HB 1189

1	A bill to be entitled
2	An act relating to mental health and substance abuse
3	treatment; creating s. 394.4656, F.S.; creating the
4	Community Mental Health and Substance Abuse Treatment and
5	Crime Reduction Act; providing legislative findings and
6	intent; providing goals for the community mental health
7	and substance abuse forensic treatment system; defining
8	terms; authorizing the Department of Children and Family
9	Services, in consultation with the Agency for Health Care
10	Administration, to develop and implement a community
11	mental health and substance abuse forensic treatment
12	system; providing initiatives and strategies for the
13	community forensic system; detailing the services required
14	in the community forensic system; setting forth the
15	eligibility criteria for treatment in the system;
16	authorizing the department to develop a continuum of
17	services to implement the Community Mental Health and
18	Substance Abuse Treatment and Crime Reduction Act;
19	specifying the services and functions the department may
20	undertake; providing for implementation of the community
21	mental health and substance abuse forensic treatment
22	system; amending s. 394.655, F.S.; providing additional
23	functions of the Criminal Justice, Mental Health, and
24	Substance Abuse Policy Council; amending s. 394.656, F.S.;
25	requiring the department and the agency to cooperate with
26	counties that receive grants funding under the Criminal
27	Justice, Mental Health, and Substance Abuse Reinvestment
28	Grant Program; amending s. 394.657, F.S.; requiring county
29	councils to consult with local governing bodies when
30	planning or implementing the Community Mental Health and
31	Substance Abuse Treatment and Crime Reduction Act;
32	amending s. 409.906, F.S.; adding home and community-based
33	mental health services to the optional Medicaid services
34	offered by the state Medicaid program; amending s.
35	409.912, F.S.; allowing an exemption for persons who have
36	serious and persistent mental illnesses and who are
37	receiving services under the Community Mental Health and
38	Substance Abuse Treatment and Crime Reduction Act from
39	MediPass and managed care plans; amending s. 916.106,
40	F.S.; providing definitions; amending s. 916.107, F.S.;
41	including certain conditional releasees within certain
42	provisions relating to procedures for persons admitted to
43	state forensic mental health treatment facilities who lack
44	capacity to make informed decisions regarding mental
45	health treatment; specifying treatment procedures for a
46	client admitted to a state forensic mental health
47	treatment facility who lacks the capacity to make an
48	informed decision regarding mental health treatment at the
49	time of admission; amending s. 916.111, F.S.; providing
50	for forensic evaluator training for mental health experts;
51	amending s. 916.115, F.S.; requiring court-appointed
52	experts to have completed forensic evaluator training;
53	requiring the court-appointed expert to be a psychiatrist
54	or a licensed psychologist; requiring the Department of
55	Children and Family Services to maintain and annually
56	provide the courts with a forensic evaluator registry;
57	amending s. 916.13, F.S.; providing a timeframe for the
58	holding of a competency hearing; amending s. 916.15, F.S.;
59	providing a timeframe for the holding of a commitment
60	hearing; amending s. 916.17, F.S.; requiring that certain
61	defendants be placed in a community residential facility
62	for competency restoration in demonstration areas
63	established under the Community Mental Health and
64	Substance Abuse Treatment and Crime Reduction Act;
65	providing exceptions; providing requirements for a report
66	concerning a child who is found incompetent to proceed;
67	amending s. 985.19, F.S.; requiring that the basis for the
68	determination of incompetency of juveniles be conducted so
69	as to ensure uniform application of specified criteria;
70	requiring development of plans and requirements relating
71	to forensic evaluations; requiring that appointed experts
72	complete the forensic evaluator training program by
73	specified dates; providing an effective date.
74
75	Be It Enacted by the Legislature of the State of Florida:
76
77	Section 1.  Section 394.4656, Florida Statutes, is created
78	to read:
79	394.4656  Community Mental Health and Substance Abuse
80	Treatment and Crime Reduction Act.-
81	(1)  LEGISLATIVE FINDINGS AND INTENT.-The Legislature finds
82	that many jail inmates who have serious mental illnesses and who
83	are committed to state forensic mental health treatment
84	facilities for competency restoration could be served more
85	effectively and at less cost in community-based alternative
86	programs. The Legislature further finds that many people who
87	have serious mental illnesses and who have been discharged from
88	state forensic mental health treatment facilities could avoid
89	recidivism to the criminal justice and forensic mental health
90	systems if they received specialized treatment in the community.
91	Therefore, it is the intent of the Legislature to create the
92	Community Mental Health and Substance Abuse Treatment and Crime
93	Reduction Act to serve individuals who have mental illnesses or
94	co-occurring mental illnesses and substance abuse disorders and
95	who are involved in or at risk of entering state forensic mental
96	health treatment facilities, prisons, jails, juvenile justice
97	centers, or state civil mental health treatment facilities.
98	(2)  GOALS.-The goals of the community mental health and
99	substance abuse forensic treatment system are to:
100	(a)  Ensure public safety.
101	(b)  Ensure that services to restore forensic competency
102	are provided in the least restrictive, least costly, and most
103	effective environment.
104	(c)  Provide competency-restoration services in the
105	community if appropriate, based on consideration of public
106	safety, needs of the individual, and available resources.
107	(d)  Reduce admissions for competency restoration to state
108	forensic mental health treatment facilities.
109	(e)  Reduce rates of arrest, incarceration, and
110	reincarceration.
111	(f)  Increase outreach and services to individuals at risk
112	for involvement in the criminal justice, juvenile justice, or
113	forensic mental health systems.
114	(g)  Support collaboration among state and local
115	stakeholders, including law enforcement agencies, courts, state
116	agencies, jails, county government, service providers,
117	individuals with mental illnesses or co-occurring mental
118	illnesses and substance abuse disorders, family members,
119	advocates, and other community members.
120	(3)  DEFINITIONS.-As used in this section, the term:
121	(a)  "Agency" means the Agency for Health Care
122	Administration.
123	(b)  "Best practices" means treatment services that
124	incorporate the most effective and acceptable interventions
125	available in the care and treatment of individuals who are
126	diagnosed as having mental illnesses or co-occurring mental
127	illnesses and substance abuse disorders.
128	(c)  "Community forensic system" means the community mental
129	health and substance abuse forensic treatment system, including
130	the comprehensive set of services and supports provided to
131	individuals involved in or at risk of becoming involved in the
132	criminal justice system.
133	(d)  "Community residential facility" means a community-
134	based residential treatment setting licensed by the agency under
135	s. 394.875 or s. 429.075 or by the department under s. 397.401.
136	(e)  "Evidence-based practices" means interventions and
137	strategies that, based on the best available empirical research,
138	demonstrate effective and efficient outcomes in the care and
139	treatment of individuals who are diagnosed as having mental
140	illnesses or co-occurring mental illnesses and substance use
141	disorders.
142	(f)  "Forensic intensive care management" means activities
143	addressing the comprehensive psychiatric, social, and support
144	needs of individuals who are diagnosed as having serious and
145	persistent mental illnesses, co-occurring disorders, or severe
146	emotional disturbances, and who are involved in the criminal
147	justice system and receiving services under this section.
148	Activities include, but are not limited to, service planning,
149	service coordination, monitoring, and assistance with accessing
150	federal, state, and local benefits necessary to sustain a person
151	in the community.
152	(g)  "Geographic area" means a county, circuit, regional,
153	or multiregional area in this state.
154	(4)  SERVICE SYSTEM.-The department, in consultation with
155	the agency, may develop and implement a community mental health
156	and substance abuse forensic treatment system. The system must
157	build on local community diversion and reentry initiatives and
158	strategies that are consistent with those identified and
159	supported under s. 394.658(1) or with geographic areas that have
160	piloted a community-based diversion program.
161	(a)  The community forensic system initiatives and
162	strategies may include, but are not limited to:
163	1.  Mental health courts.
164	2.  Diversion programs.
165	3.  Alternative prosecution and sentencing techniques.
166	4.  Crisis intervention teams.
167	5.  Specialized training for criminal justice, juvenile
168	justice, and treatment services professionals.
169	6.  Specialized probation officers at the state and county
170	levels to serve individuals under correctional control in the
171	community.
172	7.  Collateral services such as supported, transitional,
173	and permanent housing, and supported employment.
174	8.  Reentry services to create or expand mental health and
175	co-occurring treatment and support for affected individuals.
176	(b)  The community forensic system must include a
177	comprehensive continuum of care and services that use evidence-
178	based and best practices to address co-occurring mental health
179	and substance abuse disorders, including the following minimum
180	services and elements:
181	1.  Competency-restoration and treatment services provided
182	in a variety of settings from least restrictive to progressively
183	more restrictive settings.
184	2.  Secure residential placement for initial service
185	delivery and stabilization.
186	3.  Forensic intensive care management.
187	4.  Supported housing.
188	5.  Supported employment.
189	6.  Medication management.
190	7.  Trauma-specific services for treatment of the effects
191	of sexual, physical, and emotional abuse or trauma experienced
192	by individuals who have mental illnesses and are involved in the
193	criminal justice system.
194	8.  Residential services to address crisis episodes and
195	short-term residential treatment.
196	9.  Treatment for co-occurring mental health and substance
197	use disorders.
198	10.  Outreach and education for individuals and their
199	families who are at risk of further involvement with the
200	criminal justice system.
201	11.  The use of involuntary outpatient placement for
202	individuals meeting the criteria provided under s. 394.4655 and
203	conditional release for individuals adjudicated incompetent to
204	proceed due to mental illness or not guilty by reason of
205	insanity as provided under s. 916.17.
206	12.  Other services or supports as identified.
207	(5)  ELIGIBILITY.-Initial implementation shall be limited
208	to adults who are adjudicated incompetent to proceed or not
209	guilty by reason of insanity under chapter 916, whose current
210	most serious charge is a felony of the third degree or a felony
211	of the second degree that did not involve violence, who meet
212	public safety criteria established by the court and treatment
213	criteria established by the department for placement in a
214	community setting, and who otherwise would be admitted to a
215	state mental health treatment facility. Contingent upon
216	legislative approval, the department may serve individuals who
217	meet the following criteria:
218	(a)  Adults who experience serious and persistent mental
219	illnesses reentering the community from state prisons.
220	(b)  Adults who have been committed to a state forensic
221	mental health treatment facility after being adjudicated
222	incompetent to proceed or not guilty by reason of insanity, and
223	who are released or who are pending release to the community by
224	the court after completing competency restoration services or
225	being found to no longer meet the criteria for continued
226	commitment placement.
227	(c)  Adults who experience serious and persistent mental
228	illnesses, who have a history of involvement in the criminal
229	justice system, or who are at risk of entering or who are
230	already involved with the criminal justice system.
231	(d)  Children deemed incompetent to proceed under s.
232	985.19.
233	(6)  DEPARTMENT RESPONSIBILITIES.-The department may
234	develop a continuum of services to implement this section in
235	accordance with subsection (4). The department may:
236	(a)  Define requirements for all providers in the community
237	forensic system.
238	(b)  Implement demonstration sites for participation, based
239	on criteria in subsection (7), which demonstrate active and
240	sustained participation in community collaborations.
241	(c)  Enter into memoranda of agreement with county planning
242	councils or committees identified in s. 394.657 that
243	participated in the Criminal Justice, Mental Health, and
244	Substance Abuse Reinvestment Grant Program pursuant to s.
245	394.656 or that have piloted a community-based diversion
246	program.
247	(d)  Identify providers to implement the continuum of
248	services. The department shall consult with county planning
249	councils or committees in the selection process.
250	(e)  Establish performance measures and reporting
251	requirements for providers participating in the community
252	forensic system. The measures shall include, at a minimum:
253	1.  The number of individuals diverted from state forensic
254	mental health treatment facilities.
255	2.  The number of individuals diverted from the criminal
256	justice system.
257	3.  The rates of arrest, incarceration, and reincarceration
258	for new criminal offenses.
259	4.  The rates of employment.
260	5.  The annual number of days in a crisis stabilization
261	unit, detoxification facility, short-term residential treatment
262	program, state civil mental health treatment facility, or state
263	forensic mental health treatment facility.
264	(f)  Monitor contracts for compliance with terms and assess
265	performance under contracts and provide an annual report by
266	October 1 to the Governor, the President of the Senate, the
267	Speaker of the House of Representatives, the Chief Justice of
268	the Florida Supreme Court, and the State Courts Administrator on
269	the implementation status of the Community Mental Health and
270	Substance Abuse Treatment and Crime Reduction Act.
271	(7)  IMPLEMENTATION.-The department may implement this
272	section within available resources. In expectation of statewide
273	implementation of this section, the department, in consultation
274	with the agency, may identify geographic areas of the state for
275	initial implementation of the pilot program sites. Future
276	expansion shall be based on findings of community readiness and
277	the potential for affecting the greatest number of individuals
278	entering the forensic mental health and criminal justice
279	systems. Criteria for selection may include:
280	(a)  Community readiness to deliver the services outlined
281	in subsection (4), demonstrated by well-established community
282	collaboration plans and local partnerships as evidenced by
283	memoranda of agreement that are submitted to and approved by the
284	department.
285	(b)  A high bed-utilization rate at state forensic mental
286	health treatment facilities.
287	(c)  Successful application for implementation grant
288	funding under the Criminal Justice, Mental Health, and Substance
289	Abuse Reinvestment Grant Program.
290	(d)  Other elements determined by the department in
291	consultation with the agency.
292	Section 2.  Paragraph (b) of subsection (11) of section
293	394.655, Florida Statutes, is amended to read:
294	394.655  The Substance Abuse and Mental Health Corporation;
295	powers and duties; composition; evaluation and reporting
296	requirements.-
297	(11)
298	(b)  The purposes purpose of the council are shall be to:
299	1.  Align policy initiatives in the criminal justice,
300	juvenile justice, and mental health, and substance abuse systems
301	to ensure the most effective use of resources and to coordinate
302	the development of legislative proposals and budget requests
303	relating to the shared needs of adults and juveniles who have a
304	mental illness, substance abuse disorders disorder, or co-
305	occurring mental health and substance abuse disorders who are
306	in, or at risk of entering, the criminal justice system.
307	2.  Provide consultation in the development of
308	comprehensive and cost-effective community-based mental health
309	and substance abuse treatment services for individuals who have
310	mental illnesses and who are receiving services in state
311	forensic mental health treatment facilities, juvenile secure
312	residential treatment centers specializing in competency
313	training, prisons, jails, and juvenile justice centers.
314	Section 3.  Subsection (1) of section 394.656, Florida
315	Statutes, is amended to read:
316	394.656  Criminal Justice, Mental Health, and Substance
317	Abuse Reinvestment Grant Program.-
318	(1)  There is created within the Department of Children and
319	Family Services the Criminal Justice, Mental Health, and
320	Substance Abuse Reinvestment Grant Program. The purpose of the
321	program is to provide funding to counties to with which they can
322	plan, implement, or expand initiatives that increase public
323	safety, avert increased spending on criminal justice, and
324	improve the accessibility and effectiveness of treatment
325	services for adults and juveniles who have a mental illness,
326	substance abuse disorder, or co-occurring mental health and
327	substance abuse disorders and who are in, or at risk of
328	entering, the criminal or juvenile justice systems. In
329	implementing the Community Mental Health and Substance Abuse
330	Treatment and Crime Reduction Act, the department and agency
331	shall work in coordination with counties that received grants
332	under the program or have piloted a community-based diversion
333	program.
334	Section 4.  Subsection (1) of section 394.657, Florida
335	Statutes, is amended to read:
336	394.657  County planning councils or committees.-
337	(1)  Each board of county commissioners shall designate the
338	county public safety coordinating council established under s.
339	951.26, or designate another criminal or juvenile justice mental
340	health and substance abuse council or committee, as the planning
341	council or committee. The public safety coordinating council or
342	other designated criminal or juvenile justice mental health and
343	substance abuse council or committee shall:,
344	(a)  Coordinate in coordination with the county offices of
345	planning and budget to, shall make a formal recommendation to
346	the board of county commissioners regarding how the Criminal
347	Justice, Mental Health, and Substance Abuse Reinvestment Grant
348	Program may best be implemented within a community. The board of
349	county commissioners may assign any entity to prepare the
350	application on behalf of the county administration for
351	submission to the corporation for review. A county may join with
352	one or more counties to form a consortium and use a regional
353	public safety coordinating council or another county-designated
354	regional criminal or juvenile justice mental health and
355	substance abuse planning council or committee for the geographic
356	area represented by the member counties.
357	(b)  Consult with local governing bodies when planning or
358	implementing the Community Mental Health and Substance Abuse
359	Treatment and Crime Reduction Act.
360	Section 5.  Subsection (28) is added to section 409.906,
361	Florida Statutes, to read:
362	409.906  Optional Medicaid services.-Subject to specific
363	appropriations, the agency may make payments for services which
364	are optional to the state under Title XIX of the Social Security
365	Act and are furnished by Medicaid providers to recipients who
366	are determined to be eligible on the dates on which the services
367	were provided. Any optional service that is provided shall be
368	provided only when medically necessary and in accordance with
369	state and federal law. Optional services rendered by providers
370	in mobile units to Medicaid recipients may be restricted or
371	prohibited by the agency. Nothing in this section shall be
372	construed to prevent or limit the agency from adjusting fees,
373	reimbursement rates, lengths of stay, number of visits, or
374	number of services, or making any other adjustments necessary to
375	comply with the availability of moneys and any limitations or
376	directions provided for in the General Appropriations Act or
377	chapter 216. If necessary to safeguard the state's systems of
378	providing services to elderly and disabled persons and subject
379	to the notice and review provisions of s. 216.177, the Governor
380	may direct the Agency for Health Care Administration to amend
381	the Medicaid state plan to delete the optional Medicaid service
382	known as "Intermediate Care Facilities for the Developmentally
383	Disabled." Optional services may include:
384	(28)  HOME AND COMMUNITY-BASED SERVICES.-The agency,
385	contingent upon appropriation of funds for this purpose, may
386	seek federal approval through a state plan amendment to
387	implement home and community-based services under the authority
388	of and in compliance with s. 1915i of the Social Security Act
389	for services provided to individuals who have been determined by
390	an independent evaluation to have disabilities that cause them
391	to become, or put them at risk of becoming, involved with the
392	criminal justice system due to their mental illness. In
393	accordance with allowances under s. 1915i of the Social Security
394	Act, these services may be limited to a select number of
395	eligible individuals in select geographic areas, as identified
396	by the agency. Eligible individuals may have incomes up to 150
397	percent of the federal poverty level. The agency shall
398	coordinate with the department to select and define the services
399	that will be submitted in the state plan amendment and provided
400	under this subsection. The agency shall disenroll individuals
401	receiving services under this subsection from MediPass or any
402	capitated or other Medicaid-managed care arrangement. Enrollment
403	in state plan services may not exceed 1,000 individuals unless
404	additional approval is obtained from the Legislature. The agency
405	must receive approval from the Legislature or Legislative Budget
406	Commission for any funding beyond that provided within initial
407	implementation revenues. After July 1, 2013, the agency may seek
408	authority to capitate Medicaid behavioral health services under
409	this subsection.
410	Section 6.  Subsection (54) is added to section 409.912,
411	Florida Statutes, to read:
412	409.912  Cost-effective purchasing of health care.-The
413	agency shall purchase goods and services for Medicaid recipients
414	in the most cost-effective manner consistent with the delivery
415	of quality medical care. To ensure that medical services are
416	effectively utilized, the agency may, in any case, require a
417	confirmation or second physician's opinion of the correct
418	diagnosis for purposes of authorizing future services under the
419	Medicaid program. This section does not restrict access to
420	emergency services or poststabilization care services as defined
421	in 42 C.F.R. part 438.114. Such confirmation or second opinion
422	shall be rendered in a manner approved by the agency. The agency
423	shall maximize the use of prepaid per capita and prepaid
424	aggregate fixed-sum basis services when appropriate and other
425	alternative service delivery and reimbursement methodologies,
426	including competitive bidding pursuant to s. 287.057, designed
427	to facilitate the cost-effective purchase of a case-managed
428	continuum of care. The agency shall also require providers to
429	minimize the exposure of recipients to the need for acute
430	inpatient, custodial, and other institutional care and the
431	inappropriate or unnecessary use of high-cost services. The
432	agency shall contract with a vendor to monitor and evaluate the
433	clinical practice patterns of providers in order to identify
434	trends that are outside the normal practice patterns of a
435	provider's professional peers or the national guidelines of a
436	provider's professional association. The vendor must be able to
437	provide information and counseling to a provider whose practice
438	patterns are outside the norms, in consultation with the agency,
439	to improve patient care and reduce inappropriate utilization.
440	The agency may mandate prior authorization, drug therapy
441	management, or disease management participation for certain
442	populations of Medicaid beneficiaries, certain drug classes, or
443	particular drugs to prevent fraud, abuse, overuse, and possible
444	dangerous drug interactions. The Pharmaceutical and Therapeutics
445	Committee shall make recommendations to the agency on drugs for
446	which prior authorization is required. The agency shall inform
447	the Pharmaceutical and Therapeutics Committee of its decisions
448	regarding drugs subject to prior authorization. The agency is
449	authorized to limit the entities it contracts with or enrolls as
450	Medicaid providers by developing a provider network through
451	provider credentialing. The agency may competitively bid single-
452	source-provider contracts if procurement of goods or services
453	results in demonstrated cost savings to the state without
454	limiting access to care. The agency may limit its network based
455	on the assessment of beneficiary access to care, provider
456	availability, provider quality standards, time and distance
457	standards for access to care, the cultural competence of the
458	provider network, demographic characteristics of Medicaid
459	beneficiaries, practice and provider-to-beneficiary standards,
460	appointment wait times, beneficiary use of services, provider
461	turnover, provider profiling, provider licensure history,
462	previous program integrity investigations and findings, peer
463	review, provider Medicaid policy and billing compliance records,
464	clinical and medical record audits, and other factors. Providers
465	shall not be entitled to enrollment in the Medicaid provider
466	network. The agency shall determine instances in which allowing
467	Medicaid beneficiaries to purchase durable medical equipment and
468	other goods is less expensive to the Medicaid program than long-
469	term rental of the equipment or goods. The agency may establish
470	rules to facilitate purchases in lieu of long-term rentals in
471	order to protect against fraud and abuse in the Medicaid program
472	as defined in s. 409.913. The agency may seek federal waivers
473	necessary to administer these policies.
474	(54)  Persons who have serious and persistent mental
475	illnesses, who are receiving services under the Community Mental
476	Health and Substance Abuse Treatment and Crime Reduction Act,
477	and who are eligible for and receiving services under the state
478	plan implemented under s. 1915i of the Social Security Act, as
479	approved by the Centers for Medicare and Medicaid Services, are
480	exempt from MediPass and managed care plans authorized under
481	this chapter, including capitated managed care plans authorized
482	under s. 409.91211.
483	Section 7.  Subsections (1) through (4) of section 916.106,
484	Florida Statutes, are renumbered as subsections (2) through (5),
485	respectively, current subsections (5) through (17) of that
486	section are renumbered as subsections (7) through (19),
487	respectively, and new subsections (1) and (6) are added to that
488	section, to read:
489	916.106  Definitions.-For the purposes of this chapter, the
490	term:
491	(1)  "Acquittee" means a defendant who has been adjudicated
492	not guilty by reason of insanity.
493	(6)  "Conditional releasee" means a person placed on
494	conditional release pursuant to s. 916.17.
495	Section 8.  Paragraph (a) of subsection (3) of section
496	916.107, Florida Statutes, is amended to read:
497	916.107  Rights of forensic clients.-
498	(3)  RIGHT TO EXPRESS AND INFORMED CONSENT.-
499	(a)  A forensic client or a person placed on conditional
500	release pursuant to s. 916.17(2) in a crisis stabilization unit
501	or a short-term residential treatment facility shall be asked to
502	give express and informed written consent for treatment. If a
503	client or such a conditional releasee refuses such treatment as
504	is deemed necessary and essential by his or her the client's
505	multidisciplinary treatment team for his or her the appropriate
506	care of the client, such treatment may be provided under the
507	following circumstances:
508	1.  In an emergency situation in which there is immediate
509	danger to the safety of the client or conditional releasee or
510	others, such treatment may be provided upon the written order of
511	a physician for a period not to exceed 48 hours, excluding
512	weekends and legal holidays. If, after the 48-hour period, the
513	client or conditional releasee has not given express and
514	informed consent to the treatment initially refused, the
515	administrator or designee of the civil or forensic facility,
516	crisis stabilization unit, or short-term residential treatment
517	facility serving individuals placed on conditional release
518	pursuant to s. 916.17(2) shall, within 48 hours, excluding
519	weekends and legal holidays, petition the committing court or
520	the circuit court serving the county in which the facility is
521	located, at the option of the facility administrator or
522	designee, for an order authorizing the continued treatment of
523	the client or conditional releasee. In the interim, the need for
524	treatment shall be reviewed every 48 hours and may be continued
525	without the consent of the client or conditional releasee upon
526	the continued written order of a physician who has determined
527	that the emergency situation continues to present a danger to
528	the safety of the client, the conditional releasee, or others.
529	2.  In a situation other than an emergency situation, the
530	administrator or designee of the civil or forensic facility,
531	crisis stabilization unit, or short-term residential treatment
532	facility shall petition the court for an order authorizing
533	necessary and essential treatment for the client or conditional
534	releasee.
535	a.  If the client has been receiving psychotherapeutic
536	medication at the jail at the time of transfer to the state
537	forensic mental health treatment facility and lacks the capacity
538	to make an informed decision regarding mental health treatment
539	at the time of admission, the admitting physician may order a
540	continuation of the psychotherapeutic medication if, in the
541	clinical judgment of the physician, abrupt cessation of the
542	psychotherapeutic medication could cause a risk to the health
543	and safety of the client during the time a court order to
544	medicate is pursued. The jail physician shall provide a current
545	psychotherapeutic medication order at the time of transfer to
546	the state mental health treatment facility.
547	b.  The court order shall allow such treatment for up to a
548	period not to exceed 90 days after following the date of the
549	entry of the order. Unless the court is notified in writing that
550	the client or conditional releasee has provided express and
551	informed consent in writing or that he or she the client has
552	been discharged by the committing court, the administrator or
553	designee shall, before prior to the expiration of the initial
554	90-day order, petition the court for an order authorizing the
555	continuation of treatment for another 90 days 90-day period.
556	This procedure shall be repeated until the client or conditional
557	releasee provides consent or is discharged by the committing
558	court.
559	3.  At the hearing on the issue of whether the court should
560	enter an order authorizing treatment for which a client or
561	conditional releasee was unable to or refused to give express
562	and informed consent, the court shall determine by clear and
563	convincing evidence that the client or conditional releasee has
564	mental illness, retardation, or autism, that the treatment not
565	consented to is essential to his or her the care of the client,
566	and that the treatment not consented to is not experimental and
567	does not present an unreasonable risk of serious, hazardous, or
568	irreversible side effects. In arriving at the substitute
569	judgment decision, the court must consider at least the
570	following factors:
571	a.  The individual's client's expressed preference
572	regarding treatment;
573	b.  The probability of adverse side effects;
574	c.  The prognosis without treatment; and
575	d.  The prognosis with treatment.
576
577	The hearing shall be as convenient to the client or conditional
578	releasee as may be consistent with orderly procedure and shall
579	be conducted in physical settings not likely to be injurious to
580	his or her the client's condition. The court may appoint a
581	general or special magistrate to preside at the hearing. The
582	client or conditional releasee or his or her the client's
583	guardian, and the representative, shall be provided
584	of the petition and the date, time, and location of
585	The client or conditional releasee has the right to
586	attorney represent him or her at the hearing, and, if the client
587	or conditional releasee is indigent, the court shall appoint the
588	office of the public defender to represent him or her the client
589	at the hearing. The client or conditional releasee may testify
590	or not, as he or she chooses, and has the right to cross-examine
591	witnesses and may present his or her own witnesses.
592	Section 9.  Section 916.111, Florida Statutes, is amended
593	to read:
594	916.111  Training of mental health experts.-The evaluation
595	of defendants for competency to proceed or for sanity at the
596	time of the commission of the offense shall be conducted in such
597	a way as to ensure uniform application of the criteria
598	enumerated in Rules 3.210 and 3.216, Florida Rules of Criminal
599	Procedure.
600	(1)  Appointed experts shall have completed forensic
601	evaluator training as specified in this section.
602	(2)  A forensic evaluator training course approved by the
603	department must be provided at least annually to ensure that
604	mental health professionals have the opportunity to be placed on
605	the department's forensic evaluator registry.
606	(a)  Beginning July 1, 2011, experts shall remain on the
607	registry if they have completed or retaken the required training
608	course within the previous 5 years. Those who have not completed
609	the training course must be removed from the registry and shall
610	not conduct evaluations for the courts.
611	(b)  A mental health professional who has completed the
612	training course within the previous 5 years must maintain
613	documentation of completion of the required training course and
614	provide current contact information to the department.
615	(3)  The department shall develop, and may contract with
616	accredited institutions:
617	(a)(1)  To provide:
618	1.(a)  A plan for training mental health professionals to
619	perform forensic evaluations and to standardize the criteria and
620	procedures to be used in these evaluations;
621	2.(b)  Clinical protocols and procedures based upon the
622	criteria of Rules 3.210 and 3.216, Florida Rules of Criminal
623	Procedure; and
624	3.(c)  Training for mental health professionals in the
625	application of these protocols and procedures in performing
626	forensic evaluations and providing reports to the courts; and
627	(b)(2)  To compile and maintain the necessary information
628	for evaluating the success of this program, including the number
629	of persons trained, the cost of operating the program, and the
630	effect on the quality of forensic evaluations as measured by
631	appropriateness of admissions to state forensic facilities and
632	to community-based care programs.
633	Section 10.  Subsection (1) of section 916.115, Florida
634	Statutes, is amended to read:
635	916.115  Appointment of experts.-
636	(1)  The court shall appoint no more than three experts to
637	determine the mental condition of a defendant in a criminal
638	case, including competency to proceed, insanity, involuntary
639	placement, and treatment. The experts may evaluate the defendant
640	in jail or in another appropriate local facility or in a
641	facility of the Department of Corrections.
642	(a)  To the extent possible, the appointed experts shall
643	have completed forensic evaluator training approved by the
644	department, and each shall be psychiatrists or a psychiatrist ,
645	licensed psychologists psychologist, or physician.
646	(b)  The department shall maintain and annually provide the
647	courts with a forensic evaluator registry list of available
648	mental health professionals who have completed the approved
649	training as experts.
650	Section 11.  Subsection (2) of section 916.13, Florida
651	Statutes, is amended to read:
652	916.13  Involuntary commitment of defendant adjudicated
653	incompetent.-
654	(2)  A defendant who has been charged with a felony and who
655	has been adjudicated incompetent to proceed due to mental
656	illness, and who meets the criteria for involuntary commitment
657	to the department under the provisions of this chapter, may be
658	committed to the department, and the department shall retain and
659	treat the defendant.
660	(a)  Within No later than 6 months after the date of
661	admission and at the end of any period of extended commitment,
662	or at any time the administrator or designee has shall have
663	determined that the defendant has regained competency to proceed
664	or no longer meets the criteria for continued commitment, the
665	administrator or designee shall file a report with the court
666	pursuant to the applicable Florida Rules of Criminal Procedure.
667	(b)  A competency hearing must be held within 30 days after
668	a court receives notification that the defendant is competent to
669	proceed or no longer meets criteria for continued commitment.
670	Section 12.  Section 916.15, Florida Statutes, is amended
671	to read:
672	916.15  Involuntary commitment of defendant adjudicated not
673	guilty by reason of insanity.-
674	(1)  The determination of whether a defendant is not guilty
675	by reason of insanity shall be determined in accordance with
676	Rule 3.217, Florida Rules of Criminal Procedure.
677	(2)  An acquittee A defendant who is acquitted of criminal
678	charges because of a finding of not guilty by reason of insanity
679	may be involuntarily committed pursuant to such finding if the
680	defendant has a mental illness and, because of the illness, is
681	manifestly dangerous to himself or herself or others.
682	(3)  Every acquittee defendant acquitted of criminal
683	charges by reason of insanity and found to meet the criteria for
684	involuntary commitment may be committed and treated in
685	accordance with the provisions of this section and the
686	applicable Florida Rules of Criminal Procedure. The department
687	shall admit an acquittee a defendant so adjudicated to an
688	appropriate facility or program for treatment and shall retain
689	and treat such acquittee defendant. No later than 6 months after
690	the date of admission, prior to the end of any period of
691	extended commitment, or at any time the administrator or
692	designee shall have determined that the acquittee defendant no
693	longer meets the criteria for continued commitment placement,
694	the administrator or designee shall file a report with the court
695	pursuant to the applicable Florida Rules of Criminal Procedure.
696	(4)  The commitment hearing must be held within 30 days
697	after the court receives notification that the acquittee no
698	longer meets the criteria for continued commitment placement.
699	(5)(4)  In all proceedings under this section, both the
700	acquittee defendant and the state shall have the right to a
701	hearing before the committing court. Evidence at such hearing
702	may be presented by the hospital administrator or the
703	administrator's designee as well as by the state and the
704	acquittee defendant. The acquittee has defendant shall have the
705	right to counsel at any such hearing. In the event that an
706	acquittee a defendant is determined to be indigent pursuant to
707	s. 27.52, the public defender shall represent the acquittee
708	defendant. The parties shall have access to the acquittee's
709	defendant's records at the treating facilities and may interview
710	or depose personnel who have had contact with the acquittee
711	defendant at the treating facilities.
712	Section 13.  Section 916.17, Florida Statutes, is amended
713	to read:
714	916.17  Conditional release.-
715	(1)  Except for an inmate currently serving a prison
716	sentence, the committing court may order a conditional release
717	of any defendant or acquittee in lieu of an involuntary
718	commitment to a facility pursuant to s. 916.13 or s. 916.15
719	based upon an approved plan for providing appropriate outpatient
720	care and treatment. Upon a recommendation that outpatient
721	treatment of the defendant or acquittee is appropriate, a
722	written plan for outpatient treatment, including recommendations
723	from qualified professionals, must be filed with the court, with
724	copies to all parties. Such a plan may also be submitted by the
725	defendant or acquittee and filed with the court with copies to
726	all parties. The plan shall include:
727	(a)  Special provisions for residential care or adequate
728	supervision of the defendant or acquittee.
729	(b)  Provisions for outpatient mental health services.
730	(c)  If appropriate, recommendations for auxiliary services
731	such as vocational training, educational services, or special
732	medical care.
733
734	In its order of conditional release, the court shall specify the
735	conditions of release based upon the release plan and shall
736	direct the appropriate agencies or persons to submit periodic
737	reports to the court regarding the defendant's or acquittee's
738	compliance with the conditions of the release and progress in
739	treatment, with copies to all parties.
740	(2)  A defendant who otherwise meets the criteria for
741	involuntary commitment under s. 916.13, but whose current most
742	serious charge is a felony of the third degree or a felony of
743	the second degree when the felony did not involve violence, must
744	be placed in a community residential facility for competency
745	restoration unless bed space or funding is unavailable for the
746	community placement or the trial court makes an explicit finding
747	that the defendant cannot be safely managed in such a placement.
748	In making such finding, the court shall consider all of the
749	following:
750	(a)  The nature and seriousness of the crime allegedly
751	committed.
752	(b)  The individual's criminal history.
753	(c)  The individual's psychiatric history.
754	(d)  The individual's history of violent behavior or
755	threats of violent behavior and risk of harm to self or others.
756	(e)  The likelihood that the individual will comply with
757	and benefit from the mental health treatment and services being
758	recommended.
759	(f)  The availability of appropriate community-based
760	services and treatment settings.
761	(g)  Other information considered relevant by the court.
762	(3)(2)  Upon the filing of an affidavit or statement under
763	oath by any person that the defendant or acquittee has failed to
764	comply with the conditions of release, that the defendant's or
765	acquittee's condition has deteriorated to the point that
766	inpatient care is required, or that the release conditions
767	should be modified, the court shall hold a hearing within 7 days
768	after receipt of the affidavit or statement under oath. After
769	the hearing, the court may modify the release conditions. The
770	court may also order that the defendant or acquittee be returned
771	to the department if it is found, after the appointment and
772	report of experts, that the person meets the criteria for
773	involuntary commitment under s. 916.13 or s. 916.15.
774	(4)(3)  If at any time it is determined after a hearing
775	that the defendant who has been conditionally released under
776	subsection (1) no longer requires court-supervised followup
777	care, the court shall terminate its jurisdiction in the cause
778	and discharge the defendant or acquittee.
779	Section 14.  Subsection (1) of section 985.19, Florida
780	Statutes, is amended to read:
781	985.19  Incompetency in juvenile delinquency cases.-
782	(1)  If, at any time prior to or during a delinquency case,
783	the court has reason to believe that the child named in the
784	petition may be incompetent to proceed with the hearing, the
785	court on its own motion may, or on the motion of the child's
786	attorney or state attorney must, stay all proceedings and order
787	an evaluation of the child's mental condition.
788	(a)  Any motion questioning the child's competency to
789	proceed must be served upon the child's attorney, the state
790	attorney, the attorneys representing the department of Juvenile
791	Justice, and the attorneys representing the Department of
792	Children and Family Services. Thereafter, any motion, notice of
793	hearing, order, or other legal pleading relating to the child's
794	competency to proceed with the hearing must be served upon the
795	child's attorney, the state attorney, the attorneys representing
796	the department of Juvenile Justice, and the attorneys
797	representing the Department of Children and Family Services.
798	(b)  All determinations of competency must shall be made at
799	a hearing, with findings of fact based on an evaluation of the
800	child's mental condition made by at least not less than two but
801	not nor more than three experts appointed by the court. The
802	basis for the determination of incompetency must be specifically
803	stated in the evaluation and must be conducted so as to ensure
804	uniform application of the criteria enumerated in Rule 8.095,
805	Florida Rules of Juvenile Procedure. In addition, A
806	recommendation as to whether residential or nonresidential
807	treatment or training is required must be included in the
808	evaluation. Experts appointed by the court to determine the
809	mental condition of a child shall be allowed reasonable fees for
810	services rendered. State employees may be paid expenses pursuant
811	to s. 112.061. The fees shall be taxed as costs in the case.
812	(c)  All court orders determining incompetency must include
813	specific written findings by the court as to the nature of the
814	incompetency and whether the child requires a secure or
815	nonsecure treatment or training environment environments.
816	(d)  The evaluation of juveniles for competency to proceed
817	shall be conducted in a manner that ensures the uniform
818	application of the criteria in Rule 8.095, Florida Rules of
819	Juvenile Procedure. The Department of Children and Family
820	Services shall develop the following:
821	1.  A plan for training mental health professionals to
822	perform forensic evaluations and for standardizing the criteria
823	and procedures to be used in such evaluations.
824	2.  Clinical protocols and procedures based on the criteria
825	in Rule 8.095, Florida Rules of Juvenile Procedure..
826	3.  Training for mental health professionals in the
827	application of these protocols and procedures for performing
828	forensic evaluations and providing reports to the courts.
829	4.  Procedures for evaluating the success of the program,
830	including the number of persons trained, the cost of operating
831	the program, and the effect on the quality of forensic
832	evaluations as measured by the appropriateness of admissions to
833	the Department of Children and Family Services' juvenile
834	competent-to-proceed programs.
835	(e)(d)  For competency incompetency evaluations related to
836	mental illness, the Department of Children and Family Services
837	shall maintain and annually provide the courts with a forensic
838	evaluator registry list of available mental health professionals
839	who have completed the approved a training as experts pursuant
840	to this section program approved by the Department of Children
841	and Family Services to perform the evaluations. To the extent
842	possible, the appointed expert shall be a psychiatrist or
843	licensed psychologist.
844	(f)  Appointed experts shall have completed forensic
845	evaluator training as follows:
846	1.  A forensic evaluator training course approved by the
847	Department of Children and Family Services must be provided at
848	least annually to ensure that mental health professionals have
849	an opportunity to be placed on the registry.
850	2.  Beginning July 1, 2011, experts shall remain on the
851	registry if they have completed or retaken the required training
852	within the previous 5 years. Those who have not completed the
853	required training within the previous 5 years must be removed
854	from the registry and shall not conduct evaluations for the
855	courts.
856	3.  A mental health professional who has completed the
857	training course within the previous 5 years must maintain
858	documentation of having completed the required training and
859	provide current contact information to the Department of
860	Children and Family Services.
861	(g)(e)  For competency incompetency evaluations related to
862	mental retardation or autism, the court shall order the Agency
863	for Persons with Disabilities to examine the child to determine
864	if the child meets the definition of "retardation" or "autism"
865	in s. 393.063 and, if so, whether the child is competent to
866	proceed with delinquency proceedings.
867	(h)(f)  A child is competent to proceed if the child has
868	sufficient present ability to consult with counsel with a
869	reasonable degree of rational understanding and the child has a
870	rational and factual understanding of the present proceedings.
871	The report must address the child's capacity to:
872	1.  Appreciate the charges or allegations against the
873	child.
874	2.  Appreciate the range and nature of possible penalties
875	that may be imposed in the proceedings against the child, if
876	applicable.
877	3.  Understand the adversarial nature of the legal process.
878	4.  Disclose to counsel facts pertinent to the proceedings
879	at issue.
880	5.  Display appropriate courtroom behavior.
881	6.  Testify relevantly.
882	(i)(g)  Immediately upon the filing of the court order
883	finding a child incompetent to proceed, the clerk of the court
884	shall notify the Department of Children and Family Services and
885	the Agency for Persons with Disabilities and fax or hand deliver
886	to the department and to the agency a referral packet that
887	includes, at a minimum, the court order, the charging documents,
888	the petition, and the court-appointed evaluator's reports.
889	(j)(h)  After placement of the child in the appropriate
890	setting, the Department of Children and Family Services in
891	consultation with the Agency for Persons with Disabilities, as
892	appropriate, must, within 30 days after placement of the child,
893	prepare and submit to the court a treatment or training plan for
894	the child's restoration of competency. A copy of the plan must
895	be served upon the child's attorney, the state attorney, and the
896	attorneys representing the Department of Juvenile Justice.
897	Section 15.  This act shall take effect July 1, 2010.

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