Florida Senate - 2016 COMMITTEE AMENDMENT
Bill No. SB 7054
Senate . House
Comm: RCS .
Appropriations Subcommittee on Health and Human Services (Sobel)
recommended the following:
1 Senate Amendment (with title amendment)
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 393.063, Florida Statutes, is reordered
6 and amended to read:
7 393.063 Definitions.—For the purposes of this chapter, the
(1) “Agency” means the Agency for Persons with
11 (1) (2) “Adult day training” means training services that
12 which take place in a nonresidential setting, separate from the
13 home or facility in which the client resides, and ; are intended
14 to support the participation of clients in daily, meaningful,
15 and valued routines of the community. Such training ; and may be
16 provided in include work-like settings that do not meet the
17 definition of supported employment.
18 (3) “Algorithm” means the mathematical formula used by the
19 agency to calculate a budget amount for clients using variables
20 that have statistically validated relationships to clients’
21 needs for services provided by the home and community-based
22 Medicaid waiver program.
23 (4) “Allocation methodology” means the process used to
24 determine a client’s iBudget by summing the amount generated by
25 the algorithm and, if applicable, any funding authorized by the
26 agency for the client pursuant to s. 393.0662(1)(b).
27 (5) (3) “Autism” means a pervasive, neurologically based
28 developmental disability of extended duration which causes
29 severe learning, communication, and behavior disorders with age
30 of onset during infancy or childhood. Individuals with autism
31 exhibit impairment in reciprocal social interaction, impairment
32 in verbal and nonverbal communication and imaginative ability,
33 and a markedly restricted repertoire of activities and
35 (6) (4) “Cerebral palsy” means a group of disabling symptoms
36 of extended duration which results from damage to the developing
37 brain that may occur before, during, or after birth and that
38 results in the loss or impairment of control over voluntary
39 muscles. For the purposes of this definition, cerebral palsy
40 does not include those symptoms or impairments resulting solely
41 from a stroke.
42 (7) (5) “Client” means any person determined eligible by the
43 agency for services under this chapter.
44 (8) (6) “Client advocate” means a friend or relative of the
45 client, or of the client’s immediate family, who advocates for
46 the best interests of the client in any proceedings under this
47 chapter in which the client or his or her family has the right
48 or duty to participate.
49 (9) (7) “Comprehensive assessment” means the process used to
50 determine eligibility for services under this chapter.
51 (10) (8) “Comprehensive transitional education program”
52 means the program established in s. 393.18.
53 (12) (9) “Developmental disability” means a disorder or
54 syndrome that is attributable to intellectual disability,
55 cerebral palsy, autism, spina bifida, Down syndrome, or Prader
56 Willi syndrome; that manifests before the age of 18; and that
57 constitutes a substantial handicap that can reasonably be
58 expected to continue indefinitely.
59 (11) (10) “Developmental disabilities center” means a state
60 owned and state-operated facility, formerly known as a “Sunland
61 Center,” providing for the care, habilitation, and
62 rehabilitation of clients with developmental disabilities.
63 (13) (11) “Direct service provider” means a person 18 years
64 of age or older who has direct face-to-face contact with a
65 client while providing services to the client or has access to a
66 client’s living areas or to a client’s funds or personal
68 (14) (12) “Domicile” means the place where a client legally
69 resides and , which place is his or her permanent home. Domicile
70 may be established as provided in s. 222.17. Domicile may not be
71 established in Florida by a minor who has no parent domiciled in
72 Florida, or by a minor who has no legal guardian domiciled in
73 Florida, or by any alien not classified as a resident alien.
74 (15) (13) “Down syndrome” means a disorder caused by the
75 presence of an extra chromosome 21.
76 (16) (14) “Express and informed consent” means consent
77 voluntarily given in writing with sufficient knowledge and
78 comprehension of the subject matter to enable the person giving
79 consent to make a knowing decision without any element of force,
80 fraud, deceit, duress, or other form of constraint or coercion.
81 (17) (15) “Family care program” means the program
82 established in s. 393.068.
83 (18) (16) “Foster care facility” means a residential
84 facility licensed under this chapter which provides a family
85 living environment including supervision and care necessary to
86 meet the physical, emotional, and social needs of its residents.
87 The capacity of such a facility may not be more than three
89 (19) (17) “Group home facility” means a residential facility
90 licensed under this chapter which provides a family living
91 environment including supervision and care necessary to meet the
92 physical, emotional, and social needs of its residents. The
93 capacity of such a facility shall be at least 4 but not more
94 than 15 residents.
95 (20) “Guardian” has the same meaning as in s. 744.102.
96 (21) (18) “Guardian advocate” means a person appointed by a
97 written order of the court to represent a person with
98 developmental disabilities under s. 393.12.
99 (22) (19) “Habilitation” means the process by which a client
100 is assisted in acquiring and maintaining to acquire and maintain
101 those life skills that which enable the client to cope more
102 effectively with the demands of his or her condition and
103 environment and to raise the level of his or her physical,
104 mental, and social efficiency. The term It includes, but is not
105 limited to, programs of formal structured education and
107 (23) (20) “High-risk child” means, for the purposes of this
108 chapter, a child from 3 to 5 years of age with one or more of
109 the following characteristics:
110 (a) A developmental delay in cognition, language, or
111 physical development.
112 (b) A child surviving a catastrophic infectious or
113 traumatic illness known to be associated with developmental
114 delay, when funds are specifically appropriated.
115 (c) A child with a parent or guardian with developmental
116 disabilities who requires assistance in meeting the child’s
117 developmental needs.
118 (d) A child who has a physical or genetic anomaly
119 associated with developmental disability.
120 (24) (21) “Intellectual disability” means significantly
121 subaverage general intellectual functioning existing
122 concurrently with deficits in adaptive behavior which manifests
123 before the age of 18 and can reasonably be expected to continue
124 indefinitely. For the purposes of this definition, the term:
125 (a) “Adaptive behavior” means the effectiveness or degree
126 with which an individual meets the standards of personal
127 independence and social responsibility expected of his or her
128 age, cultural group, and community.
129 (b) “Significantly subaverage general intellectual
130 functioning” means performance that is two or more standard
131 deviations from the mean score on a standardized intelligence
132 test specified in the rules of the agency.
134 For purposes of the application of the criminal laws and
135 procedural rules of this state to matters relating to pretrial,
136 trial, sentencing, and any matters relating to the imposition
137 and execution of the death penalty, the terms “intellectual
138 disability” or “intellectually disabled” are interchangeable
139 with and have the same meaning as the terms “mental retardation”
140 or “retardation” and “mentally retarded” as defined in this
141 section before July 1, 2013.
142 (25) (22) “Intermediate care facility for the
143 developmentally disabled” or “ICF/DD” means a residential
144 facility licensed and certified under part VIII of chapter 400.
145 (26) (23) “Medical/dental services” means medically
146 necessary services that are provided or ordered for a client by
147 a person licensed under chapter 458, chapter 459, or chapter
148 466. Such services may include, but are not limited to,
149 prescription drugs, specialized therapies, nursing supervision,
150 hospitalization, dietary services, prosthetic devices, surgery,
151 specialized equipment and supplies, adaptive equipment, and
152 other services as required to prevent or alleviate a medical or
153 dental condition.
154 (27) (24) “Personal care services” means individual
155 assistance with or supervision of essential activities of daily
156 living for self-care, including ambulation, bathing, dressing,
157 eating, grooming, and toileting, and other similar services that
158 are incidental to the care furnished and essential to the
159 health, safety, and welfare of the client if no one else is
160 available to perform those services.
161 (28) (25) “Prader-Willi syndrome” means an inherited
162 condition typified by neonatal hypotonia with failure to thrive,
163 hyperphagia or an excessive drive to eat which leads to obesity
164 usually at 18 to 36 months of age, mild to moderate intellectual
165 disability, hypogonadism, short stature, mild facial
166 dysmorphism, and a characteristic neurobehavior.
167 (29) (26) “Relative” means an individual who is connected by
168 affinity or consanguinity to the client and who is 18 years of
169 age or older.
170 (30) (27) “Resident” means a person who has a developmental
171 disability and resides at a residential facility, whether or not
172 such person is a client of the agency.
173 (31) (28) “Residential facility” means a facility providing
174 room and board and personal care for persons who have
175 developmental disabilities.
176 (32) (29) “Residential habilitation” means supervision and
177 training with the acquisition, retention, or improvement in
178 skills related to activities of daily living, such as personal
179 hygiene skills, homemaking skills, and the social and adaptive
180 skills necessary to enable the individual to reside in the
182 (33) (30) “Residential habilitation center” means a
183 community residential facility licensed under this chapter which
184 provides habilitation services. The capacity of such a facility
185 may not be fewer than nine residents. After October 1, 1989, new
186 residential habilitation centers may not be licensed and the
187 licensed capacity for any existing residential habilitation
188 center may not be increased.
189 (34) (31) “Respite service” means appropriate, short-term,
190 temporary care that is provided to a person who has a
191 developmental disability in order to meet the planned or
192 emergency needs of the person or the family or other direct
193 service provider.
194 (35) (32) “Restraint” means a physical device, method, or
195 drug used to control dangerous behavior.
196 (a) A physical restraint is any manual method or physical
197 or mechanical device, material, or equipment attached or
198 adjacent to an individual’s body so that he or she cannot easily
199 remove the restraint and which restricts freedom of movement or
200 normal access to one’s body.
201 (b) A drug used as a restraint is a medication used to
202 control the person’s behavior or to restrict his or her freedom
203 of movement and is not a standard treatment for the person’s
204 medical or psychiatric condition. Physically holding a person
205 during a procedure to forcibly administer psychotropic
206 medication is a physical restraint.
207 (c) Restraint does not include physical devices, such as
208 orthopedically prescribed appliances, surgical dressings and
209 bandages, supportive body bands, or other physical holding
210 necessary for routine physical examinations and tests; for
211 purposes of orthopedic, surgical, or other similar medical
212 treatment; to provide support for the achievement of functional
213 body position or proper balance; or to protect a person from
214 falling out of bed.
215 (36) (33) “Seclusion” means the involuntary isolation of a
216 person in a room or area from which the person is prevented from
217 leaving. The prevention may be by physical barrier or by a staff
218 member who is acting in a manner, or who is physically situated,
219 so as to prevent the person from leaving the room or area. For
220 the purposes of this chapter, the term does not mean isolation
221 due to the medical condition or symptoms of the person.
222 (37) (34) “Self-determination” means an individual’s freedom
223 to exercise the same rights as all other citizens, authority to
224 exercise control over funds needed for one’s own support,
225 including prioritizing these funds when necessary,
226 responsibility for the wise use of public funds, and self
227 advocacy to speak and advocate for oneself in order to gain
228 independence and ensure that individuals with a developmental
229 disability are treated equally.
230 (38) (35) “Specialized therapies” means those treatments or
231 activities prescribed by and provided by an appropriately
232 trained, licensed, or certified professional or staff person and
233 may include, but are not limited to, physical therapy, speech
234 therapy, respiratory therapy, occupational therapy, behavior
235 therapy, physical management services, and related specialized
236 equipment and supplies.
237 (39) (36) “Spina bifida” means , for purposes of this
238 chapter, a person with a medical diagnosis of spina bifida
239 cystica or myelomeningocele.
240 (40) (37) “Support coordinator” means a person who is
241 designated by the agency to assist individuals and families in
242 identifying their capacities, needs, and resources, as well as
243 finding and gaining access to necessary supports and services;
244 coordinating the delivery of supports and services; advocating
245 on behalf of the individual and family; maintaining relevant
246 records; and monitoring and evaluating the delivery of supports
247 and services to determine the extent to which they meet the
248 needs and expectations identified by the individual, family, and
249 others who participated in the development of the support plan.
250 (41) (38) “Supported employment” means employment located or
251 provided in an integrated work setting, with earnings paid on a
252 commensurate wage basis, and for which continued support is
253 needed for job maintenance.
254 (42) (39) “Supported living” means a category of
255 individually determined services designed and coordinated in
256 such a manner as to provide assistance to adult clients who
257 require ongoing supports to live as independently as possible in
258 their own homes, to be integrated into the community, and to
259 participate in community life to the fullest extent possible.
260 (43) (40) “Training” means a planned approach to assisting a
261 client to attain or maintain his or her maximum potential and
262 includes services ranging from sensory stimulation to
263 instruction in skills for independent living and employment.
264 (44) (41) “Treatment” means the prevention, amelioration, or
265 cure of a client’s physical and mental disabilities or
267 Section 2. Section 393.0641, Florida Statutes, is repealed.
268 Section 3. Present subsections (6) and (7) of section
269 393.065, Florida Statutes, are redesignated as subsections (7)
270 and (9), respectively, subsections (3) and (5) and present
271 subsections (6) and (7) of that section are amended, and new
272 subsections (6) and (8) are added to that section, to read:
273 393.065 Application and eligibility determination.—
274 (3) The agency shall notify each applicant, in writing, of
275 its eligibility decision. Any applicant determined by the agency
276 to be ineligible for developmenta l services has the right to
277 appeal this decision pursuant to ss. 120.569 and 120.57.
278 (5) Except as otherwise directed by law, beginning July 1,
279 2010, The agency shall assign and provide priority to clients
280 waiting for waiver services in the following order:
281 (a) Category 1, which includes clients deemed to be in
282 crisis as described in rule, shall be given first priority in
283 moving from the waiting list to the waiver.
284 (b) Category 2, which includes clients on the waiting
285 children on the wait list who are:
286 1. From the child welfare system with an open case in the
287 Department of Children and Families’ statewide automated child
288 welfare information system and who are:
289 a. Transitioning out of the child welfare system at the
290 finalization of an adoption, a reunification with a family
291 member, a permanent placement with a relative, or a guardianship
292 with a nonrelative; or
293 b. At least 18 years old, but not yet 22 years old, and who
294 need both waiver services and extended foster care services; or
295 2. At least 18 years old, but not yet 22 years old, and who
296 withdrew consent pursuant to s. 39.6251(5)(c) to remain in
297 extended foster care.
299 For clients who are eligible under sub-subparagraph 1.b., the
300 agency shall provide waiver services, including residential
301 habilitation, and the community-based care lead agency shall
302 fund room and board at the rates established in s. 409.145(4)
303 and provide case management and related services as defined in
304 s. 409.986(3)(e). Such clients may receive both waiver services
305 and services under s. 39.6251 which may not duplicate services
306 available through the Medicaid state plan.
307 (c) Category 3, which includes, but is not required to be
308 limited to, clients:
309 1. Whose caregiver has a documented condition that is
310 expected to render the caregiver unable to provide care within
311 the next 12 months and for whom a caregiver is required but no
312 alternate caregiver is available;
313 2. At substantial risk of incarceration or court commitment
314 without supports;
315 3. Whose documented behaviors or physical needs place them
316 or their caregiver at risk of serious harm and other supports
317 are not currently available to alleviate the situation; or
318 4. Who are identified as ready for discharge within the
319 next year from a state mental health hospital or skilled nursing
320 facility and who require a caregiver but for whom no caregiver
321 is available, or whose caregiver cannot provide the care needed.
322 (d) Category 4, which includes, but is not required to be
323 limited to, clients whose caregivers are 70 years of age or
324 older and for whom a caregiver is required but no alternate
325 caregiver is available.
326 (e) Category 5, which includes, but is not required to be
327 limited to, clients who are expected to graduate within the next
328 12 months from secondary school and need support to obtain a
329 meaningful day activity, or maintain competitive employment, or
330 to pursue an accredited program of postsecondary education to
331 which they have been accepted.
332 (f) Category 6, which includes clients 21 years of age or
333 older who do not meet the criteria for category 1, category 2,
334 category 3, category 4, or category 5.
335 (g) Category 7, which includes clients younger than 21
336 years of age who do not meet the criteria for category 1,
337 category 2, category 3, or category 4.
339 Within categories 3, 4, 5, 6, and 7, the agency shall maintain a
340 waiting wait list of clients placed in the order of the date
341 that the client is determined eligible for waiver services.
342 (6) The agency shall allow an individual who meets the
343 eligibility requirements pursuant to subsection (1) to receive
344 home and community-based services in this state if the
345 individual’s parent or legal guardian is an active duty military
346 servicemember and if at the time of the servicemember’s transfer
347 to this state, the individual was receiving home and community
348 based services in another state.
349 (7) (6) The client, the client’s guardian, or the client’s
350 family must ensure that accurate, up-to-date contact information
351 is provided to the agency at all times. Notwithstanding s.
352 393.0651, the agency shall send an annual letter requesting
353 updated information from the client, the client’s guardian, or
354 the client’s family. The agency shall remove from the waiting
355 wait list any individual who cannot be located using the contact
356 information provided to the agency, fails to meet eligibility
357 requirements, or becomes domiciled outside the state.
358 (8) Agency action that selects individuals to receive
359 waiver services pursuant to this section does not establish a
360 right to a hearing or an administrative proceeding under chapter
361 120 for individuals remaining on the waiting list.
362 (9) (7) The agency and the Agency for Health Care
363 Administration may adopt rules specifying application
364 procedures, criteria associated with the waiting list wait-list
365 categories, procedures for administering the waiting wait list,
366 including tools for prioritizing waiver enrollment within
367 categories, and eligibility criteria as needed to administer
368 this section.
369 Section 4. Subsection (2) of section 393.066, Florida
370 Statutes, is amended to read:
371 393.066 Community services and treatment.—
372 (2) Necessary All services needed shall be purchased,
373 rather than instead of provided directly by the agency, when the
374 purchase of services such arrangement is more cost-efficient
375 than providing them having those services provided directly. All
376 purchased services must be approved by the agency. Persons or
377 entities under contract with the agency to provide services
378 shall use agency data management systems to document service
379 provision to clients. Contracted persons and entities shall meet
380 the minimum hardware and software technical requirements
381 established by the agency for the use of such systems. Such
382 persons or entities shall also meet any requirements established
383 by the agency for training and professional development of staff
384 providing direct services to clients.
385 Section 5. Section 393.0662, Florida Statutes, is amended
386 to read:
387 393.0662 Individual budgets for delivery of home and
388 community-based services; iBudget system established.—The
389 Legislature finds that improved financial management of the
390 existing home and community-based Medicaid waiver program is
391 necessary to avoid deficits that impede the provision of
392 services to individuals who are on the waiting list for
393 enrollment in the program. The Legislature further finds that
394 clients and their families should have greater flexibility to
395 choose the services that best allow them to live in their
396 community within the limits of an established budget. Therefore,
397 the Legislature intends that the agency, in consultation with
398 the Agency for Health Care Administration, shall manage develop
399 and implement a comprehensive redesign of the service delivery
400 system using individual budgets as the basis for allocating the
401 funds appropriated for the home and community-based services
402 Medicaid waiver program among eligible enrolled clients. The
403 service delivery system that uses individual budgets shall be
404 called the iBudget system.
405 (1) The agency shall administer establish an individual
406 budget, referred to as an iBudget, for each individual served by
407 the home and community-based services Medicaid waiver program.
408 The funds appropriated to the agency shall be allocated through
409 the iBudget system to eligible, Medicaid-enrolled clients. For
410 the iBudget system, eligible clients shall include individuals
411 with a diagnosis of Down syndrome or a developmental disability
412 as defined in s. 393.063. The iBudget system shall be designed
413 to provide for: enhanced client choice within a specified
414 service package; appropriate assessment strategies; an efficient
415 consumer budgeting and billing process that includes
416 reconciliation and monitoring components; a redefined role for
417 support coordinators which that avoids potential conflicts of
418 interest; a flexible and streamlined service review process; and
419 a methodology and process that ensures the equitable allocation
420 of available funds to each client based on the client’s level of
421 need, as determined by the variables in the allocation
423 (a) In developing each client’s iBudget, the agency shall
424 use the an allocation algorithm and methodology as defined in s.
425 393.063(4). The algorithm shall use variables that have been
426 determined by the agency to have a statistically validated
427 relationship to the client’s level of need for services provided
428 through the home and community-based services Medicaid waiver
429 program. The algorithm and methodology may consider individual
430 characteristics, including, but not limited to, a client’s age
431 and living situation, information from a formal assessment
432 instrument that the agency determines is valid and reliable, and
433 information from other assessment processes.
434 (b) The allocation methodology shall determine provide the
435 algorithm that determines the amount of funds allocated to a
436 client’s iBudget.
437 (c) The agency may authorize funding approve an increase in
438 the amount of funds allocated, as determined by the algorithm,
439 based on a the client having one or more of the following needs
440 that cannot be accommodated within the funding as determined by
441 the algorithm and having no other resources, supports, or
442 services available to meet the need:
443 1. An extraordinary need that would place the health and
444 safety of the client, the client’s caregiver, or the public in
445 immediate, serious jeopardy unless the increase is approved.
446 However, the presence of an extraordinary need in and of itself
447 does not warrant authorized funding by the agency. An
448 extraordinary need may include, but is not limited to:
449 a. The loss of or a change in the client’s caregiver
450 arrangement or a documented need based on a medical, behavioral,
451 or psychological assessment;
452 b. a . A documented history of significant, potentially life
453 threatening behaviors, such as recent attempts at suicide,
454 arson, nonconsensual sexual behavior, or self-injurious behavior
455 requiring medical attention;
456 c. b . A complex medical condition that requires active
457 intervention by a licensed nurse on an ongoing basis that cannot
458 be taught or delegated to a nonlicensed person;
459 d. c . A chronic comorbid condition. As used in this
460 subparagraph, the term “comorbid condition” means a medical
461 condition existing simultaneously but independently with another
462 medical condition in a patient; or
463 e. d . A need for total physical assistance with activities
464 such as eating, bathing, toileting, grooming, and personal
467 However, the presence of an extraordinary need alone does not
468 warrant an increase in the amount of funds allocated to a
469 client’s iBudget as determined by the algorithm.
470 2. A significant need for one-time or temporary support or
471 services that, if not provided, would place the health and
472 safety of the client, the client’s caregiver, or the public in
473 serious jeopardy , unless the increase is approved. A significant
474 need may include, but is not limited to, the provision of
475 environmental modifications, durable medical equipment, services
476 to address the temporary loss of support from a caregiver, or
477 special services or treatment for a serious temporary condition
478 when the service or treatment is expected to ameliorate the
479 underlying condition. As used in this subparagraph, the term
480 “temporary” means a period of fewer than 12 continuous months.
481 However, the presence of such significant need for one-time or
482 temporary supports or services alone does not in and of itself
483 warrant authorized funding by the agency an increase in the
484 amount of funds allocated to a client’s iBudget as determined by
485 the algorithm.
486 3. A significant increase in the need for services after
487 the beginning of the service plan year which that would place
488 the health and safety of the client, the client’s caregiver, or
489 the public in serious jeopardy because of substantial changes in
490 the client’s circumstances, including, but not limited to,
491 permanent or long-term loss or incapacity of a caregiver, loss
492 of services authorized under the state Medicaid plan due to a
493 change in age, or a significant change in medical or functional
494 status which requires the provision of additional services on a
495 permanent or long-term basis that cannot be accommodated within
496 the client’s current iBudget. As used in this subparagraph, the
497 term “long-term” means a period of 12 or more continuous months.
498 However, such significant increase in need for services of a
499 permanent or long-term nature alone does not in and of itself
500 warrant authorized funding by the agency warrant an increase in
501 the amount of funds allocated to a client’s iBudget as
502 determined by the algorithm.
503 4. A significant need for transportation services to a
504 waiver-funded adult day training program or to waiver-funded
505 employment services when such need cannot be accommodated within
506 a client’s iBudget as determined by the algorithm without
507 affecting the health and safety of the client, if public
508 transportation is not an option due to the unique needs of the
509 client or other transportation resources are not reasonably
512 The agency shall reserve portions of the appropriation for the
513 home and community-based services Medicaid waiver program for
514 adjustments required pursuant to this paragraph and may use the
515 services of an independent actuary in determining the amount of
516 the portions to be reserved.
517 (d) (c) A client’s iBudget shall be the total of the amount
518 determined by the algorithm and any additional funding provided
519 pursuant to paragraph (b). A client’s annual expenditures for
520 home and community-based services Medicaid waiver services may
521 not exceed the limits of his or her iBudget. The total of all
522 clients’ projected annual iBudget expenditures may not exceed
523 the agency’s appropriation for waiver services.
524 (2) The Agency for Health Care Administration, in
525 consultation with the agency, shall seek federal approval to
526 amend current waivers, request a new waiver, and amend contracts
527 as necessary to manage the iBudget system, to improve services
528 for eligible and enrolled clients, and to improve the delivery
529 of services implement the iBudget system to serve eligible,
530 enrolled clients through the home and community-based services
531 Medicaid waiver program and the Consumer-Directed Care Plus
533 (3) The agency shall transition all eligible, enrolled
534 clients to the iBudget system. The agency may gradually phase in
535 the iBudget system.
536 (a) While the agency phases in the iBudget system, the
537 agency may continue to serve eligible, enrolled clients under
538 the four-tiered waiver system established under s. 393.065 while
539 those clients await transitioning to the iBudget system.
540 (b) The agency shall design the phase-in process to ensure
541 that a client does not experience more than one-half of any
542 expected overall increase or decrease to his or her existing
543 annualized cost plan during the first year that the client is
544 provided an iBudget due solely to the transition to the iBudget
546 (3) (4) A client must use all available services authorized
547 under the state Medicaid plan, school-based services, private
548 insurance and other benefits, and any other resources that may
549 be available to the client before using funds from his or her
550 iBudget to pay for support and services.
551 (4) (5) The service limitations in s. 393.0661(3)(f)1., 2.,
552 and 3. do not apply to the iBudget system.
553 (5) (6) Rates for any or all services established under
554 rules of the Agency for Health Care Administration must shall be
555 designated as the maximum rather than a fixed amount for
556 individuals who receive an iBudget, except for services
557 specifically identified in those rules that the agency
558 determines are not appropriate for negotiation, which may
559 include, but are not limited to, residential habilitation
561 (6) (7) The agency shall ensure that clients and caregivers
562 have access to training and education that to inform them about
563 the iBudget system and enhance their ability for self-direction.
564 Such training and education must shall be offered in a variety
565 of formats; and at a minimum, must shall address the policies
566 and processes of the iBudget system and ; the roles and
567 responsibilities of consumers, caregivers, waiver support
568 coordinators, providers, and the agency; must provide ;
569 information available to help the client make decisions
570 regarding the iBudget system; and must provide examples of
571 support and resources available in the community.
572 (7) (8) The agency shall collect data to evaluate the
573 implementation and outcomes of the iBudget system.
574 (8) (9) The agency and the Agency for Health Care
575 Administration may adopt rules specifying the allocation
576 algorithm and methodology; criteria and processes for clients to
577 access reserved funds for extraordinary needs, temporarily or
578 permanently changed needs, and one-time needs; and processes and
579 requirements for selection and review of services, development
580 of support and cost plans, and management of the iBudget system
581 as needed to administer this section.
582 Section 6. Section 393.0679, Florida Statutes, is created
583 to read:
584 393.0679 Utilization review.—The agency shall conduct
585 utilization review activities in intermediate care facilities
586 for individuals with developmental disabilities, both public and
587 private, as necessary to meet the requirements of the approved
588 Medicaid state plan and federal law, and such facilities shall
589 comply with any requests for information and documentation made
590 by the agency and permit any agency inspections in connection
591 with such activities.
592 Section 7. Subsection (1), paragraphs (a) and (b) of
593 subsection (4), paragraphs (b), (e), (f), (g), and (h) of
594 subsection (5), subsection (6), paragraph (d) of subsection (7),
595 subsection (10), and paragraph (b) of subsection (12) of section
596 393.11, Florida Statutes, are amended, and subsection (14) is
597 added to that section, to read:
598 393.11 Involuntary admission to residential services.—
599 (1) JURISDICTION.—If a person has an intellectual
600 disability or autism and requires involuntary admission to
601 residential services provided by the agency, the circuit court
602 of the county in which the person resides has jurisdiction to
603 conduct a hearing and enter an order involuntarily admitting the
604 person in order for the person to receive the care, treatment,
605 habilitation, and rehabilitation that the person needs. For the
606 purpose of identifying intellectual disability or autism,
607 diagnostic capability shall be established by the agency. Except
608 as otherwise specified, the proceedings under this section are
609 governed by the Florida Rules of Civil Procedure.
610 (4) AGENCY PARTICIPATION.—
611 (a) Upon receiving the petition, the court shall
612 immediately order the developmental services program of the
613 agency to examine the person being considered for involuntary
614 admission to residential services.
615 (b) Following examination, the agency shall file a written
616 report with the court at least 10 working days before the date
617 of the hearing. The report must be served on the petitioner, the
618 person who has the intellectual disability or autism, and the
619 person’s attorney at the time the report is filed with the
621 (5) EXAMINING COMMITTEE.—
622 (b) The court shall appoint at least three disinterested
623 experts who have demonstrated to the court an expertise in the
624 diagnosis, evaluation, and treatment of persons who have
625 intellectual disabilities or autism. The committee must include
626 at least one licensed and qualified physician, one licensed and
627 qualified psychologist, and one qualified professional who, at a
628 minimum, has a master’s degree in social work, special
629 education, or vocational rehabilitation counseling, to examine
630 the person and to testify at the hearing on the involuntary
631 admission to residential services.
632 (e) The committee shall prepare a written report for the
633 court. The report must explicitly document the extent that the
634 person meets the criteria for involuntary admission. The report,
635 and expert testimony, must include, but not be limited to:
636 1. The degree of the person’s intellectual disability or
637 autism and whether, using diagnostic capabilities established by
638 the agency, the person is eligible for agency services;
639 2. Whether, because of the person’s degree of intellectual
640 disability or autism, the person:
641 a. Lacks sufficient capacity to give express and informed
642 consent to a voluntary application for services pursuant to s.
643 393.065 and lacks basic survival and self-care skills to such a
644 degree that close supervision and habilitation in a residential
645 setting are necessary and, if not provided, would result in a
646 threat of substantial harm to the person’s well-being; or
647 b. Lacks basic survival and self-care skills to such a
648 degree that close supervision and habilitation in a residential
649 setting is necessary and if not provided would result in a real
650 and present threat of substantial harm to the person’s well
651 being; or
652 b. c . Is likely to physically injure others if allowed to
653 remain at liberty.
654 3. The purpose to be served by residential care;
655 4. A recommendation on the type of residential placement
656 which would be the most appropriate and least restrictive for
657 the person; and
658 5. The appropriate care, habilitation, and treatment.
659 (f) The committee shall file the report with the court at
660 least 10 working days before the date of the hearing. The report
661 must be served on the petitioner, the person who has the
662 intellectual disability or autism, the person’s attorney at the
663 time the report is filed with the court, and the agency.
664 (g) Members of the examining committee shall receive a
665 reasonable fee to be determined by the court. The fees shall be
666 paid from the general revenue fund of the county in which the
667 person who has the intellectual disability or autism resided
668 when the petition was filed.
669 (h) The agency shall develop and prescribe by rule one or
670 more standard forms to be used as a guide for members of the
671 examining committee.
672 (6) COUNSEL; GUARDIAN AD LITEM.—
673 (a) The person who has the intellectual disability or
674 autism must be represented by counsel at all stages of the
675 judicial proceeding. If the person is indigent and cannot afford
676 counsel, the court shall appoint a public defender at least 20
677 working days before the scheduled hearing. The person’s counsel
678 shall have full access to the records of the service provider
679 and the agency. In all cases, the attorney shall represent the
680 rights and legal interests of the person, regardless of who
681 initiates the proceedings or pays the attorney attorney’s fee.
682 (b) If the attorney, during the course of his or her
683 representation, reasonably believes that the person who has the
684 intellectual disability or autism cannot adequately act in his
685 or her own interest, the attorney may seek the appointment of a
686 guardian ad litem. A prior finding of incompetency is not
687 required before a guardian ad litem is appointed pursuant to
688 this section.
689 (7) HEARING.—
690 (d) The person who has the intellectual disability or
691 autism must be physically present throughout the entire
692 proceeding. If the person’s attorney believes that the person’s
693 presence at the hearing is not in his or her best interest, the
694 person’s presence may be waived once the court has seen the
695 person and the hearing has commenced.
696 (10) COMPETENCY.—
697 (a) The issue of competency is separate and distinct from a
698 determination of the appropriateness of involuntary admission to
699 residential services due to intellectual disability or autism.
700 (b) The issue of the competency of a person who has an
701 intellectual disability or autism for purposes of assigning
702 guardianship shall be determined in a separate proceeding
703 according to the procedures and requirements of chapter 744. The
704 issue of the competency of a person who has an intellectual
705 disability or autism for purposes of determining whether the
706 person is competent to proceed in a criminal trial shall be
707 determined in accordance with chapter 916.
708 (12) APPEAL.—
709 (b) The filing of an appeal by the person who has an
710 intellectual disability or autism stays admission of the person
711 into residential care. The stay remains in effect during the
712 pendency of all review proceedings in Florida courts until a
713 mandate issues.
714 (14) REVIEW OF CONTINUED INVOLUNTARY ADMISSION TO
715 RESIDENTIAL SERVICES.—
716 (a) If a person is involuntarily admitted to residential
717 services provided by the agency, the agency shall employ or, if
718 necessary, contract with a qualified evaluator to conduct a
719 review annually, unless otherwise ordered, to determine the
720 appropriateness of the person’s continued involuntary admission
721 to residential services based on the criteria in paragraph
722 (8)(b). The review must include an assessment of the most
723 appropriate and least restrictive type of residential placement
724 for the person.
725 (b) A placement resulting from an involuntary admission to
726 residential services must be reviewed by the court at a hearing
727 annually, unless a shorter review period is ordered. The agency
728 shall provide to the court the completed reviews by the
729 qualified evaluator. The review hearing must determine whether
730 the person continues to meet the criteria in paragraph (8)(b)
731 and, if so, whether the person still requires involuntary
732 placement in a residential setting and whether the person is
733 receiving adequate care, treatment, habilitation, and
734 rehabilitation in the residential setting.
735 (c) The agency shall provide a copy of the annual review
736 and reasonable notice of the hearing to the appropriate state’s
737 attorney, if applicable, and the person’s attorney and guardian,
738 or guardian advocate if one is appointed.
739 (d) As used in this subsection, the term “qualified
740 evaluator” means a psychiatrist licensed under chapter 458 or
741 chapter 459, or a psychologist licensed under chapter 490, who
742 has demonstrated to the court an expertise in the diagnosis,
743 evaluation, and treatment of persons with intellectual
745 Section 8. For the purpose of incorporating the amendment
746 made by this act to section 393.18, Florida Statutes, in a
747 reference thereto, subsection (15) of section 393.067, Florida
748 Statutes, is reenacted to read:
749 393.067 Facility licensure.—
750 (15) The agency is not required to contract with facilities
751 licensed pursuant to this chapter.
752 Section 9. Section 26 of chapter 2015-222, Laws of Florida,
753 is repealed.
754 Section 10. Section 393.18, Florida Statutes, is reenacted
755 and amended to read:
756 393.18 Comprehensive transitional education program.—A
757 comprehensive transitional education program serves individuals
758 is a group of jointly operating centers or units, the collective
759 purpose of which is to provide a sequential series of
760 educational care, training, treatment, habilitation, and
761 rehabilitation services to persons who have developmental
762 disabilities, and who have severe or moderate maladaptive
763 behaviors, severe maladaptive behaviors and co-occurring complex
764 medical conditions, or a dual diagnosis of developmental
765 disability and mental illness. However, this section does not
766 require such programs to provide services only to persons with
767 developmental disabilities. All such Services provided by the
768 program must shall be temporary in nature and delivered in a
769 manner designed to achieve structured residential setting,
770 having the primary goal of incorporating the principles
771 principle of self-determination and person-centered planning to
772 transition individuals to the most appropriate, least
773 restrictive community living option of their choice which is not
774 operated as a in establishing permanent residence for persons
775 with maladaptive behaviors in facilities that are not associated
776 with the comprehensive transitional education program. The
777 supervisor of the clinical director of the program licensee must
778 hold a doctorate degree with a primary focus in behavior
779 analysis from an accredited university, be a certified behavior
780 analyst pursuant to s. 393.17, and have at least 1 year of
781 experience in providing behavior analysis services for
782 individuals with developmental disabilities. The staff must
783 shall include behavior analysts and teachers, as appropriate,
784 who must shall be available to provide services in each
785 component center or unit of the program. A behavior analyst must
786 be certified pursuant to s. 393.17.
787 (1) Comprehensive transitional education programs must
788 shall include a minimum of two component centers or units, one
789 of which shall be an intensive treatment and educational center
790 or a transitional training and educational center, which
791 provides services to persons with maladaptive behaviors in the
792 following components sequential order:
793 (a) Intensive treatment and education educational center.
794 This component provides is a self-contained residential unit
795 providing intensive behavioral and educational programming for
796 individuals whose conditions persons with severe maladaptive
797 behaviors whose behaviors preclude placement in a less
798 restrictive environment due to the threat of danger or injury to
799 themselves or others. Continuous-shift staff are shall be
800 required for this component.
801 (b) Intensive Transitional training and education
802 educational center.—This component provides is a residential
803 unit for persons with moderate maladaptive behaviors providing
804 concentrated psychological and educational programming that
805 emphasizes a transition toward a less restrictive environment.
806 Continuous-shift staff are shall be required for this component.
807 (c) Community Transition residence.—This component provides
808 is a residential center providing educational programs and any
809 support services, training, and care that are needed to assist
810 persons with maladaptive behaviors to avoid regression to more
811 restrictive environments while preparing them for more
812 independent living. Continuous-shift staff are shall be required
813 for this component.
814 (d) Alternative living center. —This component is a
815 residential unit providing an educational and family living
816 environment for persons with maladaptive behaviors in a
817 moderately unrestricted setting. Residential staff shall be
818 required for this component.
819 (e) Independent living education center. —This component is
820 a facility providing a family living environment for persons
821 with maladaptive behaviors in a largely unrestricted setting and
822 includes education and monitoring that is appropriate to support
823 the development of independent living skills.
824 (2) Components of a comprehensive transitional education
825 program are subject to the license issued under s. 393.067 to a
826 comprehensive transitional education program and may be located
827 on a single site or multiple sites as long as such components
828 are located within the same agency region.
829 (3) Comprehensive transitional education programs shall
830 develop individual education plans for each school-aged person
831 with maladaptive behaviors, severe maladaptive behaviors and co
832 occurring complex medical conditions, or a dual diagnosis of
833 developmental disability and mental illness who receives
834 services from the program. Each individual education plan shall
835 be developed in accordance with the criteria specified in 20
836 U.S.C. ss. 401 et seq., and 34 C.F.R. part 300. Educational
837 components of the program, including individual education plans,
838 must be integrated with the referring school district of each
839 school-aged resident to the extent possible.
840 (4) For comprehensive transitional education programs, The
841 total number of persons in a comprehensive transitional
842 education program residents who are being provided with services
843 may not in any instance exceed the licensed capacity of 120
844 residents, and each residential unit within the component
845 centers of a the program authorized under this section may not
846 in any instance exceed 15 residents. However, a program that was
847 authorized to operate residential units with more than 15
848 residents before July 1, 2015, may continue to operate such
850 (5) Beginning July 1, 2016, the agency may approve the
851 proposed admission or readmission of individuals into a
852 comprehensive transitional education program for up to 2 years
853 subject to a specific review process. The agency may allow an
854 individual to live in this setting for a longer period of time
855 if, after a clinical review is conducted by the agency, it is
856 determined that remaining in the program for a longer period of
857 time is in the best interest of the individual.
858 (6) Comprehensive transitional education programs shall
859 provide continuous recorded video and audio monitoring in all
860 residential common areas. Recordings must be maintained for at
861 least 60 days during which time the agency may review them at
862 any time. At the request of the agency, the comprehensive
863 transitional education program shall retain specified recordings
864 indefinitely throughout the course of an investigation into
865 allegations of potential abuse or neglect.
866 (7) Comprehensive transitional education programs shall
867 operate and maintain a video and audio monitoring system that
868 enables authorized agency staff to monitor program activities
869 and facilities in real time from an off-site location. To the
870 extent possible, such monitoring may be in a manner that
871 precludes detection or knowledge of the monitoring by staff who
872 may be present in monitored areas.
873 (8) Licensure is authorized for a comprehensive
874 transitional education program that, by July 1, 1989:
875 (a) Was in actual operation; or
876 (b) Owned a fee simple interest in real property for which
877 a county or municipal government has approved zoning that allows
878 the placement of a facility operated by the program and has
879 registered an intent with the agency to operate a comprehensive
880 transitional education program. However, nothing prohibits the
881 assignment of licensure eligibility by such a registrant to
882 another entity at a different site within the state if the
883 entity is in compliance with the criteria of this subsection and
884 local zoning requirements and each residential facility within
885 the component centers or units of the program authorized under
886 this paragraph does not exceed a capacity of 15 persons.
887 (9) Notwithstanding subsection (8), in order to maximize
888 federal revenues and provide for children needing special
889 behavioral services, the agency may authorize the licensure of a
890 facility that:
891 (a) Provides residential services for children who have
892 developmental disabilities and intensive behavioral problems as
893 defined by the agency; and
894 (b) As of July 1, 2010, served children who were served by
895 the child welfare system and who have an open case in the State
896 Automated Child Welfare Information System.
898 The facility must be in compliance with all program criteria and
899 local land use and zoning requirements and may not exceed a
900 capacity of 15 children.
901 Section 11. Subsection (2) of section 393.501, Florida
902 Statutes, is amended to read:
903 393.501 Rulemaking.—
904 (2) Such rules must address the number of facilities on a
905 single lot or on adjacent lots, except that there is no
906 restriction on the number of facilities designated as community
907 residential homes located within a planned residential community
908 as those terms are defined in s. 419.001(1). In adopting rules,
909 comprehensive transitional education programs an alternative
910 living center and an independent living education center, as
911 described in s. 393.18, are subject to s. 419.001, except that
912 such program centers are exempt from the 1,000-foot-radius
913 requirement of s. 419.001(2) if:
914 (a) The program centers are located on a site zoned in a
915 manner that permits all the components of a comprehensive
916 transitional education program center to be located on the site;
918 (b) There are no more than three such program centers
919 within a radius of 1,000 feet.
920 Section 12. Paragraph (b) of subsection (1) of section
921 383.141, Florida Statutes, is amended to read:
922 383.141 Prenatally diagnosed conditions; patient to be
923 provided information; definitions; information clearinghouse;
924 advisory council.—
925 (1) As used in this section, the term:
926 (b) “Developmental disability” includes Down syndrome and
927 other developmental disabilities defined by s. 393.063(12) s.
929 Section 13. Paragraph (d) of subsection (2) of section
930 1002.385, Florida Statutes, is amended to read:
931 1002.385 Florida personal learning scholarship accounts.—
932 (2) DEFINITIONS.—As used in this section, the term:
933 (d) “Disability” means, for a 3- or 4-year-old child or for
934 a student in kindergarten to grade 12, autism spectrum disorder,
935 as defined in the Diagnostic and Statistical Manual of Mental
936 Disorders, Fifth Edition, published by the American Psychiatric
937 Association; cerebral palsy, as defined in s. 393.063(6) s.
938 393.063(4); Down syndrome, as defined in s. 393.063(15) s.
939 393.063(13); an intellectual disability, as defined in s.
940 393.063(24) s. 393.063(21); Prader-Willi syndrome, as defined in
941 s. 393.063(28) s. 393.063(25); or spina bifida, as defined in s.
942 393.063(39) s. 393.063(36); for a student in kindergarten, being
943 a high-risk child, as defined in s. 393.063(23)(a) s.
944 393.063(20)(a); muscular dystrophy; and Williams syndrome.
945 Section 14. This act shall take effect June 30, 2016, or,
946 if this act fails to become a law until after that date, it
947 shall take effect upon becoming a law and operate retroactively
948 to June 30, 2016.
950 ================= T I T L E A M E N D M E N T ================
951 And the title is amended as follows:
952 Delete everything before the enacting clause
953 and insert:
954 A bill to be entitled
955 An act relating to the Agency for Persons with
956 Disabilities; amending s. 393.063, F.S.; redefining
957 and defining terms; repealing s. 393.0641, F.S.,
958 relating to a program for the prevention and treatment
959 of severe self-injurious behavior; amending s.
960 393.065, F.S.; providing for the assignment of
961 priority to clients waiting for waiver services;
962 requiring the agency to allow an individual to receive
963 specified services if the individual’s parent or legal
964 guardian is an active duty military servicemember,
965 under certain circumstances; requiring the agency to
966 send an annual letter requesting updated information
967 to clients, their guardians, or their families;
968 providing that certain agency action does not
969 establish a right to a hearing or an administrative
970 proceeding; amending s. 393.066, F.S.; providing for
971 the use of an agency data management system; providing
972 requirements for persons or entities under contract
973 with the agency; amending s. 393.0662, F.S.; revising
974 the allocations methodology that the agency is
975 required to use to develop each client’s iBudget;
976 adding client needs that qualify as extraordinary
977 needs, which may result in the approval of an increase
978 in a client’s allocated funds; revising duties of the
979 Agency for Health Care Administration relating to the
980 iBudget system; creating s. 393.0679, F.S.; requiring
981 the Agency for Persons with Disabilities to conduct a
982 certain utilization review; requiring specified
983 intermediate care facilities to comply with certain
984 requests and inspections by the agency; amending s.
985 393.11, F.S.; providing for annual reviews for persons
986 involuntarily committed to residential services;
987 requiring the agency to employ or contract with a
988 qualified evaluator; providing requirements for annual
989 reviews; requiring a hearing to be held to consider
990 the results of an annual review; requiring the agency
991 to provide a copy of the review to certain persons;
992 defining a term; reenacting s. 393.067(15), F.S.,
993 relating to contracts between the Agency for Persons
994 with Disabilities and licensed facilities, to
995 incorporate the amendments made to s. 393.18, F.S., in
996 a reference thereto; repealing s. 26 of ch. 2015-222,
997 Laws of Florida, relating to the abrogation of the
998 scheduled expiration of an amendment to s. 393.18,
999 F.S., and the scheduled reversion of the text of that
1000 section; reenacting and amending s. 393.18, F.S.;
1001 revising the purposes of comprehensive transitional
1002 education programs; providing qualification
1003 requirements for the supervisor of the clinical
1004 director of a specified licensee; revising the
1005 organization and operation of components of a program;
1006 providing for the integration of educational
1007 components with the local school district; authorizing
1008 the agency to approve the admission or readmission of
1009 an individual to a program; providing for video and
1010 audio recording and monitoring of common areas and
1011 program activities and facilities; providing for
1012 licensure of such programs; amending s. 393.501, F.S.;
1013 conforming provisions to changes made by the act;
1014 amending ss. 383.141 and 1002.385, F.S.; conforming
1015 cross references; providing an effective date.