Florida Senate - 2015 SB 7068
By the Committee on Appropriations
1 A bill to be entitled
2 An act relating to mental health and substance abuse
3 services; amending s. 394.455, F.S.; revising the
4 definition of “mental illness” to include dementia and
5 traumatic brain injuries; amending s. 394.492, F.S.;
6 redefining the terms “adolescent” and “child or
7 adolescent at risk of emotional disturbance”; creating
8 s. 394.761, F.S.; requiring the Agency for Health Care
9 Administration and the Department of Children and
10 Families to develop a plan to obtain federal approval
11 for increasing the availability of federal Medicaid
12 funding for behavioral health care; establishing
13 improved integration of behavioral health and primary
14 care services through the development and effective
15 implementation of coordinated care organizations as
16 the primary goal of obtaining the additional funds;
17 requiring the agency and the department to submit the
18 written plan, which must include certain information,
19 to the Legislature by a specified date; amending s.
20 394.875, F.S.; requiring that, by a specified date,
21 the department modify certain licensure rules and
22 procedures; providing requirements for providers;
23 amending s. 394.9082, F.S.; revising Legislative
24 findings and intent; redefining terms; requiring the
25 managing entities, rather than the department, to
26 develop and implement a plan with a certain purpose;
27 requiring the regional network to offer access to
28 certain services; requiring the plan to be developed
29 in a certain manner; requiring the department to
30 designate the regional network as a coordinated care
31 organization after certain conditions are met;
32 removing a provision providing legislative intent;
33 requiring the department to contract with community
34 based managing entities for the development of
35 specified objectives; removing duties of the
36 department, the secretary of the department, and
37 managing entities; removing a provision regarding the
38 requirement of funding the managing entity’s contract
39 through departmental funds; removing legislative
40 intent; requiring that the department’s contract with
41 each managing entity be performance based; providing
42 for scaled penalties and liquidated damages if a
43 managing entity fails to perform after a reasonable
44 opportunity for corrective action; requiring the plan
45 for the coordination and integration of certain
46 services to be developed in a certain manner and to
47 incorporate certain models; providing requirements for
48 the department when entering into contracts with a
49 managing entity; requiring the department to consider
50 specified factors when considering a new contractor;
51 revising the goals of the coordinated care
52 organization; requiring a coordinated care
53 organization to consist of a comprehensive provider
54 network that includes specified elements; requiring
55 that specified treatment providers be initially
56 included in the provider network; providing for
57 continued participation in the provider network;
58 revising the network management and administrative
59 functions of the managing entities; requiring that the
60 managing entity support network providers in certain
61 ways; authorizing the managing entity to prioritize
62 certain populations when necessary; requiring that, by
63 a certain date, a managing entity’s governing board
64 consist of a certain number of members selected by the
65 managing entity in a specified manner; providing
66 requirements for the governing board; removing
67 departmental responsibilities; removing a reporting
68 requirement; authorizing, rather than requiring, the
69 department to adopt rules; creating s. 397.402, F.S.;
70 requiring that the department modify certain licensure
71 rules and procedures by a certain date; providing
72 requirements for a provider; amending s. 397.427,
73 F.S.; removing provisions requiring the department to
74 determine the need for establishing providers of
75 medication-assisted treatment services for opiate
76 addiction; removing provisions requiring the
77 department to adopt rules; amending s. 409.967, F.S.;
78 requiring that certain plans or contracts include
79 specified requirements; amending s. 409.973, F.S.;
80 requiring each plan operating in the managed medical
81 assistance program to work with the managing entity to
82 establish specific organizational supports and service
83 protocols; amending s. 409.975, F.S.; revising the
84 categories from which the agency must determine which
85 providers are essential Medicaid providers; repealing
86 s. 394.4674, F.S., relating to a plan and report;
87 repealing s. 394.4985, F.S., relating to districtwide
88 information and referral network and implementation;
89 repealing s. 394.657, F.S., relating to county
90 planning councils or committees; repealing s. 394.745,
91 F.S., relating to an annual report and compliance of
92 providers under contract with department; repealing s.
93 394.9084, F.S., relating to the Florida Self-Directed
94 Care program; repealing s. 397.331, F.S., relating to
95 definitions; repealing s. 397.333, F.S., relating to
96 the Statewide Drug Policy Advisory Council; repealing
97 s. 397.801, F.S., relating to substance abuse
98 impairment coordination; repealing s. 397.811, F.S.,
99 relating to juvenile substance abuse impairment
100 coordination; repealing s. 397.821, F.S., relating to
101 juvenile substance abuse impairment prevention and
102 early intervention councils; repealing s. 397.901,
103 F.S., relating to prototype juvenile addictions
104 receiving facilities; repealing s. 397.93, F.S.,
105 relating to children’s substance abuse services and
106 target populations; repealing s. 397.94, F.S.,
107 relating to children’s substance abuse services and
108 the information and referral network; repealing s.
109 397.951, F.S., relating to treatment and sanctions;
110 repealing s. 397.97, F.S., relating to children’s
111 substance abuse services and demonstration models;
112 amending ss. 397.321, 397.98, 409.966, 943.031, and
113 943.042, F.S.; conforming provisions and cross
114 references to changes made by the act; reenacting ss.
115 39.407(6)(a), 394.67(21), 394.674(1)(b), 394.676(1),
116 409.1676(2)(c), and 409.1677(1)(b), F.S., relating to
117 the term “suitable for residential treatment” or
118 “suitability,” the term “residential treatment center
119 for children and adolescents,” children’s mental
120 health services, the indigent psychiatric medication
121 program, and the term “serious behavioral problems,”
122 respectively, to incorporate the amendment made to s.
123 394.492, F.S., in references thereto; providing
124 effective dates.
126 Be It Enacted by the Legislature of the State of Florida:
128 Section 1. Subsection (18) of section 394.455, Florida
129 Statutes, is amended to read:
130 394.455 Definitions.—As used in this part, unless the
131 context clearly requires otherwise, the term:
132 (18) “Mental illness” means an impairment of the mental or
133 emotional processes that exercise conscious control of one’s
134 actions or of the ability to perceive or understand reality,
135 which impairment substantially interferes with the person’s
136 ability to meet the ordinary demands of living. For the purposes
137 of this part, the term does not include a developmental
138 disability as defined in chapter 393, dementia, traumatic brain
139 injuries, intoxication, or conditions manifested only by
140 antisocial behavior or substance abuse impairment.
141 Section 2. Subsections (1), (4), and (6) of section
142 394.492, Florida Statutes, are amended to read:
143 394.492 Definitions.—As used in ss. 394.490-394.497, the
145 (1) “Adolescent” means a person who is at least 13 years of
146 age but under
18 21 years of age.
147 (4) “Child or adolescent at risk of emotional disturbance”
148 means a person under 18 21 years of age who has an increased
149 likelihood of becoming emotionally disturbed because of risk
150 factors that include, but are not limited to:
151 (a) Being homeless.
152 (b) Having a family history of mental illness.
153 (c) Being physically or sexually abused or neglected.
154 (d) Abusing alcohol or other substances.
155 (e) Being infected with human immunodeficiency virus (HIV).
156 (f) Having a chronic and serious physical illness.
157 (g) Having been exposed to domestic violence.
158 (h) Having multiple out-of-home placements.
159 (6) “Child or adolescent who has a serious emotional
160 disturbance or mental illness” means a person under 18 21 years
161 of age who:
162 (a) Is diagnosed as having a mental, emotional, or
163 behavioral disorder that meets one of the diagnostic categories
164 specified in the most recent edition of the Diagnostic and
165 Statistical Manual of Mental Disorders of the American
166 Psychiatric Association; and
167 (b) Exhibits behaviors that substantially interfere with or
168 limit his or her role or ability to function in the family,
169 school, or community, which behaviors are not considered to be a
170 temporary response to a stressful situation.
172 The term includes a child or adolescent who meets the criteria
173 for involuntary placement under s. 394.467(1).
174 Section 3. Section 394.761, Florida Statutes, is created to
176 394.761 Revenue maximization.—The agency and the department
177 shall develop a plan to obtain federal approval for increasing
178 the availability of federal Medicaid funding for behavioral
179 health care. Increased funding will be used to advance the goal
180 of improved integration of behavioral health and primary care
181 services through development and effective implementation of
182 coordinated care organizations as described in s. 394.9082(3).
183 The agency and the department shall submit the written plan to
184 the President of the Senate and the Speaker of the House of
185 Representatives no later than November 1, 2015. The plan shall
186 identify the amount of general revenue funding appropriated for
187 mental health and substance abuse services which is eligible to
188 be used as state Medicaid match. The plan must evaluate
189 alternative uses of increased Medicaid funding, including
190 expansion of Medicaid eligibility for the severely and
191 persistently mentally ill; increased reimbursement rates for
192 behavioral health services; adjustments to the capitation rate
193 for Medicaid enrollees with chronic mental illness and substance
194 use disorders; supplemental payments to mental health and
195 substance abuse providers through a designated state health
196 program or other mechanisms; and innovative programs for
197 incentivizing improved outcomes for behavioral health
198 conditions. The plan shall identify the advantages and
199 disadvantages of each alternative and assess the potential of
200 each for achieving improved integration of services. The plan
201 shall identify the types of federal approvals necessary to
202 implement each alternative and project a timeline for
204 Section 4. Subsection (11) is added to section 394.875,
205 Florida Statutes, to read:
206 394.875 Crisis stabilization units, residential treatment
207 facilities, and residential treatment centers for children and
208 adolescents; authorized services; license required.—
209 (11) No later than January 1, 2016, the department shall
210 modify licensure rules and procedures to create an option for a
211 single, consolidated license for a provider who offers multiple
212 types of mental health and substance abuse services regulated
213 under this chapter and chapter 397. Providers eligible for a
214 consolidated license must operate these services through a
215 single corporate entity and a unified management structure. Any
216 provider serving adult and children must meet departmental
217 standards for separate facilities and other requirements
218 necessary to ensure children’s safety and promote therapeutic
220 Section 5. Effective upon this act becoming a law, section
221 394.9082, Florida Statutes, is amended to read:
222 394.9082 Behavioral health managing entities.—
223 (1) LEGISLATIVE FINDINGS AND INTENT.—The Legislature finds
224 that untreated behavioral health disorders constitute major
225 health problems for residents of this state, are a major
226 economic burden to the citizens of this state, and substantially
227 increase demands on the state’s juvenile and adult criminal
228 justice systems, the child welfare system, and health care
229 systems. The Legislature finds that behavioral health disorders
230 respond to appropriate treatment, rehabilitation, and supportive
231 intervention. The Legislature finds that the state’s return on
232 its it has made a substantial long-term investment in the
233 funding of the community-based behavioral health prevention and
234 treatment service systems and facilities can be enhanced by
235 integration of these services with primary care in order to
236 provide critical emergency, acute care, residential, outpatient,
237 and rehabilitative and recovery-based services. The Legislature
238 finds that local communities have also made substantial
239 investments in behavioral health services, contracting with
240 safety net providers who by mandate and mission provide
241 specialized services to vulnerable and hard-to-serve populations
242 and have strong ties to local public health and public safety
243 agencies. The Legislature finds that a regional management
244 structure for that places the responsibility for publicly
245 financed behavioral health treatment and prevention services
246 within a single private, nonprofit entity at the local level
247 will improve promote improved access to care, promote service
248 continuity, and provide for more efficient and effective
249 delivery of substance abuse and mental health services. The
250 Legislature finds that streamlining administrative processes
251 will create cost efficiencies and provide flexibility to better
252 match available services to consumers’ identified needs.
253 (2) DEFINITIONS.—As used in this section, the term:
254 (a) “Behavioral health services” means mental health
255 services and substance abuse prevention and treatment services
256 as defined in this chapter and chapter 397 which are provided
257 using state and federal funds.
258 ( b) “Decisionmaking model” means a comprehensive management
259 information system needed to answer the following management
260 questions at the federal, state, regional, circuit, and local
261 provider levels: who receives what services from which providers
262 with what outcomes and at what costs?
263 (b) (c) “Geographic area” means a county, circuit, regional,
264 or a region as described in s. 409.966 multiregional area in
265 this state.
266 (c) (d) “Managing entity” means a corporation that is
267 organized in this state, is designated or filed as a nonprofit
268 organization under s. 501(c)(3) of the Internal Revenue Code,
269 and is under contract to the department to manage the day-to-day
270 operational delivery of behavioral health services as of July 1,
271 2015 through an organized system of care.
272 (e) “Provider networks” mean the direct service agencies
273 that are under contract with a managing entity and that together
274 constitute a comprehensive array of emergency, acute care,
275 residential, outpatient, recovery support, and consumer support
277 (3) COORDINATED CARE ORGANIZATIONS SERVICE DELIVERY
278 STRATEGIES.—The department may work through managing entities
279 shall to develop and implement a plan to create a coordinated
280 regional network of behavioral health service providers. The
281 regional network must offer access to a comprehensive range of
282 services and continuity of care for service delivery strategies
283 that will improve the coordination, integration, and management
284 of the delivery of behavioral health services to people with who
285 have mental illness or substance use disorders. The plan must be
286 developed through a collaborative process between the managing
287 entity and providers in the region. The department shall
288 designate the regional network as a coordinated care
289 organization after the relationships, linkages, and interactions
290 among network providers are formalized through written
291 agreements that establish common protocols for intake and
292 assessment, mechanisms for data sharing, joint operational
293 procedures, and integrated care planning and case management. It
294 is the intent of the Legislature that a well-managed service
295 delivery system will increase access for those in need of care,
296 improve the coordination and continuity of care for vulnerable
297 and high-risk populations, and redirect service dollars from
298 restrictive care settings to community-based recovery services.
299 (4) CONTRACT FOR SERVICES.—
300 (a) The department must may contract for the purchase and
301 management of behavioral health services with community-based
302 managing entities for the development of a regional coordinated
303 care organization, network management services, and the
304 administrative functions defined in subsection (6). The
305 department may require a managing entity to contract for
306 specialized services that are not currently part of the managing
307 entity’s network if the department determines that to do so is
308 in the best interests of consumers of services. The secretary
309 shall determine the schedule for phasing in contracts with
310 managing entities. The managing entities shall, at a minimum, be
311 accountable for the operational oversight of the delivery of
312 behavioral health services funded by the department and for the
313 collection and submission of the required data pertaining to
314 these contracted services. A managing entity shall serve a
315 geographic area designated by the department. The geographic
316 area must be of sufficient size in population and have enough
317 public funds for behavioral health services to allow for
318 flexibility and maximum efficiency.
319 (b) The operating costs of the managing entity contract
320 shall be funded through funds from the department and any
321 savings and efficiencies achieved through the implementation of
322 managing entities when realized by their participating provider
323 network agencies. The department recognizes that managing
324 entities will have infrastructure development costs during
325 start-up so that any efficiencies to be realized by providers
326 from consolidation of management functions, and the resulting
327 savings, will not be achieved during the early years of
328 operation. The department shall negotiate a reasonable and
329 appropriate administrative cost rate with the managing entity.
330 The Legislature intends that reduced local and state contract
331 management and other administrative duties passed on to the
332 managing entity allows funds previously allocated for these
333 purposes to be proportionately reduced and the savings used to
334 purchase the administrative functions of the managing entity.
335 Policies and procedures of the department for monitoring
336 contracts with managing entities shall include provisions for
337 eliminating duplication of the department’s and the managing
338 entities’ contract management and other administrative
339 activities in order to achieve the goals of cost-effectiveness
340 and regulatory relief. To the maximum extent possible, provider
341 monitoring activities shall be assigned to the managing entity.
342 (c) The department’s contract with each managing entity
343 must be a performance-based agreement requiring specific
344 results, setting measureable performance standards and
345 timelines, and identifying consequences for failure to timely
346 plan and implement a regional, coordinated care organization.
347 The consequences specified in the contract must correlate to a
348 schedule of penalties, scaled to the nature and significance of
349 the managing entity’s failure to perform, and must include
350 liquidated damages. The contract must provide a reasonable
351 opportunity for managing entities to implement corrective
352 actions, but must require progress toward achievement of the
353 performance standards identified in paragraph (e) Contracting
354 and payment mechanisms for services must promote clinical and
355 financial flexibility and responsiveness and must allow
356 different categorical funds to be integrated at the point of
357 service. The plan for coordination and integration of services
358 required by subsection (3) shall be developed based on
359 contracted service array must be determined by using public
360 input and , needs assessment, and must incorporate promising,
361 evidence-based and promising best practice models. The
362 department may employ care management methodologies, prepaid
363 capitation, and case rate or other methods of payment which
364 promote flexibility, efficiency, and accountability.
365 (d) The department shall establish a 3-year performance
366 based contract with each managing entity on the next date of
367 contract renewal after the effective date of this act. All
368 managing entities must be operating under performance-based
369 contracts by July 1, 2017. Managing entities with contracts
370 subject to renewal on July 1, 2015, shall receive a contract
371 renewal, if available, or a contract extension under s.
372 287.057(12) until the performance-based contract can be
374 (e) The contract must identify performance standards that
375 are critical to the implementation of a coordinated care
376 organization. Failure to achieve these specific standards
377 constitutes a disqualification of the entity resulting in a
378 notice of termination, which is effective upon selection of a
379 new contractor. If a managing entity is disqualified due to
380 performance failure, the department shall issue an invitation to
381 negotiate in order to select a new contractor. The new
382 contractor must be a managing entity in another region, a
383 Medicaid managed care organization operating in the same region,
384 or a behavioral health specialty managed care organization. The
385 department shall consider the input and recommendations of
386 network providers in the selection of the new contractor. The
387 invitation to negotiate shall specify the criteria and the
388 relative weight of the criteria that will be used in selecting
389 the new contractor. The department must consider all of the
390 following factors:
391 1. Experience serving persons with mental health and
392 substance use disorders.
393 2. Establishment of community partnerships with behavioral
394 health providers.
395 3. Demonstrated organizational capabilities for network
396 management functions.
397 4. Capability to integrate behavioral health with primary
398 care services.
399 (5) GOALS.—The primary goal of the coordinated care
400 organization service delivery strategies is to improve outcomes
401 for persons needing provide a design for an effective
402 coordination, integration, and management approach for
403 delivering effective behavioral health services to persons who
404 are experiencing a mental health or substance abuse crisis, who
405 have a disabling mental illness or a substance use or co
406 occurring disorder, and require extended services in order to
407 recover from their illness, or who need brief treatment or
408 longer-term supportive interventions to avoid a crisis or
409 disability. Other goals include:
410 (a) Improving Accountability for measureable and
411 transparent a local system of behavioral health care services to
412 meet performance outcomes and standards through the use of
413 reliable and timely data.
414 (b) Enhancing the Continuity of care for all children,
415 adolescents, and adults who receive services from the
416 coordinated care organization enter the publicly funded
417 behavioral health service system.
418 (c) Value-based purchasing of behavioral health services
419 that maximizes the return on investment to local, state, and
420 federal funding sources Preserving the “safety net” of publicly
421 funded behavioral health services and providers, and recognizing
422 and ensuring continued local contributions to these services, by
423 establishing locally designed and community-monitored systems of
425 (d) Providing Early diagnosis and treatment interventions
426 to enhance recovery and prevent hospitalization.
427 (e) Regional service delivery systems that are responsive
428 to Improving the assessment of local needs for behavioral health
430 (f) Quality care that is provided using Improving the
431 overall quality of behavioral health services through the use of
432 evidence-based, best practice, and promising practice models.
433 (g) Demonstrating improved service Integration of between
434 behavioral health services programs and other programs, such as
435 vocational rehabilitation, education, child welfare, primary
436 health care, emergency services, juvenile justice, and criminal
438 (h) Providing for additional testing of creative and
439 flexible strategies for financing behavioral health services to
440 enhance individualized treatment and support services.
441 (i) Promoting cost-effective quality care.
442 (j) Working with the state to coordinate admissions and
443 discharges from state civil and forensic hospitals and
444 coordinating admissions and discharges from residential
445 treatment centers.
446 (k) Improving the integration, accessibility, and
447 dissemination of behavioral health data for planning and
448 monitoring purposes.
449 (l) Promoting specialized behavioral health services to
450 residents of assisted living facilities.
451 (m) Working with the state and other stakeholders to reduce
452 the admissions and the length of stay for dependent children in
453 residential treatment centers.
454 (n) Providing services to adults and children with co
455 occurring disorders of mental illnesses and substance abuse
457 (o) Providing services to elder adults in crisis or at-risk
458 for placement in a more restrictive setting due to a serious
459 mental illness or substance abuse.
460 (6) ESSENTIAL ELEMENTS.— It is the intent of the Legislature
461 that the department may plan for and enter into contracts with
462 managing entities to manage care in geographical areas
463 throughout the state .
464 (a) A coordinated care organization must consist of a
465 comprehensive provider network that includes the following
466 elements: The managing entity must demonstrate the ability of
467 its network of providers to comply with the pertinent provisions
468 of this chapter and chapter 397 and to ensure the provision of
469 comprehensive behavioral health services. The network of
470 providers must include, but need not be limited to, community
471 mental health agencies, substance abuse treatment providers, and
472 best practice consumer services providers.
473 1. A centralized receiving facility or coordinated
474 receiving system for persons needing evaluation pursuant to s.
475 394.463 or s. 397.675.
476 2. Crisis services, including mobile response teams and
477 crisis stabilization units.
478 3. Case management.
479 4. Outpatient services.
480 5. Residential services.
481 6. Hospital inpatient care.
482 7. Aftercare and other postdischarge services.
483 8. Recovery support, including housing assistance and
484 support for competitive employment, educational attainment,
485 independent living skills development, family support and
486 education, and wellness management and self-care.
487 9. Medical services necessary for integration of behavioral
488 health services with primary care.
489 (b) The department shall terminate its mental health or
490 substance abuse provider contracts for services to be provided
491 by the managing entity at the same time it contracts with the
492 managing entity.
493 (b) (c) The managing entity shall ensure that its provider
494 network shall initially include all is broadly conceived. All
495 mental health or substance abuse treatment providers currently
496 receiving public funds pursuant to this chapter or chapter 397.
497 Continued participation in the network is subject to credentials
498 and performance standards set by the managing entity and
499 approved by the department under contract with the department
500 shall be offered a contract by the managing entity.
501 (c) (d ) The network management and administrative functions
502 of the department may contract with managing entities to provide
503 the following core functions include:
504 1. Financial management accountability.
505 2. Allocation of funds to network providers in a manner
506 that reflects the department’s strategic direction and plans.
507 3. Provider monitoring to ensure compliance with federal
508 and state laws, rules, and regulations.
509 4. Data collection, reporting, and analysis.
510 5. Information systems necessary for the delivery of
511 coordinated care and integrated services Operational plans to
512 implement objectives of the department’s strategic plan.
513 6. Contract compliance.
514 7. Performance measurement based on nationally recognized
515 standards such as those developed by the National Quality Forum,
516 the National Committee for Quality Assurance, or similar
517 credible sources management.
518 8. Collaboration with community stakeholders, including
519 local government.
520 9. System of care through network development.
521 9. 10 . Consumer care coordination.
522 10. 11. Continuous quality improvement.
523 12. Timely access to appropriate services.
524 13. Cost-effectiveness and system improvements.
525 14. Assistance in the development of the department’s
526 strategic plan.
527 15. Participation in community, circuit, regional, and
528 state planning.
529 11. 16. Resource management and maximization, including
530 pursuit of third-party payments and grant applications.
531 12. 17. Incentives for providers to improve quality and
533 13. 18. Liaison with consumers.
534 14. 19. Community needs assessment.
535 15. 20. Securing local matching funds.
536 (d) The managing entity shall support network providers to
537 offer comprehensive and coordinated care to all persons in need,
538 but may develop a prioritization framework when necessary to
539 make the best use of limited resources. Priority populations
541 1. Individuals in crisis stabilization units who are on the
542 waitlist for placement in a state treatment facility;
543 2. Individuals in state treatment facilities on the
544 waitlist for community care;
545 3. Parents or caretakers with child welfare involvement;
546 4. Individuals with multiple arrests and incarceration as a
547 result of their behavioral health condition; and
548 5. Individuals with behavioral health disorders and
549 comorbidities consistent with the characteristics of patients in
550 the region’s population of behavioral health service users who
551 account for a disproportionately high percentage of service
553 (e) The managing entity shall ensure that written
554 cooperative agreements are developed and implemented among the
555 criminal and juvenile justice systems, the local community-based
556 care network, and the local behavioral health providers in the
557 geographic area which define strategies and alternatives for
558 diverting people who have mental illness and substance abuse
559 problems from the criminal justice system to the community.
560 These agreements must also address the provision of appropriate
561 services to persons who have behavioral health problems and
562 leave the criminal justice system.
563 (f) Managing entities must collect and submit data to the
564 department regarding persons served, outcomes of persons served,
565 and the costs of services provided through the department’s
566 contract. The department shall evaluate managing entity services
567 based on consumer-centered outcome measures that reflect
568 national standards that can dependably be measured. The
569 department shall work with managing entities to establish
570 performance standards related to:
571 1. The extent to which individuals in the community receive
573 2. The improvement of quality of care for individuals
575 3. The success of strategies to divert jail, prison, and
576 forensic facility admissions.
577 4. Consumer and family satisfaction.
578 5. The satisfaction of key community constituents such as
579 law enforcement agencies, juvenile justice agencies, the courts,
580 the schools, local government entities, hospitals, and others as
581 appropriate for the geographical area of the managing entity.
582 (g) The Agency for Health Care Administration may establish
583 a certified match program, which must be voluntary. Under a
584 certified match program, reimbursement is limited to the federal
585 Medicaid share to Medicaid-enrolled strategy participants. The
586 agency may take no action to implement a certified match program
587 unless the consultation provisions of chapter 216 have been met.
588 The agency may seek federal waivers that are necessary to
589 implement the behavioral health service delivery strategies.
590 (7) MANAGING ENTITY REQUIREMENTS.—The department may adopt
591 rules and contractual standards related to and a process for the
592 qualification and operation of managing entities which are
593 based, in part, on the following criteria:
594 (a) As of December 31, 2015, a managing entity’s governing
595 board governance structure shall consist of 15 members selected
596 by the managing entity as follows: be representative and shall,
597 at a minimum, include consumers and family members, appropriate
598 community stakeholders and organizations, and providers of
599 substance abuse and mental health services as defined in this
600 chapter and chapter 397. If there are one or more private
601 receiving facilities in the geographic coverage area of a
602 managing entity, the managing entity shall have one
603 representative for the private-receiving facilities as an ex
604 officio member of its board of directors.
605 1. Four representatives of consumers and their families,
606 selected from nominations submitted by behavioral health service
607 providers in the region.
608 2. Two representatives of local governments in the region,
609 selected from nominations submitted by county and municipal
610 governments in the region.
611 3. Two representatives of law enforcement, appointed by the
612 Attorney General.
613 4. Two representatives of employers in the region, selected
614 from nominations submitted by Chambers of Commerce in the
616 5. Two representatives of service providers involved with
617 the child welfare system, appointed by the community-based care
618 lead agency.
619 6. Three representatives of health care professionals and
620 health facilities in the region which are not under contract to
621 the managing entity, selected from nominations submitted by
622 local medical societies, hospitals, and other health care
623 organizations in the region.
624 (b) The managing entity must create a transparent process
625 for nomination and selection of board members and must adopt a
626 procedure for establishing staggered term limits which ensures
627 that no individual serves more than 8 consecutive years on the
628 governing board A managing entity that was originally formed
629 primarily by substance abuse or mental health providers must
630 present and demonstrate a detailed, consensus approach to
631 expanding its provider network and governance to include both
632 substance abuse and mental health providers.
633 (c) A managing entity must submit a network management plan
634 and budget in a form and manner determined by the department.
635 The plan must detail the means for implementing the duties to be
636 contracted to the managing entity and the efficiencies to be
637 anticipated by the department as a result of executing the
638 contract. The department may require modifications to the plan
639 and must approve the plan before contracting with a managing
640 entity. The department may contract with a managing entity that
641 demonstrates readiness to assume core functions, and may
642 continue to add functions and responsibilities to the managing
643 entity’s contract over time as additional competencies are
644 developed as identified in paragraph (g). Notwithstanding other
645 provisions of this section, the department may continue and
646 expand managing entity contracts if the department determines
647 that the managing entity meets the requirements specified in
648 this section.
649 (d) Notwithstanding paragraphs (b) and (c), a managing
650 entity that is currently a fully integrated system providing
651 mental health and substance abuse services, Medicaid, and child
652 welfare services is permitted to continue operating under its
653 current governance structure as long as the managing entity can
654 demonstrate to the department that consumers, other
655 stakeholders, and network providers are included in the planning
657 (d) (e) Managing entities shall operate in a transparent
658 manner, providing public access to information, notice of
659 meetings, and opportunities for broad public participation in
660 decisionmaking. The managing entity’s network management plan
661 must detail policies and procedures that ensure transparency.
662 (e) (f) Before contracting with a managing entity, the
663 department must perform an onsite readiness review of a managing
664 entity to determine its operational capacity to satisfactorily
665 perform the duties to be contracted.
666 (f) (g) The department shall engage community stakeholders,
667 including providers and managing entities under contract with
668 the department, in the development of objective standards to
669 measure the competencies of managing entities and their
670 readiness to assume the responsibilities described in this
671 section, and the outcomes to hold them accountable.
672 (8) DEPARTMENT RESPONSIBILITIES.—With the introduction of
673 managing entities to monitor department-contracted providers’
674 day-to-day operations, the department and its regional and
675 circuit offices will have increased ability to focus on broad
676 systemic substance abuse and mental health issues. After the
677 department enters into a managing entity contract in a
678 geographic area, the regional and circuit offices of the
679 department in that area shall direct their efforts primarily to
680 monitoring the managing entity contract, including negotiation
681 of system quality improvement goals each contract year, and
682 review of the managing entity’s plans to execute department
683 strategic plans; carrying out statutorily mandated licensure
684 functions; conducting community and regional substance abuse and
685 mental health planning; communicating to the department the
686 local needs assessed by the managing entity; preparing
687 department strategic plans; coordinating with other state and
688 local agencies; assisting the department in assessing local
689 trends and issues and advising departmental headquarters on
690 local priorities; and providing leadership in disaster planning
691 and preparation.
692 (8) (9) FUNDING FOR MANAGING ENTITIES.—
693 (a) A contract established between the department and a
694 managing entity under this section shall be funded by general
695 revenue, other applicable state funds, or applicable federal
696 funding sources. A managing entity may carry forward documented
697 unexpended state funds from one fiscal year to the next;
698 however, the cumulative amount carried forward may not exceed 8
699 percent of the total contract. Any unexpended state funds in
700 excess of that percentage must be returned to the department.
701 The funds carried forward may not be used in a way that would
702 create increased recurring future obligations or for any program
703 or service that is not currently authorized under the existing
704 contract with the department. Expenditures of funds carried
705 forward must be separately reported to the department. Any
706 unexpended funds that remain at the end of the contract period
707 shall be returned to the department. Funds carried forward may
708 be retained through contract renewals and new procurements as
709 long as the same managing entity is retained by the department.
710 (b) The method of payment for a fixed-price contract with a
711 managing entity must provide for a 2-month advance payment at
712 the beginning of each fiscal year and equal monthly payments
714 (10) REPORTING.—Reports of the department’s activities,
715 progress, and needs in achieving the goal of contracting with
716 managing entities in each circuit and region statewide must be
717 submitted to the appropriate substantive and appropriations
718 committees in the Senate and the House of Representatives on
719 January 1 and July 1 of each year until the full transition to
720 managing entities has been accomplished statewide.
721 (9) (11) RULES.—The department may shall adopt rules to
722 administer this section and, as necessary, to further specify
723 requirements of managing entities.
724 Section 6. Section 397.402, Florida Statutes, is created to
726 397.402 Single, consolidated license.—No later than January
727 1, 2016, the department shall modify licensure rules and
728 procedures to create an option for a single, consolidated
729 license for a provider that offers multiple types of mental
730 health and substance abuse services regulated under chapters 394
731 and 397. Providers eligible for a consolidated license must
732 operate these services through a single corporate entity and a
733 unified management structure. Any provider serving both adults
734 and children must meet departmental standards for separate
735 facilities and other requirements necessary to ensure the safety
736 of children and promote therapeutic efficacy.
737 Section 7. Section 397.427, Florida Statutes, is amended,
738 to read:
739 397.427 Medication-assisted treatment service providers;
740 rehabilitation program; needs assessment and provision of
741 services; persons authorized to issue takeout medication;
742 unlawful operation; penalty.—
743 (1) Providers of medication-assisted treatment services for
744 opiate addiction may not be licensed unless they provide
745 supportive rehabilitation programs. Supportive rehabilitation
746 programs include, but are not limited to, counseling, therapy,
747 and vocational rehabilitation.
748 (2) The department shall determine the need for
749 establishing providers of medication-assisted treatment services
750 for opiate addiction.
751 (a) Providers of medication-assisted treatment services for
752 opiate addiction may be established only in response to the
753 department’s determination and publication of need for
754 additional medication treatment services.
755 (b) The department shall prescribe by rule the types of
756 medication-assisted treatment services for opiate addiction for
757 which it is necessary to conduct annual assessments of need. If
758 needs assessment is required, the department shall annually
759 conduct the assessment and publish a statement of findings which
760 identifies each substate entity’s need.
761 (c) Notwithstanding paragraphs (a) and (b), the license for
762 medication-assisted treatment programs for opiate addiction
763 licensed before October 1, 1990, may not be revoked solely
764 because of the department’s determination concerning the need
765 for medication-assisted treatment services for opiate addiction.
766 (3) The department shall adopt rules necessary to
767 administer this section, including, but not limited to, rules
768 prescribing criteria and procedures for:
769 (a) Determining the need for additional medication-assisted
770 treatment services for opiate addiction.
771 (b) Selecting providers for medication-assisted treatment
772 services for opiate addiction when the number of responses to a
773 publication of need exceeds the determined need.
774 (c) Administering any federally required rules,
775 regulations, or procedures.
776 (2) (4) A service provider operating in violation of this
777 section is subject to proceedings in accordance with this
778 chapter to enjoin that unlawful operation.
779 (3) (5) Notwithstanding s. 465.019(2), a physician
780 assistant, a registered nurse, an advanced registered nurse
781 practitioner, or a licensed practical nurse working for a
782 licensed service provider may deliver takeout medication for
783 opiate treatment to persons enrolled in a maintenance treatment
784 program for medication-assisted treatment for opiate addiction
786 (a) The medication-assisted treatment program for opiate
787 addiction has an appropriate valid permit issued pursuant to
788 rules adopted by the Board of Pharmacy;
789 (b) The medication for treatment of opiate addiction has
790 been delivered pursuant to a valid prescription written by the
791 program’s physician licensed pursuant to chapter 458 or chapter
793 (c) The medication for treatment of opiate addiction which
794 is ordered appears on a formulary and is prepackaged and
795 prelabeled with dosage instructions and distributed from a
796 source authorized under chapter 499;
797 (d) Each licensed provider adopts written protocols which
798 provide for supervision of the physician assistant, registered
799 nurse, advanced registered nurse practitioner, or licensed
800 practical nurse by a physician licensed pursuant to chapter 458
801 or chapter 459 and for the procedures by which patients’
802 medications may be delivered by the physician assistant,
803 registered nurse, advanced registered nurse practitioner, or
804 licensed practical nurse. Such protocols shall be signed by the
805 supervising physician and either the administering registered
806 nurse, the advanced registered nurse practitioner, or the
807 licensed practical nurse.
808 (e) Each licensed service provider maintains and has
809 available for inspection by representatives of the Board of
810 Pharmacy all medical records and patient care protocols,
811 including records of medications delivered to patients, in
812 accordance with the board.
813 (4) (6) The department shall also determine the need for
814 establishing medication-assisted treatment for substance use
815 disorders other than opiate dependence. Service providers within
816 the publicly funded system shall be funded for provision of
817 these services based on the availability of funds.
818 (5) (7) Service providers that provide medication-assisted
819 treatment for substance abuse other than opiate dependence shall
820 provide counseling services in conjunction with medication
821 assisted treatment.
822 (6) (8) The department shall adopt rules necessary to
823 administer medication-assisted treatment services, including,
824 but not limited to, rules prescribing criteria and procedures
826 (a) Determining the need for medication-assisted treatment
827 services within the publicly funded system.
828 (b) Selecting medication-assisted service providers within
829 the publicly funded system.
830 (c) Administering any federally required rules,
831 regulations, or procedures related to the provision of
832 medication-assisted treatment.
833 (7) (9) A physician assistant, a registered nurse, an
834 advanced registered nurse practitioner, or a licensed practical
835 nurse working for a licensed service provider may deliver
836 medication as prescribed by rule if:
837 (a) The service provider is authorized to provide
838 medication-assisted treatment;
839 (b) The medication has been administered pursuant to a
840 valid prescription written by the program’s physician who is
841 licensed under chapter 458 or chapter 459; and
842 (c) The medication ordered appears on a formulary or meets
843 federal requirements for medication-assisted treatment.
844 (8) (10) Each licensed service provider that provides
845 medication-assisted treatment must adopt written protocols as
846 specified by the department and in accordance with federally
847 required rules, regulations, or procedures. The protocol shall
848 provide for the supervision of the physician assistant,
849 registered nurse, advanced registered nurse practitioner, or
850 licensed practical nurse working under the supervision of a
851 physician who is licensed under chapter 458 or chapter 459. The
852 protocol must specify how the medication will be used in
853 conjunction with counseling or psychosocial treatment and that
854 the services provided will be included on the treatment plan.
855 The protocol must specify the procedures by which medication
856 assisted treatment may be administered by the physician
857 assistant, registered nurse, advanced registered nurse
858 practitioner, or licensed practical nurse. These protocols shall
859 be signed by the supervising physician and the administering
860 physician assistant, registered nurse, advanced registered nurse
861 practitioner, or licensed practical nurse.
862 (9) (11) Each licensed service provider shall maintain and
863 have available for inspection by representatives of the Board of
864 Pharmacy all medical records and protocols, including records of
865 medications delivered to individuals in accordance with rules of
866 the board.
867 Section 8. Present paragraphs (d) through (m) of subsection
868 (2) of section 409.967, Florida Statutes, are redesignated as
869 paragraphs (e) through (n), respectively, and a new paragraph
870 (d) is added to that subsection, to read:
871 409.967 Managed care plan accountability.—
872 (2) The agency shall establish such contract requirements
873 as are necessary for the operation of the statewide managed care
874 program. In addition to any other provisions the agency may deem
875 necessary, the contract must require:
876 (d) Quality care.—Managed care plans shall provide, or
877 contract for the provision of, care coordination to facilitate
878 the appropriate delivery of behavioral health care services in
879 the least restrictive setting with treatment and recovery
880 capabilities that address the needs of the patient. Services
881 shall be provided in a manner that integrates behavioral health
882 services and primary care. Plans shall be required to achieve
883 specific behavioral health outcome standards, established by the
884 agency in consultation with the Department of Children and
886 Section 9. Subsection (5) is added to section 409.973,
887 Florida Statutes, to read:
888 409.973 Benefits.—
889 (5) INTEGRATED BEHAVIORAL HEALTH INITIATIVE.—Each plan
890 operating in the managed medical assistance program shall work
891 with the managing entity in its service area to establish
892 specific organizational supports and service protocols that
893 enhance the integration and coordination of primary care and
894 behavioral health services for Medicaid recipients. Progress in
895 this initiative will be measured using the integration framework
896 and core measures developed by the Agency for Healthcare
897 Research and Quality.
898 Section 10. Paragraph (a) of subsection (1) of section
899 409.975, Florida Statutes, is amended to read:
900 409.975 Managed care plan accountability.—In addition to
901 the requirements of s. 409.967, plans and providers
902 participating in the managed medical assistance program shall
903 comply with the requirements of this section.
904 (1) PROVIDER NETWORKS.—Managed care plans must develop and
905 maintain provider networks that meet the medical needs of their
906 enrollees in accordance with standards established pursuant to
907 s. 409.967(2)(c). Except as provided in this section, managed
908 care plans may limit the providers in their networks based on
909 credentials, quality indicators, and price.
910 (a) Plans must include all providers in the region that are
911 classified by the agency as essential Medicaid providers, unless
912 the agency approves, in writing, an alternative arrangement for
913 securing the types of services offered by the essential
914 providers. Providers are essential for serving Medicaid
915 enrollees if they offer services that are not available from any
916 other provider within a reasonable access standard, or if they
917 provided a substantial share of the total units of a particular
918 service used by Medicaid patients within the region during the
919 last 3 years and the combined capacity of other service
920 providers in the region is insufficient to meet the total needs
921 of the Medicaid patients. The agency may not classify physicians
922 and other practitioners as essential providers. The agency, at a
923 minimum, shall determine which providers in the following
924 categories are essential Medicaid providers:
925 1. Federally qualified health centers.
926 2. Statutory teaching hospitals as defined in s.
928 3. Hospitals that are trauma centers as defined in s.
930 4. Hospitals located at least 25 miles from any other
931 hospital with similar services.
932 5. Publicly funded behavioral health service providers.
934 Managed care plans that have not contracted with all essential
935 providers in the region as of the first date of recipient
936 enrollment, or with whom an essential provider has terminated
937 its contract, must negotiate in good faith with such essential
938 providers for 1 year or until an agreement is reached, whichever
939 is first. Payments for services rendered by a nonparticipating
940 essential provider shall be made at the applicable Medicaid rate
941 as of the first day of the contract between the agency and the
942 plan. A rate schedule for all essential providers shall be
943 attached to the contract between the agency and the plan. After
944 1 year, managed care plans that are unable to contract with
945 essential providers shall notify the agency and propose an
946 alternative arrangement for securing the essential services for
947 Medicaid enrollees. The arrangement must rely on contracts with
948 other participating providers, regardless of whether those
949 providers are located within the same region as the
950 nonparticipating essential service provider. If the alternative
951 arrangement is approved by the agency, payments to
952 nonparticipating essential providers after the date of the
953 agency’s approval shall equal 90 percent of the applicable
954 Medicaid rate. If the alternative arrangement is not approved by
955 the agency, payment to nonparticipating essential providers
956 shall equal 110 percent of the applicable Medicaid rate.
957 Section 11. Section 394.4674, Florida Statutes, is
959 Section 12. Section 394.4985, Florida Statutes, is
961 Section 13. Section 394.657, Florida Statutes, is repealed.
962 Section 14. Section 394.745, Florida Statutes, is repealed.
963 Section 15. Section 394.9084, Florida Statutes, is
965 Section 16. Section 397.331, Florida Statutes, is repealed.
966 Section 17. Section 397.333, Florida Statutes, is repealed.
967 Section 18. Section 397.801, Florida Statutes, is repealed.
968 Section 19. Section 397.811, Florida Statutes, is repealed.
969 Section 20. Section 397.821, Florida Statutes, is repealed.
970 Section 21. Section 397.901, Florida Statutes, is repealed.
971 Section 22. Section 397.93, Florida Statutes, is repealed.
972 Section 23. Section 397.94, Florida Statutes, is repealed.
973 Section 24. Section 397.951, Florida Statutes, is repealed.
974 Section 25. Section 397.97, Florida Statutes, is repealed.
975 Section 26. Subsection (15) of section 397.321, Florida
976 Statutes, is amended to read:
977 397.321 Duties of the department.—The department shall:
978 (15) Appoint a substance abuse impairment coordinator to
979 represent the department in efforts initiated by the statewide
980 substance abuse impairment prevention and treatment coordinator
981 established in s. 397.801 and to assist the statewide
982 coordinator in fulfilling the responsibilities of that position.
983 Section 27. Subsection (1) of section 397.98, Florida
984 Statutes, is amended to read:
985 397.98 Children’s substance abuse services; utilization
987 (1) Utilization management shall be an integral part of
988 each Children’s Network of Care Demonstration Model as described
989 under s. 397.97. The utilization management process shall
990 include procedures for analyzing the allocation and use of
991 resources by the purchasing agent. Such procedures shall
993 (a) Monitoring the appropriateness of admissions to
994 residential services or other levels of care as determined by
995 the department.
996 (b) Monitoring the duration of care.
997 (c) Developing profiles of network providers which describe
998 their patterns of delivering care.
999 (d) Authorizing care for high-cost services.
1000 Section 28. Paragraph (e) of subsection (3) of section
1001 409.966, Florida Statutes, is amended to read:
1002 409.966 Eligible plans; selection.—
1003 (3) QUALITY SELECTION CRITERIA.—
1004 (e) To ensure managed care plan participation in Regions 1
1005 and 2, the agency shall award an additional contract to each
1006 plan with a contract award in Region 1 or Region 2. Such
1007 contract shall be in any other region in which the plan
1008 submitted a responsive bid and negotiates a rate acceptable to
1009 the agency. If a plan that is awarded an additional contract
1010 pursuant to this paragraph is subject to penalties pursuant to
1011 s. 409.967(2)(i) s. 409.967(2)(h) for activities in Region 1 or
1012 Region 2, the additional contract is automatically terminated
1013 180 days after the imposition of the penalties. The plan must
1014 reimburse the agency for the cost of enrollment changes and
1015 other transition activities.
1016 Section 29. Paragraph (a) of subsection (5) of section
1017 943.031, Florida Statutes, is amended to read:
1018 943.031 Florida Violent Crime and Drug Control Council.—
1019 (5) DUTIES OF COUNCIL.—Subject to funding provided to the
1020 department by the Legislature, the council shall provide advice
1021 and make recommendations, as necessary, to the executive
1022 director of the department.
1023 (a) The council may advise the executive director on the
1024 feasibility of undertaking initiatives which include, but are
1025 not limited to, the following:
1026 1. Establishing a program that provides grants to criminal
1027 justice agencies that develop and implement effective violent
1028 crime prevention and investigative programs and which provides
1029 grants to law enforcement agencies for the purpose of drug
1030 control, criminal gang, and illicit money laundering
1031 investigative efforts or task force efforts that are determined
1032 by the council to significantly contribute to achieving the
1033 state’s goal of reducing drug-related crime, that represent
1034 significant criminal gang investigative efforts, that represent
1035 a significant illicit money laundering investigative effort, or
1036 that otherwise significantly support statewide strategies
1037 developed by the Statewide Drug Policy Advisory Council
1038 established under s. 397.333, subject to the limitations
1039 provided in this section. The grant program may include an
1040 innovations grant program to provide startup funding for new
1041 initiatives by local and state law enforcement agencies to
1042 combat violent crime or to implement drug control, criminal
1043 gang, or illicit money laundering investigative efforts or task
1044 force efforts by law enforcement agencies, including, but not
1045 limited to, initiatives such as:
1046 a. Providing enhanced community-oriented policing.
1047 b. Providing additional undercover officers and other
1048 investigative officers to assist with violent crime
1049 investigations in emergency situations.
1050 c. Providing funding for multiagency or statewide drug
1051 control, criminal gang, or illicit money laundering
1052 investigative efforts or task force efforts that cannot be
1053 reasonably funded completely by alternative sources and that
1054 significantly contribute to achieving the state’s goal of
1055 reducing drug-related crime, that represent significant criminal
1056 gang investigative efforts, that represent a significant illicit
1057 money laundering investigative effort, or that otherwise
1058 significantly support statewide strategies developed by the
1059 Statewide Drug Policy Advisory Council established under s.
1061 2. Expanding the use of automated biometric identification
1062 systems at the state and local levels.
1063 3. Identifying methods to prevent violent crime.
1064 4. Identifying methods to enhance multiagency or statewide
1065 drug control, criminal gang, or illicit money laundering
1066 investigative efforts or task force efforts that significantly
1067 contribute to achieving the state’s goal of reducing drug
1068 related crime, that represent significant criminal gang
1069 investigative efforts, that represent a significant illicit
1070 money laundering investigative effort, or that otherwise
1071 significantly support statewide strategies developed by the
1072 Statewide Drug Policy Advisory Council established under s.
1074 5. Enhancing criminal justice training programs that
1075 address violent crime, drug control, illicit money laundering
1076 investigative techniques, or efforts to control and eliminate
1077 criminal gangs.
1078 6. Developing and promoting crime prevention services and
1079 educational programs that serve the public, including, but not
1080 limited to:
1081 a. Enhanced victim and witness counseling services that
1082 also provide crisis intervention, information referral,
1083 transportation, and emergency financial assistance.
1084 b. A well-publicized rewards program for the apprehension
1085 and conviction of criminals who perpetrate violent crimes.
1086 7. Enhancing information sharing and assistance in the
1087 criminal justice community by expanding the use of community
1088 partnerships and community policing programs. Such expansion may
1089 include the use of civilian employees or volunteers to relieve
1090 law enforcement officers of clerical work in order to enable the
1091 officers to concentrate on street visibility within the
1093 Section 30. Subsection (1) of section 943.042, Florida
1094 Statutes, is amended to read:
1095 943.042 Violent Crime Investigative Emergency and Drug
1096 Control Strategy Implementation Account.—
1097 (1) There is created a Violent Crime Investigative
1098 Emergency and Drug Control Strategy Implementation Account
1099 within the Department of Law Enforcement Operating Trust Fund.
1100 The account shall be used to provide emergency supplemental
1101 funds to:
1102 (a) State and local law enforcement agencies that are
1103 involved in complex and lengthy violent crime investigations, or
1104 matching funding to multiagency or statewide drug control or
1105 illicit money laundering investigative efforts or task force
1106 efforts that significantly contribute to achieving the state’s
1107 goal of reducing drug-related crime, that represent a
1108 significant illicit money laundering investigative effort, or
1109 that otherwise significantly support statewide strategies
1110 developed by the Statewide Drug Policy Advisory Council
1111 established under s. 397.333;
1112 (b) State and local law enforcement agencies that are
1113 involved in violent crime investigations which constitute a
1114 significant emergency within the state; or
1115 (c) Counties that demonstrate a significant hardship or an
1116 inability to cover extraordinary expenses associated with a
1117 violent crime trial.
1118 Section 31. For the purpose of incorporating the amendment
1119 made by this act to section 394.492, Florida Statutes, in a
1120 reference thereto, paragraph (a) of subsection (6) of section
1121 39.407, Florida Statutes, is reenacted to read:
1122 39.407 Medical, psychiatric, and psychological examination
1123 and treatment of child; physical, mental, or substance abuse
1124 examination of person with or requesting child custody.—
1125 (6) Children who are in the legal custody of the department
1126 may be placed by the department, without prior approval of the
1127 court, in a residential treatment center licensed under s.
1128 394.875 or a hospital licensed under chapter 395 for residential
1129 mental health treatment only pursuant to this section or may be
1130 placed by the court in accordance with an order of involuntary
1131 examination or involuntary placement entered pursuant to s.
1132 394.463 or s. 394.467. All children placed in a residential
1133 treatment program under this subsection must have a guardian ad
1134 litem appointed.
1135 (a) As used in this subsection, the term:
1136 1. “Residential treatment” means placement for observation,
1137 diagnosis, or treatment of an emotional disturbance in a
1138 residential treatment center licensed under s. 394.875 or a
1139 hospital licensed under chapter 395.
1140 2. “Least restrictive alternative” means the treatment and
1141 conditions of treatment that, separately and in combination, are
1142 no more intrusive or restrictive of freedom than reasonably
1143 necessary to achieve a substantial therapeutic benefit or to
1144 protect the child or adolescent or others from physical injury.
1145 3. “Suitable for residential treatment” or “suitability”
1146 means a determination concerning a child or adolescent with an
1147 emotional disturbance as defined in s. 394.492(5) or a serious
1148 emotional disturbance as defined in s. 394.492(6) that each of
1149 the following criteria is met:
1150 a. The child requires residential treatment.
1151 b. The child is in need of a residential treatment program
1152 and is expected to benefit from mental health treatment.
1153 c. An appropriate, less restrictive alternative to
1154 residential treatment is unavailable.
1155 Section 32. For the purpose of incorporating the amendment
1156 made by this act to section 394.492, Florida Statutes, in a
1157 reference thereto, subsection (21) of section 394.67, Florida
1158 Statutes, is reenacted to read:
1159 394.67 Definitions.—As used in this part, the term:
1160 (21) “Residential treatment center for children and
1161 adolescents” means a 24-hour residential program, including a
1162 therapeutic group home, which provides mental health services to
1163 emotionally disturbed children or adolescents as defined in s.
1164 394.492(5) or (6) and which is a private for-profit or not-for
1165 profit corporation licensed by the agency which offers a variety
1166 of treatment modalities in a more restrictive setting.
1167 Section 33. For the purpose of incorporating the amendment
1168 made by this act to section 394.492, Florida Statutes, in a
1169 reference thereto, paragraph (b) of subsection (1) of section
1170 394.674, Florida Statutes, is reenacted to read:
1171 394.674 Eligibility for publicly funded substance abuse and
1172 mental health services; fee collection requirements.—
1173 (1) To be eligible to receive substance abuse and mental
1174 health services funded by the department, an individual must be
1175 a member of at least one of the department’s priority
1176 populations approved by the Legislature. The priority
1177 populations include:
1178 (b) For children’s mental health services:
1179 1. Children who are at risk of emotional disturbance as
1180 defined in s. 394.492(4).
1181 2. Children who have an emotional disturbance as defined in
1182 s. 394.492(5).
1183 3. Children who have a serious emotional disturbance as
1184 defined in s. 394.492(6).
1185 4. Children diagnosed as having a co-occurring substance
1186 abuse and emotional disturbance or serious emotional
1188 Section 34. For the purpose of incorporating the amendment
1189 made by this act to section 394.492, Florida Statutes, in a
1190 reference thereto, subsection (1) of section 394.676, Florida
1191 Statutes, is reenacted to read:
1192 394.676 Indigent psychiatric medication program.—
1193 (1) Within legislative appropriations, the department may
1194 establish the indigent psychiatric medication program to
1195 purchase psychiatric medications for persons as defined in s.
1196 394.492(5) or (6) or pursuant to s. 394.674(1), who do not
1197 reside in a state mental health treatment facility or an
1198 inpatient unit.
1199 Section 35. For the purpose of incorporating the amendment
1200 made by this act to section 394.492, Florida Statutes, in a
1201 reference thereto, paragraph (c) of subsection (2) of section
1202 409.1676, Florida Statutes, is reenacted to read:
1203 409.1676 Comprehensive residential group care services to
1204 children who have extraordinary needs.—
1205 (2) As used in this section, the term:
1206 (c) “Serious behavioral problems” means behaviors of
1207 children who have been assessed by a licensed master’s-level
1208 human-services professional to need at a minimum intensive
1209 services but who do not meet the criteria of s. 394.492(7). A
1210 child with an emotional disturbance as defined in s. 394.492(5)
1211 or (6) may be served in residential group care unless a
1212 determination is made by a mental health professional that such
1213 a setting is inappropriate. A child having a serious behavioral
1214 problem must have been determined in the assessment to have at
1215 least one of the following risk factors:
1216 1. An adjudication of delinquency and be on conditional
1217 release status with the Department of Juvenile Justice.
1218 2. A history of physical aggression or violent behavior
1219 toward self or others, animals, or property within the past
1221 3. A history of setting fires within the past year.
1222 4. A history of multiple episodes of running away from home
1223 or placements within the past year.
1224 5. A history of sexual aggression toward other youth.
1225 Section 36. For the purpose of incorporating the amendment
1226 made by this act to section 394.492, Florida Statutes, in a
1227 reference thereto, paragraph (b) of subsection (1) of section
1228 409.1677, Florida Statutes, is reenacted to read:
1229 409.1677 Model comprehensive residential services
1231 (1) As used in this section, the term:
1232 (b) “Serious behavioral problems” means behaviors of
1233 children who have been assessed by a licensed master’s-level
1234 human-services professional to need at a minimum intensive
1235 services but who do not meet the criteria of s. 394.492(6) or
1236 (7). A child with an emotional disturbance as defined in s.
1237 394.492(5) may be served in residential group care unless a
1238 determination is made by a mental health professional that such
1239 a setting is inappropriate.
1240 Section 37. Except as otherwise expressly provided in this
1241 act and except for this section, which shall take effect upon
1242 this act becoming a law, this act shall take effect July 1,