Florida Senate - 2020                      CS for CS for SB 1440
       By the Committees on Appropriations; and Children, Families, and
       Elder Affairs; and Senators Powell and Rouson
       576-04571-20                                          20201440c2
    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 a plan promoting the development
   22         of a coordinated system of care for certain services;
   23         providing requirements for the planning process;
   24         requiring each managing entity to submit such plan to
   25         the department by a specified date; requiring the
   26         entities involved in the planning process to implement
   27         such plan by a specified date; requiring that such
   28         plan be reviewed and updated periodically; amending s.
   29         394.9082, F.S.; revising the duties of the department
   30         relating to priority populations that will benefit
   31         from care coordination; requiring that a managing
   32         entity’s behavioral health care needs assessment
   33         include certain information regarding gaps in certain
   34         services; requiring a managing entity to promote the
   35         use of available crisis intervention services;
   36         amending s. 409.175, F.S.; revising requirements
   37         relating to preservice training for foster parents;
   38         amending s. 409.967, F.S.; requiring the agency to
   39         conduct, or contract for, the testing of provider
   40         network databases maintained by Medicaid managed care
   41         plans for specified purposes; amending s. 409.988,
   42         F.S.; revising the duties of a lead agency relating to
   43         individuals providing care for dependent children;
   44         amending s. 985.601, F.S.; requiring the Department of
   45         Juvenile Justice to participate in the planning
   46         process for promoting a coordinated system of care for
   47         children and adolescents; amending s. 1003.02, F.S.;
   48         requiring each district school board to participate in
   49         the planning process for promoting a coordinated
   50         system of care; amending s. 1004.44, F.S.; requiring
   51         the Louis de la Parte Florida Mental Health Institute
   52         to develop, in consultation with other entities, a
   53         model response protocol for schools by a specified
   54         date; amending s. 1006.04, F.S.; requiring the
   55         educational multiagency network to participate in the
   56         planning process for promoting a coordinated system of
   57         care; requiring the Department of Children and
   58         Families and the Agency for Health Care Administration
   59         to assess the quality of care provided in crisis
   60         stabilization units to certain children and
   61         adolescents; requiring the department and agency to
   62         review current standards of care for certain settings
   63         and make recommendations; requiring the department and
   64         agency to jointly submit a report to the Governor and
   65         the Legislature by a specified date; providing an
   66         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) is added to subsection (4) of
   85  section 394.495, Florida Statutes, and subsection (7) is added
   86  to that section, to read:
   87         394.495 Child and adolescent mental health system of care;
   88  programs and services.—
   89         (4) The array of services may include, but is not limited
   90  to:
   91         (q)Crisis response services provided through mobile
   92  response teams.
   93         (7)(a)The department shall contract with managing entities
   94  for mobile response teams throughout the state to provide
   95  immediate, onsite behavioral health crisis services to children,
   96  adolescents, and young adults ages 18 to 25, inclusive, who:
   97         1.Have an emotional disturbance;
   98         2.Are experiencing an acute mental or emotional crisis;
   99         3.Are experiencing escalating emotional or behavioral
  100  reactions and symptoms that impact their ability to function
  101  typically within the family, living situation, or community
  102  environment; or
  103         4.Are served by the child welfare system and are
  104  experiencing or are at high risk of placement instability.
  105         (b)A mobile response team shall, at a minimum:
  106         1.Respond to new requests for services within 60 minutes
  107  after such requests are made.
  108         2.Respond to a crisis in the location where the crisis is
  109  occurring.
  110         3.Provide behavioral health crisis-oriented services that
  111  are responsive to the needs of the child, adolescent, or young
  112  adult and his or her family.
  113         4.Provide evidence-based practices to children,
  114  adolescents, young adults, and families to enable them to
  115  independently and effectively deescalate and respond to
  116  behavioral challenges that they are facing and to reduce the
  117  potential for future crises.
  118         5.Provide screening, standardized assessments, early
  119  identification, and referrals to community services.
  120         6.Engage the child, adolescent, or young adult and his or
  121  her family as active participants in every phase of the
  122  treatment process whenever possible.
  123         7.Develop a care plan for the child, adolescent, or young
  124  adult.
  125         8.Provide care coordination by facilitating the transition
  126  to ongoing services.
  127         9.Ensure there is a process in place for informed consent
  128  and confidentiality compliance measures.
  129         10.Promote information sharing and the use of innovative
  130  technology.
  131         11.Coordinate with the managing entity within the service
  132  location and other key entities providing services and supports
  133  to the child, adolescent, or young adult and his or her family,
  134  including, but not limited to, the child, adolescent, or young
  135  adult’s school, the local educational multiagency network for
  136  severely emotionally disturbed students under s. 1006.04, the
  137  child welfare system, and the juvenile justice system.
  138         (c)When procuring mobile response teams, the managing
  139  entity must, at a minimum:
  140         1.Collaborate with local sheriff’s offices and public
  141  schools in the planning, development, evaluation, and selection
  142  processes.
  143         2.Require that services be made available 24 hours per
  144  day, 7 days per week, with onsite response time to the location
  145  of the referred crisis within 60 minutes after the request for
  146  services is made.
  147         3.Require the provider to establish response protocols
  148  with local law enforcement agencies, local community-based care
  149  lead agencies as defined in s. 409.986(3), the child welfare
  150  system, and the Department of Juvenile Justice.
  151         4.Require access to a board-certified or board-eligible
  152  psychiatrist or psychiatric nurse practitioner.
  153         5.Require mobile response teams to refer children,
  154  adolescents, or young adults and their families to an array of
  155  crisis response services that address individual and family
  156  needs, including screening, standardized assessments, early
  157  identification, and community services as necessary to address
  158  the immediate crisis event.
  159         Section 3. Section 394.4955, Florida Statutes, is created
  160  to read:
  161         394.4955Coordinated system of care; child and adolescent
  162  mental health treatment and support.—
  163         (1)Pursuant to s. 394.9082(5)(d), each managing entity
  164  shall develop a plan that promotes the development and effective
  165  implementation of a coordinated system of care which integrates
  166  services provided through providers funded by the state’s child
  167  serving systems and facilitates access by children and
  168  adolescents, as resources permit, to needed mental health
  169  treatment and services at any point of entry regardless of the
  170  time of year, intensity, or complexity of the need, and other
  171  systems with which such children and adolescents are involved,
  172  as well as treatment and services available through other
  173  systems for which they would qualify.
  174         (2)(a)The managing entity shall lead a planning process
  175  that includes, but is not limited to, children and adolescents
  176  with behavioral health needs and their families; behavioral
  177  health service providers; law enforcement agencies; school
  178  districts or superintendents; the multiagency network for
  179  students with emotional or behavioral disabilities; the
  180  department; and representatives of the child welfare and
  181  juvenile justice systems, early learning coalitions, the Agency
  182  for Health Care Administration, Medicaid managed medical
  183  assistance plans, the Agency for Persons with Disabilities, the
  184  Department of Juvenile Justice, and other community partners. An
  185  organization receiving state funding must participate in the
  186  planning process if requested by the managing entity.
  187         (b)The managing entity and collaborating organizations
  188  shall take into consideration the geographical distribution of
  189  the population, needs, and resources, and create separate plans
  190  on an individual county or multi-county basis, as needed, to
  191  maximize collaboration and communication at the local level.
  192         (c)To the extent permitted by available resources, the
  193  coordinated system of care shall include the array of services
  194  listed in s. 394.495.
  195         (d)Each plan shall integrate with the local plan developed
  196  under s. 394.4573.
  197         (3)By July 1, 2021, the managing entity shall complete the
  198  plans developed under this section and submit them to the
  199  department. By July 1, 2022, the entities involved in the
  200  planning process shall implement the coordinated system of care
  201  specified in each plan. The managing entity and collaborating
  202  organizations shall review and update the plans, as necessary,
  203  at least every 3 years thereafter.
  204         (4)The managing entity and collaborating organizations
  205  shall create integrated service delivery approaches within
  206  current resources that facilitate parents and caregivers
  207  obtaining services and support by making referrals to
  208  specialized treatment providers, if necessary, with follow up to
  209  ensure services are received.
  210         (5)The managing entity and collaborating organizations
  211  shall document each coordinated system of care for children and
  212  adolescents through written memoranda of understanding or other
  213  binding arrangements.
  214         (6)The managing entity shall identify gaps in the arrays
  215  of services for children and adolescents listed in s. 394.495
  216  available under each plan and include relevant information in
  217  its annual needs assessment required by s. 394.9082.
  218         Section 4. Paragraph (c) of subsection (3) and paragraphs
  219  (b) and (d) of subsection (5) of section 394.9082, Florida
  220  Statutes, are amended, and paragraph (t) is added to subsection
  221  (5) of that section, to read:
  222         394.9082 Behavioral health managing entities.—
  223         (3) DEPARTMENT DUTIES.—The department shall:
  224         (c) Define the priority populations that will benefit from
  225  receiving care coordination. In defining such populations, the
  226  department shall take into account the availability of resources
  227  and consider:
  228         1. The number and duration of involuntary admissions within
  229  a specified time.
  230         2. The degree of involvement with the criminal justice
  231  system and the risk to public safety posed by the individual.
  232         3. Whether the individual has recently resided in or is
  233  currently awaiting admission to or discharge from a treatment
  234  facility as defined in s. 394.455.
  235         4. The degree of utilization of behavioral health services.
  236         5. Whether the individual is a parent or caregiver who is
  237  involved with the child welfare system.
  238         6.Whether the individual is an adolescent, as defined in
  239  s. 394.492, who requires assistance in transitioning to services
  240  provided in the adult system of care.
  241         (5) MANAGING ENTITY DUTIES.—A managing entity shall:
  242         (b) Conduct a community behavioral health care needs
  243  assessment every 3 years in the geographic area served by the
  244  managing entity which identifies needs by subregion. The process
  245  for conducting the needs assessment shall include an opportunity
  246  for public participation. The assessment shall include, at a
  247  minimum, the information the department needs for its annual
  248  report to the Governor and Legislature pursuant to s. 394.4573.
  249  The assessment shall also include a list and descriptions of any
  250  gaps in the arrays of services for children or adolescents
  251  identified pursuant to s. 394.4955 and recommendations for
  252  addressing such gaps. The managing entity shall provide the
  253  needs assessment to the department.
  254         (d) Promote the development and effective implementation of
  255  a coordinated system of care pursuant to ss. 394.4573 and
  256  394.495 s. 394.4573.
  257         (t)Promote the use of available crisis intervention
  258  services by requiring contracted providers to provide contact
  259  information for mobile response teams established under s.
  260  394.495 to parents and caregivers of children, adolescents, and
  261  young adults between ages 18 and 25, inclusive, who receive
  262  safety-net behavioral health services.
  263         Section 5. Paragraph (b) of subsection (14) of section
  264  409.175, Florida Statutes, is amended to read:
  265         409.175 Licensure of family foster homes, residential
  266  child-caring agencies, and child-placing agencies; public
  267  records exemption.—
  268         (14)
  269         (b) As a condition of licensure, foster parents shall
  270  successfully complete preservice training. The preservice
  271  training shall be uniform statewide and shall include, but not
  272  be limited to, such areas as:
  273         1. Orientation regarding agency purpose, objectives,
  274  resources, policies, and services;
  275         2. Role of the foster parent as a treatment team member;
  276         3. Transition of a child into and out of foster care,
  277  including issues of separation, loss, and attachment;
  278         4. Management of difficult child behavior that can be
  279  intensified by placement, by prior abuse or neglect, and by
  280  prior placement disruptions;
  281         5. Prevention of placement disruptions;
  282         6. Care of children at various developmental levels,
  283  including appropriate discipline; and
  284         7. Effects of foster parenting on the family of the foster
  285  parent; and
  286         8.Information about and contact information for the local
  287  mobile response team as a means for addressing a behavioral
  288  health crisis or preventing placement disruption.
  289         Section 6. Paragraph (c) of subsection (2) of section
  290  409.967, Florida Statutes, is amended to read:
  291         409.967 Managed care plan accountability.—
  292         (2) The agency shall establish such contract requirements
  293  as are necessary for the operation of the statewide managed care
  294  program. In addition to any other provisions the agency may deem
  295  necessary, the contract must require:
  296         (c) Access.—
  297         1. The agency shall establish specific standards for the
  298  number, type, and regional distribution of providers in managed
  299  care plan networks to ensure access to care for both adults and
  300  children. Each plan must maintain a regionwide network of
  301  providers in sufficient numbers to meet the access standards for
  302  specific medical services for all recipients enrolled in the
  303  plan. The exclusive use of mail-order pharmacies may not be
  304  sufficient to meet network access standards. Consistent with the
  305  standards established by the agency, provider networks may
  306  include providers located outside the region. A plan may
  307  contract with a new hospital facility before the date the
  308  hospital becomes operational if the hospital has commenced
  309  construction, will be licensed and operational by January 1,
  310  2013, and a final order has issued in any civil or
  311  administrative challenge. Each plan shall establish and maintain
  312  an accurate and complete electronic database of contracted
  313  providers, including information about licensure or
  314  registration, locations and hours of operation, specialty
  315  credentials and other certifications, specific performance
  316  indicators, and such other information as the agency deems
  317  necessary. The database must be available online to both the
  318  agency and the public and have the capability to compare the
  319  availability of providers to network adequacy standards and to
  320  accept and display feedback from each provider’s patients. Each
  321  plan shall submit quarterly reports to the agency identifying
  322  the number of enrollees assigned to each primary care provider.
  323  The agency shall conduct, or contract for, systematic and
  324  continuous testing of the provider network databases maintained
  325  by each plan to confirm accuracy, confirm that behavioral health
  326  providers are accepting enrollees, and confirm that enrollees
  327  have access to behavioral health services.
  328         2. Each managed care plan must publish any prescribed drug
  329  formulary or preferred drug list on the plan’s website in a
  330  manner that is accessible to and searchable by enrollees and
  331  providers. The plan must update the list within 24 hours after
  332  making a change. Each plan must ensure that the prior
  333  authorization process for prescribed drugs is readily accessible
  334  to health care providers, including posting appropriate contact
  335  information on its website and providing timely responses to
  336  providers. For Medicaid recipients diagnosed with hemophilia who
  337  have been prescribed anti-hemophilic-factor replacement
  338  products, the agency shall provide for those products and
  339  hemophilia overlay services through the agency’s hemophilia
  340  disease management program.
  341         3. Managed care plans, and their fiscal agents or
  342  intermediaries, must accept prior authorization requests for any
  343  service electronically.
  344         4. Managed care plans serving children in the care and
  345  custody of the Department of Children and Families must maintain
  346  complete medical, dental, and behavioral health encounter
  347  information and participate in making such information available
  348  to the department or the applicable contracted community-based
  349  care lead agency for use in providing comprehensive and
  350  coordinated case management. The agency and the department shall
  351  establish an interagency agreement to provide guidance for the
  352  format, confidentiality, recipient, scope, and method of
  353  information to be made available and the deadlines for
  354  submission of the data. The scope of information available to
  355  the department shall be the data that managed care plans are
  356  required to submit to the agency. The agency shall determine the
  357  plan’s compliance with standards for access to medical, dental,
  358  and behavioral health services; the use of medications; and
  359  followup on all medically necessary services recommended as a
  360  result of early and periodic screening, diagnosis, and
  361  treatment.
  362         Section 7. Paragraph (f) of subsection (1) of section
  363  409.988, Florida Statutes, is amended to read:
  364         409.988 Lead agency duties; general provisions.—
  365         (1) DUTIES.—A lead agency:
  366         (f) Shall ensure that all individuals providing care for
  367  dependent children receive:
  368         1. Appropriate training and meet the minimum employment
  369  standards established by the department.
  370         2.Contact information for the local mobile response team
  371  established under s. 394.495.
  372         Section 8. Subsection (4) of section 985.601, Florida
  373  Statutes, is amended to read:
  374         985.601 Administering the juvenile justice continuum.—
  375         (4) The department shall maintain continuing cooperation
  376  with the Department of Education, the Department of Children and
  377  Families, the Department of Economic Opportunity, and the
  378  Department of Corrections for the purpose of participating in
  379  agreements with respect to dropout prevention and the reduction
  380  of suspensions, expulsions, and truancy; increased access to and
  381  participation in high school equivalency diploma, vocational,
  382  and alternative education programs; and employment training and
  383  placement assistance. The cooperative agreements between the
  384  departments shall include an interdepartmental plan to cooperate
  385  in accomplishing the reduction of inappropriate transfers of
  386  children into the adult criminal justice and correctional
  387  systems. As part of its continuing cooperation, the department
  388  shall participate in the planning process for promoting a
  389  coordinated system of care for children and adolescents pursuant
  390  to s. 394.4955.
  391         Section 9. Subsection (5) is added to section 1003.02,
  392  Florida Statutes, to read:
  393         1003.02 District school board operation and control of
  394  public K-12 education within the school district.—As provided in
  395  part II of chapter 1001, district school boards are
  396  constitutionally and statutorily charged with the operation and
  397  control of public K-12 education within their school district.
  398  The district school boards must establish, organize, and operate
  399  their public K-12 schools and educational programs, employees,
  400  and facilities. Their responsibilities include staff
  401  development, public K-12 school student education including
  402  education for exceptional students and students in juvenile
  403  justice programs, special programs, adult education programs,
  404  and career education programs. Additionally, district school
  405  boards must:
  406         (5)Participate in the planning process for promoting a
  407  coordinated system of care for children and adolescents pursuant
  408  to s. 394.4955.
  409         Section 10. Present subsection (4) of section 1004.44,
  410  Florida Statutes, is redesignated as subsection (5), and a new
  411  subsection (4) is added to that section, to read:
  412         1004.44 Louis de la Parte Florida Mental Health Institute.
  413  There is established the Louis de la Parte Florida Mental Health
  414  Institute within the University of South Florida.
  415         (4)By August 1, 2020, the institute shall develop a model
  416  response protocol for schools to use mobile response teams
  417  established under s. 394.495. In developing the protocol, the
  418  institute shall, at a minimum, consult with school districts
  419  that effectively use such teams, school districts that use such
  420  teams less often, local law enforcement agencies, the Department
  421  of Children and Families, managing entities as defined in s.
  422  394.9082(2), and mobile response team providers.
  423         Section 11. Paragraph (c) of subsection (1) of section
  424  1006.04, Florida Statutes, is amended to read:
  425         1006.04 Educational multiagency services for students with
  426  severe emotional disturbance.—
  427         (1)
  428         (c) The multiagency network shall:
  429         1. Support and represent the needs of students in each
  430  school district in joint planning with fiscal agents of
  431  children’s mental health funds, including the expansion of
  432  school-based mental health services, transition services, and
  433  integrated education and treatment programs.
  434         2. Improve coordination of services for children with or at
  435  risk of emotional or behavioral disabilities and their families
  436  by assisting multi-agency collaborative initiatives to identify
  437  critical issues and barriers of mutual concern and develop local
  438  response systems that increase home and school connections and
  439  family engagement.
  440         3. Increase parent and youth involvement and development
  441  with local systems of care.
  442         4. Facilitate student and family access to effective
  443  services and programs for students with and at risk of emotional
  444  or behavioral disabilities that include necessary educational,
  445  residential, and mental health treatment services, enabling
  446  these students to learn appropriate behaviors, reduce
  447  dependency, and fully participate in all aspects of school and
  448  community living.
  449         5.Participate in the planning process for promoting a
  450  coordinated system of care for children and adolescents pursuant
  451  to s. 394.4955.
  452         Section 12. The Department of Children and Families and the
  453  Agency for Health Care Administration shall assess the quality
  454  of care provided in crisis stabilization units to children and
  455  adolescents who are high utilizers of crisis stabilization
  456  services. The department and agency shall review current
  457  standards of care for such settings applicable to licensure
  458  under chapters 394 and 408, Florida Statutes, and designation
  459  under s. 394.461, Florida Statutes; compare the standards to
  460  other states’ standards and relevant national standards; and
  461  make recommendations for improvements to such standards. The
  462  assessment and recommendations shall address, at a minimum,
  463  efforts by each facility to gather and assess information
  464  regarding each child or adolescent, to coordinate with other
  465  providers treating the child or adolescent, and to create
  466  discharge plans that comprehensively and effectively address the
  467  needs of the child or adolescent to avoid or reduce his or her
  468  future use of crisis stabilization services. The department and
  469  agency shall jointly submit a report of their findings and
  470  recommendations to the Governor, the President of the Senate,
  471  and the Speaker of the House of Representatives by November 15,
  472  2020.
  473         Section 13. This act shall take effect July 1, 2020.