Senate Bill sb0356er

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    2005 Legislature                         SB 356, 1st Engrossed



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  2         An act relating to substance abuse treatment;

  3         amending s. 394.499, F.S.; authorizing the

  4         Department of Children and Family Services to

  5         expand certain demonstration models; amending

  6         s. 397.311, F.S.; including intensive inpatient

  7         treatment within the service components

  8         provided by a licensed service provider;

  9         defining the term "medical monitoring";

10         amending s. 212.055, F.S., relating to the

11         county public hospital surtax; conforming a

12         cross-reference; reenacting ss. 397.405(8) and

13         397.407(1), F.S., relating to treatment

14         providers, to incorporate the amendment to s.

15         397.311, F.S., in references thereto; amending

16         ss. 397.416 and 440.102, F.S., relating to

17         treatment services and the drug-free workplace

18         program; conforming cross-references; providing

19         an effective date.

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

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23         Section 1.  Subsection (1) of section 394.499, Florida

24  Statutes, is amended to read:

25         394.499  Integrated children's crisis stabilization

26  unit/juvenile addictions receiving facility services.--

27         (1)  Beginning July 1, 2001, the Department of Children

28  and Family Services, in consultation with the Agency for

29  Health Care Administration, is authorized to establish

30  children's behavioral crisis unit demonstration models in

31  Collier, Lee, and Sarasota Counties. By December 31, 2003, the


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 1  department shall submit to the President of the Senate, the

 2  Speaker of the House of Representatives, and the chairs of the

 3  Senate and House committees that oversee departmental

 4  activities a report that evaluates the number of clients

 5  served, quality of services, performance outcomes, and

 6  feasibility of continuing or expanding the demonstration

 7  models. As a result of the recommendations regarding expansion

 8  of the demonstration models contained in the evaluation report

 9  of December 31, 2003 Beginning July 1, 2004, subject to

10  approval by the Legislature, the department, in cooperation

11  with the agency, may expand the demonstration models to other

12  areas in the state after July 1, 2005. The children's

13  behavioral crisis unit demonstration models will integrate

14  children's mental health crisis stabilization units with

15  substance abuse juvenile addictions receiving facility

16  services, to provide emergency mental health and substance

17  abuse services that are integrated within facilities licensed

18  and designated by the agency for children under 18 years of

19  age who meet criteria for admission or examination under this

20  section. The services shall be designated as "integrated

21  children's crisis stabilization unit/juvenile addictions

22  receiving facility services," shall be licensed by the agency

23  as children's crisis stabilization units, and shall meet all

24  licensure requirements for crisis stabilization units. The

25  department, in cooperation with the agency, shall develop

26  standards that address eligibility criteria; clinical

27  procedures; staffing requirements; operational,

28  administrative, and financing requirements; and investigation

29  of complaints for such integrated facility services. Standards

30  that are implemented specific to substance abuse services

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 1  shall meet or exceed existing standards for addictions

 2  receiving facilities.

 3         Section 2.  Subsection (18) of section 397.311, Florida

 4  Statutes, is amended, present subsections (19) through (29) of

 5  that section are redesignated as subsections (20) through

 6  (30), respectively, and a new subsection (19) is added to that

 7  section, to read:

 8         397.311  Definitions.--As used in this chapter, except

 9  part VIII:

10         (18)  "Licensed service provider" means a public agency

11  under this chapter, a private for-profit or not-for-profit

12  agency under this chapter, a physician or any other private

13  practitioner licensed under this chapter, or a hospital that

14  offers substance abuse impairment services through one or more

15  of the following licensable service components:

16         (a)  Addictions receiving facility, which is a

17  community-based facility designated by the department to

18  receive, screen, and assess clients found to be substance

19  abuse impaired, in need of emergency treatment for substance

20  abuse impairment, or impaired by substance abuse to such an

21  extent as to meet the criteria for involuntary admission in s.

22  397.675, and to provide detoxification and stabilization.  An

23  addictions receiving facility must be state-owned,

24  state-operated, or state-contracted, and licensed pursuant to

25  rules adopted by the department's Substance Abuse Program

26  Office which include specific authorization for the provision

27  of levels of care and a requirement of separate accommodations

28  for adults and minors. Addictions receiving facilities are

29  designated as secure facilities to provide an intensive level

30  of care and must have sufficient staff and the authority to

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 1  provide environmental security to handle aggressive and

 2  difficult-to-manage behavior and deter elopement.

 3         (b)  Detoxification, which uses medical and

 4  psychological procedures and a supportive counseling regimen

 5  to assist clients in managing toxicity and withdrawing and

 6  stabilizing from the physiological and psychological effects

 7  of substance abuse impairment.

 8         (c)  Intensive inpatient treatment, which includes a

 9  planned regimen of professionally directed evaluation,

10  observation, medical monitoring, and clinical protocols

11  provided 24 hours per day, 7 days per week in a highly

12  structured, live-in environment.

13         (d)(c)  Residential treatment, which provides a

14  structured, live-in environment within a nonhospital setting

15  on a 24-hours-a-day, 7-days-a-week basis, and which includes:

16         1.  Facilities that provide room and board and

17  treatment and rehabilitation within the primary residential

18  facility; and

19         2.  Facilities that are used for room and board only

20  and in which treatment and rehabilitation activities are

21  provided on a mandatory basis at locations other than the

22  primary residential facility. In this case, facilities used

23  for room and board and for treatment and rehabilitation are

24  operated under the auspices of the same provider, and

25  licensing and regulatory requirements would apply to both the

26  residential facility and all other facilities in which

27  treatment and rehabilitation activities occur.

28         (e)(d)  Day and night treatment, which provides a

29  nonresidential environment with a structured schedule of

30  treatment and rehabilitation services.

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 1         (f)(e)  Outpatient treatment, which provides

 2  individual, group, or family counseling for clients by

 3  appointment during scheduled operating hours, with an emphasis

 4  on assessment and treatment.

 5         (g)(f)  Medication and methadone maintenance treatment

 6  that uses methadone or other medication as authorized by state

 7  and federal law, in conjunction with medical, rehabilitative,

 8  and counseling services in the treatment of clients who are

 9  dependent upon opioid drugs.

10         (h)(g)  Prevention, which is a process involving

11  strategies aimed at the individual, the environment, or the

12  substance, which strategies preclude, forestall, or impede the

13  development of substance abuse problems and promote

14  responsible personal and social growth of individuals and

15  families toward full human potential.

16         (i)(h)  Intervention, which consists of structured

17  services targeted toward individuals or groups at risk and

18  focused on reducing those factors associated with the onset or

19  the early stages of substance abuse, and related problems.

20         (19)  "Medical monitoring" means oversight and

21  treatment, 24 hours per day by medical personnel who are

22  licensed under chapter 458, chapter 459, or chapter 464, of

23  clients whose subacute biomedical, emotional, psychosocial,

24  behavioral, or cognitive problems are so severe that the

25  clients require intensive inpatient treatment by an

26  interdisciplinary team.

27         Section 3.  Paragraph (e) of subsection (5) of section

28  212.055, Florida Statutes, is amended to read:

29         212.055  Discretionary sales surtaxes; legislative

30  intent; authorization and use of proceeds.--It is the

31  legislative intent that any authorization for imposition of a


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 1  discretionary sales surtax shall be published in the Florida

 2  Statutes as a subsection of this section, irrespective of the

 3  duration of the levy.  Each enactment shall specify the types

 4  of counties authorized to levy; the rate or rates which may be

 5  imposed; the maximum length of time the surtax may be imposed,

 6  if any; the procedure which must be followed to secure voter

 7  approval, if required; the purpose for which the proceeds may

 8  be expended; and such other requirements as the Legislature

 9  may provide.  Taxable transactions and administrative

10  procedures shall be as provided in s. 212.054.

11         (5)  COUNTY PUBLIC HOSPITAL SURTAX.--Any county as

12  defined in s. 125.011(1) may levy the surtax authorized in

13  this subsection pursuant to an ordinance either approved by

14  extraordinary vote of the county commission or conditioned to

15  take effect only upon approval by a majority vote of the

16  electors of the county voting in a referendum.  In a county as

17  defined in s. 125.011(1), for the purposes of this subsection,

18  "county public general hospital" means a general hospital as

19  defined in s. 395.002 which is owned, operated, maintained, or

20  governed by the county or its agency, authority, or public

21  health trust.

22         (e)  A governing board, agency, or authority shall be

23  chartered by the county commission upon this act becoming law.

24  The governing board, agency, or authority shall adopt and

25  implement a health care plan for indigent health care

26  services.  The governing board, agency, or authority shall

27  consist of no more than seven and no fewer than five members

28  appointed by the county commission.  The members of the

29  governing board, agency, or authority shall be at least 18

30  years of age and residents of the county.  No member may be

31  employed by or affiliated with a health care provider or the


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 1  public health trust, agency, or authority responsible for the

 2  county public general hospital. The following community

 3  organizations shall each appoint a representative to a

 4  nominating committee:  the South Florida Hospital and

 5  Healthcare Association, the Miami-Dade County Public Health

 6  Trust, the Dade County Medical Association, the Miami-Dade

 7  County Homeless Trust, and the Mayor of Miami-Dade County.

 8  This committee shall nominate between 10 and 14 county

 9  citizens for the governing board, agency, or authority.  The

10  slate shall be presented to the county commission and the

11  county commission shall confirm the top five to seven

12  nominees, depending on the size of the governing board.  Until

13  such time as the governing board, agency, or authority is

14  created, the funds provided for in subparagraph (d)2. shall be

15  placed in a restricted account set aside from other county

16  funds and not disbursed by the county for any other purpose.

17         1.  The plan shall divide the county into a minimum of

18  four and maximum of six service areas, with no more than one

19  participant hospital per service area. The county public

20  general hospital shall be designated as the provider for one

21  of the service areas.  Services shall be provided through

22  participants' primary acute care facilities.

23         2.  The plan and subsequent amendments to it shall fund

24  a defined range of health care services for both indigent

25  persons and the medically poor, including primary care,

26  preventive care, hospital emergency room care, and hospital

27  care necessary to stabilize the patient. For the purposes of

28  this section, "stabilization" means stabilization as defined

29  in s. 397.311(30) s. 397.311(29). Where consistent with these

30  objectives, the plan may include services rendered by

31  physicians, clinics, community hospitals, and alternative


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 1  delivery sites, as well as at least one regional referral

 2  hospital per service area. The plan shall provide that

 3  agreements negotiated between the governing board, agency, or

 4  authority and providers shall recognize hospitals that render

 5  a disproportionate share of indigent care, provide other

 6  incentives to promote the delivery of charity care to draw

 7  down federal funds where appropriate, and require cost

 8  containment, including, but not limited to, case management.

 9  From the funds specified in subparagraphs (d)1. and 2. for

10  indigent health care services, service providers shall receive

11  reimbursement at a Medicaid rate to be determined by the

12  governing board, agency, or authority created pursuant to this

13  paragraph for the initial emergency room visit, and a

14  per-member per-month fee or capitation for those members

15  enrolled in their service area, as compensation for the

16  services rendered following the initial emergency visit.

17  Except for provisions of emergency services, upon

18  determination of eligibility, enrollment shall be deemed to

19  have occurred at the time services were rendered. The

20  provisions for specific reimbursement of emergency services

21  shall be repealed on July 1, 2001, unless otherwise reenacted

22  by the Legislature. The capitation amount or rate shall be

23  determined prior to program implementation by an independent

24  actuarial consultant. In no event shall such reimbursement

25  rates exceed the Medicaid rate. The plan must also provide

26  that any hospitals owned and operated by government entities

27  on or after the effective date of this act must, as a

28  condition of receiving funds under this subsection, afford

29  public access equal to that provided under s. 286.011 as to

30  any meeting of the governing board, agency, or authority the

31  subject of which is budgeting resources for the retention of


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 1  charity care, as that term is defined in the rules of the

 2  Agency for Health Care Administration. The plan shall also

 3  include innovative health care programs that provide

 4  cost-effective alternatives to traditional methods of service

 5  and delivery funding.

 6         3.  The plan's benefits shall be made available to all

 7  county residents currently eligible to receive health care

 8  services as indigents or medically poor as defined in

 9  paragraph (4)(d).

10         4.  Eligible residents who participate in the health

11  care plan shall receive coverage for a period of 12 months or

12  the period extending from the time of enrollment to the end of

13  the current fiscal year, per enrollment period, whichever is

14  less.

15         5.  At the end of each fiscal year, the governing

16  board, agency, or authority shall prepare an audit that

17  reviews the budget of the plan, delivery of services, and

18  quality of services, and makes recommendations to increase the

19  plan's efficiency.  The audit shall take into account

20  participant hospital satisfaction with the plan and assess the

21  amount of poststabilization patient transfers requested, and

22  accepted or denied, by the county public general hospital.

23         Section 4.  For the purpose of incorporating the

24  amendment made by this act to section 397.311, Florida

25  Statutes, in a reference thereto, subsection (8) of section

26  397.405, Florida Statutes, is reenacted to read:

27         397.405  Exemptions from licensure.--The following are

28  exempt from the licensing provisions of this chapter:

29         (8)  An established and legally cognizable church or

30  nonprofit religious organization or denomination providing

31  substance abuse services, including prevention services, which


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 1  are exclusively religious, spiritual, or ecclesiastical in

 2  nature.  A church or nonprofit religious organization or

 3  denomination providing any of the licensable service

 4  components itemized under s. 397.311(18) is not exempt for

 5  purposes of its provision of such licensable service

 6  components but retains its exemption with respect to all

 7  services which are exclusively religious, spiritual, or

 8  ecclesiastical in nature.

 9         Section 5.  For the purpose of incorporating the

10  amendment made by this act to section 397.311, Florida

11  Statutes, in a reference thereto, subsection (1) of section

12  397.407, Florida Statutes, is reenacted to read:

13         397.407  Licensure fees.--

14         (1)  The department shall establish licensure fees by

15  rule.  The rule must prescribe a fee range that is based, at

16  least in part, on the number and complexity of programs listed

17  in s. 397.311(18) which are operated by a licensee.  The fee

18  range must be implemented over a 5-year period.  The fee

19  schedule for licensure of service components must be increased

20  annually in substantially equal increments so that, by July 1,

21  1998, the fees from the licensure of service components are

22  sufficient to cover at least 50 percent of the costs of

23  regulating the service components.  The department shall

24  specify by rule a fee range and phase-in plan for privately

25  funded licensed service providers and a fee range and phase-in

26  plan for publicly funded licensed service providers.  Fees for

27  privately funded licensed service providers must exceed the

28  fees for publicly funded licensed service providers.  The

29  first year phase-in licensure fees must be at least $150 per

30  initial license. The rule must provide for a reduction in

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 1  licensure fees for licensed service providers who hold more

 2  than one license.

 3         Section 6.  Subsection (2) of section 397.416, Florida

 4  Statutes, is amended to read:

 5         397.416  Substance abuse treatment services; qualified

 6  professional.--

 7         (2)  Notwithstanding any other provision of law, a

 8  person who was certified through a certification process

 9  recognized by the former Department of Health and

10  Rehabilitative Services before January 1, 1995, may perform

11  the duties of a qualified professional with respect to

12  substance abuse treatment services as defined in this chapter,

13  and need not meet the certification requirements contained in

14  s. 397.311(25) s. 397.311(24).

15         Section 7.  Paragraphs (d) and (g) of subsection (1) of

16  section 440.102, Florida Statutes, are amended to read:

17         440.102  Drug-free workplace program requirements.--The

18  following provisions apply to a drug-free workplace program

19  implemented pursuant to law or to rules adopted by the Agency

20  for Health Care Administration:

21         (1)  DEFINITIONS.--Except where the context otherwise

22  requires, as used in this act:

23         (d)  "Drug rehabilitation program" means a service

24  provider, established pursuant to s. 397.311(28) s.

25  397.311(27), that provides confidential, timely, and expert

26  identification, assessment, and resolution of employee drug

27  abuse.

28         (g)  "Employee assistance program" means an established

29  program capable of providing expert assessment of employee

30  personal concerns; confidential and timely identification

31  services with regard to employee drug abuse; referrals of


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 1  employees for appropriate diagnosis, treatment, and

 2  assistance; and followup services for employees who

 3  participate in the program or require monitoring after

 4  returning to work. If, in addition to the above activities, an

 5  employee assistance program provides diagnostic and treatment

 6  services, these services shall in all cases be provided by

 7  service providers pursuant to s. 397.311(28) s. 397.311(27).

 8         Section 8.  This act shall take effect July 1, 2005.

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