Florida Senate - 2012                                    SB 1516
       By Senator Negron
       28-01022-12                                           20121516__
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Persons with
    3         Disabilities; amending s. 393.062, F.S.; providing
    4         additional legislative findings relating to the
    5         provision of services for individuals who have
    6         developmental disabilities; reordering and amending s.
    7         393.063, F.S.; revising definitions and providing new
    8         definitions for “adult day services,” “nonwaiver
    9         resources,” and “waiver”; amending s. 393.065, F.S.;
   10         clarifying provisions relating to eligibility
   11         requirements based on citizenship and state residency;
   12         amending s. 393.066, F.S.; revising provisions
   13         relating to community services and treatment;
   14         requiring the agency to promote partnerships and
   15         collaborative efforts to enhance the availability of
   16         nonwaiver services; deleting an express list of
   17         services; deleting a requirement that the agency
   18         promote day habilitation services for certain clients;
   19         amending s. 393.0661, F.S.; revising provisions
   20         relating to eligibility under the Medicaid waiver
   21         redesign; providing that final tier eligibility be
   22         determined at the time a waiver slot and funding are
   23         available; providing criteria for moving a client
   24         between tiers; deleting a cap on tier one expenditures
   25         for certain clients; authorizing the agency and the
   26         Agency for Health Care Administration to adopt rules;
   27         deleting certain directions relating to the adjustment
   28         of a client’s cost plan; providing criteria for
   29         reviewing Medicaid waiver provider agreements for
   30         support coordinator services; providing that a client
   31         may not apply for additional funding if waiver
   32         expenditures are expected to exceed the amount
   33         appropriated unless the client is in crisis; deleting
   34         obsolete provisions; amending s. 393.0662, F.S.;
   35         providing criteria for calculating a client’s initial
   36         iBudget; deleting obsolete provisions; amending s.
   37         393.067, F.S.; providing that facilities that are
   38         accredited by certain organizations must be inspected
   39         and reviewed by the agency every 2 years; providing
   40         agency criteria for monitoring licensees; amending s.
   41         393.068, F.S.; conforming a cross-reference; amending
   42         s. 393.11, F.S.; clarifying eligibility for
   43         involuntary admission to residential services;
   44         amending s. 393.125, F.S.; requiring the Department of
   45         Children and Family Services to submit its hearing
   46         recommendations to the agency; amending s. 393.23,
   47         F.S.; providing that receipts from the operation of
   48         canteens, vending machines, and other activities may
   49         be used to pay client wages at sheltered workshops;
   50         amending s. 409.906, F.S.; providing limitations on
   51         the amount of cost sharing which may be required of
   52         parents for home and community-based services provided
   53         to their minor children; authorizing the adoption of
   54         rules relating to cost sharing; amending s. 514.072,
   55         F.S.; conforming a cross-reference; deleting an
   56         obsolete provision; providing an effective date.
   58  Be It Enacted by the Legislature of the State of Florida:
   60         Section 1. Section 393.062, Florida Statutes, is amended to
   61  read:
   62         393.062 Legislative findings and declaration of intent.—
   63         (1) The Legislature finds and declares that existing state
   64  programs for the treatment of individuals with developmental
   65  disabilities, which often unnecessarily place clients in
   66  institutions, are unreasonably costly, are ineffective in
   67  bringing the individual client to his or her maximum potential,
   68  and are in fact debilitating to many clients. A redirection in
   69  state treatment programs for individuals with developmental
   70  disabilities is therefore necessary if any significant
   71  amelioration of the problems faced by such individuals is ever
   72  to take place. Such redirection should place primary emphasis on
   73  programs that prevent or reduce the severity of developmental
   74  disabilities. Further, the greatest priority should shall be
   75  given to the development and implementation of community-based
   76  services that will enable individuals with developmental
   77  disabilities to achieve their greatest potential for independent
   78  and productive living, enable them to live in their own homes or
   79  in residences located in their own communities, and to permit
   80  them to be diverted or removed from unnecessary institutional
   81  placements. This goal cannot be met without ensuring the
   82  availability of community residential opportunities in the
   83  residential areas of this state. The Legislature, therefore,
   84  declares that individuals all persons with developmental
   85  disabilities who live in licensed community homes shall have a
   86  family living environment comparable to that of other state
   87  residents Floridians and that such homes must residences shall
   88  be considered and treated as a functional equivalent of a family
   89  unit and not as an institution, business, or boarding home. The
   90  Legislature further declares that, in developing community-based
   91  programs and services for individuals with developmental
   92  disabilities, private businesses, not-for-profit corporations,
   93  units of local government, and other organizations capable of
   94  providing needed services to clients in a cost-efficient manner
   95  shall be given preference in lieu of operation of programs
   96  directly by state agencies. Finally, it is the intent of the
   97  Legislature that all caretakers who are unrelated to individuals
   98  with developmental disabilities receiving care shall be of good
   99  moral character.
  100         (2) The Legislature finds that in order to maximize the
  101  delivery of services to individuals in the community who have
  102  developmental disabilities and remain within appropriated funds,
  103  service delivery must blend natural supports, community
  104  resources, and state funds. The Legislature also finds that,
  105  given the traditional role of state government to ensure the
  106  health, safety, and welfare of state residents, state funds,
  107  including waiver funds, appropriated to the agency must be
  108  reserved and prioritized for those services needed to ensure the
  109  health and safety of individuals with disabilities, and that
  110  supplemental programs and other services be supported through
  111  natural supports and community resources. To achieve this goal,
  112  the Legislature intends that the agency implement policies and
  113  procedures that establish the Medicaid waiver as the payor of
  114  last resort for home and community-based programs and services,
  115  and promote partnerships with community resources, including,
  116  but not limited to, families, volunteers, nonprofit agencies,
  117  foundations, places of worship, schools, community organizations
  118  and clubs, businesses, local governments, and federal and state
  119  agencies to provide supplemental programs and services. Further,
  120  it is the intent of the Legislature that the agency develop
  121  sound fiscal strategies that allow the agency to predict,
  122  control, manage, and operate within available funding as
  123  provided in the General Appropriations Act in order to ensure
  124  that state funds are available for health and safety needs and
  125  to maximize the number of clients served. It is further the
  126  intent of the Legislature that the agency provide services for
  127  clients residing in developmental disability centers which
  128  promote the individual’s life, health, and safety and enhance
  129  their quality of life. Finally, it is the intent of the
  130  Legislature that the agency continue the tradition of involving
  131  families, stakeholders, and other interested parties as it
  132  recasts its role to become a collaborative partner in the larger
  133  context of family and community-supported services while
  134  developing new opportunities and supports for individuals with
  135  developmental disabilities.
  136         Section 2. Section 393.063, Florida Statutes, is reordered
  137  and amended to read:
  138         393.063 Definitions.—As used in For the purposes of this
  139  chapter, the term:
  140         (1) “Agency” means the Agency for Persons with
  141  Disabilities.
  142         (2) “Adult day services” means services that are provided
  143  in a nonresidential setting, separate from the home or facility
  144  in which the client resides; that are intended to support the
  145  participation of clients in daily, meaningful, and valued
  146  routines of the community; and that may provide social
  147  activities.
  148         (3)(2) “Adult day training” means training services that
  149  are provided which take place in a nonresidential setting,
  150  separate from the home or facility in which the client resides;
  151  are intended to support the participation of clients in daily,
  152  meaningful, and valued routines of the community; and may
  153  include work-like settings that do not meet the definition of
  154  supported employment.
  155         (4)(3) “Autism” means a pervasive, neurologically based
  156  developmental disability of extended duration which causes
  157  severe learning, communication, and behavior disorders and which
  158  has an with age of onset during infancy or childhood.
  159  Individuals who have with autism exhibit impairment in
  160  reciprocal social interaction, impairment in verbal and
  161  nonverbal communication and imaginative ability, and a markedly
  162  restricted repertoire of activities and interests.
  163         (5)(4) “Cerebral palsy” means a group of disabling symptoms
  164  of extended duration which results from damage to the developing
  165  brain which that may occur before, during, or after birth and
  166  which that results in the loss or impairment of control over
  167  voluntary muscles. The term For the purposes of this definition,
  168  cerebral palsy does not include those symptoms or impairments
  169  resulting solely from a stroke.
  170         (6)(5) “Client” means an individual any person determined
  171  eligible by the agency for services under this chapter.
  172         (7)(6) “Client advocate” means a friend or relative of the
  173  client, or of the client’s immediate family, who advocates for
  174  the best interests of the client in any proceedings under this
  175  chapter in which the client or his or her family has the right
  176  or duty to participate.
  177         (8)(7) “Comprehensive assessment” means the process used to
  178  determine eligibility for services under this chapter.
  179         (9)(8) “Comprehensive transitional education program” means
  180  the program established under in s. 393.18.
  181         (11)(9) “Developmental disability” means a disorder or
  182  syndrome that is attributable to retardation, cerebral palsy,
  183  autism, spina bifida, Down syndrome, or Prader-Willi syndrome;
  184  that manifests before the age of 18; and that constitutes a
  185  substantial handicap that can reasonably be expected to continue
  186  indefinitely.
  187         (10) “Developmental disabilities center” means a state
  188  owned and state-operated facility, formerly known as a “Sunland
  189  Center,” providing for the care, habilitation, and
  190  rehabilitation of clients who have with developmental
  191  disabilities.
  192         (12)(11) “Direct service provider” means a person, 18 years
  193  of age or older, who has direct face-to-face contact with a
  194  client while providing services to that the client or who has
  195  access to a client’s living areas or to a client’s funds or
  196  personal property.
  197         (12) “Domicile” means the place where a client legally
  198  resides, which place is his or her permanent home. Domicile may
  199  be established as provided in s. 222.17. Domicile may not be
  200  established in Florida by a minor who has no parent domiciled in
  201  Florida, or by a minor who has no legal guardian domiciled in
  202  Florida, or by any alien not classified as a resident alien.
  203         (13) “Down syndrome” means a disorder caused by the
  204  presence of an extra copy of chromosome 21.
  205         (14) “Express and informed consent” means consent
  206  voluntarily given in writing with sufficient knowledge and
  207  comprehension of the subject matter to enable the person giving
  208  consent to make a knowing decision without any element of force,
  209  fraud, deceit, duress, or other form of constraint or coercion.
  210         (15) “Family care program” means the program established
  211  under in s. 393.068.
  212         (16) “Foster care facility” means a residential facility
  213  licensed under this chapter which provides a family living
  214  environment and includes including supervision and care
  215  necessary to meet the physical, emotional, and social needs of
  216  its residents. The capacity of such a facility may not be more
  217  than three residents.
  218         (17) “Group home facility” means a residential facility
  219  licensed under this chapter which provides a family living
  220  environment and includes including supervision and care
  221  necessary to meet the physical, emotional, and social needs of
  222  its residents. The capacity of such a facility must shall be at
  223  least four 4 but not more than 15 residents.
  224         (18) “Guardian advocate” means a person appointed by a
  225  written order of the court to represent an individual who has a
  226  person with developmental disabilities under s. 393.12.
  227         (19) “Habilitation” means the process by which a client is
  228  assisted to acquire and maintain those life skills that which
  229  enable the client to cope more effectively with the demands of
  230  his or her condition and environment and to raise the level of
  231  his or her physical, mental, and social efficiency. It includes,
  232  but is not limited to, programs of formal structured education
  233  and treatment.
  234         (20) “High-risk child” means, for the purposes of this
  235  chapter, a child from 3 to 5 years of age who has with one or
  236  more of the following characteristics:
  237         (a) A developmental delay in cognition, language, or
  238  physical development.
  239         (b) A child surviving a catastrophic infectious or
  240  traumatic illness known to be associated with developmental
  241  delay, if when funds are specifically appropriated.
  242         (c) A child who has with a parent or guardian who has with
  243  developmental disabilities and who requires assistance in
  244  meeting the child’s developmental needs.
  245         (d) A child who has a physical or genetic anomaly
  246  associated with developmental disability.
  247         (21) “Intermediate care facility for the developmentally
  248  disabled” or “ICF/DD” means a residential facility licensed and
  249  certified under pursuant to part VIII of chapter 400.
  250         (22) “Medical/dental services” means medically necessary
  251  services that which are provided or ordered for a client by a
  252  person licensed under chapter 458, chapter 459, or chapter 466.
  253  Such services may include, but are not limited to, prescription
  254  drugs, specialized therapies, nursing supervision,
  255  hospitalization, dietary services, prosthetic devices, surgery,
  256  specialized equipment and supplies, adaptive equipment, and
  257  other services as required to prevent or alleviate a medical or
  258  dental condition.
  259         (23) “Nonwaiver resources” means supports or services
  260  obtainable through private insurance, the Medicaid state plan,
  261  nonprofit organizations, charitable donations from private
  262  businesses, other government programs, family, natural supports,
  263  community resources, and any other source other than a waiver.
  264         (24)(23) “Personal care services” means individual
  265  assistance with or supervision of essential activities of daily
  266  living for self-care, including ambulation, bathing, dressing,
  267  eating, grooming, and toileting, and other similar services that
  268  are incidental to the care furnished and are essential, and that
  269  are provided in the amount, duration, frequency, intensity, and
  270  scope determined by the agency to be necessary for the client’s
  271  health and safety to the health, safety, and welfare of the
  272  client when there is no one else available or able to perform
  273  those services.
  274         (25)(24) “Prader-Willi syndrome” means an inherited
  275  condition typified by neonatal hypotonia with failure to thrive,
  276  hyperphagia or an excessive drive to eat which leads to obesity
  277  usually at 18 to 36 months of age, mild to moderate mental
  278  retardation, hypogonadism, short stature, mild facial
  279  dysmorphism, and a characteristic neurobehavior.
  280         (26)(25) “Relative” means an individual who is connected by
  281  affinity or consanguinity to the client and who is 18 years of
  282  age or older.
  283         (27)(26) “Resident” means an individual who has any person
  284  with developmental disabilities and who resides residing at a
  285  residential facility, whether or not such person is a client of
  286  the agency.
  287         (28)(27) “Residential facility” means a facility providing
  288  room and board and personal care for an individual who has
  289  persons with developmental disabilities.
  290         (29)(28) “Residential habilitation” means supervision and
  291  training in with the acquisition, retention, or improvement in
  292  skills related to activities of daily living, such as personal
  293  hygiene skills, homemaking skills, and the social and adaptive
  294  skills necessary to enable the individual to reside in the
  295  community.
  296         (30)(29) “Residential habilitation center” means a
  297  community residential facility licensed under this chapter which
  298  provides habilitation services. The capacity of such a facility
  299  may shall not be fewer than nine residents. After October 1,
  300  1989, new residential habilitation centers may not be licensed
  301  and the licensed capacity for any existing residential
  302  habilitation center may not be increased.
  303         (31)(30) “Respite service” means appropriate, short-term,
  304  temporary care that is provided to an individual who has a
  305  person with developmental disabilities in order to meet the
  306  planned or emergency needs of the individual person or the
  307  family or other direct service provider.
  308         (32)(31) “Restraint” means a physical device, method, or
  309  drug used to control dangerous behavior.
  310         (a) A physical restraint is any manual method or physical
  311  or mechanical device, material, or equipment attached or
  312  adjacent to the individual’s body so that he or she cannot
  313  easily remove the restraint and which restricts freedom of
  314  movement or normal access to one’s body.
  315         (b) A drug used as a restraint is a medication used to
  316  control the person’s behavior or to restrict his or her freedom
  317  of movement and is not a standard treatment for the person’s
  318  medical or psychiatric condition. Physically holding a person
  319  during a procedure to forcibly administer psychotropic
  320  medication is a physical restraint.
  321         (c) Restraint does not include physical devices, such as
  322  orthopedically prescribed appliances, surgical dressings and
  323  bandages, supportive body bands, or other physical holding when
  324  necessary for routine physical examinations and tests; for
  325  purposes of orthopedic, surgical, or other similar medical
  326  treatment; when used to provide support for the achievement of
  327  functional body position or proper balance; or when used to
  328  protect a person from falling out of bed.
  329         (33)(32) “Retardation” means significantly subaverage
  330  general intellectual functioning existing concurrently with
  331  deficits in adaptive behavior which manifest that manifests
  332  before the age of 18 and can reasonably be expected to continue
  333  indefinitely. For the purposes of this definition, the term:
  334         (a) “Significantly subaverage general intellectual
  335  functioning,for the purpose of this definition, means
  336  performance that which is two or more standard deviations from
  337  the mean score on a standardized intelligence test specified in
  338  the rules of the agency.
  339         (b) “Adaptive behavior,for the purpose of this
  340  definition, means the effectiveness or degree with which an
  341  individual meets the standards of personal independence and
  342  social responsibility expected of his or her age, cultural
  343  group, and community.
  344         (34)(33) “Seclusion” means the involuntary isolation of a
  345  person in a room or area from which the person is prevented from
  346  leaving. The prevention may be by physical barrier or by a staff
  347  member who is acting in a manner, or who is physically situated,
  348  so as to prevent the person from leaving the room or area. For
  349  the purposes of this chapter, the term does not mean isolation
  350  due to the medical condition or symptoms of the person.
  351         (35)(34) “Self-determination” means an individual’s freedom
  352  to exercise the same rights as all other citizens, authority to
  353  exercise control over funds needed for one’s own support,
  354  including prioritizing those these funds when necessary,
  355  responsibility for the wise use of public funds, and self
  356  advocacy to speak and advocate for oneself in order to gain
  357  independence and ensure that individuals who have with a
  358  developmental disability are treated equally.
  359         (36)(35) “Specialized therapies” means those treatments or
  360  activities prescribed by and provided by an appropriately
  361  trained, licensed, or certified professional or staff person and
  362  may include, but are not limited to, physical therapy, speech
  363  therapy, respiratory therapy, occupational therapy, behavior
  364  therapy, physical management services, and related specialized
  365  equipment and supplies.
  366         (37)(36) “Spina bifida” means, for purposes of this
  367  chapter, a person with a medical diagnosis of spina bifida
  368  cystica or myelomeningocele.
  369         (38)(37) “Support coordinator” means a person who is
  370  contracting with designated by the agency to assist clients
  371  individuals and families in identifying their capacities, needs,
  372  and resources, as well as finding and gaining access to
  373  necessary supports and services; locating or developing
  374  employment opportunities; coordinating the delivery of supports
  375  and services; advocating on behalf of the client individual and
  376  family; maintaining relevant records; and monitoring and
  377  evaluating the delivery of supports and services to determine
  378  the extent to which they meet the needs and expectations
  379  identified by the client individual, family, and others who
  380  participated in the development of the support plan.
  381         (39)(38) “Supported employment” means employment located or
  382  provided in an integrated work setting, with earnings paid on a
  383  commensurate wage basis, and for which continued support is
  384  needed for job maintenance.
  385         (40)(39) “Supported living” means a category of
  386  individually determined services designed and coordinated in
  387  such a manner that provides as to provide assistance to adult
  388  clients who require ongoing supports to live as independently as
  389  possible in their own homes, to be integrated into the
  390  community, and to participate in community life to the fullest
  391  extent possible.
  392         (41)(40) “Training” means a planned approach to assisting a
  393  client to attain or maintain his or her maximum potential and
  394  includes services ranging from sensory stimulation to
  395  instruction in skills for independent living and employment.
  396         (42)(41) “Treatment” means the prevention, amelioration, or
  397  cure of a client’s physical and mental disabilities or
  398  illnesses.
  399         (43) “Waiver” means a federally approved Medicaid waiver
  400  program, including, but not limited to, the Developmental
  401  Disabilities Home and Community-Based Services Waivers Tiers 1
  402  4, the Developmental Disabilities Individual Budget Waiver, and
  403  the Consumer-Directed Care Plus Program, authorized pursuant to
  404  s. 409.906 and administered by the agency to provide home and
  405  community-based services to clients.
  406         Section 3. Subsections (1) and (6) of section 393.065,
  407  Florida Statutes, are amended to read:
  408         393.065 Application and eligibility determination.—
  409         (1) Application for services shall be made, in writing, to
  410  the agency, in the service area in which the applicant resides.
  411  The agency shall review each applicant for eligibility within 45
  412  days after the date the application is signed for children under
  413  6 years of age and within 60 days after the date the application
  414  is signed for all other applicants. If When necessary to
  415  definitively identify individual conditions or needs, the agency
  416  shall provide a comprehensive assessment. Eligibility is limited
  417  to United States citizens and to qualified noncitizens who meet
  418  the criteria provided in s. 414.095(3), and who have established
  419  domicile in Florida pursuant to s. 222.17 or are otherwise
  420  determined to be legal residents of this state. Only applicants
  421  whose domicile is in Florida are eligible for services.
  422  Information accumulated by other agencies, including
  423  professional reports and collateral data, shall be considered if
  424  in this process when available.
  425         (6) The client, the client’s guardian, or the client’s
  426  family must ensure that accurate, up-to-date contact information
  427  is provided to the agency at all times. The agency shall remove
  428  from the wait list an any individual who cannot be located using
  429  the contact information provided to the agency, fails to meet
  430  eligibility requirements, or no longer qualifies as a legal
  431  resident of this state becomes domiciled outside the state.
  432         Section 4. Section 393.066, Florida Statutes, is amended to
  433  read:
  434         393.066 Community services and treatment.—
  435         (1) The agency shall plan, develop, organize, and implement
  436  its programs of services and treatment for individuals who have
  437  persons with developmental disabilities in order to assist them
  438  in living allow clients to live as independently as possible in
  439  their own homes or communities and avoid institutionalization
  440  and to achieve productive lives as close to normal as possible.
  441  All elements of community-based services shall be made
  442  available, and eligibility for these services shall be
  443  consistent across the state.
  444         (2) All Services that are not available through nonwaiver
  445  resources or not donated needed shall be purchased instead of
  446  provided directly by the agency if, when such arrangement is
  447  more cost-efficient than having those services provided
  448  directly. All purchased services must be approved by the agency.
  449  Authorization for such services is dependent on the availability
  450  of agency funding.
  451         (3) Community-based services that are medically necessary
  452  to prevent client institutionalization must be provided in the
  453  most cost-effective manner to the extent of the availability of
  454  agency resources as specified in the General Appropriations Act
  455  shall, to the extent of available resources, include:
  456         (a) Adult day training services.
  457         (b) Family care services.
  458         (c) Guardian advocate referral services.
  459         (d) Medical/dental services, except that medical services
  460  shall not be provided to clients with spina bifida except as
  461  specifically appropriated by the Legislature.
  462         (e) Parent training.
  463         (f) Personal care services.
  464         (g) Recreation.
  465         (h) Residential facility services.
  466         (i) Respite services.
  467         (j) Social services.
  468         (k) Specialized therapies.
  469         (l) Supported employment.
  470         (m) Supported living.
  471         (n) Training, including behavioral analysis services.
  472         (o) Transportation.
  473         (p) Other habilitative and rehabilitative services as
  474  needed.
  475         (4) The agency or the agency’s agents shall identify and
  476  engage in efforts to develop, increase, or enhance the
  477  availability of nonwaiver resources to individuals who have
  478  developmental disabilities. The agency shall promote
  479  partnerships and collaborative efforts with families and
  480  organizations, such as nonprofit agencies, foundations, places
  481  of worship, schools, community organizations and clubs,
  482  businesses, local governments, and state and federal agencies.
  483  The agency shall implement policies and procedures that
  484  establish waivers as the payor of last resort for home and
  485  community-based services and supports shall utilize the services
  486  of private businesses, not-for-profit organizations, and units
  487  of local government whenever such services are more cost
  488  efficient than such services provided directly by the
  489  department, including arrangements for provision of residential
  490  facilities.
  491         (5) In order to improve the potential for utilization of
  492  more cost-effective, community-based residential facilities, the
  493  agency shall promote the statewide development of day
  494  habilitation services for clients who live with a direct service
  495  provider in a community-based residential facility and who do
  496  not require 24-hour-a-day care in a hospital or other health
  497  care institution, but who may, in the absence of day
  498  habilitation services, require admission to a developmental
  499  disabilities center. Each day service facility shall provide a
  500  protective physical environment for clients, ensure that direct
  501  service providers meet minimum screening standards as required
  502  in s. 393.0655, make available to all day habilitation service
  503  participants at least one meal on each day of operation, provide
  504  facilities to enable participants to obtain needed rest while
  505  attending the program, as appropriate, and provide social and
  506  educational activities designed to stimulate interest and
  507  provide socialization skills.
  508         (5)(6) To promote independence and productivity, the agency
  509  shall provide supports and services, within available resources,
  510  to assist clients enrolled in Medicaid waivers who choose to
  511  pursue gainful employment.
  512         (6)(7) For the purpose of making needed community-based
  513  residential facilities available at the least possible cost to
  514  the state, the agency may is authorized to lease privately owned
  515  residential facilities under long-term rental agreements, if
  516  such rental agreements are projected to be less costly to the
  517  state over the useful life of the facility than state purchase
  518  or state construction of such a facility.
  519         (7)(8) The agency may adopt rules providing definitions,
  520  eligibility criteria, and procedures for the purchase of
  521  services provided pursuant to this section.
  522         Section 5. Section 393.0661, Florida Statutes, is amended
  523  to read:
  524         393.0661 Home and community-based services delivery system;
  525  comprehensive redesign.—The Legislature finds that the home and
  526  community-based services delivery system for individuals who
  527  have persons with developmental disabilities and the
  528  availability of appropriated funds are two of the critical
  529  elements in making services available. Therefore, it is the
  530  intent of the Legislature that the Agency for Persons with
  531  Disabilities shall develop and implement a comprehensive
  532  redesign of the system.
  533         (1) The redesign of the home and community-based services
  534  system must shall include, at a minimum, all actions necessary
  535  to achieve an appropriate rate structure, client choice within a
  536  specified service package, appropriate assessment strategies, an
  537  efficient billing process that contains reconciliation and
  538  monitoring components, and a redefined role for support
  539  coordinators which that avoids conflicts of interest and ensures
  540  that the client’s needs for critical services are addressed
  541  potential conflicts of interest and ensures that family/client
  542  budgets are linked to levels of need.
  543         (a) The agency shall use the Questionnaire for Situational
  544  Information, or other an assessment instruments deemed by
  545  instrument that the agency deems to be reliable and valid,
  546  including, but not limited to, the Department of Children and
  547  Family Services’ Individual Cost Guidelines or the agency’s
  548  Questionnaire for Situational Information. The agency may
  549  contract with an external vendor or may use support coordinators
  550  to complete client assessments if it develops sufficient
  551  safeguards and training to ensure ongoing inter-rater
  552  reliability.
  553         (b) The agency, with the concurrence of the Agency for
  554  Health Care Administration, may contract for the determination
  555  of medical necessity and establishment of individual budgets.
  556         (2) A provider of services rendered to clients persons with
  557  developmental disabilities pursuant to a federally approved
  558  waiver shall be reimbursed in accordance with rates adopted
  559  according to a rate methodology based upon an analysis of the
  560  expenditure history and prospective costs of providers
  561  participating in the waiver program, or under any other
  562  methodology developed by the Agency for Health Care
  563  Administration, in consultation with the agency for Persons with
  564  Disabilities, and approved by the Federal Government in
  565  accordance with the waiver.
  566         (3) The Agency for Health Care Administration, in
  567  consultation with the agency, shall seek federal approval and
  568  implement a four-tiered waiver system to serve eligible clients
  569  through the developmental disabilities and family and supported
  570  living waivers. For the purpose of the this waiver program,
  571  eligible clients shall include individuals who have with a
  572  diagnosis of Down syndrome or a developmental disability as
  573  defined in s. 393.063. The agency shall assign all clients
  574  receiving services through the developmental disabilities waiver
  575  to a tier based on the Department of Children and Family
  576  Services’ Individual Cost Guidelines, the agency’s Questionnaire
  577  for Situational Information, or another such assessment
  578  instrument deemed to be valid and reliable by the agency; client
  579  characteristics, including, but not limited to, age; and other
  580  appropriate assessment methods. Final determination of tier
  581  eligibility may not be made until a waiver slot and funding
  582  become available and only then may the client be enrolled in the
  583  appropriate tier. If a client is later determined eligible for a
  584  higher tier, assignment to the higher tier must be based on
  585  crisis criteria as adopted by rule. The agency may also later
  586  move a client to a lower tier if the client’s service needs
  587  change and can be met by services provided in a lower tier. The
  588  agency may not authorize the provision of services that are
  589  duplicated by, or above the coverage limits of, the Medicaid
  590  state plan.
  591         (a) Tier one is limited to clients who have intensive
  592  medical or adaptive service needs that cannot be met in tier
  593  two, three, or four for intensive medical or adaptive needs and
  594  that are essential for avoiding institutionalization, or who
  595  possess behavioral problems that are exceptional in intensity,
  596  duration, or frequency and present a substantial risk of harm to
  597  themselves or others. Total annual expenditures under tier one
  598  may not exceed $150,000 per client each year, provided that
  599  expenditures for clients in tier one with a documented medical
  600  necessity requiring intensive behavioral residential
  601  habilitation services, intensive behavioral residential
  602  habilitation services with medical needs, or special medical
  603  home care, as provided in the Developmental Disabilities Waiver
  604  Services Coverage and Limitations Handbook, are not subject to
  605  the $150,000 limit on annual expenditures.
  606         (b) Tier two is limited to clients whose service needs
  607  include a licensed residential facility and who are authorized
  608  to receive a moderate level of support for standard residential
  609  habilitation services or a minimal level of support for behavior
  610  focus residential habilitation services, or clients in supported
  611  living who receive more than 6 hours a day of in-home support
  612  services. Tier two also includes clients whose need for
  613  authorized services meets the criteria for tier one but which
  614  can be met within the expenditure limit of tier two. Total
  615  annual expenditures under tier two may not exceed $53,625 per
  616  client each year.
  617         (c) Tier three includes, but is not limited to, clients
  618  requiring residential placements, clients in independent or
  619  supported living situations, and clients who live in their
  620  family home. Tier three also includes clients whose need for
  621  authorized services meet the criteria for tiers one or two but
  622  which can be met within the expenditure limit of tier three.
  623  Total annual expenditures under tier three may not exceed
  624  $34,125 per client each year.
  625         (d) Tier four includes clients individuals who were
  626  enrolled in the family and supported living waiver on July 1,
  627  2007, who were shall be assigned to this tier without the
  628  assessments required by this section. Tier four also includes,
  629  but is not limited to, clients in independent or supported
  630  living situations and clients who live in their family home.
  631  Total annual expenditures under tier four may not exceed $14,422
  632  per client each year.
  633         (e) The Agency for Health Care Administration shall also
  634  seek federal approval to provide a consumer-directed option for
  635  clients persons with developmental disabilities which
  636  corresponds to the funding levels in each of the waiver tiers.
  637  The agency shall implement the four-tiered waiver system
  638  beginning with tiers one, three, and four and followed by tier
  639  two. The agency and the Agency for Health Care Administration
  640  may adopt rules necessary to administer this subsection.
  641         (f) The agency shall seek federal waivers and amend
  642  contracts as necessary to make changes to services defined in
  643  federal waiver programs administered by the agency as follows:
  644         1. Supported living coaching services may not exceed 20
  645  hours per month for clients persons who also receive in-home
  646  support services.
  647         2. Limited support coordination services is the only type
  648  of support coordination service that may be provided to clients
  649  persons under the age of 18 who live in the family home.
  650         3. Personal care assistance services are limited to 180
  651  hours per calendar month and may not include rate modifiers.
  652  Additional hours may be authorized for clients persons who have
  653  intensive physical, medical, or adaptive needs if such hours are
  654  essential for avoiding institutionalization.
  655         4. Residential habilitation services are limited to 8 hours
  656  per day. Additional hours may be authorized for clients persons
  657  who have intensive medical or adaptive needs and if such hours
  658  are essential for avoiding institutionalization, or for clients
  659  persons who possess behavioral problems that are exceptional in
  660  intensity, duration, or frequency and present a substantial risk
  661  of harming themselves or others. This restriction shall be in
  662  effect until the four-tiered waiver system is fully implemented.
  663         5. Chore services, nonresidential support services, and
  664  homemaker services are eliminated. The agency shall expand the
  665  definition of in-home support services to allow the service
  666  provider to include activities previously provided in these
  667  eliminated services.
  668         6. Massage therapy, medication review, and psychological
  669  assessment services are eliminated.
  670         5.7. The agency shall conduct supplemental cost plan
  671  reviews to verify the medical necessity of authorized services
  672  for plans that have increased by more than 8 percent during
  673  either of the 2 preceding fiscal years.
  674         6.8. The agency shall implement a consolidated residential
  675  habilitation rate structure to increase savings to the state
  676  through a more cost-effective payment method and establish
  677  uniform rates for intensive behavioral residential habilitation
  678  services.
  679         9. Pending federal approval, the agency may extend current
  680  support plans for clients receiving services under Medicaid
  681  waivers for 1 year beginning July 1, 2007, or from the date
  682  approved, whichever is later. Clients who have a substantial
  683  change in circumstances which threatens their health and safety
  684  may be reassessed during this year in order to determine the
  685  necessity for a change in their support plan.
  686         7.10. The agency shall develop a plan to eliminate
  687  redundancies and duplications between in-home support services,
  688  companion services, personal care services, and supported living
  689  coaching by limiting or consolidating such services.
  690         8.11. The agency shall develop a plan to reduce the
  691  intensity and frequency of supported employment services to
  692  clients in stable employment situations who have a documented
  693  history of at least 3 years’ employment with the same company or
  694  in the same industry.
  695         (g) The agency and the Agency for Health Care
  696  Administration may adopt rules as necessary to administer this
  697  subsection.
  698         (4) The geographic differential for Miami-Dade, Broward,
  699  and Palm Beach Counties for residential habilitation services is
  700  shall be 7.5 percent.
  701         (5) The geographic differential for Monroe County for
  702  residential habilitation services is shall be 20 percent.
  703         (6) Effective January 1, 2010, and except as otherwise
  704  provided in this section, a client served by the home and
  705  community-based services waiver or the family and supported
  706  living waiver funded through the agency shall have his or her
  707  cost plan adjusted to reflect the amount of expenditures for the
  708  previous state fiscal year plus 5 percent if such amount is less
  709  than the client’s existing cost plan. The agency shall use
  710  actual paid claims for services provided during the previous
  711  fiscal year that are submitted by October 31 to calculate the
  712  revised cost plan amount. If the client was not served for the
  713  entire previous state fiscal year or there was any single change
  714  in the cost plan amount of more than 5 percent during the
  715  previous state fiscal year, the agency shall set the cost plan
  716  amount at an estimated annualized expenditure amount plus 5
  717  percent. The agency shall estimate the annualized expenditure
  718  amount by calculating the average of monthly expenditures,
  719  beginning in the fourth month after the client enrolled,
  720  interrupted services are resumed, or the cost plan was changed
  721  by more than 5 percent and ending on August 31, 2009, and
  722  multiplying the average by 12. In order to determine whether a
  723  client was not served for the entire year, the agency shall
  724  include any interruption of a waiver-funded service or services
  725  lasting at least 18 days. If at least 3 months of actual
  726  expenditure data are not available to estimate annualized
  727  expenditures, the agency may not rebase a cost plan pursuant to
  728  this subsection. The agency may not rebase the cost plan of any
  729  client who experiences a significant change in recipient
  730  condition or circumstance which results in a change of more than
  731  5 percent to his or her cost plan between July 1 and the date
  732  that a rebased cost plan would take effect pursuant to this
  733  subsection.
  734         (6)(7) The agency shall collect premiums, fees, or other
  735  cost sharing from the parents of children being served by the
  736  agency through a waiver pursuant to s. 409.906(13)(d).
  737         (7) In determining whether to continue a Medicaid waiver
  738  provider agreement for support coordinator services, the agency
  739  shall review waiver support coordination performance to ensure
  740  that the support coordinator meets or exceeds the criteria
  741  established by the agency. The support coordinator is
  742  responsible for assisting the client in meeting his or her
  743  service needs through nonwaiver resources, as well as through
  744  the client’s budget allocation or cost plan under the waiver.
  745  The waiver is the funding source of last resort for client
  746  services. The waiver support coordinator provider agreements and
  747  performance reviews shall be conducted and managed by the
  748  agency’s area offices.
  749         (a) Criteria for evaluating support coordinator performance
  750  must include, but is not limited to:
  751         1. The protection of the health and safety of clients.
  752         2. Assisting clients to obtain employment and pursue other
  753  meaningful activities.
  754         3. Assisting clients to access services that allow them to
  755  live in their community.
  756         4. The use of family resources.
  757         5. The use of private resources.
  758         6. The use of community resources.
  759         7. The use of charitable resources.
  760         8. The use of volunteer resources.
  761         9. The use of services from other governmental entities.
  762         10. The overall outcome in securing nonwaiver resources.
  763         11. The cost-effective use of waiver resources.
  764         12. Coordinating all available resources to ensure that
  765  clients’ outcomes are met.
  766         (b) The agency may recognize consistently superior
  767  performance by exempting a waiver support coordinator from
  768  annual quality assurance reviews or other mechanisms established
  769  by the agency. The agency may issue sanctions for poor
  770  performance, including, but not limited to, a reduction in
  771  caseload size, recoupment or other financial penalties, and
  772  termination of the waiver support coordinator’s provider
  773  agreement. The agency may adopt rules to administer this
  774  subsection.
  775         (8) This section or related rule does not prevent or limit
  776  the Agency for Health Care Administration, in consultation with
  777  the agency for Persons with Disabilities, from adjusting fees,
  778  reimbursement rates, lengths of stay, number of visits, or
  779  number of services, or from limiting enrollment, or making any
  780  other adjustment necessary to comply with the availability of
  781  moneys and any limitations or directions provided in the General
  782  Appropriations Act.
  783         (9) The agency for Persons with Disabilities shall submit
  784  quarterly status reports to the Executive Office of the Governor
  785  and, the chairs of the legislative appropriations committees
  786  chair of the Senate Ways and Means Committee or its successor,
  787  and the chair of the House Fiscal Council or its successor
  788  regarding the financial status of waiver home and community
  789  based services, including the number of enrolled individuals who
  790  are receiving services through one or more programs; the number
  791  of individuals who have requested services who are not enrolled
  792  but who are receiving services through one or more programs,
  793  including with a description indicating the programs from which
  794  the individual is receiving services; the number of individuals
  795  who have refused an offer of services but who choose to remain
  796  on the list of individuals waiting for services; the number of
  797  individuals who have requested services but are not who are
  798  receiving no services; a frequency distribution indicating the
  799  length of time individuals have been waiting for services; and
  800  information concerning the actual and projected costs compared
  801  to the amount of the appropriation available to the program and
  802  any projected surpluses or deficits. If at any time an analysis
  803  by the agency, in consultation with the Agency for Health Care
  804  Administration, indicates that the cost of services is expected
  805  to exceed the amount appropriated, the agency shall submit a
  806  plan in accordance with subsection (8) to the Executive Office
  807  of the Governor and the chairs of the legislative appropriations
  808  committees, the chair of the Senate Ways and Means Committee or
  809  its successor, and the chair of the House Fiscal Council or its
  810  successor to remain within the amount appropriated. The agency
  811  shall work with the Agency for Health Care Administration to
  812  implement the plan so as to remain within the appropriation.
  813         (10) Implementation of Medicaid waiver programs and
  814  services authorized under this chapter is limited by the funds
  815  appropriated for the individual budgets pursuant to s. 393.0662
  816  and the four-tiered waiver system pursuant to subsection (3).
  817  Contracts with independent support coordinators and service
  818  providers must include provisions requiring compliance with
  819  agency cost containment initiatives. Unless a client is
  820  determined to be in crisis based on criteria adopted by rule,
  821  neither the client nor the support coordinator may apply for
  822  additional waiver funding if the agency has determined pursuant
  823  to s. 393.0661(9) that the total cost of waiver services for
  824  agency clients is expected to exceed the amount appropriated.
  825  The agency shall implement monitoring and accounting procedures
  826  necessary to track actual expenditures and project future
  827  spending compared to available appropriations for Medicaid
  828  waiver programs. If When necessary, based on projected deficits,
  829  the agency shall must establish specific corrective action plans
  830  that incorporate corrective actions for of contracted providers
  831  which that are sufficient to align program expenditures with
  832  annual appropriations. If deficits continue during the 2012-2013
  833  fiscal year, the agency in conjunction with the Agency for
  834  Health Care Administration shall develop a plan to redesign the
  835  waiver program and submit the plan to the President of the
  836  Senate and the Speaker of the House of Representatives by
  837  September 30, 2013. At a minimum, the plan must include the
  838  following elements:
  839         (a) Budget predictability.—Agency budget recommendations
  840  must include specific steps to restrict spending to budgeted
  841  amounts based on alternatives to the iBudget and four-tiered
  842  Medicaid waiver models.
  843         (b) Services.—The agency shall identify core services that
  844  are essential to provide for client health and safety and
  845  recommend the elimination of coverage for other services that
  846  are not affordable based on available resources.
  847         (c) Flexibility.—The redesign must shall be responsive to
  848  individual needs and to the extent possible encourage client
  849  control over allocated resources for their needs.
  850         (d) Support coordination services.—The plan must shall
  851  modify the manner of providing support coordination services to
  852  improve management of service utilization and increase
  853  accountability and responsiveness to agency priorities.
  854         (e) Reporting.—The agency shall provide monthly reports to
  855  the President of the Senate and the Speaker of the House of
  856  Representatives on plan progress and development on July 31,
  857  2013, and August 31, 2013.
  858         (f) Implementation.—The implementation of a redesigned
  859  program is subject to legislative approval and must shall occur
  860  by no later than July 1, 2014. The Agency for Health Care
  861  Administration shall seek federal waivers as needed to implement
  862  the redesigned plan approved by the Legislature.
  863         Section 6. Section 393.0662, Florida Statutes, is amended
  864  to read:
  865         393.0662 Individual budgets for delivery of home and
  866  community-based services; iBudget system established.—The
  867  Legislature finds that improved financial management of the
  868  existing home and community-based Medicaid waiver program is
  869  necessary to avoid deficits that impede the provision of
  870  services to individuals who are on the waiting list for
  871  enrollment in the program. The Legislature further finds that
  872  clients and their families should have greater flexibility to
  873  choose the services that best allow them to live in their
  874  community within the limits of an established budget. Therefore,
  875  the Legislature intends that the agency, in consultation with
  876  the Agency for Health Care Administration, develop and implement
  877  a comprehensive redesign of the service delivery system using
  878  individual budgets as the basis for allocating the funds
  879  appropriated for the home and community-based services Medicaid
  880  waiver program among eligible enrolled clients. The service
  881  delivery system that uses individual budgets shall be called the
  882  iBudget system.
  883         (1) The agency shall establish an individual budget, to be
  884  referred to as an iBudget, for each client individual served by
  885  the home and community-based services Medicaid waiver program.
  886  The funds appropriated to the agency shall be allocated through
  887  the iBudget system to eligible, Medicaid-enrolled clients who
  888  have. For the iBudget system, Eligible clients shall include
  889  individuals with a diagnosis of Down syndrome or a developmental
  890  disability as defined in s. 393.063. The iBudget system shall be
  891  designed to provide for: enhanced client choice within a
  892  specified service package; appropriate assessment strategies; an
  893  efficient consumer budgeting and billing process that includes
  894  reconciliation and monitoring components; a redefined role for
  895  support coordinators which that avoids potential conflicts of
  896  interest; a flexible and streamlined service review process; and
  897  a methodology and process that ensures the equitable allocation
  898  of available funds to each client based on the client’s level of
  899  need, as determined by the variables in the allocation
  900  algorithm.
  901         (2)(a) In developing each client’s iBudget, the agency
  902  shall use an allocation algorithm and methodology.
  903         (a) The algorithm shall use variables that have been
  904  determined by the agency to have a statistically validated
  905  relationship to the client’s level of need for services provided
  906  through the home and community-based services Medicaid waiver
  907  program. The algorithm and methodology may consider individual
  908  characteristics, including, but not limited to, a client’s age
  909  and living situation, information from a formal assessment
  910  instrument that the agency determines is valid and reliable, and
  911  information from other assessment processes.
  912         (b) The allocation methodology shall provide the algorithm
  913  that determines the amount of funds allocated to a client’s
  914  iBudget. The agency may approve an increase in the amount of
  915  funds allocated, as determined by the algorithm, based on the
  916  client having one or more of the following needs that cannot be
  917  accommodated within the funding as determined by the algorithm
  918  allocation and having no other resources, supports, or services
  919  available to meet such needs the need:
  920         1. An extraordinary need that would place the health and
  921  safety of the client, the client’s caregiver, or the public in
  922  immediate, serious jeopardy unless the increase is approved. An
  923  extraordinary need may include, but is not limited to:
  924         a. A documented history of significant, potentially life
  925  threatening behaviors, such as recent attempts at suicide,
  926  arson, nonconsensual sexual behavior, or self-injurious behavior
  927  requiring medical attention;
  928         b. A complex medical condition that requires active
  929  intervention by a licensed nurse on an ongoing basis that cannot
  930  be taught or delegated to a nonlicensed person;
  931         c. A chronic comorbid condition. As used in this
  932  subparagraph, the term “comorbid condition” means a medical
  933  condition existing simultaneously but independently with another
  934  medical condition in a patient; or
  935         d. A need for total physical assistance with activities
  936  such as eating, bathing, toileting, grooming, and personal
  937  hygiene.
  939  However, the presence of an extraordinary need alone does not
  940  warrant an increase in the amount of funds allocated to a
  941  client’s iBudget as determined by the algorithm.
  942         2. A significant need for one-time or temporary support or
  943  services that, if not provided, would place the health and
  944  safety of the client, the client’s caregiver, or the public in
  945  serious jeopardy, unless the increase is approved. A significant
  946  need may include, but is not limited to, the provision of
  947  environmental modifications, durable medical equipment, services
  948  to address the temporary loss of support from a caregiver, or
  949  special services or treatment for a serious temporary condition
  950  when the service or treatment is expected to ameliorate the
  951  underlying condition. As used in this subparagraph, the term
  952  “temporary” means less a period of fewer than 12 continuous
  953  months. However, the presence of such significant need for one
  954  time or temporary supports or services alone does not warrant an
  955  increase in the amount of funds allocated to a client’s iBudget
  956  as determined by the algorithm.
  957         3. A significant increase in the need for services after
  958  the beginning of the service plan year which that would place
  959  the health and safety of the client, the client’s caregiver, or
  960  the public in serious jeopardy because of substantial changes in
  961  the client’s circumstances, including, but not limited to,
  962  permanent or long-term loss or incapacity of a caregiver, loss
  963  of services authorized under the state Medicaid plan due to a
  964  change in age, or a significant change in medical or functional
  965  status which requires the provision of additional services on a
  966  permanent or long-term basis which that cannot be accommodated
  967  within the client’s current iBudget. As used in this
  968  subparagraph, the term “long-term” means a period of 12 or more
  969  continuous months. However, such significant increase in need
  970  for services of a permanent or long-term nature alone does not
  971  warrant an increase in the amount of funds allocated to a
  972  client’s iBudget as determined by the algorithm.
  974  The agency shall reserve portions of the appropriation for the
  975  home and community-based services Medicaid waiver program for
  976  adjustments required pursuant to this paragraph and may use the
  977  services of an independent actuary in determining the amount of
  978  the portions to be reserved.
  979         (c) A client’s iBudget shall be the total of the amount
  980  determined by the algorithm and any additional funding provided
  981  pursuant to paragraph (b).
  982         (d) A client shall have the flexibility to determine the
  983  type, amount, frequency, duration, and scope of the services on
  984  his or her cost plan if the agency determines that such services
  985  meet his or her health and safety needs, meet the requirements
  986  contained in the Coverage and Limitations Handbook for each
  987  service included on the cost plan, and comply with the other
  988  requirements of this section.
  989         (e) A client’s annual expenditures for home and community
  990  based services Medicaid waiver services may not exceed the
  991  limits of his or her iBudget. The total of all clients’
  992  projected annual iBudget expenditures may not exceed the
  993  agency’s appropriation for waiver services.
  994         (3)(2) The Agency for Health Care Administration, in
  995  consultation with the agency, shall seek federal approval to
  996  amend current waivers, request a new waiver, and amend contracts
  997  as necessary to implement the iBudget system to serve eligible,
  998  enrolled clients through the home and community-based services
  999  Medicaid waiver program and the Consumer-Directed Care Plus
 1000  Program.
 1001         (4)(3) The agency shall transition all eligible, enrolled
 1002  clients to the iBudget system. The agency may gradually phase in
 1003  the iBudget system.
 1004         (a) During the 2011-2012 and 2012-2013 fiscal years, the
 1005  agency shall determine a client’s initial iBudget by comparing
 1006  the client’s algorithm allocation to the client’s existing
 1007  annual cost plan and the amount for the client’s extraordinary
 1008  needs. The client’s algorithm allocation shall be the amount
 1009  determined by the algorithm, adjusted to the agency’s
 1010  appropriation and any set-asides determined necessary by the
 1011  agency, including, but not limited to, funding for extraordinary
 1012  needs. The amount for the client’s extraordinary needs shall be
 1013  the annualized sum of any of the following services authorized
 1014  on the client’s cost plan in the amount, duration, frequency,
 1015  intensity, and scope determined by the agency to be necessary
 1016  for the client’s health and safety:
 1017         1. Behavior assessment, behavior analysis services, and
 1018  behavior assistant services.
 1019         2. Consumable medical supplies.
 1020         3. Durable medical equipment.
 1021         4. In-home support services.
 1022         5. Nursing services.
 1023         6. Occupational therapy assessment and occupational
 1024  therapy.
 1025         7. Personal care assistance.
 1026         8. Physical therapy assessment and physical therapy.
 1027         9. Residential habilitation.
 1028         10. Respiratory therapy assessment and respiratory therapy.
 1029         11. Special medical home care.
 1030         12. Support coordination.
 1031         13. Supported employment.
 1032         14. Supported living coaching.
 1033         (b)If the client’s algorithm allocation is:
 1034         1. Greater than the client’s cost plan, the client’s
 1035  initial iBudget is equal to the cost plan.
 1036         2. Less than the client’s cost plan but greater than the
 1037  amount for the client’s extraordinary needs, the client’s
 1038  initial iBudget is equal to the algorithm allocation.
 1039         3. Less than the amount for the client’s extraordinary
 1040  needs, the client’s initial iBudget is equal to the amount for
 1041  the client’s extraordinary needs.
 1043  However, the client’s initial annualized iBudget amount may not
 1044  be less than 50 percent of that client’s existing annualized
 1045  cost plan.
 1046         (c) During the 2011-2012 and 2012-2013 fiscal years,
 1047  increases to a client’s initial iBudget amount may be granted
 1048  only if his or her situation meets the crisis criteria provided
 1049  under agency rule.
 1050         (d)(a) While the agency phases in the iBudget system, the
 1051  agency may continue to serve eligible, enrolled clients under
 1052  the four-tiered waiver system established under s. 393.065 while
 1053  those clients await transitioning to the iBudget system.
 1054         (b) The agency shall design the phase-in process to ensure
 1055  that a client does not experience more than one-half of any
 1056  expected overall increase or decrease to his or her existing
 1057  annualized cost plan during the first year that the client is
 1058  provided an iBudget due solely to the transition to the iBudget
 1059  system.
 1060         (5)(4) A client must use all available nonwaiver services
 1061  authorized under the state Medicaid plan, school-based services,
 1062  private insurance and other benefits, and any other resources
 1063  that may be available to the client before using funds from his
 1064  or her iBudget to pay for support and services.
 1065         (6)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
 1066  and 3. do not apply to the iBudget system.
 1067         (7)(6) Rates for any or all services established under
 1068  rules of the Agency for Health Care Administration must shall be
 1069  designated as the maximum rather than a fixed amount for clients
 1070  individuals who receive an iBudget, except for services
 1071  specifically identified in those rules that the agency
 1072  determines are not appropriate for negotiation, which may
 1073  include, but are not limited to, residential habilitation
 1074  services.
 1075         (8)(7) The agency must shall ensure that clients and
 1076  caregivers have access to training and education that informs to
 1077  inform them about the iBudget system and enhances enhance their
 1078  ability for self-direction. Such training must be provided shall
 1079  be offered in a variety of formats and, at a minimum, must shall
 1080  address the policies and processes of the iBudget system; the
 1081  roles and responsibilities of consumers, caregivers, waiver
 1082  support coordinators, providers, and the agency; information
 1083  that is available to help the client make decisions regarding
 1084  the iBudget system; and examples of nonwaiver support and
 1085  resources that may be available in the community.
 1086         (9)(8) The agency shall collect data to evaluate the
 1087  implementation and outcomes of the iBudget system.
 1088         (10)(9) The agency and the Agency for Health Care
 1089  Administration may adopt rules specifying the allocation
 1090  algorithm and methodology; criteria and processes that allow for
 1091  clients to access reserved funds for extraordinary needs,
 1092  temporarily or permanently changed needs, and one-time needs;
 1093  and processes and requirements for the selection and review of
 1094  services, development of support and cost plans, and management
 1095  of the iBudget system as needed to administer this section.
 1096         Section 7. Subsection (2) of section 393.067, Florida
 1097  Statutes, is amended to read:
 1098         393.067 Facility licensure.—
 1099         (2) The agency shall conduct annual inspections and reviews
 1100  of facilities and programs licensed under this section unless
 1101  the facility or program is currently accredited by the Joint
 1102  Commission, the Commission on Accreditation of Rehabilitation
 1103  Facilities, or the Council on Accreditation. Facilities or
 1104  programs that are operating under such accreditation must be
 1105  inspected and reviewed by the agency once every 2 years. If,
 1106  upon inspection and review, the services and service delivery
 1107  sites are not those for which the facility or program is
 1108  accredited, the facilities and programs must be inspected and
 1109  reviewed in accordance with this section and related rules
 1110  adopted by the agency. Notwithstanding current accreditation,
 1111  the agency may continue to monitor the facility or program as
 1112  necessary with respect to:
 1113         (a) Ensuring that services for which the agency is paying
 1114  are being provided.
 1115         (b) Investigating complaints, identifying problems that
 1116  would affect the safety or viability of the facility or program,
 1117  and monitoring the facility or program’s compliance with any
 1118  resulting negotiated terms and conditions, including provisions
 1119  relating to consent decrees which are unique to a specific
 1120  service and are not statements of general applicability.
 1121         (c) Ensuring compliance with federal and state laws,
 1122  federal regulations, or state rules if such monitoring does not
 1123  duplicate the accrediting organization’s review pursuant to
 1124  accreditation standards.
 1125         (d) Ensuring Medicaid compliance with federal certification
 1126  and precertification review requirements.
 1127         Section 8. Subsections (2) and (4) of section 393.068,
 1128  Florida Statutes, are amended to read:
 1129         393.068 Family care program.—
 1130         (2) Services and support authorized under the family care
 1131  program shall, to the extent of available resources, include the
 1132  services listed under s. 393.0662(4) 393.066 and, in addition,
 1133  shall include, but not be limited to:
 1134         (a) Attendant care.
 1135         (b) Barrier-free modifications to the home.
 1136         (c) Home visitation by agency workers.
 1137         (d) In-home subsidies.
 1138         (e) Low-interest loans.
 1139         (f) Modifications for vehicles used to transport the
 1140  individual with a developmental disability.
 1141         (g) Facilitated communication.
 1142         (h) Family counseling.
 1143         (i) Equipment and supplies.
 1144         (j) Self-advocacy training.
 1145         (k) Roommate services.
 1146         (l) Integrated community activities.
 1147         (m) Emergency services.
 1148         (n) Support coordination.
 1149         (o) Other support services as identified by the family or
 1150  client individual.
 1151         (4) All existing nonwaiver community resources available to
 1152  the client must be used shall be utilized to support program
 1153  objectives. Additional services may be incorporated into the
 1154  program as appropriate and to the extent that resources are
 1155  available. The agency may is authorized to accept gifts and
 1156  grants in order to carry out the program.
 1157         Section 9. Subsections (1) through (3), paragraph (b) of
 1158  subsection (4), paragraphs (f) and (g) of subsection (5),
 1159  subsection (6), paragraphs (d) and (e) of subsection (7), and
 1160  paragraph (b) of subsection (12) of section 393.11, Florida
 1161  Statutes, are amended to read:
 1162         393.11 Involuntary admission to residential services.—
 1163         (1) JURISDICTION.—If When a person is determined to be
 1164  eligible to receive services from the agency mentally retarded
 1165  and requires involuntary admission to residential services
 1166  provided by the agency, the circuit court of the county in which
 1167  the person resides shall have jurisdiction to conduct a hearing
 1168  and enter an order involuntarily admitting the person in order
 1169  for that the person to may receive the care, treatment,
 1170  habilitation, and rehabilitation that he or she which the person
 1171  needs. For the purpose of identifying mental retardation or
 1172  autism, diagnostic capability shall be established by the
 1173  agency. Except as otherwise specified, the proceedings under
 1174  this section are shall be governed by the Florida Rules of Civil
 1175  Procedure.
 1176         (2) PETITION.—
 1177         (a) A petition for involuntary admission to residential
 1178  services may be executed by a petitioning commission or the
 1179  agency.
 1180         (b) The petitioning commission shall consist of three
 1181  persons. One of whom these persons shall be a physician licensed
 1182  and practicing under chapter 458 or chapter 459.
 1183         (c) The petition shall be verified and shall:
 1184         1. State the name, age, and present address of the
 1185  commissioners and their relationship to the person who is the
 1186  subject of the petition with mental retardation or autism;
 1187         2. State the name, age, county of residence, and present
 1188  address of the person who is the subject of the petition with
 1189  mental retardation or autism;
 1190         3. Allege that the commission believes that the person
 1191  needs involuntary residential services and specify the factual
 1192  information on which the belief is based;
 1193         4. Allege that the person lacks sufficient capacity to give
 1194  express and informed consent to a voluntary application for
 1195  services and lacks the basic survival and self-care skills to
 1196  provide for the person’s well-being or is likely to physically
 1197  injure others if allowed to remain at liberty; and
 1198         5. State which residential setting is the least restrictive
 1199  and most appropriate alternative and specify the factual
 1200  information on which the belief is based.
 1201         (d) The petition shall be filed in the circuit court of the
 1202  county in which the person who is the subject of the petition
 1203  with mental retardation or autism resides.
 1204         (3) NOTICE.—
 1205         (a) Notice of the filing of the petition shall be given to
 1206  the defendant individual and his or her legal guardian. The
 1207  notice shall be given both verbally and in writing in the
 1208  language of the defendant client, or in other modes of
 1209  communication of the defendant client, and in English. Notice
 1210  shall also be given to such other persons as the court may
 1211  direct. The petition for involuntary admission to residential
 1212  services shall be served with the notice.
 1213         (b) If Whenever a motion or petition has been filed
 1214  pursuant to s. 916.303 to dismiss criminal charges against a
 1215  defendant with retardation or autism, and a petition is filed to
 1216  involuntarily admit the defendant to residential services under
 1217  this section, the notice of the filing of the petition shall
 1218  also be given to the defendant’s attorney, the state attorney of
 1219  the circuit from which the defendant was committed, and the
 1220  agency.
 1221         (c) The notice shall state that a hearing shall be set to
 1222  inquire into the need of the defendant person with mental
 1223  retardation or autism for involuntary residential services. The
 1224  notice shall also state the date of the hearing on the petition.
 1225         (d) The notice shall state that the defendant individual
 1226  with mental retardation or autism has the right to be
 1227  represented by counsel of his or her own choice and that, if the
 1228  defendant person cannot afford an attorney, the court shall
 1229  appoint one.
 1230         (4) AGENCY PARTICIPATION.—
 1231         (b) Following examination, the agency shall file a written
 1232  report with the court not less than 10 working days before the
 1233  date of the hearing. The report must be served on the
 1234  petitioner, the defendant person with mental retardation, and
 1235  the defendant’s person’s attorney at the time the report is
 1236  filed with the court.
 1237         (5) EXAMINING COMMITTEE.—
 1238         (f) The committee shall file the report with the court not
 1239  less than 10 working days before the date of the hearing. The
 1240  report shall be served on the petitioner, the defendant person
 1241  with mental retardation, the defendant’s person’s attorney at
 1242  the time the report is filed with the court, and the agency.
 1243         (g) Members of the examining committee shall receive a
 1244  reasonable fee to be determined by the court. The fees are to be
 1245  paid from the general revenue fund of the county in which the
 1246  defendant person with mental retardation resided when the
 1247  petition was filed.
 1248         (6) COUNSEL; GUARDIAN AD LITEM.—
 1249         (a) The defendant must person with mental retardation shall
 1250  be represented by counsel at all stages of the judicial
 1251  proceeding. If In the event the defendant person is indigent and
 1252  cannot afford counsel, the court shall appoint a public defender
 1253  not less than 20 working days before the scheduled hearing. The
 1254  defendant’s person’s counsel shall have full access to the
 1255  records of the service provider and the agency. In all cases,
 1256  the attorney shall represent the rights and legal interests of
 1257  the defendant person with mental retardation, regardless of who
 1258  may initiate the proceedings or pay the attorney’s fee.
 1259         (b) If the attorney, during the course of his or her
 1260  representation, reasonably believes that the defendant person
 1261  with mental retardation cannot adequately act in his or her own
 1262  interest, the attorney may seek the appointment of a guardian ad
 1263  litem. A prior finding of incompetency is not required before a
 1264  guardian ad litem is appointed pursuant to this section.
 1265         (7) HEARING.—
 1266         (d) The defendant may person with mental retardation shall
 1267  be physically present throughout all or part of the entire
 1268  proceeding. If the defendant’s person’s attorney or any other
 1269  interested party believes that the person’s presence at the
 1270  hearing is not in the person’s best interest, or good cause is
 1271  otherwise shown, the person’s presence may be waived once the
 1272  court may order that the defendant be excluded from the hearing
 1273  has seen the person and the hearing has commenced.
 1274         (e) The defendant person has the right to present evidence
 1275  and to cross-examine all witnesses and other evidence alleging
 1276  the appropriateness of the person’s admission to residential
 1277  care. Other relevant and material evidence regarding the
 1278  appropriateness of the person’s admission to residential
 1279  services; the most appropriate, least restrictive residential
 1280  placement; and the appropriate care, treatment, and habilitation
 1281  of the person, including written or oral reports, may be
 1282  introduced at the hearing by any interested person.
 1283         (12) APPEAL.—
 1284         (b) The filing of an appeal by the person ordered to be
 1285  involuntarily admitted under this section with mental
 1286  retardation shall stay admission of the person into residential
 1287  care. The stay shall remain in effect during the pendency of all
 1288  review proceedings in Florida courts until a mandate issues.
 1289         Section 10. Paragraph (a) of subsection (1) of section
 1290  393.125, Florida Statutes, is amended to read:
 1291         393.125 Hearing rights.—
 1292         (1) REVIEW OF AGENCY DECISIONS.—
 1293         (a) For Medicaid programs administered by the agency, any
 1294  developmental services applicant or client, or his or her
 1295  parent, guardian advocate, or authorized representative, may
 1296  request a hearing in accordance with federal law and rules
 1297  applicable to Medicaid cases and has the right to request an
 1298  administrative hearing pursuant to ss. 120.569 and 120.57. The
 1299  hearing These hearings shall be provided by the Department of
 1300  Children and Family Services pursuant to s. 409.285 and shall
 1301  follow procedures consistent with federal law and rules
 1302  applicable to Medicaid cases. At the conclusion of the hearing,
 1303  the department shall submit its recommended order to the agency
 1304  as provided in s. 120.57(1)(k) and the agency shall issue final
 1305  orders as provided in s. 120.57(1)(i).
 1306         Section 11. Subsection (1) of section 393.23, Florida
 1307  Statutes, is amended to read:
 1308         393.23 Developmental disabilities centers; trust accounts.
 1309  All receipts from the operation of canteens, vending machines,
 1310  hobby shops, sheltered workshops, activity centers, farming
 1311  projects, and other like activities operated in a developmental
 1312  disabilities center, and moneys donated to the center, must be
 1313  deposited in a trust account in any bank, credit union, or
 1314  savings and loan association authorized by the State Treasury as
 1315  a qualified depository to do business in this state, if the
 1316  moneys are available on demand.
 1317         (1) Moneys in the trust account must be expended for the
 1318  benefit, education, or welfare of clients. However, if
 1319  specified, moneys that are donated to the center must be
 1320  expended in accordance with the intentions of the donor. Trust
 1321  account money may not be used for the benefit of agency
 1322  employees or to pay the wages of such employees. The welfare of
 1323  clients includes the expenditure of funds for the purchase of
 1324  items for resale at canteens or vending machines, and for the
 1325  establishment of, maintenance of, and operation of canteens,
 1326  hobby shops, recreational or entertainment facilities, sheltered
 1327  workshops that include client wages, activity centers, farming
 1328  projects, or other like facilities or programs established at
 1329  the center for the benefit of clients.
 1330         Section 12. Paragraph (d) of subsection (13) of section
 1331  409.906, Florida Statutes, is amended to read:
 1332         409.906 Optional Medicaid services.—Subject to specific
 1333  appropriations, the agency may make payments for services which
 1334  are optional to the state under Title XIX of the Social Security
 1335  Act and are furnished by Medicaid providers to recipients who
 1336  are determined to be eligible on the dates on which the services
 1337  were provided. Any optional service that is provided shall be
 1338  provided only when medically necessary and in accordance with
 1339  state and federal law. Optional services rendered by providers
 1340  in mobile units to Medicaid recipients may be restricted or
 1341  prohibited by the agency. Nothing in this section shall be
 1342  construed to prevent or limit the agency from adjusting fees,
 1343  reimbursement rates, lengths of stay, number of visits, or
 1344  number of services, or making any other adjustments necessary to
 1345  comply with the availability of moneys and any limitations or
 1346  directions provided for in the General Appropriations Act or
 1347  chapter 216. If necessary to safeguard the state’s systems of
 1348  providing services to elderly and disabled persons and subject
 1349  to the notice and review provisions of s. 216.177, the Governor
 1350  may direct the Agency for Health Care Administration to amend
 1351  the Medicaid state plan to delete the optional Medicaid service
 1352  known as “Intermediate Care Facilities for the Developmentally
 1353  Disabled.” Optional services may include:
 1355         (d) The agency shall request federal approval to develop a
 1356  system to require payment of premiums, fees, or other cost
 1357  sharing by the parents of a child younger than 18 years of age
 1358  who is being served by a waiver under this subsection if the
 1359  adjusted household income is greater than 100 percent of the
 1360  federal poverty level. The amount of the premium, fee, or cost
 1361  sharing shall be calculated using a sliding scale based on the
 1362  size of the family, the amount of the parent’s adjusted gross
 1363  income, and the federal poverty guidelines. The premium, fee, or
 1364  other cost sharing paid by a parent may not exceed the cost of
 1365  waiver services to the client. Parents who have more than one
 1366  child receiving services may not be required to pay more than
 1367  the amount required for the child who has the highest
 1368  expenditures. Parents who do not live with each other remain
 1369  responsible for paying the required contribution. The client may
 1370  not be denied waiver services due to nonpayment by a parent.
 1371  Adoptive and foster parents are exempt from payment of any
 1372  premiums, fees, or other cost-sharing for waiver services. The
 1373  agency shall request federal approval as necessary to implement
 1374  the program. The premium and cost-sharing system developed by
 1375  the agency shall not adversely affect federal funding to the
 1376  state. Upon receiving After the agency receives federal
 1377  approval, if required, the agency, the Agency for Persons with
 1378  Disabilities, and the Department of Children and Family Services
 1379  may implement the system and collect income information from
 1380  parents of children who will be affected by this paragraph. The
 1381  parents must provide information upon request. The agency shall
 1382  prepare a report to include the estimated operational cost of
 1383  implementing the premium, fee, and cost-sharing system and the
 1384  estimated revenues to be collected from parents of children in
 1385  the waiver program. The report shall be delivered to the
 1386  President of the Senate and the Speaker of the House of
 1387  Representatives by June 30, 2012. The agency, the Department of
 1388  Children and Family Services, and the Agency for Persons with
 1389  Disabilities may adopt rules to administer this paragraph.
 1390         Section 13. Section 514.072, Florida Statutes, is amended
 1391  to read:
 1392         514.072 Certification of swimming instructors for people
 1393  who have developmental disabilities required.—Any person working
 1394  at a swimming pool who holds himself or herself out as a
 1395  swimming instructor specializing in training people who have a
 1396  developmental disability developmental disabilities, as defined
 1397  in s. 393.063(11) 393.063(10), may be certified by the Dan
 1398  Marino Foundation, Inc., in addition to being certified under s.
 1399  514.071. The Dan Marino Foundation, Inc., must develop
 1400  certification requirements and a training curriculum for
 1401  swimming instructors for people who have developmental
 1402  disabilities and must submit the certification requirements to
 1403  the Department of Health for review by January 1, 2007. A person
 1404  certified under s. 514.071 before July 1, 2007, must meet the
 1405  additional certification requirements of this section before
 1406  January 1, 2008. A person certified under s. 514.071 on or after
 1407  July 1, 2007, must meet the additional certification
 1408  requirements of this section within 6 months after receiving
 1409  certification under s. 514.071.
 1410         Section 14. This act shall take effect July 1, 2012.