Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. CS for CS for SB 1516
                                Barcode 483064                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  03/01/2012           .                                

       The Committee on Budget Subcommittee on Health and Human
       Services Appropriations (Negron) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 393.062, Florida Statutes, is amended to
    6  read:
    7         393.062 Legislative findings and declaration of intent.—
    8         (1) The Legislature finds and declares that existing state
    9  programs for the treatment of individuals with developmental
   10  disabilities, which often unnecessarily place individuals
   11  clients in institutions, are unreasonably costly, are
   12  ineffective in bringing the individual client to his or her
   13  maximum potential, and are in fact debilitating to many
   14  individuals clients. A redirection in state treatment programs
   15  for individuals with developmental disabilities is therefore
   16  necessary if any significant amelioration of the problems faced
   17  by such individuals is ever to take place. Such redirection
   18  should place primary emphasis on programs that prevent or reduce
   19  the severity of developmental disabilities. Further, the
   20  greatest priority should shall be given to the development and
   21  implementation of community-based services for that will enable
   22  individuals with developmental disabilities which will protect
   23  their health, safety, and welfare, and enable such individuals
   24  to achieve their greatest potential for independent and
   25  productive living, enable them to live in their own homes or in
   26  residences located in their own communities, and permit them to
   27  be diverted or moved removed from unnecessary institutional
   28  placements. This goal cannot be met without ensuring the
   29  availability of community residential opportunities in the
   30  residential areas of this state. The Legislature, therefore,
   31  declares that individuals all persons with developmental
   32  disabilities who live in licensed community homes shall have a
   33  family living environment comparable to that of other state
   34  residents Floridians and that such homes must residences shall
   35  be considered and treated as the a functional equivalent of a
   36  family unit and not as an institution, business, or boarding
   37  home. The Legislature further declares that, in developing
   38  community-based programs and services for individuals with
   39  developmental disabilities, private businesses, not-for-profit
   40  corporations, units of local government, and other organizations
   41  capable of providing needed services to clients in a cost
   42  efficient manner shall be given preference in lieu of operation
   43  of programs directly by state agencies. Finally, it is the
   44  intent of the Legislature that all caretakers who are unrelated
   45  to individuals with developmental disabilities receiving care
   46  shall be of good moral character.
   47         (2) The Legislature finds that in order to maximize the
   48  delivery of services to individuals in the community who have
   49  developmental disabilities and remain within appropriated funds,
   50  service delivery must blend natural supports, community
   51  resources, and state funds. The Legislature also finds that,
   52  given the traditional role of state government in ensuring the
   53  health, safety, and welfare of state residents, and the intent
   54  that waiver funds be used to avoid institutionalization, state
   55  funds, including waiver funds, appropriated to the agency must
   56  be reserved and prioritized for those services needed to ensure
   57  the health, safety, and welfare of individuals who have
   58  developmental disabilities in noninstitutional settings. It is
   59  therefore the intent of the Legislature that the agency develop
   60  sound fiscal strategies that allow the agency to predict,
   61  control, manage, and operate within available funding as
   62  provided in the General Appropriations Act in order to ensure
   63  that state funds are available for health, safety, and welfare,
   64  to avoid institutionalization, and to maximize the number of
   65  individuals who have developmental disabilities who receive
   66  services. It is further the intent of the Legislature that the
   67  agency provide services for individuals residing in
   68  developmental disability centers that promote the individual’s
   69  health, safety, and welfare and enhance their quality of life.
   70  Finally, the Legislature intends that the agency continue the
   71  tradition of involving families, stakeholders, and other
   72  interested parties as it recasts its role as a collaborative
   73  partner in the larger context of family and community-supported
   74  services and develops new opportunities and supports for
   75  individuals with developmental disabilities.
   76         Section 2. Section 393.063, Florida Statutes, is reordered
   77  and amended to read:
   78         393.063 Definitions.—As used in For the purposes of this
   79  chapter, the term:
   80         (1) “Agency” means the Agency for Persons with
   81  Disabilities.
   82         (2) “Adult day services” means services that are provided
   83  in a nonresidential setting, separate from the home or facility
   84  in which the individual resides, unless he or she resides in a
   85  planned residential community as defined in s. 419.001(1), and
   86  that are intended to support the participation of individuals in
   87  meaningful activities that do not require formal training, which
   88  may include a variety of activities, including social
   89  activities.
   90         (3)(2) “Adult day training” means training that is
   91  conducted services which take place in a nonresidential setting,
   92  separate from the home or facility in which the individual
   93  client resides, unless he or she resides in a planned
   94  residential community as defined in s. 419.001(1)(d); are
   95  intended to support the individual’s participation of clients in
   96  daily, meaningful, and valued routines of the community; and may
   97  include work-like settings that do not meet the definition of
   98  supported employment.
   99         (4)(3) “Autism” means a pervasive, neurologically based
  100  developmental disability of extended duration which causes
  101  severe learning, communication, and behavior disorders and which
  102  has an with age of onset during infancy or childhood.
  103  Individuals who have with autism exhibit impairment in
  104  reciprocal social interaction, impairment in verbal and
  105  nonverbal communication and imaginative ability, and a markedly
  106  restricted repertoire of activities and interests.
  107         (5)(4) “Cerebral palsy” means a group of disabling symptoms
  108  of extended duration which results from damage to the developing
  109  brain which that may occur before, during, or after birth and
  110  which that results in the loss or impairment of control over
  111  voluntary muscles. The term For the purposes of this definition,
  112  cerebral palsy does not include those symptoms or impairments
  113  resulting solely from a stroke.
  114         (6)(5) “Client” means an individual any person determined
  115  eligible by the agency for services under this chapter.
  116         (7)(6) “Client advocate” means a friend or relative of an
  117  individual the client, or of the individual’s client’s immediate
  118  family, who advocates for the individual’s best interests of the
  119  client in any proceedings under this chapter in which the
  120  individual client or his or her family has the right or duty to
  121  participate.
  122         (8)(7) “Comprehensive assessment” means the process used to
  123  determine eligibility for services under this chapter.
  124         (9)(8) “Comprehensive transitional education program” means
  125  the program established under in s. 393.18.
  126         (11)(9) “Developmental disability” means a disorder or
  127  syndrome that is attributable to retardation, cerebral palsy,
  128  autism, spina bifida, Down syndrome, or Prader-Willi syndrome;
  129  that manifests before the age of 18; and that constitutes a
  130  substantial handicap that can reasonably be expected to continue
  131  indefinitely.
  132         (10) “Developmental disabilities center” means a state
  133  owned and state-operated facility, formerly known as a “Sunland
  134  Center,” providing for the care, habilitation, and
  135  rehabilitation of individuals who have clients with
  136  developmental disabilities.
  137         (12)(11) “Direct service provider” means a person, 18 years
  138  of age or older, who has direct face-to-face contact with an
  139  individual a client while providing services to that individual
  140  the client or who has access to his or her a client’s living
  141  areas, or to a client’s funds, or personal property.
  142         (12) “Domicile” means the place where a client legally
  143  resides, which place is his or her permanent home. Domicile may
  144  be established as provided in s. 222.17. Domicile may not be
  145  established in Florida by a minor who has no parent domiciled in
  146  Florida, or by a minor who has no legal guardian domiciled in
  147  Florida, or by any alien not classified as a resident alien.
  148         (13) “Down syndrome” means a disorder caused by the
  149  presence of an extra chromosome 21.
  150         (14) “Express and informed consent” means consent
  151  voluntarily given in writing with sufficient knowledge and
  152  comprehension of the subject matter to enable the person giving
  153  consent to make a knowing decision without any element of force,
  154  fraud, deceit, duress, or other form of constraint or coercion.
  155         (15) “Family care program” means the program established
  156  under in s. 393.068.
  157         (16) “Foster care facility” means a residential facility
  158  licensed under this chapter which provides a family living
  159  environment and includes including supervision and care
  160  necessary to meet the physical, emotional, and social needs of
  161  its residents. The capacity of such a facility may not be more
  162  than three residents.
  163         (17) “Group home facility” means a residential facility
  164  licensed under this chapter which provides a family living
  165  environment and includes including supervision and care
  166  necessary to meet the physical, emotional, and social needs of
  167  its residents. The capacity of such a facility must shall be at
  168  least four 4 but not more than 15 residents.
  169         (18) “Guardian advocate” means a person appointed by a
  170  written order of the court to represent an individual who has a
  171  person with developmental disability disabilities under s.
  172  393.12.
  173         (19) “Habilitation” means the process by which an
  174  individual who has a developmental disability a client is
  175  assisted to acquire and maintain those life skills that which
  176  enable the individual client to cope more effectively with the
  177  demands of his or her condition and environment and to raise the
  178  level of his or her physical, mental, and social efficiency. It
  179  includes, but is not limited to, programs of formal structured
  180  education and treatment.
  181         (20) “High-risk child” means, for the purposes of this
  182  chapter, a child from 3 to 5 years of age who has with one or
  183  more of the following characteristics:
  184         (a) A developmental delay in cognition, language, or
  185  physical development.
  186         (b) A child surviving a catastrophic infectious or
  187  traumatic illness known to be associated with developmental
  188  delay, if when funds are specifically appropriated.
  189         (c) A child who has with a parent or guardian who has with
  190  developmental disabilities and who requires assistance in
  191  meeting the child’s developmental needs.
  192         (d) A child who has a physical or genetic anomaly
  193  associated with developmental disability.
  194         (21) “Intermediate care facility for the developmentally
  195  disabled” or “ICF/DD” means a residential facility licensed and
  196  certified under pursuant to part VIII of chapter 400.
  197         (22) “Medical/dental services” means medically necessary
  198  services that which are provided or ordered for an individual a
  199  client by a person licensed under chapter 458, chapter 459, or
  200  chapter 466. Such services may include, but are not limited to,
  201  prescription drugs, specialized therapies, nursing supervision,
  202  hospitalization, dietary services, prosthetic devices, surgery,
  203  specialized equipment and supplies, adaptive equipment, and
  204  other services as required to prevent or alleviate a medical or
  205  dental condition.
  206         (23) “Nonwaiver resources” means supports or services that
  207  may be obtained through private insurance, the Medicaid state
  208  plan, nonprofit organizations, charitable donations from private
  209  businesses, other government programs, family, natural supports,
  210  community resources, and any other source other than a waiver.
  211         (24)(23) “Personal care services” means individual
  212  assistance with or supervision of essential activities of daily
  213  living for self-care, including ambulation, bathing, dressing,
  214  eating, grooming, and toileting, and other similar services that
  215  are incidental to the care furnished and are essential, and that
  216  are provided in the amount, duration, frequency, intensity, and
  217  scope determined by the agency to be necessary for an
  218  individual’s to the health, safety, and welfare and to avoid
  219  institutionalization of the client when there is no one else
  220  available or able to perform those services.
  221         (25)(24) “Prader-Willi syndrome” means an inherited
  222  condition typified by neonatal hypotonia with failure to thrive,
  223  hyperphagia or an excessive drive to eat which leads to obesity
  224  usually at 18 to 36 months of age, mild to moderate mental
  225  retardation, hypogonadism, short stature, mild facial
  226  dysmorphism, and a characteristic neurobehavior.
  227         (26)(25) “Relative” means a person an individual who is
  228  connected by affinity or consanguinity to an individual the
  229  client and who is 18 years of age or older.
  230         (27)(26) “Resident” means an individual who has a any
  231  person with developmental disability and who resides
  232  disabilities residing at a residential facility, regardless of
  233  whether he or she has been determined eligible for agency
  234  services or not such person is a client of the agency.
  235         (28)(27) “Residential facility” means a facility providing
  236  room and board and personal care for individuals who have
  237  persons with developmental disabilities.
  238         (29)(28) “Residential habilitation” means supervision and
  239  training in with the acquisition, retention, or improvement in
  240  skills related to activities of daily living, such as personal
  241  hygiene skills, homemaking skills, and the social and adaptive
  242  skills necessary to enable the individual to reside in the
  243  community.
  244         (30)(29) “Residential habilitation center” means a
  245  community residential facility licensed under this chapter which
  246  provides habilitation services. The capacity of such a facility
  247  may shall not be fewer than nine residents. After October 1,
  248  1989, new residential habilitation centers may not be licensed
  249  and the licensed capacity for any existing residential
  250  habilitation center may not be increased.
  251         (31)(30) “Respite service” means appropriate, short-term,
  252  temporary care that is provided to an individual who has a
  253  person with developmental disability in order disabilities to
  254  meet the planned or emergency needs of the individual person or
  255  the family or other direct service provider.
  256         (32)(31) “Restraint” means a physical device, method, or
  257  drug used to control dangerous behavior.
  258         (a) A physical restraint is any manual method or physical
  259  or mechanical device, material, or equipment attached or
  260  adjacent to the individual’s body so that he or she cannot
  261  easily remove the restraint and which restricts freedom of
  262  movement or normal access to one’s body.
  263         (b) A drug used as a restraint is a medication used to
  264  control the individual’s person’s behavior or to restrict his or
  265  her freedom of movement and is not a standard treatment for the
  266  individual’s person’s medical or psychiatric condition.
  267  Physically holding an individual a person during a procedure to
  268  forcibly administer psychotropic medication is a physical
  269  restraint.
  270         (c) Restraint does not include physical devices, such as
  271  orthopedically prescribed appliances, surgical dressings and
  272  bandages, supportive body bands, seatbelts or wheelchair tie
  273  downs, or other physical holding when necessary for routine
  274  physical examinations and tests; for purposes of orthopedic,
  275  surgical, or other similar medical treatment; when used to
  276  provide support for the achievement of functional body position
  277  or proper balance; or when used to protect an individual a
  278  person from falling out of bed or a wheelchair; or when used for
  279  safety during transportation.
  280         (33)(32) “Retardation” means significantly subaverage
  281  general intellectual functioning existing concurrently with
  282  deficits in adaptive behavior which manifest that manifests
  283  before the age of 18 and can reasonably be expected to continue
  284  indefinitely. As used in this subsection, the term:
  285         (a) “Significantly subaverage general intellectual
  286  functioning,for the purpose of this definition, means
  287  performance that which is two or more standard deviations from
  288  the mean score on a standardized intelligence test specified in
  289  the rules of the agency.
  290         (b) “Adaptive behavior,for the purpose of this
  291  definition, means the effectiveness or degree with which an
  292  individual meets the standards of personal independence and
  293  social responsibility expected of his or her age, cultural
  294  group, and community.
  295         (34)(33) “Seclusion” means the involuntary isolation of an
  296  individual a person in a room or area from which the individual
  297  person is prevented from leaving. The prevention may be by
  298  physical barrier or by a staff member who is acting in a manner,
  299  or who is physically situated, so as to prevent the individual
  300  person from leaving the room or area. For the purposes of this
  301  chapter, the term does not mean isolation due to the
  302  individual’s medical condition or symptoms of the person.
  303         (35)(34) “Self-determination” means an individual’s freedom
  304  to exercise the same rights as all other citizens, authority to
  305  exercise control over funds needed for one’s own support,
  306  including prioritizing those these funds when necessary,
  307  responsibility for the wise use of public funds, and self
  308  advocacy to speak and advocate for oneself in order to gain
  309  independence and ensure that individuals who have with a
  310  developmental disability are treated equally.
  311         (36)(35) “Specialized therapies” means those treatments or
  312  activities prescribed by and provided by an appropriately
  313  trained, licensed, or certified professional or staff person and
  314  may include, but are not limited to, physical therapy, speech
  315  therapy, respiratory therapy, occupational therapy, behavior
  316  therapy, physical management services, and related specialized
  317  equipment and supplies.
  318         (37)(36) “Spina bifida” means an individual who has been
  319  given, for purposes of this chapter, a person with a medical
  320  diagnosis of spina bifida cystica or myelomeningocele.
  321         (38)(37) “Support coordinator” means a person who is
  322  contracting with designated by the agency to assist individuals
  323  and families in identifying their capacities, needs, and
  324  resources, as well as finding and gaining access to necessary
  325  supports and services; assisting with locating or developing
  326  employment opportunities; coordinating the delivery of supports
  327  and services; advocating on behalf of the individual and family;
  328  maintaining relevant records; and monitoring and evaluating the
  329  delivery of supports and services to determine the extent to
  330  which they meet the needs and expectations identified by the
  331  individual, family, and others who participated in the
  332  development of the support plan.
  333         (39)(38) “Supported employment” means employment located or
  334  provided in an integrated work setting, with earnings paid on a
  335  commensurate wage basis, and for which continued support is
  336  needed for job maintenance.
  337         (40)(39) “Supported living” means a category of
  338  individually determined services designed and coordinated in
  339  such a manner that provides as to provide assistance to adults
  340  adult clients who require ongoing supports to live as
  341  independently as possible in their own homes, to be integrated
  342  into the community, and to participate in community life to the
  343  fullest extent possible.
  344         (41)(40) “Training” means a planned approach to assisting
  345  an individual a client to attain or maintain his or her maximum
  346  potential and includes services ranging from sensory stimulation
  347  to instruction in skills for independent living and employment.
  348         (42)(41) “Treatment” means the prevention, amelioration, or
  349  cure of an individual’s a client’s physical and mental
  350  disabilities or illnesses.
  351         (43) “Waiver” means a federally approved Medicaid waiver
  352  program, including, but not limited to, the Developmental
  353  Disabilities Home and Community-Based Services Waivers Tiers 1
  354  4, the Developmental Disabilities Individual Budget Waiver, and
  355  the Consumer-Directed Care Plus Program, authorized pursuant to
  356  s. 409.906 and administered by the agency to provide home and
  357  community-based services to individuals who have developmental
  358  disabilities.
  359         Section 3. Subsections (1) and (6) of section 393.065,
  360  Florida Statutes, are amended to read:
  361         393.065 Application and eligibility determination.—
  362         (1) Application for services shall be made, in writing, to
  363  the agency, in the service area in which the applicant resides.
  364  The agency shall review each applicant for eligibility within 45
  365  days after the date the application is signed for children under
  366  6 years of age and within 60 days after the date the application
  367  is signed for all other applicants. If When necessary to
  368  definitively identify individual conditions or needs, the agency
  369  shall provide a comprehensive assessment. Eligibility is limited
  370  to United States citizens and to qualified noncitizens who meet
  371  the criteria provided in s. 414.095(3), and who have established
  372  domicile in Florida pursuant to s. 222.17 or are otherwise
  373  determined to be legal residents of this state. Only applicants
  374  whose domicile is in Florida are eligible for services.
  375  Information accumulated by other agencies, including
  376  professional reports and collateral data, shall be considered if
  377  in this process when available.
  378         (6) The individual, or the individual’s client, the
  379  client’s guardian, or the client’s family, must ensure that
  380  accurate, up-to-date contact information is provided to the
  381  agency at all times. The agency shall remove from the wait list
  382  an any individual who cannot be located using the contact
  383  information provided to the agency, fails to meet eligibility
  384  requirements, or no longer qualifies as a legal resident of this
  385  state becomes domiciled outside the state.
  386         Section 4. Section 393.066, Florida Statutes, is amended to
  387  read:
  388         393.066 Community services and treatment.—
  389         (1) The agency shall plan, develop, organize, and implement
  390  its programs of services and treatment for individuals who have
  391  persons with developmental disabilities in order to assist them
  392  in living allow clients to live as independently as possible in
  393  their own homes or communities, to support them in maximizing
  394  their independence using innovative, effective, efficient, and
  395  sustainable solutions, and to avoid institutionalization and to
  396  achieve productive lives as close to normal as possible. All
  397  elements of community-based services shall be made available,
  398  and eligibility for these services shall be consistent across
  399  the state.
  400         (2) All Services that are not available through nonwaiver
  401  resources or that are not donated needed shall be purchased
  402  instead of provided directly by the agency if, when such
  403  arrangement is more cost-efficient than having those services
  404  provided directly. All purchased services must be approved by
  405  the agency. Authorization for such services is dependent on the
  406  availability of agency funding.
  407         (3) Community Community-based services that are medically
  408  necessary to prevent the institutionalization of individuals
  409  with developmental disabilities must be provided in the most
  410  cost-effective manner to the extent of the availability of
  411  agency resources as specified in the General Appropriations Act.
  412  These services may shall, to the extent of available resources,
  413  include:
  414         (a) Adult day training and adult day services.
  415         (b) Family care services.
  416         (c) Guardian advocate referral services.
  417         (d) Medical/dental services, except that medical services
  418  shall not be provided to individuals clients with spina bifida
  419  except as specifically appropriated by the Legislature.
  420         (e) Parent training.
  421         (e)(f) Personal care services and personal support
  422  services.
  423         (g) Recreation.
  424         (f)(h) Residential habilitation facility services.
  425         (g)(i) Respite services.
  426         (h)(j)Support coordination Social services.
  427         (i)(k) Specialized therapies.
  428         (j)(l) Supported employment.
  429         (k)(m) Supported living.
  430         (l)(n) Training, including behavioral analysis services.
  431         (m)(o) Transportation.
  432         (n)(p) Other habilitative and rehabilitative services as
  433  needed.
  434         (4) The agency or the agency’s agents shall identify and
  435  engage in efforts to develop, increase, or enhance the
  436  availability of nonwaiver resources to individuals who have
  437  developmental disabilities. The agency shall promote
  438  partnerships and collaborative efforts with families;
  439  organizations, such as nonprofit agencies and foundations;
  440  places of worship; schools; community organizations and clubs;
  441  businesses; local governments; and state and federal agencies
  442  shall utilize the services of private businesses, not-for-profit
  443  organizations, and units of local government whenever such
  444  services are more cost-efficient than such services provided
  445  directly by the department, including arrangements for provision
  446  of residential facilities.
  447         (5) In order to improve the potential for utilization of
  448  more cost-effective, community-based residential facilities, the
  449  agency shall promote the statewide development of day
  450  habilitation services for clients who live with a direct service
  451  provider in a community-based residential facility and who do
  452  not require 24-hour-a-day care in a hospital or other health
  453  care institution, but who may, in the absence of day
  454  habilitation services, require admission to a developmental
  455  disabilities center. Each day service facility shall provide a
  456  protective physical environment for clients, ensure that direct
  457  service providers meet minimum screening standards as required
  458  in s. 393.0655, make available to all day habilitation service
  459  participants at least one meal on each day of operation, provide
  460  facilities to enable participants to obtain needed rest while
  461  attending the program, as appropriate, and provide social and
  462  educational activities designed to stimulate interest and
  463  provide socialization skills.
  464         (5)(6) To promote independence and productivity, the agency
  465  shall provide supports and services, within available resources,
  466  to assist individuals clients enrolled in Medicaid waivers who
  467  choose to pursue gainful employment.
  468         (6)(7) For the purpose of making needed community-based
  469  residential facilities available at the least possible cost to
  470  the state, the agency may is authorized to lease privately owned
  471  residential facilities under long-term rental agreements, if
  472  such rental agreements are projected to be less costly to the
  473  state over the useful life of the facility than state purchase
  474  or state construction of such a facility.
  475         (7)(8) The agency may adopt rules providing definitions,
  476  eligibility criteria, and procedures for the purchase of
  477  services provided pursuant to this section.
  478         Section 5. Section 393.0661, Florida Statutes, is amended
  479  to read:
  480         393.0661 Home and community-based services delivery system;
  481  comprehensive redesign.—The Legislature finds that the home and
  482  community-based services delivery system for individuals who
  483  have persons with developmental disabilities and the
  484  availability of appropriated funds are two of the critical
  485  elements in making services available. Therefore, it is the
  486  intent of the Legislature that the Agency for Persons with
  487  Disabilities shall develop and implement a comprehensive
  488  redesign of the system.
  489         (1) The redesign of the home and community-based services
  490  system must shall include, at a minimum, all actions necessary
  491  to achieve an appropriate rate structure, individual client
  492  choice within a specified service package, appropriate
  493  assessment strategies, an efficient billing process that
  494  contains reconciliation and monitoring components, and a
  495  redefined role for support coordinators which that avoids
  496  conflicts of interest and ensures that an individual’s needs for
  497  critical services, which maximize his or her independence and
  498  avoid institutionalization through the use of innovative,
  499  effective, efficient, and sustainable solutions, are addressed
  500  potential conflicts of interest and ensures that family/client
  501  budgets are linked to levels of need.
  502         (a) The agency shall use the Questionnaire for Situational
  503  Information or another needs an assessment instrument deemed by
  504  instrument that the agency deems to be reliable and valid,
  505  including, but not limited to, the Department of Children and
  506  Family Services’ Individual Cost Guidelines or the agency’s
  507  Questionnaire for Situational Information. The agency may
  508  contract with an external vendor or may use support coordinators
  509  to complete individual needs client assessments if it develops
  510  sufficient safeguards and training to ensure ongoing inter-rater
  511  reliability.
  512         (b) The agency, with the concurrence of the Agency for
  513  Health Care Administration, may contract for the determination
  514  of medical necessity and establishment of individual budgets.
  515         (2) A provider of services rendered to individuals who have
  516  persons with developmental disabilities pursuant to a federally
  517  approved waiver shall be reimbursed according to a rate
  518  methodology based upon an analysis of the expenditure history
  519  and prospective costs of providers participating in the waiver
  520  program, or under any other methodology developed by the Agency
  521  for Health Care Administration, in consultation with the agency
  522  for Persons with Disabilities, and approved by the Federal
  523  Government in accordance with the waiver.
  524         (3) The Agency for Health Care Administration, in
  525  consultation with the agency, shall seek federal approval and
  526  implement a four-tiered waiver system to serve eligible
  527  individuals clients through the developmental disabilities and
  528  family and supported living waivers. For the purpose of the this
  529  waiver program, eligible individuals clients shall include
  530  individuals who have with a diagnosis of Down syndrome or a
  531  developmental disability as defined in s. 393.063. The agency
  532  shall assign all individuals clients receiving services through
  533  the developmental disabilities waiver to a tier based on the
  534  Department of Children and Family Services’ Individual Cost
  535  Guidelines, the agency’s Questionnaire for Situational
  536  Information, or another such assessment instrument deemed to be
  537  valid and reliable by the agency; individual client
  538  characteristics, including, but not limited to, age; and other
  539  appropriate assessment methods. Final determination of tier
  540  eligibility may not be made until a waiver slot and funding
  541  become available and only then may the individual be enrolled in
  542  the appropriate tier. If an individual is later determined
  543  eligible for a higher tier, assignment to the higher tier must
  544  be based on crisis criteria as adopted by rule. The agency may
  545  also later move an individual to a lower tier if his or her
  546  service needs change and can be met by services provided in a
  547  lower tier. The agency may not authorize the provision of
  548  services that are duplicated by, or that are above the coverage
  549  limits of, the Medicaid state plan.
  550         (a) Tier one is limited to individuals clients who have
  551  intensive medical or adaptive service needs that cannot be met
  552  in tier two, three, or four for intensive medical or adaptive
  553  needs and that are essential for avoiding institutionalization,
  554  or who possess behavioral problems that are exceptional in
  555  intensity, duration, or frequency and present a substantial risk
  556  of harm to themselves or others. Total annual expenditures under
  557  tier one may not exceed $150,000 per client each year, provided
  558  that expenditures for clients in tier one with a documented
  559  medical necessity requiring intensive behavioral residential
  560  habilitation services, intensive behavioral residential
  561  habilitation services with medical needs, or special medical
  562  home care, as provided in the Developmental Disabilities Waiver
  563  Services Coverage and Limitations Handbook, are not subject to
  564  the $150,000 limit on annual expenditures.
  565         (b) Tier two is limited to individuals clients whose
  566  service needs include a licensed residential facility and who
  567  are authorized to receive a moderate level of support for
  568  standard residential habilitation services or a minimal level of
  569  support for behavior focus residential habilitation services, or
  570  individuals clients in supported living who receive more than 6
  571  hours a day of in-home support services. Tier two also includes
  572  individuals whose need for authorized services meets the
  573  criteria for tier one but can be met within the expenditure
  574  limit of tier two. Total annual expenditures under tier two may
  575  not exceed $53,625 per individual client each year.
  576         (c) Tier three includes, but is not limited to, individuals
  577  who require clients requiring residential placements,
  578  individuals who are clients in independent or supported living
  579  situations, and individuals clients who live in their family
  580  home. Tier three also includes individuals whose need for
  581  authorized services meets the criteria for tiers one or two but
  582  can be met within the expenditure limit of tier three. Total
  583  annual expenditures under tier three may not exceed $34,125 per
  584  individual client each year.
  585         (d) Tier four includes individuals who were enrolled in the
  586  family and supported living waiver on July 1, 2007, and were who
  587  shall be assigned to this tier without the assessments required
  588  by this section. Tier four also includes, but is not limited to,
  589  individuals clients in independent or supported living
  590  situations and individuals clients who live in their family
  591  home. Total annual expenditures under tier four may not exceed
  592  $14,422 per individual client each year.
  593         (e) The Agency for Health Care Administration shall also
  594  seek federal approval to provide a consumer-directed option for
  595  individuals who have persons with developmental disabilities
  596  which corresponds to the funding levels in each of the waiver
  597  tiers. The agency shall implement the four-tiered waiver system
  598  beginning with tiers one, three, and four and followed by tier
  599  two. The agency and the Agency for Health Care Administration
  600  may adopt rules necessary to administer this subsection.
  601         (f) The agency shall seek federal waivers and amend
  602  contracts as necessary to make changes to services defined in
  603  federal waiver programs administered by the agency as follows:
  604         1. Supported living coaching services may not exceed 20
  605  hours per month for individuals persons who also receive in-home
  606  support services.
  607         2. Limited support coordination services is the only type
  608  of support coordination service that may be provided to
  609  individuals persons under the age of 18 who live in the family
  610  home.
  611         3. Personal care assistance services are limited to 180
  612  hours per calendar month and may not include rate modifiers.
  613  Additional hours may be authorized for individuals persons who
  614  have intensive physical, medical, or adaptive needs if such
  615  hours are essential for avoiding institutionalization.
  616         4. Residential habilitation services are limited to 8 hours
  617  per day. Additional hours may be authorized for individuals
  618  persons who have intensive medical or adaptive needs and if such
  619  hours are essential for avoiding institutionalization, or for
  620  individuals persons who possess behavioral problems that are
  621  exceptional in intensity, duration, or frequency and present a
  622  substantial risk of harming themselves or others. This
  623  restriction shall be in effect until the four-tiered waiver
  624  system is fully implemented.
  625         5. Chore services, nonresidential support services, and
  626  homemaker services are eliminated. The agency shall expand the
  627  definition of in-home support services to allow the service
  628  provider to include activities previously provided in these
  629  eliminated services.
  630         6. Massage therapy, medication review, and psychological
  631  assessment services are eliminated.
  632         5.7. The agency shall conduct supplemental cost plan
  633  reviews to verify the medical necessity of authorized services
  634  for plans that have increased by more than 8 percent during
  635  either of the 2 preceding fiscal years.
  636         6.8. The agency shall implement a consolidated residential
  637  habilitation rate structure to increase savings to the state
  638  through a more cost-effective payment method and establish
  639  uniform rates for intensive behavioral residential habilitation
  640  services.
  641         9. Pending federal approval, the agency may extend current
  642  support plans for clients receiving services under Medicaid
  643  waivers for 1 year beginning July 1, 2007, or from the date
  644  approved, whichever is later. Clients who have a substantial
  645  change in circumstances which threatens their health and safety
  646  may be reassessed during this year in order to determine the
  647  necessity for a change in their support plan.
  648         7.10. The agency shall develop a plan to eliminate
  649  redundancies and duplications between in-home support services,
  650  companion services, personal care services, and supported living
  651  coaching by limiting or consolidating such services.
  652         8.11. The agency shall develop a plan to reduce the
  653  intensity and frequency of supported employment services to
  654  individuals clients in stable employment situations who have a
  655  documented history of at least 3 years’ employment with the same
  656  company or in the same industry.
  657         (g) The agency and the Agency for Health Care
  658  Administration may adopt rules to administer this subsection.
  659         (4) The geographic differential for Miami-Dade, Broward,
  660  and Palm Beach Counties for residential habilitation services is
  661  shall be 7.5 percent.
  662         (5) The geographic differential for Monroe County for
  663  residential habilitation services is shall be 20 percent.
  664         (6) Effective January 1, 2010, and except as otherwise
  665  provided in this section, a client served by the home and
  666  community-based services waiver or the family and supported
  667  living waiver funded through the agency shall have his or her
  668  cost plan adjusted to reflect the amount of expenditures for the
  669  previous state fiscal year plus 5 percent if such amount is less
  670  than the client’s existing cost plan. The agency shall use
  671  actual paid claims for services provided during the previous
  672  fiscal year that are submitted by October 31 to calculate the
  673  revised cost plan amount. If the client was not served for the
  674  entire previous state fiscal year or there was any single change
  675  in the cost plan amount of more than 5 percent during the
  676  previous state fiscal year, the agency shall set the cost plan
  677  amount at an estimated annualized expenditure amount plus 5
  678  percent. The agency shall estimate the annualized expenditure
  679  amount by calculating the average of monthly expenditures,
  680  beginning in the fourth month after the client enrolled,
  681  interrupted services are resumed, or the cost plan was changed
  682  by more than 5 percent and ending on August 31, 2009, and
  683  multiplying the average by 12. In order to determine whether a
  684  client was not served for the entire year, the agency shall
  685  include any interruption of a waiver-funded service or services
  686  lasting at least 18 days. If at least 3 months of actual
  687  expenditure data are not available to estimate annualized
  688  expenditures, the agency may not rebase a cost plan pursuant to
  689  this subsection. The agency may not rebase the cost plan of any
  690  client who experiences a significant change in recipient
  691  condition or circumstance which results in a change of more than
  692  5 percent to his or her cost plan between July 1 and the date
  693  that a rebased cost plan would take effect pursuant to this
  694  subsection.
  695         (6)(7) The agency may shall collect premiums or cost
  696  sharing pursuant to s. 409.906(13)(d).
  697         (7) In determining whether to continue Medicaid waiver
  698  provider agreements for service providers, including support
  699  coordinators, the agency shall review provider performance to
  700  ensure that the provider meets or exceeds the criteria
  701  established by the agency. The provider agreements and
  702  performance reviews shall be managed and conducted by the
  703  agency’s area offices.
  704         (a) Criteria for evaluating the performance of a service
  705  provider include, but are not limited to:
  706         1. The protection of the health, safety, and welfare of the
  707  individual.
  708         2. Assisting the individual and his or her support
  709  coordinator in identifying nonwaiver resources that may be
  710  available to meet the individual’s needs. The waiver is the
  711  funding source of last resort for services.
  712         3. Providing services that are authorized in the service
  713  authorization approved by the agency.
  714         (b) The support coordinator is responsible for assisting
  715  the individual in meeting his or her service needs through
  716  nonwaiver resources, as well as through the individual’s budget
  717  allocation or cost plan under the waiver. The waiver is the
  718  funding source of last resort for services. Criteria for
  719  evaluating the performance of a support coordinator include, but
  720  are not limited to:
  721         1. The protection of the health, safety, and welfare of
  722  individuals.
  723         2. Assisting individuals in obtaining employment and
  724  pursuing other meaningful activities.
  725         3. Assisting individuals in accessing services that allow
  726  them to live in their community.
  727         4. The use of family resources.
  728         5. The use of private or third-party resources.
  729         6. The use of community resources.
  730         7. The use of charitable resources.
  731         8. The use of volunteer resources.
  732         9. The use of services from other governmental entities.
  733         10. The overall outcome in securing nonwaiver resources.
  734         11. The cost-effective use of waiver resources.
  735         12. Coordinating all available resources to ensure that the
  736  individual’s outcomes are met.
  737         (c) The agency may recognize consistently superior
  738  performance by exempting a service provider, including support
  739  coordinators, from annual quality assurance reviews or other
  740  mechanisms established by the agency. The agency may issue
  741  sanctions for poor performance, including, but not limited to, a
  742  reduction in the number of individuals served by the provider,
  743  recoupment or other financial penalties, and termination of the
  744  waiver provider agreement.
  745         (d) The agency may adopt rules to administer this
  746  subsection.
  747         (8) This section or related rule does not prevent or limit
  748  the Agency for Health Care Administration, in consultation with
  749  the agency for Persons with Disabilities, from adjusting fees,
  750  reimbursement rates, lengths of stay, number of visits, or
  751  number of services, or from limiting enrollment, or making any
  752  other adjustment necessary to comply with the availability of
  753  moneys and any limitations or directions provided in the General
  754  Appropriations Act.
  755         (9) The agency for Persons with Disabilities shall submit
  756  quarterly status reports to the Executive Office of the Governor
  757  and, the chairs of the legislative appropriations committees
  758  chair of the Senate Ways and Means Committee or its successor,
  759  and the chair of the House Fiscal Council or its successor
  760  regarding the financial status of waiver home and community
  761  based services, including the number of enrolled individuals who
  762  are receiving services through one or more programs; the number
  763  of individuals who have requested services who are not enrolled
  764  but who are receiving services through one or more programs,
  765  including with a description indicating the programs from which
  766  the individual is receiving services; the number of individuals
  767  who have refused an offer of services but who choose to remain
  768  on the list of individuals waiting for services; the number of
  769  individuals who have requested services but who are not
  770  receiving no services; a frequency distribution indicating the
  771  length of time individuals have been waiting for services; and
  772  information concerning the actual and projected costs compared
  773  to the amount of the appropriation available to the program and
  774  any projected surpluses or deficits. If at any time an analysis
  775  by the agency, in consultation with the Agency for Health Care
  776  Administration, indicates that the cost of services is expected
  777  to exceed the amount appropriated, the agency shall submit a
  778  plan in accordance with subsection (8) to the Executive Office
  779  of the Governor and the chairs of the legislative appropriations
  780  committees, the chair of the Senate Ways and Means Committee or
  781  its successor, and the chair of the House Fiscal Council or its
  782  successor to remain within the amount appropriated. The agency
  783  shall work with the Agency for Health Care Administration to
  784  implement the plan so as to remain within the appropriation.
  785         (10) Implementation of Medicaid waiver programs and
  786  services authorized under this chapter is limited by the funds
  787  appropriated for the individual budgets pursuant to s. 393.0662
  788  and the four-tiered waiver system pursuant to subsection (3).
  789  Contracts with independent support coordinators and service
  790  providers must include provisions requiring compliance with
  791  agency cost containment initiatives. The agency shall implement
  792  monitoring and accounting procedures necessary to track actual
  793  expenditures and project future spending compared to available
  794  appropriations for Medicaid waiver programs. If When necessary,
  795  based on projected deficits, the agency shall must establish
  796  specific corrective action plans that incorporate corrective
  797  actions for of contracted providers which that are sufficient to
  798  align program expenditures with annual appropriations. If
  799  deficits continue during the 2012-2013 fiscal year, the agency
  800  in conjunction with the Agency for Health Care Administration
  801  shall develop a plan to redesign the waiver program and submit
  802  the plan to the President of the Senate and the Speaker of the
  803  House of Representatives by September 30, 2013. At a minimum,
  804  the plan must include the following elements:
  805         (a) Budget predictability.—Agency budget recommendations
  806  must include specific steps to restrict spending to budgeted
  807  amounts based on alternatives to the iBudget and four-tiered
  808  Medicaid waiver models.
  809         (b) Services.—The agency shall identify core services that
  810  are essential to provide for individual client health and safety
  811  and recommend the elimination of coverage for other services
  812  that are not affordable based on available resources.
  813         (c) Flexibility.—The redesign must shall be responsive to
  814  individual needs and to the extent possible encourage individual
  815  client control over allocated resources for their needs.
  816         (d) Support coordination services.—The plan must shall
  817  modify the manner of providing support coordination services to
  818  improve management of service utilization and increase
  819  accountability and responsiveness to agency priorities.
  820         (e) Reporting.—The agency shall provide monthly reports to
  821  the President of the Senate and the Speaker of the House of
  822  Representatives on plan progress and development on July 31,
  823  2013, and August 31, 2013.
  824         (f) Implementation.—The implementation of a redesigned
  825  program is subject to legislative approval and must shall occur
  826  by no later than July 1, 2014. The Agency for Health Care
  827  Administration shall seek federal waivers as needed to implement
  828  the redesigned plan approved by the Legislature.
  829         Section 6. Section 393.0662, Florida Statutes, is amended
  830  to read:
  831         393.0662 Individual budgets for delivery of home and
  832  community-based services; iBudget system established.—The
  833  Legislature finds that improved financial management of the
  834  existing home and community-based Medicaid waiver program is
  835  necessary to avoid deficits that impede the provision of
  836  services to individuals who are on the waiting list for
  837  enrollment in the program. The Legislature further finds that
  838  individuals clients and their families should have greater
  839  flexibility to choose the services that best allow them to live
  840  in their community within the limits of an established budget.
  841  Therefore, the Legislature intends that the agency, in
  842  consultation with the Agency for Health Care Administration,
  843  develop and implement a comprehensive redesign of the service
  844  delivery system using individual budgets as the basis for
  845  allocating the funds appropriated for the home and community
  846  based services Medicaid waiver program among eligible enrolled
  847  individuals clients. The service delivery system that uses
  848  individual budgets shall be called the iBudget system.
  849         (1) The agency shall establish a an individual budget, to
  850  be referred to as an iBudget, for each individual served by the
  851  home and community-based services Medicaid waiver program. The
  852  funds appropriated to the agency shall be allocated through the
  853  iBudget system to eligible, Medicaid-enrolled individuals who
  854  have clients. For the iBudget system, Eligible clients shall
  855  include individuals with a diagnosis of Down syndrome or a
  856  developmental disability as defined in s. 393.063. The iBudget
  857  system shall be designed to provide for: enhanced individual
  858  client choice within a specified service package; appropriate
  859  assessment strategies; an efficient consumer budgeting and
  860  billing process that includes reconciliation and monitoring
  861  components; a redefined role for support coordinators which that
  862  avoids potential conflicts of interest; a flexible and
  863  streamlined service review process; and a methodology and
  864  process that ensures the equitable allocation of available funds
  865  to each individual client based on his or her the client’s level
  866  of need, as determined by the variables in the allocation
  867  algorithm.
  868         (2)(a) In developing each individual’s client’s iBudget,
  869  the agency shall use an allocation algorithm and methodology.
  870         (a) The algorithm shall use variables that have been
  871  determined by the agency to have a statistically validated
  872  relationship to an individual’s the client’s level of need for
  873  services provided through the home and community-based services
  874  Medicaid waiver program. The algorithm and methodology may
  875  consider individual characteristics, including, but not limited
  876  to, an individual’s a client’s age and living situation,
  877  information from a formal assessment instrument that the agency
  878  determines is valid and reliable, and information from other
  879  assessment processes.
  880         (b) The allocation methodology shall provide the algorithm
  881  that determines the amount of funds allocated to an individual’s
  882  a client’s iBudget. The agency may approve an increase in the
  883  amount of funds allocated, as determined by the algorithm, based
  884  on the individual client having one or more of the following
  885  needs that cannot be accommodated within the funding as
  886  determined by the algorithm allocation and having no other
  887  resources, supports, or services available to meet such needs
  888  the need:
  889         1. An extraordinary need that would place the health and
  890  safety of the individual client, the individual’s client’s
  891  caregiver, or the public in immediate, serious jeopardy unless
  892  the increase is approved. An extraordinary need may include, but
  893  is not limited to:
  894         a. A documented history of significant, potentially life
  895  threatening behaviors, such as recent attempts at suicide,
  896  arson, nonconsensual sexual behavior, or self-injurious behavior
  897  requiring medical attention;
  898         b. A complex medical condition that requires active
  899  intervention by a licensed nurse on an ongoing basis that cannot
  900  be taught or delegated to a nonlicensed person;
  901         c. A chronic comorbid condition. As used in this
  902  subparagraph, the term “comorbid condition” means a medical
  903  condition existing simultaneously but independently with another
  904  medical condition in a patient; or
  905         c.d. A need for significant total physical assistance with
  906  activities such as eating, bathing, toileting, grooming, and
  907  personal hygiene.
  909  However, the presence of an extraordinary need alone does not
  910  warrant an increase in the amount of funds allocated to an
  911  individual’s a client’s iBudget as determined by the algorithm.
  912         2. A significant need for one-time or temporary support or
  913  services that, if not provided, would place the health and
  914  safety of the individual client, the individual’s client’s
  915  caregiver, or the public in serious jeopardy, unless the
  916  increase is approved. A significant need may include, but is not
  917  limited to, the provision of environmental modifications,
  918  durable medical equipment, services to address the temporary
  919  loss of support from a caregiver, or special services or
  920  treatment for a serious temporary condition when the service or
  921  treatment is expected to ameliorate the underlying condition. As
  922  used in this subparagraph, the term “temporary” means less a
  923  period of fewer than 12 continuous months. However, the presence
  924  of such significant need for one-time or temporary supports or
  925  services alone does not warrant an increase in the amount of
  926  funds allocated to an individual’s a client’s iBudget as
  927  determined by the algorithm.
  928         3. A significant increase in the need for services after
  929  the beginning of the service plan year which that would place
  930  the health and safety of the individual client, the individual’s
  931  client’s caregiver, or the public in serious jeopardy because of
  932  substantial changes in the individual’s client’s circumstances,
  933  including, but not limited to, permanent or long-term loss or
  934  incapacity of a caregiver, loss of services authorized under the
  935  state Medicaid plan due to a change in age, or a significant
  936  change in medical or functional status which requires the
  937  provision of additional services on a permanent or long-term
  938  basis which that cannot be accommodated within the individual’s
  939  client’s current iBudget. As used in this subparagraph, the term
  940  “long-term” means a period of 12 or more continuous months.
  941  However, such significant increase in need for services of a
  942  permanent or long-term nature alone does not warrant an increase
  943  in the amount of funds allocated to an individual’s a client’s
  944  iBudget as determined by the algorithm.
  946  The agency shall reserve portions of the appropriation for the
  947  home and community-based services Medicaid waiver program for
  948  adjustments required pursuant to this paragraph and may use the
  949  services of an independent actuary in determining the amount of
  950  the portions to be reserved.
  951         (c) An individual’s A client’s iBudget shall be the total
  952  of the amount determined by the algorithm and any additional
  953  funding provided pursuant to paragraph (b).
  954         (d) An individual’s iBudget cost plan must meet the
  955  requirements contained in the Coverage and Limitation Handbook
  956  for each service included, and must comply with the other
  957  requirements of this section. An individual has the flexibility
  958  to determine the type, amount, frequency, duration, and scope of
  959  services included in the approved cost plan as long as the
  960  agency determines that such services meet his or her health and
  961  safety needs and are necessary to avoid institutionalization.
  962         (e)An individual’s A client’s annual expenditures for home
  963  and community-based services Medicaid waiver services may not
  964  exceed the limits of his or her iBudget. The total of all
  965  clients’ projected annual iBudget expenditures may not exceed
  966  the agency’s appropriation for waiver services.
  967         (3)(2) The Agency for Health Care Administration, in
  968  consultation with the agency, shall seek federal approval to
  969  amend current waivers, request a new waiver, and amend contracts
  970  as necessary to implement the iBudget system to serve eligible,
  971  enrolled individuals clients through the home and community
  972  based services Medicaid waiver program and the Consumer-Directed
  973  Care Plus Program.
  974         (4)(3) The agency shall transition all eligible, enrolled
  975  individuals clients to the iBudget system. The agency may
  976  gradually phase in the iBudget system.
  977         (a) During the phase-in of the iBudget system, the agency
  978  shall determine an individual’s initial iBudget by comparing the
  979  individual’s algorithm allocation to the individual’s current
  980  annualized cost plan and extraordinary needs. The individual’s
  981  algorithm allocation shall be the amount determined by the
  982  algorithm, adjusted to the agency’s appropriation and any set
  983  asides determined necessary by the agency, including, but not
  984  limited to, funding for individuals who have extraordinary needs
  985  as delineated in paragraph (2)(b). The amount of funding needed
  986  to address each individual’s extraordinary needs shall be
  987  reviewed by the area office in order to determine the medical
  988  necessity for each service in the amount, duration, frequency,
  989  intensity, and scope that meets the individual’s needs. The
  990  agency shall consider the individual’s characteristics based on
  991  a needs assessment as well as the his or her living setting,
  992  availability of natural supports, family circumstances, and
  993  other factors that may affect the level of service needed by the
  994  individual.
  995         (b) The individual’s medical-necessity review must include
  996  a comparison of the following:
  997         1. If the individual’s algorithm allocation is greater than
  998  the individual annualized cost plan, the individual’s iBudget is
  999  equal to the annualized cost plan amount.
 1000         2. If the individual’s algorithm allocation is less than
 1001  the individual’s annualized cost plan but greater than the
 1002  amount for the individual’s needs including extraordinary needs,
 1003  the individual’s iBudget is equal to the algorithm allocation.
 1004         3. If the individual’s algorithm allocation is less than
 1005  the amount for the individual’s needs including extraordinary
 1006  needs, the individual’s iBudget is equal to the amount for the
 1007  individual’s extraordinary needs.
 1009  The individual’s annualized iBudget amount may not be less than
 1010  50 percent of his or her annualized cost plan. If the
 1011  individual’s iBudget is less than his or her annualized cost
 1012  plan, and is within $1,000 of the current cost plan, the agency
 1013  may adjust the iBudget to equal the cost plan amount.
 1014         (c) During the 2011-2012 and 2012-2013 fiscal years,
 1015  increases to an individual’s initial iBudget amount may be
 1016  granted only if the criteria for extraordinary needs as
 1017  delineated in paragraph (2)(b) are met.
 1018         (d)(a) While the agency phases in the iBudget system, the
 1019  agency may continue to serve eligible, enrolled individuals
 1020  clients under the four-tiered waiver system established under s.
 1021  393.065 while those individuals clients await transitioning to
 1022  the iBudget system.
 1023         (b) The agency shall design the phase-in process to ensure
 1024  that a client does not experience more than one-half of any
 1025  expected overall increase or decrease to his or her existing
 1026  annualized cost plan during the first year that the client is
 1027  provided an iBudget due solely to the transition to the iBudget
 1028  system.
 1029         (5)(4)An individual A client must use all available
 1030  nonwaiver services authorized under the state Medicaid plan,
 1031  school-based services, private insurance and other benefits, and
 1032  any other resources that may be available to him or her the
 1033  client before using funds from his or her iBudget to pay for
 1034  support and services.
 1035         (6)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
 1036  and 3. do not apply to the iBudget system.
 1037         (7)(6) Rates for any or all services established under
 1038  rules of the Agency for Health Care Administration must shall be
 1039  designated as the maximum rather than a fixed amount for
 1040  individuals who receive an iBudget, except for services
 1041  specifically identified in those rules that the agency
 1042  determines are not appropriate for negotiation, which may
 1043  include, but are not limited to, residential habilitation
 1044  services.
 1045         (8)(7) The agency must shall ensure that individuals
 1046  clients and caregivers have access to training and education
 1047  that informs to inform them about the iBudget system and
 1048  enhances enhance their ability for self-direction. Such training
 1049  must be provided shall be offered in a variety of formats and,
 1050  at a minimum, must shall address the policies and processes of
 1051  the iBudget system; the roles and responsibilities of consumers,
 1052  caregivers, waiver support coordinators, providers, and the
 1053  agency; information that is available to help the individual
 1054  client make decisions regarding the iBudget system; and examples
 1055  of nonwaiver support and resources that may be available in the
 1056  community.
 1057         (9)(8) The agency shall collect data to evaluate the
 1058  implementation and outcomes of the iBudget system.
 1059         (10)(9) The agency and the Agency for Health Care
 1060  Administration may adopt rules specifying the allocation
 1061  algorithm and methodology; criteria and processes that allow
 1062  individuals for clients to access reserved funds for
 1063  extraordinary needs, temporarily or permanently changed needs,
 1064  and one-time needs; and processes and requirements for the
 1065  selection and review of services, development of support and
 1066  cost plans, and management of the iBudget system as needed to
 1067  administer this section.
 1068         Section 7. Subsection (2) of section 393.067, Florida
 1069  Statutes, is amended to read:
 1070         393.067 Facility licensure.—
 1071         (2) The agency shall conduct annual inspections and reviews
 1072  of facilities and programs licensed under this section unless
 1073  the facility or program is currently accredited by the Joint
 1074  Commission, the Commission on Accreditation of Rehabilitation
 1075  Facilities, or the Council on Accreditation. Facilities or
 1076  programs that are operating under such accreditation must be
 1077  inspected and reviewed by the agency once every 2 years. If,
 1078  upon inspection and review, the services and service delivery
 1079  sites are not those for which the facility or program is
 1080  accredited, the facilities and programs must be inspected and
 1081  reviewed in accordance with this section and related rules
 1082  adopted by the agency.
 1083         (a) Notwithstanding current accreditation, the agency may
 1084  continue to monitor the facility or program as necessary with
 1085  respect to:
 1086         1. Ensuring that services for which the agency is paying
 1087  are being provided.
 1088         2. Investigating complaints, identifying problems that
 1089  would affect the safety or viability of the facility or program,
 1090  and monitoring the facility’s or program’s compliance with any
 1091  resulting negotiated terms and conditions, including provisions
 1092  relating to consent decrees which are unique to a specific
 1093  service and are not statements of general applicability.
 1094         3. Ensuring compliance with federal and state laws, federal
 1095  regulations, or state rules if such monitoring does not
 1096  duplicate the accrediting organization’s review pursuant to
 1097  accreditation standards.
 1098         4. Ensuring Medicaid compliance with federal certification
 1099  and precertification review requirements.
 1100         (b) The agency shall conduct ongoing health and safety
 1101  surveys that pertain to the regular monitoring and oversight of
 1102  agency-licensed residential facilities in accordance with the
 1103  frequency schedule specified in administrative rules.
 1104         Section 8. Subsections (2), (3), and (4) of section
 1105  393.068, Florida Statutes, are amended to read:
 1106         393.068 Family care program.—
 1107         (2) Services and support authorized under the family care
 1108  program shall, to the extent of available resources, include the
 1109  services listed under s. 393.0662(4) 393.066 and, in addition,
 1110  shall include, but not be limited to:
 1111         (a) Attendant care.
 1112         (b) Barrier-free modifications to the home.
 1113         (c) Home visitation by agency workers.
 1114         (d) In-home subsidies.
 1115         (e) Low-interest loans.
 1116         (f) Modifications for vehicles used to transport the
 1117  individual with a developmental disability.
 1118         (g) Facilitated communication.
 1119         (h) Family counseling.
 1120         (i) Equipment and supplies.
 1121         (j) Self-advocacy training.
 1122         (k) Roommate services.
 1123         (l) Integrated community activities.
 1124         (m) Emergency services.
 1125         (n) Support coordination.
 1126         (o) Other support services as identified by the family or
 1127  individual.
 1128         (3) If the agency determines that When it is determined by
 1129  the agency to be more cost-effective and in the best interest of
 1130  the individual client to provide services maintain such client
 1131  in the home of a direct service provider, the parent or guardian
 1132  of the individual client or, if competent, the individual client
 1133  may enroll the client in the family care program. The direct
 1134  service provider of an individual a client enrolled in the
 1135  family care program shall be reimbursed according to a rate
 1136  schedule set by the agency, except that in-home subsidies shall
 1137  be provided in accordance with s. 393.0695.
 1138         (4) All existing nonwaiver community resources available to
 1139  an individual must be used the client shall be utilized to
 1140  support program objectives. Additional services may be
 1141  incorporated into the program as appropriate and to the extent
 1142  that resources are available. The agency may is authorized to
 1143  accept gifts and grants in order to carry out the program.
 1144         Section 9. Section 393.11, Florida Statutes, is amended to
 1145  read:
 1146         393.11 Involuntary admission to residential services.—
 1147         (1) JURISDICTION.—If an individual When a person is
 1148  determined to be eligible to receive services from the agency
 1149  mentally retarded and requires involuntary admission to
 1150  residential services provided by the agency, the circuit court
 1151  of the county in which the individual person resides shall have
 1152  jurisdiction to conduct a hearing and enter an order
 1153  involuntarily admitting the individual person in order to
 1154  provide that the person may receive the care, treatment,
 1155  habilitation, and rehabilitation that he or she which the person
 1156  needs. For the purpose of identifying mental retardation or
 1157  autism, diagnostic capability shall be established by the
 1158  agency. Except as otherwise specified, the proceedings under
 1159  this section are shall be governed by the Florida Rules of Civil
 1160  Procedure.
 1161         (2) PETITION.—
 1162         (a) A petition for involuntary admission to residential
 1163  services may be executed by a petitioning commission or the
 1164  agency.
 1165         (b) The petitioning commission shall consist of three
 1166  persons,. one of whom these persons shall be a physician
 1167  licensed and practicing under chapter 458 or chapter 459.
 1168         (c) The petition must shall be verified and must shall:
 1169         1. State the name, age, and present address of the
 1170  commissioners and their relationship to the individual who is
 1171  the subject of the petition person with mental retardation or
 1172  autism;
 1173         2. State the name, age, county of residence, and present
 1174  address of the individual who is the subject of the petition
 1175  person with mental retardation or autism;
 1176         3. Allege that the individual commission believes that the
 1177  person needs involuntary residential services and specify the
 1178  factual information on which the belief is based;
 1179         4. Allege that the individual person lacks sufficient
 1180  capacity to give express and informed consent to a voluntary
 1181  application for services and lacks the basic survival and self
 1182  care skills to provide for the individual’s person’s well-being
 1183  or is likely to physically injure others if allowed to remain at
 1184  liberty; and
 1185         5. State which residential setting is the least restrictive
 1186  and most appropriate alternative and specify the factual
 1187  information on which the belief is based.
 1188         (d) The petition shall be filed in the circuit court of the
 1189  county in which the individual who is the subject of the
 1190  petition person with mental retardation or autism resides.
 1191         (3) NOTICE.—
 1192         (a) Notice of the filing of the petition shall be given to
 1193  the individual and his or her legal guardian. The notice shall
 1194  be given both verbally and in writing in the language of the
 1195  individual client, or in other modes of communication of the
 1196  individual client, and in English. Notice shall also be given to
 1197  such other persons as the court may direct. The petition for
 1198  involuntary admission to residential services shall be served
 1199  with the notice.
 1200         (b) If Whenever a motion or petition has been filed
 1201  pursuant to s. 916.303 to dismiss criminal charges against an
 1202  individual a defendant with retardation or autism, and a
 1203  petition is filed to involuntarily admit the individual
 1204  defendant to residential services under this section, the notice
 1205  of the filing of the petition shall also be given to the
 1206  individual’s defendant’s attorney, the state attorney of the
 1207  circuit from which the individual defendant was committed, and
 1208  the agency.
 1209         (c) The notice shall state that a hearing shall be set to
 1210  inquire into the need of the individual person with mental
 1211  retardation or autism for involuntary residential services. The
 1212  notice shall also state the date of the hearing on the petition.
 1213         (d) The notice shall state that the individual with mental
 1214  retardation or autism has the right to be represented by counsel
 1215  of his or her own choice and that, if the individual person
 1216  cannot afford an attorney, the court shall appoint one.
 1217         (4) AGENCY PARTICIPATION.—
 1218         (a) Upon receiving the petition, the court shall
 1219  immediately order the developmental services program of the
 1220  agency to examine the individual person being considered for
 1221  involuntary admission to residential services.
 1222         (b) Following examination, the agency shall file a written
 1223  report with the court not less than 10 working days before the
 1224  date of the hearing. The report must be served on the
 1225  petitioner, the individual who is the subject of the petition
 1226  person with mental retardation, and the individual’s person’s
 1227  attorney at the time the report is filed with the court.
 1228         (c) The report must contain the findings of the agency’s
 1229  evaluation, any recommendations deemed appropriate, and a
 1230  determination of whether the individual person is eligible for
 1231  services under this chapter.
 1232         (5) EXAMINING COMMITTEE.—
 1233         (a) Upon receiving the petition, the court shall
 1234  immediately appoint an examining committee to examine the
 1235  individual person being considered for involuntary admission to
 1236  residential services provided by the agency.
 1237         (b) The court shall appoint no fewer than three
 1238  disinterested experts who have demonstrated to the court an
 1239  expertise in the diagnosis, evaluation, and treatment of
 1240  individuals persons with mental retardation. The committee must
 1241  include at least one licensed and qualified physician, one
 1242  licensed and qualified psychologist, and one qualified
 1243  professional with a minimum of a masters degree in social work,
 1244  special education, or vocational rehabilitation counseling, to
 1245  examine the individual person and to testify at the hearing on
 1246  the involuntary admission to residential services.
 1247         (c) Counsel for the individual person who is being
 1248  considered for involuntary admission to residential services and
 1249  counsel for the petition commission have has the right to
 1250  challenge the qualifications of those appointed to the examining
 1251  committee.
 1252         (d) Members of the committee may not be employees of the
 1253  agency or be associated with each other in practice or in
 1254  employer-employee relationships. Members of the committee may
 1255  not have served as members of the petitioning commission.
 1256  Members of the committee may not be employees of the members of
 1257  the petitioning commission or be associated in practice with
 1258  members of the commission.
 1259         (e) The committee shall prepare a written report for the
 1260  court. The report must explicitly document the extent that the
 1261  individual person meets the criteria for involuntary admission.
 1262  The report, and expert testimony, must include, but not be
 1263  limited to:
 1264         1. The degree of the individual’s person’s mental
 1265  retardation and whether, using diagnostic capabilities
 1266  established by the agency, the individual person is eligible for
 1267  agency services;
 1268         2. Whether, because of the individual’s person’s degree of
 1269  mental retardation, the individual person:
 1270         a. Lacks sufficient capacity to give express and informed
 1271  consent to a voluntary application for services pursuant to s.
 1272  393.065;
 1273         b. Lacks basic survival and self-care skills to such a
 1274  degree that close supervision and habilitation in a residential
 1275  setting is necessary and if not provided would result in a real
 1276  and present threat of substantial harm to the individual’s
 1277  person’s well-being; or
 1278         c. Is likely to physically injure others if allowed to
 1279  remain at liberty.
 1280         3. The purpose to be served by residential care;
 1281         4. A recommendation on the type of residential placement
 1282  which would be the most appropriate and least restrictive for
 1283  the individual person; and
 1284         5. The appropriate care, habilitation, and treatment.
 1285         (f) The committee shall file the report with the court not
 1286  less than 10 working days before the date of the hearing. The
 1287  report shall be served on the petitioner, the individual who is
 1288  the subject of the petition person with mental retardation, the
 1289  individual’s person’s attorney at the time the report is filed
 1290  with the court, and the agency.
 1291         (g) Members of the examining committee shall receive a
 1292  reasonable fee to be determined by the court. The fees are to be
 1293  paid from the general revenue fund of the county in which the
 1294  individual who is the subject of the petition person with mental
 1295  retardation resided when the petition was filed.
 1296         (h) The agency shall develop and prescribe by rule one or
 1297  more standard forms to be used as a guide for members of the
 1298  examining committee.
 1299         (6) COUNSEL; GUARDIAN AD LITEM.—
 1300         (a) The individual who is the subject of the petition must
 1301  person with mental retardation shall be represented by counsel
 1302  at all stages of the judicial proceeding. If In the event the
 1303  individual person is indigent and cannot afford counsel, the
 1304  court shall appoint a public defender not less than 20 working
 1305  days before the scheduled hearing. The individual’s person’s
 1306  counsel shall have full access to the records of the service
 1307  provider and the agency. In all cases, the attorney shall
 1308  represent the rights and legal interests of the individual
 1309  person with mental retardation, regardless of who initiates may
 1310  initiate the proceedings or pays the attorney pay the attorney’s
 1311  fee.
 1312         (b) If the attorney, during the course of his or her
 1313  representation, reasonably believes that the individual person
 1314  with mental retardation cannot adequately act in his or her own
 1315  interest, the attorney may seek the appointment of a guardian ad
 1316  litem. A prior finding of incompetency is not required before a
 1317  guardian ad litem is appointed pursuant to this section.
 1318         (7) HEARING.—
 1319         (a) The hearing for involuntary admission shall be
 1320  conducted, and the order shall be entered, in the county in
 1321  which the petition is filed. The hearing shall be conducted in a
 1322  physical setting not likely to be injurious to the individual’s
 1323  person’s condition.
 1324         (b) A hearing on the petition must be held as soon as
 1325  practicable after the petition is filed, but reasonable delay
 1326  for the purpose of investigation, discovery, or procuring
 1327  counsel or witnesses shall be granted.
 1328         (c) The court may appoint a general or special magistrate
 1329  to preside. Except as otherwise specified, the magistrate’s
 1330  proceeding shall be governed by the Florida Rules of Civil
 1331  Procedure.
 1332         (d) The individual who is the subject of the petition may
 1333  person with mental retardation shall be physically present
 1334  throughout all or part of the entire proceeding. If the
 1335  defendant’s person’s attorney or any other interested party
 1336  believes that the individual’s person’s presence at the hearing
 1337  is not in the individual’s person’s best interest, or good cause
 1338  is otherwise shown, the person’s presence may be waived once the
 1339  court may order the individual to be excluded from the hearing
 1340  has seen the person and the hearing has commenced.
 1341         (e) The individual who is the subject of the petition
 1342  person has the right to present evidence and to cross-examine
 1343  all witnesses and other evidence alleging the appropriateness of
 1344  the individual’s person’s admission to residential care. Other
 1345  relevant and material evidence regarding the appropriateness of
 1346  the individual’s person’s admission to residential services; the
 1347  most appropriate, least restrictive residential placement; and
 1348  the appropriate care, treatment, and habilitation of the
 1349  individual person, including written or oral reports, may be
 1350  introduced at the hearing by any interested person.
 1351         (f) The petitioning commission may be represented by
 1352  counsel at the hearing. The petitioning commission shall have
 1353  the right to call witnesses, present evidence, cross-examine
 1354  witnesses, and present argument on behalf of the petitioning
 1355  commission.
 1356         (g) All evidence shall be presented according to chapter
 1357  90. The burden of proof shall be on the party alleging the
 1358  appropriateness of the individual’s person’s admission to
 1359  residential services. The burden of proof shall be by clear and
 1360  convincing evidence.
 1361         (h) All stages of each proceeding shall be stenographically
 1362  reported.
 1363         (8) ORDER.—
 1364         (a) In all cases, the court shall issue written findings of
 1365  fact and conclusions of law to support its decision. The order
 1366  must state the basis for the findings of fact.
 1367         (b) An order of involuntary admission to residential
 1368  services may not be entered unless the court finds that:
 1369         1. The individual person is mentally retarded or autistic;
 1370         2. Placement in a residential setting is the least
 1371  restrictive and most appropriate alternative to meet the
 1372  individual’s person’s needs; and
 1373         3. Because of the individual’s person’s degree of mental
 1374  retardation or autism, the individual person:
 1375         a. Lacks sufficient capacity to give express and informed
 1376  consent to a voluntary application for services pursuant to s.
 1377  393.065 and lacks basic survival and self-care skills to such a
 1378  degree that close supervision and habilitation in a residential
 1379  setting is necessary and, if not provided, would result in a
 1380  real and present threat of substantial harm to the individual’s
 1381  person’s well-being; or
 1382         b. Is likely to physically injure others if allowed to
 1383  remain at liberty.
 1384         (c) If the evidence presented to the court is not
 1385  sufficient to warrant involuntary admission to residential
 1386  services, but the court feels that residential services would be
 1387  beneficial, the court may recommend that the individual person
 1388  seek voluntary admission.
 1389         (d) If an order of involuntary admission to residential
 1390  services provided by the agency is entered by the court, a copy
 1391  of the written order shall be served upon the individual person,
 1392  the individual’s person’s counsel, the agency, and the state
 1393  attorney and the individual’s person’s defense counsel, if
 1394  applicable. The order of involuntary admission sent to the
 1395  agency shall also be accompanied by a copy of the examining
 1396  committee’s report and other reports contained in the court
 1397  file.
 1398         (e) Upon receiving the order, the agency shall, within 45
 1399  days, provide the court with a copy of the individual’s person’s
 1400  family or individual support plan and copies of all examinations
 1401  and evaluations, outlining his or her the treatment and
 1402  rehabilitative programs. The agency shall document that the
 1403  individual person has been placed in the most appropriate, least
 1404  restrictive and cost-beneficial residential setting. A copy of
 1405  the family or individual support plan and other examinations and
 1406  evaluations shall be served upon the individual person and the
 1407  individual’s person’s counsel at the same time the documents are
 1408  filed with the court.
 1411         (a) An order authorizing an admission to residential care
 1412  may not be considered an adjudication of mental incompetency. An
 1413  individual A person is not presumed incompetent solely by reason
 1414  of the individual’s person’s involuntary admission to
 1415  residential services. An individual A person may not be denied
 1416  the full exercise of all legal rights guaranteed to citizens of
 1417  this state and of the United States.
 1418         (b) Any minor involuntarily admitted to residential
 1419  services shall, upon reaching majority, be given a hearing to
 1420  determine the continued appropriateness of his or her
 1421  involuntary admission.
 1422         (10) COMPETENCY.—
 1423         (a) The issue of competency shall be separate and distinct
 1424  from a determination of the appropriateness of involuntary
 1425  admission to residential services for a condition of mental
 1426  retardation.
 1427         (b) The issue of the competency of an individual who is
 1428  mentally retarded a person with mental retardation for purposes
 1429  of assigning guardianship shall be determined in a separate
 1430  proceeding according to the procedures and requirements of
 1431  chapter 744. The issue of the competency of an individual who
 1432  has a person with mental retardation or autism for purposes of
 1433  determining whether the individual person is competent to
 1434  proceed in a criminal trial shall be determined in accordance
 1435  with chapter 916.
 1436         (11) CONTINUING JURISDICTION.—The court that which issues
 1437  the initial order for involuntary admission to residential
 1438  services under this section has continuing jurisdiction to enter
 1439  further orders to ensure that the individual person is receiving
 1440  adequate care, treatment, habilitation, and rehabilitation,
 1441  including psychotropic medication and behavioral programming.
 1442  Upon request, the court may transfer the continuing jurisdiction
 1443  to the court where the individual a client resides if it is
 1444  different than the juridiction from where the original
 1445  involuntary admission order was issued. An individual A person
 1446  may not be released from an order for involuntary admission to
 1447  residential services except by the order of the court.
 1448         (12) APPEAL.—
 1449         (a) Any party to the proceeding who is affected by an order
 1450  of the court, including the agency, may appeal to the
 1451  appropriate district court of appeal within the time and in the
 1452  manner prescribed by the Florida Rules of Appellate Procedure.
 1453         (b) The filing of an appeal by the individual ordered to be
 1454  involuntarily admitted under this section stays the person with
 1455  mental retardation shall stay admission of the individual person
 1456  into residential care. The stay shall remain in effect during
 1457  the pendency of all review proceedings in Florida courts until a
 1458  mandate issues.
 1459         (13) HABEAS CORPUS.—At any time and without notice, an
 1460  individual any person involuntarily admitted into residential
 1461  care, or the individual’s person’s parent or legal guardian in
 1462  his or her behalf, is entitled to file a petition for a writ of
 1463  habeas corpus to question the cause, legality, and
 1464  appropriateness of the individual’s person’s involuntary
 1465  admission. Each individual person, or the individual’s person’s
 1466  parent or legal guardian, shall receive specific written notice
 1467  of the right to petition for a writ of habeas corpus at the time
 1468  of his or her involuntary placement.
 1469         Section 10. Paragraph (a) of subsection (1) of section
 1470  393.125, Florida Statutes, is amended to read:
 1471         393.125 Hearing rights.—
 1472         (1) REVIEW OF AGENCY DECISIONS.—
 1473         (a) For Medicaid programs administered by the agency, any
 1474  developmental services applicant or client, or his or her
 1475  parent, guardian advocate, or authorized representative, may
 1476  request a hearing in accordance with federal law and rules
 1477  applicable to Medicaid cases and has the right to request an
 1478  administrative hearing pursuant to ss. 120.569 and 120.57. The
 1479  hearing These hearings shall be provided by the Department of
 1480  Children and Family Services pursuant to s. 409.285 and shall
 1481  follow procedures consistent with federal law and rules
 1482  applicable to Medicaid cases. At the conclusion of the hearing,
 1483  the department shall submit its recommended order to the agency
 1484  as provided in s. 120.57(1)(k) and the agency shall issue final
 1485  orders as provided in s. 120.57(1)(i).
 1486         Section 11. Subsection (1) of section 393.23, Florida
 1487  Statutes, is amended to read:
 1488         393.23 Developmental disabilities centers; trust accounts.
 1489  All receipts from the operation of canteens, vending machines,
 1490  hobby shops, sheltered workshops, activity centers, farming
 1491  projects, and other like activities operated in a developmental
 1492  disabilities center, and moneys donated to the center, must be
 1493  deposited in a trust account in any bank, credit union, or
 1494  savings and loan association authorized by the State Treasury as
 1495  a qualified depository to do business in this state, if the
 1496  moneys are available on demand.
 1497         (1) Moneys in the trust account must be expended for the
 1498  benefit, education, or welfare of individuals receiving services
 1499  from the agency clients. However, if specified, moneys that are
 1500  donated to the center must be expended in accordance with the
 1501  intentions of the donor. Trust account money may not be used for
 1502  the benefit of agency employees or to pay the wages of such
 1503  employees. The welfare of individuals receiving services clients
 1504  includes the expenditure of funds for the purchase of items for
 1505  resale at canteens or vending machines;, and for the
 1506  establishment of, maintenance of, and operation of canteens,
 1507  hobby shops, recreational or entertainment facilities, sheltered
 1508  workshops, activity centers, and farming projects; for the
 1509  employment wages of individuals receiving services; and for, or
 1510  other like facilities or programs established at the center for
 1511  the benefit of such individuals clients.
 1512         Section 12. Section 393.28, Florida Statutes, is created to
 1513  read:
 1514         393.28Food service and environmental sanitation
 1515  standards.—
 1516         (1) STANDARDS.—The agency shall adopt sanitation standards
 1517  by rule related to food-borne illnesses and environmental
 1518  hazards to ensure the protection of individuals served in
 1519  facilities licensed or regulated by the agency pursuant to s.
 1520  393.067. Such rules may include sanitation requirements for the
 1521  storage, preparation, and serving of food as well as for
 1522  detecting and preventing diseases caused by natural and manmade
 1523  factors in the environment.
 1524         (2) VIOLATIONS.—The agency may impose sanctions pursuant to
 1525  s. 393.0673 against any establishment or operator licensed
 1526  pursuant to s. 393.067 for violations of sanitary standards.
 1527         (3) FOOD AND INSPECTION SERVICES.—The agency shall provide
 1528  or contract with another entity for the provision of food
 1529  services and for inspection services to enforce food and
 1530  environmental sanitation standards.
 1531         Section 13. Paragraph (b) of subsection (2) of section
 1532  393.502, Florida Statutes, is amended to read:
 1533         393.502 Family care councils.—
 1534         (2) MEMBERSHIP.—
 1535         (b) At least three of the members of the council must be
 1536  individuals receiving or waiting to receive services from the
 1537  agency consumers. One such member shall be an individual a
 1538  consumer who has been receiving received services within the 4
 1539  years before prior to the date of recommendation, or the legal
 1540  guardian of such a consumer. The remainder of the council
 1541  members shall be parents, grandparents, nonpaid full-time
 1542  caregivers, nonpaid legal guardians, or siblings of individuals
 1543  who have persons with developmental disabilities and who qualify
 1544  for services pursuant to this chapter. A nonpaid full-time
 1545  caregiver or nonpaid legal guardian may not serve at the same
 1546  time as the individual who is receiving care from the caregiver
 1547  or who is the ward of the guardian.
 1548         Section 14. Section 514.072, Florida Statutes, is amended
 1549  to read:
 1550         514.072 Certification of swimming instructors for people
 1551  who have developmental disabilities required.—Any person working
 1552  at a swimming pool who holds himself or herself out as a
 1553  swimming instructor specializing in training people who have
 1554  developmental disabilities, as defined in s. 393.063
 1555  393.063(10), may be certified by the Dan Marino Foundation,
 1556  Inc., in addition to being certified under s. 514.071. The Dan
 1557  Marino Foundation, Inc., must develop certification requirements
 1558  and a training curriculum for swimming instructors for people
 1559  who have developmental disabilities and must submit the
 1560  certification requirements to the Department of Health for
 1561  review by January 1, 2007. A person certified under s. 514.071
 1562  before July 1, 2007, must meet the additional certification
 1563  requirements of this section before January 1, 2008. A person
 1564  certified under s. 514.071 on or after July 1, 2007, must meet
 1565  the additional certification requirements of this section within
 1566  6 months after receiving certification under s. 514.071.
 1567         Section 15. This act shall take effect upon becoming a law.
 1569  ================= T I T L E  A M E N D M E N T ================
 1570         And the title is amended as follows:
 1571         Delete everything before the enacting clause
 1572  and insert:
 1573                        A bill to be entitled                      
 1574         An act relating to the Agency for Persons with
 1575         Disabilities; amending s. 393.062, F.S.; providing
 1576         additional legislative findings relating to the
 1577         provision of services for individuals who have
 1578         developmental disabilities; reordering and amending s.
 1579         393.063, F.S.; revising current definitions and
 1580         providing definitions for the terms “adult day
 1581         services,” “nonwaiver resources,” and “waiver”;
 1582         amending s. 393.065, F.S.; clarifying provisions
 1583         relating to eligibility requirements based on
 1584         citizenship and state residency; amending s. 393.066,
 1585         F.S.; revising provisions relating to community
 1586         services and treatment; revising an express list of
 1587         services; requiring the agency to promote partnerships
 1588         and collaborative efforts to enhance the availability
 1589         of nonwaiver services; deleting a requirement that the
 1590         agency promote day habilitation services for certain
 1591         individuals; amending s. 393.0661, F.S.; revising
 1592         provisions relating to eligibility under the Medicaid
 1593         waiver redesign; providing that final tier eligibility
 1594         be determined at the time a waiver slot and funding
 1595         are available; providing criteria for moving an
 1596         individual between tiers; deleting a cap on tier one
 1597         expenditures for certain individuals; authorizing the
 1598         agency and the Agency for Health Care Administration
 1599         to adopt rules; deleting certain directions relating
 1600         to the adjustment of an individual’s cost plan;
 1601         providing criteria for reviewing Medicaid waiver
 1602         provider agreements, including support coordinators;
 1603         deleting obsolete provisions; amending s. 393.0662,
 1604         F.S.; providing criteria for calculating an
 1605         individual’s iBudget; deleting obsolete provisions;
 1606         amending s. 393.067, F.S.; requiring that facilities
 1607         that are accredited by certain organizations be
 1608         inspected and reviewed by the agency every 2 years;
 1609         providing agency criteria for monitoring licensees;
 1610         amending s. 393.068, F.S.; conforming a cross
 1611         reference and terminology; amending s. 393.11, F.S.;
 1612         clarifying eligibility for involuntary admission to
 1613         residential services; amending s. 393.125, F.S.;
 1614         requiring the Department of Children and Family
 1615         Services to submit its hearing recommendations to the
 1616         agency; amending s. 393.23, F.S.; providing that
 1617         receipts from the operation of canteens, vending
 1618         machines, and other activities may be used to pay
 1619         certain wages; creating s. 393.28, F.S.; directing the
 1620         agency to adopt sanitation standards by rule;
 1621         providing penalties for violations; authorizing the
 1622         agency to contract for food services and inspection
 1623         services to enforce standards; amending s. 393.502,
 1624         F.S.; revising the membership of family care councils;
 1625         amending s. 514.072, F.S.; conforming a cross
 1626         reference; deleting an obsolete provision; providing
 1627         an effective date.