Florida Senate - 2016              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 7054
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Persons with
    3         Disabilities; amending s. 393.063, F.S.; redefining
    4         and defining terms; repealing s. 393.0641, F.S.,
    5         relating to a program for the prevention and treatment
    6         of severe self-injurious behavior; amending s.
    7         393.065, F.S.; providing for the assignment of
    8         priority to clients waiting for waiver services;
    9         requiring the agency to allow an individual to receive
   10         specified services if the individual’s parent or legal
   11         guardian is an active duty military servicemember,
   12         under certain circumstances; requiring the agency to
   13         send an annual letter requesting updated information
   14         to clients, their guardians, or their families;
   15         providing that certain agency action does not
   16         establish a right to a hearing or an administrative
   17         proceeding; amending s. 393.066, F.S.; providing for
   18         the use of an agency data management system; providing
   19         requirements for persons or entities under contract
   20         with the agency; amending s. 393.0662, F.S.; revising
   21         the allocations methodology that the agency is
   22         required to use to develop each client’s iBudget;
   23         adding client needs that qualify as extraordinary
   24         needs, which may result in the approval of an increase
   25         in a client’s allocated funds; revising duties of the
   26         Agency for Health Care Administration relating to the
   27         iBudget system; creating s. 393.0679, F.S.; requiring
   28         the Agency for Persons with Disabilities to conduct a
   29         certain utilization review; requiring specified
   30         intermediate care facilities to comply with certain
   31         requests and inspections by the agency; amending s.
   32         393.11, F.S.; providing for annual reviews for persons
   33         involuntarily committed to residential services;
   34         requiring the agency to employ or contract with a
   35         qualified evaluator; providing requirements for annual
   36         reviews; requiring a hearing to be held to consider
   37         the results of an annual review; requiring the agency
   38         to provide a copy of the review to certain persons;
   39         defining a term; reenacting s. 393.067(15), F.S.,
   40         relating to contracts between the Agency for Persons
   41         with Disabilities and licensed facilities, to
   42         incorporate the amendments made to s. 393.18, F.S., in
   43         a reference thereto; repealing s. 26 of ch. 2015-222,
   44         Laws of Florida, relating to the abrogation of the
   45         scheduled expiration of an amendment to s. 393.18,
   46         F.S., and the scheduled reversion of the text of that
   47         section; reenacting and amending s. 393.18, F.S.;
   48         revising the purposes of comprehensive transitional
   49         education programs; providing qualification
   50         requirements for the supervisor of the clinical
   51         director of a specified licensee; revising the
   52         organization and operation of components of a program;
   53         providing for the integration of educational
   54         components with the local school district; authorizing
   55         the agency to approve the admission or readmission of
   56         an individual to a program; providing for video and
   57         audio recording and monitoring of common areas and
   58         program activities and facilities; providing for
   59         licensure of such programs; amending s. 393.501, F.S.;
   60         conforming provisions to changes made by the act;
   61         amending ss. 383.141 and 1002.385, F.S.; conforming
   62         cross references; providing an effective date.
   64  Be It Enacted by the Legislature of the State of Florida:
   66         Section 1. Section 393.063, Florida Statutes, is reordered
   67  and amended to read:
   68         393.063 Definitions.—For the purposes of this chapter, the
   69  term:
   70         (2)(1) “Agency” means the Agency for Persons with
   71  Disabilities.
   72         (1)(2) “Adult day training” means training services that
   73  which take place in a nonresidential setting, separate from the
   74  home or facility in which the client resides, and; are intended
   75  to support the participation of clients in daily, meaningful,
   76  and valued routines of the community. Such training; and may be
   77  provided in include work-like settings that do not meet the
   78  definition of supported employment.
   79         (3) “Algorithm” means the mathematical formula used by the
   80  agency to calculate a budget amount for clients using variables
   81  that have statistically validated relationships to clients’
   82  needs for services provided by the home and community-based
   83  Medicaid waiver program.
   84         (4) “Allocation methodology” means the process used to
   85  determine a client’s iBudget by summing the amount generated by
   86  the algorithm and, if applicable, any funding authorized by the
   87  agency for the client pursuant to s. 393.0662(1)(b).
   88         (5)(3) “Autism” means a pervasive, neurologically based
   89  developmental disability of extended duration which causes
   90  severe learning, communication, and behavior disorders with age
   91  of onset during infancy or childhood. Individuals with autism
   92  exhibit impairment in reciprocal social interaction, impairment
   93  in verbal and nonverbal communication and imaginative ability,
   94  and a markedly restricted repertoire of activities and
   95  interests.
   96         (6)(4) “Cerebral palsy” means a group of disabling symptoms
   97  of extended duration which results from damage to the developing
   98  brain that may occur before, during, or after birth and that
   99  results in the loss or impairment of control over voluntary
  100  muscles. For the purposes of this definition, cerebral palsy
  101  does not include those symptoms or impairments resulting solely
  102  from a stroke.
  103         (7)(5) “Client” means any person determined eligible by the
  104  agency for services under this chapter.
  105         (8)(6) “Client advocate” means a friend or relative of the
  106  client, or of the client’s immediate family, who advocates for
  107  the best interests of the client in any proceedings under this
  108  chapter in which the client or his or her family has the right
  109  or duty to participate.
  110         (9)(7) “Comprehensive assessment” means the process used to
  111  determine eligibility for services under this chapter.
  112         (10)(8) “Comprehensive transitional education program”
  113  means the program established in s. 393.18.
  114         (12)(9) “Developmental disability” means a disorder or
  115  syndrome that is attributable to intellectual disability,
  116  cerebral palsy, autism, spina bifida, Down syndrome, or Prader
  117  Willi syndrome; that manifests before the age of 18; and that
  118  constitutes a substantial handicap that can reasonably be
  119  expected to continue indefinitely.
  120         (11)(10) “Developmental disabilities center” means a state
  121  owned and state-operated facility, formerly known as a “Sunland
  122  Center,” providing for the care, habilitation, and
  123  rehabilitation of clients with developmental disabilities.
  124         (13)(11) “Direct service provider” means a person 18 years
  125  of age or older who has direct face-to-face contact with a
  126  client while providing services to the client or has access to a
  127  client’s living areas or to a client’s funds or personal
  128  property.
  129         (14)(12) “Domicile” means the place where a client legally
  130  resides and, which place is his or her permanent home. Domicile
  131  may be established as provided in s. 222.17. Domicile may not be
  132  established in Florida by a minor who has no parent domiciled in
  133  Florida, or by a minor who has no legal guardian domiciled in
  134  Florida, or by any alien not classified as a resident alien.
  135         (15)(13) “Down syndrome” means a disorder caused by the
  136  presence of an extra chromosome 21.
  137         (16)(14) “Express and informed consent” means consent
  138  voluntarily given in writing with sufficient knowledge and
  139  comprehension of the subject matter to enable the person giving
  140  consent to make a knowing decision without any element of force,
  141  fraud, deceit, duress, or other form of constraint or coercion.
  142         (17)(15) “Family care program” means the program
  143  established in s. 393.068.
  144         (18)(16) “Foster care facility” means a residential
  145  facility licensed under this chapter which provides a family
  146  living environment including supervision and care necessary to
  147  meet the physical, emotional, and social needs of its residents.
  148  The capacity of such a facility may not be more than three
  149  residents.
  150         (19)(17) “Group home facility” means a residential facility
  151  licensed under this chapter which provides a family living
  152  environment including supervision and care necessary to meet the
  153  physical, emotional, and social needs of its residents. The
  154  capacity of such a facility shall be at least 4 but not more
  155  than 15 residents.
  156         (20) “Guardian” has the same meaning as in s. 744.102.
  157         (21)(18) “Guardian advocate” means a person appointed by a
  158  written order of the court to represent a person with
  159  developmental disabilities under s. 393.12.
  160         (22)(19) “Habilitation” means the process by which a client
  161  is assisted in acquiring and maintaining to acquire and maintain
  162  those life skills that which enable the client to cope more
  163  effectively with the demands of his or her condition and
  164  environment and to raise the level of his or her physical,
  165  mental, and social efficiency. The term It includes, but is not
  166  limited to, programs of formal structured education and
  167  treatment.
  168         (23)(20) “High-risk child” means, for the purposes of this
  169  chapter, a child from 3 to 5 years of age with one or more of
  170  the following characteristics:
  171         (a) A developmental delay in cognition, language, or
  172  physical development.
  173         (b) A child surviving a catastrophic infectious or
  174  traumatic illness known to be associated with developmental
  175  delay, when funds are specifically appropriated.
  176         (c) A child with a parent or guardian with developmental
  177  disabilities who requires assistance in meeting the child’s
  178  developmental needs.
  179         (d) A child who has a physical or genetic anomaly
  180  associated with developmental disability.
  181         (24)(21) “Intellectual disability” means significantly
  182  subaverage general intellectual functioning existing
  183  concurrently with deficits in adaptive behavior which manifests
  184  before the age of 18 and can reasonably be expected to continue
  185  indefinitely. For the purposes of this definition, the term:
  186         (a) “Adaptive behavior” means the effectiveness or degree
  187  with which an individual meets the standards of personal
  188  independence and social responsibility expected of his or her
  189  age, cultural group, and community.
  190         (b) “Significantly subaverage general intellectual
  191  functioning” means performance that is two or more standard
  192  deviations from the mean score on a standardized intelligence
  193  test specified in the rules of the agency.
  195  For purposes of the application of the criminal laws and
  196  procedural rules of this state to matters relating to pretrial,
  197  trial, sentencing, and any matters relating to the imposition
  198  and execution of the death penalty, the terms “intellectual
  199  disability” or “intellectually disabled” are interchangeable
  200  with and have the same meaning as the terms “mental retardation”
  201  or “retardation” and “mentally retarded” as defined in this
  202  section before July 1, 2013.
  203         (25)(22) “Intermediate care facility for the
  204  developmentally disabled” or “ICF/DD” means a residential
  205  facility licensed and certified under part VIII of chapter 400.
  206         (26)(23) “Medical/dental services” means medically
  207  necessary services that are provided or ordered for a client by
  208  a person licensed under chapter 458, chapter 459, or chapter
  209  466. Such services may include, but are not limited to,
  210  prescription drugs, specialized therapies, nursing supervision,
  211  hospitalization, dietary services, prosthetic devices, surgery,
  212  specialized equipment and supplies, adaptive equipment, and
  213  other services as required to prevent or alleviate a medical or
  214  dental condition.
  215         (27)(24) “Personal care services” means individual
  216  assistance with or supervision of essential activities of daily
  217  living for self-care, including ambulation, bathing, dressing,
  218  eating, grooming, and toileting, and other similar services that
  219  are incidental to the care furnished and essential to the
  220  health, safety, and welfare of the client if no one else is
  221  available to perform those services.
  222         (28)(25) “Prader-Willi syndrome” means an inherited
  223  condition typified by neonatal hypotonia with failure to thrive,
  224  hyperphagia or an excessive drive to eat which leads to obesity
  225  usually at 18 to 36 months of age, mild to moderate intellectual
  226  disability, hypogonadism, short stature, mild facial
  227  dysmorphism, and a characteristic neurobehavior.
  228         (29)(26) “Relative” means an individual who is connected by
  229  affinity or consanguinity to the client and who is 18 years of
  230  age or older.
  231         (30)(27) “Resident” means a person who has a developmental
  232  disability and resides at a residential facility, whether or not
  233  such person is a client of the agency.
  234         (31)(28) “Residential facility” means a facility providing
  235  room and board and personal care for persons who have
  236  developmental disabilities.
  237         (32)(29) “Residential habilitation” means supervision and
  238  training with the acquisition, retention, or improvement in
  239  skills related to activities of daily living, such as personal
  240  hygiene skills, homemaking skills, and the social and adaptive
  241  skills necessary to enable the individual to reside in the
  242  community.
  243         (33)(30) “Residential habilitation center” means a
  244  community residential facility licensed under this chapter which
  245  provides habilitation services. The capacity of such a facility
  246  may not be fewer than nine residents. After October 1, 1989, new
  247  residential habilitation centers may not be licensed and the
  248  licensed capacity for any existing residential habilitation
  249  center may not be increased.
  250         (34)(31) “Respite service” means appropriate, short-term,
  251  temporary care that is provided to a person who has a
  252  developmental disability in order to meet the planned or
  253  emergency needs of the person or the family or other direct
  254  service provider.
  255         (35)(32) “Restraint” means a physical device, method, or
  256  drug used to control dangerous behavior.
  257         (a) A physical restraint is any manual method or physical
  258  or mechanical device, material, or equipment attached or
  259  adjacent to an individual’s body so that he or she cannot easily
  260  remove the restraint and which restricts freedom of movement or
  261  normal access to one’s body.
  262         (b) A drug used as a restraint is a medication used to
  263  control the person’s behavior or to restrict his or her freedom
  264  of movement and is not a standard treatment for the person’s
  265  medical or psychiatric condition. Physically holding a person
  266  during a procedure to forcibly administer psychotropic
  267  medication is a physical restraint.
  268         (c) Restraint does not include physical devices, such as
  269  orthopedically prescribed appliances, surgical dressings and
  270  bandages, supportive body bands, or other physical holding
  271  necessary for routine physical examinations and tests; for
  272  purposes of orthopedic, surgical, or other similar medical
  273  treatment; to provide support for the achievement of functional
  274  body position or proper balance; or to protect a person from
  275  falling out of bed.
  276         (36)(33) “Seclusion” means the involuntary isolation of a
  277  person in a room or area from which the person is prevented from
  278  leaving. The prevention may be by physical barrier or by a staff
  279  member who is acting in a manner, or who is physically situated,
  280  so as to prevent the person from leaving the room or area. For
  281  the purposes of this chapter, the term does not mean isolation
  282  due to the medical condition or symptoms of the person.
  283         (37)(34) “Self-determination” means an individual’s freedom
  284  to exercise the same rights as all other citizens, authority to
  285  exercise control over funds needed for one’s own support,
  286  including prioritizing these funds when necessary,
  287  responsibility for the wise use of public funds, and self
  288  advocacy to speak and advocate for oneself in order to gain
  289  independence and ensure that individuals with a developmental
  290  disability are treated equally.
  291         (38)(35) “Specialized therapies” means those treatments or
  292  activities prescribed by and provided by an appropriately
  293  trained, licensed, or certified professional or staff person and
  294  may include, but are not limited to, physical therapy, speech
  295  therapy, respiratory therapy, occupational therapy, behavior
  296  therapy, physical management services, and related specialized
  297  equipment and supplies.
  298         (39)(36) “Spina bifida” means, for purposes of this
  299  chapter, a person with a medical diagnosis of spina bifida
  300  cystica or myelomeningocele.
  301         (40)(37) “Support coordinator” means a person who is
  302  designated by the agency to assist individuals and families in
  303  identifying their capacities, needs, and resources, as well as
  304  finding and gaining access to necessary supports and services;
  305  coordinating the delivery of supports and services; advocating
  306  on behalf of the individual and family; maintaining relevant
  307  records; and monitoring and evaluating the delivery of supports
  308  and services to determine the extent to which they meet the
  309  needs and expectations identified by the individual, family, and
  310  others who participated in the development of the support plan.
  311         (41)(38) “Supported employment” means employment located or
  312  provided in an integrated work setting, with earnings paid on a
  313  commensurate wage basis, and for which continued support is
  314  needed for job maintenance.
  315         (42)(39) “Supported living” means a category of
  316  individually determined services designed and coordinated in
  317  such a manner as to provide assistance to adult clients who
  318  require ongoing supports to live as independently as possible in
  319  their own homes, to be integrated into the community, and to
  320  participate in community life to the fullest extent possible.
  321         (43)(40) “Training” means a planned approach to assisting a
  322  client to attain or maintain his or her maximum potential and
  323  includes services ranging from sensory stimulation to
  324  instruction in skills for independent living and employment.
  325         (44)(41) “Treatment” means the prevention, amelioration, or
  326  cure of a client’s physical and mental disabilities or
  327  illnesses.
  328         Section 2. Section 393.0641, Florida Statutes, is repealed.
  329         Section 3. Present subsections (6) and (7) of section
  330  393.065, Florida Statutes, are redesignated as subsections (7)
  331  and (9), respectively, subsections (3) and (5) and present
  332  subsections (6) and (7) of that section are amended, and new
  333  subsections (6) and (8) are added to that section, to read:
  334         393.065 Application and eligibility determination.—
  335         (3) The agency shall notify each applicant, in writing, of
  336  its eligibility decision. Any applicant determined by the agency
  337  to be ineligible for developmental services has the right to
  338  appeal this decision pursuant to ss. 120.569 and 120.57.
  339         (5) Except as otherwise directed by law, beginning July 1,
  340  2010, The agency shall assign and provide priority to clients
  341  waiting for waiver services in the following order:
  342         (a) Category 1, which includes clients deemed to be in
  343  crisis as described in rule, shall be given first priority in
  344  moving from the waiting list to the waiver.
  345         (b) Category 2, which includes clients on the waiting
  346  children on the wait list who are:
  347         1. From the child welfare system with an open case in the
  348  Department of Children and Families’ statewide automated child
  349  welfare information system and who are:
  350         a. Transitioning out of the child welfare system at the
  351  finalization of an adoption, a reunification with a family
  352  member, a permanent placement with a relative, or a guardianship
  353  with a nonrelative; or
  354         b. At least 18 years old, but not yet 22 years old, and who
  355  need both waiver services and extended foster care services; or
  356         2. At least 18 years old, but not yet 22 years old, and who
  357  withdrew consent pursuant to s. 39.6251(5)(c) to remain in
  358  extended foster care.
  360  For clients who are eligible under sub-subparagraph 1.b., the
  361  agency shall provide waiver services, including residential
  362  habilitation, and the community-based care lead agency shall
  363  fund room and board at the rates established in s. 409.145(4)
  364  and provide case management and related services as defined in
  365  s. 409.986(3). Such clients may receive both waiver services and
  366  services under s. 39.6251 which may not duplicate services
  367  available through the Medicaid state plan.
  368         (c) Category 3, which includes, but is not required to be
  369  limited to, clients:
  370         1. Whose caregiver has a documented condition that is
  371  expected to render the caregiver unable to provide care within
  372  the next 12 months and for whom a caregiver is required but no
  373  alternate caregiver is available;
  374         2. At substantial risk of incarceration or court commitment
  375  without supports;
  376         3. Whose documented behaviors or physical needs place them
  377  or their caregiver at risk of serious harm and other supports
  378  are not currently available to alleviate the situation; or
  379         4. Who are identified as ready for discharge within the
  380  next year from a state mental health hospital or skilled nursing
  381  facility and who require a caregiver but for whom no caregiver
  382  is available, or whose caregiver cannot provide the care needed.
  383         (d) Category 4, which includes, but is not required to be
  384  limited to, clients whose caregivers are 70 years of age or
  385  older and for whom a caregiver is required but no alternate
  386  caregiver is available.
  387         (e) Category 5, which includes, but is not required to be
  388  limited to, clients who are expected to graduate within the next
  389  12 months from secondary school and need support to obtain a
  390  meaningful day activity, or maintain competitive employment, or
  391  to pursue an accredited program of postsecondary education to
  392  which they have been accepted.
  393         (f) Category 6, which includes clients 21 years of age or
  394  older who do not meet the criteria for category 1, category 2,
  395  category 3, category 4, or category 5.
  396         (g) Category 7, which includes clients younger than 21
  397  years of age who do not meet the criteria for category 1,
  398  category 2, category 3, or category 4.
  400  Within categories 3, 4, 5, 6, and 7, the agency shall maintain a
  401  waiting wait list of clients placed in the order of the date
  402  that the client is determined eligible for waiver services.
  403         (6) The agency shall allow an individual who meets the
  404  eligibility requirements pursuant to subsection (1) to receive
  405  home and community-based services in this state if the
  406  individual’s parent or legal guardian is an active duty military
  407  servicemember and if at the time of the servicemember’s transfer
  408  to this state, the individual was receiving home and community
  409  based services in another state.
  410         (7)(6) The client, the client’s guardian, or the client’s
  411  family must ensure that accurate, up-to-date contact information
  412  is provided to the agency at all times. Notwithstanding s.
  413  393.0651, the agency shall send an annual letter requesting
  414  updated information from the client, the client’s guardian, or
  415  the client’s family. The agency shall remove from the waiting
  416  wait list any individual who cannot be located using the contact
  417  information provided to the agency, fails to meet eligibility
  418  requirements, or becomes domiciled outside the state.
  419         (8) Agency action that selects individuals to receive
  420  waiver services pursuant to this section does not establish a
  421  right to a hearing or an administrative proceeding under chapter
  422  120 for individuals remaining on the waiting list.
  423         (9)(7) The agency and the Agency for Health Care
  424  Administration may adopt rules specifying application
  425  procedures, criteria associated with the waiting list wait-list
  426  categories, procedures for administering the waiting wait list,
  427  including tools for prioritizing waiver enrollment within
  428  categories, and eligibility criteria as needed to administer
  429  this section.
  430         Section 4. Subsection (2) of section 393.066, Florida
  431  Statutes, is amended to read:
  432         393.066 Community services and treatment.—
  433         (2) Necessary All services needed shall be purchased,
  434  rather than instead of provided directly by the agency, when the
  435  purchase of services such arrangement is more cost-efficient
  436  than providing them having those services provided directly. All
  437  purchased services must be approved by the agency. Persons or
  438  entities under contract with the agency to provide services
  439  shall use agency data management systems to document service
  440  provision to clients. Contracted persons and entities shall meet
  441  the minimum hardware and software technical requirements
  442  established by the agency for the use of such systems. Such
  443  persons or entities shall also meet any requirements established
  444  by the agency for training and professional development of staff
  445  providing direct services to clients.
  446         Section 5. Section 393.0662, Florida Statutes, is amended
  447  to read:
  448         393.0662 Individual budgets for delivery of home and
  449  community-based services; iBudget system established.—The
  450  Legislature finds that improved financial management of the
  451  existing home and community-based Medicaid waiver program is
  452  necessary to avoid deficits that impede the provision of
  453  services to individuals who are on the waiting list for
  454  enrollment in the program. The Legislature further finds that
  455  clients and their families should have greater flexibility to
  456  choose the services that best allow them to live in their
  457  community within the limits of an established budget. Therefore,
  458  the Legislature intends that the agency, in consultation with
  459  the Agency for Health Care Administration, shall manage develop
  460  and implement a comprehensive redesign of the service delivery
  461  system using individual budgets as the basis for allocating the
  462  funds appropriated for the home and community-based services
  463  Medicaid waiver program among eligible enrolled clients. The
  464  service delivery system that uses individual budgets shall be
  465  called the iBudget system.
  466         (1) The agency shall administer establish an individual
  467  budget, referred to as an iBudget, for each individual served by
  468  the home and community-based services Medicaid waiver program.
  469  The funds appropriated to the agency shall be allocated through
  470  the iBudget system to eligible, Medicaid-enrolled clients. For
  471  the iBudget system, eligible clients shall include individuals
  472  with a diagnosis of Down syndrome or a developmental disability
  473  as defined in s. 393.063. The iBudget system shall be designed
  474  to provide for: enhanced client choice within a specified
  475  service package; appropriate assessment strategies; an efficient
  476  consumer budgeting and billing process that includes
  477  reconciliation and monitoring components; a redefined role for
  478  support coordinators which that avoids potential conflicts of
  479  interest; a flexible and streamlined service review process; and
  480  a methodology and process that ensures the equitable allocation
  481  of available funds to each client based on the client’s level of
  482  need, as determined by the variables in the allocation
  483  algorithm.
  484         (a) In developing each client’s iBudget, the agency shall
  485  use the an allocation algorithm and methodology as defined in s.
  486  393.063. The algorithm shall use variables that have been
  487  determined by the agency to have a statistically validated
  488  relationship to the client’s level of need for services provided
  489  through the home and community-based services Medicaid waiver
  490  program. The algorithm and methodology may consider individual
  491  characteristics, including, but not limited to, a client’s age
  492  and living situation, information from a formal assessment
  493  instrument that the agency determines is valid and reliable, and
  494  information from other assessment processes.
  495         (b) The allocation methodology shall determine provide the
  496  algorithm that determines the amount of funds allocated to a
  497  client’s iBudget.
  498         (c) The agency may authorize funding approve an increase in
  499  the amount of funds allocated, as determined by the algorithm,
  500  based on a the client having one or more of the following needs
  501  that cannot be accommodated within the funding as determined by
  502  the algorithm and having no other resources, supports, or
  503  services available to meet the need:
  504         1. An extraordinary need that would place the health and
  505  safety of the client, the client’s caregiver, or the public in
  506  immediate, serious jeopardy unless the increase is approved.
  507  However, the presence of an extraordinary need in and of itself
  508  does not warrant authorized funding by the agency. An
  509  extraordinary need may include, but is not limited to:
  510         a. The loss of or a change in the client’s caregiver
  511  arrangement or a documented need based on a medical, behavioral,
  512  or psychological assessment;
  513         b.a. A documented history of significant, potentially life
  514  threatening behaviors, such as recent attempts at suicide,
  515  arson, nonconsensual sexual behavior, or self-injurious behavior
  516  requiring medical attention;
  517         c.b. A complex medical condition that requires active
  518  intervention by a licensed nurse on an ongoing basis that cannot
  519  be taught or delegated to a nonlicensed person;
  520         d.c. A chronic comorbid condition. As used in this
  521  subparagraph, the term “comorbid condition” means a medical
  522  condition existing simultaneously but independently with another
  523  medical condition in a patient; or
  524         e.d. A need for total physical assistance with activities
  525  such as eating, bathing, toileting, grooming, and personal
  526  hygiene.
  528  However, the presence of an extraordinary need alone does not
  529  warrant an increase in the amount of funds allocated to a
  530  client’s iBudget as determined by the algorithm.
  531         2. A significant need for one-time or temporary support or
  532  services that, if not provided, would place the health and
  533  safety of the client, the client’s caregiver, or the public in
  534  serious jeopardy, unless the increase is approved. A significant
  535  need may include, but is not limited to, the provision of
  536  environmental modifications, durable medical equipment, services
  537  to address the temporary loss of support from a caregiver, or
  538  special services or treatment for a serious temporary condition
  539  when the service or treatment is expected to ameliorate the
  540  underlying condition. As used in this subparagraph, the term
  541  “temporary” means a period of fewer than 12 continuous months.
  542  However, the presence of such significant need for one-time or
  543  temporary supports or services alone does not in and of itself
  544  warrant authorized funding by the agency an increase in the
  545  amount of funds allocated to a client’s iBudget as determined by
  546  the algorithm.
  547         3. A significant increase in the need for services after
  548  the beginning of the service plan year which that would place
  549  the health and safety of the client, the client’s caregiver, or
  550  the public in serious jeopardy because of substantial changes in
  551  the client’s circumstances, including, but not limited to,
  552  permanent or long-term loss or incapacity of a caregiver, loss
  553  of services authorized under the state Medicaid plan due to a
  554  change in age, or a significant change in medical or functional
  555  status which requires the provision of additional services on a
  556  permanent or long-term basis that cannot be accommodated within
  557  the client’s current iBudget. As used in this subparagraph, the
  558  term “long-term” means a period of 12 or more continuous months.
  559  However, such significant increase in need for services of a
  560  permanent or long-term nature alone does not in and of itself
  561  warrant authorized funding by the agency warrant an increase in
  562  the amount of funds allocated to a client’s iBudget as
  563  determined by the algorithm.
  564         4. A significant need for transportation services to a
  565  waiver-funded adult day training program or to waiver-funded
  566  employment services when such need cannot be accommodated within
  567  a client’s iBudget as determined by the algorithm without
  568  affecting the health and safety of the client, if public
  569  transportation is not an option due to the unique needs of the
  570  client or other transportation resources are not reasonably
  571  available.
  573  The agency shall reserve portions of the appropriation for the
  574  home and community-based services Medicaid waiver program for
  575  adjustments required pursuant to this paragraph and may use the
  576  services of an independent actuary in determining the amount of
  577  the portions to be reserved.
  578         (d)(c)A client’s iBudget shall be the total of the amount
  579  determined by the algorithm and any additional funding provided
  580  pursuant to paragraph (b). A client’s annual expenditures for
  581  home and community-based services Medicaid waiver services may
  582  not exceed the limits of his or her iBudget. The total of all
  583  clients’ projected annual iBudget expenditures may not exceed
  584  the agency’s appropriation for waiver services.
  585         (2) The Agency for Health Care Administration, in
  586  consultation with the agency, shall seek federal approval to
  587  amend current waivers, request a new waiver, and amend contracts
  588  as necessary to manage the iBudget system, to improve services
  589  for eligible and enrolled clients, and to improve the delivery
  590  of services implement the iBudget system to serve eligible,
  591  enrolled clients through the home and community-based services
  592  Medicaid waiver program and the Consumer-Directed Care Plus
  593  Program.
  594         (3) The agency shall transition all eligible, enrolled
  595  clients to the iBudget system. The agency may gradually phase in
  596  the iBudget system.
  597         (a) While the agency phases in the iBudget system, the
  598  agency may continue to serve eligible, enrolled clients under
  599  the four-tiered waiver system established under s. 393.065 while
  600  those clients await transitioning to the iBudget system.
  601         (b) The agency shall design the phase-in process to ensure
  602  that a client does not experience more than one-half of any
  603  expected overall increase or decrease to his or her existing
  604  annualized cost plan during the first year that the client is
  605  provided an iBudget due solely to the transition to the iBudget
  606  system.
  607         (3)(4) A client must use all available services authorized
  608  under the state Medicaid plan, school-based services, private
  609  insurance and other benefits, and any other resources that may
  610  be available to the client before using funds from his or her
  611  iBudget to pay for support and services.
  612         (4)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
  613  and 3. do not apply to the iBudget system.
  614         (5)(6) Rates for any or all services established under
  615  rules of the Agency for Health Care Administration must shall be
  616  designated as the maximum rather than a fixed amount for
  617  individuals who receive an iBudget, except for services
  618  specifically identified in those rules that the agency
  619  determines are not appropriate for negotiation, which may
  620  include, but are not limited to, residential habilitation
  621  services.
  622         (6)(7) The agency shall ensure that clients and caregivers
  623  have access to training and education that to inform them about
  624  the iBudget system and enhance their ability for self-direction.
  625  Such training and education must shall be offered in a variety
  626  of formats; and at a minimum, must shall address the policies
  627  and processes of the iBudget system and; the roles and
  628  responsibilities of consumers, caregivers, waiver support
  629  coordinators, providers, and the agency; must provide;
  630  information available to help the client make decisions
  631  regarding the iBudget system; and must provide examples of
  632  support and resources available in the community.
  633         (7)(8) The agency shall collect data to evaluate the
  634  implementation and outcomes of the iBudget system.
  635         (8)(9) The agency and the Agency for Health Care
  636  Administration may adopt rules specifying the allocation
  637  algorithm and methodology; criteria and processes for clients to
  638  access reserved funds for extraordinary needs, temporarily or
  639  permanently changed needs, and one-time needs; and processes and
  640  requirements for selection and review of services, development
  641  of support and cost plans, and management of the iBudget system
  642  as needed to administer this section.
  643         Section 6. Section 393.0679, Florida Statutes, is created
  644  to read:
  645         393.0679 Utilization review.—The agency shall conduct
  646  utilization review activities in intermediate care facilities
  647  for individuals with developmental disabilities, both public and
  648  private, as necessary to meet the requirements of the approved
  649  Medicaid state plan and federal law, and such facilities shall
  650  comply with any requests for information and documentation made
  651  by the agency and permit any agency inspections in connection
  652  with such activities.
  653         Section 7. Subsection (1), paragraphs (a) and (b) of
  654  subsection (4), paragraphs (b), (e), (f), (g), and (h) of
  655  subsection (5), subsection (6), paragraph (d) of subsection (7),
  656  subsection (10), and paragraph (b) of subsection (12) of section
  657  393.11, Florida Statutes, are amended, and subsection (14) is
  658  added to that section, to read:
  659         393.11 Involuntary admission to residential services.—
  660         (1) JURISDICTION.—If a person has an intellectual
  661  disability or autism and requires involuntary admission to
  662  residential services provided by the agency, the circuit court
  663  of the county in which the person resides has jurisdiction to
  664  conduct a hearing and enter an order involuntarily admitting the
  665  person in order for the person to receive the care, treatment,
  666  habilitation, and rehabilitation that the person needs. For the
  667  purpose of identifying intellectual disability or autism,
  668  diagnostic capability shall be established by the agency. Except
  669  as otherwise specified, the proceedings under this section are
  670  governed by the Florida Rules of Civil Procedure.
  671         (4) AGENCY PARTICIPATION.—
  672         (a) Upon receiving the petition, the court shall
  673  immediately order the developmental services program of the
  674  agency to examine the person being considered for involuntary
  675  admission to residential services.
  676         (b) Following examination, the agency shall file a written
  677  report with the court at least 10 working days before the date
  678  of the hearing. The report must be served on the petitioner, the
  679  person who has the intellectual disability or autism, and the
  680  person’s attorney at the time the report is filed with the
  681  court.
  682         (5) EXAMINING COMMITTEE.—
  683         (b) The court shall appoint at least three disinterested
  684  experts who have demonstrated to the court an expertise in the
  685  diagnosis, evaluation, and treatment of persons who have
  686  intellectual disabilities or autism. The committee must include
  687  at least one licensed and qualified physician, one licensed and
  688  qualified psychologist, and one qualified professional who, at a
  689  minimum, has a master’s degree in social work, special
  690  education, or vocational rehabilitation counseling, to examine
  691  the person and to testify at the hearing on the involuntary
  692  admission to residential services.
  693         (e) The committee shall prepare a written report for the
  694  court. The report must explicitly document the extent that the
  695  person meets the criteria for involuntary admission. The report,
  696  and expert testimony, must include, but not be limited to:
  697         1. The degree of the person’s intellectual disability or
  698  autism and whether, using diagnostic capabilities established by
  699  the agency, the person is eligible for agency services;
  700         2. Whether, because of the person’s degree of intellectual
  701  disability or autism, the person:
  702         a. Lacks sufficient capacity to give express and informed
  703  consent to a voluntary application for services pursuant to s.
  704  393.065 and lacks basic survival and self-care skills to such a
  705  degree that close supervision and habilitation in a residential
  706  setting are necessary and, if not provided, would result in a
  707  threat of substantial harm to the person’s well-being; or
  708         b. Lacks basic survival and self-care skills to such a
  709  degree that close supervision and habilitation in a residential
  710  setting is necessary and if not provided would result in a real
  711  and present threat of substantial harm to the person’s well
  712  being; or
  713         b.c. Is likely to physically injure others if allowed to
  714  remain at liberty.
  715         3. The purpose to be served by residential care;
  716         4. A recommendation on the type of residential placement
  717  which would be the most appropriate and least restrictive for
  718  the person; and
  719         5. The appropriate care, habilitation, and treatment.
  720         (f) The committee shall file the report with the court at
  721  least 10 working days before the date of the hearing. The report
  722  must be served on the petitioner, the person who has the
  723  intellectual disability or autism, the person’s attorney at the
  724  time the report is filed with the court, and the agency.
  725         (g) Members of the examining committee shall receive a
  726  reasonable fee to be determined by the court. The fees shall be
  727  paid from the general revenue fund of the county in which the
  728  person who has the intellectual disability or autism resided
  729  when the petition was filed.
  730         (h) The agency shall develop and prescribe by rule one or
  731  more standard forms to be used as a guide for members of the
  732  examining committee.
  733         (6) COUNSEL; GUARDIAN AD LITEM.—
  734         (a) The person who has the intellectual disability or
  735  autism must be represented by counsel at all stages of the
  736  judicial proceeding. If the person is indigent and cannot afford
  737  counsel, the court shall appoint a public defender at least 20
  738  working days before the scheduled hearing. The person’s counsel
  739  shall have full access to the records of the service provider
  740  and the agency. In all cases, the attorney shall represent the
  741  rights and legal interests of the person, regardless of who
  742  initiates the proceedings or pays the attorney attorney’s fee.
  743         (b) If the attorney, during the course of his or her
  744  representation, reasonably believes that the person who has the
  745  intellectual disability or autism cannot adequately act in his
  746  or her own interest, the attorney may seek the appointment of a
  747  guardian ad litem. A prior finding of incompetency is not
  748  required before a guardian ad litem is appointed pursuant to
  749  this section.
  750         (7) HEARING.—
  751         (d) The person who has the intellectual disability or
  752  autism must be physically present throughout the entire
  753  proceeding. If the person’s attorney believes that the person’s
  754  presence at the hearing is not in his or her best interest, the
  755  person’s presence may be waived once the court has seen the
  756  person and the hearing has commenced.
  757         (10) COMPETENCY.—
  758         (a) The issue of competency is separate and distinct from a
  759  determination of the appropriateness of involuntary admission to
  760  residential services due to intellectual disability or autism.
  761         (b) The issue of the competency of a person who has an
  762  intellectual disability or autism for purposes of assigning
  763  guardianship shall be determined in a separate proceeding
  764  according to the procedures and requirements of chapter 744. The
  765  issue of the competency of a person who has an intellectual
  766  disability or autism for purposes of determining whether the
  767  person is competent to proceed in a criminal trial shall be
  768  determined in accordance with chapter 916.
  769         (12) APPEAL.—
  770         (b) The filing of an appeal by the person who has an
  771  intellectual disability or autism stays admission of the person
  772  into residential care. The stay remains in effect during the
  773  pendency of all review proceedings in Florida courts until a
  774  mandate issues.
  777         (a) If a person is involuntarily admitted to residential
  778  services provided by the agency, the agency shall employ or, if
  779  necessary, contract with a qualified evaluator to conduct a
  780  review annually, unless otherwise ordered, to determine the
  781  appropriateness of the person’s continued involuntary admission
  782  to residential services based on the criteria in paragraph
  783  (8)(b). The review must include an assessment of the most
  784  appropriate and least restrictive type of residential placement
  785  for the person.
  786         (b) A placement resulting from an involuntary admission to
  787  residential services must be reviewed by the court at a hearing
  788  annually, unless a shorter review period is ordered. The agency
  789  shall provide to the court the completed reviews by the
  790  qualified evaluator. The review hearing must determine whether
  791  the person continues to meet the criteria in paragraph (8)(b)
  792  and, if so, whether the person still requires involuntary
  793  placement in a residential setting and whether the person is
  794  receiving adequate care, treatment, habilitation, and
  795  rehabilitation in the residential setting.
  796         (c) The agency shall provide a copy of the annual review
  797  and reasonable notice of the hearing to the appropriate state’s
  798  attorney, if applicable, and the person’s attorney and guardian,
  799  or guardian advocate if one is appointed.
  800         (d) As used in this subsection, the term “qualified
  801  evaluator” means a psychiatrist licensed under chapter 458 or
  802  chapter 459, or a psychologist licensed under chapter 490, who
  803  has demonstrated to the court an expertise in the diagnosis,
  804  evaluation, and treatment of persons with intellectual
  805  disabilities.
  806         Section 8. For the purpose of incorporating the amendment
  807  made by this act to section 393.18, Florida Statutes, in a
  808  reference thereto, subsection (15) of section 393.067, Florida
  809  Statutes, is reenacted to read:
  810         393.067 Facility licensure.—
  811         (15) The agency is not required to contract with facilities
  812  licensed pursuant to this chapter.
  813         Section 9. Section 26 of chapter 2015-222, Laws of Florida,
  814  is repealed.
  815         Section 10. Section 393.18, Florida Statutes, is reenacted
  816  and amended to read:
  817         393.18 Comprehensive transitional education program.—A
  818  comprehensive transitional education program serves individuals
  819  is a group of jointly operating centers or units, the collective
  820  purpose of which is to provide a sequential series of
  821  educational care, training, treatment, habilitation, and
  822  rehabilitation services to persons who have developmental
  823  disabilities, and who have severe or moderate maladaptive
  824  behaviors, severe maladaptive behaviors and co-occurring complex
  825  medical conditions, or a dual diagnosis of developmental
  826  disability and mental illness. However, this section does not
  827  require such programs to provide services only to persons with
  828  developmental disabilities. All such Services provided by the
  829  program must shall be temporary in nature and delivered in a
  830  manner designed to achieve structured residential setting,
  831  having the primary goal of incorporating the principles
  832  principle of self-determination and person-centered planning to
  833  transition individuals to the most appropriate, least
  834  restrictive community living option of their choice which is not
  835  operated as a in establishing permanent residence for persons
  836  with maladaptive behaviors in facilities that are not associated
  837  with the comprehensive transitional education program. The
  838  supervisor of the clinical director of the program licensee must
  839  hold a doctorate degree with a primary focus in behavior
  840  analysis from an accredited university, be a certified behavior
  841  analyst pursuant to s. 393.17, and have at least 1 year of
  842  experience in providing behavior analysis services for
  843  individuals with developmental disabilities. The staff must
  844  shall include behavior analysts and teachers, as appropriate,
  845  who must shall be available to provide services in each
  846  component center or unit of the program. A behavior analyst must
  847  be certified pursuant to s. 393.17.
  848         (1) Comprehensive transitional education programs must
  849  shall include a minimum of two component centers or units, one
  850  of which shall be an intensive treatment and educational center
  851  or a transitional training and educational center, which
  852  provides services to persons with maladaptive behaviors in the
  853  following components sequential order:
  854         (a) Intensive treatment and education educational center.
  855  This component provides is a self-contained residential unit
  856  providing intensive behavioral and educational programming for
  857  individuals whose conditions persons with severe maladaptive
  858  behaviors whose behaviors preclude placement in a less
  859  restrictive environment due to the threat of danger or injury to
  860  themselves or others. Continuous-shift staff are shall be
  861  required for this component.
  862         (b) Intensive Transitional training and education
  863  educational center.—This component provides is a residential
  864  unit for persons with moderate maladaptive behaviors providing
  865  concentrated psychological and educational programming that
  866  emphasizes a transition toward a less restrictive environment.
  867  Continuous-shift staff are shall be required for this component.
  868         (c) Community Transition residence.—This component provides
  869  is a residential center providing educational programs and any
  870  support services, training, and care that are needed to assist
  871  persons with maladaptive behaviors to avoid regression to more
  872  restrictive environments while preparing them for more
  873  independent living. Continuous-shift staff are shall be required
  874  for this component.
  875         (d) Alternative living center.—This component is a
  876  residential unit providing an educational and family living
  877  environment for persons with maladaptive behaviors in a
  878  moderately unrestricted setting. Residential staff shall be
  879  required for this component.
  880         (e) Independent living education center.—This component is
  881  a facility providing a family living environment for persons
  882  with maladaptive behaviors in a largely unrestricted setting and
  883  includes education and monitoring that is appropriate to support
  884  the development of independent living skills.
  885         (2) Components of a comprehensive transitional education
  886  program are subject to the license issued under s. 393.067 to a
  887  comprehensive transitional education program and may be located
  888  on a single site or multiple sites as long as such components
  889  are located within the same agency region.
  890         (3) Comprehensive transitional education programs shall
  891  develop individual education plans for each school-aged person
  892  with maladaptive behaviors, severe maladaptive behaviors and co
  893  occurring complex medical conditions, or a dual diagnosis of
  894  developmental disability and mental illness who receives
  895  services from the program. Each individual education plan shall
  896  be developed in accordance with the criteria specified in 20
  897  U.S.C. ss. 401 et seq., and 34 C.F.R. part 300. Educational
  898  components of the program, including individual education plans,
  899  must be integrated with the referring school district of each
  900  school-aged resident to the extent possible.
  901         (4) For comprehensive transitional education programs, The
  902  total number of persons in a comprehensive transitional
  903  education program residents who are being provided with services
  904  may not in any instance exceed the licensed capacity of 120
  905  residents, and each residential unit within the component
  906  centers of a the program authorized under this section may not
  907  in any instance exceed 15 residents. However, a program that was
  908  authorized to operate residential units with more than 15
  909  residents before July 1, 2015, may continue to operate such
  910  units.
  911         (5) Beginning July 1, 2016, the agency may approve the
  912  proposed admission or readmission of individuals into a
  913  comprehensive transitional education program for up to 2 years
  914  subject to a specific review process. The agency may allow an
  915  individual to live in this setting for a longer period of time
  916  if, after a clinical review is conducted by the agency, it is
  917  determined that remaining in the program for a longer period of
  918  time is in the best interest of the individual.
  919         (6) Comprehensive transitional education programs shall
  920  provide continuous recorded video and audio monitoring in all
  921  residential common areas. Recordings must be maintained for at
  922  least 60 days during which time the agency may review them at
  923  any time. At the request of the agency, the comprehensive
  924  transitional education program shall retain specified recordings
  925  indefinitely throughout the course of an investigation into
  926  allegations of potential abuse or neglect.
  927         (7) Comprehensive transitional education programs shall
  928  operate and maintain a video and audio monitoring system that
  929  enables authorized agency staff to monitor program activities
  930  and facilities in real time from an off-site location. To the
  931  extent possible, such monitoring may be in a manner that
  932  precludes detection or knowledge of the monitoring by staff who
  933  may be present in monitored areas.
  934         (8) Licensure is authorized for a comprehensive
  935  transitional education program that, by July 1, 1989:
  936         (a) Was in actual operation; or
  937         (b) Owned a fee simple interest in real property for which
  938  a county or municipal government has approved zoning that allows
  939  the placement of a facility operated by the program and has
  940  registered an intent with the agency to operate a comprehensive
  941  transitional education program. However, nothing prohibits the
  942  assignment of licensure eligibility by such a registrant to
  943  another entity at a different site within the state if the
  944  entity is in compliance with the criteria of this subsection and
  945  local zoning requirements and each residential facility within
  946  the component centers or units of the program authorized under
  947  this paragraph does not exceed a capacity of 15 persons.
  948         (9) Notwithstanding subsection (8), in order to maximize
  949  federal revenues and provide for children needing special
  950  behavioral services, the agency may authorize the licensure of a
  951  facility that:
  952         (a) Provides residential services for children who have
  953  developmental disabilities and intensive behavioral problems as
  954  defined by the agency; and
  955         (b) As of July 1, 2010, served children who were served by
  956  the child welfare system and who have an open case in the State
  957  Automated Child Welfare Information System.
  959  The facility must be in compliance with all program criteria and
  960  local land use and zoning requirements and may not exceed a
  961  capacity of 15 children.
  962         Section 11. Subsection (2) of section 393.501, Florida
  963  Statutes, is amended to read:
  964         393.501 Rulemaking.—
  965         (2) Such rules must address the number of facilities on a
  966  single lot or on adjacent lots, except that there is no
  967  restriction on the number of facilities designated as community
  968  residential homes located within a planned residential community
  969  as those terms are defined in s. 419.001(1). In adopting rules,
  970  comprehensive transitional education programs an alternative
  971  living center and an independent living education center, as
  972  described in s. 393.18, are subject to s. 419.001, except that
  973  such program centers are exempt from the 1,000-foot-radius
  974  requirement of s. 419.001(2) if:
  975         (a) The program centers are located on a site zoned in a
  976  manner that permits all the components of a comprehensive
  977  transitional education program center to be located on the site;
  978  or
  979         (b) There are no more than three such program centers
  980  within a radius of 1,000 feet.
  981         Section 12. Paragraph (b) of subsection (1) of section
  982  383.141, Florida Statutes, is amended to read:
  983         383.141 Prenatally diagnosed conditions; patient to be
  984  provided information; definitions; information clearinghouse;
  985  advisory council.—
  986         (1) As used in this section, the term:
  987         (b) “Developmental disability” includes Down syndrome and
  988  other developmental disabilities defined by s. 393.063(12) s.
  989  393.063(9).
  990         Section 13. Paragraph (d) of subsection (2) of section
  991  1002.385, Florida Statutes, is amended to read:
  992         1002.385 Florida personal learning scholarship accounts.—
  993         (2) DEFINITIONS.—As used in this section, the term:
  994         (d) “Disability” means, for a 3- or 4-year-old child or for
  995  a student in kindergarten to grade 12, autism spectrum disorder,
  996  as defined in the Diagnostic and Statistical Manual of Mental
  997  Disorders, Fifth Edition, published by the American Psychiatric
  998  Association; cerebral palsy, as defined in s. 393.063(6) s.
  999  393.063(4); Down syndrome, as defined in s. 393.063(15) s.
 1000  393.063(13); an intellectual disability, as defined in s.
 1001  393.063(24) s. 393.063(21); Prader-Willi syndrome, as defined in
 1002  s. 393.063(28) s. 393.063(25); or spina bifida, as defined in s.
 1003  393.063(39) s. 393.063(36); for a student in kindergarten, being
 1004  a high-risk child, as defined in s. 393.063(23)(a) s.
 1005  393.063(20)(a); muscular dystrophy; and Williams syndrome.
 1006         Section 14. This act shall take effect June 30, 2016, or,
 1007  if this act fails to become a law until after that date, it
 1008  shall take effect upon becoming a law and operate retroactively
 1009  to June 30, 2016.