Florida Senate - 2020 SB 1554
By Senator Baxley
12-01043A-20 20201554__
1 A bill to be entitled
2 An act relating to substance abuse and mental health;
3 amending s. 394.455, F.S.; revising the definition of
4 the term “mental illness” to exclude conditions
5 manifested by dementia or traumatic brain injury;
6 amending s. 394.674, F.S.; revising eligibility
7 requirements for certain substance abuse and mental
8 health services; providing priority for specified
9 individuals; conforming provisions to changes made by
10 the act; amending s. 394.908, F.S.; revising the
11 definition of the term “individuals in need”; revising
12 distribution of funding for substance abuse and mental
13 health services; amending s. 394.9085, F.S.;
14 conforming a cross-reference; amending s. 397.311,
15 F.S.; revising definitions; amending s. 397.4012,
16 F.S.; revising entities that are exempt from certain
17 licensing requirements; amending s. 397.4073, F.S.;
18 providing an exemption from background screening
19 requirements for certain peer specialists; amending s.
20 916.106, F.S.; revising the definition of the term
21 “mental illness”; amending ss. 916.13 and 916.15,
22 F.S.; requiring the Department of Children and
23 Families to request certain medical information from
24 jails; requiring county jails to provide such
25 information within a specified timeframe; requiring
26 the maintenance of psychotropic medications to
27 specified defendants under certain circumstances;
28 providing an exception; providing an effective date.
29
30 Be It Enacted by the Legislature of the State of Florida:
31
32 Section 1. Subsection (28) of section 394.455, Florida
33 Statutes, is amended to read:
34 394.455 Definitions.—As used in this part, the term:
35 (28) “Mental illness” means an impairment of the mental or
36 emotional processes that exercise conscious control of one’s
37 actions or of the ability to perceive or understand reality,
38 which impairment substantially interferes with the person’s
39 ability to meet the ordinary demands of living. For the purposes
40 of this part, the term does not include a developmental
41 disability as defined in chapter 393, intoxication, or
42 conditions manifested only by dementia, traumatic brain injury,
43 antisocial behavior, or substance abuse.
44 Section 2. Section 394.674, Florida Statutes, is amended to
45 read:
46 394.674 Eligibility for publicly funded substance abuse and
47 mental health services; fee collection requirements.—
48 (1) To be eligible to receive substance abuse and mental
49 health services funded by the department, an individual must be
50 indigent, uninsured, or underinsured and meet at least one of
51 the following criteria a member of at least one of the
52 department’s priority populations approved by the Legislature.
53 The priority populations include:
54 (a) For adult mental health services, an individual must
55 be:
56 1. An adult who has a serious mental illness, as defined by
57 the department using criteria that, at a minimum, include
58 diagnosis, prognosis, functional impairment, and receipt of
59 disability income for a psychiatric condition.
60 2. An adult at risk of serious mental illness who:
61 a.(I) Has a primary diagnosis of a mental disorder as
62 defined in the most recent edition of the Diagnostic and
63 Statistical Manual of Mental Disorders published by the American
64 Psychiatric Association that is not considered a serious mental
65 illness; or
66 (II) Has a condition with a Z-code diagnosis code in the
67 most recent edition of the Diagnostic and Statistical Manual of
68 Mental Disorders published by the American Psychiatric
69 Association; and
70 b. Experiences a severe stressful event and has problems
71 coping or has symptoms that place the individual at risk of more
72 restrictive interventions.
73 3. A child or adolescent at risk of emotional disturbance,
74 as defined in s. 394.492.
75 4. A child or adolescent who has an emotional disturbance,
76 as defined in s. 394.492.
77 5. A child or adolescent who has a serious emotional
78 disturbance or mental illness, as defined in s. 394.492.
79 6. An individual who has a primary diagnosis of mental
80 illness and a co-occurring substance use disorder.
81 7. An individual experiencing an acute mental or emotional
82 crisis, as defined in s. 394.67.
83 Adults who have severe and persistent mental illness, as
84 designated by the department using criteria that include
85 severity of diagnosis, duration of the mental illness, ability
86 to independently perform activities of daily living, and receipt
87 of disability income for a psychiatric condition. Included
88 within this group are:
89 a. Older adults in crisis.
90 b. Older adults who are at risk of being placed in a more
91 restrictive environment because of their mental illness.
92 c. Persons deemed incompetent to proceed or not guilty by
93 reason of insanity under chapter 916.
94 d. Other persons involved in the criminal justice system.
95 e. Persons diagnosed as having co-occurring mental illness
96 and substance abuse disorders.
97 2. Persons who are experiencing an acute mental or
98 emotional crisis as defined in s. 394.67(17).
99 (b) For substance abuse services, an individual must
100 children’s mental health services:
101 1. Have a substance use disorder that meets one of the
102 diagnostic categories specified in the most recent edition of
103 the Diagnostic and Statistical Manual of Mental Disorders
104 published by the American Psychiatric Association.
105 2. Have a substance use disorder that meets one of the
106 diagnostic categories specified in the most recent edition of
107 the Diagnostic and Statistical Manual of Mental Disorders
108 published by the American Psychiatric Association as the primary
109 diagnosis and a co-occurring mental illness or serious emotional
110 disturbance.
111 3. Be at risk for initiating alcohol or drug use.
112 Children who are at risk of emotional disturbance as
113 defined in s. 394.492(4).
114 2. Children who have an emotional disturbance as defined in
115 s. 394.492(5).
116 3. Children who have a serious emotional disturbance as
117 defined in s. 394.492(6).
118 4. Children diagnosed as having a co-occurring substance
119 abuse and emotional disturbance or serious emotional
120 disturbance.
121 (c) For substance abuse treatment services:
122 1. Adults who have substance abuse disorders and a history
123 of intravenous drug use.
124 2. Persons diagnosed as having co-occurring substance abuse
125 and mental health disorders.
126 3. Parents who put children at risk due to a substance
127 abuse disorder.
128 4. Persons who have a substance abuse disorder and have
129 been ordered by the court to receive treatment.
130 5. Children at risk for initiating drug use.
131 6. Children under state supervision.
132 7. Children who have a substance abuse disorder but who are
133 not under the supervision of a court or in the custody of a
134 state agency.
135 8. Persons identified as being part of a priority
136 population as a condition for receiving services funded through
137 the Center for Mental Health Services and Substance Abuse
138 Prevention and Treatment Block Grants.
139 (2) Providers receiving funds from the department for
140 behavioral health services must give priority to:
141 (a) Pregnant women and women with dependent children.
142 (b) Intravenous drug users.
143 (c) Individuals who have a substance use disorder and have
144 been ordered by the court to receive treatment.
145 (d) Parents, legal guardians, or caregivers with child
146 welfare involvement and parents, legal guardians, or caregivers
147 who put children at risk due to substance abuse.
148 (e) Children and adolescents under state supervision.
149 (f) Individuals involved in the criminal justice system,
150 including those deemed incompetent to proceed or not guilty by
151 reason of insanity under chapter 916.
152 (3)(2) Crisis services, as defined in s. 394.67, must,
153 within the limitations of available state and local matching
154 resources, be available to each individual person who is
155 eligible for services under subsection (1), regardless of the
156 individual’s person’s ability to pay for such services. An
157 individual A person who is experiencing a mental health crisis
158 and who does not meet the criteria for involuntary examination
159 under s. 394.463(1), or an individual a person who is
160 experiencing a substance abuse crisis and who does not meet the
161 involuntary admission criteria in s. 397.675, must contribute to
162 the cost of his or her care and treatment pursuant to the
163 sliding fee scale developed under subsection (5) (4), unless
164 charging a fee is contraindicated because of the crisis
165 situation.
166 (4)(3) Mental health services, substance abuse services,
167 and crisis services, as defined in s. 394.67, must, within the
168 limitations of available state and local matching resources, be
169 available to each individual person who is eligible for services
170 under subsection (1). Such individual person must contribute to
171 the cost of his or her care and treatment pursuant to the
172 sliding fee scale developed under subsection (5) (4).
173 (5)(4) The department shall adopt rules to implement client
174 eligibility, client enrollment, and fee collection requirements
175 for publicly funded substance abuse and mental health services.
176 (a) The rules must require each provider under contract
177 with the department or a managing entity that which enrolls
178 eligible individuals persons into treatment to develop a sliding
179 fee scale for individuals persons who have a net family income
180 at or above 150 percent of the Federal Poverty Income
181 Guidelines, unless otherwise required by state or federal law.
182 The sliding fee scale must use the uniform schedule of discounts
183 by which a provider under contract with the department or a
184 managing entity discounts its established client charges for
185 services supported with state, federal, or local funds, using,
186 at a minimum, factors such as family income, financial assets,
187 and family size as declared by the individual person or the
188 individual’s person’s guardian. The rules must include uniform
189 criteria to be used by all service providers in developing the
190 schedule of discounts for the sliding fee scale.
191 (b) The rules must address the most expensive types of
192 treatment, such as residential and inpatient treatment, in order
193 to make it possible for an individual a client to responsibly
194 contribute to his or her mental health or substance abuse care
195 without jeopardizing the family’s financial stability. An
196 individual A person who is not eligible for Medicaid and whose
197 net family income is less than 150 percent of the Federal
198 Poverty Income Guidelines must pay a portion of his or her
199 treatment costs which is comparable to the copayment amount
200 required by the Medicaid program for Medicaid clients under
201 pursuant to s. 409.9081.
202 (c) The rules must require that individuals persons who
203 receive financial assistance from the Federal Government because
204 of a disability and are in long-term residential treatment
205 settings contribute to their board and care costs and treatment
206 costs and must be consistent with the provisions in s. 409.212.
207 (6)(5) An individual A person who meets the eligibility
208 criteria in subsection (1) shall be served in accordance with
209 the appropriate district substance abuse and mental health
210 services plan specified in s. 394.75 and within available
211 resources.
212 Section 3. Section 394.908, Florida Statutes, is amended to
213 read:
214 394.908 Substance abuse and mental health funding equity;
215 distribution of appropriations.—In recognition of the historical
216 inequity in the funding of substance abuse and mental health
217 services for the department’s districts and regions and to
218 rectify this inequity and provide for equitable funding in the
219 future throughout the state, the following funding process shall
220 be used:
221 (1) Funding thresholds for substance abuse and mental
222 health services in each of the current districts, statewide,
223 shall be established based on the current number of individuals
224 in need per district of substance abuse and mental health
225 services, respectively.
226 (2) “Individuals in need” means those persons who meet
227 eligibility criteria under s. 394.674 fit the profile of the
228 respective priority populations and require mental health or
229 substance abuse services.
230 (3) Any additional funding beyond the 2005-2006 fiscal year
231 base appropriation for substance abuse alcohol, drug abuse, and
232 mental health services shall be allocated to districts for
233 substance abuse and mental health services based on:
234 (a) Epidemiological estimates of disabilities that apply to
235 individuals in need the respective priority populations.
236 (b) A pro rata share distribution that ensures districts
237 below the statewide average funding level per individual in each
238 priority population of “individuals in need” receive funding
239 necessary to achieve equity.
240 (4) Priority populations for Individuals in need shall be
241 displayed for each district and distributed concurrently with
242 the approved operating budget. The display by priority
243 population shall show: The annual number of individuals served
244 based on prior year actual numbers, the annual cost per
245 individual served, and the estimated number of the total
246 priority population for individuals in need.
247 (5) The annual cost per individual served shall be defined
248 as the total actual funding for mental health or substance abuse
249 services each priority population divided by the number of
250 individuals receiving mental health or substance abuse services
251 served in the priority population for that year.
252 Section 4. Subsection (6) of section 394.9085, Florida
253 Statutes, is amended to read:
254 394.9085 Behavioral provider liability.—
255 (6) For purposes of this section, the terms “detoxification
256 services,” “addictions receiving facility,” and “receiving
257 facility” have the same meanings as those provided in ss.
258 397.311(26)(a)3. ss. 397.311(26)(a)4., 397.311(26)(a)1., and
259 394.455(39), respectively.
260 Section 5. Paragraph (a) of subsection (26) of section
261 397.311, Florida Statutes, is amended to read:
262 397.311 Definitions.—As used in this chapter, except part
263 VIII, the term:
264 (26) Licensed service components include a comprehensive
265 continuum of accessible and quality substance abuse prevention,
266 intervention, and clinical treatment services, including the
267 following services:
268 (a) “Clinical treatment” means a professionally directed,
269 deliberate, and planned regimen of services and interventions
270 that are designed to reduce or eliminate the misuse of drugs and
271 alcohol and promote a healthy, drug-free lifestyle. As defined
272 by rule, “clinical treatment services” include, but are not
273 limited to, the following licensable service components:
274 1. “Addictions receiving facility” is a secure, acute care
275 facility that provides, at a minimum, detoxification and
276 stabilization services; is operated 24 hours per day, 7 days per
277 week; and is designated by the department to serve individuals
278 found to be substance use impaired as described in s. 397.675
279 who meet the placement criteria for this component.
280 2. “Day or night treatment” is a service provided in a
281 nonresidential environment, with a structured schedule of
282 treatment and rehabilitative services.
283 3. “Day or night treatment with community housing” means a
284 program intended for individuals who can benefit from living
285 independently in peer community housing while participating in
286 treatment services for a minimum of 5 hours a day for a minimum
287 of 25 hours per week.
288 3.4. “Detoxification” is a service involving subacute care
289 that is provided on an inpatient or an outpatient basis to
290 assist individuals to withdraw from the physiological and
291 psychological effects of substance abuse and who meet the
292 placement criteria for this component.
293 4.5. “Intensive inpatient treatment” includes a planned
294 regimen of evaluation, observation, medical monitoring, and
295 clinical protocols delivered through an interdisciplinary team
296 approach provided 24 hours per day, 7 days per week, in a highly
297 structured, live-in environment.
298 5.6. “Intensive outpatient treatment” is a service that
299 provides individual or group counseling in a more structured
300 environment, is of higher intensity and duration than outpatient
301 treatment, and is provided to individuals who meet the placement
302 criteria for this component.
303 6.7. “Medication-assisted treatment for opioid use
304 disorders opiate addiction” is a service that uses methadone or
305 other medication as authorized by state and federal law, in
306 combination with medical, rehabilitative, supportive, and
307 counseling services in the treatment of individuals who are
308 dependent on opioid drugs.
309 7.8. “Outpatient treatment” is a service that provides
310 individual, group, or family counseling by appointment during
311 scheduled operating hours for individuals who meet the placement
312 criteria for this component.
313 8.9. “Residential treatment” is a service provided in a
314 structured live-in environment within a nonhospital setting on a
315 24-hours-per-day, 7-days-per-week basis, and is intended for
316 individuals who meet the placement criteria for this component.
317 Section 6. Section 397.4012, Florida Statutes, is amended
318 to read:
319 397.4012 Exemptions from licensure.—The following are
320 exempt from the licensing provisions of this chapter:
321 (1) A hospital or hospital-based component licensed under
322 chapter 395.
323 (2) A nursing home facility as defined in s. 400.021.
324 (3) A substance abuse education program established
325 pursuant to s. 1003.42.
326 (4) A facility or institution operated by the Federal
327 Government.
328 (5) A physician or physician assistant licensed under
329 chapter 458 or chapter 459.
330 (6) A psychologist licensed under chapter 490.
331 (7) A social worker, marriage and family therapist, or
332 mental health counselor licensed under chapter 491.
333 (8) A legally cognizable church or nonprofit religious
334 organization or denomination providing substance abuse services,
335 including prevention services, which are solely religious,
336 spiritual, or ecclesiastical in nature. A church or nonprofit
337 religious organization or denomination providing any of the
338 licensed service components itemized under s. 397.311(26) is not
339 exempt from substance abuse licensure but retains its exemption
340 with respect to all services which are solely religious,
341 spiritual, or ecclesiastical in nature.
342 (9) Facilities licensed under chapter 393 which, in
343 addition to providing services to persons with developmental
344 disabilities, also provide services to persons developmentally
345 at risk as a consequence of exposure to alcohol or other legal
346 or illegal drugs while in utero.
347 (10) DUI education and screening services provided pursuant
348 to ss. 316.192, 316.193, 322.095, 322.271, and 322.291. Persons
349 or entities providing treatment services must be licensed under
350 this chapter unless exempted from licensing as provided in this
351 section.
352 (11) A facility licensed under s. 394.875 as a crisis
353 stabilization unit.
354
355 The exemptions from licensure in subsections (3), (4), (8), (9),
356 and (10) this section do not apply to any service provider that
357 receives an appropriation, grant, or contract from the state to
358 operate as a service provider as defined in this chapter or to
359 any substance abuse program regulated under pursuant to s.
360 397.4014. Furthermore, this chapter may not be construed to
361 limit the practice of a physician or physician assistant
362 licensed under chapter 458 or chapter 459, a psychologist
363 licensed under chapter 490, a psychotherapist licensed under
364 chapter 491, or an advanced practice registered nurse licensed
365 under part I of chapter 464, who provides substance abuse
366 treatment, so long as the physician, physician assistant,
367 psychologist, psychotherapist, or advanced practice registered
368 nurse does not represent to the public that he or she is a
369 licensed service provider and does not provide services to
370 individuals under pursuant to part V of this chapter. Failure to
371 comply with any requirement necessary to maintain an exempt
372 status under this section is a misdemeanor of the first degree,
373 punishable as provided in s. 775.082 or s. 775.083.
374 Section 7. Paragraph (a) of subsection (1) of section
375 397.4073, Florida Statutes, is amended to read:
376 397.4073 Background checks of service provider personnel.—
377 (1) PERSONNEL BACKGROUND CHECKS; REQUIREMENTS AND
378 EXCEPTIONS.—
379 (a) For all individuals screened on or after July 1, 2019,
380 background checks shall apply as follows:
381 1. All owners, directors, chief financial officers, and
382 clinical supervisors of service providers are subject to level 2
383 background screening as provided under s. 408.809 and chapter
384 435. Inmate substance abuse programs operated directly or under
385 contract with the Department of Corrections are exempt from this
386 requirement.
387 2. All service provider personnel who have direct contact
388 with children receiving services or with adults who are
389 developmentally disabled receiving services are subject to level
390 2 background screening as provided under s. 408.809 and chapter
391 435.
392 3. All peer specialists who have direct contact with
393 individuals receiving services are subject to level 2 background
394 screening as provided under s. 408.809 and chapter 435. Peer
395 specialists employed or certified before July 1, 2019, are
396 exempt from this requirement if, at the time of their employment
397 or certification, the department knew about any disqualifying
398 offenses of the peer specialist.
399 Section 8. Subsection (14) of section 916.106, Florida
400 Statutes, is amended to read:
401 916.106 Definitions.—For the purposes of this chapter, the
402 term:
403 (14) “Mental illness” means an impairment of the emotional
404 processes that exercise conscious control of one’s actions, or
405 of the ability to perceive or understand reality, which
406 impairment substantially interferes with the defendant’s ability
407 to meet the ordinary demands of living. For the purposes of this
408 chapter, the term does not apply to defendants who have only an
409 intellectual disability or autism or a defendant with traumatic
410 brain injury or dementia who lacks a co-occurring mental
411 illness, and does not include intoxication or conditions
412 manifested only by antisocial behavior or substance abuse
413 impairment.
414 Section 9. Paragraph (b) of subsection (2) of section
415 916.13, Florida Statutes, is amended to read:
416 916.13 Involuntary commitment of defendant adjudicated
417 incompetent.—
418 (2) A defendant who has been charged with a felony and who
419 has been adjudicated incompetent to proceed due to mental
420 illness, and who meets the criteria for involuntary commitment
421 under this chapter, may be committed to the department, and the
422 department shall retain and treat the defendant. Within 2
423 business days after receipt of a completed copy of the court
424 commitment order containing all documentation required by the
425 applicable Florida Rules of Criminal Procedure, the department
426 shall request all medical information relating to the defendant
427 from the jail. The jail shall provide the department with all
428 medical information relating to the defendant within 3 business
429 days after receipt of the department’s request.
430 (b) A competency hearing shall be held within 30 days after
431 the court receives notification that the defendant is competent
432 to proceed or no longer meets the criteria for continued
433 commitment. The defendant must be transported to the committing
434 court’s jurisdiction for the hearing. Each defendant returning
435 to a jail shall continue to receive the same psychotropic
436 medications as prescribed by the facility physician at the time
437 of discharge from a forensic or civil facility, unless the jail
438 physician determines there is a compelling medical reason to
439 change or discontinue the medication for the health and safety
440 of the defendant. If the jail physician changes or discontinues
441 the medication and the defendant is later determined at the
442 competency hearing to be incompetent to stand trial and is
443 recommitted to the department, the jail physician may not change
444 or discontinue the defendant’s prescribed psychotropic
445 medication upon the defendant’s next discharge from the forensic
446 or civil facility.
447 Section 10. Subsections (3) and (5) of section 916.15,
448 Florida Statutes, are amended to read:
449 916.15 Involuntary commitment of defendant adjudicated not
450 guilty by reason of insanity.—
451 (3) Every defendant acquitted of criminal charges by reason
452 of insanity and found to meet the criteria for involuntary
453 commitment may be committed and treated in accordance with the
454 provisions of this section and the applicable Florida Rules of
455 Criminal Procedure. Within 2 business days after receipt of a
456 completed copy of the court commitment order containing all
457 documentation required by the applicable Florida Rules of
458 Criminal Procedure, the department shall request all medical
459 information relating to the defendant from the jail. The jail
460 shall provide the department with all medical information
461 relating to the defendant within 3 business days after receipt
462 of the department’s request. The department shall admit a
463 defendant so adjudicated to an appropriate facility or program
464 for treatment and shall retain and treat such defendant. No
465 later than 6 months after the date of admission, before prior to
466 the end of any period of extended commitment, or at any time the
467 administrator or designee determines shall have determined that
468 the defendant no longer meets the criteria for continued
469 commitment placement, the administrator or designee shall file a
470 report with the court pursuant to the applicable Florida Rules
471 of Criminal Procedure.
472 (5) The commitment hearing shall be held within 30 days
473 after the court receives notification that the defendant no
474 longer meets the criteria for continued commitment. The
475 defendant must be transported to the committing court’s
476 jurisdiction for the hearing. Each defendant returning to a jail
477 shall continue to receive the same psychotropic medications as
478 prescribed by the facility physician at the time of discharge
479 from a forensic or civil facility, unless the jail physician
480 determines there is a compelling medical reason to change or
481 discontinue the medication for the health and safety of the
482 defendant. If the jail physician changes or discontinues the
483 medication and the defendant is later determined at the
484 competency hearing to be incompetent to stand trial and is
485 recommitted to the department, the jail physician may not change
486 or discontinue the defendant’s prescribed psychotropic
487 medication upon the defendant’s next discharge from the forensic
488 or civil facility.
489 Section 11. This act shall take effect July 1, 2020.