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2016 Florida Statutes

Title XXIX PUBLIC HEALTH
Chapter 391
CHILDREN'S MEDICAL SERVICES
CHAPTER 391
CHAPTER 391
CHILDREN’S MEDICAL SERVICES
PART I
GENERAL PROVISIONS
(ss. 391.011-391.097)
PART II
CHILDREN’S MEDICAL SERVICES COUNCILS AND
PANELS
(ss. 391.221, 391.223)
PART III
EARLY STEPS PROGRAM
(ss. 391.301-391.308)
PART I
GENERAL PROVISIONS
391.011 Short title.
391.016 Purposes and functions.
391.021 Definitions.
391.025 Applicability and scope.
391.026 Powers and duties of the department.
391.028 Administration.
391.029 Program eligibility.
391.0315 Benefits.
391.035 Provider qualifications.
391.037 Physicians; private sector services.
391.045 Reimbursement.
391.047 Third-party payments.
391.055 Service delivery systems.
391.065 Health care provider agreements.
391.071 Quality of care requirements.
391.081 Grievance reporting and resolution requirements.
391.095 Program integrity.
391.097 Research and evaluation.
391.011 Short title.—The provisions of this chapter may be cited as the “Children’s Medical Services Act.”
History.—s. 1, ch. 78-106; s. 2, ch. 98-288.
391.016 Purposes and functions.—The Children’s Medical Services program is established for the following purposes and authorized to perform the following functions:
(1) Provide to children with special health care needs a family-centered, comprehensive, and coordinated statewide managed system of care that links community-based health care with multidisciplinary, regional, and tertiary pediatric specialty care. The program shall coordinate and maintain a consistent medical home for participating children.
(2) Provide essential preventive, evaluative, and early intervention services for children at risk for or having special health care needs, in order to prevent or reduce long-term disabilities.
History.—s. 2, ch. 78-106; s. 3, ch. 98-288; s. 74, ch. 2012-184.
391.021 Definitions.—When used in this act, the term:
(1) “Children’s Medical Services network” or “network” means a statewide managed care service system that includes health care providers, as defined in this section.
(2) “Children with special health care needs” means those children younger than 21 years of age who have chronic and serious physical, developmental, behavioral, or emotional conditions and who require health care and related services of a type or amount beyond that which is generally required by children.
(3) “Department” means the Department of Health.
(4) “Eligible individual” means a child with a special health care need or a female with a high-risk pregnancy, who meets the financial and medical eligibility standards established in s. 391.029.
(5) “Health care provider” means a health care professional, health care facility, or entity licensed or certified to provide health services in this state that meets the criteria as established by the department.
(6) “Health services” includes the prevention, diagnosis, and treatment of human disease, pain, injury, deformity, or disabling conditions.
(7) “Participant” means an eligible individual who is enrolled in the Children’s Medical Services program.
(8) “Program” means the Children’s Medical Services program established in the department.
History.—s. 3, ch. 78-106; s. 695, ch. 95-148; s. 87, ch. 97-101; s. 4, ch. 98-288; s. 43, ch. 99-397; s. 15, ch. 2004-350; s. 75, ch. 2012-184.
391.025 Applicability and scope.—
(1) The Children’s Medical Services program consists of the following components:
(a) The newborn screening program established in s. 383.14.
(b) The regional perinatal intensive care centers program established in ss. 383.15-383.19.
(c) The developmental evaluation and intervention program, including the Early Steps Program.
(d) The Children’s Medical Services network.
(2) The Children’s Medical Services program shall not be deemed an insurer and is not subject to the licensing requirements of the Florida Insurance Code or the rules adopted thereunder.
History.—s. 5, ch. 98-288; s. 10, ch. 2000-253; s. 409, ch. 2003-261; s. 72, ch. 2003-416; s. 16, ch. 2004-350; s. 76, ch. 2012-184; s. 89, ch. 2014-17; s. 4, ch. 2016-238.
391.026 Powers and duties of the department.—The department shall have the following powers, duties, and responsibilities:
(1) To provide or contract for the provision of health services to eligible individuals.
(2) To provide services to abused and neglected children through child protection teams pursuant to s. 39.303.
(3) To determine the medical and financial eligibility of individuals seeking health services from the program.
(4) To coordinate a comprehensive delivery system for eligible individuals to take maximum advantage of all available funds.
(5) To coordinate with programs relating to children’s medical services in cooperation with other public and private agencies.
(6) To initiate and coordinate applications to federal agencies and private organizations for funds, services, or commodities relating to children’s medical programs.
(7) To sponsor or promote grants for projects, programs, education, or research in the field of children with special health needs, with an emphasis on early diagnosis and treatment.
(8) To oversee and operate the Children’s Medical Services network.
(9) To establish reimbursement mechanisms for the Children’s Medical Services network.
(10) To establish Children’s Medical Services network standards and credentialing requirements for health care providers and health care services.
(11) To serve as a provider and principal case manager for children with special health care needs under Titles XIX and XXI of the Social Security Act.
(12) To monitor the provision of health services in the program, including the utilization and quality of health services.
(13) To administer the Children with Special Health Care Needs program in accordance with Title V of the Social Security Act.
(14) To establish and operate a grievance resolution process for participants and health care providers.
(15) To maintain program integrity in the Children’s Medical Services program.
(16) To receive and manage health care premiums, capitation payments, and funds from federal, state, local, and private entities for the program. The department may contract with a third-party administrator for processing claims, monitoring medical expenses, and other related services necessary to the efficient and cost-effective operation of the Children’s Medical Services network. The department is authorized to maintain a minimum reserve for the Children’s Medical Services network in an amount that is the greater of:
(a) Ten percent of total projected expenditures for Title XIX-funded and Title XXI-funded children; or
(b) Two percent of total annualized payments from the Agency for Health Care Administration for Title XIX and Title XXI of the Social Security Act.
(17) To provide or contract for peer review and other quality-improvement activities.
(18) To adopt rules pursuant to ss. 120.536(1) and 120.54 to administer the Children’s Medical Services Act.
(19) To serve as the lead agency in administering the Early Steps Program pursuant to part C of the federal Individuals with Disabilities Education Act and part III of this chapter.
History.—s. 4, ch. 78-106; s. 96, ch. 98-200; s. 6, ch. 98-288; s. 23, ch. 2000-242; s. 1, ch. 2006-28; s. 77, ch. 2012-184; s. 69, ch. 2013-15; s. 8, ch. 2015-177; s. 5, ch. 2016-238.
391.028 Administration.—
(1) The Director of Children’s Medical Services must be a physician licensed under chapter 458 or chapter 459 who has specialized training and experience in the provision of health care to children and who has recognized skills in leadership and the promotion of children’s health programs. The director shall be the deputy secretary and the Deputy State Health Officer for Children’s Medical Services and is appointed by and reports to the State Surgeon General. The director may appoint such other staff as necessary for the operation of the program subject to the approval of the State Surgeon General.
(2) The director shall provide for an operational system using such department staff and contract providers as necessary. The program shall implement the following program activities under physician supervision on a statewide basis:
(a) Case management services for network participants;
(b) Management and oversight of local program activities;
(c) Medical and financial eligibility determination for the program in accordance with s. 391.029;
(d) Determination of a level of care and medical complexity for long-term care services;
(e) Authorizing services in the program and developing spending plans;
(f) Development of treatment plans; and
(g) Resolution of complaints and grievances from participants and health care providers.
(3) Each Children’s Medical Services area office shall be directed by a physician licensed under chapter 458 or chapter 459 who has specialized training and experience in the provision of health care to children. The director of a Children’s Medical Services area office shall be appointed by the director from the active panel of Children’s Medical Services physician consultants.
History.—s. 9, ch. 78-106; s. 17, ch. 96-403; s. 33, ch. 97-237; s. 7, ch. 98-288; s. 26, ch. 99-397; s. 45, ch. 2008-6; s. 78, ch. 2012-184.
Note.—Subsection (1) former s. 391.051.
391.029 Program eligibility.—
(1) Eligibility for the Children’s Medical Services program is based on the diagnosis of one or more chronic and serious medical conditions and the family’s need for specialized services.
(2) The following individuals are eligible to receive services through the program:
(a) A high-risk pregnant female who is enrolled in Medicaid.
(b) Children with serious special health care needs from birth to 21 years of age who are enrolled in Medicaid.
(c) Children with serious special health care needs from birth to 19 years of age who are enrolled in a program under Title XXI of the Social Security Act.
(3) Subject to the availability of funds, the following individuals may receive services through the program:
(a) Children with serious special health care needs from birth to 21 years of age who do not qualify for Medicaid or Title XXI of the Social Security Act but who are unable to access, due to lack of providers or lack of financial resources, specialized services that are medically necessary or essential family support services. Families shall participate financially in the cost of care based on a sliding fee scale established by the department.
(b) Children with special health care needs from birth to 21 years of age, as provided in Title V of the Social Security Act.
(c) An infant who receives an award of compensation under s. 766.31(1). The Florida Birth-Related Neurological Injury Compensation Association shall reimburse the Children’s Medical Services Network the state’s share of funding, which must thereafter be used to obtain matching federal funds under Title XXI of the Social Security Act.
(4) Any child who has been provided with surgical or medical care or treatment under this act prior to being adopted and has serious and chronic special health needs shall continue to be eligible to be provided with such care or treatment after his or her adoption, regardless of the financial ability of the persons adopting the child.
History.—s. 6, ch. 13620, 1929; CGL 1936 Supp. 3640(6); s. 1, ch. 57-21; ss. 19, 35, ch. 69-106; s. 1, ch. 73-114; s. 178, ch. 77-147; s. 1, ch. 77-159; ss. 8, 13, 14, ch. 78-106; s. 1, ch. 78-332; s. 696, ch. 95-148; s. 8, ch. 98-288; s. 73, ch. 2003-416; s. 39, ch. 2004-5; s. 17, ch. 2004-350; s. 79, ch. 2012-184.
Note.—Subsection (3) former s. 391.046; subsection (4) former s. 391.07.
391.0315 Benefits.—Benefits provided under the program for children with special health care needs shall be equivalent to benefits provided to children as specified in ss. 409.905 and 409.906. The department may offer additional benefits for early intervention services, respite services, genetic testing, genetic and nutritional counseling, and parent support services, if such services are determined to be medically necessary.
History.—s. 9, ch. 98-288; s. 27, ch. 99-397; s. 80, ch. 2012-184.
391.035 Provider qualifications.—
(1) The department shall establish the criteria to designate health care providers to participate in the Children’s Medical Services network. The department shall follow, whenever available, national guidelines for selecting health care providers to serve children with special health care needs.
(2) The department shall require that all health care providers under contract with the program be duly licensed in the state, if such licensure is available, and meet such criteria as may be established by the department.
(3) The department may initiate agreements with other state or local governmental programs or institutions for the coordination of health care to eligible individuals receiving services from such programs or institutions.
(4) Notwithstanding any other law, the department may contract with health care providers licensed in another state to provide health services to participants in the Children’s Medical Services program when necessary due to an emergency or in order to provide specialty services or greater convenience to the participants for receiving timely and effective health care services. The department may adopt rules to administer this subsection.
History.—ss. 6, 7, ch. 78-106; s. 10, ch. 98-288; s. 18, ch. 2004-350.
Note.—Subsection (2) former s. 391.036; subsection (3) former s. 391.041.
391.037 Physicians; private sector services.—It is not a violation of s. 112.313(7) for a physician licensed under chapter 458 or chapter 459 who is providing private sector services to clients of the department or who is employed by or has a contractual relationship with any business entity or agency that is a contract provider for the department to also be employed by the department to provide services under this chapter or chapter 39 if:
(1) The physician does not enter into contracts with the department on behalf of any business entity or agency with whom the physician is employed or has an employment or contractual relationship.
(2) The physician’s private sector employment or contractual relationship does not create a conflict between the physician’s private sector interests and public duties or impede the full and faithful discharge of the physician’s public duties as an employee of the department.
(3) The physician’s employment with the department does not compromise the ability of department clients to make a voluntary choice among department-referred physicians and private providers for their medical services.
History.—s. 16, ch. 2001-53.
391.045 Reimbursement.—
(1) The department shall reimburse health care providers for services rendered through the Children’s Medical Services network using cost-effective methods, including, but not limited to, capitation, discounted fee-for-service, unit costs, and cost reimbursement. Medicaid reimbursement rates shall be utilized to the maximum extent possible, where applicable.
(2) Reimbursement to the Children’s Medical Services program for services provided to children with special health care needs who participate in the Florida Kidcare program and who are not Medicaid recipients shall be on a capitated basis.
History.—s. 11, ch. 98-288.
391.047 Third-party payments.—The Children’s Medical Services program shall comply with s. 402.24, concerning third-party liabilities and recovery of third-party payments for health services.
History.—s. 12, ch. 98-288.
391.055 Service delivery systems.—
(1) The program shall apply managed care methods to ensure the efficient operation of the Children’s Medical Services network. Such methods include, but are not limited to, capitation payments, utilization management and review, prior authorization, and case management.
(2) The components of the network are:
(a) Qualified primary care physicians who shall serve as the gatekeepers and who shall be responsible for the provision or authorization of health services to an eligible individual who is enrolled in the Children’s Medical Services network.
(b) Comprehensive specialty care arrangements that meet the requirements of s. 391.035 to provide acute care, specialty care, long-term care, and chronic disease management for eligible individuals.
(c) Case management services.
(3) The Children’s Medical Services network may contract with school districts participating in the certified school match program pursuant to ss. 409.908(22) and 1011.70 for the provision of school-based services, as provided for in s. 409.9071, for Medicaid-eligible children who are enrolled in the Children’s Medical Services network.
(4) If a newborn has an abnormal screening result for metabolic or other hereditary and congenital disorders which is identified through the newborn screening program pursuant to s. 383.14, the newborn shall be referred to the Children’s Medical Services program for additional testing, medical management, early intervention services, or medical referral.
History.—s. 13, ch. 98-288; s. 978, ch. 2002-387; s. 19, ch. 2004-350; s. 31, ch. 2016-65.
391.065 Health care provider agreements.—The department is authorized to establish health care provider agreements for participation in the Children’s Medical Services program.
History.—s. 14, ch. 98-288.
391.071 Quality of care requirements.—The Children’s Medical Services program shall develop quality of care and service integration standards and reporting requirements for health care providers that participate in the Children’s Medical Services program. The program shall ensure that these standards are not duplicative of other standards and requirements for health care providers.
History.—s. 15, ch. 98-288.
391.081 Grievance reporting and resolution requirements.—The department shall adopt and implement a system to provide assistance to eligible individuals and health care providers to resolve complaints and grievances. To the greatest extent possible, the department shall use existing grievance reporting and resolution processes. The department shall ensure that the system developed for the Children’s Medical Services program does not duplicate existing grievance reporting and resolution processes.
History.—s. 16, ch. 98-288.
391.095 Program integrity.—The department shall operate a system to oversee the activities of Children’s Medical Services program participants, and health care providers and their representatives, to prevent fraudulent and abusive behavior, overutilization and duplicative utilization, and neglect of participants and to recover overpayments as appropriate. For the purposes of this section, the terms “abuse” and “fraud” have the meanings provided in s. 409.913. The department shall refer incidents of suspected fraud and abuse, and overutilization and duplicative utilization, to the appropriate regulatory agency.
History.—s. 17, ch. 98-288.
391.097 Research and evaluation.—
(1) The department may initiate, fund, and conduct research and evaluation projects to improve the delivery of children’s medical services. The department may cooperate with public and private agencies engaged in work of a similar nature.
(2) The Children’s Medical Services network shall be included in any evaluation conducted in accordance with the provisions of Title XXI of the Social Security Act as enacted by the Legislature.
History.—s. 10, ch. 78-106; s. 18, ch. 98-288.
Note.—Former s. 391.061.
PART II
CHILDREN’S MEDICAL SERVICES
COUNCILS AND PANELS
391.221 Statewide Children’s Medical Services Network Advisory Council.
391.223 Technical advisory panels.
391.221 Statewide Children’s Medical Services Network Advisory Council.—
(1) The State Surgeon General may appoint a Statewide Children’s Medical Services Network Advisory Council for the purpose of acting as an advisory body to the department. Specifically, the duties of the council shall include, but not be limited to:
(a) Recommending standards and credentialing requirements for health care providers rendering health services to Children’s Medical Services network participants.
(b) Making recommendations to the director of Children’s Medical Services concerning the selection of health care providers for the Children’s Medical Services network.
(c) Reviewing and making recommendations concerning network health care provider or participant disputes that are brought to the attention of the advisory council.
(d) Providing input to the Children’s Medical Services program on the policies governing the Children’s Medical Services network.
(e) Reviewing the financial reports and financial status of the network and making recommendations concerning the methods of payment and cost controls for the network.
(f) Reviewing and recommending the scope of benefits for the network.
(g) Reviewing network performance measures and outcomes and making recommendations for improvements to the network and its maintenance and collection of data and information.
(2) The council shall be composed of 12 members representing the private health care provider sector, families with children who have special health care needs, the Agency for Health Care Administration, the Chief Financial Officer, the Florida Chapter of the American Academy of Pediatrics, an academic health center pediatric program, and the health insurance industry. Members shall be appointed for 4-year, staggered terms. In no case shall an employee of the Department of Health serve as a member or as an ex officio member of the advisory council. A vacancy shall be filled for the remainder of the unexpired term in the same manner as the original appointment. A member may not be appointed to more than two consecutive terms. However, a member may be reappointed after being off the council for at least 2 years.
(3) Members shall receive no compensation, but shall be reimbursed for per diem and travel expenses in accordance with the provisions of s. 112.061.
History.—s. 23, ch. 98-288; s. 44, ch. 99-397; s. 410, ch. 2003-261; s. 46, ch. 2008-6.
391.223 Technical advisory panels.—The State Surgeon General may establish technical advisory panels to assist in developing specific policies and procedures for the Children’s Medical Services program.
History.—s. 25, ch. 98-288; s. 46, ch. 99-397; s. 47, ch. 2008-6.
PART III
EARLY STEPS PROGRAM
391.301 Early Steps Program; establishment and goals.
391.302 Definitions.
391.308 Early Steps Program.
391.301 Early Steps Program; establishment and goals.—
(1) The Early Steps Program is established within the department to serve infants and toddlers who are at risk of developmental disabilities based on a physical or mental condition and infants and toddlers with developmental delays by providing developmental evaluation and early intervention and by providing families with training and support services in a variety of home and community settings in order to enhance family and caregiver competence, confidence, and capacity to meet their child’s developmental needs and desired outcomes.
(2) The program may include screening and referral services at all hospitals providing Level II or Level III neonatal intensive care services, in order to promptly identify newborns with disabilities or with conditions associated with risks of developmental delays so that families may gain as early as possible the services and skills they need to support their infants’ development.
(3) The program must integrate information and coordinate services with other programs serving infants and toddlers, including, but not limited to, the Healthy Start program, the newborn screening program, and the Blind Babies Program.
(4) The program must:
(a) Provide services to enhance the development of infants and toddlers with disabilities and delays.
(b) Expand the recognition by health care providers, families, and the public of the significant brain development that occurs during a child’s first 3 years of life.
(c) Maintain the importance of the family in all areas of the child’s development and support the family’s participation in early intervention services and decisions affecting the child.
(d) Operate a comprehensive, coordinated interagency system of early intervention services and supports in accordance with part C of the federal Individuals with Disabilities Education Act.
(e) Ensure timely evaluation, individual planning, and early intervention services necessary to meet the unique needs of eligible infants and toddlers.
(f) Build the service capacity and enhance the competencies of health care providers serving infants and toddlers with unique needs and abilities.
(g) Ensure programmatic and fiscal accountability through establishment of a high-capacity data system, active monitoring of performance indicators, and ongoing quality improvement.
History.—s. 12, ch. 89-379; s. 25, ch. 91-282; s. 7, ch. 94-140; s. 26, ch. 98-288; s. 51, ch. 2004-350; s. 6, ch. 2016-238.
Note.—Former s. 383.215(1), (2).
391.302 Definitions.—As used in ss. 391.301-391.308, the term:
(1) “Developmental delay” means a condition, identified and measured through appropriate instruments and procedures, which may delay physical, cognitive, communication, social or emotional, or adaptive development.
(2) “Developmental disability” means a condition, identified and measured through appropriate instruments and procedures, which may impair physical, cognitive, communication, social or emotional, or adaptive development.
(3) “Developmental intervention” or “early intervention” means individual and group therapies and services needed to enhance both the infant’s or toddler’s growth and development and family functioning. The term includes habilitative services and assistive technology devices, rehabilitative services and assistive technology devices, and parent support and training.
(4) “Habilitative services and devices” means health care services and assistive technology devices that help a child maintain, learn, or improve skills and functioning for daily living.
(5) “Infant or toddler” or “child” means a child from birth until the child’s third birthday.
(6) “Local program office” means an office that administers the Early Steps Program within a municipality, county, or region.
(7) “Rehabilitative services and devices” means restorative and remedial services that maintain or enhance the current level of functioning of a child if there is a possibility of improvement or reversal of impairment.
History.—s. 12, ch. 89-379; s. 7, ch. 94-140; s. 1039, ch. 95-148; s. 20, ch. 2004-350; s. 7, ch. 2016-238.
Note.—Former s. 383.215(3).
391.308 Early Steps Program.—The department shall implement and administer part C of the federal Individuals with Disabilities Education Act (IDEA), which shall be known as the “Early Steps Program.”
(1) PERFORMANCE STANDARDS.—The department shall ensure that the Early Steps Program complies with the following performance standards:
(a) The program must provide services from referral through transition in a family-centered manner that recognizes and responds to unique circumstances and needs of infants and toddlers and their families as measured by a variety of qualitative data, including satisfaction surveys, interviews, focus groups, and input from stakeholders.
(b) The program must provide individualized family support plans that are understandable and usable by families, health care providers, and payers and that identify the current level of functioning of the infant or toddler, family supports and resources, expected outcomes, and specific early intervention services needed to achieve the expected outcomes, as measured by periodic system independent evaluation.
(c) The program must help each family to use available resources in a way that maximizes the child’s access to services necessary to achieve the outcomes of the individualized family support plan, as measured by family feedback and by independent assessments of services used by each child.
(d) The program must offer families access to quality services that effectively enable infants and toddlers with developmental disabilities and developmental delays to achieve optimal functional levels as measured by an independent evaluation of outcome indicators in social or emotional skills, communication, and adaptive behaviors.
(2) DUTIES OF THE DEPARTMENT.—The department shall:
(a) Annually prepare a grant application to the United States Department of Education for funding early intervention services for infants and toddlers with disabilities, from birth through 36 months of age, and their families pursuant to part C of the federal Individuals with Disabilities Education Act.
(b) Jointly with the Department of Education, provide a reading initiative as an early intervention service for infants and toddlers.
(c) Annually develop a state plan for the Early Steps Program.
1. The plan must assess the need for early intervention services, evaluate the extent of the statewide need that is met by the program, identify barriers to fully meeting the need, and recommend specific action steps to improve program performance.
2. The plan must be developed through an inclusive process that involves families, local program offices, health care providers, and other stakeholders.
(d) Ensure local program offices educate hospitals that provide Level II and Level III neonatal intensive care services about the Early Steps Program and the referral process for the provision of developmental evaluation and intervention services.
(e) Establish standards and qualifications for developmental evaluation and early intervention service providers, including standards for determining the adequacy of provider networks in each local program office service area.
(f) Establish statewide uniform protocols and procedures to determine eligibility for developmental evaluation and early intervention services.
(g) Establish a consistent, statewide format and procedure for preparing and completing an individualized family support plan.
(h) Promote interagency cooperation and coordination, with the Medicaid program, the Department of Education program pursuant to part B of the federal Individuals with Disabilities Education Act, and programs providing child screening such as the Florida Diagnostic and Learning Resources System, the Office of Early Learning, Healthy Start, and the Help Me Grow program.
1. Coordination with the Medicaid program shall be developed and maintained through written agreements with the Agency for Health Care Administration and Medicaid managed care organizations as well as through active and ongoing communication with these organizations. The department shall assist local program offices to negotiate agreements with Medicaid managed care organizations in the service areas of the local program offices. Such agreements may be formal or informal.
2. Coordination with education programs pursuant to part B of the federal Individuals with Disabilities Education Act shall be developed and maintained through written agreements with the Department of Education. The department shall assist local program offices to negotiate agreements with school districts in the service areas of the local program offices.
(i) Develop and disseminate the knowledge and methods necessary to effectively coordinate benefits among various payer types.
(j) Provide a mediation process and if necessary, an appeals process for applicants found ineligible for developmental evaluation or early intervention services or denied financial support for such services.
(k) Competitively procure local program offices to provide services throughout the state in accordance with chapter 287. The department shall specify the requirements and qualifications for local program offices in the procurement document.
(l) Establish performance standards and other metrics for evaluation of local program offices, including standards for measuring timeliness of services, outcomes of early intervention services, and administrative efficiency. Performance standards and metrics shall be developed in consultation with local program offices.
(m) Provide technical assistance to the local program offices.
(3) ELIGIBILITY.—The department shall apply the following eligibility criteria if specific funding is provided, and the associated applicable eligibility criteria are identified, in the General Appropriations Act:
(a) Infants and toddlers are eligible for an evaluation to determine the presence of a developmental disability or the risk of a developmental delay based on a physical or medical condition.
(b) Infants and toddlers determined to have a developmental delay based on informed clinical opinion and an evaluation using a standard evaluation instrument which results in a score that is 1.5 standard deviations from the mean in two or more of the following domains: physical, cognitive, communication, social or emotional, and adaptive.
(c) Infants and toddlers determined to have a developmental delay based on informed clinical opinion and an evaluation using a standard evaluation instrument which results in a score that is 2.0 standard deviations from the mean in one of the following domains: physical, cognitive, communication, social or emotional, and adaptive.
(d) Infants and toddlers determined to have a developmental delay based on informed clinical opinion and an evaluation using a standard evaluation instrument which results in a score that is 1.5 standard deviations from the mean in one or more of the following domains: physical, cognitive, communication, social or emotional, and adaptive.
(e) Infants and toddlers determined to have a developmental delay based on informed clinical opinion.
(f) Infants and toddlers at risk of developmental delay based on an established condition known to result in developmental delay, or a physical or mental condition known to create a risk of developmental delay.
(4) DUTIES OF THE LOCAL PROGRAM OFFICES.—A local program office shall:
(a) Evaluate a child to determine eligibility within 45 calendar days after the child is referred to the program.
(b) Notify the parent or legal guardian of his or her child’s eligibility status initially and at least annually thereafter. If a child is determined not to be eligible, the local program office must provide the parent or legal guardian with written information on the right to an appeal and the process for making such an appeal.
(c) Secure and maintain interagency agreements or contracts with local school districts in a local service area.
(d) Provide services directly or procure services from health care providers that meet or exceed the minimum qualifications established for service providers. The local program office must become a Medicaid provider if it provides services directly.
(e) Provide directly or procure services that are, to the extent possible, delivered in a child’s natural environment, such as in the child’s home or community setting. The inability to provide services in the natural environment is not a sufficient reason to deny services.
(f) Develop an individualized family support plan for each child served. The plan must:
1. Be completed within 45 calendar days after the child is referred to the program;
2. Be developed in conjunction with the child’s parent or legal guardian who provides written consent for the services included in the plan;
3. Be reviewed at least every 6 months with the parent or legal guardian and updated if needed; and
4. Include steps to transition to school or other future services by the child’s third birthday.
(g) Assess the progress of the child and his or her family in meeting the goals of the individualized family support plan.
(h) For each service required by the individualized family support plan, refer the child to an appropriate service provider or work with Medicaid managed care organizations or private insurers to secure the needed services.
(i) Provide service coordination, including contacting the appropriate service provider to determine whether the provider can timely deliver the service, providing the parent or legal guardian with the name and contact information of the service provider and the date and location of the service of any appointment made on behalf of the child, and contacting the parent or legal guardian after the service is provided to ensure that the service is timely delivered and to determine whether the family requests additional services.
(j) Negotiate and maintain agreements with Medicaid providers and Medicaid managed care organizations in its area.
1. With the parent’s or legal guardian’s permission, the services in the child’s approved individualized family support plan shall be communicated to the Medicaid managed care organization. Services that cannot be funded by Medicaid must be specifically identified and explained to the family.
2. The agreement between the local program office and Medicaid managed care organizations must establish methods of communication and procedures for the timely approval of services covered by Medicaid.
(k) Develop agreements and arrangements with private insurers in order to coordinate benefits and services for any mutual enrollee.
1. The child’s approved individualized family support plan may be communicated to the child’s insurer with the parent’s or legal guardian’s permission.
2. The local program office and private insurers shall establish methods of communication and procedures for the timely approval of services covered by the child’s insurer, if appropriate and approved by the child’s parent or legal guardian.
(l) Provide to the department data necessary for an evaluation of the local program office performance.
(5) ACCOUNTABILITY REPORTING.—By December 1 of each year, the department shall prepare and submit a report that assesses the performance of the Early Steps Program to the Governor, the President of the Senate, the Speaker of the House of Representatives, and the Florida Interagency Coordinating Council for Infants and Toddlers. The department must address the performance standards in subsection (1) and report actual performance compared to the standards for the prior fiscal year. The data used to compile the report must be submitted by each local program office in the state. The department shall report on all of the following measures:
(a) Number and percentage of infants and toddlers served with an individualized family support plan.
(b) Number and percentage of infants and toddlers demonstrating improved social or emotional skills after the program.
(c) Number and percentage of infants and toddlers demonstrating improved use of knowledge and cognitive skills after the program.
(d) Number and percentage of families reporting positive outcomes in their infant’s and toddler’s development as a result of early intervention services.
(e) Progress toward meeting the goals of individualized family support plans.
(f) Any additional measures established by the department.
(6) STATE INTERAGENCY COORDINATING COUNCIL.—The Florida Interagency Coordinating Council for Infants and Toddlers shall serve as the state interagency coordinating council required by 34 C.F.R. s. 303.600. The council shall be housed for administrative purposes in the department, and the department shall provide administrative support to the council.
(7) TRANSITION TO EDUCATION.—
(a) At least 90 days before a child reaches 3 years of age, the local program office shall initiate transition planning to ensure the child’s successful transition from the Early Steps Program to a school district program for children with disabilities or to another program as part of an individual family support plan.
(b) At least 90 days before a child reaches 3 years of age, the local program office shall:
1. Notify the local school district in which the child resides and the Department of Education that the child may be eligible for special education or related services as determined by the local school district pursuant to ss. 1003.21 and 1003.57, unless the child’s parent or legal guardian has opted out of such notification; and
2. Upon approval by the child’s parent or legal guardian, convene a transition conference that includes participation of a local school district representative and the parent or legal guardian to discuss options for and availability of services.
(c) The local school district shall evaluate and determine a child’s eligibility to receive special education or related services pursuant to part B of the federal Individuals with Disabilities Education Act and ss. 1003.21 and 1003.57.
(d) The local program office, in conjunction with the local school district, shall modify a child’s individual family support plan or, if applicable, the local school district shall develop an individual education plan for the child pursuant to ss. 1003.57, 1003.571, and 1003.5715, which identifies special education or related services that the child will receive and the providers or agencies that will provide such services.
(e) If a child is determined to be ineligible for school district program services, the local program office and the local school district shall provide the child’s parent or legal guardian with written information on other available services or community resources.
(f) The local program office shall negotiate and maintain an interagency agreement with each local school district in its service area pursuant to the Individuals with Disabilities Education Act, 20 U.S.C. s. 1435(a)(10)(F). Each interagency agreement must be reviewed at least annually and updated upon review, if needed.
History.—s. 5, ch. 2004-245; s. 22, ch. 2004-350; s. 9, ch. 2016-238.