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
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
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
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
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
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 wit h 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 a ny person
285 wi th 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 wit h 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
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
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 wh en 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
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 wit h 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 , whe n 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 C ommunity-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 resource s, 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
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
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 th at 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
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 f or 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, pro vided 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 person s with developmental disabilities whi ch
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 tw o . 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
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
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
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
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 Medi caid
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 diagn osis 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
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 Medica id 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
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 Medic aid 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
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 individual’s 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
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
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 Wh en 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 ma y receive the care, treatment,
1164 habilitation, and rehabilitation that he or she whi ch 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
1170 (2) PETITION.—
1171 (a) A petition for involuntary admission to residential
1172 services may be executed by a petitioning commission or the
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 m ental 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 ment al 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
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 sha ll
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 onc e 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:
1365 (13) HOME AND COMMUNITY-BASED SERVICES.—
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.