more standard forms to be used as a guide for members of the
  671  examining committee.
  672         (6) COUNSEL; GUARDIAN AD LITEM.—
  673         (a) The person who has the intellectual disability or
  674  autism must be represented by counsel at all stages of the
  675  judicial proceeding. If the person is indigent and cannot afford
  676  counsel, the court shall appoint a public defender at least 20
  677  working days before the scheduled hearing. The person’s counsel
  678  shall have full access to the records of the service provider
  679  and the agency. In all cases, the attorney shall represent the
  680  rights and legal interests of the person, regardless of who
  681  initiates the proceedings or pays the attorney attorney’s fee.
  682         (b) If the attorney, during the course of his or her
  683  representation, reasonably believes that the person who has the
  684  intellectual disability or autism cannot adequately act in his
  685  or her own interest, the attorney may seek the appointment of a
  686  guardian ad litem. A prior finding of incompetency is not
  687  required before a guardian ad litem is appointed pursuant to
  688  this section.
  689         (7) HEARING.—
  690         (d) The person who has the intellectual disability or
  691  autism must be physically present throughout the entire
  692  proceeding. If the person’s attorney believes that the person’s
  693  presence at the hearing is not in his or her best interest, the
  694  person’s presence may be waived once the court has seen the
  695  person and the hearing has commenced.
  696         (10) COMPETENCY.—
  697         (a) The issue of competency is separate and distinct from a
  698  determination of the appropriateness of involuntary admission to
  699  residential services due to intellectual disability or autism.
  700         (b) The issue of the competency of a person who has an
  701  intellectual disability or autism for purposes of assigning
  702  guardianship shall be determined in a separate proceeding
  703  according to the procedures and requirements of chapter 744. The
  704  issue of the competency of a person who has an intellectual
  705  disability or autism for purposes of determining whether the
  706  person is competent to proceed in a criminal trial shall be
  707  determined in accordance with chapter 916.
  708         (12) APPEAL.—
  709         (b) The filing of an appeal by the person who has an
  710  intellectual disability or autism stays admission of the person
  711  into residential care. The stay remains in effect during the
  712  pendency of all review proceedings in Florida courts until a
  713  mandate issues.
  716         (a) If a person is involuntarily admitted to residential
  717  services provided by the agency, the agency shall employ or, if
  718  necessary, contract with a qualified evaluator to conduct a
  719  review annually, unless otherwise ordered, to determine the
  720  appropriateness of the person’s continued involuntary admission
  721  to residential services based on the criteria in paragraph
  722  (8)(b). The review must include an assessment of the most
  723  appropriate and least restrictive type of residential placement
  724  for the person.
  725         (b) A placement resulting from an involuntary admission to
  726  residential services must be reviewed by the court at a hearing
  727  annually, unless a shorter review period is ordered. The agency
  728  shall provide to the court the completed reviews by the
  729  qualified evaluator. The review hearing must determine whether
  730  the person continues to meet the criteria in paragraph (8)(b)
  731  and, if so, whether the person still requires involuntary
  732  placement in a residential setting and whether the person is
  733  receiving adequate care, treatment, habilitation, and
  734  rehabilitation in the residential setting.
  735         (c) The agency shall provide a copy of the annual review
  736  and reasonable notice of the hearing to the appropriate state’s
  737  attorney, if applicable, and the person’s attorney and guardian,
  738  or guardian advocate if one is appointed.
  739         (d) As used in this subsection, the term “qualified
  740  evaluator” means a psychiatrist licensed under chapter 458 or
  741  chapter 459, or a psychologist licensed under chapter 490, who
  742  has demonstrated to the court an expertise in the diagnosis,
  743  evaluation, and treatment of persons with intellectual
  744  disabilities.
  745         Section 8. For the purpose of incorporating the amendment
  746  made by this act to section 393.18, Florida Statutes, in a
  747  reference thereto, subsection (15) of section 393.067, Florida
  748  Statutes, is reenacted to read:
  749         393.067 Facility licensure.—
  750         (15) The agency is not required to contract with facilities
  751  licensed pursuant to this chapter.
  752         Section 9. Section 26 of chapter 2015-222, Laws of Florida,
  753  is repealed.
  754         Section 10. Section 393.18, Florida Statutes, is reenacted
  755  and amended to read:
  756         393.18 Comprehensive transitional education program.—A
  757  comprehensive transitional education program serves individuals
  758  is a group of jointly operating centers or units, the collective
  759  purpose of which is to provide a sequential series of
  760  educational care, training, treatment, habilitation, and
  761  rehabilitation services to persons who have developmental
  762  disabilities, and who have severe or moderate maladaptive
  763  behaviors, severe maladaptive behaviors and co-occurring complex
  764  medical conditions, or a dual diagnosis of developmental
  765  disability and mental illness. However, this section does not
  766  require such programs to provide services only to persons with
  767  developmental disabilities. All such Services provided by the
  768  program must shall be temporary in nature and delivered in a
  769  manner designed to achieve structured residential setting,
  770  having the primary goal of incorporating the principles
  771  principle of self-determination and person-centered planning to
  772  transition individuals to the most appropriate, least
  773  restrictive community living option of their choice which is not
  774  operated as a in establishing permanent residence for persons
  775  with maladaptive behaviors in facilities that are not associated
  776  with the comprehensive transitional education program. The
  777  supervisor of the clinical director of the program licensee must
  778  hold a doctorate degree with a primary focus in behavior
  779  analysis from an accredited university, be a certified behavior
  780  analyst pursuant to s. 393.17, and have at least 1 year of
  781  experience in providing behavior analysis services for
  782  individuals with developmental disabilities. The staff must
  783  shall include behavior analysts and teachers, as appropriate,
  784  who must shall be available to provide services in each
  785  component center or unit of the program. A behavior analyst must
  786  be certified pursuant to s. 393.17.
  787         (1) Comprehensive transitional education programs must
  788  shall include a minimum of two component centers or units, one
  789  of which shall be an intensive treatment and educational center
  790  or a transitional training and educational center, which
  791  provides services to persons with maladaptive behaviors in the
  792  following components sequential order:
  793         (a) Intensive treatment and education educational center.
  794  This component provides is a self-contained residential unit
  795  providing intensive behavioral and educational programming for
  796  individuals whose conditions persons with severe maladaptive
  797  behaviors whose behaviors preclude placement in a less
  798  restrictive environment due to the threat of danger or injury to
  799  themselves or others. Continuous-shift staff are shall be
  800  required for this component.
  801         (b) Intensive Transitional training and education
  802  educational center.—This component provides is a residential
  803  unit for persons with moderate maladaptive behaviors providing
  804  concentrated psychological and educational programming that
  805  emphasizes a transition toward a less restrictive environment.
  806  Continuous-shift staff are shall be required for this component.
  807         (c) Community Transition residence.—This component provides
  808  is a residential center providing educational programs and any
  809  support services, training, and care that are needed to assist
  810  persons with maladaptive behaviors to avoid regression to more
  811  restrictive environments while preparing them for more
  812  independent living. Continuous-shift staff are shall be required
  813  for this component.
  814         (d) Alternative living center.—This component is a
  815  residential unit providing an educational and family living
  816  environment for persons with maladaptive behaviors in a
  817  moderately unrestricted setting. Residential staff shall be
  818  required for this component.
  819         (e) Independent living education center.—This component is
  820  a facility providing a family living environment for persons
  821  with maladaptive behaviors in a largely unrestricted setting and
  822  includes education and monitoring that is appropriate to support
  823  the development of independent living skills.
  824         (2) Components of a comprehensive transitional education
  825  program are subject to the license issued under s. 393.067 to a
  826  comprehensive transitional education program and may be located
  827  on a single site or multiple sites as long as such components
  828  are located within the same agency region.
  829         (3) Comprehensive transitional education programs shall
  830  develop individual education plans for each school-aged person
  831  with maladaptive behaviors, severe maladaptive behaviors and co
  832  occurring complex medical conditions, or a dual diagnosis of
  833  developmental disability and mental illness who receives
  834  services from the program. Each individual education plan shall
  835  be developed in accordance with the criteria specified in 20
  836  U.S.C. ss. 401 et seq., and 34 C.F.R. part 300. Educational
  837  components of the program, including individual education plans,
  838  must be integrated with the referring school district of each
  839  school-aged resident to the extent possible.
  840         (4) For comprehensive transitional education programs, The
  841  total number of persons in a comprehensive transitional
  842  education program residents who are being provided with services
  843  may not in any instance exceed the licensed capacity of 120
  844  residents, and each residential unit within the component
  845  centers of a the program authorized under this section may not
  846  in any instance exceed 15 residents. However, a program that was
  847  authorized to operate residential units with more than 15
  848  residents before July 1, 2015, may continue to operate such
  849  units.
  850         (5) Beginning July 1, 2016, the agency may approve the
  851  proposed admission or readmission of individuals into a
  852  comprehensive transitional education program for up to 2 years
  853  subject to a specific review process. The agency may allow an
  854  individual to live in this setting for a longer period of time
  855  if, after a clinical review is conducted by the agency, it is
  856  determined that remaining in the program for a longer period of
  857  time is in the best interest of the individual.
  858         (6) Comprehensive transitional education programs shall
  859  provide continuous recorded video and audio monitoring in all
  860  residential common areas. Recordings must be maintained for at
  861  least 60 days during which time the agency may review them at
  862  any time. At the request of the agency, the comprehensive
  863  transitional education program shall retain specified recordings
  864  indefinitely throughout the course of an investigation into
  865  allegations of potential abuse or neglect.
  866         (7) Comprehensive transitional education programs shall
  867  operate and maintain a video and audio monitoring system that
  868  enables authorized agency staff to monitor program activities
  869  and facilities in real time from an off-site location. To the
  870  extent possible, such monitoring may be in a manner that
  871  precludes detection or knowledge of the monitoring by staff who
  872  may be present in monitored areas.
  873         (8) Licensure is authorized for a comprehensive
  874  transitional education program that, by July 1, 1989:
  875         (a) Was in actual operation; or
  876         (b) Owned a fee simple interest in real property for which
  877  a county or municipal government has approved zoning that allows
  878  the placement of a facility operated by the program and has
  879  registered an intent with the agency to operate a comprehensive
  880  transitional education program. However, nothing prohibits the
  881  assignment of licensure eligibility by such a registrant to
  882  another entity at a different site within the state if the
  883  entity is in compliance with the criteria of this subsection and
  884  local zoning requirements and each residential facility within
  885  the component centers or units of the program authorized under
  886  this paragraph does not exceed a capacity of 15 persons.
  887         (9) Notwithstanding subsection (8), in order to maximize
  888  federal revenues and provide for children needing special
  889  behavioral services, the agency may authorize the licensure of a
  890  facility that:
  891         (a) Provides residential services for children who have
  892  developmental disabilities and intensive behavioral problems as
  893  defined by the agency; and
  894         (b) As of July 1, 2010, served children who were served by
  895  the child welfare system and who have an open case in the State
  896  Automated Child Welfare Information System.
  898  The facility must be in compliance with all program criteria and
  899  local land use and zoning requirements and may not exceed a
  900  capacity of 15 children.
  901         Section 11. Subsection (2) of section 393.501, Florida
  902  Statutes, is amended to read:
  903         393.501 Rulemaking.—
  904         (2) Such rules must address the number of facilities on a
  905  single lot or on adjacent lots, except that there is no
  906  restriction on the number of facilities designated as community
  907  residential homes located within a planned residential community
  908  as those terms are defined in s. 419.001(1). In adopting rules,
  909  comprehensive transitional education programs an alternative
  910  living center and an independent living education center, as
  911  described in s. 393.18, are subject to s. 419.001, except that
  912  such program centers are exempt from the 1,000-foot-radius
  913  requirement of s. 419.001(2) if:
  914         (a) The program centers are located on a site zoned in a
  915  manner that permits all the components of a comprehensive
  916  transitional education program center to be located on the site;
  917  or
  918         (b) There are no more than three such program centers
  919  within a radius of 1,000 feet.
  920         Section 12. Paragraph (b) of subsection (1) of section
  921  383.141, Florida Statutes, is amended to read:
  922         383.141 Prenatally diagnosed conditions; patient to be
  923  provided information; definitions; information clearinghouse;
  924  advisory council.—
  925         (1) As used in this section, the term:
  926         (b) “Developmental disability” includes Down syndrome and
  927  other developmental disabilities defined by s. 393.063(12) s.
  928  393.063(9).
  929         Section 13. Paragraph (d) of subsection (2) of section
  930  1002.385, Florida Statutes, is amended to read:
  931         1002.385 Florida personal learning scholarship accounts.—
  932         (2) DEFINITIONS.—As used in this section, the term:
  933         (d) “Disability” means, for a 3- or 4-year-old child or for
  934  a student in kindergarten to grade 12, autism spectrum disorder,
  935  as defined in the Diagnostic and Statistical Manual of Mental
  936  Disorders, Fifth Edition, published by the American Psychiatric
  937  Association; cerebral palsy, as defined in s. 393.063(6) s.
  938  393.063(4); Down syndrome, as defined in s. 393.063(15) s.
  939  393.063(13); an intellectual disability, as defined in s.
  940  393.063(24) s. 393.063(21); Prader-Willi syndrome, as defined in
  941  s. 393.063(28) s. 393.063(25); or spina bifida, as defined in s.
  942  393.063(39) s. 393.063(36); for a student in kindergarten, being
  943  a high-risk child, as defined in s. 393.063(23)(a) s.
  944  393.063(20)(a); muscular dystrophy; and Williams syndrome.
  945         Section 14. This act shall take effect June 30, 2016, or,
  946  if this act fails to become a law until after that date, it
  947  shall take effect upon becoming a law and operate retroactively
  948  to June 30, 2016.
  950  ================= T I T L E  A M E N D M E N T ================
  951  And the title is amended as follows:
  952         Delete everything before the enacting clause
  953  and insert:
  954                        A bill to be entitled                      
  955         An act relating to the Agency for Persons with
  956         Disabilities; amending s. 393.063, F.S.; redefining
  957         and defining terms; repealing s. 393.0641, F.S.,
  958         relating to a program for the prevention and treatment
  959         of severe self-injurious behavior; amending s.
  960         393.065, F.S.; providing for the assignment of
  961         priority to clients waiting for waiver services;
  962         requiring the agency to allow an individual to receive
  963         specified services if the individual’s parent or legal
  964         guardian is an active duty military servicemember,
  965         under certain circumstances; requiring the agency to
  966         send an annual letter requesting updated information
  967         to clients, their guardians, or their families;
  968         providing that certain agency action does not
  969         establish a right to a hearing or an administrative
  970         proceeding; amending s. 393.066, F.S.; providing for
  971         the use of an agency data management system; providing
  972         requirements for persons or entities under contract
  973         with the agency; amending s. 393.0662, F.S.; revising
  974         the allocations methodology that the agency is
  975         required to use to develop each client’s iBudget;
  976         adding client needs that qualify as extraordinary
  977         needs, which may result in the approval of an increase
  978         in a client’s allocated funds; revising duties of the
  979         Agency for Health Care Administration relating to the
  980         iBudget system; creating s. 393.0679, F.S.; requiring
  981         the Agency for Persons with Disabilities to conduct a
  982         certain utilization review; requiring specified
  983         intermediate care facilities to comply with certain
  984         requests and inspections by the agency; amending s.
  985         393.11, F.S.; providing for annual reviews for persons
  986         involuntarily committed to residential services;
  987         requiring the agency to employ or contract with a
  988         qualified evaluator; providing requirements for annual
  989         reviews; requiring a hearing to be held to consider
  990         the results of an annual review; requiring the agency
  991         to provide a copy of the review to certain persons;
  992         defining a term; reenacting s. 393.067(15), F.S.,
  993         relating to contracts between the Agency for Persons
  994         with Disabilities and licensed facilities, to
  995         incorporate the amendments made to s. 393.18, F.S., in
  996         a reference thereto; repealing s. 26 of ch. 2015-222,
  997         Laws of Florida, relating to the abrogation of the
  998         scheduled expiration of an amendment to s. 393.18,
  999         F.S., and the scheduled reversion of the text of that
 1000         section; reenacting and amending s. 393.18, F.S.;
 1001         revising the purposes of comprehensive transitional
 1002         education programs; providing qualification
 1003         requirements for the supervisor of the clinical
 1004         director of a specified licensee; revising the
 1005         organization and operation of components of a program;
 1006         providing for the integration of educational
 1007         components with the local school district; authorizing
 1008         the agency to approve the admission or readmission of
 1009         an individual to a program; providing for video and
 1010         audio recording and monitoring of common areas and
 1011         program activities and facilities; providing for
 1012         licensure of such programs; amending s. 393.501, F.S.;
 1013         conforming provisions to changes made by the act;
 1014         amending ss. 383.141 and 1002.385, F.S.; conforming
 1015         cross references; providing an effective date.