Florida Senate - 2016                   (PROPOSED BILL) SPB 7054
       FOR CONSIDERATION By the Committee on Children, Families, and
       Elder Affairs
       586-02099-16                                          20167054pb
    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 and
    4         defining terms; repealing s. 393.0641, F.S., relating
    5         to a program for the prevention and treatment of
    6         severe self-injurious behavior; amending s. 393.065,
    7         F.S.; providing for the assignment of priority to
    8         clients waiting for waiver services; requiring an
    9         agency to allow a certain individual to receive such
   10         services if the individual’s parent or legal guardian
   11         is an active-duty military service member; requiring
   12         the agency to send an annual letter to clients and
   13         their guardians or families; providing that certain
   14         agency action does not establish a right to a hearing
   15         or an administrative proceeding; amending s. 393.066,
   16         F.S.; providing for the use of an agency data
   17         management system; providing requirements for persons
   18         or entities under contract with the agency; amending
   19         s. 393.0662, F.S.; adding client needs that qualify as
   20         extraordinary needs, which may result in the approval
   21         of an increase in a client’s allocated funds; revising
   22         duties of the Agency for Health Care Administration
   23         relating to the iBudget system; creating s. 393.0679,
   24         F.S.; requiring the Agency for Persons with
   25         Disabilities to conduct a certain utilization review;
   26         requiring certain intermediate care facilities to
   27         comply with certain requests and inspections by the
   28         agency; amending s. 393.11, F.S.; providing for annual
   29         reviews for persons involuntarily committed to
   30         residential services; requiring the agency to contract
   31         with a qualified evaluator; providing requirements for
   32         annual reviews; requiring a hearing to be held to
   33         consider the results of an annual review; requiring
   34         the agency to provide a copy of the review to certain
   35         persons; defining a term; repealing s. 26 of chapter
   36         2015-222, Laws of Florida; abrogating the scheduled
   37         expiration of an amendment to s. 393.18, F.S., and the
   38         scheduled reversion of the text of that section;
   39         reenacting and amending s. 393.18, F.S.; revising the
   40         purposes of comprehensive transitional education
   41         programs; providing qualification requirements for the
   42         clinical director of a comprehensive transitional
   43         education program; revising the organization and
   44         operation of components of a program; providing for
   45         the integration of educational components with the
   46         local school district; authorizing the agency to
   47         approve the admission or readmission of an individual
   48         to a program; providing for video and audio recording
   49         and monitoring of common areas and program activities
   50         and facilities; providing for licensure of such
   51         programs; amending s. 393.501, F.S.; conforming
   52         provisions to changes made by the act; amending ss.
   53         383.141 and 1002.385, F.S.; conforming cross
   54         references; providing an effective date.
   56  Be It Enacted by the Legislature of the State of Florida:
   58         Section 1. Section 393.063, Florida Statutes, is amended to
   59  read:
   60         393.063 Definitions.—For the purposes of this chapter, the
   61  term:
   62         (2)(1) “Agency” means the Agency for Persons with
   63  Disabilities.
   64         (1)(2) “Adult day training” means training services that
   65  which take place in a nonresidential setting, separate from the
   66  home or facility in which the client resides, and; are intended
   67  to support the participation of clients in daily, meaningful,
   68  and valued routines of the community. Such training; and may be
   69  provided in include work-like settings that do not meet the
   70  definition of supported employment.
   71         (3) “Algorithm” means the mathematical formula developed by
   72  the agency based upon statistically valid relationships between
   73  the need for services and selected health and social
   74  characteristics which is used to calculate a potential amount of
   75  financial support through the home and community-based services
   76  Medicaid waiver program.
   77         (4) “Allocation methodology” means the process for
   78  determining the iBudget allocation for an individual which
   79  considers:
   80         (a) The algorithm amount applicable to an individual based
   81  on a formal assessment instrument used by the agency pursuant to
   82  s. 393.0661(1)(a); and
   83         (b) Any needs identified by the agency during the client
   84  review process which cannot be accommodated within the funding
   85  determined by the algorithm and are provided for in s.
   86  393.0662(1)(b).
   87         (5)(3) “Autism” means a pervasive, neurologically based
   88  developmental disability of extended duration which causes
   89  severe learning, communication, and behavior disorders with age
   90  of onset during infancy or childhood. Individuals with autism
   91  exhibit impairment in reciprocal social interaction, impairment
   92  in verbal and nonverbal communication and imaginative ability,
   93  and a markedly restricted repertoire of activities and
   94  interests.
   95         (6)(4) “Cerebral palsy” means a group of disabling symptoms
   96  of extended duration which results from damage to the developing
   97  brain that may occur before, during, or after birth and that
   98  results in the loss or impairment of control over voluntary
   99  muscles. For the purposes of this definition, cerebral palsy
  100  does not include those symptoms or impairments resulting solely
  101  from a stroke.
  102         (7)(5) “Client” means any person determined eligible by the
  103  agency for services under this chapter.
  104         (8)(6) “Client advocate” means a friend or relative of the
  105  client, or of the client’s immediate family, who advocates for
  106  the best interests of the client in any proceedings under this
  107  chapter in which the client or his or her family has the right
  108  or duty to participate.
  109         (9)(7) “Comprehensive assessment” means the process used to
  110  determine eligibility for services under this chapter.
  111         (10)(8) “Comprehensive transitional education program”
  112  means the program established in s. 393.18.
  113         (12)(9) “Developmental disability” means a disorder or
  114  syndrome that is attributable to intellectual disability,
  115  cerebral palsy, autism, spina bifida, Down syndrome, or Prader
  116  Willi syndrome; that manifests before the age of 18; and that
  117  constitutes a substantial handicap that can reasonably be
  118  expected to continue indefinitely.
  119         (11)(10) “Developmental disabilities center” means a state
  120  owned and state-operated facility, formerly known as a “Sunland
  121  Center,” providing for the care, habilitation, and
  122  rehabilitation of clients with developmental disabilities.
  123         (13)(11) “Direct service provider” means a person 18 years
  124  of age or older who has direct face-to-face contact with a
  125  client while providing services to the client or has access to a
  126  client’s living areas or to a client’s funds or personal
  127  property.
  128         (14)(12) “Domicile” means the place where a client legally
  129  resides and, which place is his or her permanent home. Domicile
  130  may be established as provided in s. 222.17. Domicile may not be
  131  established in Florida by a minor who has no parent domiciled in
  132  Florida, or by a minor who has no legal guardian domiciled in
  133  Florida, or by any alien not classified as a resident alien.
  134         (15)(13) “Down syndrome” means a disorder caused by the
  135  presence of an extra chromosome 21.
  136         (16)(14) “Express and informed consent” means consent
  137  voluntarily given in writing with sufficient knowledge and
  138  comprehension of the subject matter to enable the person giving
  139  consent to make a knowing decision without any element of force,
  140  fraud, deceit, duress, or other form of constraint or coercion.
  141         (17)(15) “Family care program” means the program
  142  established in s. 393.068.
  143         (18)(16) “Foster care facility” means a residential
  144  facility licensed under this chapter which provides a family
  145  living environment including supervision and care necessary to
  146  meet the physical, emotional, and social needs of its residents.
  147  The capacity of such a facility may not be more than three
  148  residents.
  149         (19)(17) “Group home facility” means a residential facility
  150  licensed under this chapter which provides a family living
  151  environment including supervision and care necessary to meet the
  152  physical, emotional, and social needs of its residents. The
  153  capacity of such a facility shall be at least 4 but not more
  154  than 15 residents.
  155         (20) “Guardian” has the same meaning as in s. 744.102.
  156         (21)(18) “Guardian advocate” means a person appointed by a
  157  written order of the court to represent a person with
  158  developmental disabilities under s. 393.12.
  159         (22)(19) “Habilitation” means the process by which a client
  160  is assisted in acquiring and maintaining to acquire and maintain
  161  those life skills that which enable the client to cope more
  162  effectively with the demands of his or her condition and
  163  environment and to raise the level of his or her physical,
  164  mental, and social efficiency. It includes, but is not limited
  165  to, programs of formal structured education and treatment.
  166         (23)(20) “High-risk child” means, for the purposes of this
  167  chapter, a child from 3 to 5 years of age with one or more of
  168  the following characteristics:
  169         (a) A developmental delay in cognition, language, or
  170  physical development.
  171         (b) A child surviving a catastrophic infectious or
  172  traumatic illness known to be associated with developmental
  173  delay, when funds are specifically appropriated.
  174         (c) A child with a parent or guardian with developmental
  175  disabilities who requires assistance in meeting the child’s
  176  developmental needs.
  177         (d) A child who has a physical or genetic anomaly
  178  associated with developmental disability.
  179         (24) “Initial support plan” means the first support plan
  180  that identifies the needs of the individual for supports and
  181  services prior to enrollment in the iBudget waiver.
  182         (25)(21) “Intellectual disability” means significantly
  183  subaverage general intellectual functioning existing
  184  concurrently with deficits in adaptive behavior which manifests
  185  before the age of 18 and can reasonably be expected to continue
  186  indefinitely. For the purposes of this definition, the term:
  187         (a) “Adaptive behavior” means the effectiveness or degree
  188  with which an individual meets the standards of personal
  189  independence and social responsibility expected of his or her
  190  age, cultural group, and community.
  191         (b) “Significantly subaverage general intellectual
  192  functioning” means performance that is two or more standard
  193  deviations from the mean score on a standardized intelligence
  194  test specified in the rules of the agency.
  196  For purposes of the application of the criminal laws and
  197  procedural rules of this state to matters relating to pretrial,
  198  trial, sentencing, and any matters relating to the imposition
  199  and execution of the death penalty, the terms “intellectual
  200  disability” or “intellectually disabled” are interchangeable
  201  with and have the same meaning as the terms “mental retardation”
  202  or “retardation” and “mentally retarded” as defined in this
  203  section before July 1, 2013.
  204         (26)(22) “Intermediate care facility for the
  205  developmentally disabled” or “ICF/DD” means a residential
  206  facility licensed and certified under part VIII of chapter 400.
  207         (27)(23) “Medical/dental services” means medically
  208  necessary services that are provided or ordered for a client by
  209  a person licensed under chapter 458, chapter 459, or chapter
  210  466. Such services may include, but are not limited to,
  211  prescription drugs, specialized therapies, nursing supervision,
  212  hospitalization, dietary services, prosthetic devices, surgery,
  213  specialized equipment and supplies, adaptive equipment, and
  214  other services as required to prevent or alleviate a medical or
  215  dental condition.
  216         (28)(24) “Personal care services” means individual
  217  assistance with or supervision of essential activities of daily
  218  living for self-care, including ambulation, bathing, dressing,
  219  eating, grooming, and toileting, and other similar services that
  220  are incidental to the care furnished and essential to the
  221  health, safety, and welfare of the client if no one else is
  222  available to perform those services.
  223         (29)(25) “Prader-Willi syndrome” means an inherited
  224  condition typified by neonatal hypotonia with failure to thrive,
  225  hyperphagia or an excessive drive to eat which leads to obesity
  226  usually at 18 to 36 months of age, mild to moderate intellectual
  227  disability, hypogonadism, short stature, mild facial
  228  dysmorphism, and a characteristic neurobehavior.
  229         (30)(26) “Relative” means an individual who is connected by
  230  affinity or consanguinity to the client and who is 18 years of
  231  age or older.
  232         (31)(27) “Resident” means a person who has a developmental
  233  disability and resides at a residential facility, whether or not
  234  such person is a client of the agency.
  235         (32) “Resident alien” means a person who is not a citizen
  236  of the United States but who currently resides in the United
  237  States and is classified under Title 8 of the Code of Federal
  238  Regulations as either a permanent resident, permanent resident
  239  alien, lawful permanent resident, resident alien permit holder,
  240  or green card holder.
  241         (33)(28) “Residential facility” means a facility providing
  242  room and board and personal care for persons who have
  243  developmental disabilities.
  244         (34)(29) “Residential habilitation” means supervision and
  245  training with the acquisition, retention, or improvement in
  246  skills related to activities of daily living, such as personal
  247  hygiene skills, homemaking skills, and the social and adaptive
  248  skills necessary to enable the individual to reside in the
  249  community.
  250         (35)(30) “Residential habilitation center” means a
  251  community residential facility licensed under this chapter which
  252  provides habilitation services. The capacity of such a facility
  253  may not be fewer than nine residents. After October 1, 1989, new
  254  residential habilitation centers may not be licensed and the
  255  licensed capacity for any existing residential habilitation
  256  center may not be increased.
  257         (36)(31) “Respite service” means appropriate, short-term,
  258  temporary care that is provided to a person who has a
  259  developmental disability in order to meet the planned or
  260  emergency needs of the person or the family or other direct
  261  service provider.
  262         (37)(32) “Restraint” means a physical device, method, or
  263  drug used to control dangerous behavior.
  264         (a) A physical restraint is any manual method or physical
  265  or mechanical device, material, or equipment attached or
  266  adjacent to an individual’s body so that he or she cannot easily
  267  remove the restraint and which restricts freedom of movement or
  268  normal access to one’s body.
  269         (b) A drug used as a restraint is a medication used to
  270  control the person’s behavior or to restrict his or her freedom
  271  of movement and is not a standard treatment for the person’s
  272  medical or psychiatric condition. Physically holding a person
  273  during a procedure to forcibly administer psychotropic
  274  medication is a physical restraint.
  275         (c) Restraint does not include physical devices, such as
  276  orthopedically prescribed appliances, surgical dressings and
  277  bandages, supportive body bands, or other physical holding
  278  necessary for routine physical examinations and tests; for
  279  purposes of orthopedic, surgical, or other similar medical
  280  treatment; to provide support for the achievement of functional
  281  body position or proper balance; or to protect a person from
  282  falling out of bed.
  283         (38)(33) “Seclusion” means the involuntary isolation of a
  284  person in a room or area from which the person is prevented from
  285  leaving. The prevention may be by physical barrier or by a staff
  286  member who is acting in a manner, or who is physically situated,
  287  so as to prevent the person from leaving the room or area. For
  288  the purposes of this chapter, the term does not mean isolation
  289  due to the medical condition or symptoms of the person.
  290         (39)(34) “Self-determination” means an individual’s freedom
  291  to exercise the same rights as all other citizens, authority to
  292  exercise control over funds needed for one’s own support,
  293  including prioritizing these funds when necessary,
  294  responsibility for the wise use of public funds, and self
  295  advocacy to speak and advocate for oneself in order to gain
  296  independence and ensure that individuals with a developmental
  297  disability are treated equally.
  298         (40(35) “Specialized therapies” means those treatments or
  299  activities prescribed by and provided by an appropriately
  300  trained, licensed, or certified professional or staff person and
  301  may include, but are not limited to, physical therapy, speech
  302  therapy, respiratory therapy, occupational therapy, behavior
  303  therapy, physical management services, and related specialized
  304  equipment and supplies.
  305         (41)(36) “Spina bifida” means, for purposes of this
  306  chapter, a person with a medical diagnosis of spina bifida
  307  cystica or myelomeningocele.
  308         (42)(37) “Support coordinator” means a person who is
  309  designated by the agency to assist individuals and families in
  310  identifying their capacities, needs, and resources, as well as
  311  finding and gaining access to necessary supports and services;
  312  coordinating the delivery of supports and services; advocating
  313  on behalf of the individual and family; maintaining relevant
  314  records; and monitoring and evaluating the delivery of supports
  315  and services to determine the extent to which they meet the
  316  needs and expectations identified by the individual, family, and
  317  others who participated in the development of the support plan.
  318         (43)(38) “Supported employment” means employment located or
  319  provided in an integrated work setting, with earnings paid on a
  320  commensurate wage basis, and for which continued support is
  321  needed for job maintenance.
  322         (44)(39) “Supported living” means a category of
  323  individually determined services designed and coordinated in
  324  such a manner as to provide assistance to adult clients who
  325  require ongoing supports to live as independently as possible in
  326  their own homes, to be integrated into the community, and to
  327  participate in community life to the fullest extent possible.
  328         (45)(40) “Training” means a planned approach to assisting a
  329  client to attain or maintain his or her maximum potential and
  330  includes services ranging from sensory stimulation to
  331  instruction in skills for independent living and employment.
  332         (46)(41) “Treatment” means the prevention, amelioration, or
  333  cure of a client’s physical and mental disabilities or
  334  illnesses.
  335         Section 2. Section 393.0641, Florida Statutes, is repealed.
  336         Section 3. Subsections (3) and (5) of section 393.065,
  337  Florida Statutes, are amended, present subsections (6) and (7)
  338  of that section are amended and redesignated as subsections (7)
  339  and (9), respectively, and new subsections (6) and (8) are added
  340  to that section, to read:
  341         393.065 Application and eligibility determination.—
  342         (3) The agency shall notify each applicant, in writing, of
  343  its eligibility decision. Any applicant determined by the agency
  344  to be ineligible for developmental services has the right to
  345  appeal this decision pursuant to ss. 120.569 and 120.57.
  346         (5) Except as otherwise directed by law, beginning July 1,
  347  2010, The agency shall assign and provide priority to clients
  348  waiting for waiver services in the following order:
  349         (a) Category 1, which includes clients deemed to be in
  350  crisis as described in rule, shall be given first priority in
  351  moving from the waiting list to the waiver.
  352         (b) Category 2, which includes:, which includes children
  353         1. Individuals on the waiting wait list who are from the
  354  child welfare system with an open case in the Department of
  355  Children and Families’ statewide automated child welfare
  356  information system and are:
  357         a. Transitioning out of the child welfare system at the
  358  finalization of an adoption, a reunification with family
  359  members, a permanent placement with a relative, or a
  360  guardianship with a nonrelative; or
  361         b. At least 18 years old, but not yet 22 years old, and
  362  need both waiver services and extended foster care services.
  363  These individuals may receive both waiver services and services
  364  under s. 39.6251 but services may not duplicate services
  365  available through the Medicaid state plan.
  366         2. Individuals on the waiting list who are at least 18
  367  years old but not yet 22 years old and who withdrew consent to
  368  remain in the extended foster care system pursuant to s.
  369  39.6251(5)(c).
  370         3. Individuals who are at least 18 years old but not yet 22
  371  years old and are eligible under sub-subparagraph 1.b. The
  372  agency shall provide waiver services, including residential
  373  habilitation, to these individuals. The community-based care
  374  lead agency shall fund room and board at the rate established in
  375  s. 409.145(4) and provide case management and related services
  376  as defined in s. 409.986(3)(e).
  377         (c) Category 3, which includes, but is not required to be
  378  limited to, clients:
  379         1. Whose caregiver has a documented condition that is
  380  expected to render the caregiver unable to provide care within
  381  the next 12 months and for whom a caregiver is required but no
  382  alternate caregiver is available;
  383         2. At substantial risk of incarceration or court commitment
  384  without supports;
  385         3. Whose documented behaviors or physical needs place them
  386  or their caregiver at risk of serious harm and other supports
  387  are not currently available to alleviate the situation; or
  388         4. Who are identified as ready for discharge within the
  389  next year from a state mental health hospital or skilled nursing
  390  facility and who require a caregiver but for whom no caregiver
  391  is available or whose caregiver is unable to provide the care
  392  needed.
  393         (d) Category 4, which includes, but is not required to be
  394  limited to, clients whose caregivers are 70 years of age or
  395  older and for whom a caregiver is required but no alternate
  396  caregiver is available.
  397         (e) Category 5, which includes, but is not required to be
  398  limited to, clients who are expected to graduate within the next
  399  12 months from secondary school and need support to obtain a
  400  meaningful day activity, or maintain competitive employment, or
  401  to pursue an accredited program of postsecondary education to
  402  which they have been accepted.
  403         (f) Category 6, which includes clients 21 years of age or
  404  older who do not meet the criteria for category 1, category 2,
  405  category 3, category 4, or category 5.
  406         (g) Category 7, which includes clients younger than 21
  407  years of age who do not meet the criteria for category 1,
  408  category 2, category 3, or category 4.
  410  Within categories 3, 4, 5, 6, and 7, the agency shall maintain a
  411  waiting wait list of clients placed in the order of the date
  412  that the client is determined eligible for waiver services.
  413         (6) The agency shall allow an individual who meets the
  414  eligibility requirements under subsection (1) to receive home
  415  and community-based services in this state if the individual’s
  416  parent or legal guardian is an active-duty military service
  417  member and if at the time of the service member’s transfer to
  418  this state, the individual was receiving home and community
  419  based services in another state.
  420         (7)(6) The client, the client’s guardian, or the client’s
  421  family must ensure that accurate, up-to-date contact information
  422  is provided to the agency at all times. Notwithstanding s.
  423  393.0651, the agency shall send an annual letter requesting
  424  updated information from the client, the client’s guardian, or
  425  the client’s family. The agency shall remove from the waiting
  426  wait list any individual who cannot be located using the contact
  427  information provided to the agency, fails to meet eligibility
  428  requirements, or becomes domiciled outside the state.
  429         (8) Agency action that selects individuals to receive
  430  waiver services pursuant to this section does not establish a
  431  right to a hearing or an administrative proceeding under chapter
  432  120 for individuals remaining on the waiting list.
  433         (9)(7) The agency and the Agency for Health Care
  434  Administration may adopt rules specifying application
  435  procedures, criteria associated with the waiting list wait-list
  436  categories, procedures for administering the waiting wait list,
  437  including tools for prioritizing waiver enrollment within
  438  categories, and eligibility criteria as needed to administer
  439  this section.
  440         Section 4. Subsection (2) of section 393.066, Florida
  441  Statutes, is amended to read:
  442         393.066 Community services and treatment.—
  443         (2) Necessary All services needed shall be purchased,
  444  rather than instead of provided directly by the agency, when the
  445  purchase of services such arrangement is more cost-efficient
  446  than providing them having those services provided directly. All
  447  purchased services must be approved by the agency. Persons or
  448  entities under contract with the agency to provide services
  449  shall use agency data management systems to document service
  450  provision to clients. Contracted persons and entities shall meet
  451  the minimum hardware and software technical requirements
  452  established by the agency for the use of such systems. Such
  453  persons or entities shall also meet any requirements established
  454  by the agency for training and professional development of staff
  455  providing direct services to clients.
  456         Section 5. Section 393.0662, Florida Statutes, is amended
  457  to read:
  458         393.0662 Individual budgets for delivery of home and
  459  community-based services; iBudget system established.—The
  460  Legislature finds that improved financial management of the
  461  existing home and community-based Medicaid waiver program is
  462  necessary to avoid deficits that impede the provision of
  463  services to individuals who are on the waiting list for
  464  enrollment in the program. The Legislature further finds that
  465  clients and their families should have greater flexibility to
  466  choose the services that best allow them to live in their
  467  community within the limits of an established budget. Therefore,
  468  the Legislature intends that the agency, in consultation with
  469  the Agency for Health Care Administration, shall manage develop
  470  and implement a comprehensive redesign of the service delivery
  471  system using individual budgets as the basis for allocating the
  472  funds appropriated for the home and community-based services
  473  Medicaid waiver program among eligible enrolled clients. The
  474  service delivery system that uses individual budgets shall be
  475  called the iBudget system.
  476         (1) The agency shall administer establish an individual
  477  budget, referred to as an iBudget, for each individual served by
  478  the home and community-based services Medicaid waiver program.
  479  The funds appropriated to the agency shall be allocated through
  480  the iBudget system to eligible, Medicaid-enrolled clients. For
  481  the iBudget system, eligible clients shall include individuals
  482  with a diagnosis of Down syndrome or a developmental disability
  483  as defined in s. 393.063. The iBudget system shall be designed
  484  to provide for: enhanced client choice within a specified
  485  service package; appropriate assessment strategies; an efficient
  486  consumer budgeting and billing process that includes
  487  reconciliation and monitoring components; a redefined role for
  488  support coordinators that avoids potential conflicts of
  489  interest; a flexible and streamlined service review process; and
  490  a methodology and process that ensures the equitable allocation
  491  of available funds to each client based on the client’s level of
  492  need, as determined by the variables in the allocation
  493  methodology algorithm.
  494         (a) In developing each client’s iBudget, the agency shall
  495  use the allocation an allocation algorithm and methodology as
  496  defined in s. 393.063(4). The algorithm shall use variables that
  497  have been determined by the agency to have a statistically
  498  validated relationship to the client’s level of need for
  499  services provided through the home and community-based services
  500  Medicaid waiver program. The algorithm and methodology may
  501  consider individual characteristics, including, but not limited
  502  to, a client’s age and living situation, information from a
  503  formal assessment instrument that the agency determines is valid
  504  and reliable, and information from other assessment processes.
  505         (b) The allocation methodology shall determine provide the
  506  algorithm that determines the amount of funds allocated to a
  507  client’s iBudget. The agency may approve an increase in the
  508  amount of funds allocated, as determined by the algorithm, based
  509  on a the client having one or more of the following needs that
  510  cannot be accommodated within the funding as determined by the
  511  algorithm and having no other resources, supports, or services
  512  available to meet the need:
  513         1. An extraordinary need that would place the health and
  514  safety of the client, the client’s caregiver, or the public in
  515  immediate, serious jeopardy unless the increase is approved.
  516  However, the presence of an extraordinary need in and of itself
  517  does not warrant an increase in the amount of funds allocated to
  518  a client’s iBudget. An extraordinary need may include, but is
  519  not limited to:
  520         a. The client’s age and living situation, a change in
  521  living situation, the loss of or a change in the client’s
  522  caregiver arrangement, or a documented need based on a
  523  behavioral or psychological assessment;
  524         b.a. A documented history of significant, potentially life
  525  threatening behaviors, such as recent attempts at suicide,
  526  arson, nonconsensual sexual behavior, or self-injurious behavior
  527  requiring medical attention;
  528         c.b. A complex medical condition that requires active
  529  intervention by a licensed nurse on an ongoing basis that cannot
  530  be taught or delegated to a nonlicensed person;
  531         d.c. A chronic comorbid condition. As used in this
  532  subparagraph, the term “comorbid condition” means a medical
  533  condition existing simultaneously but independently with another
  534  medical condition in a patient; or
  535         e.d. A need for total physical assistance with activities
  536  such as eating, bathing, toileting, grooming, and personal
  537  hygiene.
  539  However, the presence of an extraordinary need alone does not
  540  warrant an increase in the amount of funds allocated to a
  541  client’s iBudget as determined by the algorithm.
  542         2. A significant need for one-time or temporary support or
  543  services that, if not provided, would place the health and
  544  safety of the client, the client’s caregiver, or the public in
  545  serious jeopardy, unless the increase is approved. A significant
  546  need may include, but is not limited to, the provision of
  547  environmental modifications, durable medical equipment, services
  548  to address the temporary loss of support from a caregiver, or
  549  special services or treatment for a serious temporary condition
  550  when the service or treatment is expected to ameliorate the
  551  underlying condition. As used in this subparagraph, the term
  552  “temporary” means a period of fewer than 12 continuous months.
  553  However, the presence of such significant need for one-time or
  554  temporary supports or services alone does not warrant an
  555  increase in the amount of funds allocated to a client’s iBudget
  556  as determined by the algorithm.
  557         3. A significant increase in the need for services after
  558  the beginning of the service plan year that would place the
  559  health and safety of the client, the client’s caregiver, or the
  560  public in serious jeopardy because of substantial changes in the
  561  client’s circumstances, including, but not limited to, permanent
  562  or long-term loss or incapacity of a caregiver, loss of services
  563  authorized under the state Medicaid plan due to a change in age,
  564  or a significant change in medical or functional status which
  565  requires the provision of additional services on a permanent or
  566  long-term basis that cannot be accommodated within the client’s
  567  current iBudget. As used in this subparagraph, the term “long
  568  term” means a period of 12 or more continuous months. However,
  569  such significant increase in need for services of a permanent or
  570  long-term nature alone does not in and of itself warrant an
  571  increase in the amount of funds allocated to a client’s iBudget
  572  as determined by the algorithm.
  573         4. A significant need for transportation services to a
  574  waiver-funded adult day training program or to waiver-funded
  575  employment services when such need cannot be accommodated within
  576  a client’s iBudget as determined by the algorithm without
  577  affecting the health and safety of the client, if public
  578  transportation is not an option due to the unique needs of the
  579  client or other transportation resources are not reasonably
  580  available.
  582  The agency shall reserve portions of the appropriation for the
  583  home and community-based services Medicaid waiver program for
  584  adjustments required pursuant to this paragraph and may use the
  585  services of an independent actuary in determining the amount of
  586  the portions to be reserved.
  587         (c) A client’s iBudget shall be the total of the amount
  588  determined by the algorithm and any additional funding provided
  589  pursuant to paragraph (b). A client’s annual expenditures for
  590  home and community-based services Medicaid waiver services may
  591  not exceed the limits of his or her iBudget. The total of all
  592  clients’ projected annual iBudget expenditures may not exceed
  593  the agency’s appropriation for waiver services.
  594         (2) The Agency for Health Care Administration, in
  595  consultation with the agency, shall seek federal approval to
  596  amend current waivers, request a new waiver, and amend contracts
  597  as necessary to manage the iBudget system, to improve services
  598  for eligible and enrolled clients, and to improve the delivery
  599  of services implement the iBudget system to serve eligible,
  600  enrolled clients through the home and community-based services
  601  Medicaid waiver program and the Consumer-Directed Care Plus
  602  Program to persons with a dual diagnosis of a developmental
  603  disability and a mental health diagnosis.
  604         (3) The agency shall transition all eligible, enrolled
  605  clients to the iBudget system. The agency may gradually phase in
  606  the iBudget system.
  607         (a) While the agency phases in the iBudget system, the
  608  agency may continue to serve eligible, enrolled clients under
  609  the four-tiered waiver system established under s. 393.065 while
  610  those clients await transitioning to the iBudget system.
  611         (b) The agency shall design the phase-in process to ensure
  612  that a client does not experience more than one-half of any
  613  expected overall increase or decrease to his or her existing
  614  annualized cost plan during the first year that the client is
  615  provided an iBudget due solely to the transition to the iBudget
  616  system.
  617         (3)(4) A client must use all available services authorized
  618  under the state Medicaid plan, school-based services, private
  619  insurance and other benefits, and any other resources that may
  620  be available to the client before using funds from his or her
  621  iBudget to pay for support and services.
  622         (5) The service limitations in s. 393.0661(3)(f)1., 2., and
  623  3. do not apply to the iBudget system.
  624         (4)(6) Rates for any or all services established under
  625  rules of the Agency for Health Care Administration must shall be
  626  designated as the maximum rather than a fixed amount for
  627  individuals who receive an iBudget, except for services
  628  specifically identified in those rules that the agency
  629  determines are not appropriate for negotiation, which may
  630  include, but are not limited to, residential habilitation
  631  services.
  632         (5)(7) The agency shall ensure that clients and caregivers
  633  have access to training and education that to inform them about
  634  the iBudget system and enhance their ability for self-direction.
  635  Such training and education must shall be offered in a variety
  636  of formats and, at a minimum, must shall address the policies
  637  and processes of the iBudget system and; the roles and
  638  responsibilities of consumers, caregivers, waiver support
  639  coordinators, providers, and the agency, and must provide;
  640  information available to help the client make decisions
  641  regarding the iBudget system; and examples of support and
  642  resources available in the community.
  643         (6)(8) The agency shall collect data to evaluate the
  644  implementation and outcomes of the iBudget system.
  645         (7)(9) The agency and the Agency for Health Care
  646  Administration may adopt rules specifying the allocation
  647  algorithm and methodology; criteria and processes for clients to
  648  access reserved funds for extraordinary needs, temporarily or
  649  permanently changed needs, and one-time needs; and processes and
  650  requirements for selection and review of services, development
  651  of support and cost plans, and management of the iBudget system
  652  as needed to administer this section.
  653         Section 6. Section 393.0679, Florida Statutes, is created
  654  to read:
  655         393.0679 Utilization review.—The agency shall conduct
  656  utilization review activities in intermediate care facilities
  657  for individuals with developmental disabilities, both public and
  658  private, as necessary to meet the requirements of the approved
  659  Medicaid state plan and federal law, and such facilities shall
  660  comply with any requests for information and documentation made
  661  by the agency and permit any agency inspections in connection
  662  with such activities.
  663         Section 7. Subsection (1), paragraphs (a) and (b) of
  664  subsection (4), paragraphs (b), (e), (f), (g), and (h) of
  665  subsection (5), subsection (6), paragraph (d) of subsection (7),
  666  subsection (10), and paragraph (b) of subsection (12) of section
  667  393.11, Florida Statutes, are amended, and subsection (14) is
  668  added to that section, to read:
  669         393.11 Involuntary admission to residential services.—
  670         (1) JURISDICTION.—If a person has an intellectual
  671  disability or autism and requires involuntary admission to
  672  residential services provided by the agency, the circuit court
  673  of the county in which the person resides has jurisdiction to
  674  conduct a hearing and enter an order involuntarily admitting the
  675  person in order for the person to receive the care, treatment,
  676  habilitation, and rehabilitation that the person needs. For the
  677  purpose of identifying intellectual disability or autism,
  678  diagnostic capability shall be established by the agency. Except
  679  as otherwise specified, the proceedings under this section are
  680  governed by the Florida Rules of Civil Procedure.
  681         (4) AGENCY PARTICIPATION.—
  682         (a) Upon receiving the petition, the court shall
  683  immediately order the developmental services program of the
  684  agency to examine the person being considered for involuntary
  685  admission to residential services.
  686         (b) Following examination, the agency shall file a written
  687  report with the court at least 10 working days before the date
  688  of the hearing. The report must be served on the petitioner, the
  689  person who has the intellectual disability or autism, and the
  690  person’s attorney at the time the report is filed with the
  691  court.
  692         (5) EXAMINING COMMITTEE.—
  693         (b) The court shall appoint at least three disinterested
  694  experts who have demonstrated to the court an expertise in the
  695  diagnosis, evaluation, and treatment of persons who have
  696  intellectual disabilities or autism. The committee must include
  697  at least one licensed and qualified physician, one licensed and
  698  qualified psychologist, and one qualified professional who, at a
  699  minimum, has a master’s degree in social work, special
  700  education, or vocational rehabilitation counseling, to examine
  701  the person and to testify at the hearing on the involuntary
  702  admission to residential services.
  703         (e) The committee shall prepare a written report for the
  704  court. The report must explicitly document the extent that the
  705  person meets the criteria for involuntary admission. The report,
  706  and expert testimony, must include, but not be limited to:
  707         1. The degree of the person’s intellectual disability or
  708  autism and whether, using diagnostic capabilities established by
  709  the agency, the person is eligible for agency services;
  710         2. Whether, because of the person’s degree of intellectual
  711  disability or autism, the person:
  712         a. Lacks sufficient capacity to give express and informed
  713  consent to a voluntary application for services pursuant to s.
  714  393.065 and lacks basic survival and self-care skills to such a
  715  degree that close supervision and habilitation in a residential
  716  setting is necessary and, if not provided, would result in a
  717  threat of substantial harm to the person’s well-being; or
  718         b. Lacks basic survival and self-care skills to such a
  719  degree that close supervision and habilitation in a residential
  720  setting is necessary and if not provided would result in a real
  721  and present threat of substantial harm to the person’s well
  722  being; or
  723         b.c. Is likely to physically injure others if allowed to
  724  remain at liberty.
  725         3. The purpose to be served by residential care;
  726         4. A recommendation on the type of residential placement
  727  which would be the most appropriate and least restrictive for
  728  the person; and
  729         5. The appropriate care, habilitation, and treatment.
  730         (f) The committee shall file the report with the court at
  731  least 10 working days before the date of the hearing. The report
  732  must be served on the petitioner, the person who has the
  733  intellectual disability or autism, the person’s attorney at the
  734  time the report is filed with the court, and the agency.
  735         (g) Members of the examining committee shall receive a
  736  reasonable fee to be determined by the court. The fees shall be
  737  paid from the general revenue fund of the county in which the
  738  person who has the intellectual disability or autism resided
  739  when the petition was filed.
  740         (h) The agency shall develop and prescribe by rule one or
  741  more standard forms to be used as a guide for members of the
  742  examining committee.
  743         (6) COUNSEL; GUARDIAN AD LITEM.—
  744         (a) The person who has the intellectual disability or
  745  autism must be represented by counsel at all stages of the
  746  judicial proceeding. If the person is indigent and cannot afford
  747  counsel, the court shall appoint a public defender at least 20
  748  working days before the scheduled hearing. The person’s counsel
  749  shall have full access to the records of the service provider
  750  and the agency. In all cases, the attorney shall represent the
  751  rights and legal interests of the person, regardless of who
  752  initiates the proceedings or pays the attorney attorney’s fee.
  753         (b) If the attorney, during the course of his or her
  754  representation, reasonably believes that the person who has the
  755  intellectual disability or autism cannot adequately act in his
  756  or her own interest, the attorney may seek the appointment of a
  757  guardian ad litem. A prior finding of incompetency is not
  758  required before a guardian ad litem is appointed pursuant to
  759  this section.
  760         (7) HEARING.—
  761         (d) The person who has the intellectual disability or
  762  autism must be physically present throughout the entire
  763  proceeding. If the person’s attorney believes that the person’s
  764  presence at the hearing is not in his or her best interest, the
  765  person’s presence may be waived once the court has seen the
  766  person and the hearing has commenced.
  767         (10) COMPETENCY.—
  768         (a) The issue of competency is separate and distinct from a
  769  determination of the appropriateness of involuntary admission to
  770  residential services due to intellectual disability or autism.
  771         (b) The issue of the competency of a person who has an
  772  intellectual disability or autism for purposes of assigning
  773  guardianship shall be determined in a separate proceeding
  774  according to the procedures and requirements of chapter 744. The
  775  issue of the competency of a person who has an intellectual
  776  disability or autism for purposes of determining whether the
  777  person is competent to proceed in a criminal trial shall be
  778  determined in accordance with chapter 916.
  779         (12) APPEAL.—
  780         (b) The filing of an appeal by the person who has an
  781  intellectual disability or autism stays admission of the person
  782  into residential care. The stay remains in effect during the
  783  pendency of all review proceedings in Florida courts until a
  784  mandate issues.
  785         (14) COMMITMENT REVIEW.—
  786         (a) For persons involuntarily admitted to residential
  787  services by court order pursuant to this section, such
  788  involuntary admission, unless otherwise ordered by the court,
  789  must be reviewed annually. Placements resulting from an order
  790  for involuntary admission must be part of the review. The agency
  791  shall contract with a qualified evaluator to perform such
  792  reviews which must be provided to the court upon completion.
  793         (b) Upon receipt of an annual review by the court, a
  794  hearing must be held to consider the results of the review and
  795  to determine whether the person continues to meet the criteria
  796  specified in paragraph (8)(b). If the person continues to meet
  797  the criteria, the court shall determine whether he or she still
  798  requires involuntary admission to a residential setting, whether
  799  the person is in the most appropriate and least restrictive
  800  setting, and whether the person is receiving adequate care,
  801  treatment, habilitation, and rehabilitation in the residential
  802  setting.
  803         (c) The agency shall provide a copy of the annual review
  804  and reasonable notice of the hearing to the appropriate state’s
  805  attorney, if applicable, and the person’s attorney and guardian
  806  or guardian advocate, if one is appointed.
  807         (d) For purposes of this subsection, the term “qualified
  808  evaluator” means a licensed psychologist with expertise in the
  809  diagnosis, evaluation, and treatment of persons with
  810  intellectual disabilities or autism.
  811         Section 8. Section 26 of chapter 2015-222, Laws of Florida,
  812  is repealed.
  813         Section 9. Section 393.18, Florida Statutes, is reenacted
  814  and amended to read:
  815         393.18 Comprehensive transitional education program.—A
  816  comprehensive transitional education program serves individuals
  817  is a group of jointly operating centers or units, the collective
  818  purpose of which is to provide a sequential series of
  819  educational care, training, treatment, habilitation, and
  820  rehabilitation services to persons who have developmental
  821  disabilities, and who have severe or moderate maladaptive
  822  behaviors, severe maladaptive behaviors and co-occurring complex
  823  medical conditions, or a dual diagnosis of developmental
  824  disability and mental illness. However, this section does not
  825  require such programs to provide services only to persons with
  826  developmental disabilities. All such Services provided by the
  827  program must shall be temporary in nature and delivered in a
  828  manner designed to achieve structured residential setting,
  829  having the primary goal of incorporating the principles
  830  principle of self-determination and person-centered planning to
  831  transition individuals to the most appropriate, least
  832  restrictive community living option of their choice which is not
  833  operated as a in establishing permanent residence for persons
  834  with maladaptive behaviors in facilities that are not associated
  835  with the comprehensive transitional education program. The
  836  clinical director of the program must hold a doctorate degree
  837  with a primary focus in behavior analysis from an accredited
  838  university, be a certified behavior analyst pursuant to s.
  839  393.17, and have at least 1 year of experience in providing
  840  behavior analysis services for individuals with developmental
  841  disabilities. The staff must shall include behavior analysts and
  842  teachers, as appropriate, who must shall be available to provide
  843  services in each component center or unit of the program. A
  844  behavior analyst must be certified pursuant to s. 393.17.
  845         (1) Comprehensive transitional education programs must
  846  shall include a minimum of two component centers or units, one
  847  of which shall be an intensive treatment and educational center
  848  or a transitional training and educational center, which
  849  provides services to persons with maladaptive behaviors in the
  850  following components sequential order:
  851         (a) Intensive treatment and education educational center.
  852  This component provides is a self-contained residential unit
  853  providing intensive behavioral and educational programming for
  854  individuals whose conditions persons with severe maladaptive
  855  behaviors whose behaviors preclude placement in a less
  856  restrictive environment due to the threat of danger or injury to
  857  themselves or others. Continuous-shift staff are shall be
  858  required for this component.
  859         (b) Intensive Transitional training and education
  860  educational center.—This component provides is a residential
  861  unit for persons with moderate maladaptive behaviors providing
  862  concentrated psychological and educational programming that
  863  emphasizes a transition toward a less restrictive environment.
  864  Continuous-shift staff are shall be required for this component.
  865         (c) Community Transition residence.—This component provides
  866  is a residential center providing educational programs and any
  867  support services, training, and care that are needed to assist
  868  persons with maladaptive behaviors to avoid regression to more
  869  restrictive environments while preparing them for more
  870  independent living. Continuous-shift staff may shall be required
  871  for this component.
  872         (d) Alternative living center.—This component is a
  873  residential unit providing an educational and family living
  874  environment for persons with maladaptive behaviors in a
  875  moderately unrestricted setting. Residential staff shall be
  876  required for this component.
  877         (e) Independent living education center.—This component is
  878  a facility providing a family living environment for persons
  879  with maladaptive behaviors in a largely unrestricted setting and
  880  includes education and monitoring that is appropriate to support
  881  the development of independent living skills.
  882         (2) Components of a comprehensive transitional education
  883  program are subject to the license issued under s. 393.067 to a
  884  comprehensive transitional education program and may be located
  885  on a single site or multiple sites as long as such components
  886  are located within the same agency region.
  887         (3) Comprehensive transitional education programs shall
  888  develop individual education plans for each person with
  889  maladaptive behaviors, severe maladaptive behaviors and co
  890  occurring complex medical conditions, or a dual diagnosis of
  891  developmental disability and mental illness who receives
  892  services from the program. Each individual education plan shall
  893  be developed in accordance with the criteria specified in 20
  894  U.S.C. ss. 401 et seq., and 34 C.F.R. part 300. Educational
  895  components of the program, including individual education plans,
  896  must be integrated with the local school district to the extent
  897  possible.
  898         (4) For comprehensive transitional education programs, The
  899  total number of persons in a comprehensive transitional
  900  education program residents who are being provided with services
  901  may not in any instance exceed the licensed capacity of 120
  902  residents, and each residential unit within the component
  903  centers of a the program authorized under this section may not
  904  in any instance exceed 15 residents. However, a program that was
  905  authorized to operate residential units with more than 15
  906  residents before July 1, 2015, may continue to operate such
  907  units.
  908         (5) Beginning July 1, 2016, the agency may approve the
  909  proposed admission or readmission of individuals into a
  910  comprehensive transitional education program for up to 2 years
  911  subject to a specific review process. The agency may allow an
  912  individual to live in this setting for a longer period of time
  913  if, after a clinical review is conducted by the agency, it is
  914  determined that remaining in the program for a longer period of
  915  time is in the best interest of the individual.
  916         (6) Comprehensive transitional education programs shall
  917  provide continuous recorded video and audio monitoring in all
  918  residential common areas. Recordings must be maintained for at
  919  least 60 days during which time the agency may review them at
  920  any time. At the request of the agency, the comprehensive
  921  transitional education program shall retain specified recordings
  922  indefinitely throughout the course of an investigation into
  923  allegations of potential abuse or neglect.
  924         (7) Comprehensive transitional education programs shall
  925  operate and maintain a video and audio monitoring system that
  926  enables authorized agency staff to monitor program activities
  927  and facilities in real time from an off-site location. To the
  928  extent possible, such monitoring may be in a manner that
  929  precludes detection or knowledge of the monitoring by staff who
  930  may be present in monitored areas.
  931         (8) Licensure is authorized for a comprehensive
  932  transitional education program that, by July 1, 1989:
  933         (a) Was in actual operation; or
  934         (b) Owned a fee simple interest in real property for which
  935  a county or municipal government has approved zoning that allows
  936  the placement of a facility operated by the program and has
  937  registered an intent with the agency to operate a comprehensive
  938  transitional education program. However, nothing prohibits the
  939  assignment of licensure eligibility by such a registrant to
  940  another entity at a different site within the state if the
  941  entity is in compliance with the criteria of this subsection and
  942  local zoning requirements and each residential facility within
  943  the component centers or units of the program authorized under
  944  this paragraph does not exceed a capacity of 15 persons.
  945         (9) Notwithstanding subsection (8), in order to maximize
  946  federal revenues and provide for children needing special
  947  behavioral services, the agency may authorize the licensure of a
  948  facility that:
  949         (a) Provides residential services for children who have
  950  developmental disabilities and intensive behavioral problems as
  951  defined by the agency; and
  952         (b) As of July 1, 2010, served children who were served by
  953  the child welfare system and who have an open case in the State
  954  Automated Child Welfare Information System.
  956  The facility must be in compliance with all program criteria and
  957  local land use and zoning requirements and may not exceed a
  958  capacity of 15 children.
  959         Section 10. Subsection (2) of section 393.501, Florida
  960  Statutes, is amended to read:
  961         393.501 Rulemaking.—
  962         (2) Such rules must address the number of facilities on a
  963  single lot or on adjacent lots, except that there is no
  964  restriction on the number of facilities designated as community
  965  residential homes located within a planned residential community
  966  as those terms are defined in s. 419.001(1). In adopting rules,
  967  comprehensive transitional education programs an alternative
  968  living center and an independent living education center, as
  969  described in s. 393.18, are subject to s. 419.001, except that
  970  such program centers are exempt from the 1,000-foot-radius
  971  requirement of s. 419.001(2) if:
  972         (a) The program centers are located on a site zoned in a
  973  manner that permits all the components of a comprehensive
  974  transitional education program center to be located on the site;
  975  or
  976         (b) There are no more than three such program centers
  977  within a radius of 1,000 feet.
  978         Section 11. Paragraph (b) of subsection (1) of section
  979  383.141, Florida Statutes, is amended to read:
  980         383.141 Prenatally diagnosed conditions; patient to be
  981  provided information; definitions; information clearinghouse;
  982  advisory council.—
  983         (1) As used in this section, the term:
  984         (b) “Developmental disability” includes Down syndrome and
  985  other developmental disabilities defined by s. 393.063(12) s.
  986  393.063(9).
  987         Section 12. Paragraph (d) of subsection (2) of section
  988  1002.385, Florida Statutes, is amended to read:
  989         1002.385 Florida personal learning scholarship accounts.—
  990         (2) DEFINITIONS.—As used in this section, the term:
  991         (d) “Disability” means, for a 3- or 4-year-old child or for
  992  a student in kindergarten to grade 12, autism spectrum disorder,
  993  as defined in the Diagnostic and Statistical Manual of Mental
  994  Disorders, Fifth Edition, published by the American Psychiatric
  995  Association; cerebral palsy, as defined in s. 393.063(6) s.
  996  393.063(4); Down syndrome, as defined in s. 393.063(15) s.
  997  393.063(13); an intellectual disability, as defined in s.
  998  393.063(25) s. 393.063(21); Prader-Willi syndrome, as defined in
  999  s. 393.063(29) s. 393.063(25); or spina bifida, as defined in s.
 1000  393.063(41) s. 393.063(36); for a student in kindergarten, being
 1001  a high-risk child, as defined in s. 393.063(23)(a) s.
 1002  393.063(20)(a); muscular dystrophy; and Williams syndrome.
 1003         Section 13. This act shall take effect July 1, 2016.