Florida Senate - 2016                             CS for SB 7054
       By the Committees on Appropriations; and Children, Families, and
       Elder Affairs
       576-04977-16                                          20167054c1
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Persons with
    3         Disabilities; amending s. 393.063, F.S.; revising
    4         definitions; repealing s. 393.0641, F.S., relating to
    5         a program for the prevention and treatment of severe
    6         self-injurious behavior; amending s. 393.065, F.S.;
    7         providing for the assignment of priority to clients
    8         waiting for waiver services; requiring the agency to
    9         allow an individual to receive specified services if
   10         the individual’s parent or legal guardian is an active
   11         duty military servicemember, under certain
   12         circumstances; requiring the agency to send an annual
   13         letter requesting updated information to clients,
   14         their guardians, or their families; providing that
   15         certain agency action does not establish a right to a
   16         hearing or an administrative proceeding; amending s.
   17         393.066, F.S.; providing for the use of an agency data
   18         management system; providing requirements for persons
   19         or entities under contract with the agency; amending
   20         s. 393.0662, F.S.; revising the allocations
   21         methodology that the agency is required to use to
   22         develop each client’s iBudget; adding client needs
   23         that qualify as extraordinary needs, which may result
   24         in the approval of an increase in a client’s allocated
   25         funds; revising duties of the Agency for Health Care
   26         Administration relating to the iBudget system;
   27         creating s. 393.0663, F.S.; providing legislative
   28         findings; establishing The Arc Dental Program in the
   29         Agency for Persons with Disabilities; authorizing the
   30         agency to enter into a memorandum of agreement with
   31         and assist The Arc of Florida; providing requirements
   32         for the memorandum of agreement; requiring the agency
   33         to submit an annual report to the Governor and the
   34         Legislature; providing that implementation of the
   35         program is contingent upon an appropriation; creating
   36         s. 393.0679, F.S.; requiring the Agency for Persons
   37         with Disabilities to conduct a certain utilization
   38         review; requiring specified intermediate care
   39         facilities to comply with certain requests and
   40         inspections by the agency; amending s. 393.11, F.S.;
   41         providing for annual reviews for persons involuntarily
   42         committed to residential services; requiring the
   43         agency to employ or contract with a qualified
   44         evaluator; providing requirements for annual reviews;
   45         requiring a hearing to be held to consider the results
   46         of an annual review; requiring the agency to provide a
   47         copy of the review to certain persons; defining a
   48         term; repealing s. 24 of chapter 2015-222, Laws of
   49         Florida, relating to the abrogation of the scheduled
   50         expiration of an amendment to s. 393.067(15), F.S.,
   51         and the scheduled reversion of the text of that
   52         section; repealing s. 26 of chapter 2015-222, Laws of
   53         Florida, relating to the abrogation of the scheduled
   54         expiration of an amendment to s. 393.18, F.S., and the
   55         scheduled reversion of the text of that section;
   56         reenacting s. 393.067(15), F.S., relating to contracts
   57         between the agency and licensed facilities; reenacting
   58         and amending s. 393.18, F.S.; revising the purposes of
   59         comprehensive transitional education programs;
   60         requiring the supervisor of the clinical director of
   61         such programs to meet specified requirements;
   62         requiring such programs to include specified
   63         components; revising the organization and operation of
   64         the components; requiring components of a program to
   65         be located within the same agency region; providing
   66         for the integration of educational components of the
   67         program, including individual education plans, with
   68         the local school district of school-aged residents;
   69         requiring licensees that have entered into settlement
   70         agreements with the agency to comply with the
   71         agreement or face disciplinary action; authorizing the
   72         agency to approve the proposed admission or
   73         readmission of an individual to a program for a
   74         specified period of time; providing for an extended
   75         stay under certain circumstances; amending s. 393.501,
   76         F.S.; conforming provisions to changes made by the
   77         act; amending ss. 383.141 and 1002.385, F.S.;
   78         conforming cross references; providing effective
   79         dates.
   81  Be It Enacted by the Legislature of the State of Florida:
   83         Section 1. Section 393.063, Florida Statutes, is reordered
   84  and amended to read:
   85         393.063 Definitions.—For the purposes of this chapter, the
   86  term:
   87         (2)(1) “Agency” means the Agency for Persons with
   88  Disabilities.
   89         (1)(2) “Adult day training” means training services that
   90  which take place in a nonresidential setting, separate from the
   91  home or facility in which the client resides, and; are intended
   92  to support the participation of clients in daily, meaningful,
   93  and valued routines of the community. Such training; and may be
   94  provided in include work-like settings that do not meet the
   95  definition of supported employment.
   96         (3) “Algorithm” means the mathematical formula used by the
   97  agency to calculate a budget amount for clients using variables
   98  that have statistically validated relationships to clients’
   99  needs for services provided by the home and community-based
  100  Medicaid waiver program.
  101         (4) “Allocation methodology” means the process used to
  102  determine a client’s iBudget by summing the amount generated by
  103  the algorithm and, if applicable, any funding authorized by the
  104  agency for the client pursuant to s. 393.0662(1)(b).
  105         (5)(3) “Autism” means a pervasive, neurologically based
  106  developmental disability of extended duration which causes
  107  severe learning, communication, and behavior disorders with age
  108  of onset during infancy or childhood. Individuals with autism
  109  exhibit impairment in reciprocal social interaction, impairment
  110  in verbal and nonverbal communication and imaginative ability,
  111  and a markedly restricted repertoire of activities and
  112  interests.
  113         (6)(4) “Cerebral palsy” means a group of disabling symptoms
  114  of extended duration which results from damage to the developing
  115  brain that may occur before, during, or after birth and that
  116  results in the loss or impairment of control over voluntary
  117  muscles. For the purposes of this definition, cerebral palsy
  118  does not include those symptoms or impairments resulting solely
  119  from a stroke.
  120         (7)(5) “Client” means any person determined eligible by the
  121  agency for services under this chapter.
  122         (8)(6) “Client advocate” means a friend or relative of the
  123  client, or of the client’s immediate family, who advocates for
  124  the best interests of the client in any proceedings under this
  125  chapter in which the client or his or her family has the right
  126  or duty to participate.
  127         (9)(7) “Comprehensive assessment” means the process used to
  128  determine eligibility for services under this chapter.
  129         (10)(8) “Comprehensive transitional education program”
  130  means the program established in s. 393.18.
  131         (12)(9) “Developmental disability” means a disorder or
  132  syndrome that is attributable to intellectual disability,
  133  cerebral palsy, autism, spina bifida, Down syndrome, or Prader
  134  Willi syndrome; that manifests before the age of 18; and that
  135  constitutes a substantial handicap that can reasonably be
  136  expected to continue indefinitely.
  137         (11)(10) “Developmental disabilities center” means a state
  138  owned and state-operated facility, formerly known as a “Sunland
  139  Center,” providing for the care, habilitation, and
  140  rehabilitation of clients with developmental disabilities.
  141         (13)(11) “Direct service provider” means a person 18 years
  142  of age or older who has direct face-to-face contact with a
  143  client while providing services to the client or has access to a
  144  client’s living areas or to a client’s funds or personal
  145  property.
  146         (14)(12) “Domicile” means the place where a client legally
  147  resides and, which place is his or her permanent home. Domicile
  148  may be established as provided in s. 222.17. Domicile may not be
  149  established in Florida by a minor who has no parent domiciled in
  150  Florida, or by a minor who has no legal guardian domiciled in
  151  Florida, or by any alien not classified as a resident alien.
  152         (15)(13) “Down syndrome” means a disorder caused by the
  153  presence of an extra chromosome 21.
  154         (16)(14) “Express and informed consent” means consent
  155  voluntarily given in writing with sufficient knowledge and
  156  comprehension of the subject matter to enable the person giving
  157  consent to make a knowing decision without any element of force,
  158  fraud, deceit, duress, or other form of constraint or coercion.
  159         (17)(15) “Family care program” means the program
  160  established in s. 393.068.
  161         (18)(16) “Foster care facility” means a residential
  162  facility licensed under this chapter which provides a family
  163  living environment including supervision and care necessary to
  164  meet the physical, emotional, and social needs of its residents.
  165  The capacity of such a facility may not be more than three
  166  residents.
  167         (19)(17) “Group home facility” means a residential facility
  168  licensed under this chapter which provides a family living
  169  environment including supervision and care necessary to meet the
  170  physical, emotional, and social needs of its residents. The
  171  capacity of such a facility shall be at least 4 but not more
  172  than 15 residents.
  173         (20) “Guardian” has the same meaning as in s. 744.102.
  174         (21)(18) “Guardian advocate” means a person appointed by a
  175  written order of the court to represent a person with
  176  developmental disabilities under s. 393.12.
  177         (22)(19) “Habilitation” means the process by which a client
  178  is assisted in acquiring and maintaining to acquire and maintain
  179  those life skills that which enable the client to cope more
  180  effectively with the demands of his or her condition and
  181  environment and to raise the level of his or her physical,
  182  mental, and social efficiency. The term It includes, but is not
  183  limited to, programs of formal structured education and
  184  treatment.
  185         (23)(20) “High-risk child” means, for the purposes of this
  186  chapter, a child from 3 to 5 years of age with one or more of
  187  the following characteristics:
  188         (a) A developmental delay in cognition, language, or
  189  physical development.
  190         (b) A child surviving a catastrophic infectious or
  191  traumatic illness known to be associated with developmental
  192  delay, when funds are specifically appropriated.
  193         (c) A child with a parent or guardian with developmental
  194  disabilities who requires assistance in meeting the child’s
  195  developmental needs.
  196         (d) A child who has a physical or genetic anomaly
  197  associated with developmental disability.
  198         (24)(21) “Intellectual disability” means significantly
  199  subaverage general intellectual functioning existing
  200  concurrently with deficits in adaptive behavior which manifests
  201  before the age of 18 and can reasonably be expected to continue
  202  indefinitely. For the purposes of this definition, the term:
  203         (a) “Adaptive behavior” means the effectiveness or degree
  204  with which an individual meets the standards of personal
  205  independence and social responsibility expected of his or her
  206  age, cultural group, and community.
  207         (b) “Significantly subaverage general intellectual
  208  functioning” means performance that is two or more standard
  209  deviations from the mean score on a standardized intelligence
  210  test specified in the rules of the agency.
  212  For purposes of the application of the criminal laws and
  213  procedural rules of this state to matters relating to pretrial,
  214  trial, sentencing, and any matters relating to the imposition
  215  and execution of the death penalty, the terms “intellectual
  216  disability” or “intellectually disabled” are interchangeable
  217  with and have the same meaning as the terms “mental retardation”
  218  or “retardation” and “mentally retarded” as defined in this
  219  section before July 1, 2013.
  220         (25)(22) “Intermediate care facility for the
  221  developmentally disabled” or “ICF/DD” means a residential
  222  facility licensed and certified under part VIII of chapter 400.
  223         (26)(23) “Medical/dental services” means medically
  224  necessary services that are provided or ordered for a client by
  225  a person licensed under chapter 458, chapter 459, or chapter
  226  466. Such services may include, but are not limited to,
  227  prescription drugs, specialized therapies, nursing supervision,
  228  hospitalization, dietary services, prosthetic devices, surgery,
  229  specialized equipment and supplies, adaptive equipment, and
  230  other services as required to prevent or alleviate a medical or
  231  dental condition.
  232         (27)(24) “Personal care services” means individual
  233  assistance with or supervision of essential activities of daily
  234  living for self-care, including ambulation, bathing, dressing,
  235  eating, grooming, and toileting, and other similar services that
  236  are incidental to the care furnished and essential to the
  237  health, safety, and welfare of the client if no one else is
  238  available to perform those services.
  239         (28)(25) “Prader-Willi syndrome” means an inherited
  240  condition typified by neonatal hypotonia with failure to thrive,
  241  hyperphagia or an excessive drive to eat which leads to obesity
  242  usually at 18 to 36 months of age, mild to moderate intellectual
  243  disability, hypogonadism, short stature, mild facial
  244  dysmorphism, and a characteristic neurobehavior.
  245         (29)(26) “Relative” means an individual who is connected by
  246  affinity or consanguinity to the client and who is 18 years of
  247  age or older.
  248         (30)(27) “Resident” means a person who has a developmental
  249  disability and resides at a residential facility, whether or not
  250  such person is a client of the agency.
  251         (31)(28) “Residential facility” means a facility providing
  252  room and board and personal care for persons who have
  253  developmental disabilities.
  254         (32)(29) “Residential habilitation” means supervision and
  255  training with the acquisition, retention, or improvement in
  256  skills related to activities of daily living, such as personal
  257  hygiene skills, homemaking skills, and the social and adaptive
  258  skills necessary to enable the individual to reside in the
  259  community.
  260         (33)(30) “Residential habilitation center” means a
  261  community residential facility licensed under this chapter which
  262  provides habilitation services. The capacity of such a facility
  263  may not be fewer than nine residents. After October 1, 1989, new
  264  residential habilitation centers may not be licensed and the
  265  licensed capacity for any existing residential habilitation
  266  center may not be increased.
  267         (34)(31) “Respite service” means appropriate, short-term,
  268  temporary care that is provided to a person who has a
  269  developmental disability in order to meet the planned or
  270  emergency needs of the person or the family or other direct
  271  service provider.
  272         (35)(32) “Restraint” means a physical device, method, or
  273  drug used to control dangerous behavior.
  274         (a) A physical restraint is any manual method or physical
  275  or mechanical device, material, or equipment attached or
  276  adjacent to an individual’s body so that he or she cannot easily
  277  remove the restraint and which restricts freedom of movement or
  278  normal access to one’s body.
  279         (b) A drug used as a restraint is a medication used to
  280  control the person’s behavior or to restrict his or her freedom
  281  of movement and is not a standard treatment for the person’s
  282  medical or psychiatric condition. Physically holding a person
  283  during a procedure to forcibly administer psychotropic
  284  medication is a physical restraint.
  285         (c) Restraint does not include physical devices, such as
  286  orthopedically prescribed appliances, surgical dressings and
  287  bandages, supportive body bands, or other physical holding
  288  necessary for routine physical examinations and tests; for
  289  purposes of orthopedic, surgical, or other similar medical
  290  treatment; to provide support for the achievement of functional
  291  body position or proper balance; or to protect a person from
  292  falling out of bed.
  293         (36)(33) “Seclusion” means the involuntary isolation of a
  294  person in a room or area from which the person is prevented from
  295  leaving. The prevention may be by physical barrier or by a staff
  296  member who is acting in a manner, or who is physically situated,
  297  so as to prevent the person from leaving the room or area. For
  298  the purposes of this chapter, the term does not mean isolation
  299  due to the medical condition or symptoms of the person.
  300         (37)(34) “Self-determination” means an individual’s freedom
  301  to exercise the same rights as all other citizens, authority to
  302  exercise control over funds needed for one’s own support,
  303  including prioritizing these funds when necessary,
  304  responsibility for the wise use of public funds, and self
  305  advocacy to speak and advocate for oneself in order to gain
  306  independence and ensure that individuals with a developmental
  307  disability are treated equally.
  308         (38)(35) “Specialized therapies” means those treatments or
  309  activities prescribed by and provided by an appropriately
  310  trained, licensed, or certified professional or staff person and
  311  may include, but are not limited to, physical therapy, speech
  312  therapy, respiratory therapy, occupational therapy, behavior
  313  therapy, physical management services, and related specialized
  314  equipment and supplies.
  315         (39)(36) “Spina bifida” means, for purposes of this
  316  chapter, a person with a medical diagnosis of spina bifida
  317  cystica or myelomeningocele.
  318         (40)(37) “Support coordinator” means a person who is
  319  designated by the agency to assist individuals and families in
  320  identifying their capacities, needs, and resources, as well as
  321  finding and gaining access to necessary supports and services;
  322  coordinating the delivery of supports and services; advocating
  323  on behalf of the individual and family; maintaining relevant
  324  records; and monitoring and evaluating the delivery of supports
  325  and services to determine the extent to which they meet the
  326  needs and expectations identified by the individual, family, and
  327  others who participated in the development of the support plan.
  328         (41)(38) “Supported employment” means employment located or
  329  provided in an integrated work setting, with earnings paid on a
  330  commensurate wage basis, and for which continued support is
  331  needed for job maintenance.
  332         (42)(39) “Supported living” means a category of
  333  individually determined services designed and coordinated in
  334  such a manner as to provide assistance to adult clients who
  335  require ongoing supports to live as independently as possible in
  336  their own homes, to be integrated into the community, and to
  337  participate in community life to the fullest extent possible.
  338         (43)(40) “Training” means a planned approach to assisting a
  339  client to attain or maintain his or her maximum potential and
  340  includes services ranging from sensory stimulation to
  341  instruction in skills for independent living and employment.
  342         (44)(41) “Treatment” means the prevention, amelioration, or
  343  cure of a client’s physical and mental disabilities or
  344  illnesses.
  345         Section 2. Section 393.0641, Florida Statutes, is repealed.
  346         Section 3. Present subsections (6) and (7) of section
  347  393.065, Florida Statutes, are redesignated as subsections (7)
  348  and (9), respectively, subsections (3) and (5) and present
  349  subsections (6) and (7) of that section are amended, and new
  350  subsections (6) and (8) are added to that section, to read:
  351         393.065 Application and eligibility determination.—
  352         (3) The agency shall notify each applicant, in writing, of
  353  its eligibility decision. Any applicant determined by the agency
  354  to be ineligible for developmental services has the right to
  355  appeal this decision pursuant to ss. 120.569 and 120.57.
  356         (5) Except as otherwise directed by law, beginning July 1,
  357  2010, The agency shall assign and provide priority to clients
  358  waiting for waiver services in the following order:
  359         (a) Category 1, which includes clients deemed to be in
  360  crisis as described in rule, shall be given first priority in
  361  moving from the waiting list to the waiver.
  362         (b) Category 2, which includes clients on the waiting
  363  children on the wait list who are:
  364         1. From the child welfare system with an open case in the
  365  Department of Children and Families’ statewide automated child
  366  welfare information system and who are:
  367         a. Transitioning out of the child welfare system at the
  368  finalization of an adoption, a reunification with a family
  369  member, a permanent placement with a relative, or a guardianship
  370  with a nonrelative; or
  371         b. At least 18 years old, but not yet 22 years old, and who
  372  need both waiver services and extended foster care services; or
  373         2. At least 18 years old, but not yet 22 years old, and who
  374  withdrew consent pursuant to s. 39.6251(5)(c) to remain in
  375  extended foster care.
  377  For clients who are eligible under sub-subparagraph 1.b., the
  378  agency shall provide waiver services, including residential
  379  habilitation, and the community-based care lead agency shall
  380  fund room and board at the rates established in s. 409.145(4)
  381  and provide case management and related services as defined in
  382  s. 409.986(3). Such clients may receive both waiver services and
  383  services under s. 39.6251 which may not duplicate services
  384  available through the Medicaid state plan.
  385         (c) Category 3, which includes, but is not required to be
  386  limited to, clients:
  387         1. Whose caregiver has a documented condition that is
  388  expected to render the caregiver unable to provide care within
  389  the next 12 months and for whom a caregiver is required but no
  390  alternate caregiver is available;
  391         2. At substantial risk of incarceration or court commitment
  392  without supports;
  393         3. Whose documented behaviors or physical needs place them
  394  or their caregiver at risk of serious harm and other supports
  395  are not currently available to alleviate the situation; or
  396         4. Who are identified as ready for discharge within the
  397  next year from a state mental health hospital or skilled nursing
  398  facility and who require a caregiver but for whom no caregiver
  399  is available, or whose caregiver cannot provide the care needed.
  400         (d) Category 4, which includes, but is not required to be
  401  limited to, clients whose caregivers are 70 years of age or
  402  older and for whom a caregiver is required but no alternate
  403  caregiver is available.
  404         (e) Category 5, which includes, but is not required to be
  405  limited to, clients who are expected to graduate within the next
  406  12 months from secondary school and need support to obtain a
  407  meaningful day activity, or maintain competitive employment, or
  408  to pursue an accredited program of postsecondary education to
  409  which they have been accepted.
  410         (f) Category 6, which includes clients 21 years of age or
  411  older who do not meet the criteria for category 1, category 2,
  412  category 3, category 4, or category 5.
  413         (g) Category 7, which includes clients younger than 21
  414  years of age who do not meet the criteria for category 1,
  415  category 2, category 3, or category 4.
  417  Within categories 3, 4, 5, 6, and 7, the agency shall maintain a
  418  waiting wait list of clients placed in the order of the date
  419  that the client is determined eligible for waiver services.
  420         (6) The agency shall allow an individual who meets the
  421  eligibility requirements pursuant to subsection (1) to receive
  422  home and community-based services in this state if the
  423  individual’s parent or legal guardian is an active duty military
  424  servicemember and if at the time of the servicemember’s transfer
  425  to this state, the individual was receiving home and community
  426  based services in another state.
  427         (7)(6) The client, the client’s guardian, or the client’s
  428  family must ensure that accurate, up-to-date contact information
  429  is provided to the agency at all times. Notwithstanding s.
  430  393.0651, the agency shall send an annual letter requesting
  431  updated information from the client, the client’s guardian, or
  432  the client’s family. The agency shall remove from the waiting
  433  wait list any individual who cannot be located using the contact
  434  information provided to the agency, fails to meet eligibility
  435  requirements, or becomes domiciled outside the state.
  436         (8) Agency action that selects individuals to receive
  437  waiver services pursuant to this section does not establish a
  438  right to a hearing or an administrative proceeding under chapter
  439  120 for individuals remaining on the waiting list.
  440         (9)(7) The agency and the Agency for Health Care
  441  Administration may adopt rules specifying application
  442  procedures, criteria associated with the waiting list wait-list
  443  categories, procedures for administering the waiting wait list,
  444  including tools for prioritizing waiver enrollment within
  445  categories, and eligibility criteria as needed to administer
  446  this section.
  447         Section 4. Subsection (2) of section 393.066, Florida
  448  Statutes, is amended to read:
  449         393.066 Community services and treatment.—
  450         (2) Necessary All services needed shall be purchased,
  451  rather than instead of provided directly by the agency, when the
  452  purchase of services such arrangement is more cost-efficient
  453  than providing them having those services provided directly. All
  454  purchased services must be approved by the agency. Persons or
  455  entities under contract with the agency to provide services
  456  shall use agency data management systems to document service
  457  provision to clients. Contracted persons and entities shall meet
  458  the minimum hardware and software technical requirements
  459  established by the agency for the use of such systems. Such
  460  persons or entities shall also meet any requirements established
  461  by the agency for training and professional development of staff
  462  providing direct services to clients.
  463         Section 5. Section 393.0662, Florida Statutes, is amended
  464  to read:
  465         393.0662 Individual budgets for delivery of home and
  466  community-based services; iBudget system established.—The
  467  Legislature finds that improved financial management of the
  468  existing home and community-based Medicaid waiver program is
  469  necessary to avoid deficits that impede the provision of
  470  services to individuals who are on the waiting list for
  471  enrollment in the program. The Legislature further finds that
  472  clients and their families should have greater flexibility to
  473  choose the services that best allow them to live in their
  474  community within the limits of an established budget. Therefore,
  475  the Legislature intends that the agency, in consultation with
  476  the Agency for Health Care Administration, shall manage develop
  477  and implement a comprehensive redesign of the service delivery
  478  system using individual budgets as the basis for allocating the
  479  funds appropriated for the home and community-based services
  480  Medicaid waiver program among eligible enrolled clients. The
  481  service delivery system that uses individual budgets shall be
  482  called the iBudget system.
  483         (1) The agency shall administer establish an individual
  484  budget, referred to as an iBudget, for each individual served by
  485  the home and community-based services Medicaid waiver program.
  486  The funds appropriated to the agency shall be allocated through
  487  the iBudget system to eligible, Medicaid-enrolled clients. For
  488  the iBudget system, eligible clients shall include individuals
  489  with a diagnosis of Down syndrome or a developmental disability
  490  as defined in s. 393.063. The iBudget system shall be designed
  491  to provide for: enhanced client choice within a specified
  492  service package; appropriate assessment strategies; an efficient
  493  consumer budgeting and billing process that includes
  494  reconciliation and monitoring components; a redefined role for
  495  support coordinators which that avoids potential conflicts of
  496  interest; a flexible and streamlined service review process; and
  497  a methodology and process that ensures the equitable allocation
  498  of available funds to each client based on the client’s level of
  499  need, as determined by the variables in the allocation
  500  algorithm.
  501         (a) In developing each client’s iBudget, the agency shall
  502  use the an allocation algorithm and methodology as defined in s.
  503  393.063. The algorithm shall use variables that have been
  504  determined by the agency to have a statistically validated
  505  relationship to the client’s level of need for services provided
  506  through the home and community-based services Medicaid waiver
  507  program. The algorithm and methodology may consider individual
  508  characteristics, including, but not limited to, a client’s age
  509  and living situation, information from a formal assessment
  510  instrument that the agency determines is valid and reliable, and
  511  information from other assessment processes.
  512         (b) The allocation methodology shall determine provide the
  513  algorithm that determines the amount of funds allocated to a
  514  client’s iBudget.
  515         (b) The agency may authorize funding approve an increase in
  516  the amount of funds allocated, as determined by the algorithm,
  517  based on a the client having one or more of the following needs
  518  that cannot be accommodated within the funding as determined by
  519  the algorithm and having no other resources, supports, or
  520  services available to meet the need:
  521         1. An extraordinary need that would place the health and
  522  safety of the client, the client’s caregiver, or the public in
  523  immediate, serious jeopardy unless the increase is approved.
  524  However, the presence of an extraordinary need in and of itself
  525  does not warrant authorized funding by the agency. An
  526  extraordinary need may include, but is not limited to:
  527         a. The loss of or a change in the client’s caregiver
  528  arrangement or a documented need based on a medical, behavioral,
  529  or psychological assessment;
  530         b.a. A documented history of significant, potentially life
  531  threatening behaviors, such as recent attempts at suicide,
  532  arson, nonconsensual sexual behavior, or self-injurious behavior
  533  requiring medical attention;
  534         c.b. A complex medical condition that requires active
  535  intervention by a licensed nurse on an ongoing basis that cannot
  536  be taught or delegated to a nonlicensed person;
  537         d.c. A chronic comorbid condition. As used in this
  538  subparagraph, the term “comorbid condition” means a medical
  539  condition existing simultaneously but independently with another
  540  medical condition in a patient; or
  541         e.d. A need for total physical assistance with activities
  542  such as eating, bathing, toileting, grooming, and personal
  543  hygiene.
  545  However, the presence of an extraordinary need alone does not
  546  warrant an increase in the amount of funds allocated to a
  547  client’s iBudget as determined by the algorithm.
  548         2. A significant need for one-time or temporary support or
  549  services that, if not provided, would place the health and
  550  safety of the client, the client’s caregiver, or the public in
  551  serious jeopardy, unless the increase is approved. A significant
  552  need may include, but is not limited to, the provision of
  553  environmental modifications, durable medical equipment, services
  554  to address the temporary loss of support from a caregiver, or
  555  special services or treatment for a serious temporary condition
  556  when the service or treatment is expected to ameliorate the
  557  underlying condition. As used in this subparagraph, the term
  558  “temporary” means a period of fewer than 12 continuous months.
  559  However, the presence of such significant need for one-time or
  560  temporary supports or services alone does not in and of itself
  561  warrant authorized funding by the agency an increase in the
  562  amount of funds allocated to a client’s iBudget as determined by
  563  the algorithm.
  564         3. A significant increase in the need for services after
  565  the beginning of the service plan year which that would place
  566  the health and safety of the client, the client’s caregiver, or
  567  the public in serious jeopardy because of substantial changes in
  568  the client’s circumstances, including, but not limited to,
  569  permanent or long-term loss or incapacity of a caregiver, loss
  570  of services authorized under the state Medicaid plan due to a
  571  change in age, or a significant change in medical or functional
  572  status which requires the provision of additional services on a
  573  permanent or long-term basis that cannot be accommodated within
  574  the client’s current iBudget. As used in this subparagraph, the
  575  term “long-term” means a period of 12 or more continuous months.
  576  However, such significant increase in need for services of a
  577  permanent or long-term nature alone does not in and of itself
  578  warrant authorized funding by the agency warrant an increase in
  579  the amount of funds allocated to a client’s iBudget as
  580  determined by the algorithm.
  581         4. A significant need for transportation services to a
  582  waiver-funded adult day training program or to waiver-funded
  583  employment services when such need cannot be accommodated within
  584  a client’s iBudget as determined by the algorithm without
  585  affecting the health and safety of the client, when public
  586  transportation is not an option due to the unique needs of the
  587  client, or when other transportation resources are not
  588  reasonably available.
  590  The agency shall reserve portions of the appropriation for the
  591  home and community-based services Medicaid waiver program for
  592  adjustments required pursuant to this paragraph and may use the
  593  services of an independent actuary in determining the amount of
  594  the portions to be reserved.
  595         (c) A client’s iBudget shall be the total of the amount
  596  determined by the algorithm and any additional funding provided
  597  pursuant to paragraph (b). A client’s annual expenditures for
  598  home and community-based services Medicaid waiver services may
  599  not exceed the limits of his or her iBudget. The total of all
  600  clients’ projected annual iBudget expenditures may not exceed
  601  the agency’s appropriation for waiver services.
  602         (2) The Agency for Health Care Administration, in
  603  consultation with the agency, shall seek federal approval to
  604  amend current waivers, request a new waiver, and amend contracts
  605  as necessary to manage the iBudget system, to improve services
  606  for eligible and enrolled clients, and to improve the delivery
  607  of services implement the iBudget system to serve eligible,
  608  enrolled clients through the home and community-based services
  609  Medicaid waiver program and the Consumer-Directed Care Plus
  610  Program.
  611         (3) The agency shall transition all eligible, enrolled
  612  clients to the iBudget system. The agency may gradually phase in
  613  the iBudget system.
  614         (a) While the agency phases in the iBudget system, the
  615  agency may continue to serve eligible, enrolled clients under
  616  the four-tiered waiver system established under s. 393.065 while
  617  those clients await transitioning to the iBudget system.
  618         (b) The agency shall design the phase-in process to ensure
  619  that a client does not experience more than one-half of any
  620  expected overall increase or decrease to his or her existing
  621  annualized cost plan during the first year that the client is
  622  provided an iBudget due solely to the transition to the iBudget
  623  system.
  624         (3)(4) A client must use all available services authorized
  625  under the state Medicaid plan, school-based services, private
  626  insurance and other benefits, and any other resources that may
  627  be available to the client before using funds from his or her
  628  iBudget to pay for support and services.
  629         (4)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
  630  and 3. do not apply to the iBudget system.
  631         (5)(6) Rates for any or all services established under
  632  rules of the Agency for Health Care Administration must shall be
  633  designated as the maximum rather than a fixed amount for
  634  individuals who receive an iBudget, except for services
  635  specifically identified in those rules that the agency
  636  determines are not appropriate for negotiation, which may
  637  include, but are not limited to, residential habilitation
  638  services.
  639         (6)(7) The agency shall ensure that clients and caregivers
  640  have access to training and education that to inform them about
  641  the iBudget system and enhance their ability for self-direction.
  642  Such training and education must shall be offered in a variety
  643  of formats; and at a minimum, must shall address the policies
  644  and processes of the iBudget system and; the roles and
  645  responsibilities of consumers, caregivers, waiver support
  646  coordinators, providers, and the agency; must provide;
  647  information available to help the client make decisions
  648  regarding the iBudget system; and must provide examples of
  649  support and resources available in the community.
  650         (7)(8) The agency shall collect data to evaluate the
  651  implementation and outcomes of the iBudget system.
  652         (8)(9) The agency and the Agency for Health Care
  653  Administration may adopt rules specifying the allocation
  654  algorithm and methodology; criteria and processes for clients to
  655  access reserved funds for extraordinary needs, temporarily or
  656  permanently changed needs, and one-time needs; and processes and
  657  requirements for selection and review of services, development
  658  of support and cost plans, and management of the iBudget system
  659  as needed to administer this section.
  660         Section 6. Section 393.0663, Florida Statutes, is created
  661  to read:
  662         393.0663 The Arc Dental Program.—
  663         (1) The Legislature finds that many individuals with
  664  intellectual or developmental disabilities in this state are in
  665  need of dental treatment and that such individuals often lack
  666  access to such services. The Legislature further finds that The
  667  Arc of Florida, a not-for-profit organization that maintains
  668  programs to assist in the delivery of needed services to
  669  individuals with intellectual or developmental disabilities,
  670  operates The Arc of Florida Dental Program to provide dental
  671  services to such individuals. Since the 2012-2013 fiscal year,
  672  the Legislature has appropriated general revenue funds to the
  673  organization to allow it to recruit 180 dental practices to
  674  provide dental services to hundreds of individuals with
  675  intellectual or developmental disabilities. Such services
  676  include X-rays, cleanings, fluoride treatments, fillings, root
  677  canals, crowns, extractions, and dentures. The Legislature finds
  678  that it is in the public interest to establish a program to
  679  assist The Arc of Florida in providing dental services to
  680  individuals with intellectual or developmental disabilities.
  681         (2) The Arc Dental Program is established in the Agency for
  682  Persons with Disabilities. The agency shall enter into a
  683  memorandum of agreement with and provide assistance to The Arc
  684  of Florida in operating and expanding The Arc of Florida Dental
  685  Program. The memorandum of agreement entered into between the
  686  agency and The Arc of Florida shall require quantifiable,
  687  measurable, and verifiable units of deliverables and require The
  688  Arc of Florida to submit an annual accounting of the funding
  689  allocated by the agency.
  690         (3) Beginning January 1, 2018, and each January 1
  691  thereafter, the agency shall submit a report to the Governor,
  692  the President of the Senate, and the Speaker of the House of
  693  Representatives which summarizes contract performance by The Arc
  694  of Florida for the previous fiscal year.
  695         (4) Implementation of the Arc Dental Program is contingent
  696  upon appropriation.
  697         Section 7. Section 393.0679, Florida Statutes, is created
  698  to read:
  699         393.0679 Utilization review.—The agency shall conduct
  700  utilization review activities in intermediate care facilities
  701  for individuals with developmental disabilities, both public and
  702  private, as necessary to meet the requirements of the approved
  703  Medicaid state plan and federal law, and such facilities shall
  704  comply with any requests for information and documentation made
  705  by the agency and permit any agency inspections in connection
  706  with such activities.
  707         Section 8. Subsection (1), paragraphs (a) and (b) of
  708  subsection (4), paragraphs (b), (e), (f), (g), and (h) of
  709  subsection (5), subsection (6), paragraph (d) of subsection (7),
  710  subsection (10), and paragraph (b) of subsection (12) of section
  711  393.11, Florida Statutes, are amended, and subsection (14) is
  712  added to that section, to read:
  713         393.11 Involuntary admission to residential services.—
  714         (1) JURISDICTION.—If a person has an intellectual
  715  disability or autism and requires involuntary admission to
  716  residential services provided by the agency, the circuit court
  717  of the county in which the person resides has jurisdiction to
  718  conduct a hearing and enter an order involuntarily admitting the
  719  person in order for the person to receive the care, treatment,
  720  habilitation, and rehabilitation that the person needs. For the
  721  purpose of identifying intellectual disability or autism,
  722  diagnostic capability shall be established by the agency. Except
  723  as otherwise specified, the proceedings under this section are
  724  governed by the Florida Rules of Civil Procedure.
  725         (4) AGENCY PARTICIPATION.—
  726         (a) Upon receiving the petition, the court shall
  727  immediately order the developmental services program of the
  728  agency to examine the person being considered for involuntary
  729  admission to residential services.
  730         (b) Following examination, the agency shall file a written
  731  report with the court at least 10 working days before the date
  732  of the hearing. The report must be served on the petitioner, the
  733  person who has the intellectual disability or autism, and the
  734  person’s attorney at the time the report is filed with the
  735  court.
  736         (5) EXAMINING COMMITTEE.—
  737         (b) The court shall appoint at least three disinterested
  738  experts who have demonstrated to the court an expertise in the
  739  diagnosis, evaluation, and treatment of persons who have
  740  intellectual disabilities or autism. The committee must include
  741  at least one licensed and qualified physician, one licensed and
  742  qualified psychologist, and one qualified professional who, at a
  743  minimum, has a master’s degree in social work, special
  744  education, or vocational rehabilitation counseling, to examine
  745  the person and to testify at the hearing on the involuntary
  746  admission to residential services.
  747         (e) The committee shall prepare a written report for the
  748  court. The report must explicitly document the extent that the
  749  person meets the criteria for involuntary admission. The report,
  750  and expert testimony, must include, but not be limited to:
  751         1. The degree of the person’s intellectual disability or
  752  autism and whether, using diagnostic capabilities established by
  753  the agency, the person is eligible for agency services;
  754         2. Whether, because of the person’s degree of intellectual
  755  disability or autism, the person:
  756         a. Lacks sufficient capacity to give express and informed
  757  consent to a voluntary application for services pursuant to s.
  758  393.065 and lacks basic survival and self-care skills to such a
  759  degree that close supervision and habilitation in a residential
  760  setting are necessary and, if not provided, would result in a
  761  threat of substantial harm to the person’s well-being; or
  762         b. Lacks basic survival and self-care skills to such a
  763  degree that close supervision and habilitation in a residential
  764  setting is necessary and if not provided would result in a real
  765  and present threat of substantial harm to the person’s well
  766  being; or
  767         b.c. Is likely to physically injure others if allowed to
  768  remain at liberty.
  769         3. The purpose to be served by residential care;
  770         4. A recommendation on the type of residential placement
  771  which would be the most appropriate and least restrictive for
  772  the person; and
  773         5. The appropriate care, habilitation, and treatment.
  774         (f) The committee shall file the report with the court at
  775  least 10 working days before the date of the hearing. The report
  776  must be served on the petitioner, the person who has the
  777  intellectual disability or autism, the person’s attorney at the
  778  time the report is filed with the court, and the agency.
  779         (g) Members of the examining committee shall receive a
  780  reasonable fee to be determined by the court. The fees shall be
  781  paid from the general revenue fund of the county in which the
  782  person who has the intellectual disability or autism resided
  783  when the petition was filed.
  784         (h) The agency shall develop and prescribe by rule one or
  785  more standard forms to be used as a guide for members of the
  786  examining committee.
  787         (6) COUNSEL; GUARDIAN AD LITEM.—
  788         (a) The person who has the intellectual disability or
  789  autism must be represented by counsel at all stages of the
  790  judicial proceeding. If the person is indigent and cannot afford
  791  counsel, the court shall appoint a public defender at least 20
  792  working days before the scheduled hearing. The person’s counsel
  793  shall have full access to the records of the service provider
  794  and the agency. In all cases, the attorney shall represent the
  795  rights and legal interests of the person, regardless of who
  796  initiates the proceedings or pays the attorney attorney’s fee.
  797         (b) If the attorney, during the course of his or her
  798  representation, reasonably believes that the person who has the
  799  intellectual disability or autism cannot adequately act in his
  800  or her own interest, the attorney may seek the appointment of a
  801  guardian ad litem. A prior finding of incompetency is not
  802  required before a guardian ad litem is appointed pursuant to
  803  this section.
  804         (7) HEARING.—
  805         (d) The person who has the intellectual disability or
  806  autism must be physically present throughout the entire
  807  proceeding. If the person’s attorney believes that the person’s
  808  presence at the hearing is not in his or her best interest, the
  809  person’s presence may be waived once the court has seen the
  810  person and the hearing has commenced.
  811         (10) COMPETENCY.—
  812         (a) The issue of competency is separate and distinct from a
  813  determination of the appropriateness of involuntary admission to
  814  residential services due to intellectual disability or autism.
  815         (b) The issue of the competency of a person who has an
  816  intellectual disability or autism for purposes of assigning
  817  guardianship shall be determined in a separate proceeding
  818  according to the procedures and requirements of chapter 744. The
  819  issue of the competency of a person who has an intellectual
  820  disability or autism for purposes of determining whether the
  821  person is competent to proceed in a criminal trial shall be
  822  determined in accordance with chapter 916.
  823         (12) APPEAL.—
  824         (b) The filing of an appeal by the person who has an
  825  intellectual disability or autism stays admission of the person
  826  into residential care. The stay remains in effect during the
  827  pendency of all review proceedings in Florida courts until a
  828  mandate issues.
  831         (a) If a person is involuntarily admitted to residential
  832  services provided by the agency, the agency shall employ or, if
  833  necessary, contract with a qualified evaluator to conduct a
  834  review annually, unless otherwise ordered, to determine the
  835  appropriateness of the person’s continued involuntary admission
  836  to residential services based on the criteria in paragraph
  837  (8)(b). The review must include an assessment of the most
  838  appropriate and least restrictive type of residential placement
  839  for the person.
  840         (b) A placement resulting from an involuntary admission to
  841  residential services must be reviewed by the court at a hearing
  842  annually, unless a shorter review period is ordered. The agency
  843  shall provide to the court the completed reviews by the
  844  qualified evaluator. The review hearing must determine whether
  845  the person continues to meet the criteria in paragraph (8)(b)
  846  and, if so, whether the person still requires involuntary
  847  placement in a residential setting and whether the person is
  848  receiving adequate care, treatment, habilitation, and
  849  rehabilitation in the residential setting.
  850         (c) The agency shall provide a copy of the annual review
  851  and reasonable notice of the hearing to the appropriate state’s
  852  attorney, if applicable, and the person’s attorney and guardian,
  853  or guardian advocate if one is appointed.
  854         (d) As used in this subsection, the term “qualified
  855  evaluator” means a psychiatrist licensed under chapter 458 or
  856  chapter 459, or a psychologist licensed under chapter 490, who
  857  has demonstrated to the court an expertise in the diagnosis,
  858  evaluation, and treatment of persons with intellectual
  859  disabilities.
  860         Section 9. Effective June 30, 2016, or, if this act fails
  861  to become a law until after that date, effective upon becoming a
  862  law and operating retroactively to June 30, 2016, sections 24
  863  and 26 of chapter 2015-222, Laws of Florida, are repealed.
  864         Section 10. Subsection (15) of section 393.067, Florida
  865  Statutes, is reenacted to read:
  866         393.067 Facility licensure.—
  867         (15) The agency is not required to contract with facilities
  868  licensed pursuant to this chapter.
  869         Section 11. Section 393.18, Florida Statutes, is reenacted
  870  and amended to read:
  871         393.18 Comprehensive transitional education program.—A
  872  comprehensive transitional education program serves individuals
  873  is a group of jointly operating centers or units, the collective
  874  purpose of which is to provide a sequential series of
  875  educational care, training, treatment, habilitation, and
  876  rehabilitation services to persons who have developmental
  877  disabilities, and who have severe or moderate maladaptive
  878  behaviors, severe maladaptive behaviors and co-occurring complex
  879  medical conditions, or a dual diagnosis of developmental
  880  disability and mental illness. However, this section does not
  881  require such programs to provide services only to persons with
  882  developmental disabilities. All such Services provided by the
  883  program must shall be temporary in nature and delivered in a
  884  manner designed to achieve structured residential setting,
  885  having the primary goal of incorporating the principles
  886  principle of self-determination and person-centered planning to
  887  transition individuals to the most appropriate, least
  888  restrictive community living option of their choice which is not
  889  operated as a in establishing permanent residence for persons
  890  with maladaptive behaviors in facilities that are not associated
  891  with the comprehensive transitional education program. The
  892  supervisor of the clinical director of the program licensee must
  893  hold a doctorate degree with a primary focus in behavior
  894  analysis from an accredited university, be a certified behavior
  895  analyst pursuant to s. 393.17, and have at least 1 year of
  896  experience in providing behavior analysis services for
  897  individuals with developmental disabilities. The staff must
  898  shall include behavior analysts and teachers, as appropriate,
  899  who shall be available to provide services in each component
  900  center or unit of the program. A behavior analyst must be
  901  certified pursuant to s. 393.17.
  902         (1) Comprehensive transitional education programs must
  903  shall include a minimum of two component centers or units, one
  904  of which shall be an intensive treatment and educational center
  905  or a transitional training and educational center, which
  906  provides services to persons with maladaptive behaviors in the
  907  following components sequential order:
  908         (a) Intensive treatment and education educational center.
  909  This component provides is a self-contained residential unit
  910  providing intensive behavioral and educational programming for
  911  individuals whose conditions persons with severe maladaptive
  912  behaviors whose behaviors preclude placement in a less
  913  restrictive environment due to the threat of danger or injury to
  914  themselves or others. Continuous-shift staff are shall be
  915  required for this component.
  916         (b) Intensive Transitional training and education
  917  educational center.—This component provides is a residential
  918  unit for persons with moderate maladaptive behaviors providing
  919  concentrated psychological and educational programming that
  920  emphasizes a transition toward a less restrictive environment.
  921  Continuous-shift staff are shall be required for this component.
  922         (c) Community Transition residence.—This component provides
  923  is a residential center providing educational programs and any
  924  support services, training, and care that are needed to assist
  925  persons with maladaptive behaviors to avoid regression to more
  926  restrictive environments while preparing individuals them for
  927  more independent living. Continuous-shift staff are shall be
  928  required for this component.
  929         (d) Alternative living center.—This component is a
  930  residential unit providing an educational and family living
  931  environment for persons with maladaptive behaviors in a
  932  moderately unrestricted setting. Residential staff shall be
  933  required for this component.
  934         (e) Independent living education center.—This component is
  935  a facility providing a family living environment for persons
  936  with maladaptive behaviors in a largely unrestricted setting and
  937  includes education and monitoring that is appropriate to support
  938  the development of independent living skills.
  939         (2) Components of a comprehensive transitional education
  940  program are subject to the license issued under s. 393.067 to a
  941  comprehensive transitional education program and may be located
  942  on a single site or multiple sites as long as such components
  943  are located within the same agency region.
  944         (3) Comprehensive transitional education programs shall
  945  develop individual education plans for each school-aged person
  946  with maladaptive behaviors, severe maladaptive behaviors and co
  947  occurring complex medical conditions, or a dual diagnosis of
  948  development disability and mental illness who receives services
  949  from the program. Each individual education plan shall be
  950  developed in accordance with the criteria specified in 20 U.S.C.
  951  ss. 401 et seq., and 34 C.F.R. part 300. To the extent possible,
  952  educational components of the program, including individual
  953  education plans, must be integrated with the referring school
  954  district of each school-aged resident.
  955         (4) For comprehensive transitional education programs, The
  956  total number of persons in a comprehensive transitional
  957  education program residents who are being provided with services
  958  may not in any instance exceed the licensed capacity of 120
  959  residents, and each residential unit within the component
  960  centers of a the program authorized under this section may not
  961  in any instance exceed 15 residents. However, a program that was
  962  authorized to operate residential units with more than 15
  963  residents before July 1, 2015, may continue to operate such
  964  units.
  965         (5)Any licensee that has executed a settlement agreement
  966  with the agency which is enforceable by the court must comply
  967  with the terms of the settlement agreement or be subject to
  968  grounds for discipline as provided by law and rule.
  969         (6) Beginning July 1, 2016, the agency may approve the
  970  proposed admission or readmission of individuals into a
  971  comprehensive transitional education program for up to 2 years,
  972  subject to a specific review process. The agency may allow an
  973  individual to live in this setting for a longer period of time
  974  if, after a clinical review is conducted by the agency, it is
  975  determined that remaining in the program for a longer period of
  976  time is in the best interest of the individual.
  977         Section 12. Subsection (2) of section 393.501, Florida
  978  Statutes, is amended to read:
  979         393.501 Rulemaking.—
  980         (2) Such rules must address the number of facilities on a
  981  single lot or on adjacent lots, except that there is no
  982  restriction on the number of facilities designated as community
  983  residential homes located within a planned residential community
  984  as those terms are defined in s. 419.001(1). In adopting rules,
  985  comprehensive transitional education programs an alternative
  986  living center and an independent living education center, as
  987  described in s. 393.18, are subject to s. 419.001, except that
  988  such program centers are exempt from the 1,000-foot-radius
  989  requirement of s. 419.001(2) if:
  990         (a) The program centers are located on a site zoned in a
  991  manner that permits all the components of a comprehensive
  992  transitional education program center to be located on the site;
  993  or
  994         (b) There are no more than three such program centers
  995  within a radius of 1,000 feet.
  996         Section 13. Paragraph (b) of subsection (1) of section
  997  383.141, Florida Statutes, is amended to read:
  998         383.141 Prenatally diagnosed conditions; patient to be
  999  provided information; definitions; information clearinghouse;
 1000  advisory council.—
 1001         (1) As used in this section, the term:
 1002         (b) “Developmental disability” includes Down syndrome and
 1003  other developmental disabilities defined by s. 393.063(12) s.
 1004  393.063(9).
 1005         Section 14. Paragraph (d) of subsection (2) of section
 1006  1002.385, Florida Statutes, is amended to read:
 1007         1002.385 Florida personal learning scholarship accounts.—
 1008         (2) DEFINITIONS.—As used in this section, the term:
 1009         (d) “Disability” means, for a 3- or 4-year-old child or for
 1010  a student in kindergarten to grade 12, autism spectrum disorder,
 1011  as defined in the Diagnostic and Statistical Manual of Mental
 1012  Disorders, Fifth Edition, published by the American Psychiatric
 1013  Association; cerebral palsy, as defined in s. 393.063(6) s.
 1014  393.063(4); Down syndrome, as defined in s. 393.063(15) s.
 1015  393.063(13); an intellectual disability, as defined in s.
 1016  393.063(24) s. 393.063(21); Prader-Willi syndrome, as defined in
 1017  s. 393.063(28) s. 393.063(25); or spina bifida, as defined in s.
 1018  393.063(39) s. 393.063(36); for a student in kindergarten, being
 1019  a high-risk child, as defined in s. 393.063(23)(a) s.
 1020  393.063(20)(a); muscular dystrophy; and Williams syndrome.
 1021         Section 15. Except as otherwise expressly provided in this
 1022  act and except for this section, which shall take effect upon
 1023  this act becoming a law, this act shall take effect July 1,
 1024  2016.