Item C26County of Monroe
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BOARD OF COUNTY COMMISSIONERS
Mayor George Neugent, District 2
The Florida. Key
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Mayor Pro Tem David Rice, District 4
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Danny L. Kolhage, District I
Heather Carruthers, District 3
Sylvia J. Murphy, District 5
County Commission Meeting
April 12, 2017
Agenda Item Number: C26
Agenda Item Summary #2859
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Laura DeLoach (305)292 -4482
No
AGENDA ITEM WORDING: Approval of an action plan, as presented by the designated
Managing Entity for Monroe County and Miami /Dade County, South Florida Behavioral Health
Network ( SFBHN), for a centralized receiving system for Monroe County as required by Senate Bill
12 (Chapter 2016 -241), for implementation July 1, 2017.
ITEM BACKGROUND: In 2016 Senate Bill 12 relating to mental health and substance abuse, was
approved, providing amendments to Florida Statute Chapter 394, Mental Health. Under F.S.
394.4573, counties along with the managing entity and community stakeholders are to plan a
designated receiving system. The plan is to be completed and implemented by July 01, 2017. On
March 2, 2017 South Florida Behavioral Health Network ( SFBHN) held a Monroe County SB 12
Planning meeting with community members and providers (attendance roster attached). As a result
of the meeting an action plan for a Centralized Receiving System for Monroe County was developed
along with a Care Coordination plan (Draft workflow document attached, finalized document to be
provided on the revised agenda).
PREVIOUS RELEVANT BOCC ACTION: Monroe County annually provides required matching
funds for substance abuse and mental health services including transportation.
CONTRACT /AGREEMENT CHANGES:
No
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
SFBHN 04 -12 -17 Agenda Documentation
FINANCIAL IMPACT:
Effective Date: 07/01/2017
Expiration Date: N/A
Total Dollar Value of Contract: N/A
Total Cost to County: $0
Current Year Portion: N/A
Budgeted: N/A
Source of Funds: N/A
CPI: No
Indirect Costs: No
Estimated Ongoing Costs Not Included in above dollar amounts: N/A
Revenue Producing: No
Grant: No
County Match: N/A
Insurance Required: N/A
Additional Details:
If yes, amount:
None.
REVIEWED BY:
Christine Limbert
Maria Slavik
Tina Boan
Kathy Peters
Board of County Commissioners
Completed
03/29/2017 9:34 AM
Completed
03/29/2017 9:35 AM
Completed
03/29/2017 9:37 AM
Completed
03/29/2017 9:39 AM
Pending
04/12/2017 9:00 AM
I "W-I 2
Enforcement (LE) for Baker/
Marchman Acts
nearest
financial eligibility Facility
er of new admissions in FY 15.16 in
DO County:
Mental Health:
1,680
Substance Abuse:
428
en's Mental Health:
225
en's Substance Abuse
151
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Monroe County SB 12 Planning Meeting
Thursday, March 2, 2017
Morning Session — (9:00am)
AGENDA
(SFBHN Staff: John, Steve, Laura, Betty, Carol, Joanna)
Welcome and Introductions
2. Review of Senate Bill (SB) 12
3. Centralized Receiving Facility (CRF) Proposal
4. Transportation Plan Discussions
5. Care Coordination Activities
6. Follow -up Activities
7. Adjournment
Monroe County Housing Planning Meeting
Thursday, March 2, 2017
Afternoon
AGENDA
(SFBHN Staff: Maria)
1. Welcome and Introductions
2. Review of Housing Needs in Monroe County
3. Site Visits of Housing Providers (Samuel's House, AIDS Help, De Poo)
4. Follow -up Activities
5. Adjournment
Monroe County Provider Visits
Friday, March 3, 2017
AGENDA
(SFBHN Staff: Betty, Carol, Joanna, Maria)
9:00am — Volunteers of America
10:00am — Florida Keys Outreach Coalition (FKOC)
11:30 am — Guidance Care Center (GCC) CSU Marathon
Attendance List for 3 2 17 SFBHN Monroe County SC 12 Planning Meeting
THE FLORIDA SENATE
2016 SUMMARY OF LEGISLATION PASSED
Committee on Children, Families,
And Elder Affairs
CS /SB 12 — Mental Health and Substance Abuse
by Appropriations Committee and Senators Garcia, Galvano and Ring
The bill addresses Florida's system for the delivery of behavioral health services. The bill
provides for mental health services for children, parents, and others seeking custody of children
involved in dependency court proceedings. The bill identifies the components of a coordinated
system of care to be provided for individuals with mental illness or substance use disorder and
defines a "No Wrong Door" model for accessing care.
The Agency for Health Care Administration (AHCA) and the Department of Children and
Families (DCF) are directed to modify licensure requirements through the rulemaking process if
possible, to create an option for a single, consolidated license to provide both mental health and
substance use disorder services. For modifications requiring statutory revisions, the agency and
the department shall produce a plan for consolidation to the Legislature by November 1, 2016.
Additionally, by December 31, 2016, AHCA and DCF are directed to develop a plan to increase
federal funding for behavioral health care; compile detailed documentation of the cost and
reimbursements for Medicaid covered services provided to Medicaid eligible individuals by
providers of behavioral health care services. If the report provides clear and convincing evidence c�
that Medicaid reimbursements are less than the costs of providing services, the agency and the 0
department shall request additional trust fund authority necessary to draw down Medicaid funds
as a match for the documented general revenue expenditures supporting covered services 2
delivered to eligible individuals.
To more closely align the Baker Act (mental illness) and Marchman Act (substance abuse), the 0
bill modifies the legal procedures and timelines, as well as processes for assessment, evaluation,
and provision of services.
The duties and responsibilities of DCF are revised for the contract and oversight of the managing
entities'. The duties and responsibilities of the managing entities are also revised. The new duties
include, among others, the requirement to conduct a community behavioral health care needs
assessment every three years in the geographic area served by the managing entity; determine the
optimal array of services to meet the needs identified in the needs assessment and develop
strategies to divert people with mental illness or substance use disorder from the criminal justice
system and collaborate with the Department of Juvenile Justice and the state court system to
integrate behavioral health services with the child welfare system.
I See s. 394.9082, F.S. A managing entity is a not - for -profit corporation organized in Florida which is under contract
with DCF on a regional basis to manage the day -to -day operational delivery of behavioral health services through an
organized system of care and a network of providers who are contracted with the managing entity to provide a
comprehensive array of emergency, acute care, residential, outpatient, recovery support, and consurner support
services related to behavioral health.
This summary is provided for information only and does not represent the opinion of any Senator, Senate Officer, or Senate Office.
CS /SB 12 Page: 1
2016 Summnary of Legislation Passed
Committee on Children, Families,
And Elder Affairs
By September 1 of each year, beginning in 2017, each managing entity is required to develop
and submit a plan to the department describing the strategies for enhancing services and
addressing three to five priority needs in the service area. The plans must be developed with
input from consumers and their families, local governments, local law enforcement agencies, and
other stakeholders.
The department is directed to update the crisis stabilization services utilization database. The
database is renamed the acute care services utilization database. Managing entities are required
to 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.
The bill allows 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 to be in a multi -story building and may be
authorized on floors other than the ground floor.
The department is to develop certain forms to be used by law enforcement for use when a person
is taken into custody under chapter 397. The department is also to develop a website and post
standard forms to be used to file a petition for involuntary admission under the Marchman Act.
The bill has a fiscal impact of $400,000 in nonrecurring funds from the Operations and
Maintenance Trust Fund to DCF for the purpose of modifying the existing crisis stabilization
database to collect and analyze data and information pursuant to s. 397.321, F.S.
If approved by the Governor, these provisions take effect July 1, 2016
Vote: Senate 38 -0; House 118 -1
This summary is provided for information only and does not represent the opinion of any Senator, Senate Officer, or Senate Office.
CS /SB 12 Page: 2
CHAPTER 2016 -241
Committee Substitute for Senate Bill No. 12
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An act relating to mental health and substance abuse; amending s. 29.004,
F.S.; including services provided to treatment -based mental health
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programs within case management funded from state revenues as an
element of the state courts system; amending s. 39.01, F.S.; defining a
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term; amending s. 39.407, F.S.; requiring assessment findings to be
provided to the plan that is financially responsible for a child's care in
residential treatment under certain circumstances; amending s. 394.453,
F.S.; revising legislative intent; amending s. 394.4573, F.S.; requiring the
Department of Children and Families to submit a certain assessment to
the Governor and Legislature by a specified date; defining and revising
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terms; providing essential elements of a coordinated system of care;
providing requirements for the department's annual assessment; author-
izing the department to award certain grants; deleting duties and
measures of the department regarding continuity of care management
systems; amending s. 394.461, F.S.; creating a designated receiving
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system that functions as a no- wrong -door model, based on certain
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receiving system models; authorizing, rather than requiring, the depart-
ment to adopt rules to implement the designated receiving system;
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repealing s. 394.675, F.S., relating to the substance abuse and mental
health service system; amending ss. 394.75 and 394.76, F.S.; conforming
provisions and cross - references to changes made by the act; amending s.
394.4597, F.S.; revising the prioritization of health care surrogates to be
selected for involuntary patients; specifying certain persons who are
prohibited from being selected as an individual's representative; amend-
ing s. 394.4598, F.S.; specifying certain persons who are prohibited from
being appointed as a person's guardian advocate; amending s. 394.462,
F.S.; requiring that counties develop and implement transportation plans;
providing requirements for the plans; revising requirements for trans-
portation to receiving facilities and treatment facilities; revising excep-
tions to such requirements; amending s. 394.467, F.S.; revising criteria for
involuntary inpatient placement; revising criteria for a procedure for
continued involuntary inpatient services; specifying requirements for a
certain waiver of the patient's attendance at a hearing; requiring the court
to consider certain testimony and evidence regarding a patient's incom-
petence; amending s. 394.46715, F.S.; revising rulemaking authority of
the department; amending s. 394.4685, F.S.; requiring a public receiving
facility initiating a patient transfer to a licensed hospital for certain
mental health services to provide notice and transfer patient records to the
hospital; amending s. 394.656, F.S.; revising the membership of the
Criminal Justice, Mental Health, and Substance Abuse Statewide Grant
Review Committee; providing duties for the committee; authorizing a not -
for- profit community provider or managing entity to apply for certain
grants; revising eligibility for such grants; defining a term; creating s.
394.761, F.S.; requiring the agency and the department to develop a plan
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
for revenue maximization; providing requirements for the plan; providing
duties for the agency and department relating to the plan; requiring the
plan to be submitted to the Legislature by a certain date; amending s.
394.879, F.S.; providing that certain facilities may be in a multi -story
building and authorized on certain floors; requiring the department to
develop a plan to create an option for a single, consolidated license for
certain providers by a specified date; amending s. 394.9082, F.S.;
providing a purpose for behavioral health managing entities; revising
definitions; providing duties of the department; requiring the department
to revise its contracts with managing entities; providing duties for
managing entities; providing requirements for network accreditation
and systems coordination agreements; providing for performance mea-
surement and accountability and enhancements plans; providing a
funding mechanism for managing entities; renaming the Crisis Stabiliza-
tion Services Utilization Database as the Acute Care Services Utilization
Database; requiring certain providers to provide utilization data; deleting
provisions relating to legislative findings and intent, service delivery
strategies, essential elements, reporting requirements, and rulemaking
authority; amending s. 397.305, F.S.; providing legislative intent; amend-
ing s. 397.311, F.S.; defining and redefining terms; conforming a cross -
reference; amending s. 397.321, F.S.; deleting a requirement for the
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department to appoint a substance abuse impairment coordinator;
requiring the department to develop certain forms, display such forms
on its website, and notify certain entities of the existence and availability
of such forms; amending s. 397.675, F.S.; revising the criteria for
involuntary admissions due to substance abuse or co- occurring mental
health disorders; amending s. 397.6772, F.S.; requiring law enforcement
officers to use standard forms developed by the department to execute a
certain written report; amending s. 397.6773, F.S.; revising a cross -
reference; amending s. 397.679, F.S.; authorizing specified licensed
professionals to complete a certificate for the involuntary admission of
an individual; amending s. 397.679 1, F.S.; providing a list of professionals
authorized to initiate a certificate for an emergency assessment or
admission of a person who has a substance abuse disorder; amending s.
397.6793, F.S.; revising the criteria for initiation of a certificate for an
emergency admission for a person who is substance abuse impaired;
amending s. 397.6795, F.S.; revising the list of persons authorized to
deliver a person for an emergency assessment; amending s. 397.681, F.S.;
prohibiting the court from charging a fee for involuntary petitions;
amending s. 397.6811, F.S.; revising the list of persons authorized to
file a petition for an involuntary assessment and stabilization; amending
s. 397.6814, F.S.; prohibiting a fee from being charged for the filing of a
petition for involuntary assessment and stabilization; amending s.
397.6818, F.S.; limiting the validity of an order for involuntary admission
to 7 days after it is signed unless otherwise specified in the order;
amending s. 397.6819, F.S.; revising the responsibilities of service
providers who admit an individual for an involuntary assessment and
stabilization; amending s. 397.695, F.S.; authorizing certain persons to file
a petition for involuntary outpatient services of an individual; providing
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
procedures and requirements for such petitions; amending s. 397.6951,
F.S.; requiring that certain additional information be included in a
petition for involuntary outpatient services; amending s. 397.6955, F.S.;
requiring a court to fulfill certain additional duties upon the filing of a
petition for involuntary outpatient services; amending s. 397.6957, F.S.;
providing additional requirements for a hearing on a petition for
involuntary outpatient services; amending s. 397.697, F.S.; authorizing
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a court to make a determination of involuntary outpatient services;
extending the timeframe a respondent receives certain publicly funded
licensed services; authorizing a court to order a respondent to undergo
treatment through a publicly or privately funded licensed service provider
under certain circumstances; requiring a copy of the court's order to be
sent to the managing entity; amending s. 397.6971, F.S.; establishing the
requirements for an early release from involuntary outpatient services;
amending s. 397.6975, F.S.; requiring the court to appoint certain counsel;
providing requirements for hearings on petitions for continued involun-
tary outpatient services; requiring notice of such hearings; amending s.
397.6977, F.S.; conforming provisions to changes made by the act; creating
s. 397.6978, F.S.; providing for the appointment of guardian advocates if
an individual is found incompetent to consent to treatment; prohibiting
specified persons from being appointed as an individual's guardian
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advocate; providing requirements for a facility requesting the appoint-
ment of a guardian advocate; requiring a training course for guardian
advocates; providing requirements for the training course; providing
requirements for the prioritization of individuals to be selected as
guardian advocates; authorizing certain guardian advocates to consent
to medical treatment; providing exceptions; providing procedures for the
discharge of a guardian advocate; amending s. 409.967, F.S.; requiring
managed care plans to provide for quality care; amending s. 409.973, F.S.;
providing an integrated behavioral health initiative; reenacting s.
409.975(6), F.S., relating to provider payment; providing legislative
intent; amending s. 491.0045, F.S.; revising registration requirements
for interns; repealing s. 394.4674, F.S., relating to the comprehensive plan
and report on the deinstitutionalization of patients in a treatment facility;
repealing s. 394.4985, F.S., relating to the implementation of a district -
wide information and referral network; repealing s. 394.745, F.S., relating
to the annual report on the compliance of providers under contract with
the department; repealing s. 397.331, F.S., relating to definitions and
legislative intent; repealing part IX of chapter 397, F.S., consisting of ss.
397.801, 397.811, and 397.821, F.S., relating to substance abuse impair-
ment coordination, juvenile substance abuse impairment coordination,
and juvenile substance abuse impairment prevention and early interven-
tion councils, respectively; repealing s. 397.901, F.S., relating to prototype
juvenile addictions receiving facilities; repealing s. 397.93, F.S., relating to
target populations for children's substance abuse services; repealing s.
397.94, F.S., relating to the information and referral network for
children's substance abuse services; repealing s. 397.951, F.S., relating
to substance abuse treatment and sanctions; repealing s. 397.97, F.S.,
relating to demonstration models for children's substance abuse services;
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repealing s. 397.98, F.S., relating to utilization management for children's
substance abuse services; amending ss. 39.407, 39.524, 212.055, 394.4599,
394.495, 394.496, 394.9085, 397.321, 397.405, 397.407, 397.416, 397.4871,
409.1678, 409.966, 409.972, 440.102, 744.704, and 960.065, F.S.; con-
forming cross - references; requiring the Secretary of Children and
Families to appoint a workgroup on the use of advance directives for
substance use disorders; requiring a report to the Governor and
Legislature by a specified date; providing for expiration of the workgroup;
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amending s. 61.13, F.S.; providing that a parenting plan that provides for
shared parental responsibility over health care decisions must authorize
either parent to consent to mental health treatment for the child;
amending s. 39.001, F.S.; conforming provisions to changes made by the
act; amending ss. 39.507 and 39.521, F.S.; providing for consideration of
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mental health issues and involvement in mental health programs in
adjudicatory hearings and orders; providing requirements for certain
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court orders; revising the qualifications for administrators of mental
health and substance abuse assessments or evaluations; amending s.
394.4655, F.S.; defining the terms "court" and "criminal county court ";
providing for involuntary outpatient services; authorizing certain licensed
physicians and psychiatric nurses to provide a second opinion regarding a
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recommendation for involuntary outpatient services under certain cir-
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cumstances; requiring a service provider to document certain inquiries;
requiring the managing entity to document certain efforts; making
technical changes; amending s. 394.4599, F.S.; conforming provisions to
changes made by the act; amending s. 394.455, F.S.; defining and
redefining terms; amending s. 394.463, F.S.; authorizing circuit or county
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courts to enter ex parte orders for involuntary examinations; requiring a
facility to provide copies of ex parte orders, reports, and certificates to the
department, rather than the Agency for Health Care Administration;
requiring the department to receive certain orders, certificates, and
reports; requiring the department to receive and maintain copies of
certain documents; prohibiting a person from being held for involuntary
examination for more than a specified period of time; providing exceptions;
requiring certain individuals to be released to law enforcement custody;
providing exceptions; conforming cross - references; amending s. 394.4615,
F.S.; conforming a cross - reference; providing an appropriation; providing
an effective date.
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Be It Enacted by the Legislature of the State of Florida:
Section 1. Paragraph (e) is added to subsection (10) of section 29.004,
Florida Statutes, to read:
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29.004 State courts system. —For purposes of implementing s. 14, Art. V
of the State Constitution, the elements of the state courts system to be
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provided from state revenues appropriated by general law are as follows:
(10) Case management. Case management includes:
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
(e) Service referral, coordination, monitoring, and tracking for treat-
ment -based mental health court programs under chapter 394.
Case management may not include costs associated with the application of
therapeutic jurisprudence principles by the courts. Case management also
may not include case intake and records management conducted by the clerk
of court.
Section 2. Subsections (65) through (79) of section 39.01, Florida
Statutes, are renumbered as subsections (66) through (80), respectively,
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and a new subsection (65) is added to that section to read:
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39.01 Definitions. —When used in this chapter, unless the context
otherwise requires:
(65) "Qualified professional" means a physician or a physician assistant
licensed under chapter 458 or chapter 459: a psychiatrist licensed under
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chapter 458 or chapter 459; a psychologist as defined in s. 490.003(7) or a
professional licensed under chapter 491; or a psychiatric nurse as defined in
s. 394.455.
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Section 3. Paragraph (c) of subsection (6) of section 39.407, Florida
Statutes, is amended to read:
39.407 Medical, psychiatric, and psychological examination and treat -
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ment of child; physical, mental, or substance abuse examination of person
with or requesting child custody.—
(6) Children who are in the legal custody of the department may be
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placed by the department, without prior approval of the court, in a
residential treatment center licensed under s. 394.875 or a hospital licensed
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under chapter 395 for residential mental health treatment only pursuant to
this section or may be placed by the court in accordance with an order of
involuntary examination or involuntary placement entered pursuant to s.
394.463 or s. 394.467. All children placed in a residential treatment program
under this subsection must have a guardian ad litem appointed.
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(c) Before a child is admitted under this subsection, the child shall be
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assessed for suitability for residential treatment by a qualified evaluator
who has conducted a personal examination and assessment of the child and
has made written findings that:
1. The child appears to have an emotional disturbance serious enough to
require residential treatment and is reasonably likely to benefit from the
treatment.
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2. The child has been provided with a clinically appropriate explanation
of the nature and purpose of the treatment.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
3. All available modalities of treatment less restrictive than residential
treatment have been considered, and a less restrictive alternative that
would offer comparable benefits to the child is unavailable.
A copy of the written findings of the evaluation and suitability assessment
a)
must be provided to the department, to the guardian ad litem, and, if the
child is a member of a Medicaid managed care plan, to the plan that is
financially responsible for the child's care in residential treatment, all of
whom must be provided with who shall have the opportunity to discuss the
findings with the evaluator.
Section 4. Section 394.453, Florida Statutes, is amended to read:
394.453 Legislative intent.—
It is the intent of the Legislature_
(a) To authorize and direct the Department of Children and Families to
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evaluate, research, plan, and recommend to the Governor and the Legis-
lature programs designed to reduce the occurrence, severity, duration, and
disabling aspects of mental, emotional, and behavioral disorders.
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it i the inte of the Legislature That treatment programs for such
disorders eh" 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_
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1. Such persons be provided with emergency service and temporary
detention for evaluation when required;
2. Such persons that be admitted to treatment facilities on a
voluntary basis when extended or continuing care is needed and unavailable
in the community;
3. that Involuntary placement be provided only when expert evaluation
determines t it is necessary;
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4. tha-t Any involuntary treatment or examination be accomplished in a
setting that whieh is clinically appropriate and most likely to facilitate the
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person's return to the community as soon as possible; and
5. thftt 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
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
disorders and co- occurring mental health and substance use disorders to live
successfullv 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 ffifthef intent the Legislattife that the least
of Festfie
intervention be based the individual
means of employed on needs of eaeh
w ithi n the s eepe of E , l , . It is the policy of this state that
the use of restraint and seclusion on clients is justified only as an emergency
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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.
Section 5. Section 394.4573, Florida Statutes, is amended to read:
394.4573 Coordinated system of care; annual assessment; essential
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elements Continuity of c m anageme nt s y ste m; measures of performance;
system improvement grants; reports. — On or before December 1 of each
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year, the department shall submit to the Governor, the President of the
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Senate, and the Speaker of the House of Representatives an assessment of
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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
department's assessment shall consider, at a minimum, the needs assess-
ments conducted by the managing entities pursuant to s. 394.9082(5).
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Beginning in 2017, the department shall compile and include in the report
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all plans submitted by managing entities pursuant to s. 394.9082(8) and the
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department's evaluation of each plan.
(1) As used in F the p 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
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coordination is to enhance the delivery of treatment services and recovery
supports and to improve outcomes among priority populations.
�{ "Case management" means those direct services provided to a
client in order to assess his or her activities „;,.,,,a at assess c li e ,+ needs,
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plan, or arrange Ong services, coordinate service providers, link li nkin
the service system to a client, monitor coordinating the var sy ste m
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service delivery, and evaluate patient outcomes to
ensure the client is receivinLy the appropriate services eval • at t h e e ff e
(b " Case ma n a ger" means an individual who works with elients, and
their families and signifieant others, to provide ease managem
(e) "Client managef" means an empleyee of the depaAment who is
assigned to speeifie provider ageneies and geographie areas to ensure tha
the full range of needed ailable to efients.
L
Le " Coordinated system re m of care ________a-___„+ s t e - ,, a
means a system that assures, within available reseurees, that elie U
have aeeess 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 U
partnership or mutual agreement withi the m health , „ d e ff
system
(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 CL
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 re- g
ssponse 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 c
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 Id
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 CD
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 ermitted b available resources the designated
p X �
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-
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wrong -door model that responds to individual needs and integrates services
amonLy 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.
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c. A tiered receiving system that consists of multiple entry points, some
of which offer only specialized or limited services. Each service provider shall
L o
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
L
CL
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.
U
0
(c) Transportation in accordance with a plan developed under s. 394.462.
(d) Crisis services, including 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(9) by July1, 2017, and,
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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.
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(i) Hospital inpatient care.
J) Aftercare and other post- discharge services.
(k) Medication - assisted treatment and medication management.
(1) Recovery support, including, but not limited to, support for compe-
titive 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
a
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
U
evaluation of the supervision and support needs of the individual and the
L
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.
CL
(3) SYSTEM IMPROVEMENT GRANTS.— Subject to a specific appro-
CL
priation by the Legislature, the department may award system improve-
ment grants to managing entities based on a detailed plan to enhance
0
services in accordance with the no- wrong -door model as defined in subsec-
tion (1) and to address specific needs identified in the assessment prepared
by the department pursuant to this section. Such a grant must be awarded
g
through a performance -based contract that links payments to the docu-
mented and measurable achievement of system improvements. The dpi -
the health thr-ough the
pfevision of mental eafe, pfevision of elient and ease
ineluding from treatment f4eilities to
a
management, efients referred state
health f4eilities. Sueh inelude
eemmunity mental system shall a network of
throughout the designed to:
elient managers and ease state
(a) Reduee the to
possibility of a elient's admission of Feadmission a state
f4eility.
rd
treatment
04
(b) Provide for designation in to
e ereation or of an geney eaeh ee unty
4e intake for he-Al-th
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single serviees eaeh person seeking mental-
Sueh information
servi es. ageney shall provide and referral serviees
to that the leas
neeessary ensure efients reeeive fnest appropriate and
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form based the individual the
U)
restrietive of eare, on needs of person seekin
houfs 7 days i l
r-
pef - day, pef week, repraet;eabi, at a ntr
(e) Adveeate behalf the to that
on of efient ensure all appropriate serviets
are aff-orded to the elient in a timely and dignified manner.
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(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
11
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F P " acket Pg. 937
eendition
(3) The department is direeted to develop inelude in
and eontraets ;,vidhi
to
tm
V .-Aders measures of perfermanee with re ard geais and
in the Sueh to the
objeetives as speeified state plan. measures shall use,
a)
iders. The department
a)
shall plan monitoring visits of eem unity
N
health f4eilities federal, leeal
- a
mental with other state, and governmental
Section 6. Section 394.461, Florida Statutes, is amended to read:
394.461 Designation of receiving and treatment facilities and receivin-
L
systems —The department is authorized to designate and monitor receiving
facilities, aid treatment facilities and receiving systems and may suspend
L
or withdraw such designation for failure to comply with this part and rules
CL
adopted under this part. Unless designated by the department, facilities are
CL
not permitted to hold or treat involuntary patients under this part.
(1) RECEIVING FACILITY. —The department may designate any com-
' C O 4
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
g
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
c
facility. A civil patient shall not be admitted to a state treatment facility
without previously undergoing a transfer evaluation. Before a court hearing
for involuntary placement in a state treatment facility, the court shall
receive and consider the information documented in the transfer evaluation.
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
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
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.
S
4. Number of bed days by payor class.
5. Average length of stay by payor class.
N
6. Total revenues by payor class.
L
(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.
_
0
(c) The data required under this subsection shall be submitted to the
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department no later than 90 days following the end of the facility's fiscal
CL
year. A facility designated as a public receiving or treatment facility shall
submit its initial report for the 6 -month period ending June 30, 2008.
04
(d) The department shall issue an annual report based on the data
required pursuant to this subsection. The report shall include individual
r_
g
facilities' data, as well as statewide totals. The report shall be submitted to
the Governor, the President of the Senate, and the Speaker of the House of
Representatives.
(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.
r°
394.462 must support the operation of the receiving system.
RULES. —The department may shaU adopt rules relating to:
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(a) Procedures and criteria for receiving and evaluating facility applica-
tions 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.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
(c) Procedures and criteria for designating receiving systems which may
include consideration of the adeauacv of services provided by facilities
within the receiving system to meet the needs of the geographic area using
available resources.
Ld��O Procedures for receiving complaints against a designated facility or
designated receiving system and for initiating inspections and investiga-
tions of facilities or receiving systems alleged to have violated the provisions
of this part or rules adopted under this part.
U
T
L
L0{1) Procedures and criteria for the suspension or withdrawal of
designation as a receiving facility or receiving system
Section 7. Section 394.675, Florida Statutes, is repealed.
L
Section 8. Subsection (3) and paragraph (b) of subsection (4) of section
394.75, Florida Statutes, are amended to read:
0
394.75 State and district substance abuse and mental health plans.-
0
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(3) The district health and human services board shall prepare an
CL
CL
integrated district substance abuse and mental health plan. The plan shall
be prepared and updated on a schedule established by the 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 and 394.675 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
U
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.
04
(d) A record of the total funds allocated to each provider.
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(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.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
The plan shall be submitted by the district board to the district adminis-
trator and to the governing bodies for review, comment, and approval.
(4) The district plan shall:
(b) Provide the means for meeting the needs of the district's eligible
U)
clients, specified in ss. 394.4573 and 394.674 and 394.675 for substance
abuse and mental health services.
Section 9. Paragraph (a) of subsection (3) of section 394.76, Florida
Statutes, is amended to read:
'a
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
a)
level shall be provided as follows:
(3) The state share of financial participation shall be determined by the
L
0
following formula:
c
(a) The state share of approved program costs shall be a percentage of
L CL
the net balance determined by deducting from the total operating cost of
CL
services and programs, as specified in s. 394.4573 `�°^�r) 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.
c
Section 10. Paragraphs (d) and (e) of subsection (2) of section 394.4597,
Florida Statutes, are amended to read:
394.4597 Persons to be notified; patient's representative. -
(2) INVOLUNTARY PATIENTS. —
0
(d) When the receiving or treatment facility selects a representative,
0
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:
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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.
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5. An adult friend of the patient.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
6. The Florida leeal in
appropriate adveeaey eetineil as provided s.
4 n�6.
(e) The following persons are prohibited from selection as a patient's
representative.
W
1. A professional providing clinical services to the patient under this
part•
2. The licensed professional who initiated the involuntary examination
U
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
L
patient, including clinical services.
0
6. A creditor of the patient.
L
CL
CL
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 ^ h, ^a p p rov iding , ,. to t h e
this f4eility dire to
patient tinder part, an employee of a providing erAees
the this department
=
U
patient tinder part, a employee, a person providin
to the in business
other substantial serAees patient a professional or
the be the
eapaeity, or a erediter of patient shall not appointed as patient's
. t
Section 11. Subsections (2) through (7) of section 394.4598, Florida
Statutes, are renumbered as subsections (3) through (8), respectively, a new
subsection (2) is added to that section, and present subsections (3) and (4) of
04
that section are amended, to read:
V
CD
394.4598 Guardian advocate. —
(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.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
(c) An employee, an administrator, or a board member of the facilit
rovidinLy 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.
L
(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.
0
LC{34 In lieu of the training required of guardians appointed pursuant to
L CL
chapter 744, Pfief to a guardian advocate must, at a minimum, participate
CL
in a 4 -hour training course approved by the court before exercising his or her
authority the g adveeate shall attend „ traini eourse approv
the At a minimum, this training course of not lens tha n ho must
0
include at minimum information about the patient rights, psychotropic
medications, the diagnosis of mental illness, the ethics of medical decision-
. 2
making, and duties of guardian advocates. Thi tr in ,, r s h a t +„v„
"
eha 744
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LL 4� The required training course and the information to be supplied to
c
prospective guardian advocates before prior to their appointment the
training eours for g rdi advocate must be developed and eemplet
through „ ,,,., rse developed by the department, ftftd approved by the chief
judge of the circuit court, and taught by a court - approved organization,
which. Co approved organizations may include, but is are not limited to, a
community college ,,,.ri,ri unity of ;unieM ee"eMefi a guardianship organiza-
c
tion ^,•„raianship organizatio a and the 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 r +r a;r r +; 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.
M
Section 12. Section 394.462, Florida Statutes, is amended to read:
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
394.462 Transportation. — A transportation plan shall be developed and
implemented by each countv by July 1. 2017. 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 involun-
tary examination under s. 394.463 or involuntary admission under s.
397.6772, s. 397.679, s. 397.6798, or s. 397.6811, 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
L
medical transport services or private transport companies, as appropriate.
The plan shall comply with the transportation provisions of this section and
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ss. 397.6772, 397.6795, 397.6822, and 397.697.
(1) TRANSPORTATION TO A RECEIVING FACILITY.—
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(a) Each county shall designate a single law enforcement agency within
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the county, or portions thereof, to take a person into custody upon the entry
CL
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 or an exception under subsection (4), or to the
°®
nearest receiving facility if neither apply for e.,amin do
(bL The designated law enforcement agency may decline to transport
the person to a receiving facility only if.
a.4- 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; and
b.2 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.
2.3 The entity providing transportation juri sdietio n designated b y- th e
eetint 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
health hare eerperatio or ot source, if the person receiving the
transportation has applicable coverage is eevered b, ee polie
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
shall first be processed in the same manner as any other criminal suspect.
The law enforcement agency shall thereafter immediately notify the
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Packet Pg. 944
expenses.
b. From the person receiving the transportation.
c. From a financial settlement for medical care, treatment, hospitaliza-
tion, or transportation payable or accruing to the injured party.
Lc-14-4 A Any company that transports a patient pursuant to this
subsection is considered an independent contractor and is solely liable for
the safe and dignified transport tfans eftatie of the patient. Such company
must be insured and provide no less than $100,000 in liability insurance
with respect to the transport tramertat -o of patients.
_
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Jjj�c4 Any company that contracts with a governing board of a county to
transport patients shall comply with the applicable rules of the department
U
to ensure the safety and dignity of the patients.
LOFd4 When a law enforcement officer takes custody of a person pursuant
L
0
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
L
CL
person in custody.
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k{-e-} 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.
-{ } When any law enforcement officer has custody of a person based on
U
either noncriminal or minor criminal behavior that meets the statutory
guidelines for involuntary examination pursuant to s. 394.463 u ndef this
p-aA, the law enforcement officer shall transport the person to the
appropriate facility within the designated receiving system pursuant to a
transportation plan or an exception under subsection (4), or to the nearest
receiving facility if neither apply f ,..° t 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 or an exception under subsection
(4), or to the nearest facility if neither apply.
h{g} 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
shall first be processed in the same manner as any other criminal suspect.
The law enforcement agency shall thereafter immediately notify the
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
appropriate facility within the designated receiving system pursuant to a
transportation plan or an exception under subsection (4), or to the nearest
publie receiving facility if neither apply. The receiving facility, whieh 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 mental health
tM
examination and treatment to the person where he or she is held.
Di Fh4 If the appropriate law enforcement officer believes that a person
a)
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.
L
W{O The costs of transportation, evaluation, hospitalization, and treat-
ment 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.
�{} The appropriate facility within the designated receiving system
>
pursuant to a transportation plan or an exception under subsection (4), or
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the nearest receiving facility if neither apply, 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
(1) The appropriate facility within the designated receiving system
pursuant to a transportation plan or an exception under subsection (4), or
the nearest receiving facility if neither apply, 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
c
services.
�{} Each law enforcement agency designated pursuant to paragraph
(a) shall establish a policy that develop a memera o f .,d„r di
rd
whieh reflects a single set of protocols for the safe and secure transportation
of + vr erson and transfer of custody of the person. Each law enforcement
agency shall provide a copy of the protocols to the managing entity These
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reteeels m also address er intervention m easures.
Ln &+ When a jurisdiction has entered into a contract with an emergency
LL
medical transport service or a private transport company for transportation
of persons to reeeivixg 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
ca
being transported is such that transportation by a law enforcement officer is
necessary.
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L0{ft} Nothing This section may not s be construed to limit
emergency examination and treatment of incapacitated persons provided in
accordance with the provisions of 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 specifX
how in the hospitalized patient will be transported to, from, and
between facilities in a is hospitali sha'�r-ange- €er suhreeluiied-
t Fanspe f t d an d s h n , ee +nie safe and dignified manner fir
tion the The board is
N
_
of patient. governing of eaeh eounty autherized
transport for the transportation
r_
eentraet with private eempanies of sueh
a)
(b) A Any company that transports a patient pursuant to this subsection
L
4-
is considered an independent contractor and is solely liable for the safe and
dignified transportation of the patient. Such company must be insured and
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provide no less than $100,000 in liability insurance with respect to the
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transport tf n„ 1 eftatien of patients.
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(c) A Afty company that contracts with one or more counties t4e
governi board of „ ,,,.,,n+„ to transport patients in accordance with this
section shall comply with the applicable rules of the department to ensure
the safety and dignity of the patients.
g
(d) County or municipal law enforcement and correctional personnel and
r_
equipment may s hall not be used to transport patients adjudicated
incapacitated or found by the court to meet the criteria for involuntary
placement pursuant to s. 394.467, except in small rural counties where there
c
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 relin-
quished to a responsible individual at the appropriate receiving or treatment
Id
facility.
04
(4) EXCEPTIONS. —An exception to the requirements of this section
CD
may be granted by the secretary of the department for the purposes of
improving service coordination or better meeting the special needs of
individuals. A proposal for an exception must be submitted to the
department ti the — distrie+ �strator after being approved by the
governing boards of any affected counties prior to submissio to the
r_
(a) A proposal for an exception must identify the specific provision from
which an exception is requested; describe how the proposal will be
implemented by participating law enforcement agencies and transportation
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authorities; and provide a plan for the coordination of services stl eh as ease
(b) The exception may be granted only for:
1. An arrangement centralizing and improving the provision of services
within a district, which may include an exception to the requirement for
transportation to the nearest receiving facility;
2. An arrangement by which a facility may provide, in addition to
required psychiatric or substance use disorder services, an environment and
services which are uniquely tailored to the needs of an identified group of
persons with special needs, such as persons with hearing impairments or
visual impairments, or elderly persons with physical frailties; or
3. A specialized transportation system that provides an efficient and
0
humane method of transporting patients to receiving facilities, among
L
receiving facilities, and to treatment facilities.
c
a-ad approved every 5 years by the seeretaT-y-.
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The exceptions provided in this subsection shall expire on June 30, 2017, and
no new exceptions shall be granted after that date. After June 30, 2017, the
transport of a patient to a facility that is not the nearest facility must be
00
made pursuant to a plan as provided in this section.
Section 13. Section 394.467, Florida Statutes, is amended to read.
_c
394.467 Involuntary inpatient placement.—
(1) CRITERIA. —A person may be ordered for plaeed in involuntary
0
inpatient placement for treatment upon a finding of the court by clear and
convincing evidence that:
(a) He or she has a mental illness is mentally it and because of his or her
mental illness:
rd
La. He or she has refused voluntary inpatient placement for treatment
after sufficient and conscientious explanation and disclosure of the purpose
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of inpatient placement for treatment; or
b. He or she is unable to determine for himself or herself whether
inpatient placement is necessary; and
2.a. He or she is manifestly incapable of surviving alone or with the help
of willing 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
21
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b. There is substantial likelihood that in the near future he or she will
inflict serious bodily harm on self or others himself of h,.M f of ane
person, as evidenced by recent behavior causing, attempting, or threatening
such harm; and
(b) All available less restrictive treatment alternatives that -.� would
U)
offer an opportunity for improvement of his or her condition have been
judged to be inappropriate.
(2) ADMISSION TO A TREATMENT FACILITY. —A patient may be
retained by a reeeiving facility or involuntarily placed in a treatment facility
upon the recommendation of the administrator of the reeeivixg facility
where the patient has been examined and after adherence to the notice and
=
hearing procedures provided in s. 394.4599. The recommendation must be
supported by the opinion of a psychiatrist and the second opinion of a clinical
psychologist or another psychiatrist, both of whom have personally
examined the patient within the preceding 72 hours, that the criteria for
involuntary inpatient placement are met. However, in a county that has a
population of fewer than 50,000, if the administrator certifies that a
psychiatrist or clinical psychologist is not available to provide the second
L
opinion, the second opinion may be provided by a licensed physician who has
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postgraduate training and experience in diagnosis and treatment of mental
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illness an d n TM us disorders or by a psychiatric nurse. Any second opinion
authorized in this subsection may be conducted through a face -to -face
examination, in person, or by electronic means. Such recommendation shall
be entered on a petition for an involuntary inpatient placement certificate
that authorizes the reeeiving facility to retain the patient pending transfer
g
to a treatment facility or completion of a hearing.
(3) PETITION FOR INVOLUNTARY INPATIENT PLACEMENT. —The
E
administrator of the facility shall file a petition for involuntary inpatient
placement in the court in the county where the patient is located. Upon
c
filing, the clerk of the court shall provide copies to the department, the
patient, the patient's guardian or representative, and the state attorney and
public defender of the judicial circuit in which the patient is located. A Ne fee
may not shftg be charged for the filing of a petition under this subsection.
rd
(4) APPOINTMENT OF COUNSEL. — Within 1 court working day after
the filing of a petition for involuntary inpatient placement, 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. The clerk of
the court shall immediately notify the public defender of such appointment.
Any attorney representing the patient shall have 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.
(5) CONTINUANCE OF HEARING. —The patient is entitled, with the
concurrence of the patient's counsel, to at least one continuance of the
hearing The .,t;.,.,,,nee shall for ref up to 4 weeks.
22
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(6) HEARING ON INVOLUNTARY INPATIENT PLACEMENT.
(a)1. The court shall hold the hearing on involuntary inpatient place-
ment within 5 court working days, unless a continuance is granted.
2. Except for good cause documented in the court file, the hearing must
shall be held in the county or the facility., as appropriate, where the patient is
w o
located must and be as convenient to the patient as is may be
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, and the patient's counsel does not object, the court
may waive the presence 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 petitioning facility administrator, as the
real party in interest in the proceeding.
U
34, The court may appoint a gener or rr ^^ ^' magistrate to preside at
the hearing. One of the professionals who executed the petition for
—
involuntary inpatient placement certificate shall be a witness. The patient
and the patient's guardian or representative shall be informed by the court
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of the right to an independent expert examination. If the patient cannot
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afford such an examination, the court shall ensure that one is provided, as
otherwise provided for by law provide for one The independent expert's
report is shall be confidential and not discoverable, unless the expert is to be
called as a witness for the patient at the hearing. 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.
(b) If the court concludes that the patient meets the criteria for
involuntary inpatient placement, it may shall order that the patient be
transferred to a treatment facility or, if the patient is at a treatment facility,
c
that the patient be retained there or be treated at any other appropriate
^ ^r treatment facility, or that the patient receive services from
M ^ ^eivi g or treatment f4ei ity on an involuntary basis, for oaf up to
90 days 6 menth However, any order for involuntary mental health
tm
services in a treatment facility may be for up to 6 months. The order shall
rd
specify the nature and extent of the patient's mental illness. The court may
not order an individual with traumatic brain injury or dementia who lacks a
04
co- occurring mental illness to be involuntarily_ placed in a state treatment
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facility. The facility shall discharge a patient any time the patient no longer
meets the criteria for involuntary inpatient placement, unless the patient
has transferred to voluntary status.
(c) If at any time before prior to the conclusion of the hearing on
involuntary inpatient placement it appears to the court that the person does
not meet the criteria for involuntary inpatient placement under this section,
but instead meets the criteria for involuntary outpatient services laee rent
ca
the court may order the person evaluated for involuntary outpatient services
plaeemen pursuant to s. 394.4655. The petition and hearing procedures set
23
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forth in s. 394.4655 shall apply. If the person instead meets the criteria for
involuntary assessment, protective custody, or involuntary admission
pursuant to s. 397.675, then the court may order the person to be admitted
for involuntary assessment for a period of 5 days pursuant to s. 397.6811.
Thereafter, all proceedings are shall be governed by chapter 397.
(d) At the hearing on involuntary inpatient placement, the court shall
consider testimony and evidence regarding the patient's competence to
consent to treatment. If the court finds that the patient is incompetent to
•
consent to treatment, it shall appoint a guardian advocate as provided in s.
394.4598.
(e) The administrator of the petitioning reeeiving facility shall provide a
0
copy of the court order and adequate documentation of a patient's mental
illness to the administrator of a treatment facility if the whenever- patient
is ordered for involuntary inpatient placement, whether by civil or criminal
court. The documentation must shall 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
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any patient directed to its facilities on an involuntary basis, whether by civil
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or criminal court order, who is not accompanied at the safne tifne by
adequate orders and documentation.
04
(7) PROCEDURE FOR CONTINUED INVOLUNTARY INPATIENT
PLACEMENT.—
(a) Hearings on petitions for continued involuntary inpatient placement
of an individual placed at any treatment facility are shall be administrative
hearings and must sheM be conducted in accordance with the provision S.
�
120.57(1), except that any order entered by the administrative law judge is
c
shall be 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 shall be governed by the provisions oz' s. 916.15.
(b) If the patient continues to meet the criteria for involuntary inpatient
placement and is being treated at a treatment facility the administrator
shall, before pie the expiration of the period dtifing whieh the treatment
facility is authorized to retain the patient, file a petition requesting
authorization for continued involuntary inpatient placement. The request
must shall 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 involuntarily placed, and an individualized plan of continued
treatment. Notice of the hearing must shall be provided as provided set n
in s. 394.4599. If a patient's attendance at the hearing is voluntarily waived,
the administrative law judge must determine that the waiver is knowing
M
and voluntary before waiving the presence of the patient from all or a portion
of the hearing. Alternatively, if at the hearing the administrative law judge
24
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finds that attendance at the hearing is not consistent with the best interests
of the patient, 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.
U)
(c) Unless the patient is otherwise represented or is ineligible, he or she
shall be represented at the hearing on the petition for continued involuntary
inpatient placement by the public defender of the circuit in which the facility
is located.
L
(d) If at a hearing it is shown that the patient continues to meet the
criteria for involuntary inpatient placement, the administrative law judge
shall sign the order for continued involuntary inpatient placement for up to
90 days a pefiea not to ^._„^ ^a 6 month, However, any order for involuntary
a)
mental health services in a treatment facility may be for up to 6 months. The
same procedure shall be repeated before pfief to the expiration of each
additional period the patient is retained.
(e) If continued involuntary inpatient placement is necessary for a
> 0
patient admitted while serving a criminal sentence, but his or her whose
L CL
sentence is about to expire, or for a minor patien involuntarily placed, w hile
a inef 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.
0
(f) If the patient has been previously found incompetent to consent to
0
treatment, the administrative law judge shall consider testimony and
evidence regarding the patient's competence. If the administrative law
judge finds evidence that the patient is now competent to consent to
treatment, the administrative law judge may issue a recommended order to
U =
the court that found the patient incompetent to consent to treatment that
c
the patient's competence be restored and that any guardian advocate
previously appointed be discharged.
(g) If the patient has been ordered to undergo involuntary inpatient
placement and has previously been found incompetent to consent to
ry
treatment, the court shall consider testimony and evidence regarding the
patient's incompetence. If the patient's competency to consent to treatment
is restored, the discharge of the guardian advocate shall be governed by s.
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394.4598.
The procedure required in this subsection must be followed before the
expiration of each additional period the patient is involuntarily receiving
services.
(8) RETURN TO FACILITY OF PATIENT- a patient involuntarily
held When a pat + at a treatment facility under this part leaves the facility
ca ca
without the administrator's authorization, the administrator may authorize
a search for the patient and his or her the return of thepatien to the facility.
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The administrator may request the assistance of a law enforcement agency
in this regard the s for an r„ +„r., of the .,atie.,+
Section 14. Section 394.46715, Florida Statutes, is amended to read:
394.46715 Rulemaking authority. —The department may adopt rules to
administer this part D ent of Childre a nd Families shall i E , y
39 461 C 39 463 39 4655 .,,.,,J 2(Q4 4��7 .,...,.ti,,.,.,,7 „�.,..,t b t
, , , e f ae t
These be for the the health,
rules shall purpose of preteeting safety, and we14-
being of per - - -4, treated, or plaeed under this ae
Section 15. Subsection (2) of section 394.4685, Florida Statutes, is
amended to read:
394.4685 Transfer of patients among facilities. —
(2) TRANSFER FROM PUBLIC TO PRIVATE FACILITIES.—
0
(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
CL
CL
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
g
the hospital all records relating to the emergency psychiatric or medical
condition.
Section 16. Section 394.656, Florida Statutes, is amended to read:
394.656 Criminal Justice, Mental Health, and Substance Abuse Re-
0
investment Grant Program.—
(1) There is created within the Department of Children and Families the
Criminal Justice, Mental Health, and Substance Abuse Reinvestment Grant
rd
Program. The purpose of the program is to provide funding to counties with
which they may use to ean plan, implement, or expand initiatives that
increase public safety, avert increased spending on criminal justice, and
CD
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,
E
and Substance Abuse Statewide Grant Review Committee. The committee
shall include:
(a) One representative of the Department of Children and Families;
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(b)
One representative of the Department of Corrections;
(c)
One representative of the Department of Juvenile Justice;
mental health license.
(3) The committee shall serve as the advisory body to review policy and
(d)
One representative of the Department of Elderly Affairs;
and substance abuse disorders on communities, criminal justice agencies,
and the court system. The committee shall advise the department in
(e)
One representative of the Office of the State Courts Administrator;-
(f)
One representative of the Department of Veterans' Affairs;
health disorders, community corrections, and law enforcement. To the
extent possible, the mem oft committee shall have expertise in grant
(g)
One representative of the Florida Sheriffs Association;
(h)
One representative of the Florida Police Chiefs Association;
5 a ( j(u7 A county or a not - for - profit community provider or managing
entity designated by the county planning council or committee, as described
CO
(i)
One representative of the Florida Association of Counties;
implementation or expansion grant. The purpose of the grants is to
demonstrate that investment in treatment efforts related to mental illness,
(i)
One representative of the Florida Alcohol and Drug Abuse Associa-
abuse disorders results in a reduced demand on the resources of the judicial,
tion;
corrections, juvenile detention, and health and social services systems.
(k)
One representative of the Florida Association of Managing Entities;
0
—
(1)
One representative of the Florida Council for Community Mental
H ealth;
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(m)
One representative of the National Alliance of Mental Illness;
LO
(n)
One representative of the Florida ProsecutinLy Attornevs Association:
(o) One representative of the Florida Public Defender Association; and
r-
g
(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.
rd
(4) The committee must have experience in substance use and mental
health disorders, community corrections, and law enforcement. To the
extent possible, the mem oft committee shall have expertise in grant
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review writing, , grant reviewi and grant application scoring.
5 a ( j(u7 A county or a not - for - profit community provider or managing
entity designated by the county planning council or committee, as described
CO
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
ca
abuse disorders results in a reduced demand on the resources of the judicial,
corrections, juvenile detention, and health and social services systems.
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(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 eounty planning council or committee
that is in compliance with the membership requirements set forth in this
p p q
section.
U)
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
U
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 or a project. For purposes of this Para iaaph, the term
"sequential intercept mapping" means a process for reviewing a local
community's mental health, substance abuse, criminal justice, and related
systems and identif�g points of interceptions where interventions may be
L
made to prevent an individual with a substance abuse disorder or mental
CL
CL
illness from deeper involvement in the criminal justice system.
J6�(44 The grant review and selection committee shall select the grant
recipients and notify the department of Childre and Fam in writing of
the recipients' names of the appheant who hE,ve bee ,.l b t h e
eemmittee t. -.47. Contingent upon the availability of funds and
g
upon notification by the grant review and selection committee of those
applicants approved to receive planning, implementation, or expansion
grants, the department of Childre and Famili may transfer funds
appropriated for the grant program to a selected grant recipient to an
eoun awa a gra
Section 17. Section 394.761, Florida Statutes, is created to read:
394.761 Revenue maximization. —
rd
(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
CD
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
M
the department shall evaluate alternative uses of increased Medicaid
funding, including seeking Medicaid eligibility for the severely and
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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 alter-
native'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.
L
(3) The department, in coordination with the agency and the managing
entities, shall compile detailed documentation of the cost and reimburse-
ments for Medicaid covered services provided to Medicaid eligible individ-
uals 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
CL
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
g
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
5
in such a manner as is allowed by federal law and regulations.
c
(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.
rd
Section 18. Subsection (5) of section 394.879, Florida Statutes, is
amended, and subsection (6) is added to that section, to read:
394.879 Rules; enforcement. —
CD
(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 receivinLy facilitv that is collocated with a
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centralized receiving facility may be in a multi -story 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. U
T
L
(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 L
substance abuse services, or both, regulated under chapters 394 and 397,
respectively. In the plan, the department and the agency shall identify the U
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. L
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Section 19. Section 394.9082, Florida Statutes, is amended to read:
(Substantial rewording of section. See
s. 394.9082, F.S., for present text.)
394.9082 Behavioral health managing entities.—
g
(1) INTENT AND PURPOSE.—
E
(a) The Legislature finds that untreated behavioral health disorders
constitute major health problems for residents of this state, are a major
c
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, rehabilita-
tion, and supportive intervention. The Legislature finds that local commu-
nities 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
CD
strong ties to local public health and public safetyagencies. 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.
30
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b) The purpose of the behavioral health manap-inLy 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. —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.
N
(b) "Coordinated system of care" means the array of mental health
services and substance abuse services described in s. 394.4573.
(c) "Geo r�aphic area" means one or more contiguous counties, circuits, or
regions as described in s. 409.966.
4-
(d) "Managed behavioral health organization" means a Medicaid man -
aged care organization currently under contract with the statewide
Medicaid managed medical assistance program in this state pursuant to
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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 geo-
graphic region defined by unifying service and provider utilization patterns.
(3) DEPARTMENT DUTIES. —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:
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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 ublic safety posed b the individual.
p y
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04
3. Whether the individual has recently resided in or is currently
awaiting admission to or discharge from a treatment facility as defined in
r-
s. 394.455.
behavioral health services through the managing entity to coordinate care.
4. The degree of utilization of behavioral health services.
(i) Coordinate procedures for the referral and admission of patients to,
5. Whether the individual is a parent or caregiver who is involved with
the child welfare system.
(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
c
the provision of behavioral health services as part of the contract with the
department.
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(1) Periodically review contract and reporting requirements and reduce
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(e) Provide technical assistance to the managing entities.
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(f) Promote the coordination of behavioral health care and primary care.
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04
(g) Facilitate coordination between the managing entity and other
payors of behavioral health care.
r-
(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.
CD
(1) Periodically review contract and reporting requirements and reduce
costly, duplicative, and unnecessary administrative requirements.
(4) CONTRACT WITH MANAGING ENTITIES. —
(a) In contracting for services with managing entities under this section,
r-
the department shall first attempt to contract with not - for - profit, commu-
nity -based organizations with competence in managing provider networks
M
serving persons with mental health and substance use disorders to serve as
managing entities.
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(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.
U)
(c) If the managing entity is a not - for - profit, community -based organiza-
tion, 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,
0)
it must establish an advisory board that meets the same requirements
specified in paragraph (c) for a governing board.
4-
(e) If the department issues an invitation to negotiate pursuant to
Paragraph (b), the department shall consider, at a minimum, the following
factors:
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1. Experience serving persons with mental health and substance use
disorders.
2. Established community partnerships with behavioral health care
providers.
g
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
ry
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,
fundinLy, and services to allow for flexibilitv and efficiencv.
33
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
(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.
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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).
(5) MANAGING ENTITY DUTIES. —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
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3 years in the geographic area served by the managing entity which
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identifies needs by subregion. The process for conducting the needs
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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.
0
394.4573. The managing entity shall provide the needs assessment to the
department.
g
(c) Determine the optimal array of services to meet the needs identified
in the community behavioral health care needs assessment and expand the
a)
scope of services as resources become available.
0
(d) Promote the development and effective implementation of a coordi-
nated system of care pursuant to s. 394.4573.
(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
CD
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 im-
prove access to and effectiveness. aualitv. and outcomes of behavioral health
34
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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 the may remain in the network. The managing entit shall
y y In g y
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.
N
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
L
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 confidentialit laws, aws, statutes, and
CL
regulations.
(1) 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
g
public receiving facilities.
(m) Monitor network providers' performance and their compliance with
contract requirements and federal and state laws, rules, regulations, and
U '
grant requirements.
c
(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
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entity performance and provider performance, and the reporting of outcomes
and costs of services.
(p) Operate in a transparent manner, providing access to
�public
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 s sv tem
of care and their families. local Lyovernments. and other communitv
35
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
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, pro rg ams, 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,
U
and increase diversion from the criminal and juvenile justice systems.
L
3. Collaboration with the child welfare system shall seek, at a minimum,
0
—
to provide effective and timely services to parents and caregivers involved in
the child welfare system.
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(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 in-
creased 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 July1, 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 July1, 2016, shall earn network accredita-
tion 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
r_
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 manap-inLy
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
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.
(7) PERFORMANCE MEASUREMENT AND ACCOUNTABILITY. —
Managing entities shall collect and submit data to the department regarding
a
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
a
systems, in meeting the community's behavioral health needs, based on
consumer - centered outcome measures that reflect national standards, if
L
possible, that can be accurately measured. The department shall work with
managing entities to establish performance standards, including, but not
limited to:
CL
(a) The extent to which individuals in the community receive services,
CL
including, but not limited to, parents or caregivers involved in the child
welfare system who need behavioral health services.
04
(b) The improvement in the overall behavioral health of a community.
(c) 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.
(d) The success of strategies to:
0
1. 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;
rd
2. Integrate behavioral health services with the child welfare system;
and
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3. Address the housing needs of individuals being released from public
receiving facilities who are homeless.
(e) Consumer and family satisfaction.
..
(f) 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,
ca
and other organizations, as appropriate, for the geographical service area of
the manap-inL- entitv.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
(8) ENHANCEMENT PLANS. —By September 1 of each year, beginning
in 2017, each managing entity shall develop and submit to the department a
description of strategies for enhancinLy services and addressinLy 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. —
L
(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
L
fiscal year to the next, but the cumulative amount carried forward may not
CL
exceed 8 percent of the annual amount of the contract. Any unexpended state
CL
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
g
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.
0
(b) The method of payment for a fixed -price contract with a mana n
entity shall provide for a 2 -month advance payment at the beginning of each
fiscal year and equal monthly payments thereafter.
(10) ACUTE CARE SERVICES UTILIZATION DATABASE. —The de-
rd
partment 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 receivinLy facilities. detoxification facilities. addictions receivinLy
38
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facilities, managing entities, and the department for the implementation
and to meet the reauirements. 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:
E
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 and utilized beds, the
number of beds purchased by the department, the number of clients
U 6
qualifying as indigent who occupy any of those beds, the total number of
unoccupied licensed beds, regardless of funding, and the number in excess of
licensed capacity. Crisis units licensed for both adult and child use will
report as a single unit.
L-
(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
cn
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 incon-
sistent 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)
p
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
UM
stabilization services and detoxification and addictions receiving services
provided on a statewide and an individual provider basis.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 D /37/b
Section 20. Subsections (4) through (9) of section 397.305, Florida
Statutes, are renumbered as subsections (6) though (11), respectively, and
new subsections (4) and (5) are added to that section, to read:
E
397.305 Legislative findings, intent and purpose.—
g,
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(4) It is the intent of the Legislature that licensed, qualified health
professionals be authorized to practice to the full extent of their education
and training in the performance of professional functions necessary to carry
out the intent of this chapter. U
T
(5) It is the intent of the Legislature to establish expectations that
services provided to persons in this state use the coordination -of -care
principles characteristic of recovery- oriented services and include social L
support services, such as housing support, life skills and vocational training,
and employment assistance necessary for persons who have substance use
disorders or co- occurring substance use and mental health disorders to live
successfully in their communities.
Section 21. Present subsection (19) of section 391.311, Florida Statutes,
>
is redesignated as subsection (20), present subsections (20) through (45) of
L
that section are redesignated as subsections (23) through (48), respectively,
CL
a
new subsections (19), (21), and (22) are added to that section, and present
subsections (30) and (38) of that section are amended, to read:
00
397.311 Definitions. —As used in this chapter, except part VIII, the term:
(19) "Incompetent to consent to treatment" means a state in which a
r_
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person's judgment is so affected by 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 health, mental health, or substance abuse
treatment.
U
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(21) "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.
r°
(22) "Involuntary services" means an array of behavioral health services
04
that may be ordered by the court for persons with substance abuse
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impairment or co- occurring substance abuse impairment and mental health
disorders.
33 {W "Qualified professional" means a physician or a physician
assistant licensed under chapter 458 or chapter 459; a professional licensed
under chapter 490 or chapter 491; an advanced registered nurse practitioner
having „ sp „ lty i n .,r.,,,i iatry licensed under part I of chapter 464; or a
person who is certified through a department- recognized certification
M
process for substance abuse treatment services and who holds, at a
minimum, a bachelor's degree. A person who is certified in substance
40
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abuse treatment services by a state - recognized certification process in
another state at the time of employment with a licensed substance abuse
provider in this state may perform the functions of a qualified professional as
defined in this chapter but must meet certification requirements contained
in this subsection no later than 1 year after his or her date of employment.
41 {-3$-) "Service component" or "component" means a discrete opera-
tional entity within a service provider which is subject to licensing as defined
by rule. Service components include prevention, intervention, and clinical
treatment described in subsection (25) (}.
L
Section 22. Subsections (16) through (20) of section 397.321, Florida a)
Statutes, are renumbered as subsections (15) through (19), respectively,
present subsection (15) is amended, and a new subsection (20) is added to
that section, to read:
397.321 Duties of the department. —The department shall:
L
0
(20) Develop and prominently display on its website all forms necessary LO
for the implementation and administration of parts IV and V of this chapter.
These forms shall include, but are not limited to, a petition for involuntary
admission form and all related pleading forms, orms, and a form to be used by law
enforcement agencies pursuant to s. 397.6772. The department shall notify
law enforcement agencies, the courts, and other state agencies of the
existence and availability of such forms.
Section 23. Section 397.675, Florida Statutes, is amended to read: c
397.675 Criteria for involuntary admissions, including protective cus-
tody, emergency admission, and other involuntary assessment, involuntary
treatment, and alternative involuntary assessment for minors, for purposes
of assessment and stabilization, and for involuntary treatment. —A person
meets the criteria for involuntary admission if there is good faith reason to
believe that the person is substance abuse impaired or has a co- occurring
mental health disorder and, because of such impairment or disorder CD
(1) Has lost the power of self - control with respect to substance abuse use;
and e
(2)(a) Has - inflieted, of t hfeatened of attempted to infl ar unle� �
admitted is likely to infliet, physieal harm on himself or herself or another; OF E
{} Is in need of substance abuse services and, by reason of substance
abuse impairment, his or her judgment has been so impaired that he or she
perso the is incapable of appreciating his or her need for such services and
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
of making a rational decision in that regard although t h e fete; h o-- evef
mere refusal to receive such services does not constitute evidence of lack of
judgment with respect to his or her need for such services
(b) Without care or treatment, is likely to suffer from neglect or refuse to
a)
care for himself or herself; that such neglect or refusal poses a real and
present threat of substantial harm to his or her well - being; and that it is not
apparent that such harm may be avoided through the help of willing famil
y g p g
members or friends or the provision of other services, or there is substantial
likelihood that the person has inflicted, or threatened to or attempted to
inflict, or, unless admitted, is likely to inflict, physical harm on himself,
herself, or another
Section 24. Subsection (1) of section 397.6772, Florida Statutes, is
amended to read:
397.6772 Protective custody without consent.—
(1) If a person in circumstances which justify protective custody as
0
4-
described in s. 397.677 fails or refuses to consent to assistance and a law
enforcement officer has determined that a hospital or a licensed detoxifica-
L CL
tion or addictions receiving facility is the most appropriate place for the
CL
person, the officer may, after giving due consideration to the expressed
wishes of the person:
(a) Take the person to a hospital or to a licensed detoxification or
addictions receiving facility against the person's will but without using
unreasonable force The officer shall use the standard form developed by the
department pursuant to s. 397.321 to execute a written report detailing the
circumstances under which the person was taken into custody. The written
report shall be included in the patient's clinical record or
U
(b) In the case of an adult, detain the person for his or her own protection
0
in any municipal or county jail or other appropriate detention facility.
Such detention is not to be considered an arrest for any purpose, and no
entry or other record may be made to indicate that the person has been
rd
detained or charged with any crime. The officer in charge of the detention
facility must notify the nearest appropriate licensed service provider within
the first 8 hours after detention that the person has been detained. It is the
CD
duty of the detention facility to arrange, as necessary, for transportation of
the person to an appropriate licensed service provider with an available bed.
Persons taken into protective custody must be assessed by the attending
physician within the 72 -hour period and without unnecessary delay, to
determine the need for further services.
Section 25. Paragraph (a) of subsection (1) of section 397.6773, Florida
Statutes, is amended to read:
397.6773 Dispositional alternatives after protective custody. -
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(1) An individual who is in protective custody must be released by a
qualified professional when:
(a) The individual no longer meets the involuntary admission criteria in
s. 397.675 397.6754)
E
Section 26. Section 397.679, Florida Statutes, is amended to read:
397.679 Emergency admission; circumstances justifying. —A person who
meets the criteria for involuntary admission in s. 397.675 may be admitted
to a hospital or to a licensed detoxification facility or addictions receiving
L
facility for emergency assessment and stabilization, or to a less intensive
component of a licensed service provider for assessment only, upon receipt by
the facility of a the physiei certificate by a physician, an advanced
registered nurse practitioner, a psychiatric nurse, a clinical psychologist, a
clinical social worker, a marriage and family therapist, a mental health
counselor, a physician assistant working under the scope of practice of the
supervising physician, or a master's - level - certified addictions professional
for substance abuse services, if the certificate is specific to substance abuse
—
impairment, and the completion of an application for emergency admission.
0
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Section 27. Section 397.6791, Florida Statutes, is amended to read:
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CL
397.6791 Emergency admission; persons who may initiate. —The follow-
ing persons may request a certificate for aft emergency assessment or
admission:
(1) In the case of an adult, any professional who may issue a professional
certificate pursuant to s. 397.6793 t h e eeft f inn p' ysieia , the person's
BU
spouse or legal guardian, any relative of the person, or any other responsible
adult who has personal knowledge of the person's substance abuse
impairment.
(2) In the case of a minor, the minor's parent, legal guardian, or legal
custodian.
Section 28. Section 397.6793, Florida Statutes, is amended to read:
rd
397.6793 Professional's Drhysieian's certificate for emergency admission.
04
(1) A physician, a clinical psychologist, a physician assistant working
under the scope of practice of the supervising physician, a psychiatric nurse,
an advanced registered nurse practitioner, a mental health counselor, a
marriage and family therapist, a master's - level - certified addictions profes-
sional for substance abuse services, or a clinical social worker may execute a
professional's certificate for emergency admission. The professional's
phy sieian certificate must include the name of the person to be admitted,
the relationship between the person and the professional executing the
certificate physieian the relationship between the applicant and the
M
professional physieian any relationship between the professional physiemn
and the licensed service provider, an4 a statement that the person has been
43
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examined and assessed within the preceding 5 days after e€ the application
date, and must inel ae factual allegations with respect to the need for
emergency admission, including:
(a) The reason for theme belief that the person is substance
a)
abuse impaired; an4
(b) The reason for the by sieian's belief that because of such impairment
E
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the person has lost the power of self - control with respect to substance abuse;
and e ither
(61. The reason for the belief .,i, believes that without care or
treatment, the person is likely to suffer from neglect or refuse to care for
himself or herself: that such neglect or refusal poses a real and present
threat of substantial harm to his or her well - being- and that it is not
apparent that such harm may be avoided through the help of willing family
U
members or friends or the provision of other services, or there is substantial
likelihood that the person has inflicted or unless admitted, is likely to inflict,
physical harm on himself, e+ herself, or another ethers unless „afflitt.a or
—
2. The reason for the belief p1,-•..;,,ia believes that the person's refusal to
voluntarily receive care is based on judgment so impaired by reason of
CL
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substance abuse that the person is incapable of appreciating his or her need
for care and of making a rational decision regarding his or her need for care.
(2) The professional's p hysieia certificate must recommend the least
restrictive type of service that is appropriate for the person. The certificate
must be signed by the professional physieian If other less restrictive means
are not available, such as voluntary ppearance for outpatient evaluation, a
law enforcement officer shall take the person named in the certificate into
custody and deliver him or her to the appropriate facility for involuntary
assessment and stabilization.
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(3) A signed copy of the professional's certificate shall
accompany the person and shall be made a part of the person's clinical
record, together with a signed copy of the application. The application and
the professional's phys certificate authorize the involuntary admis-
sion of the person pursuant to, and subject to the provisions of, ss. 397.679-
397.6797.
(4) The professional's certificate is valid for 7 days after issuance.
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(5) The professional's certificate must indicate whether the
person requires transportation assistance for delivery for emergency
admission and specify, pursuant to s. 397.6795, the type of transportation
assistance necessary.
Section 29. Section 397.6795, Florida Statutes, is amended to read:
397.6795 Transportation- assisted delivery of persons for emergency
assessment. —An applicant for a person's emergency admission, of the
44
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person's spouse or guardian, or a law enforcement officer ^ a health e ffi e -F
may deliver a person named in the professional's certificate for
emergency admission to a hospital or a licensed detoxification facility or
addictions receiving facility for emergency assessment and stabilization.
Section 30. Subsection (1) of section 397.681, Florida Statutes, is
amended to read:
397.681 Involuntary petitions; general provisions; court jurisdiction and '
right to counsel. —
(1) JURISDICTION. —The courts have jurisdiction of involuntary as-
sessment and stabilization petitions and involuntary treatment petitions for
substance abuse impaired persons, and such petitions must be filed with the
clerk of the court in the county where the person is located. The clerk of the
court may not charge a fee for the filing of a petition under this section. The
chief judge may appoint a general or special magistrate to preside over all or
part of the proceedings. The alleged impaired person is named as the
respondent.
Section 31. Subsection (1) of section 397.6811, Florida Statutes, is CL
CL
amended to read:
397.6811 Involuntary assessment and stabilization. —A person deter-
mined by the court to appear to meet the criteria for involuntary admission
under s. 397.675 may be admitted for a period of 5 days to a hospital or to a
licensed detoxification facility or addictions receiving facility, for involun-
tary assessment and stabilization or to a less restrictive component of a
licensed service provider for assessment only upon entry of a court order or
upon receipt by the licensed service provider of a petition. Involuntary
assessment and stabilization may be initiated by the submission of a petition
to the court.
(1) If the person upon whose behalf the petition is being filed is an adult, r-
a petition for involuntary assessment and stabilization may be filed by the
respondent's spouse or legal guardian, any relative, a private practitioner,
the director of a licensed service provider or the director's designee, or an
adult any th ree adul who has direct lie personal knowledge of the
respondent's substance abuse impairment.
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Section 32. Section 397.6814, Florida Statutes, is amended to read:
397.6814 Involuntary assessment and stabilization; contents of petition.
A petition for involuntary assessment and stabilization must contain the
name of the respondent.; the name of the applicant or applicants. ;; the
relationship between the respondent and the applicant and the name of the
respondent's attorney, if known, an d a statement of the r espo ndent's ability �
to a ffera an attorn and must state facts to support the need for
involuntary assessment and stabilization, including:
45
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(1) The reason for the petitioner's belief that the respondent is substance
abuse impaired; an4
(2) The reason for the petitioner's belief that because of such impairment E
the respondent has lost the power of self - control with respect to substance
abuse; and ei thef
(3)(a) The reason the petitioner believes that the respondent has
inflicted or is likely to inflict physical harm on himself or herself or others
unless admitted; or
L
(b) The reason the petitioner believes that the respondent's refusal to
a)
voluntarily receive care is based on judgment so impaired by reason of
=
substance abuse that the respondent is incapable of appreciating his or her
need for care and of making a rational decision regarding that need for care.
a)
If the respondent has refused to submit to an assessment, such refusal must
be alleged in the petition.
0
A fee may not be charged for the filing of a petition pursuant to this section.
0
Section 33. Subsection (4) is added to section 397.6818, Florida Statutes,
L CL
to read:
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397.6818 Court determination. —At the hearing initiated in accordance
with s. 397.6811(1), the court shall hear all relevant testimony. The
respondent must be present unless the court has reason to believe that
°®
his or her presence is likely to be injurious to him or her, in which event the
court shall appoint a guardian advocate to represent the respondent. The
respondent has the right to examination by a court - appointed qualified
professional. After hearing all the evidence, the court shall determine
whether there is a reasonable basis to believe the respondent meets the
involuntary admission criteria of s. 397.675.
c
(4) The order is valid only for the period specified in the order or, if a
period is not specified, for 7 days after the order is signed.
Section 34. Section 397.6819, Florida Statutes, is amended to read:
397.6819 Involuntary assessment and stabilization; responsibility of
licensed service provider. —A licensed service provider may admit an
individual for involuntary assessment and stabilization for a period not to
exceed 5 days unless a petition for involuntary services has been initiated
and the individual is being retained pursuant to s. 397.6822(3) or a request
for an extension of time has been filed with the court pursuant to s. 397.6821
The assessment of the individual must occur within 72 hours be assessed
r_
., ith ,,+ ]inn d e l a y by a qualified professional. If an assessment is
performed by a qualified professional who is not a physician, the assessment
M
must be reviewed by a physician before the end of the assessment period.
Section 35. Section 397.695, Florida Statutes, is amended to read:
46
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397.695 Involuntary services tfe n ; persons who may petition. —
(1) If the respondent is an adult, a petition for involuntary services
E
tre a t men t may be filed by the respondent's spouse or legal guardian, any
E
relative, a service provider, or an adult any three adi who has direct have
personal knowledge of the respondent's substance abuse impairment and his
or her prior course of assessment and treatment.
(2) If the respondent is a minor, a petition for involuntary treatment may
be filed by a parent, legal guardian, or service provider.
L
Section 36. Section 397.6951, Florida Statutes, is amended to read:
N
397.6951 Contents of petition for involuntary services +Men —A
petition for involuntary services tre a t men n must contain the name of the
respondent to he „ar itt ; the name of the petitioner or petitioners; the
u
relationship between the respondent and the petitioner; the name of the
respondent's attorney, if known and „ state of the petitioner's v.,,,w
Lo
edge of the M ^ ^ p^ an ,the findings and
—
recommendations of the assessment performed by the qualified professional;
and the factual allegations presented by the petitioner establishing the need
L
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for involuntary outpatient services. The factual allegations must demon-
strate tfeat ent i
(1) The reason for the petitioner's belief that the respondent is substance
abuse impaired;
(2) The reason for the petitioner's belief that because of such impairment
•.
the respondent has lost the power of self - control with respect to substance
abuse; and ei ther
(3)(a) The reason the petitioner believes that the respondent has
U
inflicted or is likely to inflict physical harm on himself or herself or others
unless the court orders the involuntary services d or
(b) The reason the petitioner believes that the respondent's refusal to
voluntarily receive care is based on judgment so impaired by reason of
substance abuse that the respondent is incapable of appreciating his or her
need for care and of making a rational decision regarding that need for care.
Section 37. Section 397.6955, Florida Statutes, is amended to read:
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397.6955 Duties of court upon filing of petition for involuntary services
treatment.—
U-
Upon the filing of a petition for the involuntary services for tre atmen
of a substance abuse impaired person with the clerk of the court, the court
shall immediately determine whether the respondent is represented by an
attorney or whether the appointment of counsel for the respondent is
appropriate. If the court appoints counsel for the person, the clerk of the
court shall immediately notify the office of criminal conflict and civil regional
47
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counsel, created pursuant to s. 27.511, of the appointment. The office of
criminal conflict and civil regional counsel shall represent the person until
the petition is dismissed, the court order expires, or the person is discharged
from involuntary services. An attorney that represents the person named in
the petition shall have access to the person, witnesses, and records relevant
to the presentation of the person's case and shall represent the interests of
the person, regardless of the source of payment to the attorney.
The court shall schedule a hearing to be held on the petition within 5
40 days unless a continuance is granted. The court may appoint a magistrate
to preside at the hearing
a
A copy of the petition and notice of the hearing must be provided to
a)
N
the respondent; the respondent's parent, guardian, or legal custodian, in the
case of a minor; the respondent's attorney, if known; the petitioner; the
respondent's spouse or guardian, if applicable; and such other persons as the
court may direct If the respondent is a minor a copy of the petition and
notice of the hearing must be a have sueh petitio a order personally
delivered to the respondent if he o r the is a miner The court shall also issue
a summons to the person whose admission is sought.
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Section 38. Section 397.6957, Florida Statutes, is amended to read:
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CL
397.6957 Hearing on petition for involuntary services tre atmen t .—
(1) At a hearing on a petition for involuntary services tfe n , the
court shall hear and review all relevant evidence, including the review of
results of the assessment completed by the qualified professional in
g
connection with the respondent's protective custody, emergency admission,
involuntary assessment, or alternative involuntary admission. The respon-
dent must be present unless the court finds that his or her presence is likely
to be injurious to himself or herself or others, in which event the court must
appoint a guardian advocate to act in behalf of the respondent throughout
the proceedings.
(2) The petitioner has the burden of proving by clear and convincing
evidence that
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(a) The respondent is substance abuse impaired and has a history of lack
04
of compliance with treatment for substance abuse - ; and
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(b) Because of such impairment the respondent is unlikely to voluntarily
participate in the recommended services or is unable to determine for
himself or herself whether services are necessary the respondent has lost t
pewef o f self ee ntfel with M et to ,.,,b e a b u , and- ei ther
1. Without services, the respondent is likely to suffer from neglect or
refuse to care for himself or herself; that such neglect or refusal poses a real
and present threat of substantial harm to his or her well - being; and that
M
there is a substantial likelihood that without services the respondent will
cause serious bodilv harm to himself. herself. or another in the near future.
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as evidenced by recent behavior The r has inflie +,.a o is lik ., +,.
infliet harm himself herself
physieal on or or others unless adm or
2. The respondent's refusal to voluntarily receive care is based on
judgment so impaired by reason of substance abuse that the respondent is
incapable of appreciating his or her need for care and of making a rational
decision regarding that need for care.
(3) One of the qualified professionals who executed the involuntary
services certificate must be a witness. The court shall allow testimony from
individuals, including family members, deemed by the court to be relevant
under state law, regarding the respondent's prior history and how that prior
history relates to the person's current condition. The testimony in the
hearing must be under oath, and the proceedings must be recorded. The
patient may refuse to testify at the hearing_
x{-34 At the conclusion of the hearing the court shall e ither dismiss the
petition or order the respondent to receive u ndergo involuntary services
from his or her substance „Luse t Fea t men t, with t h e M ndent's chosen
licensed service provider if to deli th i u „L
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,,,,
t r+ri en t w r possible and appropriate.
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Section 39. Section 397.697, Florida Statutes, is amended to read:
397.697 Court determination; effect of court order for involuntary
services subst,,nee abuse treatment
c
(1) When the court finds that the conditions for involuntary services
subst nee „L tfeatm have been proved by clear and convincing
evidence, it may order the respondent to receive u ndergo involuntary
services from tre atment a publicly funded licensed service provider for a
u
period not to exceed 90 60 days. The court may also order a respondent to
c
undergo treatment through a privately funded licensed service provider if
ca
the respondent has the ability to pay for the treatment, or if any person on
the respondent's behalf voluntarily demonstrates a willingness and an
ability to pay for the treatment. If the court finds it necessary, it may direct
<
the sheriff to take the respondent into custody and deliver him or her to the
licensed service provider specified in the court order, or to the nearest
appropriate licensed service provider, for involuntary services +T^n
When the conditions justifying involuntary services +Mein no longer
exist, the individual must be released as provided in s. 397.6971. When the
conditions justifying involuntary services treatment are expected to exist
L
after 90 60 days of services +gin a renewal of the involuntary services
treatment order may be requested pursuant to s. 397.6975 before prior to the
end of the 90 -dav 6 0 day period.
(2) In all cases resulting in an order for involuntary services sub ee
„L treatment the court shall retain jurisdiction over the case and the
parties for the entry of such further orders as the circumstances may
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require. The court's requirements for notification of proposed release must
be included in the original tre atme nt order.
(3) An involuntary services tree order authorizes the licensed
service provider to require the individual to receive services that u nderge
sueh treatment as will benefit him or her, including services tre at
any licensable service component of a licensed service provider.
(4) If the court orders involuntary services, a copy of the order must be
sent to the managing entity within 1 working day after it is received from the
court. Documents may be submitted electronically though existing data
systems, if applicable.
Section 40. Section 397.6971, Florida Statutes, is amended to read:
397.6971 Early release from involuntary services substanee abuse
�
ten .—
L
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(1) At any time before prior to the end of the 90 -day 60 day involuntary
services tre period, or before prior to the end of any extension granted
L
pursuant to s. 397.6975, an individual receiving admitt or involuntary
CL
services tre atme nt may be determined eligible for discharge to the most
CL
appropriate referral or disposition for the individual when any of the
following apply
(a) The individual no longer meets the criteria for involuntary admission
r_
and has given his or her informed consent to be transferred to voluntary
g
treatment status_;
(b) If the individual was admitted on the grounds of likelihood of
E
infliction of physical harm upon himself or herself or others, such likelihood
no longer exists,-,-or
c
(c) If the individual was admitted on the grounds of need for assessment
and stabilization or treatment, accompanied by inability to make a
a
determination respecting such need—,either:
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1. Such inability no longer exists; or
2. It is evident that further treatment will not bring about further
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significant improvements in the individual's condition_;
(d) The individual is no longer in need of services_-
(e) The director of the service provider determines that the individual is
r_
beyond the safe management capabilities of the provider.
(2) Whenever a qualified professional determines that an individual
admitted for involuntary services qualifies treatment is ready for early
release under for any of the reasons listed in subsection (1), the service
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provider shall immediately discharge the individual and must notify all
persons specified by the court in the original treatment order.
Section 41. Section 397.6975, Florida Statutes, is amended to read:
397.6975 Extension of involuntary services r••i. e abuse treat en
period. —
(1) Whenever a service provider believes that an individual who is
• :
nearing the scheduled date of his or her release from involuntary services
treatment continues to meet the criteria for involuntary services +Teen
in s. 397.693, a petition for renewal of the involuntary services tre atmen
order may be filed with the court at least 10 days before the expiration of the
court - ordered services tre atmen period. The court shall immediately
schedule a hearing to be held not more than 15 days after filing of the
petition. The court shall provide the copy of the petition for renewal and the
notice of the hearing to all parties to the proceeding. The hearing is
conducted pursuant to s. 397.6957.
(2) If the court finds that the petition for renewal of the involuntary
>
services tree order should be granted, it may order the respondent to
L
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receive u ndefge involuntary services then for a period not to exceed an
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additional 90 days. When the conditions justifying involuntary services
..
then no longer exist, the individual must be released as provided in s.
L o n
397.6971. When the conditions justifying involuntary services tre atmen
continue to exist after an additional 90 days of service additional treatment,
a new petition requesting renewal of the involuntary services then
r o -
order may be filed pursuant to this section.
(3) Within 1 court working day after the filing of a petition for continued
involuntary services, the court shall appoint the office of criminal conflict
and civil regional counsel to represent the respondent, unless the respondent
c
is otherwise represented by counsel. The clerk of the court shall immediately
notify the office of criminal conflict and civil regional counsel of such
appointment. The office of criminal conflict and civil regional counsel shall
represent the respondent until the petition is dismissed or the court order
expires or the respondent is discharged from involuntary services. Any
ry
attorney representing the respondent shall have access to the respondent,
witnesses, and records relevant to the presentation of the respondent's case
and shall represent the interests of the respondent, regardless of the source
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of payment to the attorney.
(4) Hearings on petitions for continued involuntary services shall be
before the circuit court. The court may ppoint a magistrate to preside at the
hearing. The procedures for obtaining an order pursuant to this section shall
be in accordance with s. 397.697.
(5) Notice of hearing shall be provided to the respondent or his or her
counsel. The respondent and the respondent's counsel may agree to a period
of continued involuntary services without a court hearinLy.
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(6) The same procedure shall be repeated before the expiration of each
additional period of involuntary services.
(7) If the respondent has previously been found incompetent to consent
to treatment, the court shall consider testimony and evidence regarding the
respondent's competence.
Section 42. Section 397.6977, Florida Statutes, is amended to read:
397.6977 Disposition of individual upon completion of involuntary
services su .,b tr,, . + —At the conclusion of the 90 -day 60
4ay period of court - ordered involuntary services tre a t men t , the respondent
individual is automatically discharged unless a motion for renewal of the
involuntary services tree order has been filed with the court pursuant
to s. 397.6975.
Section 43. Section 397.6978, Florida Statutes, is created to read:
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0
397.6978 Guardian advocate; patient incompetent to consent; substance
abuse disorder. —
(1) The administrator of a receiving facility or an addictions receiving
CL
facility may petition the court for the appointment of a guardian advocate
based upon the opinion of a qualified professional that the patient is
incompetent to consent to treatment. If the court finds that a patient is
0
incompetent to consent to treatment and has not been adjudicated
incapacitated and that a guardian with the authority to consent to substance
g
abuse treatment has not been appointed, it may 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 shall appoint the office
of criminal conflict and civil regional counsel to represent him or her at the
hearing. The patient has the right to testify, cross - examine witnesses, and
0
present witnesses. The proceeding shall be recorded electronically or
stenographically, and testimony must be provided under oath. One of the
qualified professionals authorized to give an opinion in support of a petition
for involuntary services, as described in s. 397.693, must testify. A guardian
advocate must meet the qualifications of a guardian contained in part IV of
chapter 744. The person who is appointed as a guardian advocate must agree
to the appointment.
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(2) The following persons are prohibited from appointment as a patient's
guardian advocate:
(a) A professional providing clinical services to the individual under this
part•
(b) The qualified professional who initiated the involuntary examination
2
of the individual, if the examination was initiated by a qualified profes-
sional's certificate.
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(c) An employee, an administrator, or a board member of the facilit
rovidinLy the examination of the individual.
(d) An employee, an administrator, or a board member of the treatment
facility providing treatment of the individual.
(e) A person providing any substantial professional services, excluding
public guardians or professional guardians, to the individual, including
clinical services.
(f) A creditor of the individual.
(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 individual was the petitioner.
(h) A person subject to an injunction for protection against repeat
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violence, stalking, sexual violence, or dating violence under s. 784.046,
L o
whether the order of injunction is temporary or final, and for which the
—
individual was the petitioner.
L
(3) A facility requesting appointment of a guardian advocate must,
CL
CL
before the appointment, provide the prospective guardian advocate with
information about the duties and responsibilities of guardian advocates,
, ,
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including information about the ethics of medical decisionmaking. Before
asking a guardian advocate to give consent to treatment for a patient, the
facility must provide to the guardian advocate sufficient information so that
the guardian advocate can decide whether to give express and informed
consent to the treatment. Such information must include information that
demonstrates that the treatment is essential to the care of the patient and
does not present an unreasonable risk of serious, hazardous, or irreversible
side effects. If possible, before giving consent to treatment, the guardian
advocate must personally meet and talk with the patient and the patient's
physician. If that is not possible, the discussion may be conducted by
telephone. 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.
rd
(4) In lieu of the training required for guardians appointed pursuant to
chapter 744, a guardian advocate shall attend at least a 4 -hour training
course approved by the court before exercising his or her authority. At a
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minimum, the training course must include information about patient
rights, the diagnosis of substance abuse disorders, the ethics of medical
LL
decisionmaking, and the duties of guardian advocates.
(5) The required training course and the information to be supplied to
r-
prospective guardian advocates before their appointment must be developed
by the department, approved by the chief judge of the circuit court, and
c u o
taught by a court - approved organization, which may include, but need not be
limited to. a communitv colleLye. a Lyuardianshib organization. a local bar
53
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association, or The Florida Bar. The training course may be web - based,
provided in video format. or provided in 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.
L
(6) In selecting a guardian advocate, the court shall give preference to
the patient's health care surrogate, if one has already been designated by the
patient. If the patient has not previously designated a health care surrogate,
the selection shall be made, except for good cause documented in the court a)
record, from among the following persons, listed in order of priority
L
(a) The spouse of the patient. 0
(b) An adult child of the patient. L
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(c) A parent of the patient.
(d) The adult next of kin of the patient.
0
(e) An adult friend of the patient.
r-
(f) An adult trained and willing to serve as the guardian advocate for the
_c
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
c
health care surrogate, the court may authorize the guardian advocate to
consent to medical treatment as well as substance abuse disorder treatment.
Unless otherwise limited by the court, a guardian advocate with authority to
consent to medical treatment has the same authority to make health care
decisions and is 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 a proceeding separate from the proceed-
ing to determine the competence of the patient to consent to medical
treatment, the guardian advocate may not consent to:
(a) Abortion.
(b) Sterilization.
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M
(c) Electroshock therapy.
(d) Psychosurgery.
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(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 authorization 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. In complying with this subsection, the court shall follow the
procedures set forth in subsection (1).
(8) The guardian advocate shall be discharged when the patient is
discharged from an order for involuntary services or when the patient is
transferred from involuntary to voluntary status. The court or a hearing
officer shall consider the competence of the patient as provided in subsection
(1) and may consider an involuntarily placed patient's competence to consent
to services at any hearing. Upon sufficient evidence, the court may restore,
or the magistrate 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.
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Section 44. Paragraphs (d) through (m) of subsection (2) of section
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409.967, Florida Statutes, are redesignated as paragraphs (e) through (n),
respectively, and a new paragraph (d) is added to that subsection, to read:
409.967 Managed care plan accountability. —
(2) The agency shall establish such contract requirements as are
g
necessary for the operation of the statewide managed care program. In
addition to any other provisions the agency may deem necessary, the
contract must require:
(d) Quality care.— Managed care plans shall provide, or contract for the
c
provision of, care coordination to facilitate the appropriate delivery of
behavioral health care services in the least restrictive setting with
treatment and recovery capabilities that address the needs of the patient.
Services shall be provided in a manner that integrates behavioral health
services and primary care. Plans shall be required to achieve specific
behavioral health outcome standards, established by the agency in con-
sultation with the department.
CD
Section 45. Subsection (5) is added to section 409.973, Florida Statutes,
to read:
409.973 Benefits. —
(5) INTEGRATED BEHAVIORAL HEALTH INITIATIVE. —Each plan
r-
operating in the managed medical assistance program shall work with the
managing entity in its service area to establish specific organizational
supports and protocols that enhance the integration and coordination of
primary care and behavioral health services for Medicaid recipients.
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Progress in this initiative shall be measured using the integration frame-
work and core measures developed by the Agency for Healthcare Research
and Quality.
Section 46. Notwithstanding the amendment made to s. 409.975(6),
a)
Florida Statutes, by HB 5101, 1st Eng., 2016 Regular Session, subsection (6)
of section 409.975, Florida Statutes, is reenacted to read:
409.975 Managed care plan accountability. —In addition to the require-
ments of s. 409.967, plans and providers participating in the managed
medical assistance program shall comply with the requirements of this
section.
(6) PROVIDER PAYMENT.— Managed care plans and hospitals shall
negotiate mutually acceptable rates, methods, and terms of payment. For
rates, methods, and terms of payment negotiated after the contract between
the agency and the plan is executed, plans shall pay hospitals, at a
minimum, the rate the agency would have paid on the first day of the
contract between the provider and the plan. Such payments to hospitals may
_
not exceed 120 percent of the rate the agency would have paid on the first
day of the contract between the provider and the plan, unless specifically
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approved by the agency. Payment rates may be updated periodically.
Section 47. It is the intent of the Legislature that the reenactment of s.
409.975(6), Florida Statutes, shall control over the amendment to that
subsection made by HB 5101, 1st Eng., 2016 Regular Session, regardless of
the order in which they are enacted.
Section 48. Section 491.0045, Florida Statutes, is amended to read:
491.0045 Intern registration; requirements.-
0
(1) �'feetive jan,,,ry ', 1 Q9o, An individual who has not satisfied
i to r et . i Fl f a„ to sat c , the postgraduate or post- master's
level experience requirements, as specified in s. 491.005(1)(c), (3)(c), or (4)(c),
must register as an intern in the profession for which he or she is seeking
licensure before prior e commencing the post- master's experience require-
ment or an individual who intends to satisfy part of the required graduate -
04
level practicum, internship, or field experience, outside the academic arena
for any profession, must register as an intern in the profession for which he
or she is seeking licensure before prior to commencing the practicum,
internship, or field experience.
(2) The department shall register as a clinical social worker intern,
r_
marriage and family therapist intern, or mental health counselor intern
each applicant who the board certifies has:
(a) Completed the application form and remitted a nonrefundable
+"
application fee not to exceed $200, as set by board rule;
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(b)1. Completed the education requirements as specified in s.
491.005(1)(c), (3)(c), or (4)(c) for the profession for which he or she is
applying for licensure, if needed; and
E
2. Submitted an acceptable supervision plan, as determined by the
board, for meeting the practicum, internship, or field work required for
licensure that was not satisfied in his or her graduate program.
(c) Identified a qualified supervisor.
(3) An individual registered under this section must remain under
supervision while practicing under registered intern status until h o the :s
1 ---tiee the profession for whieh he or she applied.
Y
uRres�s* e+. �i�nn��ssr .�sLr.�ssrazrr.�as�reerss . r.�t
has applied.
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An individual who fails individual who h E , v ,.a th
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failed to by 4) the
register as required subseetion shall register with
QePartfnentbe€ ore Tams,,. , 2000 individuals who to comply with this
section may su bseetion sh not be granted a license under this chapter and
any time spent by the individual completing the experience requirement as
specified in s. 491.005(1)(c), (3)(c), or (4)(c) before prior to registering as an
intern does shall not count toward completion of the sueh requirement.
(5) An intern registration is valid for 5 years.
c
(6) A registration issued on or before March 31, 2017, expires March 31,
2022, and may not be renewed or reissued. Any registration issued after
March 31, 2017, expires 60 months after the date it is issued. A subsequent
intern registration may not be issued unless the candidate has passed the
theory and practice examination described in s. 491.005(1)(d), (3)(d), and
(4)(d).
04
(7) An individual who has held a provisional license issued by the board
may not apply for an intern registration in the same profession.
CD
Section 49. Section 394.4674, Florida Statutes, is repealed.
Section 50. Section 394.4985, Florida Statutes, is repealed.
Section 51. Section 394.745, Florida Statutes, is repealed.
Section 52. Section 397.331, Florida Statutes, is repealed.
Section 53. Section 397.801. Florida Statutes. is repealed.
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Section 54. Section 397.811. Florida Statutes. is repealed.
Section 55. Section 397.821, Florida Statutes, is repealed.
Section 56. Section 397.901, Florida Statutes, is repealed.
Section 57. Section 397.93, Florida Statutes, is repealed.
Section 58. Section 397.94, Florida Statutes, is repealed.
Section 59. Section 397.951, Florida Statutes, is repealed.
Section 60. Section 397.97, Florida Statutes, is repealed.
Section 61. Section 397.98, Florida Statutes, is repealed.
L
Section 62. Paragraph (a) of subsection (3) of section 39.407, Florida
Statutes, is amended to read:
0
39.407 Medical, psychiatric, and psychological examination and treat-
ment of child; physical, mental, or substance abuse examination of person
with or requesting child custody. —
(3)(a)1. Except as otherwise provided in subparagraph (b)1. or para-
graph (e), before the department provides psychotropic medications to a
0
child in its custody, the prescribing physician shall attempt to obtain express
00
and informed consent, as defined in s. 394.455(15) s. 394.455(94 and as
described in s. 394.459(3)(a), from the child's parent or legal guardian. The
department must take steps necessary to facilitate the inclusion of the
parent in the child's consultation with the physician. However, if the
parental rights of the parent have been terminated, the parent's location or
identity is unknown or cannot reasonably be ascertained, or the parent
declines to give express and informed consent, the department may, after
consultation with the prescribing physician, seek court authorization to
provide the psychotropic medications to the child. Unless parental rights
have been terminated and if it is possible to do so, the department shall
continue to involve the parent in the decisionmaking process regarding the
provision of psychotropic medications. If, at any time, a parent whose
parental rights have not been terminated provides express and informed
consent to the provision of a psychotropic medication, the requirements of
this section that the department seek court authorization do not apply to
that medication until such time as the parent no longer consents.
2. Any time the department seeks a medical evaluation to determine the
need to initiate or continue a psychotropic medication for a child, the
department must provide to the evaluating physician all pertinent medical
information known to the department concerning that child.
Section 63. Subsection (1) of section 39.524, Florida Statutes, is amended
+"
to read:
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39.524 Safe - harbor placement.
(1) Except as provided in s. 39.407 or s. 985.801, a dependent child 6
years of age or older who has been found to be a victim of sexual exploitation
as defined in s. 39.01(70)(8) s must be assessed for placement in
a safe house or safe foster home as provided in s. 409.1678 using the initial
screening and assessment instruments provided in s. 409.1754(1). If such
placement is determined to be appropriate for the child as a result of this
assessment, the child may be placed in a safe house or safe foster home, if
'
one is available. However, the child may be placed in another setting, if the
other setting is more appropriate to the child's needs or if a safe house or safe
a
foster home is unavailable, as long as the child's behaviors are managed so
ILA
as not to endanger other children served in that setting.
_
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Section 64. Paragraph (e) of subsection (5) of section 212.055, Florida
Statutes, is amended to read:
212.055 Discretionary sales surtaxes; legislative intent; authorization
and use of proceeds. —It is the legislative intent that any authorization for
—
imposition of a discretionary sales surtax shall be published in the Florida
Statutes as a subsection of this section, irrespective of the duration of the
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levy. Each enactment shall specify the types of counties authorized to levy;
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the rate or rates which may be imposed; the maximum length of time the
surtax may be imposed, if any; the procedure which must be followed to
secure voter approval, if required; the purpose for which the proceeds may be
expended; and such other requirements as the Legislature may provide.
Taxable transactions and administrative procedures shall be as provided in
s. 212.054.
(5) COUNTY PUBLIC HOSPITAL SURTAX. —Any county as defined in
S. 125.011(1) may levy the surtax authorized in this subsection pursuant to
an ordinance either approved by extraordinary vote of the county commis-
c
sion or conditioned to take effect only upon approval by a majority vote of the
electors of the county voting in a referendum. In a county as defined in s.
125.011(1), for the purposes of this subsection, "county public general
hospital" means a general hospital as defined in s. 395.002 which is owned,
operated, maintained, or governed by the county or its agency, authority, or
rd
public health trust.
(e) A governing board, agency, or authority shall be chartered by the
county commission upon this act becoming law. The governing board,
agency, or authority shall adopt and implement a health care plan for
indigent health care services. The governing board, agency, or authority
shall consist of no more than seven and no fewer than five members
appointed by the county commission. The members of the governing board,
agency, or authority shall be at least 18 years of age and residents of the
county. No member may be employed by or affiliated with a health care
provider or the public health trust, agency, or authority responsible for the
M
county public general hospital. The following community organizations shall
each appoint a representative to a nominating committee: the South Florida
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
Hospital and Healthcare Association, the Miami -Dade County Public Health
Trust, the Dade County Medical Association, the Miami -Dade County
Homeless Trust, and the Mayor of Miami -Dade County. This committee
shall nominate between 10 and 14 county citizens for the governing board,
agency, or authority. The slate shall be presented to the county commission
and the county commission shall confirm the top five to seven nominees,
depending on the size of the governing board. Until such time as the
governing board, agency, or authority is created, the funds provided for in
subparagraph (d)2. shall be placed in a restricted account set aside from
other county funds and not disbursed by the county for any other purpose.
1. The plan shall divide the county into a minimum of four and maximum
of six service areas, with no more than one participant hospital per service
area. The county public general hospital shall be designated as the provider
for one of the service areas. Services shall be provided through participants'
primary acute care facilities.
2. The plan and subsequent amendments to it shall fund a defined range
L
of health care services for both indigent persons and the medically poor,
including primary care, preventive care, hospital emergency room care, and
hospital care necessary to stabilize the patient. For the purposes of this
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section, "stabilization" means stabilization as defined in s. 397.311(44)
`�Q''�, 397 Where consistent with these objectives, the plan may include
services rendered by physicians, clinics, community hospitals, and alter-
native delivery sites, as well as at least one regional referral hospital per
service area. The plan shall provide that agreements negotiated between the
governing board, agency, or authority and providers shall recognize
hospitals that render a disproportionate share of indigent care, provide
other incentives to promote the delivery of charity care to draw down federal
funds where appropriate, and require cost containment, including, but not
limited to, case management. From the funds specified in subparagraphs (d)
1. and 2. for indigent health care services, service providers shall receive
reimbursement at a Medicaid rate to be determined by the governing board,
agency, or authority created pursuant to this paragraph for the initial
emergency room visit, and a per- member per -month fee or capitation for
those members enrolled in their service area, as compensation for the
services rendered following the initial emergency visit. Except for provisions
of emergency services, upon determination of eligibility, enrollment shall be
deemed to have occurred at the time services were rendered. The provisions
for specific reimbursement of emergency services shall be repealed on July 1,
2001, unless otherwise reenacted by the Legislature. The capitation amount
or rate shall be determined before prior to program implementation by an
independent actuarial consultant. In no event shall such reimbursement
rates exceed the Medicaid rate. The plan must also provide that any
hospitals owned and operated by government entities on or after the
effective date of this act must, as a condition of receiving funds under this
subsection, afford public access equal to that provided under s. 286.011 as to
any meeting of the governing board, agency, or authority the subject of which
is budgeting resources for the retention of charity care, as that term is
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defined in the rules of the Agency for Health Care Administration. The plan
shall also include innovative health care programs that provide cost -
effective alternatives to traditional methods of service and delivery funding.
3. The plan's benefits shall be made available to all county residents
currently eligible to receive health care services as indigents or medically
poor as defined in paragraph (4)(d).
4. Eligible residents who participate in the health care plan shall receive
coverage for a period of 12 months or the period extending from the time of
enrollment to the end of the current fiscal year, per enrollment period,
a
whichever is less.
N
5. At the end of each fiscal year, the governing board, agency, or
authority shall prepare an audit that reviews the budget of the plan, delivery
of services, and quality of services, and makes recommendations to increase
the plan's efficiency. The audit shall take into account participant hospital
satisfaction with the plan and assess the amount of poststabilization patient
transfers requested, and accepted or denied, by the county public general
hospital.
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Section 65. Paragraph (c) of subsection (2) of section 394.4599, Florida
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Statutes, is amended to read:
394.4599 Notice. —
(2) INVOLUNTARY ADMISSION.—
(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
tM
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
plaeemen is filed with the court pursuant to s. 394.463(210) s--.
394.463(2)(i4 � The receiving facility may seek assistance from a law
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
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.
Section 66. Subsection (3) and paragraph (p) of subsection (4) of section
394.495, Florida Statutes, are amended to read:
E
394.495 Child and adolescent mental health system of care; programs
and services.—
a
(3) Assessments must be performed by:
0
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(a) A professional as defined in s. 394.455(5), (7), (32), (35), or (36) s:
2nd • ACC(2) (4) (21) (23) or (24)
U
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(b) A professional licensed under chapter 491; or
0
(c) A person who is under the direct supervision of a qualified profes-
>
sional as defined in s. 394.455(5), (7), (32), (35), or (36) s. ` 9 ^ 55(2), ( 4`, (2 `,
L
(23), or (24) or a professional licensed under chapter 491.
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(4) The array of services may include, but is not limited to:
(p) Trauma - informed services for children who have suffered sexual
exploitation as defined in s. 39.01(70)(8) S. 2n n, LVnv g)
Section 67. Subsection (5) of section 394.496, Florida Statutes, is
amended to read:
394.496 Service planning.—
U
(5) A professional as defined in s. 394.455(5), (7), (32), (35), or (36) s
0
` 9 ^55(2) (4` (21 (23) or (2 4) or a professional licensed under chapter 491
a
must be included among those persons developing the services plan.
Section 68. Subsection (6) of section 394.9085, Florida Statutes, is
amended to read:
394.9085 Behavioral provider liability. —
(6) For purposes of this section, the terms "detoxification services,"
"addictions receiving facility," and "receiving facility" have the same
meanings as those provided in ss. 397.311(25)(a)4., 397.311(25)(a)1., and
394. 455(39) 397.311(22)(a)4., 397 311(22)(a)1., 394.455(2
ss. and , respec-
r_
tively.
Section 69. Subsections (16) through (20) of section 397.321, Florida
Statutes, are renumbered as subsections (15) through (19), respectively, and
present subsection (15) of that section is amended, to read:
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397.321 Duties of the department. —The department shall:
department in initiated by the
E
efferts statewide substanee ab---
treatment in 397.801 to
a)
ment prevention and eeordinater established s. and
ist the in ftilfilling the that
statewide eeordinater responsibilities of
U)
Section 70. Subsection (8) of section 397.405, Florida Statutes, is
amended to read:
397.405 Exemptions from licensure. —The following are exempt from the
licensing provisions of this chapter:
L
(8) A legally cognizable church or nonprofit religious organization or
denomination providing substance abuse services, including prevention
U
services, which are solely religious, spiritual, or ecclesiastical in nature. A
church or nonprofit religious organization or denomination providing any of
the licensed service components itemized under s. 397.311(25) ° 907 R, , to
_
is not exempt from substance abuse licensure but retains its exemption with
respect to all services which are solely religious, spiritual, or ecclesiastical in
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nature.
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The exemptions from licensure in this section do not apply to any service
provider that receives an appropriation, grant, or contract from the state to
CO
operate as a service provider as defined in this chapter or to any substance
—
abuse program regulated pursuant to s. 397.406. Furthermore, this chapter
may not be construed to limit the practice of a physician or physician
assistant licensed under chapter 458 or chapter 459, a psychologist licensed
under chapter 490, a psychotherapist licensed under chapter 491, or an
advanced registered nurse practitioner licensed under part I of chapter 464,
who provides substance abuse treatment, so long as the physician, physician
c
assistant, psychologist, psychotherapist, or advanced registered nurse
practitioner does not represent to the public that he or she is a licensed
service provider and does not provide services to individuals pursuant to
part V of this chapter. Failure to comply with any requirement necessary to
maintain an exempt status under this section is a misdemeanor of the first
r°
degree, punishable as provided in s. 775.082 or s. 775.083.
Section 71. Subsections (1) and (5) of section 397.407, Florida Statutes,
CD
are amended to read:
z
397.407 Licensure process; fees. —
(1) The department shall establish the licensure process to include fees
and categories of licenses and must prescribe a fee range that is based, at
least in part, on the number and complexity of programs listed in s.
397.311(25) s. 397.311(224 11(224 which are operated by a licensee. The fees from
the licensure of service components are sufficient to cover at least 50 percent
of the costs of regulating the service components. The department shall
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specify a fee range for public and privately funded licensed service providers.
Fees for privately funded licensed service providers must exceed the fees for
publicly funded licensed service providers.
(5) The department may issue probationary, regular, and interim
0
licenses. The department shall issue one license for each service component
that is operated by a service provider and defined pursuant to s. 397.311(25)
S . 397 2, , (22� The license is valid only for the specific service components
listed for each specific location identified on the license. The licensed service
provider shall apply for a new license at least 60 days before the addition of
any service components or 30 days before the relocation of any of its service
sites. Provision of service components or delivery of services at a location not
identified on the license may be considered an unlicensed operation that
authorizes the department to seek an injunction against operation as
provided in s. 397.401, in addition to other sanctions authorized by s.
397.415. Probationary and regular licenses may be issued only after all
required information has been submitted. A license may not be transferred.
As used in this subsection, the term "transfer" includes, but is not limited to,
the transfer of a majority of the ownership interest in the licensed entity or
transfer of responsibilities under the license to another entity by contractual
arrangement.
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Section 72. Section 397.416, Florida Statutes, is amended to read:
397.416 Substance abuse treatment services; qualified professional. —
Notwithstanding any other provision of law, a person who was certified
through a certification process recognized by the former Department of
g
Health and Rehabilitative Services before January 1, 1995, may perform the
duties of a qualified professional with respect to substance abuse treatment
services as defined in this chapter, and need not meet the certification
requirements contained in s. 397.311(33) s. 120' 2„/2m
Section 73. Subsection (2) of section 397.4871, Florida Statutes, is
amended to read:
397.4871 Recovery residence administrator certification. —
rd
(2) The department shall approve at least one credentialing entity by
December 1, 2015, for the purpose of developing and administering a
voluntary credentialing program for administrators. The department shall
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approve any credentialing entity that the department endorses pursuant to
s. 397.321(15) s. 2 97. 2 2 1 (6 if the credentialing entity also meets the
requirements of this section. The approved credentialing entity shall:
(a) Establish recovery residence administrator core competencies, certi-
r_
fication requirements, testing instruments, and recertification require-
ments.
(b) Establish a process to administer the certification application, award,
+"
and maintenance processes.
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(c) Develop and administer:
1. A code of ethics and disciplinary process.
2. Biennial continuing education requirements and annual certification
renewal requirements.
3. An education provider program to approve training entities that are
qualified to provide precertification training to applicants and continuing
education opportunities to certified persons.
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Section 74. Paragraph (c) of subsection (1) and paragraphs (a) and (b) of
subsection (6) of section 409.1678, Florida Statutes, are amended to read: t!
409.1678 Specialized residential options for children who are victims of
sexual exploitation. —
(1) DEFINITIONS. —As used in this section, the term:
0
(c) "Sexually exploited child" means a child who has suffered sexual
exploitation as defined in s. 39.01(70)(8) s. 20 n' « nv and is ineligible for 0
relief and benefits under the federal Trafficking Victims Protection Act, 22 L CL
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U.S.C. ss. 7101 et seq.
(6) LOCATION INFORMATION. -
00
(a) Information about the location of a safe house, safe foster home, or
other residential facility serving victims of sexual exploitation, as defined in
s. 39.01(70)(8) s. 39. which is held by an agency, as defined in s.
119.011, is confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of
the State Constitution. This exemption applies to such confidential and
exempt information held by an agency before, on, or after the effective date of
the exemption.
(b) Information about the location of a safe house, safe foster home, or
other residential facility serving victims of sexual exploitation, as defined in
s. 39.01(70)(8) s. 39. may be provided to an agency, as defined in s.
119.011, as necessary to maintain health and safety standards and to
address emergency situations in the safe house, safe foster home, or other
residential facility.
Section 75. Paragraph (e) of subsection (3) of section 409.966, Florida
Statutes, is amended to read: _
409.966 Eligible plans; selection. —
(3) QUALITY SELECTION CRITERIA.—
E
(e) To ensure managed care plan participation in Regions 1 and 2, the
agency shall award an additional contract to each plan with a contract award
in Region 1 or Region 2. Such contract shall be in any other region in which
the plan submitted a responsive bid and negotiates a rate acceptable to the
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agency. If a plan that is awarded an additional contract pursuant to this
paragraph is subject to penalties pursuant to s. 409.967(2)(1) n ^ nQ QrZ7twi,)
for activities in Region 1 or Region 2, the additional contract is automatically
terminated 180 days after the imposition of the penalties. The plan must
reimburse the agency for the cost of enrollment changes and other transition
activities.
Section 76. Paragraph (b) of subsection (1) of section 409.972, Florida
Statutes, is amended to read:
L
409.972 Mandatory and voluntary enrollment. —
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(1) The following Medicaid - eligible persons are exempt from mandatory
managed care enrollment required by s. 409.965, and may voluntarily choose
to participate in the managed medical assistance program:
(b) Medicaid recipients residing in residential commitment facilities
operated through the Department of Juvenile Justice or a mental heal
treatment facility f eyes as defined in s. 394.455(47) by - QQA.A
0
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Section 77. Paragraphs (d) and (g) of subsection (1) of section 440.102,
CL
CL
Florida Statutes, are amended to read:
440.102 Drug -free workplace program requirements. —The following
provisions apply to a drug -free workplace program implemented pursuant
to law or to rules adopted by the Agency for Health Care Administration:
(1) DEFINITIONS.— Except where the context otherwise requires, as
used in this act:
(d) "Drug rehabilitation program" means a service provider, established
U
pursuant to s. 397.311(42) - . QQ' '2 1 ± X09) that provides confidential, timely,
and expert identification, assessment, and resolution of employee drug
abuse.
(g) "Employee assistance program" means an established program
capable of providing expert assessment of employee personal concerns;
confidential and timely identification services with regard to employee drug
abuse; referrals of employees for appropriate diagnosis, treatment, and
assistance; and followup services for employees who participate in the
program or require monitoring after returning to work. If, in addition to the
above activities, an employee assistance program provides diagnostic and
treatment services, these services shall in all cases be provided by service
providers pursuant to s. 397.311(42) s. QQT 21 1 L2Q
Section 78. Subsection (7) of section 744.704, Florida Statutes, is
amended to read:
744.704 Powers and duties.—
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(7) A public guardian may s hft4 not commit a ward to a ment health
treatment facility, as defined in s. 394.455(47) °. QQ^.^l �'tl ,without an
involuntary placement proceeding as provided by law.
Section 79. Subsection (5) of section 960.065, Florida Statutes, is
0
amended to read:
960.065 Eligibility for awards.—
.
(5) A person is not ineligible for an award pursuant to paragraph (2)(a), u
paragraph (2)(b), or paragraph (2)(c) if that person is a victim of sexual
exploitation of a child as defined in s. 39.01(70)(8) S. 311 .01(69)(g) .
Section 80. The Secretary of Children and Families shall appoint a Y
workgroup to consider the feasibility of individuals using advance directives
to express the treatment wishes for substance use disorders. The workgroub U
shall be composed of individuals with expertise in the treatment of
substance use disorders. The workgroup must review the use of advance
directives in mental health, the use of advance directives for substance use
—
disorders in other states, and the use of similar legal instruments to express
the treatment wishes of individuals suffering from substance use disorders.
k
The workgroup shall provide a report to the Governor, the President of the
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Senate, and the Speaker of the House of Representatives by Januar 1, 2017.
The report must include recommendations on the feasibility of using
advance directives for individuals with substance use disorders and
recommendations for any revisions to state laws or agency rules. The
members of the workgroup are not entitled to reimbursement from the
Department of Children and Families for travel for workgroup meetings
unless they are employees of the department. This section expires on May
2017.
Section 81. Paragraph (b) of subsection (2) of section 61.13, Florida
0
Statutes, is amended to read:
61.13 Support of children; parenting and time - sharing; powers of court.
(2)
(b) A parenting plan approved by the court must, at a minimum_,
04
1. Describe in adequate detail how the parents will share and be
CD
responsible for the daily tasks associated with the upbringing of the child;
2. Include the time - sharing schedule arrangements that specify the time
LL
that the minor child will spend with each parent;
3. Designate a d ...,atie who will be responsible for_
a. Any and all forms of health care If the court orders shared parental
responsibility over health care decisions the parenting plan must provide
that either parent may consent to mental health treatment for the child.
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b. School - related matters, including the address to be used for school
boundary determination and registration-.-, ftft
c. Other activities; and
0
4. Describe in adequate detail the methods and technologies that the
parents will use to communicate with the child.
Section 82. Subsection (6) of section 39.001, Florida Statutes, is amended
• :
to read:
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39.001 Purposes and intent; personnel standards and screening.—
(6) MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES.—
(a) The Legislature recognizes that early referral and comprehensive
treatment can help combat mental illnesses and substance abuse disorders
in families and that treatment is cost - effective.
0
(b The Legislature establishes the following goals for the state related to
mental illness and substance abuse treatment services in the dependency
process:
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1. To ensure the safety of children.
2. To prevent and remediate the consequences of mental illnesses and
0
substance abuse disorders on families involved in protective supervision or
foster care and reduce the occurrences of mental illnesses and substance
_c
abuse disorders including alcohol abuse or related disorders for families
who are at risk of being involved in protective supervision or foster care.
3. To expedite permanency for children and reunify healthy, intact
families, when appropriate.
c
4. To support families in recovery.
(c) The Legislature finds that children in the care of the state's
dependency system need appropriate health care services, that the impact
of mental illnesses and substance abuse disorders on health indicates the
need for health care services to include treatment for mental health and
substance abuse disorders for Ito children and parents, where
appropriate, and that it is in the state's best interest that such children be
provided the services they need to enable them to become and remain
independent of state care. In order to provide these services, the state's
dependency system must have the ability to identify and provide appropriate
intervention and treatment for children with personal or family - related
mental illness and substance abuse problems.
(d) It is the intent of the Legislature to encourage the use of the mental
health court program model established under chapter 394 and the drug
court program model established under by s. 397.334 and authorize courts to
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assess children and persons who have custody or are requesting custody of
children where good cause is shown to identify and address mental illnesses
and substance abuse disorders pr oblems as the court deems appropriate at
every stage of the dependency process. Participation in treatment, including
a mental health court program or a treatment -based drug court program,
may be required by the court following adjudication. Participation in
assessment and treatment before i3fief to adjudication is shame voluntary,
except as provided in s. 39.407(16).
(e) It is therefore the purpose of the Legislature to provide authority for
the state to contract with mental health service providers and community
substance abuse treatment providers for the development and operation of
specialized support and overlay services for the dependency system, which L
will be fully implemented and used as resources permit.
(f) Participation in a mental health court program or a the treatment -
based drug court program does not divest any public or private agency of its
responsibility for a child or adult, but is intended to enable these agencies to
better meet their needs through shared responsibility and resources.
0
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Section 83. Subsection (10) of section 39.507, Florida Statutes, is CL
CL
amended to read:
39.507 Adjudicatory hearings; orders of adjudication. —
(10) After an adjudication of dependency, or a finding of dependency in
which where adjudication is withheld, the court may order a person who has
g
custody or is requesting custody of the child to submit to a mental health or
substance abuse disorder assessment or evaluation. The order may be made
only upon good cause shown and pursuant to notice and procedural
requirements provided under the Florida Rules of Juvenile Procedure.
U
The assessment or evaluation must be administered by an appropriate a
c
qualified professional, as defined in s. 39.01 or s. 397.311. The court may also
require such person to participate in and comply with treatment and
services identified as necessary, including, when appropriate and available,
participation in and compliance with a mental health court program
established under chapter 394 or a treatment -based drug court program
established under s. 397.334. In addition to supervision by the department,
the court, including the mental health court program or treatment -based
'
drug court program, may oversee the progress and compliance with
treatment by a person who has custody or is requesting custody of the
child. The court may impose appropriate available sanctions for noncom-
pliance upon a person who has custody or is requesting custody of the child or
make a finding of noncompliance for consideration in determining whether
an alternative placement of the child is in the child's best interests. Any
order entered under this subsection may be made only upon good cause
shown. This subsection does not authorize placement of a child with a person
B
seeking custody, other than the parent or legal custodian, who requires
mental health or substance abuse disorder treatment.
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Section 84. Paragraph (b) of subsection (1) of section 39.521, Florida
Statutes, is amended to read:
39.521 Disposition hearings; powers of disposition.—
(1) A disposition hearing shall be conducted by the court, if the court
finds that the facts alleged in the petition for dependency were proven in the
adjudicatory hearing, or if the parents or legal custodians have consented to
the finding of dependency or admitted the allegations in the petition, have
failed to appear for the arraignment hearing after proper notice, or have not
been located despite a diligent search having been conducted.
(b) When any child is adjudicated by a court to be dependent, the court
having jurisdiction of the child has the power by order to:
1. Require the parent and, when appropriate, the legal custodian and the
child to participate in treatment and services identified as necessary. The
court may require the person who has custody or who is requesting custody
of the child to submit to a mental health or substance abuse disorder
—
assessment or evaluation. The order may be made only pon good cause
shown and pursuant to notice and procedural requirements provided under
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the Florida Rules of Juvenile Procedure. The mental health assessment or
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evaluation must be administered by a qualified professional as defined in s.
39.01, and the substance abuse assessment or evaluation must be adminis-
tered by qualified professional as defined in s. 397.311. The court may also
require such person to participate in and comply with treatment and
°®
services identified as necessary, including, when appropriate and available,
participation in and compliance with a mental health court program
established under chapter 394 or a treatment -based drug court program
established under s. 397.334. In addition to supervision by the department,
the court, including the mental health court program or the treatment -based
drug court program, may oversee the progress and compliance with
c
treatment by a person who has custody or is requesting custody of the
child. The court may impose appropriate available sanctions for noncom-
pliance upon a person who has custody or is requesting custody of the child or
make a finding of noncompliance for consideration in determining whether
an alternative placement of the child is in the child's best interests. Any
Id
order entered under this subparagraph may be made only upon good cause
shown. This subparagraph does not authorize placement of a child with a
person seeking custody of the child, other than the child's parent or legal
CD
custodian, who requires mental health or substance abuse disorder treat-
ment.
2. Require, if the court deems necessary, the parties to participate in
..
dependency mediation.
3. Require placement of the child either under the protective supervision
of an authorized agent of the department in the home of one or both of the
child's parents or in the home of a relative of the child or another adult
approved by the court, or in the custody of the department. Protective
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supervision continues until the court terminates it or until the child reaches
the age of 18, whichever date is first. Protective supervision shall be
terminated by the court whenever the court determines that permanency
has been achieved for the child, whether with a parent, another relative, or a
legal custodian, and that protective supervision is no longer needed. The
termination of supervision may be with or without retaining jurisdiction, at
the court's discretion, and shall in either case be considered a permanency
option for the child. The order terminating supervision by the department
must shall set forth the powers of the custodian of the child and shall include
the powers ordinarily granted to a guardian of the person of a minor unless
otherwise specified. Upon the court's termination of supervision by the
department, ae further judicial reviews are not required if --�s
permanency has been established for the child.
Section 85. Section 394.4655, Florida Statutes, is amended to read:
394.4655 Involuntary outpatient services plaeement
L
(1) DEFINITIONS. —As used in this section, the term:
L
(a) "Court" means a circuit court or a criminal county court.
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(b) "Criminal county court" means a county court exercising its original
jurisdiction in a misdemeanor case under s. 34.01.
0
�� CRITERIA FOR INVOLUNTARY OUTPATIENT SERVICES
o
PLAGEMENT. person may be ordered to involuntary outpatient services
plaeemen upon a finding of the court by clear and convincing evidence, that
the person meets all of the following criteria by „ lear and ee
a,.n
Wit
�
0
(a) The person is 18 years of age or older_;
(b) The person has a mental illness_;
(c) The person is unlikely to survive safely in the community without
supervision, based on a clinical determination_;
(d) The person has a history of lack of compliance with treatment for
mental illness_;
(e) The person has:
1. At least twice within the immediately preceding 36 months been
involuntarily admitted to a receiving or treatment facility as defined in s.
394.455, or has received mental health services in a forensic or correctional
facility. The 36 -month period does not include any period during which the
person was admitted or incarcerated; or
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2. Engaged in one or more acts of serious violent behavior toward self or
others, or attempts at serious bodily harm to himself or herself or others,
within the preceding 36 months_;
(f) The person is, as a result of his or her mental illness, unlikely to
voluntarily participate in the recommended treatment plan and either he or
she has refused voluntary services plaeement for treatment after sufficient
and conscientious explanation and disclosure of why the services are
necessary r �� r���� r . + c r +r +ri . + or is unable to
a)
determine for himself or herself whether services are plaeement is
necessary_;
N
(g) In view of the person's treatment history and current behavior, the
person is in need of involuntary outpatient services plaeement in order to
prevent a relapse or deterioration that would be likely to result in serious
U
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)_;
(h) It is likely that the person will benefit from involuntary outpatient
services. plae ement; , . d
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(i) All available, less restrictive alternatives that would offer an
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opportunity for improvement of his or her condition have been judged to
be inappropriate or unavailable.
�F24 INVOLUNTARY OUTPATIENT SERVICES .—
(a)1. A patient who is being recommended for involuntary outpatient
services plaeement by the administrator of the reeeiving facility where the
patient has been examined may be retained by the facility after adherence to
the notice procedures provided in s. 394.4599. The recommendation must be
c
supported by the opinion of a psychiatrist and the second opinion of a clinical
psychologist or another psychiatrist, both of whom have personally
examined the patient within the preceding 72 hours, that the criteria for
involuntary outpatient services plaeement are met. However, in eount
i,,,ying a pep ulation of feweF tha 50 if the administrator certifies that a
r°
psychiatrist or clinical psychologist is not available to provide the second
opinion, the second opinion may be provided by a licensed physician who has
postgraduate training and experience in diagnosis and treatment of mental
illness, a physician assistant who has at least 3 years' experience and is
supervised by such licensed physician or a psychiatrist, a clinical social
worker, a n d nervous disorders or by a psychiatric nurse. Any second opinion
authorized in this subparagraph may be conducted through a face -to -face
examination, in person or by electronic means. Such recommendation must
be entered on an involuntary outpatient services plaeement certificate that
authorizes the reeeiving facility to retain the patient pending completion of a
hearing. The certificate must sh" be made a part of the patient's clinical
record.
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2. If the patient 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 reeeiving facility while awaiting the hearing for involun-
tary outpatient services placement Before filing a petition for involuntary
outpatient services tre a t men n , the administrator of the a reeeivin facility or
a designated department representative must identify the service provider
that will have primary responsibility for service provision under an order for
involuntary outpatient services plaeemen , unless the person 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. The service provider shall prepare a written proposed treatment 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 placemen order that addresses the nature and extent of
the mental illness and any co- occurring substance use disorder that
necessitate involuntary outpatient services The treatment plan must
specify the likely level of care, including the use of medication, and
anticipated discharge criteria for terminating involuntary outpatient
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The the „
services. serviee pfevi shall also pfevide a eepy of
treatment to the the the f4eility.
plan patient and administrater of reeeiving
The treatment the the
plan must speeify nature and extent of patient's
illness, the that
00
ntal address reduetion of symptoms neeessifnize
for the treatment that to treat the
0
objeetives serviees and are provided
illness the in living ffinetiening in the
per-son's mental and assist pefsen and
,, n it y or to prevent „ re or deterior Service providers may
select and supervise other individuals to implement specific aspects of the
treatment plan. The services in the then 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. The service provider must certify to the court in the proposed
tM
treatment plan whether sufficient services for improvement and stabiliza-
tion are currently available and whether the service provider agrees to
provide those services. If the service provider certifies that the services in
the proposed treatment plan are not available, the petitioner may not file the
petition. The service provider must notify the managing entity if the
requested services are not available. The managing entity must document
such efforts to obtain the requested services.
(b) If a patient in involuntary inpatient placement meets the criteria for
involuntary outpatient services placement the administrator of the treat -
ment facility may, before the expiration of the period during which the
then facility s authorized to retain the recommend involun-
Y patient, p
tary outpatient services placement The recommendation must be supported
by the opinion of a psychiatrist and the second opinion of a clinical
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psychologist or another psychiatrist, both of whom have personally
examined the patient within the preceding 72 hours, that the criteria for
involuntary outpatient services plaee -eat are met. However, in eount3�
having „ populatio of fe tha 50 if the administrator certifies that a
psychiatrist or clinical psychologist is not available to provide the second
opinion, the second opinion may be provided by a licensed physician who has
postgraduate training and experience in diagnosis and treatment of mental
illness, a physician assistant who has at least three years' experience and is
supervised by such licensed physician or a psychiatrist, a clinical social
worker, a n d nervous disorders or by a psychiatric nurse. Any second opinion
authorized in this subparagraph may be conducted through a face -to -face
examination, in person or by electronic means. Such recommendation must
be entered on an involuntary outpatient services plaeemen certificate, and
the certificate must be made a part of the patient's clinical record.
(61. The administrator of the treatment facility shall provide a copy of
the involuntary outpatient services plaeement certificate and a copy of the
state mental health discharge form to the managing entity a dep
representati in the county where the patient will be residing. For persons
who are leaving a state mental health treatment facility, the petition for
L
involuntary outpatient services plaeeme must be filed in the county where
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the patient will be residing.
2. The service provider that will have primary responsibility for service
LO
provision shall be identified by the designated department representative
before prior to the order for involuntary outpatient services plaeement and
must, before prior e filing a petition for involuntary outpatient services
plaeeme certify to the court whether the services recommended in the
patient's discharge plan are available in the leeal eemmunity and whether
the service provider agrees to provide those services. The service provider
must develop with the patient, or the patient's guardian advocate, if
appointed, a treatment or service plan that addresses the needs identified
in the discharge plan. The plan must be deemed to be clinically appropriate
by a physician, clinical psychologist, psychiatric nurse, mental health
counselor, marriage and family therapist, or clinical social worker, as
defined in this chapter, who consults with, or is employed or contracted by,
rd
the service provider.
3. If the service provider certifies that the services in the proposed
treatment or service plan are not available, the petitioner may not file the
petition. The service provider must notify the managing entity if the
requested services are not available. The managing entity must document
such efforts to obtain the requested services.
..
LC� PETITION FOR INVOLUNTARY OUTPATIENT SERVICES
r-
a)
PLACEMENT.
(a) A petition for involuntary outpatient services plaeemen maybe filed
+"
by:
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1. The administrator of a receiving facility; or
2. The administrator of a treatment facility.
(b) Each required criterion for involuntary outpatient services pl-aee-
ment must be alleged and substantiated in the petition for involuntary
outpatient services plaeement A copy of the certificate recommending
involuntary outpatient services plaeement completed by a qualified profes-
sional specified in subsection (3) {� must be attached to the petition. A copy
of the proposed treatment plan must be attached to the petition. Before the
petition is filed, the service provider shall certify that the services in the
proposed tree plan are available. If the necessary services are not
in the to th e
—
av ailable patien e eal eemmunityze respond person
individual . ar the petition may not be filed. The service provider must
notify the managing entity if the requested services are not available. The
managing entity must document such efforts to obtain the requested
services.
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0
(c) The petition for involuntary outpatient services plaeemet 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
L CL
filed in the county where the patient will reside. When the petition has been
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filed, the clerk of the court shall provide copies of the petition and the
proposed treatment plan 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
filing a petition under this subsection.
g
L5�44 APPOINTMENT OF COUNSEL. — Within 1 court working day
E_
after the filing of a petition for involuntary outpatient services pl-aeement
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
c
counsel. The clerk of the court shall immediately notify the public defender
of the appointment. The public defender shall represent the person until the
petition is dismissed, the court order expires, or the patient is discharged
from involuntary outpatient services plaeement An attorney who represents
the patient must be provided shall have 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.
L6 5 CONTINUANCE OF HEARING. —The patient is entitled, with
the concurrence of the patient's counsel, to at least one continuance of the
LL
hearing. The continuance shall be for a period of up to 4 weeks.
HEARING ON INVOLUNTARY OUTPATIENT SERVICES PLA-
E
CEMENT.—
(a)1. The court shall hold the hearing on involuntary outpatient services
+"
plaeemen within 5 working days after the filing of the petition, unless a
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continuance is granted. The hearing must s be held in the county where
the petition is filed, must shfrll be as convenient to the patient as is
consistent with orderly procedure, and must 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 and if the patient's counsel does not object, the court
may waive the presence 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.
2. The court may appoint a magistrate mastef to preside at the hearing.
One of the professionals who executed the involuntary outpatient services
=
plaeement 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
a)
independent expert examination. If the patient cannot afford such an
examination, the court shall ensure that one is provided, as otherwise
provided by law pr r e . The independent expert's report is shall be
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
L
individuals, including family members, deemed by the court to be relevant
CL
under state law, regarding the person's prior history and how that prior
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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.
0
(b)1. If the court concludes that the patient meets the criteria for
r-
involuntary outpatient services pl-aeement pursuant to subsection (2) {�, the
+"
court shall issue an order for involuntary outpatient services pl-aeement The
court order shall be for a period of up to 90 days ors The order must
specify the nature and extent of the patient's mental illness. The order of the
court and the treatment plan must A� be made part of the patient's clinical
c
record. The service provider shall discharge a patient from involuntary
outpatient servicesn when the order expires or any time the
patient no longer meets the criteria for involuntary placement. Upon
discharge, the service provider shall send a certificate of discharge to the
court.
rd
2. 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
service provider 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 ^,r, ney fef Health Caf ^ a.. inist .i by the service provider within
1 working day after it is received from the court. The order may be submitted
electronically through existing data systems. After the pl-aeement order for
M
involuntary services is issued, the service provider and the patient may
modify ref the treatment plan. For any material modification of the
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treatment plan to which the patient or if one is appointed, the patient's
guardian advocate agrees, if appointed d oes ,,,.... ^ ^ , the service provider shall
send notice of the modification to the court. Any material modifications of
the treatment plan which are contested by the patient or the patient's
guardian advocate, if applicable appointed, must be approved or disapproved
by the court consistent with subsection (3)
3. If, in the clinical judgment of a physician, the patient has failed or has
refused to comply with the treatment ordered by the court, and, in the
clinical judgment of the physician, efforts were made to solicit compliance
and the patient may meet the criteria for involuntary examination, a person
a
may be brought to a receiving facility pursuant to s. 394.463. If, after
examination, the patient does not meet the criteria for involuntary inpatient
placement pursuant to s. 394.467, the patient must be discharged from the
reeeivixg facility. The involuntary outpatient services plaeement order shall
0
remain in effect unless the service provider determines that the patient no
longer meets the criteria for involuntary outpatient services plaeement or
until the order expires. The service provider must determine whether
modifications should be made to the existing treatment plan and must
attempt to continue to engage the patient in treatment. For any material
P
modification of the treatment plan to which the patient or the patient's
CL
guardian advocate, if applicable appointed, agrees wee the service
CL
provider shall send notice of the modification to the court. Any material
modifications of the treatment plan which are contested by the patient or the
patient's guardian advocate, if applicable appointed must be approved or
00
disapproved by the court consistent with subsection (3)
r-
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(c) If, at any time before the conclusion of the initial hearing on
+"
involuntary outpatient services plaeemen it appears to the court that
the person does not meet the criteria for involuntary outpatient services
plaeemen under this section but, instead, meets the criteria for involuntary
inpatient placement, the court may order the person admitted for involun-
c
tary inpatient examination under s. 394.463. If the person instead meets the
criteria for involuntary assessment, protective custody, or involuntary
admission pursuant to s. 397.675, the court may order the person to be
admitted for involuntary assessment for a period of 5 days pursuant to s.
397.6811. Thereafter, all proceedings are shall be governed by chapter 397.
(d) At the hearing on involuntary outpatient services placement the
04
court shall consider testimony and evidence regarding the patient's
CD
competence to consent to services tre a t men n . If the court finds that the
patient is incompetent to consent to treatment, it shall appoint a guardian
advocate as provided in s. 394.4598. The guardian advocate shall be
LL
appointed or discharged in accordance with s. 394.4598.
..
(e) The administrator of the receiving facility or the designated depart-
ment 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 plaeemen Such documentation must
include any advance directives made by the patient, a psychiatric evaluation
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of the patient, and any evaluations of the patient performed by a eliflieffl
psychologist or a clinical social worker.
PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATI-
ENT SERVICES .—
(a)1. If the person continues to meet the criteria for involuntary
outpatient services plaeement the service provider shall, at least 10 days
before the expiration of the period during which the treatment is ordered for
the person, file in the e at court that issued the order for involuntary
outpatient services a petition for continued involuntary outpatient services
plaeeme The court shall immediately schedule a hearing on the petition to
U)
be held within 15 days after the petition is filed.
_
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2. The existing involuntary outpatient services pl-aeement order remains
in effect until disposition on the petition for continued involuntary out-
patient services plaeement
L
3. A certificate shall be attached to the petition which includes a
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statement from the person's physician or clinical psychologist justifying
the request, a brief description of the patient's treatment during the time he
L
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or she was receiving involuntary services involuntarily -heed and an
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individualized plan of continued treatment.
4. The service provider shall develop the individualized plan of con-
tinued treatment in consultation with the patient or the patient's guardian
04
advocate, if applicable appointed. When the petition has been filed, the clerk
of the court shall provide copies of the certificate and the individualized plan
of continued services tre atme nt to the department, the patient, the patient's
guardian advocate, the state attorney, and the patient's private counsel or
the public defender.
0
(b) Within 1 court working day after the filing of a petition for continued
involuntary outpatient services plaeemen , 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. 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 or the
court order expires or the patient is discharged from involuntary outpatient
servicesnt Any attorney representing the patient shall have 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.
(c) Hearings on petitions for continued involuntary outpatient services
must .,',,,,,,ri ent s be before the emit court that issued the order for
involuntary outpatient services The court may appoint a magistrate master
to preside at the hearing. The procedures for obtaining an order pursuant to
this paragraph must meet the requirements of shall be in ,,,,,, ee wit
+"
subsection (7) {�, except that the time period included in paragraph 2 e
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�� is not applicable in determining the appropriateness of additional
periods of involuntary outpatient placement.
(d) Notice of the hearing must shill be provided as set forth in s.
394.4599. The patient and the patient's attorney may agree to a period of
E
continued outpatient services plaeement without a court hearing.
(e) The same procedure must sh-ll be repeated before the expiration of
each additional period the patient is placed in treatment.
(f) If the patient has previously been found incompetent to consent to
�-
treatment, the court shall consider testimony and evidence regarding the
patient's competence. Section 394.4598 governs the discharge of the
guardian advocate if the patient's competency to consent to treatment has
been restored.
Section 86. Paragraphs (c) and (d) of subsection (2) of section 394.4599,
Florida Statutes, are amended to read:
,0
394.4599 Notice. —
L
(2) INVOLUNTARY ADMISSION. —
CL
(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.
0
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) s-
394.463(2)(i4. 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.
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(d) The written notice of the filing of the petition for involuntary services
for plaeement ef an individual being held must contain the following:
1. Notice that the petition for:
receiving or treatment facility or his or her designee.
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Packet Pg. 1006
U)
a. Involuntary inpatient treatment pursuant to s. 394.467 has been filed
with the circuit court in the county in which the individual is hospitalized
U)
and the address of such courts
b. Involuntar outpatient services pursuant to s. 394.4655 has been filed
- v
with the criminal county court, as defined in s. 394.4655(1), or the circuit
court, as applicable, in the county in which the individual is hospitalized and
the address of such court
_
L
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.
c
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.
L CL
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4. Notice that the individual, the individual's guardian, guardian
advocate, health care surrogate or proxy, or representative, or the admin-
istrator may apply for a change of venue for the convenience of the parties or
witnesses or because of the condition of the individual.
0
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.
Section 87. Section 394.455, Florida Statutes, is amended to read:
394.455 Definitions. —As used in this part, unless the e^nt^ °t eleaf .
res otherwise the term:
(1) "Access center" means a facility that has medical, mental health, and
substance abuse professionals to provide emergency screening and evalua-
tion for mental health or substance abuse disorders and may provide
transportation to an appropriate facility if an individual is in need of more
CD
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.
M
i3U�� "Administrator" means the chief administrative officer of a
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receiving or treatment facility or his or her designee.
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(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.
L5 $ "Clinical psychologist" means a psychologist as defined in s.
490.003(7) with 3 years of postdoctoral experience in the practice of clinical
psychology, inclusive of the experience required for licensure, or a
psychologist employed by a facility operated by the United States Depart-
ment of Veterans Affairs that qualifies as a receiving or treatment facility
.
under this part.
L
LQ -34 "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.
M44 "Clinical social worker" means a person licensed as a clinical social
worker under s. 491.005 or s. 491.006 ^ham 491
0
L8 -54 "Community facility" means a a4i-y community service provider
that contracts ^er ±e± - a with the department to furnish substance abuse
P
or mental health services under part IV of this chapter.
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CL
L9��64 "Community mental health center or clinic" means a publicly
funded, not - for - profit center that •eh contracts with the department for
the provision of inpatient, outpatient, day treatment, or emergency services.
10 � "Court," unless otherwise specified, means the circuit court.
.
11 00 "Department" means the Department of Children and Families.
(12) "Designated receiving facility" means a facility pproved 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.
(13) "Detoxification facility" means a facility licensed to provide detox-
ification services under chapter 397.
(14) "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.
15 4J9 "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
B
form of constraint or coercion.
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16 � "Facility" means any hospital, community facility, public or
private facility, or receiving or treatment facility providing for the evalua-
tion, diagnosis, care, treatment, training, or hospitalization of persons who
appear to have a mental illness or who have been diagnosed as having a E
mental illness or substance abuse impairment The term 'Taeility" does not
include a any program or an entity licensed under pursuant to chapter 400 or
chapter 429.
17 {} "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.
18 {} "Guardian advocate" means a person appointed by a court to
a)
N
—
make decisions regarding mental health treatment on behalf of a patient
who has been found incompetent to consent to treatment pursuant to this
The be b
part. guardian adveeate may granted speeifie additional powers
•
19 {� "Hospital" means a hospital f6eility a defined i n , 395.002 a
L
0
4-
licensed under chapter 395 and part II of chapter 408.
L
20 { W "Incapacitated" means that a person has been adjudicated
CL
CL
incapacitated pursuant to part V of chapter 744 and a guardian of the
person has been appointed.
21 { W "Incompetent to consent to treatment" means a state in which
that a person's judgment is so affected by a his mental illness or a
substance abuse impairment that he or sheen lacks the capacity to
make a well- reasoned, willful, and knowing decision concerning his or her
medical, or mental health or substance abuse treatment.
(22) "Involuntary examination" means an examination performed under
U
s. 394.463, s. 397.6772, s. 397.679, s. 397.6798, or s. 397.6811 to determine
c
whether a person qualifies for involuntary services.
(23) "Involuntary services" means court - ordered outpatient services or
inpatient placement for mental health treatment pursuant to s. 394.4655 or
s. 394.467.
04
24 � "Law enforcement officer" has the same meaning as provided
means a l en f e M,,,.. ent e ffi er as defi in s. 943.10.
CD
(25) "Marriage and family therapist" means a person licensed to practice
marriage and family therapy under s. 491.005 or s. 491.006.
(26) "Mental health counselor" means a person licensed to practice
mental health counseling under s. 491.005 or s. 491.006.
27 4-74 "Mental health overlay program" means a mobile service that
provides an independent examination for voluntary admission
ie� and a range of supplemental onsite services to persons with a
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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 purstiant to
this part through a mental health overlay program must only be provided
under contract with the department for this sefv; or be attached to a public
receiving facility that is also a community mental health center.
28 � "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 substan-
tially 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 condi-
tions manifested only by antisocial behavior or substance abuse Wit.
(29) "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.
30 {fig} "Mobile crisis response service" means a nonresidential crisis
P
service atta h to a ubli, r eee i v i n g c,,eilit., and available 24 hours per a
CL
CL
day, 7 days per a 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, t ake plaee for the purpose of identifying appropriate
treatment services.
0
LL 11{- "Patient" means any person with or without a co- occurring
substance abuse disorder, who is held or accepted for mental health
treatment.
U
0
32 {� "Physician" means a medical practitioner licensed under chap-
ter 458 or chapter 459 who has experience in the diagnosis and treatment of
mental illness a n d nervous disorders or a physician employed by a facility
operated by the United States Department of Veterans Affairs or the United
tm
States Department of Defense whieh qu alifies as a reeeiving or treat en
c,, ,.,der this p
04
(33) "Physician assistant" means a person licensed under chapter 458 or
chapter 459 who has experience in the diagnosis and treatment of mental
disorders.
34 {� "Private facility" means a any hospital or facility operated by a
for - profit or not - for - profit corporation or association which that provides
mental health or substance abuse services and is not a public facility.
35 � "Psychiatric nurse" means an advanced registered nurse practi-
tioner certified under s. 464.012 who has a master's or doctoral degree in
psychiatric nursing, holds a national advanced practice certification as a
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psychiatric mental health advanced practice nurse, and has 2 years of post-
master's clinical experience under the supervision of a physician.
36 {-24) "Psychiatrist" means a medical practitioner licensed under
chapter 458 or chapter 459 who has p a;,,,,.nosea and treated me nt a l
a nd s di fs for at least a pefi of not less tha 3 years, inclusive
of psychiatric residency.
r_
L M{-2 "Public facility" means a airy facility that has contracted with
the department to provide mental health services to all persons, regardless
of t-h, -4 ability to pay, and is receiving state funds for such purpose.
a)
N
(38) "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 s. 394.455.
39 {26} "Receiving facility" means a aRy public or private facility or
L
hospital designated by the department to receive and hold or refer, as
appropriate, involuntary patients under emergency conditions of for mental
health or substance abuse psyehiatrie evaluation and to provide sho
CL
treatment or transportation to the appropriate service provider The term
does not include a county jail.
40 {� "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.
g
41 {2 { "Restraint" means_ a ph aa eal devie , met-hod of dFug used +
(a) A physical restraint including is, any manual method or physical or
c
mechanical device, material, or equipment attached or adjacent to an the
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 re-
straint" 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
CD
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 used as „ r i a medication used to control a the
person's behavior or to restrict his or her freedom of movement which aid is
not part of the standard treatment regimen of a person with a diagnosed
Z
mental illness who i a elie t oft the d ei3 ,r+,. en t Ph a li v i, E ,
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department when rendering such services to a person pursuant to the
provisions of this part. Patients treated in facilities of the United States
85
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ph re str a int .
bands, holding for
or other physieal when neeessary routine physieal
tests; for
tM
examinations and or purposes of orthopedie, surgieal, or othe
funetional body balanee; to
ment of position or proper or when used preteet Ei
c e c out of be
42 {fig} "Seclusion" means the physical segregation of a pets .n in an
fashion 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 eaple the term does not mean isolation due to a person's medical
L o
condition or symptoms.
43 {W "Secretary" means the Secretary of Children and Families.
P
CL
CL
(44) "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 registered nurse practitioner, a
psychiatric nurse, or a qualified professional as defined in s. 39.01.
(45) "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.
46 414 "Transfer evaluation" means the process by which
by the a di e ffi e of the d ent whereby y a person who is
being considered for placement in a state treatment facility is first evaluated
for appropriateness of admission to such t4e facility by a „^ri,ri un it y b ase
efinie.
47 {-32} "Treatment facility" means a a+iy 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
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Government shall be solely those whose care is the responsibility of the
United States Department of Veterans Affairs.
(48) "Triage center" means a facility that has medical, mental health,
and substance abuse professionals present or on call to provide emergencX
screening and evaluation for mental health or substance abuse disorders for
individuals transported to the center by a law enforcement officer.
entity tinder eentraet with the Department of Children and Families to
worker, a 1 family therapist, a mental health eounseler,
L
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10 n
6', WA
. ...............
i
(36) " Marriag e a family therapist me ans a person heensed as r a LO
04
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Section 88. Subsection (2) of section 394.463, Florida Statutes, is
amended to read:
394.463 Involuntary examination. —
rd
(2) INVOLUNTARY EXAMINATION.— 04
(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
written or „ 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, shall take the person into custody and
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deliver him or her to an appropriate, or the nearest, Feeeivixg facility within
the designated receiving system pursuant to s. 394.462 for involuntary
examination. The order of the court shall be made a part of the patient's
clinical record. A No fee may not sly be charged for the filing of an order
under this subsection. A Any r,,,,,,;vin facility accepting the patient based
on this order must send a copy of the order to the department for
u rare Adminis tration o the next working day. The order may be
submitted electronically through existing data systems, if available. The
order shall be valid only until the person is delivered to the facility or
•
exe etited or , if not ,...,. a for the period specified in the order itself,
whichever comes first If no time limit is specified in the order, the order
shall be valid for 7 days after the date that the order was signed.
2. A law enforcement officer shall take a person who appears to meet the
criteria for involuntary examination into custody and deliver the person or
a)
have him or her delivered to an appropriate, or the nearest, reeeiving facility
within the designated receiving system pursuant to s. 394.462 for examina-
tion. The officer shall execute a written report detailing the circumstances
under which the person was taken into custody, which must and the FepeA
sl-a4 be made a part of the patient's clinical record. Any reeeiving facility
L
accepting the patient based on this report must send a copy of the report to
the department ^ geney for u Car A dministration o the next working
CL
day.
3. A physician, clinical psychologist, psychiatric nurse, mental health
counselor, marriage and family therapist, or 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, sueh as ., far.,
appearance f eutpat t evaluation a law enforcement officer shall take
c
into custody the person named in the certificate i nte eustedy and deliver him
or her to the appropriate, or nearest, reeeiving 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. The report
ry
and certificate shall be made a part of the patient's clinical record. Any
reeeivixg facility accepting the patient based on this certificate must send a
copy of the certificate to the department geney for u rare Admi
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;rtM�r the next working day. The document may be submitted
electronically through existing data systems, if applicable.
(b) A person may sly 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
M
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
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the person is transported to a receiving facility. A Feeeivin 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 Ageney fef T eal�are
n a. inistfat of such admission by certified mail or by e -mail, if available,
by n,.'� 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 serve and execute such order on any
a
day of the week, at any time of the day or night.
(d) A law enforcement officer acting in accordance with an ex parte order
F
issued pursuant to this subsection may use such reasonable physical force as
is necessary to gain entry to the premises, and any dwellings, buildings, or
U
other structures located on the premises, and to take custody of the person
who is the subject of the ex parte order.
(e) The department ^ g,,ney for u rare Adminis tration shall receive
>
and maintain the copies of ex parte orders, involuntary outpatient services
L
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plaeemen orders issued pursuant to s. 394.4655, involuntary inpatient
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placement orders issued pursuant to s. 394.467, professional certificates,
and law enforcement officers' reports. These documents shall be considered
part of the clinical record, governed by the provisions of s. 394.4615. These
documents shall be used to The ageney sal prepare annual reports
analyzing the data obtained from these documents, without information
identifying patients, and shall provide copies of 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.
(f) A patient shall 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 reeeiving facility without unnecessary delay
to determine if the criteria for involuntary services are met. Emergency
treatment may be provided and may, upon the order of a physician if the
physician determines,' t reat m ent if it is a ,.a 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 or, if the
receiving facility is owned or operated by a hospital or health system, 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 and n us di fs and 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
M
However , be held ; c,, for
psychiatrist. a p atie n t of y
involuntary examination longer than 72 hour—,.
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
(9) Within the 72 -hour examination period or, if the 72 hours ends on a
weekend or holiday. no later than the next workinLy day thereafter. 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 the provisions of subpara-
graph 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 if
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inpatient treatment is deemed necessary or with the criminal county court,
as defined in s. 394.4655(1), as applicable. When inpatient treatment is
deemed necessary, the least restrictive treatment consistent with the
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optimum improvement of the patient's condition shall be made available.
W hen a petition is to be filed for involuntary outpatient placement, it shall
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be filed by one of the petitioners specified in s. 394.4655(4)(a). A petition for
involuntary inpatient placement shall be filed by the facility administrator.
�{g} A person for whom an involuntary examination has been initiated
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who is being evaluated or treated at a hospital for an emergency medical
g
condition specified in s. 395.002 must be examined by a reeeivixg facility
within 72 hours. The 72 -hour 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 outpatient services
plaeemen pursuant to s. 394.4655(2) 394.4655(i) or involuntary inpatient
placement pursuant to s. 394.467(1), the patient may be offered voluntary
services or placement, 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
inpatient services pl-aeement or involuntary outpatient placement must be
entered into the patient's clinical record. N othing am This paragraph is not
intended to prevent a hospital providing emergency medical services from
LL
appropriately transferring a patient to another hospital before prior to
stabilization if --previ&4 the requirements of s. 395.1041(3)(c) have been
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met.
E
Di 4h4 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:
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Ch. 2016 -241 LAWS OF FLORIDA Ch. 201 C.26a
1. The patient must be examined by a designated M,.,,, ivi facility and
released; or
2. The patient must be transferred to a designated reeeiving facility in
which appropriate medical treatment is available. However, the wing
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.
( ) Within the hour exa p erio d o the 72 hours ends on �
weekend of e e one of the
patient following aetions must be taken, based on the individual needs of the
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inpatient treatment is deemed neeessary, the least restrietive treatment- .2
tent with the eptimum imprevement of the patient's eendition shall be
made availab W he n a pet is to be filed fo ;.,.,.,h o tpati
piaeemeir�it shall be fi by one of the petitioners speeified in s.
394.4655 p ccrcro n f ; oi rpeix praccrrrcrr shal be
filed by the f6eility administfatef.
Section 89. Subsection (3) of section 394.4615, Florida Statutes, is r-
amended to read:
394.4615 Clinical records; confidentiality. —
®
04
(3) Information from the clinical record may be released in the following
circumstances: CD
(a) When a patient has declared an intention to harm other persons.
When such declaration 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,
90
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Packet Pg. 1016
a
3.
The patient, unless
he or she is eharged with a
erifne, shall be asked
to
CL
inpatient treatment is deemed neeessary, the least restrietive treatment- .2
tent with the eptimum imprevement of the patient's eendition shall be
made availab W he n a pet is to be filed fo ;.,.,.,h o tpati
piaeemeir�it shall be fi by one of the petitioners speeified in s.
394.4655 p ccrcro n f ; oi rpeix praccrrrcrr shal be
filed by the f6eility administfatef.
Section 89. Subsection (3) of section 394.4615, Florida Statutes, is r-
amended to read:
394.4615 Clinical records; confidentiality. —
®
04
(3) Information from the clinical record may be released in the following
circumstances: CD
(a) When a patient has declared an intention to harm other persons.
When such declaration 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,
90
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Packet Pg. 1016
3.
The patient, unless
he or she is eharged with a
erifne, shall be asked
to
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if sueh
eensent is
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e
given
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inpatient treatment is deemed neeessary, the least restrietive treatment- .2
tent with the eptimum imprevement of the patient's eendition shall be
made availab W he n a pet is to be filed fo ;.,.,.,h o tpati
piaeemeir�it shall be fi by one of the petitioners speeified in s.
394.4655 p ccrcro n f ; oi rpeix praccrrrcrr shal be
filed by the f6eility administfatef.
Section 89. Subsection (3) of section 394.4615, Florida Statutes, is r-
amended to read:
394.4615 Clinical records; confidentiality. —
®
04
(3) Information from the clinical record may be released in the following
circumstances: CD
(a) When a patient has declared an intention to harm other persons.
When such declaration 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,
90
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Packet Pg. 1016
Ch. 2016 -241 LAWS OF FLORIDA Ch. 2 C.26a
compilation of treatment data, aftercare planning, or evaluation of pro
grams.
For the purpose of determining whether a person meets the criteria for
involuntary outpatient placement or for preparing the proposed treatment
plan pursuant to s. 394.4655, 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 identified in s. 394.4655(7)(b)2. 394.4655(6)(b42 in accordance
with state and federal law. U
Section 90. For the 2016 -2017 fiscal - year, the sum of $400,000 in
nonrecurring funds is appropriated from the Operations and Maintenance
Trust Fund to the Department of Children and Families for the purpose of
modifying the existing crisis stabilization database to collect and analyze
data and information pursuant to s. 397.321, Florida Statutes, as amended
by this act.
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Section 91. This act shall take effect July 1, 2016.
Approved by the Governor April 15, 2016. P
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Filed in Office Secretary of State April 15, 2016.
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91
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Packet Pg. 1017