Week 6 – February 19, 2016
HOUSE AND SENATE CONSIDER A FLURRY OF BILLS; BUDGET CONFERENCE DELAYED
With 3 weeks left until the end of session, House and Senate leadership announced that budget conference negotiations will not commence until this coming week as allocations (spending amounts) for the various budget committees cannot be made until big ticket items such as the Governor’s tax reduction and economic incentives package, and Seminole Gaming Compact are settled. However, both chambers operated at full speed, moving forward several bills of interest to child advocates.
Among the flurry of activities this week were the much anticipated Senate confirmation actions of several agency heads, the most notable being, that of the Department of Health (DOH) Surgeon General, Dr. John Armstrong. On February 16, the Senate Health Policy Committee held a confirmation hearing for Dr. John Armstrong during which Dr. Armstrong received several questions about reductions in staff, reduced usage of county health clinics, and the Early Steps and Children’s Medical Services (CMS) programs. (See details under Topics of Interest). Department of Children and Families and Department of Juvenile Justice Secretaries Mike Carroll and Christina Daly were confirmed by the Senate on February 18.
EARLY LEARNING AND SCHOOL READINESS
Early Learning – Child Care Development Block Grant
HB 7053, a bill to bring Florida into statutory compliance with new federal requirements for the School Readiness program is awaiting action in the Senate. The bill provides for the drawdown of federal block grant funding for subsidized child care, and directs the Office of Early Learning to develop (through rule making) quality standards for publicly-funded child care, including appropriate group size requirements. The Senate companion, SB 7058 by Education Pre-K-12 was passed unanimously by the Senate Appropriations Committee on February 18, and has been placed on the Special Order Calendar for full Senate consideration on February 23. SB 7058 was amended in the Appropriations Committee to add the language of SB 7034, the Early Steps bill.
A similar bill, SB 1166 relating to education funding by Sen. Don Gaetz (R-Destin) is awaiting action in the Appropriations Committee. The bill includes language relating to background screening and criminal background checks of child care personnel. SB 2502, the Implementing Bill for the 2016-2017 General Appropriations Act also includes language on child care block grant reauthorization which was substituted for HB 5003, Implementing the 2016-2017 Appropriations Act.
The rate of 3rd grade students performing below grade level in reading has consistently exceeded 40 percent over the past several years. SB 1068 attempts to address this situation by expanding public school reading requirements relating to interventions and instructional supports, teacher certification and training, and school improvement and accountability. The bill is scheduled to be heard in the Senate Appropriations Subcommittee on Education on February 24.
The House companion, CS/CS/HB 7021 by Rep. Janet Adkins (R-Fernandina Beach) is awaiting full House consideration.
HEALTH AND WELLNESS
Florida KidCare Program
HB 89 by Rep. Jose Diaz (R-Miami) that would allow children of lawfully residing immigrants, who have been living in the United States less than five years to be insured under the Florida KidCare program is awaiting full House action in week 8. HB 89 extends Children’s Health Insurance Program (CHIP) and Medicaid eligibility to a “lawfully residing child” who meets other eligibility qualifications of the program. The bill specifies that the statutory changes do not extend KidCare eligibility to undocumented immigrants. The Senate companion, SB 248 by Sen. Rene Garcia (R-Miami) is awaiting a hearing in the full Senate Appropriations Committee (the last stop before heading to the Senate floor). However, SB 2508, the Health Care Services budget conforming bill includes similar language which was substituted for HB 5101 – the Medicaid bill, and will be negotiated in budget conference.
Early Steps Program
SB 7034 by Children, Families, and Elder Affairs was temporarily postponed and retained on the Senate Special Order Calendar, thereby still awaiting floor action. However, the language in SB 7034 was amended onto SB 7058 on February 18 in the Appropriations Committee and that bill is scheduled to be considered by the full Senate on February 23. The bill renames the “Infants and Toddlers Early Intervention Program” as the “Early Steps Program,” sets accountability standards, and revises requirements for the Department of Health (DOH) to maintain a clearinghouse of information for parents and health care providers on developmental evaluation and early intervention programs. The bill also requires the development of an individual family support plan for each child served in the program, and expands eligibility to serve additional children. The House companion, HB 943 by Rep. Julio Gonzalez (R-Venice) is still awaiting action in the Health Care Appropriations Subcommittee which is not scheduled to meet again. However, efforts are being taken to amend the language onto HB 941.
Children’s Medical Services
SB 1240 by Sen. Eleanor Sobel (D-Hollywood) relating to Children’s Medical Services (CMS) eligibility and enrollment, is awaiting action in the Appropriations Subcommittee on Health and Human Services. The bill requires the Department of Health to use an appropriate assessment instrument to determine clinical eligibility for the CMS program. It also requires the department to provide notice to a parent or guardian of a child who has been determined clinically ineligible for the Children’s Medical Services program, of the parent’s or guardian’s appeal rights under ch. 120, F.S. The House companion, HB 1117 by Rep. Mia Jones (D-Jacksonville) is awaiting action in the Health Quality Subcommittee, and will likely not be heard this session.
SB 7087 by the Select Committee on Affordable Healthcare Access and Rep. Chris Sprowls (R-Clearwater) that provides practice standards and registration requirements to provide telehealth services in Florida passed the Health and Human Services Committee on February 17. A similar bill, CS/SB 1686 by Sen. Aaron Bean (R-Jacksonville) is awaiting action in Appropriations.
Prepaid Dental Plans
SB 994 by Sen. Joe Negron (R-Palm City) was passed unanimously by the Appropriations Committee on February 18. The bill removes dental services from the list of minimum benefits that Managed Medical Assistance (MMA) plans must provide, effective March 1, 2019. Instead, effective July 1, 2017, AHCA must implement a statewide Prepaid Dental Health Plan (PDHP) program for children and adults, and begin enrollment by March 1, 2019. AHCA must contract with at least two licensed dental managed care providers through a competitive procurement process to provide dental benefits. AHCA is authorized to seek any necessary state plan amendment or federal waivers to implement the statewide PDHP program. The bill requires AHCA to prepare a comprehensive report on dental services which must examine the effectiveness of the managed care plans in providing dental care, improving access to dental care and dental health, and achieving satisfactory outcomes for recipients and providers. The bill authorizes the Legislature to use the findings of the report to establish the scope of minimum benefits under the MMA program for future procurements of eligible plans; specifically, the Legislature may use the findings of the report to determine whether dental benefits should be benefits under the MMA program or be provided separately.
The House companion, HB 819 by Rep. Jose Felix Diaz (R-Miami) has been placed on the Special Order Calendar for House consideration on February 23.
Mental Health and Substance Abuse
PCS/SB 12 by Sen. Rene Garcia (R-Hialeah) addresses Florida’s system for the delivery of behavioral health services. The bill provides for mental health services for children, parents, and others seeking custody of children involved in dependency court proceedings. The bill creates a coordinated system of care to be provided either by a community or a region for those suffering from mental illness or substance use disorder through a “No Wrong Door” system of single access points. The Agency for Health Care Administration (AHCA) and the Department of Children and Families (DCF) are directed to modify licensure requirements to create an option for a single, consolidated license to provide both mental health and substance use disorder services.
Although, although there is no additional state funding provided, the AHCA and the DCF are directed to develop a plan to increase federal funding for behavioral health care. To the extent possible, the bill aligns the legal processes, timelines, and processes for assessment, evaluation, and receipt of available services of the Baker Act (mental illness) and Marchman Act (substance abuse) to assist individuals in recovery, and reduce readmission to the system. The duties and responsibilities of the DCF are also revised to set performance measures and standards for managing entities and to allow the agency to enter into contracts with managing entities that support efficient and effective administration of the behavioral health system, as well as to ensure accountability for performance.
CS/HB 7097 by the House Children and Families Subcommittee and Representatives Harrell, Peters and Pilon was voted favorably in the Health and Human Services Committee on February 17. A similar bill, SB 1336 by Sen. Jack Latvala (R-Clearwater) is awaiting action in the Appropriations Committee.
Dental Program for Medicaid Eligible Children
SB 580 by Sen. Denise Grimsley (R-Sebring) relating to reimbursement for Dental Hygiene Services for Children, was voted favorably in the Appropriations Committee on February 18. The bill has been placed on the Special Order Calendar for Senate consideration on February 24. CS/SB 580 authorizes the Agency for Health Care Administration (AHCA) to reimburse a health access setting under the Medicaid program for remedial dental services (remedial tasks) delivered by a dental hygienist when provided to a Medicaid recipient younger than 21 years of age. Remedial tasks are defined as intra-oral tasks that do not create unalterable changes in the mouth or contiguous structures, are reversible, and do not expose the patient to increased risks.
The House companion, CS/HB 595, by Rep. Rene Plasencia (R-Orlando) is awaiting action by the full House.
Direct Primary Care
CS/CS/SB 132 by Sen. Denise Grimsley (R-Sebring) that creates a new section of Florida Statutes related to the application of the Florida Insurance Code for direct primary care agreements passed the Fiscal Policy Committee on February 17. The bill provides that a direct primary care agreement is not insurance and is not subject to the Florida Insurance Code. The bill defines the terms, “direct primary care agreement,” “primary care provider,” and “primary care service,” and specifies certain provisions that must be included in a direct primary care agreement.
The House companion, CS/CS/HB 37 by Rep. Fred Costello (R-Port Orange) is awaiting House consideration.
CS/CS/HB 139 by Rep. W. Travis Cummings (R-Orange Park) requires the Department of Health (DOH) to develop and implement a dental care access account initiative to benefit dentists employed by a public health program or committed to opening a private practice capable of serving at least 1,200 patients in a dental health professional shortage area or medically underserved area. The bill passed the Health and Human Services Committee on February 17. The bill requires DOH to implement an electronic benefits transfer system enabling selected dentists to spend awarded funds on:
The Senate companion, SB 234 by Sen. Don Gaetz (R-Destin) is awaiting action in Appropriations.
Public School Recess
HB 33 by Rep. Rene Plasencia (R-Orlando) requires each district school board to provide 100 minutes of supervised, safe, and unstructured free-play recess each week for students in kindergarten through grade 5, and students in grade 6 who are enrolled in a school that contains one or more elementary grades. The recess must be provided for at least 20 consecutive minutes each day and may not be withheld for academic or punitive reasons.
The bill passed the House on February 18 on a vote of 112:2, and now heads to the Senate. The Senate companion, SB 1002 by Sen. Alan Hays (R-Umatilla) is still awaiting action in the Education Pre-K-12 Committee (it’s first committee of reference).
Healthy Food Financing – Food Deserts
CS/SB 760, by Sen. Aaron Bean (R-Jacksonville) is awaiting action in the Appropriations Committee. The bill directs the Department of Agriculture and Consumer Services (DACS) to establish a program to provide financing to retailers to construct, rehabilitate, or expand grocery stores in underserved communities in low- and moderate-income areas.
The House companion CS/HB 153 by Rep. David Santiago (R-Deltona) was voted favorably by the State Affairs Committee on February 18.
Child Welfare System
SB 7018 by Sen. Nancy Detert (R-Venice) is awaiting action in its last stop before floor action, the Senate Appropriations Committee. The bill requires DCF, in collaboration with certain stakeholders, to develop a continuum of care for children in the child welfare system. This continuum of care must be a complete range of placement options, programs, and services for children served by, or at risk of being served by, the dependency system. The continuum of care requires a quality rating system for residential group care, as well as an annual report.
The bill creates a new section of law that requires an initial assessment whenever a child has been determined to need an out-of-home placement to aid in guiding the child into the least restrictive placement and help determine any services needed. The bill also requires an in-depth assessment to be completed for each child placed in out-of-home care, to supplement the initial assessment and further determine service and placement needs.
The bill creates permanency teams that are required to review out-of-home placements for certain children who have historically faced barriers to permanency. The bill also outlines the intervention services to be provided by lead agencies.
The House companion HB 599 by Rep. Neil Combee (R-Auburndale) and Rep. Gayle Harrell (R-Stuart) passed favorably in the Health Care Appropriations Subcommittee on February 8, and now heads to the Health and Human Services Committee.
Child Protection Teams (CATs)
SB 670, by Sen. Don Gaetz (R-Destin) is scheduled in the Senate Judiciary Committee on February 16. The bill applies immunity from personal liability in certain actions to any member of a child protection (CPT) team, in certain circumstances. The bill passed the House Civil Justice Subcommittee on January 13. As a result, CPT members may not be held personally liable for torts committed in such capacity; instead the state may be held liable up to the limits established under the state’s statutory waiver of sovereign immunity. A child protection team (CPT) is a medically directed, multidisciplinary team of professionals contracted by the Children’s Medical Services (CMS) Program in the Department of Health (DOH). CPTs supplement the child protective investigation activities of local sheriffs’ offices and the Department of Children and Families (DCF) in cases of child abuse, abandonment, and neglect. CPTs provide expertise in evaluating alleged child abuse and neglect, assessing risk and protective factors, and providing recommendations for interventions to protect children and to enhance a caregiver’s capacity to provide a safer environment when possible. HB 715 by Rep. Gayle Harrell is awaiting action in the House Appropriations Committee.
Civil Citations and Diversion Programs
HB 7085 by the House Criminal Justice Subcommittee and Rep. Carlos Trujillo (R-Doral) relating to juvenile civil citation and similar diversion programs is awaiting action in the Judiciary Committee which is not scheduled to meet again for this session. The bill requires the establishment of civil citation or similar diversion programs for juveniles; provides definitions; and, specifies program eligibility, participation, and implementation requirements. A similar bill, SB 408 by Sen. Thad Altman (R-Cape Canaveral) was passed by the Criminal Justice Committee on February 16 on a vote of 3:2. The bill is scheduled to be heard in Children, Families, and Elder Affairs on February 24.
Confidentiality of Juvenile Records
SB 700 by Sen. Darren Soto (D-Kissimmee) that specifies that certain confidential information obtained under chapter 985, F.S., relating to juvenile justice, is exempt from public records requirements was voted favorably in the Fiscal Policy Committee on February 17. The House companion, HB 293 by Rep. Sharon Pritchett (D-Miramar) has been placed on the Special Order Calendar for full House consideration on February 23.
OTHER BILLS AFFECTING CHILDREN
CS/SB 784 by Senator Anitere Flores (R-Miami) was voted favorably in the Fiscal Policy Committee on February 17. It has been placed on the Special Order Calendar for full Senate consideration on February 23. The bill addresses human trafficking and offenses that are often associated with human trafficking by:
The House companion, CS/CS/HB 545 by Rep. Ross Spano (R-Riverview) was voted favorably in the Judiciary Committee on January 21. It has been added to the Special Order Calendar for House consideration on February 23.
Temporary Cash Assistance Program
HB 563 by Rep. Matt Gaetz (R-Shalimar) adds proof of application for employment to eligibility requirements for receiving temporary cash assistance; decreases the lifetime cumulative total time limit for receiving temporary cash assistance; and, adds proof of application for employment to work activity requirements for participation in the temporary cash assistance program. The bill is awaiting full House consideration. The Senate companion, SB 750 by Sen. Travis Hutson (R-Palm Coast) was passed by the Children, Families, and Elder Affairs Committee on January 18. It is scheduled to be heard in the Appropriations Subcommittee on Health and Human Services on February 24.
Ad Valorem Taxation
CS/SB 766 by Sen. Anitere Flores (R-Miami) which makes several changes related to the Value Adjustment Board (VAB) process passed the Finance and Tax Committee on February 16, and now heads to Appropriations. The bill:
The bill also makes permanent the ability of a school district to levy 75 percent of a school district’s most recent prior period funding adjustment millage in the event that the final tax roll is delayed for longer than one year.
The House companion, CS/CS/HB 499 by Rep. Bryan Avila (R-Hialeah) was voted favorably in the Appropriations Committee on February 16.
OTHER TOPICS OF INTEREST
Senate Confirmation Hearings
During the Senate Health Policy confirmation hearing of Dr. John Armstrong, Dr. Armstrong gave remarks on the recent reduction in infant mortality in Florida, and his priorities to address health inequities through the launching of the Florida’s Healthy Babies initiative as well as activities to address the HIV/AIDS epidemic in Florida. He mentioned briefly that this year has been a transitional year for the medically fragile program for children which led to a revised eligibility screening tool for the program (6,000 children screened of which 85% were determined eligible for the program). Chairman Aaron Bean (R-Jacksonville) inquired about the DOH initiatives to address the Zika Virus (there are 21 confirmed cases in Florida) that adversely affect pregnant women. According to Dr. Armstrong, there are 29 counties in Florida designated as highly prone counties for the Zika Virus. The DOH has activated staff to address the virus, continues to focus on public awareness and education, established a Hotline, and has acquired test kits for the virus (Florida has sufficient supplies of the kits). Dr. Armstrong has been invited to participate this coming week in a Congressional Hearing in Washington, DC on Florida’s initiatives regarding the Zika Virus epidemic.
When asked about the core mission of DOH, Dr. Armstrong commented that it included broader outreach with the Legislature, media, and communities; continuation of the Healthiest Choice Program (seat belt safety, helmet use, etc.); and improved communication with Florida’s diverse ethnic communities. Sen. Eleanor Sobel (D-Hollywood), Vice-Chair, inquired about the workforce reduction in the agency. Dr. Armstrong commented that the positions eliminated were those authorized but not funded (referred to as ‘phantom positions’) and there is a pool of 1,000 vacant positions if needed by the County Health Departments. Sen. Don Gaetz (R-Destin) asked what happens to people accessing services from county health departments now that they are seeing 200,000 fewer patients and providing 800,000 fewer individual services than they did when Armstrong became surgeon general in 2012. Dr. Armstrong responded that the result of the Affordable Care Act, Florida Medicaid Managed Care programs, and the state’s 51 federally qualified health centers have contributed to the changing dynamics in health care access and delivery. Sen. Gaetz also asked if Dr. Armstrong will advise the Governor not to veto funding (which the Governor did in 2015) for the state’s 125 free and charitable clinics serving low income people. He expressed strong support for the budget issue and for the clinics. Sen. Anitere Flores (R-Miami) asked for information about Qualified Health Centers and clarification on the additional DOH staffing in Communication’s. Dr. Armstrong noted that DOH has tripled their communication’s staff from 8 to 24 to address the many public health challenges in Florida. Sen. Garcia (R-Hialeah) asked about Early Steps and the screening process and Children’s Medical Services. Dr. Armstrong commented that DOH continues to screen children and is moving forward. Concerning CMS, DOH has an integrated health systems (PDCARE and S. FL Community Care Network) and Parent Hotline which are in place to address the needs of medically fragile children. When asked whether DOH is contacting families regarding the new eligibility/screening tool for children, Dr. Armstrong commented that DOH is monitoring this closely, planning a workshop in April to redouble efforts. Sen. Arthenia Joyner (D-Tampa) asked about the pediatric cardiac advisory panel and plans to re-establish the panel in statute. Dr. Armstrong responded that he met the letter of the law and has delegated the responsibilities of the panel to a ‘technical advisory panel.’ Eighteen public appearance cards were submitted for public testimony on his confirmation. Due to time constraints, however, no public input was taken but the names of those in support were read into the record. Sen. Denise Grimsley (R-Sebring) moved his nomination, seconded by Sen. Bill Galvano (R-Bradenton). The vote was 5 yeas, 4 nays. The nomination now moves to the Senate Ethnics and Elections’ Committee which is scheduled to meet on February 23.
Poverty in Florida
Another noteworthy activity this past week was the presentation by Amy Baker, Chief Economist, Florida Office of Economic and Demographic Research before the Senate Committee on Children, Families, and Elder Affairs on Florida’s Families and Children Below the Federal Poverty Level (see Poverty in Florida, pp. 44-68). Ms. Baker provided an overview of the Official Federal Poverty Threshold, Statistics, and how cash income is measured. The following are some startling statistics between 2010-2014:
Ms. Baker’s presentation also included supplemental information on poverty and low-income programs that are federally funded, federally funded with a required level of state support, or funded by shared federal/state funds. The programs addressed specific needs including: healthcare, housing, food, tax breaks and cash assistance to alleviate the conditions of poverty, at-risk and prevention programs, and poverty avoidance.