HB 0727 2004
1	A bill to be entitled
2	An act relating to mental health and vocational
3	rehabilitation services; creating pt. VI of ch. 394, F.S.,
4	relating to self-directed and family-directed mental
5	health and vocational rehabilitation services; providing a
6	popular name; providing legislative findings and intent;
7	providing definitions; providing a program for self-
8	directed mental health and vocational rehabilitation
9	services for adults; providing eligibility and other
10	program requirements; providing for statewide and local
11	steering councils; providing authority to request certain
12	federal waivers and to request and use certain grants;
13	providing for transfer of certain funds; providing for
14	ongoing review and annual reports; providing rulemaking
15	authority; providing for a pilot program for family-
16	directed mental health services for children based on the
17	self-directed care program for adults; providing
18	eligibility and other pilot program requirements;
19	providing background screening requirements; providing
20	rulemaking authority; providing for annual reports;
21	providing for future repeal of the pilot program;
22	repealing s. 394.9084, F.S., relating to the pilot project
23	for client-directed and choice-based adult mental health
24	services; providing an effective date.
25
26	Be It Enacted by the Legislature of the State of Florida:
27
28	Section 1. Part VI of chapter 394, Florida Statutes,
29	consisting of sections 394.9501 and 394.9503, Florida Statutes,
30	is created to read:
31	PART VI
32	SELF-DIRECTED AND FAMILY-DIRECTED MENTAL HEALTH AND VOCATIONAL
33	REHABILITATION SERVICES
34	394.9501 Self-directed mental health and vocational
35	rehabilitation services.--
36	(1) POPULAR NAME.--This section may be cited by the
37	popular name the "Florida Self-Directed Care (FloridaSDC) Act."
38	(2) LEGISLATIVE FINDINGS AND INTENT.--
39	(a) The Legislature finds that alternatives to traditional
40	assignment of adults with mental health needs to community
41	mental health centers based on geographic location should be
42	encouraged as a function of self-determination. The Legislature
43	finds that alternatives to traditional assignment of adults with
44	mental health needs who are also in need of vocational
45	rehabilitation based on sole-source contracts should be
46	encouraged as a function of self-determination. The Legislature
47	finds that giving adults in need of mental health and vocational
48	rehabilitation services the opportunity to select the services
49	they need and the providers they want enhances their sense of
50	dignity and autonomy. The Legislature also finds that providing
51	adults choice and control, as tested in current research and
52	demonstration projects, has been beneficial and should be
53	developed further and implemented statewide.
54	(b) It is the intent of the Legislature to nurture the
55	autonomy of those adult citizens of the state who have
56	psychiatric disabilities by providing access to mental health
57	care and vocational rehabilitation services they need in the
58	least restrictive, most integrated setting. It is the intent of
59	the Legislature to give such individuals more choices in and
60	greater control over the purchased mental health care and
61	vocational rehabilitation services they receive.
62	(3) DEFINITIONS.--As used in this section, the term:
63	(a) "Agency" means the Agency for Health Care
64	Administration.
65	(b) "Budget allowance" means the amount of money made
66	available to a participant to purchase needed mental health care
67	and vocational rehabilitation services, based on the results of
68	a needs assessment.
69	(c) "Department" means the Department of Children and
70	Family Services.
71	(d) "Division" means the Division of Vocational
72	Rehabilitation of the Department of Education.
73	(e) "Fiscal intermediary" means an entity approved by the
74	department that helps the participant manage his or her budget
75	allowances.
76	(f) "Participant" means a person 18 years of age or older
77	who has chosen to participate in the program, who has met the
78	enrollment requirements, and who has received approved budget
79	allowances.
80	(g) "Provider" means a person licensed or otherwise
81	permitted to render services eligible for reimbursement under
82	this program for whom the participant is not the employer of
83	record.
84	(h) "Recovery coach" means an individual who provides
85	technical assistance to participants in meeting their
86	responsibilities under this section.
87	(i) "Self-determination" refers to a mechanism to fiscally
88	allow the money to follow the individual to allow the
89	opportunity for freedom of choice in what is necessary to
90	purchase to recover from a mental illness, emotional
91	disturbance, or behavioral problem and to seek vocational
92	rehabilitation services that best fit the individual's needs.
93	(4) SELF-DIRECTED CARE.--
94	(a) Program established.--The department shall establish
95	the self-directed care (FloridaSDC) program for adults, which
96	shall be based on the principles of participant choice and
97	control. The department shall establish interagency cooperative
98	agreements with and shall work with the agency, the division,
99	and the Social Security Administration to implement and
100	administer the program. The program shall allow enrolled persons
101	the opportunity to choose the providers of services and to
102	direct the delivery of services to best meet their mental health
103	care and vocational rehabilitation needs. The department shall
104	operate the program within the funds appropriated by the
105	Legislature and funds obtained through agency, division, and
106	department waivers.
107	(b) Eligibility and enrollment.--
108	1. The target populations for the program are adults with
109	a severe and persistent mental illness. An adult with a severe
110	and persistent mental illness means a person who is age 18 or
111	older, has a diagnosis or diagnostic impression of Axis I or
112	Axis II mental disorder, and:
113	a. Receives supplemental security income (SSI) due to
114	psychiatric disability;
115	b. Receives social security disability income (SSDI) due
116	to psychiatric disability;
117	c. Receives disabled veterans income due to psychiatric
118	disability;
119	d. Receives any other type of disability income due to
120	psychiatric disability;
121	e. Receives social security income for reasons other than
122	psychiatric disability and does not need, is unable to apply, or
123	refuses to apply for disability income;
124	f. Does not receive disability income due to psychiatric
125	disability, but has an application in process or has received
126	such income within the last 5 years; or
127	g. Is legally competent to direct his or her own affairs.
128	2. Participants must be permanent residents of the
129	district or subdistrict in which the program they participate in
130	is located.
131	(c) Budget allowances.--Participants enrolled in the
132	program shall be given quarterly budget allowances based on the
133	average cost to serve a similar individual in the district or
134	subdistrict of service for the previous fiscal year. These
135	allowances shall be paid on an annual prepaid case rate to the
136	fiscal intermediary for management purposes. Budget allowances
137	shall be managed on behalf of participants by a fiscal
138	intermediary approved by the department. The department shall
139	develop purchasing guidelines, subject to approval of the agency
140	and the division, to assist participants in using the budget
141	allowances to purchase needed, cost-effective services. Funding
142	for budget allowances shall come through department funding,
143	agency funds obtained through any waiver of s. 1115 of the
144	Social Security Act, 42 U.S.C. s. 1315, or division funds
145	obtained through any special vocational rehabilitation waiver.
146	(d) Services.--Participants shall use budget allowances
147	only to pay for community-based services that meet the
148	participant's mental health care and vocational rehabilitation
149	needs and are a cost-efficient use of funds. The department, the
150	agency, and the division, in collaboration with the statewide
151	steering councils, shall develop purchasing guidelines that may
152	be adjusted with approval to meet the needs of each district and
153	subdistrict.
154	(e) Participant roles and responsibilities.--Participants
155	shall be allowed to choose the providers of services, as well as
156	when and how the services are provided. The roles and
157	responsibilities of a participant include, but are not limited
158	to, the following:
159	1. Communicating needs, preferences, and expectations
160	about services being purchased.
161	2. Ending the services of an unsatisfactory provider.
162	3. Providing the fiscal agent with all information
163	necessary for provider payments.
164	(f) Department roles and responsibilities.--The roles and
165	responsibilities of the department set forth in this section
166	include, but are not limited to, the following:
167	1. Adhering to the original intent of the pilot project
168	created pursuant to chapter 2001-152, Laws of Florida, and
169	maintaining fidelity to the original model that was developed
170	and implemented as a result of that chapter law.
171	2. Assessing each participant's mental health care and
172	vocational rehabilitation needs, helping with the service plan,
173	and providing ongoing support with the service plan.
174	3. Approving the fiscal intermediary. The fiscal
175	intermediary may not be a provider of behavioral health care
176	services.
177	4. Establishing the minimum qualifications for all
178	providers and being the final arbiter of the fitness of any
179	individual to be a provider.
180	5. Establishing, at the beginning of each fiscal year, the
181	number of available slots in the program for each district.
182	Based on the number of slots for each district, the department
183	shall contract with the fiscal intermediary on an annual prepaid
184	case rate that is based on the previous year's average cost to
185	provide department-funded mental health services, agency-funded
186	mental health services, and division-funded vocational
187	rehabilitation services. The number of slots available each
188	fiscal year shall be evaluated and adjusted based on consumer
189	demand. Participants may enroll and disenroll at any time during
190	the course of the fiscal year; however, the number of available
191	slots in the program within each district may not be changed
192	until the beginning of each fiscal year.
193	(g) Fiscal intermediary roles and responsibilities.--The
194	roles and responsibilities of the fiscal intermediary include,
195	but are not limited to, the following:
196	1. Providing recordkeeping and fiscal processing services.
197	2. Retaining the participant-directed care funds,
198	processing provider enrollment information, if any, reviewing
199	records to ensure correctness, writing checks to providers, and
200	maintaining district-level service staff.
201	3. Employing recovery coaches who shall provide training,
202	technical assistance, and support to the participant. The fiscal
203	intermediary may not provide direct services to participants
204	beyond those provided by the recovery coaches.
205	(5) STEERING COUNCILS.--A statewide steering council shall
206	guide the program. Local steering councils shall guide the
207	program in each district and subdistrict. The statewide steering
208	council and each local steering council shall be composed of at
209	least 11 program participants and 9 family members. Only program
210	participants and family members are eligible to serve on a
211	statewide or local steering council. Providers of behavioral
212	health care services are not eligible to serve on any steering
213	council. Each local steering council shall adopt and be governed
214	by bylaws and shall have a single seat on the statewide steering
215	council. The department, the agency, the division, and the
216	fiscal intermediary shall, after consultation with local
217	advocacy groups in each district or subdistrict, establish
218	requirements regarding the number of programs to be offered
219	within a district or subdistrict. Although the statewide and
220	local steering councils will not have financial management
221	responsibility for the program, each council shall function as a
222	stakeholder in each program in which it is involved. The
223	department, agency, and division must consider and respond to
224	all requests and recommendations from the local steering council
225	in each district's or subdistrict's programs. The department has
226	final authority on and responsibility for operation of the
227	program.
228	(6) FEDERAL WAIVERS; GRANTS.--
229	(a) The department shall take all necessary action to
230	ensure state compliance with federal regulations. The
231	department, the agency, and the division shall apply for any
232	federal waiver or waiver amendment necessary to implement the
233	program. At minimum, the agency, in collaboration with the
234	department, shall seek a waiver of s. 1115 of the Social
235	Security Act, 42 U.S.C. s. 1315; the department shall seek a
236	Supplemental Security Administration (SSA) waiver; and the
237	division, in collaboration with the department, shall seek a
238	vocational rehabilitation waiver based on the fiscal principles
239	of self-determination.
240	(b) The department may apply for and use any funds from
241	private, state, and federal grants provided for self-directed
242	care, voucher, and self-determination programs, including those
243	providing substance abuse and mental health care. Such funds may
244	only be used as specified in the grants.
245	(c) The approval of all waivers is not required for
246	implementation and operation of the program, but the program may
247	not provide services for which a waiver is required without
248	getting approval for that waiver.
249	(7) FUNDS TRANSFER.--The department may transfer funds
250	allocated to substance abuse and mental health services to the
251	fiscal intermediary based on the average cost of service in the
252	previous fiscal year for each district for every participant
253	enrolled in the program. The funds the department, agency, and
254	division transfer each year shall be a prepaid case rate based
255	on the previous year's annual average cost to serve in each
256	district. The funds transferred shall also be based on the
257	number of slots in the program allocated for each district each
258	year.
259	(8) REVIEWS AND REPORTS.--The department, the agency, and
260	the division shall each, on an ongoing basis, review and assess
261	the implementation of the program. By January 31 of each year,
262	the department shall submit a written report to the chairs of
263	the appropriate substantive committees of the Legislature that
264	includes review of the program by the department, the agency,
265	and the division and contains recommendations for improvements
266	to the program. The department shall administer all three
267	waivers through the interagency agreements established pursuant
268	to paragraph (4)(a).
269	(9) RULES.--The department, the agency, and the division
270	are authorized to adopt and enforce rules pursuant to ss.
271	120.536(1) and 120.54 necessary to implement and administer this
272	section. The statewide steering council must review and approve
273	such rules prior to their being proposed for adoption.
274	394.9503 Family-directed care (FloridaFDC) pilot
275	program.--
276	(1) The Department of Children and Family Services shall
277	develop a family-directed care (FloridaFDC) pilot program in a
278	district selected by the department. The pilot program shall
279	provide mental health treatment and support services to children
280	who are at risk of emotional disturbance or who have an
281	emotional disturbance or a serious emotional disturbance. The
282	program shall be organized and operated in the same manner as
283	the self-directed care (FloridaSDC) program established under s.
284	394.9501. The department may use for the pilot program any funds
285	of the FloridaSDC program secured from grants provided for
286	substance abuse and mental health care that are restricted to
287	services for children.
288	(2) The target populations for the FloridaFDC program
289	shall be children who are at risk of emotional disturbance or
290	who have an emotional disturbance or a serious emotional
291	disturbance. The child must be living at home with his or her
292	family in order to participate in the pilot program.
293	(a) A child at risk of emotional disturbance is a person
294	under 18 years of age who is currently referred for placement in
295	a program for students with emotional handicaps in accordance
296	with the Individuals with Disabilities Education Act.
297	(b) A child with an emotional disturbance means a child
298	who meets one of the following criteria:
299	1. Has a diagnosis listed in the Diagnostic and
300	Statistical Manual of the American Psychiatric Association and a
301	Children's Global Assessment Scale score of 51-60.
302	2. Is currently classified as a student with an emotional
303	handicap by a local school district.
304	(c) A child with a serious emotional disturbance is a
305	person under 18 years of age who meets one of the following
306	criteria:
307	1. Has a diagnosis of schizophrenia or other psychotic
308	disorder, major depression, mood disorder, or personality
309	disorder.
310	2. Has a diagnosis listed in the Diagnostic and
311	Statistical Manual of the American Psychiatric Association and a
312	Children's Global Assessment Scale score of 50 or below.
313	3. Is currently classified as a student with serious
314	emotional disturbance by a local school district.
315	4. Is currently receiving supplemental security income
316	benefits for a psychiatric disability.
317	(3) The following children are not eligible to participate
318	in the pilot program:
319	(a) Children who are in the custody of the Department of
320	Children and Family Services.
321	(b) Children with a primary diagnosis of developmental
322	disability, pervasive developmental disorder, substance abuse,
323	communication disorder, learning disorder, or autism.
324	(4) All persons who render care to children under this
325	section must comply with the requirements of s. 435.05. Persons
326	shall be excluded from employment pursuant to s. 435.06. Persons
327	excluded from employment may request an exemption from
328	disqualification, as provided in s. 435.07. Persons not subject
329	to certification or professional licensure may request an
330	exemption from the Department of Children and Family Services.
331	In considering a request for an exemption, the department shall
332	comply with the provisions of s. 435.07. For purposes of this
333	section, a person who has undergone screening, who is qualified
334	for employment under this section and applicable rule, and who
335	has not been unemployed for more than 180 days following such
336	screening is not required to be rescreened. Such person must
337	attest under penalty of perjury to not having been convicted of
338	a disqualifying offense since completing such screening.
339	(5) The Department of Children and Family Services may
340	adopt rules pursuant to ss. 120.536(1) and 120.54 necessary to
341	implement the provisions of this section.
342	(6) The Department of Children and Family Services shall
343	submit a report concerning the progress of the pilot program to
344	the appropriate legislative committees by December 1 of each
345	year of the pilot program.
346	(7) This section is repealed July 1, 2008.
347	Section 2. Section 394.9084, Florida Statutes, is
348	repealed.
349	Section 3. This act shall take effect July 1, 2004.