HB 0463

CS

CHAMBER ACTION

1	The Committee on Future of Florida's Families recommends the
2	following:
3
4	Committee Substitute
5	Remove the entire bill and insert:
6	A bill to be entitled
7	An act relating to mental health; amending s. 394.455,
8	F.S.; revising a definition; providing additional
9	definitions of terms used in pt. I of ch. 394, F.S., "The
10	Baker Act"; amending s. 394.4598, F.S.; revising language
11	with respect to the guardian advocate; providing for
12	discharge under certain circumstances; amending s.
13	394.4615, F.S.; providing for release of certain clinical
14	records to certain persons for certain purposes; amending
15	s. 394.463, F.S.; revising criteria and procedures for
16	involuntary examination; creating s. 394.4655, F.S.;
17	providing criteria and procedures for involuntary
18	outpatient placement; providing for a voluntary
19	examination for outpatient placement; providing for a
20	petition for involuntary outpatient placement; providing
21	for appointment of counsel; providing for continuance of
22	hearings; providing for a hearing on involuntary
23	outpatient placement; setting forth procedures for the
24	hearing; providing for appointment of a master to preside;
25	providing for an independent examination; requiring a
26	court to order involuntary outpatient placement under
27	certain circumstances; requiring a treatment plan;
28	providing for plan modification; providing for a patient
29	to be brought to a receiving facility upon failure or
30	refusal to comply with the treatment plan; requiring
31	attachment of a copy of the treatment plan to a petition;
32	providing for involuntary inpatient placement or
33	involuntary assessment; requiring consideration of a
34	patient's competence to proceed; requiring a list of
35	guardian advocates to be submitted to the court; defining
36	the role of a guardian advocate; providing for discharge
37	of the guardian advocate; requiring certain documentation;
38	allowing a person for whom an involuntary outpatient
39	placement petition has been filed to agree to a voluntary
40	treatment agreement; specifying requirements for
41	agreements; providing for modifications; providing for
42	filing of an affidavit of noncompliance with a voluntary
43	treatment plan; requiring a hearing; requiring dismissal
44	of petitions in certain circumstances; providing
45	procedures for continued involuntary outpatient placement;
46	providing for a continued involuntary outpatient placement
47	certificate; requiring a hearing; requiring appointment of
48	a public defender; requiring hearings; providing for
49	appointment of a special master; authorizing a patient and
50	the patient's attorney to agree to a period of continued
51	outpatient placement without a court hearing; amending s.
52	394.467, F.S.; revising language with respect to
53	involuntary inpatient placement to conform to changes made
54	by the act; revising requirements for evaluation and
55	placement; amending ss. 394.495, 394.496, 394.498,
56	419.001, and 744.704, F.S.; correcting cross references;
57	authorizing the Department of Children and Family Services
58	to adopt rules; providing severability; providing an
59	effective date.
60
61	Be It Enacted by the Legislature of the State of Florida:
62
63	Section 1.  Subsection (3) of section 394.455, Florida
64	Statutes, is amended, existing subsections (16) through (28) are
65	renumbered as subsections (18) through (30), respectively,
66	existing subsections (29) and (30) are renumbered as subsections
67	(32) and (33), respectively, and new subsections (16), (17), and
68	(31) are added to said section, to read:
69	394.455  Definitions.--As used in this part, unless the
70	context clearly requires otherwise, the term:
71	(3)  "Clinical record" means all parts of the record
72	required to be maintained and includes all medical records,
73	progress notes, charts, and admission and discharge data, and
74	all other information recorded by a facility which pertains to
75	the patient's hospitalization or and treatment.
76	(16)  "Involuntary examination" means an examination
77	performed under s. 394.463 to determine if an individual
78	qualifies for involuntary inpatient treatment under s.
79	394.467(1) or involuntary outpatient treatment under s.
80	394.4655(1).
81	(17)  "Involuntary placement" means involuntary outpatient
82	treatment pursuant to s. 394.4655 or involuntary inpatient
83	treatment pursuant to s. 394.467.
84	(31)  "Service provider" means any public or private
85	receiving facility, an entity under contract with the Department
86	of Children and Family Services to provide mental health
87	services, a clinical psychologist, a clinical social worker, a
88	physician, a nurse providing psychiatric services consistent
89	with chapter 464, or a community mental health center or clinic
90	as defined in this part.
91	Section 2.  Subsections (1) and (7) of section 394.4598,
92	Florida Statutes, are amended to read:
93	394.4598  Guardian advocate.--
94	(1)  The administrator may petition the court for the
95	appointment of a guardian advocate based upon the opinion of a
96	psychiatrist that the patient is incompetent to consent to
97	treatment. If the court finds that a patient is incompetent to
98	consent to treatment and has not been adjudicated incapacitated
99	and a guardian with the authority to consent to mental health
100	treatment appointed, it shall appoint a guardian advocate. The
101	patient has the right to have an attorney represent him or her
102	at the hearing. If the person is indigent, the court shall
103	appoint the office of the public defender to represent him or
104	her at the hearing. The patient has the right to testify, cross-
105	examine witnesses, and present witnesses. The proceeding shall
106	be recorded either electronically or stenographically, and
107	testimony shall be provided under oath. One of the professionals
108	authorized to give an opinion in support of a petition for
109	involuntary placement, as described in s. 394.4655 or s.
110	394.467(2), must testify. A guardian advocate must meet the
111	qualifications of a guardian contained in part IV of chapter
112	744, except that a professional referred to in this part, an
113	employee of the facility providing direct services to the
114	patient under this part, a departmental employee, a facility
115	administrator, or member of the Florida local advocacy council
116	shall not be appointed. A person who is appointed as a guardian
117	advocate must agree to the appointment.
118	(7)  The guardian advocate shall be discharged when the
119	patient is discharged from an order for involuntary outpatient
120	placement or involuntary inpatient placement a receiving or
121	treatment facility to the community or when the patient is
122	transferred from involuntary to voluntary status. The court or a
123	hearing officer shall consider the competence of the patient
124	pursuant to subsection (1) and may consider an involuntarily
125	placed patient's competence to consent to treatment at any
126	hearing. Upon sufficient evidence, the court may restore, or the
127	hearing officer may recommend that the court restore, the
128	patient's competence. A copy of the order restoring competence
129	or the certificate of discharge containing the restoration of
130	competence shall be provided to the patient and the guardian
131	advocate.
132	Section 3.  Subsection (3) of section 394.4615, Florida
133	Statutes, is amended to read:
134	394.4615  Clinical records; confidentiality.--
135	(3)  Information from the clinical record may be released
136	under the following circumstances when:
137	(a)  When a patient has declared an intention to harm other
138	persons. When such declaration has been made, the administrator
139	may authorize the release of sufficient information to provide
140	adequate warning to the person threatened with harm by the
141	patient.
142	(b)  When the administrator of the facility or secretary of
143	the department deems release to a qualified researcher as
144	defined in administrative rule, an aftercare treatment provider,
145	or an employee or agent of the department is necessary for
146	treatment of the patient, maintenance of adequate records,
147	compilation of treatment data, aftercare planning, or evaluation
148	of programs.
149	(c)  For the purpose of determining whether a person meets
150	the criteria for involuntary outpatient placement or for
151	preparing the proposed treatment plan pursuant to s. 394.4655,
152	the clinical record may be released to the state attorney, the
153	public defender, or the patient's private legal counsel; to the
154	court; and to the appropriate mental health professionals,
155	including the service provider identified in s.
156	394.4655(6)(b)2., in accordance with state and federal law.
157	Section 4.  Subsection (1) and paragraphs (e), (g), and (i)
158	of subsection (2) of section 394.463, Florida Statutes, are
159	amended to read:
160	394.463  Involuntary examination.--
161	(1)  CRITERIA.--A person may be taken to a receiving
162	facility for involuntary examination if there is reason to
163	believe that the person has a mental illness he or she is
164	mentally ill and because of his or her mental illness:
165	(a)1.  The person has refused voluntary examination after
166	conscientious explanation and disclosure of the purpose of the
167	examination; or
168	2.  The person is unable to determine for himself or
169	herself whether examination is necessary; and
170	(b)  Based upon the person's current reported or observed
171	behavior, considering any mental health history, there is a
172	substantial likelihood that without care or treatment:
173	1.  Without care or treatment, The person will is likely to
174	suffer from neglect or refuse to care for himself or herself;
175	such neglect or refusal will pose poses a real and present
176	threat of substantial harm to his or her well-being; and it is
177	not apparent that such harm may be avoided through the help of
178	willing family members or friends or the provision of other
179	services; or
180	2.  There is a substantial likelihood that without care or
181	treatment The person will cause serious bodily harm to himself
182	or herself or others in the near future, as evidenced by recent
183	behavior.
184	(2)  INVOLUNTARY EXAMINATION.--
185	(e)  The Agency for Health Care Administration shall
186	receive and maintain the copies of ex parte orders, involuntary
187	outpatient placement orders issued pursuant to s. 394.4655,
188	involuntary inpatient orders issued pursuant to s. 394.467,
189	professional certificates, and law enforcement officers'
190	reports. These documents shall be considered part of the
191	clinical record, governed by the provisions of s. 394.4615. The
192	agency shall prepare annual reports analyzing the data obtained
193	from these documents, without information identifying patients,
194	and shall provide copies of reports to the department, the
195	President of the Senate, the Speaker of the House of
196	Representatives, and the minority leaders of the Senate and the
197	House of Representatives.
198	(g)  A person for whom an involuntary examination has been
199	initiated who is being evaluated or treated at a hospital for an
200	emergency medical condition specified in s. 395.002 must be
201	examined by a receiving facility within 72 hours. The 72-hour
202	period begins when the patient arrives at the hospital and
203	ceases when the attending physician documents that the patient
204	has an emergency medical condition. If the patient is examined
205	at a hospital providing emergency medical services by a
206	professional qualified to perform an involuntary examination and
207	is found as a result of that examination not to meet the
208	criteria for involuntary outpatient placement pursuant to s.
209	394.4655(1) or involuntary inpatient placement pursuant to s.
210	394.467(1), the patient may be offered voluntary placement, if
211	appropriate, or released directly from the hospital providing
212	emergency medical services. The finding by the professional that
213	the patient has been examined and does not meet the criteria for
214	involuntary inpatient or involuntary outpatient placement must
215	be entered into the patient's clinical record. Nothing in this
216	paragraph is intended to prevent a hospital providing emergency
217	medical services from appropriately transferring a patient to
218	another hospital prior to stabilization, provided the
219	requirements of s. 395.1041(3)(c) have been met.
220	(i)  Within the 72-hour examination period or, if the 72
221	hours ends on a weekend or holiday, no later than the next
222	working day thereafter, one of the following actions must be
223	taken, based on the individual needs of the patient:
224	1.  The patient shall be released, unless he or she is
225	charged with a crime, in which case the patient shall be
226	returned to the custody of a law enforcement officer;
227	2.  The patient shall be released, subject to the
228	provisions of subparagraph 1., for voluntary outpatient
229	treatment;
230	3.  The patient, unless he or she is charged with a crime,
231	shall be asked to give express and informed consent to placement
232	as a voluntary patient, and, if such consent is given, the
233	patient shall be admitted as a voluntary patient; or
234	4.  If treatment is deemed necessary and the patient has
235	failed to consent to voluntary inpatient or outpatient
236	treatment, a petition for involuntary placement must shall be
237	filed in the circuit appropriate court. The petition must seek
238	involuntary placement of the patient in by the facility
239	administrator when treatment is deemed necessary; in which case,
240	the least restrictive treatment consistent with the optimum
241	improvement of the patient's condition. A petition for
242	involuntary outpatient placement shall be filed by one of the
243	petitioners specified in s. 394.4655(3)(a). A petition for
244	involuntary inpatient placement shall be filed by the facility
245	administrator shall be made available.
246	Section 5.  Section 394.4655, Florida Statutes, is created
247	to read:
248	394.4655  Involuntary outpatient placement.--
249	(1)  CRITERIA FOR INVOLUNTARY OUTPATIENT PLACEMENT.--A
250	person may be ordered to involuntary outpatient placement upon a
251	finding of the court that, by clear and convincing evidence:
252	(a)  The person is 18 years of age or older.
253	(b)  The person has a mental illness.
254	(c)  The person is unlikely to survive safely in the
255	community without supervision, based on a clinical
256	determination.
257	(d)  The person has a history of lack of compliance with
258	treatment for mental illness.
259	(e)  The person has:
260	1.  At least twice within the preceding 36 months been
261	involuntarily admitted to a receiving or treatment facility as
262	defined in s. 394.455 or has received mental health services in
263	a forensic or correctional facility. The 36-month period does
264	not include any period during which the person was admitted or
265	incarcerated; or
266	2.  Engaged in one or more acts of serious violent behavior
267	toward himself or herself or others, or attempts at serious
268	bodily harm to himself or herself or others, within the
269	preceding 36 months.
270	(f)  The person is, as a result of his or her mental
271	illness, unlikely to voluntarily participate in the recommended
272	treatment pursuant to the treatment plan.
273	(g)  In view of the person's treatment history and current
274	behavior, the person is in need of involuntary outpatient
275	placement in order to prevent a relapse or deterioration that
276	would be likely to result in serious bodily harm to himself or
277	herself or others, or a substantial harm to his or her well-
278	being as set forth in s. 394.463(1).
279	(h)  It is likely that the person will benefit from
280	involuntary outpatient placement.
281	(i)  All available less restrictive alternatives that would
282	offer an opportunity for improvement of his or her condition
283	have been judged to be inappropriate or unavailable.
284	(2)  INVOLUNTARY OUTPATIENT PLACEMENT.--
285	(a)  From a receiving facility.--A patient may be retained
286	by a receiving facility upon the recommendation of the
287	administrator of a receiving facility where the patient has been
288	examined and after adherence to the notice and hearing
289	procedures provided in s. 394.4599. The recommendation must be
290	supported by the opinion of a psychiatrist and the second
291	opinion of a clinical psychologist or another psychiatrist, both
292	of whom have personally examined the patient within the
293	preceding 72 hours, that the criteria for involuntary outpatient
294	placement are met. However, in a county having a population of
295	less than 50,000, if the administrator certifies that no
296	psychiatrist or clinical psychologist is available to provide
297	the second opinion, such second opinion may be provided by a
298	licensed physician who has postgraduate training and experience
299	in diagnosis and treatment of mental and nervous disorders or by
300	a nurse providing psychiatric services consistent with chapter
301	464. Such recommendation must be entered on an involuntary
302	outpatient placement certificate, which certificate must
303	authorize the receiving facility to retain the patient pending
304	completion of a hearing. If the patient has been stabilized and
305	no longer meets the criteria for involuntary examination
306	pursuant to s. 394.463(1), the patient must be released from the
307	receiving facility while awaiting the hearing for involuntary
308	outpatient placement.
309	(b)  Voluntary examination for outpatient placement.--A
310	patient may choose to be examined on an outpatient basis for an
311	involuntary outpatient placement certificate if such an
312	arrangement can be made. The certificate must be supported by
313	the opinion of a psychiatrist and the second opinion of a
314	clinical psychologist or another psychiatrist, both of whom have
315	personally examined the patient within the preceding 7 calendar
316	days, that the criteria for involuntary outpatient placement are
317	met. However, in a county having a population of less than
318	50,000, if the psychiatrist certifies that no psychiatrist or
319	clinical psychologist is available to provide the second
320	opinion, the second opinion may be provided by a licensed
321	physician who has postgraduate training and experience in
322	diagnosis and treatment of mental and nervous disorders or by a
323	nurse providing psychiatric services consistent with chapter
324	464.
325	(c)  From a treatment facility.--If a patient in
326	involuntary inpatient placement meets the criteria for
327	involuntary outpatient placement, the administrator of the
328	treatment facility may, before expiration of the period during
329	which the treatment facility is authorized to retain the
330	patient, recommend involuntary outpatient placement. The
331	recommendation must be supported by the opinion of a
332	psychiatrist and the second opinion of a clinical psychologist
333	or another psychiatrist, both of whom have personally examined
334	the patient within the preceding 72 hours, that the criteria for
335	involuntary outpatient placement are met. However, in a county
336	having a population of less than 50,000, if the administrator
337	certifies that no psychiatrist or clinical psychologist is
338	available to provide the second opinion, such second opinion may
339	be provided by a licensed physician with postgraduate training
340	and experience in diagnosis and treatment of mental and nervous
341	disorders or by a nurse providing psychiatric services
342	consistent with chapter 464. Such recommendation must be entered
343	on an involuntary outpatient placement certificate.
344	(3)  PETITION FOR INVOLUNTARY OUTPATIENT PLACEMENT.--
345	(a)  A petition for involuntary outpatient placement may be
346	filed by:
347	1.  The administrator of the facility pursuant to paragraph
348	(2)(a);
349	2.  One of the examining professionals for persons examined
350	on a voluntary outpatient basis pursuant to paragraph (2)(b).
351	Upon filing the petition, the examining professional shall
352	provide a copy of the petition to the administrator of the
353	receiving facility or designated department representative that
354	will identify the service provider for the involuntary
355	outpatient placement unless the person is otherwise
356	participating in outpatient psychiatric treatment and is not in
357	need of public financing for that treatment, in which case the
358	person, if eligible, may be involuntarily committed to the
359	existing psychiatric treatment relationship; or
360	3.  The administrator of a treatment facility pursuant to
361	paragraph (2)(c). Upon filing the petition, the administrator
362	shall provide a copy of the petition to the administrator of the
363	receiving facility or designated department representative that
364	will identify the service provider for the involuntary
365	outpatient placement unless the person is otherwise
366	participating in outpatient psychiatric treatment and is not in
367	need of public financing for that treatment, in which case the
368	person, if eligible, may be involuntarily committed to the
369	existing psychiatric treatment relationship.
370	(b)  Each required criterion for involuntary outpatient
371	placement must be alleged and substantiated in the petition for
372	involuntary outpatient placement. A copy of the certificate
373	recommending involuntary outpatient placement completed by a
374	qualified professional specified in subsection (2) shall be
375	attached to the petition. A copy of the treatment plan specified
376	in subparagraph (6)(b)2. must be attached to the petition. At
377	the time the petition is filed, the service provider shall
378	certify that the services in the proposed treatment plan are
379	available. If the necessary services are not available in the
380	patient's local community to respond to the person's individual
381	needs, the petition may not be filed.
382	(c)  The petition for involuntary outpatient placement must
383	be filed in the county in which the patient is located. When the
384	petition has been filed, the clerk of the court shall provide
385	copies of the petition and the proposed treatment plan to the
386	department, the patient, the patient's guardian or
387	representative, and the state attorney and public defender of
388	the judicial circuit in which the patient is located. A fee may
389	not be charged for the filing of a petition under this
390	subsection.
391	(4)  APPOINTMENT OF COUNSEL.--Within 1 court working day
392	after the filing of a petition for involuntary outpatient
393	placement, the court shall appoint the public defender to
394	represent the person who is the subject of the petition, unless
395	the person is otherwise represented by counsel. The clerk of the
396	court shall immediately notify the public defender of such
397	appointment. The public defender shall represent the person
398	until the petition is dismissed, the court order expires, or the
399	patient is discharged from involuntary outpatient placement. An
400	attorney who represents the patient shall have access to the
401	patient, witnesses, and records relevant to the presentation of
402	the patient's case and shall represent the interests of the
403	patient, regardless of the source of payment to the attorney.
404	(5)  CONTINUANCE OF HEARING.--The patient is entitled, with
405	the concurrence of the patient's counsel, to at least one
406	continuance of the hearing. The continuance shall be for a
407	period of up to 4 weeks.
408	(6)  HEARING ON INVOLUNTARY OUTPATIENT PLACEMENT.--
409	(a)1.  The court shall hold the hearing on involuntary
410	outpatient placement within 5 days after the petition is filed,
411	unless a continuance is granted. The hearing shall be held in
412	the county in which the patient is located, shall be as
413	convenient to the patient as is consistent with orderly
414	procedure, and shall be conducted in physical settings not
415	likely to be injurious to the patient's condition. If the court
416	finds that the patient's attendance at the hearing is not
417	consistent with the best interests of the patient and the
418	patient's counsel does not object, the court may waive the
419	presence of the patient from all or any portion of the hearing.
420	The state attorney for the circuit in which the patient is
421	located shall represent the state, rather than the petitioner,
422	as the real party in interest in the proceeding.
423	2.  The court may appoint a master to preside at the
424	hearing. One of the professionals who executed the involuntary
425	outpatient placement certificate shall be a witness. The patient
426	and the patient's guardian or representative shall be informed
427	by the court of the right to an independent expert examination.
428	If the patient cannot afford such an examination, the court
429	shall provide for one. The independent expert's report shall be
430	confidential and not discoverable, unless the expert is to be
431	called as a witness for the patient at the hearing. The court
432	shall allow testimony from individuals, including family
433	members, deemed by the court to be relevant under state law,
434	regarding the person's prior history and how that prior history
435	relates to the person's current condition. The testimony in the
436	hearing must be given under oath and the proceedings must be
437	recorded. The patient may refuse to testify at the hearing.
438	(b)1.  If the court concludes that the patient meets the
439	criteria for involuntary outpatient placement pursuant to
440	subsection (1), the court shall issue an order for involuntary
441	outpatient placement. The court order shall be for a period of
442	up to 6 months. The service provider shall discharge a patient
443	from involuntary outpatient treatment any time the patient no
444	longer meets the criteria for involuntary placement.
445	2.  The administrator of a receiving facility or a
446	designated department representative shall identify the service
447	provider that will have primary responsibility for service
448	provision under the order. The service provider shall prepare a
449	written proposed treatment plan and submit the plan to the court
450	before the hearing for the court's consideration for inclusion
451	in the involuntary outpatient placement order. The service
452	provider shall also provide a copy of the proposed treatment
453	plan to the petitioner. The treatment plan must specify the
454	nature and extent of the patient's mental illness. The treatment
455	plan may include provisions for case management, intensive case
456	management, or assertive community treatment. The treatment plan
457	may also require that the patient make use of a service provider
458	to supply any of the following categories of services to the
459	individual: medication, periodic urinalysis to determine
460	compliance with treatment, individual or group therapy, day or
461	partial-day programming activities, educational and vocational
462	training or activities, alcohol or substance abuse treatment and
463	counseling and periodic tests for the presence of alcohol or
464	illegal drugs for persons with a history of alcohol or substance
465	abuse, supervision of living arrangements, and any other
466	services prescribed to treat the person's mental illness and to
467	assist the person in living and functioning in the community or
468	to attempt to prevent a relapse or deterioration. Service
469	providers may select and provide supervision to other
470	individuals, not enumerated in this subparagraph, to implement
471	specific aspects of the treatment plan, such as medication
472	monitoring. The services in the treatment plan shall be deemed
473	to be clinically appropriate by a physician, clinical
474	psychologist, nurse providing psychiatric services consistent
475	with chapter 464, or clinical social worker who consults with,
476	or is employed or contracted by, the service provider. The
477	service provider must certify to the court in the proposed
478	treatment plan whether sufficient services for improvement and
479	stabilization are currently available and whether the service
480	provider agrees to provide those services. If the service
481	provider certifies that the services in the proposed treatment
482	plan are not available, the petitioner shall withdraw the
483	petition. The court may not order the department or the service
484	provider to provide services if the program or service is not
485	available in the patient's local community, there is no space
486	available in the program or service for the patient, or funding
487	is not available for the program or service. A copy of the order
488	must be sent to the Agency for Health Care Administration by the
489	service provider within 1 working day after the order is
490	received from the court. After the placement order is issued,
491	the service provider and the patient may modify provisions of
492	the treatment plan. For any material modification of the
493	treatment plan to which the patient or the patient's guardian
494	advocate, if appointed, does agree, the service provider shall
495	send notice of the modification to the court. Any material
496	modification of the treatment plan that is contested by the
497	patient or the patient's guardian advocate, if appointed, must
498	be in writing and prepared by the service provider or
499	administrator for approval by the court.
500	3.  If, in the clinical judgment of a physician, the
501	patient has failed or refused to comply with the treatment
502	ordered by the court and, in the clinical judgment of the
503	physician, efforts were made to solicit compliance and the
504	patient may meet the criteria for involuntary examination, a
505	person may be brought to a receiving facility pursuant to s.
506	394.463. If, after examination, the patient does not meet the
507	criteria for involuntary inpatient placement pursuant to s.
508	394.467, the patient must be discharged from the receiving
509	facility. The service provider must determine whether
510	modifications should be made to the existing treatment plan and
511	must attempt to continue to engage the patient in treatment. For
512	any material modification of the treatment plan to which the
513	patient or the patient's guardian advocate, if appointed, does
514	agree, the service provider shall send notice of the
515	modification to the court. Any material modification of the
516	treatment plan that is contested by the patient or the patient's
517	guardian advocate, if appointed, must be approved by the court.
518	(c)  If, at any time before the conclusion of the initial
519	hearing on involuntary outpatient placement, it appears to the
520	court that the person does not meet the criteria for involuntary
521	outpatient placement under this section but instead meets the
522	criteria for involuntary inpatient placement, the court may
523	order the person admitted for involuntary examination pursuant
524	to s. 394.463. If the person instead meets the criteria for
525	involuntary assessment, protective custody, or involuntary
526	admission pursuant to s. 397.675, the court may order the person
527	to be admitted for involuntary assessment for a period of 5 days
528	pursuant to s. 397.6811. Thereafter, all proceedings shall be
529	governed by chapter 397.
530	(d)  At the hearing on involuntary outpatient placement,
531	the court shall consider testimony and evidence regarding the
532	patient's competence to consent to treatment. If the court finds
533	that the patient is incompetent to consent to treatment, the
534	court shall appoint a guardian advocate as provided in s.
535	394.4598. The guardian advocate shall be appointed or discharged
536	in accordance with s. 394.4598.
537	(e)  The administrator of the receiving facility or the
538	designated department representative shall provide a copy of the
539	court order and adequate documentation of a patient's mental
540	illness to the service provider for involuntary outpatient
541	placement. Such documentation must include any advance
542	directives made by the patient, a psychiatric evaluation of the
543	patient, and any evaluations of the patient performed by a
544	clinical psychologist or a clinical social worker.
545	(7)  PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT
546	PLACEMENT.--
547	(a)  If the person continues to meet the criteria for
548	involuntary outpatient placement, the service provider shall,
549	before expiration of the period during which the treatment is
550	ordered for the person, file in the circuit court a continued
551	involuntary outpatient placement certificate which shall be
552	accompanied by a statement from the person's physician or
553	clinical psychologist justifying the request, a brief
554	description of the patient's treatment during the time he or she
555	was involuntarily placed, and an individualized plan of
556	continued treatment.
557	(b)  Within 1 court working day after the filing of a
558	petition for continued involuntary outpatient placement, the
559	court shall appoint the public defender to represent the person
560	who is the subject of the petition, unless the person is
561	otherwise represented by counsel. The clerk of the court shall
562	immediately notify the public defender of such appointment. The
563	public defender shall represent the person until the petition is
564	dismissed, the court order expires, or the patient is discharged
565	from involuntary outpatient placement. Any attorney representing
566	the patient shall have access to the patient, witnesses, and
567	records relevant to the presentation of the patient's case and
568	shall represent the interests of the patient, regardless of the
569	source of payment to the attorney.
570	(c)  Hearings on petitions for continued involuntary
571	outpatient placement shall be before the circuit court. The
572	court may appoint a master to preside at the hearing. The
573	procedures for obtaining an order pursuant to this paragraph
574	shall be in accordance with the provisions of subsection (6),
575	except that the time period included in paragraph (1)(e) is not
576	applicable in determining the appropriateness of additional
577	periods of involuntary outpatient placement.
578	(d)  Notice of the hearing shall be provided as set forth
579	in s. 394.4599. The patient and the patient's attorney may agree
580	to a period of continued outpatient placement without a court
581	hearing.
582	(e)  The same procedure shall be repeated prior to the
583	expiration of each additional period the patient is placed in
584	treatment.
585	(f)  If the patient has been previously found incompetent
586	to consent to treatment, the court shall consider testimony and
587	evidence regarding the patient's competence. Section 394.4598
588	governs the discharge of the guardian advocate if the patient's
589	competency to consent to treatment is restored.
590	Section 6.  Section 394.467, Florida Statutes, is amended
591	to read:
592	394.467  Involuntary inpatient placement.--
593	(1)  CRITERIA.--A person may be involuntarily placed in
594	involuntary inpatient placement for treatment upon a finding of
595	the court by clear and convincing evidence that:
596	(a)  He or she is mentally ill and because of his or her
597	mental illness:
598	1.a.  He or she has refused voluntary placement for
599	treatment after sufficient and conscientious explanation and
600	disclosure of the purpose of placement for treatment; or
601	b.  He or she is unable to determine for himself or herself
602	whether placement is necessary; and
603	2.a.  He or she is manifestly incapable of surviving alone
604	or with the help of willing and responsible family or friends,
605	including available alternative services, and, without
606	treatment, is likely to suffer from neglect or refuse to care
607	for himself or herself, and such neglect or refusal poses a real
608	and present threat of substantial harm to his or her well-being;
609	or
610	b.  There is substantial likelihood that in the near future
611	he or she will inflict serious bodily harm on himself or herself
612	or another person, as evidenced by recent behavior causing,
613	attempting, or threatening such harm; and
614	(b)  All available less restrictive treatment alternatives
615	which would offer an opportunity for improvement of his or her
616	condition have been judged to be inappropriate.
617	(2)  ADMISSION TO A TREATMENT FACILITY.--A patient may be
618	retained by a receiving facility or involuntarily placed in a
619	treatment facility upon the recommendation of the administrator
620	of a receiving facility where the patient has been examined and
621	after adherence to the notice and hearing procedures provided in
622	s. 394.4599. The recommendation must be supported by the opinion
623	of a psychiatrist and the second opinion of a clinical
624	psychologist or another psychiatrist, both of whom have
625	personally examined the patient within the preceding 72 hours,
626	that the criteria for involuntary inpatient placement are met.
627	However, in counties of less than 50,000 population, if the
628	administrator certifies that no psychiatrist or clinical
629	psychologist is available to provide the second opinion, such
630	second opinion may be provided by a licensed physician with
631	postgraduate training and experience in diagnosis and treatment
632	of mental and nervous disorders or by a psychiatric nurse
633	providing psychiatric services consistent with chapter 464. Such
634	recommendation shall be entered on an involuntary inpatient
635	placement certificate, which certificate shall authorize the
636	receiving facility to retain the patient pending transfer to a
637	treatment facility or completion of a hearing.
638	(3)  PETITION FOR INVOLUNTARY INPATIENT PLACEMENT.--The
639	administrator of the facility shall file a petition for
640	involuntary inpatient placement in the court in the county where
641	the patient is located. Upon filing, the clerk of the court
642	shall provide copies to the department, the patient, the
643	patient's guardian or representative, and the state attorney and
644	public defender of the judicial circuit in which the patient is
645	located. No fee shall be charged for the filing of a petition
646	under this subsection.
647	(4)  APPOINTMENT OF COUNSEL.--Within 1 court working day
648	after the filing of a petition for involuntary inpatient
649	placement, the court shall appoint the public defender to
650	represent the person who is the subject of the petition, unless
651	the person is otherwise represented by counsel. The clerk of the
652	court shall immediately notify the public defender of such
653	appointment. Any attorney representing the patient shall have
654	access to the patient, witnesses, and records relevant to the
655	presentation of the patient's case and shall represent the
656	interests of the patient, regardless of the source of payment to
657	the attorney.
658	(5)  CONTINUANCE OF HEARING.--The patient is entitled, with
659	the concurrence of the patient's counsel, to at least one
660	continuance of the hearing. The continuance shall be for a
661	period of up to 4 weeks.
662	(6)  HEARING ON INVOLUNTARY INPATIENT PLACEMENT.--
663	(a)1.  The court shall hold the hearing on involuntary
664	inpatient placement within 5 days, unless a continuance is
665	granted. The hearing shall be held in the county where the
666	patient is located and shall be as convenient to the patient as
667	may be consistent with orderly procedure and shall be conducted
668	in physical settings not likely to be injurious to the patient's
669	condition. If the court finds that the patient's attendance at
670	the hearing is not consistent with the best interests of the
671	patient, and the patient's counsel does not object, the court
672	may waive the presence of the patient from all or any portion of
673	the hearing. The state attorney for the circuit in which the
674	patient is located shall represent the state, rather than the
675	petitioning facility administrator, as the real party in
676	interest in the proceeding.
677	2.  The court may appoint a master to preside at the
678	hearing. One of the professionals who executed the involuntary
679	inpatient placement certificate shall be a witness. The patient
680	and the patient's guardian or representative shall be informed
681	by the court of the right to an independent expert examination.
682	If the patient cannot afford such an examination, the court
683	shall provide for one. The independent expert's report shall be
684	confidential and not discoverable, unless the expert is to be
685	called as a witness for the patient at the hearing. The
686	testimony in the hearing must be given under oath, and the
687	proceedings must be recorded. The patient may refuse to testify
688	at the hearing.
689	(b)  If the court concludes that the patient meets the
690	criteria for involuntary inpatient placement, it shall order
691	that the patient be transferred to a treatment facility or, if
692	the patient is at a treatment facility, that the patient be
693	retained there or be treated at any other appropriate receiving
694	or treatment facility, or that the patient receive services from
695	a receiving or treatment facility, on an involuntary basis, for
696	a period of up to 6 months. The order shall specify the nature
697	and extent of the patient's mental illness. The facility shall
698	discharge a patient any time the patient no longer meets the
699	criteria for involuntary inpatient placement, unless the patient
700	has transferred to voluntary status.
701	(c)  If at any time prior to the conclusion of the hearing
702	on involuntary inpatient placement it appears to the court that
703	the person does not meet the criteria for involuntary inpatient
704	placement under this section chapter, but instead meets the
705	criteria for involuntary outpatient placement, the court may
706	order the person evaluated for involuntary outpatient placement
707	pursuant to s. 394.4655. The petition and hearing procedures set
708	forth in s. 394.4655 shall apply. If the person instead meets
709	the criteria for involuntary assessment, protective custody, or
710	involuntary admission pursuant to s. 397.675, then the court may
711	order the person to be admitted for involuntary assessment for a
712	period of 5 days pursuant to s. 397.6811. Thereafter, all
713	proceedings shall be governed by chapter 397.
714	(d)  At the hearing on involuntary inpatient placement, the
715	court shall consider testimony and evidence regarding the
716	patient's competence to consent to treatment. If the court finds
717	that the patient is incompetent to consent to treatment, it
718	shall appoint a guardian advocate as provided in s. 394.4598.
719	(e)  The administrator of the receiving facility shall
720	provide a copy of the court order and adequate documentation of
721	a patient's mental illness to the administrator of a treatment
722	facility whenever a patient is ordered for involuntary inpatient
723	placement, whether by civil or criminal court. Such
724	documentation shall include any advance directives made by the
725	patient, a psychiatric evaluation of the patient, and any
726	evaluations of the patient performed by a clinical psychologist
727	or a clinical social worker. The administrator of a treatment
728	facility may refuse admission to any patient directed to its
729	facilities on an involuntary basis, whether by civil or criminal
730	court order, who is not accompanied at the same time by adequate
731	orders and documentation.
732	(7)  PROCEDURE FOR CONTINUED INVOLUNTARY INPATIENT
733	PLACEMENT.--
734	(a)  Hearings on petitions for continued involuntary
735	inpatient placement shall be administrative hearings and shall
736	be conducted in accordance with the provisions of s. 120.57(1),
737	except that any order entered by the hearing officer shall be
738	final and subject to judicial review in accordance with s.
739	120.68. Orders concerning patients committed after successfully
740	pleading not guilty by reason of insanity shall be governed by
741	the provisions of s. 916.15.
742	(b)  If the patient continues to meet the criteria for
743	involuntary inpatient placement, the administrator shall, prior
744	to the expiration of the period during which the treatment
745	facility is authorized to retain the patient, file a petition
746	requesting authorization for continued involuntary inpatient
747	placement. The request shall be accompanied by a statement from
748	the patient's physician or clinical psychologist justifying the
749	request, a brief description of the patient's treatment during
750	the time he or she was involuntarily placed, and an
751	individualized plan of continued treatment. Notice of the
752	hearing shall be provided as set forth in s. 394.4599. If at the
753	hearing the hearing officer finds that attendance at the hearing
754	is not consistent with the best interests of the patient, the
755	hearing officer may waive the presence of the patient from all
756	or any portion of the hearing, unless the patient, through
757	counsel, objects to the waiver of presence. The testimony in the
758	hearing must be under oath, and the proceedings must be
759	recorded.
760	(c)  Unless the patient is otherwise represented or is
761	ineligible, he or she shall be represented at the hearing on the
762	petition for continued involuntary inpatient placement by the
763	public defender of the circuit in which the facility is located.
764	(d)  If at a hearing it is shown that the patient continues
765	to meet the criteria for involuntary inpatient placement, the
766	administrative law judge shall sign the order for continued
767	involuntary inpatient placement for a period not to exceed 6
768	months. The same procedure shall be repeated prior to the
769	expiration of each additional period the patient is retained.
770	(e)  If continued involuntary inpatient placement is
771	necessary for a patient admitted while serving a criminal
772	sentence, but whose sentence is about to expire, or for a
773	patient involuntarily placed while a minor but who is about to
774	reach the age of 18, the administrator shall petition the
775	administrative law judge for an order authorizing continued
776	involuntary inpatient placement.
777	(f)  If the patient has been previously found incompetent
778	to consent to treatment, the hearing officer shall consider
779	testimony and evidence regarding the patient's competence. If
780	the hearing officer finds evidence that the patient is now
781	competent to consent to treatment, the hearing officer may issue
782	a recommended order to the court that found the patient
783	incompetent to consent to treatment that the patient's
784	competence be restored and that any guardian advocate previously
785	appointed be discharged.
786	(8)  RETURN OF PATIENTS.--When a patient at a treatment
787	facility leaves the facility without authorization, the
788	administrator may authorize a search for the patient and the
789	return of the patient to the facility. The administrator may
790	request the assistance of a law enforcement agency in the search
791	for and return of the patient.
792	Section 7.  Paragraphs (a) and (c) of subsection (3) of
793	section 394.495, Florida Statutes, are amended to read:
794	394.495  Child and adolescent mental health system of care;
795	programs and services.--
796	(3)  Assessments must be performed by:
797	(a)  A professional as defined in s. 394.455(2), (4),
798	(23)(21), (25)(23), or (26)(24);
799	(c)  A person who is under the direct supervision of a
800	professional as defined in s. 394.455(2), (4), (23)(21),
801	(25)(23), or (26)(24) or a professional licensed under chapter
802	491.
803
804	The department shall adopt by rule statewide standards for
805	mental health assessments, which must be based on current
806	relevant professional and accreditation standards.
807	Section 8.  Subsection (6) of section 394.496, Florida
808	Statutes, is amended to read:
809	394.496  Service planning.--
810	(6)  A professional as defined in s. 394.455(2), (4),
811	(23)(21), (25)(23), or (26)(24) or a professional licensed under
812	chapter 491 must be included among those persons developing the
813	services plan.
814	Section 9.  Paragraphs (a) and (c) of subsection (4) of
815	section 394.498, Florida Statutes, are amended to read:
816	394.498  Child and Adolescent Interagency System of Care
817	Demonstration Models.--
818	(4)  ESSENTIAL ELEMENTS.--
819	(a)  In order to be approved as a Child and Adolescent
820	Interagency System of Care Demonstration Model, the applicant
821	must demonstrate its capacity to perform the following
822	functions:
823	1.  Form a consortium of purchasers, which includes at
824	least three of the following agencies:
825	a.  The Mental Health Program and Family Safety and
826	Preservation Program of the Department of Children and Family
827	Services.
828	b.  The Medicaid program of the Agency for Health Care
829	Administration.
830	c.  The local school district.
831	d.  The Department of Juvenile Justice.
832
833	Each agency that participates in the consortium shall enter into
834	a written interagency agreement that defines each agency's
835	responsibilities.
836	2.  Establish an oversight body that is responsible for
837	directing the demonstration model. The oversight body must
838	include representatives from the state agencies that comprise
839	the consortium of purchasers under subparagraph 1., as well as
840	local governmental entities, a juvenile court judge, parents,
841	and other community entities. The responsibilities of the
842	oversight body must be specified in writing.
843	3.  Select a target population of children and adolescents,
844	regardless of whether the child or adolescent is eligible or
845	ineligible for Medicaid, based on the following parameters:
846	a.  The child or adolescent has a serious emotional
847	disturbance or mental illness, as defined in s. 394.492(6),
848	based on an assessment conducted by a licensed practitioner
849	defined in s. 394.455(2), (4), (23)(21), (25)(23), or (26)(24)
850	or by a professional licensed under chapter 491;
851	b.  The total service costs per child or adolescent have
852	exceeded $3,000 per month;
853	c.  The child or adolescent has had multiple out-of-home
854	placements;
855	d.  The existing array of services does not effectively
856	meet the needs of the child or adolescent;
857	e.  The case of the child or adolescent has been staffed by
858	a district collaborative planning team and satisfactory results
859	have not been achieved through existing case services plans; and
860	f.  The parent or legal guardian of the child or adolescent
861	consents to participating in the demonstration model.
862	4.  Select a geographic site for the demonstration model. A
863	demonstration model may be comprised of one or more counties and
864	may include multiple service districts of the Department of
865	Children and Family Services.
866	5.  Develop a mechanism for selecting the pool of children
867	and adolescents who meet the criteria specified in this section
868	for participating in the demonstration model.
869	6.  Establish a pooled funding plan that allocates
870	proportionate costs to the purchasers. The plan must address all
871	of the service needs of the child or adolescent, and funds may
872	not be identified in the plan by legislative appropriation
873	category or any other state or federal funding category.
874	a.  The funding plan shall be developed based on an
875	analysis of expenditures made by each participating state agency
876	during the previous 2 fiscal years in which services were
877	provided for the target population or for individuals who have
878	characteristics that are similar to the target population.
879	b.  Based on the results of this cost analysis, funds shall
880	be collected from each of the participating state agencies and
881	deposited into a central financial account.
882	c.  A financial body shall be designated to manage the pool
883	of funds and shall have the capability to pay for individual
884	services specified in a services plan.
885	7.  Identify a care management entity that reports to the
886	oversight body. For purposes of the demonstration models, the
887	term "care management entity" means the entity that assumes
888	responsibility for the organization, planning, purchasing, and
889	management of mental health treatment services to the target
890	population in the demonstration model. The care management
891	entity may not provide direct services to the target population.
892	The care management entity shall:
893	a.  Manage the funds of the demonstration model within
894	budget allocations. The administrative costs associated with the
895	operation of the demonstration model must be itemized in the
896	entity's operating budget.
897	b.  Purchase individual services in a timely manner.
898	c.  Review the completed client assessment information and
899	complete additional assessments that are needed, including an
900	assessment of the strengths of the child or adolescent and his
901	or her family.
902	d.  Organize a child-family team to develop a single,
903	unified services plan for the child or adolescent, in accordance
904	with ss. 394.490-394.497. The team shall include the parents and
905	other family members of the child or adolescent, friends and
906	community-based supporters of the child or adolescent, and
907	appropriate service providers who are familiar with the problems
908	and needs of the child or adolescent and his or her family. The
909	plan must include a statement concerning the strengths of the
910	child or adolescent and his or her family, and must identify the
911	natural supports in the family and the community that might be
912	used in addressing the service needs of the child or adolescent.
913	A copy of the completed service plan shall be provided to the
914	parents of the child or adolescent.
915	e.  Identify a network of providers that meet the
916	requirements of paragraph (b).
917	f.  Identify informal, unpaid supporters, such as persons
918	from the child's or adolescent's neighborhood, civic
919	organizations, clubs, and churches.
920	g.  Identify additional service providers who can work
921	effectively with the child or adolescent and his or her family,
922	including, but not limited to, a home health aide, mentor,
923	respite care worker, and in-home behavioral health care worker.
924	h.  Implement a case management system that concentrates on
925	the strengths of the child or adolescent and his or her family
926	and uses these strengths in case planning and implementation
927	activities. The case manager is primarily responsible for
928	developing the services plan and shall report to the care
929	management entity. The case manager shall monitor and oversee
930	the services provided by the network of providers. The parents
931	must be informed about contacting the care management entity or
932	comparable entity to address concerns of the parents.
933
934	Each person or organization that performs any of the care
935	management responsibilities specified in this subparagraph is
936	responsible only to the care management entity. However, such
937	care management responsibilities do not preclude the person or
938	organization from performing other responsibilities for another
939	agency or provider.
940	8.  Develop a mechanism for measuring compliance with the
941	goals of the demonstration models specified in subsection (2),
942	which mechanism includes qualitative and quantitative
943	performance outcomes, report on compliance rates, and conduct
944	quality improvement functions. At a minimum, the mechanism for
945	measuring compliance must include the outcomes and measures
946	established in the General Appropriations Act and the outcomes
947	and measures that are unique to the demonstration models.
948	9.  Develop mechanisms to ensure that family
949	representatives have a substantial role in planning the
950	demonstration model and in designing the instrument for
951	measuring the effectiveness of services provided.
952	10.  Develop and monitor grievance procedures.
953	11.  Develop policies to ensure that a child or adolescent
954	is not rejected or ejected from the demonstration model because
955	of a clinical condition or a specific service need.
956	12.  Develop policies to require that a participating state
957	agency remains a part of the demonstration model for its entire
958	duration.
959	13.  Obtain training for the staff involved in all aspects
960	of the project.
961	(c)  In order for children, adolescents, and families of
962	children and adolescents to receive timely and effective
963	services, the basic provider network identified in each
964	demonstration model must be well designed and managed. The
965	provider network should be able to meet the needs of a
966	significant proportion of the target population. The applicant
967	must demonstrate the capability to manage the network of
968	providers for the purchasers that participate in the
969	demonstration model. The applicant must demonstrate its ability
970	to perform the following network management functions:
971	1.  Identify providers within the designated area of the
972	demonstration model which are currently funded by the state
973	agencies included in the model, and identify additional
974	providers that are needed to provide additional services for the
975	target population. The network of providers may include:
976	a.  Licensed mental health professionals as defined in s.
977	394.455(2), (4), (23)(21), (25)(23), or (26)(24);
978	b.  Professionals licensed under chapter 491;
979	c.  Teachers certified under s. 1012.56;
980	d.  Facilities licensed under chapter 395, as a hospital;
981	s. 394.875, as a crisis stabilization unit or short-term
982	residential facility; or s. 409.175, as a residential child-
983	caring agency; and
984	e.  Other community agencies.
985	2.  Define access points and service linkages of providers
986	in the network.
987	3.  Define the ways in which providers and participating
988	state agencies are expected to collaborate in providing
989	services.
990	4.  Define methods to measure the collective performance
991	outcomes of services provided by providers and state agencies,
992	measure the performance of individual agencies, and implement a
993	quality improvement process across the provider network.
994	5.  Develop brochures for family members which are written
995	in understandable terminology, to help families identify
996	appropriate service providers, choose the provider, and access
997	care directly whenever possible.
998	6.  Ensure that families are given a substantial role in
999	planning and monitoring the provider network.
1000	7.  Train all providers with respect to the principles of
1001	care outlined in this section, including effective techniques of
1002	cooperation, the wraparound process and strengths-based
1003	assessment, the development of service plans, and techniques of
1004	case management.
1005	Section 10.  Paragraph (d) of subsection (1) of section
1006	419.001, Florida Statutes, is amended to read:
1007	419.001  Site selection of community residential homes.--
1008	(1)  For the purposes of this section, the following
1009	definitions shall apply:
1010	(d)  "Resident" means any of the following: a frail elder
1011	as defined in s. 400.618; a physically disabled or handicapped
1012	person as defined in s. 760.22(7)(a); a developmentally disabled
1013	person as defined in s. 393.063(12); a nondangerous mentally ill
1014	person as defined in s. 394.455(20)(18); or a child as defined
1015	in s. 39.01(14), s. 984.03(9) or (12), or s. 985.03(8).
1016	Section 11.  Subsection (7) of section 744.704, Florida
1017	Statutes, is amended to read:
1018	744.704  Powers and duties.--
1019	(7)  A public guardian shall not commit a ward to a mental
1020	health treatment facility, as defined in s. 394.455(33)(30),
1021	without an involuntary placement proceeding as provided by law.
1022	Section 12.  The Department of Children and Family Services
1023	may adopt any rules necessary to implement the provisions of ss.
1024	394.455, 394.4598, 394.4615, 394.463, and 394.467, Florida
1025	Statutes, as amended or created by this act. These rules shall
1026	be for the purpose of protecting the health, safety, and well-
1027	being of persons examined, treated, or placed under this act.
1028	Section 13.  If any provision of this act or its
1029	application to any person or circumstance is held invalid, the
1030	invalidity does not affect other provisions or applications of
1031	the act which can be given effect without the invalid provision
1032	or application, and to this end the provisions of this act are
1033	severable.
1034	Section 14.  This act shall take effect January 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.