Florida Senate - 2012                      CS for CS for SB 1516
       By the Committees on Health Regulation; and Children, Families,
       and Elder Affairs; and Senators Negron and Garcia
       588-03233-12                                          20121516c2
    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         393.502, F.S.; revising the membership of family care
   48         councils; amending s. 409.906, F.S.; providing
   49         limitations on the amount of cost sharing which may be
   50         required of parents for home and community-based
   51         services provided to their minor children; authorizing
   52         the adoption of rules relating to cost sharing;
   53         amending s. 514.072, F.S.; conforming a cross
   54         reference; deleting an obsolete provision; providing
   55         an effective date.
   57  Be It Enacted by the Legislature of the State of Florida:
   59         Section 1. Section 393.062, Florida Statutes, is amended to
   60  read:
   61         393.062 Legislative findings and declaration of intent.—
   62         (1) The Legislature finds and declares that existing state
   63  programs for the treatment of individuals with developmental
   64  disabilities, which often unnecessarily place clients in
   65  institutions, are unreasonably costly, are ineffective in
   66  bringing the individual client to his or her maximum potential,
   67  and are in fact debilitating to many clients. A redirection in
   68  state treatment programs for individuals with developmental
   69  disabilities is therefore necessary if any significant
   70  amelioration of the problems faced by such individuals is ever
   71  to take place. Such redirection should place primary emphasis on
   72  programs that prevent or reduce the severity of developmental
   73  disabilities. Further, the greatest priority should shall be
   74  given to the development and implementation of community-based
   75  services that will enable individuals with developmental
   76  disabilities to achieve their greatest potential for independent
   77  and productive living, enable them to live in their own homes or
   78  in residences located in their own communities, and to permit
   79  them to be diverted or removed from unnecessary institutional
   80  placements. This goal cannot be met without ensuring the
   81  availability of community residential opportunities in the
   82  residential areas of this state. The Legislature, therefore,
   83  declares that individuals all persons with developmental
   84  disabilities who live in licensed community homes shall have a
   85  family living environment comparable to that of other state
   86  residents Floridians and that such homes must residences shall
   87  be considered and treated as a functional equivalent of a family
   88  unit and not as an institution, business, or boarding home. The
   89  Legislature further declares that, in developing community-based
   90  programs and services for individuals with developmental
   91  disabilities, private businesses, not-for-profit corporations,
   92  units of local government, and other organizations capable of
   93  providing needed services to clients in a cost-efficient manner
   94  shall be given preference in lieu of operation of programs
   95  directly by state agencies. Finally, it is the intent of the
   96  Legislature that all caretakers who are unrelated to individuals
   97  with developmental disabilities receiving care shall be of good
   98  moral character.
   99         (2) The Legislature finds that in order to maximize the
  100  delivery of services to individuals in the community who have
  101  developmental disabilities and remain within appropriated funds,
  102  service delivery must blend natural supports, community
  103  resources, and state funds. The Legislature also finds that,
  104  given the traditional role of state government to ensure the
  105  health, safety, and welfare of state residents, state funds,
  106  including waiver funds, appropriated to the agency must be
  107  reserved and prioritized for those services needed to ensure the
  108  health and safety of individuals with disabilities, and that
  109  supplemental programs and other services be supported through
  110  natural supports and community resources. To achieve this goal,
  111  the Legislature intends that the agency implement policies and
  112  procedures that establish the Medicaid waiver as the payor of
  113  last resort for home and community-based programs and services,
  114  and promote partnerships with community resources, including,
  115  but not limited to, families, volunteers, nonprofit agencies,
  116  foundations, places of worship, schools, community organizations
  117  and clubs, businesses, local governments, and federal and state
  118  agencies to provide supplemental programs and services. Further,
  119  it is the intent of the Legislature that the agency develop
  120  sound fiscal strategies that allow the agency to predict,
  121  control, manage, and operate within available funding as
  122  provided in the General Appropriations Act in order to ensure
  123  that state funds are available for health and safety needs and
  124  to maximize the number of clients served. It is further the
  125  intent of the Legislature that the agency provide services for
  126  clients residing in developmental disability centers which
  127  promote the individual’s life, health, and safety and enhance
  128  their quality of life. Finally, it is the intent of the
  129  Legislature that the agency continue the tradition of involving
  130  families, stakeholders, and other interested parties as it
  131  recasts its role to become a collaborative partner in the larger
  132  context of family and community-supported services while
  133  developing new opportunities and supports for individuals with
  134  developmental disabilities.
  135         Section 2. Section 393.063, Florida Statutes, is reordered
  136  and amended to read:
  137         393.063 Definitions.—As used in For the purposes of this
  138  chapter, the term:
  139         (1) “Agency” means the Agency for Persons with
  140  Disabilities.
  141         (2) “Adult day services” means services that are provided
  142  in a nonresidential setting, separate from the home or facility
  143  in which the client resides, unless the client resides in a
  144  planned residential community as defined in s. 419.001(1); that
  145  are intended to support the participation of clients in daily,
  146  meaningful, and valued routines of the community; and that may
  147  provide social activities.
  148         (3)(2) “Adult day training” means training services that
  149  which take place in a nonresidential setting, separate from the
  150  home or facility in which the client resides, unless the client
  151  resides in a planned residential community as defined in s.
  152  419.001(1)(d); are intended to support the participation of
  153  clients in daily, meaningful, and valued routines of the
  154  community; and may include work-like settings that do not meet
  155  the definition of supported employment.
  156         (4)(3) “Autism” means a pervasive, neurologically based
  157  developmental disability of extended duration which causes
  158  severe learning, communication, and behavior disorders and which
  159  has an with age of onset during infancy or childhood.
  160  Individuals who have with autism exhibit impairment in
  161  reciprocal social interaction, impairment in verbal and
  162  nonverbal communication and imaginative ability, and a markedly
  163  restricted repertoire of activities and interests.
  164         (5)(4) “Cerebral palsy” means a group of disabling symptoms
  165  of extended duration which results from damage to the developing
  166  brain which that may occur before, during, or after birth and
  167  which that results in the loss or impairment of control over
  168  voluntary muscles. The term For the purposes of this definition,
  169  cerebral palsy does not include those symptoms or impairments
  170  resulting solely from a stroke.
  171         (6)(5) “Client” means an individual any person determined
  172  eligible by the agency for services under this chapter.
  173         (7)(6) “Client advocate” means a friend or relative of the
  174  client, or of the client’s immediate family, who advocates for
  175  the best interests of the client in any proceedings under this
  176  chapter in which the client or his or her family has the right
  177  or duty to participate.
  178         (8)(7) “Comprehensive assessment” means the process used to
  179  determine eligibility for services under this chapter.
  180         (9)(8) “Comprehensive transitional education program” means
  181  the program established under in s. 393.18.
  182         (11)(9) “Developmental disability” means a disorder or
  183  syndrome that is attributable to retardation, cerebral palsy,
  184  autism, spina bifida, Down syndrome, or Prader-Willi syndrome;
  185  that manifests before the age of 18; and that constitutes a
  186  substantial handicap that can reasonably be expected to continue
  187  indefinitely.
  188         (10) “Developmental disabilities center” means a state
  189  owned and state-operated facility, formerly known as a “Sunland
  190  Center,” providing for the care, habilitation, and
  191  rehabilitation of clients who have with developmental
  192  disabilities.
  193         (12)(11) “Direct service provider” means a person, 18 years
  194  of age or older, who has direct face-to-face contact with a
  195  client while providing services to that the client or who has
  196  access to a client’s living areas or to a client’s funds or
  197  personal property.
  198         (12) “Domicile” means the place where a client legally
  199  resides, which place is his or her permanent home. Domicile may
  200  be established as provided in s. 222.17. Domicile may not be
  201  established in Florida by a minor who has no parent domiciled in
  202  Florida, or by a minor who has no legal guardian domiciled in
  203  Florida, or by any alien not classified as a resident alien.
  204         (13) “Down syndrome” means a disorder caused by the
  205  presence of an extra copy of chromosome 21.
  206         (14) “Express and informed consent” means consent
  207  voluntarily given in writing with sufficient knowledge and
  208  comprehension of the subject matter to enable the person giving
  209  consent to make a knowing decision without any element of force,
  210  fraud, deceit, duress, or other form of constraint or coercion.
  211         (15) “Family care program” means the program established
  212  under in s. 393.068.
  213         (16) “Foster care facility” means a residential facility
  214  licensed under this chapter which provides a family living
  215  environment and includes including supervision and care
  216  necessary to meet the physical, emotional, and social needs of
  217  its residents. The capacity of such a facility may not be more
  218  than three residents.
  219         (17) “Group home facility” means a residential facility
  220  licensed under this chapter which provides a family living
  221  environment and includes including supervision and care
  222  necessary to meet the physical, emotional, and social needs of
  223  its residents. The capacity of such a facility must shall be at
  224  least four 4 but not more than 15 residents.
  225         (18) “Guardian advocate” means a person appointed by a
  226  written order of the court to represent an individual who has a
  227  person with developmental disabilities under s. 393.12.
  228         (19) “Habilitation” means the process by which a client is
  229  assisted to acquire and maintain those life skills that which
  230  enable the client to cope more effectively with the demands of
  231  his or her condition and environment and to raise the level of
  232  his or her physical, mental, and social efficiency. It includes,
  233  but is not limited to, programs of formal structured education
  234  and treatment.
  235         (20) “High-risk child” means, for the purposes of this
  236  chapter, a child from 3 to 5 years of age who has with one or
  237  more of the following characteristics:
  238         (a) A developmental delay in cognition, language, or
  239  physical development.
  240         (b) A child surviving a catastrophic infectious or
  241  traumatic illness known to be associated with developmental
  242  delay, if when funds are specifically appropriated.
  243         (c) A child who has with a parent or guardian who has with
  244  developmental disabilities and who requires assistance in
  245  meeting the child’s developmental needs.
  246         (d) A child who has a physical or genetic anomaly
  247  associated with developmental disability.
  248         (21) “Intermediate care facility for the developmentally
  249  disabled” or “ICF/DD” means a residential facility licensed and
  250  certified under pursuant to part VIII of chapter 400.
  251         (22) “Medical/dental services” means medically necessary
  252  services that which are provided or ordered for a client by a
  253  person licensed under chapter 458, chapter 459, or chapter 466.
  254  Such services may include, but are not limited to, prescription
  255  drugs, specialized therapies, nursing supervision,
  256  hospitalization, dietary services, prosthetic devices, surgery,
  257  specialized equipment and supplies, adaptive equipment, and
  258  other services as required to prevent or alleviate a medical or
  259  dental condition.
  260         (23) “Nonwaiver resources” means supports or services
  261  obtainable through private insurance, the Medicaid state plan,
  262  nonprofit organizations, charitable donations from private
  263  businesses, other government programs, family, natural supports,
  264  community resources, and any other source other than a waiver.
  265         (24)(23) “Personal care services” means individual
  266  assistance with or supervision of essential activities of daily
  267  living for self-care, including ambulation, bathing, dressing,
  268  eating, grooming, and toileting, and other similar services that
  269  are incidental to the care furnished and are essential, and that
  270  are provided in the amount, duration, frequency, intensity, and
  271  scope determined by the agency to be necessary for the client’s
  272  health and safety to the health, safety, and welfare of the
  273  client when there is no one else available or able to perform
  274  those services.
  275         (25)(24) “Prader-Willi syndrome” means an inherited
  276  condition typified by neonatal hypotonia with failure to thrive,
  277  hyperphagia or an excessive drive to eat which leads to obesity
  278  usually at 18 to 36 months of age, mild to moderate mental
  279  retardation, hypogonadism, short stature, mild facial
  280  dysmorphism, and a characteristic neurobehavior.
  281         (26)(25) “Relative” means an individual who is connected by
  282  affinity or consanguinity to the client and who is 18 years of
  283  age or older.
  284         (27)(26) “Resident” means an individual who has any person
  285  with developmental disabilities and who resides residing at a
  286  residential facility, whether or not such person is a client of
  287  the agency.
  288         (28)(27) “Residential facility” means a facility providing
  289  room and board and personal care for an individual who has
  290  persons with developmental disabilities.
  291         (29)(28) “Residential habilitation” means supervision and
  292  training in with the acquisition, retention, or improvement in
  293  skills related to activities of daily living, such as personal
  294  hygiene skills, homemaking skills, and the social and adaptive
  295  skills necessary to enable the individual to reside in the
  296  community.
  297         (30)(29) “Residential habilitation center” means a
  298  community residential facility licensed under this chapter which
  299  provides habilitation services. The capacity of such a facility
  300  may shall not be fewer than nine residents. After October 1,
  301  1989, new residential habilitation centers may not be licensed
  302  and the licensed capacity for any existing residential
  303  habilitation center may not be increased.
  304         (31)(30) “Respite service” means appropriate, short-term,
  305  temporary care that is provided to an individual who has a
  306  person with developmental disabilities in order to meet the
  307  planned or emergency needs of the individual person or the
  308  family or other direct service provider.
  309         (32)(31) “Restraint” means a physical device, method, or
  310  drug used to control dangerous behavior.
  311         (a) A physical restraint is any manual method or physical
  312  or mechanical device, material, or equipment attached or
  313  adjacent to the individual’s body so that he or she cannot
  314  easily remove the restraint and which restricts freedom of
  315  movement or normal access to one’s body.
  316         (b) A drug used as a restraint is a medication used to
  317  control the person’s behavior or to restrict his or her freedom
  318  of movement and is not a standard treatment for the person’s
  319  medical or psychiatric condition. Physically holding a person
  320  during a procedure to forcibly administer psychotropic
  321  medication is a physical restraint.
  322         (c) Restraint does not include physical devices, such as
  323  orthopedically prescribed appliances, surgical dressings and
  324  bandages, supportive body bands, or other physical holding when
  325  necessary for routine physical examinations and tests; for
  326  purposes of orthopedic, surgical, or other similar medical
  327  treatment; when used to provide support for the achievement of
  328  functional body position or proper balance; or when used to
  329  protect a person from falling out of bed.
  330         (33)(32) “Retardation” means significantly subaverage
  331  general intellectual functioning existing concurrently with
  332  deficits in adaptive behavior which manifest that manifests
  333  before the age of 18 and can reasonably be expected to continue
  334  indefinitely. For the purposes of this definition, the term:
  335         (a) “Significantly subaverage general intellectual
  336  functioning,for the purpose of this definition, means
  337  performance that which is two or more standard deviations from
  338  the mean score on a standardized intelligence test specified in
  339  the rules of the agency.
  340         (b) “Adaptive behavior,for the purpose of this
  341  definition, means the effectiveness or degree with which an
  342  individual meets the standards of personal independence and
  343  social responsibility expected of his or her age, cultural
  344  group, and community.
  345         (34)(33) “Seclusion” means the involuntary isolation of a
  346  person in a room or area from which the person is prevented from
  347  leaving. The prevention may be by physical barrier or by a staff
  348  member who is acting in a manner, or who is physically situated,
  349  so as to prevent the person from leaving the room or area. For
  350  the purposes of this chapter, the term does not mean isolation
  351  due to the medical condition or symptoms of the person.
  352         (35)(34) “Self-determination” means an individual’s freedom
  353  to exercise the same rights as all other citizens, authority to
  354  exercise control over funds needed for one’s own support,
  355  including prioritizing those these funds when necessary,
  356  responsibility for the wise use of public funds, and self
  357  advocacy to speak and advocate for oneself in order to gain
  358  independence and ensure that individuals who have with a
  359  developmental disability are treated equally.
  360         (36)(35) “Specialized therapies” means those treatments or
  361  activities prescribed by and provided by an appropriately
  362  trained, licensed, or certified professional or staff person and
  363  may include, but are not limited to, physical therapy, speech
  364  therapy, respiratory therapy, occupational therapy, behavior
  365  therapy, physical management services, and related specialized
  366  equipment and supplies.
  367         (37)(36) “Spina bifida” means, for purposes of this
  368  chapter, a person with a medical diagnosis of spina bifida
  369  cystica or myelomeningocele.
  370         (38)(37) “Support coordinator” means a person who is
  371  contracting with designated by the agency to assist clients
  372  individuals and families in identifying their capacities, needs,
  373  and resources, as well as finding and gaining access to
  374  necessary supports and services; locating or developing
  375  employment opportunities; coordinating the delivery of supports
  376  and services; advocating on behalf of the client individual and
  377  family; maintaining relevant records; and monitoring and
  378  evaluating the delivery of supports and services to determine
  379  the extent to which they meet the needs and expectations
  380  identified by the client individual, family, and others who
  381  participated in the development of the support plan.
  382         (39)(38) “Supported employment” means employment located or
  383  provided in an integrated work setting, with earnings paid on a
  384  commensurate wage basis, and for which continued support is
  385  needed for job maintenance.
  386         (40)(39) “Supported living” means a category of
  387  individually determined services designed and coordinated in
  388  such a manner that provides as to provide assistance to adult
  389  clients who require ongoing supports to live as independently as
  390  possible in their own homes, to be integrated into the
  391  community, and to participate in community life to the fullest
  392  extent possible.
  393         (41)(40) “Training” means a planned approach to assisting a
  394  client to attain or maintain his or her maximum potential and
  395  includes services ranging from sensory stimulation to
  396  instruction in skills for independent living and employment.
  397         (42)(41) “Treatment” means the prevention, amelioration, or
  398  cure of a client’s physical and mental disabilities or
  399  illnesses.
  400         (43) “Waiver” means a federally approved Medicaid waiver
  401  program, including, but not limited to, the Developmental
  402  Disabilities Home and Community-Based Services Waivers Tiers 1
  403  4, the Developmental Disabilities Individual Budget Waiver, and
  404  the Consumer-Directed Care Plus Program, authorized pursuant to
  405  s. 409.906 and administered by the agency to provide home and
  406  community-based services to clients.
  407         Section 3. Subsections (1) and (6) of section 393.065,
  408  Florida Statutes, are amended to read:
  409         393.065 Application and eligibility determination.—
  410         (1) Application for services shall be made, in writing, to
  411  the agency, in the service area in which the applicant resides.
  412  The agency shall review each applicant for eligibility within 45
  413  days after the date the application is signed for children under
  414  6 years of age and within 60 days after the date the application
  415  is signed for all other applicants. If When necessary to
  416  definitively identify individual conditions or needs, the agency
  417  shall provide a comprehensive assessment. Eligibility is limited
  418  to United States citizens and to qualified noncitizens who meet
  419  the criteria provided in s. 414.095(3), and who have established
  420  domicile in Florida pursuant to s. 222.17 or are otherwise
  421  determined to be legal residents of this state. Only applicants
  422  whose domicile is in Florida are eligible for services.
  423  Information accumulated by other agencies, including
  424  professional reports and collateral data, shall be considered if
  425  in this process when available.
  426         (6) The client, the client’s guardian, or the client’s
  427  family must ensure that accurate, up-to-date contact information
  428  is provided to the agency at all times. The agency shall remove
  429  from the wait list an any individual who cannot be located using
  430  the contact information provided to the agency, fails to meet
  431  eligibility requirements, or no longer qualifies as a legal
  432  resident of this state becomes domiciled outside the state.
  433         Section 4. Section 393.066, Florida Statutes, is amended to
  434  read:
  435         393.066 Community services and treatment.—
  436         (1) The agency shall plan, develop, organize, and implement
  437  its programs of services and treatment for individuals who have
  438  persons with developmental disabilities in order to assist them
  439  in living allow clients to live as independently as possible in
  440  their own homes or communities, to support them in maximizing
  441  their independence using innovative, effective, efficient, and
  442  sustainable solutions, and to avoid institutionalization and to
  443  achieve productive lives as close to normal as possible. All
  444  elements of community-based services shall be made available,
  445  and eligibility for these services shall be consistent across
  446  the state.
  447         (2) All Services that are not available through nonwaiver
  448  resources or not donated needed shall be purchased instead of
  449  provided directly by the agency if, when such arrangement is
  450  more cost-efficient than having those services provided
  451  directly. All purchased services must be approved by the agency.
  452  Authorization for such services is dependent on the availability
  453  of agency funding.
  454         (3) Community Community-based services that are medically
  455  necessary to prevent client institutionalization must be
  456  provided in the most cost-effective manner to the extent of the
  457  availability of agency resources as specified in the General
  458  Appropriations Act. These services may shall, to the extent of
  459  available resources, include:
  460         (a) Adult day training and adult day services.
  461         (b) Family care services.
  462         (c) Guardian advocate referral services.
  463         (d) Medical/dental services, except that medical services
  464  shall not be provided to clients with spina bifida except as
  465  specifically appropriated by the Legislature.
  466         (e) Parent training.
  467         (e)(f) Personal care services.
  468         (g) Recreation.
  469         (f)(h) Residential habilitation facility services.
  470         (g)(i) Respite services.
  471         (h)(j)Support coordination Social services.
  472         (i)(k) Specialized therapies.
  473         (j)(l) Supported employment.
  474         (k)(m) Supported living.
  475         (l)(n) Training, including behavioral analysis services.
  476         (m)(o) Transportation.
  477         (n)(p) Other habilitative and rehabilitative services as
  478  needed.
  479         (4) The agency or the agency’s agents shall identify and
  480  engage in efforts to develop, increase, or enhance the
  481  availability of nonwaiver resources to individuals who have
  482  developmental disabilities. The agency shall promote
  483  partnerships and collaborative efforts with families and
  484  organizations, such as nonprofit agencies, foundations, places
  485  of worship, schools, community organizations and clubs,
  486  businesses, local governments, and state and federal agencies.
  487  The agency shall implement policies and procedures that
  488  establish waivers as the payor of last resort for home and
  489  community-based services and supports shall utilize the services
  490  of private businesses, not-for-profit organizations, and units
  491  of local government whenever such services are more cost
  492  efficient than such services provided directly by the
  493  department, including arrangements for provision of residential
  494  facilities.
  495         (5) In order to improve the potential for utilization of
  496  more cost-effective, community-based residential facilities, the
  497  agency shall promote the statewide development of day
  498  habilitation services for clients who live with a direct service
  499  provider in a community-based residential facility and who do
  500  not require 24-hour-a-day care in a hospital or other health
  501  care institution, but who may, in the absence of day
  502  habilitation services, require admission to a developmental
  503  disabilities center. Each day service facility shall provide a
  504  protective physical environment for clients, ensure that direct
  505  service providers meet minimum screening standards as required
  506  in s. 393.0655, make available to all day habilitation service
  507  participants at least one meal on each day of operation, provide
  508  facilities to enable participants to obtain needed rest while
  509  attending the program, as appropriate, and provide social and
  510  educational activities designed to stimulate interest and
  511  provide socialization skills.
  512         (5)(6) To promote independence and productivity, the agency
  513  shall provide supports and services, within available resources,
  514  to assist clients enrolled in Medicaid waivers who choose to
  515  pursue gainful employment.
  516         (6)(7) For the purpose of making needed community-based
  517  residential facilities available at the least possible cost to
  518  the state, the agency may is authorized to lease privately owned
  519  residential facilities under long-term rental agreements, if
  520  such rental agreements are projected to be less costly to the
  521  state over the useful life of the facility than state purchase
  522  or state construction of such a facility.
  523         (7)(8) The agency may adopt rules providing definitions,
  524  eligibility criteria, and procedures for the purchase of
  525  services provided pursuant to this section.
  526         Section 5. Section 393.0661, Florida Statutes, is amended
  527  to read:
  528         393.0661 Home and community-based services delivery system;
  529  comprehensive redesign.—The Legislature finds that the home and
  530  community-based services delivery system for individuals who
  531  have persons with developmental disabilities and the
  532  availability of appropriated funds are two of the critical
  533  elements in making services available. Therefore, it is the
  534  intent of the Legislature that the Agency for Persons with
  535  Disabilities shall develop and implement a comprehensive
  536  redesign of the system.
  537         (1) The redesign of the home and community-based services
  538  system must shall include, at a minimum, all actions necessary
  539  to achieve an appropriate rate structure, client choice within a
  540  specified service package, appropriate assessment strategies, an
  541  efficient billing process that contains reconciliation and
  542  monitoring components, and a redefined role for support
  543  coordinators which that avoids conflicts of interest and ensures
  544  that the client’s needs for critical services are addressed
  545  potential conflicts of interest and ensures that family/client
  546  budgets are linked to levels of need.
  547         (a) The agency shall use the Questionnaire for Situational
  548  Information, or other an assessment instruments deemed by
  549  instrument that the agency deems to be reliable and valid,
  550  including, but not limited to, the Department of Children and
  551  Family Services’ Individual Cost Guidelines or the agency’s
  552  Questionnaire for Situational Information. The agency may
  553  contract with an external vendor or may use support coordinators
  554  to complete client assessments if it develops sufficient
  555  safeguards and training to ensure ongoing inter-rater
  556  reliability.
  557         (b) The agency, with the concurrence of the Agency for
  558  Health Care Administration, may contract for the determination
  559  of medical necessity and establishment of individual budgets.
  560         (2) A provider of services rendered to persons with
  561  developmental disabilities pursuant to a federally approved
  562  waiver shall be reimbursed according to a rate methodology based
  563  upon an analysis of the expenditure history and prospective
  564  costs of providers participating in the waiver program, or under
  565  any other methodology developed by the Agency for Health Care
  566  Administration, in consultation with the agency for Persons with
  567  Disabilities, and approved by the Federal Government in
  568  accordance with the waiver.
  569         (3) The Agency for Health Care Administration, in
  570  consultation with the agency, shall seek federal approval and
  571  implement a four-tiered waiver system to serve eligible clients
  572  through the developmental disabilities and family and supported
  573  living waivers. For the purpose of the this waiver program,
  574  eligible clients shall include individuals who have with a
  575  diagnosis of Down syndrome or a developmental disability as
  576  defined in s. 393.063. The agency shall assign all clients
  577  receiving services through the developmental disabilities waiver
  578  to a tier based on the Department of Children and Family
  579  Services’ Individual Cost Guidelines, the agency’s Questionnaire
  580  for Situational Information, or another such assessment
  581  instrument deemed to be valid and reliable by the agency; client
  582  characteristics, including, but not limited to, age; and other
  583  appropriate assessment methods. Final determination of tier
  584  eligibility may not be made until a waiver slot and funding
  585  become available and only then may the client be enrolled in the
  586  appropriate tier. If a client is later determined eligible for a
  587  higher tier, assignment to the higher tier must be based on
  588  crisis criteria as adopted by rule. The agency may also later
  589  move a client to a lower tier if the client’s service needs
  590  change and can be met by services provided in a lower tier. The
  591  agency may not authorize the provision of services that are
  592  duplicated by, or above the coverage limits of, the Medicaid
  593  state plan.
  594         (a) Tier one is limited to clients who have intensive
  595  medical or adaptive service needs that cannot be met in tier
  596  two, three, or four for intensive medical or adaptive needs and
  597  that are essential for avoiding institutionalization, or who
  598  possess behavioral problems that are exceptional in intensity,
  599  duration, or frequency and present a substantial risk of harm to
  600  themselves or others. Total annual expenditures under tier one
  601  may not exceed $150,000 per client each year, provided that
  602  expenditures for clients in tier one with a documented medical
  603  necessity requiring intensive behavioral residential
  604  habilitation services, intensive behavioral residential
  605  habilitation services with medical needs, or special medical
  606  home care, as provided in the Developmental Disabilities Waiver
  607  Services Coverage and Limitations Handbook, are not subject to
  608  the $150,000 limit on annual expenditures.
  609         (b) Tier two is limited to clients whose service needs
  610  include a licensed residential facility and who are authorized
  611  to receive a moderate level of support for standard residential
  612  habilitation services or a minimal level of support for behavior
  613  focus residential habilitation services, or clients in supported
  614  living who receive more than 6 hours a day of in-home support
  615  services. Tier two also includes clients whose need for
  616  authorized services meets the criteria for tier one but which
  617  can be met within the expenditure limit of tier two. Total
  618  annual expenditures under tier two may not exceed $53,625 per
  619  client each year.
  620         (c) Tier three includes, but is not limited to, clients
  621  requiring residential placements, clients in independent or
  622  supported living situations, and clients who live in their
  623  family home. Tier three also includes clients whose need for
  624  authorized services meet the criteria for tiers one or two but
  625  which can be met within the expenditure limit of tier three.
  626  Total annual expenditures under tier three may not exceed
  627  $34,125 per client each year.
  628         (d) Tier four includes clients individuals who were
  629  enrolled in the family and supported living waiver on July 1,
  630  2007, who were shall be assigned to this tier without the
  631  assessments required by this section. Tier four also includes,
  632  but is not limited to, clients in independent or supported
  633  living situations and clients who live in their family home.
  634  Total annual expenditures under tier four may not exceed $14,422
  635  per client each year.
  636         (e) The Agency for Health Care Administration shall also
  637  seek federal approval to provide a consumer-directed option for
  638  clients persons with developmental disabilities which
  639  corresponds to the funding levels in each of the waiver tiers.
  640  The agency shall implement the four-tiered waiver system
  641  beginning with tiers one, three, and four and followed by tier
  642  two. The agency and the Agency for Health Care Administration
  643  may adopt rules necessary to administer this subsection.
  644         (f) The agency shall seek federal waivers and amend
  645  contracts as necessary to make changes to services defined in
  646  federal waiver programs administered by the agency as follows:
  647         1. Supported living coaching services may not exceed 20
  648  hours per month for clients persons who also receive in-home
  649  support services.
  650         2. Limited support coordination services is the only type
  651  of support coordination service that may be provided to clients
  652  persons under the age of 18 who live in the family home.
  653         3. Personal care assistance services are limited to 180
  654  hours per calendar month and may not include rate modifiers.
  655  Additional hours may be authorized for clients persons who have
  656  intensive physical, medical, or adaptive needs if such hours are
  657  essential for avoiding institutionalization.
  658         4. Residential habilitation services are limited to 8 hours
  659  per day. Additional hours may be authorized for clients persons
  660  who have intensive medical or adaptive needs and if such hours
  661  are essential for avoiding institutionalization, or for clients
  662  persons who possess behavioral problems that are exceptional in
  663  intensity, duration, or frequency and present a substantial risk
  664  of harming themselves or others. This restriction shall be in
  665  effect until the four-tiered waiver system is fully implemented.
  666         5. Chore services, nonresidential support services, and
  667  homemaker services are eliminated. The agency shall expand the
  668  definition of in-home support services to allow the service
  669  provider to include activities previously provided in these
  670  eliminated services.
  671         6. Massage therapy, medication review, and psychological
  672  assessment services are eliminated.
  673         5.7. The agency shall conduct supplemental cost plan
  674  reviews to verify the medical necessity of authorized services
  675  for plans that have increased by more than 8 percent during
  676  either of the 2 preceding fiscal years.
  677         6.8. The agency shall implement a consolidated residential
  678  habilitation rate structure to increase savings to the state
  679  through a more cost-effective payment method and establish
  680  uniform rates for intensive behavioral residential habilitation
  681  services.
  682         9. Pending federal approval, the agency may extend current
  683  support plans for clients receiving services under Medicaid
  684  waivers for 1 year beginning July 1, 2007, or from the date
  685  approved, whichever is later. Clients who have a substantial
  686  change in circumstances which threatens their health and safety
  687  may be reassessed during this year in order to determine the
  688  necessity for a change in their support plan.
  689         7.10. The agency shall develop a plan to eliminate
  690  redundancies and duplications between in-home support services,
  691  companion services, personal care services, and supported living
  692  coaching by limiting or consolidating such services.
  693         8.11. The agency shall develop a plan to reduce the
  694  intensity and frequency of supported employment services to
  695  clients in stable employment situations who have a documented
  696  history of at least 3 years’ employment with the same company or
  697  in the same industry.
  698         (g) The agency and the Agency for Health Care
  699  Administration may adopt rules as necessary to administer this
  700  subsection.
  701         (4) The geographic differential for Miami-Dade, Broward,
  702  and Palm Beach Counties for residential habilitation services is
  703  shall be 7.5 percent.
  704         (5) The geographic differential for Monroe County for
  705  residential habilitation services is shall be 20 percent.
  706         (6) Effective January 1, 2010, and except as otherwise
  707  provided in this section, a client served by the home and
  708  community-based services waiver or the family and supported
  709  living waiver funded through the agency shall have his or her
  710  cost plan adjusted to reflect the amount of expenditures for the
  711  previous state fiscal year plus 5 percent if such amount is less
  712  than the client’s existing cost plan. The agency shall use
  713  actual paid claims for services provided during the previous
  714  fiscal year that are submitted by October 31 to calculate the
  715  revised cost plan amount. If the client was not served for the
  716  entire previous state fiscal year or there was any single change
  717  in the cost plan amount of more than 5 percent during the
  718  previous state fiscal year, the agency shall set the cost plan
  719  amount at an estimated annualized expenditure amount plus 5
  720  percent. The agency shall estimate the annualized expenditure
  721  amount by calculating the average of monthly expenditures,
  722  beginning in the fourth month after the client enrolled,
  723  interrupted services are resumed, or the cost plan was changed
  724  by more than 5 percent and ending on August 31, 2009, and
  725  multiplying the average by 12. In order to determine whether a
  726  client was not served for the entire year, the agency shall
  727  include any interruption of a waiver-funded service or services
  728  lasting at least 18 days. If at least 3 months of actual
  729  expenditure data are not available to estimate annualized
  730  expenditures, the agency may not rebase a cost plan pursuant to
  731  this subsection. The agency may not rebase the cost plan of any
  732  client who experiences a significant change in recipient
  733  condition or circumstance which results in a change of more than
  734  5 percent to his or her cost plan between July 1 and the date
  735  that a rebased cost plan would take effect pursuant to this
  736  subsection.
  737         (6)(7) The agency shall collect premiums, fees, or other
  738  cost sharing from the parents of children being served by the
  739  agency through a waiver pursuant to s. 409.906(13)(d).
  740         (7) In determining whether to continue a Medicaid waiver
  741  provider agreement for support coordinator services, the agency
  742  shall review waiver support coordination performance to ensure
  743  that the support coordinator meets or exceeds the criteria
  744  established by the agency. The support coordinator is
  745  responsible for assisting the client in meeting his or her
  746  service needs through nonwaiver resources, as well as through
  747  the client’s budget allocation or cost plan under the waiver.
  748  The waiver is the funding source of last resort for client
  749  services. The waiver support coordinator provider agreements and
  750  performance reviews shall be conducted and managed by the
  751  agency’s area offices.
  752         (a) Criteria for evaluating support coordinator performance
  753  must include, but is not limited to:
  754         1. The protection of the health and safety of clients.
  755         2. Assisting clients to obtain employment and pursue other
  756  meaningful activities.
  757         3. Assisting clients to access services that allow them to
  758  live in their community.
  759         4. The use of family resources.
  760         5. The use of private resources.
  761         6. The use of community resources.
  762         7. The use of charitable resources.
  763         8. The use of volunteer resources.
  764         9. The use of services from other governmental entities.
  765         10. The overall outcome in securing nonwaiver resources.
  766         11. The cost-effective use of waiver resources.
  767         12. Coordinating all available resources to ensure that
  768  clients’ outcomes are met.
  769         (b) The agency may recognize consistently superior
  770  performance by exempting a waiver support coordinator from
  771  annual quality assurance reviews or other mechanisms established
  772  by the agency. The agency may issue sanctions for poor
  773  performance, including, but not limited to, a reduction in
  774  caseload size, recoupment or other financial penalties, and
  775  termination of the waiver support coordinator’s provider
  776  agreement. The agency may adopt rules to administer this
  777  subsection.
  778         (8) This section or related rule does not prevent or limit
  779  the Agency for Health Care Administration, in consultation with
  780  the agency for Persons with Disabilities, from adjusting fees,
  781  reimbursement rates, lengths of stay, number of visits, or
  782  number of services, or from limiting enrollment, or making any
  783  other adjustment necessary to comply with the availability of
  784  moneys and any limitations or directions provided in the General
  785  Appropriations Act.
  786         (9) The agency for Persons with Disabilities shall submit
  787  quarterly status reports to the Executive Office of the Governor
  788  and, the chairs of the legislative appropriations committees
  789  chair of the Senate Ways and Means Committee or its successor,
  790  and the chair of the House Fiscal Council or its successor
  791  regarding the financial status of waiver home and community
  792  based services, including the number of enrolled individuals who
  793  are receiving services through one or more programs; the number
  794  of individuals who have requested services who are not enrolled
  795  but who are receiving services through one or more programs,
  796  including with a description indicating the programs from which
  797  the individual is receiving services; the number of individuals
  798  who have refused an offer of services but who choose to remain
  799  on the list of individuals waiting for services; the number of
  800  individuals who have requested services but are not who are
  801  receiving no services; a frequency distribution indicating the
  802  length of time individuals have been waiting for services; and
  803  information concerning the actual and projected costs compared
  804  to the amount of the appropriation available to the program and
  805  any projected surpluses or deficits. If at any time an analysis
  806  by the agency, in consultation with the Agency for Health Care
  807  Administration, indicates that the cost of services is expected
  808  to exceed the amount appropriated, the agency shall submit a
  809  plan in accordance with subsection (8) to the Executive Office
  810  of the Governor and the chairs of the legislative appropriations
  811  committees, the chair of the Senate Ways and Means Committee or
  812  its successor, and the chair of the House Fiscal Council or its
  813  successor to remain within the amount appropriated. The agency
  814  shall work with the Agency for Health Care Administration to
  815  implement the plan so as to remain within the appropriation.
  816         (10) Implementation of Medicaid waiver programs and
  817  services authorized under this chapter is limited by the funds
  818  appropriated for the individual budgets pursuant to s. 393.0662
  819  and the four-tiered waiver system pursuant to subsection (3).
  820  Contracts with independent support coordinators and service
  821  providers must include provisions requiring compliance with
  822  agency cost containment initiatives. The agency shall implement
  823  monitoring and accounting procedures necessary to track actual
  824  expenditures and project future spending compared to available
  825  appropriations for Medicaid waiver programs. If When necessary,
  826  based on projected deficits, the agency shall must establish
  827  specific corrective action plans that incorporate corrective
  828  actions for of contracted providers which that are sufficient to
  829  align program expenditures with annual appropriations. If
  830  deficits continue during the 2012-2013 fiscal year, the agency
  831  in conjunction with the Agency for Health Care Administration
  832  shall develop a plan to redesign the waiver program and submit
  833  the plan to the President of the Senate and the Speaker of the
  834  House of Representatives by September 30, 2013. At a minimum,
  835  the plan must include the following elements:
  836         (a) Budget predictability.—Agency budget recommendations
  837  must include specific steps to restrict spending to budgeted
  838  amounts based on alternatives to the iBudget and four-tiered
  839  Medicaid waiver models.
  840         (b) Services.—The agency shall identify core services that
  841  are essential to provide for client health and safety and
  842  recommend the elimination of coverage for other services that
  843  are not affordable based on available resources.
  844         (c) Flexibility.—The redesign must shall be responsive to
  845  individual needs and to the extent possible encourage client
  846  control over allocated resources for their needs.
  847         (d) Support coordination services.—The plan must shall
  848  modify the manner of providing support coordination services to
  849  improve management of service utilization and increase
  850  accountability and responsiveness to agency priorities.
  851         (e) Reporting.—The agency shall provide monthly reports to
  852  the President of the Senate and the Speaker of the House of
  853  Representatives on plan progress and development on July 31,
  854  2013, and August 31, 2013.
  855         (f) Implementation.—The implementation of a redesigned
  856  program is subject to legislative approval and must shall occur
  857  by no later than July 1, 2014. The Agency for Health Care
  858  Administration shall seek federal waivers as needed to implement
  859  the redesigned plan approved by the Legislature.
  860         Section 6. Section 393.0662, Florida Statutes, is amended
  861  to read:
  862         393.0662 Individual budgets for delivery of home and
  863  community-based services; iBudget system established.—The
  864  Legislature finds that improved financial management of the
  865  existing home and community-based Medicaid waiver program is
  866  necessary to avoid deficits that impede the provision of
  867  services to individuals who are on the waiting list for
  868  enrollment in the program. The Legislature further finds that
  869  clients and their families should have greater flexibility to
  870  choose the services that best allow them to live in their
  871  community within the limits of an established budget. Therefore,
  872  the Legislature intends that the agency, in consultation with
  873  the Agency for Health Care Administration, develop and implement
  874  a comprehensive redesign of the service delivery system using
  875  individual budgets as the basis for allocating the funds
  876  appropriated for the home and community-based services Medicaid
  877  waiver program among eligible enrolled clients. The service
  878  delivery system that uses individual budgets shall be called the
  879  iBudget system.
  880         (1) The agency shall establish an individual budget, to be
  881  referred to as an iBudget, for each client individual served by
  882  the home and community-based services Medicaid waiver program.
  883  The funds appropriated to the agency shall be allocated through
  884  the iBudget system to eligible, Medicaid-enrolled clients who
  885  have. For the iBudget system, Eligible clients shall include
  886  individuals with a diagnosis of Down syndrome or a developmental
  887  disability as defined in s. 393.063. The iBudget system shall be
  888  designed to provide for: enhanced client choice within a
  889  specified service package; appropriate assessment strategies; an
  890  efficient consumer budgeting and billing process that includes
  891  reconciliation and monitoring components; a redefined role for
  892  support coordinators which that avoids potential conflicts of
  893  interest; a flexible and streamlined service review process; and
  894  a methodology and process that ensures the equitable allocation
  895  of available funds to each client based on the client’s level of
  896  need, as determined by the variables in the allocation
  897  algorithm.
  898         (2)(a) In developing each client’s iBudget, the agency
  899  shall use an allocation algorithm and methodology.
  900         (a) The algorithm shall use variables that have been
  901  determined by the agency to have a statistically validated
  902  relationship to the client’s level of need for services provided
  903  through the home and community-based services Medicaid waiver
  904  program. The algorithm and methodology may consider individual
  905  characteristics, including, but not limited to, a client’s age
  906  and living situation, information from a formal assessment
  907  instrument that the agency determines is valid and reliable, and
  908  information from other assessment processes.
  909         (b) The allocation methodology shall provide the algorithm
  910  that determines the amount of funds allocated to a client’s
  911  iBudget. The agency may approve an increase in the amount of
  912  funds allocated, as determined by the algorithm, based on the
  913  client having one or more of the following needs that cannot be
  914  accommodated within the funding as determined by the algorithm
  915  allocation and having no other resources, supports, or services
  916  available to meet such needs the need:
  917         1. An extraordinary need that would place the health and
  918  safety of the client, the client’s caregiver, or the public in
  919  immediate, serious jeopardy unless the increase is approved. An
  920  extraordinary need may include, but is not limited to:
  921         a. A documented history of significant, potentially life
  922  threatening behaviors, such as recent attempts at suicide,
  923  arson, nonconsensual sexual behavior, or self-injurious behavior
  924  requiring medical attention;
  925         b. A complex medical condition that requires active
  926  intervention by a licensed nurse on an ongoing basis that cannot
  927  be taught or delegated to a nonlicensed person;
  928         c. A chronic comorbid condition. As used in this
  929  subparagraph, the term “comorbid condition” means a medical
  930  condition existing simultaneously but independently with another
  931  medical condition in a patient; or
  932         d. A need for total physical assistance with activities
  933  such as eating, bathing, toileting, grooming, and personal
  934  hygiene.
  936  However, the presence of an extraordinary need alone does not
  937  warrant an increase in the amount of funds allocated to a
  938  client’s iBudget as determined by the algorithm.
  939         2. A significant need for one-time or temporary support or
  940  services that, if not provided, would place the health and
  941  safety of the client, the client’s caregiver, or the public in
  942  serious jeopardy, unless the increase is approved. A significant
  943  need may include, but is not limited to, the provision of
  944  environmental modifications, durable medical equipment, services
  945  to address the temporary loss of support from a caregiver, or
  946  special services or treatment for a serious temporary condition
  947  when the service or treatment is expected to ameliorate the
  948  underlying condition. As used in this subparagraph, the term
  949  “temporary” means less a period of fewer than 12 continuous
  950  months. However, the presence of such significant need for one
  951  time or temporary supports or services alone does not warrant an
  952  increase in the amount of funds allocated to a client’s iBudget
  953  as determined by the algorithm.
  954         3. A significant increase in the need for services after
  955  the beginning of the service plan year which that would place
  956  the health and safety of the client, the client’s caregiver, or
  957  the public in serious jeopardy because of substantial changes in
  958  the client’s circumstances, including, but not limited to,
  959  permanent or long-term loss or incapacity of a caregiver, loss
  960  of services authorized under the state Medicaid plan due to a
  961  change in age, or a significant change in medical or functional
  962  status which requires the provision of additional services on a
  963  permanent or long-term basis which that cannot be accommodated
  964  within the client’s current iBudget. As used in this
  965  subparagraph, the term “long-term” means a period of 12 or more
  966  continuous months. However, such significant increase in need
  967  for services of a permanent or long-term nature alone does not
  968  warrant an increase in the amount of funds allocated to a
  969  client’s iBudget as determined by the algorithm.
  971  The agency shall reserve portions of the appropriation for the
  972  home and community-based services Medicaid waiver program for
  973  adjustments required pursuant to this paragraph and may use the
  974  services of an independent actuary in determining the amount of
  975  the portions to be reserved.
  976         (c) A client’s iBudget shall be the total of the amount
  977  determined by the algorithm and any additional funding provided
  978  pursuant to paragraph (b).
  979         (d) A client shall have the flexibility to determine the
  980  type, amount, frequency, duration, and scope of the services on
  981  his or her cost plan if the agency determines that such services
  982  meet his or her health and safety needs, meet the requirements
  983  contained in the Coverage and Limitations Handbook for each
  984  service included on the cost plan, and comply with the other
  985  requirements of this section.
  986         (e) A client’s annual expenditures for home and community
  987  based services Medicaid waiver services may not exceed the
  988  limits of his or her iBudget. The total of all clients’
  989  projected annual iBudget expenditures may not exceed the
  990  agency’s appropriation for waiver services.
  991         (3)(2) The Agency for Health Care Administration, in
  992  consultation with the agency, shall seek federal approval to
  993  amend current waivers, request a new waiver, and amend contracts
  994  as necessary to implement the iBudget system to serve eligible,
  995  enrolled clients through the home and community-based services
  996  Medicaid waiver program and the Consumer-Directed Care Plus
  997  Program.
  998         (4)(3) The agency shall transition all eligible, enrolled
  999  clients to the iBudget system. The agency may gradually phase in
 1000  the iBudget system.
 1001         (a) During the transition, the agency shall determine an
 1002  individual’s initial iBudget by comparing the individual’s
 1003  algorithm allocation to the individual’s current annual cost
 1004  plan and the individual’s extraordinary needs. The individual’s
 1005  algorithm allocation shall be the amount determined by the
 1006  algorithm, adjusted to the agency’s appropriation and any set
 1007  asides determined necessary by the agency, including, but not
 1008  limited to, funding for individuals who have extraordinary needs
 1009  as delineated in paragraph (2)(b). The amount of funding needed
 1010  to address the individual’s extraordinary needs shall be
 1011  reviewed for each individual by the area office in order to
 1012  determine medical necessity for each service in the amount,
 1013  duration, frequency, intensity, and scope that meets the
 1014  individual’s needs. The agency shall consider the individual’s
 1015  characteristics based on a needs assessment as well as the
 1016  individual’s living setting, availability of natural supports,
 1017  family circumstances, and other factors that may affect the
 1018  level of service needed.
 1019         (b) The individual’s medical-necessity review must include
 1020  a comparison of the following:
 1021         1. If the individual’s algorithm allocation is greater than
 1022  the individual cost plan, the individual’s initial iBudget shall
 1023  be equal to the total cost plan amount.
 1024         2. If the individual’s algorithm allocation is less than
 1025  the individual’s cost plan but is greater than the amount for
 1026  the individual’s extraordinary needs, the individual’s initial
 1027  iBudget shall be equal to the algorithm allocation.
 1028         3. If the individual’s algorithm allocation is less than
 1029  the amount for the individual’s extraordinary needs, the
 1030  individual’s initial iBudget shall be equal to the amount for
 1031  the individual’s extraordinary needs.
 1033  The individuals initial annualized iBudget amount may not be
 1034  less than 50 percent of that individual’s existing annualized
 1035  cost plan. If the individual’s initial iBudget is less than the
 1036  individual’s current cost plan, and is within $1,000 of the
 1037  current cost plan, the agency may adjust the iBudget to equal
 1038  the cost plan amount.
 1039         (c) During the 2011-2012 and 2012-2013 fiscal years,
 1040  increases to an individual’s initial iBudget amount may be
 1041  granted only if a significant change in circumstances has
 1042  occurred and if the criteria for extraordinary needs as
 1043  described above are met.
 1044         (d)(a) While the agency phases in the iBudget system, the
 1045  agency may continue to serve eligible, enrolled clients under
 1046  the four-tiered waiver system established under s. 393.065 while
 1047  those clients await transitioning to the iBudget system.
 1048         (b) The agency shall design the phase-in process to ensure
 1049  that a client does not experience more than one-half of any
 1050  expected overall increase or decrease to his or her existing
 1051  annualized cost plan during the first year that the client is
 1052  provided an iBudget due solely to the transition to the iBudget
 1053  system.
 1054         (5)(4) A client must use all available nonwaiver services
 1055  authorized under the state Medicaid plan, school-based services,
 1056  private insurance and other benefits, and any other resources
 1057  that may be available to the client before using funds from his
 1058  or her iBudget to pay for support and services.
 1059         (6)(5) The service limitations in s. 393.0661(3)(f)1., 2.,
 1060  and 3. do not apply to the iBudget system.
 1061         (7)(6) Rates for any or all services established under
 1062  rules of the Agency for Health Care Administration must shall be
 1063  designated as the maximum rather than a fixed amount for clients
 1064  individuals who receive an iBudget, except for services
 1065  specifically identified in those rules that the agency
 1066  determines are not appropriate for negotiation, which may
 1067  include, but are not limited to, residential habilitation
 1068  services.
 1069         (8)(7) The agency must shall ensure that clients and
 1070  caregivers have access to training and education that informs to
 1071  inform them about the iBudget system and enhances enhance their
 1072  ability for self-direction. Such training must be provided shall
 1073  be offered in a variety of formats and, at a minimum, must shall
 1074  address the policies and processes of the iBudget system; the
 1075  roles and responsibilities of consumers, caregivers, waiver
 1076  support coordinators, providers, and the agency; information
 1077  that is available to help the client make decisions regarding
 1078  the iBudget system; and examples of nonwaiver support and
 1079  resources that may be available in the community.
 1080         (9)(8) The agency shall collect data to evaluate the
 1081  implementation and outcomes of the iBudget system.
 1082         (10)(9) The agency and the Agency for Health Care
 1083  Administration may adopt rules specifying the allocation
 1084  algorithm and methodology; criteria and processes that allow for
 1085  clients to access reserved funds for extraordinary needs,
 1086  temporarily or permanently changed needs, and one-time needs;
 1087  and processes and requirements for the selection and review of
 1088  services, development of support and cost plans, and management
 1089  of the iBudget system as needed to administer this section.
 1090         Section 7. Subsection (2) of section 393.067, Florida
 1091  Statutes, is amended to read:
 1092         393.067 Facility licensure.—
 1093         (2) The agency shall conduct annual inspections and reviews
 1094  of facilities and programs licensed under this section unless
 1095  the facility or program is currently accredited by the Joint
 1096  Commission, the Commission on Accreditation of Rehabilitation
 1097  Facilities, or the Council on Accreditation. Facilities or
 1098  programs that are operating under such accreditation must be
 1099  inspected and reviewed by the agency once every 2 years. If,
 1100  upon inspection and review, the services and service delivery
 1101  sites are not those for which the facility or program is
 1102  accredited, the facilities and programs must be inspected and
 1103  reviewed in accordance with this section and related rules
 1104  adopted by the agency. Notwithstanding current accreditation,
 1105  the agency may continue to monitor the facility or program as
 1106  necessary with respect to:
 1107         (a) Ensuring that services for which the agency is paying
 1108  are being provided.
 1109         (b) Investigating complaints, identifying problems that
 1110  would affect the safety or viability of the facility or program,
 1111  and monitoring the facility or program’s compliance with any
 1112  resulting negotiated terms and conditions, including provisions
 1113  relating to consent decrees which are unique to a specific
 1114  service and are not statements of general applicability.
 1115         (c) Ensuring compliance with federal and state laws,
 1116  federal regulations, or state rules if such monitoring does not
 1117  duplicate the accrediting organization’s review pursuant to
 1118  accreditation standards.
 1119         (d) Ensuring Medicaid compliance with federal certification
 1120  and precertification review requirements.
 1121         Section 8. Subsections (2) and (4) of section 393.068,
 1122  Florida Statutes, are amended to read:
 1123         393.068 Family care program.—
 1124         (2) Services and support authorized under the family care
 1125  program shall, to the extent of available resources, include the
 1126  services listed under s. 393.0662(4) 393.066 and, in addition,
 1127  shall include, but not be limited to:
 1128         (a) Attendant care.
 1129         (b) Barrier-free modifications to the home.
 1130         (c) Home visitation by agency workers.
 1131         (d) In-home subsidies.
 1132         (e) Low-interest loans.
 1133         (f) Modifications for vehicles used to transport the
 1134  individual with a developmental disability.
 1135         (g) Facilitated communication.
 1136         (h) Family counseling.
 1137         (i) Equipment and supplies.
 1138         (j) Self-advocacy training.
 1139         (k) Roommate services.
 1140         (l) Integrated community activities.
 1141         (m) Emergency services.
 1142         (n) Support coordination.
 1143         (o) Other support services as identified by the family or
 1144  client individual.
 1145         (4) All existing nonwaiver community resources available to
 1146  the client must be used shall be utilized to support program
 1147  objectives. Additional services may be incorporated into the
 1148  program as appropriate and to the extent that resources are
 1149  available. The agency may is authorized to accept gifts and
 1150  grants in order to carry out the program.
 1151         Section 9. Subsections (1) through (3), paragraph (b) of
 1152  subsection (4), paragraphs (f) and (g) of subsection (5),
 1153  subsection (6), paragraphs (d) and (e) of subsection (7), and
 1154  paragraph (b) of subsection (12) of section 393.11, Florida
 1155  Statutes, are amended to read:
 1156         393.11 Involuntary admission to residential services.—
 1157         (1) JURISDICTION.—If When a person is determined to be
 1158  eligible to receive services from the agency mentally retarded
 1159  and requires involuntary admission to residential services
 1160  provided by the agency, the circuit court of the county in which
 1161  the person resides shall have jurisdiction to conduct a hearing
 1162  and enter an order involuntarily admitting the person in order
 1163  for that the person to may receive the care, treatment,
 1164  habilitation, and rehabilitation that he or she which the person
 1165  needs. For the purpose of identifying mental retardation or
 1166  autism, diagnostic capability shall be established by the
 1167  agency. Except as otherwise specified, the proceedings under
 1168  this section are shall be governed by the Florida Rules of Civil
 1169  Procedure.
 1170         (2) PETITION.—
 1171         (a) A petition for involuntary admission to residential
 1172  services may be executed by a petitioning commission or the
 1173  agency.
 1174         (b) The petitioning commission shall consist of three
 1175  persons. One of whom these persons shall be a physician licensed
 1176  and practicing under chapter 458 or chapter 459.
 1177         (c) The petition shall be verified and shall:
 1178         1. State the name, age, and present address of the
 1179  commissioners and their relationship to the person who is the
 1180  subject of the petition with mental retardation or autism;
 1181         2. State the name, age, county of residence, and present
 1182  address of the person who is the subject of the petition with
 1183  mental retardation or autism;
 1184         3. Allege that the commission believes that the person
 1185  needs involuntary residential services and specify the factual
 1186  information on which the belief is based;
 1187         4. Allege that the person lacks sufficient capacity to give
 1188  express and informed consent to a voluntary application for
 1189  services and lacks the basic survival and self-care skills to
 1190  provide for the person’s well-being or is likely to physically
 1191  injure others if allowed to remain at liberty; and
 1192         5. State which residential setting is the least restrictive
 1193  and most appropriate alternative and specify the factual
 1194  information on which the belief is based.
 1195         (d) The petition shall be filed in the circuit court of the
 1196  county in which the person who is the subject of the petition
 1197  with mental retardation or autism resides.
 1198         (3) NOTICE.—
 1199         (a) Notice of the filing of the petition shall be given to
 1200  the defendant individual and his or her legal guardian. The
 1201  notice shall be given both verbally and in writing in the
 1202  language of the defendant client, or in other modes of
 1203  communication of the defendant client, and in English. Notice
 1204  shall also be given to such other persons as the court may
 1205  direct. The petition for involuntary admission to residential
 1206  services shall be served with the notice.
 1207         (b) If Whenever a motion or petition has been filed
 1208  pursuant to s. 916.303 to dismiss criminal charges against a
 1209  defendant with retardation or autism, and a petition is filed to
 1210  involuntarily admit the defendant to residential services under
 1211  this section, the notice of the filing of the petition shall
 1212  also be given to the defendant’s attorney, the state attorney of
 1213  the circuit from which the defendant was committed, and the
 1214  agency.
 1215         (c) The notice shall state that a hearing shall be set to
 1216  inquire into the need of the defendant person with mental
 1217  retardation or autism for involuntary residential services. The
 1218  notice shall also state the date of the hearing on the petition.
 1219         (d) The notice shall state that the defendant individual
 1220  with mental retardation or autism has the right to be
 1221  represented by counsel of his or her own choice and that, if the
 1222  defendant person cannot afford an attorney, the court shall
 1223  appoint one.
 1224         (4) AGENCY PARTICIPATION.—
 1225         (b) Following examination, the agency shall file a written
 1226  report with the court not less than 10 working days before the
 1227  date of the hearing. The report must be served on the
 1228  petitioner, the defendant person with mental retardation, and
 1229  the defendant’s person’s attorney at the time the report is
 1230  filed with the court.
 1231         (5) EXAMINING COMMITTEE.—
 1232         (f) The committee shall file the report with the court not
 1233  less than 10 working days before the date of the hearing. The
 1234  report shall be served on the petitioner, the defendant person
 1235  with mental retardation, the defendant’s person’s attorney at
 1236  the time the report is filed with the court, and the agency.
 1237         (g) Members of the examining committee shall receive a
 1238  reasonable fee to be determined by the court. The fees are to be
 1239  paid from the general revenue fund of the county in which the
 1240  defendant person with mental retardation resided when the
 1241  petition was filed.
 1242         (6) COUNSEL; GUARDIAN AD LITEM.—
 1243         (a) The defendant must person with mental retardation shall
 1244  be represented by counsel at all stages of the judicial
 1245  proceeding. If In the event the defendant person is indigent and
 1246  cannot afford counsel, the court shall appoint a public defender
 1247  not less than 20 working days before the scheduled hearing. The
 1248  defendant’s person’s counsel shall have full access to the
 1249  records of the service provider and the agency. In all cases,
 1250  the attorney shall represent the rights and legal interests of
 1251  the defendant person with mental retardation, regardless of who
 1252  may initiate the proceedings or pay the attorney’s fee.
 1253         (b) If the attorney, during the course of his or her
 1254  representation, reasonably believes that the defendant person
 1255  with mental retardation cannot adequately act in his or her own
 1256  interest, the attorney may seek the appointment of a guardian ad
 1257  litem. A prior finding of incompetency is not required before a
 1258  guardian ad litem is appointed pursuant to this section.
 1259         (7) HEARING.—
 1260         (d) The defendant may person with mental retardation shall
 1261  be physically present throughout all or part of the entire
 1262  proceeding. If the defendant’s person’s attorney or any other
 1263  interested party believes that the person’s presence at the
 1264  hearing is not in the person’s best interest, or good cause is
 1265  otherwise shown, the person’s presence may be waived once the
 1266  court may order that the defendant be excluded from the hearing
 1267  has seen the person and the hearing has commenced.
 1268         (e) The defendant person has the right to present evidence
 1269  and to cross-examine all witnesses and other evidence alleging
 1270  the appropriateness of the person’s admission to residential
 1271  care. Other relevant and material evidence regarding the
 1272  appropriateness of the person’s admission to residential
 1273  services; the most appropriate, least restrictive residential
 1274  placement; and the appropriate care, treatment, and habilitation
 1275  of the person, including written or oral reports, may be
 1276  introduced at the hearing by any interested person.
 1277         (12) APPEAL.—
 1278         (b) The filing of an appeal by the person ordered to be
 1279  involuntarily admitted under this section with mental
 1280  retardation shall stay admission of the person into residential
 1281  care. The stay shall remain in effect during the pendency of all
 1282  review proceedings in Florida courts until a mandate issues.
 1283         Section 10. Paragraph (a) of subsection (1) of section
 1284  393.125, Florida Statutes, is amended to read:
 1285         393.125 Hearing rights.—
 1286         (1) REVIEW OF AGENCY DECISIONS.—
 1287         (a) For Medicaid programs administered by the agency, any
 1288  developmental services applicant or client, or his or her
 1289  parent, guardian advocate, or authorized representative, may
 1290  request a hearing in accordance with federal law and rules
 1291  applicable to Medicaid cases and has the right to request an
 1292  administrative hearing pursuant to ss. 120.569 and 120.57. The
 1293  hearing These hearings shall be provided by the Department of
 1294  Children and Family Services pursuant to s. 409.285 and shall
 1295  follow procedures consistent with federal law and rules
 1296  applicable to Medicaid cases. At the conclusion of the hearing,
 1297  the department shall submit its recommended order to the agency
 1298  as provided in s. 120.57(1)(k) and the agency shall issue final
 1299  orders as provided in s. 120.57(1)(i).
 1300         Section 11. Subsection (1) of section 393.23, Florida
 1301  Statutes, is amended to read:
 1302         393.23 Developmental disabilities centers; trust accounts.
 1303  All receipts from the operation of canteens, vending machines,
 1304  hobby shops, sheltered workshops, activity centers, farming
 1305  projects, and other like activities operated in a developmental
 1306  disabilities center, and moneys donated to the center, must be
 1307  deposited in a trust account in any bank, credit union, or
 1308  savings and loan association authorized by the State Treasury as
 1309  a qualified depository to do business in this state, if the
 1310  moneys are available on demand.
 1311         (1) Moneys in the trust account must be expended for the
 1312  benefit, education, or welfare of clients. However, if
 1313  specified, moneys that are donated to the center must be
 1314  expended in accordance with the intentions of the donor. Trust
 1315  account money may not be used for the benefit of agency
 1316  employees or to pay the wages of such employees. The welfare of
 1317  clients includes the expenditure of funds for the purchase of
 1318  items for resale at canteens or vending machines, and for the
 1319  establishment of, maintenance of, and operation of canteens,
 1320  hobby shops, recreational or entertainment facilities, sheltered
 1321  workshops that include client wages, activity centers, farming
 1322  projects, or other like facilities or programs established at
 1323  the center for the benefit of clients.
 1324         Section 12. Paragraph (b) of subsection (2) of section
 1325  393.502, Florida Statutes, is amended to read:
 1326         393.502 Family care councils.—
 1327         (2) MEMBERSHIP.—
 1328         (b) At least three of the members of the council must be
 1329  individuals receiving or waiting to receive services from the
 1330  agency consumers. One such member shall be an individual a
 1331  consumer who has been receiving received services within the 4
 1332  years before prior to the date of recommendation, or the legal
 1333  guardian of such a consumer. The remainder of the council
 1334  members shall be parents, grandparents, nonpaid full-time
 1335  caregivers, nonpaid legal guardians, or siblings of individual’s
 1336  who have persons with developmental disabilities and who qualify
 1337  for services pursuant to this chapter. A nonpaid full-time
 1338  caregiver or nonpaid legal guardian may not serve at the same
 1339  time as the individual who is receiving care from the caregiver
 1340  or who is the ward of the guardian.
 1341         Section 13. Paragraph (d) of subsection (13) of section
 1342  409.906, Florida Statutes, is amended to read:
 1343         409.906 Optional Medicaid services.—Subject to specific
 1344  appropriations, the agency may make payments for services which
 1345  are optional to the state under Title XIX of the Social Security
 1346  Act and are furnished by Medicaid providers to recipients who
 1347  are determined to be eligible on the dates on which the services
 1348  were provided. Any optional service that is provided shall be
 1349  provided only when medically necessary and in accordance with
 1350  state and federal law. Optional services rendered by providers
 1351  in mobile units to Medicaid recipients may be restricted or
 1352  prohibited by the agency. Nothing in this section shall be
 1353  construed to prevent or limit the agency from adjusting fees,
 1354  reimbursement rates, lengths of stay, number of visits, or
 1355  number of services, or making any other adjustments necessary to
 1356  comply with the availability of moneys and any limitations or
 1357  directions provided for in the General Appropriations Act or
 1358  chapter 216. If necessary to safeguard the state’s systems of
 1359  providing services to elderly and disabled persons and subject
 1360  to the notice and review provisions of s. 216.177, the Governor
 1361  may direct the Agency for Health Care Administration to amend
 1362  the Medicaid state plan to delete the optional Medicaid service
 1363  known as “Intermediate Care Facilities for the Developmentally
 1364  Disabled.” Optional services may include:
 1366         (d) The agency shall request federal approval to develop a
 1367  system to require payment of premiums, fees, or other cost
 1368  sharing by the parents of a child younger than 18 years of age
 1369  who is being served by a waiver under this subsection if the
 1370  adjusted household income is greater than 100 percent of the
 1371  federal poverty level. The amount of the premium, fee, or cost
 1372  sharing shall be calculated using a sliding scale based on the
 1373  size of the family, the amount of the parent’s adjusted gross
 1374  income, and the federal poverty guidelines. The premium, fee, or
 1375  other cost sharing paid by a parent may not exceed the cost of
 1376  waiver services to the client. Parents who have more than one
 1377  child receiving services may not be required to pay more than
 1378  the amount required for the child who has the highest
 1379  expenditures. Parents who do not live with each other remain
 1380  responsible for paying the required contribution. The client may
 1381  not be denied waiver services due to nonpayment by a parent.
 1382  Adoptive and foster parents are exempt from payment of any
 1383  premiums, fees, or other cost-sharing for waiver services. The
 1384  agency shall request federal approval as necessary to implement
 1385  the program. Upon receiving The premium and cost-sharing system
 1386  developed by the agency shall not adversely affect federal
 1387  funding to the state. After the agency receives federal
 1388  approval, if required, the agency, the Agency for Persons with
 1389  Disabilities, and the Department of Children and Family Services
 1390  may implement the system and collect income information from
 1391  parents of children who will be affected by this paragraph. The
 1392  parents must provide information upon request. The agency shall
 1393  prepare a report to include the estimated operational cost of
 1394  implementing the premium, fee, and cost-sharing system and the
 1395  estimated revenues to be collected from parents of children in
 1396  the waiver program. The report shall be delivered to the
 1397  President of the Senate and the Speaker of the House of
 1398  Representatives by June 30, 2012. The agency, the Department of
 1399  Children and Family Services, and the Agency for Persons with
 1400  Disabilities may adopt rules to administer this paragraph.
 1401         Section 14. Section 514.072, Florida Statutes, is amended
 1402  to read:
 1403         514.072 Certification of swimming instructors for people
 1404  who have developmental disabilities required.—Any person working
 1405  at a swimming pool who holds himself or herself out as a
 1406  swimming instructor specializing in training people who have a
 1407  developmental disability developmental disabilities, as defined
 1408  in s. 393.063(11) 393.063(10), may be certified by the Dan
 1409  Marino Foundation, Inc., in addition to being certified under s.
 1410  514.071. The Dan Marino Foundation, Inc., must develop
 1411  certification requirements and a training curriculum for
 1412  swimming instructors for people who have developmental
 1413  disabilities and must submit the certification requirements to
 1414  the Department of Health for review by January 1, 2007. A person
 1415  certified under s. 514.071 before July 1, 2007, must meet the
 1416  additional certification requirements of this section before
 1417  January 1, 2008. A person certified under s. 514.071 on or after
 1418  July 1, 2007, must meet the additional certification
 1419  requirements of this section within 6 months after receiving
 1420  certification under s. 514.071.
 1421         Section 15. This act shall take effect July 1, 2012.