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
       603-04240-12                                          20121516c3
    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
   60  read:
   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
  135  Disabilities.
  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
  143  activities.
  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
  175  participate.
  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
  185  indefinitely.
  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.
  226  393.12.
  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
  297  community.
  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
  323  restraint.
  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
  412  disabilities.
  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
  441  read:
  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,
  467  include:
  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
  476  services.
  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
  487  needed.
  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
  565  reliability.
  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
  664  home.
  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
  694  services.
  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
  748  subsection.
  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
  761  individual.
  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
  776  individuals.
  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
  800  subsection.
  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
  921  algorithm.
  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
 1048  individual.
 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
 1082  system.
 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
 1098  services.
 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
 1110  community.
 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
 1181  individual.
 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
 1199  read:
 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
 1214  Procedure.
 1215         (2) PETITION.—
 1216         (a) A petition for involuntary admission to residential
 1217  services may be executed by a petitioning commission or the
 1218  agency.
 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
 1226  autism;
 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
 1305  committee.
 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.
 1326  393.065;
 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
 1365  fee.
 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
 1385  Procedure.
 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
 1409  commission.
 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
 1416  reported.
 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
 1451  file.
 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.
 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
 1480  retardation.
 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
 1567  read:
 1568         393.28Food service and environmental sanitation
 1569  standards.—
 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.