Senate Bill sb1258c2
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Florida Senate - 2001 CS for CS for SB 1258
By the Committees on Health, Aging and Long-Term Care;
Children and Families; and Senator Mitchell
317-1690A-01
1 A bill to be entitled
2 An act relating to behavioral health services;
3 providing legislative findings with respect to
4 providing mental health and
5 substance-abuse-treatment services; permitting
6 the Department of Children and Family Services
7 and the Agency for Health Care Administration
8 to contract for the establishment of two
9 behavioral health service delivery strategies
10 to test methods and techniques for
11 coordinating, integrating, and managing the
12 delivery of mental health services and
13 substance-abuse-treatment services for persons
14 with emotional, mental, or addictive disorders;
15 requiring a managing entity for each service
16 delivery strategy; requiring that costs be
17 shared by the Department of Children and Family
18 Services and the Agency for Health Care
19 Administration; specifying the goals of the
20 service delivery strategies; specifying the
21 target population of persons to be enrolled
22 under each strategy; requiring a continuing
23 care system; requiring an advisory body for
24 each demonstration model; requiring certain
25 cooperative agreements; providing reporting
26 requirements; requiring an independent entity
27 to evaluate the service delivery strategies;
28 requiring annual reports; creating a Behavioral
29 Health Services Integration Workgroup;
30 requiring the Secretary of the Department of
31 Children and Family Services to appoint members
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1 to the Workgroup; providing authority for a
2 transfer of funds to support the Workgroup;
3 requiring the Workgroup to report to the
4 Governor and the Legislature; creating s.
5 394.499, F.S.; authorizing the Department of
6 Children and Family Services, in consultation
7 with the Agency for Health Care Administration,
8 to establish children's behavioral crisis unit
9 demonstration models to provide integrated
10 emergency mental health and substance abuse
11 services to persons under 18 years of age at
12 facilities licensed as children's crisis
13 stabilization units; providing for standards,
14 procedures, and requirements for services;
15 providing eligibility criteria; requiring the
16 department to report on the initial
17 demonstration models; providing for expanding
18 the demonstration models; providing for
19 independent evaluation and report; providing
20 rulemaking authority; amending s. 394.66, F.S.;
21 providing legislative intent; creating s.
22 394.741, F.S.; requiring the Agency for Health
23 Care Administration and the Department of
24 Children and Family Services to accept
25 accreditation in lieu of its administrative and
26 program monitoring under certain circumstances;
27 amending s. 394.90, F.S.; requiring the Agency
28 for Health Care Administration to accept
29 accreditation in lieu of its onsite licensure
30 reviews; amending s. 397.411, F.S.; requiring
31 the Department of Children and Family Services
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1 to accept accreditation in lieu of its onsite
2 licensure reviews; amending s. 397.403, F.S.;
3 conforming provisions; providing an effective
4 date.
5
6 Be It Enacted by the Legislature of the State of Florida:
7
8 Section 1. Behavioral Health Service Delivery
9 Strategies.--
10 (1) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
11 finds that a management structure that places the
12 responsibility for mental health and substance-abuse-treatment
13 services within a single entity and that contains a flexible
14 funding arrangement will allow for customized services to meet
15 individual client needs and will provide incentives for
16 provider agencies to serve persons in the target population
17 who have the most complex treatment and support needs. The
18 Legislature recognizes that in order for the state's publicly
19 funded mental health and substance-abuse-treatment systems to
20 evolve into a single well-integrated behavioral health system,
21 a transition period is needed and demonstration sites must be
22 established where new ideas and technologies can be tested and
23 critically reviewed.
24 (2) DEFINITIONS.--As used in this section, the term:
25 (a) "Behavioral health services" means mental health
26 services and substance-abuse-treatment services that are
27 provided with state and federal funds.
28 (b) "Managing entity" means an entity that manages the
29 delivery of behavioral health services.
30 (3) SERVICE DELIVERY STRATEGIES.--The Department of
31 Children and Family Services and the Agency for Health Care
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1 Administration shall develop service delivery strategies that
2 will improve the coordination, integration, and management of
3 the delivery of mental health and substance-abuse-treatment
4 services to persons with emotional, mental, or addictive
5 disorders. It is the intent of the Legislature that a
6 well-managed service delivery system will increase access for
7 those in need of care, improve the coordination and continuity
8 of care for vulnerable and high-risk populations, redirect
9 service dollars from restrictive care settings and out-of-date
10 service models to community-based psychiatric rehabilitation
11 services, and reward cost-effective and appropriate care
12 patterns. The Legislature recognizes that the Medicaid, mental
13 health, and substance-abuse-treatment programs are three
14 separate systems and that each has unique characteristics,
15 including unique requirements for eligibility. To move toward
16 a well-integrated system of behavioral health care services
17 will require careful planning and implementation. It is the
18 intent of the Legislature that the service delivery strategies
19 will be the first phase of transferring the provision and
20 management of mental health and substance-abuse-treatment
21 services provided by the Department of Children and Family
22 Services and the Medicaid program from traditional
23 fee-for-service and unit-cost contracting methods to
24 risk-sharing arrangements. As used in this section, the term
25 "behavioral health care services" means mental health services
26 and substance-abuse-treatment services that are provided with
27 state and federal funds.
28 (4) CONTRACT FOR SERVICES.--
29 (a) The Department of Children and Family Services and
30 the Agency for Health Care Administration may contract for the
31 provision or management of behavioral health services with a
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1 managing entity in at least two geographic areas. Both the
2 Department of Children and Family Services and the Agency for
3 Health Care Administration must contract with the same
4 managing entity in any distinct geographic area where the
5 strategy operates. This managing entity shall be accountable
6 for the delivery of behavioral health services specified by
7 the department and the agency for children, adolescents, and
8 adults. The geographic area must be of sufficient size in
9 population and have enough public funds for behavioral health
10 services to allow for flexibility and maximum efficiency. At
11 least one demonstration model must be in the G. Pierce Wood
12 Memorial Hospital catchment area.
13 (b) Under one of the service delivery strategies, the
14 Department of Children and Family Services may contract with a
15 prepaid mental health plan that operates under section
16 409.912, Florida Statutes, to be the managing entity. Under
17 this strategy, the Department of Children and Family Services
18 is not required to competitively procure those services and,
19 notwithstanding other provisions of law, may employ
20 prospective payment methodologies that the department finds
21 are necessary to improve client care or institute more
22 efficient practices. The Department of Children and Family
23 Services may employ in its contract any provision of the
24 current prepaid behavioral health care plan authorized under
25 s. 409.912(3)(a) and (b), Florida Statutes, or any other
26 provision necessary to improve quality, access, continuity,
27 and price. Any contracts under this strategy in Area 6 of the
28 Agency for Health Care Administration or in the prototype
29 region under section 20.19(7), Florida Statutes, of the
30 Department of Children and Family Services may be entered with
31 the existing substance-abuse-treatment provider network if an
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1 administrative services organization is part of its network.
2 In Area 6 of the Agency for Health Care Administration or in
3 the prototype region of the Department of Children and Family
4 Services, the Department of Children and Family Services and
5 the Agency for Health Care Administration may employ
6 alternative service delivery and financing methodologies,
7 which may include prospective payment for certain population
8 groups. The population groups that are to be provided these
9 substance-abuse services would include at a minimum:
10 individuals and families receiving family safety services;
11 Medicaid-eligible children, adolescents, and adults who are
12 substance-abuse-impaired; or current recipients and persons at
13 risk of needing cash assistance under Florida's welfare reform
14 initiatives.
15 (c) Under the second service delivery strategy, the
16 Department of Children and Family Services and the Agency for
17 Health Care Administration shall competitively procure a
18 contract for the management of behavioral health services with
19 a managing entity. The Department of Children and Family
20 Services and the Agency for Health Care Administration may
21 purchase from the managing entity the management services
22 necessary to improve continuity of care and access to care,
23 contain costs, and improve quality of care. The managing
24 entity shall manage and coordinate all publicly funded
25 diagnostic or assessment services, acute care services,
26 rehabilitative services, support services, and continuing care
27 services for persons who meet the financial criteria specified
28 in part IV of chapter 394, Florida Statutes, for publicly
29 funded mental health and substance-abuse-treatment services or
30 for persons who are Medicaid eligible. The managing entity
31 shall be solely accountable for a geographic area and shall
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1 coordinate the emergency care system. The managing entity may
2 be a network of existing providers with an
3 administrative-services organization that can function
4 independently, may be an administrative-services organization
5 that is independent of local provider agencies, or may be an
6 entity of state or local government.
7 (d) Under both strategies, the Department of Children
8 and Family Services and the Agency for Health Care
9 Administration may:
10 1. Establish benefit packages based on the level of
11 severity of illness and level of client functioning;
12 2. Align and integrate procedure codes, standards, or
13 other requirements if it is jointly determined that these
14 actions will simplify or improve client services and
15 efficiencies in service delivery;
16 3. Use prepaid per capita and prepaid aggregate
17 fixed-sum payment methodologies; and
18 4. Modify their current procedure codes to increase
19 clinical flexibility, encourage the use of the most-effective
20 interventions, and support rehabilitative activities.
21 (e) The cost of the managing entity contract shall be
22 funded through a combination of funds from the Department of
23 Children and Family Services and the Agency for Health Care
24 Administration. To operate the managing entity, the Department
25 of Children and Family Services and the Agency for Health Care
26 Administration may not expend more than 10 percent of the
27 annual appropriations for mental health and
28 substance-abuse-treatment services prorated to the geographic
29 areas and must include all behavioral health Medicaid funds,
30 including psychiatric inpatient funds. This restriction does
31 not apply to a prepaid behavioral health plan that is
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1 authorized under section 409.912(3)(a) and (b), Florida
2 Statutes.
3 (f) Contracting and payment mechanisms for services
4 should promote flexibility and responsiveness and should allow
5 different categorical funds to be combined. The service array
6 should be determined by using needs assessment and
7 best-practice models.
8 (g) Medicaid reimbursement shall remain
9 fee-for-service and the mental health and
10 substance-abuse-treatment contracts under the Department of
11 Children and Family Services shall be based on unit service
12 costs until there has been sufficient experience with case-mix
13 analysis and service modeling to determine appropriate
14 prospective payment methodologies.
15 (h) Medicaid contracts for Behavioral Health Overlay
16 Services for dependent children or delinquent children will
17 remain fee-for-service. Any provider who currently contracts
18 to provide Medicaid behavioral health services with
19 residential group care facilities under the Family Safety
20 program of the Department of Children and Family Services or
21 with the Department of Juvenile Justice to serve delinquent
22 youth in residential commitment programs shall be included in
23 the network of providers in both service delivery strategies
24 and shall continue the existing staffing arrangements. During
25 the operation of the service delivery strategies, any new
26 behavioral health provider that enters into a contract with
27 residential group care facilities under the Family Safety
28 program of the Department of Children and Family Services or
29 with the Department of Juvenile Justice for delinquent youth
30 in residential commitment programs shall also be included in
31 the network.
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1 (5) GOALS.--The goal of the service delivery
2 strategies is to provide a design for an effective
3 coordination, integration, and management approach for
4 delivering effective behavioral health services to persons who
5 are experiencing a mental health or substance abuse crisis,
6 who have a disabling mental illness or substance abuse
7 disorder and will require extended services in order to
8 recover from their illness, or who need brief treatment or
9 supportive interventions to avoid a crisis or disability.
10 Other goals of the models include the following:
11 (a) Improve accountability for a local system of
12 behavioral health care services to meet performance outcomes
13 and standards.
14 (b) Assure continuity of care for all children,
15 adolescents, and adults who enter the publicly funded
16 behavioral health service system.
17 (c) Provide early diagnosis and treatment
18 interventions to enhance recovery and prevent hospitalization.
19 (d) Improve assessment of local needs for behavioral
20 health services.
21 (e) Improve the overall quality of behavioral health
22 services through the use of best-practice models.
23 (f) Demonstrate improved service integration between
24 behavioral health programs and other programs, such as
25 vocational rehabilitation, education, child welfare, primary
26 health care, emergency services, and criminal justice.
27 (g) Provide for additional testing of creative and
28 flexible strategies for financing behavioral health services
29 to enhance individualized treatment and support services.
30 (h) Control the costs of services without sacrificing
31 quality of care.
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1 (i) Coordinate the admissions and discharges from
2 state mental health hospitals and residential treatment
3 centers.
4 (j) Improve the integration, accessibility, and
5 dissemination of behavioral health data for planning and
6 monitoring purposes.
7 (k) Promote specialized behavioral health services to
8 residents of assisted living facilities.
9 (l) Reduce the admissions and the length of stay for
10 dependent children in residential treatment centers.
11 (m) Provide services to abused and neglected children
12 and their families as indicated in court-ordered case plans.
13 (6) ESSENTIAL ELEMENTS.--
14 (a) The managing entity must demonstrate the ability
15 of its network of providers to comply with the pertinent
16 provisions of chapters 394 and 397, Florida Statutes, and to
17 assure the provision of comprehensive behavioral health
18 services. The network of providers shall include, but is not
19 limited to, mental health centers, substance-abuse-treatment
20 providers, hospitals, licensed psychiatrists, licensed
21 psychiatric nurses, and mental health professionals licensed
22 under chapter 490 or chapter 491, Florida Statutes. A
23 behavioral health client served by the network under the
24 service delivery strategies may reside in his or her own home
25 or in settings including, but not limited to, assisted living
26 facilities, skilled nursing facilities, foster homes, or group
27 homes.
28 (b) The target population to be served in the service
29 delivery strategies must include children, adolescents, and
30 adults who fall into the following categories:
31 1. Adults in mental health crisis;
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1 2. Older adults in crisis;
2 3. Adults with serious and persistent mental illness;
3 4. Adults with substance-abuse problems;
4 5. Adults with forensic involvement;
5 6. Older adults with severe and persistent mental
6 illness;
7 7. Older adults with substance-abuse problems;
8 8. Children and adolescents with serious emotional
9 disturbances as defined in section 394.492(6), Florida
10 Statutes;
11 9. Children with substance-abuse problems as defined
12 in section 397.93(2), Florida Statutes;
13 10. Children and adolescents in state custody pursuant
14 to chapter 39, Florida Statutes; and
15 11. Children and adolescents in residential commitment
16 programs of the Department of Juvenile Justice pursuant to
17 chapter 985, Florida Statutes.
18 (c) The service delivery strategies must include a
19 continuing care system for persons whose clinical and
20 functional status indicates the need for these services. These
21 persons will be eligible for a range of treatment,
22 rehabilitative, and support services until they no longer need
23 the services to maintain or improve their level of
24 functioning. Given the long-term nature of some mental and
25 addictive disorders, continuing care services should be
26 sensitive to the variable needs of individuals across time and
27 shall be designed to help assure easy access for persons with
28 these long-term problems. The Department of Children and
29 Family Services shall develop criteria for the continuing care
30 program for behavioral health services.
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1 (d) A local body or group must be identified by the
2 district administrator of the Department of Children and
3 Family Services to serve in an advisory capacity to the
4 behavioral health service delivery strategy and must include
5 representatives of the local school system, the judicial
6 system, county government, public and private Baker Act
7 receiving facilities, and law enforcement agencies; a consumer
8 of the public behavioral health system; and a family member of
9 a consumer of the publicly funded system. This advisory body
10 may be the community alliance established under section
11 20.19(6), Florida Statutes, or any other suitable established
12 local group.
13 (e) The managing entity shall ensure that written
14 cooperative agreements are developed among the judicial
15 system, the criminal justice system, and the local behavioral
16 health providers in the geographic area which define
17 strategies and alternatives for diverting, from the criminal
18 justice system to the civil system as provided under part I of
19 chapter 394, Florida Statutes, or chapter 397, Florida
20 Statutes, persons with behavioral health problems who are
21 arrested for a misdemeanor. These agreements must also address
22 the provision of appropriate services to persons with
23 behavioral health problems who leave the criminal justice
24 system.
25 (f) Managing entities must submit data to the
26 Department of Children and Family Services and the Agency for
27 Health Care Administration on the use of services and the
28 outcomes for all enrolled clients. Managing entities must meet
29 performance standards developed by the Agency for Health Care
30 Administration and the Department of Children and Family
31 Services related to:
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1 1. The rate at which individuals in the community
2 receive services, including persons who receive followup care
3 after emergencies.
4 2. Clinical improvement of individuals served,
5 clinically and functionally.
6 3. Reduction of jail admissions.
7 4. Consumer and family satisfaction.
8 5. Satisfaction of key community constituents such as
9 law enforcement agencies, juvenile justice agencies, the
10 courts, the schools, local government entities, and others as
11 appropriate for the locality.
12 (g) The Agency for Health Care Administration may
13 establish a certified match program, which must be voluntary.
14 Under a certified match program, reimbursement is limited to
15 the federal Medicaid share to Medicaid-enrolled strategy
16 participants. The agency shall take no action to implement a
17 certified match program without ensuring that the consultation
18 provisions of chapter 216, Florida Statutes, have been met.
19 The agency may seek federal waivers that are necessary to
20 implement the behavioral health service delivery strategies.
21 (h)1. The Department of Children and Family Services,
22 in consultation with the Agency for Health Care
23 Administration, shall prepare an amendment by October 31,
24 2001, to the 2001 master state plan required under section
25 394.75(1), Florida Statutes, which describes each service
26 delivery strategy, including at least the following details:
27 a. Operational design;
28 b. Counties or service districts included in each
29 strategy;
30 c. Expected outcomes; and
31 d. Timeframes.
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1 2. The amendment shall specifically address the
2 application of each service delivery strategy to
3 substance-abuse services, including:
4 a. The development of substance-abuse-service
5 protocols;
6 b. Credentialing requirements for substance-abuse
7 services; and
8 c. The development of new service models for
9 individuals with co-occurring mental health and
10 substance-abuse disorders.
11 3. The amendment must specifically address the
12 application of each service delivery strategy to the child
13 welfare system, including:
14 a. The development of service models that support
15 working with both children and their families in a
16 community-based care system and that are specific to the child
17 welfare system.
18 b. A process for providing services to abused and
19 neglected children and their families as indicated in
20 court-ordered case plans.
21 (7) MONITORING AND EVALUATION.--The Department of
22 Children and Family Services and the Agency for Health Care
23 Administration shall provide routine monitoring and oversight
24 of and technical assistance to the managing entities. The
25 Louis de la Parte Florida Mental Health Institute shall
26 conduct an ongoing formative evaluation of each strategy to
27 identify the most effective methods and techniques used to
28 manage, integrate, and deliver behavioral health services. The
29 entity conducting the evaluation shall report to the
30 Department of Children and Family Services, the Agency for
31 Health Care Administration, the Executive Office of the
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1 Governor, and the Legislature every 12 months regarding the
2 status of the implementation of the service delivery
3 strategies. The report must include a summary of activities
4 that have occurred during the past 12 months of implementation
5 and any problems or obstacles that prevented, or may prevent
6 in the future, the managing entity from achieving performance
7 goals and measures. The first status report is due January 1,
8 2002. After the service delivery strategies have been
9 operational for 1 year, the status report must include an
10 analysis of administrative costs and the status of the
11 achievement of performance outcomes. Upon receiving the annual
12 report from the evaluator, the Department of Children and
13 Family Services and the Agency for Health Care Administration
14 shall jointly make any recommendations to the Executive Office
15 of the Governor regarding changes in the service delivery
16 strategies or in the implementation of the strategies,
17 including timeframes. The Executive Office of the Governor
18 shall consult with the appropriate legislative committees
19 prior to making changes in the design of the strategies or
20 prior to implementing the strategies in other geographic
21 areas. If the Executive Office of the Governor makes no
22 recommendation to implement the service delivery strategies in
23 other areas of the state after the strategies have operated
24 for 3 years, the strategies will cease. The Executive Office
25 of the Governor shall then submit a final report to the
26 Legislature which details the reasons for terminating the
27 strategies.
28 Section 2. Behavioral Health Services Integration
29 Workgroup.--
30 (1) The Secretary of the Department of Children and
31 Family Services shall establish the Behavioral Health Services
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1 Integration Workgroup, which, at a minimum, shall include
2 representatives from the following: Department of Juvenile
3 Justice, the Department of Corrections, and the Department of
4 Education; the Office of Drug Control Policy; the Agency for
5 Health Care Administration; and county jails, homeless
6 coalitions, county government, providers of behavioral health
7 services, public and private Baker Act receiving facilities,
8 providers of child-protection services, assisted living
9 facilities serving behavioral health clients, and consumers of
10 behavioral health services and their families. The Behavioral
11 Health Services Integration Workgroup shall assess barriers to
12 the effective and efficient integration of mental health and
13 substance-abuse-treatment services across various systems,
14 propose solutions to these barriers, and ensure that plans for
15 mental health and substance-abuse-treatment services which are
16 required by statute consider these solutions. Under chapter
17 216, Florida Statutes, the Department of Children and Family
18 Services may transfer up to $200,000 to support the Behavioral
19 Health Services Integration Workgroup.
20 (2) The Behavioral Health Services Integration
21 Workgroup shall submit a report to the Governor, the President
22 of the Senate, and the Speaker of the House of Representatives
23 by January 1, 2002, regarding the Workgroup's progress toward
24 achieving the goals specified in subsection (1).
25 Section 3. Section 394.499, Florida Statutes, is
26 created to read:
27 394.499 Integrated children's crisis stabilization
28 unit/juvenile addictions receiving facility services.--
29 (1) Beginning July 1, 2001, the Department of Children
30 and Family Services, in consultation with the Agency for
31 Health Care Administration, is authorized to establish
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1 children's behavioral crisis unit demonstration models in
2 Collier, Lee, and Sarasota Counties. By December 31, 2003, the
3 department shall submit to the President of the Senate, the
4 Speaker of the House of Representatives, and the chairs of the
5 Senate and House committees that oversee departmental
6 activities a report that evaluates the number of clients
7 served, quality of services, performance outcomes, and
8 feasibility of continuing or expanding the demonstration
9 models. Beginning July 1, 2004, subject to approval by the
10 Legislature, the department, in cooperation with the agency,
11 may expand the demonstration models to other areas in the
12 state. The children's behavioral crisis unit demonstration
13 models will integrate children's mental health crisis
14 stabilization units with substance abuse juvenile addictions
15 receiving facility services, to provide emergency mental
16 health and substance abuse services that are integrated within
17 facilities licensed and designated by the agency for children
18 under 18 years of age who meet criteria for admission or
19 examination under this section. The services shall be
20 designated as "integrated children's crisis stabilization
21 unit/juvenile addictions receiving facility services," shall
22 be licensed by the agency as children's crisis stabilization
23 units, and shall meet all licensure requirements for crisis
24 stabilization units. The department, in cooperation with the
25 agency, shall develop standards that address eligibility
26 criteria, clinical procedures, staffing requirements,
27 operational, administrative, and financing requirements, and
28 investigation of complaints for such integrated facility
29 services. Standards that are implemented specific to substance
30 abuse services shall meet or exceed existing standards for
31 addictions receiving facilities.
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1 (2) Children eligible to receive integrated children's
2 crisis stabilization unit/juvenile addictions receiving
3 facility services include:
4 (a) A person under 18 years of age for whom voluntary
5 application is made by his or her guardian, if such person is
6 found to show evidence of mental illness and to be suitable
7 for treatment pursuant to s. 394.4625. A person under 18 years
8 of age may be admitted for integrated facility services only
9 after a hearing to verify that the consent to admission is
10 voluntary.
11 (b) A person under 18 years of age who may be taken to
12 a receiving facility for involuntary examination, if there is
13 reason to believe that he or she is mentally ill and because
14 of his or her mental illness, pursuant to s. 394.463:
15 1. Has refused voluntary examination after
16 conscientious explanation and disclosure of the purpose of the
17 examination; or
18 2. Is unable to determine for himself or herself
19 whether examination is necessary; and
20 a. Without care or treatment is likely to suffer from
21 neglect or refuse to care for himself or herself; such neglect
22 or refusal poses a real and present threat of substantial harm
23 to his or her well-being; and it is not apparent that such
24 harm may be avoided through the help of willing family members
25 or friends or the provision of other services; or
26 b. There is a substantial likelihood that without care
27 or treatment he or she will cause serious bodily harm to
28 himself or herself or others in the near future, as evidenced
29 by recent behavior.
30
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1 (c) A person under 18 years of age who wishes to enter
2 treatment for substance abuse and applies to a service
3 provider for voluntary admission, pursuant to s. 397.601.
4 (d) A person under 18 years of age who meets the
5 criteria for involuntary admission because there is good faith
6 reason to believe the person is substance abuse impaired
7 pursuant to s. 397.675 and, because of such impairment:
8 1. Has lost the power of self-control with respect to
9 substance use; and
10 2.a. Has inflicted, or threatened or attempted to
11 inflict, or unless admitted is likely to inflict, physical
12 harm on himself or herself or another; or
13 b. Is in need of substance abuse services and, by
14 reason of substance abuse impairment, his or her judgment has
15 been so impaired that the person is incapable of appreciating
16 his or her need for such services and of making a rational
17 decision in regard thereto; however, mere refusal to receive
18 such services does not constitute evidence of lack of judgment
19 with respect to his or her need for such services.
20 (e) A person under 18 years of age who meets the
21 criteria for examination or admission under paragraph (b) or
22 paragraph (d) and has a coexisting mental health and substance
23 abuse disorder.
24 (3) The department shall contract for an independent
25 evaluation of the children's behavioral crisis unit
26 demonstration models to identify the most effective ways to
27 provide integrated crisis stabilization unit/juvenile
28 addiction receiving facility services to children. The
29 evaluation shall be reported to the Legislature by December
30 31, 2003.
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1 (4) The department, in cooperation with the agency, is
2 authorized to adopt rules regarding standards and procedures
3 for integrated children's crisis stabilization unit/juvenile
4 addictions receiving facility services.
5 Section 4. Nothing in section 3 of this act shall be
6 construed to require an existing crisis stabilization unit or
7 juvenile addictions receiving facility to convert to a
8 children's behavioral crisis unit.
9 Section 5. Subsections (13) and (14) are added to
10 section 394.66, Florida Statutes, to read:
11 394.66 Legislative intent with respect to substance
12 abuse and mental health services.--It is the intent of the
13 Legislature to:
14 (13) Promote best practices and the highest quality of
15 care in contacted alcohol, drug abuse, and mental health
16 services through achievement of national accreditation.
17 (14) Ensure that the state agencies, licensing and
18 monitoring contracted providers, perform in the most
19 cost-efficient and effective manner with limited duplication
20 and disruption to organizations providing services.
21 Section 6. Section 394.741, Florida Statutes, is
22 created to read:
23 394.741 Accreditation requirements for providers of
24 behavioral health services.--
25 (1) As used in this section, the term "behavioral
26 health services" means mental health and substance abuse
27 treatment services.
28 (2) Notwithstanding any provision of law to the
29 contrary, accreditation shall be accepted by the agency and
30 department in lieu of the agency's and department's facility
31 licensure on-site review requirements and shall be accepted as
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1 a substitute for the department's administrative and program
2 monitoring requirements, except as required by subsections (3)
3 and (4):
4 (a) Any organization from which the department
5 purchases behavioral health care services that is accredited
6 by the Joint Commission on Accreditation of Healthcare
7 Organizations or the Council on Accreditation for Children and
8 Family Services, or have those services that are being
9 purchased by the department accredited by CARF--the
10 Rehabilitation Accreditation Commission.
11 (b) Any mental health facility licensed by the agency
12 or any substance abuse component licensed by the department
13 that is accredited by the Joint Commission on Accreditation of
14 Healthcare Organizations, CARF--the Rehabilitation
15 Accreditation Commission or the Council on Accreditation of
16 Children and Family Services.
17 (c) Any network of providers from which the department
18 or the agency purchase behavioral health care services
19 accredited by the Joint Commission on Accreditation of
20 Healthcare Organizations, CARF--the Rehabilitation
21 Accreditation Commission, the Council on Accreditation of
22 Children and Family Services, or the National Committee for
23 Quality Assurance. A provider organization, which is part of
24 an accredited network, is afforded the same rights under this
25 part.
26 (3) For mental health services, the department and the
27 agency may adopt rules that establish:
28 (a) Additional standards for monitoring and licensing
29 accredited programs and facilities that the department and the
30 agency have determined are not specifically and distinctly
31 covered by the accreditation standards and processes. These
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1 standards and the associated monitoring must not duplicate the
2 standards and processes already covered by the accrediting
3 bodies.
4 (b) An on-site monitoring process between 24 months
5 and 36 months after accreditation for non-residential
6 facilities to assure that accredited organizations exempt from
7 licensing and monitoring activities under this part continue
8 to comply with critical standards.
9 (c) An on-site monitoring process between 12 months
10 and 24 months after accreditation for residential facilities
11 to assure that accredited organizations exempt from licensing
12 and monitoring activities under this part continue to comply
13 with critical standards.
14 (4) For substance abuse services, the department shall
15 conduct full licensure inspections every three years and shall
16 develop in rule criteria which would justify more frequent
17 inspections.
18 (5) The department and the agency shall be given
19 access to all accreditation reports, corrective action plans,
20 and performance data submitted to the accrediting
21 organizations. When major deficiencies, as defined by the
22 accrediting organization, are identified through the
23 accreditation process, the department and the agency may
24 perform followup monitoring to assure that such deficiencies
25 are corrected and that the corrections are sustained over
26 time. Proof of compliance with fire and health safety
27 standards will be submitted as required by rule.
28 (6) The department or agency, by accepting the survey
29 or inspection of an accrediting organization, does not forfeit
30 its rights to perform inspections at any time, including
31
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1 contract monitoring to ensure that deliverables are provided
2 in accordance with the contract.
3 (7) The department and the agency shall report to the
4 Legislature by January 1, 2003, on the viability of mandating
5 all organizations under contract with the department for the
6 provision of behavioral healthcare services, or licensed by
7 the agency or department to be accredited. The department and
8 the agency shall also report to the Legislature by January 1,
9 2003, on the viability of privatizing all licensure and
10 monitoring functions through an accrediting organization.
11 (8) The accreditation requirements of this section
12 shall apply to contracted organizations that are already
13 accredited immediately upon becoming law.
14 Section 7. Subsection (5) of section 394.90, Florida
15 Statutes, is amended to read:
16 394.90 Inspection; right of entry; records.--
17 (5)(a) The agency shall may accept, in lieu of its own
18 inspections for licensure, the survey or inspection of an
19 accrediting organization, if the provider is accredited
20 according to the provisions of s. 394.741 and the agency
21 receives the report of the accrediting organization. The
22 department, in consultation with the agency, shall develop,
23 and adopt by rule, specific criteria for assuring that the
24 accrediting organization has specific standards and experience
25 related to the program area being licensed, specific criteria
26 for accepting the standards and survey methodologies of an
27 accrediting organization, delineations of the obligations of
28 accrediting organizations to assure adherence to those
29 standards, criteria for receiving, accepting and maintaining
30 the confidentiality of the survey and corrective action
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1 reports, and allowance for the agency's participation in
2 surveys.
3 (b) The agency shall conduct compliance investigations
4 and sample validation inspections to evaluate the inspection
5 process of accrediting organizations to ensure minimum
6 standards are maintained as provided in Florida statute and
7 rule. The agency may conduct a lifesafety inspection in
8 calendar years in which an accrediting organization survey is
9 not conducted and shall conduct a full state inspection,
10 including a lifesafety inspection, if an accrediting
11 organization survey has not been conducted within the previous
12 36 months. The agency, by accepting the survey or inspection
13 of an accrediting organization, does not forfeit its right to
14 perform inspections.
15 Section 8. Subsection (2) of section 397.411, Florida
16 Statutes, is amended to read:
17 397.411 Inspection; right of entry; records.--
18 (2)(a) The department shall may accept, in lieu of its
19 own inspections for licensure, the survey or inspection of an
20 accrediting organization, if the provider is accredited
21 according to the provisions of s. 394.741 and the department
22 receives the report of the accrediting organization. The
23 department shall develop, and adopt by rule, specific criteria
24 for assuring that the accrediting organization has specific
25 standards and experience related to the program area being
26 licensed; specific criteria for accepting the standards and
27 survey methodologies of an accrediting organization;
28 delineations of the obligations of accrediting organizations
29 to assure adherence to those standards; criteria for
30 receiving, accepting, and maintaining the confidentiality of
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1 the survey and corrective action reports; and allowance for
2 the department's participation in surveys.
3 (b) The department shall conduct compliance
4 investigations and sample validation inspections to evaluate
5 the inspection process of accrediting organizations to ensure
6 minimum standards are maintained as provided in Florida
7 statute and rule. The department may conduct a fire, safety,
8 and health inspection in calendar years in which an
9 accrediting organization survey is not conducted and shall
10 conduct a full state inspection, including a lifesafety
11 inspection, if an accrediting organization survey has not been
12 conducted within the previous 36 months. The department, by
13 accepting the survey or inspection of an accrediting
14 organization, does not forfeit its right to perform
15 inspections.
16 Section 9. Subsection (3) of section 397.403, Florida
17 Statutes, is amended to read:
18 397.403 License application.--
19 (3) The department shall accept proof of accreditation
20 by CARF--the Rehabilitation Accreditation Commission on
21 Accreditation of Rehabilitation Facilities (CARF) or the Joint
22 Commission on Accreditation of Health Care Organizations
23 (JCAHCO), or through any other nationally recognized
24 certification process that is acceptable to the department and
25 meets the minimum licensure requirements under this chapter,
26 in lieu of requiring the applicant to submit the information
27 required by paragraphs (1)(a)-(c).
28 Section 10. This act shall take effect upon becoming a
29 law.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 CS for Senate Bill 1258
3
4 The Committee Substitute for Committee Substitute for Senate
Bill 1258 adds definitions for "behavioral health services"
5 and "managing entity"; exempts current prepaid behavioral
health contractors from a 10 percent limit on administrative
6 costs; requires that Medicaid contracts for behavioral health
overlay services remain fee-for-service and that present and
7 future providers be included as network providers under the
strategies that will be developed; adds additional goals to
8 the strategies including reduction in admissions and length of
stay in child residential treatment centers and the provision
9 of services to abused and neglected children and their
families per court ordered case plans; clarifies that
10 performance standards are to be developed by the Agency for
Health Care Administration and the Department of Children and
11 Family Services; requires additional details to be described
in the master state plan including development of models
12 supporting working with children in the child welfare system
and a process for providing court-ordered services to abused
13 and neglected children and their families; adds providers of
child protection services to the Behavioral Health Integration
14 Workgroup; authorizes the Department of Children and Family
Services to establish children's behavioral crisis
15 demonstration models in certain counties; and requires the
Agency for Health Care Administration and the Department of
16 Children and Family Services to accept accreditation in lieu
of onsite licensure reviews and in lieu of administrative and
17 program monitoring under certain circumstances for certain
behavioral health services providers.
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