This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives. STORAGE NAME: h0485a.LFS DATE: 3/15/2023 HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: HB 485 Veterans' Services and Recognition SPONSOR(S): Salzman and others TIED BILLS: IDEN./SIM. BILLS: SB 824 REFERENCE ACTION ANALYST STAFF DIRECTOR or BUDGET/POLICY CHIEF 1) Local Administration, Federal Affairs & Special Districts Subcommittee 18 Y, 0 N Mwakyanjala Darden 2) Health Care Appropriations Subcommittee 3) Health & Human Services Committee SUMMARY ANALYSIS The Florida Department of Veterans’ Affairs (FDVA) operates a network of nine state veterans’ homes and provides statewide outreach to connect veterans with services, benefits and support. FDVA offers benefits and services in the fields of health care, mental health and substance abuse, claims support, education, employment, housing, burial benefits, and legal assistance. The U.S. Department of Veterans’ Affairs (VA) is principally responsible for the delivery of health care services to veterans. Boards of county commissioners and governing bodies of municipalities may employ veteran service officers and prescribe their duties, compensation, and terms of employment. Adult day health care is a program established by the VA with the goal of allowing veterans to have a place during the day for social activities, peer support, companionship, and recreation. The program is intended for veterans who need help with activities of daily living, who are isolated, or whose caregiver is experiencing burden. State law recognizes adult day care centers, however, facilities that operate under the federal government or any agency thereof are exempt from current state law pertaining to adult day care centers and regulation by the Agency for Health Care Administration. The bill creates the Division of Long-term Care (Division) within FDVA. The Division is to oversee the operations of veterans’ adult day health care programs. The bill provides that the executive director of FDVA (Director) shall appoint operators who will be responsible for the overall operation of each operator’s state authorized veterans’ adult day health care program. The director may designate contractors responsible for the operations of an adult day health care entity authorized under federal law to perform the same duties as operators. Eligible veterans who are residents of the state and have a service-connected disability will have priority admittance. The bill also revises eligibility requirements of county and city veteran service officers and designates the week of November 11 of each year as “Veterans Week.” STORAGE NAME: h0485a.LFS PAGE: 2 DATE: 3/15/2023 FULL ANALYSIS I. SUBSTANTIVE ANALYSIS A. EFFECT OF PROPOSED CHANGES: Present Situation Florida Department of Veterans’ Affairs The Florida Department of Veterans’ Affairs (FDVA) is a nearly 1,500-member constitutionally chartered 1 department with a budget of $171 million for FY 2022-23. 2 FDVA operates a network of nine state veterans’ homes and provides statewide outreach to connect veterans with services, benefits, and support. 3 FDVA offers benefits and services in the fields of health care, mental health and substance abuse, claims support, education, employment, housing, burial benefits, and legal assistance. 4 Health Care The U.S. Department of Veterans’ Affairs (VA) is principally responsible for the delivery of health care services to veterans. 5 Eligibility for hospital, nursing home, and domiciliary care depends on a number of factors. Veterans qualify for specified health care services depending on disability status, time of service, active duty status during service, toxic exposure during service, annual income, or the need for support. 6 Veteran Service Officers Boards of county commissioners and governing bodies of municipalities may employ veteran service officers and prescribe their duties, compensation, and terms of employment. 7 A veteran service officer must be a veteran who served as a member of the U.S. Armed Forces during a period of war, 8 served at least 18 months’ active duty in the Armed Forces, and be separated from such service under honorable conditions. 9 Legal Holidays and Observances State law provides designations for legal holidays and special observances. Depending on the holiday or special observance, certain actions may be required to be performed for the commemoration or observance of the date, day, or month. There are 21 legal holidays 10 established in law and 36 special observances. 11 Adult Day Care Centers Adult day care centers provide therapeutic services and activities for adults in a non-institutional setting. 12 Participants may utilize a variety of services offered during any part of a day totaling less than 1 Art. IV, s. 11, Fla. Const. 2 Ch. 2022-156, Laws of Fla., pg. 141. 3 Florida Department of Veterans Affairs, Florida Department of Veterans’ Affairs – Our Vision and Mission, available at https://www.floridavets.org/leadership/ (last visited on Mar. 12, 2023). 4 Florida Department of Veterans Affairs, Benefits & Services, available at https://www.floridavets.org/benefits-services/ (last visited on Mar. 12, 2023). 5 Florida Department of Veterans Affairs, Health Care, available at https://www.floridavets.org/benefits-services/health-care/ (last visited on Mar. 12, 2023). 6 38 U.S.C. s. 1710. 7 S. 292.11, F.S. 8 Period of war is defined as the Spanish-American War, the Mexican border period, World War I, World War II, the Korean conflict, the Vietnam era, the Persian Gulf War, and the period beginning on the date of any declaration of war by the Congress and ending on the date prescribed by Presidential proclamation or concurrent resolution of the Congress. 38 U.S.C. s. 101(11). 9 S. 292.11(1), F.S. 10 S. 683.01, F.S. 11 Ss. 683.04 - 683.3341, F.S. 12 S. 429.901(3), F.S. STORAGE NAME: h0485a.LFS PAGE: 3 DATE: 3/15/2023 24 hours. Basic services provided by adult day care centers include leisure activities, self-care training, nutritional services, and respite care. 13 These facilities are licensed by the Agency for Health Care Administration. 14 However, facilities that operate under the federal government or any agency thereof are exempt from the current state law pertaining to adult day care centers. 15 The VA’s Adult Day Health Care Program (Program) was established by the VA with the goal of allowing veterans to have a place during the day for social activities, peer support, companionship, and recreation. 16 The Program is intended for veterans who need help with activities of daily living, those who are isolated, or whose caregiver is experiencing burden. Health services such as care from nurses, therapists, social workers, and others may also be provided. The Program may be provided at VA medical centers, state Veterans Homes, or through community organizations. In order to receive a federal grant or grant funding for an adult day health care program, the state must meet the following specific federal requirements: If an adult day health care program is located within a nursing home, domiciliary, or other care facility, the adult health care program must have its own separate designated space during operational hours. The indoor space for the adult day health care program must be at least 100 sq. ft. per participant including office space for staff, and must be 60 sq. ft. per participant excluding office space for staff. Each program will need to design and partition its space to meet its own needs, but must make available certain federally mandated functional areas. 17 Furnishings must be available for all participants, including functional furniture appropriate to the participants’ needs. 18 Effect of Proposed Changes The bill creates the Division of Long-term Care (Division) within FDVA. The Division is to oversee the operations of veterans’ adult day health care programs. The bill provides that the executive director of FDVA (Director) shall appoint operators who will be responsible for the overall operation of each operator’s state authorized veterans’ adult day health care program. The Director may designate contractors responsible for the operations of an adult day health care entity authorized under federal law to perform the same duties as operators. While the bill provides that the operator shall determine eligibility of the applicants for admission into adult day health care programs, the bill also provides general eligibility requirements and an admittance priority. In order to be eligible for the program, a person must: Be a veteran as defined by state law; Need adult day health care; Be a resident of the state at the time of application for admission to the program; Not owe money to FDVA for services rendered during any previous stay at a department facility; Have applied for all financial assistance reasonably available through governmental sources; and Have been approved as eligible for care and treatment by the VA. The bill provides that an operator may waive the residency requirement for an applicant as long as the veteran would be otherwise eligible under the requirements listed above and the applicant is a disaster evacuee of a state that is under a declared state of emergency. The bill establishes the following admittance priority for eligible veterans: Residents of the state. 13 Id. 14 S. 429.903, F.S. 15 S. 429.905, F.S. 16 U.S. Department of Veterans Affairs, Adult Day Health Care, available at https://www.va.gov/geriatrics/pages/Adult_Day_Health_Care.asp (last visited Mar. 12, 2023). 17 For the list of federally mandated functional areas, see 38 C.F.R. s. 59.160(c)(1)-(11). 18 38 C.F.R. s. 59.160. STORAGE NAME: h0485a.LFS PAGE: 4 DATE: 3/15/2023 Veterans who have a service-connected disability as determined by the VA or were discharged or released from military service for disability incurred or aggravated in the line of duty and the disability is the condition for which adult day health care is needed. Veterans who have a non-service-connected disability and is unable to defray the expense of adult day health care and so states under oath before a notary public or other officer authorized to administer an oath. Operators are authorized to admit veterans who have sufficient means to fund their own support but who would otherwise be eligible for admittance if the program has available room. The bill requires the programs under the Division to be open to audit and inspection by the Auditor General and the Office of Program Policy Analysis and Government Accountability. The bill grants rulemaking authority to the operator and the director to adopt rules necessary for the proper administration of the program, including rules to preserve the order and enforcement of discipline in the program. The rules must conform as nearly as possible to the rules and regulations for comparable facilities of the VA. The bill revises the eligibility requirement of county and city veteran service officers to provide that any veteran as defined by state law may serve as a veteran service officer. The bill designates the week of November 11 of each year “Veterans Week.” The governor is authorized to issue a proclamation during Veterans Week and may call public officials, schools, private organizations, and residents of the state to commemorate Veterans Week and servicemembers. B. SECTION DIRECTORY: Section 1: Amends s. 20.37, F.S., creating the Division of Long-term Care within the Florida Department of Veterans’ Affairs. Section 2: Amends s. 292.11, F.S., revising the definition for county and city veteran service officers. Section 3: Creates part III of ch. 296, F.S., to be cited as the “Veteran’s Adult Day Health Care of Florida Act.,” providing for the establishment of basic standards for the operation of veterans’ adult day health care programs. Section 4: Creates s. 683.1475, F.S., designating the week of November 11 of each year as “Veterans Week.” Section 5: Provides that the bill will take effect July 1, 2023. II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT A. FISCAL IMPACT ON STATE GOVERNMENT: 1. Revenues: See Fiscal Comments. 2. Expenditures: See Fiscal Comments. B. FISCAL IMPACT ON LOCAL GOVERNMENTS: 1. Revenues: None. STORAGE NAME: h0485a.LFS PAGE: 5 DATE: 3/15/2023 2. Expenditures: None. C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR: Qualifying private contractors that are currently providing services in other settings may now be eligible to be designated as operators. D. FISCAL COMMENTS: The bill authorizes FDVA to operate, or contract with third parties to operate, adult day care programs. These programs may increase expenditures by FDVA, but may also be offset by funds received from VA for the program. III. COMMENTS A. CONSTITUTIONAL ISSUES: 1. Applicability of Municipality/County Mandates Provision: Not Applicable. This bill does not appear to require counties or municipalities to spend funds or take action requiring the expenditures of funds; reduce the authority that counties or municipalities have to raise revenues in the aggregate; or reduce the percentage of state tax shared with counties or municipalities. 2. Other: None. B. RULE-MAKING AUTHORITY: The bill grants rulemaking authority to the operator and the director to adopt rules necessary for the administration of the program, including rules to preserve the order and enforcement of discipline in the program. The rules must conform as nearly as possible to the rules and regulations for comparable facilities of the VA. C. DRAFTING ISSUES OR OTHER COMMENTS: None. IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES None.