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
31
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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
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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:
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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
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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.)
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