Florida Senate - 2020                                     SB 920
       By Senator Rouson
       19-01316-20                                            2020920__
    1                        A bill to be entitled                      
    2         An act relating to first-episode psychosis programs;
    3         amending ss. 394.455 and 394.67, F.S.; defining the
    4         term “first-episode psychosis program”; amending s.
    5         394.658, F.S.; revising the application criteria for
    6         the Criminal Justice, Mental Health, and Substance
    7         Abuse Reinvestment Grant Program to include support
    8         for first-episode psychosis programs; amending s.
    9         394.4573, F.S.; requiring the Department of Children
   10         and Families to include specified information
   11         regarding first-episode psychosis programs in its
   12         annual assessment of behavioral health services;
   13         defining the term “first-episode psychosis program”;
   14         providing that first-episode psychosis programs are an
   15         essential element of a coordinated system of care;
   16         amending ss. 394.495, 394.496, 394.674, 394.9085,
   17         409.972, 464.012, and 744.2007, F.S.; conforming
   18         cross-references; providing an effective date.
   20  Be It Enacted by the Legislature of the State of Florida:
   22         Section 1. Present subsections (17) through (48) of section
   23  394.455, Florida Statutes, are redesignated as subsections (18)
   24  through (49), respectively, and a new subsection (17) is added
   25  to that section, to read:
   26         394.455 Definitions.—As used in this part, the term:
   27         (17)“First-episode psychosis program” means an evidence
   28  based program for individuals from 15 through 30 years of age
   29  who are experiencing the early indications of serious mental
   30  illness, especially symptoms of a first psychotic episode, and
   31  which includes, but is not limited to, intensive case
   32  management, individual or group therapy, supported employment,
   33  family education and supports, and the provision of appropriate
   34  psychotropic medication as needed.
   35         Section 2. Present subsections (10) through (24) of section
   36  394.67, Florida Statutes, are redesignated as subsections (11)
   37  through (25), respectively, a new subsection (10) is added to
   38  that section, and subsection (3) of that section is amended, to
   39  read:
   40         394.67 Definitions.—As used in this part, the term:
   41         (3) “Crisis services” means short-term evaluation,
   42  stabilization, and brief intervention services provided to a
   43  person who is experiencing an acute mental or emotional crisis,
   44  as defined in subsection (18) (17), or an acute substance abuse
   45  crisis, as defined in subsection (19) (18), to prevent further
   46  deterioration of the person’s mental health. Crisis services are
   47  provided in settings such as a crisis stabilization unit, an
   48  inpatient unit, a short-term residential treatment program, a
   49  detoxification facility, or an addictions receiving facility; at
   50  the site of the crisis by a mobile crisis response team; or at a
   51  hospital on an outpatient basis.
   52         (10)“First-episode psychosis program” means an evidence
   53  based program for individuals from 15 through 30 years of age
   54  who are experiencing the early indications of serious mental
   55  illness, especially symptoms of a first psychotic episode, and
   56  which includes, but is not limited to, intensive case
   57  management, individual or group therapy, supported employment,
   58  family education and supports, and the provision of appropriate
   59  psychotropic medication as needed.
   60         Section 3. Paragraph (b) of subsection (1) of section
   61  394.658, Florida Statutes, is amended to read:
   62         394.658 Criminal Justice, Mental Health, and Substance
   63  Abuse Reinvestment Grant Program requirements.—
   64         (1) The Criminal Justice, Mental Health, and Substance
   65  Abuse Statewide Grant Review Committee, in collaboration with
   66  the Department of Children and Families, the Department of
   67  Corrections, the Department of Juvenile Justice, the Department
   68  of Elderly Affairs, and the Office of the State Courts
   69  Administrator, shall establish criteria to be used to review
   70  submitted applications and to select the county that will be
   71  awarded a 1-year planning grant or a 3-year implementation or
   72  expansion grant. A planning, implementation, or expansion grant
   73  may not be awarded unless the application of the county meets
   74  the established criteria.
   75         (b) The application criteria for a 3-year implementation or
   76  expansion grant shall require information from a county that
   77  demonstrates its completion of a well-established collaboration
   78  plan that includes public-private partnership models and the
   79  application of evidence-based practices. The implementation or
   80  expansion grants may support programs and diversion initiatives
   81  that include, but need not be limited to:
   82         1. Mental health courts;
   83         2. Diversion programs;
   84         3. Alternative prosecution and sentencing programs;
   85         4. Crisis intervention teams;
   86         5. Treatment accountability services;
   87         6. Specialized training for criminal justice, juvenile
   88  justice, and treatment services professionals;
   89         7. Service delivery of collateral services such as housing,
   90  transitional housing, and supported employment; and
   91         8. Reentry services to create or expand mental health and
   92  substance abuse services and supports for affected persons; and
   93         9.First-episode psychosis programs.
   94         Section 4. Section 394.4573, Florida Statutes, is amended
   95  to read:
   96         394.4573 Coordinated system of care; annual assessment;
   97  essential elements; measures of performance; system improvement
   98  grants; reports.—On or before December 1 of each year, the
   99  department shall submit to the Governor, the President of the
  100  Senate, and the Speaker of the House of Representatives an
  101  assessment of the behavioral health services in this state. The
  102  assessment shall consider, at a minimum, the extent to which
  103  designated receiving systems function as no-wrong-door models,
  104  the availability of treatment and recovery services that use
  105  recovery-oriented and peer-involved approaches, the availability
  106  of less-restrictive services, and the use of evidence-informed
  107  practices. The assessment shall also consider the availability
  108  of and access to first-episode psychosis programs and identify
  109  any gaps in the availability of and access to such programs in
  110  the state. The department’s assessment shall consider, at a
  111  minimum, the needs assessments conducted by the managing
  112  entities pursuant to s. 394.9082(5). Beginning in 2017, the
  113  department shall compile and include in the report all plans
  114  submitted by managing entities pursuant to s. 394.9082(8) and
  115  the department’s evaluation of each plan.
  116         (1) As used in this section:
  117         (a) “Care coordination” means the implementation of
  118  deliberate and planned organizational relationships and service
  119  procedures that improve the effectiveness and efficiency of the
  120  behavioral health system by engaging in purposeful interactions
  121  with individuals who are not yet effectively connected with
  122  services to ensure service linkage. Examples of care
  123  coordination activities include development of referral
  124  agreements, shared protocols, and information exchange
  125  procedures. The purpose of care coordination is to enhance the
  126  delivery of treatment services and recovery supports and to
  127  improve outcomes among priority populations.
  128         (b) “Case management” means those direct services provided
  129  to a client in order to assess his or her needs, plan or arrange
  130  services, coordinate service providers, link the service system
  131  to a client, monitor service delivery, and evaluate patient
  132  outcomes to ensure the client is receiving the appropriate
  133  services.
  134         (c) “Coordinated system of care” means the full array of
  135  behavioral and related services in a region or community offered
  136  by all service providers, whether participating under contract
  137  with the managing entity or by another method of community
  138  partnership or mutual agreement.
  139         (d)“First-episode psychosis program” means an evidence
  140  based program for individuals from 15 through 30 years of age
  141  who are experiencing the early indications of serious mental
  142  illness, especially symptoms of a first psychotic episode, and
  143  which includes, but is not limited to, intensive case
  144  management, individual or group therapy, supported employment,
  145  family education and supports, and the provision of appropriate
  146  psychotropic medication as needed.
  147         (e)(d) “No-wrong-door model” means a model for the delivery
  148  of acute care services to persons who have mental health or
  149  substance use disorders, or both, which optimizes access to
  150  care, regardless of the entry point to the behavioral health
  151  care system.
  152         (2) The essential elements of a coordinated system of care
  153  include:
  154         (a) Community interventions, such as prevention, primary
  155  care for behavioral health needs, therapeutic and supportive
  156  services, crisis response services, and diversion programs.
  157         (b) A designated receiving system that consists of one or
  158  more facilities serving a defined geographic area and
  159  responsible for assessment and evaluation, both voluntary and
  160  involuntary, and treatment or triage of patients who have a
  161  mental health or substance use disorder, or co-occurring
  162  disorders.
  163         1. A county or several counties shall plan the designated
  164  receiving system using a process that includes the managing
  165  entity and is open to participation by individuals with
  166  behavioral health needs and their families, service providers,
  167  law enforcement agencies, and other parties. The county or
  168  counties, in collaboration with the managing entity, shall
  169  document the designated receiving system through written
  170  memoranda of agreement or other binding arrangements. The county
  171  or counties and the managing entity shall complete the plan and
  172  implement the designated receiving system by July 1, 2017, and
  173  the county or counties and the managing entity shall review and
  174  update, as necessary, the designated receiving system at least
  175  once every 3 years.
  176         2. To the extent permitted by available resources, the
  177  designated receiving system shall function as a no-wrong-door
  178  model. The designated receiving system may be organized in any
  179  manner which functions as a no-wrong-door model that responds to
  180  individual needs and integrates services among various
  181  providers. Such models include, but are not limited to:
  182         a. A central receiving system that consists of a designated
  183  central receiving facility that serves as a single entry point
  184  for persons with mental health or substance use disorders, or
  185  co-occurring disorders. The central receiving facility shall be
  186  capable of assessment, evaluation, and triage or treatment or
  187  stabilization of persons with mental health or substance use
  188  disorders, or co-occurring disorders.
  189         b. A coordinated receiving system that consists of multiple
  190  entry points that are linked by shared data systems, formal
  191  referral agreements, and cooperative arrangements for care
  192  coordination and case management. Each entry point shall be a
  193  designated receiving facility and shall, within existing
  194  resources, provide or arrange for necessary services following
  195  an initial assessment and evaluation.
  196         c. A tiered receiving system that consists of multiple
  197  entry points, some of which offer only specialized or limited
  198  services. Each service provider shall be classified according to
  199  its capabilities as either a designated receiving facility or
  200  another type of service provider, such as a triage center, a
  201  licensed detoxification facility, or an access center. All
  202  participating service providers shall, within existing
  203  resources, be linked by methods to share data, formal referral
  204  agreements, and cooperative arrangements for care coordination
  205  and case management.
  207  An accurate inventory of the participating service providers
  208  which specifies the capabilities and limitations of each
  209  provider and its ability to accept patients under the designated
  210  receiving system agreements and the transportation plan
  211  developed pursuant to this section shall be maintained and made
  212  available at all times to all first responders in the service
  213  area.
  214         (c) Transportation in accordance with a plan developed
  215  under s. 394.462.
  216         (d) Crisis services, including mobile response teams,
  217  crisis stabilization units, addiction receiving facilities, and
  218  detoxification facilities.
  219         (e) Case management. Each case manager or person directly
  220  supervising a case manager who provides Medicaid-funded targeted
  221  case management services shall hold a valid certification from a
  222  department-approved credentialing entity as defined in s.
  223  397.311(10) by July 1, 2017, and, thereafter, within 6 months
  224  after hire.
  225         (f) Care coordination that involves coordination with other
  226  local systems and entities, public and private, which are
  227  involved with the individual, such as primary care, child
  228  welfare, behavioral health care, and criminal and juvenile
  229  justice organizations.
  230         (g) Outpatient services.
  231         (h) Residential services.
  232         (i) Hospital inpatient care.
  233         (j) Aftercare and other postdischarge services.
  234         (k) Medication-assisted treatment and medication
  235  management.
  236         (l) Recovery support, including, but not limited to,
  237  support for competitive employment, educational attainment,
  238  independent living skills development, family support and
  239  education, wellness management and self-care, and assistance in
  240  obtaining housing that meets the individual’s needs. Such
  241  housing may include mental health residential treatment
  242  facilities, limited mental health assisted living facilities,
  243  adult family care homes, and supportive housing. Housing
  244  provided using state funds must provide a safe and decent
  245  environment free from abuse and neglect.
  246         (m) Care plans shall assign specific responsibility for
  247  initial and ongoing evaluation of the supervision and support
  248  needs of the individual and the identification of housing that
  249  meets such needs. For purposes of this paragraph, the term
  250  “supervision” means oversight of and assistance with compliance
  251  with the clinical aspects of an individual’s care plan.
  252         (n)First-episode psychosis programs.
  253         (3) SYSTEM IMPROVEMENT GRANTS.—Subject to a specific
  254  appropriation by the Legislature, the department may award
  255  system improvement grants to managing entities based on a
  256  detailed plan to enhance services in accordance with the no
  257  wrong-door model as defined in subsection (1) and to address
  258  specific needs identified in the assessment prepared by the
  259  department pursuant to this section. Such a grant must be
  260  awarded through a performance-based contract that links payments
  261  to the documented and measurable achievement of system
  262  improvements.
  263         Section 5. Subsection (3) of section 394.495, Florida
  264  Statutes, is amended to read:
  265         394.495 Child and adolescent mental health system of care;
  266  programs and services.—
  267         (3) Assessments must be performed by:
  268         (a) A professional as defined in s. 394.455(5), (7), (33),
  269  (32), (35), or (36), or (37);
  270         (b) A professional licensed under chapter 491; or
  271         (c) A person who is under the direct supervision of a
  272  qualified professional as defined in s. 394.455(5), (7), (33),
  273  (32), (35), or (36), or (37) or a professional licensed under
  274  chapter 491.
  275         Section 6. Subsection (5) of section 394.496, Florida
  276  Statutes, is amended to read:
  277         394.496 Service planning.—
  278         (5) A professional as defined in s. 394.455(5), (7), (33),
  279  (32), (35), or (36), or (37) or a professional licensed under
  280  chapter 491 must be included among those persons developing the
  281  services plan.
  282         Section 7. Paragraph (a) of subsection (1) of section
  283  394.674, Florida Statutes, is amended to read:
  284         394.674 Eligibility for publicly funded substance abuse and
  285  mental health services; fee collection requirements.—
  286         (1) To be eligible to receive substance abuse and mental
  287  health services funded by the department, an individual must be
  288  a member of at least one of the department’s priority
  289  populations approved by the Legislature. The priority
  290  populations include:
  291         (a) For adult mental health services:
  292         1. Adults who have severe and persistent mental illness, as
  293  designated by the department using criteria that include
  294  severity of diagnosis, duration of the mental illness, ability
  295  to independently perform activities of daily living, and receipt
  296  of disability income for a psychiatric condition. Included
  297  within this group are:
  298         a. Older adults in crisis.
  299         b. Older adults who are at risk of being placed in a more
  300  restrictive environment because of their mental illness.
  301         c. Persons deemed incompetent to proceed or not guilty by
  302  reason of insanity under chapter 916.
  303         d. Other persons involved in the criminal justice system.
  304         e. Persons diagnosed as having co-occurring mental illness
  305  and substance abuse disorders.
  306         2. Persons who are experiencing an acute mental or
  307  emotional crisis as defined in s. 394.67(18) s. 394.67(17).
  308         Section 8. Subsection (6) of section 394.9085, Florida
  309  Statutes, is amended to read:
  310         394.9085 Behavioral provider liability.—
  311         (6) For purposes of this section, the terms “detoxification
  312  services,” “addictions receiving facility,” and “receiving
  313  facility” have the same meanings as those provided in ss.
  314  397.311(26)(a)4., 397.311(26)(a)1., and 394.455(40) 394.455(39),
  315  respectively.
  316         Section 9. Paragraph (b) of subsection (1) of section
  317  409.972, Florida Statutes, is amended to read:
  318         409.972 Mandatory and voluntary enrollment.—
  319         (1) The following Medicaid-eligible persons are exempt from
  320  mandatory managed care enrollment required by s. 409.965, and
  321  may voluntarily choose to participate in the managed medical
  322  assistance program:
  323         (b) Medicaid recipients residing in residential commitment
  324  facilities operated through the Department of Juvenile Justice
  325  or a treatment facility as defined in s. 394.455(48) s.
  326  394.455(47).
  327         Section 10. Paragraph (e) of subsection (4) of section
  328  464.012, Florida Statutes, is amended to read:
  329         464.012 Licensure of advanced practice registered nurses;
  330  fees; controlled substance prescribing.—
  331         (4) In addition to the general functions specified in
  332  subsection (3), an advanced practice registered nurse may
  333  perform the following acts within his or her specialty:
  334         (e) A psychiatric nurse, who meets the requirements in s.
  335  394.455(36) s. 394.455(35), within the framework of an
  336  established protocol with a psychiatrist, may prescribe
  337  psychotropic controlled substances for the treatment of mental
  338  disorders.
  339         Section 11. Subsection (7) of section 744.2007, Florida
  340  Statutes, is amended to read:
  341         744.2007 Powers and duties.—
  342         (7) A public guardian may not commit a ward to a treatment
  343  facility, as defined in s. 394.455(48) s. 394.455(47), without
  344  an involuntary placement proceeding as provided by law.
  345         Section 12. This act shall take effect July 1, 2020.