Florida Senate - 2009                        COMMITTEE AMENDMENT
       Bill No. SB 2018
       
       
       
       
       
       
                                Barcode 154306                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: FAV            .                                
                  04/06/2009           .                                
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       The Committee on Children, Families, and Elder Affairs (Wise)
       recommended the following:
       
    1         Senate Substitute for Amendment (107744) (with title
    2  amendment)
    3  
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1.  Section 394.4656, Florida Statutes, is created
    7  to read:
    8         394.4656Community Mental Health and Substance Abuse
    9  Treatment and Crime Reduction Act.—
   10         (1)LEGISLATIVE FINDINGS AND INTENT.—The Legislature finds
   11  that many jail inmates who have serious mental illnesses and who
   12  are committed to state forensic mental health treatment
   13  facilities for competency restoration could be served more
   14  effectively and at less cost in community-based alternative
   15  programs. The Legislature further finds that many people who
   16  have serious mental illnesses and who have been discharged from
   17  state forensic mental health treatment facilities could avoid
   18  recidivism to the criminal justice and forensic mental health
   19  systems if they received specialized treatment in the community.
   20  Therefore, it is the intent of the Legislature to create the
   21  Community Mental Health and Substance Abuse Treatment and Crime
   22  Reduction Act to serve individuals who have mental illnesses or
   23  co-occurring mental illnesses and substance abuse disorders and
   24  who are involved in or at risk of entering state forensic mental
   25  health treatment facilities, prisons, jails, juvenile justice
   26  centers, or state civil mental health treatment facilities.
   27         (2)GOALS.—The goals of the community mental health and
   28  substance abuse forensic treatment system are to:
   29         (a)Ensure public safety.
   30         (b)Ensure that services to restore forensic competency are
   31  provided in the least restrictive, least costly, and most
   32  effective environment.
   33         (c)Provide competency-restoration services in the
   34  community if appropriate, based on consideration of public
   35  safety, needs of the individual, and available resources.
   36         (d)Reduce admissions for competency restoration to state
   37  forensic mental health treatment facilities.
   38         (e)Reduce rates of arrest, incarceration, and
   39  reincarceration.
   40         (f)Increase outreach and services to individuals at risk
   41  for involvement in the criminal justice, juvenile justice, or
   42  forensic mental health systems.
   43         (g)Support collaboration among state and local
   44  stakeholders, including law enforcement agencies, courts, state
   45  agencies, jails, county government, service providers,
   46  individuals with mental illnesses or co-occurring mental
   47  illnesses and substance abuse disorders, family members,
   48  advocates, and other community members.
   49         (3)DEFINITIONS.—As used in this section, the term:
   50         (a)“Best practices” means treatment services that
   51  incorporate the most effective and acceptable interventions
   52  available in the care and treatment of individuals who are
   53  diagnosed as having a mental illness or a co-occurring mental
   54  illness and substance abuse disorder.
   55         (b)“Community forensic system” means the community mental
   56  health and substance abuse forensic treatment system, including
   57  the comprehensive set of services and supports provided to
   58  individuals involved in or at risk of becoming involved in the
   59  criminal justice system.
   60         (c)“Community residential facility” means a community
   61  based residential treatment setting licensed by the agency under
   62  s. 394.875 or s. 429.075, or by the department under s. 397.401.
   63         (d)“Evidence-based practices” means interventions and
   64  strategies that, based on the best available empirical research,
   65  demonstrate effective and efficient outcomes in the care and
   66  treatment of individuals who are diagnosed as having mental
   67  illnesses or co-occurring mental illnesses and substance use
   68  disorders.
   69         (e)“Forensic intensive care management” means activities
   70  addressing the comprehensive psychiatric, social, and support
   71  needs of individuals who are diagnosed as having serious and
   72  persistent mental illnesses, co-occurring disorders, or severe
   73  emotional disturbances, and who are involved in the justice
   74  system and receiving services under this section. Activities
   75  include, but are not limited to, service planning, service
   76  coordination, monitoring, and assistance with accessing federal,
   77  state, and local benefits necessary to sustain a person in the
   78  community.
   79         (f)“Geographic area” means a county, circuit, regional, or
   80  multiregional area in this state.
   81         (4)SERVICE SYSTEM.—The department, in consultation with
   82  the agency, shall develop and implement a community mental
   83  health and substance abuse forensic treatment system. The system
   84  must build on local community diversion and reentry initiatives
   85  and strategies that are consistent with those identified and
   86  supported under s. 394.658(1), or with geographic areas that
   87  have piloted a community-based diversion program .
   88         (a)The community forensic system initiatives and
   89  strategies may include, but are not limited to:
   90         1.Mental health courts.
   91         2.Diversion programs.
   92         3.Alternative prosecution and sentencing techniques.
   93         4.Crisis intervention teams.
   94         5.Specialized training for criminal justice, juvenile
   95  justice, and treatment services professionals.
   96         6.Specialized probation officers at the state and county
   97  levels to serve individuals under correctional control in the
   98  community.
   99         7.Collateral services such as supported, transitional, and
  100  permanent housing, and supported employment.
  101         8.Reentry services to create or expand mental health and
  102  co-occurring treatment and supports for affected individuals.
  103         (b)The community forensic system must include a
  104  comprehensive continuum of care and services that use evidence
  105  based and best practices to address co-occurring mental health
  106  and substance abuse disorder, including the following minimum
  107  services and elements:
  108         1.Competency-restoration and treatment services provided
  109  in a variety of settings from least restrictive to progressively
  110  more restrictive settings.
  111         2.Forensic intensive care management.
  112         3.Supported housing.
  113         4.Supported employment.
  114         5.Medication management.
  115         6.Trauma-specific services for treatment of the effects of
  116  sexual, physical, and emotional abuse or trauma experienced by
  117  individuals who have mental illnesses and are involved in the
  118  criminal justice system.
  119         7.Residential services to address crisis episodes and
  120  short-term residential treatment.
  121         8.Treatment for co-occurring mental health and substance
  122  use disorders.
  123         9.Outreach and education for individuals and their
  124  families who are at risk of further involvement with the justice
  125  system.
  126         10.The use of involuntary outpatient placement for
  127  individuals meeting the criteria as provided under s. 394.4655
  128  and conditional release for individuals adjudicated incompetent
  129  to proceed due to mental illness or not guilty by reason of
  130  insanity as provided under s. 916.17.
  131         11.Other services or supports as identified.
  132         (5)ELIGIBILITY.—The department may serve individuals who
  133  meet the criteria in this subsection. The department must give
  134  highest priority for services under this section to:
  135         (a)Adults who are adjudicated incompetent to proceed or
  136  not guilty by reason of insanity under chapter 916 and ordered
  137  by the court into forensic commitment, whose current most
  138  serious charge is a felony of the third degree or a felony of
  139  the second degree if the felony did not involve violence, and
  140  who meet public safety criteria established by the court and
  141  treatability criteria established by the department for
  142  placement in a community setting.
  143         (b)Adults who experience serious and persistent mental
  144  illnesses reentering the community from state prisons.
  145         (c)Adults who have been committed to a state forensic
  146  mental health treatment facility after being adjudicated
  147  incompetent to proceed or not guilty by reason of insanity, and
  148  who are released or who are pending release to the community by
  149  the court after completing competency restoration services or
  150  being found to no longer meet the criteria for continued
  151  commitment placement.
  152         (d)Adults who experience serious and persistent mental
  153  illnesses, who have a history of involvement in the justice
  154  system, or who are at risk of entering or who are already
  155  involved with the criminal justice system.
  156         (e)Children deemed incompetent to proceed under s. 985.19.
  157         (6)DEPARTMENT RESPONSIBILITIES.—The department may develop
  158  a continuum of services to implement this section in accordance
  159  with subsection (4). The department may:
  160         (a)Define requirements for all providers in the community
  161  forensic system.
  162         (b)Select demonstration sites for participation, based on
  163  criteria in subsection (7), which demonstrate active and
  164  sustained participation in community collaborations.
  165         (c)Enter into memoranda of agreement with county planning
  166  councils or committees identified in s. 394.657 that
  167  participated in the criminal justice, mental health, and
  168  substance abuse reinvestment grant program pursuant to s.
  169  394.656, or that piloted a community-based diversion program.
  170         (d)Identify providers to implement the continuum of
  171  services. The department shall consult with county planning
  172  councils or committees in the selection process.
  173         (e)Establish performance measures and reporting
  174  requirements for providers participating in the community
  175  forensic system. The measures shall include, at a minimum:
  176         1.The number of individuals diverted from state forensic
  177  ment al health treatment facilities.
  178         2.The number of individuals diverted from the criminal
  179  justice system.
  180         3.The rates of arrest, incarceration, and reincarceration
  181  for new criminal offenses.
  182         4.The rates of employment.
  183         5.The annual number of days in a crisis stabilization
  184  unit, detoxification facility, short-term residential treatment
  185  program, state civil mental health treatment facility, or state
  186  forensic mental health treatment facility.
  187         (f)Monitor contracts for compliance with terms and assess
  188  performance under contracts; provide an annual report to the
  189  Governor, the President of the Senate, the Speaker of the House
  190  of Representatives, the Chief Justice of the Florida Supreme
  191  Court, and the State Courts Administrator on the implementation
  192  status of the Community Mental Health and Substance Abuse
  193  Treatment and Crime Reduction Act.
  194         (7)IMPLEMENTATION.—The department may implement this
  195  section within available resources. In expectation of statewide
  196  implementation, the department may establish demonstration sites
  197  in the following geographic areas of the state: Escambia, Leon,
  198  and Dade counties and the Tampa Bay area. Each site must be
  199  selected based on findings of communityreadiness and the
  200  potential for affecting the greatest number of individuals
  201  entering the forensic mental health and criminal justice
  202  systems. Criteria for selection may include:
  203         (a)Community readiness to deliver the services outlined in
  204  subsection (4), demonstrated by well-established community
  205  collaboration plans and local partnerships as evidenced by
  206  memoranda of agreement that are submitted to and approved by the
  207  department.
  208         (b)A high bed-utilization rate at state forensic mental
  209  health treatment facilities.
  210         (c)Successful application for implementation grant funding
  211  under the Criminal Justice, Mental Health, and Substance Abuse
  212  Reinvestment Grant Program.
  213         (d)Other elements determined by the department in
  214  consultation with the agency.
  215         Section 2. Paragraph (b) of subsection (11) of section
  216  394.655, Florida Statutes, is amended to read:
  217         394.655 The Substance Abuse and Mental Health Corporation;
  218  powers and duties; composition; evaluation and reporting
  219  requirements.—
  220         (11)
  221         (b) The purpose of the council shall be to:
  222         1. Align policy initiatives in the criminal justice,
  223  juvenile justice, and mental health, and substance abuse systems
  224  to ensure the most effective use of resources and to coordinate
  225  the development of legislative proposals and budget requests
  226  relating to the shared needs of adults and juveniles who have a
  227  mental illness, substance abuse disorder, or co-occurring mental
  228  health and substance abuse disorders who are in, or at risk of
  229  entering, the criminal justice system.
  230         2.Provide consultation in the development of comprehensive
  231  and cost-effective community-based mental health and substance
  232  abuse treatment services for individuals who have mental
  233  illnesses and who are receiving services in state forensic
  234  mental health treatment facilities, juvenile secure residential
  235  treatment centers specializing in competency training, and
  236  prisons. The council shall appoint an advisory committee to
  237  review and monitor the implementation of the Community Mental
  238  Health and Substance Abuse Treatment and Crime Reduction Act.
  239  The advisory committee shall include at least one person who has
  240  received services and one family member of a person who has
  241  received services under this section.
  242         Section 3. Subsection (1) of section 394.656, Florida
  243  Statutes, is amended to read:
  244         394.656 Criminal Justice, Mental Health, and Substance
  245  Abuse Reinvestment Grant Program.—
  246         (1) There is created within the Department of Children and
  247  Family Services the Criminal Justice, Mental Health, and
  248  Substance Abuse Reinvestment Grant Program. The purpose of the
  249  program is to provide funding to counties to with which they can
  250  plan, implement, or expand initiatives that increase public
  251  safety, avert increased spending on criminal justice, and
  252  improve the accessibility and effectiveness of treatment
  253  services for adults and juveniles who have a mental illness,
  254  substance abuse disorder, or co-occurring mental health and
  255  substance abuse disorders and who are in, or at risk of
  256  entering, the criminal or juvenile justice systems. In
  257  implementing the Community Mental Health and Substance Abuse
  258  Treatment and Crime Reduction Act, the department and agency
  259  shall work in coordination with counties that received grants
  260  under the program or piloted a community-based diversion
  261  program.
  262         Section 4. Subsection (1) of section 394.657, Florida
  263  Statutes, is amended to read:
  264         394.657 County planning councils or committees.—
  265         (1) Each board of county commissioners shall designate the
  266  county public safety coordinating council established under s.
  267  951.26, or designate another criminal or juvenile justice mental
  268  health and substance abuse council or committee, as the planning
  269  council or committee. The public safety coordinating council or
  270  other designated criminal or juvenile justice mental health and
  271  substance abuse council or committee shall:,
  272         (a)Coordinate in coordination with the county offices of
  273  planning and budget to, shall make a formal recommendation to
  274  the board of county commissioners regarding how the Criminal
  275  Justice, Mental Health, and Substance Abuse Reinvestment Grant
  276  Program may best be implemented within a community. The board of
  277  county commissioners may assign any entity to prepare the
  278  application on behalf of the county administration for
  279  submission to the corporation for review. A county may join with
  280  one or more counties to form a consortium and use a regional
  281  public safety coordinating council or another county-designated
  282  regional criminal or juvenile justice mental health and
  283  substance abuse planning council or committee for the geographic
  284  area represented by the member counties.
  285         (b)Consult with local governing bodies when planning or
  286  implementing the Community Mental Health and Substance Abuse
  287  Treatment and Crime Reduction Act.
  288         Section 5. Subsection (28) is added to section 409.906,
  289  Florida Statutes, to read:
  290         409.906 Optional Medicaid services.—Subject to specific
  291  appropriations, the agency may make payments for services which
  292  are optional to the state under Title XIX of the Social Security
  293  Act and are furnished by Medicaid providers to recipients who
  294  are determined to be eligible on the dates on which the services
  295  were provided. Any optional service that is provided shall be
  296  provided only when medically necessary and in accordance with
  297  state and federal law. Optional services rendered by providers
  298  in mobile units to Medicaid recipients may be restricted or
  299  prohibited by the agency. Nothing in this section shall be
  300  construed to prevent or limit the agency from adjusting fees,
  301  reimbursement rates, lengths of stay, number of visits, or
  302  number of services, or making any other adjustments necessary to
  303  comply with the availability of moneys and any limitations or
  304  directions provided for in the General Appropriations Act or
  305  chapter 216. If necessary to safeguard the state’s systems of
  306  providing services to elderly and disabled persons and subject
  307  to the notice and review provisions of s. 216.177, the Governor
  308  may direct the Agency for Health Care Administration to amend
  309  the Medicaid state plan to delete the optional Medicaid service
  310  known as “Intermediate Care Facilities for the Developmentally
  311  Disabled.” Optional services may include:
  312         (28)HOME AND COMMUNITY-BASED SERVICES.—The agency,
  313  contingent upon appropriation of funds for this purpose, may
  314  seek federal approval through a state plan amendment to
  315  implement home and community-based services under the authority
  316  of and in compliance with s. 1915i of the Social Security Act
  317  for services provided to individuals who have been determined by
  318  an independent evaluation to have disabilities that cause them
  319  to become, or put them at risk of becoming, involved with the
  320  criminal justice system due to their mental illness. In
  321  accordance with allowances under s. 1915i of the Social Security
  322  Act, these services may be limited to a select number of
  323  eligible individuals in select geographic areas, as identified
  324  by the agency. Eligible individuals may have incomes up to 150
  325  percent of the federal poverty level. The agency shall
  326  coordinate with the department to select and define the services
  327  that will be submitted in the state plan amendment and provided
  328  under this subsection. The agency shall disenroll individuals
  329  receiving services under this subsection from MediPass, or any
  330  capitated or other Medicaid-managed care arrangement. Enrollment
  331  in state plan services may not exceed 1,000 individuals unless
  332  additional approval is obtained from the Legislature. The agency
  333  must receive approval from the Legislature or Legislative Budget
  334  Commission for any funding beyond that provided within initial
  335  implementation revenues. After July 1, 2012, the agency may seek
  336  authority to capitate Medicaid behavioral health services under
  337  this subsection.
  338         Section 6. Subsection (54) is added to section 409.912,
  339  Florida Statutes, to read:
  340         409.912 Cost-effective purchasing of health care.—The
  341  agency shall purchase goods and services for Medicaid recipients
  342  in the most cost-effective manner consistent with the delivery
  343  of quality medical care. To ensure that medical services are
  344  effectively utilized, the agency may, in any case, require a
  345  confirmation or second physician’s opinion of the correct
  346  diagnosis for purposes of authorizing future services under the
  347  Medicaid program. This section does not restrict access to
  348  emergency services or poststabilization care services as defined
  349  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  350  shall be rendered in a manner approved by the agency. The agency
  351  shall maximize the use of prepaid per capita and prepaid
  352  aggregate fixed-sum basis services when appropriate and other
  353  alternative service delivery and reimbursement methodologies,
  354  including competitive bidding pursuant to s. 287.057, designed
  355  to facilitate the cost-effective purchase of a case-managed
  356  continuum of care. The agency shall also require providers to
  357  minimize the exposure of recipients to the need for acute
  358  inpatient, custodial, and other institutional care and the
  359  inappropriate or unnecessary use of high-cost services. The
  360  agency shall contract with a vendor to monitor and evaluate the
  361  clinical practice patterns of providers in order to identify
  362  trends that are outside the normal practice patterns of a
  363  provider’s professional peers or the national guidelines of a
  364  provider’s professional association. The vendor must be able to
  365  provide information and counseling to a provider whose practice
  366  patterns are outside the norms, in consultation with the agency,
  367  to improve patient care and reduce inappropriate utilization.
  368  The agency may mandate prior authorization, drug therapy
  369  management, or disease management participation for certain
  370  populations of Medicaid beneficiaries, certain drug classes, or
  371  particular drugs to prevent fraud, abuse, overuse, and possible
  372  dangerous drug interactions. The Pharmaceutical and Therapeutics
  373  Committee shall make recommendations to the agency on drugs for
  374  which prior authorization is required. The agency shall inform
  375  the Pharmaceutical and Therapeutics Committee of its decisions
  376  regarding drugs subject to prior authorization. The agency is
  377  authorized to limit the entities it contracts with or enrolls as
  378  Medicaid providers by developing a provider network through
  379  provider credentialing. The agency may competitively bid single
  380  source-provider contracts if procurement of goods or services
  381  results in demonstrated cost savings to the state without
  382  limiting access to care. The agency may limit its network based
  383  on the assessment of beneficiary access to care, provider
  384  availability, provider quality standards, time and distance
  385  standards for access to care, the cultural competence of the
  386  provider network, demographic characteristics of Medicaid
  387  beneficiaries, practice and provider-to-beneficiary standards,
  388  appointment wait times, beneficiary use of services, provider
  389  turnover, provider profiling, provider licensure history,
  390  previous program integrity investigations and findings, peer
  391  review, provider Medicaid policy and billing compliance records,
  392  clinical and medical record audits, and other factors. Providers
  393  shall not be entitled to enrollment in the Medicaid provider
  394  network. The agency shall determine instances in which allowing
  395  Medicaid beneficiaries to purchase durable medical equipment and
  396  other goods is less expensive to the Medicaid program than long
  397  term rental of the equipment or goods. The agency may establish
  398  rules to facilitate purchases in lieu of long-term rentals in
  399  order to protect against fraud and abuse in the Medicaid program
  400  as defined in s. 409.913. The agency may seek federal waivers
  401  necessary to administer these policies.
  402         (54)Persons who have serious and persistent mental
  403  illnesses, who are receiving services under the Community Mental
  404  Health and Substance Abuse Crime Reduction Act, and who are
  405  eligible for and receiving services under the state plan
  406  implemented under s. 1915i of the Social Security Act, as
  407  approved by the Centers for Medicare and Medicaid Services, are
  408  exempt from MediPass and managed care plans authorized under
  409  this chapter, including capitated managed care plans authorized
  410  under s. 409.91211.
  411         Section 7. Paragraph (a) of subsection (3) of section
  412  916.107, Florida Statutes, is amended to read:
  413         916.107 Rights of forensic clients.—
  414         (3) RIGHT TO EXPRESS AND INFORMED CONSENT.—
  415         (a) A forensic client shall be asked to give express and
  416  informed written consent for treatment. If a client refuses such
  417  treatment as is deemed necessary and essential by the client’s
  418  multidisciplinary treatment team for the appropriate care of the
  419  client, such treatment may be provided under the following
  420  circumstances:
  421         1. In an emergency situation in which there is immediate
  422  danger to the safety of the client or others, such treatment may
  423  be provided upon the written order of a physician for a period
  424  not to exceed 48 hours, excluding weekends and legal holidays.
  425  If, after the 48-hour period, the client has not given express
  426  and informed consent to the treatment initially refused, the
  427  administrator or designee of the civil or forensic facility
  428  shall, within 48 hours, excluding weekends and legal holidays,
  429  petition the committing court or the circuit court serving the
  430  county in which the facility is located, at the option of the
  431  facility administrator or designee, for an order authorizing the
  432  continued treatment of the client. In the interim, the need for
  433  treatment shall be reviewed every 48 hours and may be continued
  434  without the consent of the client upon the continued written
  435  order of a physician who has determined that the emergency
  436  situation continues to present a danger to the safety of the
  437  client or others.
  438         2. In a situation other than an emergency situation, the
  439  administrator or designee of the facility shall petition the
  440  court for an order authorizing necessary and essential treatment
  441  for the client.
  442         a.If the client has been receiving psychotherapeutic
  443  medication at the jail at the time of transfer to the state
  444  forensic mental health treatment facility and lacks the capacity
  445  to make an informed decision regarding mental health treatment
  446  at the time of admission, the admitting physician may order a
  447  continuation of the psychotherapeutic medication if, in the
  448  clinical judgment of the physician, abrupt cessation of the
  449  psychotherapeutic medication could cause a risk to the health
  450  and safety of the client during the time a court order to
  451  medicate is pursued. The jail physician shall provide a current
  452  psychotherapeutic medication order at the time of transfer to
  453  the admitting facility.
  454         b. The court order shall allow such treatment for up to a
  455  period not to exceed 90 days following the date of the entry of
  456  the order. Unless the court is notified in writing that the
  457  client has provided express and informed consent in writing or
  458  that the client has been discharged by the committing court, the
  459  administrator or designee shall, before prior to the expiration
  460  of the initial 90-day order, petition the court for an order
  461  authorizing the continuation of treatment for another 90 days
  462  90-day period. This procedure shall be repeated until the client
  463  provides consent or is discharged by the committing court.
  464         3. At the hearing on the issue of whether the court should
  465  enter an order authorizing treatment for which a client was
  466  unable to or refused to give express and informed consent, the
  467  court shall determine by clear and convincing evidence that the
  468  client has mental illness, retardation, or autism, that the
  469  treatment not consented to is essential to the care of the
  470  client, and that the treatment not consented to is not
  471  experimental and does not present an unreasonable risk of
  472  serious, hazardous, or irreversible side effects. In arriving at
  473  the substitute judgment decision, the court must consider at
  474  least the following factors:
  475         a. The client’s expressed preference regarding treatment;
  476         b. The probability of adverse side effects;
  477         c. The prognosis without treatment; and
  478         d. The prognosis with treatment.
  479  
  480         The hearing shall be as convenient to the client as may be
  481  consistent with orderly procedure and shall be conducted in
  482  physical settings not likely to be injurious to the client’s
  483  condition. The court may appoint a general or special magistrate
  484  to preside at the hearing. The client or the client’s guardian,
  485  and the representative, shall be provided with a copy of the
  486  petition and the date, time, and location of the hearing. The
  487  client has the right to have an attorney represent him or her at
  488  the hearing, and, if the client is indigent, the court shall
  489  appoint the office of the public defender to represent the
  490  client at the hearing. The client may testify or not, as he or
  491  she chooses, and has the right to cross-examine witnesses and
  492  may present his or her own witnesses.
  493         Section 8. Section 916.111, Florida Statutes, is amended to
  494  read:
  495         916.111 Training of mental health experts.—The evaluation
  496  of defendants for competency to proceed or for sanity at the
  497  time of the commission of the offense shall be conducted in such
  498  a way as to ensure uniform application of the criteria
  499  enumerated in Rules 3.210 and 3.216, Florida Rules of Criminal
  500  Procedure.
  501         (1)A forensic evaluator training course approved by the
  502  department must be provided at least annually to ensure that
  503  mental health professionals have the opportunity to be placed on
  504  the department’s forensic evaluator registry.
  505         (a)Beginning July 1, 2010, experts shall remain on the
  506  registry if they have completed or retaken the required training
  507  within the previous 5 years. Those who have not completed the
  508  training must be removed from the registry and may not conduct
  509  evaluations for the courts.
  510         (b)A mental health professional who has completed the
  511  training course within the previous 5 years must maintain
  512  documentation of completion of the required training and provide
  513  current contact information to the department.
  514         (2) The department shall develop, and may contract with
  515  accredited institutions:
  516         (a)(1) To provide:
  517         1.(a) A plan for training mental health professionals to
  518  perform forensic evaluations and to standardize the criteria and
  519  procedures to be used in these evaluations;
  520         2.(b) Clinical protocols and procedures based upon the
  521  criteria of Rules 3.210 and 3.216, Florida Rules of Criminal
  522  Procedure; and
  523         3.(c) Training for mental health professionals in the
  524  application of these protocols and procedures in performing
  525  forensic evaluations and providing reports to the courts; and
  526         (b)(2) To compile and maintain the necessary information
  527  for evaluating the success of this program, including the number
  528  of persons trained, the cost of operating the program, and the
  529  effect on the quality of forensic evaluations as measured by
  530  appropriateness of admissions to state forensic facilities and
  531  to community-based care programs.
  532         Section 9. Subsection (1) of section 916.115, Florida
  533  Statutes, is amended to read:
  534         916.115 Appointment of experts.—
  535         (1) The court shall appoint no more than three experts to
  536  determine the mental condition of a defendant in a criminal
  537  case, including competency to proceed, insanity, involuntary
  538  placement, and treatment. The experts may evaluate the defendant
  539  in jail or in another appropriate local facility or in a
  540  facility of the Department of Corrections.
  541         (a) To the extent possible, The appointed experts shall
  542  have completed forensic evaluator training as provided in s.
  543  916.111 approved by the department, and each shall be a
  544  psychiatrist, or licensed psychologist, or physician.
  545         (b) The department shall maintain and annually provide the
  546  courts with a forensic evaluator registry list of available
  547  mental health professionals who have completed the approved
  548  training as experts.
  549         Section 10. Section 916.13, Florida Statutes, is amended to
  550  read:
  551         916.13 Involuntary commitment of defendant adjudicated
  552  incompetent.—
  553         (1) Every defendant who is charged with a felony and who is
  554  adjudicated incompetent to proceed may be involuntarily
  555  committed for treatment upon a finding by the court of clear and
  556  convincing evidence that:
  557         (a) The defendant has a mental illness and because of the
  558  mental illness:
  559         1. The defendant is manifestly incapable of surviving alone
  560  or with the help of willing and responsible family or friends,
  561  including available alternative services, and, without
  562  treatment, the defendant is likely to suffer from neglect or
  563  refuse to care for herself or himself and such neglect or
  564  refusal poses a real and present threat of substantial harm to
  565  the defendant’s well-being; or
  566         2. There is a substantial likelihood that in the near
  567  future the defendant will inflict serious bodily harm on herself
  568  or himself or another person, as evidenced by recent behavior
  569  causing, attempting, or threatening such harm;
  570         (b) All available, less restrictive treatment alternatives,
  571  including treatment in community residential facilities or
  572  community inpatient or outpatient settings, which would offer an
  573  opportunity for improvement of the defendant’s condition have
  574  been judged to be inappropriate; and
  575         (c) There is a substantial probability that the mental
  576  illness causing the defendant’s incompetence will respond to
  577  treatment and the defendant will regain competency to proceed in
  578  the reasonably foreseeable future.
  579         (2) A defendant who has been charged with a felony and who
  580  has been adjudicated incompetent to proceed due to mental
  581  illness, and who meets the criteria for involuntary commitment
  582  to the department under the provisions of this chapter, may be
  583  committed to the department, and the department shall retain and
  584  treat the defendant.
  585         (a)Within No later than 6 months after the date of
  586  admission and at the end of any period of extended commitment,
  587  or at any time the administrator or designee has shall have
  588  determined that the defendant has regained competency to proceed
  589  or no longer meets the criteria for continued commitment, the
  590  administrator or designee shall file a report with the court
  591  pursuant to the applicable Florida Rules of Criminal Procedure.
  592         (b)Within 30 days after the court receives notification
  593  that a defendant is competent to proceed or no longer meets the
  594  criteria for continued commitment, the defendant shall be
  595  transported back to jail pursuant to s. 916.107(10) for the
  596  purpose of holding a competency hearing.
  597         (c)A competency hearing must be held within 30 days after
  598  a court receives notification that the defendant is competent to
  599  proceed or no longer meets criteria for continued commitment.
  600         Section 11. Present subsection (4) of section 916.15,
  601  Florida Statutes, is renumbered as subsection (5), and a new
  602  subsection (4) is added to that section, to read:
  603         916.15 Involuntary commitment of defendant adjudicated not
  604  guilty by reason of insanity.—
  605         (4)Within 30 days after the court is notified that a
  606  defendant no longer meets the criteria for involuntary
  607  commitment placement, the defendant shall be transported back to
  608  jail for the purpose of holding a commitment hearing. The
  609  commitment hearing must be held within 45 days after the court
  610  receives notification that the defendant no longer meets the
  611  criteria for continued commitment placement.
  612         Section 12. Present subsections (2) and (3) of section
  613  916.17, Florida Statutes, are renumbered as subsections (3) and
  614  (4), respectively, and a new subsection (2) is added to that
  615  section, to read:
  616         916.17 Conditional release.—
  617         (2)A defendant who otherwise meets the criteria for
  618  involuntary commitment under s. 916.13, but whose current most
  619  serious charge is a felony of the third degree or a felony of
  620  the second degree when the felony did not involve violence, must
  621  be placed in a community residential facility for competency
  622  restoration in pilot sites established in s. 394.4656, unless
  623  bed space or funding is unavailable for the community placement
  624  or the trial court makes an explicit finding that the defendant
  625  cannot be safely managed in such a placement. In making such
  626  finding, the court shall consider all of the following:
  627         (a)The nature and seriousness of the crime allegedly
  628  committed.
  629         (b)The individual’s criminal history.
  630         (c)The individual’s psychiatric history.
  631         (d)The individual’s history of violent behavior or threats
  632  of violent behavior and risk of harm to self or others.
  633         (e)The likelihood that the individual will comply with and
  634  benefit from the mental health treatment and services being
  635  recommended.
  636         (f)The availability of appropriate community-based
  637  services and treatment settings.
  638         (g)Other information considered relevant by the court.
  639         Section 13. Paragraphs (b) through (h) of subsection (1) of
  640  section 985.19, Florida Statutes, are amended to read:
  641         985.19 Incompetency in juvenile delinquency cases.—
  642         (1) If, at any time prior to or during a delinquency case,
  643  the court has reason to believe that the child named in the
  644  petition may be incompetent to proceed with the hearing, the
  645  court on its own motion may, or on the motion of the child’s
  646  attorney or state attorney must, stay all proceedings and order
  647  an evaluation of the child’s mental condition.
  648         (b) All determinations of competency must shall be made at
  649  a hearing, with findings of fact based on an evaluation of the
  650  child’s mental condition made by at least not less than two but
  651  not nor more than three experts appointed by the court. The
  652  basis for the determination of incompetency must be specifically
  653  stated in the evaluation and must be conducted so as to ensure
  654  uniform application of the criteria enumerated in the Florida
  655  Rules of Juvenile Procedure. In addition, A recommendation as to
  656  whether residential or nonresidential treatment or training is
  657  required must be included in the evaluation. Experts appointed
  658  by the court to determine the mental condition of a child shall
  659  be allowed reasonable fees for services rendered. State
  660  employees may be paid expenses pursuant to s. 112.061. The fees
  661  shall be taxed as costs in the case.
  662         (c) All court orders determining incompetency must include
  663  specific written findings by the court as to the nature of the
  664  incompetency and whether the child requires secure or nonsecure
  665  treatment or training environments.
  666         (d)The evaluation of juveniles for competency to proceed
  667  shall be conducted in a manner that ensures the uniform
  668  application of the criteria in the Florida Rules of Juvenile
  669  Procedure. The department shall develop, and may contract with
  670  accredited institutions to provide:
  671         1.A plan for training mental health professionals to
  672  perform forensic evaluations and for standardizing the criteria
  673  and procedures to be used in such evaluations;
  674         2.Clinical protocols and procedures based on the criteria
  675  in the Florida Rules of Juvenile Procedure;
  676         3.Training for mental health professionals in the
  677  application of these protocols and procedures for performing
  678  forensic evaluations and providing reports to the courts; and
  679         4.Evaluation of the success of the program, including the
  680  number of persons trained, the cost of operating the program,
  681  and the effect on the quality of forensic evaluations as
  682  measured by the appropriateness of admissions to the
  683  department’s juvenile competent to proceed programs.
  684         (e)(d) For incompetency competency evaluations related to
  685  mental illness, the Department of Children and Family Services
  686  shall maintain and annually provide the courts with a forensic
  687  evaluator registry list of available mental health professionals
  688  who have completed a training program approved by the Department
  689  of Children and Family Services to perform the evaluations as
  690  provided in this section. An appointed expert must be a
  691  psychiatrist or licensed psychologist and must be included in
  692  the registry.
  693         1.A forensic evaluator training course approved by the
  694  department must be provided at least annually to ensure that
  695  mental health professionals have an opportunity to be placed on
  696  the department’s registry.
  697         2.Beginning July 1, 2010, experts shall remain on the
  698  registry if they have completed or retaken the required training
  699  within the previous 5 years. Those who have not completed the
  700  required training within the previous 5 years must be removed
  701  from the registry and may not conduct evaluations for the
  702  courts.
  703         3.A mental health professional who has completed the
  704  training course within the previous 5 years must maintain
  705  documentation of having completing the required training and
  706  provide current contact information to the department.
  707         (f)(e) For incompetency evaluations related to mental
  708  retardation or autism, the court shall order the Agency for
  709  Persons with Disabilities to examine the child to determine if
  710  the child meets the definition of “retardation” or “autism” in
  711  s. 393.063 and, if so, whether the child is competent to proceed
  712  with delinquency proceedings.
  713         (g)(f) A child is competent to proceed if the child has
  714  sufficient present ability to consult with counsel with a
  715  reasonable degree of rational understanding and the child has a
  716  rational and factual understanding of the present proceedings.
  717  The report must address the child’s capacity to:
  718         1. Appreciate the charges or allegations against the child.
  719         2. Appreciate the range and nature of possible penalties
  720  that may be imposed in the proceedings against the child, if
  721  applicable.
  722         3. Understand the adversarial nature of the legal process.
  723         4. Disclose to counsel facts pertinent to the proceedings
  724  at issue.
  725         5. Display appropriate courtroom behavior.
  726         6. Testify relevantly.
  727         (h)(g) Immediately upon the filing of the court order
  728  finding a child incompetent to proceed, the clerk of the court
  729  shall notify the Department of Children and Family Services and
  730  the Agency for Persons with Disabilities and fax or hand deliver
  731  to the department and to the agency a referral packet that
  732  includes, at a minimum, the court order, the charging documents,
  733  the petition, and the court-appointed evaluator’s reports.
  734         (i)(h) After placement of the child in the appropriate
  735  setting, the Department of Children and Family Services in
  736  consultation with the Agency for Persons with Disabilities, as
  737  appropriate, must, within 30 days after placement of the child,
  738  prepare and submit to the court a treatment or training plan for
  739  the child’s restoration of competency. A copy of the plan must
  740  be served upon the child’s attorney, the state attorney, and the
  741  attorneys representing the Department of Juvenile Justice.
  742         Section 14. This act shall take effect July 1, 2009.
  743  
  744  
  745  ================= T I T L E  A M E N D M E N T ================
  746         And the title is amended as follows:
  747         Delete everything before the enacting clause
  748  and insert:
  749                        A bill to be entitled                      
  750         An act relating to mental health; creating s.
  751         394.4656, F.S.; creating the Community Mental Health
  752         and Substance Abuse Treatment and Crime Reduction Act;
  753         providing legislative findings and intent; providing
  754         goals for the community mental health and substance
  755         abuse forensic treatment system; defining terms;
  756         requiring the Department of Children and Family
  757         Services, in consultation with the Agency for Health
  758         Care Administration, to develop and implement a
  759         community mental health and substance abuse forensic
  760         treatment system; providing initiatives and strategies
  761         for the community forensic system; detailing the
  762         services to be provided in the community forensic
  763         system; setting forth the eligibility criteria for
  764         treatment in the system; authorizing the department to
  765         develop a continuum of services to implement the
  766         Community Mental Health and Substance Abuse Treatment
  767         and Crime Reduction Act; specifying the services and
  768         functions the department must undertake; authorizing
  769         the department to establishe pilot sites within the
  770         state where the community mental health and substance
  771         abuse forensic treatment system will be implemented;
  772         amending s. 394.655, F.S.; providing additional
  773         functions of the Criminal Justice, Mental Health, and
  774         Substance Abuse Policy Council; amending s. 394.656,
  775         F.S.; requiring the department and the agency to
  776         cooperate with counties that receive grants funding
  777         under the Criminal Justice, Mental Health, and
  778         Substance Abuse Reinvestment Grant Program; amending
  779         s. 394.657, F.S.; requiring county councils to consult
  780         with local government when planning or implementing
  781         the Community Mental Health and Substance Abuse
  782         Treatment and Crime Reduction Act; amending s.
  783         409.906, F.S.; adding home and community-based mental
  784         health services to the optional Medicaid services
  785         offered by the state Medicaid program; amending s.
  786         409.912, F.S.; exempting persons who have serious and
  787         persistent mental illnesses and who are receiving
  788         services under the Community Mental Health and
  789         Substance Abuse Crime Reduction Act from MediPass and
  790         managed care plans; amending s. 916.107, F.S.;
  791         specifying treatment procedures for a client admitted
  792         to a state forensic mental health treatment facility
  793         who lacks the capacity to make an informed decision
  794         regarding mental health treatment at the time of
  795         admission; amending s. 916.111, F.S.; providing for
  796         forensic evaluator training for mental health experts;
  797         amending s. 916.115, F.S.; requiring court-appointed
  798         experts to have completed forensic evaluator training;
  799         requiring the court-appointed expert to be a
  800         psychiatrist or a licensed psychologist; requiring the
  801         Department of Children and Family Services to maintain
  802         and annually provide the courts with a forensic
  803         evaluator registry; amending s. 916.13, F.S.;
  804         providing timeframes for competency hearings to be
  805         held; amending s. 916.15, F.S.; providing timeframes
  806         for commitment hearings to be held; amending s.
  807         916.17, F.S.; requiring that certain defendants be
  808         placed in a community residential facility for
  809         competency restoration in demonstration areas
  810         established under the Community Mental Health and
  811         Substance Abuse Treatment and Crime Reduction Act;
  812         providing exceptions; amending s. 985.19, F.S.;
  813         authorizing the department to develop and contract for
  814         training mental health professionals to perform
  815         forensic evaluations, the protocols and procedures to
  816         be used, and standardizing the criteria used; revising
  817         requirements relating to the forensic evaluator
  818         training program that appointed experts must complete;
  819         providing an effective date.
  820