HB 0727

CS

CHAMBER ACTION

1	The Committee on Future of Florida's Families recommends the
2	following:
3
4	Committee Substitute
5	Remove the entire bill and insert:
6	A bill to be entitled
7	An act relating to mental health and vocational
8	rehabilitation services; creating part VI of chapter 394,
9	F.S., relating to self-directed and family-directed mental
10	health and vocational rehabilitation services; providing a
11	popular name; providing legislative intent; providing for
12	implementation and expansion; providing definitions;
13	providing a program for self-directed mental health and
14	vocational rehabilitation services for adults; providing
15	eligibility and other program requirements; providing
16	limitations; providing for statewide and local advisory
17	councils; providing authority to request certain federal
18	waivers and to request and use certain grants; providing
19	for transfer of certain funds; providing for ongoing
20	review and reports; providing rulemaking and overall
21	authority; providing for a pilot program for family-
22	directed mental health treatment and support services for
23	certain children based on the self-directed care program
24	for adults; providing eligibility and other pilot program
25	requirements; providing background screening requirements;
26	providing rulemaking authority; providing for annual
27	reports; providing for future repeal of the pilot program;
28	repealing s. 394.9084, F.S., relating to the pilot project
29	for client-directed and choice-based adult mental health
30	services; providing an effective date.
31
32	Be It Enacted by the Legislature of the State of Florida:
33
34	Section 1.  Part VI of chapter 394, Florida Statutes,
35	consisting of sections 394.9501 and 394.9503, is created to
36	read:
37	PART VI
38	SELF-DIRECTED AND FAMILY-DIRECTED MENTAL HEALTH
39	AND VOCATIONAL REHABILITATION SERVICES
40	394.9501  Self-directed mental health and vocational
41	rehabilitation services.--
42	(1)  POPULAR NAME.--This section may be cited by the
43	popular name the "Florida Self-Directed Care (FloridaSDC) Act."
44	(2)  LEGISLATIVE INTENT.--The Legislature finds that the
45	experience, courage, and philosophy of the advocates who helped
46	to initiate the self-directed care pilot for adults with
47	psychiatric disabilities in Northeast Florida has created a new
48	modality of care, has increased personal responsibility, and has
49	empowered individuals. The Legislature finds that many adults
50	with psychiatric disabilities are able to choose the providers
51	and services that best help them to achieve recovery from mental
52	illness. It is the intent of the Legislature to provide adults
53	with a mental illness and children with or at risk for emotional
54	disturbances and their families the opportunity to exercise
55	choice and control in managing their mental health recovery by
56	offering a program of self-directed care with a wide range of
57	choices in and control over the purchased mental health care and
58	vocational rehabilitation services they access. The Legislature
59	finds that some families of children with or at risk for
60	emotional disturbances are able to choose the providers and
61	services best able to assist them in recovery. The Legislature
62	intends to test the self-directed modality for these families in
63	a pilot project.
64	(3)  IMPLEMENTATION AND EXPANSION.--The department shall
65	expand this program as resources become available. The
66	administrative costs for sites added after July 1, 2004, shall
67	not be paid from funds appropriated for direct client services.
68	(4)  DEFINITIONS.--As used in this section, the term:
69	(a)  "Adult with a mental illness" means a person who is
70	age 18 or older and who has a diagnosis or diagnostic impression
71	of an Axis I or Axis II mental disorder.
72	(b)  "Agency" means the Agency for Health Care
73	Administration.
74	(c)  "Budget allowance" means the amount of funds made
75	available to the managing entity on behalf of a participant to
76	purchase needed mental health treatment, rehabilitation and
77	enrichment, and vocational rehabilitation services, based on the
78	results of an assessment of a participant's needs and goals.
79	(d)  "Department" means the Department of Children and
80	Family Services.
81	(e)  "Division" means the Division of Vocational
82	Rehabilitation of the Department of Education.
83	(f)  "Freedom account" means an account in which a
84	participant who receives supplemental security income (SSI) or
85	social security disability income (SSDI) is permitted to save
86	funds to assist in achieving independence by reaching
87	educational and vocational goals.
88	(g)  "Managing entity" means the single organization
89	approved by the department to provide fiscal intermediary
90	services and administrative support.
91	(h)  "Participant" means a person who has chosen to
92	participate in the program, who has met the enrollment
93	requirements, and who has received a budget allowance.
94	(i)  "Provider" means a person or organization licensed or
95	otherwise permitted to render services eligible for
96	reimbursement under this program for which the participant is
97	not the employer of record.
98	(j)  "Quality advocate" means a mental health professional
99	who is licensed or eligible for licensure pursuant to chapter
100	490 or chapter 491 who manages the delivery of direct services
101	to participants.
102	(k)  "Recovery coach" means an individual who provides
103	technical assistance to participants in meeting their
104	responsibilities under this section.
105	(l)  "Self-determination" means a fiscal mechanism that
106	gives the individual an opportunity to choose the providers and
107	services necessary for recovery from a mental illness or an
108	emotional disturbance.
109	(5)  SELF-DIRECTED CARE.--
110	(a)  Program established.--The department shall establish
111	the Florida self-directed care (FloridaSDC) program for adults,
112	which shall be based on the principles of participant choice and
113	control. The department shall establish interagency cooperative
114	agreements and work with the agency, the division, and the
115	Social Security Administration to implement and administer the
116	FloridaSDC program. The FloridaSDC program shall give enrolled
117	persons the opportunity to choose the providers of services and
118	to direct the delivery of services to best meet their mental
119	health care and vocational rehabilitation needs. The department
120	shall operate the direct-services portion of the FloridaSDC
121	program within the funds appropriated by the Legislature and
122	other funds obtained through the agency, division, and
123	department. The FloridaSDC program shall consist of four
124	subcomponents. A participant must participate in at least one
125	and may participate in any of the following subcomponents for
126	which they are eligible:
127	1.  Department mental health services.--This subcomponent
128	provides a budget allowance that includes community mental
129	health outpatient, community support, and case management
130	services. This budget allowance excludes Florida Assertive
131	Community Treatment (FACT) services for adults; residential
132	services; and emergency stabilization services, including crisis
133	stabilization units, short-term residential treatment, and
134	inpatient services. The participant must be eligible as provided
135	in the waiver of s. 1115 of the Social Security Act, 42 U.S.C.
136	s. 1315.
137	2.  Agency mental health services.--This subcomponent
138	includes in the budget allowance Medicaid community mental
139	health services and mental health targeted case management
140	services.
141	3.  Vocational rehabilitation.--This subcomponent includes
142	funds available for an eligible participant as provided by the
143	Rehabilitation Act of 1973, as amended.
144	4.  Social Security Administration.--This subcomponent
145	includes funds from any social security income program.
146	(b)  Eligibility and enrollment.--To be eligible for
147	enrollment in the FloridaSDC program, a person must be an adult
148	with a severe and persistent mental illness who:
149	1.a.  Receives supplemental security income (SSI), social
150	security disability income (SSDI), disabled veterans income, or
151	any other type of disability income due to psychiatric
152	disability;
153	b.  Receives social security income (SSI) for reasons other
154	than psychiatric disability; or
155	c.  Does not receive disability income due to psychiatric
156	disability but has an application in process or has received
157	such income within the last 5 years.
158	2.  Is legally competent to direct his or her own affairs.
159	3.  Is not enrolled in Florida Assertive Community
160	Treatment (FACT) services.
161	4.  Lives in the department's district in which the program
162	he or she participates in is located.
163	5.  Applies for Medicaid and other income-support programs
164	for which he or she may qualify.
165	(c)  Participation.--Participation in the FloridaSDC
166	program is voluntary and participants may disenroll at any time.
167	Agency and department services shall be available on the first
168	day of the month after a person disenrolls.
169	(d)  Budget allowances.--Participants enrolled in the
170	FloridaSDC program shall be given a monthly budget allowance
171	based on the results of their assessed needs and goals and the
172	financial resources of the program. Budget allowances shall be
173	managed on behalf of participants by the managing entity as the
174	fiscal intermediary. The department, in collaboration with the
175	statewide advisory council, shall develop purchasing guidelines,
176	approved by the agency and the division, to assist participants
177	in using the budget allowance to purchase needed, cost-effective
178	services. The department shall determine the total amount of
179	budget allowances available for each site by calculating the
180	average cost to serve eligible participants during the previous
181	fiscal year. Individual budget allowances may vary in accordance
182	with the participants' approved recovery plans. Funding for
183	budget allowances shall be provided through department funding,
184	agency funds made available through a waiver of s. 1115 of the
185	Social Security Act, 42 U.S.C. s. 1315, and division funds.
186	(e)  Services.--The managing entity for the FloridaSDC
187	program shall use budget allowances to pay for community-based
188	services that meet the participant's mental health care and
189	vocational rehabilitation needs based on the individual's
190	recovery plan goals and that are a cost-efficient use of such
191	funds. Such funds shall be considered the payer of last resort
192	and must be coordinated with any other benefits for which the
193	participant is eligible.
194	(f)  Participant roles and responsibilities.--Participants
195	in the FloridaSDC program shall choose the providers of
196	services, as well as when and how the services are provided. The
197	roles and responsibilities of participants include, but are not
198	limited to, the following:
199	1.  Communicating needs, preferences, and expectations
200	about services being purchased.
201	2.  Ending the services of an unsatisfactory provider.
202	3.  Providing the managing entity with all information
203	necessary for provider payments.
204	(g)  Department roles and responsibilities.--The roles and
205	responsibilities of the department under the FloridaSDC program
206	include, but are not limited to, the following:
207	1.  Establishing standards for approval of the managing
208	entity. The managing entity may not be a provider of behavioral
209	health care services or be a managed care organization.
210	2.  Establishing, in consultation with the agency and the
211	division, the minimum qualifications for all providers and being
212	the final arbiter of the fitness of any individual or
213	organization to be a provider.
214	3.  Establishing, at the beginning of each fiscal year, the
215	number of available openings in the program for each district.
216	(h)  Managing entity roles and responsibilities.--
217	1.  The roles and responsibilities of the managing entity
218	under the FloridaSDC program include, but are not limited to,
219	the following:
220	a.  Providing recordkeeping and fiscal processing services
221	and providing for an audit by an independent certified public
222	accountant annually.
223	b.  Retaining the participant-directed care funds in
224	distinct categories by program subcomponent, processing provider
225	enrollment information, if any, reviewing records to ensure
226	correctness, making payments to providers for services, ensuring
227	timely account activity and balance reporting to participants
228	and FloridaSDC program staff, and maintaining district-level
229	FloridaSDC service staff.
230	c.  Contracting recovery coaches who shall provide
231	training, technical assistance, and support to participants. The
232	managing entity may not provide direct services to participants
233	beyond those provided by the recovery coaches and quality
234	advocates.
235	d.  Establishing a provider network.
236	e.  Providing controls to prevent overspending of budget
237	allowances and separate accounting for each program
238	subcomponent, and ensuring that funds expended meet all federal
239	requirements and purchasing guidelines established by the
240	department.
241	f.  Maintaining each participant's freedom account under s.
242	1110(b) of the Social Security Act.
243	g.  Assessing each participant's mental health care and
244	vocational rehabilitation needs, helping with the recovery plan,
245	and providing ongoing support with the recovery plan.
246	h.  Expediting linkages for FloridaSDC participants to
247	other mental health services not available through the program.
248	i.  Educating each participant about the use of advanced
249	medical and psychiatric directives.
250	2.  Employees, board members, or owners of the managing
251	entity may not serve on boards of mental health care providers
252	or any other entity that would result in a conflict of interest.
253	(6)  LIMITATIONS.--Participants enrolled in the agency
254	mental health services subcomponent are excluded from enrollment
255	in any program that prepays Medicaid community mental health or
256	mental health targeted case management benefits and may not
257	access Medicaid reimbursed mental health benefits under a fee-
258	for-service program. The vocational rehabilitation subcomponent
259	is contingent upon federal legislation allowing for a
260	demonstration program that will permit vocational rehabilitation
261	funds to flow through the managing entity. Participation in the
262	Social Security Administration subcomponent is contingent upon
263	federal approval of a demonstration project authorized by a
264	waiver.
265	(7)  ADVISORY COUNCILS.--Local advisory councils shall
266	guide the FloridaSDC program in each participating district.
267	Each local advisory council shall adhere to the intent of the
268	FloridaSDC program to provide choice and control to
269	participants. At least 51 percent of the members of the local
270	advisory councils shall be participants in the FloridaSDC
271	program. A statewide advisory council of at least five and no
272	more than nine members shall guide the FloridaSDC program. The
273	statewide advisory council shall be comprised of local advisory
274	council members. At least 51 percent of the members of the
275	statewide advisory council shall be participants in the
276	FloridaSDC program. The remaining council memberships shall be
277	comprised of adult family members of individuals who have been
278	diagnosed with a psychiatric disability. Providers of behavioral
279	health care services, or their staff, owners, or board members,
280	are not eligible to serve on any advisory council. Members of
281	local and statewide advisory councils shall serve without
282	compensation but are entitled to reimbursement for travel and
283	per diem expenses pursuant to s. 112.061. The department shall
284	develop policies and rules regarding appointment, operation, and
285	terms of memberships for both the state and local advisory
286	councils. The department shall consider requests and
287	recommendations from the statewide advisory council for
288	improvements to the FloridaSDC program.
289	(8)  FEDERAL WAIVERS; GRANTS.--
290	(a)  The department shall take all necessary action to
291	ensure state compliance with federal regulations. The agency, in
292	collaboration with the department, shall seek a waiver of s.
293	1115 of the Social Security Act, 42 U.S.C. s. 1315; the
294	department shall expeditiously seek any available Supplemental
295	Security Administration (SSA) waivers under s. 1110(b) of the
296	Social Security Act; and the division, in collaboration with the
297	department, shall seek federal approval to participate in the
298	FloridaSDC program.
299	(b)  The department may apply for and use any funds from
300	private, state, and federal grants provided for self-directed
301	care, voucher, and self-determination programs, including those
302	providing substance abuse and mental health care.
303	(c)  The FloridaSDC program may operate while awaiting
304	approval of federal waivers, but the program may not provide
305	services for which a waiver is required without first obtaining
306	approval for that waiver.
307	(9)  FUNDS TRANSFER.--The department, the agency, and the
308	division may transfer funds as identified in paragraph (5)(a) to
309	the managing entity.
310	(10)  REVIEWS AND REPORTS.--The department, the agency, and
311	the division shall each, on an ongoing basis, review and assess
312	the implementation of the FloridaSDC program. The department
313	shall implement an evaluation of the program through June 2006.
314	If the agency obtains a federal waiver, the evaluation shall be
315	used to demonstrate effectiveness. The evaluation is considered
316	part of administrative funds and cannot be paid for by service
317	dollars. Beginning January 31, 2005, the department shall
318	biannually submit a written report to the chairs of the
319	appropriate substantive committees of the Legislature that
320	includes review of the FloridaSDC program by the department, the
321	agency, and the division and that contains recommendations for
322	improvements to the program.
323	(11)  RULES.--The department, the agency, and the division
324	shall have rulemaking authority to implement the provisions of
325	this section. These rules shall be for the purpose of enhancing
326	choice in and control over the purchased mental health and
327	vocational rehabilitative services accessed by FloridaSDC
328	participants. The statewide advisory council and other
329	interested stakeholders may participate in the development and
330	review of such rules prior to their adoption.
331	(12)  AUTHORITY.--The department has final authority on and
332	responsibility for operation of the FloridaSDC program.
333	394.9503  Family-directed care (FloridaFDC) pilot
334	program.--
335	(1)  The Department of Children and Family Services shall
336	develop a family-directed care (FloridaFDC) pilot program in a
337	district selected by the department. The FloridaFDC pilot
338	program shall provide mental health treatment and support
339	services for children who are at risk of emotional disturbance
340	or who have an emotional disturbance or a serious emotional
341	disturbance. The FloridaFDC pilot program shall be organized and
342	operated in the same manner and intent as the self-directed care
343	(FloridaSDC) program established under s. 394.9501. The
344	department may use for the FloridaFDC pilot program any funds of
345	the FloridaSDC program secured from grants provided for
346	substance abuse and mental health services that are designated
347	for services to children.
348	(2)  Participants in the FloridaFDC pilot program shall be
349	children who are at risk of emotional disturbance or who have an
350	emotional disturbance or a serious emotional disturbance. The
351	child must be living at home with his or her family or legal
352	guardian in order to participate in the FloridaFDC pilot
353	program.
354	(a)  A child at risk of emotional disturbance is a person
355	under 18 years of age who is currently referred for mental
356	health treatment in a program for students with emotional
357	disabilities in accordance with the Individuals with
358	Disabilities Education Act and for whom there are strong
359	clinical indicators that in the near future such child will
360	require treatment and care from the public mental health care
361	system.
362	(b)  A child with an emotional disturbance is a person
363	under 18 years of age who meets one of the following criteria:
364	1.  Has a diagnosis listed in the Diagnostic and
365	Statistical Manual of the American Psychiatric Association and a
366	Children's Global Assessment Scale score of 51-60.
367	2.  Is currently classified as a student with an emotional
368	disturbance by a local school district.
369	(c)  A child with a serious emotional disturbance is a
370	person under 18 years of age who meets one of the following
371	criteria:
372	1.  Has a diagnosis of schizophrenia or other psychotic
373	disorder, major depression, mood disorder, or personality
374	disorder.
375	2.  Has a diagnosis listed in the Diagnostic and
376	Statistical Manual of the American Psychiatric Association and a
377	Children's Global Assessment Scale score of 50 or below.
378	3.  Is currently classified as a student with a serious
379	emotional disturbance by a local school district.
380	4.  Is currently receiving supplemental security income
381	(SSI) benefits for a psychiatric disability.
382	(3)  The following children are not eligible to participate
383	in the FloridaFDC pilot program:
384	(a)  Children who are in the custody of the Department of
385	Children and Family Services.
386	(b)  Children with a primary diagnosis of developmental
387	disability, pervasive developmental disorder, substance abuse,
388	communication disorder, learning disorder, or autism.
389	(4)  All persons who render care to children under this
390	section must comply with the requirements of chapter 435. For
391	purposes of this section, a person who has undergone screening,
392	who is qualified for employment under this section and
393	applicable rules, and who has not been unemployed for more than
394	180 days following such screening is not required to be
395	rescreened. Such person must attest under penalty of perjury to
396	not having been convicted of a disqualifying offense since
397	completing such screening.
398	(5)  The Department of Children and Family Services, the
399	Agency for Health Care Administration, and the Division of
400	Vocational Rehabilitation of the Department of Education shall
401	have rulemaking authority to implement the provisions of this
402	section. These rules shall be for the purpose of enhancing
403	choice in and control over the purchased mental health and
404	vocational rehabilitative services received by FloridaFDC pilot
405	program participants. The statewide advisory council created
406	under s. 394.9501 and other interested stakeholders may
407	participate in the development and review of such rules prior to
408	their adoption.
409	(6)  The Department of Children and Family Services shall
410	submit a report concerning the progress of the FloridaFDC pilot
411	program to the appropriate legislative committees by December 1
412	of each year of the pilot program.
413	(7)  This section is repealed July 1, 2008.
414	Section 2.  Section 394.9084, Florida Statutes, is
415	repealed.
416	Section 3.  This act shall take effect July 1, 2004.

CODING: Words stricken are deletions; words underlined are additions.