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Volume I Fall Issue 14 February 11, 2008

Tuesday, Feb. 19, 2008

House Healthcare Council 8 am - 12 pm House Policy & Budget 1:45 pm - 4:45 pm Senate Health & Human Services Appropriations 4:30 pm - 6 pm Wednesday, Feb. 20, 2008 Senate Children, Families, & Elder Affairs 2:15 pm - 4:45 pm Thursday, Feb. 21, 2008 Senate Health & Human Services Appropriations 1:30 pm - 6 pm Friday, Feb. 22, 2008 Senate Health & Human Services Appropriations 9 am - 3 pm

On February 8, 2008, Bob Brown-Barrios, Policy Coordinator for the Governor's Office of Policy and Budget, gave a presentation on the Governor's recommended Budget for FY 2008-2009 to the Senate Health and Human Services Appropriations Committee. He said this is a time when human services are most needed by the state's children, seniors, and those with disablities and to maintain the gains that have been made over the past five years. He said the $23.8 billion budget for this area comes mostly from trust funds and reserves. Brown-Barrios told the members that using nonrecurring money for recurring issues is not unusual in the budget process. He said the governor's focus was on preserving direct care services.
Major recommendations for the APD include:

• $54.9 million to restore nonrecurring waiver funding
• $11.5 million for enhancements and changes to APD information systems (ABC system);
• $5.9 million to enroll 250 crisis cases in the waiver; and
• $1.3 million for additional full time positions for the Mentally Retarded Defendant Program.

Senator Nan Rich, committee vice-Chair expressed concern about using nonrecurring funds for these programs. Brown-Barrios responded by saying the reserves are for "rainy days" and they are here. He said the cash in the trust funds is just sitting there so "why not do something for the people?" Senator Rich preferred to look at increasing taxes such as the cigarette tax, or review some of the tax exemptions rather than "raiding the trust funds." Senator Don Gaetz said this approach creates a set of expectations that may not be able to be met in the future.

Senate Committee On Health And Human Services Appropriations Program Options: At the request of the Committee Chairman Senator Durell Peaden, APD Director Jane Johnson presented members with program options to the current service delivery system to address the agency's budget issues. She said the options were for them to consider and direct the agency on which ones to implement.
The options included the following:

• Expanding Consumer Directed Care Plus (CDC+) Program;
• Developing A Hybrid of Traditional Waiver and CDC+
• Traditional Waiver Financing with Individual Budgets;
• Implementing "Supports Waiver" for Children in Foster Care;
• Exploring the Use of Additional Supports Waivers;
• Status Quo;
• Rebasing Cost Plans to Prior Year Expenditures;
• Developing Cost Effective Alternatives to Existing Services;
• Restructuring Current Oversight Processes;
• Additional Incremental Service and Rate Reductions;
• Providing of Waiver Services Through Managed Care Model.

The full presentation regarding these options can be viewed on our website at apd.myflorida.com/legislative/senate-hhs-committee-02-07-2008.ppt. Senator Rich expressed concerns about the length of time it will take to complete the assessment process that is required in SB 1124 and said it could be done faster if the current waiver support coordinators were allowed to do them. Director Johnson responded by saying the current system of using OPS employees as approved by the Legislature provides for a scientific review in conjunction with interrater reliability. This process also gives the WSC more time to spend with consumers and families.

A discussion then took place about services APD is paying for that should be picked up by other agencies and service entities. Senator Gaetz asked Director Johnson to bring examples for their review. He also asked her which of the options she preferred. She said expansion of the CDC+ program and rebasing and freezing cost plans were her choices.

Based on suggestions submitted by area staff and stakeholders, a number of legislative proposals were developed for the 2008 legislative session. After much evaluation, a substantive legislative package has been submitted.

Many thanks to Senator Nan Rich (D-34) and Representative Bill Galvano (R-54) for agreeing to sponsor our legislative proposals. We look forward to working with them in an effort to improve services for individuals with developmental disabilities.
The following legislative proposals have been submitted for consideration:

Definition of Retardation and Autism: Prior to the 2006 session, the statutory definition of "retardation" and "autism" found in Chapters 393 and 916, F.S., required that the behavior manifested prior to age 18. During the 2006 session, the definition "developmental disability" was revised to include this language. In order to remove redundant language, the language in the definition of "retardation" and "autism" was revised by referencing the definition of "developmental disability". As a result, some confusion has arisen among various court officers. The proposed language is intended to resolve that confusion by restoring the pre-2006 language regarding these definitions.

Medication Administration: Section 393.506, F.S., was amended during the 2006 legislative session to give unlicensed staff the authority to administer medications to consumers (or supervise the self-administration of medications to consumers) under certain specified conditions and circumstances. However, medication administration through feeding tubes was inadvertently omitted from the list of authorized practices. Until the 2006 legislative change, unlicensed direct care staff had been administering medication through feeding tubes. The addition of the word "enteral" to the current statutory language would expand the aforementioned authority to allow direct service providers to continue administering medications through feeding tubes.

Denial of License: During the 2006 legislative session, ss. 39.202(2)(a) and 415.107(3)(a), F.S., were amended for the purposes of granting APD access to all DCF records concerning reports of abuse, neglect, abandonment, and exploitation of children and vulnerable adults. Per statute, access to such information may be used by APD during the process of licensing homes which intend to serve persons with developmental disabilities (in accordance with the provisions of s. 393.067, F.S.).

While APD now has the legislative authority to review such information (involving prospective or current licensees) as part of the licensure process, the agency would be in a much stronger position if the law clearly provided additional authority by which to deny or revoke a residential facility license in situations where it is revealed that a licensee is named as the actual caregiver responsible for the abuse, neglect, abandonment, or exploitation of a child or vulnerable adult.

Background Screening: Currently, language in s. 402.3057, F.S., exempts certain individuals from background screening requirements pursuant to Chapter 393. This exemption does not apply to those individuals who have had a 90-day break in employment (from the job for which they were originally screened). The proposed change to s. 393.0657, F.S., would add the 90-day employment break in order to ensure consistency with s. 402.3057, F.S.. More importantly, it would offer additional safeguards regarding those individuals hired to render services to persons with developmental disabilities.

Rename Developmental Disabilities Institutions: Over the years, the residential facilities operated by the state for persons with developmental disabilities have had many titles. As progress was made in the identification and treatment of developmental disabilities, terminology has changed to avoid terms that might be considered negative. These facilities are currently called Developmental Disabilities Institutions. In the spirit of progress and maintaining the dignity of the residents of these facilities and their families, it is proposed that the name be changed to Developmental Disabilities Centers. It is felt this title is more reflective of the types of services and the quality of life.

Notice of Proceedings: Currently, there is no requirement that APD receive notice of proceedings regarding residents of the Mentally Retarded Defendant Program. The proposal recommends adding language which would require APD be notified of proceedings and provided the opportunity to be heard.

Appointment of Experts: During the 2005 session, s. 916.301, F.S., was amended from "the court shall appoint two experts" to "the court shall appoint the following". The conjunctive "and" or disjunctive "or" between the subsections (a) and (b) was not included in the new language. This created some confusion as to whether the legislature intended to reduce the number of court-ordered evaluations from two (department and outside expert) or one (department or outside expert). It is felt the intent was not to allow evaluation by one expert. The proposed language clarifies that two experts are required.

On February 5, 2008, Council Chairman Aaron Bean opened the meeting saying the (agency) base budgets are a "real monster." He said in the past recurring money in the base budgets was not usually scrutinized, but since the downturn in the economy and projected revenue shortfalls "priorities have changed." House Speaker Marco Rubio has said it is "critical that we (the House) begin to take serious steps to reduce the recurring expenditures."

The Council will be launching a review of base budgets and appointing subcommittees to zero in on specific programs that have traditionally been funded. The subcommittees will make recommendations about eliminating some of the ongoing projects. Council members Representatives Denise Grimsley (R-Sebring) and Jimmy Patronis (R-Panama City) were assigned review the Agency for Health Care Administration and Agency for Persons with Disabilities. Chairman Bean said other members who were not specifically assigned to a committee could go where they felt they would be of most benefit. The review will take place over the next three to four weeks. He charged the subcommittees to look at all expenditures no matter how small; to look at whether they are in keeping with the agency's core mission, if they have statewide application, including Community Budget Issue Requests (member projects) that have become ongoing programs as well as base budget contracts.

The Council will meet again on Tuesday, February 12 from 9:30 a.m. - 12 Noon and from 1:30 to 4 p.m. in Morris Hall in the House Office Building. The afternoon session will be for public comment and anyone wishing to speak should call the Council at (850) 414-5600. Chairman Bean strongly recommended that participants be prepared to identify alternative programs that could be eliminated or reduced if they want to keep a program or service.

On February 12, 2008, Bob Brown-Barrios, Policy Coordinator for the Governor's Office of Policy and Budget, gave a presentation on the Governor's recommended Budget for FY 2008-2009 to the House Health Care Council. He said this is a time when human services are most needed by the state's children, seniors, and those with disabilities and to maintain the gains that have been made over the past five years. He said the $23.8 billion budget for this area comes mostly from trust funds and reserves. Brown-Barrios told the members that using nonrecurring money for recurring issues is not unusual in the budget process. He said the governor's focus was on preserving direct care services.
Major recommendations for the APD include:

• $54.9 million to restore nonrecurring waiver funding
• $11.5 million for enhancements and changes to APD information systems (ABC system);
• $5.9 million to enroll 250 crisis cases in the waiver; and
• $1.3 million for additional full time positions for the Mentally Retarded Defendant Program.

The Council then provided time for individuals to speak, express their concerns, or offer suggestions to the Council. Margaret Hooper, with the Disabilities Council, offered assistance to the Council as they undertook the difficult job of addressing the budget. She indicated support for containment.

Patty Houghland, with the Family Care Council, provided support for APD and stated the agency should not be merged with another agency. She emphasized that the agency just got started and progress has been made. She went on to say that the aging population of parents of individuals with developmental disabilities and the fact that the developmental disabilities population is living longer is impacting budget needs. She indicated that the problems we are addressing have always been there, they just were not visible until the agency became a stand alone agency.

Betty Kay Clements, with the Suncoast Area Family Care Council, stated APD also agreed that the agency should not be merged with another agency. She indicated that being a stand alone agency makes the needs of the developmental disabilities community more visible. She also indicated that managed care is not the answer to the issues.

Pauline Lipp, with the Area 13 Family Care Council, stated they do not support merging APD with another state agency. She also indicated that APD has been successful and has made progress.

Diane Ciccarelli, a waiver support coordinator, stated success should not measured by utilization. She recommended that the ABC computer system not be updated. These funds should be used to provide services rather than simplifying someone's job. She also stated that the dental community needs to be mobilized to provide dental services for individuals with developmental disabilities. She indicated these services not be the responsibility of APD and could save 7.7 million dollars.

On February 5, 2008, Jerry McDaniel, Director of Governor's Office of Policy and Budget, gave members an overview of the Governor's budget recommendations for FY 2008-2009. He said the Governor was taking the approach of funding out of reserves and trust funds, including the Tobacco Trust Fund as an alternative to more severe budget cuts or raising taxes. The Council took exception to this approach.

Representative Ray Sansom, the Council Chairman who has oversight of the House budget, told McDaniel the House will not accept the Governor's proposal to use the state's reserves to cover the $1.1 billion shortfall. Instead, the House is looking at reducing next year's budget (FY 2008-2009) by as much as $2.5 billion - including reducing the current budget (FY 2007-2008) during the first few weeks of session with a budget reduction between $300 million to $600 million. Rep. Sansom said he wants state government to look at itself for ways to economize.

The Senate Committee on Criminal Justice met on February 6 and considered SB 366. This bill proposed to reclassify the offense of aggravated abuse of elderly person or disabled adults from a second-degree felony to a first-degree felony. The bill also requires certified law enforcement officers to complete training in identifying and investigating elder abuse and neglect. The bill referred to Senate Children, Families, and Elder Affairs as favorable.

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