Senate Bill 0358

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    Florida Senate - 2000                                   SB 358

    By the Committee on Children and Families





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  1                      A bill to be entitled

  2         An act relating to substance abuse and mental

  3         health services; amending s. 394.455, F.S.;

  4         redefining the term "mental illness" for

  5         purposes of part I of ch. 394, F.S.; amending

  6         s. 394.492, F.S.; redefining the term "child or

  7         adolescent who is experiencing an acute mental

  8         or emotional crisis" for purposes of part III

  9         of ch. 394, F.S.; amending s. 394.493, F.S.;

10         revising the income standard that is the basis

11         for a sliding fee scale adopted by the

12         Department of Children and Family Services for

13         mental health services provided to children and

14         adolescents; amending s. 394.65, F.S.;

15         redesignating part IV of ch. 394, F.S., as "The

16         Community Substance Abuse and Mental Health

17         Services Act"; amending s. 394.66, F.S.;

18         providing legislative intent with respect to

19         substance abuse and mental health services;

20         amending s. 394.67, F.S.; providing additional

21         definitions; creating s. 394.674, F.S.;

22         providing criteria for clinical and financial

23         eligibility for substance abuse and mental

24         health services funded by the Department of

25         Children and Family Services; providing

26         requirements for the department in the

27         provision of crisis services, substance abuse

28         services, and mental health services;

29         specifying requirements for counties in

30         spending certain funds for local substance

31         abuse and mental health services; authorizing

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  1         the use of funds for activities to prevent

  2         substance abuse; requiring that the Department

  3         of Children and Family Services adopt rules;

  4         requiring the department to establish a sliding

  5         fee scale for clients who receive substance

  6         abuse and mental health services; amending s.

  7         394.675, F.S.; revising the types of services

  8         provided by the department under the substance

  9         abuse and mental health service system;

10         amending s. 394.74, F.S., relating to contracts

11         for substance abuse and mental health programs;

12         conforming provisions to changes made by the

13         act; amending s. 394.75, F.S.; requiring

14         district health and human services boards

15         rather than planning councils to prepare

16         substance abuse and mental health plans;

17         providing requirements for the plans; revising

18         the population groups to be addressed in the

19         plans to conform to changes made by the act;

20         amending ss. 394.76, 394.77, 394.78, 394.79,

21         394.908, F.S., relating to the financing of

22         district programs and services, uniform

23         information and reporting systems, procedures

24         for audits and dispute resolution, and

25         distribution of appropriations; conforming

26         provisions to changes made by the act;

27         requiring the Department of Children and Family

28         Services to submit a master plan to the

29         Legislature for implementing a publicly funded,

30         community-based system of care for mental

31         health and substance abuse services; providing

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  1         requirements for the master plan; requiring the

  2         department to submit a report to the

  3         Legislature which describes the compliance of

  4         providers with performance outcome standards;

  5         providing an effective date.

  6

  7  Be It Enacted by the Legislature of the State of Florida:

  8

  9         Section 1.  Subsection (18) of section 394.455, Florida

10  Statutes, is amended to read:

11         394.455  Definitions.--As used in this part, unless the

12  context clearly requires otherwise, the term:

13         (18)  "Mental illness" means an impairment of the

14  mental or emotional processes that exercise conscious control

15  of one's actions or of the ability to perceive or understand

16  reality, which impairment substantially interferes with a

17  person's ability to meet the ordinary demands of living,

18  regardless of etiology. For the purposes of this part, the

19  term does not include retardation or developmental disability

20  as defined in chapter 393, intoxication, or conditions

21  manifested only by antisocial behavior or substance abuse

22  impairment.

23         Section 2.  Subsection (7) of section 394.492, Florida

24  Statutes, is amended to read:

25         394.492  Definitions.--As used in ss. 394.490-394.497,

26  the term:

27         (7)  "Child or adolescent who is experiencing an acute

28  mental or emotional crisis" means a child or adolescent who

29  experiences a psychotic episode or a high level of mental or

30  emotional distress which may be precipitated by a traumatic

31  event or a perceived life problem for which the individual's

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  1  typical coping strategies are inadequate. The term an acute

  2  mental or emotional problem and includes a child or adolescent

  3  who meets the criteria for involuntary examination specified

  4  in s. 394.463(1).

  5         Section 3.  Subsection (2) of section 394.493, Florida

  6  Statutes, is amended to read:

  7         394.493  Target populations for child and adolescent

  8  mental health services funded through the department.--

  9         (2)  Each mental health provider under contract with

10  the department to provide mental health services to the target

11  population shall collect fees from the parent or legal

12  guardian of the child or adolescent receiving services. The

13  fees shall be based on a sliding fee scale for families whose

14  net family income is at or above 150 between 100 percent and

15  200 percent of the Federal Poverty Income Guidelines. The

16  department shall adopt, by rule, a sliding fee scale for

17  statewide implementation. A family whose net family income is

18  200 percent or more above the Federal Poverty Income

19  Guidelines is responsible for paying the cost of services.

20  Fees collected from families shall be retained in the service

21  district and used for expanding child and adolescent mental

22  health treatment services.

23         Section 4.  Section 394.65, Florida Statutes, is

24  amended to read:

25         394.65  Short title.--This part may be cited shall be

26  known as "The Community Substance Alcohol, Drug Abuse, and

27  Mental Health Services Act."

28         Section 5.  Section 394.66, Florida Statutes, is

29  amended to read:

30

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  1         394.66  Legislative intent with respect to substance

  2  alcohol, drug abuse, and mental health services.--It is the

  3  intent of the Legislature to:

  4         (1)  Promote and improve the mental health of the

  5  citizens of the state by making substance abuse and mental

  6  health treatment and support services available to those

  7  persons who are most in need and least able to pay through a

  8  community-based system of care comprehensive, coordinated

  9  alcohol, drug abuse, and mental health services.

10         (2)  Involve local citizens in the planning of

11  substance alcohol, drug abuse, and mental health services in

12  their communities.

13         (3)  Ensure that all activities of the Department of

14  Children and Family Services, the Agency for Health Care

15  Administration, and their respective contract providers

16  involved in the delivery of substance its contractors are

17  directed toward the coordination of planning efforts in

18  alcohol, drug abuse, and mental health treatment and

19  prevention services are coordinated and integrated with other

20  local systems and groups, public and private, such as juvenile

21  justice, criminal justice, child protection, and public health

22  organizations; school districts; and local groups or

23  organizations that focus on services to persons who are

24  elderly.

25         (4)  Provide access to crisis services to all residents

26  of the state with priority of attention being given to

27  individuals exhibiting symptoms of acute or chronic mental

28  illness, alcohol abuse, or substance drug abuse.

29         (5)  Ensure continuity of care, consistent with minimum

30  standards, for persons who are released from a state treatment

31  facility into the community.

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  1         (6)  Provide accountability for service provision

  2  through statewide standards for treatment and support services

  3  and statewide standards for management, monitoring, and

  4  reporting of information.

  5         (7)  Include substance alcohol, drug abuse, and mental

  6  health services as a component of the integrated service

  7  delivery system of the Department of Children and Family

  8  Services.

  9         (8)  Ensure that the districts of the department are

10  the focal point of all substance alcohol, drug abuse, and

11  mental health planning activities, including budget

12  submissions, grant applications, contracts, and other

13  arrangements that can be effected at the district level.

14         (9)  Organize and finance community substance alcohol,

15  drug abuse, and mental health services in local communities

16  throughout the state through locally administered service

17  delivery programs that are based on client outcomes, are

18  programmatically effective, and are financially efficient, and

19  that maximize the involvement of local citizens.

20         Section 6.  Section 394.67, Florida Statutes, is

21  amended to read:

22         394.67  Definitions.--As used in this part, the term:

23         (1)  "Adult at risk of mental illness" means a person

24  18 years of age or older who has an increased likelihood of

25  mental illness due to factors such as having a family history

26  of mental illness or substance abuse; abusing substances;

27  being or having been a victim of abuse, neglect, abandonment,

28  exploitation, or domestic violence; having problems associated

29  with aging; being homeless; experiencing the death of a family

30  member; being chronically unemployed; being the victim of a

31

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  1  crime; or being infected with human immunodeficiency virus

  2  (HIV).

  3         (2)  "Adult at risk of substance abuse impairment"

  4  means a person 18 years of age or older who has an increased

  5  likelihood of substance abuse impairment due to factors such

  6  as having a family history of substance abuse; experiencing

  7  persistent substance abuse problems; experiencing persistent

  8  mental-health problems; misusing medications; being or having

  9  been a victim of abuse, neglect, abandonment, exploitation, or

10  domestic violence; having problems associated with aging;

11  being homeless; experiencing the death of a family member;

12  being the victim of a crime; experiencing negative

13  socioeconomic conditions such as unemployment; or being

14  infected with human immunodeficiency virus (HIV).

15         (3)  "Adult who has a serious mental illness" means a

16  person 18 years of age or older who meets one of the

17  diagnostic categories in the most recent edition of the

18  Diagnostic and Statistical Manual of Mental Disorders of the

19  American Psychiatric Association, with the exception of

20  substance abuse disorders and developmental disorders, and who

21  exhibits behaviors that substantially interfere with or limit

22  functioning in one or more major life activities, including

23  basic daily living skills, such as eating, bathing, or

24  dressing; instrumental living skills, such as maintaining a

25  household or managing money; getting around the community;

26  taking prescribed medication; or functioning in social,

27  family, vocational, or educational contexts. The term includes

28  an adult who meets the criteria for involuntary placement

29  under s. 394.467(1).

30         (4)  "Adult who has a substance abuse impairment" means

31  a person 18 years of age or older who meets the diagnostic

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  1  requirements for substance abuse or substance dependence under

  2  Substance-Related Disorders in the most recent edition of the

  3  Diagnostic and Statistical Manual of Mental Disorders of the

  4  American Psychiatric Association.

  5         (1)  "Advisory council" means a district advisory

  6  council.

  7         (5)(2)  "Agency" means the Agency for Health Care

  8  Administration.

  9         (6)(3)  "Applicant" means an individual applicant, or

10  any officer, director, agent, managing employee, or affiliated

11  person, or any partner or shareholder having an ownership

12  interest equal to a 5-percent or greater interest in the

13  corporation, partnership, or other business entity.

14         (7)(4)  "Client" means any individual receiving

15  services in any substance alcohol, drug abuse, or mental

16  health facility, program, or service, which facility, program,

17  or service is operated, funded, or regulated by the agency and

18  the department or regulated by the agency.

19         (8)  "Crisis services" means short-term evaluation,

20  stabilization, and brief intervention services provided to a

21  person who is experiencing an acute mental or emotional

22  crisis, as defined in subsection (22), or an acute substance

23  abuse crisis, as defined in subsection (23), to prevent

24  further deterioration of the person's mental health. Crisis

25  services are provided in settings such as a

26  crisis-stabilization unit, an inpatient unit, a short-term

27  residential treatment program, a detoxification facility, or

28  an addictions receiving facility; at the site of the crisis by

29  a mobile crisis-response team; or at a hospital on an

30  outpatient basis.

31

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  1         (9)(5)  "Crisis-stabilization Crisis stabilization

  2  unit" means a program that provides an alternative to

  3  inpatient hospitalization and that provides brief, intensive

  4  services 24 hours a day, 7 days a week, for mentally ill

  5  individuals who are in an acutely disturbed state.

  6         (10)(6)  "Department" means the Department of Children

  7  and Family Services.

  8         (11)(7)  "Director" means any member of the official

  9  board of directors reported in the organization's annual

10  corporate report to the Florida Department of State, or, if no

11  such report is made, any member of the operating board of

12  directors. The term excludes members of separate, restricted

13  boards that serve only in an advisory capacity to the

14  operating board.

15         (12)(8)  "District administrator" means the person

16  appointed by the Secretary of Children and Family Services for

17  the purpose of administering a department service district as

18  set forth in s. 20.19.

19         (13)(9)  "District plan" or "plan" means the combined

20  district substance alcohol, drug abuse, and mental health plan

21  approved by the district administrator and governing bodies in

22  accordance with this part.

23         (14)(10)  "Federal funds" means funds from federal

24  sources for substance alcohol, drug abuse, or mental health

25  facilities and programs, exclusive of federal funds that are

26  deemed eligible by the Federal Government, and are eligible

27  through state regulation, for matching purposes.

28         (15)(11)  "Governing body" means the chief legislative

29  body of a county, a board of county commissioners, or boards

30  of county commissioners in counties acting jointly, or their

31  counterparts in a charter government.

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  1         (16)  "Health and human services board" or "board"

  2  means the board within a district or subdistrict of the

  3  department which is established in accordance with s. 20.19

  4  and designated in this part for the purpose of assessing the

  5  substance abuse and mental health needs of the community and

  6  developing a plan to address those needs.

  7         (17)(12)  "Licensed facility" means a facility licensed

  8  in accordance with this chapter.

  9         (18)(13)  "Local matching funds" means funds received

10  from governing bodies of local government, including city

11  commissions, county commissions, district school boards,

12  special tax districts, private hospital funds, private gifts,

13  both individual and corporate, and bequests and funds received

14  from community drives or any other sources.

15         (19)(14)  "Managing employee" means the administrator

16  or other similarly titled individual who is responsible for

17  the daily operation of the facility.

18         (20)  "Mental health services" means those therapeutic

19  interventions and activities that help to eliminate, reduce,

20  or manage symptoms or distress for persons who have severe

21  emotional distress or a mental illness and to effectively

22  manage the disability that often accompanies a mental illness

23  so that the person can recover from the mental illness, become

24  appropriately self-sufficient for his or her age, and live in

25  a stable family or in the community. The term includes the

26  following types of services:

27         (a)  Treatment services, such as psychiatric

28  medications and supportive psychotherapies, which are intended

29  to reduce or ameliorate the symptoms of severe distress or

30  mental illness.

31

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  1         (b)  Rehabilitative services, which are intended to

  2  reduce or eliminate the disability that is associated with

  3  mental illness. Rehabilitative services may include assessment

  4  of personal goals and strengths, readiness preparation,

  5  specific skill training, and assistance in designing

  6  environments that enable individuals to maximize their

  7  functioning and community participation.

  8         (c)  Support services, which include services that

  9  assist individuals in living successfully in environments of

10  their choice. Such services may include income supports,

11  social supports, housing supports, vocational supports, or

12  accommodations related to the symptoms or disabilities

13  associated with mental illness.

14         (d)  Case-management services, which are intended to

15  assist individuals in obtaining the formal and informal

16  resources that they need to successfully cope with the

17  consequences of their illness. Resources may include treatment

18  or rehabilitative or supportive interventions by both formal

19  and informal providers. Case management may include an

20  assessment of client needs; intervention planning with the

21  client, his or her family, and service providers; linking the

22  client to needed services; monitoring service delivery;

23  evaluating the effect of services and supports; and advocating

24  on behalf of the client.

25

26  Mental health services may be delivered in a variety of

27  settings, such as inpatient, residential, partial hospital,

28  day treatment, outpatient, club house, or a drop-in or

29  self-help center, as well as in other community settings, such

30  as the client's residence or workplace. The types and

31  intensity of services provided shall be based on the client's

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  1  clinical status and goals, community resources, and

  2  preferences. Services such as assertive community treatment

  3  involve all four types of services which are delivered by a

  4  multidisciplinary treatment team that is responsible for

  5  identified individuals who have a serious mental illness.

  6         (21)(15)  "Patient fees" means compensation received by

  7  a community substance alcohol, drug abuse, or mental health

  8  facility for services rendered to clients from any source of

  9  funds, including city, county, state, federal, and private

10  sources.

11         (22)  "Person who is experiencing an acute mental or

12  emotional crisis" means a child, adolescent, or adult who is

13  experiencing a psychotic episode or a high level of mental or

14  emotional distress which may be precipitated by a traumatic

15  event or a perceived life problem for which the individual's

16  typical coping strategies are inadequate. The term includes an

17  individual who meets the criteria for involuntary examination

18  specified in s. 394.463(1).

19         (23)  "Person who is experiencing an acute substance

20  abuse crisis" means a child, adolescent, or adult who is

21  experiencing a medical or emotional crisis because of the use

22  of alcoholic beverages or any psychoactive or mood-altering

23  substance. The term includes an individual who meets the

24  criteria for involuntary admission specified in s. 397.675.

25         (24)(16)  "Premises" means those buildings, beds, and

26  facilities located at the main address of the licensee and all

27  other buildings, beds, and facilities for the provision of

28  acute or residential care which are located in such reasonable

29  proximity to the main address of the licensee as to appear to

30  the public to be under the dominion and control of the

31  licensee.

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  1         (25)(17)  "Program office" means the Alcohol, Drug

  2  Abuse, and Mental Health Program Office of the Department of

  3  Children and Family Services.

  4         (26)  "Substance abuse services" means services

  5  designed to prevent or remediate the consequences of substance

  6  abuse, improve an individual's quality of life and

  7  self-sufficiency, and support long-term recovery. The term

  8  includes the following service categories:

  9         (a)  Prevention services, which include information

10  dissemination; education regarding the consequences of

11  substance abuse; alternative drug-free activities; problem

12  identification; referral of persons to appropriate prevention

13  programs; community-based programs that involve members of

14  local communities in prevention activities; and environmental

15  strategies to review, change, and enforce laws that control

16  the availability of controlled and illegal substances.

17         (b)  Assessment services, which include the diagnoses,

18  assessment, and evaluation of individuals and families in

19  order to identify their strengths and determine their required

20  level of care, motivation, and need for treatment and

21  ancillary services.

22         (c)  Intervention services, which include early

23  identification, short-term counseling and referral, and

24  outreach.

25         (d)  Rehabilitation services, which include

26  residential, outpatient, day or night, case-management,

27  in-home, psychiatric, and medical treatment, and methadone or

28  medication management.

29         (e)  Ancillary services, which include self-help and

30  other support groups and activities; aftercare provided in a

31  structured, therapeutic environment; supported housing;

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  1  supported employment; vocational services; and educational

  2  services.

  3         (27)(18)  "Residential treatment facility" means a

  4  facility providing residential care and treatment to

  5  individuals exhibiting symptoms of mental illness who are in

  6  need of a 24-hour-per-day, 7-day-a-week structured living

  7  environment, respite care, or long-term community placement.

  8         (28)(19)  "Service district" means a community service

  9  district as established by the department under s. 20.19 for

10  the purpose of providing community substance alcohol, drug

11  abuse, and mental health services.

12         (29)(20)  "Service provider" means any agency in which

13  all or any portion of the programs or services set forth in s.

14  394.675 are carried out.

15         Section 7.  Section 394.674, Florida Statutes, is

16  created to read:

17         394.674  Clinical and financial eligibility for

18  publicly funded substance abuse and mental health services.--

19         (1)  To be eligible to receive substance abuse and

20  mental health services financed by the department, a person

21  must:

22         (a)  Be assessed by a mental health professional, as

23  defined in s. 394.455(2), s. 394.455(4), s. 394.455(21), s.

24  394.455(23), or s. 394.455(24), as a person who is

25  experiencing an acute mental or emotional crisis, as defined

26  in s. 394.67, or be assessed by a substance abuse professional

27  under chapter 397 as a person who is experiencing an acute

28  substance abuse crisis, as defined in s. 394.67;

29         (b)  Be assessed by a mental health professional, as

30  defined in s. 394.455(2), s. 394.455(4), s. 394.455(21), s.

31  394.455(23), or s. 394.455(24), as:

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  1         1.  An adult who has a serious mental illness, as

  2  defined in s. 394.67; or

  3         2.  A child or adolescent who has an emotional

  4  disturbance, as defined in s. 394.492(5), or who has a serious

  5  emotional disturbance or mental illness, as defined in s.

  6  394.492(6);

  7         (c)  Be assessed by a qualified professional, as

  8  defined in s. 397.311 or s. 397.416, as:

  9         1.  An adult who has a substance abuse impairment, as

10  defined in s. 394.67; or

11         2.  A child or adolescent who has substance abuse

12  problems, as defined in s. 397.93(2); or

13         (d)  Be included in a priority client group identified

14  in the Substance Abuse Prevention and Treatment Block Grant,

15  Pub. L. No. 102-321.

16         (2)  Crisis services, as defined in s. 394.67, must,

17  within the limitations of available state and local matching

18  resources, be available to each person who is eligible for

19  services under paragraph (1)(a), regardless of the person's

20  ability to pay for such services. A person who is experiencing

21  a mental health crisis and who does not meet the criteria for

22  involuntary examination under s. 394.463(1), or a person who

23  is experiencing a substance abuse crisis and who does not meet

24  the involuntary admission criteria in s. 397.675, must

25  contribute to the cost of his or her care and treatment

26  pursuant to the sliding fee scale developed under subsection

27  (6), unless charging a fee is contraindicated because of the

28  crisis situation.

29         (3)  Mental health services, substance abuse services,

30  and crisis services as defined in s. 394.67, must, within the

31  limitations of available state and local matching resources,

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  1  be available to each person who is eligible for services under

  2  paragraph (1)(b), paragraph (1)(c), or paragraph (1)(d). Such

  3  person must contribute to the cost of his or her care and

  4  treatment pursuant to the sliding fee scale developed under

  5  subsection (6).

  6         (4)  If a county matches the appropriate state funds

  7  with local funds as required in s. 394.76(3)(b) during any

  8  fiscal year, the department must allow that county to spend up

  9  to 10 percent of its general revenue funds, federal block

10  grant funds, and local matching funds for the next fiscal year

11  on special local needs for substance abuse and mental health

12  services. With these funds, the county may serve children,

13  adolescents, and adults whose mental illness, emotional

14  disturbance, or substance abuse problems do not meet the

15  clinical criteria specified in subsection (1), or persons who

16  are at risk of mental illness, emotional disturbances, or

17  substance abuse problems, as defined in this chapter or

18  chapter 397. The department must provide a description in the

19  district substance abuse and mental health plan under s.

20  394.75 of all client groups that are to receive treatment and

21  support services under this subsection, as well as a

22  description of those services.

23         (5)  Subsection (4) does not prohibit the department

24  from using a portion of federal or state funds allocated for

25  substance abuse treatment for substance-abuse-prevention

26  activities. Federal mandates related to

27  substance-abuse-prevention programs must be funded and

28  implemented in accordance with federal requirements. The

29  department must describe in the district substance abuse and

30  mental health plan pursuant to s. 394.75 the children,

31  adolescents, and adults who are at risk of substance abuse

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  1  impairment and the appropriate substance-abuse-prevention

  2  services for each population group.

  3         (6)  The department shall adopt rules to implement the

  4  requirements for clinical and financial eligibility for

  5  publicly funded substance abuse and mental health services

  6  provided within the department's service districts. The rules

  7  must include a sliding fee scale for persons who have a net

  8  family income at or above 150 percent of the Federal Poverty

  9  Income Guidelines. The sliding fee scale must account for

10  geographic differentials and must use the uniform schedule of

11  discounts by which a provider under contract with the

12  department discounts its established client charges for

13  services supported by state, federal, or local funds, using

14  factors such as family income and family size. The rules must

15  address the most expensive types of treatment, such as

16  residential and inpatient treatment, making it possible for a

17  family to responsibly contribute to a family member's mental

18  health or substance abuse care without jeopardizing the

19  family's financial stability. The rules must specify that the

20  monthly fees assessed to a client who is receiving mental

21  health and substance abuse services financed by state,

22  federal, and local funds may not exceed 10 percent of the

23  family's monthly gross income. A person whose net family

24  income is less than 150 percent of the Federal Poverty Income

25  Guidelines must not be required to pay a portion of his or her

26  treatment costs.

27         (7)  A person who meets the eligibility criteria in

28  subsection (1) shall be served in accordance with the

29  appropriate district substance abuse and mental health

30  services plan specified in s. 394.75 and within available

31  resources.

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  1         Section 8.  Section 394.675, Florida Statutes, is

  2  amended to read:

  3         394.675  Substance Alcohol, drug abuse, and mental

  4  health service system.--

  5         (1)  A community-based system of comprehensive

  6  substance alcohol, drug abuse, and mental health services

  7  shall be established and shall include as follows:

  8         (a)  Crisis services.

  9         (b)  Substance abuse services.

10         (c)  Mental health services.

11         (a)  "Primary care services" are those services which,

12  at a minimum, must be made available in each service district

13  to persons who have acute or chronic mental illnesses, who are

14  acute or chronic drug dependents, and who are acute or chronic

15  alcohol abusers to provide them with immediate care and

16  treatment in crisis situations and to prevent further

17  deterioration or exacerbation of their conditions.  These

18  services include, but are not limited to,

19  emergency-stabilization services, detoxification services,

20  inpatient services, residential services, and case management

21  services.

22         (b)  "Rehabilitative services" are those services which

23  are made available to the general population at risk of

24  serious mental health problems or substance abuse problems or

25  which are provided as part of a rehabilitative program.  These

26  services are designed to prepare or train persons to function

27  within the limits of their disabilities, to restore previous

28  levels of functioning, or to improve current levels of

29  inadequate functioning. Rehabilitative services include, but

30  are not limited to, outpatient services, day treatment

31  services, and partial hospitalization services.

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  1         (c)  "Preventive services" are those services which are

  2  made available to the general population for the purpose of

  3  preventing or ameliorating the effects of alcohol abuse, drug

  4  abuse, or mental illness.  These services emphasize the

  5  reduction of the occurrence of emotional disorders, mental

  6  disorders, and substance abuse through public education, early

  7  detection, and timely intervention.  Preventive services

  8  include consultation, public education, and prevention

  9  services which have been determined through the district

10  planning process to be necessary to complete a continuum of

11  services as required by this part and which are included in

12  the district plan.

13         (2)  Notwithstanding the provisions of this part, funds

14  that which are provided through state and federal sources for

15  specific services or for specific populations shall be used

16  for those purposes.

17         Section 9.  Section 394.74, Florida Statutes, is

18  amended to read:

19         394.74  Contracts for provision of local substance

20  alcohol, drug abuse, and mental health programs.--

21         (1)  The department, when funds are available for such

22  purposes, is authorized to contract for the establishment and

23  operation of local substance alcohol, drug abuse, and mental

24  health programs with any hospital, clinic, laboratory,

25  institution, or other appropriate service provider.

26         (2)(a)  Contracts for service shall be consistent with

27  the approved district plan and the service priorities

28  established in s. 394.75(4).

29         (b)  Notwithstanding s. 394.76(3)(a) and (c), the

30  department may use unit cost methods of payment in contracts

31  for purchasing mental health and substance abuse services. The

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  1  unit cost contracting system must account for those patient

  2  fees that are paid on behalf of a specific client and those

  3  that are earned and used by the provider for those services

  4  funded in whole or in part by the department.

  5         (c)  The department may reimburse actual expenditures

  6  for startup contracts and fixed capital outlay contracts in

  7  accordance with contract specifications.

  8         (3)  Contracts shall include, but are not limited to:

  9         (a)  A provision that, within the limits of available

10  resources, substance primary care alcohol, drug abuse, and

11  mental health crisis services, as defined in s. 394.67(8),

12  shall be available to any individual residing or employed

13  within the service area, regardless of ability to pay for such

14  services, current or past health condition, or any other

15  factor;

16         (b)  A provision that such services be available with

17  priority of attention being given to individuals who exhibit

18  symptoms of chronic or acute substance alcoholism, drug abuse,

19  or mental illness and who are unable to pay the cost of

20  receiving such services;

21         (c)  A provision that every reasonable effort to

22  collect appropriate reimbursement for the cost of providing

23  substance alcohol, drug abuse, and mental health services to

24  persons able to pay for services, including first-party

25  payments and third-party payments, shall be made by facilities

26  providing services pursuant to this act;

27         (d)  A program description and line-item operating

28  budget by program service component for substance alcohol,

29  drug abuse, and mental health services, provided the entire

30  proposed operating budget for the service provider will be

31  displayed; and

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  1         (e)  A requirement that the contractor must conform to

  2  department rules and the priorities established thereunder.

  3         (4)  The department shall develop standard contract

  4  forms for use between the district administrator and community

  5  substance alcohol, drug abuse, and mental health service

  6  providers.

  7         (5)  Nothing in This part does not prevent prevents any

  8  municipality city or county, or combination of municipalities

  9  cities and counties, from owning, financing, and operating a

10  substance an alcohol, drug abuse, or mental health program by

11  entering into an arrangement with the district to provide, and

12  be reimbursed for, services provided as part of the district

13  plan.

14         Section 10.  Section 394.75, Florida Statutes, is

15  amended to read:

16         394.75  District substance alcohol, drug abuse, and

17  mental health plans.--

18         (1)(a)  The district health and human services board

19  planning council shall prepare a combined district substance

20  alcohol, drug abuse, and mental health plan.  The plan shall

21  be prepared annually on a biennial basis and shall be reviewed

22  annually and shall reflect both the program priorities

23  established by the department and the needs of the district

24  established under ss. 394.674 and 394.675.  The plan shall

25  include a program description and line-item budget by program

26  service component for substance alcohol, drug abuse, and

27  mental health service providers that will receive state funds.

28  The entire proposed operating budget for each service provider

29  shall be displayed.  A schedule, format, and procedure for

30  development and review of the plan shall be adopted

31  promulgated by the department.

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  1         (b)  The plan shall be submitted by the district board

  2  planning council to the district administrator and to the

  3  governing bodies for review, comment, and approval, as

  4  provided in subsection (9).

  5         (2)  The plan shall:

  6         (a)  Describe the publicly funded, community-based

  7  substance abuse and mental health system of care and identify

  8  statutorily defined populations, their service needs, and the

  9  resources available and required to meet their needs.

10         (b)  Provide the means for meeting the needs of the

11  district's eligible clients, specified in ss. 394.674 and

12  394.675, for substance abuse and mental health services.

13         (c)  Provide a process for coordinating the delivery of

14  services within a community-based system of care to eligible

15  clients. Such process must involve service providers, clients,

16  and other stakeholders. The process must also provide a means

17  by which providers will coordinate and cooperate to strengthen

18  linkages, achieve maximum integration of services, foster

19  efficiencies in service delivery and administration, and

20  designate responsibility for outcomes for eligible clients.

21         (d)(a)  Provide a projection of district program and

22  fiscal needs for the next fiscal year biennium, provide for

23  the orderly and economical development of needed services, and

24  indicate priorities, performance outcomes, and anticipated

25  expenditures and revenues.

26         (e)(b)  Include a summary budget request for the total

27  district substance alcohol, drug abuse, and mental health

28  program, which must shall include the funding priorities

29  established by the district planning process.

30         (f)(c)  Provide a basis for the district legislative

31  budget request.

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  1         (g)(d)  Include a policy and procedure for allocation

  2  of funds.

  3         (h)(e)  Include a procedure for securing local matching

  4  funds. Such a procedure shall be developed in consultation

  5  with governing bodies and service providers.

  6         (i)(f)  Provide for the integration of substance

  7  alcohol, drug abuse, and mental health services with the other

  8  departmental programs and with the criminal justice, juvenile

  9  justice, child protection, school, and health care systems

10  system within the district.

11         (j)(g)  Provide a plan for the coordination of services

12  in such manner as to ensure effectiveness and avoid

13  duplication, fragmentation of services, and unnecessary

14  expenditures.

15         (k)(h)  Provide for continuity of client care between

16  state treatment facilities and community programs.

17         (l)(i)  Provide for the most appropriate and economical

18  use of all existing public and private agencies and personnel.

19         (m)(j)  Provide for the fullest possible and most

20  appropriate participation by existing programs; state

21  hospitals and other hospitals; city, county, and state health

22  and family service agencies; drug abuse and alcoholism

23  programs; probation departments; physicians; psychologists;

24  social workers; public health nurses; school systems; and all

25  other public and private agencies and personnel that which are

26  required to, or may agree to, participate in the plan.

27         (n)(k)  Include an inventory of all public and private

28  substance alcohol, drug abuse, and mental health resources

29  within the district, including consumer advocacy groups

30  registered with the department.

31

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  1         (3)  The plan shall address how substance abuse and

  2  mental health primary care services will be provided and how a

  3  system of care for target populations continuum of services

  4  will be provided given the resources available in the service

  5  district. The plan must include provisions for providing

  6  clients with access to the most recently developed psychiatric

  7  medications approved by the United States Food and Drug

  8  Administration, for developing independent housing units

  9  through participation in the Section 811 program operated by

10  the United States Department of Housing and Urban Development,

11  for developing supported employment services through the

12  Division of Vocational Rehabilitation of the Department of

13  Labor and Employment Security, and for providing services to

14  adults who have a serious mental illness, as defined in s.

15  394.67, and who reside in assisted-living facilities.

16         (4)  The plan shall provide the means by which the

17  needs of the following population groups specified in s.

18  394.674 having priority will be addressed in the district.:

19         (a)  Chronic public inebriates;

20         (b)  Marginally functional alcoholics;

21         (c)  Chronic opiate abusers;

22         (d)  Poly-drug abusers;

23         (e)  Chronically mentally ill individuals;

24         (f)  Acutely mentally ill individuals;

25         (g)  Severely emotionally disturbed children and

26  adolescents;

27         (h)  Elderly persons at high risk of

28  institutionalization; and

29         (i)  Individuals returned to the community from a state

30  mental health treatment facility.

31

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  1         (5)  In developing the plan, optimum use shall be made

  2  of any federal, state, and local funds that may be available

  3  for substance alcohol, drug abuse, and mental health service

  4  planning. However, the department must provide these services

  5  within legislative appropriations.

  6         (6)  The board planning council shall establish a

  7  subcommittee to prepare the portion of the district plan

  8  relating to children and adolescents. The subcommittee shall

  9  include representative membership of any committee organized

10  or established by the district to review placement of children

11  and adolescents in residential treatment programs. The board

12  shall establish a subcommittee to prepare the portion of the

13  district plan which relates to adult mental health and

14  substance abuse. The subcommittee must include representatives

15  from the community who have an interest in mental health and

16  substance abuse treatment for adults.

17         (7)  All departments of state government and all local

18  public agencies shall cooperate with officials to assist them

19  in service planning. Each district administrator shall, upon

20  request and the availability of staff, provide consultative

21  services to the local agency directors and governing bodies.

22         (8)  The district administrator shall ensure that the

23  district plan:

24         (a)  Conforms to the priorities in the state plan, the

25  requirements of this part, and the standards adopted under

26  this part;

27         (b)  Ensures that the most effective and economical use

28  will be made of available public and private substance

29  alcohol, drug abuse, and mental health resources in the

30  service district; and

31

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  1         (c)  Has adequate provisions made for review and

  2  evaluation of the services provided in the service district.

  3         (9)  The district administrator shall require such

  4  modifications in the district plan as he or she deems

  5  necessary to bring the plan into conformance with the

  6  provisions of this part. If the district board planning

  7  council and the district administrator cannot agree on the

  8  plan, including the projected budget, the issues under dispute

  9  shall be submitted directly to the secretary of the department

10  for immediate resolution.

11         (10)  Each governing body that provides local funds has

12  the authority to require necessary modification to only that

13  portion of the district plan which affects substance alcohol,

14  drug abuse, and mental health programs and services within the

15  jurisdiction of that governing body.

16         (11)  The district administrator shall report annually

17  to the district board planning council the status of funding

18  for priorities established in the district plan.  Each report

19  must include:

20         (a)  A description of the district plan priorities that

21  were included in the district legislative budget request;

22         (b)  A description of the district plan priorities that

23  were included in the departmental budget request prepared

24  under s. 20.19; and

25         (c)  A description of the programs and services

26  included in the district plan priorities that were

27  appropriated funds by the Legislature in the legislative

28  session that preceded the report.

29         Section 11.  Subsections (3), (4), (8), (9), (10), and

30  (11) of section 394.76, Florida Statutes, are amended to read:

31

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  1         394.76  Financing of district programs and

  2  services.--If the local match funding level is not provided in

  3  the General Appropriations Act or the substantive bill

  4  implementing the General Appropriations Act, such funding

  5  level shall be provided as follows:

  6         (3)  The state share of financial participation shall

  7  be determined by the following formula:

  8         (a)  The state share of approved program costs shall be

  9  a percentage of the net balance determined by deducting from

10  the total operating cost of services and programs, as

11  specified in s. 394.675(1), those expenditures which are

12  ineligible for state participation as provided in subsection

13  (7) and those ineligible expenditures established by rule of

14  the department pursuant to s. 394.78.

15         (b)  Residential and case management services which are

16  funded as part of a deinstitutionalization project shall not

17  require local matching funds and shall not be used as local

18  matching funds.  The state and federal financial participation

19  portions of Medicaid earnings pursuant to Title XIX of the

20  Social Security Act, except for the amount of general revenue

21  equal to the amount appropriated in 1985-1986 plus all other

22  general revenue that is shifted from any other alcohol, drug

23  abuse, and mental health appropriation category after fiscal

24  year 1986-1987 or substance abuse and mental health

25  appropriation category after fiscal year 2000-2001, shall not

26  require local matching funds and shall not be used as local

27  matching funds. Local matching funds are not required for

28  general revenue transferred by the department into substance

29  alcohol, drug abuse, and mental health appropriations

30  categories during a fiscal year to match federal funds earned

31  from Medicaid services provided for mental health clients in

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  1  excess of the amounts initially appropriated. Funds for

  2  children's services which were provided through the Children,

  3  Youth, and Families Services budget which did not require

  4  local match prior to being transferred to the Substance

  5  Alcohol, Drug Abuse, and Mental Health Services budget shall

  6  be exempt from local matching requirements.  All other

  7  contracted community alcohol and mental health services and

  8  programs, except as identified in s. 394.457(3), shall require

  9  local participation on a 75-to-25 state-to-local ratio.

10         (c)  The expenditure of 100 percent of all third-party

11  payments and fees shall be considered as eligible for state

12  financial participation if such expenditures are in accordance

13  with subsection (7) and the approved district plan.

14         (d)  Fees generated by residential and case management

15  services which are funded as part of a deinstitutionalization

16  program and do not require local matching funds shall be used

17  to support program costs approved in the district plan.

18         (e)  Any earnings pursuant to Title XIX of the Social

19  Security Act in excess of the amount appropriated shall be

20  used to support program costs approved in the district plan.

21         (4)  Notwithstanding the provisions of subsection (3),

22  the department is authorized to develop and demonstrate

23  alternative financing systems for substance alcohol, drug

24  abuse, and mental health services.  Proposals for

25  demonstration projects conducted pursuant to this subsection

26  shall be reviewed by the substantive and appropriations

27  committees of the Senate and the House of Representatives

28  prior to implementation of the projects.

29         (8)  Expenditures for capital improvements relating to

30  construction of, addition to, purchase of, or renovation of a

31  community substance alcohol, drug abuse, or mental health

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  1  facility may be made by the state, provided such expenditures

  2  or capital improvements are part and parcel of an approved

  3  district plan. Nothing shall prohibit the use of such

  4  expenditures for the construction of, addition to, renovation

  5  of, or purchase of facilities owned by a county, city, or

  6  other governmental agency of the state or a nonprofit entity.

  7  Such expenditures are subject to the provisions of subsection

  8  (6).

  9         (9)(a)  State funds for community alcohol and mental

10  health services shall be matched by local matching funds as

11  provided in paragraph (3)(b).  The governing bodies within a

12  district or subdistrict shall be required to participate in

13  the funding of alcohol and mental health services under the

14  jurisdiction of such governing bodies. The amount of the

15  participation shall be at least that amount which, when added

16  to other available local matching funds, is necessary to match

17  state funds.

18         (b)  The provisions of paragraph (a) to the contrary

19  notwithstanding, no additional matching funds may be required

20  solely due to the addition in the General Appropriations Act

21  of Substance Alcohol, Drug Abuse, and Mental Health Block

22  Grant Funds for local community mental health centers and

23  alcohol project grants.

24         (10)  A local governing body is authorized to

25  appropriate moneys, in lump sum or otherwise, from its public

26  funds for the purpose of carrying out the provisions of this

27  part.  In addition to the payment of claims upon submission of

28  proper vouchers, such moneys may also, at the option of the

29  governing body, be disbursed in the form of a lump-sum or

30  advance payment for services for expenditure, in turn, by the

31  recipient of the disbursement without prior audit by the

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  1  auditor of the governing body.  Such funds shall be expended

  2  only for substance alcohol, drug abuse, or mental health

  3  purposes as provided in the approved district plan.  Each

  4  governing body appropriating and disbursing moneys pursuant to

  5  this subsection shall require the expenditure of such moneys

  6  by the recipient of the disbursement to be audited annually

  7  either in conjunction with an audit of other expenditures or

  8  by a separate audit.  Such annual audits shall be furnished to

  9  the governing bodies of each participating county and

10  municipality for their examination.

11         (11)  No additional local matching funds shall be

12  required solely due to the addition in the General

13  Appropriations Act of substance alcohol, drug abuse, and

14  mental health block grant funds for local community mental

15  health centers, drug abuse programs, and alcohol project

16  grants.

17         Section 12.  Subsection (1) of section 394.77, Florida

18  Statutes, is amended to read:

19         394.77  Uniform management information, accounting, and

20  reporting systems for providers.--The department shall

21  establish, for the purposes of control of costs:

22         (1)  A uniform management information system and fiscal

23  accounting system for use by providers of community substance

24  alcohol, drug abuse, and mental health services.

25         Section 13.  Subsections (2), (3), (4), and (5) of

26  section 394.78, Florida Statutes, are amended to read:

27         394.78  Operation and administration; personnel

28  standards; procedures for audit and monitoring of service

29  providers; resolution of disputes.--

30         (2)  The department shall, by rule, establish standards

31  of education and experience for professional and technical

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  1  personnel employed in substance alcohol, drug abuse, and

  2  mental health programs.

  3         (3)  The department shall establish, to the extent

  4  possible, a standardized auditing procedure for substance

  5  alcohol, drug abuse, and mental health service providers; and

  6  audits of service providers shall be conducted pursuant to

  7  such procedure and the applicable department rules.  Such

  8  procedure shall be supplied to all current and prospective

  9  contractors and subcontractors prior to the signing of any

10  contracts.

11         (4)  The department shall monitor service providers for

12  compliance with contracts and applicable state and federal

13  regulations.  A representative of the district health and

14  human services board planning council shall be represented on

15  the monitoring team.

16         (5)  In unresolved disputes regarding this part or

17  rules established pursuant to this part, providers and

18  district health and human services boards planning councils

19  shall adhere to formal procedures specified under s.

20  20.19(8)(n) as provided by the rules established by the

21  department.

22         Section 14.  Section 394.79, Florida Statutes, is

23  amended to read:

24         394.79  State substance alcohol, drug abuse, and mental

25  health plan.--

26         (1)  The department shall prepare an annual a biennial

27  plan for the delivery and financing of a system of substance

28  alcohol, drug abuse, and mental health services.  The plan

29  shall include:

30         (a)  The current and projected need for substance

31  alcohol, drug abuse, and mental health services, displayed

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  1  statewide and by district, and the extent to which the need is

  2  being addressed by existing services.

  3         (b)  A proposal for the development of a data system

  4  that will evaluate the effectiveness of programs and services

  5  provided to clients of the substance alcohol, drug abuse, and

  6  mental health service system.

  7         (c)  A proposal to resolve the funding discrepancies

  8  between districts.

  9         (d)  A methodology for the allocation of resources

10  available from federal, state, and local sources and a

11  description of the current level of funding available from

12  each source.

13         (e)  A description of the statewide priorities for

14  clients and services and each district's priorities for

15  clients and services.

16         (f)  Recommendations for methods of enhancing local

17  participation in the planning, organization, and financing of

18  substance alcohol, drug abuse, and mental health services.

19         (g)  A description of the current methods of

20  contracting for services, an assessment of the efficiency of

21  these methods in providing accountability for contracted

22  funds, and recommendations for improvements to the system of

23  contracting.

24         (h)  Recommendations for improving access to services

25  by clients and their families.

26         (i)  Guidelines and formats for the development of

27  district plans.

28         (j)  Recommendations for future directions for the

29  substance alcohol, drug abuse, and mental health service

30  delivery system.

31

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  1         (2)  The department shall prepare the state plan in

  2  consultation with district administrators, state treatment

  3  facility administrators, and district planning councils.

  4         (3)  A copy of the state plan shall be submitted to the

  5  Legislature and each district planning council.  A summary

  6  budget request and a summary statement of priorities from each

  7  service district shall be attached to the plan.

  8         Section 15.  Section 394.908, Florida Statutes, is

  9  amended to read:

10         394.908  Substance Alcohol, drug abuse, and mental

11  health funding equity; distribution of appropriations.--In

12  recognition of the historical inequity among service districts

13  of the former Department of Health and Rehabilitative Services

14  in the funding of substance alcohol, drug abuse, and mental

15  health services, and in order to rectify this inequity and

16  provide for equitable funding in the future throughout the

17  state, the following funding process shall be adhered to,

18  beginning with the 1997-1998 fiscal year:

19         (1)  Funding thresholds for substance alcohol, drug

20  abuse, and mental health services in each of the current

21  districts, statewide, shall be established based on the

22  current number of persons in need per district of substance

23  for alcohol and drug abuse, and for mental health services,

24  respectively.

25         (2)  "Persons in need" means those persons who fit the

26  profile of the respective target populations and require

27  mental health or substance abuse services.

28         (3)  Seventy-five Beginning July 1, 1997, 75 percent of

29  any additional funding beyond the 1996-1997 fiscal year base

30  appropriation for alcohol, drug abuse, and mental health

31

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  1  services shall be allocated to districts for substance abuse

  2  and mental health services based on:

  3         (a)  Epidemiological estimates of disabilities which

  4  apply to the respective target populations.

  5         (b)  A pro rata share distribution that ensures

  6  districts below the statewide average funding level per person

  7  in each target population of "persons in need" receive funding

  8  necessary to achieve equity.

  9         (4)  The remaining 25 percent shall be allocated based

10  on the number of persons in need of substance alcohol, drug

11  abuse, and mental health services per district without regard

12  to current funding levels.

13         (5)  Target populations for persons in need shall be

14  displayed for each district and distributed concurrently with

15  the approved operating budget. The display by target

16  population shall show:  The annual number of persons served

17  based on prior year actual numbers, the annual cost per person

18  served, the number of persons served by service cost center,

19  and the estimated number of the total target population for

20  persons in need.

21         (6)  The annual cost per person served shall be defined

22  as the total actual funding for each target population divided

23  by the number of persons served in the target population for

24  that year.

25         (7)  Commencing on July 1, 1998, all additional funding

26  pursuant to this section shall be performance-based.

27         Section 16.  (1)  The Department of Children and Family

28  Services shall prepare a master plan every 3 years for

29  implementing a publicly funded, community-based integrated

30  system of care for mental health and substance abuse services

31  throughout the state. The plan must identify strategies for

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  1  meeting the treatment and support needs of children,

  2  adolescents, and adults who have, or are at risk of having,

  3  mental, emotional, or substance abuse problems as defined in

  4  chapter 394 or chapter 397, Florida Statutes. The plan must be

  5  updated annually and must include input from persons who

  6  represent local communities and stakeholders interested in

  7  mental health and substance abuse services. The plan must

  8  include statewide policies and planning parameters that will

  9  be used by the health and human services boards in preparing

10  the district substance abuse and mental health plans under

11  section 394.75, Florida Statutes. The plan and annual updates

12  must be submitted to the President of the Senate and the

13  Speaker of the House of Representatives on January 1 of each

14  year, beginning January 1, 2001.

15         (2)  The initial master plan must include an assessment

16  of the clinical practice guidelines and standards for

17  community-based mental health and substance abuse services

18  delivered by agencies under contract with the Department of

19  Children and Family Services. The assessment must include an

20  inventory of current clinical guidelines and standards used by

21  agencies under contract with the department and by nationally

22  recognized accreditation organizations to address quality of

23  care and must specify additional clinical practice standards

24  and guidelines for new or existing services and programs. The

25  master plan must propose changes in departmental policy or

26  statutory revisions to strengthen the quality of mental health

27  and substance abuse treatment and support services.

28         Section 17.  By July 1 of each year, the Department of

29  Children and Family Services shall submit a report to the

30  Legislature which describes the compliance of providers that

31  provide substance abuse treatment programs and mental health

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  1  services under contract with the Department of Children and

  2  Family Services. The report must describe the status of

  3  compliance with the annual performance outcome standards

  4  established in the General Appropriations Act and must address

  5  the providers that meet or exceed performance standards, the

  6  providers that did not achieve performance standards for which

  7  corrective action measures were developed, and the providers

  8  whose contracts were terminated due to failure to meet the

  9  requirements of the corrective plan.

10         Section 18.  This act shall take effect July 1, 2000.

11

12            *****************************************

13                          SENATE SUMMARY

14    Redesignates part IV of ch. 394, F.S., as "The Community
      Substance Abuse and Mental Health Services Act." Revises
15    criteria and requirements for the Department of Children
      and Family Services in providing a community-based system
16    of comprehensive substance abuse and mental health
      services. Requires that the system include crisis
17    services, substance abuse services, and mental health
      services. Provides rulemaking authority for the
18    Department of Children and Family Services. Requires that
      the department establish a sliding fee scale for clients
19    who receive services under the act. Requires that
      district health and human services boards rather than
20    planning councils prepare substance abuse and mental
      health plans. Revises the population groups to be
21    addressed in the plans. Requires that the Department of
      Children and Family Services submit a master plan to the
22    Legislature every 3 years. Requires the department to
      report to the Legislature annually on the compliance of
23    providers with performance outcome standards. (See bill
      for details.)
24

25

26

27

28

29

30

31

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