The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Children, Families, and Elder Affairs
BILL: SB 1444
INTRODUCER: Senator Garcia
SUBJECT: Agency for Persons with Disabilities
DATE: March 24, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1.
Delia Cox CF
Favorable
2. FP
I. Summary:
SB 1444 requires adult day training (ADT) programs serving individuals with developmental
disabilities to be licensed by the Agency for Persons with Disabilities (the APD). The bill also
prohibits the licensure of comprehensive transitional educational programs (CTEPs) in Florida.
Specifically, the bill makes the following changes:
Clarifies the definitions of “adult day training”;
Adds a definition for “licensee,” which is the same definition as used in s. 408.803(9), F.S.,
relating to health care licensing by the Agency for Health Care Administration (the AHCA)
and the same, in part, as used in s. 400.023(2)(a), F.S., relating to nursing homes;
Requiresthe licensing and regulation of ADT programs by the APD;
Allows the APD to deny licenses for residential facilities and ADT programs when there is
evidence that the applicant is unqualified due to lack of good moral character;
Allows the APD to take disciplinary actions due to the noncompliance of ADT programs;
Clarifies the circumstances for which the APD can take disciplinary action related to verified
findings of abuse, neglect, or abandonment of a child or vulnerable adult being served by an
APD licensed facility or ADT program;
Removes obsolete language regarding CTEPs that no longer operate within the state;
Requires APD-licensed facilities and ADT programs to allow local emergency management
agencies to examine the approved emergency management plans and review and approve
plans for facilities and programs serving individuals with a complex medical condition; and
Clarifies language that the APD must not authorize funds or services to an unlicensed facility
or ADT program that requires a license.
The bill is expected to have a fiscal impact on state government and will likely have a
significant, but indeterminate impact on existing ADT programs. See Section V. Fiscal Impact
Statement.
BILL: SB 1444 Page 2
The bill is effective October 1, 2024.
II. Present Situation:
Agency for Persons with Disabilities
The APD is responsible for the provision of services to individuals with developmental
disabilities and for administering the Home and Community-Based Services (HCBS) Waiver.1
Florida has procured waivers of federal Medicaid requirements for the purpose of providing
home and community-based services to individuals at risk of institutionalization.2 The HCBS
Waiver provides services to individuals with developmental disabilities that allow them to
continue to live in their home or home-like setting and avoid institutionalization.3 Eligible
individuals must meet institutional level of care requirements.4 The overarching goal for the
APD is to prevent or reduce the severity of a developmental disability and implement
community-based services that will help individuals with developmental disabilities achieve their
greatest potential for independent and productive living in the least restrictive means.5
Regional Offices
In addition to central headquarters in Tallahassee, the APD operates a total of six regional offices
and 14 field offices throughout the state, as detailed below:6
Region Counties
Northwest Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson,
Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, and Washington
Fields 1 and 2.
Northeast Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist,
Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St. Johns, Suwannee,
Taylor, Union, and Volusia
Fields 3, 4, and 12.
Central Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange, Osceola,
Polk, Seminole, and Sumter
Fields 7, 13, and 14.
Suncoast Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco,
Pinellas, and Sarasota
1
See Section 20.197(3), F.S.
2
Rule 59G-13.080(1), F.A.C.
3
The Centers for Medicare and Medicaid Services, Home and Community-Based Services 1915(c), available at
https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-
community-based-services-1915c/index.html (last visited March 21, 2023).
4
Id.; Rule 59G-13.080(1), F.A.C.
5
See s. 393.062, F.S.
6
The APD, Regional Offices, available at https://apd.myflorida.com/region/ (last visited March 21, 2023).
BILL: SB 1444 Page 3
Suncoast Field and Field 8.
Southeast Broward, Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
Fields 9 and 10.
Southern Miami-Dade and Monroe
Field 11.
iBudget Florida Program
The APD administers Florida’s individual budget-based HCBS Waiver, known as iBudget
Florida, for individuals with specified developmental disabilities who meet Medicaid eligibility
requirements. These individuals may choose to receive services in the community through
iBudget Florida. Alternatively, they may choose to live in an institutional setting known as an
Intermediate Care Facility for the Developmentally Disabled (ICF/DD)7 through traditional
Medicaid administered by the Agency for Health Care Administration (AHCA).8
7
Section 393.063(25), F.S., defines “intermediate care facility for the developmentally disabled” to mean a residential facility
licensed and certified under part VIII of chapter 400, F.S.
8
Section 393.0662, F.S.
BILL: SB 1444 Page 4
The APD initiated implementation of iBudget Florida on May 1, 2011 with the final areas
transitioned from the previous tiered waiver system on July 1, 2013.9 The iBudget Florida
program uses an algorithm, or formula, to set individuals’ funding allocations for waiver
services.10 The APD administers iBudget Florida pursuant to s. 393.0662, F.S.
The APD serves just over 34,900 individuals through iBudget Florida, contracting with service
providers to offer 27 supports and services to assist individuals to live in their community.11
Examples of waiver services enabling children and adults to live, learn, and work in their
communities include residential habilitation, behavioral services, personal supports, adult day
training, employment services, and occupational and physical therapy.12
Licensure of Facilities by the APD
Pursuant to s. 393.067, F.S., the APD is charged with licensing community-based residential
facilities that serve and assist individuals with developmental disabilities; these include foster
care facilities, group home facilities, residential habilitation centers, and Comprehensive
Transitional Education Program (CTEPs).
The APD currently licenses over 2,100 residential facilities statewide but does not license ADT
programs.13 Through iBudget Florida, there are over 13,700 clients with ADT services on their
cost plans.14 There are also additional participants in ADT programs through Intermediate Care
Facilities for the Developmentally Disabled (ICF/DDs) and private pay arrangements.15
The APD is required to conduct annual inspections and reviews of facilities and programs
licensed under s. 393.067.16 Applications for licensure must be made to the APD on a form
furnished by it and must be accompanied by the appropriate license fee.17 All applications for
licensure must contain the following:
The name and address of the applicant, if an applicant is an individual; if the applicant is a
firm, partnership, or association, the name and address of each member thereof; if the
applicant is a corporation, its name and address and the name and address of each director
and each officer thereof; and the name by which the facility or program is to be known;
The location of the facility or program for which a license is sought;
The name of the person or persons under whose management or supervision the facility or
program will be conducted;
The number and type of residents or clients for which maintenance, care, education, or
treatment is to be provided by the facility or program;
9
The APD, Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs: First
Quarter Fiscal Year 2022-23, p. 2, November 15, 2022 (on file with the Senate Committee on Children, Families, and Elder
Affairs) (hereinafter cited as “The Quarterly Report”).
10
Id.
11
Id.
12
Id.
13
The APD, Agency Analysis of SB 1444 at p. 2. (On file with the Senate Committee on Children, Families, and Elder
Affairs).
14
Id.
15
Id.
16
Section 393.067(2), F.S.
17
Section 393.067(3), F.S.
BILL: SB 1444 Page 5
The number and location of the component centers or units which will compose the
comprehensive transitional education program;
A description of the types of services and treatment to be provided by the facility or program.
Information relating to the number, experience, and training of the employees of the facility
or program;
Certification that the staff of the facility or program will receive training to detect, report, and
prevent sexual abuse, abuse, neglect, exploitation, and abandonment, as defined in ss. 39.01
and 415.102, F.S., of residents and clients; and
Such other information as the APD determines is necessary to carry out the provisions of ch.
393, F.S.18
As a prerequisite for issuance of an initial or renewal license, the applicant, and any manager,
supervisor, and staff member of a direct service provider of a licensed facility or program, must
have submitted to Level 2 background screening as required under s. 393.0655, F.S., and a
license may not be issued or renewed if the applicant or any manager, supervisor, or staff
member of the direct service provider has failed background screenings.19 The APD is required
to determine by rule the frequency of background screening.20 Applicants must submit with each
initial or renewal application a signed affidavit under penalty of perjury stating that the applicant
and any manager, supervisor, or staff member of the direct service provider is in compliance
with all requirements for background screening.21
Applicants are required to furnish satisfactory proof of the financial ability to operate and
conduct a facility or program in accordance with the requirements of ch. 393, F.S., and agency
rules.22 APD rules23 must establish minimum standards for licensed facilities and programs
including rules requiring facilities and programs to train staff to detect, report, and prevent sexual
abuse, abuse, neglect, exploitation, and abandonment, as defined in ss. 39.01 and 415.102, F.S.,
respectively, of residents and clients, minimum standards of quality and adequacy of client care,
incident reporting requirements, and uniform fire safety standards established by the State Fire
Marshal which are appropriate to the size of the facility or of the component centers or units of
the program.24
After consultation with the Division of Emergency Management (DEM), the APD is also
required to adopt rules for foster care facilities, group home facilities, and residential habilitation
centers which establish minimum standards for the preparation and annual update of a
comprehensive emergency management plan.25 At a minimum, the rules must provide for plan
components that address:
Emergency evacuation transportation;
Adequate sheltering arrangements;
Post-disaster activities, including emergency power, food, and water;
18
Section 393.067(4), F.S.
19
Section 393.067(5), F.S.
20
Id.
21
Id.
22
Section 393.067(6), F.S.
23
Rules governing health and safety requirements for APD-licensed facilities can be found in Rule 65G-2, F.A.C.
24
Section 393.067(7), F.S.
25
Section 393.067(8), F.S.
BILL: SB 1444 Page 6
Post-disaster transportation;
Supplies;
Staffing;
Emergency equipment;
Individual identification of residents and transfer of records; and
Responding to family inquiries.26
The comprehensive emergency management plan for all CTEPs and for homes serving
individuals who have complex medical conditions is subject to review and approval by the local
emergency management agency.27 During its review, the local emergency management agency
shall ensure that the agency and the DEM, at a minimum, are given the opportunity to review the
plan.28 Appropriate volunteer organizations must be given the opportunity to review the plan.29
The local emergency management agency shall complete its review within 60 days and either
approve the plan or advise the facility of necessary revisions.30
The APD may also conduct unannounced inspections to determine compliance by foster care
facilities, group home facilities, residential habilitation centers, and CTEPs with the applicable
provisions of ch. 393, F.S., and the associated rules, including the rules adopted for training staff
of a facility or a program to detect, report, and prevent sexual abuse, abuse, neglect, exploitation,
and abandonment, as defined in ss. 39.01 and 415.102, of residents and clients.31 The facility or
program must make copies of inspection reports available to the public upon request.32 All
facilities and programs licensed by the APD must also adhere to all provisions of the Bill of
Rights of Persons with Disabilities, delineated in ch. 393.13, F.S.33
Adult Day Training Programs
Section 393.063, F.S. defines “adult day training” (ADT) to mean training services that take
place in a nonresidential setting, separate from the home or facility in which the client resides,
and are intended to support the participation of clients in daily, meaningful, and valued routines
of the community. ADT may be provided in work-like settings that do not meet the definition of
supported employment.34
ADT services are training services intended to support the participation of recipients in valued
routines of the community, including volunteering, job exploration, accessing community
resources, and self-advocacy, in settings that are age and culturally appropriate.35 Adult day
26
Id.
27
Id.
28
Id.
29
Id.
30
Id.
31
Section 393.067(9), F.S.
32
Id.
33
Section 393.067(13), F.S.
34
“Supported employment” is defined as “employment located or provided in an integrated work setting, with earnings paid
on a commensurate wage basis, and for which continued support is needed for job maintenance.” Section 393.063(43), F.S.
35
The Agency for Health Care Administration (the AHCA), Developmental Disabilities Individual Budgeting Waiver
Services Coverage and Limitations Handbook at p. 2-20. September 2021, available at
BILL: SB 1444 Page 7
training services can include meaningful day activities and training in the activities of daily
living, adaptive skills, social skills, and employment.36 The training, activities, and routine
established by the ADT must be meaningful to the recipient and provide an appropriate level of
varia