F.S. 394.65 Short title.
This part may be cited as “The Community Substance Abuse and Mental Health Services Act.”
MENTAL HEALTH
F.S. Ch. 394
in effectF.S. 394.66 Legislative intent with respect to substance abuse and mental health services.
It is the intent of the Legislature to:
(1)
Ensure that a recovery and resiliency-based substance abuse and mental health system is implemented by the department and its state-funded mental health providers.
(2)
Recognize that mental illness and substance abuse impairment are diseases that are responsive to medical and psychological interventions and management that integrate treatment, rehabilitative, and support services to achieve recovery.
(3)
Promote and improve the mental health of the citizens of the state by making substance abuse and mental health treatment and support services available to those persons who are most in need and least able to pay, through a community-based system of care.
(4)
Involve local citizens in the planning of substance abuse and mental health services in their communities.
(5)
Ensure that the department and the Agency for Health Care Administration work cooperatively in planning and designing comprehensive community-based substance abuse and mental health programs that focus on the individual needs of persons served.
(6)
Ensure that all activities of the Department of Children and Families and the Agency for Health Care Administration, and their respective contract providers, involved in the delivery of substance abuse and mental health treatment and prevention services are coordinated and integrated with other local systems and groups, public and private, such as juvenile justice, criminal justice, child protection, and public health organizations; school districts; and local groups or organizations that focus on services to older adults.
(7)
Provide access to crisis services to all residents of the state with priority of attention being given to individuals exhibiting symptoms of acute mental illness or substance abuse.
(8)
Ensure that services provided to persons with co-occurring mental illness and substance abuse problems be integrated across treatment systems.
(9)
Ensure continuity of care, consistent with minimum standards, for persons who are released from a state treatment facility into the community.
(10)
Ensure continuity of care, consistent with minimum standards, for persons with serious and persistent mental illnesses who are released from a state correctional facility into the community.
(11)
Provide accountability for service provision through statewide standards for treatment and support services, and statewide standards for management, monitoring, and reporting of information.
(12)
Include substance abuse and mental health services as a component of the integrated service delivery system of the Department of Children and Families.
(13)
Ensure that the districts of the department are the focal point of all substance abuse and mental health planning activities, including budget submissions, grant applications, contracts, and other arrangements that can be effected at the district level.
(14)
Organize and finance community substance abuse and mental health services in local communities throughout the state through locally administered service delivery programs that are based on client outcomes, are programmatically effective, and are financially efficient, and that maximize the involvement of local citizens.
(15)
Promote best practices and the highest quality of care in contracted alcohol, drug abuse, and mental health services through achievement of national accreditation.
(16)
Ensure that the state agencies licensing and monitoring contracted providers perform in the most cost-efficient and effective manner with limited duplication and disruption to organizations providing services.
F.S. 394.67 Definitions.
As used in this part, the term:
(1)
“988 suicide and crisis lifeline call center” means a call center meeting national accreditation and recognized by the department to receive 988 calls, texts, or other forms of communication in this state.
(2)
“Agency” means the Agency for Health Care Administration.
(3)
“Client” means any individual receiving services in any substance abuse or mental health facility, program, or service, which facility, program, or service is operated, funded, or regulated by the agency and the department or regulated by the agency.
(4)
“Coordinated specialty care program” means an evidence-based program for individuals who are experiencing the early indications of serious mental illness, especially symptoms of a first psychotic episode, and which includes, but is not limited to, intensive case management, individual or group therapy, supported employment, family education and supports, and the provision of appropriate psychotropic medication as needed.
(5)
“Crisis services” means short-term evaluation, stabilization, and brief intervention services provided to a person who is experiencing an acute mental or emotional crisis, as defined in subsection (19), or an acute substance abuse crisis, as defined in subsection (20), to prevent further deterioration of the person’s mental health. Crisis services are provided in settings such as a crisis stabilization unit, an inpatient unit, a short-term residential treatment program, a detoxification facility, or an addictions receiving facility; at the site of the crisis by a mobile crisis response team; at a hospital on an outpatient basis; or telephonically by a 988 suicide and crisis lifeline call center.
(6)
“Crisis stabilization unit” means a program that provides an alternative to inpatient hospitalization and that provides brief, intensive services 24 hours a day, 7 days a week, for mentally ill individuals who are in an acutely disturbed state.
(7)
“Department” means the Department of Children and Families.
(8)
“Director” means any member of the official board of directors reported in the organization’s annual corporate report to the Florida Department of State, or, if no such report is made, any member of the operating board of directors. The term excludes members of separate, restricted boards that serve only in an advisory capacity to the operating board.
(9)
“District administrator” means the person appointed by the Secretary of Children and Families for the purpose of administering a department service district as set forth in
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s. 20.19.
(10)
“District plan” or “plan” means the combined district substance abuse and mental health plan approved by the district administrator and governing bodies in accordance with this part.
(11)
“Federal funds” means funds from federal sources for substance abuse or mental health facilities and programs, exclusive of federal funds that are deemed eligible by the Federal Government, and are eligible through state regulation, for matching purposes.
(12)
“Governing body” means the chief legislative body of a county, a board of county commissioners, or boards of county commissioners in counties acting jointly, or their counterparts in a charter government.
(13)
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“Health and human services board” or “board” means the board within a district or subdistrict of the department which is established in accordance with
1
s. 20.19 and designated in this part for the purpose of assessing the substance abuse and mental health needs of the community and developing a plan to address those needs.
(14)
“Licensed facility” means a facility licensed in accordance with this chapter.
(15)
“Local matching funds” means funds received from governing bodies of local government, including city commissions, county commissions, district school boards, special tax districts, private hospital funds, private gifts, both individual and corporate, and bequests and funds received from community drives or any other sources.
(16)
“Managing employee” means the administrator or other similarly titled individual who is responsible for the daily operation of the facility.
(17)
“Mental health services” means those therapeutic interventions and activities that help to eliminate, reduce, or manage symptoms or distress for persons who have severe emotional distress or a mental illness and to effectively manage the disability that often accompanies a mental illness so that the person can recover from the mental illness, become appropriately self-sufficient for his or her age, and live in a stable family or in the community. The term also includes those preventive interventions and activities that reduce the risk for or delay the onset of mental disorders. The term includes the following types of services:
(a)
Treatment services, such as psychiatric medications and supportive psychotherapies, which are intended to reduce or ameliorate the symptoms of severe distress or mental illness.
(b)
Rehabilitative services, which are intended to reduce or eliminate the disability that is associated with mental illness. Rehabilitative services may include assessment of personal goals and strengths, readiness preparation, specific skill training, and assistance in designing environments that enable individuals to maximize their functioning and community participation.
(c)
Support services, which include services that assist individuals in living successfully in environments of their choice. Such services may include income supports, social supports, housing supports, vocational supports, or accommodations related to the symptoms or disabilities associated with mental illness.
(d)
Case management services, which are intended to assist individuals in obtaining the formal and informal resources that they need to successfully cope with the consequences of their illness. Resources may include treatment or rehabilitative or supportive interventions by both formal and informal providers. Case management may include an assessment of client needs; intervention planning with the client, his or her family, and service providers; linking the client to needed services; monitoring service delivery; evaluating the effect of services and supports; and advocating on behalf of the client.
Mental health services may be delivered in a variety of settings, such as inpatient, residential, partial hospital, day treatment, outpatient, club house, or a drop-in or self-help center, as well as in other community settings, such as the client’s residence or workplace. The types and intensity of services provided shall be based on the client’s clinical status and goals, community resources, and preferences. Services such as assertive community treatment involve all four types of services which are delivered by a multidisciplinary treatment team that is responsible for identified individuals who have a serious mental illness.
(18)
“Patient fees” means compensation received by a community substance abuse or mental health facility for services rendered to a specific client from any source of funds, including city, county, state, federal, and private sources.
(19)
“Person who is experiencing an acute mental or emotional crisis” means a child, adolescent, or adult who is experiencing a psychotic episode or a high level of mental or emotional distress which may be precipitated by a traumatic event or a perceived life problem for which the individual’s typical coping strategies are inadequate. The term includes an individual who meets the criteria for involuntary examination specified in s. 394.463(1).
(20)
“Person who is experiencing an acute substance abuse crisis” means a child, adolescent, or adult who is experiencing a medical or emotional crisis because of the use of alcoholic beverages or any psychoactive or mood-altering substance. The term includes an individual who meets the criteria for involuntary admission specified in s. 397.675.
(21)
“Premises” means those buildings, beds, and facilities located at the main address of the licensee and all other buildings, beds, and facilities for the provision of acute or residential care which are located in such reasonable proximity to the main address of the licensee as to appear to the public to be under the dominion and control of the licensee.
(22)
“Program office” means the Mental Health Program Office of the Department of Children and Families.
(23)
“Residential treatment center for children and adolescents” means a 24-hour residential program, including a therapeutic group home, which provides mental health services to emotionally disturbed children or adolescents as defined in s. 394.492(5) or (6) and which is a private for-profit or not-for-profit corporation licensed by the agency which offers a variety of treatment modalities in a more restrictive setting.
(24)
“Residential treatment facility” means a facility providing residential care and treatment to individuals exhibiting symptoms of mental illness who are in need of a 24-hour-per-day, 7-day-a-week structured living environment, respite care, or long-term community placement.
(25)
“Sliding fee scale” means a schedule of fees for identified services delivered by a service provider which are based on a uniform schedule of discounts deducted from the service provider’s usual and customary charges. These charges must be consistent with the prevailing market rates in the community for comparable services.
(26)
“Substance abuse services” means services designed to prevent or remediate the consequences of substance abuse, improve an individual’s quality of life and self-sufficiency, and support long-term recovery. The term includes the following service categories:
(a)
Prevention services, which include information dissemination; education regarding the consequences of substance abuse; alternative drug-free activities; problem identification; referral of persons to appropriate prevention programs; community-based programs that involve members of local communities in prevention activities; and environmental strategies to review, change, and enforce laws that control the availability of controlled and illegal substances.
(b)
Assessment services, which include the evaluation of individuals and families in order to identify their strengths and determine their required level of care, motivation, and need for treatment and ancillary services.
(c)
Intervention services, which include early identification, short-term counseling and referral, and outreach.
(d)
Rehabilitation services, which include residential, outpatient, day or night, case management, in-home, psychiatric, and medical treatment, and methadone or medication management.
(e)
Ancillary services, which include self-help and other support groups and activities; aftercare provided in a structured, therapeutic environment; supported housing; supported employment; vocational services; and educational services.
F.S. 394.73 Joint alcohol, drug abuse, and mental health service programs in two or more counties.
(1)
Subject to rules established by the department, any county within a service district shall have the same power to contract for alcohol, drug abuse, and mental health services as the department has under existing statutes.
(2)
In order to carry out the intent of this part and to provide alcohol, drug abuse, and mental health services in accordance with the district plan, the counties within a service district may enter into agreements with each other for the establishment of joint service programs. The agreements may provide for the joint provision or operation of services and facilities or for the provision or operation of services and facilities by one participating county under contract with other participating counties.
(3)
When a service district comprises two or more counties or portions thereof, it is the obligation of the planning council to submit to the governing bodies, prior to the budget submission date of each governing body, an estimate of the proportionate share of costs of alcohol, drug abuse, and mental health services proposed to be borne by each such governing body.
(4)
Any county desiring to withdraw from a joint program may submit to the district administrator a resolution requesting withdrawal therefrom together with a plan for the equitable adjustment and division of the assets, property, debts, and obligations, if any, of the joint program.
F.S. 394.74 Contracts for provision of local substance abuse and mental health programs.
(1)
The department, when funds are available for such purposes, is authorized to contract for the establishment and operation of local substance abuse and mental health programs with any hospital, clinic, laboratory, institution, or other appropriate service provider.
(2)(a)
Contracts for service shall be consistent with the approved district plan.
(b)
Notwithstanding s. 394.76(3)(a) and (c), the department may use unit cost methods of payment in contracts for purchasing mental health and substance abuse services. The unit cost contracting system must account for those patient fees that are paid on behalf of a specific client and those that are earned and used by the provider for those services funded in whole or in part by the department. The department may also use a fee-for-service arrangement, case rates, or a capitation arrangement in order to account for those services. The department is authorized to implement through administrative rule fee-for-service, prepaid case rate, and prepaid capitation contract methodologies to purchase mental health and substance abuse services. Fee-for-service, prepaid case rate, or prepaid capitation mechanisms shall not be implemented statewide without the elimination of the unit cost method of payment. Notwithstanding the provisions of s. 394.76(3), the department may adopt administrative rules that account for local match in a manner that is consistent with fee-for-service, prepaid case rate, and prepaid capitated payment methodologies. Such provisions may not result in a change of the ratio of state to local matching resources or in the sources of local matching funds and may not increase the amount of required local matching funds. It is the intent of the Legislature that the provisions to account for local match be consistent with the financial principles adopted for the payment of state funds.
(c)
The department may reimburse actual expenditures for startup contracts and fixed capital outlay contracts in accordance with contract specifications.
(3)
Contracts shall include, but are not limited to:
(a)
A provision that, within the limits of available resources, substance abuse and mental health crisis services, as defined in s. 394.67, shall be available to any individual residing or employed within the service area, regardless of ability to pay for such services, current or past health condition, or any other factor;
(b)
A provision that such services be available with priority of attention being given to individuals who exhibit symptoms of chronic or acute substance abuse or mental illness and who are unable to pay the cost of receiving such services;
(c)
A provision that every reasonable effort to collect appropriate reimbursement for the cost of providing substance abuse and mental health services to persons able to pay for services, including first-party payments and third-party payments, shall be made by facilities providing services pursuant to this act;
(d)
A program description and line-item operating budget by program service component for substance abuse and mental health services, provided the entire proposed operating budget for the service provider will be displayed;
(e)
A provision that client demographic, service, and outcome information required for the department’s Mental Health and Substance Abuse Data System be submitted to the department by a date specified in the contract. The department may not pay the provider unless the required information has been submitted by the specified date; and
(f)
A requirement that the contractor must conform to department rules and the priorities established thereunder.
(4)
The department shall develop standard contract forms for use between the district administrator and community substance abuse and mental health service providers.
(5)
This part does not prevent any municipality or county, or combination of municipalities and counties, from owning, financing, and operating a substance abuse or mental health program by entering into an arrangement with the district to provide, and be reimbursed for, services provided as part of the district plan.
(6)
The department may use a fee-for-service arrangement, case rates, or capitation in order to account for mental health and substance abuse services.
F.S. 394.75 State and district substance abuse and mental health plans.
(1)(a)
Every 3 years, beginning in 2001, the department, in consultation with the Medicaid program in the Agency for Health Care Administration, shall prepare a state master plan for the delivery and financing of a system of publicly funded, community-based substance abuse and mental health services throughout the state.
(b)
The initial plan must include an assessment of the clinical practice guidelines and standards for community-based mental health and substance abuse services delivered by persons or agencies under contract with the Department of Children and Families. The assessment must include an inventory of current clinical guidelines and standards used by persons and agencies under contract with the department, and by nationally recognized accreditation organizations, to address the quality of care and must specify additional clinical practice standards and guidelines for new or existing services and programs.
(c)
The plan must propose changes in department policy or statutory revisions to strengthen the quality of mental health and substance abuse treatment and support services.
(d)
The plan must identify strategies for meeting the treatment and support needs of children, adolescents, adults, and older adults who have, or are at risk of having, mental, emotional, or substance abuse problems as defined in this chapter or chapter 397.
(e)
The plan must include input from persons who represent local communities; local government entities that contribute funds to the local substance abuse and mental health treatment systems; consumers of publicly funded substance abuse and mental health services, and their families; and stakeholders interested in mental health and substance abuse services. The plan must describe the means by which this local input occurred. The plan shall be updated annually.
(f)
The plan must include statewide policies and planning parameters that will be used by the
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health and human services boards in preparing the district substance abuse and mental health plans.
(g)
The district plans shall be one component of the state master plan.
(2)
The state master plan shall also include:
(a)
A proposal for the development of a data system that will evaluate the effectiveness of programs and services provided to clients of the substance abuse and mental health service system.
(b)
A proposal to resolve the funding discrepancies between districts.
(c)
A methodology for the allocation of resources available from federal, state, and local sources and a description of the current level of funding available from each source.
(d)
A description of the statewide priorities for clients and services, and each district’s priorities for clients and services.
(e)
Recommendations for methods of enhancing local participation in the planning, organization, and financing of substance abuse and mental health services.
(f)
A description of the current methods of contracting for services, an assessment of the efficiency of these methods in providing accountability for contracted funds, and recommendations for improvements to the system of contracting.
(g)
Recommendations for improving access to services by clients and their families.
(h)
Guidelines and formats for the development of district plans.
(i)
Recommendations for future directions for the substance abuse and mental health service delivery system.
A schedule, format, and procedure for development and review of the state master plan shall be adopted by the department by June of each year. The plan and annual updates must be submitted to the President of the Senate and the Speaker of the House of Representatives by January 1 of each year.
(3)
The district
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health and human services board shall prepare an integrated district substance abuse and mental health plan. The plan shall be prepared and updated on a schedule established by the
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Alcohol, Drug Abuse, and Mental Health Program Office. The plan shall reflect the needs and program priorities established by the department and the needs of the district established under ss. 394.4573 and 394.674. The plan must list in order of priority the mental health and the substance abuse treatment needs of the district and must rank each program separately. The plan shall include:
(a)
A record of the total amount of money available in the district for mental health and substance abuse services.
(b)
A description of each service that will be purchased with state funds.
(c)
A record of the amount of money allocated for each service identified in the plan as being purchased with state funds.
(d)
A record of the total funds allocated to each provider.
(e)
A record of the total funds allocated to each provider by type of service to be purchased with state funds.
(f)
Input from community-based persons, organizations, and agencies interested in substance abuse and mental health treatment services; local government entities that contribute funds to the public substance abuse and mental health treatment systems; and consumers of publicly funded substance abuse and mental health services, and their family members. The plan must describe the means by which this local input occurred.
The plan shall be submitted by the district
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board to the district administrator and to the governing bodies for review, comment, and approval.
(4)
The district plan shall:
(a)
Describe the publicly funded, community-based substance abuse and mental health system of care, and identify statutorily defined populations, their service needs, and the resources available and required to meet their needs.
(b)
Provide the means for meeting the needs of the district’s eligible clients, specified in ss. 394.4573 and 394.674, for substance abuse and mental health services.
(c)
Provide a process for coordinating the delivery of services within a community-based system of care to eligible clients. Such process must involve service providers, clients, and other stakeholders. The process must also provide a means by which providers will coordinate and cooperate to strengthen linkages, achieve maximum integration of services, foster efficiencies in service delivery and administration, and designate responsibility for outcomes for eligible clients.
(d)
Provide a projection of district program and fiscal needs for the next fiscal year, provide for the orderly and economical development of needed services, and indicate priorities and resources for each population served, performance outcomes, and anticipated expenditures and revenues.
(e)
Include a summary budget request for the total district substance abuse and mental health program, which must include the funding priorities established by the district planning process.
(f)
Provide a basis for the district legislative budget request.
(g)
Include a policy and procedure for allocation of funds.
(h)
Include a procedure for securing local matching funds. Such a procedure shall be developed in consultation with governing bodies and service providers.
(i)
Provide for the integration of substance abuse and mental health services with the other departmental programs and with the criminal justice, juvenile justice, child protection, school, and health care systems within the district.
(j)
Provide a plan for the coordination of services in such manner as to ensure effectiveness and avoid duplication, fragmentation of services, and unnecessary expenditures.
(k)
Provide for continuity of client care between state treatment facilities and community programs to assure that discharge planning results in the rapid application for all benefits for which a client is eligible, including Medicaid coverage for persons leaving state treatment facilities and returning to community-based programs.
(l)
Provide for the most appropriate and economical use of all existing public and private agencies and personnel.
(m)
Provide for the fullest possible and most appropriate participation by existing programs; state hospitals and other hospitals; city, county, and state health and family service agencies; drug abuse and alcoholism programs; probation departments; physicians; psychologists; social workers; marriage and family therapists; mental health counselors; clinical social workers; public health nurses; school systems; and all other public and private agencies and personnel that are required to, or may agree to, participate in the plan.
(n)
Include an inventory of all public and private substance abuse and mental health resources within the district, including consumer advocacy groups and self-help groups known to the department.
(5)
The district plan shall address how substance abuse and mental health services will be provided and how a system of care for target populations will be provided given the resources available in the service district. The plan must include provisions for maximizing client access to the most recently developed psychiatric medications approved by the United States Food and Drug Administration, for developing independent housing units through participation in the Section 811 program operated by the United States Department of Housing and Urban Development, for developing supported employment services through the Division of Vocational Rehabilitation of the Department of Education, for providing treatment services to persons with co-occurring mental illness and substance abuse problems which are integrated across treatment systems, and for providing services to adults who have a serious mental illness, as defined in s. 394.67, and who reside in assisted living facilities.
(6)
The district plan shall provide the means by which the needs of the population groups specified pursuant to s. 394.674 will be addressed in the district.
(7)
In developing the district plan, optimum use shall be made of any federal, state, and local funds that may be available for substance abuse and mental health service planning. However, the department must provide these services within legislative appropriations.
(8)
The district
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health and human services board shall establish a subcommittee to prepare the portion of the district plan relating to children and adolescents. The subcommittee shall include representative membership of any committee organized or established by the district to review placement of children and adolescents in residential treatment programs. The
1
board shall establish a subcommittee to prepare the portion of the district plan which relates to adult mental health and substance abuse. The subcommittee must include representatives from the community who have an interest in mental health and substance abuse treatment for adults.
(9)
All departments of state government and all local public agencies shall cooperate with officials to assist them in service planning. Each district administrator shall, upon request and the availability of staff, provide consultative services to the local agency directors and governing bodies.
(10)
The district administrator shall ensure that the district plan:
(a)
Conforms to the priorities in the state plan, the requirements of this part, and the standards adopted under this part;
(b)
Ensures that the most effective and economical use will be made of available public and private substance abuse and mental health resources in the service district; and
(c)
Has adequate provisions made for review and evaluation of the services provided in the service district.
(11)
The district administrator shall require such modifications in the district plan as he or she deems necessary to bring the plan into conformance with the provisions of this part. If the district
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board and the district administrator cannot agree on the plan, including the projected budget, the issues under dispute shall be submitted directly to the secretary of the department for immediate resolution.
(12)
Each governing body that provides local funds has the authority to require necessary modification to only that portion of the district plan which affects substance abuse and mental health programs and services within the jurisdiction of that governing body.
(13)
The district administrator shall report annually to the district
1
board the status of funding for priorities established in the district plan. Each report must include:
(a)
A description of the district plan priorities that were included in the district legislative budget request.
(b)
A description of the district plan priorities that were included in the departmental budget request.
(c)
A description of the programs and services included in the district plan priorities that were appropriated funds by the Legislature in the legislative session that preceded the report.
F.S. 394.76 Financing of district programs and services.
If the local match funding level is not provided in the General Appropriations Act or the substantive bill implementing the General Appropriations Act, such funding level shall be provided as follows:
(1)
The district administrator shall ensure that, to the extent possible within available resources, a continuum of integrated and comprehensive services will be available within the district.
(2)
If in any fiscal year the approved state appropriation is insufficient to finance the programs and services specified by this part, the department shall have the authority to determine the amount of state funds available to each service district for such purposes in accordance with the priorities in both the state and district plans. The district administrator shall consult with the planning council to ensure that the summary operating budget conforms to the approved plan.
(3)
The state share of financial participation shall be determined by the following formula:
(a)
The state share of approved program costs shall be a percentage of the net balance determined by deducting from the total operating cost of services and programs, as specified in s. 394.4573, those expenditures which are ineligible for state participation as provided in subsection (7) and those ineligible expenditures established by rule of the department pursuant to s. 394.78.
(b)
Residential and case management services which are funded as part of a deinstitutionalization project shall not require local matching funds and shall not be used as local matching funds. The state and federal financial participation portions of Medicaid earnings pursuant to Title XIX of the Social Security Act, except for the amount of general revenue equal to the amount appropriated in 1985-1986 plus all other general revenue that is shifted from any other alcohol, drug abuse, and mental health appropriation category after fiscal year 1986-1987 or substance abuse and mental health appropriation category after fiscal year 2000-2001, shall not require local matching funds and shall not be used as local matching funds. Local matching funds are not required for general revenue transferred by the department into substance abuse and mental health appropriations categories during a fiscal year to match federal funds earned from Medicaid services provided for mental health clients in excess of the amounts initially appropriated. Funds for children’s services which were provided through the Children, Youth, and Families Services budget which did not require local match prior to being transferred to the Substance Abuse and Mental Health Services budget shall be exempt from local matching requirements. All other contracted community alcohol and mental health services and programs, except as identified in s. 394.457(3), shall require local participation on a 75-to-25 state-to-local ratio.
(c)
The expenditure of 100 percent of all third-party payments and fees shall be considered as eligible for state financial participation if such expenditures are in accordance with subsection (7) and the approved district plan.
(d)
Fees generated by residential and case management services which are funded as part of a deinstitutionalization program and do not require local matching funds shall be used to support program costs approved in the district plan.
(e)
Any earnings pursuant to Title XIX of the Social Security Act in excess of the amount appropriated shall be used to support program costs approved in the district plan.
(4)
Notwithstanding the provisions of subsection (3), the department is authorized to develop and demonstrate alternative financing systems for substance abuse and mental health services. Proposals for demonstration projects conducted pursuant to this subsection shall be reviewed by the substantive and appropriations committees of the Senate and the House of Representatives prior to implementation of the projects.
(5)
The department is authorized to make investigations and to require audits of expenditures. The department may authorize the use of private certified public accountants for such audits. Audits shall follow department guidelines.
(6)
Claims for state payment shall be made in such form and in such manner as the department determines.
(7)
The expenditures which are subject to state payment include expenditures that are approved in the district plan for salaries of personnel; approved facilities and services provided through contract; operation, maintenance, and service cost; contingency management programs authorized by a managing entity, and subject to limitations on value imposed by the Federal Government or department rule, in which participants are provided noncash incentives for positive progress in their recovery under the care of a publicly funded substance abuse treatment provider; depreciation of facilities; and such other expenditures as may be approved by the district administrator. Such expenditures do not include expenditures for compensation to members of a community agency board, except the actual and necessary expenses incurred in the performance of official duties, or expenditures for a purpose for which state payment is claimed under any other provision of law.
(8)
Expenditures for capital improvements relating to construction of, addition to, purchase of, or renovation of a community substance abuse or mental health facility may be made by the state, provided such expenditures or capital improvements are part and parcel of an approved district plan. Nothing shall prohibit the use of such expenditures for the construction of, addition to, renovation of, or purchase of facilities owned by a county, city, or other governmental agency of the state or a nonprofit entity. Such expenditures are subject to the provisions of subsection (6).
(9)(a)
State funds for community alcohol and mental health services shall be matched by local matching funds as provided in paragraph (3)(b). The governing bodies within a district or subdistrict shall be required to participate in the funding of alcohol and mental health services under the jurisdiction of such governing bodies. The amount of the participation shall be at least that amount which, when added to other available local matching funds, is necessary to match state funds.
(b)
The provisions of paragraph (a) to the contrary notwithstanding, no additional matching funds may be required solely due to the addition in the General Appropriations Act of Substance Abuse and Mental Health Block Grant Funds for local community mental health centers and alcohol project grants.
(10)
A local governing body is authorized to appropriate moneys, in lump sum or otherwise, from its public funds for the purpose of carrying out the provisions of this part. In addition to the payment of claims upon submission of proper vouchers, such moneys may also, at the option of the governing body, be disbursed in the form of a lump-sum or advance payment for services for expenditure, in turn, by the recipient of the disbursement without prior audit by the auditor of the governing body. Such funds shall be expended only for substance abuse or mental health purposes as provided in the approved district plan. Each governing body appropriating and disbursing moneys pursuant to this subsection shall require the expenditure of such moneys by the recipient of the disbursement to be audited annually either in conjunction with an audit of other expenditures or by a separate audit. Such annual audits shall be furnished to the governing bodies of each participating county and municipality for their examination.
(11)
No additional local matching funds shall be required solely due to the addition in the General Appropriations Act of substance abuse and mental health block grant funds for local community mental health centers, drug abuse programs, and alcohol project grants.
F.S. 394.77 Uniform management information, accounting, and reporting systems for providers.
The department shall establish, for the purposes of control of costs:
(1)
A uniform management information system and fiscal accounting system for use by providers of community substance abuse and mental health services.
(2)
A uniform reporting system with uniform definitions and reporting categories.
F.S. 394.78 Operation and administration; personnel standards; procedures for audit and monitoring of service providers; resolution of disputes.
(1)(a)
The Department of Children and Families shall administer this part and shall adopt rules necessary for its administration. In addition to other rulemaking authority, the department may adopt financial rules relating to conflicts of interest; related party transactions; full disclosure of revenue funds and expenses; charts of accounts for state reporting; auditing; penalties for nonperformance; benefit packages; performance outcomes, including client satisfaction and functional assessments; nonpayment and suspended payments for failure to timely submit required client service reports; and client financial eligibility requirements.
(b)
Rules of the department shall be adopted in accordance with the Administrative Procedure Act under chapter 120.
(2)
The department shall, by rule, establish standards of education and experience for professional and technical personnel employed in substance abuse and mental health programs.
(3)
The department shall establish, to the extent possible, a standardized auditing procedure for substance abuse and mental health service providers; and audits of service providers shall be conducted pursuant to such procedure and the applicable department rules. Such procedure shall be supplied to all current and prospective contractors and subcontractors prior to the signing of any contracts.
(4)
The department shall monitor service providers for compliance with contracts and applicable state and federal regulations.
(5)
The department shall, by rule, establish standards for contracting budgeting, methods of payment, and the accounting of patient fees that are earned on behalf of a specific client.
F.S. 394.80 Authorization to appropriate funds.
The several cities and counties of this state are authorized to appropriate funds to support all or any portion of the cost of services and construction not met through support by the state or federal governments.
F.S. 394.90 Inspection; right of entry; records.
(1)(a)
The agency, in accordance with s. 408.811, and the department may enter and inspect at any time a licensed facility to determine whether the facility is in compliance with this chapter, part II of chapter 408, and applicable rules.
(b)
The department and the agency may enter and inspect any premises that it has probable cause to suspect may be operating as an unlicensed crisis stabilization unit or residential treatment facility; however, such entry and inspection shall be made only with the permission of the person in charge of such premises or pursuant to warrant.
(c)
Any application for licensure under this chapter constitutes full permission for the department and the agency to enter and inspect the premises of the applicant or licensee at any time.
(2)
For purposes of monitoring and investigation, the department and the Agency for Health Care Administration shall have access to the clinical records of any client of a licensee or designated facility, the provisions of s. 394.4615 to the contrary notwithstanding.
(3)
The agency shall schedule periodic inspections of licensees so as to minimize the cost to the licensees and the disruption of the licensees’ programs. This subsection shall not be construed to limit the authority of the department and the agency to inspect the facilities of a licensee at any time.
(4)
Each licensee shall maintain as public information, available to any person upon request, copies of all reports of inspections of the licensee filed with or issued by any governmental agency during the preceding 5-year period. The licensee shall furnish a copy of the most recent inspection report of the agency to any person upon payment of a reasonable charge for copying.
(5)
The agency shall accept, in lieu of its own inspections for licensure, the survey or inspection of an accrediting organization, if the provider is accredited according to the provisions of s. 394.741 and the agency receives the report of the accrediting organization.
F.S. 394.451 Short title.
This part shall be known as “The Florida Mental Health Act” or “The Baker Act.”
F.S. 394.453 Legislative intent.
(1)
It is the intent of the Legislature:
(a)
To authorize and direct the Department of Children and Families to evaluate, research, plan, and recommend to the Governor and the Legislature programs designed to reduce the occurrence, severity, duration, and disabling aspects of mental, emotional, and behavioral disorders.
(b)
That treatment programs for such disorders include, but not be limited to, comprehensive health, social, educational, and rehabilitative services to persons requiring intensive short-term and continued treatment in order to encourage them to assume responsibility for their treatment and recovery. It is intended that:
1.
Such persons be provided with emergency service and temporary detention for evaluation when required;
2.
Such persons be admitted to treatment facilities on a voluntary basis when extended or continuing care is needed and unavailable in the community;
3.
Involuntary placement be provided only when expert evaluation determines it is necessary;
4.
Any involuntary treatment or examination be accomplished in a setting that is clinically appropriate and most likely to facilitate the person’s return to the community as soon as possible; and
5.
Individual dignity and human rights be guaranteed to all persons who are admitted to mental health facilities or who are being held under s. 394.463.
(c)
That services provided to persons in this state use the coordination-of-care principles characteristic of recovery-oriented services and include social support services, such as housing support, life skills and vocational training, and employment assistance, necessary for persons with mental health disorders and co-occurring mental health and substance use disorders to live successfully in their communities.
(d)
That licensed, qualified health professionals be authorized to practice to the fullest extent of their education and training in the performance of professional functions necessary to carry out the intent of this part.
(2)
It is the policy of this state that the use of restraint and seclusion on clients is justified only as an emergency safety measure to be used in response to imminent danger to the client or others. It is, therefore, the intent of the Legislature to achieve an ongoing reduction in the use of restraint and seclusion in programs and facilities serving persons with mental illness.
(3)
The Legislature further finds the need for additional psychiatrists to be of critical state concern and recommends the establishment of an additional psychiatry program to be offered by one of Florida’s schools of medicine currently not offering psychiatry. The program shall seek to integrate primary care and psychiatry and other evolving models of care for persons with mental health and substance use disorders. Additionally, the Legislature finds that the use of telemedicine for patient evaluation, case management, and ongoing care will improve management of patient care and reduce costs of transportation.
F.S. 394.455 Definitions.
As used in this part, the term:
(1)
“Access center” means a facility that has medical, mental health, and substance abuse professionals to provide emergency screening and evaluation for mental health or substance abuse disorders and may provide transportation to an appropriate facility if an individual is in need of more intensive services.
(2)
“Addictions receiving facility” is a secure, acute care facility that, at a minimum, provides emergency screening, evaluation, detoxification, and stabilization services; is operated 24 hours per day, 7 days per week; and is designated by the department to serve individuals found to have substance abuse impairment who qualify for services under this part.
(3)
“Administrator” means the chief administrative officer of a receiving or treatment facility or his or her designee.
(4)
“Adult” means an individual who is 18 years of age or older or who has had the disability of nonage removed under chapter 743.
(5)
“Clinical psychologist” means a person licensed to practice psychology under chapter 490 or a psychologist employed by a facility operated by the United States Department of Veterans Affairs that qualifies as a receiving or treatment facility under this part.
(6)
“Clinical record” means all parts of the record required to be maintained and includes all medical records, progress notes, charts, and admission and discharge data, and all other information recorded by facility staff which pertains to the patient’s hospitalization or treatment.
(7)
“Clinical social worker” means a person licensed as a clinical social worker under s. 491.005 or s. 491.006.
(8)
“Community facility” means a community service provider that contracts with the department to furnish substance abuse or mental health services under part IV of this chapter.
(9)
“Community mental health center or clinic” means a publicly funded, not-for-profit center that contracts with the department for the provision of inpatient, outpatient, day treatment, or emergency services.
(10)
“Coordinated specialty care program” means an evidence-based program for individuals who are experiencing the early indications of serious mental illness, especially symptoms of a first psychotic episode, and which includes, but is not limited to, intensive case management, individual or group therapy, supported employment, family education and supports, and the provision of appropriate psychotropic medication as needed.
(11)
“Court,” unless otherwise specified, means the circuit court.
(12)
“Department” means the Department of Children and Families.
(13)
“Designated receiving facility” means a facility approved by the department which may be a public or private hospital, crisis stabilization unit, or addictions receiving facility; which provides, at a minimum, emergency screening, evaluation, and short-term stabilization for mental health or substance abuse disorders; and which may have an agreement with a corresponding facility for transportation and services.
(14)
“Detoxification facility” means a facility licensed to provide detoxification services under chapter 397.
(15)
“Electronic means” means a form of telecommunication which requires all parties to maintain visual as well as audio communication when being used to conduct an examination by a qualified professional.
(16)
“Express and informed consent” means consent voluntarily given in writing, by a competent person, after sufficient explanation and disclosure of the subject matter involved to enable the person to make a knowing and willful decision without any element of force, fraud, deceit, duress, or other form of constraint or coercion.
(17)
“Facility” means any hospital, community facility, public or private facility, or receiving or treatment facility providing for the evaluation, diagnosis, care, treatment, training, or hospitalization of persons who appear to have or who have been diagnosed as having a mental illness or substance abuse impairment. The term does not include a program or an entity licensed under chapter 400 or chapter 429.
(18)
“Guardian” means the natural guardian of a minor, or a person appointed by a court to act on behalf of a ward’s person if the ward is a minor or has been adjudicated incapacitated.
(19)
“Guardian advocate” means a person appointed by a court to make decisions regarding mental health treatment on behalf of a patient who has been found incompetent to consent to treatment pursuant to this part.
(20)
“Hospital” means a hospital licensed under chapter 395 and part II of chapter 408.
(21)
“Incapacitated” means that a person has been adjudicated incapacitated pursuant to part V of chapter 744 and a guardian of the person has been appointed.
(22)
“Incompetent to consent to treatment” means a state in which a person’s judgment is so affected by a mental illness or a substance abuse impairment that he or she lacks the capacity to make a well-reasoned, willful, and knowing decision concerning his or her medical, mental health, or substance abuse treatment.
(23)
“Involuntary examination” means an examination performed under s. 394.463, s. 397.6772, s. 397.679, s. 397.6798, or s. 397.6957 to determine whether a person qualifies for involuntary services.
(24)
“Involuntary services” means court-ordered outpatient services or inpatient placement for mental health treatment pursuant to s. 394.4655 or s. 394.467.
(25)
“Law enforcement officer” has the same meaning as provided in s. 943.10.
(26)
“Marriage and family therapist” means a person licensed to practice marriage and family therapy under s. 491.005 or s. 491.006.
(27)
“Mental health counselor” means a person licensed to practice mental health counseling under s. 491.005 or s. 491.006.
(28)
“Mental health overlay program” means a mobile service that provides an independent examination for voluntary admission and a range of supplemental onsite services to persons with a mental illness in a residential setting such as a nursing home, an assisted living facility, or an adult family-care home or a nonresidential setting such as an adult day care center. Independent examinations provided through a mental health overlay program must only be provided under contract with the department or be attached to a public receiving facility that is also a community mental health center.
(29)
“Mental illness” means an impairment of the mental or emotional processes that exercise conscious control of one’s actions or of the ability to perceive or understand reality, which impairment substantially interferes with the person’s ability to meet the ordinary demands of living. For the purposes of this part, the term does not include a developmental disability as defined in chapter 393, intoxication, or conditions manifested only by dementia, traumatic brain injury, antisocial behavior, or substance abuse.
(30)
“Minor” means an individual who is 17 years of age or younger and who has not had the disability of nonage removed pursuant to s. 743.01 or s. 743.015.
(31)
“Mobile crisis response service” or “mobile response team” means a nonresidential behavioral health crisis service available 24 hours per day, 7 days per week which provides immediate intensive assessments and interventions, including screening for admission into a mental health receiving facility, an addictions receiving facility, or a detoxification facility, for the purpose of identifying appropriate treatment services.
(32)
“Patient” means any person, with or without a co-occurring substance abuse disorder, who is held or accepted for mental health treatment.
(33)
“Physician” means a medical practitioner licensed under chapter 458 or chapter 459 who has experience in the diagnosis and treatment of mental illness or a physician employed by a facility operated by the United States Department of Veterans Affairs or the United States Department of Defense.
(34)
“Physician assistant” means a person licensed under chapter 458 or chapter 459 who has experience in the diagnosis and treatment of mental disorders.
(35)
“Private facility” means a hospital or facility operated by a for-profit or not-for-profit corporation or association which provides mental health or substance abuse services and is not a public facility.
(36)
“Psychiatric nurse” means an advanced practice registered nurse licensed under s. 464.012 who has a master’s or doctoral degree in psychiatric nursing and holds a national advanced practice certification as a psychiatric mental health advanced practice nurse, and has 1 year of post-master’s clinical experience under the supervision of a physician.
(37)
“Psychiatrist” means a medical practitioner licensed under chapter 458 or chapter 459 for at least 3 years, inclusive of psychiatric residency.
(38)
“Public facility” means a facility that has contracted with the department to provide mental health services to all persons, regardless of ability to pay, and is receiving state funds for such purpose.
(39)
“Qualified professional” means a physician or a physician assistant licensed under chapter 458 or chapter 459; a psychiatrist licensed under chapter 458 or chapter 459; a psychologist as defined in s. 490.003(7); or a psychiatric nurse as defined in this section.
(40)
“Receiving facility” means a public or private facility or hospital designated by the department to receive and hold or refer, as appropriate, involuntary patients under emergency conditions for mental health or substance abuse evaluation and to provide treatment or transportation to the appropriate service provider. The term does not include a county jail.
(41)
“Representative” means a person selected to receive notice of proceedings during the time a patient is held in or admitted to a receiving or treatment facility.
(42)
“Restraint” means:
(a)
A physical restraint, including any manual method or physical or mechanical device, material, or equipment attached or adjacent to an individual’s body so that he or she cannot easily remove the restraint and which restricts freedom of movement or normal access to one’s body. “Physical restraint” includes the physical holding of a person during a procedure to forcibly administer psychotropic medication. “Physical restraint” does not include physical devices such as orthopedically prescribed appliances, surgical dressings and bandages, supportive body bands, or other physical holding when necessary for routine physical examinations and tests or for purposes of orthopedic, surgical, or other similar medical treatment when used to provide support for the achievement of functional body position or proper balance or when used to protect a person from falling out of bed.
(b)
A drug or medication used to control a person’s behavior or to restrict his or her freedom of movement which is not part of the standard treatment regimen of a person with a diagnosed mental illness.
(43)
“Seclusion” means the physical segregation or involuntary isolation of a person in a room or area from which the person is prevented from leaving. The prevention may be by physical barrier or by a staff member who is acting in a manner, or who is physically situated, so as to prevent the person from leaving the room or area. For purposes of this part, the term does not mean isolation due to a person’s medical condition or symptoms.
(44)
“Secretary” means the Secretary of Children and Families.
(45)
“Service provider” means a receiving facility, a facility licensed under chapter 397, a treatment facility, an entity under contract with the department to provide mental health or substance abuse services, a community mental health center or clinic, a psychologist, a clinical social worker, a marriage and family therapist, a mental health counselor, a physician, a psychiatrist, an advanced practice registered nurse, a psychiatric nurse, or a qualified professional as defined in s. 39.01.
(46)
“Substance abuse impairment” means a condition involving the use of alcoholic beverages or any psychoactive or mood-altering substance in such a manner that a person has lost the power of self-control and has inflicted or is likely to inflict physical harm on himself, herself, or another.
(47)
“Telehealth” has the same meaning as provided in s. 456.47.
(48)
“Transfer evaluation” means the process by which a person who is being considered for placement in a state treatment facility is evaluated for appropriateness of admission to such facility.
(49)
“Treatment facility” means a state-owned, state-operated, or state-supported hospital, center, or clinic designated by the department for extended treatment and hospitalization, beyond that provided for by a receiving facility, of persons who have a mental illness, including facilities of the United States Government, and any private facility designated by the department when rendering such services to a person pursuant to the provisions of this part. Patients treated in facilities of the United States Government shall be solely those whose care is the responsibility of the United States Department of Veterans Affairs.
(50)
“Triage center” means a facility that has medical, mental health, and substance abuse professionals present or on call to provide emergency screening and evaluation for mental health or substance abuse disorders for individuals transported to the center by a law enforcement officer.
F.S. 394.457 Operation and administration.
(1)
ADMINISTRATION.
—
The Department of Children and Families is designated the “Mental Health Authority” of Florida. The department and the Agency for Health Care Administration shall exercise executive and administrative supervision over all mental health facilities, programs, and services.
(2)
RESPONSIBILITIES OF THE DEPARTMENT.
—
The department is responsible for:
(a)
The planning, evaluation, and implementation of a complete and comprehensive statewide program of mental health, including community services, receiving and treatment facilities, child services, research, and training as authorized and approved by the Legislature, based on the annual program budget of the department. The department is also responsible for the coordination of efforts with other departments and divisions of the state government, county and municipal governments, and private agencies concerned with and providing mental health services. It is responsible for establishing standards, providing technical assistance, and exercising supervision of mental health programs of, and the treatment of patients at, community facilities, other facilities for persons who have a mental illness, and any agency or facility providing services to patients pursuant to this part.
(b)1.
Informing individuals and organizations involved in implementing this part, including, but not limited to, law enforcement officers, qualified professionals, and service providers, of the provisions of this part; the policies and procedures related to its effective implementation; their roles and responsibilities; and any other information necessary for its effective implementation. The department shall maintain:
a.
An information handbook, which must be published and updated on the department’s website annually by October 1.
b.
A repository of answers to frequently asked questions, which must be published on the department’s website and continually revised and expanded as necessary.
2.
Supporting and facilitating research by public and private agencies, institutions of higher learning, and hospitals in the interest of the elimination and amelioration of mental illness.
(3)
POWER TO CONTRACT.
—
The department may contract to provide, and be provided with, services and facilities in order to carry out its responsibilities under this part with the following agencies: public and private hospitals; receiving and treatment facilities; clinics; laboratories; departments, divisions, and other units of state government; the state colleges and universities; the community colleges; private colleges and universities; counties, municipalities, and any other governmental unit, including facilities of the United States Government; and any other public or private entity which provides or needs facilities or services. The department shall require any provider directly under contract with the department to use, at a minimum, the most recent version of the Daily Living Activities-20 (DLA-20) functional assessment tool for any patient requiring functional assessment, unless the department specifies in rule the use of a different assessment tool. Baker Act funds for community inpatient, crisis stabilization, short-term residential treatment, and screening services must be allocated to each county pursuant to the department’s funding allocation methodology. Notwithstanding s. 287.057(3)(e), contracts for community-based Baker Act services for inpatient, crisis stabilization, short-term residential treatment, and screening provided under this part, other than those with other units of government, to be provided for the department must be awarded using competitive sealed bids if the county commission of the county receiving the services makes a request to the department’s district office by January 15 of the contracting year. The district may not enter into a competitively bid contract under this provision if such action will result in increases of state or local expenditures for Baker Act services within the district. Contracts for these Baker Act services using competitive sealed bids are effective for 3 years. The department shall adopt rules establishing minimum standards for such contracted services and facilities and shall make periodic audits and inspections to assure that the contracted services are provided and meet the standards of the department.
(4)
APPLICATION FOR AND ACCEPTANCE OF GIFTS AND GRANTS.
—
The department may apply for and accept any funds, grants, gifts, or services made available to it by any agency or department of the Federal Government or any other public or private agency or individual in aid of mental health programs. All such moneys shall be deposited in the State Treasury and shall be disbursed as provided by law.
(5)
RULES.
—
(a)
The department shall adopt rules establishing forms and procedures relating to the rights and privileges of patients seeking mental health treatment from facilities under this part.
(b)
The department shall adopt rules necessary for the implementation and administration of the provisions of this part, and a program subject to the provisions of this part shall not be permitted to operate unless rules designed to ensure the protection of the health, safety, and welfare of the patients treated through such program have been adopted. Rules adopted under this subsection must include provisions governing the use of restraint and seclusion which are consistent with recognized best practices and professional judgment; prohibit inherently dangerous restraint or seclusion procedures; establish limitations on the use and duration of restraint and seclusion; establish measures to ensure the safety of program participants and staff during an incident of restraint or seclusion; establish procedures for staff to follow before, during, and after incidents of restraint or seclusion; establish professional qualifications of and training for staff who may order or be engaged in the use of restraint or seclusion; and establish mandatory reporting, data collection, and data dissemination procedures and requirements. Rules adopted under this subsection must require that each instance of the use of restraint or seclusion be documented in the record of the patient.
(c)
The department shall adopt rules establishing minimum standards for services provided by a mental health overlay program or a mobile crisis response service. Minimum standards for a mobile crisis response service must:
1.
Include the requirements of the child, adolescent, and young adult mobile response teams established under s. 394.495(7) and ensure coverage of all counties by these specified teams;
2.
Specify any training or other requirements applicable to a mobile crisis response service available to persons age 65 and over to enable the service to meet the specialized needs of such persons; and
3.
Create a structure for general mobile response teams which focuses on crisis diversion and the reduction of involuntary commitment under this chapter. The structure must require, but need not be limited to, the following:
a.
Triage and rapid crisis intervention within 60 minutes;
b.
Provision of and referral to evidence-based services that are responsive to the needs of the individual and the individual’s family;
c.
Screening, assessment, early identification, and care coordination; and
d.
Confirmation that the individual who received the mobile crisis response was connected to a service provider and prescribed medications, if needed.
(6)
PERSONNEL.
—
(a)
The department shall, by rule, establish minimum standards of education and experience for professional and technical personnel employed in mental health programs, including members of a mobile crisis response service.
(b)
The department shall design and distribute appropriate materials for the orientation and training of persons actively engaged in implementing the provisions of this part relating to the involuntary examination and placement of persons who are believed to have a mental illness.
(7)
PAYMENT FOR CARE OF PATIENTS.
—
Fees and fee collections for patients in state-owned, state-operated, or state-supported treatment facilities shall be according to s. 402.33.
F.S. 394.458 Introduction or removal of certain articles unlawful; penalty.
(1)(a)
Except as authorized by law or as specifically authorized by the person in charge of each hospital providing mental health services under this part, it is unlawful to introduce into or upon the grounds of such hospital, or to take or attempt to take or send therefrom, any of the following articles, which are hereby declared to be contraband for the purposes of this section:
1.
Any intoxicating beverage or beverage which causes or may cause an intoxicating effect;
2.
Any controlled substance as defined in chapter 893; or
3.
Any firearms or deadly weapon.
(b)
It is unlawful to transmit to, or attempt to transmit to, or cause or attempt to cause to be transmitted to, or received by, any patient of any hospital providing mental health services under this part any article or thing declared by this section to be contraband, at any place which is outside of the grounds of such hospital, except as authorized by law or as specifically authorized by the person in charge of such hospital.
(2)
A person who violates any provision of this section commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
F.S. 394.459 Rights of patients.
(1)
RIGHT TO INDIVIDUAL DIGNITY.
—
It is the policy of this state that the individual dignity of the patient shall be respected at all times and upon all occasions, including any occasion when the patient is taken into custody, held, or transported. Procedures, facilities, vehicles, and restraining devices utilized for criminals or those accused of crime shall not be used in connection with persons who have a mental illness, except for the protection of the patient or others. Persons who have a mental illness but who are not charged with a criminal offense shall not be detained or incarcerated in the jails of this state. A person who is receiving treatment for mental illness shall not be deprived of any constitutional rights. However, if such a person is adjudicated incapacitated, his or her rights may be limited to the same extent the rights of any incapacitated person are limited by law.
(2)
RIGHT TO TREATMENT.
—
(a)
A person shall not be denied treatment for mental illness and services shall not be delayed at a receiving or treatment facility because of inability to pay. However, every reasonable effort to collect appropriate reimbursement for the cost of providing mental health services to persons able to pay for services, including insurance or third-party payments, shall be made by facilities providing services pursuant to this part.
(b)
It is further the policy of the state that the least restrictive appropriate available treatment be utilized based on the individual needs and best interests of the patient and consistent with optimum improvement of the patient’s condition.
(c)
Each person who remains at a receiving or treatment facility for more than 12 hours shall be given a physical examination by a health practitioner authorized by law to give such examinations, within 24 hours after arrival at such facility.
(d)
Every patient in a facility shall be afforded the opportunity to participate in activities designed to enhance self-image and the beneficial effects of other treatments, as determined by the facility.
(e)
Not more than 5 days after admission to a facility, each patient must have and receive an individualized treatment plan in writing which the patient has had an opportunity to assist in preparing and to review before its implementation. The plan must include a space for the patient’s comments. Facilities shall update the treatment plan, including, but not limited to, the physician summary, at least every 30 days during the time a patient is in a receiving or treatment facility, except a patient retained for longer than 24 months shall have updates to his or her treatment plan at least every 60 days.
(3)
RIGHT TO EXPRESS AND INFORMED PATIENT CONSENT.
—
(a)1.
Each patient entering treatment shall be asked to give express and informed consent for admission or treatment. If the patient has been adjudicated incapacitated or found to be incompetent to consent to treatment, express and informed consent to treatment shall be sought instead from the patient’s guardian or guardian advocate. If the patient is a minor, express and informed consent for admission or treatment shall also be requested from the patient’s guardian. Express and informed consent for admission or treatment of a patient under 18 years of age shall be required from the patient’s guardian, unless the minor is seeking outpatient crisis intervention services under s. 394.4784. Express and informed consent for admission or treatment given by a patient who is under 18 years of age shall not be a condition of admission when the patient’s guardian gives express and informed consent for the patient’s admission pursuant to s. 394.463 or s. 394.467.
2.
Before giving express and informed consent, the following information shall be provided and explained in plain language to the patient, or to the patient’s guardian if the patient is 18 years of age or older and has been adjudicated incapacitated, or to the patient’s guardian advocate if the patient has been found to be incompetent to consent to treatment, or to both the patient and the guardian if the patient is a minor: the reason for admission or treatment; the proposed treatment; the purpose of the treatment to be provided; the common risks, benefits, and side effects thereof; the specific dosage range for the medication, when applicable; alternative treatment modalities; the approximate length of care; the potential effects of stopping treatment; how treatment will be monitored; and that any consent given for treatment may be revoked orally or in writing before or during the treatment period by the patient or by a person who is legally authorized to make health care decisions on behalf of the patient.
(b)
In the case of medical procedures requiring the use of a general anesthetic or electroconvulsive treatment, and prior to performing the procedure, express and informed consent shall be obtained from the patient if the patient is legally competent, from the guardian of a minor patient, from the guardian of a patient who has been adjudicated incapacitated, or from the guardian advocate of the patient if the guardian advocate has been given express court authority to consent to medical procedures or electroconvulsive treatment as provided under s. 394.4598.
(c)
When the department is the legal guardian of a patient, or is the custodian of a patient whose physician is unwilling to perform a medical procedure, including an electroconvulsive treatment, based solely on the patient’s consent and whose guardian or guardian advocate is unknown or unlocatable, the court shall hold a hearing to determine the medical necessity of the medical procedure. The patient shall be physically present, unless the patient’s medical condition precludes such presence, represented by counsel, and provided the right and opportunity to be confronted with, and to cross-examine, all witnesses alleging the medical necessity of such procedure. In such proceedings, the burden of proof by clear and convincing evidence shall be on the party alleging the medical necessity of the procedure.
(d)
The administrator of a receiving or treatment facility may, upon the recommendation of the patient’s attending physician, authorize emergency medical treatment, including a surgical procedure, if such treatment is deemed lifesaving, or if the situation threatens serious bodily harm to the patient, and permission of the patient or the patient’s guardian or guardian advocate cannot be obtained.
(4)
QUALITY OF TREATMENT.
—
(a)
Each patient shall receive services, including, for a patient placed under s. 394.4655, those services included in the court order which are suited to his or her needs, and which shall be administered skillfully, safely, and humanely with full respect for the patient’s dignity and personal integrity. Each patient shall receive such medical, vocational, social, educational, and rehabilitative services as his or her condition requires in order to live successfully in the community. In order to achieve this goal, the department is directed to coordinate its mental health programs with all other programs of the department and other state agencies.
(b)
Facilities shall develop and maintain, in a form accessible to and readily understandable by patients and consistent with rules adopted by the department, the following:
1.
Criteria, procedures, and required staff training for any use of close or elevated levels of supervision, of restraint, seclusion, or isolation, or of emergency treatment orders, and for the use of bodily control and physical management techniques.
2.
Procedures for documenting, monitoring, and requiring clinical review of all uses of the procedures described in subparagraph 1. and for documenting and requiring review of any incidents resulting in injury to patients.
3.
A system for investigating, tracking, managing, and responding to complaints by persons receiving services or individuals acting on their behalf.
(c)
A facility may not use seclusion or restraint for punishment, to compensate for inadequate staffing, or for the convenience of staff. Facilities shall ensure that all staff are made aware of these restrictions on the use of seclusion and restraint and shall make and maintain records which demonstrate that this information has been conveyed to individual staff members.
(5)
COMMUNICATION, ABUSE REPORTING, AND VISITS.
—
(a)
Each person receiving services in a facility providing mental health services under this part has the right to communicate freely and privately with persons outside the facility unless a qualified professional determines that such communication is likely to be harmful to the person or others in a manner directly related to the person’s clinical well-being, the clinical well-being of other patients, or the general safety of staff. Each facility shall make available as soon as reasonably possible to persons receiving services a telephone that allows for free local calls and access to a long-distance service. A facility is not required to pay the costs of a patient’s long-distance calls. The telephone shall be readily accessible to the patient and shall be placed so that the patient may use it to communicate privately and confidentially. The facility may establish reasonable rules for the use of this telephone, provided that the rules do not interfere with a patient’s access to a telephone to report abuse pursuant to paragraph (f).
(b)
Each patient admitted to a facility under the provisions of this part shall be allowed to receive, send, and mail sealed, unopened correspondence; and no patient’s incoming or outgoing correspondence shall be opened, delayed, held, or censored by the facility unless a qualified professional determines that such correspondence is likely to be harmful to the patient or others in a manner directly related to the patient’s clinical well-being, the clinical well-being of other patients, or the general safety of staff. If there is reason to believe that such correspondence contains items or substances which may be harmful to the patient or others, the administrator may direct reasonable examination of such mail and may regulate the disposition of such items or substances.
(c)
Each facility must permit immediate access to any patient, subject to the patient’s right to deny or withdraw consent at any time, by the patient’s family members, guardian, guardian advocate, representative, Florida statewide or local advocacy council, or attorney, unless a qualified professional determines that such access would be detrimental to the patient in a manner directly related to the patient’s clinical well-being, the clinical well-being of other patients, or the general safety of staff.
(d)
If a patient’s right to communicate with outside persons; receive, send, or mail sealed, unopened correspondence; or receive visitors is restricted by the facility, a qualified professional must record the restriction and its underlying reasons in the patient’s clinical file within 24 hours. The notice of the restriction must immediately be served on the patient, the patient’s attorney, and the patient’s guardian, guardian advocate, or representative. The restriction of a patient’s right to communicate or to receive visitors shall be reviewed at least every 3 days. The right to communicate or receive visitors shall not be restricted as a means of punishment. Nothing in this paragraph shall be construed to limit the provisions of paragraph (e).
(e)
Each facility shall establish reasonable rules governing visitors, visiting hours, and the use of telephones by patients in the least restrictive possible manner. Patients shall have the right to contact and to receive communication from their attorneys at any reasonable time.
(f)
Each patient receiving mental health treatment in any facility shall have ready access to a telephone in order to report an alleged abuse. The facility staff shall orally and in writing inform each patient of the procedure for reporting abuse and shall make every reasonable effort to present the information in a language the patient understands. A written copy of that procedure, including the telephone number of the central abuse hotline and reporting forms, shall be posted in plain view.
(g)
The department shall adopt rules providing a procedure for reporting abuse. Facility staff shall be required, as a condition of employment, to become familiar with the requirements and procedures for the reporting of abuse.
(6)
CARE AND CUSTODY OF PERSONAL EFFECTS OF PATIENTS.
—
A patient’s right to the possession of his or her clothing and personal effects shall be respected. The facility may take temporary custody of such effects when required for medical and safety reasons. A patient’s clothing and personal effects shall be inventoried upon their removal into temporary custody. Copies of this inventory shall be given to the patient and to the patient’s guardian, guardian advocate, or representative and shall be recorded in the patient’s clinical record. This inventory may be amended upon the request of the patient or the patient’s guardian, guardian advocate, or representative. The inventory and any amendments to it must be witnessed by two members of the facility staff and by the patient, if able. All of a patient’s clothing and personal effects held by the facility shall be returned to the patient immediately upon the discharge or transfer of the patient from the facility, unless such return would be detrimental to the patient. If personal effects are not returned to the patient, the reason must be documented in the clinical record along with the disposition of the clothing and personal effects, which may be given instead to the patient’s guardian, guardian advocate, or representative. As soon as practicable after an emergency transfer of a patient, the patient’s clothing and personal effects shall be transferred to the patient’s new location, together with a copy of the inventory and any amendments, unless an alternate plan is approved by the patient, if able, and by the patient’s guardian, guardian advocate, or representative.
(7)
VOTING IN PUBLIC ELECTIONS.
—
A patient who is eligible to vote according to the laws of the state has the right to vote in the primary and general elections. The department shall establish rules to enable patients to obtain voter registration forms, applications for vote-by-mail ballots, and vote-by-mail ballots.
(8)
HABEAS CORPUS.
—
(a)
At any time, and without notice, a person held in a receiving or treatment facility, or a relative, friend, guardian, guardian advocate, representative, or attorney, or the department, on behalf of such person, may petition for a writ of habeas corpus to question the cause and legality of such detention and request that the court order a return to the writ in accordance with chapter 79. Each patient held in a facility shall receive a written notice of the right to petition for a writ of habeas corpus.
(b)
At any time, and without notice, a person who is a patient in a receiving or treatment facility, or a relative, friend, guardian, guardian advocate, representative, or attorney, or the department, on behalf of such person, may file a petition in the circuit court in the county where the patient is being held alleging that the patient is being unjustly denied a right or privilege granted herein or that a procedure authorized herein is being abused. Upon the filing of such a petition, the court shall have the authority to conduct a judicial inquiry and to issue any order needed to correct an abuse of the provisions of this part.
(c)
The administrator of any receiving or treatment facility receiving a petition under this subsection shall file the petition with the clerk of the court on the next court working day.
(d)
No fee shall be charged for the filing of a petition under this subsection.
(9)
VIOLATIONS.
—
The department shall report to the Agency for Health Care Administration any violation of the rights or privileges of patients, or of any procedures provided under this part, by any facility or professional licensed or regulated by the agency. The agency is authorized to impose any sanction authorized for violation of this part, based solely on the investigation and findings of the department.
(10)
LIABILITY FOR VIOLATIONS.
—
Any person who violates or abuses any rights or privileges of patients provided by this part is liable for damages as determined by law. Any person who acts in good faith in compliance with the provisions of this part is immune from civil or criminal liability for his or her actions in connection with the admission, diagnosis, treatment, or discharge of a patient to or from a facility. However, this section does not relieve any person from liability if such person commits negligence.
(11)
RIGHT TO PARTICIPATE IN TREATMENT AND DISCHARGE PLANNING.
—
The patient shall have the opportunity to participate in treatment and discharge planning and shall be notified in writing of his or her right, upon discharge from the facility, to seek treatment from the professional or agency of the patient’s choice.
(12)
POSTING OF NOTICE OF RIGHTS OF PATIENTS.
—
Each facility shall post a notice listing and describing, in the language and terminology that the persons to whom the notice is addressed can understand, the rights provided in this section. This notice shall include a statement that provisions of the federal Americans with Disabilities Act apply and the name and telephone number of a person to contact for further information. This notice shall be posted in a place readily accessible to patients and in a format easily seen by patients. This notice shall include the telephone numbers of the Florida local advocacy council and Advocacy Center for Persons with Disabilities, Inc.
F.S. 394.460 Rights of professionals.
No professional referred to in this part shall be required to accept patients for treatment of mental, emotional, or behavioral disorders. Such participation shall be voluntary.
F.S. 394.461 Designation of receiving and treatment facilities and receiving systems.
The department is authorized to designate and monitor receiving facilities, treatment facilities, and receiving systems and may suspend or withdraw such designation for failure to comply with this part and rules adopted under this part. The department may issue a conditional designation for up to 60 days to allow the implementation of corrective measures. Unless designated by the department, facilities are not permitted to hold or treat involuntary patients under this part.
(1)
RECEIVING FACILITY.
—
The department may designate any community facility as a receiving facility. Any other facility within the state, including a private facility or a federal facility, may be so designated by the department, provided that such designation is agreed to by the governing body or authority of the facility.
(2)
TREATMENT FACILITY.
—
The department may designate any state-owned, state-operated, or state-supported facility as a state treatment facility. A civil patient shall not be admitted to a state treatment facility without previously undergoing a transfer evaluation. Before the close of the state’s case-in-chief in a hearing for involuntary placement, the state may establish that the transfer evaluation was performed and the document was properly executed by providing the court with a copy of the transfer evaluation. The court may not consider the substantive information in the transfer evaluation unless the evaluator testifies at the hearing. Any other facility, including a private facility or a federal facility, may be designated as a treatment facility by the department, provided that such designation is agreed to by the appropriate governing body or authority of the facility.
(3)
PRIVATE FACILITIES.
—
Private facilities designated as receiving and treatment facilities by the department may provide examination and treatment of involuntary patients, as well as voluntary patients, and are subject to all the provisions of this part.
(4)
REPORTING REQUIREMENTS.
—
(a)
A facility designated as a public receiving or treatment facility under this section shall report to the department on an annual basis the following data, unless these data are currently being submitted to the Agency for Health Care Administration:
1.
Number of licensed beds.
2.
Number of contract days.
3.
Number of admissions by payor class and diagnoses.
4.
Number of bed days by payor class.
5.
Average length of stay by payor class.
6.
Total revenues by payor class.
(b)
For the purposes of this subsection, “payor class” means Medicare, Medicare HMO, Medicaid, Medicaid HMO, private-pay health insurance, private-pay health maintenance organization, private preferred provider organization, the Department of Children and Families, other government programs, self-pay patients, and charity care.
(c)
The data required under this subsection shall be submitted to the department no later than 90 days following the end of the facility’s fiscal year.
(d)
The department shall issue an annual report based on the data required pursuant to this subsection. The report shall include individual facilities’ data, as well as statewide totals. The report shall be posted on the department’s website.
(5)
RECEIVING SYSTEM.
—
The department shall designate as a receiving system one or more facilities serving a defined geographic area developed pursuant to s. 394.4573 which is responsible for assessment and evaluation, both voluntary and involuntary, and treatment, stabilization, or triage for patients who have a mental illness, a substance use disorder, or co-occurring disorders. Any transportation plans developed pursuant to s. 394.462 must support the operation of the receiving system.
(6)
RULES.
—
The department may adopt rules relating to:
(a)
Procedures and criteria for receiving and evaluating facility applications for designation, which may include onsite facility inspection and evaluation of an applicant’s licensing status and performance history, as well as consideration of local service needs.
(b)
Minimum standards consistent with this part that a facility must meet and maintain in order to be designated as a receiving or treatment facility and procedures for monitoring continued adherence to such standards.
(c)
Procedures and criteria for designating receiving systems which may include consideration of the adequacy of services provided by facilities within the receiving system to meet the needs of the geographic area using available resources.
(d)
Procedures for receiving complaints against a designated facility or designated receiving system and for initiating inspections and investigations of facilities or receiving systems alleged to have violated the provisions of this part or rules adopted under this part.
(e)
Procedures and criteria for the suspension or withdrawal of designation as a receiving facility or receiving system.
F.S. 394.462 Transportation.
A transportation plan shall be developed and implemented by each county in collaboration with the managing entity in accordance with this section. A county may enter into a memorandum of understanding with the governing boards of nearby counties to establish a shared transportation plan. When multiple counties enter into a memorandum of understanding for this purpose, the counties shall notify the managing entity and provide it with a copy of the agreement. The transportation plan shall describe methods of transport to a facility within the designated receiving system for individuals subject to involuntary examination under s. 394.463 or involuntary admission under s. 397.6772, s. 397.679, s. 397.6798, or s. 397.6957, and may identify responsibility for other transportation to a participating facility when necessary and agreed to by the facility. The plan may rely on emergency medical transport services or private transport companies, as appropriate. The plan shall comply with the transportation provisions of this section and ss. 397.6772, 397.6795, and 397.697.
(1)
TRANSPORTATION TO A RECEIVING FACILITY.
—
(a)
Each county shall designate a single law enforcement agency within the county, or portions thereof, to take a person into custody upon the entry of an ex parte order or the execution of a certificate for involuntary examination by an authorized professional and to transport that person to the appropriate facility within the designated receiving system pursuant to a transportation plan.
(b)1.
The designated law enforcement agency may decline to transport the person to a receiving facility only if:
a.
The jurisdiction designated by the county has contracted on an annual basis with an emergency medical transport service or private transport company for transportation of persons to receiving facilities pursuant to this section at the sole cost of the county or as otherwise provided in the transportation plan developed by the county; and
b.
The law enforcement agency and the emergency medical transport service or private transport company agree that the continued presence of law enforcement personnel is not necessary for the safety of the person or others.
2.
The entity providing transportation may seek reimbursement for transportation expenses. The party responsible for payment for such transportation is the person receiving the transportation. The county shall seek reimbursement from the following sources in the following order:
a.
From a private or public third-party payor, if the person receiving the transportation has applicable coverage.
b.
From the person receiving the transportation.
c.
From a financial settlement for medical care, treatment, hospitalization, or transportation payable or accruing to the injured party.
(c)
A company that transports a patient pursuant to this subsection is considered an independent contractor and is solely liable for the safe and dignified transport of the patient. Such company must be insured and provide no less than $100,000 in liability insurance with respect to the transport of patients.
(d)
Any company that contracts with a governing board of a county to transport patients shall comply with the applicable rules of the department to ensure the safety and dignity of patients.
(e)
When a law enforcement officer takes custody of a person pursuant to this part, the officer may request assistance from emergency medical personnel if such assistance is needed for the safety of the officer or the person in custody.
(f)
When a member of a mental health overlay program or a mobile crisis response service is a professional authorized to initiate an involuntary examination pursuant to s. 394.463 or s. 397.675 and that professional evaluates a person and determines that transportation to a receiving facility is needed, the service, at its discretion, may transport the person to the facility or may call on the law enforcement agency or other transportation arrangement best suited to the needs of the patient.
(g)
When any law enforcement officer has custody of a person based on either noncriminal or minor criminal behavior that meets the statutory guidelines for involuntary examination pursuant to s. 394.463, the law enforcement officer shall transport the person to the appropriate facility within the designated receiving system pursuant to a transportation plan. Persons who meet the statutory guidelines for involuntary admission pursuant to s. 397.675 may also be transported by law enforcement officers to the extent resources are available and as otherwise provided by law. Such persons shall be transported to an appropriate facility within the designated receiving system pursuant to a transportation plan.
(h)
When any law enforcement officer has arrested a person for a felony and it appears that the person meets the statutory guidelines for involuntary examination or placement under this part, such person must first be processed in the same manner as any other criminal suspect. The law enforcement agency shall thereafter immediately notify the appropriate facility within the designated receiving system pursuant to a transportation plan. The receiving facility shall be responsible for promptly arranging for the examination and treatment of the person. A receiving facility is not required to admit a person charged with a crime for whom the facility determines and documents that it is unable to provide adequate security, but shall provide examination and treatment to the person where he or she is held or by telehealth.
(i)
If the appropriate law enforcement officer believes that a person has an emergency medical condition as defined in s. 395.002, the person may be first transported to a hospital for emergency medical treatment, regardless of whether the hospital is a designated receiving facility.
(j)
The costs of transportation, evaluation, hospitalization, and treatment incurred under this subsection by persons who have been arrested for violations of any state law or county or municipal ordinance may be recovered as provided in s. 901.35.
(k)
The appropriate facility within the designated receiving system pursuant to a transportation plan must accept persons brought by law enforcement officers, or an emergency medical transport service or a private transport company authorized by the county, for involuntary examination pursuant to s. 394.463.
(l)
The appropriate facility within the designated receiving system pursuant to a transportation plan must provide persons brought by law enforcement officers, or an emergency medical transport service or a private transport company authorized by the county, pursuant to s. 397.675, a basic screening or triage sufficient to refer the person to the appropriate services.
(m)
Each law enforcement agency designated pursuant to paragraph (a) shall establish a policy that reflects a single set of protocols for the safe and secure transportation and transfer of custody of the person. Each law enforcement agency shall provide a copy of the protocols to the managing entity.
(n)
When a jurisdiction has entered into a contract with an emergency medical transport service or a private transport company for transportation of persons to facilities within the designated receiving system, such service or company shall be given preference for transportation of persons from nursing homes, assisted living facilities, adult day care centers, or adult family-care homes, unless the behavior of the person being transported is such that transportation by a law enforcement officer is necessary.
(o)
This section may not be construed to limit emergency examination and treatment of incapacitated persons provided in accordance with s. 401.445.
(2)
TRANSPORTATION TO A TREATMENT FACILITY.
—
(a)
If neither the patient nor any person legally obligated or responsible for the patient is able to pay for the expense of transporting a voluntary or involuntary patient to a treatment facility, the transportation plan established by the governing board of the county or counties must specify how the hospitalized patient will be transported to, from, and between facilities in a safe and dignified manner.
(b)
A company that transports a patient pursuant to this subsection is considered an independent contractor and is solely liable for the safe and dignified transportation of the patient. Such company must be insured and provide no less than $100,000 in liability insurance with respect to the transport of patients.
(c)
A company that contracts with one or more counties to transport patients in accordance with this section shall comply with the applicable rules of the department to ensure the safety and dignity of patients.
(d)
County or municipal law enforcement and correctional personnel and equipment may not be used to transport patients adjudicated incapacitated or found by the court to meet the criteria for involuntary services pursuant to s. 394.467, except in small rural counties where there are no cost-efficient alternatives.
(3)
TRANSFER OF CUSTODY.
—
Custody of a person who is transported pursuant to this part, along with related documentation, shall be relinquished to a responsible individual at the appropriate receiving or treatment facility.
F.S. 394.463 Involuntary examination.
(1)
CRITERIA.
—
A person may be taken to a receiving facility for involuntary examination if there is reason to believe that the person has a mental illness and because of his or her mental illness:
(a)1.
The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or
2.
The person is unable to determine for himself or herself whether examination is necessary; and
(b)1.
Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing, able, and responsible family members or friends or the provision of other services; or
2.
There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior.
(2)
INVOLUNTARY EXAMINATION.
—
(a)
An involuntary examination may be initiated by any one of the following means:
1.
A circuit or county court may enter an ex parte order stating that a person appears to meet the criteria for involuntary examination and specifying the findings on which that conclusion is based. The ex parte order for involuntary examination must be based on written or oral sworn testimony that includes specific facts that support the findings. If other less restrictive means are not available, such as voluntary appearance for outpatient evaluation, a law enforcement officer, or other designated agent of the court, must take the person into custody and deliver him or her to an appropriate, or the nearest, facility within the designated receiving system pursuant to s. 394.462 for involuntary examination. The order of the court must be made a part of the patient’s clinical record. A fee may not be charged for the filing of an order under this subsection. A facility accepting the patient based on this order must send a copy of the order to the department within 5 working days. Within 6 hours after the court issues an order, the clerk of the court shall electronically submit the order to the sheriff or a law enforcement agency in the county where the order is to be served. The order is valid only until the person is delivered to the facility or for the period specified in the order itself, whichever comes first. If a time limit is not specified in the order, the order is valid for 7 days after the date that the order was signed.
2.
A law enforcement officer may take a person who appears to meet the criteria for involuntary examination into custody and deliver the person or have him or her delivered to an appropriate, or the nearest, facility within the designated receiving system pursuant to s. 394.462 for examination. A law enforcement officer transporting a person pursuant to this section shall restrain the person in the least restrictive manner available and appropriate under the circumstances. If transporting a minor and the parent or legal guardian of the minor is present, before departing, the law enforcement officer must provide the parent or legal guardian of the minor with the name, address, and contact information for the facility within the designated receiving system to which the law enforcement officer is transporting the minor, subject to any safety and welfare concerns for the minor. The officer shall execute a written report detailing the circumstances under which the person was taken into custody, which must be made a part of the patient’s clinical record. The report must include all emergency contact information for the person that is readily accessible to the law enforcement officer, including information available through electronic databases maintained by the Department of Law Enforcement or by the Department of Highway Safety and Motor Vehicles. Such emergency contact information may be used by a receiving facility only for the purpose of informing listed emergency contacts of a patient’s whereabouts pursuant to s. 119.0712(2)(d). Any facility accepting the patient based on this report must send a copy of the report to the department within 5 working days.
3.
A physician, a physician assistant, a clinical psychologist, a psychiatric nurse, an advanced practice registered nurse registered under s. 464.0123, a mental health counselor, a marriage and family therapist, or a clinical social worker may execute a certificate stating that he or she has examined a person within the preceding 48 hours and finds that the person appears to meet the criteria for involuntary examination and stating the observations upon which that conclusion is based. If other less restrictive means, such as voluntary appearance for outpatient evaluation, are not available, a law enforcement officer must take into custody the person named in the certificate and deliver him or her to the appropriate, or nearest, facility within the designated receiving system pursuant to s. 394.462 for involuntary examination. The law enforcement officer shall execute a written report detailing the circumstances under which the person was taken into custody and include all emergency contact information required under subparagraph 2. Such emergency contact information may be used by a receiving facility only for the purpose of informing listed emergency contacts of a patient’s whereabouts pursuant to s. 119.0712(2)(d). The report and certificate must be made a part of the patient’s clinical record. Any facility accepting the patient based on this certificate must send a copy of the certificate to the department within 5 working days. The document may be submitted electronically through existing data systems, if applicable.
When sending the order, report, or certificate to the department, a facility shall, at a minimum, provide information about which action was taken regarding the patient under paragraph (g), which information must also be made a part of the patient’s clinical record.
(b)
A person may not be removed from any program or residential placement licensed under chapter 400 or chapter 429 and transported to a receiving facility for involuntary examination unless an ex parte order, a professional certificate, or a law enforcement officer’s report is first prepared. If the condition of the person is such that preparation of a law enforcement officer’s report is not practicable before removal, the report shall be completed as soon as possible after removal, but in any case before the person is transported to a receiving facility. A facility admitting a person for involuntary examination who is not accompanied by the required ex parte order, professional certificate, or law enforcement officer’s report shall notify the department of such admission by certified mail or by e-mail, if available, by the next working day. The provisions of this paragraph do not apply when transportation is provided by the patient’s family or guardian.
(c)
A law enforcement officer acting in accordance with an ex parte order issued pursuant to this subsection may:
1.
Serve and execute such order on any day of the week, at any time of the day or night; and
2.
Use such reasonable physical force as is necessary to gain entry to the premises, and any dwellings, buildings, or other structures located on the premises, and take custody of the person who is the subject of the ex parte order. When practicable, a law enforcement officer who has received crisis intervention team (CIT) training shall be assigned to serve and execute the ex parte order.
(d)1.
A law enforcement officer taking custody of a person under this subsection may seize and hold a firearm or any ammunition the person possesses at the time of taking him or her into custody if the person poses a potential danger to himself or herself or others and has made a credible threat of violence against another person.
2.
If the law enforcement officer takes custody of the person at the person’s residence and the criteria in subparagraph 1. have been met, the law enforcement officer may seek the voluntary surrender of firearms or ammunition kept in the residence which have not already been seized under subparagraph 1. If such firearms or ammunition are not voluntarily surrendered, or if the person has other firearms or ammunition that were not seized or voluntarily surrendered when he or she was taken into custody, a law enforcement officer may petition the appropriate court under s. 790.401 for a risk protection order against the person.
3.
Firearms or ammunition seized or voluntarily surrendered under this paragraph must be made available for return no later than 24 hours after the person taken into custody can document that he or she is no longer subject to involuntary examination and has been released or discharged from any inpatient or involuntary outpatient treatment provided or ordered under paragraph (g), unless a risk protection order entered under s. 790.401 directs the law enforcement agency to hold the firearms or ammunition for a longer period or the person is subject to a firearm purchase disability under s. 790.065(2), or a firearm possession and firearm ownership disability under s. 790.064. The process for the actual return of firearms or ammunition seized or voluntarily surrendered under this paragraph may not take longer than 7 days.
4.
Law enforcement agencies must develop policies and procedures relating to the seizure, storage, and return of firearms or ammunition held under this paragraph.
(e)
The department shall receive and maintain the copies of ex parte orders, involuntary services orders issued pursuant to ss. 394.4655 and 394.467, professional certificates, law enforcement officers’ reports, and reports relating to the transportation of patients. These documents shall be considered part of the clinical record, governed by the provisions of s. 394.4615. These documents shall be provided to the Louis de la Parte Florida Mental Health Institute established under s. 1004.44 by the department and used by the institute to prepare annual reports analyzing the data obtained from these documents, without including the personal identifying information of the patient. The information in the reports may include, but need not be limited to, a state level analysis of involuntary examinations, including a description of demographic characteristics of individuals and the geographic locations of involuntary examinations; counts of the number of involuntary examinations at each receiving facility; and reporting and analysis of trends for involuntary examinations within the state. The report shall also include counts of and provide demographic, geographic, and other relevant information about individuals with a developmental disability, as defined in s. 393.063, or a traumatic brain injury or dementia who were taken to a receiving facility for involuntary examination pursuant to this section and determined not to have a co-occurring mental illness. The institute shall post the reports on its website and provide copies of such reports to the department, the President of the Senate, the Speaker of the House of Representatives, and the minority leaders of the Senate and the House of Representatives by November 30 of each year.
(f)
A patient must be examined by a physician or a clinical psychologist, or by a psychiatric nurse performing within the framework of an established protocol with a psychiatrist at a facility without unnecessary delay to determine if the criteria for involuntary services are met. Such examination shall include, but not be limited to, consideration of the patient’s treatment history at the facility and any information regarding the patient’s condition and behavior provided by knowledgeable individuals. Evidence that criteria under subparagraph (1)(b)1. are met may include, but need not be limited to, repeated admittance for involuntary examination despite implementation of appropriate discharge plans. For purposes of this paragraph, the term “repeated admittance” means three or more admissions into the facility within the immediately preceding 12 months. An individual’s basic needs being served while admitted to the facility may not be considered evidence that criteria under subparagraph (1)(b)1. are met. Emergency treatment may be provided upon the order of a physician or a psychiatric nurse practicing within the framework of an established protocol with a psychiatrist if the physician or psychiatric nurse determines that such treatment is necessary for the safety of the patient or others. The patient may not be released by the receiving facility or its contractor without the documented approval of a psychiatrist or a clinical psychologist with at least 3 years of clinical experience or, if the receiving facility is owned or operated by a hospital, health system, or nationally accredited community mental health center, the release may also be approved by a psychiatric nurse performing within the framework of an established protocol with a psychiatrist, or an attending emergency department physician with experience in the diagnosis and treatment of mental illness after completion of an involuntary examination pursuant to this subsection. A psychiatric nurse may not approve the release of a patient if the involuntary examination was initiated by a psychiatrist unless the release is approved by the initiating psychiatrist. The release may be approved through telehealth.
(g)
The examination period must be for up to 72 hours and begins when a patient arrives at the receiving facility. For a minor, the examination shall be initiated within 12 hours after the patient’s arrival at the facility. Within the examination period, one of the following actions must be taken, based on the individual needs of the patient:
1.
The patient shall be released, unless he or she is charged with a crime, in which case the patient shall be returned to the custody of a law enforcement officer;
2.
The patient shall be released, subject to subparagraph 1., for voluntary outpatient treatment;
3.
The patient, unless he or she is charged with a crime, shall be asked to give express and informed consent to placement as a voluntary patient and, if such consent is given, the patient shall be admitted as a voluntary patient; or
4.
A petition for involuntary services shall be filed in the circuit court or with the county court, as applicable. When inpatient treatment is deemed necessary, the least restrictive treatment consistent with the optimum improvement of the patient’s condition shall be made available. The petition shall be filed by one of the petitioners specified in s. 394.467, and the court shall dismiss an untimely filed petition. If a patient’s 72-hour examination period ends on a weekend or holiday, including the hours before the ordinary business hours on the morning of the next working day, and the receiving facility:
a.
Intends to file a petition for involuntary services, such patient may be held at the facility through the next working day thereafter and the petition must be filed no later than such date. If the facility fails to file the petition by the ordinary close of business on the next working day, the patient shall be released from the receiving facility following approval pursuant to paragraph (f).
b.
Does not intend to file a petition for involuntary services, the receiving facility may postpone release of a patient until the next working day thereafter only if a qualified professional documents that adequate discharge planning and procedures in accordance with s. 394.468, and approval pursuant to paragraph (f), are not possible until the next working day.
(h)
A person for whom an involuntary examination has been initiated who is being evaluated or treated at a hospital for an emergency medical condition specified in s. 395.002 must be examined by a facility within the examination period specified in paragraph (g). The examination period begins when the patient arrives at the hospital and ceases when the attending physician documents that the patient has an emergency medical condition. If the patient is examined at a hospital providing emergency medical services by a professional qualified to perform an involuntary examination and is found as a result of that examination not to meet the criteria for involuntary services pursuant to s. 394.467, the patient may be offered voluntary outpatient or inpatient services, if appropriate, or released directly from the hospital providing emergency medical services. The finding by the professional that the patient has been examined and does not meet the criteria for involuntary services must be entered into the patient’s clinical record. This paragraph is not intended to prevent a hospital providing emergency medical services from appropriately transferring a patient to another hospital before stabilization if the requirements of s. 395.1041(3)(c) have been met.
(i)
One of the following must occur within 12 hours after the patient’s attending physician documents that the patient’s medical condition has stabilized or that an emergency medical condition does not exist:
1.
The patient must be examined by a facility and released; or
2.
The patient must be transferred to a designated facility in which appropriate medical treatment is available. However, the facility must be notified of the transfer within 2 hours after the patient’s condition has been stabilized or after determination that an emergency medical condition does not exist. The designated facility may retain the patient for the remainder of the 72-hour examination period under paragraph (g), notwithstanding a failure of the transferring facility to comply with the 12-hour transfer requirement or the 2-hour notice requirement of this paragraph, if the patient continues to meet the criteria for involuntary examination under subsection (1).
(3)
NOTICE OF RELEASE.
—
Notice of the release shall be given to the patient’s guardian or representative, to any person who executed a certificate admitting the patient to the receiving facility, and to any court which ordered the patient’s evaluation. If the patient is a minor, information regarding the availability of a local mobile response service, suicide prevention resources, social supports, and local self-help groups must also be provided to the patient’s guardian or representative along with the notice of the release.
(4)
DATA ANALYSIS.
—
(a)
The department shall provide the data collected under paragraph (2)(a) and s. 1006.07(10), and child welfare data related to involuntary examinations, to the Louis de la Parte Florida Mental Health Institute established under s. 1004.44. The Agency for Health Care Administration shall provide Medicaid data to the institute, requested by the institute, related to involuntary examination of children enrolled in Medicaid for the purpose of administering the program and improving service provision for such children. The department and agency shall enter into any necessary agreements with the institute to provide such data. The institute shall use such data to, at a minimum, analyze data on both the initiation of involuntary examinations of children and the initiation of involuntary examinations of students who are removed from a school; identify any patterns or trends and cases in which involuntary examinations are repeatedly initiated on the same child or student; study root causes for such patterns, trends, or repeated involuntary examinations; and make recommendations to encourage the use of alternatives to eliminate inappropriate initiations of such examinations.
(b)
The institute shall analyze service data on individuals who are high utilizers of crisis stabilization services provided in designated receiving facilities, and shall, at a minimum, identify any patterns or trends and make recommendations to decrease avoidable admissions. Recommendations may be addressed in the department’s contracts with the behavioral health managing entities and in the contracts between the Agency for Health Care Administration and the Medicaid managed medical assistance plans.
(c)
The institute shall publish a report on its findings and recommendations on its website and submit the report to the Governor, the President of the Senate, the Speaker of the House of Representatives, the department, and the Agency for Health Care Administration by November 1 of each odd-numbered year.
(5)
UNLAWFUL ACTIVITIES RELATING TO EXAMINATION AND TREATMENT; PENALTIES.
—
(a)
A person may not knowingly and willfully:
1.
Furnish false information for the purpose of obtaining emergency or other involuntary admission of another;
2.
Cause or otherwise secure, or conspire with or assist another to cause or secure, any emergency or other involuntary procedure of another person under false pretenses; or
3.
Cause, or conspire with or assist another to cause, without lawful justification, the denial to any person of any right accorded pursuant to this chapter.
(b)
A person who violates this subsection commits a misdemeanor of the first degree, punishable as provided in s. 775.082 and by a fine not exceeding $5,000.
F.S. 394.464 Court records; confidentiality.
(1)
All petitions for voluntary and involuntary admission for mental health treatment, court orders, and related records that are filed with or by a court under this part are confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution. Pleadings and other documents made confidential and exempt by this section may be disclosed by the clerk of the court, upon request, to any of the following:
(a)
The petitioner.
(b)
The petitioner’s attorney.
(c)
The respondent.
(d)
The respondent’s attorney.
(e)
The respondent’s guardian or guardian advocate, if applicable.
(f)
In the case of a minor respondent, the respondent’s parent, guardian, legal custodian, or guardian advocate.
(g)
The respondent’s treating health care practitioner.
(h)
The respondent’s health care surrogate or proxy.
(i)
The Department of Children and Families, without charge.
(j)
The Department of Corrections, without charge, if the respondent is committed or is to be returned to the custody of the Department of Corrections from the Department of Children and Families.
(k)
A person or entity authorized to view records upon a court order for good cause. In determining if there is good cause for the disclosure of records, the court must weigh the person or entity’s need for the information against potential harm to the respondent from the disclosure.
(2)
This section does not preclude the clerk of the court from submitting the information required by s. 790.065 to the Department of Law Enforcement.
(3)
The clerk of the court may not publish personal identifying information on a court docket or in a publicly accessible file.
(4)
A person or entity receiving information pursuant to this section shall maintain that information as confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
(5)
The exemption under this section applies to all documents filed with a court before, on, or after July 1, 2019.
F.S. 394.467 Involuntary inpatient placement and involuntary outpatient services.
(1)
DEFINITIONS.
—
As used in this section, the term:
(a)
“Court” means a circuit court or, for commitments only to involuntary outpatient services as defined in paragraph (c), a county court.
(b)
“Involuntary inpatient placement” means placement in a secure receiving or treatment facility providing stabilization and treatment services to a person 18 years of age or older who does not voluntarily consent to services under this chapter, or a minor who does not voluntarily assent to services under this chapter.
(c)
“Involuntary outpatient services” means services provided in the community to a person who does not voluntarily consent to or participate in services under this chapter.
(d)
“Services plan” means an individualized plan detailing the recommended behavioral health services and supports based on a thorough assessment of the needs of the patient, to safeguard and enhance the patient’s health and well-being in the community.
(2)
CRITERIA FOR INVOLUNTARY SERVICES.
—
A person may be ordered by a court to be provided involuntary services upon a finding of the court, by clear and convincing evidence, that the person meets the following criteria:
(a)
Involuntary outpatient services.
—
A person ordered to involuntary outpatient services must meet the following criteria:
1.
The person has a mental illness and, because of his or her mental illness:
a.
He or she is unlikely to voluntarily participate in a recommended services plan and has refused voluntary services for treatment after sufficient and conscientious explanation and disclosure of why the services are necessary; or
b.
Is unable to determine for himself or herself whether services are necessary.
2.
The person is unlikely to survive safely in the community without supervision, based on a clinical determination.
3.
The person has a history of lack of compliance with treatment for mental illness.
4.
In view of the person’s treatment history and current behavior, the person is in need of involuntary outpatient services in order to prevent a relapse or deterioration that would be likely to result in serious bodily harm to himself or herself or others, or a substantial harm to his or her well-being as set forth in s. 394.463(1).
5.
It is likely that the person will benefit from involuntary outpatient services.
6.
All available less restrictive alternatives that would offer an opportunity for improvement of the person’s condition have been deemed to be inappropriate or unavailable.
(b)
Involuntary inpatient placement.
—
A person ordered to involuntary inpatient placement must meet the following criteria:
1.
The person has a mental illness and, because of his or her mental illness:
a.
He or she has refused voluntary inpatient placement for treatment after sufficient and conscientious explanation and disclosure of the purpose of treatment; or
b.
Is unable to determine for himself or herself whether inpatient placement is necessary; and
2.a.
He or she is incapable of surviving alone or with the help of willing, able, and responsible family or friends, including available alternative services, and, without treatment, is likely to suffer from neglect or refuse to care for himself or herself, and such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; or
b.
Without treatment, there is a substantial likelihood that in the near future the person will inflict serious bodily harm on self or others, as evidenced by recent behavior causing, attempting to cause, or threatening to cause such harm; and
3.
All available less restrictive treatment alternatives that would offer an opportunity for improvement of the person’s condition have been deemed to be inappropriate or unavailable.
(3)
RECOMMENDATION FOR INVOLUNTARY SERVICES AND TREATMENT.
—
A patient may be recommended for involuntary inpatient placement, involuntary outpatient services, or a combination of both.
(a)
A patient may be retained by the facility that examined the patient for involuntary services until the completion of the patient’s court hearing upon the recommendation of the administrator of the facility where the patient has been examined and after adherence to the notice and hearing procedures provided in s. 394.4599. However, if a patient who is being recommended for only involuntary outpatient services has been stabilized and no longer meets the criteria for involuntary examination pursuant to s. 394.463(1), the patient must be released from the facility while awaiting the hearing for involuntary outpatient services.
(b)
The recommendation that the involuntary services criteria reasonably appear to have been met must be supported by the opinion of a psychiatrist and the second opinion of a clinical psychologist with at least 3 years of clinical experience, another psychiatrist, or a psychiatric nurse practicing within the framework of an established protocol with a psychiatrist, who personally examined the patient. For involuntary inpatient placement, the patient must have been examined within the preceding 72 hours. For involuntary outpatient services, the patient must have been examined within the preceding 30 days.
(c)
If a psychiatrist, a clinical psychologist with at least 3 years of clinical experience, or a psychiatric nurse practicing within the framework of an established protocol with a psychiatrist is not available to provide a second opinion, the petitioner must certify as such and the second opinion may be provided by a licensed physician who has postgraduate training and experience in diagnosis and treatment of mental illness, a clinical psychologist with less than 3 years of clinical experience, or a psychiatric nurse.
(d)
Any opinion authorized in this subsection may be conducted through a face-to-face or in-person examination, or by electronic means. Recommendations for involuntary services must be entered on a petition for involuntary services, which shall be made a part of the patient’s clinical record. The filing of the petition authorizes the facility to retain the patient pending transfer to a treatment facility or completion of a hearing.
(4)
PETITION FOR INVOLUNTARY SERVICES.
—
(a)
A petition for involuntary services may be filed by:
1.
The administrator of a receiving facility;
2.
The administrator of a treatment facility; or
3.
A service provider who is treating the person being petitioned.
(b)
A petition for involuntary inpatient placement, or inpatient placement followed by outpatient services, must be filed in the court in the county where the patient is located.
(c)
A petition for involuntary outpatient services must be filed in the county where the patient is located, unless the patient is being placed from a state treatment facility, in which case the petition must be filed in the county where the patient will reside.
(d)1.
The petitioner must state in the petition:
a.
Whether the petitioner is recommending inpatient placement, outpatient services, or both.
b.
The length of time recommended for each type of involuntary services.
c.
The reasons for the recommendation.
2.
If recommending involuntary outpatient services, or a combination of involuntary inpatient placement and outpatient services, the petitioner must identify the service provider that has agreed to provide services for the person under an order for involuntary outpatient services, unless he or she is otherwise participating in outpatient psychiatric treatment and is not in need of public financing for that treatment, in which case the individual, if eligible, may be ordered to involuntary treatment pursuant to the existing psychiatric treatment relationship.
3.
When recommending an order to involuntary outpatient services, the petitioner shall prepare a written proposed services plan in consultation with the patient or the patient’s guardian advocate, if appointed, for the court’s consideration for inclusion in the involuntary outpatient services order that addresses the nature and extent of the mental illness and any co-occurring substance use disorder that necessitate involuntary outpatient services. The services plan must specify the likely needed level of care, including the use of medication, and anticipated discharge criteria for terminating involuntary outpatient services. The services in the plan must be deemed clinically appropriate by a physician, clinical psychologist, psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker who consults with, or is employed or contracted by, the service provider. If the services in the proposed services plan are not available, the petitioner may not file the petition. The petitioner must notify the managing entity if the requested services are not available. The managing entity must document such efforts to obtain the requested service. The service provider who accepts the patient for involuntary outpatient services is responsible for the development of a comprehensive treatment plan.
(e)
Each required criterion for the recommended involuntary services must be alleged and substantiated in the petition. A copy of the recommended services plan, if applicable, must be attached to the petition. The court must accept petitions and other documentation with electronic signatures.
(f)
When the petition has been filed, the clerk of the court shall provide copies of the petition and the recommended services plan, if applicable, to the department, the managing entity, the patient, the patient’s guardian or representative, the state attorney, and the public defender or the patient’s private counsel. A fee may not be charged for the filing of a petition under this subsection.
(5)
APPOINTMENT OF COUNSEL.
—
Within 1 court working day after the filing of a petition for involuntary services, the court shall appoint the public defender to represent the person who is the subject of the petition, unless the person is otherwise represented by counsel or ineligible. The clerk of the court shall immediately notify the public defender of such appointment. The public defender shall represent the person until the petition is dismissed, the court order expires, the patient is discharged from involuntary services, or the public defender is otherwise discharged by the court. Any attorney who represents the patient shall be provided access to the patient, witnesses, and records relevant to the presentation of the patient’s case and shall represent the interests of the patient, regardless of the source of payment to the attorney.
(6)
CONTINUANCE OF HEARING.
—
The patient and the state are independently entitled to seek a continuance of the hearing. The patient shall be granted a request for an initial continuance for up to 7 calendar days. The patient may request additional continuances for up to 21 calendar days in total, which shall only be granted by a showing of good cause and due diligence by the patient and the patient’s counsel before requesting the continuance. The state may request one continuance of up to 7 calendar days, which shall only be granted by a showing of good cause and due diligence by the state before requesting the continuance. The state’s failure to timely review any readily available document or failure to attempt to contact a known witness does not warrant a continuance.
(7)
HEARING ON INVOLUNTARY SERVICES.
—
(a)1.
The court shall hold a hearing on the involuntary services petition within 5 court working days after the filing of the petition, unless a continuance is granted.
2.
The court must hold any hearing on involuntary outpatient services in the county where the petition is filed. A hearing on involuntary inpatient placement, or a combination of involuntary inpatient placement and involuntary outpatient services, must be held in the county or the facility, as appropriate, where the patient is located, except for good cause documented in the court file.
3.
A hearing on involuntary services must be as convenient to the patient as is consistent with orderly procedure, and shall be conducted in physical settings not likely to be injurious to the patient’s condition. If the court finds that the patient’s attendance at the hearing is not consistent with the best interests of the patient, or the patient knowingly, intelligently, and voluntarily waives his or her right to be present, and if the patient’s counsel does not object, the court may waive the attendance of the patient from all or any portion of the hearing. The state attorney for the circuit in which the patient is located shall represent the state, rather than the petitioner, as the real party in interest in the proceeding. The facility or service provider shall make the patient’s clinical records available to the state attorney and the patient’s attorney so that the state can evaluate and prepare its case. However, these records shall remain confidential, and the state attorney may not use any record obtained under this part for criminal investigation or prosecution purposes, or for any purpose other than the patient’s civil commitment under this chapter.
(b)
The court may appoint a magistrate to preside at the hearing. The state attorney and witnesses may remotely attend and, as appropriate, testify at the hearing under oath via audio-video teleconference. A witness intending to attend remotely and testify must provide the parties with all relevant documents by the close of business on the day before the hearing. One of the professionals who executed the involuntary services certificate shall be a witness. The patient and the patient’s guardian or representative shall be informed by the court of the right to an independent expert examination. If the patient cannot afford such an examination, the court shall ensure that one is provided, as otherwise provided for by law. The independent expert’s report is confidential and not discoverable, unless the expert is to be called as a witness for the patient at the hearing. The court shall allow testimony from persons, including family members, deemed by the court to be relevant under state law, regarding the person’s prior history and how that prior history relates to the person’s current condition. The testimony in the hearing must be given under oath, and the proceedings must be recorded. The patient may refuse to testify at the hearing.
(c)
At the hearing, the court shall consider testimony and evidence regarding the patient’s competence to consent to services and treatment. If the court finds that the patient is incompetent to consent to treatment, it must appoint a guardian advocate as provided in s. 394.4598.
(8)
ORDERS OF THE COURT.
—
(a)1.
If the court concludes that the patient meets the criteria for involuntary services, the court may order a patient to involuntary inpatient placement, involuntary outpatient services, or a combination of involuntary services depending on the criteria met and which type of involuntary services best meet the needs of the patient. However, if the court orders the patient to involuntary outpatient services, the court may not order the department or the service provider to provide services if the program or service is not available in the patient’s local community, if there is no space available in the program or service for the patient, or if funding is not available for the program or service. The petitioner must notify the managing entity if the requested services are not available. The managing entity must document such efforts to obtain the requested services. A copy of the order must be sent to the managing entity by the service provider within 1 working day after it is received from the court.
2.
The order must specify the nature and extent of the patient’s mental illness and the reasons the appropriate involuntary services criteria are satisfied.
3.
An order for only involuntary outpatient services, involuntary inpatient placement, or of a combination of involuntary services may be for a period of up to 6 months.
4.
An order for a combination of involuntary services must specify the length of time the patient shall be ordered for involuntary inpatient placement and involuntary outpatient services.
5.
The order of the court and the patient’s services plan, if applicable, must be made part of the patient’s clinical record.
(b)
If the court orders a patient into involuntary inpatient placement, the court may order that the patient be retained at a receiving facility while awaiting transfer to a treatment facility; or, if the patient is at a treatment facility, that the patient be retained there or be treated at any other appropriate facility; or that the patient receive services on an involuntary basis for up to 6 months. The court may not order an individual with a developmental disability as defined in s. 393.063 or a traumatic brain injury or dementia who lacks a co-occurring mental illness to be involuntarily placed in a state treatment facility.
(c)
If at any time before the conclusion of a hearing on involuntary services, it appears to the court that the patient instead meets the criteria for involuntary admission or treatment pursuant to s. 397.675, then the court may order the person to be admitted for involuntary assessment pursuant to s. 397.6757. Thereafter, all proceedings are governed by chapter 397.
(d)
The administrator of the petitioning facility or the designated department representative shall provide a copy of the court order and adequate documentation of a patient’s mental illness to the service provider for involuntary outpatient services or the administrator of a treatment facility if the patient is ordered for involuntary inpatient placement. The documentation must include any advance directives made by the patient, a psychiatric evaluation of the patient, and any evaluations of the patient performed by a psychiatric nurse, a clinical psychologist, a marriage and family therapist, a mental health counselor, or a clinical social worker. The administrator of a treatment facility may refuse admission to any patient directed to its facilities on an involuntary basis, whether by civil or criminal court order, who is not accompanied by adequate orders and documentation.
(e)
In cases resulting in an order for involuntary outpatient services, the court shall retain jurisdiction over the case and the parties for entry of further orders as circumstances may require, including, but not limited to, monitoring compliance with treatment or ordering inpatient treatment to stabilize a person who decompensates while under court-ordered outpatient treatment and meets the commitment criteria of this section.
(9)
SERVICES PLAN MODIFICATION.
—
After the order for involuntary outpatient services is issued, the service provider and the patient may modify the services plan as provided by department rule.
(10)
NONCOMPLIANCE WITH INVOLUNTARY OUTPATIENT SERVICES.
—
(a)
If, in the clinical judgment of a physician, a psychiatrist, a clinical psychologist with at least 3 years of clinical experience, or a psychiatric nurse practicing within the framework of an established protocol with a psychiatrist, a patient receiving involuntary outpatient services has failed or has refused to comply with the services plan ordered by the court, and efforts were made to solicit compliance, the service provider must report such noncompliance to the court. The involuntary outpatient services order shall remain in effect unless the service provider determines that the patient no longer meets the criteria for involuntary outpatient services or until the order expires. The service provider must determine whether modifications should be made to the existing services plan and must attempt to continue to engage the patient in treatment. For any material modification of the services plan to which the patient or the patient’s guardian advocate, if applicable, agrees, the service provider shall send notice of the modification to the court. Any material modifications of the services plan which are contested by the patient or the patient’s guardian advocate, if applicable, must be approved or disapproved by the court.
(b)
A county court may not use incarceration as a sanction for noncompliance with the services plan, but it may order an individual evaluated for possible inpatient placement if there is significant, or are multiple instances of, noncompliance.
(11)
PROCEDURE FOR CONTINUED INVOLUNTARY SERVICES.
—
(a)
A petition for continued involuntary services must be filed if the patient continues to meet the criteria for involuntary services.
(b)1.
If a patient receiving involuntary outpatient services continues to meet the criteria for involuntary outpatient services, the service provider must file in the court that issued the initial order for involuntary outpatient services a petition for continued involuntary outpatient services.
2.
If a patient in involuntary inpatient placement continues to meet the criteria for involuntary services and is being treated at a receiving facility, the administrator must, before the expiration of the period the receiving facility is authorized to retain the patient, file in the court that issued the initial order for involuntary inpatient placement, a petition requesting authorization for continued involuntary services. The administrator may petition for inpatient or outpatient services.
3.
If a patient in involuntary inpatient placement continues to meet the criteria for involuntary services and is being treated at a treatment facility, the administrator must, before expiration of the period the treatment facility is authorized to retain the patient, file a petition requesting authorization for continued involuntary services. The administrator may petition for inpatient or outpatient services. Hearings on petitions for continued involuntary services of an individual placed at any treatment facility are administrative hearings and must be conducted in accordance with s. 120.57(1), except that any order entered by the administrative law judge is final and subject to judicial review in accordance with s. 120.68. Orders concerning patients committed after successfully pleading not guilty by reason of insanity are governed by s. 916.15.
4.
The court shall immediately schedule a hearing on the petition to be held within 15 days after the petition is filed.
5.
The existing involuntary services order shall remain in effect until disposition on the petition for continued involuntary services.
(c)
The petition must be accompanied by a statement from the patient’s physician, psychiatrist, psychiatric nurse, or clinical psychologist justifying the request, a brief description of the patient’s treatment during the time he or she was receiving involuntary services, and an individualized plan of continued treatment developed in consultation with the patient or the patient’s guardian advocate, if applicable. If the petition is for involuntary outpatient services, it must comply with the requirements of subparagraph (4)(d)3. When the petition has been filed, the clerk of the court shall provide copies of the petition and the individualized plan of continued services to the department, the patient, the patient’s guardian advocate, the state attorney, and the patient’s private counsel or the public defender.
(d)
Unless a patient is otherwise represented or is ineligible, the public defender of the circuit in which the patient is receiving services shall represent the patient at the hearing on the petition for continued involuntary services.
(e)
Hearings on petitions for continued involuntary outpatient services must be before the court that issued the order for involuntary outpatient services. However, the patient and the patient’s attorney may agree to a period of continued outpatient services without a court hearing.
(f)
Hearings on petitions for continued involuntary inpatient placement in receiving facilities, or involuntary outpatient services following involuntary inpatient services, must be held in the county or the facility, as appropriate, where the patient is located.
(g)
The court may appoint a magistrate to preside at the hearing. The procedures for obtaining an order pursuant to this paragraph must meet the requirements of subsection (7).
(h)
Notice of the hearing must be provided as set forth in s. 394.4599.
(i)
If a patient’s attendance at the hearing is voluntarily waived, the court or the administrative law judge must determine that the patient knowingly, intelligently, and voluntarily waived his or her right to be present, before waiving the presence of the patient from all or a portion of the hearing. Alternatively, if at the hearing the court or the administrative law judge finds that attendance at the hearing is not consistent with the best interests of the patient, the court or the administrative law judge may waive the presence of the patient from all or any portion of the hearing, unless the patient, through counsel, objects to the waiver of presence. The testimony in the hearing must be under oath, and the proceedings must be recorded.
(j)
If at a hearing it is shown that the patient continues to meet the criteria for involuntary services, the court or the administrative law judge shall issue an order for continued involuntary outpatient services, involuntary inpatient placement, or a combination of involuntary services for up to 6 months, as applicable. The same procedure shall be repeated before the expiration of each additional period the patient is retained.
(k)
If the patient has been ordered to undergo involuntary services and has previously been found incompetent to consent to treatment, the court shall consider testimony and evidence regarding the patient’s competence. If the patient’s competency to consent to treatment is restored, the discharge of the guardian advocate is governed by s. 394.4598. If the patient has been ordered to undergo involuntary inpatient placement only and the patient’s competency to consent to treatment is restored, the administrative law judge may issue a recommended order, to the court that found the patient incompetent to consent to treatment, that the patient’s competence be restored and that any guardian advocate previously appointed be discharged.
(l)
If continued involuntary inpatient placement is necessary for a patient in involuntary inpatient placement who was admitted while serving a criminal sentence, but his or her sentence is about to expire, or for a minor involuntarily placed, but who is about to reach the age of 18, the administrator shall petition the administrative law judge for an order authorizing continued involuntary inpatient placement.
The procedure required in this subsection must be followed before the expiration of each additional period the patient is involuntarily receiving services.
(12)
RETURN TO FACILITY.
—
If a patient has been ordered to undergo involuntary inpatient placement at a receiving or treatment facility under this part and leaves the facility without the administrator’s authorization, the administrator may authorize a search for the patient and his or her return to the facility. The administrator may request the assistance of a law enforcement agency in this regard.
(13)
DISCHARGE.
—
The patient shall be discharged upon expiration of the court order or at any time the patient no longer meets the criteria for involuntary services, unless the patient has transferred to voluntary status. Upon discharge, the service provider or facility shall send a certificate of discharge to the court.
F.S. 394.468 Admission and discharge procedures.
(1)
Admission and discharge procedures and treatment policies of the department are governed solely by this part. Such procedures and policies shall not be subject to control by court procedure rules. The matters within the purview of this part are deemed to be substantive, not procedural.
(2)
Discharge planning and procedures for any patient’s release from a receiving facility or treatment facility must include and document the patient’s needs, and actions to address such needs, for, at a minimum:
(a)
Followup behavioral health appointments;
(b)
Information on how to obtain prescribed medications, including, but not limited to, administration of long-acting injectable medications. The discharge plan must address any barriers faced by the patient to accessing long-acting injectable medications after discharge if such medication is part of the patient’s plan;
(c)
Information pertaining to:
1.
Available living arrangements.
2.
Transportation;
(d)
Referral to:
1.
Care coordination services. The patient must be referred for care coordination services if the patient meets the criteria as a member of a priority population as determined by the department under s. 394.9082(3)(c) and is in need of such services.
2.
Recovery support opportunities under s. 394.4573(2)(l), including, but not limited to, connection to a peer specialist; and
(e)
Administration of long-acting injectable medication before discharge if such medication is available to treat the patient’s diagnosed behavioral health condition and is clinically appropriate for the patient.
(3)
During the discharge transition process and while the patient is present unless determined inappropriate by a physician or psychiatric nurse practicing within the framework of an established protocol with a psychiatrist a receiving facility shall coordinate, face to face or through electronic means, discharge plans to a less restrictive community behavioral health provider, a peer specialist, a case manager, or a care coordination service. The transition process must, at a minimum, include all of the following criteria:
(a)
Implementation of policies and procedures outlining strategies for how the receiving facility will comprehensively address the needs of patients who demonstrate a high use of receiving facility services to avoid or reduce future use of crisis stabilization services. For any such patient, policies and procedures must include, at a minimum, a review of the effectiveness of previous discharge plans created by the facility for the patient, and the new discharge plan must address problems experienced with implementation of previous discharge plans.
(b)
Developing and including in discharge paperwork a personalized crisis prevention plan that identifies stressors, early warning signs or symptoms, and strategies to deal with crisis.
(c)
Requiring a staff member to seek to engage a family member, legal guardian, legal representative, or natural support in discharge planning and meet face to face or through electronic means to review the discharge instructions, including prescribed medications, follow-up appointments, and any other recommended services or follow-up resources, and document the outcome of such meeting.
When the recommended level of care at discharge is not immediately available to the patient, the receiving facility must, at a minimum, initiate a referral to an appropriate provider to meet the needs of the patient to continue care until the recommended level of care is available.
F.S. 394.469 Discharge of involuntary patients.
(1)
POWER TO DISCHARGE.
—
At any time a patient is found to no longer meet the criteria for involuntary placement, the administrator shall:
(a)
Discharge the patient, unless the patient is under a criminal charge, in which case the patient shall be transferred to the custody of the appropriate law enforcement officer;
(b)
Transfer the patient to voluntary status on his or her own authority or at the patient’s request, unless the patient is under criminal charge or adjudicated incapacitated; or
(c)
Place an improved patient, except a patient under a criminal charge, on convalescent status in the care of a community facility.
(2)
NOTICE.
—
Notice of discharge or transfer of a patient shall be given as provided in s. 394.4599.
F.S. 394.473 Attorney’s fee; expert witness fee.
(1)
In the case of an indigent person for whom an attorney is appointed pursuant to the provisions of this part, the attorney shall be compensated by the state pursuant to s. 27.5304. In the case of an indigent person, the court may appoint a public defender. The public defender shall receive no additional compensation other than that usually paid his or her office.
(2)
In the case of an indigent person for whom expert testimony is required in a court hearing pursuant to the provisions of this act, the expert, except one who is classified as a full-time employee of the state or who is receiving remuneration from the state for his or her time in attendance at the hearing, shall be compensated by the state pursuant to s. 27.5304.
F.S. 394.475 Acceptance, examination, and involuntary placement of Florida residents from out-of-state mental health authorities.
(1)
Upon the request of the state mental health authority of another state, the department is authorized to accept as a patient, for a period of not more than 15 days, a person who is and has been a bona fide resident of this state for a period of not less than 1 year.
(2)
Any person received pursuant to subsection (1) shall be examined by the staff of the state facility where such patient has been accepted, which examination shall be completed during the 15-day period.
(3)
If upon examination such a person requires continued involuntary placement, a petition for a hearing regarding involuntary placement shall be filed with the court of the county wherein the treatment facility receiving the patient is located or the county where the patient is a resident.
(4)
During the pendency of the examination period and the pendency of the involuntary placement proceedings, such person may continue to be held in the treatment facility unless the court having jurisdiction enters an order to the contrary.
F.S. 394.479 Interstate Compact on Mental Health.
The Interstate Compact on Mental Health is hereby enacted into law and entered into by this state with all other states legally joining therein in the form substantially as follows:
INTERSTATE COMPACT ON MENTAL HEALTH
The contracting states solemnly agree that:
ARTICLE I
The party states find that the proper and expeditious treatment of the mentally ill and mentally deficient can be facilitated by cooperative action, to the benefit of the patients, their families, and society as a whole. Further, the party states find that the necessity of and desirability for furnishing such care and treatment bears no primary relation to the residence or citizenship of the patient but that, on the contrary, the controlling factors of community safety and humanitarianism require that facilities and services be made available for all who are in need of them. Consequently, it is the purpose of this compact and of the party states to provide the necessary legal basis for the institutionalization or other appropriate care and treatment of the mentally ill and mentally deficient under a system that recognizes the paramount importance of patient welfare and to establish the responsibilities of the party states in terms of such welfare.
ARTICLE II
As used in this compact:
(a) “Sending state” shall mean a party state from which a patient is transported pursuant to the provisions of the compact or from which it is contemplated that a patient may be so sent.
(b) “Receiving state” shall mean a party state to which a patient is transported pursuant to the provisions of the compact or to which it is contemplated that a patient may be so sent.
(c) “Institution” shall mean any hospital or other facility maintained by a party state or political subdivision thereof for the care and treatment of mental illness or mental deficiency.
(d) “Patient” shall mean any person subject to or eligible as determined by the laws of the sending state, for institutionalization or other care, treatment, or supervision pursuant to the provisions of this compact.
(e) “Aftercare” shall mean care, treatment, and services provided a patient, as defined herein, on convalescent status or conditional release.
(f) “Mental illness” shall mean mental disease to such extent that a person so afflicted requires care and treatment for his or her own welfare, or the welfare of others, or of the community.
(g) “Mental deficiency” shall mean mental deficiency as defined by appropriate clinical authorities to such extent that a person so afflicted is incapable of managing himself or herself and his or her affairs, but shall not include mental illness as defined herein.
(h) “State” shall mean any state, territory or possession of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.
ARTICLE III
(a) Whenever a person physically present in any party state shall be in need of institutionalization by reason of mental illness or mental deficiency, he or she shall be eligible for care and treatment in an institution in that state irrespective of his or her residence, settlement or citizenship qualifications.
(b) The provisions of paragraph (a) of this article to the contrary notwithstanding, any patient may be transferred to an institution in another state whenever there are factors based upon clinical determinations indicating that the care and treatment of said patient would be facilitated or improved thereby. Any such institutionalization may be for the entire period of care and treatment or for any portion or portions thereof. The factors referred to in this paragraph shall include the patient’s full record with due regard for the location of the patient’s family, character of the illness and probable duration thereof, and such other factors as shall be considered appropriate.
(c) No state shall be obliged to receive any patient pursuant to the provisions of paragraph (b) of this article unless the sending state has given advance notice of its intention to send the patient; furnished all available medical and other pertinent records concerning the patient; given the qualified medical or other appropriate clinical authorities of the receiving state an opportunity to examine the patient if said authorities so wish; and unless the receiving state shall agree to accept the patient.
(d) In the event that the laws of the receiving state establish a system of priorities for the admission of patients, an interstate patient under this compact shall receive the same priority as a local patient and shall be taken in the same order and at the same time that he or she would be taken if he or she were a local patient.
(e) Pursuant to this compact, the determination as to the suitable place of institutionalization for a patient may be reviewed at any time and such further transfer of the patient may be made as seems likely to be in the best interest of the patient.
ARTICLE IV
(a) Whenever, pursuant to the laws of the state in which a patient is physically present, it shall be determined that the patient should receive aftercare or supervision, such care or supervision may be provided in a receiving state. If the medical or other appropriate clinical authorities having responsibility for the care and treatment of the patient in the sending state shall have reason to believe that aftercare in another state would be in the best interest of the patient and would not jeopardize the public safety, they shall request the appropriate authorities in the receiving state to investigate the desirability of affording the patient such aftercare in said receiving state, and such investigation shall be made with all reasonable speed. The request for investigation shall be accompanied by complete information concerning the patient’s intended place of residence and the identity of the person in whose charge it is proposed to place the patient, the complete medical history of the patient, and such other documents as may be pertinent.
(b) If the medical or other appropriate clinical authorities having responsibility for the care and treatment of the patient in the sending state and the appropriate authorities in the receiving state find that the best interest of the patient would be served thereby, and if the public safety would not be jeopardized thereby, the patient may receive aftercare or supervision in the receiving state.
(c) In supervising, treating, or caring for a patient on aftercare pursuant to the terms of this article, a receiving state shall employ the same standards of visitation, examination, care, and treatment that it employs for similar local patients.
ARTICLE V
Whenever a dangerous or potentially dangerous patient escapes from an institution in any party state, that state shall promptly notify all appropriate authorities within and without the jurisdiction of the escape in a manner reasonably calculated to facilitate the speedy apprehension of the escapee. Immediately upon the apprehension and identification of any such dangerous or potentially dangerous patient, he or she shall be detained in the state where found pending disposition in accordance with law.
ARTICLE VI
The duly accredited officers of any state party to this compact, upon the establishment of their authority and the identity of the patient, shall be permitted to transport any patient being moved pursuant to this compact through any and all states party to this compact, without interference.
ARTICLE VII
(a) No person shall be deemed a patient of more than one institution at any given time. Completion of transfer of any patient to an institution in a receiving state shall have the effect of making the person a patient of the institution in the receiving state.
(b) The sending state shall pay all costs of, and incidental to, the transportation of any patient pursuant to this compact, but any two or more party states may, by making a specific agreement for that purpose, arrange for a different allocation of costs as among themselves.
(c) No provision of this compact shall be construed to alter or affect any internal relationships among the departments, agencies and officers of and in the government of a party state, or between a party state and its subdivisions, as to the payment of costs, or responsibilities therefor.
(d) Nothing in this compact shall be construed to prevent any party state or subdivision thereof from asserting any right against any person, agency or other entity in regard to costs for which such party state or subdivision thereof may be responsible pursuant to any provision of this compact.
(e) Nothing in this compact shall be construed to invalidate any reciprocal agreement between a party state and a nonparty state relating to institutionalization, care or treatment of the mentally ill or mentally deficient, or any statutory authority pursuant to which such agreements may be made.
ARTICLE VIII
(a) Nothing in this compact shall be construed to abridge, diminish, or in any way impair the rights, duties, and responsibilities of any patient’s guardian on his or her own behalf or in respect of any patient for whom he or she may serve, except that where the transfer of any patient to another jurisdiction makes advisable the appointment of a supplemental or substitute guardian, any court of competent jurisdiction in the receiving state may make such supplemental or substitute appointment and the court which appointed the previous guardian shall upon being duly advised of the new appointment, and upon the satisfactory completion of such accounting and other acts as such court may by law require, relieve the previous guardian of power and responsibility to whatever extent shall be appropriate in the circumstances; provided, however, that in the case of any patient having settlement in the sending state, the court of competent jurisdiction in the sending state shall have the sole discretion to relieve a guardian appointed by it or continue his or her power and responsibility, whichever it shall deem advisable. The court in the receiving state may, in its discretion, confirm or reappoint the person or persons previously serving as guardian in the sending state in lieu of making a supplemental or substitute appointment.
(b) The term “guardian” as used in paragraph (a) of this article shall include any guardian, trustee, legal committee, conservator, or other person or agency however denominated who is charged by law with power to act for or responsibility for the person or property of a patient.
ARTICLE IX
(a) No provision of this compact except Article V shall apply to any person institutionalized while under sentence in a penal or correctional institution or while subject to trial on a criminal charge, or whose institutionalization is due to the commission of an offense for which, in the absence of mental illness or mental deficiency, said person would be subject to incarceration in a penal or correctional institution.
(b) To every extent possible, it shall be the policy of states party to this compact that no patient shall be placed or detained in any prison, jail or lockup, but such patient shall, with all expedition, be taken to a suitable institutional facility for mental illness or mental deficiency.
ARTICLE X
(a) Each party state shall appoint a “compact administrator” who, on behalf of his or her state, shall act as general coordinator of activities under the compact in his or her state and who shall receive copies of all reports, correspondence, and other documents relating to any patient processed under the compact by his or her state either in the capacity of sending or receiving state. The compact administrator or his or her duly designated representative shall be the official with whom other party states shall deal in any matter relating to the compact or any patient processed thereunder.
(b) The compact administrators of the respective party states shall have power to promulgate reasonable rules and regulations to carry out more effectively the terms and provisions of this compact.
ARTICLE XI
The duly constituted administrative authorities of any two or more party states may enter into supplementary agreements for the provision of any service or facility or for the maintenance of any institution on a joint or cooperative basis whenever the states concerned shall find that such agreements will improve services, facilities, or institutional care and treatment in the fields of mental illness or mental deficiency. No such supplementary agreement shall be construed so as to relieve any party state of any obligation which it otherwise would have under other provisions of this compact.
ARTICLE XII
This compact shall enter into full force and effect as to any state when enacted by it into law and such state shall thereafter be a party thereto with any and all states legally joining therein.
ARTICLE XIII
(a) A state party to this compact may withdraw therefrom by enacting a statute repealing the same. Such withdrawal shall take effect one year after notice thereof has been communicated officially and in writing to the governors and compact administrators of all other party states. However, the withdrawal of any state shall not change the status of any patient who has been sent to said state or sent out of said state pursuant to the provisions of the compact.
(b) Withdrawal from any agreement permitted by Article VII(b) as to costs or from any supplementary agreement made pursuant to Article XI shall be in accordance with the terms of such agreement.
ARTICLE XIV
This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable and if any phrase, clause, sentence or provision of this compact is declared to be contrary to the constitution of any party state or of the United States or the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person or circumstance shall not be affected thereby. If this compact shall be held contrary to the constitution of any state party thereto, the compact shall remain in full force and effect as to the remaining states and in full force and effect as to the state affected as to all severable matters.
F.S. 394.480 Compact administrator.
Pursuant to said compact, the Secretary of Children and Families shall be the compact administrator who, acting jointly with like officers of other party states, shall have power to promulgate rules and regulations to carry out more effectively the terms of the compact. The compact administrator is hereby authorized, empowered, and directed to cooperate with all departments, agencies, and officers of and in the government of this state and its subdivisions in facilitating the proper administration of the compact of any supplementary agreement or agreements entered into by this state thereunder.
F.S. 394.481 Supplemental agreements with other states.
The compact administrator is hereby authorized and empowered to enter into supplementary agreements with appropriate officials of other states pursuant to Articles VII and XI of the compact. In the event that such supplementary agreements shall require or contemplate the use of any institution or facility of this state or require or contemplate the provision of any service by this state, no such agreement shall have force or effect until approved by the head of the department or agency under whose jurisdiction said institution or facility is operated or whose department or agency will be charged with the rendering of such service.
F.S. 394.482 Payment of financial obligations imposed by compact.
The compact administrator, subject to the approval of the Chief Financial Officer, may make or arrange for any payments necessary to discharge any financial obligations imposed upon this state by the compact or by any supplementary agreement entered into thereunder.
F.S. 394.483 Authorized actions by administrator.
The compact administrator is hereby directed to consult with the immediate family representatives or guardian of any proposed transferee and, in the case of a proposed transferee from an institution in this state to an institution in another party state, to take no final action without approval of the committing court, if any.
F.S. 394.484 Transmission of copies of act adopting compact.
Copies of this act shall upon its approval be transmitted by the Department of State to the governor of each state, the Attorney General and the Administrator of General Services of the United States, and the Council of State Governments.
F.S. 394.490 Short title.
Sections 394.490-394.497 may be cited as the “Comprehensive Child and Adolescent Mental Health Services Act.”
F.S. 394.491 Guiding principles for the child and adolescent mental health treatment and support system.
It is the intent of the Legislature that the following principles guide the development and implementation of the publicly funded child and adolescent mental health treatment and support system:
(1)
The system should be centered on the child, adolescent, and family, with the needs and strengths of the child or adolescent and his or her family dictating the types and mix of services provided.
(2)
The families and surrogate families of children and adolescents, including, but not limited to, foster parents, should be active participants in all aspects of planning, selecting, and delivering mental health treatment services at the local level, as well as in developing statewide policies for child and adolescent mental health services.
(3)
The system of care should be community based, with accountability, the location of services, and the responsibility for management and decisionmaking resting at the local level.
(4)
The system should provide timely access to a comprehensive array of cost-effective mental health treatment and support services.
(5)
Children and adolescents who receive services should receive individualized services, guided by an individualized service plan, in accordance with the unique needs and strengths of each child or adolescent and his or her family.
(6)
Through an appropriate screening and assessment process, treatment and support systems should identify, as early as possible, children and adolescents who are in need of mental health services and should target known risk factors.
(7)
Children and adolescents should receive services within the least restrictive and most normal environment that is clinically appropriate for the service needs of the child or adolescent.
(8)
Mental health programs and services should support and strengthen families so that the family can more adequately meet the mental health needs of the family’s child or adolescent.
(9)
Children and adolescents should receive services that are integrated and linked with schools, residential child-caring agencies, and other child-related agencies and programs.
(10)
Services must be delivered in a coordinated manner so that a child or adolescent can move through the system of services in accordance with the changing needs of the child or adolescent.
(11)
The delivery of comprehensive child and adolescent mental health services must enhance the likelihood of positive outcomes and contribute to the child’s or adolescent’s ability to function effectively at home, at school, and in the community.
(12)
An older adolescent should be provided with the necessary supports and skills in preparation for coping with life as a young adult.
(13)
An adolescent should be assured a smooth transition to the adult mental health system for continuing age-appropriate treatment services.
(14)
Community-based networks must educate people to recognize emotional disturbances in children and adolescents and provide information for obtaining access to appropriate treatment and support services.
(15)
Mental health services for children and adolescents must be provided in a sensitive manner that is responsive to cultural and gender differences and special needs. Mental health services must be provided without regard to race, religion, national origin, gender, physical disability, or other characteristics.
F.S. 394.492 Definitions.
As used in ss. 394.490-394.497, the term:
(1)
“Adolescent” means a person who is at least 13 years of age but under 18 years of age.
(2)
“Case manager” means a person who is responsible for participating in the development of and implementing a services plan, linking service providers to a child or adolescent and his or her family, monitoring the delivery of services, providing advocacy services, and collecting information to determine the effect of services and treatment.
(3)
“Child” means a person from birth until the person’s 13th birthday.
(4)
“Child or adolescent at risk of emotional disturbance” means a person under 18 years of age who has an increased likelihood of becoming emotionally disturbed because of risk factors that include, but are not limited to:
(a)
Being homeless.
(b)
Having a family history of mental illness.
(c)
Being physically or sexually abused or neglected.
(d)
Abusing alcohol or other substances.
(e)
Being infected with human immunodeficiency virus (HIV).
(f)
Having a chronic and serious physical illness.
(g)
Having been exposed to domestic violence.
(h)
Having multiple out-of-home placements.
(5)
“Child or adolescent who has an emotional disturbance” means a person under 18 years of age who is diagnosed with a mental, emotional, or behavioral disorder of sufficient duration to meet one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, but who does not exhibit behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community. The emotional disturbance must not be considered to be a temporary response to a stressful situation. The term does not include a child or adolescent who meets the criteria for involuntary placement under s. 394.467(1).
(6)
“Child or adolescent who has a serious emotional disturbance or mental illness” means a person under 18 years of age who:
(a)
Is diagnosed as having a mental, emotional, or behavioral disorder that meets one of the diagnostic categories specified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association; and
(b)
Exhibits behaviors that substantially interfere with or limit his or her role or ability to function in the family, school, or community, which behaviors are not considered to be a temporary response to a stressful situation.
The term includes a child or adolescent who meets the criteria for involuntary placement under s. 394.467(1).
(7)
“Child or adolescent who is experiencing an acute mental or emotional crisis” means a child or adolescent who experiences a psychotic episode or a high level of mental or emotional distress which may be precipitated by a traumatic event or a perceived life problem for which the individual’s typical coping strategies are inadequate. The term includes a child or adolescent who meets the criteria for involuntary examination specified in s. 394.463(1).
(8)
“Department” means the Department of Children and Families.
F.S. 394.493 Target populations for child and adolescent mental health services funded through the department.
(1)
The child and adolescent mental health system of care funded through the Department of Children and Families shall serve, to the extent that resources are available, the following groups of children and adolescents who reside with their parents or legal guardians or who are placed in state custody:
(a)
Children and adolescents who are experiencing an acute mental or emotional crisis.
(b)
Children and adolescents who have a serious emotional disturbance or mental illness.
(c)
Children and adolescents who have an emotional disturbance.
(d)
Children and adolescents who are at risk of emotional disturbance.
(2)
Each mental health provider under contract with the department to provide mental health services to the target population shall collect fees from the parent or legal guardian of the child or adolescent receiving services. The fees shall be based on a sliding fee scale for families whose net family income is at or above 150 percent of the Federal Poverty Income Guidelines. The department shall adopt, by rule, a sliding fee scale for statewide implementation. Fees collected from families shall be retained in the service district and used for expanding child and adolescent mental health treatment services.
(3)
Each child or adolescent who meets the target population criteria of this section shall be served to the extent possible within available resources and consistent with the portion of the district substance abuse and mental health plan specified in s. 394.75 which pertains to child and adolescent mental health services.
(4)
Beginning with fiscal year 2020-2021 through fiscal year 2021-2022, the department and the Agency for Health Care Administration shall identify children and adolescents who are the highest utilizers of crisis stabilization services. The department and agency shall collaboratively take appropriate action within available resources to meet the behavioral health needs of such children and adolescents more effectively, and shall jointly submit to the Legislature a quarterly report listing the actions taken by both agencies to better serve such children and adolescents.
F.S. 394.494 General performance outcomes for the child and adolescent mental health treatment and support system.
(1)
It is the intent of the Legislature that the child and adolescent mental health treatment and support system achieve the following performance outcomes within the target populations who are eligible for services:
(a)
Stabilization or improvement of the emotional condition or behavior of the child or adolescent, as evidenced by resolving the presented problems and symptoms of the serious emotional disturbance recorded in the initial assessment.
(b)
Stabilization or improvement of the behavior or condition of the child or adolescent with respect to the family, so that the child or adolescent can function in the family with minimum appropriate supports.
(c)
Stabilization or improvement of the behavior or condition of the child or adolescent with respect to school, so that the child can function in the school with minimum appropriate supports.
(d)
Stabilization or improvement of the behavior or condition of the child or adolescent with respect to the way he or she interacts in the community, so that the child or adolescent can avoid behaviors that may be attributable to the emotional disturbance, such as substance abuse, unintended pregnancy, delinquency, sexually transmitted diseases, and other negative consequences.
(2)
Annually, pursuant to former s. 216.0166, the department shall develop more specific performance outcomes and performance measures to assess the performance of the child and adolescent mental health treatment and support system in achieving the intent of this section.
F.S. 394.495 Child and adolescent mental health system of care; programs and services.
(1)
The department shall establish, within available resources, an array of services to meet the individualized service and treatment needs of children and adolescents who are members of the target populations specified in s. 394.493, and of their families. It is the intent of the Legislature that a child or adolescent may not be admitted to a state mental health facility and such a facility may not be included within the array of services.
(2)
The array of services must include assessment services that provide a professional interpretation of the nature of the problems of the child or adolescent and his or her family; family issues that may impact the problems; additional factors that contribute to the problems; and the assets, strengths, and resources of the child or adolescent and his or her family. The assessment services to be provided must be determined by the clinical needs of each child or adolescent. Assessment tools used must, at a minimum, include the use of the most recent version of the Daily Living Activities-20 (DLA-20) functional assessment tool, unless the department specifies in rule the use of a different assessment tool. Assessment services include, but are not limited to, evaluation and screening in the following areas:
(a)
Physical and mental health for purposes of identifying medical and psychiatric problems.
(b)
Psychological functioning, as determined through a battery of psychological tests.
(c)
Intelligence and academic achievement.
(d)
Social and behavioral functioning.
(e)
Family functioning.
The assessment for academic achievement is the financial responsibility of the school district. The department shall cooperate with other state agencies and the school district to avoid duplicating assessment services.
(3)
Assessments must be performed by:
(a)
A clinical psychologist, clinical social worker, physician, psychiatric nurse, or psychiatrist, as those terms are defined in s. 394.455;
(b)
A professional licensed under chapter 491; or
(c)
A person who is under the direct supervision of a clinical psychologist, clinical social worker, physician, psychiatric nurse, or psychiatrist, as those terms are defined in s. 394.455, or a professional licensed under chapter 491.
(4)
The array of services may include, but is not limited to:
(a)
Prevention services.
(b)
Home-based services.
(c)
School-based services.
(d)
Family therapy.
(e)
Family support.
(f)
Respite services.
(g)
Outpatient treatment.
(h)
Day treatment.
(i)
Crisis stabilization.
(j)
Therapeutic foster care.
(k)
Residential treatment.
(l)
Inpatient hospitalization.
(m)
Case management.
(n)
Services for victims of sex offenses.
(o)
Transitional services.
(p)
Trauma-informed services for children who have suffered sexual exploitation as defined in s. 39.01(80)(g).
(q)
Crisis response services provided through mobile response teams.
(5)
In order to enhance collaboration between agencies and to facilitate the provision of services by the child and adolescent mental health treatment and support system and the school district:
(a)
The local child and adolescent mental health system of care shall include the local educational multiagency network for severely emotionally disturbed students specified in s. 1006.04.
(b)
The department, in consultation with the Department of Education, shall biennially review school-based behavioral health access in the state through telehealth, with an emphasis on underserved and rural communities. The review shall, at a minimum, assess gaps in the provision of school-based behavioral health services, the extent of use of telehealth for school-based behavioral health services, barriers to use and expansion of such telehealth services, and recommendations to address barriers and any implementation requirements. The review shall also identify any new models for increasing school-based behavioral health access. The Department of Children and Families shall submit to the Governor, the President of the Senate, and the Speaker of the House of Representatives its findings by January 1, beginning in 2026. This subsection expires June 30, 2030, unless reenacted by the Legislature.
(6)
The department shall contract for community action treatment teams throughout the state with the managing entities. A community action treatment team shall:
(a)
Provide community-based behavioral health and support services to children from 11 to 13 years of age, adolescents, and young adults from 18 to 21 years of age with serious behavioral health conditions who are at risk of out-of-home placement as demonstrated by:
1.
Repeated failures at less intensive levels of care;
2.
Two or more behavioral health hospitalizations;
3.
Involvement with the Department of Juvenile Justice;
4.
A history of multiple episodes involving law enforcement; or
5.
A record of poor academic performance or suspensions.
Children younger than 11 years of age who otherwise meet the criteria in this paragraph may be candidates for such services if they demonstrate two or more of the characteristics listed in subparagraphs 1.-5.
(b)
Use an integrated service delivery approach to comprehensively address the needs of the child, adolescent, or young adult and strengthen his or her family and support systems to assist the child, adolescent, or young adult to live successfully in the community. A community action treatment team shall address the therapeutic needs of the child, adolescent, or young adult receiving services and assist parents and caregivers in obtaining services and support. The community action treatment team shall make referrals to specialized treatment providers if necessary, with follow up by the community action treatment team to ensure services are received.
(c)
Focus on engaging the child, adolescent, or young adult and his or her family as active participants in every phase of the treatment process. Community action treatment teams shall be available to the child, adolescent, or young adult and his or her family at all times.
(d)
Coordinate with other key entities providing services and supports to the child, adolescent, or young adult and his or her family, including, but not limited to, the child’s, adolescent’s, or young adult’s school, the local educational multiagency network for severely emotionally disturbed students under s. 1006.04, the child welfare system, and the juvenile justice system. Community action treatment teams shall also coordinate with the managing entity in their service location.
(e)1.
Subject to appropriations and at a minimum, individually serve each of the following counties or regions:
a.
Alachua.
b.
Alachua, Columbia, Dixie, Hamilton, Lafayette, and Suwannee.
c.
Bay.
d.
Brevard.
e.
Collier.
f.
DeSoto and Sarasota.
g.
Duval.
h.
Escambia.
i.
Hardee, Highlands, and Polk.
j.
Hillsborough.
k.
Indian River, Martin, Okeechobee, and St. Lucie.
l.
Lake and Sumter.
m.
Lee.
n.
Manatee.
o.
Marion.
p.
Miami-Dade.
q.
Okaloosa.
r.
Orange.
s.
Palm Beach.
t.
Pasco.
u.
Pinellas.
v.
Walton.
2.
Subject to appropriations, the department shall contract for additional teams through the managing entities to ensure the availability of community action treatment team services in the remaining areas of the state.
(7)(a)
The department shall contract with managing entities for mobile response teams throughout the state to provide immediate, onsite behavioral health crisis services to children, adolescents, and young adults ages 18 to 25, inclusive, who:
1.
Have an emotional disturbance;
2.
Are experiencing an acute mental or emotional crisis;
3.
Are experiencing escalating emotional or behavioral reactions and symptoms that impact their ability to function typically within the family, living situation, or community environment; or
4.
Are served by the child welfare system and are experiencing or are at high risk of placement instability.
(b)
A mobile response team shall, at a minimum:
1.
Triage new requests to determine the level of severity and prioritize new requests that meet the clinical threshold for an in-person response. To the extent permitted by available resources, mobile response teams must provide in-person responses to such calls meeting such clinical level of response within 60 minutes after prioritization.
2.
Respond to a crisis in the location where the crisis is occurring.
3.
Provide behavioral health crisis-oriented services that are responsive to the needs of the child, adolescent, or young adult and his or her family.
4.
Provide evidence-based practices to children, adolescents, young adults, and families to enable them to de-escalate and respond to behavioral challenges that they are facing and to reduce the potential for future crises.
5.
Provide screening, standardized assessments, early identification, and referrals to community services.
6.
Provide care coordination by facilitating the transition to ongoing services.
7.
Ensure there is a process in place for informed consent and confidentiality compliance measures.
8.
Promote information sharing and the use of innovative technology.
9.
Coordinate with the applicable managing entity to establish informal partnerships with key entities providing behavioral health services and supports to children, adolescents, or young adults and their families to facilitate continuity of care.
(c)
When procuring mobile response teams, the managing entity must, at a minimum:
1.
Collaborate with local sheriff’s offices and public schools in the planning, development, evaluation, and selection processes.
2.
Require that services be made available 24 hours per day, 7 days per week.
3.
Require the provider to establish response protocols with local law enforcement agencies, local community-based care lead agencies as defined in s. 409.986(3), the child welfare system, and the Department of Juvenile Justice.
4.
Require access to a board-certified or board-eligible psychiatrist or psychiatric nurse practitioner.
5.
Require mobile response teams to refer children, adolescents, or young adults and their families to an array of crisis response services that address individual and family needs, including screening, standardized assessments, early identification, and community services as necessary to address the immediate crisis event.
F.S. 394.496 Service planning.
(1)
It is the intent of the Legislature that the service planning process:
(a)
Focus on individualized treatment and the service needs of the child or adolescent.
(b)
Concentrate on the service needs of the family and individual family members of the child’s or adolescent’s family.
(c)
Involve appropriate family members and pertinent community-based health, education, and social agencies.
(2)
The principals of the service planning process shall:
(a)
Assist the family and other caregivers in developing and implementing a workable services plan for treating the mental health problems of the child or adolescent.
(b)
Use all available resources in the community, particularly informal support services, which will assist in carrying out the goals and objectives of the services plan.
(c)
Maintain the child or adolescent in the most normal environment possible, as close to home as possible; and maintain the child in a stable school placement, which is consistent with the child’s or adolescent’s and other students’ need for safety, if the child is removed from home and placed in state custody.
(d)
Ensure the ability and likelihood of family participation in the treatment of the child or adolescent, as well as enhancing family independence by building on family strengths and assets.
(3)
The services plan must include:
(a)
A behavioral description of the problem being addressed.
(b)
A description of the services or treatment to be provided to the child or adolescent and his or her family which address the identified problem, including:
1.
The type of services or treatment.
2.
The frequency and duration of services or treatment.
3.
The location at which the services or treatment are to be provided.
4.
The name of each accountable provider of services or treatment.
(c)
A description of the measurable objectives of treatment, which, if met, will result in measurable improvements of the condition of the child or adolescent, as specified in s. 394.494.
(4)
For students who are served by exceptional student education, there must be consistency between the services prescribed in the service plan and the components of the individual education plan.
(5)
A clinical psychologist, clinical social worker, physician, psychiatric nurse, or psychiatrist, as those terms are defined in s. 394.455, or a professional licensed under chapter 491 must be included among those persons developing the services plan.
(6)
The services plan shall be developed in conference with the parent or legal guardian. If the parent or legal guardian believes that the services plan is inadequate, the parent or legal guardian may request that the department or its designee review and make recommended changes to the plan.
(7)
The services plan shall be reviewed at least every 90 days for programmatic and financial compliance.
F.S. 394.497 Case management services.
(1)
As used in this section, the term “case management” means those activities aimed at:
(a)
Developing and implementing a services plan specified in s. 394.496.
(b)
Providing advocacy services.
(c)
Linking service providers to a child or adolescent and his or her family.
(d)
Monitoring the delivery of services.
(e)
Collecting information to determine the effect of services and treatment.
(2)
The department shall develop standards for case management services and procedures for appointing case managers. It is the intent of the Legislature that case management services not be duplicated or fragmented and that such services promote the continuity and stability of a case manager assigned to a child or adolescent and his or her family.
F.S. 394.499 Integrated children’s crisis stabilization unit/juvenile addictions receiving facility services.
(1)
The Department of Children and Families, in consultation with the Agency for Health Care Administration, is authorized to establish children’s behavioral crisis unit demonstration models. The children’s behavioral crisis unit demonstration models will integrate children’s mental health crisis stabilization units with substance abuse juvenile addictions receiving facility services, to provide emergency mental health and substance abuse services that are integrated within facilities licensed and designated by the agency for children under 18 years of age who meet criteria for admission or examination under this section. The services shall be designated as “integrated children’s crisis stabilization unit/juvenile addictions receiving facility services,” shall be licensed by the agency as children’s crisis stabilization units, and shall meet all licensure requirements for crisis stabilization units. The department, in cooperation with the agency, shall develop standards that address eligibility criteria; clinical procedures; staffing requirements; operational, administrative, and financing requirements; and investigation of complaints for such integrated facility services. Standards that are implemented specific to substance abuse services shall meet or exceed existing standards for addictions receiving facilities.
(2)
Children eligible to receive integrated children’s crisis stabilization unit/juvenile addictions receiving facility services include:
(a)
A minor whose parent makes voluntary application based on the parent’s express and informed consent, and the requirements of s. 394.4625(1)(a) are met.
(b)
A person under 18 years of age who may be taken to a receiving facility for involuntary examination, if there is reason to believe that he or she is mentally ill and because of his or her mental illness, pursuant to s. 394.463:
1.
Has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination; or
2.
Is unable to determine for himself or herself whether examination is necessary; and
a.
Without care or treatment is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or
b.
There is a substantial likelihood that without care or treatment he or she will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior.
(c)
A person under 18 years of age who wishes to enter treatment for substance abuse and applies to a service provider for voluntary admission, pursuant to s. 397.601.
(d)
A person under 18 years of age who meets the criteria for involuntary admission because there is good faith reason to believe the person is substance abuse impaired pursuant to s. 397.675 and, because of such impairment:
1.
Has lost the power of self-control with respect to substance use; and
2.a.
Has inflicted, or threatened or attempted to inflict, or unless admitted is likely to inflict, physical harm on himself or herself or another; or
b.
Is in need of substance abuse services and, by reason of substance abuse impairment, his or her judgment has been so impaired that the person is incapable of appreciating his or her need for such services and of making a rational decision in regard thereto; however, mere refusal to receive such services does not constitute evidence of lack of judgment with respect to his or her need for such services.
(e)
A person under 18 years of age who meets the criteria for examination or admission under paragraph (b) or paragraph (d) and has a coexisting mental health and substance abuse disorder.
(3)
The department, in cooperation with the agency, is authorized to adopt rules regarding standards and procedures for integrated children’s crisis stabilization unit/juvenile addictions receiving facility services.
F.S. 394.656 Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program.
(1)
There is created within the Department of Children and Families the Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program. The purpose of the program is to provide funding to counties which they may use to plan, implement, or expand initiatives that increase public safety, avert increased spending on criminal justice, and improve the accessibility and effectiveness of treatment services for adults and juveniles who have a mental illness, substance abuse disorder, or co-occurring mental health and substance abuse disorders and who are in, or at risk of entering, the criminal or juvenile justice systems.
(2)
The department shall establish a Criminal Justice, Mental Health, and Substance Abuse Statewide Grant Review Committee. The committee shall include:
(a)
One representative of the Department of Children and Families;
(b)
One representative of the Department of Corrections;
(c)
One representative of the Department of Juvenile Justice;
(d)
One representative of the Department of Elderly Affairs;
(e)
One representative of the Office of the State Courts Administrator;
(f)
One representative of the Department of Veterans’ Affairs;
(g)
One representative of the Florida Sheriffs Association;
(h)
One representative of the Florida Police Chiefs Association;
(i)
One representative of the Florida Association of Counties;
(j)
One representative of the Florida Alcohol and Drug Abuse Association;
(k)
One representative of the Florida Association of Managing Entities;
(l)
One representative of the Florida Council for Community Mental Health;
(m)
One representative of the National Alliance of Mental Illness;
(n)
One representative of the Florida Prosecuting Attorneys Association;
(o)
One representative of the Florida Public Defender Association; and
(p)
One administrator of an assisted living facility that holds a limited mental health license.
(3)
The committee shall serve as the advisory body to review policy and funding issues that help reduce the impact of persons with mental illness and substance abuse disorders on communities, criminal justice agencies, and the court system. The committee shall advise the department in selecting priorities for grants and investing awarded grant moneys.
(4)
The committee must have experience in substance use and mental health disorders, community corrections, and law enforcement. To the extent possible, the committee shall have expertise in grant review and grant application scoring.
(5)(a)
A county, or a not-for-profit community provider or managing entity designated by the county planning council or committee, as described in s. 394.657, may apply for a 1-year planning grant or a 3-year implementation or expansion grant. The purpose of the grants is to demonstrate that investment in treatment efforts related to mental illness, substance abuse disorders, or co-occurring mental health and substance abuse disorders results in a reduced demand on the resources of the judicial, corrections, juvenile detention, and health and social services systems.
(b)
To be eligible to receive a 1-year planning grant or a 3-year implementation or expansion grant:
1.
A county applicant must have a planning council or committee that is in compliance with the membership requirements set forth in this section.
2.
A not-for-profit community provider or managing entity must be designated by the county planning council or committee and have written authorization to submit an application. A not-for-profit community provider or managing entity must have written authorization for each submitted application.
(c)
The department may award a 3-year implementation or expansion grant to an applicant who has not received a 1-year planning grant.
(d)
The department may require an applicant to conduct sequential intercept mapping for a project. For purposes of this paragraph, the term “sequential intercept mapping” means a process for reviewing a local community’s mental health, substance abuse, criminal justice, and related systems and identifying points of interceptions where interventions may be made to prevent an individual with a substance abuse disorder or mental illness from deeper involvement in the criminal justice system.
(6)
The grant review and selection committee shall select the grant recipients and notify the department in writing of the recipients’ names. Contingent upon the availability of funds and upon notification by the grant review and selection committee of those applicants approved to receive planning, implementation, or expansion grants, the department may transfer funds appropriated for the grant program to a selected grant recipient.
F.S. 394.657 County planning councils or committees.
(1)
Each board of county commissioners shall designate the county public safety coordinating council established under s. 951.26, or designate another criminal or juvenile justice mental health and substance abuse council or committee, as the planning council or committee. The public safety coordinating council or other designated criminal or juvenile justice mental health and substance abuse council or committee, in coordination with the county offices of planning and budget, shall make a formal recommendation to the board of county commissioners regarding how the Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program may best be implemented within a community. The board of county commissioners may assign any entity to prepare the application on behalf of the county administration for submission to the Criminal Justice, Mental Health, and Substance Abuse Statewide Grant Review Committee for review. A county may join with one or more counties to form a consortium and use a regional public safety coordinating council or another county-designated regional criminal or juvenile justice mental health and substance abuse planning council or committee for the geographic area represented by the member counties.
(2)(a)
For the purposes of this section, the membership of a designated planning council or committee must include:
1.
The state attorney, or an assistant state attorney designated by the state attorney.
2.
A public defender, or an assistant public defender designated by the public defender.
3.
A circuit judge designated by the chief judge of the circuit.
4.
A county court judge designated by the chief judge of the circuit.
5.
The chief correctional officer.
6.
The sheriff, if the sheriff is the chief correctional officer, or a person designated by the sheriff.
7.
The police chief, or a person designated by the local police chiefs association.
8.
The state probation circuit administrator, or a person designated by the state probation circuit administrator.
9.
The local court administrator, or a person designated by the local court administrator.
10.
The chairperson of the board of county commissioners, or another county commissioner designated by the chairperson, or, if the planning council is a consortium of counties, a county commissioner or designee from each member county.
11.
The director of any county probation or pretrial intervention program, if the county has such a program.
12.
The director of a local substance abuse treatment program, or a person designated by the director.
13.
The director of a community mental health agency, or a person designated by the director.
14.
A representative of the substance abuse program office and the mental health program office of the Department of Children and Families, selected by the substance abuse and mental health program supervisor of the district in which the county is located.
15.
A primary consumer of mental health services, selected by the substance abuse and mental health program supervisor of the district in which the primary consumer resides. If multiple counties apply together, a primary consumer may be selected to represent each county.
16.
A primary consumer of substance abuse services, selected by the substance abuse and mental health program supervisor of the district in which the primary consumer resides. If the planning council is a consortium of counties, a primary consumer may be selected to represent each county.
17.
A family member of a primary consumer of community-based treatment services, selected by the abuse and mental health program supervisor of the district in which the family member resides.
18.
A representative from an area homeless program or a supportive housing program.
19.
The director of the detention facility of the Department of Juvenile Justice, or a person designated by the director.
20.
The chief probation officer of the Department of Juvenile Justice, or an employee designated by the chief probation officer.
(b)
The chairperson of the board of county commissioners or another county commissioner, if designated, shall serve as the chairperson of the planning council or committee until a chairperson is elected from the membership.
(c)
All meetings of the planning council or committee, as well as its records, books, documents, and papers, shall be open and available to the public in accordance with ss. 119.07 and 286.011.
(3)(a)
If a public safety coordinating council established under s. 951.26 acts as the planning council, its membership must include all persons listed in paragraph (2)(a).
(b)
A public safety coordinating council that is acting as the planning council must include an assessment of the availability of mental health programs in addition to the assessments required under s. 951.26(2).
F.S. 394.658 Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant Program requirements.
(1)
The Criminal Justice, Mental Health, and Substance Abuse Statewide Grant Review Committee, in collaboration with the Department of Children and Families, the Department of Corrections, the Department of Juvenile Justice, the Department of Elderly Affairs, and the Office of the State Courts Administrator, shall establish criteria to be used to review submitted applications and to select the county that will be awarded a 1-year planning grant or a 3-year implementation or expansion grant. A planning, implementation, or expansion grant may not be awarded unless the application of the county meets the established criteria.
(a)
The application criteria for a 1-year planning grant must include a requirement that the applicant county or counties have a strategic plan to initiate systemic change to identify and treat individuals who have a mental illness, substance abuse disorder, or co-occurring mental health and substance abuse disorders who are in, or at risk of entering, the criminal or juvenile justice systems. The 1-year planning grant must be used to develop effective collaboration efforts among participants in affected governmental agencies, including the criminal, juvenile, and civil justice systems, mental health and substance abuse treatment service providers, transportation programs, and housing assistance programs. The collaboration efforts shall be the basis for developing a problem-solving model and strategic plan for treating adults and juveniles who are in, or at risk of entering, the criminal or juvenile justice system and doing so at the earliest point of contact, taking into consideration public safety. The planning grant shall include strategies to divert individuals from judicial commitment to community-based service programs offered by the Department of Children and Families in accordance with ss. 916.13 and 916.17.
(b)
The application criteria for a 3-year implementation or expansion grant shall require information from a county that demonstrates its completion of a well-established collaboration plan that includes public-private partnership models and the application of evidence-based practices. The implementation or expansion grants may support programs and diversion initiatives that include, but need not be limited to:
1.
Mental health courts.
2.
Diversion programs.
3.
Alternative prosecution and sentencing programs.
4.
Crisis intervention teams.
5.
Treatment accountability services.
6.
Specialized training for criminal justice, juvenile justice, and treatment services professionals.
7.
Specialized training for 911 public safety telecommunicators as defined in s. 401.465 and emergency medical technicians as defined in s. 112.1911 to assist in determining which response team is most appropriate under the circumstances. A response team may include, but is not limited to, a law enforcement agency, an emergency medical response team, a crisis intervention team, or a mobile crisis response service as defined in s. 394.455. Each affected agency must consider what resources are available in the community.
8.
Service delivery of collateral services such as housing, transitional housing, and supported employment.
9.
Reentry services to create or expand mental health and substance abuse services and supports for affected persons.
10.
Coordinated specialty care programs.
11.
Veterans treatment court programs.
(c)
Each county application must include the following information:
1.
An analysis of the current population of the jail and juvenile detention center in the county, which includes:
a.
The screening and assessment process that the county uses to identify an adult or juvenile who has a mental illness, substance abuse disorder, or co-occurring mental health and substance abuse disorders;
b.
The percentage of each category of persons admitted to the jail and juvenile detention center that represents people who have a mental illness, substance abuse disorder, or co-occurring mental health and substance abuse disorders; and
c.
An analysis of observed contributing factors that affect population trends in the county jail and juvenile detention center.
2.
A description of the strategies the county intends to use to serve one or more clearly defined subsets of the population of the jail and juvenile detention center who have a mental illness or to serve those at risk of arrest and incarceration. The proposed strategies may include identifying the population designated to receive the new interventions, a description of the services and supervision methods to be applied to that population, and the goals and measurable objectives of the new interventions. The interventions a county may use with the target population may include, but are not limited to:
a.
Specialized responses by emergency medical response teams, crisis intervention teams, mobile crisis response services, and law enforcement agencies;
b.
Centralized receiving facilities for individuals evidencing behavioral difficulties;
c.
Postbooking alternatives to incarceration;
d.
New court programs, including pretrial services and specialized dockets;
e.
Specialized diversion programs;
f.
Intensified transition services that are directed to the designated populations while they are in jail or juvenile detention to facilitate their transition to the community;
g.
Specialized probation processes;
h.
Day-reporting centers;
i.
Linkages to community-based, evidence-based treatment programs for adults and juveniles who have mental illness or substance abuse disorders; and
j.
Community services and programs designed to prevent high-risk populations from becoming involved in the criminal or juvenile justice system.
3.
The projected effect the proposed initiatives will have on the population and the budget of the jail and juvenile detention center. The information must include:
a.
The county’s estimate of how the initiative will reduce the expenditures associated with the incarceration of adults and the detention of juveniles who have a mental illness;
b.
The methodology that the county intends to use to measure the defined outcomes and the corresponding savings or averted costs;
c.
The county’s estimate of how the cost savings or averted costs will sustain or expand the mental health and substance abuse treatment services and supports needed in the community; and
d.
How the county’s proposed initiative will reduce the number of individuals judicially committed to a state mental health treatment facility.
4.
The proposed strategies that the county intends to use to preserve and enhance its community mental health and substance abuse system, which serves as the local behavioral health safety net for low-income and uninsured individuals.
5.
The proposed strategies that the county intends to use to continue the implemented or expanded programs and initiatives that have resulted from the grant funding.
(2)(a)
As used in this subsection, the term “available resources” includes in-kind contributions from participating counties.
(b)
A 1-year planning grant may not be awarded unless the applicant county makes available resources in an amount equal to the total amount of the grant, except fiscally constrained counties that are awarded reinvestment grants to establish programs pursuant to this section may not be required to provide local matching funds. A planning grant may not be used to supplant funding for existing programs. For fiscally constrained counties, the available resources may be at 50 percent of the total amount of the grant.
(c)
A 3-year implementation or expansion grant may not be awarded unless the applicant county or consortium of counties makes available resources equal to the total amount of the grant. For fiscally constrained counties, the available resources may be at 50 percent of the total amount of the grant, except fiscally constrained counties that are awarded reinvestment grants to establish programs pursuant to this section may not be required to provide local matching funds. This match shall be used for expansion of services and may not supplant existing funds for services. An implementation or expansion grant must support the implementation of new services or the expansion of services and may not be used to supplant existing services.
(3)
Using the criteria adopted by rule, the county designated or established criminal justice, juvenile justice, mental health, and substance abuse planning council or committee shall prepare the county or counties’ application for the 1-year planning or 3-year implementation or expansion grant. The county shall submit the completed application to the statewide grant review committee.
F.S. 394.659 Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Center.
(1)
There is created a Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Center at the Louis de la Parte Florida Mental Health Institute at the University of South Florida, which shall:
(a)
Provide technical assistance to counties in preparing a grant application.
(b)
Assist an applicant county in projecting the effect of the proposed intervention on the population of the county detention facility.
(c)
Assist an applicant county in monitoring the effect of a grant award on the criminal justice system in the county.
(d)
Disseminate and share evidence-based practices and best practices among grantees, including, but not limited to, the use of person-first language and trauma-responsive care, to improve patient experiences and outcomes of individuals with behavioral health conditions and encourage cooperative engagement with such individuals. For purposes of this paragraph, the term “person-first language” means language used which emphasizes the individual as a person rather than the individual’s disability, illness, or condition.
(e)
Act as a clearinghouse for information and resources related to criminal justice, juvenile justice, mental health, and substance abuse.
(f)
Coordinate and organize the process of the state interagency justice, mental health, and substance abuse work group with the outcomes of the local grant projects for state and local policy and budget developments and system planning.
(2)
The Criminal Justice, Mental Health, and Substance Abuse Technical Assistance Center shall submit an annual report to the Governor, the President of the Senate, and the Speaker of the House of Representatives by January 1 of each year. The report must include:
(a)
A detailed description of the progress made by each grantee in meeting the goals described in the application;
(b)
A description of the effect the grant-funded initiatives have had on meeting the needs of adults and juveniles who have a mental illness, substance abuse disorder, or co-occurring mental health and substance abuse disorders, thereby reducing the number of forensic commitments to state mental health treatment facilities;
(c)
A summary of the effect of the grant program on the growth and expenditures of the jail, juvenile detention center, and prison;
(d)
A summary of the initiative’s effect on the availability and accessibility of effective community-based mental health and substance abuse treatment services for adults and juveniles who have a mental illness, substance abuse disorder, or co-occurring mental health and substance abuse disorders. The summary must describe how the expanded community diversion alternatives have reduced incarceration and commitments to state mental health treatment facilities; and
(e)
A summary of how the local matching funds provided by the county or consortium of counties leveraged additional funding to further the goals of the grant program.
F.S. 394.674 Eligibility for publicly funded substance abuse and mental health services; fee collection requirements.
(1)
To be eligible to receive substance abuse and mental health services funded by the department, an individual must be a member of at least one of the department’s priority populations approved by the Legislature. The priority populations include:
(a)
For adult mental health services:
1.
Adults who have severe and persistent mental illness, as designated by the department using criteria that include severity of diagnosis, duration of the mental illness, ability to independently perform activities of daily living, and receipt of disability income for a psychiatric condition. Included within this group are:
a.
Older adults in crisis.
b.
Older adults who are at risk of being placed in a more restrictive environment because of their mental illness.
c.
Persons deemed incompetent to proceed or not guilty by reason of insanity under chapter 916.
d.
Other persons involved in the criminal justice system.
e.
Persons diagnosed as having co-occurring mental illness and substance abuse disorders.
2.
Persons who are experiencing an acute mental or emotional crisis as defined in s. 394.67.
(b)
For children’s mental health services:
1.
Children who are at risk of emotional disturbance as defined in s. 394.492(4).
2.
Children who have an emotional disturbance as defined in s. 394.492(5).
3.
Children who have a serious emotional disturbance as defined in s. 394.492(6).
4.
Children diagnosed as having a co-occurring substance abuse and emotional disturbance or serious emotional disturbance.
(c)
For substance abuse treatment services:
1.
Adults who have substance abuse disorders and a history of intravenous drug use.
2.
Persons diagnosed as having co-occurring substance abuse and mental health disorders.
3.
Parents who put children at risk due to a substance abuse disorder.
4.
Persons who have a substance abuse disorder and have been ordered by the court to receive treatment.
5.
Children at risk for initiating drug use.
6.
Children under state supervision.
7.
Children who have a substance abuse disorder but who are not under the supervision of a court or in the custody of a state agency.
8.
Persons identified as being part of a priority population as a condition for receiving services funded through the Center for Mental Health Services and Substance Abuse Prevention and Treatment Block Grants.
(2)
Crisis services, as defined in s. 394.67, must, within the limitations of available state and local matching resources, be available to each person who is eligible for services under subsection (1), regardless of the person’s ability to pay for such services. A person who is experiencing a mental health crisis and who does not meet the criteria for involuntary examination under s. 394.463(1), or a person who is experiencing a substance abuse crisis and who does not meet the involuntary admission criteria in s. 397.675, must contribute to the cost of his or her care and treatment pursuant to the sliding fee scale developed under subsection (4), unless charging a fee is contraindicated because of the crisis situation.
(3)
Mental health services, substance abuse services, and crisis services, as defined in s. 394.67, must, within the limitations of available state and local matching resources, be available to each person who is eligible for services under subsection (1). Such person must contribute to the cost of his or her care and treatment pursuant to the sliding fee scale developed under subsection (4).
(4)
The department shall adopt rules to implement client eligibility, client enrollment, and fee collection requirements for publicly funded substance abuse and mental health services.
(a)
The rules must require each provider under contract with the department which enrolls eligible persons into treatment to develop a sliding fee scale for persons who have a net family income at or above 150 percent of the Federal Poverty Income Guidelines, unless otherwise required by state or federal law. The sliding fee scale must use the uniform schedule of discounts by which a provider under contract with the department discounts its established client charges for services supported with state, federal, or local funds, using, at a minimum, factors such as family income, financial assets, and family size as declared by the person or the person’s guardian. The rules must include uniform criteria to be used by all service providers in developing the schedule of discounts for the sliding fee scale.
(b)
The rules must address the most expensive types of treatment, such as residential and inpatient treatment, in order to make it possible for a client to responsibly contribute to his or her mental health or substance abuse care without jeopardizing the family’s financial stability. A person who is not eligible for Medicaid and whose net family income is less than 150 percent of the Federal Poverty Income Guidelines must pay a portion of his or her treatment costs which is comparable to the copayment amount required by the Medicaid program for Medicaid clients pursuant to s. 409.9081.
(c)
The rules must require that persons who receive financial assistance from the Federal Government because of a disability and are in long-term residential treatment settings contribute to their board and care costs and treatment costs and must be consistent with the provisions in s. 409.212.
(5)
A person who meets the eligibility criteria in subsection (1) shall be served in accordance with the appropriate district substance abuse and mental health services plan specified in s. 394.75 and within available resources.
F.S. 394.676 Indigent psychiatric medication program.
(1)
Within legislative appropriations, the department may establish the indigent psychiatric medication program to purchase psychiatric medications for persons as defined in s. 394.492(5) or (6) or pursuant to s. 394.674(1), who do not reside in a state mental health treatment facility or an inpatient unit.
(2)
The department must adopt rules to administer the indigent psychiatric medication program. The rules must prescribe the clinical and financial eligibility of clients who may receive services under the indigent psychiatric medication program, the requirements that community-based mental health providers must meet to participate in the program, and the sanctions to be applied for failure to meet those requirements.
(3)
To the extent possible within existing appropriations, the department must ensure that non-Medicaid-eligible indigent individuals discharged from mental health treatment facilities continue to receive the medications which effectively stabilized their mental illness in the treatment facility, or newer medications, without substitution by a service provider unless such substitution is clinically indicated as determined by the licensed physician responsible for such individual’s psychiatric care.
F.S. 394.741 Accreditation requirements for providers of behavioral health care services.
(1)
As used in this section, the term “behavioral health care services” means mental health and substance abuse treatment services.
(2)
Notwithstanding any provision of law to the contrary, accreditation shall be accepted by the agency and department in lieu of the agency’s and department’s facility licensure onsite review requirements and shall be accepted as a substitute for the department’s administrative and program monitoring requirements, except as required by subsections (3) and (4), for:
(a)
An organization from which the department purchases behavioral health care services which is accredited by an accrediting organization whose standards incorporate comparable licensure regulations required by this state.
(b)
A mental health facility licensed by the agency or a substance abuse component licensed by the department which is accredited by an accrediting organization whose standards incorporate comparable licensure regulations required by this state.
(c)
A network of providers from which the department or the agency purchases behavioral health care services accredited by an accrediting organization whose standards incorporate comparable licensure regulations required by this state. A provider organization that is part of an accredited network is afforded the same rights under this part.
(3)
For organizations accredited as set forth in subsection (2), before the department or the agency conducts additional monitoring for mental health services, the department and the agency must adopt rules that establish:
(a)
Additional standards for monitoring and licensing accredited programs and facilities that the department and the agency have determined are not specifically and distinctly covered by the accreditation standards and processes. These standards and the associated monitoring must not duplicate the standards and processes already covered by the accrediting bodies.
(b)
An onsite monitoring process between 24 months and 36 months after accreditation for nonresidential facilities to assure that accredited organizations exempt from licensing and monitoring activities under this part continue to comply with critical standards.
(c)
An onsite monitoring process between 12 months and 24 months after accreditation for residential facilities to assure that accredited organizations exempt from licensing and monitoring activities under this part continue to comply with critical standards.
(4)
For substance abuse services, the department shall conduct full licensure inspections every 3 years and shall develop in rule criteria which would justify more frequent inspections.
(5)
The department and the agency shall be given access to all accreditation reports, corrective action plans, and performance data submitted to the accrediting organizations. When major deficiencies, as defined by the accrediting organization, are identified through the accreditation process, the department and the agency may perform followup monitoring to assure that such deficiencies are corrected and that the corrections are sustained over time. Proof of compliance with fire and health safety standards will be submitted as required by rule.
(6)
The department or agency, by accepting the survey or inspection of an accrediting organization, does not forfeit its rights to monitor for the purpose of ensuring that services for which the department has paid were provided. The department may investigate complaints or suspected problems and monitor the provider’s compliance with negotiated terms and conditions, including provisions relating to consent decrees, which are unique to a specific contract and are not statements of general applicability. The department may monitor compliance with federal and state statutes, federal regulations, or state administrative rules, if such monitoring does not duplicate the review of accreditation standards or independent audits pursuant to subsections (3) and (8).
(7)
For purposes of licensure and monitoring of facilities under contract with the department, the department shall rely only upon properly adopted and applicable federal and state statutes and rules.
(8)
The department shall file a State Projects Compliance Supplement pursuant to s. 215.97 for behavioral health care services. In monitoring the financial operations of its contractors, the department shall rely upon certified public accountant audits, if required. The department shall perform a desk review of its contractor’s most recent independent audit and may conduct onsite monitoring only of problems identified by these audits, or by other sources of information documenting problems with the contractor’s financial management. Certified public accountants employed by the department may conduct an onsite test of the validity of a contractor’s independent audit every third year.
(9)
The accreditation requirements of this section apply to contracted organizations that are already accredited immediately upon becoming law.
F.S. 394.761 Revenue maximization.
(1)
The agency and the department shall develop a plan to obtain federal approval for increasing the availability of federal Medicaid funding for behavioral health care. Increased funding shall be used to advance the goal of improved integration of behavioral health services and primary care services for individuals eligible for Medicaid through the development and effective implementation of the behavioral health system of care as described in s. 394.4573.
(2)
The agency and the department shall identify in the plan the amount of general revenue funding appropriated for mental health and substance abuse services eligible to be used as state Medicaid match. The agency and the department shall evaluate alternative uses of increased Medicaid funding, including seeking Medicaid eligibility for the severely and persistently mentally ill or persons with substance use disorders, increased reimbursement rates for behavioral health services, adjustments to the capitation rate for Medicaid enrollees with chronic mental illness and substance use disorders, targeted case management for individuals with substance use disorders as a Medicaid-funded service, supplemental payments to mental health and substance abuse service providers through a designated state health program or other mechanisms, and innovative programs to provide incentives for improved outcomes for behavioral health conditions. The agency and the department shall identify in the plan the advantages and disadvantages of each alternative and assess each alternative’s potential for achieving improved integration of services. The agency and the department shall identify in the plan the types of federal approvals necessary to implement each alternative and project a timeline for implementation.
(3)
The department, in coordination with the agency and the managing entities, shall compile detailed documentation of the cost and reimbursements for Medicaid covered services provided to Medicaid eligible individuals by providers of behavioral health services that are also funded for programs authorized by this chapter and chapter 397. The department’s documentation, along with a report of general revenue funds supporting behavioral health services that are not counted as maintenance of effort or match for any other federal program, must be submitted to the agency by December 31, 2016.
(4)
If the report presents clear evidence that Medicaid reimbursements are less than the costs of providing the services, the agency and the department shall request such additional trust fund authority as is necessary to draw federal Medicaid funds as a match for the documented general revenue expenditures supporting covered services delivered to eligible individuals. Payment of the federal funds shall be made to providers in such a manner as is allowed by federal law and regulations.
(5)
The agency and the department shall submit the written plan and report required in this section to the President of the Senate and the Speaker of the House of Representatives by December 31, 2016.
F.S. 394.875 Crisis stabilization units, residential treatment facilities, and residential treatment centers for children and adolescents; authorized services; license required.
(1)(a)
The purpose of a crisis stabilization unit is to stabilize and redirect a client to the most appropriate and least restrictive community setting available, consistent with the client’s needs. Crisis stabilization units may screen, assess, and admit for stabilization persons who present themselves to the unit and persons who are brought to the unit under s. 394.463. Clients may be provided 24-hour observation, medication prescribed by a physician, psychiatrist, or psychiatric nurse practicing within the framework of an established protocol with a psychiatrist, and other appropriate services. Crisis stabilization units shall provide services regardless of the client’s ability to pay.
(b)
The purpose of a residential treatment facility is to be a part of a comprehensive treatment program for mentally ill individuals in a community-based residential setting.
(c)
The purpose of a residential treatment center for children and adolescents is to provide mental health assessment and treatment services pursuant to ss. 394.491, 394.495, and 394.496 to children and adolescents who meet the target population criteria specified in s. 394.493(1)(a), (b), or (c).
(2)
The requirements of part II of chapter 408 apply to the provision of services that require licensure under ss. 394.455-394.903 and part II of chapter 408 and to entities licensed by or applying for such licensure from the Agency for Health Care Administration pursuant to ss. 394.455-394.903. A license issued by the agency is required in order to operate a crisis stabilization unit, a residential treatment facility, or a residential treatment center for children and adolescents, or to act as a crisis stabilization unit, a residential treatment facility, or a residential treatment center for children and adolescents in this state.
(3)
The following are exempt from licensure as required in ss. 394.455-394.903:
(a)
Homes for special services licensed under chapter 400.
(b)
Nursing homes licensed under chapter 400.
(4)
The department, in consultation with the agency, may establish multiple license classifications for residential treatment facilities.
(5)
The agency may not issue a license to a crisis stabilization unit unless the unit receives state mental health funds and is affiliated with a designated public receiving facility.
(6)
The agency may issue a license for a crisis stabilization unit or short-term residential treatment facility, certifying the number of authorized beds for such facility as indicated by existing need and available appropriations. The agency may disapprove an application for such a license if it determines that a facility should not be licensed pursuant to the provisions of this chapter. Any facility operating beds in excess of those authorized by the agency shall, upon demand of the agency, reduce the number of beds to the authorized number, forfeit its license, or provide evidence of a license issued pursuant to chapter 395 for the excess beds.
(7)
A children’s crisis stabilization unit which does not exceed 20 licensed beds and which provides separate facilities or a distinct part of a facility, separate staffing, and treatment exclusively for minors may be located on the same premises as a crisis stabilization unit serving adults. The department, in consultation with the agency, shall adopt rules governing facility construction, staffing and licensure requirements, and the operation of such units for minors.
(8)(a)
The department, in consultation with the agency, must adopt rules governing a residential treatment center for children and adolescents which specify licensure standards for: admission; length of stay; program and staffing; discharge and discharge planning; treatment planning; seclusion, restraints, and time-out; rights of patients under s. 394.459; use of psychotropic medications; and standards for the operation of such centers.
(b)
Residential treatment centers for children and adolescents must conspicuously place signs on their premises to warn children and adolescents of the dangers of human trafficking and to encourage the reporting of individuals observed attempting to engage in human trafficking activity. The signs must contain the telephone number for the Florida Human Trafficking Hotline, 1-855-FLA-SAFE, or such other number that the Department of Law Enforcement uses to detect and stop human trafficking. The department, in consultation with the agency, shall specify, at a minimum, the content of the signs by rule.
(9)
Notwithstanding the provisions of subsection (6), crisis stabilization units may not exceed their licensed capacity by more than 10 percent, nor may they exceed their licensed capacity for more than 3 consecutive working days or for more than 7 days in 1 month.
(10)
Notwithstanding the other provisions of this section, any facility licensed under former chapter 396 and chapter 397 for detoxification, residential level I care, and outpatient treatment may elect to license concurrently all of the beds at such facility both for that purpose and as a long-term residential treatment facility pursuant to this section, if all of the following conditions are met:
(a)
The licensure application is received by the department prior to January 1, 1993.
(b)
On January 1, 1993, the facility was licensed under former chapter 396 and chapter 397 as a facility for detoxification, residential level I care, and outpatient treatment of substance abuse.
(c)
The facility restricted its practice to the treatment of law enforcement personnel for a period of at least 12 months beginning after January 1, 1992.
(d)
The number of beds to be licensed under this chapter is equal to or less than the number of beds licensed under former chapter 396 and chapter 397 as of January 1, 1993.
(e)
The licensee agrees in writing to a condition placed upon the license that the facility will limit its treatment exclusively to law enforcement personnel and their immediate families who are seeking admission on a voluntary basis and who are exhibiting symptoms of posttraumatic stress disorder or other mental health problems, including drug or alcohol abuse, which are directly related to law enforcement work and which are amenable to verbal treatment therapies; the licensee agrees to coordinate the provision of appropriate postresidential care for discharged individuals; and the licensee further agrees in writing that a failure to meet any condition specified in this paragraph shall constitute grounds for a revocation of the facility’s license as a residential treatment facility.
(f)
The licensee agrees that the facility will meet all licensure requirements for a residential treatment facility, including minimum standards for compliance with lifesafety requirements, except those licensure requirements which are in express conflict with the conditions and other provisions specified in this subsection.
(g)
The licensee agrees that the conditions stated in this subsection must be agreed to in writing by any person acquiring the facility by any means.
Any facility licensed under this subsection is not required to provide any services to any persons except those included in the specified conditions of licensure, and is exempt from any requirements related to the 60-day or greater average length of stay imposed on community-based residential treatment facilities otherwise licensed under this chapter.
(11)
The department, in consultation with the agency, shall biennially conduct a review to identify the need for new short-term residential treatment facilities and additional beds in existing short-term residential treatment facilities. If additional funding is necessary to address such need, the department shall submit a legislative budget request for such funding. If the department can address the need within existing resources, the department shall take action to do so.
F.S. 394.876 Applications.
(1)
In addition to the requirements of part II of chapter 408, any person desiring to be licensed under this chapter shall apply to the agency and the application must contain such information as the department and the agency find necessary to determine the ability of the applicant to carry out its responsibilities under this chapter.
(2)
The applicant shall provide proof of liability insurance coverage in amounts set by the department and the agency by rule.
F.S. 394.877 Fees.
In accordance with s. 408.805, an applicant or licensee shall pay a fee for each license application submitted under this part, part II of chapter 408, and applicable rules. The amount of the fee shall be established by rule. Such fees shall be reasonably calculated to cover only the cost of regulation under this chapter.
F.S. 394.879 Rules; enforcement.
(1)
The agency, in consultation with the department, may adopt rules to administer the requirements of part II of chapter 408. The department, in consultation with the agency, shall adopt rules pursuant to ss. 120.536(1) and 120.54 to administer the provisions of this chapter, including, at a minimum, rules providing standards to ensure that:
(a)
Sufficient numbers and types of qualified personnel are on duty and available at all times to provide necessary and adequate client safety and care.
(b)
Adequate space is provided each client of a licensed facility.
(c)
Licensed facilities are limited to an appropriate number of beds.
(d)
Each licensee establishes and implements adequate infection control, housekeeping, sanitation, disaster planning, and medical recordkeeping.
(e)
Licensed facilities are established, organized, and operated in accordance with programmatic standards of the department.
(f)
The operation and purposes of these facilities assure individuals’ health, safety, and welfare.
(g)
The use of restraint and seclusion is consistent with recognized best practices and professional judgment; that inherently dangerous restraint or seclusion procedures are prohibited; that limitations are established on the use and duration of restraint and seclusion; that measures are established to ensure the safety of program participants and staff during an incident of restraint or seclusion; that procedures are created for staff to follow before, during, and after incidents of restraint or seclusion; that professional qualifications and training are established for staff who may order or be engaged in the use of restraint or seclusion; and that mandatory reporting, data collection, and data dissemination procedures and requirements are instituted. Rules adopted under this section must require that any instance of the use of restraint or seclusion shall be documented in the record of the client.
(2)
Minimum firesafety standards shall be established and enforced by the State Fire Marshal in cooperation with the department. Such standards shall be included in the rule adopted by the department after consultation with the State Fire Marshal.
(3)
The department, in consultation with the agency, shall allow any licensed facility in operation at the time of adoption of any rule a reasonable period, not to exceed 1 year, to bring itself into compliance with department rules.
(4)
In accordance with part II of chapter 408, the agency may impose an administrative penalty of no more than $500 per day against any licensee that violates any rule adopted pursuant to this section and may suspend and revoke the license and deny the renewal application of such licensee. In imposing such penalty, the agency shall consider the severity of the violation, actions taken by the licensee to correct the violation, and previous violations by the licensee.
(5)
The agency or the department may not adopt any rule governing the design, construction, erection, alteration, modification, repair, or demolition of crisis stabilization units. It is the intent of the Legislature to preempt that function to the Florida Building Commission and the State Fire Marshal through adoption and maintenance of the Florida Building Code and the Florida Fire Prevention Code. However, a crisis stabilization unit, a short-term residential treatment facility, or an integrated adult mental health crisis stabilization and addictions receiving facility that is collocated with a centralized receiving facility may be in a multistory building and may be authorized on floors other than the ground floor. The agency shall provide technical assistance to the commission and the State Fire Marshal in updating the construction standards of the Florida Building Code and the Florida Fire Prevention Code which govern crisis stabilization units. In addition, the agency may enforce the special-occupancy provisions of the Florida Building Code and the Florida Fire Prevention Code which apply to crisis stabilization units in conducting any inspection authorized under this part or part II of chapter 408.
(6)
The department and the Agency for Health Care Administration shall develop a plan to provide options for a single, consolidated license for a provider that offers multiple types of either mental health services or substance abuse services, or both, regulated under this chapter and chapter 397, respectively. In the plan, the department and the agency shall identify the statutory revisions necessary to accomplish the consolidation. To the extent possible, the department and the agency shall accomplish such consolidation administratively and by rule. The department and the agency shall submit the plan to the Governor, the President of the Senate, and the Speaker of the House of Representatives by November 1, 2016.
F.S. 394.902 Moratorium on admissions.
In accordance with part II of chapter 408, the agency may impose a moratorium on elective admissions to a licensee or any program or portion of a licensed facility if the agency determines that any condition in the facility presents a threat to the public health or safety.
F.S. 394.903 Receivership proceedings.
(1)
The agency, independently or in conjunction with the department may petition a court of competent jurisdiction for the appointment of a receiver for a crisis stabilization unit or a residential treatment facility when any of the following conditions exist:
(a)
Any person is operating a unit or facility without a license and refuses to make application for a license as required by this part.
(b)
The licensee is closing the unit or facility or has informed the agency that it intends to close and adequate arrangements have not been made for relocation of the residents within 7 days, exclusive of weekends and holidays, of the closing of the unit or facility.
(c)
The agency determines that conditions exist in the unit or facility which present an imminent danger to the health, safety, or welfare of the residents of the unit or facility or a substantial probability that death or serious physical harm would result therefrom. The agency shall, whenever possible, facilitate the continued operation of the program.
(d)
The licensee cannot meet its financial obligations for providing food, shelter, care, and utilities. Issuance of bad checks or accumulation of delinquent bills for such items as personnel salaries, food, drugs, or utilities constitutes prima facie evidence that the ownership of the unit or facility lacks the financial ability to operate the unit or facility in accordance with the requirements of this chapter and all rules adopted under this chapter.
(2)
Petitions for receivership shall take precedence over other court business unless the court determines that some other pending proceeding, having similar statutory precedence, shall have priority. A hearing shall be conducted within 5 days after the filing of the petition, at which time all interested parties shall have the opportunity to present evidence pertaining to the petition. The agency shall notify the owner or operator of the unit or facility named in the petition of its filing and the dates for the hearing. The court shall grant the petition only upon finding that the health, safety, and welfare of residents of the unit or facility would be threatened if a condition existing at the time the petition was filed is permitted to continue. A receiver shall not be appointed ex parte unless the court determines that one or more of the conditions of subsection (1) exist and that the owner or operator cannot be found, that all reasonable means of locating the owner or operator and notifying him or her of the petition and hearing have been exhausted, or that the owner or operator after notification of the hearing chooses not to attend. After such findings, the court may appoint any person qualified by education, training, or experience to carry out the responsibilities of receiver pursuant to this section, except that it shall not appoint any owner or affiliate of the unit or facility which is in receivership. Prior to the appointment as receiver of a person who is the operator, manager, or supervisor of another unit or facility, the court shall determine that the person can reasonably operate, manage, or supervise more than one unit or facility. The receiver may be appointed for up to 90 days, with the option of petitioning the court for 30-day extensions. The receiver may be selected from a list of persons qualified to act as receivers developed by the agency and presented to the court with each petition for receivership. The agency or department or a designated employee of either, may not be appointed as a receiver for more than 60 days; however, such receiver may petition the court for 30-day extensions. The agency may petition the court to appoint a substitute receiver. The court shall grant the extension upon a showing of good cause. During the first 60 days of the receivership, the agency may not take action to decertify or revoke the license of a unit or facility unless conditions causing imminent danger to the health and welfare of the residents exist and a receiver has been unable to remove those conditions. After the first 60 days of receivership, and every 60 days thereafter until the receivership is terminated, the agency shall submit to the court the results of an assessment of the unit’s or facility’s ability to assure the safety and care of the residents. If the conditions at the unit or facility or the intentions of the owner indicate that the purpose of the receivership is to close the unit or facility rather than to facilitate its continued operations, the department, in consultation with the agency, shall place the residents in appropriate alternative residential settings as quickly as possible. If, in the opinion of the court, the agency has not been diligent in its efforts to make adequate placement arrangements, the court may find the agency to be in contempt and shall order the agency to submit its plans for moving the residents.
(3)
The receiver shall make provisions for the continued health, safety, and welfare of all residents of the unit or facility and:
(a)
Shall exercise those powers and perform those duties set out by the court.
(b)
Shall operate the unit or facility in such a manner as to assure safety and adequate health care for the residents.
(c)
Shall take such action as is reasonably necessary to protect or conserve the assets or property of the unit or facility for which the receiver is appointed, or the proceeds from any transfer thereof, and he or she may use them only in the performance of the powers and duties set forth in this section or by order of the court.
(d)
May use the buildings, fixtures, furnishings, and any accompanying consumable goods in the provision of care and services to residents and to any other persons receiving services from the unit or facility at the time the petition for receivership is filed. The receiver shall collect payments for all goods and services provided to residents or others during the period of the receivership at the same rate of payment charged by the owners at the time the petition for receivership was filed or at a fair and reasonable rate otherwise approved by the court for private-pay residents.
(e)
May correct or eliminate any deficiency in the structure, furnishings, or staffing of the unit or facility which endangers the safety or health of residents while they remain in the unit or facility; however, the total cost of correction shall not exceed $3,000. The court may order expenditures for this purpose in excess of $3,000 on application from the receiver after notice to the owner. A hearing may be requested by the owner within 72 hours.
(f)
May let contracts and hire agents and employees to carry out the powers and duties of the receiver under this section.
(g)
Shall honor all leases, mortgages, and secured transactions governing the building in which the unit or facility is located and all goods and fixtures in the building of which the receiver has taken possession, but only to the extent of payments which, in the case of rental agreement, are for the use of the property during the period of the receivership or which, in the case of a purchase agreement, become due during the period of the receivership.
(h)
Shall have full power to direct, manage, hire, and discharge employees of the unit or facility subject to any contract rights they may have. The receiver shall hire and pay employees at the rate of compensation, including benefits, approved by the court. Receivership does not relieve the owner of any obligation to employees made prior to the appointment of a receiver and not carried out by the receiver.
(i)
Shall be entitled to take possession of all property or assets of residents which are in the possession of a unit or facility or its owner. The receiver shall preserve all property or assets and all resident records of which the receiver takes possession and shall provide for the prompt transfer of the property, assets, and records to the new placement of any transferred resident. An inventory list certified by the owner and by the receiver shall be made at the time the receiver takes possession of the facility.
(4)(a)
A person who is served with notice of an order of the court appointing a receiver and of the receiver’s name and address shall be liable to pay the receiver for any goods or services provided by the receiver after the date of the order if the person would have been liable for the goods or services as supplied by the owner. The receiver shall give a receipt for each payment and shall keep a copy of each receipt on file. The receiver shall deposit accounts received in a separate account and shall use this account for all disbursements.
(b)
The receiver may bring an action to enforce the liability created by paragraph (a).
(c)
A payment to the receiver of any sum owing to the facility or its owner shall discharge any obligation to the facility to the extent of the payment.
(5)(a)
A receiver may petition the court that he or she not be required to honor any lease, mortgage, secured transaction, or other wholly or partially executory contract entered into by the owner of the facility if the rent, price, or rate of interest required to be paid under the agreement was substantially in excess of a reasonable rent, price, or rate of interest at the time the contract was entered into, or if any material provision of the agreement was unreasonable, when compared to contracts negotiated under similar conditions. Any relief in this form provided by the court shall be limited to the life of the receivership, unless otherwise determined by the court.
(b)
If the receiver is in possession of real estate or goods subject to a lease, mortgage, or security interest which the receiver has obtained a court order to avoid under paragraph (a), and if the real estate or goods are necessary for the continued operation of the unit or facility under this section, the receiver may apply to the court to set a reasonable rental, price, or rate of interest to be paid by the receiver during the duration of the receivership. The court shall hold a hearing on the application within 15 days. The receiver shall send notice of the application to any known persons who own the property involved or to mortgage holders at least 10 days prior to the hearing. Payment by the receiver of the amount determined by the court to be reasonable is a defense to any action against the receiver for payment or for possession of the goods or real estate subject to the lease, security interest, or mortgage involved by any person who received such notice, but the payment does not relieve the owner of the facility of any liability for the difference between the amount paid by the receiver and the amount due under the original lease, security interest, or mortgage involved.
(6)
The court shall set the compensation of the receiver, which shall be considered a necessary expense of a receivership.
(7)
A receiver may be held liable in a personal capacity only for the receiver’s own gross negligence, intentional acts, or breaches of fiduciary duty.
(8)
The court may require a receiver to post a bond.
(9)
The court may terminate a receivership when:
(a)
The court determines that the receivership is no longer necessary because the conditions which gave rise to the receivership no longer exist; or
(b)
All of the residents in the unit or facility have been transferred or discharged.
(10)
Within 30 days after termination, unless this time period is extended by the court, the receiver shall give the court a complete accounting of all property of which the receiver has taken possession, of all funds collected and disbursed, and of the expenses of the receivership.
(11)
Nothing in this section shall be construed to relieve any owner, operator, or employee of a unit or facility placed in receivership of any civil or criminal liability incurred, or any duty imposed by law, by reason of acts or omissions of the owner, operator, or employee prior to the appointment of a receiver; nor shall anything contained in this section be construed to suspend during the receivership any obligation of the owner, operator, or employee for payment of taxes or other operating and maintenance expenses of the unit or facility or of the owner, operator, or employee or any other person for the payment of mortgages or liens. The owner shall retain the right to sell or mortgage any unit or facility under receivership, subject to approval of the court which ordered the receivership. Receivership imposed under the provisions of this chapter shall be subject to the Health Care Trust Fund pursuant to s. 408.16. The owner of a facility placed in receivership by the court shall be liable for all expenses and costs incurred by the Health Care Trust Fund which occur as a result of the receivership.
F.S. 394.907 Community mental health centers; quality assurance programs.
(1)
As used in this section, the term “community mental health center” means a publicly funded, not-for-profit center that contracts with the department for the provision of inpatient, outpatient, day treatment, or emergency services.
(2)
Any community mental health center and any facility licensed pursuant to s. 394.875 shall have an ongoing quality assurance program. The purpose of the quality assurance program shall be to objectively and systematically monitor and evaluate the appropriateness and quality of client care, to ensure that services are rendered consistent with reasonable, prevailing professional standards and to resolve identified problems.
(3)
Each facility shall develop a written plan that addresses the minimum guidelines for the quality assurance program. Such guidelines shall include, but are not limited to:
(a)
Standards for the provision of client care and treatment practices;
(b)
Procedures for the maintenance of client records;
(c)
Policies and procedures for staff development;
(d)
Standards for facility safety and maintenance;
(e)
Procedures for peer review and resource utilization;
(f)
Policies and procedures for adverse incident reporting to include verification of corrective action to remediate or minimize incidents and for reporting such incidents to the department by a timeframe as prescribed by rule.
Such plan shall be submitted to the governing board for approval and a copy provided to the department.
(4)
The quality assurance program shall be directly responsible to the executive director of the facility and shall be subject to review by the governing board of the agency.
(5)
Each facility shall designate a quality assurance manager who is an employee of the agency or under contract with the agency.
(6)
Incident reporting shall be the affirmative duty of all staff. Any person filing an incident report shall not be subject to any civil action by virtue of such incident report.
(7)
The department shall have access to all records necessary to determine licensee compliance with the provisions of this section. The records of quality assurance programs which relate solely to actions taken in carrying out the provisions of this section, and records obtained by the department to determine licensee compliance with this section, are confidential and exempt from s. 119.07(1). Such records are not admissible in any civil or administrative action, except in disciplinary proceedings by the Department of Business and Professional Regulation and the appropriate regulatory board, nor shall such records be available to the public as part of the record of investigation for, and prosecution in disciplinary proceedings made available to the public by the Department of Business and Professional Regulation or the appropriate regulatory board. Meetings or portions of meetings of quality assurance program committees that relate solely to actions taken pursuant to this section are exempt from s. 286.011.
(8)
This section does not apply to hospitals licensed pursuant to chapter 395 or programs operated within such hospitals.
F.S. 394.908 Substance abuse and mental health funding equity; distribution of appropriations.
In recognition of the historical inequity in the funding of substance abuse and mental health services for the department’s districts and regions and to rectify this inequity and provide for equitable funding in the future throughout the state, the following funding process shall be used:
(1)
Funding thresholds for substance abuse and mental health services in each of the current districts, statewide, shall be established based on the current number of individuals in need per district of substance abuse and mental health services, respectively.
(2)
“Individuals in need” means those persons who fit the profile of the respective priority populations and require mental health or substance abuse services.
(3)
Any additional funding beyond the 2005-2006 fiscal year base appropriation for alcohol, drug abuse, and mental health services shall be allocated to districts for substance abuse and mental health services based on:
(a)
Epidemiological estimates of disabilities that apply to the respective priority populations.
(b)
A pro rata share distribution that ensures districts below the statewide average funding level per individual in each priority population of “individuals in need” receive funding necessary to achieve equity.
(4)
Priority populations for individuals in need shall be displayed for each district and distributed concurrently with the approved operating budget. The display by priority population shall show: The annual number of individuals served based on prior year actual numbers, the annual cost per individual served, and the estimated number of the total priority population for individuals in need.
(5)
The annual cost per individual served shall be defined as the total actual funding for each priority population divided by the number of individuals served in the priority population for that year.
F.S. 394.910 Legislative findings and intent.
The Legislature finds that a small but extremely dangerous number of sexually violent predators exist who do not have a mental disease or defect that renders them appropriate for involuntary treatment under the Baker Act, part I of this chapter, which is intended to provide short-term treatment to individuals with serious mental disorders and then return them to the community. In contrast to persons appropriate for civil commitment under the Baker Act, sexually violent predators generally have antisocial personality features which are unamenable to existing mental illness treatment modalities, and those features render them likely to engage in criminal, sexually violent behavior. The Legislature further finds that the likelihood of sexually violent predators engaging in repeat acts of predatory sexual violence is high. The existing involuntary commitment procedures under the Baker Act for the treatment and care of mentally ill persons are inadequate to address the risk these sexually violent predators pose to society. The Legislature further finds that the prognosis for rehabilitating sexually violent predators in a prison setting is poor, the treatment needs of this population are very long term, and the treatment modalities for this population are very different from the traditional treatment modalities for people appropriate for commitment under the Baker Act. It is therefore the intent of the Legislature to create a civil commitment procedure for the long-term care and treatment of sexually violent predators.
F.S. 394.911 Legislative intent.
The Legislature intends that persons who are subject to the civil commitment procedure for sexually violent predators under this part be subject to the procedures established in this part and not to the provisions of part I of this chapter. Less restrictive alternatives are not applicable to cases initiated under this part.
F.S. 394.912 Definitions.
As used in this part, the term:
(1)
“Agency with jurisdiction” means the entity that releases, upon lawful order or authority, a person who is serving a sentence in the custody of the Department of Corrections, a person who was adjudicated delinquent and is committed to the custody of the Department of Juvenile Justice, a person who was involuntarily committed to the custody of the Department of Children and Families upon an adjudication of not guilty by reason of insanity, or a person who is serving a sentence in a county or municipal jail for a sexually violent offense as defined in paragraph (9)(i).
(2)
“Convicted of a sexually violent offense” means a person who has been:
(a)
Adjudicated guilty of a sexually violent offense after a trial, guilty plea, or plea of nolo contendere;
(b)
Adjudicated not guilty by reason of insanity of a sexually violent offense; or
(c)
Adjudicated delinquent of a sexually violent offense after a trial, guilty plea, or plea of nolo contendere.
(3)
“Department” means the Department of Children and Families.
(4)
“Likely to engage in acts of sexual violence” means the person’s propensity to commit acts of sexual violence is of such a degree as to pose a menace to the health and safety of others.
(5)
“Mental abnormality” means a mental condition affecting a person’s emotional or volitional capacity which predisposes the person to commit sexually violent offenses.
(6)
“Person” means an individual 18 years of age or older who is a potential or actual subject of proceedings under this part.
(7)
“Secretary” means the secretary of the Department of Children and Families.
(8)
“Sexually motivated” means that one of the purposes for which the defendant committed the crime was for sexual gratification.
(9)
“Sexually violent offense” means:
(a)
Murder of a human being while engaged in sexual battery in violation of s. 782.04(1)(a)2.;
(b)
Kidnapping of a child under the age of 13 and, in the course of that offense, committing:
1.
Sexual battery; or
2.
A lewd, lascivious, or indecent assault or act upon or in the presence of the child;
(c)
Committing the offense of false imprisonment upon a child under the age of 13 and, in the course of that offense, committing:
1.
Sexual battery; or
2.
A lewd, lascivious, or indecent assault or act upon or in the presence of the child;
(d)
Sexual battery in violation of s. 794.011;
(e)
Lewd, lascivious, or indecent assault or act upon or in presence of the child in violation of s. 800.04 or s. 847.0135(5);
(f)
An attempt, criminal solicitation, or conspiracy, in violation of s. 777.04, of a sexually violent offense;
(g)
Any conviction for a felony offense in effect at any time before October 1, 1998, which is comparable to a sexually violent offense under paragraphs (a)-(f) or any federal conviction or conviction in another state for a felony offense that in this state would be a sexually violent offense;
(h)
Any criminal act that, either at the time of sentencing for the offense or subsequently during civil commitment proceedings under this part, has been determined beyond a reasonable doubt to have been sexually motivated; or
(i)
A criminal offense in which the state attorney refers a person to the department for civil commitment proceedings pursuant to s. 394.9125.
(10)
“Sexually violent predator” means any person who:
(a)
Has been convicted of a sexually violent offense; and
(b)
Suffers from a mental abnormality or personality disorder that makes the person likely to engage in acts of sexual violence if not confined in a secure facility for long-term control, care, and treatment.
(11)
“Total confinement” means that the person is currently being held in any physically secure facility being operated or contractually operated for the Department of Corrections, the Department of Juvenile Justice, or the Department of Children and Families. A person shall also be deemed to be in total confinement for applicability of provisions under this part if:
(a)
The person is serving an incarcerative sentence under the custody of the Department of Corrections or the Department of Juvenile Justice and is being held in any other secure facility for any reason;
(b)
The person is serving a sentence in a county or municipal jail for a sexually violent offense as defined in paragraph (9)(i); or
(c)
A court or the agency with jurisdiction determines that the person who is being held should have been lawfully released at an earlier date and that the provisions of this part would have been applicable to the person on the date that he or she should have been lawfully released.
F.S. 394.913 Notice to state attorney and multidisciplinary team of release of sexually violent predator; establishing multidisciplinary teams; information to be provided to multidisciplinary teams.
(1)
The agency with jurisdiction over a person who has been convicted of a sexually violent offense shall give written notice to the multidisciplinary team and shall provide a copy of the notice to the state attorney of the circuit in which that person was last convicted of a sexually violent offense. If the person has never been convicted of a sexually violent offense in this state but has been convicted of a sexually violent offense in another state or in federal court, the agency with jurisdiction shall give written notice to the multidisciplinary team and a copy to the state attorney of the circuit in which the person was last convicted of any offense in this state. If the person is being confined in this state pursuant to interstate compact and has a prior or current conviction for a sexually violent offense, the agency with jurisdiction shall give written notice to the multidisciplinary team and shall provide a copy to the state attorney of the circuit in which the person plans to reside upon release or, if no residence in this state is planned, the state attorney in the circuit in which the facility from which the person to be released is located. Except as provided in s. 394.9135, the written notice must be given:
(a)
At least 545 days before the anticipated release from total confinement of a person serving a sentence in the custody of the Department of Corrections, except that in the case of a person who is totally confined for a period of less than 545 days, written notice must be given as soon as practicable;
(b)
At least 180 days before the anticipated release from residential commitment of a person committed to the custody of the Department of Juvenile Justice, except that in the case of a person who is committed to a low or moderate risk facility, written notice must be given as soon as practicable;
(c)
At least 180 days before the anticipated hearing regarding possible release of a person committed to the custody of the department who has been found not guilty by reason of insanity or mental incapacity of a sexually violent offense; or
(d)
At least 180 days before the anticipated release from total confinement of a person serving a sentence in a county or municipal jail, except that in the case of a person who is totally confined for a period of less than 180 days, written notice must be given as soon as practicable.
(2)
The agency having jurisdiction shall provide the multidisciplinary team with the following information:
(a)
The person’s name; identifying characteristics; anticipated future residence; the type of supervision the person will receive in the community, if any; and the person’s offense history;
(b)
The person’s criminal history, including police reports, victim statements, presentence investigation reports, postsentence investigation reports, if available, and any other documents containing facts of the person’s criminal incidents or indicating whether the criminal incidents included sexual acts or were sexually motivated;
(c)
Mental health, mental status, and medical records, including all clinical records and notes concerning the person;
(d)
Documentation of institutional adjustment and any treatment received and, in the case of an adjudicated delinquent committed to the Department of Juvenile Justice, copies of the most recent performance plan and performance summary; and
(e)
If the person was returned to custody after a period of supervision, documentation of adjustment during supervision and any treatment received.
(3)(a)
The secretary or his or her designee shall establish a multidisciplinary team or teams.
(b)
Each team shall include, but need not be limited to, two licensed psychiatrists or psychologists or one licensed psychiatrist and one licensed psychologist who shall each have experience in or relevant to the evaluation or treatment of persons with mental abnormalities. The department shall provide annual training to the members of the multidisciplinary team on topics including, but not limited to, research on sexual offenses or offenders, clinical evaluation methods, and the civil commitment process. Members of the team who are hired on contract are limited to 1-year contracts. Such contracts may be renewed. The department shall regularly provide feedback to each multidisciplinary team member and formally evaluate annually the performance of each member of the multidisciplinary team. Such evaluations must include, but need not be limited to, the member’s:
1.
Scope of knowledge and understanding of clinical research regarding risk factors for sexual deviance and recidivism;
2.
Ability to identify relevant clinical data from review of criminal records and other information, including recommendations of law enforcement and insights from victim advocates; and
3.
Ability to apply clinical information in a structured assessment of both static risk factors and dynamic predictors of recidivism.
(c)
The department shall maintain data on each case on the recommendations of the clinical evaluators in their clinical evaluations, the final recommendations of the multidisciplinary team, the petitions filed by state attorneys, and the results of those petitions. The department shall analyze, at least annually, this data to assess inter-rater reliability between clinical evaluators and the level of agreement between an individual evaluator’s recommendation and the multidisciplinary team’s recommendation for the same individual. The department shall also assess trends in multidisciplinary team recommendations, state attorneys filings, and the results of such filings. The state attorneys shall provide information to the department regarding filings and their results as necessary to maintain this data.
(d)
The multidisciplinary team shall assess and evaluate each person referred to the team. The multidisciplinary team shall prioritize the assessment and evaluation of persons referred under subsection (1) based upon the person’s scheduled release date. The assessment and evaluation must include a review of the person’s institutional history and treatment record, if any, the person’s criminal background, and any other factor that is relevant to the determination of whether the person is a sexually violent predator.
(e)
The multidisciplinary team may consult with law enforcement agencies and victim advocate groups during the assessment and evaluation process. A clinical evaluation of the person may be conducted. A second clinical evaluation must be conducted if a member of the multidisciplinary team questions the conclusion of the first clinical evaluation. All members of the multidisciplinary team shall review, at a minimum, the information provided in subsection (2) and any clinical evaluation before making a recommendation pursuant to paragraph (g).
(f)
Before recommending that a person meets the definition of a sexually violent predator, the person must be offered a personal interview. If the person agrees to participate in a personal interview, at least one member of the team who is a licensed psychiatrist or psychologist must conduct a personal interview of the person. If the person refuses to fully participate in a personal interview, the multidisciplinary team shall proceed with its recommendation without the interview.
(g)
The multidisciplinary team shall complete all clinical evaluations and provide the state attorney a written assessment and recommendation as to whether the person meets the definition of a sexually violent predator at least 1 month before the person’s scheduled release date from the Department of Corrections, the Department of Juvenile Justice, or the Department of Children and Families. The multidisciplinary team shall complete all clinical evaluations and provide the state attorney a written assessment and recommendation as to whether the person meets the definition of a sexually violent predator at least 24 hours before the person’s scheduled release date from a county or municipal jail.
1.
The department must recommend that the state attorney file a petition for civil commitment if at least two members of the multidisciplinary team determine that the person meets the definition of a sexually violent predator.
2.
When the department determines that a person who has received a clinical evaluation does or does not meet the definition of a sexually violent predator, the written assessment and recommendation shall be sent to the state attorney. If the state attorney questions, in writing, the determination that the person does or does not meet the definition of a sexually violent predator, the multidisciplinary team must reexamine the case before a final written assessment and recommendation is provided to the state attorney.
(h)
The Attorney General’s Office shall serve as legal counsel to the multidisciplinary team.
(4)
The multidisciplinary team shall give equal consideration in the evaluation and assessment of an offender whose sexually violent offense was an attempt, criminal solicitation, or conspiracy, in violation of s. 777.04, to commit a sexually violent offense enumerated in s. 394.912(9) as it does in the evaluation and assessment of an offender who completed such an enumerated sexually violent offense. A rule or policy may not be established which reduces the level of consideration because the sexually violent offense was an attempt, criminal solicitation, or conspiracy.
(5)
This section is not jurisdictional, and failure to comply with it in no way prevents the state attorney from proceeding against a person otherwise subject to this part.
F.S. 394.914 Petition; contents.
After receipt from the multidisciplinary team of the written assessment and positive or negative recommendation as to whether the person meets the definition of a sexually violent predator, the state attorney, in accordance with s. 394.913, may file a petition with the circuit court alleging that the person is a sexually violent predator and stating facts sufficient to support such allegation. A fee may not be charged for the filing of a petition under this section.
F.S. 394.915 Determination of probable cause; hearing; evaluation; respondent taken into custody; bail.
(1)
When the state attorney files a petition seeking to have a person declared a sexually violent predator, the judge shall determine whether probable cause exists to believe that the person named in the petition is a sexually violent predator. If the judge determines that there is probable cause to believe that the person is a sexually violent predator, the judge shall order that the person remain in custody and be immediately transferred to an appropriate secure facility if the person’s incarcerative sentence expires.
(2)
Upon the expiration of the incarcerative sentence and before the release from custody of a person whom the multidisciplinary team recommends for civil commitment, but after the state attorney files a petition under s. 394.914, the court may conduct an adversarial probable cause hearing if it determines such hearing is necessary. The court shall only consider whether to have an adversarial probable cause hearing in cases where the failure to begin a trial is not the result of any delay caused by the respondent. The person shall be provided with notice of, and an opportunity to appear in person at, an adversarial hearing. At this hearing, the judge shall:
(a)
Receive evidence and hear argument from the person and the state attorney; and
(b)
Determine whether probable cause exists to believe that the person is a sexually violent predator.
(3)
At the adversarial probable cause hearing, the person has the right to:
(a)
Be represented by counsel;
(b)
Present evidence;
(c)
Cross-examine any witnesses who testify against the person; and
(d)
View and copy all petitions and reports in the court file.
(4)
If the court again concludes that there is probable cause to believe that the person is a sexually violent predator, the court shall order that the person be held in an appropriate secure facility upon the expiration of his or her incarcerative sentence.
(5)
After a court finds probable cause to believe that the person is a sexually violent predator, the person must be held in custody in a secure facility without opportunity for pretrial release or release during the trial proceedings.
F.S. 394.916 Trial; counsel and experts; indigent persons; jury.
(1)
Within 30 days after the determination of probable cause, the court shall conduct a trial to determine whether the person is a sexually violent predator.
(2)
The trial may be continued once upon the request of either party for not more than 120 days upon a showing of good cause, or by the court on its own motion in the interests of justice, when the person will not be substantially prejudiced. No additional continuances may be granted unless the court finds that a manifest injustice would otherwise occur.
(3)
At all adversarial proceedings under this act, the person subject to this act is entitled to the assistance of counsel, and, if the person is indigent, the court must appoint the public defender or, if a conflict exists, the court must appoint a criminal conflict and civil regional counsel or other counsel to assist the person.
(4)
If the person is subjected to a mental health examination under this part, the person also may retain experts or mental health professionals to perform an examination. If the person wishes to be examined by a professional of the person’s own choice, the examiner must be provided reasonable access to the person, as well as to all relevant medical and mental health records and reports. In the case of a person who is indigent, the court, upon the person’s request, shall determine whether such an examination is necessary. If the court determines that an examination is necessary, the court shall appoint a mental health professional and determine the reasonable compensation for the professional’s services, which shall be paid by the state.
(5)
The person or the state attorney has the right to demand that the trial be before a jury of six members. A demand for a jury trial must be filed, in writing, at least 5 days before the trial. If no demand is made, the trial shall be to the court.
F.S. 394.917 Determination; commitment procedure; mistrials; housing; counsel and costs in indigent appellate cases.
(1)
The court or jury shall determine by clear and convincing evidence whether the person is a sexually violent predator. If the determination is made by a jury, the verdict must be unanimous. If the jury is unable to reach a unanimous verdict, the court must declare a mistrial and poll the jury. If a majority of the jury would find the person is a sexually violent predator, the state attorney may refile the petition and proceed according to the provisions of this part. Any retrial must occur within 90 days after the previous trial, unless the subsequent proceeding is continued in accordance with s. 394.916(2). The determination that a person is a sexually violent predator may be appealed.
(2)
If the court or jury determines that the person is a sexually violent predator, upon the expiration of the incarcerative portion of all criminal sentences and disposition of any detainers, the person shall be committed to the custody of the Department of Children and Families for control, care, treatment, and rehabilitation of criminal offenders, until such time as the person’s mental abnormality or personality disorder has so changed that it is safe for the person to be at large. At all times, persons who are detained or committed under this part shall be kept in a secure facility segregated from patients of the department who are not detained or committed under this part.
(3)
The public defender of the circuit in which a person was determined to be a sexually violent predator shall be appointed to represent the person on appeal. That public defender may request the public defender who handles criminal appeals for the circuit to represent the person on appeal in the manner provided in s. 27.51(4). If the public defender is unable to represent the person on appeal due to a conflict, the court shall appoint other counsel, who shall be compensated at a rate not less than that provided for appointed counsel in criminal cases. Filing fees for indigent appeals under this act are waived. Costs and fees related to such appeals, including the amounts paid for records, transcripts, and compensation of appointed counsel, shall be authorized by the trial court and paid from state funds that are appropriated for such purposes.
F.S. 394.918 Examinations; notice; court hearings for release of committed persons; burden of proof.
(1)
A person committed under this part shall have an examination of his or her mental condition once every year or more frequently at the court’s discretion. The person may retain or, if the person is indigent and so requests, the court may appoint, a qualified professional to examine the person. Such a professional shall have access to all records concerning the person. The results of the examination shall be provided to the court that committed the person under this part. Upon receipt of the report, the court shall conduct a review of the person’s status.
(2)
The department shall provide the person with annual written notice of the person’s right to petition the court for release over the objection of the director of the facility where the person is housed. The notice must contain a waiver of rights. The director of the facility shall forward the notice and waiver form to the court.
(3)
The court shall hold a limited hearing to determine whether there is probable cause to believe that the person’s condition has so changed that it is safe for the person to be at large and that the person will not engage in acts of sexual violence if discharged. The person has the right to be represented by counsel at the probable cause hearing and the right to be present. Both the petitioner and the respondent may present evidence that the court may weigh and consider. If the court determines that there is probable cause to believe it is safe to release the person, the court shall set a trial before the court on the issue.
(4)
At the trial before the court, the person is entitled to be present and is entitled to the benefit of all constitutional protections afforded the person at the initial trial, except for the right to a jury. The state attorney shall represent the state and has the right to have the person examined by professionals chosen by the state. At the hearing, the state bears the burden of proving, by clear and convincing evidence, that the person’s mental condition remains such that it is not safe for the person to be at large and that, if released, the person is likely to engage in acts of sexual violence.
F.S. 394.919 Authorized petition for release; procedure.
(1)
If the secretary or the secretary’s designee at any time determines that the person is not likely to commit acts of sexual violence if discharged, the secretary or the secretary’s designee shall authorize the person to petition the court for release. The petition shall be served upon the court and the state attorney. The court, upon receipt of such a petition, shall order a trial before the court within 30 days, unless continued for good cause.
(2)
The state attorney shall represent the state, and has the right to have the person examined by professionals of the state attorney’s choice. The state bears the burden of proving, by clear and convincing evidence, that the person’s mental condition remains such that it is not safe for the person to be at large and that, if released, the person is likely to engage in acts of sexual violence.
F.S. 394.920 Petition for release.
A person is not prohibited from filing a petition for discharge at any time after commitment under this part. However, if the person has previously filed such a petition without the approval of the secretary or the secretary’s designee and the court determined that the petition was without merit, a subsequent petition shall be denied unless the petition contains facts upon which a court could find that the person’s condition has so changed that a probable cause hearing is warranted.
F.S. 394.921 Release of records to agencies, multidisciplinary teams, and state attorney.
(1)
In order to protect the public, relevant information and records that are otherwise confidential or privileged shall be released to the agency with jurisdiction, to a multidisciplinary team, or to the state attorney for the purpose of meeting the notice requirements of this part and determining whether a person is or continues to be a sexually violent predator. A person, agency, or entity receiving information under this section which is confidential and exempt from the provisions of s. 119.07(1) must maintain the confidentiality of that information. Such information does not lose its confidential status due to its release under this section.
(2)
Psychological or psychiatric reports, drug and alcohol reports, treatment records, medical records, or victim impact statements that have been submitted to the court or admitted into evidence under this part shall be part of the record but shall be sealed and may be opened only pursuant to a court order.
F.S. 394.923 Immunity from civil liability.
The agency with jurisdiction and its officers and employees; the department and its officers and employees; members of the multidisciplinary team; the state attorney and the state attorney’s employees; the Department of Legal Affairs and its officers and employees; and those involved in the evaluation, care, and treatment of sexually violent persons committed under this part are immune from any civil liability for good faith conduct under this part.
F.S. 394.924 Severability.
If any section, subsection, or provision of this part is held to be unconstitutional or invalid by a court of competent jurisdiction, the remaining portions of this part shall be unaffected because the Legislature declares that the provisions of this part are severable from each other.
F.S. 394.925 Applicability of act.
This part applies to all persons currently in custody who have been convicted of a sexually violent offense, as that term is defined in s. 394.912(9), as well as to all persons convicted of a sexually violent offense and sentenced to total confinement in the future.
F.S. 394.926 Notice to victims and others of release of persons in the custody of the department.
(1)
As soon as is practicable, the department shall give written notice of the release of a person in the custody of the department to any victim of the person who is alive and whose address is known to the department or, if the victim is deceased, to the victim’s family, if the family’s address is known to the department. Failure to notify is not a reason for postponement of release. This section does not create a cause of action against the state or an employee of the state acting within the scope of the employee’s employment as a result of the failure to notify pursuant to this part.
(2)
If a person in the custody of the department who has an active or pending term of probation, community control, parole, conditional release, or other court-ordered or postprison release supervision is released, the department must immediately notify the Department of Corrections’ Office of Community Corrections in Tallahassee. The Florida Commission on Offender Review must also be immediately notified of any releases of a person who has an active or pending term of parole, conditional release, or other postprison release supervision that is administered by the Florida Commission on Offender Review.
(3)
If a person in the custody of the department is released, the department must notify the Department of Law Enforcement and the sheriff of the county in which the person intends to reside, or if unknown, the sheriff of the county in which the person was last convicted.
(4)(a)
The department, in conjunction with the Department of Law Enforcement, shall enroll and maintain a sexually violent offender in the arrest notification program through the Florida Criminal Justice Network maintained by the Department of Law Enforcement upon such offender’s release from the department’s custody. Upon receiving an alert that a sexually violent offender has been arrested for a criminal offense subsequent to his or her release, the department must immediately notify the state attorney of the circuit in which the arrest occurred.
(b)
As used in this subsection, the term “sexually violent offender” means a person who has been committed to the department as a sexually violent predator or who has been in the department’s custody based upon a court finding of probable cause to believe the person is a sexually violent predator.
F.S. 394.927 Escape while in lawful custody; notice to victim; notice to the Department of Corrections and Florida Commission on Offender Review.
(1)
A person who is held in lawful custody pursuant to a judicial finding of probable cause under s. 394.915 or pursuant to a commitment as a sexually violent predator under s. 394.916 and who escapes or attempts to escape while in such custody commits a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
(2)
If a person who is held in custody pursuant to a finding of probable cause or commitment as a sexually violent predator escapes while in custody, the department shall immediately notify the victim in accordance with s. 394.926. The state attorney that filed the petition for civil commitment of the escapee must also be immediately notified by the department. If the escapee has an active or pending term of probation, community control, parole, conditional release, or other court-ordered or postprison release supervision, the department shall also immediately notify the Department of Corrections’ Office of Community Corrections in Tallahassee. The Florida Commission on Offender Review shall also be immediately notified of an escape if the escapee has an active or pending term of parole, conditional release, or other postprison release supervision that is administered by the Florida Commission on Offender Review.
F.S. 394.928 Subsistence fees and costs of treatment.
(1)
In recognition of the fact that persons committed under this part may have sources of income and assets, which may include bank accounts, inheritances, real estate, social security payments, veteran’s payments, and other types of financial resources, and in recognition of the fact that the daily subsistence cost and costs of treatment of persons committed under this part are a burden on the taxpayers of the state, each person so committed shall:
(a)
Upon order of the court committing the person, disclose all revenue or assets to the department.
(b)
Pay from such income and assets, except where such income is exempt by state or federal law, all or a fair portion of the person’s daily subsistence and treatment costs, based upon the person’s ability to pay, the liability or potential liability of the person to the victim or the guardian or the estate of the victim, and the needs of his or her dependents.
(2)(a)
Any person who is directed to pay all or a fair portion of daily subsistence and treatment costs is entitled to reasonable advance notice of the assessment and shall be afforded an opportunity to present reasons for opposition to the assessment.
(b)
An order directing payment of all or a fair portion of a person’s daily subsistence costs may survive against the estate of the person.
F.S. 394.929 Program costs.
The Department of Children and Families is responsible for all costs relating to the evaluation and treatment of persons committed to the department’s custody as sexually violent predators. A county is not obligated to fund costs for psychological examinations, expert witnesses, court-appointed counsel, or other costs required by this part. Other costs for psychological examinations, expert witnesses, and court-appointed counsel required by this part shall be paid from state funds appropriated by general law.
F.S. 394.930 Authority to adopt rules.
The Department of Children and Families shall adopt rules for:
(1)
Procedures that must be followed by members of the multidisciplinary teams when assessing and evaluating persons subject to this part;
(2)
Education and training requirements for members of the multidisciplinary teams and professionals who assess and evaluate persons under this part;
(3)
The criteria that must exist in order for a multidisciplinary team to recommend to a state attorney that a petition should be filed to involuntarily commit a person under this part. The criteria shall include, but are not limited to, whether:
(a)
The person has a propensity to engage in future acts of sexual violence;
(b)
The person should be placed in a secure, residential facility; and
(c)
The person needs long-term treatment and care.
(4)
The designation of secure facilities for sexually violent predators who are subject to involuntary commitment under this part;
(5)
The components of the basic treatment plan for all committed persons under this part;
(6)
The protocol to inform a person that he or she is being examined to determine whether he or she is a sexually violent predator under this part.
F.S. 394.931 Quarterly and annual reports.
The Department of Corrections shall collect information and compile quarterly reports with statistics profiling inmates released the previous quarter who fit the criteria and were referred to the Department of Children and Families pursuant to this act. At a minimum, the information that must be collected and compiled for inclusion in the reports includes: whether the qualifying offense was the current offense or the prior offense; the offender’s most serious sexual offense; the total number of distinct victims of the sexual offense; whether the victim was known to the offender; whether the sexual act was consensual; whether the sexual act involved multiple victims; whether direct violence was involved in the sexual offense; the age of each victim at the time of the offense; the age of the offender at the time of the first sexual offense; whether a weapon was used; length of time since the most recent sexual offense; and the total number of prior and current sexual offense convictions. The Department of Corrections shall compile recidivism data on those referred, detained, or committed to the department. The data shall be included in the Department of Corrections’ annual report.
F.S. 394.932 Registry of experts.
The Justice Administrative Commission shall maintain a registry of mental health and other experts who are available and willing to provide examinations and expert testimony in proceedings held under this part. The commission shall advertise the registry in professional trade publications on a periodic basis and shall list the name and contact information for all persons holding themselves out to be qualified to provide examinations and expert testimony pursuant to this part upon request. It shall be the sole responsibility of parties using the services of a person listed on the registry to verify the qualifications of that person. The commission shall advise all parties that use the registry that it has not verified the professional qualifications of the persons listed on the registry and that it is the party’s responsibility to verify the person’s professional qualifications. The commission may electronically publish the names and contact information of persons requesting to be listed on the registry.
F.S. 394.4572 Screening of mental health personnel.
(1)(a)
The department and the Agency for Health Care Administration shall require level 2 background screening pursuant to chapter 435 for mental health personnel. “Mental health personnel” includes all program directors, professional clinicians, staff members, and volunteers working in public or private mental health programs and facilities who have direct contact with individuals held for examination or admitted for mental health treatment. For purposes of this chapter, employment screening of mental health personnel also includes, but is not limited to, employment screening as provided under chapter 435 and s. 408.809.
(b)
Students in the health care professions who are interning in a mental health facility licensed under chapter 395, where the primary purpose of the facility is not the treatment of minors, are exempt from the fingerprinting and screening requirements if they are under direct supervision in the actual physical presence of a licensed health care professional.
(c)
A volunteer who assists on an intermittent basis for less than 10 hours per month is exempt from the fingerprinting and screening requirements if a person who meets the screening requirement of paragraph (a) is always present and has the volunteer within his or her line of sight.
(d)
Mental health personnel working in a facility licensed under chapter 395 who work on an intermittent basis for less than 15 hours per week of direct, face-to-face contact with patients, and who are not listed on the Department of Law Enforcement Career Offender Search or the Dru Sjodin National Sex Offender Public Website, are exempt from the fingerprinting and screening requirements, except that persons working in a mental health facility where the primary purpose of the facility is the mental health treatment of minors must be fingerprinted and meet screening requirements.
(e)
Any physician licensed under chapter 458 or chapter 459 or a nurse licensed under chapter 464 who was required to undergo background screening by the Department of Health as part of his or her initial licensure and the renewal of licensure, and who has an active and unencumbered license, is not subject to background screening pursuant to this section.
(2)(a)
The department or the Agency for Health Care Administration may grant exemptions from disqualification as provided in chapter 435.
(b)
The department or the Agency for Health Care Administration, as applicable, may grant exemptions from disqualification for service provider personnel to work solely in mental health treatment programs or facilities, or in programs or facilities that treat co-occurring substance use and mental health disorders.
F.S. 394.4573 Coordinated system of care; annual assessment; essential elements; measures of performance; system improvement grants; reports.
On or before December 1 of each year, the department shall submit to the Governor, the President of the Senate, and the Speaker of the House of Representatives an assessment of the behavioral health services in this state. The assessment shall consider, at a minimum, the extent to which designated receiving systems function as no-wrong-door models, the availability of treatment and recovery services that use recovery-oriented and peer-involved approaches, the availability of less-restrictive services, and the use of evidence-informed practices. The assessment shall also consider the availability of and access to coordinated specialty care programs and identify any gaps in the availability of and access to such programs in the state. The department’s assessment shall consider, at a minimum, the needs assessments conducted by the managing entities pursuant to s. 394.9082(5). The department shall compile and include in the report all plans submitted by managing entities pursuant to s. 394.9082(8) and the department’s evaluation of each plan.
(1)
As used in this section:
(a)
“Care coordination” means the implementation of deliberate and planned organizational relationships and service procedures that improve the effectiveness and efficiency of the behavioral health system by engaging in purposeful interactions with individuals who are not yet effectively connected with services to ensure service linkage. Examples of care coordination activities include development of referral agreements, shared protocols, and information exchange procedures. The purpose of care coordination is to enhance the delivery of treatment services and recovery supports and to improve outcomes among priority populations.
(b)
“Case management” means those direct services provided to a client in order to assess his or her needs, plan or arrange services, coordinate service providers, link the service system to a client, monitor service delivery, and evaluate patient outcomes to ensure the client is receiving the appropriate services.
(c)
“Coordinated system of care” means the full array of behavioral and related services in a region or community offered by all service providers, whether participating under contract with the managing entity or by another method of community partnership or mutual agreement.
(d)
“No-wrong-door model” means a model for the delivery of acute care services to persons who have mental health or substance use disorders, or both, which optimizes access to care, regardless of the entry point to the behavioral health care system.
(2)
The essential elements of a coordinated system of care include:
(a)
Community interventions, such as prevention, primary care for behavioral health needs, therapeutic and supportive services, crisis response services, and diversion programs.
(b)
A designated receiving system that consists of one or more facilities serving a defined geographic area and responsible for assessment and evaluation, both voluntary and involuntary, and treatment or triage of patients who have a mental health or substance use disorder, or co-occurring disorders.
1.
A county or several counties shall plan the designated receiving system using a process that includes the managing entity and is open to participation by individuals with behavioral health needs and their families, service providers, law enforcement agencies, and other parties. The county or counties, in collaboration with the managing entity, shall document the designated receiving system through written memoranda of agreement or other binding arrangements. The county or counties and the managing entity shall complete the plan and implement the designated receiving system by July 1, 2017, and the county or counties and the managing entity shall review and update, as necessary, the designated receiving system at least once every 3 years.
2.
To the extent permitted by available resources, the designated receiving system shall function as a no-wrong-door model. The designated receiving system may be organized in any manner which functions as a no-wrong-door model that responds to individual needs and integrates services among various providers. Such models include, but are not limited to:
a.
A central receiving system that consists of a designated central receiving facility that serves as a single entry point for persons with mental health or substance use disorders, or co-occurring disorders. The central receiving facility shall be capable of assessment, evaluation, and triage or treatment or stabilization of persons with mental health or substance use disorders, or co-occurring disorders.
b.
A coordinated receiving system that consists of multiple entry points that are linked by shared data systems, formal referral agreements, and cooperative arrangements for care coordination and case management. Each entry point shall be a designated receiving facility and shall, within existing resources, provide or arrange for necessary services following an initial assessment and evaluation.
c.
A tiered receiving system that consists of multiple entry points, some of which offer only specialized or limited services. Each service provider shall be classified according to its capabilities as either a designated receiving facility or another type of service provider, such as a triage center, a licensed detoxification facility, or an access center. All participating service providers shall, within existing resources, be linked by methods to share data, formal referral agreements, and cooperative arrangements for care coordination and case management.
An accurate inventory of the participating service providers which specifies the capabilities and limitations of each provider and its ability to accept patients under the designated receiving system agreements and the transportation plan developed pursuant to this section shall be maintained and made available at all times to all first responders in the service area.
(c)
Transportation in accordance with a plan developed under s. 394.462.
(d)
Crisis services, including the 988 suicide and crisis lifeline call center, mobile response teams, crisis stabilization units, addiction receiving facilities, and detoxification facilities.
(e)
Case management. Each case manager or person directly supervising a case manager who provides Medicaid-funded targeted case management services shall hold a valid certification from a department-approved credentialing entity as defined in s. 397.311(11) by July 1, 2017, and, thereafter, within 6 months after hire.
(f)
Care coordination that involves coordination with other local systems and entities, public and private, which are involved with the individual, such as primary care, child welfare, behavioral health care, and criminal and juvenile justice organizations.
(g)
Outpatient services.
(h)
Residential services.
(i)
Hospital inpatient care.
(j)
Aftercare and other postdischarge services.
(k)
Medication-assisted treatment and medication management.
(l)
Recovery support, including, but not limited to, the use of peer specialists to assist in the individual’s recovery from a substance use disorder or mental illness; support for competitive employment, educational attainment, independent living skills development, family support and education, wellness management, and self-care; and assistance in obtaining housing that meets the individual’s needs. Such housing may include mental health residential treatment facilities, limited mental health assisted living facilities, adult family care homes, and supportive housing. Housing provided using state funds must provide a safe and decent environment free from abuse and neglect.
(m)
Care plans shall assign specific responsibility for initial and ongoing evaluation of the supervision and support needs of the individual and the identification of housing that meets such needs. For purposes of this paragraph, the term “supervision” means oversight of and assistance with compliance with the clinical aspects of an individual’s care plan.
(n)
Coordinated specialty care programs.
(3)
Subject to a specific appropriation by the Legislature, the department may award system improvement grants to managing entities based on a detailed plan to enhance services in accordance with the no-wrong-door model as defined in subsection (1) and to address specific needs identified in the assessment prepared by the department pursuant to this section. Such a grant must be awarded through a performance-based contract that links payments to the documented and measurable achievement of system improvements.
F.S. 394.4574 Responsibilities for coordination of services for a mental health resident who resides in an assisted living facility that holds a limited mental health license.
(1)
As used in this section, the term “mental health resident” means an individual who receives social security disability income due to a mental disorder as determined by the Social Security Administration or receives supplemental security income due to a mental disorder as determined by the Social Security Administration and receives optional state supplementation.
(2)
Medicaid managed care plans are responsible for Medicaid enrolled mental health residents, and managing entities under contract with the department are responsible for mental health residents who are not enrolled in a Medicaid health plan. A Medicaid managed care plan or a managing entity shall ensure that:
(a)
A mental health resident has been assessed by a psychiatrist, clinical psychologist, clinical social worker, or psychiatric nurse, or an individual who is supervised by one of these professionals, and determined to be appropriate to reside in an assisted living facility. The documentation must be provided to the administrator of the facility within 30 days after the mental health resident has been admitted to the facility. An evaluation completed upon discharge from a state mental hospital meets the requirements of this subsection related to appropriateness for placement as a mental health resident if it was completed within 90 days before admission to the facility.
(b)
A cooperative agreement, as required in s. 429.075, is developed by the mental health care services provider that serves a mental health resident and the administrator of the assisted living facility with a limited mental health license in which the mental health resident is living.
(c)
The community living support plan, as defined in s. 429.02, has been prepared by a mental health resident and his or her mental health case manager in consultation with the administrator of the facility or the administrator’s designee. The plan must be completed and provided to the administrator of the assisted living facility with a limited mental health license in which the mental health resident lives within 30 days after the resident’s admission. The support plan and the agreement may be in one document.
(d)
The assisted living facility with a limited mental health license is provided with documentation that the individual meets the definition of a mental health resident.
(e)
The mental health services provider assigns a case manager to each mental health resident for whom the entity is responsible. The case manager shall coordinate the development and implementation of the community living support plan defined in s. 429.02. The plan must be updated at least annually, or when there is a significant change in the resident’s behavioral health status. Each case manager shall keep a record of the date and time of any face-to-face interaction with the resident and make the record available to the responsible entity for inspection. The record must be retained for at least 2 years after the date of the most recent interaction.
(f)
Consistent monitoring and implementation of community living support plans and cooperative agreements are conducted by the resident’s case manager.
(g)
Concerns are reported to the appropriate regulatory oversight organization if a regulated provider fails to deliver appropriate services or otherwise acts in a manner that has the potential to result in harm to the resident.
(3)
The Secretary of Children and Families, in consultation with the Agency for Health Care Administration, shall require each district administrator to develop, with community input, a detailed annual plan that demonstrates how the district will ensure the provision of state-funded mental health and substance abuse treatment services to residents of assisted living facilities that hold a limited mental health license. This plan must be consistent with the substance abuse and mental health district plan developed pursuant to s. 394.75 and must address case management services; access to consumer-operated drop-in centers; access to services during evenings, weekends, and holidays; supervision of the clinical needs of the residents; and access to emergency psychiatric care.
F.S. 394.4575 Student mental health assistance program evaluation.
(1)
The Office of Program Policy Analysis and Government Accountability (OPPAGA), in consultation with the Department of Children and Families, the Department of Education, the Louis de la Parte Florida Mental Health Institute, and any other identified relevant stakeholder, must evaluate school district compliance with ss. 1001.212(11), 1006.041, and 1012.584(4) and the mental health services and supports provided to students pursuant to those sections. OPPAGA must:
(a)
By December 31, 2025, provide an initial evaluation of the expenditure plans and program outcome reports submitted by school districts as required in s. 1006.041 to the Governor, the President of the Senate, and the Speaker of the House of Representatives. The evaluation must include, but is not limited to:
1.
An assessment of school district compliance with the requirements of ss. 1001.212(11), 1006.041, and 1012.584(4).
2.
An assessment of treatment outcomes, system capacity, and performance of mental health services provided pursuant to s. 1006.041(2)(a) and (b).
3.
An assessment of the policies, procedures, and data collection that inform the reporting by school districts as required pursuant to s. 1006.041.
4.
An assessment of the mental health assistance programs’ integration into the coordinated system of care required under s. 394.4573.
5.
Identification of, and recommendations for, other relevant data and information needed from the mental health assistance programs to annually perform an effective evaluation of treatment outcomes, system capacity, performance, and level of integration with coordinated systems of care.
(b)
By December 1, 2026, provide a final review and evaluation of the mental health assistance programs within the school districts to the Governor, the President of the Senate, and the Speaker of the House of Representatives. The evaluation must include, but is not limited to:
1.
An assessment of school district compliance with the requirements of ss. 1001.212(11), 1006.041, and 1012.584(4).
2.
An assessment of the treatment outcomes, system capacity, and performance of mental health services provided pursuant to s. 1006.041(2)(a) and (b).
3.
An assessment of the mental health assistance programs’ ongoing level of integration with the coordinated system of care required under s. 394.4573.
4.
Recommendations to enhance treatment outcomes, system capacity, and performance of school-based
1
mental health assistance programs and increase the integration of those programs into the coordinated system of care.
(2)
The Department of Education and school district threat management coordinators and mental health coordinators as described in s. 1006.07 must coordinate with OPPAGA and must provide requested information, reports, and data for evaluation and inclusion in the report, including, but not limited to:
(a)
Referrals to mental health services originating from the behavioral threat process or assessment instrument, in the aggregate.
(b)
OPPAGA identified:
1.
Performance metrics.
2.
Treatment outcome metrics.
3.
System capacity metrics.
(3)
The department and the Louis de la Parte Florida Mental Health Institute must coordinate with OPPAGA and provide requested information and data related to outcomes and performance of integrated and coordinated systems of care pursuant to this chapter for evaluation and inclusion in the report.
F.S. 394.4593 Sexual misconduct prohibited; reporting required; penalties.
(1)
As used in this section, the term:
(a)
“Employee” includes any paid staff member, volunteer, or intern of the department; any person under contract with the department; and any person providing care or support to a client on behalf of the department or its providers.
(b)
“Sexual activity” means:
1.
Fondling the genital area, groin, inner thighs, buttocks, or breasts of a person.
2.
The oral, anal, or vaginal penetration by or union with the sexual organ of another or the anal or vaginal penetration of another by any other object.
3.
Intentionally touching in a lewd or lascivious manner the breasts, genitals, the genital area, or buttocks, or the clothing covering them, of a person, or forcing or enticing a person to touch the perpetrator.
4.
Intentionally masturbating in the presence of another person.
5.
Intentionally exposing the genitals in a lewd or lascivious manner in the presence of another person.
6.
Intentionally committing any other sexual act that does not involve actual physical or sexual contact with the victim, including, but not limited to, sadomasochistic abuse, sexual bestiality, or the simulation of any act involving sexual activity in the presence of a victim.
(c)
“Sexual misconduct” means any sexual activity between an employee and a patient, regardless of the consent of the patient. The term does not include an act done for a bona fide medical purpose or an internal search conducted in the lawful performance of duty by an employee.
(2)
An employee who engages in sexual misconduct with a patient who:
(a)
Is in the custody of the department; or
(b)
Resides in a receiving facility or a treatment facility, as those terms are defined in s. 394.455,
commits a felony of the second degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084. An employee may be found guilty of violating this subsection without having committed the crime of sexual battery.
(3)
The consent of the patient to sexual activity is not a defense to prosecution under this section.
(4)
This section does not apply to an employee who:
(a)
Is legally married to the patient; or
(b)
Has no reason to believe that the person with whom the employee engaged in sexual misconduct is a patient receiving services as described in subsection (2).
(5)
An employee who witnesses sexual misconduct, or who otherwise knows or has reasonable cause to suspect that a person has engaged in sexual misconduct, shall immediately report the incident to the department’s central abuse hotline and to the appropriate local law enforcement agency. Such employee shall also prepare, date, and sign an independent report that specifically describes the nature of the sexual misconduct, the location and time of the incident, and the persons involved. The employee shall deliver the report to the supervisor or program director, who is responsible for providing copies to the department’s inspector general. The inspector general shall immediately conduct an appropriate administrative investigation, and, if there is probable cause to believe that sexual misconduct has occurred, the inspector general shall notify the state attorney in the circuit in which the incident occurred.
(6)(a)
Any person who is required to make a report under this section and who knowingly or willfully fails to do so, or who knowingly or willfully prevents another person from doing so, commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.
(b)
Any person who knowingly or willfully submits inaccurate, incomplete, or untruthful information with respect to a report required under this section commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.
(c)
Any person who knowingly or willfully coerces or threatens any other person with the intent to alter testimony or a written report regarding an incident of sexual misconduct commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
(7)
The provisions and penalties set forth in this section are in addition to any other civil, administrative, or criminal action provided by law which may be applied against an employee.
F.S. 394.4595 Florida statewide and local advocacy councils; access to patients and records.
Any facility designated by the department as a receiving or treatment facility must allow access to any patient and the clinical and legal records of any patient admitted pursuant to the provisions of this act by members of the Florida statewide and local advocacy councils.
F.S. 394.4597 Persons to be notified; patient’s representative.
(1)
VOLUNTARY PATIENTS.
—
At the time a patient is voluntarily admitted to a receiving or treatment facility, the identity and contact information of a person to be notified in case of an emergency shall be entered in the patient’s clinical record.
(2)
INVOLUNTARY PATIENTS.
—
(a)
At the time a patient is admitted to a facility for involuntary examination or placement, or when a petition for involuntary placement is filed, the names, addresses, and telephone numbers of the patient’s guardian or guardian advocate, or representative if the patient has no guardian, and the patient’s attorney shall be entered in the patient’s clinical record.
(b)
If the patient has no guardian, the patient shall be asked to designate a representative. If the patient is unable or unwilling to designate a representative, the facility shall select a representative.
(c)
The patient shall be consulted with regard to the selection of a representative by the receiving or treatment facility and shall have authority to request that any such representative be replaced.
(d)
When the receiving or treatment facility selects a representative, first preference shall be given to a health care surrogate, if one has been previously selected by the patient. If the patient has not previously selected a health care surrogate, the selection, except for good cause documented in the patient’s clinical record, shall be made from the following list in the order of listing:
1.
The patient’s spouse.
2.
An adult child of the patient.
3.
A parent of the patient.
4.
The adult next of kin of the patient.
5.
An adult friend of the patient.
(e)
The following persons are prohibited from selection as a patient’s representative:
1.
A professional providing clinical services to the patient under this part.
2.
The licensed professional who initiated the involuntary examination of the patient, if the examination was initiated by professional certificate.
3.
An employee, an administrator, or a board member of the facility providing the examination of the patient.
4.
An employee, an administrator, or a board member of a treatment facility providing treatment for the patient.
5.
A person providing any substantial professional services to the patient, including clinical services.
6.
A creditor of the patient.
7.
A person subject to an injunction for protection against domestic violence under s. 741.30, whether the order of injunction is temporary or final, and for which the patient was the petitioner.
8.
A person subject to an injunction for protection against repeat violence, stalking, sexual violence, or dating violence under s. 784.046, whether the order of injunction is temporary or final, and for which the patient was the petitioner.
F.S. 394.4598 Guardian advocate.
(1)
The administrator may petition the court for the appointment of a guardian advocate based upon the opinion of a psychiatrist or psychiatric nurse practicing within the framework of an established protocol with a psychiatrist that the patient is incompetent to consent to treatment. If the court finds that a patient is incompetent to consent to treatment and has not been adjudicated incapacitated and had a guardian with the authority to consent to mental health treatment appointed, the court must appoint a guardian advocate. The patient has the right to have an attorney represent him or her at the hearing. If the person is indigent, the court must appoint the office of the public defender to represent him or her at the hearing. The patient has the right to testify, cross-examine witnesses, and present witnesses. The proceeding must be recorded, either electronically or stenographically, and testimony must be provided under oath. One of the professionals authorized to give an opinion in support of a petition for involuntary placement, as described in s. 394.4655 or s. 394.467, must testify. A guardian advocate must meet the qualifications of a guardian contained in part IV of chapter 744, except that a professional referred to in this part, an employee of the facility providing direct services to the patient under this part, a departmental employee, a facility administrator, or member of the Florida local advocacy council may not be appointed. A person appointed as a guardian advocate must agree to the appointment.
(2)
The following persons are prohibited from appointment as a patient’s guardian advocate:
(a)
A professional providing clinical services to the patient under this part.
(b)
The licensed professional who initiated the involuntary examination of the patient, if the examination was initiated by professional certificate.
(c)
An employee, an administrator, or a board member of the facility providing the examination of the patient.
(d)
An employee, an administrator, or a board member of a treatment facility providing treatment of the patient.
(e)
A person providing any substantial professional services, excluding public and professional guardians, to the patient, including clinical services.
(f)
A creditor of the patient.
(g)
A person subject to an injunction for protection against domestic violence under s. 741.30, whether the order of injunction is temporary or final, and for which the patient was the petitioner.
(h)
A person subject to an injunction for protection against repeat violence, stalking, sexual violence, or dating violence under s. 784.046, whether the order of injunction is temporary or final, and for which the patient was the petitioner.
(3)
A facility requesting appointment of a guardian advocate must, before the appointment, provide the prospective guardian advocate with information about the duties and responsibilities of guardian advocates, including the information about the ethics of medical decisionmaking. Before asking a guardian advocate to give consent to treatment for a patient, the facility shall provide to the guardian advocate sufficient information so that the guardian advocate can decide whether to give express and informed consent to the treatment, including information that the treatment is essential to the care of the patient, and that the treatment does not present an unreasonable risk of serious, hazardous, or irreversible side effects. Before giving consent to treatment, the guardian advocate must meet and talk with the patient and the patient’s physician or psychiatric nurse practicing within the framework of an established protocol with a psychiatrist in person, if at all possible, and by telephone, if not. The decision of the guardian advocate may be reviewed by the court, upon petition of the patient’s attorney, the patient’s family, or the facility administrator.
(4)
In lieu of the training required of guardians appointed pursuant to chapter 744, a guardian advocate must, at a minimum, participate in a 4-hour training course approved by the court before exercising his or her authority. At a minimum, this training course must include information about patient rights, psychotropic medications, the diagnosis of mental illness, the ethics of medical decisionmaking, and duties of guardian advocates.
(5)
The required training course and the information to be supplied to prospective guardian advocates before their appointment must be developed by the department, approved by the chief judge of the circuit court, and taught by a court-approved organization, which may include, but is not limited to, a community college, a guardianship organization, a local bar association, or The Florida Bar. The training course may be web-based, provided in video format, or other electronic means but must be capable of ensuring the identity and participation of the prospective guardian advocate. The court may waive some or all of the training requirements for guardian advocates or impose additional requirements. The court shall make its decision on a case-by-case basis and, in making its decision, shall consider the experience and education of the guardian advocate, the duties assigned to the guardian advocate, and the needs of the patient.
(6)
In selecting a guardian advocate, the court shall give preference to a health care surrogate, if one has already been designated by the patient. If the patient has not previously selected a health care surrogate, except for good cause documented in the court record, the selection shall be made from the following list in the order of listing:
(a)
The patient’s spouse.
(b)
An adult child of the patient.
(c)
A parent of the patient.
(d)
The adult next of kin of the patient.
(e)
An adult friend of the patient.
(f)
An adult trained and willing to serve as guardian advocate for the patient.
(7)
If a guardian with the authority to consent to medical treatment has not already been appointed or if the patient has not already designated a health care surrogate, the court may authorize the guardian advocate to consent to medical treatment, as well as mental health treatment. Unless otherwise limited by the court, a guardian advocate with authority to consent to medical treatment shall have the same authority to make health care decisions and be subject to the same restrictions as a proxy appointed under part IV of chapter 765. Unless the guardian advocate has sought and received express court approval in proceeding separate from the proceeding to determine the competence of the patient to consent to medical treatment, the guardian advocate may not consent to:
(a)
Abortion.
(b)
Sterilization.
(c)
Electroconvulsive treatment.
(d)
Psychosurgery.
(e)
Experimental treatments that have not been approved by a federally approved institutional review board in accordance with 45 C.F.R. part 46 or 21 C.F.R. part 56.
The court must base its decision on evidence that the treatment or procedure is essential to the care of the patient and that the treatment does not present an unreasonable risk of serious, hazardous, or irreversible side effects. The court shall follow the procedures set forth in subsection (1) of this section.
(8)
The guardian advocate shall be discharged when the patient is discharged from an order for involuntary outpatient services or involuntary inpatient placement or when the patient is transferred from involuntary to voluntary status. The court or a hearing officer shall consider the competence of the patient pursuant to subsection (1) and may consider an involuntarily placed patient’s competence to consent to treatment at any hearing. Upon sufficient evidence, the court may restore, or the hearing officer may recommend that the court restore, the patient’s competence. A copy of the order restoring competence or the certificate of discharge containing the restoration of competence shall be provided to the patient and the guardian advocate.
F.S. 394.4599 Notice.
(1)
VOLUNTARY ADMISSION.
—
Notice of an individual’s voluntary admission shall be given only at the request of the individual, except that, in an emergency, notice shall be given as determined by the facility.
(2)
INVOLUNTARY ADMISSION.
—
(a)
Whenever notice is required to be given under this part, such notice shall be given to the individual and the individual’s guardian, guardian advocate, health care surrogate or proxy, attorney, and representative.
1.
When notice is required to be given to an individual, it shall be given both orally and in writing, in the language and terminology that the individual can understand, and, if needed, the facility shall provide an interpreter for the individual.
2.
Notice to an individual’s guardian, guardian advocate, health care surrogate or proxy, attorney, and representative shall be given by mail with the date, time, and method of notice delivery documented in the clinical record. Hand delivery by a facility employee may be used as an alternative, with the date and time of delivery documented in the clinical record. If notice is given by a state attorney or an attorney for the department, a certificate of service is sufficient to document service.
(b)
A receiving facility shall give prompt notice of the whereabouts of an individual who is being involuntarily held for examination to the individual’s guardian, guardian advocate, health care surrogate or proxy, attorney or representative, or other emergency contact identified through electronic databases pursuant to s. 394.463(2)(a), by telephone or in person within 24 hours after the individual’s arrival at the facility. Contact attempts shall be documented in the individual’s clinical record and shall begin as soon as reasonably possible after the individual’s arrival.
(c)1.
A receiving facility shall give notice of the whereabouts of a minor who is being involuntarily held for examination pursuant to s. 394.463 to the minor’s parent, guardian, caregiver, or guardian advocate, in person or by telephone or other form of electronic communication, immediately after the minor’s arrival at the facility. The facility may delay notification for no more than 24 hours after the minor’s arrival if the facility has submitted a report to the central abuse hotline, pursuant to s. 39.201, based upon knowledge or suspicion of abuse, abandonment, or neglect and if the facility deems a delay in notification to be in the minor’s best interest.
2.
The receiving facility shall attempt to notify the minor’s parent, guardian, caregiver, or guardian advocate until the receiving facility receives confirmation from the parent, guardian, caregiver, or guardian advocate, verbally, by telephone or other form of electronic communication, or by recorded message, that notification has been received. Attempts to notify the parent, guardian, caregiver, or guardian advocate must be repeated at least once every hour during the first 12 hours after the minor’s arrival and once every 24 hours thereafter and must continue until such confirmation is received, unless the minor is released at the end of the 72-hour examination period, or until a petition for involuntary services is filed with the court pursuant to s. 394.463(2)(g). The receiving facility may seek assistance from a law enforcement agency to notify the minor’s parent, guardian, caregiver, or guardian advocate if the facility has not received within the first 24 hours after the minor’s arrival a confirmation by the parent, guardian, caregiver, or guardian advocate that notification has been received. The receiving facility must document notification attempts in the minor’s clinical record.
(d)
The written notice of the filing of the petition for involuntary services for an individual being held must contain the following:
1.
Notice that the petition for involuntary services pursuant to s. 394.4655 or s. 394.467 has been filed with the circuit or county court, as applicable, and the address of such court.
2.
Notice that the office of the public defender has been appointed to represent the individual in the proceeding, if the individual is not otherwise represented by counsel.
3.
The date, time, and place of the hearing and the name of each examining expert and every other person expected to testify in support of continued detention.
4.
Notice that the individual, the individual’s guardian, guardian advocate, health care surrogate or proxy, or representative, or the administrator may apply for a change of venue for the convenience of the parties or witnesses or because of the condition of the individual.
5.
Notice that the individual is entitled to an independent expert examination and, if the individual cannot afford such an examination, that the court will provide for one.
(e)
A treatment facility shall provide notice of an individual’s involuntary admission on the next regular working day after the individual’s arrival at the facility.
(f)
When an individual is to be transferred from one facility to another, notice shall be given by the facility where the individual is located before the transfer.
F.S. 394.4612 Integrated adult mental health crisis stabilization and addictions receiving facilities.
(1)
The Agency for Health Care Administration, in consultation with the Department of Children and Families, may license facilities that integrate services provided in an adult mental health crisis stabilization unit with services provided in an adult addictions receiving facility. Such a facility shall be licensed by the agency as an adult crisis stabilization unit under part IV and must meet all licensure requirements for crisis stabilization units providing integrated services.
(2)
An integrated mental health crisis stabilization unit and addictions receiving facility may provide services under this section to adults who are 18 years of age or older and who fall into one or more of the following categories:
(a)
An adult meeting the requirements for voluntary admission for mental health treatment under s. 394.4625.
(b)
An adult meeting the criteria for involuntary examination for mental illness under s. 394.463.
(c)
An adult qualifying for voluntary admission for substance abuse treatment under s. 397.601.
(d)
An adult meeting the criteria for involuntary admission for substance abuse impairment under s. 397.675.
(3)
The department, in consultation with the agency, shall adopt by rule standards that address eligibility criteria; clinical procedures; staffing requirements; operational, administrative, and financing requirements; and the investigation of complaints.
F.S. 394.4615 Clinical records; confidentiality.
(1)
A clinical record shall be maintained for each patient. The record shall include data pertaining to admission and such other information as may be required under rules of the department. A clinical record is confidential and exempt from the provisions of s. 119.07(1). Unless waived by express and informed consent, by the patient or the patient’s guardian or guardian advocate or, if the patient is deceased, by the patient’s personal representative or the family member who stands next in line of intestate succession, the confidential status of the clinical record shall not be lost by either authorized or unauthorized disclosure to any person, organization, or agency.
(2)
The clinical record shall be released when:
(a)
The patient or the patient’s guardian or legal custodian authorizes the release. The guardian, guardian advocate, or legal custodian shall be provided access to the appropriate clinical records of the patient. The patient or the patient’s guardian, guardian advocate, or legal custodian may authorize the release of information and clinical records to appropriate persons to ensure the continuity of the patient’s health care or mental health care. A receiving facility must document that, within 24 hours of admission, individuals admitted on a voluntary basis have been provided with the option to authorize the release of information from their clinical record to the individual’s health care surrogate or proxy, attorney, representative, or other known emergency contact.
(b)
The patient is represented by counsel and the records are needed by the patient’s counsel for adequate representation.
(c)
The court orders such release. In determining whether there is good cause for disclosure, the court shall weigh the need for the information to be disclosed against the possible harm of disclosure to the person to whom such information pertains.
(d)
The patient is committed to, or is to be returned to, the Department of Corrections from the Department of Children and Families, and the Department of Corrections requests such records. These records shall be furnished without charge to the Department of Corrections.
(3)
Information from the clinical record may be released in the following circumstances:
(a)
When a patient has communicated to a service provider a specific threat to cause serious bodily injury or death to an identified or a readily available person, if the service provider reasonably believes, or should reasonably believe according to the standards of his or her profession, that the patient has the apparent intent and ability to imminently or immediately carry out such threat. When such communication has been made, the administrator may authorize the release of sufficient information to provide adequate warning to the person threatened with harm by the patient.
(b)
When the administrator of the facility or secretary of the department deems release to a qualified researcher as defined in administrative rule, an aftercare treatment provider, or an employee or agent of the department is necessary for treatment of the patient, maintenance of adequate records, compilation of treatment data, aftercare planning, or evaluation of programs.
For the purpose of determining whether a person meets the criteria for involuntary services or for preparing the proposed services plan pursuant to s. 394.4655 or s. 394.467, the clinical record may be released to the state attorney, the public defender or the patient’s private legal counsel, the court, and to the appropriate mental health professionals, including the service provider under s. 394.4655 or s. 394.467, in accordance with state and federal law.
(4)
Information from the clinical record must be released when a patient has communicated to a service provider a specific threat to cause serious bodily injury or death to an identified or a readily available person, if the service provider reasonably believes, or should reasonably believe according to the standards of his or her profession, that the patient has the apparent intent and ability to imminently or immediately carry out such threat. When such communication has been made, the administrator must authorize the release of sufficient information to communicate the threat to law enforcement. A law enforcement agency that receives notification of a specific threat under this subsection must take appropriate action to prevent the risk of harm, including, but not limited to, notifying the intended victim of such threat or initiating a risk protection order. A service provider’s authorization to release information from a clinical record when communicating a threat pursuant to this section may not be the basis of any legal action or criminal or civil liability against the service provider.
(5)
Information from clinical records may be used for statistical and research purposes if the information is abstracted in such a way as to protect the identity of individuals.
(6)
Information from clinical records may be used by the Agency for Health Care Administration, the department, and the Florida advocacy councils for the purpose of monitoring facility activity and complaints concerning facilities.
(7)
Clinical records relating to a Medicaid recipient shall be furnished to the Medicaid Fraud Control Unit in the Department of Legal Affairs, upon request.
(8)
Any person, agency, or entity receiving information pursuant to this section shall maintain such information as confidential and exempt from the provisions of s. 119.07(1).
(9)
Any facility or private mental health practitioner who acts in good faith in releasing information pursuant to this section is not subject to civil or criminal liability for such release.
(10)
Nothing in this section is intended to prohibit the parent or next of kin of a person who is held in or treated under a mental health facility or program from requesting and receiving information limited to a summary of that person’s treatment plan and current physical and mental condition. Release of such information shall be in accordance with the code of ethics of the profession involved.
(11)
Patients must have reasonable access to their clinical records, unless such access is determined by the patient’s physician or the patient’s psychiatric nurse to be harmful to the patient. If the patient’s right to inspect his or her clinical record is restricted by the facility, written notice of such restriction must be given to the patient and the patient’s guardian, guardian advocate, attorney, and representative. In addition, the restriction must be recorded in the clinical record, together with the reasons for it. The restriction of a patient’s right to inspect his or her clinical record expires after 7 days but may be renewed, after review, for subsequent 7-day periods.
(12)
Any person who fraudulently alters, defaces, or falsifies the clinical record of any person receiving mental health services in a facility subject to this part, or causes or procures any of these offenses to be committed, commits a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.
F.S. 394.4625 Voluntary admissions.
(1)
AUTHORITY TO RECEIVE PATIENTS.
—
(a)
A facility may receive for observation, diagnosis, or treatment any adult who applies by express and informed consent for admission or any minor whose parent or legal guardian applies for admission. Such person may be admitted to the facility if found to show evidence of mental illness and to be suitable for treatment, and:
1.
If the person is an adult, is found to be competent to provide express and informed consent; or
2.
If the person is a minor, the parent or legal guardian provides express and informed consent and the facility performs a clinical review to verify the voluntariness of the minor’s assent.
(b)
A mental health overlay program or a mobile crisis response service or a licensed professional who is authorized to initiate an involuntary examination pursuant to s. 394.463 and is employed by a community mental health center or clinic must, pursuant to district procedure approved by the respective district administrator, conduct an initial assessment of the ability of the following persons to give express and informed consent to treatment before such persons may be admitted voluntarily:
1.
A person 60 years of age or older for whom transfer is being sought from a nursing home, assisted living facility, adult day care center, or adult family-care home, when such person has been diagnosed as suffering from dementia.
2.
A person 60 years of age or older for whom transfer is being sought from a nursing home pursuant to s. 400.0255(12).
3.
A person for whom all decisions concerning medical treatment are currently being lawfully made by the health care surrogate or proxy designated under chapter 765.
(c)
When an initial assessment of the ability of a person to give express and informed consent to treatment is required under this section, and a mobile crisis response service does not respond to the request for an assessment within 2 hours after the request is made or informs the requesting facility that it will not be able to respond within 2 hours after the request is made, the requesting facility may arrange for assessment by any licensed professional authorized to initiate an involuntary examination pursuant to s. 394.463 who is not employed by or under contract with, and does not have a financial interest in, either the facility initiating the transfer or the receiving facility to which the transfer may be made.
(d)
A facility may not admit as a voluntary patient a person who has been adjudicated incapacitated, unless the condition of incapacity has been judicially removed. If a facility admits as a voluntary patient a person who is later determined to have been adjudicated incapacitated, and the condition of incapacity had not been removed by the time of the admission, the facility must either discharge the patient or transfer the patient to involuntary status.
(e)
The health care surrogate or proxy of a voluntary patient may not consent to the provision of mental health treatment for the patient. A voluntary patient who is unwilling or unable to provide express and informed consent to mental health treatment must either be discharged or transferred to involuntary status.
(f)
Within 24 hours after admission of a voluntary patient, the treating physician or psychiatric nurse practicing within the framework of an established protocol with a psychiatrist shall document in the patient’s clinical record that the patient is able to give express and informed consent for admission. If the patient is not able to give express and informed consent for admission, the facility must either discharge the patient or transfer the patient to involuntary status pursuant to subsection (5).
(2)
DISCHARGE OF VOLUNTARY PATIENTS.
—
(a)
A facility shall discharge a voluntary patient:
1.
Who has sufficiently improved so that retention in the facility is no longer desirable. A patient may also be discharged to the care of a community facility.
2.
Who revokes consent to admission or requests discharge. A voluntary patient or a relative, friend, or attorney of the patient may request discharge either orally or in writing at any time following admission to the facility. The patient must be discharged within 24 hours of the request, unless the request is rescinded or the patient is transferred to involuntary status pursuant to this section. The 24-hour time period may be extended by a treatment facility when necessary for adequate discharge planning, but shall not exceed 3 days exclusive of weekends and holidays. If the patient, or another on the patient’s behalf, makes an oral request for discharge to a staff member, such request shall be immediately entered in the patient’s clinical record. If the request for discharge is made by a person other than the patient, the discharge may be conditioned upon the express and informed consent of the patient.
(b)
A voluntary patient who has been admitted to a facility and who refuses to consent to or revokes consent to treatment shall be discharged within 24 hours after such refusal or revocation, unless transferred to involuntary status pursuant to this section or unless the refusal or revocation is freely and voluntarily rescinded by the patient.
(3)
NOTICE OF RIGHT TO DISCHARGE.
—
At the time of admission and at least every 6 months thereafter, a voluntary patient shall be notified in writing of his or her right to apply for a discharge.
(4)
TRANSFER TO VOLUNTARY STATUS.
—
An involuntary patient who applies to be transferred to voluntary status shall be transferred to voluntary status immediately, unless the patient has been charged with a crime, or has been involuntarily placed for treatment by a court pursuant to s. 394.467 and continues to meet the criteria for involuntary placement. When transfer to voluntary status occurs, notice shall be given as provided in s. 394.4599, and, if the patient is a minor, the minor’s assent to voluntary care must be verified as provided in paragraph (1)(a).
(5)
TRANSFER TO INVOLUNTARY STATUS.
—
When a voluntary patient, or an authorized person on the patient’s behalf, makes a request for discharge, the request for discharge, unless freely and voluntarily rescinded, must be communicated to a physician, a clinical psychologist with at least 3 years of clinical experience, or a psychiatrist as quickly as possible, but not later than 12 hours after the request is made. If the patient meets the criteria for involuntary placement, the administrator of the facility must file with the court a petition for involuntary placement, within 2 court working days after the request for discharge is made. If the petition is not filed within 2 court working days, the patient must be discharged. Pending the filing of the petition, the patient may be held and emergency treatment rendered in the least restrictive manner, upon the order of a physician or a psychiatric nurse practicing within the framework of an established protocol with a psychiatrist, if it is determined that such treatment is necessary for the safety of the patient or others.
F.S. 394.4655 Orders to involuntary outpatient placement.
(1)
As used in this section, the term “involuntary outpatient placement” means involuntary outpatient services as defined in s. 394.467.
(2)
A court or a county court may order an individual to involuntary outpatient placement in accordance with the criteria for ordering a person to involuntary outpatient placement, and the requirements and processes for placement, including, but not limited to, recommendations for involuntary outpatient placement, petitions, appointment of counsel, and hearings on involuntary outpatient placement as provided under s. 394.467.
(3)
When recommending an order to involuntary outpatient placement, the petitioner, as described in s. 394.467(4), shall prepare a services plan for the patient in accordance with s. 394.467.
F.S. 394.4672 Procedure for placement of veteran with federal agency.
(1)
Whenever it is determined by the court that a person meets the criteria for involuntary placement and it appears that such person is eligible for care or treatment by the United States Department of Veterans Affairs or other agency of the United States Government, the court, upon receipt of a certificate from the United States Department of Veterans Affairs or such other agency showing that facilities are available and that the person is eligible for care or treatment therein, may place that person with the United States Department of Veterans Affairs or other federal agency. The person whose placement is sought shall be personally served with notice of the pending placement proceeding in the manner as provided in this part, and nothing in this section shall affect his or her right to appear and be heard in the proceeding. Upon placement, the person shall be subject to the rules and regulations of the United States Department of Veterans Affairs or other federal agency.
(2)
The judgment or order of placement by a court of competent jurisdiction of another state or of the District of Columbia, placing a person with the United States Department of Veterans Affairs or other federal agency for care or treatment, shall have the same force and effect in this state as in the jurisdiction of the court entering the judgment or making the order; and the courts of the placing state or of the District of Columbia shall be deemed to have retained jurisdiction of the person so placed. Consent is hereby given to the application of the law of the placing state or district with respect to the authority of the chief officer of any facility of the United States Department of Veterans Affairs or other federal agency operated in this state to retain custody or to transfer, parole, or discharge the person.
(3)
Upon receipt of a certificate of the United States Department of Veterans Affairs or such other federal agency that facilities are available for the care or treatment of mentally ill persons and that the person is eligible for care or treatment, the administrator of the receiving or treatment facility may cause the transfer of that person to the United States Department of Veterans Affairs or other federal agency. Upon effecting such transfer, the committing court shall be notified by the transferring agency. No person shall be transferred to the United States Department of Veterans Affairs or other federal agency if he or she is confined pursuant to the conviction of any felony or misdemeanor or if he or she has been acquitted of the charge solely on the ground of insanity, unless prior to transfer the court placing such person enters an order for the transfer after appropriate motion and hearing and without objection by the United States Department of Veterans Affairs.
(4)
Any person transferred as provided in this section shall be deemed to be placed with the United States Department of Veterans Affairs or other federal agency pursuant to the original placement.
F.S. 394.4685 Transfer of patients among facilities.
(1)
TRANSFER BETWEEN PUBLIC FACILITIES.
—
(a)
A patient who has been admitted to a public receiving facility, or the family member, guardian, or guardian advocate of such patient, may request the transfer of the patient to another public receiving facility. A patient who has been admitted to a public treatment facility, or the family member, guardian, or guardian advocate of such patient, may request the transfer of the patient to another public treatment facility. Depending on the medical treatment or mental health treatment needs of the patient and the availability of appropriate facility resources, the patient may be transferred at the discretion of the department. If the department approves the transfer of an involuntary patient, notice according to the provisions of s. 394.4599 shall be given prior to the transfer by the transferring facility. The department shall respond to the request for transfer within 2 working days after receipt of the request by the facility administrator.
(b)
When required by the medical treatment or mental health treatment needs of the patient or the efficient utilization of a public receiving or public treatment facility, a patient may be transferred from one receiving facility to another, or one treatment facility to another, at the department’s discretion, or, with the express and informed consent of the patient or the patient’s guardian or guardian advocate, to a facility in another state. Notice according to the provisions of s. 394.4599 shall be given prior to the transfer by the transferring facility. If prior notice is not possible, notice of the transfer shall be provided as soon as practicable after the transfer.
(2)
TRANSFER FROM PUBLIC TO PRIVATE FACILITIES.
—
(a)
A patient who has been admitted to a public receiving or public treatment facility and has requested, either personally or through his or her guardian or guardian advocate, and is able to pay for treatment in a private facility shall be transferred at the patient’s expense to a private facility upon acceptance of the patient by the private facility.
(b)
A public receiving facility initiating a patient transfer to a licensed hospital for acute care mental health services not accessible through the public receiving facility shall notify the hospital of such transfer and send the hospital all records relating to the emergency psychiatric or medical condition.
(3)
TRANSFER FROM PRIVATE TO PUBLIC FACILITIES.
—
(a)
A patient or the patient’s guardian or guardian advocate may request the transfer of the patient from a private to a public facility, and the patient may be so transferred upon acceptance of the patient by the public facility.
(b)
A private facility may request the transfer of a patient from the facility to a public facility, and the patient may be so transferred upon acceptance of the patient by the public facility. The cost of such transfer shall be the responsibility of the transferring facility.
(c)
A public facility must respond to a request for the transfer of a patient within 2 working days after receipt of the request.
(4)
TRANSFER BETWEEN PRIVATE FACILITIES.
—
A patient in a private facility or the patient’s guardian or guardian advocate may request the transfer of the patient to another private facility at any time, and the patient shall be transferred upon acceptance of the patient by the facility to which transfer is sought.
F.S. 394.4781 Residential care for psychotic and emotionally disturbed children.
(1)
DEFINITIONS.
—
As used in this section, the term:
(a)
“Department” means the Department of Children and Families.
(b)
“Psychotic or severely emotionally disturbed child” means a child so diagnosed by a psychiatrist or a clinical psychologist with at least 3 years of clinical experience, each of whom must have specialty training and experience with children. Such a severely emotionally disturbed child or psychotic child shall be considered by this diagnosis to benefit by and require residential care as contemplated by this section.
(2)
FUNDING OF PROGRAM.
—
The department shall provide for the purposes of this section such amount as shall be set forth in the annual appropriations act as payment for part of the costs of residential care for psychotic or severely emotionally disturbed children.
(3)
ADMINISTRATION OF THE PROGRAM.
—
(a)
The department shall provide the necessary application forms and office personnel to administer the purchase-of-service program.
(b)
The department shall review such applications monthly and, in accordance with available funds, the severity of the problems of the child, the availability of the needed residential care, and the financial means of the family involved, approve or disapprove each application. If an application is approved, the department shall contract for or purchase the services of an appropriate residential facility in such amounts as are determined by the annual appropriations act.
(c)
The department is authorized to promulgate such rules as are necessary for the full and complete implementation of the provisions of this section.
(d)
The department shall purchase services only from those facilities which are in compliance with standards promulgated by the department.
(4)
RULE ADOPTION.
—
The department may adopt rules to carry out this section, including rules concerning review and approval of applications for placement, cost sharing, and client eligibility for placement, and rules to ensure that facilities from which the department purchases or contracts for services under this section provide:
(a)
Minimum standards for client care and treatment practices, including ensuring that sufficient numbers and types of qualified personnel are on duty and available at all times to provide necessary and adequate client safety, care, and security.
(b)
Minimum standards for client intake and admission, eligibility criteria, discharge planning, assessment, treatment planning, continuity of care, treatment modalities, service array, medical services, physical health services, client rights, maintenance of client records, and management of the treatment environment, including standards for the use of seclusion, restraints, and time-out.
(c)
Minimum standards for facility operation and administration, fiscal accountability, personnel policies and procedures, and staff education, qualifications, experience, and training.
(d)
Minimum standards for adequate infection control, housekeeping sanitation, disaster planning, firesafety, construction standards, and emergency services.
(e)
Minimum standards for the establishment, organization, and operation of the licensed facility in accordance with program standards of the department.
(f)
Licensing requirements.
F.S. 394.4784 Minors; access to outpatient crisis intervention services and treatment.
For the purposes of this section, the disability of nonage is removed for any minor age 13 years or older to access services under the following circumstances:
(1)
OUTPATIENT DIAGNOSTIC AND EVALUATION SERVICES.
—
When any minor age 13 years or older experiences an emotional crisis to such degree that he or she perceives the need for professional assistance, he or she shall have the right to request, consent to, and receive mental health diagnostic and evaluative services provided by a licensed mental health professional, as defined by Florida Statutes, or in a mental health facility licensed by the state. The purpose of such services shall be to determine the severity of the problem and the potential for harm to the person or others if further professional services are not provided. Outpatient diagnostic and evaluative services shall not include medication and other somatic methods, aversive stimuli, or substantial deprivation. Such services shall not exceed two visits during any 1-week period in response to a crisis situation before parental consent is required for further services, and may include parental participation when determined to be appropriate by the mental health professional or facility.
(2)
OUTPATIENT CRISIS INTERVENTION, THERAPY AND COUNSELING SERVICES.
—
When any minor age 13 years or older experiences an emotional crisis to such degree that he or she perceives the need for professional assistance, he or she shall have the right to request, consent to, and receive outpatient crisis intervention services including individual psychotherapy, group therapy, counseling, or other forms of verbal therapy provided by a licensed mental health professional, as defined by Florida Statutes, or in a mental health facility licensed by the state. Such services shall not include medication and other somatic treatments, aversive stimuli, or substantial deprivation. Such services shall not exceed two visits during any 1-week period in response to a crisis situation before parental consent is required for further services, and may include parental participation when determined to be appropriate by the mental health professional or facility.
(3)
LIABILITY FOR PAYMENT.
—
The parent, parents, or legal guardian of a minor shall not be liable for payment for any such outpatient diagnostic and evaluation services or outpatient therapy and counseling services, as provided in this section, unless such parent, parents, or legal guardian participates in the outpatient diagnostic and evaluation services or outpatient therapy and counseling services and then only for the services rendered with such participation.
(4)
PROVISION OF SERVICES.
—
No licensed mental health professional shall be obligated to provide services to minors accorded the right to receive services under this section. Provision of such services shall be on a voluntary basis.
F.S. 394.4785 Children and adolescents; admission and placement in mental facilities.
(1)
A child or adolescent as defined in s. 394.492 may not be admitted to a state-owned or state-operated mental health treatment facility. A child may be admitted pursuant to s. 394.4625 or s. 394.467 to a crisis stabilization unit or a residential treatment center licensed under this chapter or a hospital licensed under chapter 395. The treatment center, unit, or hospital must provide the least restrictive available treatment that is appropriate to the individual needs of the child or adolescent and must adhere to the guiding principles, system of care, and service planning provisions contained in part III of this chapter.
(2)
A person under the age of 14 who is admitted to any hospital licensed pursuant to chapter 395 may not be admitted to a bed in a room or ward with an adult patient in a mental health unit or share common areas with an adult patient in a mental health unit. However, a person 14 years of age or older may be admitted to a bed in a room or ward in the mental health unit with an adult if the admitting physician or psychiatric nurse documents in the case record that such placement is medically indicated or for reasons of safety. Such placement must be reviewed by the attending physician or a designee or on-call physician each day and documented in the case record.
F.S. 394.4786 Intent.
(1)
The Legislature intends that all hospitals, excluding hospitals owned and operated by the department or the Department of Corrections, be assessed on a continuing basis an amount equal to 1.5 percent of the hospital’s annual net operating revenues and that the assessments be deposited into the Public Medical Assistance Trust Fund.
(2)
Further, the Legislature intends that a specialty psychiatric hospital that provides health care to specified indigent patients be eligible for reimbursement up to the amount that hospital contributed to the Public Medical Assistance Trust Fund in the previous fiscal year.
F.S. 394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and 394.4789.
As used in this section and ss. 394.4786, 394.4788, and 394.4789:
(1)
“Acute mental health services” means mental health services provided through inpatient hospitalization.
(2)
“Agency” means the Agency for Health Care Administration.
(3)
“Charity care” means that portion of hospital charges for care provided to a patient whose family income for the 12 months preceding the determination is equal to or below 150 percent of the current federal nonfarm poverty guideline or the amount of hospital charges due from the patient which exceeds 25 percent of the annual family income and for which there is no compensation. Charity care shall not include administrative or courtesy discounts, contractual allowances to third party payors, or failure of a hospital to collect full charges due to partial payment by governmental programs.
(4)
“Indigent” means an individual whose financial status would qualify him or her for charity care.
(5)
“Operating expense” means all common and accepted costs appropriate in developing and maintaining the operating of the patient care facility and its activities.
(6)
“PMATF” means the Public Medical Assistance Trust Fund.
(7)
“Specialty psychiatric hospital” means a hospital licensed by the agency pursuant to s. 395.002(28) and part II of chapter 408 as a specialty psychiatric hospital.
F.S. 394.4788 Use of certain PMATF funds for the purchase of acute care mental health services.
(1)
A hospital may be eligible to be reimbursed an amount no greater than the hospital’s previous year contribution to the PMATF for acute mental health services provided to indigent mentally ill persons who have been determined by the agency or its agent to require such treatment and who:
(a)
Do not meet Medicaid eligibility criteria, unless the agency makes a referral for a Medicaid eligible patient pursuant to s. 394.4789;
(b)
Meet the criteria for mental illness under this part; and
(c)
Meet the definition of charity care.
(2)
The agency shall annually calculate a per diem reimbursement rate for each specialty psychiatric hospital to be paid to the specialty psychiatric hospitals for the provision of acute mental health services provided to indigent mentally ill patients who meet the criteria in subsection (1). After the first rate period, providers shall be notified of new reimbursement rates for each new state fiscal year by June 1. The new reimbursement rates shall commence July 1.
(3)
Reimbursement rates shall be calculated using the most recent audited actual costs received by the agency. Cost data received each April 15 shall be used in the calculation of the rates. Historic costs shall be inflated from the midpoint of a hospital’s fiscal year to the midpoint of the state fiscal year. The inflation adjustment shall be made utilizing the latest available projections as of March 31 for the Data Resources Incorporated National and Regional Hospital Input Price Indices as calculated by the Medicaid program office.
(4)
Reimbursement shall be based on compensating a specialty psychiatric hospital at a per diem rate equal to its operating costs per inpatient day.
(5)
A hospital shall not be entitled to receive more in any one fiscal year than that hospital contributed to the PMATF during the previous fiscal year.
(6)
Hospitals that agree to participate in the program set forth in this section and ss. 394.4786, 394.4787, and 394.4789 shall agree that payment from the PMATF is payment in full for all patients for which reimbursement is received under this section and ss. 394.4786, 394.4787, and 394.4789, until the funds for this program are no longer available.
(7)
The agency shall develop a payment system to reimburse specialty psychiatric hospitals quarterly as set forth in this part.
F.S. 394.4789 Establishment of referral process and eligibility determination.
(1)
It is the intent of the Legislature that a hospital which seeks payment under s. 394.4788 shall accept referrals from the department. However, a hospital shall have the right to refuse the admission of a patient due to lack of functional bed space or lack of services appropriate to a patient’s specific treatment and no hospital shall be required to accept referrals if the costs for treating the referred patient are no longer reimbursable because the hospital has reached the level of contribution made to the PMATF in the previous fiscal year. Furthermore, a hospital that does not seek compensation for indigent mentally ill patients under the provisions of this act shall not be obliged to accept department referrals, notwithstanding any agreements it may have entered into with the department. The right of refusal in this subsection shall not affect a hospital’s requirement to provide emergency care pursuant to s. 395.1041 or other statutory requirements related to the provision of emergency care.
(2)
The department shall adopt a patient eligibility form and shall be responsible for eligibility determination. However, the department may contract with participating psychiatric hospitals for eligibility determination. The eligibility form shall provide the mechanism for determining a patient’s eligibility according to the requirements of s. 394.4788(1).
(a)
A specialty psychiatric hospital shall be eligible for reimbursement only when an eligibility form has been completed for each indigent mentally ill person for whom reimbursement is sought.
(b)
As part of eligibility determination, every effort shall be made by the hospital to determine if any third party insurance coverage is available.
F.S. 394.4915 Office of Children’s Behavioral Health Ombudsman.
The Office of Children’s Behavioral Health Ombudsman is established within the department for the purpose of being a central point to receive complaints on behalf of children and adolescents with behavioral health disorders receiving state-funded services and use such information to improve the child and adolescent mental health treatment and support system. The department and managing entities shall include information about and contact information for the office placed prominently on their websites on easily accessible web pages related to children and adolescent behavioral health services. To the extent permitted by available resources, the office shall, at a minimum:
(1)
Receive and direct to the appropriate contact within the department, the Agency for Health Care Administration, or the appropriate organizations providing behavioral health services complaints from children and adolescents and their families about the child and adolescent mental health treatment and support system.
(2)
Maintain records of complaints received and the actions taken.
(3)
Be a resource to identify and explain relevant policies or procedures to children, adolescents, and their families about the child and adolescent mental health treatment and support system.
(4)
Provide recommendations to the department to address systemic problems within the child and adolescent mental health treatment and support system that are leading to complaints. The department shall include an analysis of complaints and recommendations in the report required under s. 394.4573.
(5)
Engage in functions that may improve the child and adolescent mental health treatment and support system.
F.S. 394.4955 Coordinated system of care; child and adolescent mental health treatment and support.
(1)
Pursuant to s. 394.9082(5)(d), each managing entity shall lead the development of a plan that promotes the development and effective implementation of a coordinated system of care which integrates services provided through providers funded by the state’s child-serving systems and facilitates access by children and adolescents, as resources permit, to needed mental health treatment and services at any point of entry regardless of the time of year, intensity, or complexity of the need, and other systems with which such children and adolescents are involved, as well as treatment and services available through other systems for which they would qualify.
(2)(a)
The planning process shall include, but is not limited to, children and adolescents with behavioral health needs and their families; behavioral health service providers; law enforcement agencies; school districts or superintendents; the multiagency network for students with emotional or behavioral disabilities; the department; and representatives of the child welfare and juvenile justice systems, early learning coalitions, the Agency for Health Care Administration, Medicaid managed medical assistance plans, the Agency for Persons with Disabilities, the Department of Juvenile Justice, and other community partners. An organization receiving state funding must participate in the planning process if requested by the managing entity. State agencies shall provide reasonable staff support to the planning process if requested by the managing entity.
(b)
The planning process shall take into consideration the geographical distribution of the population, needs, and resources, and create separate plans on an individual county or multicounty basis, as needed, to maximize collaboration and communication at the local level.
(c)
To the extent permitted by available resources, the coordinated system of care shall include the array of services listed in s. 394.495.
(d)
Each plan shall integrate with the local plan developed under s. 394.4573.
(3)
By January 1, 2022, the managing entity shall complete the plans developed under this section and submit them to the department. By January 1, 2023, the entities involved in the planning process shall implement the coordinated system of care specified in each plan. The managing entity and collaborating organizations shall review and update the plans, as necessary, at least every 3 years thereafter.
(4)
The managing entity and collaborating organizations shall create integrated service delivery approaches within current resources that facilitate parents and caregivers obtaining services and support by making referrals to specialized treatment providers, if necessary, with follow up to ensure services are received.
(5)
The managing entity and collaborating organizations shall document each coordinated system of care for children and adolescents through written memoranda of understanding or other binding arrangements.
(6)
The managing entity shall identify gaps in the arrays of services for children and adolescents listed in s. 394.495 available under each plan and include relevant information in its annual needs assessment required by s. 394.9082.
F.S. 394.4995 Conversion of specified facilities to children’s behavioral crisis units; not required.
Nothing in
1
s. 394.499 shall be construed to require an existing crisis stabilization unit or juvenile addictions receiving facility to convert to a children’s behavioral crisis unit.
F.S. 394.6591 Administrative costs and number of grants awarded.
(1)
The administrative costs for each applicant county or consortium of counties may not exceed 10 percent of the total funding received for any grant.
(2)
The number of grants awarded shall be based on funding appropriated for that purpose.
F.S. 394.9082 Behavioral health managing entities.
(1)
INTENT AND PURPOSE.
—
(a)
The Legislature finds that untreated behavioral health disorders constitute major health problems for residents of this state, are a major economic burden to the citizens of this state, and substantially increase demands on the state’s juvenile and adult criminal justice systems, the child welfare system, and health care systems. The Legislature finds that behavioral health disorders respond to appropriate treatment, rehabilitation, and supportive intervention. The Legislature finds that local communities have also made substantial investments in behavioral health services, contracting with safety net providers who by mandate and mission provide specialized services to vulnerable and hard-to-serve populations and have strong ties to local public health and public safety agencies. The Legislature finds that a regional management structure that facilitates a comprehensive and cohesive system of coordinated care for behavioral health treatment and prevention services will improve access to care, promote service continuity, and provide for more efficient and effective delivery of substance abuse and mental health services. It is the intent of the Legislature that managing entities work to create linkages among various services and systems, including juvenile justice and adult criminal justice, child welfare, housing services, homeless systems of care, and health care.
(b)
The purpose of the behavioral health managing entities is to plan, coordinate, and contract for the delivery of community mental health and substance abuse services, to improve access to care, to promote service continuity, to purchase services, and to support efficient and effective delivery of services.
(2)
DEFINITIONS.
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As used in this section, the term:
(a)
“Behavioral health services” means mental health services and substance abuse prevention and treatment services as described in this chapter and chapter 397.
(b)
“Coordinated system of care” means the array of mental health services and substance abuse services described in s. 394.4573.
(c)
“Geographic area” means one or more contiguous counties, circuits, or regions as described in s. 409.966.
(d)
“Managed behavioral health organization” means a Medicaid managed care organization currently under contract with the statewide Medicaid managed medical assistance program in this state pursuant to part IV of chapter 409, including a managed care organization operating as a behavioral health specialty plan.
(e)
“Managing entity” means a corporation selected by and under contract with the department to manage the daily operational delivery of behavioral health services through a coordinated system of care.
(f)
“Provider network” means the group of direct service providers, facilities, and organizations under contract with a managing entity to provide a comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consumer support services, including prevention services.
(g)
“Subregion” means a distinct portion of a managing entity’s geographic region defined by unifying service and provider utilization patterns.
(3)
DEPARTMENT DUTIES.
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The department shall:
(a)
Contract with organizations to serve as managing entities in accordance with the requirements of this section and conduct a readiness review of any new managing entities before such entities assume their responsibilities.
(b)
Specify data reporting requirements and use of shared data systems.
(c)
Define the priority populations that will benefit from receiving care coordination. In defining such populations, the department shall take into account the availability of resources and consider:
1.
The number and duration of involuntary admissions within a specified time.
2.
The degree of involvement with the criminal justice system and the risk to public safety posed by the individual.
3.
Whether the individual has recently resided in or is currently awaiting admission to or discharge from a treatment facility as defined in s. 394.455.
4.
The degree of utilization of behavioral health services.
5.
Whether the individual is a parent or caregiver who is involved with the child welfare system.
6.
Whether the individual is an adolescent, as defined in s. 394.492, who requires assistance in transitioning to services provided in the adult system of care.
(d)
Support the development and implementation of a coordinated system of care by requiring each provider that receives state funds for behavioral health services through a direct contract with the department to work with the managing entity in the provider’s service area to coordinate the provision of behavioral health services as part of the contract with the department.
(e)
Provide technical assistance to the managing entities.
(f)
Promote the coordination of behavioral health care and primary care.
(g)
Facilitate coordination between the managing entity and other payors of behavioral health care.
(h)
Develop and provide a unique identifier for clients receiving behavioral health services through the managing entity to coordinate care.
(i)
Coordinate procedures for the referral and admission of patients to, and the discharge of patients from, treatment facilities as defined in s. 394.455 and their return to the community.
(j)
Ensure that managing entities comply with state and federal laws, rules, regulations, and grant requirements.
(k)
Develop rules for the operations of, and the requirements that shall be met by, the managing entity, if necessary.
(l)
Periodically review contract and reporting requirements and reduce costly, duplicative, and unnecessary administrative requirements.
(m)
Collect and publish, and update annually, all of the following information on its website for each managing entity:
1.
All compensation earned or awarded, whether paid or accrued, regardless of contingency, by position, for any employee, and any other person compensated through a contract for services whose services include those commonly associated with a chief executive, chief administrator, or other chief officer of a business or corporation, who receives compensation from state-appropriated funds in excess of 150 percent of the annual salary paid to the secretary of the department. For purposes of this paragraph, the term “employee” means a person filling an authorized and established position who performs labor or services for a public or private employer in exchange for salary, wages, or other remuneration.
2.
The most recent 3 years of the Return of Organization Exempt from Income Tax, Internal Revenue Service Form 990 and related documents filed with the Internal Revenue Service, auditor reports, and annual reports for each managing entity or affiliated entity.
1
(n)1.
Contract for all of the following:
a.
Biennial operational and financial audits of each managing entity to include all of the following:
(I)
A review of business practices, personnel, financial records, related parties, compensation, and other areas as determined by the department.
(II)
The services administered, the method of provider payment, expenditures, outcomes, and other information as determined by the department.
(III)
Referral patterns, including managing entity referral volume; provider referral assignments; services referred; length of time to obtain services; and key referral performance measures.
(IV)
Provider network adequacy and provider network participation in the department’s available bed platform, the Opioid Data Management System, the Agency for Health Care Administration Event Notification Service, and other department required provider data submissions.
(V)
Audits of each managing entity’s expenditures and claims. Such an audit must do both of the following:
(A)
Compare services administered through each managing entity, the outcomes of each managing entity’s expenditures, each managing entity’s expenditures for behavioral health services, and any other information as determined by the department.
(B)
Analyze services funded by each managing entity rendered to individuals who are also Medicaid beneficiaries to, at a minimum, assess the extent to which managing entities are funding services that are also available as covered services under the Medicaid program.
b.
Recommendations to improve transparency of system performance, including, but not limited to, metrics and criteria used to measure each managing entity’s performance and patient and system outcomes, and the format and method to be used to collect and report necessary data and information.
2.
Prepare a report of the information gathered in subparagraph 1. and present the final report on or before December 1, 2025, to the Governor, the President of the Senate, and the Speaker of the House of Representatives.
(4)
CONTRACT WITH MANAGING ENTITIES.
—
(a)
In contracting for services with managing entities under this section, the department shall first attempt to contract with not-for-profit, community-based organizations with competence in managing provider networks serving persons with mental health and substance use disorders to serve as managing entities.
(b)
The department shall issue an invitation to negotiate under s. 287.057 to select an organization to serve as a managing entity. If the department receives fewer than two responsive bids to the solicitation, the department shall reissue the solicitation and managed behavioral health organizations shall be eligible to bid and be awarded a contract.
(c)
If the managing entity is a not-for-profit, community-based organization, it must have a governing board that is representative. At a minimum, the governing board must include consumers and their family members; representatives of local government, area law enforcement agencies, health care facilities, and community-based care lead agencies; business leaders; and providers of substance abuse and mental health services as defined in this chapter and chapter 397.
(d)
If the managing entity is a managed behavioral health organization, it must establish an advisory board that meets the same requirements specified in paragraph (c) for a governing board.
(e)
If the department issues an invitation to negotiate pursuant to paragraph (b), the department shall consider, at a minimum, the following factors:
1.
Experience serving persons with mental health and substance use disorders.
2.
Established community partnerships with behavioral health care providers.
3.
Demonstrated organizational capabilities for network management functions.
4.
Capability to coordinate behavioral health services with primary care services.
5.
Willingness to provide recovery-oriented services and systems of care and work collaboratively with persons with mental health and substance use disorders and their families in designing such systems and delivering such services.
(f)
The department’s contracts with managing entities must support efficient and effective administration of the behavioral health system and ensure accountability for performance.
(g)
A contractor serving as a managing entity shall operate under the same data reporting, administrative, and administrative rate requirements, regardless of whether it is a for-profit or not-for-profit entity.
(h)
The contract must designate the geographic area that will be served by the managing entity, which area must be of sufficient size in population, funding, and services to allow for flexibility and efficiency.
(i)
The contract must require that, when there is a change in the managing entity in a geographic area, the managing entity work with the department to develop and implement a transition plan that ensures continuity of care for patients receiving behavioral health services.
(j)
By June 30, 2019, if all other contract requirements and performance standards are met and the department determines that a managing entity under contract as of July 1, 2016, has received network accreditation pursuant to subsection (6), the department may continue its contract with the managing entity for up to, but not exceeding, 5 years, including any and all renewals and extensions. Thereafter, the department must issue a competitive solicitation pursuant to paragraph (b).
(k)
The department’s contracts with managing entities must be made available in a publicly accessible format on the department’s website.
(l)
Every 2 years, the department shall conduct a comprehensive, multiyear review of the revenues, expenditures, and financial positions of managing entities covering the most recent 2 consecutive fiscal years. The review must include a comprehensive system-of-care analysis. The department shall submit the review to the Governor, the President of the Senate, and the Speaker of the House of Representatives by November 1 of every other year, beginning in 2023.
(5)
MANAGING ENTITY DUTIES.
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A managing entity shall:
(a)
Maintain a governing board or, if a managed behavioral health organization, an advisory board as provided in paragraph (4)(c) or paragraph (4)(d), respectively.
(b)
Conduct a community behavioral health care needs assessment every 3 years in the geographic area served by the managing entity which identifies needs by subregion. The process for conducting the needs assessment shall include an opportunity for public participation. The assessment shall include, at a minimum, the information the department needs for its annual report to the Governor and Legislature pursuant to s. 394.4573. The assessment shall also include a list and descriptions of any gaps in the arrays of services for children or adolescents identified pursuant to s. 394.4955 and recommendations for addressing such gaps. The managing entity shall provide the needs assessment to the department.
(c)
Determine the optimal array of services to meet the needs identified in the community behavioral health care needs assessment and expand the scope of services as resources become available.
(d)
Promote the development and effective implementation of a coordinated system of care pursuant to ss. 394.4573 and 394.495.
(e)
Provide assistance to counties to develop a designated receiving system pursuant to s. 394.4573 and a transportation plan pursuant to s. 394.462.
(f)
Develop strategies to divert persons with mental illness or substance use disorders from the criminal and juvenile justice systems in collaboration with the court system and the Department of Juvenile Justice and to integrate behavioral health services with the child welfare system.
(g)
Promote and support care coordination activities that will improve outcomes among individuals identified as priority populations pursuant to paragraph (3)(c).
(h)
Work independently and collaboratively with stakeholders to improve access to and effectiveness, quality, and outcomes of behavioral health services. This work may include, but is not limited to, facilitating the dissemination and use of evidence-informed practices.
(i)
Develop a comprehensive provider network of qualified providers to deliver behavioral health services. The managing entity is not required to competitively procure network providers but shall publicize opportunities to join the provider network and evaluate providers in the network to determine if they may remain in the network. A managing entity must provide notice to a provider before the provider is removed from the network. The managing entity shall publish these processes on its website. The managing entity shall ensure continuity of care for clients if a provider ceases to provide a service or leaves the network.
(j)
As appropriate, develop resources by pursuing third-party payments for services, applying for grants, assisting providers in securing local matching funds and in-kind services, and employing any other method needed to ensure that services are available and accessible.
(k)
Enter into cooperative agreements with local homeless councils and organizations for sharing information about clients, available resources, and other data or information for addressing the homelessness of persons suffering from a behavioral health crisis. All information sharing must comply with federal and state privacy and confidentiality laws, statutes, and regulations.
(l)
Work collaboratively with public receiving facilities and licensed housing providers to establish a network of licensed housing resources for mental health consumers that will prevent and reduce readmissions to public receiving facilities.
(m)
Monitor network providers’ performance and their compliance with contract requirements and federal and state laws, rules, regulations, and grant requirements.
(n)
Manage and allocate funds for services to meet federal and state laws, rules, and regulations.
(o)
Promote coordination of behavioral health care with primary care.
(p)
Implement shared data systems necessary for the delivery of coordinated care and integrated services, the assessment of managing entity performance and provider performance, and the reporting of outcomes and costs of services.
(q)
Operate in a transparent manner, providing public access to information, notice of meetings, and opportunities for public participation in managing entity decisionmaking.
(r)
Establish and maintain effective relationships with community stakeholders, including individuals served by the behavioral health system of care and their families, local governments, and other community organizations that meet the needs of individuals with mental illness or substance use disorders.
(s)
Collaborate with and encourage increased coordination between the provider network and other systems, programs, and entities, such as the child welfare system, law enforcement agencies, the criminal and juvenile justice systems, the Medicaid program, offices of the public defender, and offices of criminal conflict and civil regional counsel.
1.
Collaboration with the criminal and juvenile justice systems shall seek, at a minimum, to divert persons with mental illness, substance use disorders, or co-occurring conditions from these systems.
2.
Collaboration with the court system shall seek, at a minimum, to develop specific written procedures and agreements to maximize the use of involuntary outpatient services, reduce involuntary inpatient treatment, and increase diversion from the criminal and juvenile justice systems.
3.
Collaboration with the child welfare system shall seek, at a minimum, to provide effective and timely services to parents and caregivers involved in the child welfare system.
(t)
Promote the use of available crisis intervention services by requiring contracted providers to provide contact information for mobile response teams established under s. 394.495 to parents and caregivers of children, adolescents, and young adults between ages 18 and 25, inclusive, who receive safety-net behavioral health services.
(u)
Include the statement “
(managing entity name)
is a managing entity contracted with the Department of Children and Families” on its website and, at a minimum, in its promotional literature, managing entity-created documents and forms provided to families served by the managing entity, business cards, and stationery letterhead.
1
(v)
Report all required data to the department in a standardized electronic format to ensure interoperability and to facilitate data analysis. The submission format must meet all of the following criteria:
1.
Payments made to providers for services reported in a format that reflects the client; the service provided; the date the service is provided; the place where the service is provided; the diagnosis, if available; and other information typically reported in a standardized format for electronic data interchange that is used for health care claims processing.
2.
Information must be organized into discrete, machine-readable data elements that allow for efficient processing and integration with other datasets.
3.
All data fields must comply with established protocols as specified by the department.
4.
The standardized format must be compatible with automated systems to enable the downloading, parsing, and combining of data with other sources for analysis.
5.
Submissions must pass validation checks to confirm adherence to the required data structure and format before the submission is accepted.
1
(w)
Submit to the department all documents that are required under contract for submission on a routine basis in an electronic format that allows for accurate text recognition and data extraction as specified by the department, which may include, but is not limited to, Portable Document Format or machine-readable text files. The documents must be accompanied by metadata containing key information that ensures proper organization, processing, and integration into the department’s systems. The required metadata must include, but is not limited to, all of the following elements:
1.
A descriptive and unique name for the document, following any naming conventions prescribed by the department.
2.
The date the document is uploaded.
3.
A predefined classification indicating the nature or category of the document.
4.
Any relevant identifiers, such as application numbers, case numbers, or tracking codes, as specified by the department.
5.
The name, contact information, and any other required identification number, which may include, but is not limited to, a contract, license, or registration number, of the person or organization submitting the document.
6.
Any other metadata fields as prescribed by the department to facilitate accurate processing and analysis.
(x)
Promote the use of person-first language and trauma-informed responsive care among providers, peer organizations, and family members, including, but not limited to, through training and sharing best practices. For purposes of this paragraph, the term “person-first language” means language used which emphasizes the patient as a person rather than that patient’s disability, illness, or condition.
(y)
Require use of the most recent version of the Daily Living Activities-20 (DLA-20) functional assessment tool by all providers under contract with the managing entity, unless the department specifies in rule the use of a different assessment tool.
(6)
NETWORK ACCREDITATION AND SYSTEMS COORDINATION AGREEMENTS.
—
(a)1.
The department shall identify acceptable accreditations which address coordination within a network and, if possible, between the network and major systems and programs with which the network interacts, such as the child welfare system, the courts system, and the Medicaid program. In identifying acceptable accreditations, the department shall consider whether the accreditation facilitates integrated strategic planning, resource coordination, technology integration, performance measurement, and increased value to consumers through choice of and access to services, improved coordination of services, and effectiveness and efficiency of service delivery.
2.
All managing entities under contract with the state by July 1, 2016, shall earn accreditation deemed acceptable by the department pursuant to subparagraph 1. by June 30, 2019. Managing entities whose initial contract with the state is executed after July 1, 2016, shall earn network accreditation within 3 years after the contract execution date. Pursuant to paragraph (4)(j), the department may continue the contract of a managing entity under contract as of July 1, 2016, that earns the network accreditation within the required timeframe and maintains it throughout the contract term.
(b)
If no accreditations are available or deemed acceptable pursuant to paragraph (a) which address coordination between the provider network and major systems and programs with which the provider network interacts, each managing entity shall enter into memoranda of understanding which details mechanisms for communication and coordination. The managing entity shall enter into such memoranda with any community-based care lead agencies, circuit courts, county courts, sheriffs’ offices, offices of the public defender, offices of criminal conflict and civil regional counsel, Medicaid managed medical assistance plans, and homeless coalitions in its service area. Each managing entity under contract on July 1, 2016, shall enter into such memoranda by June 30, 2017, and each managing entity under contract after July 1, 2016, shall enter into such memoranda within 1 year after its contract execution date.
1
(7)
PERFORMANCE MEASUREMENT AND ACCOUNTABILITY.
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(a)
Managing entities shall collect and submit data to the department regarding persons served, outcomes of persons served, costs of services provided through the department’s contract, and other data as required by the department. The department shall evaluate managing entity performance and the overall progress made by the managing entity, together with other systems, in meeting the community’s behavioral health needs, based on consumer-centered outcome measures that reflect national standards, if possible, that can be accurately measured. The department shall work with managing entities to establish performance standards, including, but not limited to:
1.
The extent to which individuals in the community receive services, including, but not limited to, parents or caregivers involved in the child welfare system who need behavioral health services.
2.
The improvement in the overall behavioral health of a community.
3.
The improvement in functioning or progress in the recovery of individuals served by the managing entity, as determined using person-centered measures tailored to the population.
4.
The success of strategies to:
a.
Divert admissions from acute levels of care, jails, prisons, and forensic facilities as measured by, at a minimum, the total number and percentage of clients who, during a specified period, experience multiple admissions to acute levels of care, jails, prisons, or forensic facilities;
b.
Integrate behavioral health services with the child welfare system; and
c.
Address the housing needs of individuals being released from public receiving facilities who are homeless.
5.
Consumer and family satisfaction.
6.
The level of engagement of key community constituencies, such as law enforcement agencies, community-based care lead agencies, juvenile justice agencies, the courts, school districts, local government entities, hospitals, and other organizations, as appropriate, for the geographical service area of the managing entity.
(b)
Managing entities must submit specific measures to the department regarding individual outcomes and system functioning, which the department must post to, and maintain on, its website by the 22nd of every month, or if the 22nd day occurs on a weekend or a holiday under s. 110.117(1), the report must be posted before the conclusion of the next business day. The posted measures must reflect performance for the previous calendar month, including year-to-date totals and annual trends. Each managing entity must report each measure using a standard methodology determined by the department and submit the data to the department by the deadline specified by the department. The measures shall include data from individuals served by each managing entity for services funded by the managing entity, to the extent feasible and appropriate. The measures shall be reported and posted stratified by, at a minimum, whether the individual is a child or an adult and whether the individual is a Medicaid recipient. Such measures shall include, at a minimum, all of the following:
1.
The number and percentage of individuals who are high utilizers of crisis behavioral health services.
2.
The number and percentage of individuals referred to outpatient behavioral health services after their discharge from a receiving or treatment facility, an emergency department under this chapter, or an inpatient or residential licensed service component under chapter 397 and who begin receiving such services within 7 days after discharge.
3.
The average wait time for initial appointments for behavioral health services, categorized by the type of service.
4.
The number and percentage of individuals with significant behavioral health symptoms who are seeking urgent but noncrisis acute care and who are scheduled to be seen by a provider within 1 business day after initial contact with the provider.
5.
The number and percentage of emergency department visits per capita for behavioral health-related issues.
6.
The incidence of medication errors.
7.
The number and percentage of adverse incidents, including, but not limited to, self-harm, occurring during inpatient and outpatient behavioral health services.
8.
The number and percentage of individuals with co-occurring conditions who receive integrated care.
9.
The number and percentage of individuals discharged from a receiving or treatment facility under this chapter or an inpatient or residential licensed service component under chapter 397 who successfully transition to ongoing services at the appropriate level of care.
10.
The rate of readmissions to emergency departments due to behavioral health issues or to crisis stabilization units, addictions receiving facilities, or other inpatient levels of care under this chapter and chapter 397 within 30 days after discharge from inpatient or outpatient behavioral health services.
11.
The average length of stay for inpatient behavioral health services.
(8)
ENHANCEMENT PLANS.
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By September 1 of each year, beginning in 2017, each managing entity shall develop and submit to the department a description of strategies for enhancing services and addressing three to five priority needs in the service area. The planning process sponsored by the managing entity shall include consumers and their families, community-based care lead agencies, local governments, law enforcement agencies, service providers, community partners and other stakeholders. Each strategy must be described in detail and accompanied by an implementation plan that specifies action steps, identifies responsible parties, and delineates specific services that would be purchased, projected costs, the projected number of individuals that would be served, and the estimated benefits of the services. All or parts of these enhancement plans may be included in the department’s annual budget requests submitted to the Legislature.
(9)
FUNDING FOR MANAGING ENTITIES.
—
(a)
A contract established between the department and a managing entity under this section shall be funded by general revenue, other applicable state funds, or applicable federal funding sources. A managing entity may carry forward documented unexpended state funds from one fiscal year to the next, but the cumulative amount carried forward may not exceed 8 percent of the annual amount of the contract. Any unexpended state funds in excess of that percentage shall be returned to the department. The funds carried forward may not be used in a way that would increase future recurring obligations or for any program or service that was not authorized under the existing contract with the department. Expenditures of funds carried forward shall be separately reported to the department. Any unexpended funds that remain at the end of the contract period shall be returned to the department. Funds carried forward may be retained through contract renewals and new contract procurements as long as the same managing entity is retained by the department.
(b)
The method of payment for a fixed-price contract with a managing entity shall provide for a 2-month advance payment at the beginning of each fiscal year and equal monthly payments thereafter.
2
(c)
Notwithstanding paragraph (a), for the 2025-2026 fiscal year, a managing entity may carry forward documented unexpended funds appropriated from the State Opioid Settlement Trust Fund from 1 fiscal year to the next. Funds carried forward pursuant to this paragraph are not included in the 8 percent cumulative cap that may be carried forward. This paragraph expires July 1, 2026.
(10)
ACUTE CARE SERVICES UTILIZATION DATABASE.
—
The department shall develop, implement, and maintain standards under which a managing entity shall collect utilization data from all public receiving facilities situated within its geographical service area and all detoxification and addictions receiving facilities under contract with the managing entity. As used in this subsection, the term “public receiving facility” means an entity that meets the licensure requirements of, and is designated by, the department to operate as a public receiving facility under s. 394.875 and that is operating as a licensed crisis stabilization unit.
(a)
The department shall develop standards and protocols to be used for data collection, storage, transmittal, and analysis. The standards and protocols shall allow for compatibility of data and data transmittal between public receiving facilities, detoxification facilities, addictions receiving facilities, managing entities, and the department for the implementation, and to meet the requirements, of this subsection.
(b)
A managing entity shall require providers specified in paragraph (a) to submit data, in real time or at least daily, to the managing entity for:
1.
All admissions and discharges of clients receiving public receiving facility services who qualify as indigent, as defined in s. 394.4787.
2.
All admissions and discharges of clients receiving substance abuse services in an addictions receiving facility or detoxification facility pursuant to parts IV and V of chapter 397 who qualify as indigent.
3.
The current active census of total licensed beds, the number of beds purchased by the department, the number of clients qualifying as indigent occupying those beds, and the total number of unoccupied licensed beds, regardless of funding.
(c)
A managing entity shall require providers specified in paragraph (a) to submit data, on a monthly basis, to the managing entity which aggregates the daily data submitted under paragraph (b). The managing entity shall reconcile the data in the monthly submission to the data received by the managing entity under paragraph (b) to check for consistency. If the monthly aggregate data submitted by a provider under this paragraph are inconsistent with the daily data submitted under paragraph (b), the managing entity shall consult with the provider to make corrections necessary to ensure accurate data.
(d)
A managing entity shall require providers specified in paragraph (a) within its provider network to submit data, on an annual basis, to the managing entity which aggregates the data submitted and reconciled under paragraph (c). The managing entity shall reconcile the data in the annual submission to the data received and reconciled by the managing entity under paragraph (c) to check for consistency. If the annual aggregate data submitted by a provider under this paragraph are inconsistent with the data received and reconciled under paragraph (c), the managing entity shall consult with the provider to make corrections necessary to ensure accurate data.
(e)
After ensuring the accuracy of data pursuant to paragraphs (c) and (d), the managing entity shall submit the data to the department on a monthly and an annual basis. The department shall create a statewide database for the data described under paragraph (b) and submitted under this paragraph for the purpose of analyzing the use of publicly funded crisis stabilization services and detoxification and addictions receiving services provided on a statewide and an individual provider basis.
(f)
The department shall post on its website, by facility, the data collected pursuant to this subsection and update such posting monthly.
F.S. 394.9084 Florida Self-Directed Care program.
(1)
The Department of Children and Families, in cooperation with the Agency for Health Care Administration, may provide a client-directed and choice-based Florida Self-Directed Care program in all department service districts, in addition to the pilot projects established in district 4 and district 8, to provide mental health treatment and support services to adults who have a serious mental illness. The department may also develop and implement a client-directed and choice-based pilot project in one district to provide mental health treatment and support services for children with a serious emotional disturbance who live at home. If established, any staff who work with children must be screened under s. 435.04. The department shall implement a payment mechanism in which each client controls the money that is available for that client’s mental health treatment and support services. The department shall establish interagency cooperative agreements and work with the agency, the Division of Vocational Rehabilitation, and the Social Security Administration to implement and administer the Florida Self-Directed Care program.
(2)
To be eligible for enrollment in the Florida Self-Directed Care program, a person must be an adult with a severe and persistent mental illness.
(3)
The Florida Self-Directed Care program has four subcomponents:
(a)
Department mental health services, which include community mental health outpatient, community support, and case management services funded through the department. This subcomponent excludes Florida Assertive Community Treatment (FACT) services for adults; residential services; and emergency stabilization services, including crisis stabilization units, short-term residential treatment, and inpatient services.
(b)
Agency mental health services, which include community mental health services and mental health targeted case management services reimbursed by Medicaid.
(c)
Vocational rehabilitation, which includes funds available for an eligible participant as provided by the Rehabilitation Act of 1973, 29 U.S.C. chapter 16, as amended.
(d)
Social Security Administration.
(4)
The fiscal intermediary shall pay for the cost-efficient community-based services the participant selects to meet his or her mental health care and vocational rehabilitation needs and goals as identified on his or her recovery plan. For purposes of this section, the term “fiscal intermediary” means an entity approved by the department that helps the client manage his or her budget allowance, retains the funds, processes employment information, if any, and tax information, reviews records to ensure correctness, and writes paychecks to providers.
(5)(a)
The department shall take all necessary action to ensure state compliance with federal regulations. The agency, in collaboration with the department, shall seek federal Medicaid waivers, and the department shall expeditiously seek any available Supplemental Security Administration waivers under s. 1110(b) of the federal Social Security Act; and the division, in collaboration with the department, shall seek federal approval to participate in the Florida Self-Directed Care program. No later than June 30, 2005, the department, agency, and division shall amend and update their strategic and state plans to reflect participation in the projects, including intent to seek federal approval to provide cashout options for eligible services for participants in the projects.
(b)
The department may apply for and use any funds from private, state, and federal grants provided for self-directed care, voucher, and self-determination programs, including those providing substance abuse and mental health care.
(6)
The department, the agency, and the division may transfer funds to the fiscal intermediary.
(7)
The department, the agency, and the division shall have rulemaking authority to implement the provisions of this section. These rules shall be for the purpose of enhancing choice in and control over the purchased mental health and vocational rehabilitative services accessed by Florida Self-Directed Care participants.
(8)
The department and the agency shall complete a memorandum of agreement to delineate management roles for operation of the Florida Self-Directed Care program.
F.S. 394.9085 Behavioral provider liability.
(1)(a)
In any negligence action for damages for personal injury or wrongful death arising out of the provision of services for crisis stabilization brought against a detoxification program, an addictions receiving facility, or a designated public receiving facility, net economic damages shall be limited to $1 million per liability claim, including, but not limited to, past and future medical expenses, wage loss, and loss of earning capacity. In computing net economic damages, such damages shall be offset by any collateral source payment paid in accordance with s. 768.76.
(b)
In any negligence action for damages for personal injury or wrongful death arising out of the provision of services for crisis stabilization brought against any detoxification program, an addictions receiving facility, or a designated public receiving facility, noneconomic damages shall be limited to $200,000 per claim.
(c)
Any costs in defending actions brought under this section shall be assumed by the provider or its insurer.
(2)
The limitations on liability of a detoxification program, an addictions receiving facility, or any designated public receiving facility as described in subsection (1) shall be exclusive. Such limitations apply to each employee of the provider when the employee is acting in furtherance of the provider’s responsibilities under its contract with the department. Such limitations do not apply to a provider or employee who acts in a culpably negligent manner or with willful and wanton disregard or unprovoked physical aggression if such acts result in injury or death.
(3)
The eligible provider under this section must, as part of its contract, obtain and maintain an insurance policy providing a minimum of $1 million per claim and $3 million per incident in coverage for claims described in subsection (1).
(4)
This section does not designate a person who provides contracted services to the department as an employee or agent of the state for purposes of chapter 440.
(5)
The Legislature is cognizant of the increasing costs of goods and services each year and recognizes that fixing a set amount of compensation actually has the effect of a reduction in compensation each year. Accordingly, the conditional limitations on damages in this section shall be increased at the rate of 5 percent each year, prorated from July 1, 2006, to the date at which damages subject to such limitations are awarded by final judgment or settlement.
(6)
For purposes of this section, the terms “detoxification,” “addictions receiving facility,” and “receiving facility” have the same meanings as those provided in ss. 397.311(27)(a)4., 397.311(27)(a)1., and 394.455(40), respectively.
(7)
This section shall not be construed to waive sovereign immunity for any governmental unit or other entity protected by sovereign immunity. Section 768.28 shall continue to apply to all governmental units and such entities.
F.S. 394.9086 Commission on Mental Health and Substance Use Disorder.
(1)
CREATION.
—
The Commission on Mental Health and Substance Use Disorder, a commission as defined in s. 20.03(4), is created adjunct to the department. The department shall provide administrative and staff support services relating to the functions of the commission.
(2)
PURPOSES.
—
The purposes of the commission are to examine the current methods of providing mental health and substance use disorder services in the state and to improve the effectiveness of current practices, procedures, programs, and initiatives in providing such services; identify any barriers or deficiencies in the delivery of such services; assess the adequacy of the current infrastructure of Florida’s 988 Suicide and Crisis Lifeline system and other components of the state’s crisis response services; and recommend changes to existing laws, rules, and policies necessary to implement the commission’s recommendations.
(3)
MEMBERSHIP; TERM LIMITS; MEETINGS.
—
(a)
The commission shall be composed of 20 members as follows:
1.
A member of the Senate, appointed by the President of the Senate.
2.
A member of the House of Representatives, appointed by the Speaker of the House of Representatives.
3.
The Secretary of Children and Families or his or her designee.
4.
The Secretary of the Agency for Health Care Administration or his or her designee.
5.
A person living with a mental health disorder, appointed by the President of the Senate.
6.
A family member of a consumer of publicly funded mental health services, appointed by the President of the Senate.
7.
A representative of the Louis de la Parte Florida Mental Health Institute within the University of South Florida, appointed by the President of the Senate.
8.
A representative of a county school district, appointed by the President of the Senate.
9.
A representative of mental health courts, appointed by the Governor.
10.
A representative of a treatment facility, as defined in s. 394.455, appointed by the Speaker of the House of Representatives.
11.
A representative of a managing entity, as defined in s. 394.9082(2), appointed by the Speaker of the House of Representatives.
12.
A representative of a community substance use disorder provider, appointed by the Speaker of the House of Representatives.
13.
A psychiatrist licensed under chapter 458 or chapter 459 practicing within the mental health delivery system, appointed by the Speaker of the House of Representatives.
14.
A psychologist licensed under chapter 490 practicing within the mental health delivery system, appointed by the Governor.
15.
A mental health professional licensed under chapter 491, appointed by the Governor.
16.
An emergency room physician, appointed by the Governor.
17.
A representative from the field of law enforcement, appointed by the Governor.
18.
A representative from the criminal justice system, appointed by the Governor.
19.
A representative of a child welfare agency involved in the delivery of behavioral health services, appointed by the Governor.
20.
A representative of the statewide Florida 211 Network as described in s. 408.918, appointed by the Governor.
(b)
The Governor shall appoint the chair from the members of the commission. Appointments to the commission must be made by August 1, 2021. Members shall be appointed to serve at the pleasure of the officer who appointed the member. A vacancy on the commission shall be filled in the same manner as the original appointment.
(c)
The commission shall convene no later than September 1, 2021. The commission shall meet quarterly or upon the call of the chair. The commission may hold its meetings in person at locations throughout the state or via teleconference or other electronic means.
(d)
Members of the commission are entitled to receive reimbursement for per diem and travel expenses pursuant to s. 112.061.
(e)
Notwithstanding any other law, the commission may request and shall be provided with access to any information or records, including exempt and confidential information or records, which are necessary for the commission to carry out its duties. Information or records obtained by the commission which are otherwise exempt or confidential and exempt shall retain such exempt or confidential and exempt status, and the commission may not disclose such information or records.
(4)
DUTIES.
—
(a)
The duties of the Commission on Mental Health and Substance Use Disorder include the following:
1.
Conducting a review and evaluation of the management and functioning of the existing publicly supported mental health and substance use disorder systems and services in the department, the Agency for Health Care Administration, and all other departments which administer mental health and substance use disorder services. Such review shall include, at a minimum, a review of current goals and objectives, current planning, services strategies, coordination management, purchasing, contracting, financing, local government funding responsibility, and accountability mechanisms.
2.
Considering the unique needs of persons who are dually diagnosed.
3.
Addressing access to, financing of, and scope of responsibility in the delivery of emergency behavioral health care services.
4.
Addressing the quality and effectiveness of current mental health and substance use disorder services delivery systems, and professional staffing and clinical structure of services, roles, and responsibilities of public and private providers, such as community mental health centers; community substance use disorder agencies; hospitals, including emergency services departments; law enforcement agencies; and the judicial system.
5.
Addressing priority population groups for publicly funded mental health and substance use disorder services, identifying the comprehensive mental health and substance use disorder services delivery systems, mental health and substance use disorder needs assessment and planning activities, and local government funding responsibilities for mental health and substance use disorder services.
6.
Reviewing the implementation of chapter 2020-107, Laws of Florida.
7.
Identifying any gaps in the provision of mental health and substance use disorder services.
8.
Providing recommendations on how behavioral health managing entities may fulfill their purpose of promoting service continuity and work with community stakeholders throughout this state in furtherance of supporting the 988 Suicide and Crisis Lifeline system and other crisis response services.
9.
Conducting an overview of the current infrastructure of the 988 Suicide and Crisis Lifeline system.
10.
Analyzing the current capacity of crisis response services available throughout this state, including services provided by mobile response teams and centralized receiving facilities. The analysis must include information on the geographic area and the total population served by each mobile response team along with the average response time to each call made to a mobile response team; the number of calls that a mobile response team was unable to respond to due to staff limitations, travel distance, or other factors; and the veteran status and age groups of individuals served by mobile response teams.
11.
Evaluating and making recommendations to improve linkages between the 988 Suicide and Crisis Lifeline infrastructure and crisis response services within this state.
12.
Identifying available mental health block grant funds that can be used to support the 988 Suicide and Crisis Lifeline and crisis response infrastructure within this state, including any available funding through opioid settlements or through the American Rescue Plan Act of 2021, Pub. L. No. 117-2; the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Pub. L. No. 116-136; or other federal legislation.
13.
In consultation with the Agency for Health Care Administration, identifying sources of funding available through the Medicaid program specifically for crisis response services, including funding that may be available by seeking approval of a Section 1115 waiver submitted to the Centers for Medicare and Medicaid Services.
14.
Making recommendations regarding the mission and objectives of state-supported mental health and substance use disorder services and the planning, management, staffing, financing, contracting, coordination, and accountability mechanisms which will best foster the recommended mission and objectives.
15.
Evaluating and making recommendations regarding the establishment of a permanent, agency-level entity to manage mental health, substance use disorder, and related services statewide. At a minimum, the evaluation must consider and describe the:
a.
Specific duties and organizational structure proposed for the entity;
b.
Resource needs of the entity and possible sources of funding;
c.
Estimated impact on access to and quality of services;
d.
Impact on individuals with behavioral health needs and their families, both those currently served through the affected systems providing behavioral health services and those in need of services; and
e.
Relation to, integration with, and impact on providers, managing entities, communities, state agencies, and systems which provide mental health and substance use disorder services in this state. Such recommendations must ensure that the ability of such other agencies and systems to carry out their missions and responsibilities is not impaired.
16.
Evaluating and making recommendations regarding skills-based training that teaches participants about mental health and substance use disorder issues, including, but not limited to, Mental Health First Aid models.
(b)
The commission may call upon appropriate departments and agencies of state government for such professional assistance as may be needed in the discharge of its duties, and such departments and agencies shall provide such assistance in a timely manner.
(5)
REPORTS.
—
Beginning January 1, 2023, and annually thereafter through January 1, 2025, the commission shall submit an interim report to the President of the Senate, the Speaker of the House of Representatives, and the Governor containing its findings and recommendations on how to best provide and facilitate mental health and substance use disorder services in the state. The commission shall submit its final report to the President of the Senate, the Speaker of the House of Representatives, and the Governor by September 1, 2026.
(6)
REPEAL.
—
This section is repealed September 1, 2026, unless saved from repeal through reenactment by the Legislature.
F.S. 394.9087 Florida Veterans’ Care Coordination Program.
(1)
The Department of Veterans’ Affairs may establish the Florida Veterans’ Care Coordination Program. If the Department of Veterans’ Affairs establishes the program, it may contract with a nonprofit entity that is accredited by the Council on Accreditation, is fully accredited by the National Alliance of Information and Referral Services, and has statewide phone capacity to serve veterans to enter into agreements with Florida 211 Network participants to provide veterans and their families in this state with dedicated behavioral health care referral services, especially mental health and substance abuse services. The Department of Veterans’ Affairs shall model the program after the proof-of-concept pilot program established in 2014 by the Crisis Center of Tampa Bay and the Department of Veterans’ Affairs in Hillsborough, Pasco, Pinellas, Polk, and Manatee Counties.
(2)
The goals of the program are to:
(a)
Prevent suicides by veterans.
(b)
Increase veterans’ use of programs and services provided by the United States Department of Veterans Affairs.
(c)
Increase the number of veterans who use other available community-based programs and services.
(3)
The program must be available statewide. Program services must be provided by program teams operated by Florida 211 Network participants as authorized by s. 408.918. A Florida 211 Network participant may provide services in more than one geographic area under a single contract.
(4)
The program teams shall provide referral and care coordination services to veterans and their families and expand the existing Florida 211 Network to include the optimal range of veterans’ service organizations and programs. Florida 211 Network participants in the Florida Veterans’ Care Coordination Program must include all of the following:
(a)
Telephonic peer support, crisis intervention, and the communication of information on referral resources.
(b)
Treatment coordination, including coordination of followup care.
(c)
Suicide risk assessment.
(d)
Promotion of the safety and wellness of veterans and their families, including continuous safety planning and support.
(e)
Resource coordination, including data analysis, to facilitate acceptance, enrollment, and attendance of veterans and their families in programs and services provided by the United States Department of Veterans Affairs and other available community-based programs and services.
(f)
Immediate needs assessments, including safety planning and support.
(5)
To enhance program services, program teams shall:
(a)
Track the number of requests from callers who are veterans or members of a veteran’s family.
(b)
Follow up with callers who are veterans or members of a veteran’s family to determine whether they have acted on the referrals or received the assistance needed and whether additional referral or advocacy is needed.
(c)
Develop and implement communication strategies, such as media promotions, public service announcements, print and Internet articles, and community presentations, to inform veterans and their families about available programs and services provided by the United States Department of Veterans Affairs and other available community-based programs and services.
(d)
Document all calls and capture all necessary data to improve outreach to veterans and their families and report such data to the contracted entity.
(6)
Florida 211 Network participants in the Florida Veterans’ Care Coordination Program shall maintain a database of veteran-specific services available in the communities served by the programs. The Department of Veterans’ Affairs and its selected contractor shall work with managing entities as defined in s. 394.9082(2) to educate service providers about the Florida Veterans Support Line and the Florida Veterans’ Care Coordination Program.
(7)
Florida 211 Network participants shall collect data on the program and submit such data to the Department of Veterans’ Affairs in the format prescribed by the Department of Veterans’ Affairs. The Department of Veterans’ Affairs shall use such data to prepare a report for submittal to the Governor, the President of the Senate, and the Speaker of the House of Representatives by December 15, 2022. The report must include all of the following:
(a)
The number of calls received.
(b)
Demographic information for each caller, including, but not limited to, the caller’s military affiliation, the caller’s veteran status, and whether the caller is receiving services provided by the United States Department of Veterans Affairs or other available community-based programs and services.
(c)
The nature of each call, including, but not limited to, the concerns prompting the call and the services requested.
(d)
The outcome of each call, including, but not limited to, the services for which referrals were made and the organizations to which the caller was referred.
(e)
Services received as a result of each call.
(f)
Information regarding followup by the program team, including, but not limited to, the percentage of calls receiving followup and the outcome of followup.
(g)
Information regarding the program’s impact on each caller’s quality of life and on the avoidance of negative outcomes, including arrest and suicide.
(h)
Each caller’s level of satisfaction with program services.
F.S. 394.9088 988 suicide and crisis lifeline call center.
(1)
The department shall authorize and provide oversight of 988 suicide and crisis lifeline call centers. Unless authorized by the department, call centers are not permitted to conduct 988 suicide and crisis lifeline services. The department may implement a corrective action plan, suspension, or revocation of authorization for failure to comply with this section and rules adopted under this section.
(2)
The department shall adopt rules relating to minimum standards for 988 suicide and crisis lifeline call centers to be authorized, including, but not limited to:
(a)
Service delivery, quality of care, and performance outcomes; quality assurance standards; the adequacy and consistency of personnel certifications; and minimum training standards for personnel.
(b)
The process for authorization of 988 suicide and crisis lifeline call centers.
(3)
Authorized 988 suicide and crisis lifeline call centers shall implement a cohesive statewide plan for 988 suicide and crisis lifeline call centers to achieve statewide interoperability with the 911 system and to provide individuals with rapid and direct access to the appropriate care. The department may adopt rules to implement this subsection.
F.S. 394.9125 State attorney; authority to refer a person for civil commitment.
(1)
A state attorney shall refer a person to the department for civil commitment proceedings if:
(a)
The state attorney receives an arrest alert on the person pursuant to s. 394.926(4); and
(b)
The person is subsequently sentenced to a term of imprisonment in a county or municipal jail for any criminal offense.
(2)
A state attorney may refer a person to the department for civil commitment proceedings if the person:
(a)
Is required to register as a sexual offender pursuant to s. 943.0435;
(b)
Has previously been convicted of a sexually violent offense as defined in s. 394.912(9)(a)-(h); and
(c)
Has been sentenced to a term of imprisonment in a county or municipal jail for any criminal offense.
(3)
A state attorney who refers a person for civil commitment pursuant to subsection (1) or subsection (2) shall notify the county or municipal jail to which the person has been sentenced within 24 hours after the referral is made.
(4)(a)
If a person is sentenced to a term of imprisonment in a county or municipal jail but is not subsequently totally confined in the jail due to receiving credit for time served, the state attorney may file a petition with the circuit court within 120 hours after such person’s sentencing proceeding requesting the court to order such person into the department’s custody for purposes of initiating civil commitment proceedings.
(b)
If the judge determines that there is probable cause to believe that the person should have been referred to the department pursuant to subsection (1) or subsection (2) but that the referral was not made because the person was not totally confined in a county or municipal jail due to receiving credit for time served, the judge shall order that the person be taken into custody and delivered to the custody of the department for civil commitment proceedings.
F.S. 394.9135 Immediate releases from total confinement; transfer of person to department; time limitations on assessment, notification, and filing petition to hold in custody; filing petition after release; order into custody of department after release.
(1)(a)
If the anticipated release from total confinement of a person who has been convicted of a sexually violent offense becomes immediate for any reason, the agency with jurisdiction shall upon immediate release from total confinement transfer that person to the custody of the department to be held in an appropriate secure facility.
(b)
If a person who committed a sexually violent offense and who is serving an incarcerative sentence under the custody of the Department of Corrections, the Department of Juvenile Justice, or a local detention facility, or who is committed to the custody of the department due to an adjudication of not guilty by reason of insanity is released, the state attorney, as designated in s. 394.913, may file a petition with the circuit court within 120 hours after the person’s release alleging that:
1.
Section 394.9125, s. 394.913, or this section requires that the person be referred for consideration for civil commitment before release and the person was not referred because of a mistake, oversight, or intentional act; or
2.
The person was referred for commitment consideration but, through a mistake, oversight, or intentional act, was released rather than transferred to the custody of the Department of Children and Families as required by this part.
If the judge determines that there is probable cause to believe that the person was released in contravention of s. 394.913 or this section, the judge shall order the person to be taken into custody and delivered to an appropriate secure facility designated by the Department of Children and Families.
(2)
Within 72 hours after transfer pursuant to paragraph (1)(a) or receipt into the department’s custody pursuant to paragraph (1)(b) or s. 394.9125(4), the multidisciplinary team shall assess whether the person meets the definition of a sexually violent predator. If the multidisciplinary team determines that the person does not meet the definition of a sexually violent predator, that person shall be immediately released. If at least two members of the multidisciplinary team, after all clinical evaluations have been conducted, determine that the person meets the definition of a sexually violent predator, the team shall provide the state attorney, as designated by s. 394.913, with its written assessment and recommendation within the 72-hour period or, if the 72-hour period ends after 5 p.m. on a working day or on a weekend or holiday, within the next working day.
(3)
Within 48 hours after receipt of the written assessment and recommendation from the multidisciplinary team, the state attorney, as designated in s. 394.913, may file a petition with the circuit court alleging that the person is a sexually violent predator and stating facts sufficient to support the allegation. If a petition is not filed within 48 hours after receipt of the written assessment and recommendation by the state attorney, the person shall be immediately released, except that, if the 48-hour period ends after 5 p.m. on a working day or on a weekend or holiday, the petition may be filed on the next working day without resulting in the person’s release. If a petition is filed pursuant to this section and the judge determines that there is probable cause to believe that the person is a sexually violent predator, the judge shall order that the person be maintained in custody and held in an appropriate secure facility for further proceedings in accordance with this part.
(4)
This section is not jurisdictional, and failure to comply with the time limitations which results in the release of a person who has been convicted of a sexually violent offense is not dispositive of the case and does not prevent the state attorney from proceeding against a person otherwise subject to this part.
F.S. 394.9151 Contract authority.
The Department of Children and Families may contract with a private entity or state agency for use of and operation of facilities to comply with the requirements of this act. The Department of Children and Families may also contract with the Department of Corrections to issue a request for proposals and monitor contract compliance for these services.
F.S. 394.9155 Rules of procedure and evidence.
In all civil commitment proceedings for sexually violent predators under this part, the following shall apply:
(1)
The Florida Rules of Civil Procedure apply unless otherwise specified in this part.
(2)
The Florida Rules of Evidence apply unless otherwise specified in this part.
(3)
The psychotherapist-patient privilege under s. 90.503 does not exist or apply for communications relevant to an issue in proceedings to involuntarily commit a person under this part.
(4)
The court may consider evidence of prior behavior by a person who is subject to proceedings under this part if such evidence is relevant to proving that the person is a sexually violent predator.
(5)
Hearsay evidence, including reports of a member of the multidisciplinary team or reports produced on behalf of the multidisciplinary team, is admissible in proceedings under this part unless the court finds that such evidence is not reliable. In a trial, however, hearsay evidence may not be used as the sole basis for committing a person under this part.
(6)
Rules adopted under s. 394.930 shall not constitute:
(a)
An evidentiary predicate for the admission of any physical evidence or testimony;
(b)
A basis for excluding or otherwise limiting the presentation of any physical evidence or testimony in judicial proceedings under this part; or
(c)
Elements of the cause of action that the state needs to allege or prove in judicial proceedings under this part.
(7)
If the person who is subject to proceedings under this part refuses to be interviewed by or fully cooperate with members of the multidisciplinary team or any state mental health expert, the court may, in its discretion:
(a)
Order the person to allow members of the multidisciplinary team and any state mental health experts to review all mental health reports, tests, and evaluations by the person’s mental health expert or experts; or
(b)
Prohibit the person’s mental health experts from testifying concerning mental health tests, evaluations, or examinations of the person.
The failure of any party to comply with such rules shall not constitute a defense in any judicial proceedings under this part.
F.S. 394.9215 Right to habeas corpus.
(1)(a)
At any time after exhausting all administrative remedies, a person held in a secure facility under this part may file a petition for habeas corpus in the circuit court for the county in which the facility is located alleging that:
1.
The person’s conditions of confinement violate a statutory right under state law or a constitutional right under the State Constitution or the United States Constitution; or
2.
The facility in which the person is confined is not an appropriate secure facility, as that term is used in s. 394.915.
(b)
Upon filing a legally sufficient petition stating a prima facie case under paragraph (a), the court may direct the Department of Children and Families to file a response. If necessary, the court may conduct an evidentiary proceeding and issue an order to correct a violation of state or federal rights found to exist by the court. A final order entered under this section may be appealed to the district court of appeal. A nonfinal order may be appealed to the extent provided by the Florida Rules of Appellate Procedure. An appeal by the department shall stay the trial court’s order until disposition of the appeal.
(2)
Any claim referred to in subsection (1) may be asserted only as provided in this section. No claim referred to in subsection (1) shall be considered in commitment proceedings brought under this part. A person does not have a right to appointed counsel in any proceeding initiated under this section.
(3)
Relief granted on a petition filed under this section must be narrowly drawn and may not exceed that which is minimally necessary to correct, in the least intrusive manner possible, the violation of the state or federal rights of a particular petitioner. A court considering a petition under this section must give substantial weight to whether the granting of relief would adversely impact the operation of the detention and treatment facility or would adversely impact public safety.
(4)
The court may not enter an order releasing a person from secure detention unless the court expressly finds that no relief short of release will remedy the violation of state or federal rights which is found to have occurred.
F.S. 394.9221 Certified security personnel.
The department or an entity contracting with the department to operate a secure facility under this part is considered an employing agency as that term is defined in s. 943.10 and is authorized to employ certified correctional officers as facility security personnel.
F.S. 394.9223 Use of force.
(1)
When necessary to provide protection and security to any client, to the personnel, equipment, buildings, or grounds of a secure facility, or to citizens in the surrounding community, an employee or agent of a secure facility, or an employee of a state or local law enforcement agency, may apply physical force upon a person confined in a secure facility under this part only when and to the extent that it reasonably appears necessary. This includes the use of nonlethal devices, such as chemical agents and handheld electronic immobilization devices, when authorized by the administrator of the facility or her or his designee when the administrator is not present, and only after an employee has been trained in the appropriate use of such chemical agents and electronic devices. Chemical agents and handheld electronic devices shall be used only to the extent necessary to provide protection and security. A staff person may not carry a chemical agent or handheld electronic immobilization device on her or his person under any circumstances, except during escort of a facility resident outside of the secure perimeter of the facility, or as an authorized response to an incident within the facility which threatens the safety or security of staff or residents. Handheld electronic immobilization devices are only used during escort of a confined person outside of the secure perimeter of the facility. Circumstances under which reasonable force may be employed include:
(a)
Defending oneself against imminent use of unlawful force;
(b)
Preventing the escape of a person confined at the secure facility.
(c)
Preventing damage to property;
(d)
Quelling a disturbance; or
(e)
Overcoming physical resistance to a lawful command.
(2)
Following any use of force, each person who was physically involved shall receive a medical examination by a qualified health care provider, unless the person refuses such examination, to determine the extent of injury, if any. The examining health care provider shall prepare a report that includes, but need not be limited to, a statement of whether further examination by a physician is necessary. Any noticeable physical injury shall be examined by a physician who shall prepare a report documenting the extent and cause of the injury and the treatment prescribed. Such report shall be completed within 5 working days after the incident and shall be submitted to the facility superintendent for investigation as appropriate.
(3)
Each person who applied physical force or was responsible for making the decision to apply physical force upon a confined person shall prepare, date, and sign an independent report within 3 working days after the incident. The report shall be delivered to the facility superintendent who shall conduct an investigation and shall determine whether force was appropriately used. Copies of the report and the facility superintendent’s evaluation shall be kept in the resident’s file. A record of each incident involving an employee’s use of force and the facility superintendent’s evaluation shall be kept in the employee’s file.
(4)
An employee of a secure facility under this part who, with malicious intent:
(a)
Commits a battery upon a person confined in the facility commits a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083; or
(b)
Commits a battery or inflicts cruel or inhuman treatment by neglect or otherwise, and in so doing causes great bodily harm, permanent disability, or permanent disfigurement to a person confined in the facility, commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
F.S. 394.9265 Introduction or removal of certain articles unlawful; penalty.
(1)
Except as authorized by law or as specifically authorized by the person in charge of a secure facility providing secure confinement and treatment under this part, it is unlawful to knowingly and intentionally bring into any facility providing secure confinement and treatment under this part, or to take or attempt to take or send therefrom, any of the following articles:
(a)
Any intoxicating beverage or beverage that causes or may cause an intoxicating effect;
(b)
Any controlled substance as defined in chapter 893; or
(c)
Any firearm or weapon.
(2)
A person who violates this section commits a felony of the third degree, punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
F.S. 394.46715 Rulemaking authority.
The department may adopt rules to administer this part.
F.S. 394.47865 South Florida State Hospital; privatization.
(1)
The Department of Children and Families shall, through a request for proposals, privatize South Florida State Hospital. The department shall plan to begin implementation of this privatization initiative by July 1, 1998.
(a)
Notwithstanding s. 287.057(14), the department may enter into agreements, not to exceed 20 years, with a private provider, a coalition of providers, or another agency to finance, design, and construct a treatment facility having up to 350 beds and to operate all aspects of daily operations within the facility. The department may subcontract any or all components of this procurement to a statutorily established state governmental entity that has successfully contracted with private companies for designing, financing, acquiring, leasing, constructing, and operating major privatized state facilities.
(b)
The selected contractor is authorized to sponsor the issuance of tax-exempt bonds, certificates of participation, or other securities to finance the project, and the state is authorized to enter into a lease-purchase agreement for the treatment facility.
(2)
The contractor shall operate South Florida State Hospital as a mental health treatment facility that serves voluntarily and involuntarily committed indigent adults who meet the criteria of part I of this chapter and who reside in the South Florida State Hospital service area.
(a)
South Florida State Hospital shall remain a participant in the mental health disproportionate share program so long as the residents receive eligible services.
(b)
The department and the contractor shall ensure that the treatment facility is operated as a part of a total continuum of care for persons who are mentally ill. The contractor shall have as its primary goal for the treatment facility to effectively treat and assist residents to return to the community as quickly as possible.
(3)(a)
Current South Florida State Hospital employees who are affected by the privatization shall be given first preference for continued employment by the contractor. The department shall make reasonable efforts to find suitable job placements for employees who wish to remain within the state Career Service System.
(b)
Any savings that result from the privatization of South Florida State Hospital shall be directed to the department’s service districts 9, 10, and 11 for the delivery of community mental health services.
F.S. 394.47891 Veterans treatment court programs.
(1)
LEGISLATIVE INTENT.
—
It is the intent of the Legislature to encourage and support the judicial circuits of the state and other agencies, local governments, interested public and private entities, and individuals to create and maintain a veterans treatment court program in each judicial circuit. The purpose of a veterans treatment court program is to address the underlying causes of a veteran’s involvement with the judicial system through the use of specialized dockets, multidisciplinary teams, and evidence-based treatment. A veterans treatment court program shall use nonadversarial approaches to resolve such underlying causes. Veterans treatment court programs depend on the leadership of attorneys and judges or magistrates who are educated in the issues and science of veterans’ behaviors leading to court involvement and require a rigorous team effort to detect, discern, and assist veterans in correcting the behaviors and choices that lead to the veterans’ court involvement. This section creates a detailed statewide standard for the creation, operation, and procedures for veterans treatment court programs.
(2)
DEFINITIONS.
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For purposes of this section, the term:
(a)
“Defendant” means a veteran or servicemember who has been charged with or convicted of a criminal offense.
(b)
“Military sexual trauma” means psychological trauma that results from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while a servicemember or veteran was serving on active duty, active duty for training, or inactive duty training.
(c)
“Servicemember” means:
1.
A member of the active or reserve components of the United States Army, Navy, Air Force, Marine Corps, Space Force, or Coast Guard;
2.
A member of the Florida National Guard;
3.
A current or former contractor for the United States Department of Defense; or
4.
A current or former military member of a foreign allied country.
(d)
“Veteran” means a person who has served in the military.
(e)
“Veterans treatment court program” means a specialized docket administered by a court for veterans and servicemembers as set forth in this section.
(3)
AUTHORIZATION.
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(a)
A court with jurisdiction over criminal cases may create and administer a veterans treatment court program.
(b)
A veterans treatment court program may adjudicate misdemeanors and felonies.
(c)
The chief judge may issue administrative orders concerning the veterans treatment court program.
(d)
The chief judge and state attorney of the judicial circuit that creates and administers a veterans treatment court program have the exclusive authority to determine whether veterans who have been dishonorably discharged may participate in the veterans treatment court program within the circuit.
(4)
ADMISSION.
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A defendant who meets the eligibility requirements under subsection (8) may be admitted to a veterans treatment court program at any stage of a criminal proceeding. A defendant seeking to participate in a veterans treatment court program must submit an application to the state attorney. The state attorney must review each application and determine whether the defendant meets the eligibility requirements in subsection (8).
(5)
RECORD OF POLICIES AND PROCEDURES.
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(a)
Each veterans treatment court program shall seek input from the state attorney and other interested persons in developing and adopting policies and procedures to implement subsections (6) and (7).
(b)
A veterans treatment court program shall create a record of the policies and procedures adopted to implement subsections (6) and (7).
(6)
KEY COMPONENTS OF A VETERANS TREATMENT COURT PROGRAM.
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(a)
A veterans treatment court program shall adopt policies and procedures to implement the following key components, including:
1.
Integrating substance abuse and mental health treatment services, and any other related treatment and rehabilitation services with justice system case processing.
2.
Using a nonadversarial approach in which the state attorney and defense counsel promote public safety while protecting the due process rights of the defendant.
3.
Providing for early identification of eligible defendants.
4.
Monitoring defendants for abstinence from alcohol and drugs by frequent testing.
5.
Providing ongoing judicial interaction with each defendant.
6.
Monitoring and evaluating the achievement of each defendant’s program goals.
7.
Forging partnerships among the veterans treatment court programs, the United States Department of Veterans Affairs, the Florida Department of Veterans’ Affairs, public agencies, and community-based organizations to generate local support and enhance the effectiveness of the veterans treatment court program.
(b)
In adopting policies and procedures under this section, the court shall consult nationally recognized best practices related to the key components of veterans treatment court programs.
(7)
SUPPLEMENTAL POLICIES AND PROCEDURES OF VETERANS TREATMENT COURT PROGRAMS.
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A veterans treatment court program may adopt supplemental policies and procedures to:
(a)
Refer a defendant with a medical need to an appropriate health care provider or refer a defendant for appropriate assistance, including assistance with housing, employment, nutrition, mentoring, education, and driver license reinstatement.
(b)
Otherwise encourage participation in the veterans treatment court program.
(8)
ELIGIBILITY.
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(a)
A defendant may participate in a veterans treatment court program if he or she is approved by the state attorney, in consultation with the court, and meets the following criteria:
1.
The defendant has a service-related mental health condition, service-related traumatic brain injury, service-related substance use disorder, or service-related psychological problem or has experienced military sexual trauma.
2.
The defendant’s participation in the veterans treatment court program is in the interest of justice and of benefit to the defendant and the community.
(b)
In making the determination under subparagraph (a)2., the state attorney, in consultation with the court, must consider:
1.
The nature and circumstances of the offense charged.
2.
The special characteristics or circumstances of the defendant and any victim or alleged victim, including any recommendation of the victim or alleged victim.
3.
The defendant’s criminal history and whether the defendant previously participated in a veterans treatment court program or similar program.
4.
Whether the defendant’s needs exceed the treatment resources available to the veterans treatment court program.
5.
The impact on the community of the defendant’s participation and treatment in the veterans treatment court program.
6.
Recommendations of any law enforcement agency involved in investigating or arresting the defendant.
7.
If the defendant owes restitution, the likelihood of payment during the defendant’s participation in the veterans treatment court program.
8.
Any mitigating circumstances.
9.
Any other circumstances reasonably related to the defendant’s case.
(9)
LIBERAL CONSTRUCTION.
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The provisions of this section shall be liberally construed.
(10)
NO RIGHT TO PARTICIPATE.
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This section does not create a right of a veteran or servicemember to participate in a veterans treatment court program.
(11)
MILITARY VETERANS AND SERVICEMEMBERS COURT PROGRAMS IN OPERATION ON OR BEFORE JUNE 30, 2021.
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A Military Veterans and Servicemembers Court Program in operation under this section on or before June 30, 2021, may continue to operate but must comply with the amendments made by this act to subsections (1)-(10). This act does not affect or alter the rights or responsibilities of any person who, on or before June 30, 2021, was admitted to and participating in a Military Veterans and Servicemembers Court Program established under this section.
(12)
PUBLIC RECORDS EXEMPTION.
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(a)
Information relating to a participant or a person considered for participation in a veterans treatment court program contained in the following records is confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution:
1.
Records created or compiled during screenings for participation in the program.
2.
Records created or compiled during substance abuse screenings.
3.
Behavioral health evaluations.
4.
Subsequent treatment status reports.
(b)
Such confidential and exempt information may be disclosed:
1.
Pursuant to a written request of the participant or person considered for participation or his or her legal representative.
2.
To another governmental entity in the furtherance of its responsibilities associated with the screening of a person considered for participation in or the provision of treatment to a person in a veterans treatment court program.
(c)
If such confidential and exempt information is a substance abuse record of a service provider that pertains to the identity, diagnosis, or prognosis of or provision of services to a person, such information may be disclosed pursuant to s. 397.501(7).
(d)
If such confidential and exempt information is a record of a service provider that pertains to mental health, such information may be disclosed pursuant to s. 394.4615.
(e)
The public records exemption in this subsection applies to the information collected before, on, or after the effective date of this exemption.
(f)
This subsection is subject to the Open Government Sunset Review Act in accordance with s. 119.15 and shall stand repealed on October 2, 2029, unless reviewed and saved from repeal through reenactment by the Legislature.
F.S. 394.47892 Mental health court programs.
(1)
Each county may fund a mental health court program under which a defendant in the justice system assessed with a mental illness shall be processed in such a manner as to appropriately address the severity of the identified mental illness through treatment services tailored to the individual needs of the participant. The Legislature intends to encourage the department, the Department of Corrections, the Department of Juvenile Justice, the Department of Health, the Department of Law Enforcement, the Department of Education, and other such agencies, local governments, law enforcement agencies, interested public or private entities, and individuals to support the creation and establishment of problem-solving court programs. Participation in a mental health court program does not relieve a public or private agency of its responsibility for a child or an adult, but enables such agency to better meet the child’s or adult’s needs through shared responsibility and resources.
(2)
Mental health court programs may include pretrial intervention programs as provided in ss. 948.08, 948.16, and 985.345, postadjudicatory mental health court programs as provided in ss. 948.01 and 948.06, and review of the status of compliance or noncompliance of sentenced defendants through a mental health court program.
(3)
Entry into a pretrial mental health court program is voluntary.
(4)(a)
Entry into a postadjudicatory mental health court program as a condition of probation or community control pursuant to s. 948.01 or s. 948.06 must be based upon the sentencing court’s assessment of the defendant’s criminal history, mental health screening outcome, amenability to the services of the program, and total sentence points; the recommendation of the state attorney and the victim, if any; and the defendant’s agreement to enter the program.
(b)
A defendant who is sentenced to a postadjudicatory mental health court program and who, while a mental health court program participant, is the subject of a violation of probation or community control under s. 948.06 shall have the violation of probation or community control heard by the judge presiding over the postadjudicatory mental health court program. After a hearing on or admission of the violation, the judge shall dispose of any such violation as he or she deems appropriate if the resulting sentence or conditions are lawful.
(5)(a)
Contingent upon an annual appropriation by the Legislature, the state courts system shall establish, at a minimum, one coordinator position in each mental health court program to coordinate the responsibilities of the participating agencies and service providers. Each coordinator shall provide direct support to the mental health court program by providing coordination between the multidisciplinary team and the judiciary, providing case management, monitoring compliance of the participants in the mental health court program with court requirements, and managing the collection of data for program evaluation and accountability.
(b)
Each mental health court program shall collect sufficient client-level data and programmatic information for purposes of program evaluation. Client-level data includes primary offenses that resulted in the mental health court program referral or sentence, treatment compliance, completion status and reasons for failure to complete, offenses committed during treatment and the sanctions imposed, frequency of court appearances, and units of service. Programmatic information includes referral and screening procedures, eligibility criteria, type and duration of treatment offered, and residential treatment resources. The programmatic information and aggregate data on the number of mental health court program admissions and terminations by type of termination shall be reported annually by each mental health court program to the Office of the State Courts Administrator.
(6)
If a county chooses to fund a mental health court program, the county must secure funding from sources other than the state for those costs not otherwise assumed by the state pursuant to s. 29.004. However, this subsection does not preclude counties from using funds for treatment and other services provided through state executive branch agencies. Counties may provide, by interlocal agreement, for the collective funding of these programs.
(7)
The chief judge of each judicial circuit may appoint an advisory committee for the mental health court program. The committee shall be composed of the chief judge, or his or her designee, who shall serve as chair; the judge or judges of the mental health court program, if not otherwise designated by the chief judge as his or her designee; the state attorney, or his or her designee; the public defender, or his or her designee; the mental health court program coordinator or coordinators; community representatives; treatment representatives; and any other persons who the chair deems appropriate.
(8)(a)
Information relating to a participant or a person considered for participation in a mental health court program contained in the following records is confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution:
1.
Records created or compiled during screenings for participation in the program.
2.
Records created or compiled during substance abuse screenings.
3.
Behavioral health evaluations.
4.
Subsequent treatment status reports.
(b)
Such confidential and exempt information may be disclosed:
1.
Pursuant to a written request of the participant or person considered for participation or his or her legal representative.
2.
To another governmental entity in the furtherance of the governmental entity’s responsibilities associated with the screening of a person considered for participation in or the provision of treatment to a person in a mental health court program.
(c)
If such confidential and exempt information is a substance abuse record of a service provider that pertains to the identity, diagnosis, and prognosis of or provision of services to a person, such information may be disclosed pursuant to s. 397.501(7).
(d)
If such confidential and exempt information is a record of a service provider that pertains to mental health, such information may be disclosed pursuant to s. 394.4615.
(e)
The public records exemption in this subsection applies to the information collected before, on, or after the effective date of this exemption.
(f)
This subsection is subject to the Open Government Sunset Review Act in accordance with s. 119.15 and shall stand repealed on October 2, 2029, unless reviewed and saved from repeal through reenactment by the Legislature.
F.S. 394.90825 Boards of behavioral health managing entities; conflicts of interest.
(1)
As used in this section, the term:
(a)
“Activity” includes, but is not limited to, a contract for goods and services, a contract for the purchase of any real or tangible property, or an agreement to engage with the managing entity for the benefit of a third party in exchange for an interest in real or tangible property, a monetary benefit, or an in-kind contribution.
(b)
“Conflict of interest” means when a board member or an officer, or a relative of a board member or an officer, of the managing entity does any of the following:
1.
Enters into a contract or other transaction for goods or services with the managing entity.
2.
Holds a direct or indirect interest in a corporation, limited liability corporation, partnership, limited liability partnership, or other business entity that conducts business with the managing entity or proposes to enter into a contract or other transaction with the managing entity. For purposes of this paragraph, the term “indirect interest” has the same meaning as in s. 112.312.
3.
Knowingly obtains a direct or indirect personal, financial, professional, or other benefit as a result of the relationship of such board member or officer, or relative of the board member or officer, with the managing entity. For purposes of this paragraph, the term “benefit” does not include per diem and travel expenses paid or reimbursed to board members or officers of the managing entity in connection with their service on the board.
(c)
“Managing entity” has the same meaning as in s. 394.9082.
(d)
“Relative” means a relative within the third degree of consanguinity by blood or marriage.
(2)(a)
For any activity that is presented to the board of a managing entity for its initial consideration and approval after July 1, 2021, or any activity that involves a contract that is being considered for renewal on or after July 1, 2021, but before January 1, 2022, a board member or an officer of a managing entity shall disclose to the board any activity that may reasonably be construed to be a conflict of interest before such activity is initially considered and approved or a contract is renewed by the board. A rebuttable presumption of a conflict of interest exists if the activity was acted on by the board without prior notice as required under subsection (3).
(b)
For contracts with a managing entity which are in existence on July 1, 2021, and are not subject to renewal before January 1, 2022, a board member or an officer of the managing entity shall disclose to the board any activity that may reasonably be construed to be a conflict of interest under this section by December 31, 2021.
(3)(a)
If a board member or an officer of the managing entity, or a relative of a board member or an officer, proposes to engage in an activity as described in paragraph (2)(a), the proposed activity must be listed on the meeting agenda for the next general or special meeting of the board members, and copies of all contracts and transactional documents related to the proposed activity must be included in the agenda. The meeting agenda must clearly identify the existence of a potential conflict of interest for the proposed activity. Before a board member or an officer of the managing entity, or a relative of a board member or an officer, engages in the proposed activity, the activity and contract or other transactional documents must be approved by an affirmative vote of two-thirds of all other board members present.
(b)
If a board member or an officer of the managing entity notifies the board of a potential conflict of interest with the board member or officer, or a relative of the board member or officer, under an existing contract as described in paragraph (2)(b), the board must notice the activity on a meeting agenda for the next general or special meeting of the board members, and copies of all contracts and transactional documents related to the activity must be attached. The meeting agenda must clearly identify the existence of a potential conflict of interest. The board must be given the opportunity to approve or disapprove the conflict of interest by a vote of two-thirds of all other board members present.
(4)(a)
If the board votes against the proposed activity under paragraph (3)(a), the board member or officer of the managing entity, or the relative of the board member or officer, must notify the board in writing of his or her intention, or his or her relative’s intention, not to pursue the proposed activity, or the board member or officer shall withdraw from office before the next scheduled board meeting. If the board finds that a board member or officer has violated this paragraph, the board member or officer shall be removed from office before the next scheduled board meeting.
(b)
In the event that the board does not approve a conflict of interest as required under paragraph (3)(b), the parties to the activity may opt to cancel the activity or, in the alternative, the board member or officer of the managing entity must resign from the board before the next scheduled board meeting. If the activity canceled is a contract, the managing entity is only liable for the reasonable value of the goods and services provided up to the time of cancellation and is not liable for any termination fee, liquidated damages, or other form of penalty for such cancellation.
(5)
A board member or an officer of the managing entity, or a relative of a board member or an officer, who is a party to, or has an interest in, an activity that is a possible conflict of interest may attend the meeting at which the activity is considered by the board and may make a presentation to the board regarding the activity. After the presentation, the board member or officer, or the relative of the board member or officer, must leave the meeting during the discussion of, and the vote on, the activity. A board member or an officer who is a party to, or has an interest in, the activity shall recuse himself or herself from the vote.
(6)
A contract entered into between a board member or an officer of the managing entity, or a relative of a board member or an officer, and the managing entity which has not been properly disclosed as a conflict of interest or potential conflict of interest under this section is voidable and terminates upon the filing of a written notice terminating the contract with the board of directors which contains the consent of at least 20 percent of the voting interests of the managing entity.
F.S. 394.90826 Behavioral Health Interagency Collaboration.
(1)
The department and the Agency for Health Care Administration shall jointly establish behavioral health interagency collaboratives throughout the state with the goal of identifying and addressing ongoing challenges within the behavioral health system at the local level to improve the accessibility, availability, and quality of behavioral health services. The objectives of the regional collaboratives are to:
(a)
Facilitate enhanced interagency communication and collaboration.
(b)
Develop and promote regional strategies tailored to address community-level challenges in the behavioral health system.
(2)
The regional collaborative membership shall, at a minimum, be composed of representatives from all of the following, serving the region:
(a)
Department of Children and Families.
(b)
Agency for Health Care Administration.
(c)
Agency for Persons with Disabilities.
(d)
Department of Elder Affairs.
(e)
Department of Health.
(f)
Department of Education.
(g)
School districts.
(h)
Area agencies on aging.
(i)
Community-based care lead agencies, as defined in s. 409.986(3)(d).
(j)
Managing entities, as defined in s. 394.9082(2).
(k)
Behavioral health services providers.
(l)
Hospitals.
(m)
Medicaid Managed Medical Assistance Plans.
(n)
Police departments.
(o)
Sheriffs’ offices.
(3)
Each regional collaborative shall define the objectives of that collaborative based upon the specific needs of the region and local communities located within the region, to achieve the specified goals.
(4)
The department shall define the region to be served by each collaborative and shall be responsible for facilitating meetings.
(5)
All entities represented on the regional collaboratives shall provide assistance as appropriate and reasonably necessary to fulfill the goals of the regional collaboratives.
Source: FL Statutes (Official Site)URL: https://www.flsenate.gov/Laws/Statutes/2025/Chapter394/AllFetched: 7/8/2026