| 1 | A bill to be entitled |
| 2 | An act relating to substance abuse treatment; amending s. |
| 3 | 397.311, F.S.; including intensive inpatient treatment |
| 4 | within the service components provided by a licensed |
| 5 | service provider; defining the term "medical monitoring"; |
| 6 | amending s. 212.055, F.S., relating to the county public |
| 7 | hospital surtax; conforming a cross reference; reenacting |
| 8 | ss. 397.405(8) and 397.407(1), F.S., relating to treatment |
| 9 | providers, to incorporate the amendment to s. 397.311, |
| 10 | F.S., in references thereto; amending ss. 397.416 and |
| 11 | 440.102, F.S., relating to treatment services and the |
| 12 | drug-free workplace program; conforming cross references; |
| 13 | providing an effective date. |
| 14 |
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| 15 | Be It Enacted by the Legislature of the State of Florida: |
| 16 |
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| 17 | Section 1. Subsection (18) of section 397.311, Florida |
| 18 | Statutes, is amended, present subsections (19) through (29) of |
| 19 | that section are redesignated as subsections (20) through (30), |
| 20 | respectively, and a new subsection (19) is added to that |
| 21 | section, to read: |
| 22 | 397.311 Definitions.--As used in this chapter, except part |
| 23 | VIII: |
| 24 | (18) "Licensed service provider" means a public agency |
| 25 | under this chapter, a private for-profit or not-for-profit |
| 26 | agency under this chapter, a physician or any other private |
| 27 | practitioner licensed under this chapter, or a hospital that |
| 28 | offers substance abuse impairment services through one or more |
| 29 | of the following licensable service components: |
| 30 | (a) Addictions receiving facility, which is a community- |
| 31 | based facility designated by the department to receive, screen, |
| 32 | and assess clients found to be substance abuse impaired, in need |
| 33 | of emergency treatment for substance abuse impairment, or |
| 34 | impaired by substance abuse to such an extent as to meet the |
| 35 | criteria for involuntary admission in s. 397.675, and to provide |
| 36 | detoxification and stabilization. An addictions receiving |
| 37 | facility must be state-owned, state-operated, or state- |
| 38 | contracted, and licensed pursuant to rules adopted by the |
| 39 | department's Substance Abuse Program Office which include |
| 40 | specific authorization for the provision of levels of care and a |
| 41 | requirement of separate accommodations for adults and minors. |
| 42 | Addictions receiving facilities are designated as secure |
| 43 | facilities to provide an intensive level of care and must have |
| 44 | sufficient staff and the authority to provide environmental |
| 45 | security to handle aggressive and difficult-to-manage behavior |
| 46 | and deter elopement. |
| 47 | (b) Detoxification, which uses medical and psychological |
| 48 | procedures and a supportive counseling regimen to assist clients |
| 49 | in managing toxicity and withdrawing and stabilizing from the |
| 50 | physiological and psychological effects of substance abuse |
| 51 | impairment. |
| 52 | (c) Intensive inpatient treatment, which includes a |
| 53 | planned regimen of professionally directed evaluation, |
| 54 | observation, medical monitoring, and clinical protocols provided |
| 55 | 24 hours per day, 7 days per week in a highly structured, live- |
| 56 | in environment. |
| 57 | (d)(c) Residential treatment, which provides a structured, |
| 58 | live-in environment within a nonhospital setting on a 24-hours- |
| 59 | a-day, 7-days-a-week basis, and which includes: |
| 60 | 1. Facilities that provide room and board and treatment |
| 61 | and rehabilitation within the primary residential facility; and |
| 62 | 2. Facilities that are used for room and board only and in |
| 63 | which treatment and rehabilitation activities are provided on a |
| 64 | mandatory basis at locations other than the primary residential |
| 65 | facility. In this case, facilities used for room and board and |
| 66 | for treatment and rehabilitation are operated under the auspices |
| 67 | of the same provider, and licensing and regulatory requirements |
| 68 | would apply to both the residential facility and all other |
| 69 | facilities in which treatment and rehabilitation activities |
| 70 | occur. |
| 71 | (e)(d) Day and night treatment, which provides a |
| 72 | nonresidential environment with a structured schedule of |
| 73 | treatment and rehabilitation services. |
| 74 | (f)(e) Outpatient treatment, which provides individual, |
| 75 | group, or family counseling for clients by appointment during |
| 76 | scheduled operating hours, with an emphasis on assessment and |
| 77 | treatment. |
| 78 | (g)(f) Medication and methadone maintenance treatment that |
| 79 | uses methadone or other medication as authorized by state and |
| 80 | federal law, in conjunction with medical, rehabilitative, and |
| 81 | counseling services in the treatment of clients who are |
| 82 | dependent upon opioid drugs. |
| 83 | (h)(g) Prevention, which is a process involving strategies |
| 84 | aimed at the individual, the environment, or the substance, |
| 85 | which strategies preclude, forestall, or impede the development |
| 86 | of substance abuse problems and promote responsible personal and |
| 87 | social growth of individuals and families toward full human |
| 88 | potential. |
| 89 | (i)(h) Intervention, which consists of structured services |
| 90 | targeted toward individuals or groups at risk and focused on |
| 91 | reducing those factors associated with the onset or the early |
| 92 | stages of substance abuse, and related problems. |
| 93 | (19) "Medical monitoring" means oversight and treatment, |
| 94 | provided 24 hours per day by medical personnel who are licensed |
| 95 | under chapter 458, chapter 459, or chapter 464, of clients whose |
| 96 | subacute biomedical, emotional, psychosocial, behavioral, or |
| 97 | cognitive problems are so severe that the clients require |
| 98 | intensive inpatient treatment by an interdisciplinary team. |
| 99 | Section 2. Paragraph (e) of subsection (5) of section |
| 100 | 212.055, Florida Statutes, is amended to read: |
| 101 | 212.055 Discretionary sales surtaxes; legislative intent; |
| 102 | authorization and use of proceeds.--It is the legislative intent |
| 103 | that any authorization for imposition of a discretionary sales |
| 104 | surtax shall be published in the Florida Statutes as a |
| 105 | subsection of this section, irrespective of the duration of the |
| 106 | levy. Each enactment shall specify the types of counties |
| 107 | authorized to levy; the rate or rates which may be imposed; the |
| 108 | maximum length of time the surtax may be imposed, if any; the |
| 109 | procedure which must be followed to secure voter approval, if |
| 110 | required; the purpose for which the proceeds may be expended; |
| 111 | and such other requirements as the Legislature may provide. |
| 112 | Taxable transactions and administrative procedures shall be as |
| 113 | provided in s. 212.054. |
| 114 | (5) COUNTY PUBLIC HOSPITAL SURTAX.--Any county as defined |
| 115 | in s. 125.011(1) may levy the surtax authorized in this |
| 116 | subsection pursuant to an ordinance either approved by |
| 117 | extraordinary vote of the county commission or conditioned to |
| 118 | take effect only upon approval by a majority vote of the |
| 119 | electors of the county voting in a referendum. In a county as |
| 120 | defined in s. 125.011(1), for the purposes of this subsection, |
| 121 | "county public general hospital" means a general hospital as |
| 122 | defined in s. 395.002 which is owned, operated, maintained, or |
| 123 | governed by the county or its agency, authority, or public |
| 124 | health trust. |
| 125 | (e) A governing board, agency, or authority shall be |
| 126 | chartered by the county commission upon this act becoming law. |
| 127 | The governing board, agency, or authority shall adopt and |
| 128 | implement a health care plan for indigent health care services. |
| 129 | The governing board, agency, or authority shall consist of no |
| 130 | more than seven and no fewer than five members appointed by the |
| 131 | county commission. The members of the governing board, agency, |
| 132 | or authority shall be at least 18 years of age and residents of |
| 133 | the county. No member may be employed by or affiliated with a |
| 134 | health care provider or the public health trust, agency, or |
| 135 | authority responsible for the county public general hospital. |
| 136 | The following community organizations shall each appoint a |
| 137 | representative to a nominating committee: the South Florida |
| 138 | Hospital and Healthcare Association, the Miami-Dade County |
| 139 | Public Health Trust, the Dade County Medical Association, the |
| 140 | Miami-Dade County Homeless Trust, and the Mayor of Miami-Dade |
| 141 | County. This committee shall nominate between 10 and 14 county |
| 142 | citizens for the governing board, agency, or authority. The |
| 143 | slate shall be presented to the county commission and the county |
| 144 | commission shall confirm the top five to seven nominees, |
| 145 | depending on the size of the governing board. Until such time |
| 146 | as the governing board, agency, or authority is created, the |
| 147 | funds provided for in subparagraph (d)2. shall be placed in a |
| 148 | restricted account set aside from other county funds and not |
| 149 | disbursed by the county for any other purpose. |
| 150 | 1. The plan shall divide the county into a minimum of four |
| 151 | and maximum of six service areas, with no more than one |
| 152 | participant hospital per service area. The county public general |
| 153 | hospital shall be designated as the provider for one of the |
| 154 | service areas. Services shall be provided through participants' |
| 155 | primary acute care facilities. |
| 156 | 2. The plan and subsequent amendments to it shall fund a |
| 157 | defined range of health care services for both indigent persons |
| 158 | and the medically poor, including primary care, preventive care, |
| 159 | hospital emergency room care, and hospital care necessary to |
| 160 | stabilize the patient. For the purposes of this section, |
| 161 | "stabilization" means stabilization as defined in s. 397.311(30) |
| 162 | s. 397.311(29). Where consistent with these objectives, the plan |
| 163 | may include services rendered by physicians, clinics, community |
| 164 | hospitals, and alternative delivery sites, as well as at least |
| 165 | one regional referral hospital per service area. The plan shall |
| 166 | provide that agreements negotiated between the governing board, |
| 167 | agency, or authority and providers shall recognize hospitals |
| 168 | that render a disproportionate share of indigent care, provide |
| 169 | other incentives to promote the delivery of charity care to draw |
| 170 | down federal funds where appropriate, and require cost |
| 171 | containment, including, but not limited to, case management. |
| 172 | From the funds specified in subparagraphs (d)1. and 2. for |
| 173 | indigent health care services, service providers shall receive |
| 174 | reimbursement at a Medicaid rate to be determined by the |
| 175 | governing board, agency, or authority created pursuant to this |
| 176 | paragraph for the initial emergency room visit, and a per-member |
| 177 | per-month fee or capitation for those members enrolled in their |
| 178 | service area, as compensation for the services rendered |
| 179 | following the initial emergency visit. Except for provisions of |
| 180 | emergency services, upon determination of eligibility, |
| 181 | enrollment shall be deemed to have occurred at the time services |
| 182 | were rendered. The provisions for specific reimbursement of |
| 183 | emergency services shall be repealed on July 1, 2001, unless |
| 184 | otherwise reenacted by the Legislature. The capitation amount or |
| 185 | rate shall be determined prior to program implementation by an |
| 186 | independent actuarial consultant. In no event shall such |
| 187 | reimbursement rates exceed the Medicaid rate. The plan must also |
| 188 | provide that any hospitals owned and operated by government |
| 189 | entities on or after the effective date of this act must, as a |
| 190 | condition of receiving funds under this subsection, afford |
| 191 | public access equal to that provided under s. 286.011 as to any |
| 192 | meeting of the governing board, agency, or authority the subject |
| 193 | of which is budgeting resources for the retention of charity |
| 194 | care, as that term is defined in the rules of the Agency for |
| 195 | Health Care Administration. The plan shall also include |
| 196 | innovative health care programs that provide cost-effective |
| 197 | alternatives to traditional methods of service and delivery |
| 198 | funding. |
| 199 | 3. The plan's benefits shall be made available to all |
| 200 | county residents currently eligible to receive health care |
| 201 | services as indigents or medically poor as defined in paragraph |
| 202 | (4)(d). |
| 203 | 4. Eligible residents who participate in the health care |
| 204 | plan shall receive coverage for a period of 12 months or the |
| 205 | period extending from the time of enrollment to the end of the |
| 206 | current fiscal year, per enrollment period, whichever is less. |
| 207 | 5. At the end of each fiscal year, the governing board, |
| 208 | agency, or authority shall prepare an audit that reviews the |
| 209 | budget of the plan, delivery of services, and quality of |
| 210 | services, and makes recommendations to increase the plan's |
| 211 | efficiency. The audit shall take into account participant |
| 212 | hospital satisfaction with the plan and assess the amount of |
| 213 | poststabilization patient transfers requested, and accepted or |
| 214 | denied, by the county public general hospital. |
| 215 | Section 3. For the purpose of incorporating the amendment |
| 216 | made by this act to section 397.311, Florida Statutes, in a |
| 217 | reference thereto, subsection (8) of section 397.405, Florida |
| 218 | Statutes, is reenacted to read: |
| 219 | 397.405 Exemptions from licensure.--The following are |
| 220 | exempt from the licensing provisions of this chapter: |
| 221 | (8) An established and legally cognizable church or |
| 222 | nonprofit religious organization or denomination providing |
| 223 | substance abuse services, including prevention services, which |
| 224 | are exclusively religious, spiritual, or ecclesiastical in |
| 225 | nature. A church or nonprofit religious organization or |
| 226 | denomination providing any of the licensable service components |
| 227 | itemized under s. 397.311(18) is not exempt for purposes of its |
| 228 | provision of such licensable service components but retains its |
| 229 | exemption with respect to all services which are exclusively |
| 230 | religious, spiritual, or ecclesiastical in nature. |
| 231 | Section 4. For the purpose of incorporating the amendment |
| 232 | made by this act to section 397.311, Florida Statutes, in a |
| 233 | reference thereto, subsection (1) of section 397.407, Florida |
| 234 | Statutes, is reenacted to read: |
| 235 | 397.407 Licensure fees.-- |
| 236 | (1) The department shall establish licensure fees by rule. |
| 237 | The rule must prescribe a fee range that is based, at least in |
| 238 | part, on the number and complexity of programs listed in s. |
| 239 | 397.311(18) which are operated by a licensee. The fee range |
| 240 | must be implemented over a 5-year period. The fee schedule for |
| 241 | licensure of service components must be increased annually in |
| 242 | substantially equal increments so that, by July 1, 1998, the |
| 243 | fees from the licensure of service components are sufficient to |
| 244 | cover at least 50 percent of the costs of regulating the service |
| 245 | components. The department shall specify by rule a fee range |
| 246 | and phase-in plan for privately funded licensed service |
| 247 | providers and a fee range and phase-in plan for publicly funded |
| 248 | licensed service providers. Fees for privately funded licensed |
| 249 | service providers must exceed the fees for publicly funded |
| 250 | licensed service providers. The first year phase-in licensure |
| 251 | fees must be at least $150 per initial license. The rule must |
| 252 | provide for a reduction in licensure fees for licensed service |
| 253 | providers who hold more than one license. |
| 254 | Section 5. Subsection (2) of section 397.416, Florida |
| 255 | Statutes, is amended to read: |
| 256 | 397.416 Substance abuse treatment services; qualified |
| 257 | professional.-- |
| 258 | (2) Notwithstanding any other provision of law, a person |
| 259 | who was certified through a certification process recognized by |
| 260 | the former Department of Health and Rehabilitative Services |
| 261 | before January 1, 1995, may perform the duties of a qualified |
| 262 | professional with respect to substance abuse treatment services |
| 263 | as defined in this chapter, and need not meet the certification |
| 264 | requirements contained in s. 397.311(25) s. 397.311(24). |
| 265 | Section 6. Paragraphs (d) and (g) of subsection (1) of |
| 266 | section 440.102, Florida Statutes, are amended to read: |
| 267 | 440.102 Drug-free workplace program requirements.--The |
| 268 | following provisions apply to a drug-free workplace program |
| 269 | implemented pursuant to law or to rules adopted by the Agency |
| 270 | for Health Care Administration: |
| 271 | (1) DEFINITIONS.--Except where the context otherwise |
| 272 | requires, as used in this act: |
| 273 | (d) "Drug rehabilitation program" means a service |
| 274 | provider, established pursuant to s. 397.311(28) s. 397.311(27), |
| 275 | that provides confidential, timely, and expert identification, |
| 276 | assessment, and resolution of employee drug abuse. |
| 277 | (g) "Employee assistance program" means an established |
| 278 | program capable of providing expert assessment of employee |
| 279 | personal concerns; confidential and timely identification |
| 280 | services with regard to employee drug abuse; referrals of |
| 281 | employees for appropriate diagnosis, treatment, and assistance; |
| 282 | and followup services for employees who participate in the |
| 283 | program or require monitoring after returning to work. If, in |
| 284 | addition to the above activities, an employee assistance program |
| 285 | provides diagnostic and treatment services, these services shall |
| 286 | in all cases be provided by service providers pursuant to s. |
| 287 | 397.311(28) s. 397.311(27). |
| 288 | Section 7. This act shall take effect July 1, 2005. |