APD's > Legislative > Digest

Volume II Issue 5 April 4, 2008

• Monday, April 7, 2008
  • 1 p.m.—House Appropriations Deadline:
    All requests for floor amendments must be filed.


• Tuesday, April 8, 2008
  • 8 a.m. – 12 p.m.
    House Healthcare Council
  • 12 p.m.—House Appropriations Deadline:
    All requests to floor amendments and
    substitute amendments to floor amendments must be filed.
  • 1 p.m. – 3:30 p.m.
    Senate Health & Human Services Appropriations
  • 3:15 p.m. – 4:45 p.m.
    Senate Children, Families & Elder Affairs
  • 3:15 p.m. – 4:45 p.m.
    Senate Health Policy


• Wednesday, April 9, 2008
  • 9 a.m. – 3 p.m.
    Senate Session
  • 11 a.m. – 6 p.m.
    House Session
  • Miami-Dade County Days, Inc – Festival


• Thursday, April 10, 2008
  • 8 a.m. – 11:30 a.m.
    House Session
  • 9 a.m. – 1 p.m.
    Senate Session
  • 11 a.m. – 2 p.m.
    Hillsborough County Day
  • 1 p.m. – 4:30 p.m.
    House Policy & Budget Council
  • 2:30 p.m. – 4:30 p.m.
    Senate Health & Human Services Appropriations

From The Director

Focus on Children

Children were front and center in the state Capitol this week. Highlighted by thousands of colorful paper hands hanging throughout the Capitol Rotunda and hundreds of school children visiting their legislators during Spring break, children’s issues clearly commanded the center of attention.

On April 1, a news conference was held at the Capitol Rotunda featuring Lt. Gov. Jeff Kottkamp, who read a proclamation from Governor Charlie Crist designating the week as Children’s Week. Kottkamp talked about Governor Crist’s commitment to Florida’s youngest citizens. Some of those youngsters sang for the pleasure of the crowd of about 150 people.

After the kickoff event, I participated in a meeting of the Children and Youth Cabinet, chaired by Lt. Governor Kottcamp. The cabinet members discussed the budget cuts that have been proposed by the Legislature and the impact those cuts will have on services for children. The cabinet members also answered a series of provocative questions from a panel of youth advocates that covered issues such as foster care, safety, education, and health insurance.

On April 2, I participated in another important news conference in recognition of World Autism Day. I have been appointed by Governor Charlie Crist to serve as co-chair of the Task Force on Autism Spectrum Disorders. Joining me at this event was the other task force co-chair, Dan Marino, and Governor Crist. We talked about the need to develop a unified and coordinated agenda for addressing the issues surrounding autism in Florida. Mr. Marino talked about his son Michael, who has autism, and the importance of the early diagnosis and treatment he was able to receive. Later the governor and Marino threw a football back and forth to the delight of the crowd.

Other speakers included Senate Democratic Leader Steve Geller of Cooper City, who spoke on his bill currently being considered by the Legislature to require insurance companies to cover some of the high costs of therapies for children with autism. He said this was his last year in the Legislature and that this bill is the one special bill he wants approved as his retirement gift. The Task Force on Autism then conducted its first two-day meeting, and it was very evident that this is very diverse group of parents, advocates, and content experts intends to make meaningful progress towards improving the possibilities for individuals with autism and their families.

I look forward to tackling the many challenges our agency and the state of Florida have to face in these tight budget times, while making sure that we are looking out for Florida’s future.

House Healthcare Council

Developmental Disabilities champion, Representative Bill Galvano (R-Bradenton), presented the Agency for Persons with Disabilities 2008 legislative package to Council members on Tuesday, April 1. The bill (PCB HCC 25-08) is similar to the package presented to the Senate Children, Families and Elder Affairs Committee last week by Senator Nan Rich (R-Sunrise) (SBs 1950/1954). Specifically, the bill contains the following:

• Changes the name of the Developmental Disabilities Institutions to Developmental Disabilities Centers to more appropriately reflect the progress being made in these facilities and to maintain the dignity of the residents.
• Changes the definition of retardation in Chapters 393 and 916, Florida Statutes, back to the pre-2006 language to clarify the condition must have manifested prior to age 18, due to confusion surrounding statutory construction. (It does not alter current policy or application of this definition.)
• Revises the background screening requirement in Chapter 393, Florida Statutes, to exempt persons who have been screened in the previous 12 months, as long as they have not been continuously unemployed for more than 90 consecutive days since the previous screening.
• Adds criteria to the statute which would allow APD to deny, revoke, or suspend a license or impose an administrative fine if the licensure applicant or licensee has been verified by the Department of Children and Families to be a caregiver responsible for abuse, neglect, or abandonment of a child; abuse, neglect or exploitation of an adult; or previously had a license revoked by APD, the Agency for Health Care Administration, or DCF.
• Clarifies that at least two experts, one of which is a psychologist, are required in court- ordered evaluations of a person with autism or retardation.
• Requires a 15-day timeframe for a Sheriff to transport a defendant back to jail to await hearing, and a 30-day timeframe for a competency hearing to be scheduled by the court.

This provision will timely move defendants out of treatment facilities and back to the court system. It will also help the agency avoid waiting lists for forensic beds and assist in meeting the Chapter 916, Florida Statutes, requirement for a committed person to be admitted to a forensic facility within 15 days of the court order.

The bill passed unanimously.

House Bill 739 – Guardian Advocacy

House Bill 739 was tweaked a little further this week and passed out of the Healthcare Council on Tuesday. This bill now:

• Provides of a list of persons from which thecourt must select a guardian advocate; provides that the guardian advocate need not be represented by an attorney.
• Revises requirements for petitions seeking appointments of guardian advocates to exclude names of proposed guardian advocates.
• Modifies persons to whom notice of filing of petition must be given to include family members.
• Requires a court order to name a guardian advocate and reasons for selection.
• Modifies who may be appointed counsel to a person with developmental disabilities; includes office of criminal conflict and civil regional counsel.
• Revises powers and duties of guardian advocates with respect to financial accounting requirements.
• Requires the court to consider whether the person with a developmental disability has any advance directives (health care surrogate, durable power of attorney, etc.) and, if they do, differentiate their duties from the guardian advocate in the letters of appointment: Includes a restoration of rights section.

The bill now moves on to the Policy and Budget Council for its consideration. The Agency for Persons with Disabilities continues to work with Representative Ambler, the Advocacy Center for Persons with Disabilities, Inc., the Florida Bar and the Florida Developmental Disabilities Council to effect improvements in the current laws.

There was no activity this week in the Senate on its similar bill (SB 688).

Successful Changes in CDC+

Several changes for the better have occurred in the Consumer Directed Care Plus program in recent months. In March, APD took over as the fiscal intermediary for CDC+. After a succession of four private companies serving in this role, APD brought the payment function in-house in order to improve the quality of service. APD employees worked overtime, including nights and weekends, to gear up for the new operation. The first payroll came off without a hitch, and by the time the second payroll was processed, rave reviews were pouring in.

"The response we have had from our customers is overwhelmingly positive," said Sherry Jackson, CDC+ Administrator in APD's Central Office.

"Thank you for the hard work that you have done to make this transition successful," wrote Sue Cannon in an e-mail. "I know that we, as representatives, often have been difficult to work with, but your professionalism, commitment, and kindness go beyond what we have seen before. We appreciate the respect that you show toward us and the personal situations that we deal with on a daily basis. It has made all the difference in the world inregard to this program and the people we care for."

Similar sentiments were expressed in an e-mail from Joanna Rydzewski, who is the representative for her son. "Even when the system had glitches, the staff fixed it right away and got my payroll completed and checks in the mail on time and my employees were paid as promised," Rydzewski wrote. "I personally would like to take the time to thank each and every one who is on this dedicated team of staff workers for a job well done."

Another success for CDC+ recently occurred at the federal level. APD has been working closely with the Agency for Health Care Administration, the lead agency for CDC+, in filing an application to ensure that the program will continue beyond its pilot phase. That hard work paid off when the Centers for Medicare and Medicaid Services (CMS) approved the application, which will move the CDC+ program to a permanent state plan Medicaid option under 1915(j) authority. The application was structured to make the new, permanent program almost identical to the current CDC+ program. An enhancement of quality assurance monitoring will be one of the few major changes. Only the current number of participants will be authorized when the new program begins.

Senate Health and Human Services Appropriations Committee

Senator Nan Rich offered an amendment to Senate Appropriations bill, SB 7084, during the Senate HHS Appropriations Committee meeting Wednesday, April 2, that requires the Agency for Persons with Disabilities to contract with independent waiver support coordinators to conduct needs assessments for individuals currently enrolled in the HCBS waiver and those on the wait list, if funds are available. Senator Rich stated in the meeting that this amendment is not intended to replace the 75 employees that have been hired by the agency who are currently conducting assessments for individuals on the waiver as required by SB 1124 last session. She said the independent coordinators must meet the same inter-rater reliability standards and training requirements as the current assessors. She also specified they were not to conduct assessments on individuals they are serving.

There were no further changes to the agency budget.

Important Bills Report

Senate Bill 2654 By Senator Steven Geller and House Bill 1291 by Representative Ari Porth create the "Window of Opportunity Act." These bills

• Require large-group health insurance plans to provide coverage for screening, diagnosis, intervention, and treatment of autism spectrum disorders in certain children.
• Require large-group health insurance plans to provide coverage for diagnostic screening of autism spectrum disorders in healthy babies and children, and the intervention and treatment of these disorders through speech therapy, occupational therapy, physical therapy, applied behavior analysis, treatment by a psychiatrist or psychologist, and any other necessary medical care as prescribed by the insured’s treating medical physician in accordance with a treatment plan. Further, health insurance plans may not deny, refuse to issue or reissue coverage, terminate, or restrict coverage because an individual is diagnosed with an autism spectrum disorder.
• Specify that, to be eligible for benefits and coverage, an individual must be diagnosed with an autism spectrum disorder at 8 years of age or younger. Benefits and coverage must be provided to eligible persons that are under 18 years of age or who are in high school.

SB 2654 passed unanimously in the Senate Health Policy Committee Tuesday, April 1. HB 1291 has not yet been put on the agenda by Chairman Aaron Bean in the Healthcare Council.

Several families spoke in favor of the bill, providing insight into the problems they have faced obtaining necessary services for their children. One parent stated that while she would prefer to work, she quit her job as a critical care nurse so she would be eligible for assistance to pay for services she could not afford. Another family stated they could not afford to pay for services for their child, who became violent, presenting a serious threat of harm to himself. He was placed in a temporary placement and when it was time for them to pick him up, they declined to take him back. He eventually was placed in the custody of DCF and is now getting services. The parents stated this was not what they wanted, but saw no other way to get services for their child. Governor Crist was watching the meeting on television and upon hearing the testimony of the families, came to the meeting. He spoke to the committee members and applauded Senator Geller for his efforts.

After much emotional discussion, with one speaker representing the insurance industry opposing the bill, the bill was reported favorably.

Senate Education Pre-K – 12
Committee

The Committee took up a substitute amendment to SB 318 by Senator Lee Constantine (R-Orlando) which would require DCF or APD, within 10 days of an exceptional student with a disability being "placed" or "referred" to a "private residential care facility," to provide notification of the placement or referral to the school district in which the facility is located. This applies when the placement or referral is for the primary purpose of addressing residential, or other noneducational needs, and the placement or referral crosses school district lines.

This bill is the result of recent litigation in which school districts sued APD for payment of educational services because the school districts (Palm Beach, Seminole County, and Orange County) were not notified when the child moved. APD prevailed in the suits. Consequently, legislators requested OPPAGA to conduct a study which basically concluded that APD and DCF must notify school districts when a child is moved from one district to another. APD, DCF, and DOE are working with legislative committee staff, legislators, and OPPAGA to help clarify financial responsibilities of students with disabilities.

A similar bill, HB 359 by Rep. Scott Randolph (D-Orlando), has not been heard yet in the House.

Senate Committee on Health Policy

The Committee met on April 1, and considered SB 988 and SB 2654. Senate Bill 988, sponsored by Senator Stephen Wise (R-Jacksonville), addresses transitional services for young adults with disabilities. The bill establishes the Health Care Transition Services Task Force for Young Adults with Disabilities. The task force would be composed of individuals with expertise in youth transitional needs, including a representative from APD. The task force must obtain input from key stakeholders, community stakeholders, public agencies, the medical practice community, and youth who have chronic special health care needs and disabilities and their families to assess the need for health care transition services and to identify barriers that impede access to comprehensive medical treatment and health care for youth and young adults who have chronic special health care needs and disabilities. The task force would be required to submit a report of its findings and recommendations to the Governor, the President of the Senate, and the Speaker of the House of Representatives. The plan is to provide input to promote the integration of health care transition services with transition programs for education, vocation, and independent living, including funding sources. The bill passed unanimously.

House Policy and Budget Council

The Council met on April 3, and considered several appropriations bills. The General Appropriations Act, PCB PBC 08-03, was the subject of much debate. The primary debate was about the funding reductions in the healthcare portions of the bill. Representative Shelley Vana (D-West Palm Beach) expressed concern that the rate paid for services in the ICF/DD programs had been reduced by 10%. She asked how they could continue to provide services for individuals with developmental disabilities who were already experiencing budget problems. Representative Aaron Bean (R-Fernandina Beach) indicated the Council had considered that and felt the providers would be able to continue to operate with the reduced rate.

Representative J.C. Planas (R-Miami) withdrew an amendment that would have given $200,000 from APD’s budget to Applied Behavioral Analysis in Broward, Palm Beach, and Miami-Dade counties. After approximately seven hours of debate, the bill was reported favorably.

The Council also considered PCB 08-06, addressing changes in health care. The bill, sponsored by the House Policy and Budget Committee, eliminates the Statewide Advocacy Center (SAC) and Local Advocacy Councils (LAC). Representative Loranne Ausley (D-Tallahassee) expressed concern that eliminating these entities would result in individuals with developmental disabilities having no one to advocate for them. Representative Bill Galvano (R-Bradenton) indicated there were other advocacy groups that could fill this role. Representative Ausley said she would like to work with Representative Galvano on this issue to see if another avenue would work.

Ken Littlefield, Director of the Statewide Advocacy Center, spoke in opposition to this portion of the bill. He stated that eliminating the SAC and the LACs would result in the "loss of the guardrail at the top of the cliff." He indicated that when individuals fell from the cliff, there would be no one to assist them.

Sylvia Smith, with the Advocacy Center for Persons with Disabilities, indicated that elimination of the SAC and the LACs would result in no one looking into issues of abuse. She stated that they do not receive copies of abuse reports and therefore, cannot advocate for those who are abused.

After much debate, the bill was reported favorably.

HB 5087, sponsored by the House Policy and Budget Council, is comparable to SB 1866, sponsored by the Senate Health and Human Services Appropriations Committee.

Representative Vana asked how individuals would be able to get a determination of moderate need to participate in tier two. Representative Galvano said the PSA process was based on identified need as determined through assessment.

Representative Mary Brandenburg (D-Lake Worth) asked if Palm Beach, Broward, Miami-Dade, and Monroe counties would lose funding due to the geographic differential adjustment. Representative Galvano explained that these counties were going to see a reduction. However, the bill would allow the reduction to be phased in.

Representative Jack Seiler (D-Pompano Beach) asked if moving the fair hearings from DOAH to DCF conflicted with the court ruling in this issue. Representative Galvano explained that the bill established the authority to have DCF conduct the hearings, aligning these hearings with other hearings in statute. Representative Seiler then asked if holding Medicaid hearings at DCF, while those hearings not related to Medicaid would be held in another venue, would result in fewer protections for either group. Representative Galvano explained that it would not, as all hearings would be conducted consistent with federal requirements.

Sylvia Smith, with the Advocacy Center for Persons with Disabilities, expressed concern about moving the hearings to DCF. She stated that the costs for having the hearings at DOAH over the last year may be inflated due to the increased hearings resulting from implementation of SB 1124. She indicated that individuals won 44% of their appeals through DOAH and only 7% through DCF. She indicated that DOAH had more experience and a better understanding in the application of precedent cases. After much discussion, the bill was reported favorably.

Senate Session

The Senate met in session on April 3, and Senate Bill 2216, by Senator Ronda Storms (R– Brandon) addressing adult protection and care, was read for the second time. The bill, sponsored by the Senate Children, Families, and Elder Affairs Committee, adds protections for the elderly by providing the Department of Children and Families (DCF) with access to records of the Department of Highway Safety and Motor Vehicles (DHSMV) to be used to conduct protective investigations. The bill also expands the types of crimes that are classified as disqualifying offenses for employment purposes in long-term care facilities. Long-term facilities would be required to conduct a search of the Department of Law Enforcement's sexual offender database for each prospective resident before admission or immediately after admission. The facility must maintain verification that all residents have been screened. The information obtained may be used by the facility to assess the needs of the resident and to provide adequate and appropriate health care and protective and support services in accordance with this part. The information obtained may be disclosed to other residents. Reports of abuse by someone other than a relative caregiver or household member would be immediately transferred to the appropriate county sheriff's office.

There were several floor amendments to the bill and it is now awaiting final action by the Senate.

House Safety and Security Council

The Council met on April 1, and considered HB 427. The bill, sponsored by Representative Pat Patterson (R-Deland), revises the definition of correctional officer to include institutional security personnel employed in forensic facilities. This would mean APD security personnel at MRDP would be defined as correctional officers. The bill was reported favorably.