Florida Senate - 2020                                    SB 1554
       
       
        
       By Senator Baxley
       
       
       
       
       
       12-01043A-20                                          20201554__
    1                        A bill to be entitled                      
    2         An act relating to substance abuse and mental health;
    3         amending s. 394.455, F.S.; revising the definition of
    4         the term “mental illness” to exclude conditions
    5         manifested by dementia or traumatic brain injury;
    6         amending s. 394.674, F.S.; revising eligibility
    7         requirements for certain substance abuse and mental
    8         health services; providing priority for specified
    9         individuals; conforming provisions to changes made by
   10         the act; amending s. 394.908, F.S.; revising the
   11         definition of the term “individuals in need”; revising
   12         distribution of funding for substance abuse and mental
   13         health services; amending s. 394.9085, F.S.;
   14         conforming a cross-reference; amending s. 397.311,
   15         F.S.; revising definitions; amending s. 397.4012,
   16         F.S.; revising entities that are exempt from certain
   17         licensing requirements; amending s. 397.4073, F.S.;
   18         providing an exemption from background screening
   19         requirements for certain peer specialists; amending s.
   20         916.106, F.S.; revising the definition of the term
   21         “mental illness”; amending ss. 916.13 and 916.15,
   22         F.S.; requiring the Department of Children and
   23         Families to request certain medical information from
   24         jails; requiring county jails to provide such
   25         information within a specified timeframe; requiring
   26         the maintenance of psychotropic medications to
   27         specified defendants under certain circumstances;
   28         providing an exception; providing an effective date.
   29  
   30  Be It Enacted by the Legislature of the State of Florida:
   31  
   32         Section 1. Subsection (28) of section 394.455, Florida
   33  Statutes, is amended to read:
   34         394.455 Definitions.—As used in this part, the term:
   35         (28) “Mental illness” means an impairment of the mental or
   36  emotional processes that exercise conscious control of one’s
   37  actions or of the ability to perceive or understand reality,
   38  which impairment substantially interferes with the person’s
   39  ability to meet the ordinary demands of living. For the purposes
   40  of this part, the term does not include a developmental
   41  disability as defined in chapter 393, intoxication, or
   42  conditions manifested only by dementia, traumatic brain injury,
   43  antisocial behavior, or substance abuse.
   44         Section 2. Section 394.674, Florida Statutes, is amended to
   45  read:
   46         394.674 Eligibility for publicly funded substance abuse and
   47  mental health services; fee collection requirements.—
   48         (1) To be eligible to receive substance abuse and mental
   49  health services funded by the department, an individual must be
   50  indigent, uninsured, or underinsured and meet at least one of
   51  the following criteria a member of at least one of the
   52  department’s priority populations approved by the Legislature.
   53  The priority populations include:
   54         (a) For adult mental health services, an individual must
   55  be:
   56         1. An adult who has a serious mental illness, as defined by
   57  the department using criteria that, at a minimum, include
   58  diagnosis, prognosis, functional impairment, and receipt of
   59  disability income for a psychiatric condition.
   60         2.An adult at risk of serious mental illness who:
   61         a.(I)Has a primary diagnosis of a mental disorder as
   62  defined in the most recent edition of the Diagnostic and
   63  Statistical Manual of Mental Disorders published by the American
   64  Psychiatric Association that is not considered a serious mental
   65  illness; or
   66         (II)Has a condition with a Z-code diagnosis code in the
   67  most recent edition of the Diagnostic and Statistical Manual of
   68  Mental Disorders published by the American Psychiatric
   69  Association; and
   70         b.Experiences a severe stressful event and has problems
   71  coping or has symptoms that place the individual at risk of more
   72  restrictive interventions.
   73         3.A child or adolescent at risk of emotional disturbance,
   74  as defined in s. 394.492.
   75         4. A child or adolescent who has an emotional disturbance,
   76  as defined in s. 394.492.
   77         5.A child or adolescent who has a serious emotional
   78  disturbance or mental illness, as defined in s. 394.492.
   79         6.An individual who has a primary diagnosis of mental
   80  illness and a co-occurring substance use disorder.
   81         7.An individual experiencing an acute mental or emotional
   82  crisis, as defined in s. 394.67.
   83         Adults who have severe and persistent mental illness, as
   84  designated by the department using criteria that include
   85  severity of diagnosis, duration of the mental illness, ability
   86  to independently perform activities of daily living, and receipt
   87  of disability income for a psychiatric condition. Included
   88  within this group are:
   89         a.Older adults in crisis.
   90         b.Older adults who are at risk of being placed in a more
   91  restrictive environment because of their mental illness.
   92         c.Persons deemed incompetent to proceed or not guilty by
   93  reason of insanity under chapter 916.
   94         d.Other persons involved in the criminal justice system.
   95         e.Persons diagnosed as having co-occurring mental illness
   96  and substance abuse disorders.
   97         2.Persons who are experiencing an acute mental or
   98  emotional crisis as defined in s. 394.67(17).
   99         (b) For substance abuse services, an individual must
  100  children’s mental health services:
  101         1. Have a substance use disorder that meets one of the
  102  diagnostic categories specified in the most recent edition of
  103  the Diagnostic and Statistical Manual of Mental Disorders
  104  published by the American Psychiatric Association.
  105         2.Have a substance use disorder that meets one of the
  106  diagnostic categories specified in the most recent edition of
  107  the Diagnostic and Statistical Manual of Mental Disorders
  108  published by the American Psychiatric Association as the primary
  109  diagnosis and a co-occurring mental illness or serious emotional
  110  disturbance.
  111         3.Be at risk for initiating alcohol or drug use.
  112         Children who are at risk of emotional disturbance as
  113  defined in s. 394.492(4).
  114         2.Children who have an emotional disturbance as defined in
  115  s. 394.492(5).
  116         3.Children who have a serious emotional disturbance as
  117  defined in s. 394.492(6).
  118         4.Children diagnosed as having a co-occurring substance
  119  abuse and emotional disturbance or serious emotional
  120  disturbance.
  121         (c)For substance abuse treatment services:
  122         1.Adults who have substance abuse disorders and a history
  123  of intravenous drug use.
  124         2.Persons diagnosed as having co-occurring substance abuse
  125  and mental health disorders.
  126         3.Parents who put children at risk due to a substance
  127  abuse disorder.
  128         4.Persons who have a substance abuse disorder and have
  129  been ordered by the court to receive treatment.
  130         5.Children at risk for initiating drug use.
  131         6.Children under state supervision.
  132         7.Children who have a substance abuse disorder but who are
  133  not under the supervision of a court or in the custody of a
  134  state agency.
  135         8.Persons identified as being part of a priority
  136  population as a condition for receiving services funded through
  137  the Center for Mental Health Services and Substance Abuse
  138  Prevention and Treatment Block Grants.
  139         (2)Providers receiving funds from the department for
  140  behavioral health services must give priority to:
  141         (a)Pregnant women and women with dependent children.
  142         (b)Intravenous drug users.
  143         (c)Individuals who have a substance use disorder and have
  144  been ordered by the court to receive treatment.
  145         (d)Parents, legal guardians, or caregivers with child
  146  welfare involvement and parents, legal guardians, or caregivers
  147  who put children at risk due to substance abuse.
  148         (e)Children and adolescents under state supervision.
  149         (f)Individuals involved in the criminal justice system,
  150  including those deemed incompetent to proceed or not guilty by
  151  reason of insanity under chapter 916.
  152         (3)(2) Crisis services, as defined in s. 394.67, must,
  153  within the limitations of available state and local matching
  154  resources, be available to each individual person who is
  155  eligible for services under subsection (1), regardless of the
  156  individual’s person’s ability to pay for such services. An
  157  individual A person who is experiencing a mental health crisis
  158  and who does not meet the criteria for involuntary examination
  159  under s. 394.463(1), or an individual a person who is
  160  experiencing a substance abuse crisis and who does not meet the
  161  involuntary admission criteria in s. 397.675, must contribute to
  162  the cost of his or her care and treatment pursuant to the
  163  sliding fee scale developed under subsection (5) (4), unless
  164  charging a fee is contraindicated because of the crisis
  165  situation.
  166         (4)(3) Mental health services, substance abuse services,
  167  and crisis services, as defined in s. 394.67, must, within the
  168  limitations of available state and local matching resources, be
  169  available to each individual person who is eligible for services
  170  under subsection (1). Such individual person must contribute to
  171  the cost of his or her care and treatment pursuant to the
  172  sliding fee scale developed under subsection (5) (4).
  173         (5)(4) The department shall adopt rules to implement client
  174  eligibility, client enrollment, and fee collection requirements
  175  for publicly funded substance abuse and mental health services.
  176         (a) The rules must require each provider under contract
  177  with the department or a managing entity that which enrolls
  178  eligible individuals persons into treatment to develop a sliding
  179  fee scale for individuals persons who have a net family income
  180  at or above 150 percent of the Federal Poverty Income
  181  Guidelines, unless otherwise required by state or federal law.
  182  The sliding fee scale must use the uniform schedule of discounts
  183  by which a provider under contract with the department or a
  184  managing entity discounts its established client charges for
  185  services supported with state, federal, or local funds, using,
  186  at a minimum, factors such as family income, financial assets,
  187  and family size as declared by the individual person or the
  188  individual’s person’s guardian. The rules must include uniform
  189  criteria to be used by all service providers in developing the
  190  schedule of discounts for the sliding fee scale.
  191         (b) The rules must address the most expensive types of
  192  treatment, such as residential and inpatient treatment, in order
  193  to make it possible for an individual a client to responsibly
  194  contribute to his or her mental health or substance abuse care
  195  without jeopardizing the family’s financial stability. An
  196  individual A person who is not eligible for Medicaid and whose
  197  net family income is less than 150 percent of the Federal
  198  Poverty Income Guidelines must pay a portion of his or her
  199  treatment costs which is comparable to the copayment amount
  200  required by the Medicaid program for Medicaid clients under
  201  pursuant to s. 409.9081.
  202         (c) The rules must require that individuals persons who
  203  receive financial assistance from the Federal Government because
  204  of a disability and are in long-term residential treatment
  205  settings contribute to their board and care costs and treatment
  206  costs and must be consistent with the provisions in s. 409.212.
  207         (6)(5)An individual A person who meets the eligibility
  208  criteria in subsection (1) shall be served in accordance with
  209  the appropriate district substance abuse and mental health
  210  services plan specified in s. 394.75 and within available
  211  resources.
  212         Section 3. Section 394.908, Florida Statutes, is amended to
  213  read:
  214         394.908 Substance abuse and mental health funding equity;
  215  distribution of appropriations.—In recognition of the historical
  216  inequity in the funding of substance abuse and mental health
  217  services for the department’s districts and regions and to
  218  rectify this inequity and provide for equitable funding in the
  219  future throughout the state, the following funding process shall
  220  be used:
  221         (1) Funding thresholds for substance abuse and mental
  222  health services in each of the current districts, statewide,
  223  shall be established based on the current number of individuals
  224  in need per district of substance abuse and mental health
  225  services, respectively.
  226         (2) “Individuals in need” means those persons who meet
  227  eligibility criteria under s. 394.674 fit the profile of the
  228  respective priority populations and require mental health or
  229  substance abuse services.
  230         (3) Any additional funding beyond the 2005-2006 fiscal year
  231  base appropriation for substance abuse alcohol, drug abuse, and
  232  mental health services shall be allocated to districts for
  233  substance abuse and mental health services based on:
  234         (a) Epidemiological estimates of disabilities that apply to
  235  individuals in need the respective priority populations.
  236         (b) A pro rata share distribution that ensures districts
  237  below the statewide average funding level per individual in each
  238  priority population of “individuals in need” receive funding
  239  necessary to achieve equity.
  240         (4) Priority populations for Individuals in need shall be
  241  displayed for each district and distributed concurrently with
  242  the approved operating budget. The display by priority
  243  population shall show: The annual number of individuals served
  244  based on prior year actual numbers, the annual cost per
  245  individual served, and the estimated number of the total
  246  priority population for individuals in need.
  247         (5) The annual cost per individual served shall be defined
  248  as the total actual funding for mental health or substance abuse
  249  services each priority population divided by the number of
  250  individuals receiving mental health or substance abuse services
  251  served in the priority population for that year.
  252         Section 4. Subsection (6) of section 394.9085, Florida
  253  Statutes, is amended to read:
  254         394.9085 Behavioral provider liability.—
  255         (6) For purposes of this section, the terms “detoxification
  256  services,” “addictions receiving facility,” and “receiving
  257  facility” have the same meanings as those provided in ss.
  258  397.311(26)(a)3. ss. 397.311(26)(a)4., 397.311(26)(a)1., and
  259  394.455(39), respectively.
  260         Section 5. Paragraph (a) of subsection (26) of section
  261  397.311, Florida Statutes, is amended to read:
  262         397.311 Definitions.—As used in this chapter, except part
  263  VIII, the term:
  264         (26) Licensed service components include a comprehensive
  265  continuum of accessible and quality substance abuse prevention,
  266  intervention, and clinical treatment services, including the
  267  following services:
  268         (a) “Clinical treatment” means a professionally directed,
  269  deliberate, and planned regimen of services and interventions
  270  that are designed to reduce or eliminate the misuse of drugs and
  271  alcohol and promote a healthy, drug-free lifestyle. As defined
  272  by rule, “clinical treatment services” include, but are not
  273  limited to, the following licensable service components:
  274         1. “Addictions receiving facility” is a secure, acute care
  275  facility that provides, at a minimum, detoxification and
  276  stabilization services; is operated 24 hours per day, 7 days per
  277  week; and is designated by the department to serve individuals
  278  found to be substance use impaired as described in s. 397.675
  279  who meet the placement criteria for this component.
  280         2. “Day or night treatment” is a service provided in a
  281  nonresidential environment, with a structured schedule of
  282  treatment and rehabilitative services.
  283         3.“Day or night treatment with community housing” means a
  284  program intended for individuals who can benefit from living
  285  independently in peer community housing while participating in
  286  treatment services for a minimum of 5 hours a day for a minimum
  287  of 25 hours per week.
  288         3.4. “Detoxification” is a service involving subacute care
  289  that is provided on an inpatient or an outpatient basis to
  290  assist individuals to withdraw from the physiological and
  291  psychological effects of substance abuse and who meet the
  292  placement criteria for this component.
  293         4.5. “Intensive inpatient treatment” includes a planned
  294  regimen of evaluation, observation, medical monitoring, and
  295  clinical protocols delivered through an interdisciplinary team
  296  approach provided 24 hours per day, 7 days per week, in a highly
  297  structured, live-in environment.
  298         5.6. “Intensive outpatient treatment” is a service that
  299  provides individual or group counseling in a more structured
  300  environment, is of higher intensity and duration than outpatient
  301  treatment, and is provided to individuals who meet the placement
  302  criteria for this component.
  303         6.7. “Medication-assisted treatment for opioid use
  304  disorders opiate addiction” is a service that uses methadone or
  305  other medication as authorized by state and federal law, in
  306  combination with medical, rehabilitative, supportive, and
  307  counseling services in the treatment of individuals who are
  308  dependent on opioid drugs.
  309         7.8. “Outpatient treatment” is a service that provides
  310  individual, group, or family counseling by appointment during
  311  scheduled operating hours for individuals who meet the placement
  312  criteria for this component.
  313         8.9. “Residential treatment” is a service provided in a
  314  structured live-in environment within a nonhospital setting on a
  315  24-hours-per-day, 7-days-per-week basis, and is intended for
  316  individuals who meet the placement criteria for this component.
  317         Section 6. Section 397.4012, Florida Statutes, is amended
  318  to read:
  319         397.4012 Exemptions from licensure.—The following are
  320  exempt from the licensing provisions of this chapter:
  321         (1) A hospital or hospital-based component licensed under
  322  chapter 395.
  323         (2) A nursing home facility as defined in s. 400.021.
  324         (3) A substance abuse education program established
  325  pursuant to s. 1003.42.
  326         (4) A facility or institution operated by the Federal
  327  Government.
  328         (5) A physician or physician assistant licensed under
  329  chapter 458 or chapter 459.
  330         (6) A psychologist licensed under chapter 490.
  331         (7) A social worker, marriage and family therapist, or
  332  mental health counselor licensed under chapter 491.
  333         (8) A legally cognizable church or nonprofit religious
  334  organization or denomination providing substance abuse services,
  335  including prevention services, which are solely religious,
  336  spiritual, or ecclesiastical in nature. A church or nonprofit
  337  religious organization or denomination providing any of the
  338  licensed service components itemized under s. 397.311(26) is not
  339  exempt from substance abuse licensure but retains its exemption
  340  with respect to all services which are solely religious,
  341  spiritual, or ecclesiastical in nature.
  342         (9) Facilities licensed under chapter 393 which, in
  343  addition to providing services to persons with developmental
  344  disabilities, also provide services to persons developmentally
  345  at risk as a consequence of exposure to alcohol or other legal
  346  or illegal drugs while in utero.
  347         (10) DUI education and screening services provided pursuant
  348  to ss. 316.192, 316.193, 322.095, 322.271, and 322.291. Persons
  349  or entities providing treatment services must be licensed under
  350  this chapter unless exempted from licensing as provided in this
  351  section.
  352         (11) A facility licensed under s. 394.875 as a crisis
  353  stabilization unit.
  354  
  355  The exemptions from licensure in subsections (3), (4), (8), (9),
  356  and (10) this section do not apply to any service provider that
  357  receives an appropriation, grant, or contract from the state to
  358  operate as a service provider as defined in this chapter or to
  359  any substance abuse program regulated under pursuant to s.
  360  397.4014. Furthermore, this chapter may not be construed to
  361  limit the practice of a physician or physician assistant
  362  licensed under chapter 458 or chapter 459, a psychologist
  363  licensed under chapter 490, a psychotherapist licensed under
  364  chapter 491, or an advanced practice registered nurse licensed
  365  under part I of chapter 464, who provides substance abuse
  366  treatment, so long as the physician, physician assistant,
  367  psychologist, psychotherapist, or advanced practice registered
  368  nurse does not represent to the public that he or she is a
  369  licensed service provider and does not provide services to
  370  individuals under pursuant to part V of this chapter. Failure to
  371  comply with any requirement necessary to maintain an exempt
  372  status under this section is a misdemeanor of the first degree,
  373  punishable as provided in s. 775.082 or s. 775.083.
  374         Section 7. Paragraph (a) of subsection (1) of section
  375  397.4073, Florida Statutes, is amended to read:
  376         397.4073 Background checks of service provider personnel.—
  377         (1) PERSONNEL BACKGROUND CHECKS; REQUIREMENTS AND
  378  EXCEPTIONS.—
  379         (a) For all individuals screened on or after July 1, 2019,
  380  background checks shall apply as follows:
  381         1. All owners, directors, chief financial officers, and
  382  clinical supervisors of service providers are subject to level 2
  383  background screening as provided under s. 408.809 and chapter
  384  435. Inmate substance abuse programs operated directly or under
  385  contract with the Department of Corrections are exempt from this
  386  requirement.
  387         2. All service provider personnel who have direct contact
  388  with children receiving services or with adults who are
  389  developmentally disabled receiving services are subject to level
  390  2 background screening as provided under s. 408.809 and chapter
  391  435.
  392         3. All peer specialists who have direct contact with
  393  individuals receiving services are subject to level 2 background
  394  screening as provided under s. 408.809 and chapter 435. Peer
  395  specialists employed or certified before July 1, 2019, are
  396  exempt from this requirement if, at the time of their employment
  397  or certification, the department knew about any disqualifying
  398  offenses of the peer specialist.
  399         Section 8. Subsection (14) of section 916.106, Florida
  400  Statutes, is amended to read:
  401         916.106 Definitions.—For the purposes of this chapter, the
  402  term:
  403         (14) “Mental illness” means an impairment of the emotional
  404  processes that exercise conscious control of one’s actions, or
  405  of the ability to perceive or understand reality, which
  406  impairment substantially interferes with the defendant’s ability
  407  to meet the ordinary demands of living. For the purposes of this
  408  chapter, the term does not apply to defendants who have only an
  409  intellectual disability or autism or a defendant with traumatic
  410  brain injury or dementia who lacks a co-occurring mental
  411  illness, and does not include intoxication or conditions
  412  manifested only by antisocial behavior or substance abuse
  413  impairment.
  414         Section 9. Paragraph (b) of subsection (2) of section
  415  916.13, Florida Statutes, is amended to read:
  416         916.13 Involuntary commitment of defendant adjudicated
  417  incompetent.—
  418         (2) A defendant who has been charged with a felony and who
  419  has been adjudicated incompetent to proceed due to mental
  420  illness, and who meets the criteria for involuntary commitment
  421  under this chapter, may be committed to the department, and the
  422  department shall retain and treat the defendant. Within 2
  423  business days after receipt of a completed copy of the court
  424  commitment order containing all documentation required by the
  425  applicable Florida Rules of Criminal Procedure, the department
  426  shall request all medical information relating to the defendant
  427  from the jail. The jail shall provide the department with all
  428  medical information relating to the defendant within 3 business
  429  days after receipt of the department’s request.
  430         (b) A competency hearing shall be held within 30 days after
  431  the court receives notification that the defendant is competent
  432  to proceed or no longer meets the criteria for continued
  433  commitment. The defendant must be transported to the committing
  434  court’s jurisdiction for the hearing. Each defendant returning
  435  to a jail shall continue to receive the same psychotropic
  436  medications as prescribed by the facility physician at the time
  437  of discharge from a forensic or civil facility, unless the jail
  438  physician determines there is a compelling medical reason to
  439  change or discontinue the medication for the health and safety
  440  of the defendant. If the jail physician changes or discontinues
  441  the medication and the defendant is later determined at the
  442  competency hearing to be incompetent to stand trial and is
  443  recommitted to the department, the jail physician may not change
  444  or discontinue the defendant’s prescribed psychotropic
  445  medication upon the defendant’s next discharge from the forensic
  446  or civil facility.
  447         Section 10. Subsections (3) and (5) of section 916.15,
  448  Florida Statutes, are amended to read:
  449         916.15 Involuntary commitment of defendant adjudicated not
  450  guilty by reason of insanity.—
  451         (3) Every defendant acquitted of criminal charges by reason
  452  of insanity and found to meet the criteria for involuntary
  453  commitment may be committed and treated in accordance with the
  454  provisions of this section and the applicable Florida Rules of
  455  Criminal Procedure. Within 2 business days after receipt of a
  456  completed copy of the court commitment order containing all
  457  documentation required by the applicable Florida Rules of
  458  Criminal Procedure, the department shall request all medical
  459  information relating to the defendant from the jail. The jail
  460  shall provide the department with all medical information
  461  relating to the defendant within 3 business days after receipt
  462  of the department’s request. The department shall admit a
  463  defendant so adjudicated to an appropriate facility or program
  464  for treatment and shall retain and treat such defendant. No
  465  later than 6 months after the date of admission, before prior to
  466  the end of any period of extended commitment, or at any time the
  467  administrator or designee determines shall have determined that
  468  the defendant no longer meets the criteria for continued
  469  commitment placement, the administrator or designee shall file a
  470  report with the court pursuant to the applicable Florida Rules
  471  of Criminal Procedure.
  472         (5) The commitment hearing shall be held within 30 days
  473  after the court receives notification that the defendant no
  474  longer meets the criteria for continued commitment. The
  475  defendant must be transported to the committing court’s
  476  jurisdiction for the hearing. Each defendant returning to a jail
  477  shall continue to receive the same psychotropic medications as
  478  prescribed by the facility physician at the time of discharge
  479  from a forensic or civil facility, unless the jail physician
  480  determines there is a compelling medical reason to change or
  481  discontinue the medication for the health and safety of the
  482  defendant. If the jail physician changes or discontinues the
  483  medication and the defendant is later determined at the
  484  competency hearing to be incompetent to stand trial and is
  485  recommitted to the department, the jail physician may not change
  486  or discontinue the defendant’s prescribed psychotropic
  487  medication upon the defendant’s next discharge from the forensic
  488  or civil facility.
  489         Section 11. This act shall take effect July 1, 2020.