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 Fiscal Policy
BILL: CS/CS/SB 1594
INTRODUCER: Fiscal Policy Committee; Committee on Health Policy; Senator Brodeur and others
SUBJECT: Agency for Persons with Disabilities
DATE: April 26, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Favorable
2. Brown Brown HP Fav/CS
3. Delia Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 1594 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. The bill also modifies the eligibility criteria for, and operation of, Florida’s Home and
Community-Based Services (HCBS) Medicaid Waiver administered by the APD.
Specifically, the bill:
 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;
 Requires the 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;
BILL: CS/CS/SB 1594 Page 2
 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;
 Clarifies language that, beginning October 1, 2024, the APD must not authorize funds or
services to an unlicensed facility or ADT program that requires a license;
 Clarifies the timeframes within which the APD must process applications for the HCBS
Waiver;
 Identifies timeframes for processing an application for crisis waiver enrollment from an
applicant who is not currently an APD client;
 Clarifies that eligibility for admissions to Intermediate Care Facilities for the
Developmentally Disabled (ICF/DDs) are to be completed by the APD; and
 Clarifies that the level of care criteria for eligibility for the HCBS Waiver program is the
same as that required by federal law.
Additionally, the bill requires the APD to convene an interagency workgroup to create a
continuum of guidance and information for individuals with developmental disabilities and their
families, including guidance and information across the lifespan of such individuals related to
their education, workforce skills, daily living skills, and supportive services for greater
independence.
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.
The bill provides an effective date of July 1, 2023.
II. Present Situation:
Agency for Persons with Disabilities
The Agency for Persons with Disabilities (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
1
See Section 20.197(3), F.S.
2
Rule 59G-13.080(1), F.A.C.
3
The Centers for Medicare & 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.
BILL: CS/CS/SB 1594 Page 3
developmental disabilities achieve their greatest potential for independent and productive living
in the least restrictive means.5
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
Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson,
Northwest
Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, and
Washington
Fields 1 and 2.
Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler,
Northeast
Gilchrist, Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St.
Johns, Suwannee, Taylor, Union, and Volusia
Fields 3, 4, and 12.
Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange,
Central
Osceola, Polk, Seminole, and Sumter
Fields 7, 13, and 14.
Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee,
Suncoast
Pasco, Pinellas, and Sarasota
Suncoast Field and Field 8.
Broward, Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
Southeast
Fields 9 and 10.
Miami-Dade and Monroe
Southern
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
5
See s. 393.062, F.S.
6
Agency for Persons with Disabilities, Regional Offices, available at https://apd.myflorida.com/region/ (last visited March
21, 2023).
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 ch. 400, F.S.
8
Section 393.0662, F.S.
BILL: CS/CS/SB 1594 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
Eligibility for iBudget Services
The application process for individuals wishing to receive services through the iBudget program
are detailed in s. 393.065, F.S. The APD must review applications for eligibility within 45 days
for children under 6 years of age and within 60 days for all other applicants.13 Individuals who
are determined to be eligible for the Waiver program are either given a slot in the program or
placed on a wait list. Currently, due to demand exceeding available funding, individuals with
developmental disabilities who wish to receive HCBS services from the APD are placed on a
wait list for services in priority categories of need, unless they are in crisis.14 As of March 1,
2023 there are approximately 22,225 individuals on the HCBS Waiver wait list.15
The needs of APD clients are classified into seven categories16 and are prioritized in the
following decreasing order of priority:
 Category 1 – Clients deemed to be in crisis.
 Category 2 – Specified children from the child welfare system.17
 Category 3 – Includes, but is not limited to, clients:
o Whose caregiver has a documented condition that is expected to render the caregiver
unable to provide care within the next 12 months and for whom a caregiver is required
but no alternate caregiver is available;
o Who are at substantial risk of incarceration or court commitment without supports;
o Whose documented behaviors or physical needs place them or their caregiver at risk of
serious harm and other supports are not currently available to alleviate the situation; or
o Who are identified as ready for discharge within the next year from a state mental health
hospital or skilled nursing facility and who require a caregiver but for whom no caregiver
is available.
9
Agency for Persons with Disabilities, 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
Section 393.065(1), F.S.
14
Section 393.065, F.S.; See Rule 65G-1.047, F.A.C., for crisis status criteria.
15
E-mail from JP Bell, APD Legislative Affairs Director, March 16, 2023 (on file with the Senate Committee on Children,
Families, and Elder Affairs) (hereinafter cited as, “The APD March 16 E-mail”).
16
Section 393.065(5), F.S.
17
See s. 393.065(5)(b), F.S., for specific criteria.
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 Category 4 – Includes, but is not limited to, clients whose caregivers are 70 years of age or
older and for whom a caregiver is required but no alternate caregiver is available.
 Category 5 – Includes, but is not limited to, clients who are expected to graduate within the
next 12 months from secondary school and need support to obtain or maintain competitive
employment, or to pursue an accredited program of postsecondary education to which they
have been accepted.
 Category 6 – Clients 21 years of age or older who do not meet the criteria for categories 1-5.
 Category 7 – Clients younger than 21 years of age who do not meet the criteria for categories
1-4.18
Because the APD receives extensive documentation to verify identity, domicile, and
documentation of clinical eligibility, most applications are incomplete upon receipt and require
additional time to process.19 The APD also provides for a comprehensive assessment when
needed to confirm eligibility for an applicant.20
Section 393.066, F.S., requires the APD to plan, develop, organize, and implement its programs
of services and treatment for persons with developmental disabilities to allow clients to live as
independently as possible in their own homes or communities and to achieve productive lives as
close to normal as possible.21 All elements of community-based services must be made available,
and eligibility for these services must be consistent across the state.22
Necessary services for clients must be purchased, rather than provided directly by the APD,
when the purchase of services is more cost-efficient than providing such services directly.
However, all purchased services must be approved by the APD. 23
Although s. 393.066, F.S., indicates that the APD provides community services and treatment to
clients, there is a conflict with s. 393.065, F.S., which indicates that to provide immediate
services or crisis intervention to applicants, the APD must arrange for emergency eligibility
determination, with a full eligibility review to be accomplished within 45 days of the emergency
eligibility determination.24 Crisis intervention services to address immediate emergencies are
available through other programs outside of the APD, including child and adult protective
services through the Department of Children and Families (the DCF).25
Due to funding constraints, eligible individuals seeking HCBS waiver services are enrolled on
the waiting list in the priority order defined in 393.065, F.S. As of March 1, 2023, there were
8,974 individuals under the age of 21 in Category 7 of the waiting list.26 However, many of these
individuals are eligible for full Medicaid benefits and are not waiting for services due to
18
Section 393.065(5), F.S.
19
Agency for Persons with Disabilities, Agency Analysis of SB 1594, p. 2 (on file with the Senate Committee on Children,
Families, and Elder Affairs) (hereinafter cited as, “The APD SB 1594 Analysis”).
20
Id.
21
Section 393.066(1), F.S.
22
Id.
23
Section 393.066(2), F.S.
24
The APD SB 1594 Analysis at p. 2.
25
Id.
26
The APD March 16 E-mail.
BILL: CS/CS/SB 1594 Page 6
coverage through the Medicaid program under the Early and Periodic, Screening, Diagnosis, and
Treatment (EPSDT) requirements. As required by federal law, Florida Medicaid provides
services to eligible recipients under the age of 21 years, if such services are medically necessary
to correct or ameliorate a defect, a condition, or a physical or mental illness.27 The EPSDT
provides a comprehensive array of prevention, diagnostic, and treatment services for Medicaid
recipients who are the age of 21 years, as specified in Section 1905(a)(4)(B) of the Social
Security Act (the Act) and defined in 42 U.S.C. § 1396d(r)(5) and 42 CFR 441.50.28
Intermediate Care Facilities for the Developmentally Disabled
In addition to meeting eligibility criteria identified in s. 393.063, F.S., clients who are seeking to
enroll on the HCBS Waiver must meet the level of care for services in an ICF for placement on the
waiting list.29 An intermediate care facility for the developmentally disabled (ICF/DD) provides
health and rehabilitative services to individuals with developmental disabilities in a protected
residential setting.30 ICF/DDs are licensed and regulated by the Agency for Health Care
Administration (AHCA) under Part VIII of ch. 400, F.S., and ch. 59A-26, F.A.C. ICF/DDs
provide the following services:
 Nursing services;
 Activity services;
 Dental services;
 Dietary services (including therapeutic diet);
 Pharmacy services;
 Physician services;
 Rehabilitative care services;
 Room/bed and maintenance services; and
 S