This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1517.CFS
DATE: 3/24/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 1517 Agency for Persons with Disabilities
SPONSOR(S): Plakon
TIED BILLS: IDEN./SIM. BILLS: SB 1444
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Children, Families & Seniors Subcommittee Guzzo Brazzell
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
Adult day training (ADT) services are intended to support the participation of Medicaid recipients with developmental
disabilities in valued routines of the community, including volunteering, job exploration, accessing community
resources, and self-advocacy, in settings that are age and culturally appropriate. ADT services can include
meaningful day activities and training in the activities of daily living, adaptive skills, and employment. ADT services
generally begin at the age of 22 when a recipient is out of the public-school system.
ADT services are a covered service under the Developmental Disabilities Individual Budgeting (iBudget) Waiver,
which is operated by the Agency for Persons with Disabilities (APD). Currently, APD has authority to enroll ADT
providers who meet minimum education requirements and background screening requirements, but they do not
have licensure authority, so there are no initial or continued compliance standards for client care. As a result, APD
does not have the authority to take disciplinary actions on ADT providers. A recent analysis by APD identified a
significant number of issues adversely impacting the health and safety of APD clients.
Current law authorizes APD to license comprehensive transitional education program (CTEPs), residential facilities
for individuals who have developmental disabilities or severe maladaptive behaviors, or are dually diagnosed with
mental illnesses. APD closed the state’s only CTEP in 2018 after egregious instances of abuse and neglect.
HB 1517 provides authority for APD to license ADT providers and requires APD to adopt rules to create initial and
continued licensure requirements relating to:
Training to detect, prevent, and report abuse, neglect, exploitation, and abandonment;
Proof of financial ability to operate;
Quality and adequacy of client care;
Incident reporting;
Uniform fire safety standards; and
The preparation and annual update of a comprehensive emergency management plan.
The bill authorizes APD to take disciplinary action relating to verified findings of abuse, neglect, or abandonment of
a child or vulnerable adult and prohibits a licensee from delegating the ultimate responsibility for the safety and care
of clients in its care to others.
The bill repeals s. 393.18, F.S., effectively removing the authority for APD to license CTEPs.
The bill is expected to have a significant negative fiscal impact on state government resulting from the need of
seven full time equivalent positions for APD to implement the bill. The bill has no fiscal impact on local government.
The bill provides an effective date of October 1, 2024. STORAGE NAME: h1517.CFS PAGE: 2
DATE: 3/24/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Florida Medicaid
Medicaid is the health care safety net for low-income Floridians. Medicaid is a partnership of the federal
and state governments established to provide coverage for health services for eligible persons. The
program is administered by the Agency for Health Care Administration (AHCA) and financed by federal
and state funds. AHCA delegates certain functions to other state agencies, including the Department of
Children and Families (DCF), the Department of Health, the Agency for Persons with Disabilities, and
the Department of Elderly Affairs (DOEA).
The structure of each state’s Medicaid program varies, and what states must pay for is largely
determined by the federal government, as a condition of receiving federal funds.
1
Federal law sets the
amount, scope, and duration of services offered in the program, among other requirements. These
federal requirements create an entitlement that comes with constitutional due process protections. The
entitlement means that two parts of the Medicaid cost equation – people and utilization – are largely
predetermined for the states. The federal government sets the minimum mandatory populations to be
included in every state Medicaid program. The federal government also sets the minimum mandatory
benefits to be covered in every state Medicaid program. States can add benefits, with federal approval.
States have some flexibility in the provision of Medicaid services. A 1915(c) waiver allows states to
develop Medicaid home and community-based services to meet the needs of people who prefer to
receive long-term care services and supports in their home or community instead of in an institutional
setting.
AHCA, as the designated single state agency for Medicaid, administers the Developmental Disability
Individual Budgeting (iBudget) Waiver under a 1915(c) waiver. Through an interagency agreement,
APD is the state agency responsible for the operation of the iBudget Waiver.
Agency for Persons with Disabilities
The Agency for Persons with Disabilities (APD) provides services to persons with developmental
disabilities. A developmental disability is defined as a disorder or syndrome that is attributable to
intellectual disability, cerebral palsy, autism, spina bifida, Down syndrome, Phelan-McDermid
syndrome, or Prader-Willi syndrome; that manifests before the age of 18; and that constitutes a
substantial handicap that can reasonably be expected to continue indefinitely.
2
Adult Day Training
Adult day training (ADT) services are training services intended to support the participation of Medicaid
recipients with developmental disabilities in valued routines of the community, including volunteering,
job exploration, accessing community resources, and self-advocacy, in settings that are age and
culturally appropriate. ADT services can include meaningful day activities and training in the activities of
daily living, adaptive skills, and employment. The training, activities, and routine established by the
trainer must be meaningful to the recipient and provide an appropriate level of variation and interest.
ADT services generally are offered for individuals age 22 and above, when a recipient is out of the
public-school system.
1
Title 42 U.S.C. §§ 1396-1396w-5; Title 42 C.F.R. Part 430-456 (§§ 430.0-456.725) (2016).
2
S. 393.063(12), F.S. STORAGE NAME: h1517.CFS PAGE: 3
DATE: 3/24/2023
APD currently licenses over 2,100 residential facilities statewide but does not license ADT programs.
ADT services are a covered service under the iBudget Waiver, which is operated by APD. Through the
iBudget Waiver, there are over 13,700 clients with ADT services on their cost plans. Currently, APD
has authority to enroll ADT providers who meet minimum education requirements and background
screening requirements, but they do not have licensure authority, so there are no initial or continued
compliance standards for client care. As a result, APD does not have the authority to leverage
administrative fines, sanctions, or moratoriums on ADT providers. Additionally, some ADT programs
are not enrolled iBudget Waiver providers. These settings are reimbursed via private pay arrangements
with clients and their families which precludes APD from initiating any type of disciplinary action against
such programs in response to health and safety issues (since those providers do not hold either a
license or contract with APD).
A recent analysis by APD of incident data relating to abuse, neglect, and exploitation of ADT recipients
identified a significant number of issues adversely impacting the health and safety of APD clients.
3
During the last 4 years, there have been 125 instances where DCF conducted protective services
investigations for abuse, neglect, or exploitation related to ADT services with 34 instances of verified
findings. Additionally, APD received 2,807 incident reports related to ADT services.
4
APD reviewed past incident reports occurring in ADT facilities to identify ways that such incidents could
be avoided or mitigated. Although APD cannot completely prevent incidents, APD found that that some
incidents that occurred were a result of environmental hazards not addressed through current waiver
standards for ADT services. Additionally, increased enforcement of appropriate staffing ratios could
reduce some incidents, such as elopements and client injuries. Further, required training could assist
ADTs in proper use of medical equipment and the implementation of behavioral interventions.
Comprehensive Transition Education Program (CTEP)
A comprehensive transitional education program (CTEP) is a type of residential facility authorized in
statute that serves individuals who have developmental disabilities, severe maladaptive behaviors, or a
dual diagnosis of a developmental disability and a mental illness.
5
Services provided by a CTEP must
be temporary in nature and delivered in a manner designed to achieve the primary goal of incorporating
the principles of self-determination and person-centered planning to transition individuals to the most
appropriate, least restrictive community living option of their choice.
APD closed Carlton Palms, the state’s only CTEP, in October 2018 as a result of multiple instances of
egregious abuse and neglect committed against APD clients. All 200 residents were subsequently
transferred to smaller community settings. However, current statutory language exists which would
allow for the licensure of new CTEPs. These programs render treatment in large-scale residential
settings; however, current federal requirements prohibit the provision of iBudget Waiver services in
such environments. Since most APD clients are receiving services through the iBudget Waiver
program, APD focuses on offering community-based services in smaller and more family-like settings
and does not anticipate licensing new CTEPs in the future.
3
Agency for Persons with Disabilities, Agency Analysis of 2023 HB 1517 (on file with Children, Families & Seniors Subcommittee staff).
4
Id.
5
S. 393.18, F.S. STORAGE NAME: h1517.CFS PAGE: 4
DATE: 3/24/2023
Effect of the Bill
HB 1517 provides authority for APD to license ADT providers and requires APD to adopt rules to create
initial and continued licensure requirements relating to:
Training to detect, prevent, and report sexual abuse, abuse, neglect, exploitation, and
abandonment;
Proof of financial ability to operate;
Quality and adequacy of client care;
Incident reporting;
Uniform fire safety standards; and
The preparation and annual update of a comprehensive emergency management plan.
The bill authorizes APD to take disciplinary action relating to verified findings of abuse, neglect, or
abandonment of a child or vulnerable adult and prohibits a licensee from delegating the ultimate
responsibility for the safety and care of clients in its care to others. Further, this bill clarifies that APD’s
ability to impose disciplinary actions is not necessarily negated by a licensee’s remedial action.
When considering an application for the licensure of an ADT or residential facility, APD may deny an
application if it is determined that there is evidence that the applicant is unqualified due to lack of good
moral character. “Good moral character” includes a personal history of honest, fairness, and respect for
the rights of others and the laws of the state and nation.
The bill removes obsolete language regarding Comprehensive Training and Education Programs that
no longer operate within the state. This will prohibit the licensure of any future facilities.
The bill provides an effective date of October 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amends s. 393.063, F.S. relating to definitions.
Section 2: Amends s. 393.0655, F.S., relating to screening of direct service providers.
Section 3: Amends s. 393.067, F.S., relating to facility licensure.
Section 4: Amends s. 393.0673, F.S., relating to denial, suspension, or revocation of license;
moratorium on admissions; administrative fines; procedures.
Section 5: Amends s. 393.0678, F.S., relating to receivership proceedings.
Section 6: Amends s. 393.135, F.S., relating to sexual misconduct prohibited; reporting required;
penalties.
Section 7: Repeals s. 393.18, F.S., relating to comprehensive transitional education program.
Section 8: Amends s. 394.875, F.S., relating to crisis stabilization units, residential treatment facilities,
and residential treatment centers for children and adolescents; authorized services; license
required.
Section 9: Amends s. 383.141, F.S., relating to prenatally diagnosed conditions; patient to be provided
information; definitions; information clearinghouse; advisory council.
Section 10: Amends s. 400.063, F.S., relating to resident protection.
Section 11: Amends s. 1002.394, F.S., relating to The Family Empowerment Scholarship Program.
Section 12: Provides an effective date of October 1, 2024.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
STORAGE NAME: h1517.CFS PAGE: 5
DATE: 3/24/2023
1. Revenues:
None.
2. Expenditures:
The bill is expected to have a significant negative fiscal impact on state government resulting from
the need of seven full time equivalent positions at a total cost of $457,616 in recurring funding for
APD to implement the bill.
6
B. FISCAL IMPACT ON LOCAL GOVE RNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. This bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The bill provides sufficient rule-making authority to APD to implement the provisions of the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
6
Supra note 3.