Florida Senate - 2012                             CS for SB 1516
       By the Committee on Children, Families, and Elder Affairs; and
       Senators Negron and Garcia
       586-02378-12                                          20121516c1
    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; revising 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; deleting obsolete
   31         provisions; amending s. 393.0662, F.S.; providing
   32         criteria for calculating a client’s initial iBudget;
   33         deleting obsolete provisions; amending s. 393.067,
   34         F.S.; providing that facilities that are accredited by
   35         certain organizations must be inspected and reviewed
   36         by the agency every 2 years; providing agency criteria
   37         for monitoring licensees; amending s. 393.068, F.S.;
   38         conforming a cross-reference; amending s. 393.11,
   39         F.S.; clarifying eligibility for involuntary admission
   40         to residential services; amending s. 393.125, F.S.;
   41         requiring the Department of Children and Family
   42         Services to submit its hearing recommendations to the
   43         agency; amending s. 393.23, F.S.; providing that
   44         receipts from the operation of canteens, vending
   45         machines, and other activities may be used to pay
   46         client wages at sheltered workshops; amending s.
   47         409.906, F.S.; providing limitations on the amount of
   48         cost sharing which may be required of parents for home
   49         and community-based services provided to their minor
   50         children; authorizing the adoption of rules relating
   51         to cost sharing; amending s. 514.072, F.S.; conforming
   52         a cross-reference; deleting an obsolete provision;
   53         providing an effective date.
   55  Be It Enacted by the Legislature of the State of Florida:
   57         Section 1. Section 393.062, Florida Statutes, is amended to
   58  read:
   59         393.062 Legislative findings and declaration of intent.—
   60         (1) The Legislature finds and declares that existing state
   61  programs for the treatment of individuals with developmental
   62  disabilities, which often unnecessarily place clients in
   63  institutions, are unreasonably costly, are ineffective in
   64  bringing the individual client to his or her maximum potential,
   65  and are in fact debilitating to many clients. A redirection in
   66  state treatment programs for individuals with developmental
   67  disabilities is therefore necessary if any significant
   68  amelioration of the problems faced by such individuals is ever
   69  to take place. Such redirection should place primary emphasis on
   70  programs that prevent or reduce the severity of developmental
   71  disabilities. Further, the greatest priority should shall be
   72  given to the development and implementation of community-based
   73  services that will enable individuals with developmental
   74  disabilities to achieve their greatest potential for independent
   75  and productive living, enable them to live in their own homes or
   76  in residences located in their own communities, and to permit
   77  them to be diverted or removed from unnecessary institutional
   78  placements. This goal cannot be met without ensuring the
   79  availability of community residential opportunities in the
   80  residential areas of this state. The Legislature, therefore,
   81  declares that individuals all persons with developmental
   82  disabilities who live in licensed community homes shall have a
   83  family living environment comparable to that of other state
   84  residents Floridians and that such homes must residences shall
   85  be considered and treated as a functional equivalent of a family
   86  unit and not as an institution, business, or boarding home. The
   87  Legislature further declares that, in developing community-based
   88  programs and services for individuals with developmental
   89  disabilities, private businesses, not-for-profit corporations,
   90  units of local government, and other organizations capable of
   91  providing needed services to clients in a cost-efficient manner
   92  shall be given preference in lieu of operation of programs
   93  directly by state agencies. Finally, it is the intent of the
   94  Legislature that all caretakers who are unrelated to individuals
   95  with developmental disabilities receiving care shall be of good
   96  moral character.
   97         (2) The Legislature finds that in order to maximize the
   98  delivery of services to individuals in the community who have
   99  developmental disabilities and remain within appropriated funds,
  100  service delivery must blend natural supports, community
  101  resources, and state funds. The Legislature also finds that,
  102  given the traditional role of state government to ensure the
  103  health, safety, and welfare of state residents, state funds,
  104  including waiver funds, appropriated to the agency must be
  105  reserved and prioritized for those services needed to ensure the
  106  health and safety of individuals with disabilities, and that
  107  supplemental programs and other services be supported through
  108  natural supports and community resources. To achieve this goal,
  109  the Legislature intends that the agency implement policies and
  110  procedures that establish the Medicaid waiver as the payor of
  111  last resort for home and community-based programs and services,
  112  and promote partnerships with community resources, including,
  113  but not limited to, families, volunteers, nonprofit agencies,
  114  foundations, places of worship, schools, community organizations
  115  and clubs, businesses, local governments, and federal and state
  116  agencies to provide supplemental programs and services. Further,
  117  it is the intent of the Legislature that the agency develop
  118  sound fiscal strategies that allow the agency to predict,
  119  control, manage, and operate within available funding as
  120  provided in the General Appropriations Act in order to ensure
  121  that state funds are available for health and safety needs and
  122  to maximize the number of clients served. It is further the
  123  intent of the Legislature that the agency provide services for
  124  clients residing in developmental disability centers which
  125  promote the individual’s life, health, and safety and enhance
  126  their quality of life. Finally, it is the intent of the
  127  Legislature that the agency continue the tradition of involving
  128  families, stakeholders, and other interested parties as it
  129  recasts its role to become a collaborative partner in the larger
  130  context of family and community-supported services while
  131  developing new opportunities and supports for individuals with
  132  developmental disabilities.
  133         Section 2. Section 393.063, Florida Statutes, is reordered
  134  and amended to read:
  135         393.063 Definitions.—As used in For the purposes of this
  136  chapter, the term:
  137         (1) “Agency” means the Agency for Persons with
  138  Disabilities.
  139         (2) “Adult day services” means services that are provided
  140  in a nonresidential setting, separate from the home or facility
  141  in which the client resides, unless the client resides in a
  142  planned residential community as defined in s. 419.001(1); that
  143  are intended to support the participation of clients in daily,
  144  meaningful, and valued routines of the community; and that may
  145  provide social activities.
  146         (3)(2) “Adult day training” means training services that
  147  which take place in a nonresidential setting, separate from the
  148  home or facility in which the client resides, unless the client
  149  resides in a planned residential community as defined in s.
  150  419.001(1)(d); are intended to support the participation of
  151  clients in daily, meaningful, and valued routines of the
  152  community; and may include work-like settings that do not meet
  153  the definition of supported employment.
  154         (4)(3) “Autism” means a pervasive, neurologically based
  155  developmental disability of extended duration which causes
  156  severe learning, communication, and behavior disorders and which
  157  has an with age of onset during infancy or childhood.
  158  Individuals who have with autism exhibit impairment in
  159  reciprocal social interaction, impairment in verbal and
  160  nonverbal communication and imaginative ability, and a markedly
  161  restricted repertoire of activities and interests.
  162         (5)(4) “Cerebral palsy” means a group of disabling symptoms
  163  of extended duration which results from damage to the developing
  164  brain which that may occur before, during, or after birth and
  165  which that results in the loss or impairment of control over
  166  voluntary muscles. The term For the purposes of this definition,
  167  cerebral palsy does not include those symptoms or impairments
  168  resulting solely from a stroke.
  169         (6)(5) “Client” means an individual any person determined
  170  eligible by the agency for services under this chapter.
  171         (7)(6) “Client advocate” means a friend or relative of the
  172  client, or of the client’s immediate family, who advocates for
  173  the best interests of the client in any proceedings under this
  174  chapter in which the client or his or her family has the right
  175  or duty to participate.
  176         (8)(7) “Comprehensive assessment” means the process used to
  177  determine eligibility for services under this chapter.
  178         (9)(8) “Comprehensive transitional education program” means
  179  the program established under in s. 393.18.
  180         (11)(9) “Developmental disability” means a disorder or
  181  syndrome that is attributable to retardation, cerebral palsy,
  182  autism, spina bifida, Down syndrome, or Prader-Willi syndrome;
  183  that manifests before the age of 18; and that constitutes a
  184  substantial handicap that can reasonably be expected to continue
  185  indefinitely.
  186         (10) “Developmental disabilities center” means a state
  187  owned and state-operated facility, formerly known as a “Sunland
  188  Center,” providing for the care, habilitation, and
  189  rehabilitation of clients who have with developmental
  190  disabilities.
  191         (12)(11) “Direct service provider” means a person, 18 years
  192  of age or older, who has direct face-to-face contact with a
  193  client while providing services to that the client or who has
  194  access to a client’s living areas or to a client’s funds or
  195  personal property.
  196         (12) “Domicile” means the place where a client legally
  197  resides, which place is his or her permanent home. Domicile may
  198  be established as provided in s. 222.17. Domicile may not be
  199  established in Florida by a minor who has no parent domiciled in
  200  Florida, or by a minor who has no legal guardian domiciled in
  201  Florida, or by any alien not classified as a resident alien.
  202         (13) “Down syndrome” means a disorder caused by the
  203  presence of an extra copy of chromosome 21.
  204         (14) “Express and informed consent” means consent
  205  voluntarily given in writing with sufficient knowledge and
  206  comprehension of the subject matter to enable the person giving
  207  consent to make a knowing decision without any element of force,
  208  fraud, deceit, duress, or other form of constraint or coercion.
  209         (15) “Family care program” means the program established
  210  under in s. 393.068.
  211         (16) “Foster care facility” means a residential facility
  212  licensed under this chapter which provides a family living
  213  environment and includes including supervision and care
  214  necessary to meet the physical, emotional, and social needs of
  215  its residents. The capacity of such a facility may not be more
  216  than three residents.
  217         (17) “Group home facility” means a residential facility
  218  licensed under this chapter which provides a family living
  219  environment and includes including supervision and care
  220  necessary to meet the physical, emotional, and social needs of
  221  its residents. The capacity of such a facility must shall be at
  222  least four 4 but not more than 15 residents.
  223         (18) “Guardian advocate” means a person appointed by a
  224  written order of the court to represent an individual who has a
  225  person with developmental disabilities under s. 393.12.
  226         (19) “Habilitation” means the process by which a client is
  227  assisted to acquire and maintain those life skills that which
  228  enable the client to cope more effectively with the demands of
  229  his or her condition and environment and to raise the level of
  230  his or her physical, mental, and social efficiency. It includes,
  231  but is not limited to, programs of formal structured education
  232  and treatment.
  233         (20) “High-risk child” means, for the purposes of this
  234  chapter, a child from 3 to 5 years of age who has with one or
  235  more of the following characteristics:
  236         (a) A developmental delay in cognition, language, or
  237  physical development.
  238         (b) A child surviving a catastrophic infectious or
  239  traumatic illness known to be associated with developmental
  240  delay, if when funds are specifically appropriated.
  241         (c) A child who has with a parent or guardian who has with
  242  developmental disabilities and who requires assistance in
  243  meeting the child’s developmental needs.
  244         (d) A child who has a physical or genetic anomaly
  245  associated with developmental disability.
  246         (21) “Intermediate care facility for the developmentally
  247  disabled” or “ICF/DD” means a residential facility licensed and
  248  certified under pursuant to part VIII of chapter 400.
  249         (22) “Medical/dental services” means medically necessary
  250  services that which are provided or ordered for a client by a
  251  person licensed under chapter 458, chapter 459, or chapter 466.
  252  Such services may include, but are not limited to, prescription
  253  drugs, specialized therapies, nursing supervision,
  254  hospitalization, dietary services, prosthetic devices, surgery,
  255  specialized equipment and supplies, adaptive equipment, and
  256  other services as required to prevent or alleviate a medical or
  257  dental condition.
  258         (23) “Nonwaiver resources” means supports or services
  259  obtainable through private insurance, the Medicaid state plan,
  260  nonprofit organizations, charitable donations from private
  261  businesses, other government programs, family, natural supports,
  262  community resources, and any other source other than a waiver.
  263         (24)(23) “Personal care services” means individual
  264  assistance with or supervision of essential activities of daily
  265  living for self-care, including ambulation, bathing, dressing,
  266  eating, grooming, and toileting, and other similar services that
  267  are incidental to the care furnished and are essential, and that
  268  are provided in the amount, duration, frequency, intensity, and
  269  scope determined by the agency to be necessary for the client’s
  270  health and safety to the health, safety, and welfare of the
  271  client when there is no one else available or able to perform
  272  those services.
  273         (25)(24) “Prader-Willi syndrome” means an inherited
  274  condition typified by neonatal hypotonia with failure to thrive,
  275  hyperphagia or an excessive drive to eat which leads to obesity
  276  usually at 18 to 36 months of age, mild to moderate mental
  277  retardation, hypogonadism, short stature, mild facial
  278  dysmorphism, and a characteristic neurobehavior.
  279         (26)(25) “Relative” means an individual who is connected by
  280  affinity or consanguinity to the client and who is 18 years of
  281  age or older.
  282         (27)(26) “Resident” means an individual who has any person
  283  with developmental disabilities and who resides residing at a
  284  residential facility, whether or not such person is a client of
  285  the agency.
  286         (28)(27) “Residential facility” means a facility providing
  287  room and board and personal care for an individual who has
  288  persons with developmental disabilities.
  289         (29)(28) “Residential habilitation” means supervision and
  290  training in with the acquisition, retention, or improvement in
  291  skills related to activities of daily living, such as personal
  292  hygiene skills, homemaking skills, and the social and adaptive
  293  skills necessary to enable the individual to reside in the
  294  community.
  295         (30)(29) “Residential habilitation center” means a
  296  community residential facility licensed under this chapter which
  297  provides habilitation services. The capacity of such a facility
  298  may shall not be fewer than nine residents. After October 1,
  299  1989, new residential habilitation centers may not be licensed
  300  and the licensed capacity for any existing residential
  301  habilitation center may not be increased.
  302         (31)(30) “Respite service” means appropriate, short-term,
  303  temporary care that is provided to an individual who has a
  304  person with developmental disabilities in order to meet the
  305  planned or emergency needs of the individual person or the
  306  family or other direct service provider.
  307         (32)(31) “Restraint” means a physical device, method, or
  308  drug used to control dangerous behavior.
  309         (a) A physical restraint is any manual method or physical
  310  or mechanical device, material, or equipment attached or
  311  adjacent to the individual’s body so that he or she cannot
  312  easily remove the restraint and which restricts freedom of
  313  movement or normal access to one’s body.
  314         (b) A drug used as a restraint is a medication used to
  315  control the person’s behavior or to restrict his or her freedom
  316  of movement and is not a standard treatment for the person’s
  317  medical or psychiatric condition. Physically holding a person
  318  during a procedure to forcibly administer psychotropic
  319  medication is a physical restraint.
  320         (c) Restraint does not include physical devices, such as
  321  orthopedically prescribed appliances, surgical dressings and
  322  bandages, supportive body bands, or other physical holding when
  323  necessary for routine physical examinations and tests; for
  324  purposes of orthopedic, surgical, or other similar medical
  325  treatment; when used to provide support for the achievement of
  326  functional body position or proper balance; or when used to
  327  protect a person from falling out of bed.
  328         (33)(32) “Retardation” means significantly subaverage
  329  general intellectual functioning existing concurrently with
  330  deficits in adaptive behavior which manifest that manifests
  331  before the age of 18 and can reasonably be expected to continue
  332  indefinitely. For the purposes of this definition, the term:
  333         (a) “Significantly subaverage general intellectual
  334  functioning,for the purpose of this definition, means
  335  performance that which is two or more standard deviations from
  336  the mean score on a standardized intelligence test specified in
  337  the rules of the agency.
  338         (b) “Adaptive behavior,for the purpose of this
  339  definition, means the effectiveness or degree with which an
  340  individual meets the standards of personal independence and
  341  social responsibility expected of his or her age, cultural
  342  group, and community.
  343         (34)(33) “Seclusion” means the involuntary isolation of a
  344  person in a room or area from which the person is prevented from
  345  leaving. The prevention may be by physical barrier or by a staff
  346  member who is acting in a manner, or who is physically situated,
  347  so as to prevent the person from leaving the room or area. For
  348  the purposes of this chapter, the term does not mean isolation
  349  due to the medical condition or symptoms of the person.
  350         (35)(34) “Self-determination” means an individual’s freedom
  351  to exercise the same rights as all other citizens, authority to
  352  exercise control over funds needed for one’s own support,
  353  including prioritizing those these funds when necessary,
  354  responsibility for the wise use of public funds, and self
  355  advocacy to speak and advocate for oneself in order to gain
  356  independence and ensure that individuals who have with a
  357  developmental disability are treated equally.
  358         (36)(35) “Specialized therapies” means those treatments or
  359  activities prescribed by and provided by an appropriately
  360  trained, licensed, or certified professional or staff person and
  361  may include, but are not limited to, physical therapy, speech
  362  therapy, respiratory therapy, occupational therapy, behavior
  363  therapy, physical management services, and related specialized
  364  equipment and supplies.
  365         (37)(36) “Spina bifida” means, for purposes of this
  366  chapter, a person with a medical diagnosis of spina bifida
  367  cystica or myelomeningocele.
  368         (38)(37) “Support coordinator” means a person who is
  369  contracting with designated by the agency to assist clients
  370  individuals and families in identifying their capacities, needs,
  371  and resources, as well as finding and gaining access to
  372  necessary supports and services; locating or developing
  373  employment opportunities; coordinating the delivery of supports
  374  and services; advocating on behalf of the client individual and
  375  family; maintaining relevant records; and monitoring and
  376  evaluating the delivery of supports and services to determine
  377  the extent to which they meet the needs and expectations
  378  identified by the client individual, family, and others who
  379  participated in the development of the support plan.
  380         (39)(38) “Supported employment” means employment located or
  381  provided in an integrated work setting, with earnings paid on a
  382  commensurate wage basis, and for which continued support is
  383  needed for job maintenance.
  384         (40)(39) “Supported living” means a category of
  385  individually determined services designed and coordinated in
  386  such a manner that provides as to provide assistance to adult
  387  clients who require ongoing supports to live as independently as
  388  possible in their own homes, to be integrated into the
  389  community, and to participate in community life to the fullest
  390  extent possible.
  391         (41)(40) “Training” means a planned approach to assisting a
  392  client to attain or maintain his or her maximum potential and
  393  includes services ranging from sensory stimulation to
  394  instruction in skills for independent living and employment.
  395         (42)(41) “Treatment” means the prevention, amelioration, or
  396  cure of a client’s physical and mental disabilities or
  397  illnesses.
  398         (43) “Waiver” means a federally approved Medicaid waiver
  399  program, including, but not limited to, the Developmental
  400  Disabilities Home and Community-Based Services Waivers Tiers 1
  401  4, the Developmental Disabilities Individual Budget Waiver, and
  402  the Consumer-Directed Care Plus Program, authorized pursuant to
  403  s. 409.906 and administered by the agency to provide home and
  404  community-based services to clients.
  405         Section 3. Subsections (1) and (6) of section 393.065,
  406  Florida Statutes, are amended to read:
  407         393.065 Application and eligibility determination.—
  408         (1) Application for services shall be made, in writing, to
  409  the agency, in the service area in which the applicant resides.
  410  The agency shall review each applicant for eligibility within 45
  411  days after the date the application is signed for children under
  412  6 years of age and within 60 days after the date the application
  413  is signed for all other applicants. If When necessary to
  414  definitively identify individual conditions or needs, the agency
  415  shall provide a comprehensive assessment. Eligibility is limited
  416  to United States citizens and to qualified noncitizens who meet
  417  the criteria provided in s. 414.095(3), and who have established
  418  domicile in Florida pursuant to s. 222.17 or are otherwise
  419  determined to be legal residents of this state. Only applicants
  420  whose domicile is in Florida are eligible for services.
  421  Information accumulated by other agencies, including
  422  professional reports and collateral data, shall be considered if
  423  in this process when available.
  424         (6) The client, the client’s guardian, or the client’s
  425  family must ensure that accurate, up-to-date contact information
  426  is provided to the agency at all times. The agency shall remove
  427  from the wait list an any individual who cannot be located using
  428  the contact information provided to the agency, fails to meet
  429  eligibility requirements, or no longer qualifies as a legal
  430  resident of this state becomes domiciled outside the state.
  431         Section 4. Section 393.066, Florida Statutes, is amended to
  432  read:
  433         393.066 Community services and treatment.—
  434         (1) The agency shall plan, develop, organize, and implement
  435  its programs of services and treatment for individuals who have
  436  persons with developmental disabilities in order to assist them
  437  in living allow clients to live as independently as possible in
  438  their own homes or communities and avoid institutionalization
  439  and to achieve productive lives as close to normal as possible.
  440  All elements of community-based services shall be made
  441  available, and eligibility for these services shall be
  442  consistent across the state.
  443         (2) All Services that are not available through nonwaiver
  444  resources or not donated needed shall be purchased instead of
  445  provided directly by the agency if, when such arrangement is
  446  more cost-efficient than having those services provided
  447  directly. All purchased services must be approved by the agency.
  448  Authorization for such services is dependent on the availability
  449  of agency funding.
  450         (3) Community Community-based services that are medically
  451  necessary to prevent client institutionalization must be
  452  provided in the most cost-effective manner to the extent of the
  453  availability of agency resources as specified in the General
  454  Appropriations Act. These services may shall, to the extent of
  455  available resources, include:
  456         (a) Adult day training and adult day 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         (e)(f) Personal care services.
  464         (g) Recreation.
  465         (f)(h) Residential habilitation facility services.
  466         (g)(i) Respite services.
  467         (h)(j)Support coordination Social services.
  468         (i)(k) Specialized therapies.
  469         (j)(l) Supported employment.
  470         (k)(m) Supported living.
  471         (l)(n) Training, including behavioral analysis services.
  472         (m)(o) Transportation.
  473         (n)(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 persons with
  557  developmental disabilities pursuant to a federally approved
  558  waiver shall be reimbursed according to a rate methodology based
  559  upon an analysis of the expenditure history and prospective
  560  costs of providers participating in the waiver program, or under
  561  any other methodology developed by the Agency for Health Care
  562  Administration, in consultation with the agency for Persons with
  563  Disabilities, and approved by the Federal Government in
  564  accordance with the waiver.
  565         (3) The Agency for Health Care Administration, in
  566  consultation with the agency, shall seek federal approval and
  567  implement a four-tiered waiver system to serve eligible clients
  568  through the developmental disabilities and family and supported
  569  living waivers. For the purpose of the this waiver program,
  570  eligible clients shall include individuals who have with a
  571  diagnosis of Down syndrome or a developmental disability as
  572  defined in s. 393.063. The agency shall assign all clients
  573  receiving services through the developmental disabilities waiver
  574  to a tier based on the Department of Children and Family
  575  Services’ Individual Cost Guidelines, the agency’s Questionnaire
  576  for Situational Information, or another such assessment
  577  instrument deemed to be valid and reliable by the agency; client
  578  characteristics, including, but not limited to, age; and other
  579  appropriate assessment methods. Final determination of tier
  580  eligibility may not be made until a waiver slot and funding
  581  become available and only then may the client be enrolled in the
  582  appropriate tier. If a client is later determined eligible for a
  583  higher tier, assignment to the higher tier must be based on
  584  crisis criteria as adopted by rule. The agency may also later
  585  move a client to a lower tier if the client’s service needs
  586  change and can be met by services provided in a lower tier. The
  587  agency may not authorize the provision of services that are
  588  duplicated by, or above the coverage limits of, the Medicaid
  589  state plan.
  590         (a) Tier one is limited to clients who have intensive
  591  medical or adaptive service needs that cannot be met in tier
  592  two, three, or four for intensive medical or adaptive needs and
  593  that are essential for avoiding institutionalization, or who
  594  possess behavioral problems that are exceptional in intensity,
  595  duration, or frequency and present a substantial risk of harm to
  596  themselves or others. Total annual expenditures under tier one
  597  may not exceed $150,000 per client each year, provided that
  598  expenditures for clients in tier one with a documented medical
  599  necessity requiring intensive behavioral residential
  600  habilitation services, intensive behavioral residential
  601  habilitation services with medical needs, or special medical
  602  home care, as provided in the Developmental Disabilities Waiver
  603  Services Coverage and Limitations Handbook, are not subject to
  604  the $150,000 limit on annual expenditures.
  605         (b) Tier two is limited to clients whose service needs
  606  include a licensed residential facility and who are authorized
  607  to receive a moderate level of support for standard residential
  608  habilitation services or a minimal level of support for behavior
  609  focus residential habilitation services, or clients in supported
  610  living who receive more than 6 hours a day of in-home support
  611  services. Tier two also includes clients whose need for
  612  authorized services meets the criteria for tier one but which
  613  can be met within the expenditure limit of tier two. Total
  614  annual expenditures under tier two may not exceed $53,625 per
  615  client each year.
  616         (c) Tier three includes, but is not limited to, clients
  617  requiring residential placements, clients in independent or
  618  supported living situations, and clients who live in their
  619  family home. Tier three also includes clients whose need for
  620  authorized services meet the criteria for tiers one or two but
  621  which can be met within the expenditure limit of tier three.
  622  Total annual expenditures under tier three may not exceed
  623  $34,125 per client each year.
  624         (d) Tier four includes clients individuals who were
  625  enrolled in the family and supported living waiver on July 1,
  626  2007, who were shall be assigned to this tier without the
  627  assessments required by this section. Tier four also includes,
  628  but is not limited to, clients in independent or supported
  629  living situations and clients who live in their family home.
  630  Total annual expenditures under tier four may not exceed $14,422
  631  per client each year.
  632         (e) The Agency for Health Care Administration shall also
  633  seek federal approval to provide a consumer-directed option for
  634  clients persons with developmental disabilities which
  635  corresponds to the funding levels in each of the waiver tiers.
  636  The agency shall implement the four-tiered waiver system
  637  beginning with tiers one, three, and four and followed by tier
  638  two. The agency and the Agency for Health Care Administration
  639  may adopt rules necessary to administer this subsection.
  640         (f) The agency shall seek federal waivers and amend
  641  contracts as necessary to make changes to services defined in
  642  federal waiver programs administered by the agency as follows:
  643         1. Supported living coaching services may not exceed 20
  644  hours per month for clients persons who also receive in-home
  645  support services.
  646         2. Limited support coordination services is the only type
  647  of support coordination service that may be provided to clients
  648  persons under the age of 18 who live in the family home.
  649         3. Personal care assistance services are limited to 180
  650  hours per calendar month and may not include rate modifiers.
  651  Additional hours may be authorized for clients persons who have
  652  intensive physical, medical, or adaptive needs if such hours are
  653  essential for avoiding institutionalization.
  654         4. Residential habilitation services are limited to 8 hours
  655  per day. Additional hours may be authorized for clients persons
  656  who have intensive medical or adaptive needs and if such hours
  657  are essential for avoiding institutionalization, or for clients
  658  persons who possess behavioral problems that are exceptional in
  659  intensity, duration, or frequency and present a substantial risk
  660  of harming themselves or others. This restriction shall be in
  661  effect until the four-tiered waiver system is fully implemented.
  662         5. Chore services, nonresidential support services, and
  663  homemaker services are eliminated. The agency shall expand the
  664  definition of in-home support services to allow the service
  665  provider to include activities previously provided in these
  666  eliminated services.
  667         6. Massage therapy, medication review, and psychological
  668  assessment services are eliminated.
  669         5.7. The agency shall conduct supplemental cost plan
  670  reviews to verify the medical necessity of authorized services
  671  for plans that have increased by more than 8 percent during
  672  either of the 2 preceding fiscal years.
  673         6.8. The agency shall implement a consolidated residential
  674  habilitation rate structure to increase savings to the state
  675  through a more cost-effective payment method and establish
  676  uniform rates for intensive behavioral residential habilitation
  677  services.
  678         9. Pending federal approval, the agency may extend current
  679  support plans for clients receiving services under Medicaid
  680  waivers for 1 year beginning July 1, 2007, or from the date
  681  approved, whichever is later. Clients who have a substantial
  682  change in circumstances which threatens their health and safety
  683  may be reassessed during this year in order to determine the
  684  necessity for a change in their support plan.
  685         7.10. The agency shall develop a plan to eliminate
  686  redundancies and duplications between in-home support services,
  687  companion services, personal care services, and supported living
  688  coaching by limiting or consolidating such services.
  689         8.11. The agency shall develop a plan to reduce the
  690  intensity and frequency of supported employment services to
  691  clients in stable employment situations who have a documented
  692  history of at least 3 years’ employment with the same company or
  693  in the same industry.
  694         (g) The agency and the Agency for Health Care
  695  Administration may adopt rules as necessary to administer this
  696  subsection.
  697         (4) The geographic differential for Miami-Dade, Broward,
  698  and Palm Beach Counties for residential habilitation services is
  699  shall be 7.5 percent.
  700         (5) The geographic differential for Monroe County for
  701  residential habilitation services is shall be 20 percent.
  702         (6) Effective January 1, 2010, and except as otherwise
  703  provided in this section, a client served by the home and
  704  community-based services waiver or the family and supported
  705  living waiver funded through the agency shall have his or her
  706  cost plan adjusted to reflect the amount of expenditures for the
  707  previous state fiscal year plus 5 percent if such amount is less
  708  than the client’s existing cost plan. The agency shall use
  709  actual paid claims for services provided during the previous
  710  fiscal year that are submitted by October 31 to calculate the
  711  revised cost plan amount. If the client was not served for the
  712  entire previous state fiscal year or there was any single change
  713  in the cost plan amount of more than 5 percent during the
  714  previous state fiscal year, the agency shall set the cost plan
  715  amount at an estimated annualized expenditure amount plus 5
  716  percent. The agency shall estimate the annualized expenditure
  717  amount by calculating the average of monthly expenditures,
  718  beginning in the fourth month after the client enrolled,
  719  interrupted services are resumed, or the cost plan was changed
  720  by more than 5 percent and ending on August 31, 2009, and
  721  multiplying the average by 12. In order to determine whether a
  722  client was not served for the entire year, the agency shall
  723  include any interruption of a waiver-funded service or services
  724  lasting at least 18 days. If at least 3 months of actual
  725  expenditure data are not available to estimate annualized
  726  expenditures, the agency may not rebase a cost plan pursuant to
  727  this subsection. The agency may not rebase the cost plan of any
  728  client who experiences a significant change in recipient
  729  condition or circumstance which results in a change of more than
  730  5 percent to his or her cost plan between July 1 and the date
  731  that a rebased cost plan would take effect pursuant to this
  732  subsection.
  733         (6)(7) The agency shall collect premiums, fees, or other
  734  cost sharing from the parents of children being served by the
  735  agency through a waiver pursuant to s. 409.906(13)(d).
  736         (7) In determining whether to continue a Medicaid waiver
  737  provider agreement for support coordinator services, the agency
  738  shall review waiver support coordination performance to ensure
  739  that the support coordinator meets or exceeds the criteria
  740  established by the agency. The support coordinator is
  741  responsible for assisting the client in meeting his or her
  742  service needs through nonwaiver resources, as well as through
  743  the client’s budget allocation or cost plan under the waiver.
  744  The waiver is the funding source of last resort for client
  745  services. The waiver support coordinator provider agreements and
  746  performance reviews shall be conducted and managed by the
  747  agency’s area offices.
  748         (a) Criteria for evaluating support coordinator performance
  749  must include, but is not limited to:
  750         1. The protection of the health and safety of clients.
  751         2. Assisting clients to obtain employment and pursue other
  752  meaningful activities.
  753         3. Assisting clients to access services that allow them to
  754  live in their community.
  755         4. The use of family resources.
  756         5. The use of private resources.
  757         6. The use of community resources.
  758         7. The use of charitable resources.
  759         8. The use of volunteer resources.
  760         9. The use of services from other governmental entities.
  761         10. The overall outcome in securing nonwaiver resources.
  762         11. The cost-effective use of waiver resources.
  763         12. Coordinating all available resources to ensure that
  764  clients’ outcomes are met.
  765         (b) The agency may recognize consistently superior
  766  performance by exempting a waiver support coordinator from
  767  annual quality assurance reviews or other mechanisms established
  768  by the agency. The agency may issue sanctions for poor
  769  performance, including, but not limited to, a reduction in
  770  caseload size, recoupment or other financial penalties, and
  771  termination of the waiver support coordinator’s provider
  772  agreement. The agency may adopt rules to administer this
  773  subsection.
  774         (8) This section or related rule does not prevent or limit
  775  the Agency for Health Care Administration, in consultation with
  776  the agency for Persons with Disabilities, from adjusting fees,
  777  reimbursement rates, lengths of stay, number of visits, or
  778  number of services, or from limiting enrollment, or making any
  779  other adjustment necessary to comply with the availability of
  780  moneys and any limitations or directions provided in the General
  781  Appropriations Act.
  782         (9) The agency for Persons with Disabilities shall submit
  783  quarterly status reports to the Executive Office of the Governor
  784  and, the chairs of the legislative appropriations committees
  785  chair of the Senate Ways and Means Committee or its successor,
  786  and the chair of the House Fiscal Council or its successor
  787  regarding the financial status of waiver home and community
  788  based services, including the number of enrolled individuals who
  789  are receiving services through one or more programs; the number
  790  of individuals who have requested services who are not enrolled
  791  but who are receiving services through one or more programs,
  792  including with a description indicating the programs from which
  793  the individual is receiving services; the number of individuals
  794  who have refused an offer of services but who choose to remain
  795  on the list of individuals waiting for services; the number of
  796  individuals who have requested services but are not who are
  797  receiving no services; a frequency distribution indicating the
  798  length of time individuals have been waiting for services; and
  799  information concerning the actual and projected costs compared
  800  to the amount of the appropriation available to the program and
  801  any projected surpluses or deficits. If at any time an analysis
  802  by the agency, in consultation with the Agency for Health Care
  803  Administration, indicates that the cost of services is expected
  804  to exceed the amount appropriated, the agency shall submit a
  805  plan in accordance with subsection (8) to the Executive Office
  806  of the Governor and the chairs of the legislative appropriations
  807  committees, the chair of the Senate Ways and Means Committee or
  808  its successor, and the chair of the House Fiscal Council or its
  809  successor to remain within the amount appropriated. The agency
  810  shall work with the Agency for Health Care Administration to
  811  implement the plan so as to remain within the appropriation.
  812         (10) Implementation of Medicaid waiver programs and
  813  services authorized under this chapter is limited by the funds
  814  appropriated for the individual budgets pursuant to s. 393.0662
  815  and the four-tiered waiver system pursuant to subsection (3).
  816  Contracts with independent support coordinators and service
  817  providers must include provisions requiring compliance with
  818  agency cost containment initiatives. The agency shall implement
  819  monitoring and accounting procedures necessary to track actual
  820  expenditures and project future spending compared to available
  821  appropriations for Medicaid waiver programs. If When necessary,
  822  based on projected deficits, the agency shall must establish
  823  specific corrective action plans that incorporate corrective
  824  actions for of contracted providers which that are sufficient to
  825  align program expenditures with annual appropriations. If
  826  deficits continue during the 2012-2013 fiscal year, the agency
  827  in conjunction with the Agency for Health Care Administration
  828  shall develop a plan to redesign the waiver program and submit
  829  the plan to the President of the Senate and the Speaker of the
  830  House of Representatives by September 30, 2013. At a minimum,
  831  the plan must include the following elements:
  832         (a) Budget predictability.—Agency budget recommendations
  833  must include specific steps to restrict spending to budgeted
  834  amounts based on alternatives to the iBudget and four-tiered
  835  Medicaid waiver models.
  836         (b) Services.—The agency shall identify core services that
  837  are essential to provide for client health and safety and
  838  recommend the elimination of coverage for other services that
  839  are not affordable based on available resources.
  840         (c) Flexibility.—The redesign must shall be responsive to
  841  individual needs and to the extent possible encourage client
  842  control over allocated resources for their needs.
  843         (d) Support coordination services.—The plan must shall
  844  modify the manner of providing support coordination services to
  845  improve management of service utilization and increase
  846  accountability and responsiveness to agency priorities.
  847         (e) Reporting.—The agency shall provide monthly reports to
  848  the President of the Senate and the Speaker of the House of
  849  Representatives on plan progress and development on July 31,
  850  2013, and August 31, 2013.
  851         (f) Implementation.—The implementation of a redesigned
  852  program is subject to legislative approval and must shall occur
  853  by no later than July 1, 2014. The Agency for Health Care
  854  Administration shall seek federal waivers as needed to implement
  855  the redesigned plan approved by the Legislature.
  856         Section 6. Section 393.0662, Florida Statutes, is amended
  857  to read:
  858         393.0662 Individual budgets for delivery of home and
  859  community-based services; iBudget system established.—The
  860  Legislature finds that improved financial management of the
  861  existing home and community-based Medicaid waiver program is
  862  necessary to avoid deficits that impede the provision of
  863  services to individuals who are on the waiting list for
  864  enrollment in the program. The Legislature further finds that
  865  clients and their families should have greater flexibility to
  866  choose the services that best allow them to live in their
  867  community within the limits of an established budget. Therefore,
  868  the Legislature intends that the agency, in consultation with
  869  the Agency for Health Care Administration, develop and implement
  870  a comprehensive redesign of the service delivery system using
  871  individual budgets as the basis for allocating the funds
  872  appropriated for the home and community-based services Medicaid
  873  waiver program among eligible enrolled clients. The service
  874  delivery system that uses individual budgets shall be called the
  875  iBudget system.
  876         (1) The agency shall establish an individual budget, to be
  877  referred to as an iBudget, for each client individual served by
  878  the home and community-based services Medicaid waiver program.
  879  The funds appropriated to the agency shall be allocated through
  880  the iBudget system to eligible, Medicaid-enrolled clients who
  881  have. For the iBudget system, Eligible clients shall include
  882  individuals with a diagnosis of Down syndrome or a developmental
  883  disability as defined in s. 393.063. The iBudget system shall be
  884  designed to provide for: enhanced client choice within a
  885  specified service package; appropriate assessment strategies; an
  886  efficient consumer budgeting and billing process that includes
  887  reconciliation and monitoring components; a redefined role for
  888  support coordinators which that avoids potential conflicts of
  889  interest; a flexible and streamlined service review process; and
  890  a methodology and process that ensures the equitable allocation
  891  of available funds to each client based on the client’s level of
  892  need, as determined by the variables in the allocation
  893  algorithm.
  894         (2)(a) In developing each client’s iBudget, the agency
  895  shall use an allocation algorithm and methodology.
  896         (a) The algorithm shall use variables that have been
  897  determined by the agency to have a statistically validated
  898  relationship to the client’s level of need for services provided
  899  through the home and community-based services Medicaid waiver
  900  program. The algorithm and methodology may consider individual
  901  characteristics, including, but not limited to, a client’s age
  902  and living situation, information from a formal assessment
  903  instrument that the agency determines is valid and reliable, and
  904  information from other assessment processes.
  905         (b) The allocation methodology shall provide the algorithm
  906  that determines the amount of funds allocated to a client’s
  907  iBudget. The agency may approve an increase in the amount of
  908  funds allocated, as determined by the algorithm, based on the
  909  client having one or more of the following needs that cannot be
  910  accommodated within the funding as determined by the algorithm
  911  allocation and having no other resources, supports, or services
  912  available to meet such needs the need:
  913         1. An extraordinary need that would place the health and
  914  safety of the client, the client’s caregiver, or the public in
  915  immediate, serious jeopardy unless the increase is approved. An
  916  extraordinary need may include, but is not limited to:
  917         a. A documented history of significant, potentially life
  918  threatening behaviors, such as recent attempts at suicide,
  919  arson, nonconsensual sexual behavior, or self-injurious behavior
  920  requiring medical attention;
  921         b. A complex medical condition that requires active
  922  intervention by a licensed nurse on an ongoing basis that cannot
  923  be taught or delegated to a nonlicensed person;
  924         c. A chronic comorbid condition. As used in this
  925  subparagraph, the term “comorbid condition” means a medical
  926  condition existing simultaneously but independently with another
  927  medical condition in a patient; or
  928         d. A need for total physical assistance with activities
  929  such as eating, bathing, toileting, grooming, and personal
  930  hygiene.
  932  However, the presence of an extraordinary need alone does not
  933  warrant an increase in the amount of funds allocated to a
  934  client’s iBudget as determined by the algorithm.
  935         2. A significant need for one-time or temporary support or
  936  services that, if not provided, would place the health and
  937  safety of the client, the client’s caregiver, or the public in
  938  serious jeopardy, unless the increase is approved. A significant
  939  need may include, but is not limited to, the provision of
  940  environmental modifications, durable medical equipment, services
  941  to address the temporary loss of support from a caregiver, or
  942  special services or treatment for a serious temporary condition
  943  when the service or treatment is expected to ameliorate the
  944  underlying condition. As used in this subparagraph, the term
  945  “temporary” means less a period of fewer than 12 continuous
  946  months. However, the presence of such significant need for one
  947  time or temporary supports or services alone does not warrant an
  948  increase in the amount of funds allocated to a client’s iBudget
  949  as determined by the algorithm.
  950         3. A significant increase in the need for services after
  951  the beginning of the service plan year which that would place
  952  the health and safety of the client, the client’s caregiver, or
  953  the public in serious jeopardy because of substantial changes in
  954  the client’s circumstances, including, but not limited to,
  955  permanent or long-term loss or incapacity of a caregiver, loss
  956  of services authorized under the state Medicaid plan due to a
  957  change in age, or a significant change in medical or functional
  958  status which requires the provision of additional services on a
  959  permanent or long-term basis which that cannot be accommodated
  960  within the client’s current iBudget. As used in this
  961  subparagraph, the term “long-term” means a period of 12 or more
  962  continuous months. However, such significant increase in need
  963  for services of a permanent or long-term nature alone does not
  964  warrant an increase in the amount of funds allocated to a
  965  client’s iBudget as determined by the algorithm.
  967  The agency shall reserve portions of the appropriation for the
  968  home and community-based services Medicaid waiver program for
  969  adjustments required pursuant to this paragraph and may use the
  970  services of an independent actuary in determining the amount of
  971  the portions to be reserved.
  972         (c) A client’s iBudget shall be the total of the amount
  973  determined by the algorithm and any additional funding provided
  974  pursuant to paragraph (b).
  975         (d) A client shall have the flexibility to determine the
  976  type, amount, frequency, duration, and scope of the services on
  977  his or her cost plan if the agency determines that such services
  978  meet his or her health and safety needs, meet the requirements
  979  contained in the Coverage and Limitations Handbook for each
  980  service included on the cost plan, and comply with the other
  981  requirements of this section.
  982         (e) A client’s annual expenditures for home and community
  983  based services Medicaid waiver services may not exceed the
  984  limits of his or her iBudget. The total of all clients’
  985  projected annual iBudget expenditures may not exceed the
  986  agency’s appropriation for waiver services.
  987         (3)(2) The Agency for Health Care Administration, in
  988  consultation with the agency, shall seek federal approval to
  989  amend current waivers, request a new waiver, and amend contracts
  990  as necessary to implement the iBudget system to serve eligible,
  991  enrolled clients through the home and community-based services
  992  Medicaid waiver program and the Consumer-Directed Care Plus
  993  Program.
  994         (4)(3) The agency shall transition all eligible, enrolled
  995  clients to the iBudget system. The agency may gradually phase in
  996  the iBudget system.
  997         (a) During the 2011-2012 and 2012-2013 fiscal years, the
  998  agency shall determine a client’s initial iBudget by comparing
  999  the client’s algorithm allocation to the client’s existing
 1000  annual cost plan and the amount for the client’s extraordinary
 1001  needs. The client’s algorithm allocation shall be the amount
 1002  determined by the algorithm, adjusted to the agency’s
 1003  appropriation and any set-asides determined necessary by the
 1004  agency, including, but not limited to, funding for extraordinary
 1005  needs. The amount for the client’s extraordinary needs shall be
 1006  the annualized sum of any of the following services authorized
 1007  on the client’s cost plan in the amount, duration, frequency,
 1008  intensity, and scope determined by the agency to be necessary
 1009  for the client’s health and safety:
 1010         1. Behavior assessment, behavior analysis services, and
 1011  behavior assistant services.
 1012         2. Consumable medical supplies.
 1013         3. Durable medical equipment.
 1014         4. In-home support services.
 1015         5. Nursing services.
 1016         6. Occupational therapy assessment and occupational
 1017  therapy.
 1018         7. Personal care assistance.
 1019         8. Physical therapy assessment and physical therapy.
 1020         9. Residential habilitation.
 1021         10. Respiratory therapy assessment and respiratory therapy.
 1022         11. Special medical home care.
 1023         12. Support coordination.
 1024         13. Supported employment.
 1025         14. Supported living coaching.
 1026         (b)If the client’s algorithm allocation is:
 1027         1. Greater than the client’s cost plan, the client’s
 1028  initial iBudget is equal to the cost plan.
 1029         2. Less than the client’s cost plan but greater than the
 1030  amount for the client’s extraordinary needs, the client’s
 1031  initial iBudget is equal to the algorithm allocation.
 1032         3. Less than the amount for the client’s extraordinary
 1033  needs, the client’s initial iBudget is equal to the amount for
 1034  the client’s extraordinary needs.
 1036  However, the client’s initial annualized iBudget amount may not
 1037  be less than 50 percent of that client’s existing annualized
 1038  cost plan.
 1039         (c) During the 2011-2012 and 2012-2013 fiscal years,
 1040  increases to a client’s initial iBudget amount may be granted
 1041  only if his or her situation meets the crisis criteria provided
 1042  under agency rule.
 1043         (d)(a) While the agency phases in the iBudget system, the
 1044  agency may continue to serve eligible, enrolled clients under
 1045  the four-tiered waiver system established under s. 393.065 while
 1046  those clients await transitioning to the iBudget system.
 1047         (b) The agency shall design the phase-in process to ensure
 1048  that a client does not experience more than one-half of any
 1049  expected overall increase or decrease to his or her existing
 1050  annualized cost plan during the first year that the client is
 1051  provided an iBudget due solely to the transition to the iBudget
 1052  system.
 1053         (5)(4) A client must use all available nonwaiver services
 1054  authorized under the state Medicaid plan, school-based services,
 1055  private insurance and other benefits, and any other resources
 1056  that may be available to the client before using funds from his
 1057  or her iBudget to pay for support and services.
 1058         (6)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
 1059  and 3. do not apply to the iBudget system.
 1060         (7)(6) Rates for any or all services established under
 1061  rules of the Agency for Health Care Administration must shall be
 1062  designated as the maximum rather than a fixed amount for clients
 1063  individuals who receive an iBudget, except for services
 1064  specifically identified in those rules that the agency
 1065  determines are not appropriate for negotiation, which may
 1066  include, but are not limited to, residential habilitation
 1067  services.
 1068         (8)(7) The agency must shall ensure that clients and
 1069  caregivers have access to training and education that informs to
 1070  inform them about the iBudget system and enhances enhance their
 1071  ability for self-direction. Such training must be provided shall
 1072  be offered in a variety of formats and, at a minimum, must shall
 1073  address the policies and processes of the iBudget system; the
 1074  roles and responsibilities of consumers, caregivers, waiver
 1075  support coordinators, providers, and the agency; information
 1076  that is available to help the client make decisions regarding
 1077  the iBudget system; and examples of nonwaiver support and
 1078  resources that may be available in the community.
 1079         (9)(8) The agency shall collect data to evaluate the
 1080  implementation and outcomes of the iBudget system.
 1081         (10)(9) The agency and the Agency for Health Care
 1082  Administration may adopt rules specifying the allocation
 1083  algorithm and methodology; criteria and processes that allow for
 1084  clients to access reserved funds for extraordinary needs,
 1085  temporarily or permanently changed needs, and one-time needs;
 1086  and processes and requirements for the selection and review of
 1087  services, development of support and cost plans, and management
 1088  of the iBudget system as needed to administer this section.
 1089         Section 7. Subsection (2) of section 393.067, Florida
 1090  Statutes, is amended to read:
 1091         393.067 Facility licensure.—
 1092         (2) The agency shall conduct annual inspections and reviews
 1093  of facilities and programs licensed under this section unless
 1094  the facility or program is currently accredited by the Joint
 1095  Commission, the Commission on Accreditation of Rehabilitation
 1096  Facilities, or the Council on Accreditation. Facilities or
 1097  programs that are operating under such accreditation must be
 1098  inspected and reviewed by the agency once every 2 years. If,
 1099  upon inspection and review, the services and service delivery
 1100  sites are not those for which the facility or program is
 1101  accredited, the facilities and programs must be inspected and
 1102  reviewed in accordance with this section and related rules
 1103  adopted by the agency. Notwithstanding current accreditation,
 1104  the agency may continue to monitor the facility or program as
 1105  necessary with respect to:
 1106         (a) Ensuring that services for which the agency is paying
 1107  are being provided.
 1108         (b) Investigating complaints, identifying problems that
 1109  would affect the safety or viability of the facility or program,
 1110  and monitoring the facility or program’s compliance with any
 1111  resulting negotiated terms and conditions, including provisions
 1112  relating to consent decrees which are unique to a specific
 1113  service and are not statements of general applicability.
 1114         (c) Ensuring compliance with federal and state laws,
 1115  federal regulations, or state rules if such monitoring does not
 1116  duplicate the accrediting organization’s review pursuant to
 1117  accreditation standards.
 1118         (d) Ensuring Medicaid compliance with federal certification
 1119  and precertification review requirements.
 1120         Section 8. Subsections (2) and (4) of section 393.068,
 1121  Florida Statutes, are amended to read:
 1122         393.068 Family care program.—
 1123         (2) Services and support authorized under the family care
 1124  program shall, to the extent of available resources, include the
 1125  services listed under s. 393.0662(4) 393.066 and, in addition,
 1126  shall include, but not be limited to:
 1127         (a) Attendant care.
 1128         (b) Barrier-free modifications to the home.
 1129         (c) Home visitation by agency workers.
 1130         (d) In-home subsidies.
 1131         (e) Low-interest loans.
 1132         (f) Modifications for vehicles used to transport the
 1133  individual with a developmental disability.
 1134         (g) Facilitated communication.
 1135         (h) Family counseling.
 1136         (i) Equipment and supplies.
 1137         (j) Self-advocacy training.
 1138         (k) Roommate services.
 1139         (l) Integrated community activities.
 1140         (m) Emergency services.
 1141         (n) Support coordination.
 1142         (o) Other support services as identified by the family or
 1143  client individual.
 1144         (4) All existing nonwaiver community resources available to
 1145  the client must be used shall be utilized to support program
 1146  objectives. Additional services may be incorporated into the
 1147  program as appropriate and to the extent that resources are
 1148  available. The agency may is authorized to accept gifts and
 1149  grants in order to carry out the program.
 1150         Section 9. Subsections (1) through (3), paragraph (b) of
 1151  subsection (4), paragraphs (f) and (g) of subsection (5),
 1152  subsection (6), paragraphs (d) and (e) of subsection (7), and
 1153  paragraph (b) of subsection (12) of section 393.11, Florida
 1154  Statutes, are amended to read:
 1155         393.11 Involuntary admission to residential services.—
 1156         (1) JURISDICTION.—If When a person is determined to be
 1157  eligible to receive services from the agency mentally retarded
 1158  and requires involuntary admission to residential services
 1159  provided by the agency, the circuit court of the county in which
 1160  the person resides shall have jurisdiction to conduct a hearing
 1161  and enter an order involuntarily admitting the person in order
 1162  for that the person to may receive the care, treatment,
 1163  habilitation, and rehabilitation that he or she which the person
 1164  needs. For the purpose of identifying mental retardation or
 1165  autism, diagnostic capability shall be established by the
 1166  agency. Except as otherwise specified, the proceedings under
 1167  this section are shall be governed by the Florida Rules of Civil
 1168  Procedure.
 1169         (2) PETITION.—
 1170         (a) A petition for involuntary admission to residential
 1171  services may be executed by a petitioning commission or the
 1172  agency.
 1173         (b) The petitioning commission shall consist of three
 1174  persons. One of whom these persons shall be a physician licensed
 1175  and practicing under chapter 458 or chapter 459.
 1176         (c) The petition shall be verified and shall:
 1177         1. State the name, age, and present address of the
 1178  commissioners and their relationship to the person who is the
 1179  subject of the petition with mental retardation or autism;
 1180         2. State the name, age, county of residence, and present
 1181  address of the person who is the subject of the petition with
 1182  mental retardation or autism;
 1183         3. Allege that the commission believes that the person
 1184  needs involuntary residential services and specify the factual
 1185  information on which the belief is based;
 1186         4. Allege that the person lacks sufficient capacity to give
 1187  express and informed consent to a voluntary application for
 1188  services and lacks the basic survival and self-care skills to
 1189  provide for the person’s well-being or is likely to physically
 1190  injure others if allowed to remain at liberty; and
 1191         5. State which residential setting is the least restrictive
 1192  and most appropriate alternative and specify the factual
 1193  information on which the belief is based.
 1194         (d) The petition shall be filed in the circuit court of the
 1195  county in which the person who is the subject of the petition
 1196  with mental retardation or autism resides.
 1197         (3) NOTICE.—
 1198         (a) Notice of the filing of the petition shall be given to
 1199  the defendant individual and his or her legal guardian. The
 1200  notice shall be given both verbally and in writing in the
 1201  language of the defendant client, or in other modes of
 1202  communication of the defendant client, and in English. Notice
 1203  shall also be given to such other persons as the court may
 1204  direct. The petition for involuntary admission to residential
 1205  services shall be served with the notice.
 1206         (b) If Whenever a motion or petition has been filed
 1207  pursuant to s. 916.303 to dismiss criminal charges against a
 1208  defendant with retardation or autism, and a petition is filed to
 1209  involuntarily admit the defendant to residential services under
 1210  this section, the notice of the filing of the petition shall
 1211  also be given to the defendant’s attorney, the state attorney of
 1212  the circuit from which the defendant was committed, and the
 1213  agency.
 1214         (c) The notice shall state that a hearing shall be set to
 1215  inquire into the need of the defendant person with mental
 1216  retardation or autism for involuntary residential services. The
 1217  notice shall also state the date of the hearing on the petition.
 1218         (d) The notice shall state that the defendant individual
 1219  with mental retardation or autism has the right to be
 1220  represented by counsel of his or her own choice and that, if the
 1221  defendant person cannot afford an attorney, the court shall
 1222  appoint one.
 1223         (4) AGENCY PARTICIPATION.—
 1224         (b) Following examination, the agency shall file a written
 1225  report with the court not less than 10 working days before the
 1226  date of the hearing. The report must be served on the
 1227  petitioner, the defendant person with mental retardation, and
 1228  the defendant’s person’s attorney at the time the report is
 1229  filed with the court.
 1230         (5) EXAMINING COMMITTEE.—
 1231         (f) The committee shall file the report with the court not
 1232  less than 10 working days before the date of the hearing. The
 1233  report shall be served on the petitioner, the defendant person
 1234  with mental retardation, the defendant’s person’s attorney at
 1235  the time the report is filed with the court, and the agency.
 1236         (g) Members of the examining committee shall receive a
 1237  reasonable fee to be determined by the court. The fees are to be
 1238  paid from the general revenue fund of the county in which the
 1239  defendant person with mental retardation resided when the
 1240  petition was filed.
 1241         (6) COUNSEL; GUARDIAN AD LITEM.—
 1242         (a) The defendant must person with mental retardation shall
 1243  be represented by counsel at all stages of the judicial
 1244  proceeding. If In the event the defendant person is indigent and
 1245  cannot afford counsel, the court shall appoint a public defender
 1246  not less than 20 working days before the scheduled hearing. The
 1247  defendant’s person’s counsel shall have full access to the
 1248  records of the service provider and the agency. In all cases,
 1249  the attorney shall represent the rights and legal interests of
 1250  the defendant person with mental retardation, regardless of who
 1251  may initiate the proceedings or pay the attorney’s fee.
 1252         (b) If the attorney, during the course of his or her
 1253  representation, reasonably believes that the defendant person
 1254  with mental retardation cannot adequately act in his or her own
 1255  interest, the attorney may seek the appointment of a guardian ad
 1256  litem. A prior finding of incompetency is not required before a
 1257  guardian ad litem is appointed pursuant to this section.
 1258         (7) HEARING.—
 1259         (d) The defendant may person with mental retardation shall
 1260  be physically present throughout all or part of the entire
 1261  proceeding. If the defendant’s person’s attorney or any other
 1262  interested party believes that the person’s presence at the
 1263  hearing is not in the person’s best interest, or good cause is
 1264  otherwise shown, the person’s presence may be waived once the
 1265  court may order that the defendant be excluded from the hearing
 1266  has seen the person and the hearing has commenced.
 1267         (e) The defendant person has the right to present evidence
 1268  and to cross-examine all witnesses and other evidence alleging
 1269  the appropriateness of the person’s admission to residential
 1270  care. Other relevant and material evidence regarding the
 1271  appropriateness of the person’s admission to residential
 1272  services; the most appropriate, least restrictive residential
 1273  placement; and the appropriate care, treatment, and habilitation
 1274  of the person, including written or oral reports, may be
 1275  introduced at the hearing by any interested person.
 1276         (12) APPEAL.—
 1277         (b) The filing of an appeal by the person ordered to be
 1278  involuntarily admitted under this section with mental
 1279  retardation shall stay admission of the person into residential
 1280  care. The stay shall remain in effect during the pendency of all
 1281  review proceedings in Florida courts until a mandate issues.
 1282         Section 10. Paragraph (a) of subsection (1) of section
 1283  393.125, Florida Statutes, is amended to read:
 1284         393.125 Hearing rights.—
 1285         (1) REVIEW OF AGENCY DECISIONS.—
 1286         (a) For Medicaid programs administered by the agency, any
 1287  developmental services applicant or client, or his or her
 1288  parent, guardian advocate, or authorized representative, may
 1289  request a hearing in accordance with federal law and rules
 1290  applicable to Medicaid cases and has the right to request an
 1291  administrative hearing pursuant to ss. 120.569 and 120.57. The
 1292  hearing These hearings shall be provided by the Department of
 1293  Children and Family Services pursuant to s. 409.285 and shall
 1294  follow procedures consistent with federal law and rules
 1295  applicable to Medicaid cases. At the conclusion of the hearing,
 1296  the department shall submit its recommended order to the agency
 1297  as provided in s. 120.57(1)(k) and the agency shall issue final
 1298  orders as provided in s. 120.57(1)(i).
 1299         Section 11. Subsection (1) of section 393.23, Florida
 1300  Statutes, is amended to read:
 1301         393.23 Developmental disabilities centers; trust accounts.
 1302  All receipts from the operation of canteens, vending machines,
 1303  hobby shops, sheltered workshops, activity centers, farming
 1304  projects, and other like activities operated in a developmental
 1305  disabilities center, and moneys donated to the center, must be
 1306  deposited in a trust account in any bank, credit union, or
 1307  savings and loan association authorized by the State Treasury as
 1308  a qualified depository to do business in this state, if the
 1309  moneys are available on demand.
 1310         (1) Moneys in the trust account must be expended for the
 1311  benefit, education, or welfare of clients. However, if
 1312  specified, moneys that are donated to the center must be
 1313  expended in accordance with the intentions of the donor. Trust
 1314  account money may not be used for the benefit of agency
 1315  employees or to pay the wages of such employees. The welfare of
 1316  clients includes the expenditure of funds for the purchase of
 1317  items for resale at canteens or vending machines, and for the
 1318  establishment of, maintenance of, and operation of canteens,
 1319  hobby shops, recreational or entertainment facilities, sheltered
 1320  workshops that include client wages, activity centers, farming
 1321  projects, or other like facilities or programs established at
 1322  the center for the benefit of clients.
 1323         Section 12. Paragraph (d) of subsection (13) of section
 1324  409.906, Florida Statutes, is amended to read:
 1325         409.906 Optional Medicaid services.—Subject to specific
 1326  appropriations, the agency may make payments for services which
 1327  are optional to the state under Title XIX of the Social Security
 1328  Act and are furnished by Medicaid providers to recipients who
 1329  are determined to be eligible on the dates on which the services
 1330  were provided. Any optional service that is provided shall be
 1331  provided only when medically necessary and in accordance with
 1332  state and federal law. Optional services rendered by providers
 1333  in mobile units to Medicaid recipients may be restricted or
 1334  prohibited by the agency. Nothing in this section shall be
 1335  construed to prevent or limit the agency from adjusting fees,
 1336  reimbursement rates, lengths of stay, number of visits, or
 1337  number of services, or making any other adjustments necessary to
 1338  comply with the availability of moneys and any limitations or
 1339  directions provided for in the General Appropriations Act or
 1340  chapter 216. If necessary to safeguard the state’s systems of
 1341  providing services to elderly and disabled persons and subject
 1342  to the notice and review provisions of s. 216.177, the Governor
 1343  may direct the Agency for Health Care Administration to amend
 1344  the Medicaid state plan to delete the optional Medicaid service
 1345  known as “Intermediate Care Facilities for the Developmentally
 1346  Disabled.” Optional services may include:
 1348         (d) The agency shall request federal approval to develop a
 1349  system to require payment of premiums, fees, or other cost
 1350  sharing by the parents of a child younger than 18 years of age
 1351  who is being served by a waiver under this subsection if the
 1352  adjusted household income is greater than 100 percent of the
 1353  federal poverty level. The amount of the premium, fee, or cost
 1354  sharing shall be calculated using a sliding scale based on the
 1355  size of the family, the amount of the parent’s adjusted gross
 1356  income, and the federal poverty guidelines. The premium, fee, or
 1357  other cost sharing paid by a parent may not exceed the cost of
 1358  waiver services to the client. Parents who have more than one
 1359  child receiving services may not be required to pay more than
 1360  the amount required for the child who has the highest
 1361  expenditures. Parents who do not live with each other remain
 1362  responsible for paying the required contribution. The client may
 1363  not be denied waiver services due to nonpayment by a parent.
 1364  Adoptive and foster parents are exempt from payment of any
 1365  premiums, fees, or other cost-sharing for waiver services. The
 1366  agency shall request federal approval as necessary to implement
 1367  the program. The premium and cost-sharing system developed by
 1368  the agency shall not adversely affect federal funding to the
 1369  state. Upon receiving After the agency receives federal
 1370  approval, if required, the agency, the Agency for Persons with
 1371  Disabilities, and the Department of Children and Family Services
 1372  may implement the system and collect income information from
 1373  parents of children who will be affected by this paragraph. The
 1374  parents must provide information upon request. The agency shall
 1375  prepare a report to include the estimated operational cost of
 1376  implementing the premium, fee, and cost-sharing system and the
 1377  estimated revenues to be collected from parents of children in
 1378  the waiver program. The report shall be delivered to the
 1379  President of the Senate and the Speaker of the House of
 1380  Representatives by June 30, 2012. The agency, the Department of
 1381  Children and Family Services, and the Agency for Persons with
 1382  Disabilities may adopt rules to administer this paragraph.
 1383         Section 13. Section 514.072, Florida Statutes, is amended
 1384  to read:
 1385         514.072 Certification of swimming instructors for people
 1386  who have developmental disabilities required.—Any person working
 1387  at a swimming pool who holds himself or herself out as a
 1388  swimming instructor specializing in training people who have a
 1389  developmental disability developmental disabilities, as defined
 1390  in s. 393.063(11) 393.063(10), may be certified by the Dan
 1391  Marino Foundation, Inc., in addition to being certified under s.
 1392  514.071. The Dan Marino Foundation, Inc., must develop
 1393  certification requirements and a training curriculum for
 1394  swimming instructors for people who have developmental
 1395  disabilities and must submit the certification requirements to
 1396  the Department of Health for review by January 1, 2007. A person
 1397  certified under s. 514.071 before July 1, 2007, must meet the
 1398  additional certification requirements of this section before
 1399  January 1, 2008. A person certified under s. 514.071 on or after
 1400  July 1, 2007, must meet the additional certification
 1401  requirements of this section within 6 months after receiving
 1402  certification under s. 514.071.
 1403         Section 14. This act shall take effect July 1, 2012.