HB 0779

CS

CHAMBER ACTION

1	The Health & Families Council recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to substance abuse treatment; amending s.
7	394.499, F.S.; authorizing the Department of Children and
8	Family Services to expand certain demonstration models;
9	amending s. 397.311, F.S.; including intensive inpatient
10	treatment within the service components provided by a
11	licensed service provider; defining the term "medical
12	monitoring"; amending s. 212.055, F.S., relating to the
13	county public hospital surtax; conforming a cross
14	reference; reenacting ss. 397.405(8) and 397.407(1), F.S.,
15	relating to treatment providers, to incorporate the
16	amendment to s. 397.311, F.S., in references thereto;
17	amending ss. 397.416 and 440.102, F.S., relating to
18	treatment services and the drug-free workplace program;
19	conforming cross references; providing an effective date.
20
21	Be It Enacted by the Legislature of the State of Florida:
22
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 and
28	Family Services, in consultation with the Agency for Health Care
29	Administration, is authorized to establish children's behavioral
30	crisis unit demonstration models in Collier, Lee, and Sarasota
31	Counties. By December 31, 2003, the department shall submit to
32	the President of the Senate, the Speaker of the House of
33	Representatives, and the chairs of the Senate and House
34	committees that oversee departmental activities a report that
35	evaluates the number of clients served, quality of services,
36	performance outcomes, and feasibility of continuing or expanding
37	the demonstration models. As a result of the recommendations
38	regarding expansion of the demonstration models contained in the
39	evaluation report of December 31, 2003 Beginning July 1, 2004,
40	subject to approval by the Legislature, the department, in
41	cooperation with the agency, may expand the demonstration models
42	to other areas in the state after July 1, 2005. The children's
43	behavioral crisis unit demonstration models will integrate
44	children's mental health crisis stabilization units with
45	substance abuse juvenile addictions receiving facility services,
46	to provide emergency mental health and substance abuse services
47	that are integrated within facilities licensed and designated by
48	the agency for children under 18 years of age who meet criteria
49	for admission or examination under this section. The services
50	shall be designated as "integrated children's crisis
51	stabilization unit/juvenile addictions receiving facility
52	services," shall be licensed by the agency as children's crisis
53	stabilization units, and shall meet all licensure requirements
54	for crisis stabilization units. The department, in cooperation
55	with the agency, shall develop standards that address
56	eligibility criteria; clinical procedures; staffing
57	requirements; operational, administrative, and financing
58	requirements; and investigation of complaints for such
59	integrated facility services. Standards that are implemented
60	specific to substance abuse services shall meet or exceed
61	existing standards for addictions receiving facilities.
62	Section 2.  Subsection (18) of section 397.311, Florida
63	Statutes, is amended, present subsections (19) through (29) of
64	that section are redesignated as subsections (20) through (30),
65	respectively, and a new subsection (19) is added to that
66	section, to read:
67	397.311  Definitions.--As used in this chapter, except part
68	VIII:
69	(18)  "Licensed service provider" means a public agency
70	under this chapter, a private for-profit or not-for-profit
71	agency under this chapter, a physician or any other private
72	practitioner licensed under this chapter, or a hospital that
73	offers substance abuse impairment services through one or more
74	of the following licensable service components:
75	(a)  Addictions receiving facility, which is a community-
76	based facility designated by the department to receive, screen,
77	and assess clients found to be substance abuse impaired, in need
78	of emergency treatment for substance abuse impairment, or
79	impaired by substance abuse to such an extent as to meet the
80	criteria for involuntary admission in s. 397.675, and to provide
81	detoxification and stabilization.  An addictions receiving
82	facility must be state-owned, state-operated, or state-
83	contracted, and licensed pursuant to rules adopted by the
84	department's Substance Abuse Program Office which include
85	specific authorization for the provision of levels of care and a
86	requirement of separate accommodations for adults and minors.
87	Addictions receiving facilities are designated as secure
88	facilities to provide an intensive level of care and must have
89	sufficient staff and the authority to provide environmental
90	security to handle aggressive and difficult-to-manage behavior
91	and deter elopement.
92	(b)  Detoxification, which uses medical and psychological
93	procedures and a supportive counseling regimen to assist clients
94	in managing toxicity and withdrawing and stabilizing from the
95	physiological and psychological effects of substance abuse
96	impairment.
97	(c)  Intensive inpatient treatment, which includes a
98	planned regimen of professionally directed evaluation,
99	observation, medical monitoring, and clinical protocols provided
100	24 hours per day, 7 days per week in a highly structured, live-
101	in environment.
102	(d)(c)  Residential treatment, which provides a structured,
103	live-in environment within a nonhospital setting on a 24-hours-
104	a-day, 7-days-a-week basis, and which includes:
105	1.  Facilities that provide room and board and treatment
106	and rehabilitation within the primary residential facility; and
107	2.  Facilities that are used for room and board only and in
108	which treatment and rehabilitation activities are provided on a
109	mandatory basis at locations other than the primary residential
110	facility. In this case, facilities used for room and board and
111	for treatment and rehabilitation are operated under the auspices
112	of the same provider, and licensing and regulatory requirements
113	would apply to both the residential facility and all other
114	facilities in which treatment and rehabilitation activities
115	occur.
116	(e)(d)  Day and night treatment, which provides a
117	nonresidential environment with a structured schedule of
118	treatment and rehabilitation services.
119	(f)(e)  Outpatient treatment, which provides individual,
120	group, or family counseling for clients by appointment during
121	scheduled operating hours, with an emphasis on assessment and
122	treatment.
123	(g)(f)  Medication and methadone maintenance treatment that
124	uses methadone or other medication as authorized by state and
125	federal law, in conjunction with medical, rehabilitative, and
126	counseling services in the treatment of clients who are
127	dependent upon opioid drugs.
128	(h)(g)  Prevention, which is a process involving strategies
129	aimed at the individual, the environment, or the substance,
130	which strategies preclude, forestall, or impede the development
131	of substance abuse problems and promote responsible personal and
132	social growth of individuals and families toward full human
133	potential.
134	(i)(h)  Intervention, which consists of structured services
135	targeted toward individuals or groups at risk and focused on
136	reducing those factors associated with the onset or the early
137	stages of substance abuse, and related problems.
138	(19)  "Medical monitoring" means oversight and treatment,
139	provided 24 hours per day by medical personnel who are licensed
140	under chapter 458, chapter 459, or chapter 464, of clients whose
141	subacute biomedical, emotional, psychosocial, behavioral, or
142	cognitive problems are so severe that the clients require
143	intensive inpatient treatment by an interdisciplinary team.
144	Section 3.  Paragraph (e) of subsection (5) of section
145	212.055, Florida Statutes, is amended to read:
146	212.055  Discretionary sales surtaxes; legislative intent;
147	authorization and use of proceeds.--It is the legislative intent
148	that any authorization for imposition of a discretionary sales
149	surtax shall be published in the Florida Statutes as a
150	subsection of this section, irrespective of the duration of the
151	levy.  Each enactment shall specify the types of counties
152	authorized to levy; the rate or rates which may be imposed; the
153	maximum length of time the surtax may be imposed, if any; the
154	procedure which must be followed to secure voter approval, if
155	required; the purpose for which the proceeds may be expended;
156	and such other requirements as the Legislature may provide.
157	Taxable transactions and administrative procedures shall be as
158	provided in s. 212.054.
159	(5)  COUNTY PUBLIC HOSPITAL SURTAX.--Any county as defined
160	in s. 125.011(1) may levy the surtax authorized in this
161	subsection pursuant to an ordinance either approved by
162	extraordinary vote of the county commission or conditioned to
163	take effect only upon approval by a majority vote of the
164	electors of the county voting in a referendum.  In a county as
165	defined in s. 125.011(1), for the purposes of this subsection,
166	"county public general hospital" means a general hospital as
167	defined in s. 395.002 which is owned, operated, maintained, or
168	governed by the county or its agency, authority, or public
169	health trust.
170	(e)  A governing board, agency, or authority shall be
171	chartered by the county commission upon this act becoming law.
172	The governing board, agency, or authority shall adopt and
173	implement a health care plan for indigent health care services.
174	The governing board, agency, or authority shall consist of no
175	more than seven and no fewer than five members appointed by the
176	county commission.  The members of the governing board, agency,
177	or authority shall be at least 18 years of age and residents of
178	the county.  No member may be employed by or affiliated with a
179	health care provider or the public health trust, agency, or
180	authority responsible for the county public general hospital.
181	The following community organizations shall each appoint a
182	representative to a nominating committee:  the South Florida
183	Hospital and Healthcare Association, the Miami-Dade County
184	Public Health Trust, the Dade County Medical Association, the
185	Miami-Dade County Homeless Trust, and the Mayor of Miami-Dade
186	County. This committee shall nominate between 10 and 14 county
187	citizens for the governing board, agency, or authority.  The
188	slate shall be presented to the county commission and the county
189	commission shall confirm the top five to seven nominees,
190	depending on the size of the governing board.  Until such time
191	as the governing board, agency, or authority is created, the
192	funds provided for in subparagraph (d)2. shall be placed in a
193	restricted account set aside from other county funds and not
194	disbursed by the county for any other purpose.
195	1.  The plan shall divide the county into a minimum of four
196	and maximum of six service areas, with no more than one
197	participant hospital per service area. The county public general
198	hospital shall be designated as the provider for one of the
199	service areas.  Services shall be provided through participants'
200	primary acute care facilities.
201	2.  The plan and subsequent amendments to it shall fund a
202	defined range of health care services for both indigent persons
203	and the medically poor, including primary care, preventive care,
204	hospital emergency room care, and hospital care necessary to
205	stabilize the patient. For the purposes of this section,
206	"stabilization" means stabilization as defined in s. 397.311(30)
207	s. 397.311(29). Where consistent with these objectives, the plan
208	may include services rendered by physicians, clinics, community
209	hospitals, and alternative delivery sites, as well as at least
210	one regional referral hospital per service area. The plan shall
211	provide that agreements negotiated between the governing board,
212	agency, or authority and providers shall recognize hospitals
213	that render a disproportionate share of indigent care, provide
214	other incentives to promote the delivery of charity care to draw
215	down federal funds where appropriate, and require cost
216	containment, including, but not limited to, case management.
217	From the funds specified in subparagraphs (d)1. and 2. for
218	indigent health care services, service providers shall receive
219	reimbursement at a Medicaid rate to be determined by the
220	governing board, agency, or authority created pursuant to this
221	paragraph for the initial emergency room visit, and a per-member
222	per-month fee or capitation for those members enrolled in their
223	service area, as compensation for the services rendered
224	following the initial emergency visit. Except for provisions of
225	emergency services, upon determination of eligibility,
226	enrollment shall be deemed to have occurred at the time services
227	were rendered. The provisions for specific reimbursement of
228	emergency services shall be repealed on July 1, 2001, unless
229	otherwise reenacted by the Legislature. The capitation amount or
230	rate shall be determined prior to program implementation by an
231	independent actuarial consultant. In no event shall such
232	reimbursement rates exceed the Medicaid rate. The plan must also
233	provide that any hospitals owned and operated by government
234	entities on or after the effective date of this act must, as a
235	condition of receiving funds under this subsection, afford
236	public access equal to that provided under s. 286.011 as to any
237	meeting of the governing board, agency, or authority the subject
238	of which is budgeting resources for the retention of charity
239	care, as that term is defined in the rules of the Agency for
240	Health Care Administration. The plan shall also include
241	innovative health care programs that provide cost-effective
242	alternatives to traditional methods of service and delivery
243	funding.
244	3.  The plan's benefits shall be made available to all
245	county residents currently eligible to receive health care
246	services as indigents or medically poor as defined in paragraph
247	(4)(d).
248	4.  Eligible residents who participate in the health care
249	plan shall receive coverage for a period of 12 months or the
250	period extending from the time of enrollment to the end of the
251	current fiscal year, per enrollment period, whichever is less.
252	5.  At the end of each fiscal year, the governing board,
253	agency, or authority shall prepare an audit that reviews the
254	budget of the plan, delivery of services, and quality of
255	services, and makes recommendations to increase the plan's
256	efficiency.  The audit shall take into account participant
257	hospital satisfaction with the plan and assess the amount of
258	poststabilization patient transfers requested, and accepted or
259	denied, by the county public general hospital.
260	Section 4.  For the purpose of incorporating the amendment
261	made by this act to section 397.311, Florida Statutes, in a
262	reference thereto, subsection (8) of section 397.405, Florida
263	Statutes, is reenacted to read:
264	397.405  Exemptions from licensure.--The following are
265	exempt from the licensing provisions of this chapter:
266	(8)  An established and legally cognizable church or
267	nonprofit religious organization or denomination providing
268	substance abuse services, including prevention services, which
269	are exclusively religious, spiritual, or ecclesiastical in
270	nature.  A church or nonprofit religious organization or
271	denomination providing any of the licensable service components
272	itemized under s. 397.311(18) is not exempt for purposes of its
273	provision of such licensable service components but retains its
274	exemption with respect to all services which are exclusively
275	religious, spiritual, or ecclesiastical in nature.
276	Section 5.  For the purpose of incorporating the amendment
277	made by this act to section 397.311, Florida Statutes, in a
278	reference thereto, subsection (1) of section 397.407, Florida
279	Statutes, is reenacted to read:
280	397.407  Licensure fees.--
281	(1)  The department shall establish licensure fees by rule.
282	The rule must prescribe a fee range that is based, at least in
283	part, on the number and complexity of programs listed in s.
284	397.311(18) which are operated by a licensee.  The fee range
285	must be implemented over a 5-year period.  The fee schedule for
286	licensure of service components must be increased annually in
287	substantially equal increments so that, by July 1, 1998, the
288	fees from the licensure of service components are sufficient to
289	cover at least 50 percent of the costs of regulating the service
290	components.  The department shall specify by rule a fee range
291	and phase-in plan for privately funded licensed service
292	providers and a fee range and phase-in plan for publicly funded
293	licensed service providers.  Fees for privately funded licensed
294	service providers must exceed the fees for publicly funded
295	licensed service providers.  The first year phase-in licensure
296	fees must be at least $150 per initial license. The rule must
297	provide for a reduction in licensure fees for licensed service
298	providers who hold more than one license.
299	Section 6.  Subsection (2) of section 397.416, Florida
300	Statutes, is amended to read:
301	397.416  Substance abuse treatment services; qualified
302	professional.--
303	(2)  Notwithstanding any other provision of law, a person
304	who was certified through a certification process recognized by
305	the former Department of Health and Rehabilitative Services
306	before January 1, 1995, may perform the duties of a qualified
307	professional with respect to substance abuse treatment services
308	as defined in this chapter, and need not meet the certification
309	requirements contained in s. 397.311(25) s. 397.311(24).
310	Section 7.  Paragraphs (d) and (g) of subsection (1) of
311	section 440.102, Florida Statutes, are amended to read:
312	440.102  Drug-free workplace program requirements.--The
313	following provisions apply to a drug-free workplace program
314	implemented pursuant to law or to rules adopted by the Agency
315	for Health Care Administration:
316	(1)  DEFINITIONS.--Except where the context otherwise
317	requires, as used in this act:
318	(d)  "Drug rehabilitation program" means a service
319	provider, established pursuant to s. 397.311(28) s. 397.311(27),
320	that provides confidential, timely, and expert identification,
321	assessment, and resolution of employee drug abuse.
322	(g)  "Employee assistance program" means an established
323	program capable of providing expert assessment of employee
324	personal concerns; confidential and timely identification
325	services with regard to employee drug abuse; referrals of
326	employees for appropriate diagnosis, treatment, and assistance;
327	and followup services for employees who participate in the
328	program or require monitoring after returning to work. If, in
329	addition to the above activities, an employee assistance program
330	provides diagnostic and treatment services, these services shall
331	in all cases be provided by service providers pursuant to s.
332	397.311(28) s. 397.311(27).
333	Section 8.  This act shall take effect July 1, 2005.

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