Florida Senate - 2020                                    SB 1440
       By Senator Powell
       30-01668-20                                           20201440__
    1                        A bill to be entitled                      
    2         An act relating to children’s mental health; amending
    3         s. 394.493, F.S.; requiring the Department of Children
    4         and Families and the Agency for Health Care
    5         Administration to identify certain children and
    6         adolescents who use crisis stabilization services
    7         during specified fiscal years; requiring the
    8         department and agency to collaboratively meet the
    9         behavioral health needs of such children and
   10         adolescents and submit a quarterly report to the
   11         Legislature; amending s. 394.495, F.S.; including
   12         crisis response services provided through mobile
   13         response teams in the array of services available to
   14         children and adolescents; requiring the department to
   15         contract with managing entities for mobile response
   16         teams to provide certain services to certain children,
   17         adolescents, and young adults; providing requirements
   18         for such mobile response teams; providing requirements
   19         for managing entities when procuring mobile response
   20         teams; creating s. 394.4955, F.S.; requiring managing
   21         entities to develop and implement plans promoting the
   22         development of a coordinated system of care for
   23         certain services; providing requirements for the
   24         planning process; requiring each managing entity to
   25         submit and implement such plan by a specified date;
   26         requiring that such plan be reviewed and updated
   27         periodically; providing requirements for managing
   28         entities and collaborating organizations relating to
   29         such plan; amending s. 394.9082, F.S.; revising the
   30         duties of the department relating to priority
   31         populations that will benefit from care coordination;
   32         requiring that a managing entity’s behavioral health
   33         care needs assessment include certain information
   34         regarding gaps in certain services; requiring a
   35         managing entity to promote the use of available crisis
   36         intervention services; amending s. 409.175, F.S.;
   37         revising requirements relating to preservice training
   38         for foster parents; amending s. 409.988, F.S.;
   39         revising the duties of a lead agency relating to
   40         individuals providing care for dependent children;
   41         amending s. 985.601, F.S.; requiring the Department of
   42         Juvenile Justice to participate in the planning
   43         process for promoting a coordinated system of care for
   44         children and adolescents; amending s. 1003.02, F.S.;
   45         requiring each district school board to participate in
   46         the planning process for promoting a coordinated
   47         system of care for children and adolescents; amending
   48         s. 1004.44, F.S.; requiring the Louis de la Parte
   49         Florida Mental Health Institute to develop, in
   50         consultation with other entities, a model response
   51         protocol for schools; amending s. 1006.04, F.S.;
   52         requiring the educational multiagency network to
   53         participate in the planning process for promoting a
   54         coordinated system of care for children and
   55         adolescents; amending s. 1011.62, F.S.; revising the
   56         elements of a plan required for school district
   57         funding under the mental health assistance allocation;
   58         requiring the Department of Children and Families and
   59         the Agency for Health Care Administration to assess
   60         the quality of care provided in crisis stabilization
   61         units to certain children and adolescents; requiring
   62         the department and agency to review current standards
   63         of care for certain settings and make recommendations;
   64         requiring the department and agency to jointly submit
   65         a report to the Governor and the Legislature by a
   66         specified date; providing an effective date.
   68  Be It Enacted by the Legislature of the State of Florida:
   70         Section 1. Subsection (4) is added to section 394.493,
   71  Florida Statutes, to read:
   72         394.493 Target populations for child and adolescent mental
   73  health services funded through the department.—
   74         (4)Beginning with fiscal year 2020-2021 through fiscal
   75  year 2021-2022, the department and the Agency for Health Care
   76  Administration shall identify children and adolescents who are
   77  the highest utilizers of crisis stabilization services. The
   78  department and agency shall collaboratively take appropriate
   79  action within available resources to meet the behavioral health
   80  needs of such children and adolescents more effectively, and
   81  shall jointly submit to the Legislature a quarterly report
   82  listing the actions taken by both agencies to better serve such
   83  children and adolescents.
   84         Section 2. Paragraph (q) of subsection (4) and subsection
   85  (7) are added to section 394.495, Florida Statutes, to read:
   86         394.495 Child and adolescent mental health system of care;
   87  programs and services.—
   88         (4) The array of services may include, but is not limited
   89  to:
   90         (q)Crisis response services provided through mobile
   91  response teams.
   92         (7)(a)The department shall contract with managing entities
   93  for mobile response teams throughout the state to provide
   94  immediate, onsite behavioral health crisis services to children,
   95  adolescents, and young adults ages 18 to 25, inclusive, who:
   96         1.Have an emotional disturbance;
   97         2.Are experiencing an acute mental or emotional crisis;
   98         3.Are experiencing escalating emotional or behavioral
   99  reactions and symptoms that impact their ability to function
  100  typically within the family, living situation, or community
  101  environment; or
  102         4.Are served by the child welfare system and are
  103  experiencing or are at high risk of placement instability.
  104         (b)A mobile response team shall, at a minimum:
  105         1.Respond to new requests for services within 60 minutes
  106  after such requests are made.
  107         2.Respond to a crisis in the location where the crisis is
  108  occurring.
  109         3.Provide behavioral health crisis-oriented services that
  110  are responsive to the needs of the child, adolescent, or young
  111  adult and his or her family.
  112         4.Provide evidence-based practices to children,
  113  adolescents, young adults, and families to enable them to
  114  independently and effectively deescalate and respond to
  115  behavioral challenges that they are facing and to reduce the
  116  potential for future crises.
  117         5.Provide screening, standardized assessments, early
  118  identification, and referrals to community services.
  119         6.Engage the child, adolescent, or young adult and his or
  120  her family as active participants in every phase of the
  121  treatment process whenever possible.
  122         7.Develop a care plan for the child, adolescent, or young
  123  adult.
  124         8.Provide care coordination by facilitating the transition
  125  to ongoing services.
  126         9.Ensure there is a process in place for informed consent
  127  and confidentiality compliance measures.
  128         10.Promote information sharing and the use of innovative
  129  technology.
  130         11.Coordinate with the managing entity within the service
  131  location and other key entities providing services and supports
  132  to the child, adolescent, or young adult and his or her family,
  133  including, but not limited to, the child, adolescent, or young
  134  adult’s school, the local educational multiagency network for
  135  severely emotionally disturbed students under s. 1006.04, the
  136  child welfare system, and the juvenile justice system.
  137         (c)When procuring mobile response teams, the managing
  138  entity must, at a minimum:
  139         1.Collaborate with local sheriff’s offices and public
  140  schools in the planning, development, evaluation, and selection
  141  processes.
  142         2.Require that services be made available 24 hours per
  143  day, 7 days per week, with onsite response time to the location
  144  of the referred crisis within 60 minutes after the request for
  145  services is made.
  146         3.Require the provider to establish response protocols
  147  with local law enforcement agencies, local community-based care
  148  lead agencies as defined in s. 409.986(3), the child welfare
  149  system, and the Department of Juvenile Justice. The response
  150  protocol with a school district shall be consistent with the
  151  model response protocol developed under s. 1004.44.
  152         4.Require access to a board-certified or board-eligible
  153  psychiatrist or psychiatric nurse practitioner.
  154         5.Require mobile response teams to refer children,
  155  adolescents, or young adults and their families to an array of
  156  crisis response services that address individual and family
  157  needs, including screening, standardized assessments, early
  158  identification, and community services as necessary to address
  159  the immediate crisis event.
  160         Section 3. Section 394.4955, Florida Statutes, is created
  161  to read:
  162         394.4955Coordinated system of care; child and adolescent
  163  mental health treatment and support.—
  164         (1)Pursuant to s. 394.9082(5)(d), each managing entity
  165  shall develop a plan that promotes the development and effective
  166  implementation of a coordinated system of care which integrates
  167  services provided through providers funded by the state’s child
  168  serving systems and facilitates access by children and
  169  adolescents, as resources permit, to needed mental health
  170  treatment and services at any point of entry regardless of the
  171  time of year, intensity, or complexity of the need, and other
  172  systems with which such children and adolescents are involved,
  173  as well as treatment and services available through other
  174  systems for which they would qualify.
  175         (2)(a)The managing entity shall lead a planning process
  176  that includes, but is not limited to, children and adolescents
  177  with behavioral health needs and their families; behavioral
  178  health service providers; law enforcement agencies; school
  179  districts or superintendents; the multiagency network for
  180  students with emotional or behavioral disabilities; the
  181  department; and representatives of the child welfare and
  182  juvenile justice systems, early learning coalitions, the Agency
  183  for Health Care Administration, Medicaid managed medical
  184  assistance plans, the Agency for Persons with Disabilities, the
  185  Department of Juvenile Justice, and other community partners. An
  186  organization receiving state funding must participate in the
  187  planning process if requested by the managing entity.
  188         (b)The managing entity and collaborating organizations
  189  shall take into consideration the geographical distribution of
  190  the population, needs, and resources, and create separate plans
  191  on an individual county or multi-county basis, as needed, to
  192  maximize collaboration and communication at the local level.
  193         (c)To the extent permitted by available resources, the
  194  coordinated system of care shall include the array of services
  195  listed in s. 394.495.
  196         (d)Each plan shall integrate with the local plan developed
  197  under s. 394.4573.
  198         (3)By July 1, 2021, the managing entity shall complete the
  199  plans developed under this section and submit them to the
  200  department. By July 1, 2022, the entities involved in the
  201  planning process shall implement the coordinated system of care
  202  specified in each plan. The managing entity and collaborating
  203  organizations shall review and update the plans, as necessary,
  204  at least every 3 years thereafter.
  205         (4)The managing entity and collaborating organizations
  206  shall create integrated service delivery approaches within
  207  current resources that facilitate parents and caregivers
  208  obtaining services and support by making referrals to
  209  specialized treatment providers, if necessary, with follow-up to
  210  ensure services are received.
  211         (5)The managing entity and collaborating organizations
  212  shall document each coordinated system of care for children and
  213  adolescents through written memoranda of understanding or other
  214  binding arrangements.
  215         (6)The managing entity shall identify gaps in the arrays
  216  of services for children and adolescents listed in s. 394.495
  217  available under each plan and include relevant information in
  218  its annual needs assessment required by s. 394.9082.
  219         Section 4. Paragraph (c) of subsection (3) and paragraphs
  220  (b) and (d) of subsection (5) of section 394.9082, Florida
  221  Statutes, are amended, and paragraph (t) is added to subsection
  222  (5) of that section, to read:
  223         394.9082 Behavioral health managing entities.—
  224         (3) DEPARTMENT DUTIES.—The department shall:
  225         (c) Define the priority populations that will benefit from
  226  receiving care coordination. In defining such populations, the
  227  department shall take into account the availability of resources
  228  and consider:
  229         1. The number and duration of involuntary admissions within
  230  a specified time.
  231         2. The degree of involvement with the criminal justice
  232  system and the risk to public safety posed by the individual.
  233         3. Whether the individual has recently resided in or is
  234  currently awaiting admission to or discharge from a treatment
  235  facility as defined in s. 394.455.
  236         4. The degree of utilization of behavioral health services.
  237         5. Whether the individual is a parent or caregiver who is
  238  involved with the child welfare system.
  239         6.Whether the individual is an adolescent, as defined in
  240  s. 394.492, who requires assistance in transitioning to services
  241  provided in the adult system of care.
  242         (5) MANAGING ENTITY DUTIES.—A managing entity shall:
  243         (b) Conduct a community behavioral health care needs
  244  assessment every 3 years in the geographic area served by the
  245  managing entity which identifies needs by subregion. The process
  246  for conducting the needs assessment shall include an opportunity
  247  for public participation. The assessment shall include, at a
  248  minimum, the information the department needs for its annual
  249  report to the Governor and Legislature pursuant to s. 394.4573.
  250  The assessment shall also include a list and descriptions of any
  251  gaps in the arrays of services for children or adolescents
  252  identified pursuant to s. 394.4955 and recommendations for
  253  addressing such gaps. The managing entity shall provide the
  254  needs assessment to the department.
  255         (d) Promote the development and effective implementation of
  256  a coordinated system of care pursuant to ss. 394.4573 and
  257  394.495 s. 394.4573.
  258         (t)Promote the use of available crisis intervention
  259  services by requiring contracted providers to provide contact
  260  information for mobile response teams established under s.
  261  394.495 to parents and caregivers of children, adolescents, and
  262  young adults between ages 18 and 25, inclusive, who receive
  263  safety-net behavioral health services.
  264         Section 5. Paragraph (b) of subsection (14) of section
  265  409.175, Florida Statutes, is amended to read:
  266         409.175 Licensure of family foster homes, residential
  267  child-caring agencies, and child-placing agencies; public
  268  records exemption.—
  269         (14)
  270         (b) As a condition of licensure, foster parents shall
  271  successfully complete preservice training. The preservice
  272  training shall be uniform statewide and shall include, but not
  273  be limited to, such areas as:
  274         1. Orientation regarding agency purpose, objectives,
  275  resources, policies, and services;
  276         2. Role of the foster parent as a treatment team member;
  277         3. Transition of a child into and out of foster care,
  278  including issues of separation, loss, and attachment;
  279         4. Management of difficult child behavior that can be
  280  intensified by placement, by prior abuse or neglect, and by
  281  prior placement disruptions;
  282         5. Prevention of placement disruptions;
  283         6. Care of children at various developmental levels,
  284  including appropriate discipline; and
  285         7. Effects of foster parenting on the family of the foster
  286  parent; and
  287         8.Information about and contact information for the local
  288  mobile response team as a means for addressing a behavioral
  289  health crisis or preventing placement disruption.
  290         Section 6. Paragraph (f) of subsection (1) of section
  291  409.988, Florida Statutes, is amended to read:
  292         409.988 Lead agency duties; general provisions.—
  293         (1) DUTIES.—A lead agency:
  294         (f) Shall ensure that all individuals providing care for
  295  dependent children receive:
  296         1. Appropriate training and meet the minimum employment
  297  standards established by the department.
  298         2.Contact information for the local mobile response team
  299  established under s. 394.495.
  300         Section 7. Subsection (4) of section 985.601, Florida
  301  Statutes, is amended to read:
  302         985.601 Administering the juvenile justice continuum.—
  303         (4) The department shall maintain continuing cooperation
  304  with the Department of Education, the Department of Children and
  305  Families, the Department of Economic Opportunity, and the
  306  Department of Corrections for the purpose of participating in
  307  agreements with respect to dropout prevention and the reduction
  308  of suspensions, expulsions, and truancy; increased access to and
  309  participation in high school equivalency diploma, vocational,
  310  and alternative education programs; and employment training and
  311  placement assistance. The cooperative agreements between the
  312  departments shall include an interdepartmental plan to cooperate
  313  in accomplishing the reduction of inappropriate transfers of
  314  children into the adult criminal justice and correctional
  315  systems. As part of its continuing cooperation, the department
  316  shall participate in the planning process for promoting a
  317  coordinated system of care for children and adolescents pursuant
  318  to s. 394.4955.
  319         Section 8. Subsection (5) is added to section 1003.02,
  320  Florida Statutes, to read:
  321         1003.02 District school board operation and control of
  322  public K-12 education within the school district.—As provided in
  323  part II of chapter 1001, district school boards are
  324  constitutionally and statutorily charged with the operation and
  325  control of public K-12 education within their school district.
  326  The district school boards must establish, organize, and operate
  327  their public K-12 schools and educational programs, employees,
  328  and facilities. Their responsibilities include staff
  329  development, public K-12 school student education including
  330  education for exceptional students and students in juvenile
  331  justice programs, special programs, adult education programs,
  332  and career education programs. Additionally, district school
  333  boards must:
  334         (5)Participate in the planning process for promoting a
  335  coordinated system of care for children and adolescents pursuant
  336  to s. 394.4955.
  337         Section 9. Subsection (4) of section 1004.44, Florida
  338  Statutes, is redesignated as subsection (5), and a new
  339  subsection (4) is added to that section, to read:
  340         1004.44 Louis de la Parte Florida Mental Health Institute.
  341  There is established the Louis de la Parte Florida Mental Health
  342  Institute within the University of South Florida.
  343         (4)By August 1, 2020, the institute shall develop a model
  344  response protocol for schools to use mobile response teams
  345  established under s. 394.495. In developing the protocol, the
  346  institute shall, at a minimum, consult with school districts
  347  that effectively use such teams, school districts that use such
  348  teams less often, local law enforcement agencies, the Department
  349  of Children and Families, managing entities as defined in s.
  350  394.9082(2), and mobile response team providers.
  351         Section 10. Paragraph (c) of subsection (1) of section
  352  1006.04, Florida Statutes, is amended to read:
  353         1006.04 Educational multiagency services for students with
  354  severe emotional disturbance.—
  355         (1)
  356         (c) The multiagency network shall:
  357         1. Support and represent the needs of students in each
  358  school district in joint planning with fiscal agents of
  359  children’s mental health funds, including the expansion of
  360  school-based mental health services, transition services, and
  361  integrated education and treatment programs.
  362         2. Improve coordination of services for children with or at
  363  risk of emotional or behavioral disabilities and their families
  364  by assisting multi-agency collaborative initiatives to identify
  365  critical issues and barriers of mutual concern and develop local
  366  response systems that increase home and school connections and
  367  family engagement.
  368         3. Increase parent and youth involvement and development
  369  with local systems of care.
  370         4. Facilitate student and family access to effective
  371  services and programs for students with and at risk of emotional
  372  or behavioral disabilities that include necessary educational,
  373  residential, and mental health treatment services, enabling
  374  these students to learn appropriate behaviors, reduce
  375  dependency, and fully participate in all aspects of school and
  376  community living.
  377         5.Participate in the planning process for promoting a
  378  coordinated system of care for children and adolescents pursuant
  379  to s. 394.4955.
  380         Section 11. Paragraph (b) of subsection (16) of section
  381  1011.62, Florida Statutes, is amended to read:
  382         1011.62 Funds for operation of schools.—If the annual
  383  allocation from the Florida Education Finance Program to each
  384  district for operation of schools is not determined in the
  385  annual appropriations act or the substantive bill implementing
  386  the annual appropriations act, it shall be determined as
  387  follows:
  388         (16) MENTAL HEALTH ASSISTANCE ALLOCATION.—The mental health
  389  assistance allocation is created to provide funding to assist
  390  school districts in establishing or expanding school-based
  391  mental health care; train educators and other school staff in
  392  detecting and responding to mental health issues; and connect
  393  children, youth, and families who may experience behavioral
  394  health issues with appropriate services. These funds shall be
  395  allocated annually in the General Appropriations Act or other
  396  law to each eligible school district. Each school district shall
  397  receive a minimum of $100,000, with the remaining balance
  398  allocated based on each school district’s proportionate share of
  399  the state’s total unweighted full-time equivalent student
  400  enrollment. Charter schools that submit a plan separate from the
  401  school district are entitled to a proportionate share of
  402  district funding. The allocated funds may not supplant funds
  403  that are provided for this purpose from other operating funds
  404  and may not be used to increase salaries or provide bonuses.
  405  School districts are encouraged to maximize third-party health
  406  insurance benefits and Medicaid claiming for services, where
  407  appropriate.
  408         (b) The plans required under paragraph (a) must be focused
  409  on a multitiered system of supports to deliver evidence-based
  410  mental health care assessment, diagnosis, intervention,
  411  treatment, and recovery services to students with one or more
  412  mental health or co-occurring substance abuse diagnoses and to
  413  students at high risk of such diagnoses. The provision of these
  414  services must be coordinated with a student’s primary mental
  415  health care provider and with other mental health providers
  416  involved in the student’s care. At a minimum, the plans must
  417  include the following elements:
  418         1. Direct employment of school-based mental health services
  419  providers to expand and enhance school-based student services
  420  and to reduce the ratio of students to staff in order to better
  421  align with nationally recommended ratio models. These providers
  422  include, but are not limited to, certified school counselors,
  423  school psychologists, school social workers, and other licensed
  424  mental health professionals. The plan also must identify
  425  strategies to increase the amount of time that school-based
  426  student services personnel spend providing direct services to
  427  students, which may include the review and revision of district
  428  staffing resource allocations based on school or student mental
  429  health assistance needs.
  430         2.An interagency agreement or memorandum of understanding
  431  with the managing entity, as defined in s. 394.9082(2), that
  432  facilitates referrals of students to community-based services
  433  and coordinates care for students served by school-based and
  434  community-based providers. Such agreement or memorandum of
  435  understanding must address the sharing of records and
  436  information as authorized under s. 1006.07(7)(d) to coordinate
  437  care and increase access to appropriate services.
  438         3.2. Contracts or interagency agreements with one or more
  439  local community behavioral health providers or providers of
  440  Community Action Team services to provide a behavioral health
  441  staff presence and services at district schools. Services may
  442  include, but are not limited to, mental health screenings and
  443  assessments, individual counseling, family counseling, group
  444  counseling, psychiatric or psychological services, trauma
  445  informed care, mobile crisis services, and behavior
  446  modification. These behavioral health services may be provided
  447  on or off the school campus and may be supplemented by
  448  telehealth.
  449         4.3. Policies and procedures, including contracts with
  450  service providers, which will ensure that:
  451         a.Parents of students are provided information about
  452  behavioral health services available through the students’
  453  school or local community-based behavioral health services
  454  providers, including, but not limited to, the mobile response
  455  team as established in s. 394.495 serving their area. A school
  456  may meet this requirement by providing information about and
  457  Internet addresses for web-based directories or guides of local
  458  behavioral health services as long as such directories or guides
  459  are easily navigated and understood by individuals unfamiliar
  460  with behavioral health delivery systems or services and include
  461  specific contact information for local behavioral health
  462  providers.
  463         b.School districts use the services of the mobile response
  464  teams to the extent that such services are available. Each
  465  school district shall establish policies and procedures to carry
  466  out the model response protocol developed under s. 1004.44.
  467         c. Students who are referred to a school-based or
  468  community-based mental health service provider for mental health
  469  screening for the identification of mental health concerns and
  470  ensure that the assessment of students at risk for mental health
  471  disorders occurs within 15 days of referral. School-based mental
  472  health services must be initiated within 15 days after
  473  identification and assessment, and support by community-based
  474  mental health service providers for students who are referred
  475  for community-based mental health services must be initiated
  476  within 30 days after the school or district makes a referral.
  477         d.Referrals to behavioral health services available
  478  through other delivery systems or payors for which a student or
  479  individuals living in the household of a student receiving
  480  services under this subsection may qualify, if such services
  481  appear to be needed or enhancements in those individuals’
  482  behavioral health would contribute to the improved well-being of
  483  the student.
  484         5.4. Strategies or programs to reduce the likelihood of at
  485  risk students developing social, emotional, or behavioral health
  486  problems, depression, anxiety disorders, suicidal tendencies, or
  487  substance use disorders.
  488         6.5. Strategies to improve the early identification of
  489  social, emotional, or behavioral problems or substance use
  490  disorders, to improve the provision of early intervention
  491  services, and to assist students in dealing with trauma and
  492  violence.
  493         Section 12. The Department of Children and Families and the
  494  Agency for Health Care Administration shall assess the quality
  495  of care provided in crisis stabilization units to children and
  496  adolescents who are high utilizers of crisis stabilization
  497  services. The department and agency shall review current
  498  standards of care for such settings applicable to licensure
  499  under chapters 394 and 408, Florida Statutes, and designation
  500  under s. 394.461, Florida Statutes; compare the standards to
  501  other states’ standards and relevant national standards; and
  502  make recommendations for improvements to such standards. The
  503  assessment and recommendations shall address, at a minimum,
  504  efforts by each facility to gather and assess information
  505  regarding each child or adolescent, to coordinate with other
  506  providers treating the child or adolescent, and to create
  507  discharge plans that comprehensively and effectively address the
  508  needs of the child or adolescent to avoid or reduce his or her
  509  future use of crisis stabilization services. The department and
  510  agency shall jointly submit a report of their findings and
  511  recommendations to the Governor, the President of the Senate,
  512  and the Speaker of the House of Representatives by November 15,
  513  2020.
  514         Section 13. This act shall take effect July 1, 2020.