Florida Senate - 2012 CS for CS for CS for SB 1516
By the Committees on Budget Subcommittee on Health and Human
Services Appropriations; 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 current definitions and
8 providing definitions for the terms “adult day
9 services,” “nonwaiver resources,” and “waiver”;
10 amending s. 393.065, F.S.; clarifying provisions
11 relating to eligibility requirements based on
12 citizenship and state residency; amending s. 393.066,
13 F.S.; revising provisions relating to community
14 services and treatment; revising an express list of
15 services; requiring the agency to promote partnerships
16 and collaborative efforts to enhance the availability
17 of nonwaiver services; deleting a requirement that the
18 agency promote day habilitation services for certain
19 individuals; amending s. 393.0661, F.S.; revising
20 provisions relating to eligibility under the Medicaid
21 waiver redesign; providing that final tier eligibility
22 be determined at the time a waiver slot and funding
23 are available; providing criteria for moving an
24 individual between tiers; deleting a cap on tier one
25 expenditures for certain individuals; authorizing the
26 agency and the Agency for Health Care Administration
27 to adopt rules; deleting certain directions relating
28 to the adjustment of an individual’s cost plan;
29 providing criteria for reviewing Medicaid waiver
30 provider agreements, including support coordinators;
31 deleting obsolete provisions; amending s. 393.0662,
32 F.S.; providing criteria for calculating an
33 individual’s iBudget; deleting obsolete provisions;
34 amending s. 393.067, F.S.; requiring that facilities
35 that are accredited by certain organizations be
36 inspected and reviewed by the agency every 2 years;
37 providing agency criteria for monitoring licensees;
38 amending s. 393.068, F.S.; conforming a cross
39 reference and terminology; amending s. 393.11, F.S.;
40 clarifying eligibility for involuntary admission to
41 residential services; amending s. 393.125, F.S.;
42 requiring the Department of Children and Family
43 Services to submit its hearing recommendations to the
44 agency; amending s. 393.23, F.S.; providing that
45 receipts from the operation of canteens, vending
46 machines, and other activities may be used to pay
47 certain wages; creating s. 393.28, F.S.; directing the
48 agency to adopt sanitation standards by rule;
49 providing penalties for violations; authorizing the
50 agency to contract for food services and inspection
51 services to enforce standards; amending s. 393.502,
52 F.S.; revising the membership of family care councils;
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 individuals
65 clients in institutions, are unreasonably costly, are
66 ineffective in bringing the individual client to his or her
67 maximum potential, and are in fact debilitating to many
68 individuals clients. A redirection in state treatment programs
69 for individuals with developmental disabilities is therefore
70 necessary if any significant amelioration of the problems faced
71 by such individuals is ever to take place. Such redirection
72 should place primary emphasis on programs that prevent or reduce
73 the severity of developmental disabilities. Further, the
74 greatest priority should shall be given to the development and
75 implementation of community-based services for that will enable
76 individuals with developmental disabilities which will protect
77 their health, safety, and welfare, and enable such individuals
78 to achieve their greatest potential for independent and
79 productive living, enable them to live in their own homes or in
80 residences located in their own communities, and permit them to
81 be diverted or moved removed from unnecessary institutional
82 placements. This goal cannot be met without ensuring the
83 availability of community residential opportunities in the
84 residential areas of this state. The Legislature, therefore,
85 declares that individuals all persons with developmental
86 disabilities who live in licensed community homes shall have a
87 family living environment comparable to that of other state
88 residents Floridians and that such homes must residences shall
89 be considered and treated as the a functional equivalent of a
90 family unit and not as an institution, business, or boarding
91 home. The Legislature further declares that , in developing
92 community-based programs and services for individuals with
93 developmental disabilities, private businesses, not-for-profit
94 corporations, units of local government, and other organizations
95 capable of providing needed services to clients in a cost
96 efficient manner shall be given preference in lieu of operation
97 of programs directly by state agencies. Finally, it is the
98 intent of the Legislature that all caretakers who are unrelated
99 to individuals with developmental disabilities receiving care
100 shall be of good moral character.
101 (2) The Legislature finds that in order to maximize the
102 delivery of services to individuals in the community who have
103 developmental disabilities and remain within appropriated funds,
104 service delivery must blend natural supports, community
105 resources, and state funds. The Legislature also finds that,
106 given the traditional role of state government in ensuring the
107 health, safety, and welfare of state residents, and the intent
108 that waiver funds be used to avoid institutionalization, state
109 funds, including waiver funds, appropriated to the agency must
110 be reserved and prioritized for those services needed to ensure
111 the health, safety, and welfare of individuals who have
112 developmental disabilities in noninstitutional settings. It is
113 therefore the intent of the Legislature that the agency develop
114 sound fiscal strategies that allow the agency to predict,
115 control, manage, and operate within available funding as
116 provided in the General Appropriations Act in order to ensure
117 that state funds are available for health, safety, and welfare,
118 to avoid institutionalization, and to maximize the number of
119 individuals who have developmental disabilities who receive
120 services. It is further the intent of the Legislature that the
121 agency provide services for individuals residing in
122 developmental disability centers that promote the individual’s
123 health, safety, and welfare and enhance their quality of life.
124 Finally, the Legislature intends that the agency continue the
125 tradition of involving families, stakeholders, and other
126 interested parties as it recasts its role as a collaborative
127 partner in the larger context of family and community-supported
128 services and develops new opportunities and supports for
129 individuals with developmental disabilities.
130 Section 2. Section 393.063, Florida Statutes, is reordered
131 and amended to read:
132 393.063 Definitions.—As used in For the purposes of this
133 chapter, the term:
134 (1) “Agency” means the Agency for Persons with
136 (2) “Adult day services” means services that are provided
137 in a nonresidential setting, separate from the home or facility
138 in which the individual resides, unless he or she resides in a
139 planned residential community as defined in s. 419.001(1), and
140 that are intended to support the participation of individuals in
141 meaningful activities that do not require formal training, which
142 may include a variety of activities, including social
144 (3) (2) “Adult day training” means training that is
145 conducted services which take place in a nonresidential setting,
146 separate from the home or facility in which the individual
147 client resides, unless he or she resides in a planned
148 residential community as defined in s. 419.001(1)(d); are
149 intended to support the individual’s participation of clients in
150 daily, meaningful, and valued routines of the community; and may
151 include work-like settings that do not meet the definition of
152 supported employment.
153 (4) (3) “Autism” means a pervasive, neurologically based
154 developmental disability of extended duration which causes
155 severe learning, communication, and behavior disorders and which
156 has an with age of onset during infancy or childhood.
157 Individuals who have with autism exhibit impairment in
158 reciprocal social interaction, impairment in verbal and
159 nonverbal communication and imaginative ability, and a markedly
160 restricted repertoire of activities and interests.
161 (5) (4) “Cerebral palsy” means a group of disabling symptoms
162 of extended duration which results from damage to the developing
163 brain which that may occur before, during, or after birth and
164 which that results in the loss or impairment of control over
165 voluntary muscles. The term For the purposes of this definition,
166 cerebral palsy does not include those symptoms or impairments
167 resulting solely from a stroke.
168 (6) (5) “Client” means an individual any person determined
169 eligible by the agency for services under this chapter.
170 (7) (6) “Client advocate” means a friend or relative of an
171 individual the client, or of the individual’s client’s immediate
172 family, who advocates for the individual’s best interests of the
173 client in any proceedings under this chapter in which the
174 individual client or his or her family has the right or duty to
176 (8) (7) “Comprehensive assessment” means the process used to
177 determine eligibility for services under this chapter.
178 (9) (8) “Comprehensive transitional education program” means
179 the program established under in s. 393.18.
180 (11) (9) “Developmental disability” means a disorder or
181 syndrome that is attributable to retardation, cerebral palsy,
182 autism, spina bifida, Down syndrome, or Prader-Willi syndrome;
183 that manifests before the age of 18; and that constitutes a
184 substantial handicap that can reasonably be expected to continue
186 (10) “Developmental disabilities center” means a state
187 owned and state-operated facility, formerly known as a “Sunland
188 Center,” providing for the care, habilitation, and
189 rehabilitation of individuals who have clients with
190 developmental disabilities.
191 (12) (11) “Direct service provider” means a person, 18 years
192 of age or older, who has direct face-to-face contact with an
193 individual a client while providing services to that individual
194 the client or who has access to his or her a client’s living
195 areas, or to a client’s funds, or personal property.
196 (12) “Domicile” means the place where a client legally
197 resides, which place is his or her permanent home. Domicile may
198 be established as provided in s. 222.17 . Domicile may not be
199 established in Florida by a minor who has no parent domiciled in
200 Florida, or by a minor who has no legal guardian domiciled in
201 Florida, or by any alien not classified as a resident alien.
202 (13) “Down syndrome” means a disorder caused by the
203 presence of an extra chromosome 21.
204 (14) “Express and informed consent” means consent
205 voluntarily given in writing with sufficient knowledge and
206 comprehension of the subject matter to enable the person giving
207 consent to make a knowing decision without any element of force,
208 fraud, deceit, duress, or other form of constraint or coercion.
209 (15) “Family care program” means the program established
210 under in s. 393.068.
211 (16) “Foster care facility” means a residential facility
212 licensed under this chapter which provides a family living
213 environment and includes including supervision and care
214 necessary to meet the physical, emotional, and social needs of
215 its residents. The capacity of such a facility may not be more
216 than three residents.
217 (17) “Group home facility” means a residential facility
218 licensed under this chapter which provides a family living
219 environment and includes including supervision and care
220 necessary to meet the physical, emotional, and social needs of
221 its residents. The capacity of such a facility must shall be at
222 least four 4 but not more than 15 residents.
223 (18) “Guardian advocate” means a person appointed by a
224 written order of the court to represent an individual who has a
225 person with developmental disability disabilities under s.
227 (19) “Habilitation” means the process by which an
228 individual who has a developmental disability a client is
229 assisted to acquire and maintain those life skills that which
230 enable the individual client to cope more effectively with the
231 demands of his or her condition and environment and to raise the
232 level of his or her physical, mental, and social efficiency. It
233 includes, but is not limited to, programs of formal structured
234 education 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 an individual a
253 client by a person licensed under chapter 458, chapter 459, or
254 chapter 466. Such services may include, but are not limited to,
255 prescription 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 that
261 may be obtained through private insurance, the Medicaid state
262 plan, 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 an
272 individual’s to the health, safety, and welfare and to avoid
273 institutionalization of the client when there is no one else
274 available or able to perform 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 a person an individual who is
282 connected by affinity or consanguinity to an individual the
283 client and who is 18 years of age or older.
284 (27) (26) “Resident” means an individual who has a any
285 person with developmental disability and who resides
286 disabilities residing at a residential facility, regardless of
287 whether he or she has been determined eligible for agency
288 services or not such person is a client of the agency.
289 (28) (27) “Residential facility” means a facility providing
290 room and board and personal care for individuals who have
291 persons with developmental disabilities.
292 (29) (28) “Residential habilitation” means supervision and
293 training in with the acquisition, retention, or improvement in
294 skills related to activities of daily living, such as personal
295 hygiene skills, homemaking skills, and the social and adaptive
296 skills necessary to enable the individual to reside in the
298 (30) (29) “Residential habilitation center” means a
299 community residential facility licensed under this chapter which
300 provides habilitation services. The capacity of such a facility
301 may shall not be fewer than nine residents. After October 1,
302 1989, new residential habilitation centers may not be licensed
303 and the licensed capacity for any existing residential
304 habilitation center may not be increased.
305 (31) (30) “Respite service” means appropriate, short-term,
306 temporary care that is provided to an individual who has a
307 person with developmental disability in order disabilities to
308 meet the planned or emergency needs of the individual person or
309 the family or other direct service provider.
310 (32) (31) “Restraint” means a physical device, method, or
311 drug used to control dangerous behavior.
312 (a) A physical restraint is any manual method or physical
313 or mechanical device, material, or equipment attached or
314 adjacent to the individual’s body so that he or she cannot
315 easily remove the restraint and which restricts freedom of
316 movement or normal access to one’s body.
317 (b) A drug used as a restraint is a medication used to
318 control the individual’s person’s behavior or to restrict his or
319 her freedom of movement and is not a standard treatment for the
320 individual’s person’s medical or psychiatric condition.
321 Physically holding an individual a person during a procedure to
322 forcibly administer psychotropic medication is a physical
324 (c) Restraint does not include physical devices, such as
325 orthopedically prescribed appliances, surgical dressings and
326 bandages, supportive body bands, seatbelts or wheelchair tie
327 downs, or other physical holding when necessary for routine
328 physical examinations and tests; for purposes of orthopedic,
329 surgical, or other similar medical treatment; when used to
330 provide support for the achievement of functional body position
331 or proper balance; or when used to protect an individual a
332 person from falling out of bed or a wheelchair; or when used for
333 safety during transportation.
334 (33) (32) “Retardation” means significantly subaverage
335 general intellectual functioning existing concurrently with
336 deficits in adaptive behavior which manifest that manifests
337 before the age of 18 and can reasonably be expected to continue
338 indefinitely. As used in this subsection, the term:
339 (a) “Significantly subaverage general intellectual
340 functioning ,” for the purpose of this definition, means
341 performance that which is two or more standard deviations from
342 the mean score on a standardized intelligence test specified in
343 the rules of the agency.
344 (b) “Adaptive behavior ,” for the purpose of this
345 definition, means the effectiveness or degree with which an
346 individual meets the standards of personal independence and
347 social responsibility expected of his or her age, cultural
348 group, and community.
349 (34) (33) “Seclusion” means the involuntary isolation of an
350 individual a person in a room or area from which the individual
351 person is prevented from leaving. The prevention may be by
352 physical barrier or by a staff member who is acting in a manner,
353 or who is physically situated, so as to prevent the individual
354 person from leaving the room or area. For the purposes of this
355 chapter, the term does not mean isolation due to the
356 individual’s medical condition or symptoms of the person.
357 (35) (34) “Self-determination” means an individual’s freedom
358 to exercise the same rights as all other citizens, authority to
359 exercise control over funds needed for one’s own support,
360 including prioritizing those these funds when necessary,
361 responsibility for the wise use of public funds, and self
362 advocacy to speak and advocate for oneself in order to gain
363 independence and ensure that individuals who have with a
364 developmental disability are treated equally.
365 (36) (35) “Specialized therapies” means those treatments or
366 activities prescribed by and provided by an appropriately
367 trained, licensed, or certified professional or staff person and
368 may include, but are not limited to, physical therapy, speech
369 therapy, respiratory therapy, occupational therapy, behavior
370 therapy, physical management services, and related specialized
371 equipment and supplies.
372 (37) (36) “Spina bifida” means an individual who has been
373 given , for purposes of this chapter, a person with a medical
374 diagnosis of spina bifida cystica or myelomeningocele.
375 (38) (37) “Support coordinator” means a person who is
376 contracting with designated by the agency to assist individuals
377 and families in identifying their capacities, needs, and
378 resources, as well as finding and gaining access to necessary
379 supports and services; assisting with locating or developing
380 employment opportunities; coordinating the delivery of supports
381 and services; advocating on behalf of the individual and family;
382 maintaining relevant records; and monitoring and evaluating the
383 delivery of supports and services to determine the extent to
384 which they meet the needs and expectations identified by the
385 individual, family, and others who participated in the
386 development of the support plan.
387 (39) (38) “Supported employment” means employment located or
388 provided in an integrated work setting, with earnings paid on a
389 commensurate wage basis, and for which continued support is
390 needed for job maintenance.
391 (40) (39) “Supported living” means a category of
392 individually determined services designed and coordinated in
393 such a manner that provides as to provide assistance to adults
394 adult clients who require ongoing supports to live as
395 independently as possible in their own homes, to be integrated
396 into the community, and to participate in community life to the
397 fullest extent possible.
398 (41) (40) “Training” means a planned approach to assisting
399 an individual a client to attain or maintain his or her maximum
400 potential and includes services ranging from sensory stimulation
401 to instruction in skills for independent living and employment.
402 (42) (41) “Treatment” means the prevention, amelioration, or
403 cure of an individual’s a client’s physical and mental
404 disabilities or illnesses.
405 (43) “Waiver” means a federally approved Medicaid waiver
406 program, including, but not limited to, the Developmental
407 Disabilities Home and Community-Based Services Waivers Tiers 1
408 4, the Developmental Disabilities Individual Budget Waiver, and
409 the Consumer-Directed Care Plus Program, authorized pursuant to
410 s. 409.906 and administered by the agency to provide home and
411 community-based services to individuals who have developmental
413 Section 3. Subsections (1) and (6) of section 393.065,
414 Florida Statutes, are amended to read:
415 393.065 Application and eligibility determination.—
416 (1) Application for services shall be made, in writing, to
417 the agency , in the service area in which the applicant resides.
418 The agency shall review each applicant for eligibility within 45
419 days after the date the application is signed for children under
420 6 years of age and within 60 days after the date the application
421 is signed for all other applicants. If When necessary to
422 definitively identify individual conditions or needs, the agency
423 shall provide a comprehensive assessment. Eligibility is limited
424 to United States citizens and to qualified noncitizens who meet
425 the criteria provided in s. 414.095(3), and who have established
426 domicile in Florida pursuant to s. 222.17 or are otherwise
427 determined to be legal residents of this state. Only applicants
428 whose domicile is in Florida are eligible for services.
429 Information accumulated by other agencies, including
430 professional reports and collateral data, shall be considered if
431 in this process when available.
432 (6) The individual, or the individual’s client, the
433 client’s guardian , or the client’s family, must ensure that
434 accurate, up-to-date contact information is provided to the
435 agency at all times. The agency shall remove from the wait list
436 an any individual who cannot be located using the contact
437 information provided to the agency, fails to meet eligibility
438 requirements, or no longer qualifies as a legal resident of this
439 state becomes domiciled outside the state.
440 Section 4. Section 393.066, Florida Statutes, is amended to
442 393.066 Community services and treatment.—
443 (1) The agency shall plan, develop, organize, and implement
444 its programs of services and treatment for individuals who have
445 persons with developmental disabilities in order to assist them
446 in living allow clients to live as independently as possible in
447 their own homes or communities, to support them in maximizing
448 their independence using innovative, effective, efficient, and
449 sustainable solutions, and to avoid institutionalization and to
450 achieve productive lives as close to normal as possible. All
451 elements of community-based services shall be made available,
452 and eligibility for these services shall be consistent across
453 the state.
454 (2) All Services that are not available through nonwaiver
455 resources or that are not donated needed shall be purchased
456 instead of provided directly by the agency if , when such
457 arrangement is more cost-efficient than having those services
458 provided directly. All purchased services must be approved by
459 the agency. Authorization for such services is dependent on the
460 availability of agency funding.
461 (3) Community Community-based services that are medically
462 necessary to prevent the institutionalization of individuals
463 with developmental disabilities must be provided in the most
464 cost-effective manner to the extent of the availability of
465 agency resources as specified in the General Appropriations Act.
466 These services may shall, to the extent of available resources,
468 (a) Adult day training and adult day services.
469 (b) Family care services.
470 (c) Guardian advocate referral services.
471 (d) Medical/dental services, except that medical services
472 shall not be provided to individuals clients with spina bifida
473 except as specifically appropriated by the Legislature.
474 (e) Parent training.
475 (e) (f) Personal care services and personal support
477 (g) Recreation.
478 (f) (h) Residential habilitation facility services.
479 (g) (i) Respite services.
480 (h) (j) Support coordination Social services.
481 (i) (k) Specialized therapies.
482 (j) (l) Supported employment.
483 (k) (m) Supported living.
484 (l) (n) Training, including behavioral analysis services.
485 (m) (o) Transportation.
486 (n) (p) Other habilitative and rehabilitative services as
488 (4) The agency or the agency’s agents shall identify and
489 engage in efforts to develop, increase, or enhance the
490 availability of nonwaiver resources to individuals who have
491 developmental disabilities. The agency shall promote
492 partnerships and collaborative efforts with families;
493 organizations, such as nonprofit agencies and foundations;
494 places of worship; schools; community organizations and clubs;
495 businesses; local governments; and state and federal agencies
496 shall utilize the services of private businesses, not-for-profit
497 organizations, and units of local government whenever such
498 services are more cost-efficient than such services provided
499 directly by the department, including arrangements for provision
500 of residential facilities.
501 (5) In order to improve the potential for utilization of
502 more cost-effective, community-based residential facilities, the
503 agency shall promote the statewide development of day
504 habilitation services for clients who live with a direct service
505 provider in a community-based residential facility and who do
506 not require 24-hour-a-day care in a hospital or other health
507 care institution, but who may, in the absence of day
508 habilitation services, require admission to a developmental
509 disabilities center. Each day service facility shall provide a
510 protective physical environment for clients, ensure that direct
511 service providers meet minimum screening standards as required
512 in s. 393.0655 , make available to all day habilitation service
513 participants at least one meal on each day of operation, provide
514 facilities to enable participants to obtain needed rest while
515 attending the program, as appropriate, and provide social and
516 educational activities designed to stimulate interest and
517 provide socialization skills.
518 (5) (6) To promote independence and productivity, the agency
519 shall provide supports and services, within available resources,
520 to assist individuals clients enrolled in Medicaid waivers who
521 choose to pursue gainful employment.
522 (6) (7) For the purpose of making needed community-based
523 residential facilities available at the least possible cost to
524 the state, the agency may is authorized to lease privately owned
525 residential facilities under long-term rental agreements , if
526 such rental agreements are projected to be less costly to the
527 state over the useful life of the facility than state purchase
528 or state construction of such a facility.
529 (7) (8) The agency may adopt rules providing definitions,
530 eligibility criteria, and procedures for the purchase of
531 services provided pursuant to this section.
532 Section 5. Section 393.0661, Florida Statutes, is amended
533 to read:
534 393.0661 Home and community-based services delivery system;
535 comprehensive redesign.—The Legislature finds that the home and
536 community-based services delivery system for individuals who
537 have persons with developmental disabilities and the
538 availability of appropriated funds are two of the critical
539 elements in making services available. Therefore, it is the
540 intent of the Legislature that the Agency for Persons with
541 Disabilities shall develop and implement a comprehensive
542 redesign of the system.
543 (1) The redesign of the home and community-based services
544 system must shall include, at a minimum, all actions necessary
545 to achieve an appropriate rate structure, individual client
546 choice within a specified service package, appropriate
547 assessment strategies, an efficient billing process that
548 contains reconciliation and monitoring components, and a
549 redefined role for support coordinators which that avoids
550 conflicts of interest and ensures that an individual’s needs for
551 critical services, which maximize his or her independence and
552 avoid institutionalization through the use of innovative,
553 effective, efficient, and sustainable solutions, are addressed
554 potential conflicts of interest and ensures that family/client
555 budgets are linked to levels of need.
556 (a) The agency shall use the Questionnaire for Situational
557 Information or another needs an assessment instrument deemed by
558 instrument that the agency deems to be reliable and valid ,
559 including, but not limited to, the Department of Children and
560 Family Services’ Individual Cost Guidelines or the agency’s
561 Questionnaire for Situational Information. The agency may
562 contract with an external vendor or may use support coordinators
563 to complete individual needs client assessments if it develops
564 sufficient safeguards and training to ensure ongoing inter-rater
566 (b) The agency, with the concurrence of the Agency for
567 Health Care Administration, may contract for the determination
568 of medical necessity and establishment of individual budgets.
569 (2) A provider of services rendered to individuals who have
570 persons with developmental disabilities pursuant to a federally
571 approved waiver shall be reimbursed according to a rate
572 methodology based upon an analysis of the expenditure history
573 and prospective costs of providers participating in the waiver
574 program, or under any other methodology developed by the Agency
575 for Health Care Administration, in consultation with the agency
576 for Persons with Disabilities, and approved by the Federal
577 Government in accordance with the waiver.
578 (3) The Agency for Health Care Administration, in
579 consultation with the agency, shall seek federal approval and
580 implement a four-tiered waiver system to serve eligible
581 individuals clients through the developmental disabilities and
582 family and supported living waivers. For the purpose of the this
583 waiver program, eligible individuals clients shall include
584 individuals who have with a diagnosis of Down syndrome or a
585 developmental disability as defined in s. 393.063. The agency
586 shall assign all individuals clients receiving services through
587 the developmental disabilities waiver to a tier based on the
588 Department of Children and Family Services’ Individual Cost
589 Guidelines, the agency’s Questionnaire for Situational
590 Information , or another such assessment instrument deemed to be
591 valid and reliable by the agency; individual client
592 characteristics, including, but not limited to, age; and other
593 appropriate assessment methods. Final determination of tier
594 eligibility may not be made until a waiver slot and funding
595 become available and only then may the individual be enrolled in
596 the appropriate tier. If an individual is later determined
597 eligible for a higher tier, assignment to the higher tier must
598 be based on crisis criteria as adopted by rule. The agency may
599 also later move an individual to a lower tier if his or her
600 service needs change and can be met by services provided in a
601 lower tier. The agency may not authorize the provision of
602 services that are duplicated by, or that are above the coverage
603 limits of, the Medicaid state plan.
604 (a) Tier one is limited to individuals clients who have
605 intensive medical or adaptive service needs that cannot be met
606 in tier two, three, or four for intensive medical or adaptive
607 needs and that are essential for avoiding institutionalization,
608 or who possess behavioral problems that are exceptional in
609 intensity, duration, or frequency and present a substantial risk
610 of harm to themselves or others. Total annual expenditures under
611 tier one may not exceed $150,000 per client each year, provided
612 that expenditures for clients in tier one with a documented
613 medical necessity requiring intensive behavioral residential
614 habilitation services, intensive behavioral residential
615 habilitation services with medical needs, or special medical
616 home care, as provided in the Developmental Disabilities Waiver
617 Services Coverage and Limitations Handbook, are not subject to
618 the $150,000 limit on annual expenditures.
619 (b) Tier two is limited to individuals clients whose
620 service needs include a licensed residential facility and who
621 are authorized to receive a moderate level of support for
622 standard residential habilitation services or a minimal level of
623 support for behavior focus residential habilitation services, or
624 individuals clients in supported living who receive more than 6
625 hours a day of in-home support services. Tier two also includes
626 individuals whose need for authorized services meets the
627 criteria for tier one but can be met within the expenditure
628 limit of tier two. Total annual expenditures under tier two may
629 not exceed $53,625 per individual client each year.
630 (c) Tier three includes, but is not limited to, individuals
631 who require clients requiring residential placements,
632 individuals who are clients in independent or supported living
633 situations, and individuals clients who live in their family
634 home. Tier three also includes individuals whose need for
635 authorized services meets the criteria for tiers one or two but
636 can be met within the expenditure limit of tier three. Total
637 annual expenditures under tier three may not exceed $34,125 per
638 individual client each year.
639 (d) Tier four includes individuals who were enrolled in the
640 family and supported living waiver on July 1, 2007, and were who
641 shall be assigned to this tier without the assessments required
642 by this section. Tier four also includes, but is not limited to,
643 individuals clients in independent or supported living
644 situations and individuals clients who live in their family
645 home. Total annual expenditures under tier four may not exceed
646 $14,422 per individual client each year.
647 (e) The Agency for Health Care Administration shall also
648 seek federal approval to provide a consumer-directed option for
649 individuals who have persons with developmental disabilities
650 which corresponds to the funding levels in each of the waiver
651 tiers. The agency shall implement the four-tiered waiver system
652 beginning with tiers one, three, and four and followed by tier
653 two. The agency and the Agency for Health Care Administration
654 may adopt rules necessary to administer this subsection.
655 (f) The agency shall seek federal waivers and amend
656 contracts as necessary to make changes to services defined in
657 federal waiver programs administered by the agency as follows:
658 1. Supported living coaching services may not exceed 20
659 hours per month for individuals persons who also receive in-home
660 support services.
661 2. Limited support coordination services is the only type
662 of support coordination service that may be provided to
663 individuals persons under the age of 18 who live in the family
665 3. Personal care assistance services are limited to 180
666 hours per calendar month and may not include rate modifiers.
667 Additional hours may be authorized for individuals persons who
668 have intensive physical, medical, or adaptive needs if such
669 hours are essential for avoiding institutionalization.
670 4. Residential habilitation services are limited to 8 hours
671 per day. Additional hours may be authorized for individuals
672 persons who have intensive medical or adaptive needs and if such
673 hours are essential for avoiding institutionalization, or for
674 individuals persons who possess behavioral problems that are
675 exceptional in intensity, duration, or frequency and present a
676 substantial risk of harming themselves or others. This
677 restriction shall be in effect until the four-tiered waiver
678 system is fully implemented.
679 5. Chore services, nonresidential support services, and
680 homemaker services are eliminated. The agency shall expand the
681 definition of in-home support services to allow the service
682 provider to include activities previously provided in these
683 eliminated services.
684 6. Massage therapy, medication review, and psychological
685 assessment services are eliminated.
686 5. 7. The agency shall conduct supplemental cost plan
687 reviews to verify the medical necessity of authorized services
688 for plans that have increased by more than 8 percent during
689 either of the 2 preceding fiscal years.
690 6. 8. The agency shall implement a consolidated residential
691 habilitation rate structure to increase savings to the state
692 through a more cost-effective payment method and establish
693 uniform rates for intensive behavioral residential habilitation
695 9. Pending federal approval, the agency may extend current
696 support plans for clients receiving services under Medicaid
697 waivers for 1 year beginning July 1, 2007, or from the date
698 approved, whichever is later. Clients who have a substantial
699 change in circumstances which threatens their health and safety
700 may be reassessed during this year in order to determine the
701 necessity for a change in their support plan.
702 7. 10 . The agency shall develop a plan to eliminate
703 redundancies and duplications between in-home support services,
704 companion services, personal care services, and supported living
705 coaching by limiting or consolidating such services.
706 8. 11 . The agency shall develop a plan to reduce the
707 intensity and frequency of supported employment services to
708 individuals clients in stable employment situations who have a
709 documented history of at least 3 years’ employment with the same
710 company or in the same industry.
711 (g) The agency and the Agency for Health Care
712 Administration may adopt rules to administer this subsection.
713 (4) The geographic differential for Miami-Dade, Broward,
714 and Palm Beach Counties for residential habilitation services is
715 shall be 7.5 percent.
716 (5) The geographic differential for Monroe County for
717 residential habilitation services is shall be 20 percent.
718 (6) Effective January 1, 2010, and except as otherwise
719 provided in this section, a client served by the home and
720 community-based services waiver or the family and supported
721 living waiver funded through the agency shall have his or her
722 cost plan adjusted to reflect the amount of expenditures for the
723 previous state fiscal year plus 5 percent if such amount is less
724 than the client’s existing cost plan. The agency shall use
725 actual paid claims for services provided during the previous
726 fiscal year that are submitted by October 31 to calculate the
727 revised cost plan amount. If the client was not served for the
728 entire previous state fiscal year or there was any single change
729 in the cost plan amount of more than 5 percent during the
730 previous state fiscal year, the agency shall set the cost plan
731 amount at an estimated annualized expenditure amount plus 5
732 percent. The agency shall estimate the annualized expenditure
733 amount by calculating the average of monthly expenditures,
734 beginning in the fourth month after the client enrolled,
735 interrupted services are resumed, or the cost plan was changed
736 by more than 5 percent and ending on August 31, 2009, and
737 multiplying the average by 12. In order to determine whether a
738 client was not served for the entire year, the agency shall
739 include any interruption of a waiver-funded service or services
740 lasting at least 18 days. If at least 3 months of actual
741 expenditure data are not available to estimate annualized
742 expenditures, the agency may not rebase a cost plan pursuant to
743 this subsection. The agency may not rebase the cost plan of any
744 client who experiences a significant change in recipient
745 condition or circumstance which results in a change of more than
746 5 percent to his or her cost plan between July 1 and the date
747 that a rebased cost plan would take effect pursuant to this
749 (6) (7) The agency may shall collect premiums or cost
750 sharing pursuant to s. 409.906(13)(d).
751 (7) In determining whether to continue Medicaid waiver
752 provider agreements for service providers, including support
753 coordinators, the agency shall review provider performance to
754 ensure that the provider meets or exceeds the criteria
755 established by the agency. The provider agreements and
756 performance reviews shall be managed and conducted by the
757 agency’s area offices.
758 (a) Criteria for evaluating the performance of a service
759 provider include, but are not limited to:
760 1. The protection of the health, safety, and welfare of the
762 2. Assisting the individual and his or her support
763 coordinator in identifying nonwaiver resources that may be
764 available to meet the individual’s needs. The waiver is the
765 funding source of last resort for services.
766 3. Providing services that are authorized in the service
767 authorization approved by the agency.
768 (b) The support coordinator is responsible for assisting
769 the individual in meeting his or her service needs through
770 nonwaiver resources, as well as through the individual’s budget
771 allocation or cost plan under the waiver. The waiver is the
772 funding source of last resort for services. Criteria for
773 evaluating the performance of a support coordinator include, but
774 are not limited to:
775 1. The protection of the health, safety, and welfare of
777 2. Assisting individuals in obtaining employment and
778 pursuing other meaningful activities.
779 3. Assisting individuals in accessing services that allow
780 them to live in their community.
781 4. The use of family resources.
782 5. The use of private or third-party resources.
783 6. The use of community resources.
784 7. The use of charitable resources.
785 8. The use of volunteer resources.
786 9. The use of services from other governmental entities.
787 10. The overall outcome in securing nonwaiver resources.
788 11. The cost-effective use of waiver resources.
789 12. Coordinating all available resources to ensure that the
790 individual’s outcomes are met.
791 (c) The agency may recognize consistently superior
792 performance by exempting a service provider, including support
793 coordinators, from annual quality assurance reviews or other
794 mechanisms established by the agency. The agency may issue
795 sanctions for poor performance, including, but not limited to, a
796 reduction in the number of individuals served by the provider,
797 recoupment or other financial penalties, and termination of the
798 waiver provider agreement.
799 (d) The agency may adopt rules to administer this
801 (8) This section or related rule does not prevent or limit
802 the Agency for Health Care Administration, in consultation with
803 the agency for Persons with Disabilities, from adjusting fees,
804 reimbursement rates, lengths of stay, number of visits, or
805 number of services, or from limiting enrollment, or making any
806 other adjustment necessary to comply with the availability of
807 moneys and any limitations or directions provided in the General
808 Appropriations Act.
809 (9) The agency for Persons with Disabilities shall submit
810 quarterly status reports to the Executive Office of the Governor
811 and , the chairs of the legislative appropriations committees
812 chair of the Senate Ways and Means Committee or its successor,
813 and the chair of the House Fiscal Council or its successor
814 regarding the financial status of waiver home and community
815 based services, including the number of enrolled individuals who
816 are receiving services through one or more programs; the number
817 of individuals who have requested services who are not enrolled
818 but who are receiving services through one or more programs,
819 including with a description indicating the programs from which
820 the individual is receiving services; the number of individuals
821 who have refused an offer of services but who choose to remain
822 on the list of individuals waiting for services; the number of
823 individuals who have requested services but who are not
824 receiving no services; a frequency distribution indicating the
825 length of time individuals have been waiting for services; and
826 information concerning the actual and projected costs compared
827 to the amount of the appropriation available to the program and
828 any projected surpluses or deficits. If at any time an analysis
829 by the agency, in consultation with the Agency for Health Care
830 Administration, indicates that the cost of services is expected
831 to exceed the amount appropriated, the agency shall submit a
832 plan in accordance with subsection (8) to the Executive Office
833 of the Governor and the chairs of the legislative appropriations
834 committees , the chair of the Senate Ways and Means Committee or
835 its successor, and the chair of the House Fiscal Council or its
836 successor to remain within the amount appropriated. The agency
837 shall work with the Agency for Health Care Administration to
838 implement the plan so as to remain within the appropriation.
839 (10) Implementation of Medicaid waiver programs and
840 services authorized under this chapter is limited by the funds
841 appropriated for the individual budgets pursuant to s. 393.0662
842 and the four-tiered waiver system pursuant to subsection (3).
843 Contracts with independent support coordinators and service
844 providers must include provisions requiring compliance with
845 agency cost containment initiatives. The agency shall implement
846 monitoring and accounting procedures necessary to track actual
847 expenditures and project future spending compared to available
848 appropriations for Medicaid waiver programs. If When necessary,
849 based on projected deficits, the agency shall must establish
850 specific corrective action plans that incorporate corrective
851 actions for of contracted providers which that are sufficient to
852 align program expenditures with annual appropriations. If
853 deficits continue during the 2012-2013 fiscal year, the agency
854 in conjunction with the Agency for Health Care Administration
855 shall develop a plan to redesign the waiver program and submit
856 the plan to the President of the Senate and the Speaker of the
857 House of Representatives by September 30, 2013. At a minimum,
858 the plan must include the following elements:
859 (a) Budget predictability.—Agency budget recommendations
860 must include specific steps to restrict spending to budgeted
861 amounts based on alternatives to the iBudget and four-tiered
862 Medicaid waiver models.
863 (b) Services.—The agency shall identify core services that
864 are essential to provide for individual client health and safety
865 and recommend the elimination of coverage for other services
866 that are not affordable based on available resources.
867 (c) Flexibility.—The redesign must shall be responsive to
868 individual needs and to the extent possible encourage individual
869 client control over allocated resources for their needs.
870 (d) Support coordination services.—The plan must shall
871 modify the manner of providing support coordination services to
872 improve management of service utilization and increase
873 accountability and responsiveness to agency priorities.
874 (e) Reporting.—The agency shall provide monthly reports to
875 the President of the Senate and the Speaker of the House of
876 Representatives on plan progress and development on July 31,
877 2013, and August 31, 2013.
878 (f) Implementation.—The implementation of a redesigned
879 program is subject to legislative approval and must shall occur
880 by no later than July 1, 2014. The Agency for Health Care
881 Administration shall seek federal waivers as needed to implement
882 the redesigned plan approved by the Legislature.
883 Section 6. Section 393.0662, Florida Statutes, is amended
884 to read:
885 393.0662 Individual budgets for delivery of home and
886 community-based services; iBudget system established.—The
887 Legislature finds that improved financial management of the
888 existing home and community-based Medicaid waiver program is
889 necessary to avoid deficits that impede the provision of
890 services to individuals who are on the waiting list for
891 enrollment in the program. The Legislature further finds that
892 individuals clients and their families should have greater
893 flexibility to choose the services that best allow them to live
894 in their community within the limits of an established budget.
895 Therefore, the Legislature intends that the agency, in
896 consultation with the Agency for Health Care Administration,
897 develop and implement a comprehensive redesign of the service
898 delivery system using individual budgets as the basis for
899 allocating the funds appropriated for the home and community
900 based services Medicaid waiver program among eligible enrolled
901 individuals clients. The service delivery system that uses
902 individual budgets shall be called the iBudget system.
903 (1) The agency shall establish a an individual budget, to
904 be referred to as an iBudget, for each individual served by the
905 home and community-based services Medicaid waiver program. The
906 funds appropriated to the agency shall be allocated through the
907 iBudget system to eligible, Medicaid-enrolled individuals who
908 have clients. For the iBudget system, Eligible clients shall
909 include individuals with a diagnosis of Down syndrome or a
910 developmental disability as defined in s. 393.063. The iBudget
911 system shall be designed to provide for: enhanced individual
912 client choice within a specified service package; appropriate
913 assessment strategies; an efficient consumer budgeting and
914 billing process that includes reconciliation and monitoring
915 components; a redefined role for support coordinators which that
916 avoids potential conflicts of interest; a flexible and
917 streamlined service review process; and a methodology and
918 process that ensures the equitable allocation of available funds
919 to each individual client based on his or her the client’s level
920 of need, as determined by the variables in the allocation
922 (2) (a) In developing each individual’s client’s iBudget,
923 the agency shall use an allocation algorithm and methodology.
924 (a) The algorithm shall use variables that have been
925 determined by the agency to have a statistically validated
926 relationship to an individual’s the client’s level of need for
927 services provided through the home and community-based services
928 Medicaid waiver program. The algorithm and methodology may
929 consider individual characteristics, including, but not limited
930 to, an individual’s a client’s age and living situation,
931 information from a formal assessment instrument that the agency
932 determines is valid and reliable, and information from other
933 assessment processes.
934 (b) The allocation methodology shall provide the algorithm
935 that determines the amount of funds allocated to an individual’s
936 a client’s iBudget. The agency may approve an increase in the
937 amount of funds allocated , as determined by the algorithm, based
938 on the individual client having one or more of the following
939 needs that cannot be accommodated within the funding as
940 determined by the algorithm allocation and having no other
941 resources, supports, or services available to meet such needs
942 the need:
943 1. An extraordinary need that would place the health and
944 safety of the individual client, the individual’s client’s
945 caregiver, or the public in immediate, serious jeopardy unless
946 the increase is approved. An extraordinary need may include, but
947 is not limited to:
948 a. A documented history of significant, potentially life
949 threatening behaviors, such as recent attempts at suicide,
950 arson, nonconsensual sexual behavior, or self-injurious behavior
951 requiring medical attention;
952 b. A complex medical condition that requires active
953 intervention by a licensed nurse on an ongoing basis that cannot
954 be taught or delegated to a nonlicensed person;
955 c. A chronic comorbid condition. As used in this
956 subparagraph, the term “comorbid condition” means a medical
957 condition existing simultaneously but independently with another
958 medical condition in a patient; or
959 c. d. A need for significant total physical assistance with
960 activities such as eating, bathing, toileting, grooming, and
961 personal hygiene.
963 However, the presence of an extraordinary need alone does not
964 warrant an increase in the amount of funds allocated to an
965 individual’s a client’s iBudget as determined by the algorithm.
966 2. A significant need for one-time or temporary support or
967 services that, if not provided, would place the health and
968 safety of the individual client, the individual’s client’s
969 caregiver, or the public in serious jeopardy, unless the
970 increase is approved. A significant need may include, but is not
971 limited to, the provision of environmental modifications,
972 durable medical equipment, services to address the temporary
973 loss of support from a caregiver, or special services or
974 treatment for a serious temporary condition when the service or
975 treatment is expected to ameliorate the underlying condition. As
976 used in this subparagraph, the term “temporary” means less a
977 period of fewer than 12 continuous months. However, the presence
978 of such significant need for one-time or temporary supports or
979 services alone does not warrant an increase in the amount of
980 funds allocated to an individual’s a client’s iBudget as
981 determined by the algorithm.
982 3. A significant increase in the need for services after
983 the beginning of the service plan year which that would place
984 the health and safety of the individual client, the individual’s
985 client’s caregiver, or the public in serious jeopardy because of
986 substantial changes in the individual’s client’s circumstances,
987 including, but not limited to, permanent or long-term loss or
988 incapacity of a caregiver, loss of services authorized under the
989 state Medicaid plan due to a change in age, or a significant
990 change in medical or functional status which requires the
991 provision of additional services on a permanent or long-term
992 basis which that cannot be accommodated within the individual’s
993 client’s current iBudget. As used in this subparagraph, the term
994 “long-term” means a period of 12 or more continuous months.
995 However, such significant increase in need for services of a
996 permanent or long-term nature alone does not warrant an increase
997 in the amount of funds allocated to an individual’s a client’s
998 iBudget as determined by the algorithm.
1000 The agency shall reserve portions of the appropriation for the
1001 home and community-based services Medicaid waiver program for
1002 adjustments required pursuant to this paragraph and may use the
1003 services of an independent actuary in determining the amount of
1004 the portions to be reserved.
1005 (c) An individual’s A client’s iBudget shall be the total
1006 of the amount determined by the algorithm and any additional
1007 funding provided pursuant to paragraph (b).
1008 (d) An individual’s iBudget cost plan must meet the
1009 requirements contained in the Coverage and Limitation Handbook
1010 for each service included, and must comply with the other
1011 requirements of this section. An individual has the flexibility
1012 to determine the type, amount, frequency, duration, and scope of
1013 services included in the approved cost plan as long as the
1014 agency determines that such services meet his or her health and
1015 safety needs and are necessary to avoid institutionalization.
1016 (e) An individual’s A client’s annual expenditures for home
1017 and community-based services Medicaid waiver services may not
1018 exceed the limits of his or her iBudget. The total of all
1019 clients’ projected annual iBudget expenditures may not exceed
1020 the agency’s appropriation for waiver services.
1021 (3) (2) The Agency for Health Care Administration, in
1022 consultation with the agency, shall seek federal approval to
1023 amend current waivers, request a new waiver, and amend contracts
1024 as necessary to implement the iBudget system to serve eligible,
1025 enrolled individuals clients through the home and community
1026 based services Medicaid waiver program and the Consumer-Directed
1027 Care Plus Program.
1028 (4) (3) The agency shall transition all eligible, enrolled
1029 individuals clients to the iBudget system. The agency may
1030 gradually phase in the iBudget system.
1031 (a) During the phase-in of the iBudget system, the agency
1032 shall determine an individual’s initial iBudget by comparing the
1033 individual’s algorithm allocation to the individual’s current
1034 annualized cost plan and extraordinary needs. The individual’s
1035 algorithm allocation shall be the amount determined by the
1036 algorithm, adjusted to the agency’s appropriation and any set
1037 asides determined necessary by the agency, including, but not
1038 limited to, funding for individuals who have extraordinary needs
1039 as delineated in paragraph (2)(b). The amount of funding needed
1040 to address each individual’s extraordinary needs shall be
1041 reviewed by the area office in order to determine the medical
1042 necessity for each service in the amount, duration, frequency,
1043 intensity, and scope that meets the individual’s needs. The
1044 agency shall consider the individual’s characteristics based on
1045 a needs assessment as well as the his or her living setting,
1046 availability of natural supports, family circumstances, and
1047 other factors that may affect the level of service needed by the
1049 (b) The individual’s medical-necessity review must include
1050 a comparison of the following:
1051 1. If the individual’s algorithm allocation is greater than
1052 the individual annualized cost plan, the individual’s iBudget is
1053 equal to the annualized cost plan amount.
1054 2. If the individual’s algorithm allocation is less than
1055 the individual’s annualized cost plan but greater than the
1056 amount for the individual’s needs including extraordinary needs,
1057 the individual’s iBudget is equal to the algorithm allocation.
1058 3. If the individual’s algorithm allocation is less than
1059 the amount for the individual’s needs including extraordinary
1060 needs, the individual’s iBudget is equal to the amount for the
1061 individual’s extraordinary needs.
1063 The individual’s annualized iBudget amount may not be less than
1064 50 percent of his or her annualized cost plan. If the
1065 individual’s iBudget is less than his or her annualized cost
1066 plan, and is within $1,000 of the current cost plan, the agency
1067 may adjust the iBudget to equal the cost plan amount.
1068 (c) During the 2011-2012 and 2012-2013 fiscal years,
1069 increases to an individual’s initial iBudget amount may be
1070 granted only if the criteria for extraordinary needs as
1071 delineated in paragraph (2)(b) are met.
1072 (d) (a) While the agency phases in the iBudget system, the
1073 agency may continue to serve eligible, enrolled individuals
1074 clients under the four-tiered waiver system established under s.
1075 393.065 while those individuals clients await transitioning to
1076 the iBudget system.
1077 (b) The agency shall design the phase-in process to ensure
1078 that a client does not experience more than one-half of any
1079 expected overall increase or decrease to his or her existing
1080 annualized cost plan during the first year that the client is
1081 provided an iBudget due solely to the transition to the iBudget
1083 (5) (4) An individual A client must use all available
1084 nonwaiver services authorized under the state Medicaid plan,
1085 school-based services, private insurance and other benefits, and
1086 any other resources that may be available to him or her the
1087 client before using funds from his or her iBudget to pay for
1088 support and services.
1089 (6) (5) The service limitations in s. 393.0661(3)(f)1., 2.,
1090 and 3. do not apply to the iBudget system.
1091 (7) (6) Rates for any or all services established under
1092 rules of the Agency for Health Care Administration must shall be
1093 designated as the maximum rather than a fixed amount for
1094 individuals who receive an iBudget, except for services
1095 specifically identified in those rules that the agency
1096 determines are not appropriate for negotiation, which may
1097 include, but are not limited to, residential habilitation
1099 (8) (7) The agency must shall ensure that individuals
1100 clients and caregivers have access to training and education
1101 that informs to inform them about the iBudget system and
1102 enhances enhance their ability for self-direction. Such training
1103 must be provided shall be offered in a variety of formats and,
1104 at a minimum, must shall address the policies and processes of
1105 the iBudget system; the roles and responsibilities of consumers,
1106 caregivers, waiver support coordinators, providers, and the
1107 agency; information that is available to help the individual
1108 client make decisions regarding the iBudget system; and examples
1109 of nonwaiver support and resources that may be available in the
1111 (9) (8) The agency shall collect data to evaluate the
1112 implementation and outcomes of the iBudget system.
1113 (10) (9) The agency and the Agency for Health Care
1114 Administration may adopt rules specifying the allocation
1115 algorithm and methodology; criteria and processes that allow
1116 individuals for clients to access reserved funds for
1117 extraordinary needs, temporarily or permanently changed needs,
1118 and one-time needs; and processes and requirements for the
1119 selection and review of services, development of support and
1120 cost plans, and management of the iBudget system as needed to
1121 administer this section.
1122 Section 7. Subsection (2) of section 393.067, Florida
1123 Statutes, is amended to read:
1124 393.067 Facility licensure.—
1125 (2) The agency shall conduct annual inspections and reviews
1126 of facilities and programs licensed under this section unless
1127 the facility or program is currently accredited by the Joint
1128 Commission, the Commission on Accreditation of Rehabilitation
1129 Facilities, or the Council on Accreditation. Facilities or
1130 programs that are operating under such accreditation must be
1131 inspected and reviewed by the agency once every 2 years. If,
1132 upon inspection and review, the services and service delivery
1133 sites are not those for which the facility or program is
1134 accredited, the facilities and programs must be inspected and
1135 reviewed in accordance with this section and related rules
1136 adopted by the agency.
1137 (a) Notwithstanding current accreditation, the agency may
1138 continue to monitor the facility or program as necessary with
1139 respect to:
1140 1. Ensuring that services for which the agency is paying
1141 are being provided.
1142 2. Investigating complaints, identifying problems that
1143 would affect the safety or viability of the facility or program,
1144 and monitoring the facility’s or program’s compliance with any
1145 resulting negotiated terms and conditions, including provisions
1146 relating to consent decrees which are unique to a specific
1147 service and are not statements of general applicability.
1148 3. Ensuring compliance with federal and state laws, federal
1149 regulations, or state rules if such monitoring does not
1150 duplicate the accrediting organization’s review pursuant to
1151 accreditation standards.
1152 4. Ensuring Medicaid compliance with federal certification
1153 and precertification review requirements.
1154 (b) The agency shall conduct ongoing health and safety
1155 surveys that pertain to the regular monitoring and oversight of
1156 agency-licensed residential facilities in accordance with the
1157 frequency schedule specified in administrative rules.
1158 Section 8. Subsections (2), (3), and (4) of section
1159 393.068, Florida Statutes, are amended to read:
1160 393.068 Family care program.—
1161 (2) Services and support authorized under the family care
1162 program shall, to the extent of available resources, include the
1163 services listed under s. 393.0662(4) 393.066 and, in addition,
1164 shall include, but not be limited to:
1165 (a) Attendant care.
1166 (b) Barrier-free modifications to the home.
1167 (c) Home visitation by agency workers.
1168 (d) In-home subsidies.
1169 (e) Low-interest loans.
1170 (f) Modifications for vehicles used to transport the
1171 individual with a developmental disability.
1172 (g) Facilitated communication.
1173 (h) Family counseling.
1174 (i) Equipment and supplies.
1175 (j) Self-advocacy training.
1176 (k) Roommate services.
1177 (l) Integrated community activities.
1178 (m) Emergency services.
1179 (n) Support coordination.
1180 (o) Other support services as identified by the family or
1182 (3) If the agency determines that When it is determined by
1183 the agency to be more cost-effective and in the best interest of
1184 the individual client to provide services maintain such client
1185 in the home of a direct service provider, the parent or guardian
1186 of the individual client or, if competent, the individual client
1187 may enroll the client in the family care program. The direct
1188 service provider of an individual a client enrolled in the
1189 family care program shall be reimbursed according to a rate
1190 schedule set by the agency, except that in-home subsidies shall
1191 be provided in accordance with s. 393.0695.
1192 (4) All existing nonwaiver community resources available to
1193 an individual must be used the client shall be utilized to
1194 support program objectives. Additional services may be
1195 incorporated into the program as appropriate and to the extent
1196 that resources are available. The agency may is authorized to
1197 accept gifts and grants in order to carry out the program.
1198 Section 9. Section 393.11, Florida Statutes, is amended to
1200 393.11 Involuntary admission to residential services.—
1201 (1) JURISDICTION.—If an individual When a person is
1202 determined to be eligible to receive services from the agency
1203 mentally retarded and requires involuntary admission to
1204 residential services provided by the agency, the circuit court
1205 of the county in which the individual person resides shall have
1206 jurisdiction to conduct a hearing and enter an order
1207 involuntarily admitting the individual person in order to
1208 provide that the person may receive the care, treatment,
1209 habilitation, and rehabilitation that he or she which the person
1210 needs. For the purpose of identifying mental retardation or
1211 autism, diagnostic capability shall be established by the
1212 agency. Except as otherwise specified, the proceedings under
1213 this section are shall be governed by the Florida Rules of Civil
1215 (2) PETITION.—
1216 (a) A petition for involuntary admission to residential
1217 services may be executed by a petitioning commission or the
1219 (b) The petitioning commission shall consist of three
1220 persons, . one of whom these persons shall be a physician
1221 licensed and practicing under chapter 458 or chapter 459.
1222 (c) The petition must shall be verified and must shall:
1223 1. State the name, age, and present address of the
1224 commissioners and their relationship to the individual who is
1225 the subject of the petition person with mental retardation or
1227 2. State the name, age, county of residence, and present
1228 address of the individual who is the subject of the petition
1229 person with mental retardation or autism;
1230 3. Allege that the individual commission believes that the
1231 person needs involuntary residential services and specify the
1232 factual information on which the belief is based;
1233 4. Allege that the individual person lacks sufficient
1234 capacity to give express and informed consent to a voluntary
1235 application for services and lacks the basic survival and self
1236 care skills to provide for the individual’s person’s well-being
1237 or is likely to physically injure others if allowed to remain at
1238 liberty; and
1239 5. State which residential setting is the least restrictive
1240 and most appropriate alternative and specify the factual
1241 information on which the belief is based.
1242 (d) The petition shall be filed in the circuit court of the
1243 county in which the individual who is the subject of the
1244 petition person with mental retardation or autism resides.
1245 (3) NOTICE.—
1246 (a) Notice of the filing of the petition shall be given to
1247 the individual and his or her legal guardian. The notice shall
1248 be given both verbally and in writing in the language of the
1249 individual client, or in other modes of communication of the
1250 individual client, and in English. Notice shall also be given to
1251 such other persons as the court may direct. The petition for
1252 involuntary admission to residential services shall be served
1253 with the notice.
1254 (b) If Whenever a motion or petition has been filed
1255 pursuant to s. 916.303 to dismiss criminal charges against an
1256 individual a defendant with retardation or autism, and a
1257 petition is filed to involuntarily admit the individual
1258 defendant to residential services under this section, the notice
1259 of the filing of the petition shall also be given to the
1260 individual’s defendant’s attorney, the state attorney of the
1261 circuit from which the individual defendant was committed, and
1262 the agency.
1263 (c) The notice shall state that a hearing shall be set to
1264 inquire into the need of the individual person with mental
1265 retardation or autism for involuntary residential services. The
1266 notice shall also state the date of the hearing on the petition.
1267 (d) The notice shall state that the individual with mental
1268 retardation or autism has the right to be represented by counsel
1269 of his or her own choice and that, if the individual person
1270 cannot afford an attorney, the court shall appoint one.
1271 (4) AGENCY PARTICIPATION.—
1272 (a) Upon receiving the petition, the court shall
1273 immediately order the developmental services program of the
1274 agency to examine the individual person being considered for
1275 involuntary admission to residential services.
1276 (b) Following examination, the agency shall file a written
1277 report with the court not less than 10 working days before the
1278 date of the hearing. The report must be served on the
1279 petitioner, the individual who is the subject of the petition
1280 person with mental retardation, and the individual’s person’s
1281 attorney at the time the report is filed with the court.
1282 (c) The report must contain the findings of the agency’s
1283 evaluation, any recommendations deemed appropriate, and a
1284 determination of whether the individual person is eligible for
1285 services under this chapter.
1286 (5) EXAMINING COMMITTEE.—
1287 (a) Upon receiving the petition, the court shall
1288 immediately appoint an examining committee to examine the
1289 individual person being considered for involuntary admission to
1290 residential services provided by the agency.
1291 (b) The court shall appoint no fewer than three
1292 disinterested experts who have demonstrated to the court an
1293 expertise in the diagnosis, evaluation, and treatment of
1294 individuals persons with mental retardation. The committee must
1295 include at least one licensed and qualified physician, one
1296 licensed and qualified psychologist, and one qualified
1297 professional with a minimum of a masters degree in social work,
1298 special education, or vocational rehabilitation counseling, to
1299 examine the individual person and to testify at the hearing on
1300 the involuntary admission to residential services.
1301 (c) Counsel for the individual person who is being
1302 considered for involuntary admission to residential services and
1303 counsel for the petition commission have has the right to
1304 challenge the qualifications of those appointed to the examining
1306 (d) Members of the committee may not be employees of the
1307 agency or be associated with each other in practice or in
1308 employer-employee relationships. Members of the committee may
1309 not have served as members of the petitioning commission.
1310 Members of the committee may not be employees of the members of
1311 the petitioning commission or be associated in practice with
1312 members of the commission.
1313 (e) The committee shall prepare a written report for the
1314 court. The report must explicitly document the extent that the
1315 individual person meets the criteria for involuntary admission.
1316 The report, and expert testimony, must include, but not be
1317 limited to:
1318 1. The degree of the individual’s person’s mental
1319 retardation and whether, using diagnostic capabilities
1320 established by the agency, the individual person is eligible for
1321 agency services;
1322 2. Whether, because of the individual’s person’s degree of
1323 mental retardation, the individual person:
1324 a. Lacks sufficient capacity to give express and informed
1325 consent to a voluntary application for services pursuant to s.
1327 b. Lacks basic survival and self-care skills to such a
1328 degree that close supervision and habilitation in a residential
1329 setting is necessary and if not provided would result in a real
1330 and present threat of substantial harm to the individual’s
1331 person’s well-being; or
1332 c. Is likely to physically injure others if allowed to
1333 remain at liberty.
1334 3. The purpose to be served by residential care;
1335 4. A recommendation on the type of residential placement
1336 which would be the most appropriate and least restrictive for
1337 the individual person; and
1338 5. The appropriate care, habilitation, and treatment.
1339 (f) The committee shall file the report with the court not
1340 less than 10 working days before the date of the hearing. The
1341 report shall be served on the petitioner, the individual who is
1342 the subject of the petition person with mental retardation, the
1343 individual’s person’s attorney at the time the report is filed
1344 with the court, and the agency.
1345 (g) Members of the examining committee shall receive a
1346 reasonable fee to be determined by the court. The fees are to be
1347 paid from the general revenue fund of the county in which the
1348 individual who is the subject of the petition person with mental
1349 retardation resided when the petition was filed.
1350 (h) The agency shall develop and prescribe by rule one or
1351 more standard forms to be used as a guide for members of the
1352 examining committee.
1353 (6) COUNSEL; GUARDIAN AD LITEM.—
1354 (a) The individual who is the subject of the petition must
1355 person with mental retardation shall be represented by counsel
1356 at all stages of the judicial proceeding. If In the event the
1357 individual person is indigent and cannot afford counsel, the
1358 court shall appoint a public defender not less than 20 working
1359 days before the scheduled hearing. The individual’s person’s
1360 counsel shall have full access to the records of the service
1361 provider and the agency. In all cases, the attorney shall
1362 represent the rights and legal interests of the individual
1363 person with mental retardation, regardless of who initiates may
1364 initiate the proceedings or pays the attorney pay the attorney’s
1366 (b) If the attorney, during the course of his or her
1367 representation, reasonably believes that the individual person
1368 with mental retardation cannot adequately act in his or her own
1369 interest, the attorney may seek the appointment of a guardian ad
1370 litem. A prior finding of incompetency is not required before a
1371 guardian ad litem is appointed pursuant to this section.
1372 (7) HEARING.—
1373 (a) The hearing for involuntary admission shall be
1374 conducted, and the order shall be entered, in the county in
1375 which the petition is filed. The hearing shall be conducted in a
1376 physical setting not likely to be injurious to the individual’s
1377 person’s condition.
1378 (b) A hearing on the petition must be held as soon as
1379 practicable after the petition is filed, but reasonable delay
1380 for the purpose of investigation, discovery, or procuring
1381 counsel or witnesses shall be granted.
1382 (c) The court may appoint a general or special magistrate
1383 to preside. Except as otherwise specified, the magistrate’s
1384 proceeding shall be governed by the Florida Rules of Civil
1386 (d) The individual who is the subject of the petition may
1387 person with mental retardation shall be physically present
1388 throughout all or part of the entire proceeding. If the
1389 defendant’s person’s attorney or any other interested party
1390 believes that the individual’s person’s presence at the hearing
1391 is not in the individual’s person’s best interest, or good cause
1392 is otherwise shown, the person’s presence may be waived once the
1393 court may order the individual to be excluded from the hearing
1394 has seen the person and the hearing has commenced.
1395 (e) The individual who is the subject of the petition
1396 person has the right to present evidence and to cross-examine
1397 all witnesses and other evidence alleging the appropriateness of
1398 the individual’s person’s admission to residential care. Other
1399 relevant and material evidence regarding the appropriateness of
1400 the individual’s person’s admission to residential services; the
1401 most appropriate, least restrictive residential placement; and
1402 the appropriate care, treatment, and habilitation of the
1403 individual person, including written or oral reports, may be
1404 introduced at the hearing by any interested person.
1405 (f) The petitioning commission may be represented by
1406 counsel at the hearing. The petitioning commission shall have
1407 the right to call witnesses, present evidence, cross-examine
1408 witnesses, and present argument on behalf of the petitioning
1410 (g) All evidence shall be presented according to chapter
1411 90. The burden of proof shall be on the party alleging the
1412 appropriateness of the individual’s person’s admission to
1413 residential services. The burden of proof shall be by clear and
1414 convincing evidence.
1415 (h) All stages of each proceeding shall be stenographically
1417 (8) ORDER.—
1418 (a) In all cases, the court shall issue written findings of
1419 fact and conclusions of law to support its decision. The order
1420 must state the basis for the findings of fact.
1421 (b) An order of involuntary admission to residential
1422 services may not be entered unless the court finds that:
1423 1. The individual person is mentally retarded or autistic;
1424 2. Placement in a residential setting is the least
1425 restrictive and most appropriate alternative to meet the
1426 individual’s person’s needs; and
1427 3. Because of the individual’s person’s degree of mental
1428 retardation or autism, the individual person:
1429 a. Lacks sufficient capacity to give express and informed
1430 consent to a voluntary application for services pursuant to s.
1431 393.065 and lacks basic survival and self-care skills to such a
1432 degree that close supervision and habilitation in a residential
1433 setting is necessary and, if not provided, would result in a
1434 real and present threat of substantial harm to the individual’s
1435 person’s well-being; or
1436 b. Is likely to physically injure others if allowed to
1437 remain at liberty.
1438 (c) If the evidence presented to the court is not
1439 sufficient to warrant involuntary admission to residential
1440 services, but the court feels that residential services would be
1441 beneficial, the court may recommend that the individual person
1442 seek voluntary admission.
1443 (d) If an order of involuntary admission to residential
1444 services provided by the agency is entered by the court, a copy
1445 of the written order shall be served upon the individual person,
1446 the individual’s person’s counsel, the agency, and the state
1447 attorney and the individual’s person’s defense counsel, if
1448 applicable. The order of involuntary admission sent to the
1449 agency shall also be accompanied by a copy of the examining
1450 committee’s report and other reports contained in the court
1452 (e) Upon receiving the order, the agency shall, within 45
1453 days, provide the court with a copy of the individual’s person’s
1454 family or individual support plan and copies of all examinations
1455 and evaluations, outlining his or her the treatment and
1456 rehabilitative programs. The agency shall document that the
1457 individual person has been placed in the most appropriate, least
1458 restrictive and cost-beneficial residential setting. A copy of
1459 the family or individual support plan and other examinations and
1460 evaluations shall be served upon the individual person and the
1461 individual’s person’s counsel at the same time the documents are
1462 filed with the court.
1463 (9) EFFECT OF THE ORDER OF INVOLUNTARY ADMISSION TO
1464 RESIDENTIAL SERVICES.—
1465 (a) An order authorizing an admission to residential care
1466 may not be considered an adjudication of mental incompetency. An
1467 individual A person is not presumed incompetent solely by reason
1468 of the individual’s person’s involuntary admission to
1469 residential services. An individual A person may not be denied
1470 the full exercise of all legal rights guaranteed to citizens of
1471 this state and of the United States.
1472 (b) Any minor involuntarily admitted to residential
1473 services shall, upon reaching majority, be given a hearing to
1474 determine the continued appropriateness of his or her
1475 involuntary admission.
1476 (10) COMPETENCY.—
1477 (a) The issue of competency shall be separate and distinct
1478 from a determination of the appropriateness of involuntary
1479 admission to residential services for a condition of mental
1481 (b) The issue of the competency of an individual who is
1482 mentally retarded a person with mental retardation for purposes
1483 of assigning guardianship shall be determined in a separate
1484 proceeding according to the procedures and requirements of
1485 chapter 744. The issue of the competency of an individual who
1486 has a person with mental retardation or autism for purposes of
1487 determining whether the individual person is competent to
1488 proceed in a criminal trial shall be determined in accordance
1489 with chapter 916.
1490 (11) CONTINUING JURISDICTION.—The court that which issues
1491 the initial order for involuntary admission to residential
1492 services under this section has continuing jurisdiction to enter
1493 further orders to ensure that the individual person is receiving
1494 adequate care, treatment, habilitation, and rehabilitation,
1495 including psychotropic medication and behavioral programming.
1496 Upon request, the court may transfer the continuing jurisdiction
1497 to the court where the individual a client resides if it is
1498 different than the juridiction from where the original
1499 involuntary admission order was issued. An individual A person
1500 may not be released from an order for involuntary admission to
1501 residential services except by the order of the court.
1502 (12) APPEAL.—
1503 (a) Any party to the proceeding who is affected by an order
1504 of the court, including the agency, may appeal to the
1505 appropriate district court of appeal within the time and in the
1506 manner prescribed by the Florida Rules of Appellate Procedure.
1507 (b) The filing of an appeal by the individual ordered to be
1508 involuntarily admitted under this section stays the person with
1509 mental retardation shall stay admission of the individual person
1510 into residential care. The stay shall remain in effect during
1511 the pendency of all review proceedings in Florida courts until a
1512 mandate issues.
1513 (13) HABEAS CORPUS.—At any time and without notice, an
1514 individual any person involuntarily admitted into residential
1515 care, or the individual’s person’s parent or legal guardian in
1516 his or her behalf, is entitled to file a petition for a writ of
1517 habeas corpus to question the cause, legality, and
1518 appropriateness of the individual’s person’s involuntary
1519 admission. Each individual person, or the individual’s person’s
1520 parent or legal guardian, shall receive specific written notice
1521 of the right to petition for a writ of habeas corpus at the time
1522 of his or her involuntary placement.
1523 Section 10. Paragraph (a) of subsection (1) of section
1524 393.125, Florida Statutes, is amended to read:
1525 393.125 Hearing rights.—
1526 (1) REVIEW OF AGENCY DECISIONS.—
1527 (a) For Medicaid programs administered by the agency, any
1528 developmental services applicant or client, or his or her
1529 parent, guardian advocate, or authorized representative, may
1530 request a hearing in accordance with federal law and rules
1531 applicable to Medicaid cases and has the right to request an
1532 administrative hearing pursuant to ss. 120.569 and 120.57. The
1533 hearing These hearings shall be provided by the Department of
1534 Children and Family Services pursuant to s. 409.285 and shall
1535 follow procedures consistent with federal law and rules
1536 applicable to Medicaid cases. At the conclusion of the hearing,
1537 the department shall submit its recommended order to the agency
1538 as provided in s. 120.57(1)(k) and the agency shall issue final
1539 orders as provided in s. 120.57(1)(i).
1540 Section 11. Subsection (1) of section 393.23, Florida
1541 Statutes, is amended to read:
1542 393.23 Developmental disabilities centers; trust accounts.
1543 All receipts from the operation of canteens, vending machines,
1544 hobby shops, sheltered workshops, activity centers, farming
1545 projects, and other like activities operated in a developmental
1546 disabilities center, and moneys donated to the center, must be
1547 deposited in a trust account in any bank, credit union, or
1548 savings and loan association authorized by the State Treasury as
1549 a qualified depository to do business in this state, if the
1550 moneys are available on demand.
1551 (1) Moneys in the trust account must be expended for the
1552 benefit, education, or welfare of individuals receiving services
1553 from the agency clients. However, if specified, moneys that are
1554 donated to the center must be expended in accordance with the
1555 intentions of the donor. Trust account money may not be used for
1556 the benefit of agency employees or to pay the wages of such
1557 employees. The welfare of individuals receiving services clients
1558 includes the expenditure of funds for the purchase of items for
1559 resale at canteens or vending machines; , and for the
1560 establishment of, maintenance of, and operation of canteens,
1561 hobby shops, recreational or entertainment facilities, sheltered
1562 workshops, activity centers, and farming projects; for the
1563 employment wages of individuals receiving services; and for , or
1564 other like facilities or programs established at the center for
1565 the benefit of such individuals clients.
1566 Section 12. Section 393.28, Florida Statutes, is created to
1568 393.28 Food service and environmental sanitation
1570 (1) STANDARDS.—The agency shall adopt sanitation standards
1571 by rule related to food-borne illnesses and environmental
1572 hazards to ensure the protection of individuals served in
1573 facilities licensed or regulated by the agency pursuant to s.
1574 393.067. Such rules may include sanitation requirements for the
1575 storage, preparation, and serving of food as well as for
1576 detecting and preventing diseases caused by natural and manmade
1577 factors in the environment.
1578 (2) VIOLATIONS.—The agency may impose sanctions pursuant to
1579 s. 393.0673 against any establishment or operator licensed
1580 pursuant to s. 393.067 for violations of sanitary standards.
1581 (3) FOOD AND INSPECTION SERVICES.—The agency shall provide
1582 or contract with another entity for the provision of food
1583 services and for inspection services to enforce food and
1584 environmental sanitation standards.
1585 Section 13. Paragraph (b) of subsection (2) of section
1586 393.502, Florida Statutes, is amended to read:
1587 393.502 Family care councils.—
1588 (2) MEMBERSHIP.—
1589 (b) At least three of the members of the council must be
1590 individuals receiving or waiting to receive services from the
1591 agency consumers. One such member shall be an individual a
1592 consumer who has been receiving received services within the 4
1593 years before prior to the date of recommendation , or the legal
1594 guardian of such a consumer. The remainder of the council
1595 members shall be parents, grandparents, nonpaid full-time
1596 caregivers, nonpaid legal guardians, or siblings of individuals
1597 who have persons with developmental disabilities and who qualify
1598 for services pursuant to this chapter. A nonpaid full-time
1599 caregiver or nonpaid legal guardian may not serve at the same
1600 time as the individual who is receiving care from the caregiver
1601 or who is the ward of the guardian.
1602 Section 14. Section 514.072, Florida Statutes, is amended
1603 to read:
1604 514.072 Certification of swimming instructors for people
1605 who have developmental disabilities required.—Any person working
1606 at a swimming pool who holds himself or herself out as a
1607 swimming instructor specializing in training people who have
1608 developmental disabilities, as defined in s. 393.063
1609 393.063 (10), may be certified by the Dan Marino Foundation,
1610 Inc., in addition to being certified under s. 514.071. The Dan
1611 Marino Foundation, Inc., must develop certification requirements
1612 and a training curriculum for swimming instructors for people
1613 who have developmental disabilities and must submit the
1614 certification requirements to the Department of Health for
1615 review by January 1, 2007. A person certified under s. 514.071
1616 before July 1, 2007, must meet the additional certification
1617 requirements of this section before January 1, 2008. A person
1618 certified under s. 514.071 on or after July 1, 2007, must meet
1619 the additional certification requirements of this section within
1620 6 months after receiving certification under s. 514.071 .
1621 Section 15. This act shall take effect upon becoming a law.