Florida Senate - 2016 PROPOSED COMMITTEE SUBSTITUTE
Bill No. SB 7054
Ì366342"Î366342
576-03409-16
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.
63
64 Be It Enacted by the Legislature of the State of Florida:
65
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.
194
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.
359
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.
399
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.
527
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.
572
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.
775 (14) REVIEW OF CONTINUED INVOLUNTARY ADMISSION TO
776 RESIDENTIAL SERVICES.—
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.
958
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.