HomeMy WebLinkAboutItem C08 BOARD OF COUNTY COMMISSIONERS
COUNTY of MONROE Mayor Michelle Lincoln,District 2
The Florida. Keys Mayor Pro Tem David Rice,District 4
p Craig Cates,District 1
James K. Scholl,District 3
- Holly Merrill Raschein,District 5
Regular Meeting
June 10, 2026
Agenda Item Number: C8
26-32139
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: NA STAFF CONTACT: Andrew Roltsch
AGENDA ITEM WORDING:
Approval of the Monroe County Designated Receiving System Plan for 2026-2029 as presented by South
Florida Behavioral Health Network, d.b.a. Thriving Mind South Florida, the designated Managing Entity for
Monroe County and Miami/Dade County. The plan designates Guidance Care Center as the primary provider
and sole public receiving facility for Monroe County as required by Senate Bill 12 (Chapter 2016-241).
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 were to plan a designated receiving system. The
initial plan was completed and implemented on July 1, 2017. On March 2, 2017, South Florida
Behavioral Health Network (SFBHN) held a Monroe County SB 12 Planning meeting with
community members and providers. As a result of the meeting an action plan for a Centralized
Receiving System for Monroe County was developed. The Monroe County Designated Receiving
System Plan (Plan) for 2026 to 2029 is brought before the Board for approval and acceptance as
prepared and presented by SFBHN/Thriving Minds South Florida, the designated managing entity for
Monroe County. The Plan was previously approved by the BOCC at its 7/19/23 meeting.
PREVIOUS RELEVANT BOCC ACTION:
July 19, 2023, agenda item D.9, the BOCC approved of the Monroe County Designated Receiving
System Plan for 2023-2026. March 17, 2021, agenda item C.11, the BOCC approved of the Monroe
County Designated Receiving System Plan for 2021-2023. (Note: March 17 agenda item was a
correction of the plan's cover sheet to read 2021-2023). May 17, 2017, Agenda Item No. C.21, the
BOCC approved the Designated Receiving System plan 2017-2020, as designated by the Managing
Entity for Monroe County, South Florida Behavioral Health Network, for a centralized receiving
system for Monroe County as required by Senate Bill 12 (Chapter 2016-241)
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION:
Approval
DOCUMENTATION:
FINANCIAL IMPACT:
Effective Date: 07/01/2026
Expiration Date: 06/30/2029
Total Dollar Value of Contract:
Total Cost to County:
Current Year Portion:
Budgeted:
Source of Funds:
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: If yes, amount:
Grant:
County Match:
MONROE COUNTY
IIII)esligina-ted 111IRecellIvIlling SystemIIII° IIII i
2026-2029
Developed Pursuant to.:-
Florida Mental Health (Baker) Act
Chapter 394, Florida Statutes
and
Substance Abuse Services (Marchman) Act
Chapter 397, Florida Statutes
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Table �� Contents
° �==°�� =°
Tablenf Contents ............................................................................................................................ 2
Section |: Background and Purpose.................................................................................................4
Statutory Authority----------------------------------------4
No-Wrong-Door Model and Entry Points ----------------------------'4
ORGGoals................................................................................................................................... 5
Florida Crisis Services Continuum................................................................................................ 5
Integration with 988 Suicide and Crisis Lifeina-------------------------' G
Mobile Response Teams (K4RTn)................................................................................................. 8
Collaboration with Lmxv Enforcement and Crisis Intervention Teorna /[1Tl------------ 8
Cana Coordination and Referrals.................................................................................................. O
PlanPeriod and Review............................................................................................................... 7
Definitions........................................................................................................................................ 8
Section U: Monroe County Designated Receiving System.............................................................. 11
A. Coordinated Receiving System Structure............................................................................... 11
Centralized Receiving Facility (CRF) ...................................................................................... 11
B. Geographic F&aokona ------------------------------------.. 11
C. Receiving Facility Capacity and Coordination ------------------------ 11
Funded Beds at Public Receiving Fau|UUaa-------------------------' 12
Section U|: Inventory ofParticipating Service Providers ---------------------' 12
A. Public Receiving Facilities...................................................................................................... 12
B. Privately Operated Baker Act Receiving Facilities.................................................................. 12
C. Federally Funded Facility-Veterans Services ...................................................................... 13
O. Addiction Receiving Facilities and Detoxification Services..................................................... 13
Section UI-B: Acute and Ambulatory Care Service Fkovva--------------------- 13
A. Acute Care- Public Receiving Facility................................................................................... 13
B. Acute Cana- Private Receiving Foci|itv---------------------------. 14
C. Ambulatory Cane Services ---------------------------------' 15
Section |V: Designated Receiving 8vatenn Agreements ---------------------' 15
A. Data Sharing and Information Technology............................................................................. 16
B. Network Service Provider Cortnacto, Business Associate Agreements, and Data Sharing
Agreements................................................................................................................................ 1O
C. Privacy and Confidentiality Requirements.............................................................................. 10
O. Gvatenn Monitoring and Quality Improvement......................................................................... 17
E. Continuous System Development.......................................................................................... 17
Attachment B: Transportation Plan - Monroe County .................................................................... 20
i Purpose and Authority------------------------------------. 28
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GuidingPrinciples................................................................................................................... 2O
U. Criteria for Involuntary Examination- Baker Act..................................................................... 28
Baker Act-72-Hour Examination Period................................................................................ 27
Authorized Initiation of Baker Act Involuntary Examination -----------------' 27
Ill. Criteria for Involuntary Admission - Marchrnon Act............................................................... 28
|V. Law Enforcement Designation for Transportation.................................................................. 28
V. Transportation bv Mobile Crisis Response Team or Mental Health Overlay Program............. 28
VI. Baker Act-Transport Requirements and Special PooutsUona --------------- 29
Role of Emergency Medical Services /EMSA and Ambulance ................................................. 30
VIi Required Forms and Documentation.................................................................................... 3O
Law Enforcement Required Forms.......................................................................................... 3O
EMS /Ambulance Required Documentation........................................................................... 3O
Mobile Response Team (K4RT) Required Ooournentakion------------------. 31
Electronic Baker Act Documentation ha-Boher Act)................................................................. 31
ViU. Marohnnan Act-Transport Requirements........................................................................... 31
|X K4arohnnan Act- Required Forms------------------------------ 33
X. Receiving Facility Acceptance and Transfers......................................................................... 32
)0. Centralized Receiving Facility (CRF)..---------------------------' 32
XIi Plan Review and Coordination------------------------------- 32
)gU. Effective Date and Term...................................................................................................... 33
Appendix A: Designated Receiving Fao|UUaa- Monroe County -----------------' 37
Baker Act Receiving Facilities .................................................................................................... 37
Facilities with Significant Medical Capability............................................................................... 37
GCC Satellite Office Locations................................................................................................... 37
Appendix B: Addiction Receiving Facilities and Inpatient Detoxification Facilities .......................... 38
ForAdults................................................................................................................................... 38
ForJuveniles.............................................................................................................................. 38
Statutory References -Attachment B......................................................................................... 38
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Section
N Background� � ��
��������� ~� °������������ ��� Purpose
The Monroe County Designated Receiving System ([)R8) Plan describes how the community
coordinates services for individuals experiencing o behavioral health criaia, including mental health
crises and substance use emergencies. The goal of the DRS is to ensure that individuals receive
timely assessment, atobi|izstion, and access ho appropriate treatment and support services.
This Plan is developed in partnership with Monroe County, Thriving Mind South Florida (the
Managing Entity for behavioral health services in Monroe County and yNionni-Oode County), the
Florida Department ofChildren and Families (Department), |000| |oxv enforcement agenniem, and
other community stakeholders.
Statutory Authority
Florida |avv naquinao each community to establish a coordinated crisis response system under the
following statutes:
§ D94.4573, Fla. Stai: Designated Receiving Systems-requires development ofeDRS operating under
allo-N<mong-DooromodeL
§ 394.483, Fla. Stat.: Involuntary Examination (BakerAct)-establishes criteria, procedures, and the 72-
hour examination period.
§ 394.4G2, Fla. Stat.: Jranaportation-govenns transport of individuals for involuntary examination.
§ 394.875. Fla. Stat.: Crisis Stabilization Units-governs CSV operation and designation,
§ 394.9D82, Fla. Stat.: Managing Entities-governs the role and responsibilities nf the Managing Entity.
§ 394.455. Fla. Stmt.: Definitions-including public facility and designated receiving facility.
§ 397.311. Fla. Stmt.: Addiction Receiving Facilities-governs ARF and JAF7F licensing and designation.
§ 397.401(6), Fla. Stat.: A/7F Capacity-allows ARFoto exceed licensed capacity by4pbo /D96 for nm
more than 3 consecutive working days or7 days/n any one month.
§ 397.675, Fla. Stat.: Involuntary Admission (&anrhonan Act)-establishes criteria for involuntary
admissions.
§ 395.002. Fla. Stmt.: Emergency medical condition definition-governs medical priority in transport.
45 C.F.R. §§ 184.3O8, 164.314: /fIPA/4 Security and Privacy Rules-govern PHI sharing acnongDRS
participants.
42 C.F.R. Part 2: Confidentiality mf Substance Use Disorder Patient Records.
No-Wiroing-IlDooir IModelll and II:..:..`Jntiry 1112ollints;
Under Section 394.4573. Florida 8totutes, Monroe Countv's [)R8 operates under the No-Wrong-
Door nnoda|, ensuring that individuals can enter the behavioral health ayobarn through multiple
access points and be connected to appropriate mann regardless of their entry point. Examples of
entry points include:
^ Law enforcement under the Baker Act orMavchmanAct
^ Calls tothe 088 Suicide and Crisis Lifeline
^ Mobile Response Team crisis interventions
^ Emergency departments and hospitals
^ Crisis stabilization units and detoxification facilities
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• Community behavioral health providers and walk-in crisis services
• Referrals from courts,jails, schools, or community partners
• Self-referrals or family referrals through GCC or any satellite office
Regardless of where an individual first seeks help, the system ensures that every person receives:
screening and assessment; crisis stabilization when necessary; referral to the appropriate level of
care; and connection to ongoing behavioral health services.
IICIIIS GoallIs
The DRS is designed to:
• Ensure timely access to crisis services
• Improve coordination between law enforcement, hospitals, and behavioral health providers
• Reduce unnecessary incarceration and emergency room utilization
• Ensure individuals receive care regardless of their ability to pay
• Improve outcomes through coordinated treatment and follow-up services
Thriving Mind South Florida, as the Managing Entity for Behavioral Health Services, is responsible
for coordinating the public crisis system, working with community partners to ensure services are
available and accessible, contracting with providers to deliver a continuum of behavioral health
services, and monitoring system performance to ensure compliance with state requirements.
I11:::::'111oir11da Clriiis iiis Services Continuum
Florida recognizes a broader behavioral health crisis services continuum designed to provide
multiple levels of crisis intervention and stabilization. Monroe County's DRS operates within this
statewide crisis continuum. Key components include:
pill 11
988 Suicide &Crisis Statewide and national crisis call, text, and chat system providing
Lifeline immediate behavioral health support and connecting individuals to local
crisis resources. 988 counselors may provide crisis counseling,
referrals, dispatch MRTs, or contact emergency services when
necessary.
Mobile Response Community-based behavioral health professionals who respond in-
Teams ( Ts) person to crisis situations to conduct assessments, de-escalate crises,
connect individuals to services, and transport individuals when
authorized. §§ 394.463, 397.675, Fla. Stat.
Crisis Stabilization Short-term residential crisis programs providing psychiatric stabilization,
Units (CSUs) evaluation, and treatment for individuals experiencing acute mental
health crises. § 394.875, Fla. Stat.
Addiction Receiving Facilities providing short-term evaluation and stabilization for individuals
Facilities (AFs) experiencing substance use crises under the Marchman Act. § 397.311,
Fla. Stat.
Detoxification Services Medically supervised services assisting individuals experiencing
substance withdrawal to stabilize prior to ongoing treatment.
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Hospital Emergency Hospital-based emergency services providing immediate medical and
Departments psychiatric evaluation for individuals in ohaia.
Community Behavioral Outpatient and community-based providers delivering ongoing
Health Providers behavioral health treatment and support services.
Care Coordination Services assisting individuals in navigating the system and connecting
Services to appropriate levels nf ongoing care. § 394.S082. Fla. SbaL
111integiratilloin wilth 988 Suicide and Cil Ill~11-fellIlline
Monroe County participates in the national 988 Suicide and Crisis Life|ine, which provides 24-hour
crisis support via phone, tax1, and chat. 988 counselors may provide crisis counae|ing, referrals to
amn/ioea. dispatch Mobile Response Teome, or contact emergency services when necessary.
Integration ofgOO into the crisis system improves access to behavioral health services and helps
reduce unnecessary law enforcement involvement oremergency department utilization.
Molbill1le lRespoinse I eams (11MIR I s)
Mobile Response Teams (W1RTs) are behavioral health professionals who respond to individuals
experiencing behavioral health orioaa in community settings. MRT aan/inao may be requested
through the 988 crisis |ina, behavioral health pruvidoro, self and family referro|a, schools or
oonnnnunih/ organizations, |ovv anforcernent, or hospitals and emergency departments.
Mobile Response Teams provide: crisis assessment and intervention; de-escalation of behavioral
health emergencies; referrals to appropriate treatment services; and connection to community
resources. MRTn help divert individuals from unnecessary hospitalization or criminal justice
involvement when aofa and appropriate. When MRT staff are authorized professionals under
Florida |aw, they may initiate involuntary examinations and coordinate transportation through |avv
enforcement, EMS or authorized transport providers contracted by the County when necessary.
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Law enforcement agencies are critical partners in the Monroe County crisis response system. Lovv
enforcement participates in the OR8 through implementation of the county Transportation Plan;
coordination with receiving facilities; participation in crisis response partnerships; and collaboration
with behavioral health providers and Mobile Response Taonna.
The Monroe County Crisis Intervention Team /C|T\ program is community-based initiative that
strengthens collaboration between |ovv enforcement oQanoiaa and behavioral health providers. The
C|T program is designed to: improve safety for individuals in criaia, responding offioers, and the
uonnnnunih/; reduce unnecessary arrests and incarceration of individuals with nnanto| i||naee or
substance use disorders; facilitate connection to behavioral health services; and strengthen
ou||oboradun between |ovv enforoemnant, behavioral health pruvidara, and community partners.
Call Coordination and lReferra Ills
Once on individual has been stabilized at receiving facility, providers develop o discharge plan
that identifies the most appropriate next level of care. Individuals may he referred to: outpatient
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mental health treatment; substance use treatment services; residential treatment programs;
community behavioral health providers; or care coordination services. Thriving Mind South Florida
provides oversight and coordination of referrals to ensure individuals are connected to appropriate
services within the behavioral health system.
IIP3IIIin IIP'eiriod and IReview
This Plan covers the period July 1, 2026, through June 30, 2029. Pursuant to Section 394.4573,
Florida Statutes, Monroe County and the Managing Entity shall review and update this Plan at least
once every three (3) years to ensure it reflects changes in state law, system capacity, community
needs, and best practices. An accurate inventory of participating service providers shall be
maintained and made available at all times to all first responders through the Thriving Mind South
Florida website.
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Definitions
����°������ons
The following Aanns, as used in this Fqon, are defined pursuant to Chapters 394 and 397. Florida
Stotutes, and applicable federal regu|oUons, unless context otherwise requires.
988 Suicide and Crisis A statewide and national crisis call, text, and chat system providing
Lifeline immediate behavioral health support and connecting individuals to
|uco| crisis resources. Established under the Noduno| Suicide
Hotline Designation Act uf2020.
Addiction Receiving A facility licensed and designated by the Department to receive and
Facility (ARF) hold persons with substance use disorders for involuntary admission
or protective custody under the K4orohmon Act. An ARF may not
exceed its licensed capacity by more than 10 percent and may not
exceed its licensed capacity for more than 3 consecutive working
days or for more than 7 days in 1 month. § 397.401/0\; § 397.311.
Fla. Stat.
Baker Act The Florida Mental Health (Baker)Act, Chmpter894. Florida
Statutes, governing the exeminotinn, trnotment, and rights of
persons with mental i||neaa, including voluntary and involuntary
examination procedures.
Business Associate A written contract governing the permitted uses and diao|onunoa of
Agreement (BAA) Protected Health Information (PHI) between covered onddea,
required under H|PAA. 45 C.F.R. §8 164.308. 184.314.
Cmma Coordination A service that oaaiata individuals in navigating the behavioral health
oyotenn. arranging linkages to appropriate levels of care, treatment
aervioaa, and community supports. § 394.9082. Fla. 8taL
Centralized Receiving A aing|e-entry-pnint facility within the DR8 capable of assessment,
Facility (CRF) eva|uadon, triaga, treatment, and stabilization uf persons with
mental health or substance use disorders. Monroe Counb/'o CRF is
Guidance Cona Center. Inc., 3000 41ot Street (]oeon. Marathon, FL.
openating24/7. § 3S44573. Fla. GtoL
Centralized Receiving AUeaignoteU receiving system consisting of one designated central
System receiving fooi|ib/that servos as the single point of entry for persons
with mental health or substance use Uianrdnra, or co-occurring
disorders. Monroe Counb/'s OR8 operates as m Centralized
Receiving System. § 394.4573. Fla. Stet.
Certificate for A written document executed by an authorized professional initiating
Involuntary e Baker Act involuntary examination. Authorized professionals
Examination include: physicians, licensed clinical psychologists, |ioonaod
psychiatric nurses, licensed mental health counselors, licensed
marriage and family therapists, and licensed n|inion| social workers.
§ 384.463/2\/a\2. Fla. 8toL
Circuit 16 The Florida Department of Children and Families administrative
circuit encompassing Monroe County, served by the OCF Southern
Region Office of Substance Abuse and Mental Health.
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Co-Occurring Disorder The simultaneous presence of both a mental health disorder and a
substance use disorder in an individual (also referred to as a dual
diagnosis).
Crisis Intervention A community-based initiative that strengthens collaboration between
Team (CIT) law enforcement and behavioral health providers to improve
response to individuals in crisis, reduce unnecessary arrests, and
facilitate diversion to appropriate behavioral health services.
Crisis Stabilization Unit A short-term residential facility or unit providing immediate
( ) stabilization, assessment, treatment, and discharge planning for
individuals experiencing acute mental health crises. § 394.875, Fla.
Stat.
Department The Florida Department of Children and Families, responsible for
administering behavioral health services, designating receiving
facilities, and funding public mental health and substance use
programs.
Designated Receiving A facility approved by the Department to receive and assess
Facility individuals involuntarily transported under the Baker Act or
Marchman Act. § 394.455(17), Fla. Stat.
Designated Receiving A community-based system of care required by § 394.4573, Fla.
System ( ) Stat., that functions as a No-Wrong-Door model for persons with
mental illness or substance use disorders, ensuring coordinated
access to assessment, stabilization, and treatment. Monroe
County's DRS operates as a Centralized Receiving System.
Detoxification ( T ) Medically supervised management of acute withdrawal symptoms
for individuals with substance use disorders, providing physiological
stabilization prior to entry into ongoing treatment.
Electronic Baker Act(e- Baker Act examination forms completed, transmitted, and stored
Baker Act) through secure electronic systems in lieu of paper forms, consistent
with HIPAA, HITECH, and Florida health information laws.
Emergency Medical A federal law requiring hospitals with emergency departments to
Treatment and Active provide medical screening examinations and stabilizing treatment to
Labor Act( AL ) any individual regardless of ability to pay, and governing patient
transfer requirements.
x Parte Order A court order issued by a circuit or county judge directing law
enforcement to take a person into custody for involuntary Baker Act
examination, issued without prior notice to the individual. §
394.463(2)(a)1, Fla. Stat.
Guidance Care Center, The sole public designated receiving facility in Monroe County,
Inc. ( CC) serving as the Centralized Receiving Facility and providing CSU,
ARF, Inpatient Detox, and Screening services. Address: 3000 41st
Street Ocean, Marathon, FL 33050. Phone: 305-434-7660. GCC
also operates satellite offices throughout the Florida Keys.
Indigent An individual determined unable to pay for behavioral health
services pursuant to applicable state and federal eligibility criteria.
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Involuntary Admission An admission under the [Nonnhmen Act when e person meets
substance abuse impairment criteria and is unable to make
rational decision regarding the need for treatment. § 397.075. Fla.
Otot.
Involuntary A Baker Act examination ufa person who has refused orieunable
Examination to consent tn voluntary examination and who poses e risk of harm or
is unable tu care for themselves. § 384.403(1). Fla. StoL
Managing Entity An organization under contract with the Department to manage the
provision of behavioral health services within a specific geographic
area. In Monroe County (and yNiami-OadeCounb/\. the Managing
Entity iaThriving Mind South Florida. § 394.9082. Fla. GbsL
KMamchmnanAcK The Substance Abuse Services /yNannhman\Act, Chapter 397.
Florida Statutes, governing assessment and treatment ofpersons
with substance use disorders, including voluntary and involuntary
oUnnisainna.
Mobile Response Team Anonnmunity-UaseU teem of behavioral health professionals who
(0qRT) respond in-person to crisis situations to conduct assessments, de-
escalate crises, initiate involuntary examinations where criteria are
met, and transport individuals to appropriate receiving facilities. §§
394.463. 397.675. Fla. 8tst.
No-Wrong-Door Model A service delivery framework required by § 394.4573. Fla. Sbot.,
ensuring that individuals can access appropriate behavioral health
services regardless of their initial point of entry into the system.
Protected Health Individually identifiable health information created, nnoeived.
Information (PHI) maintained, or transmitted byo covered entity, ae defined under
H|PAA. 45C.F.F|. § 188.103.
Public Receiving Adeoignated receiving facility that has contracted with the
Facility Department to provide mental health services toall persons
regardless of ability to pay and which receives state funds for such
purpose. § 394.455. Fla. StoL
72-HourExamnination The maximum period a designated receiving facility may hold an
Period individual for involuntary examination under the Baker Act,
beginning upon arrival mt and acceptance by the facility. G394.463.
Fla. Stet.
Thriving Mind South The Managing Entity under contract with the Department to manage
Florida behavioral health services in Monroe County and Miami-Dade
County. § 3S4.9O82. Fla. Stad.
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Section
NN �� County Designated
���.m� Receiving
~ ��v���
����~���� ~~� °�°������ `������°� �������=~�= °^������N��� ������m
A Coordinated Receiving System Structure
Monroe Counb/'sDesignated Receiving 8vs&am is organized oso Centralized Receiving System,
consistent with Section 394.4573. Florida Statutes. The system designates Guidance Core Canter.
Inc. oa the ainQ|a-antry-pointCentralized Receiving Fooi|itv (CF(F). linking crisis services across the
Florida Keys through formal referral ogreements, shared data oyotema, and cooperative core
coordination. This approach maintains the current law enforcement transport prooaaa, ensuring that
individuals under the Baker Act or Monchman Act are transported to the nearest appropriate
receiving fooi|ib/, consistent with the No-Wrong-Door mandate.
Centralized Receiving Facility (CRF)
Guidance Care Center, Inc. (GCC)
3000 41 st Street Ocean, Marathon, Florida 33050
Phone: 305-434-7660
Hours: Open 24 hours per day, 7 days per week
Services: CSU (adults) - Inpatient Detoxification - ARF - Screening and Assessment
Satellite offices throughout Monroe County (Key West and Key Largo) to support screening
and level-of-care assessment across the Florida Keys.
The CRF must accept all individuals brought by law enforcement pursuant to this Plan.
111:3~ Geogralphlic 11IRegiloins
Due to the geographic characteristics ofMonroe County as o chain of islands (the Florida Keys),
crisis services one organized to provide 000eaaib|e core oor000 the full extent of the county.
Guidance Cora Center operates satellite offices in key locations to ensure that screening and level-
of-care assessment are available to residents throughout the Keys.
Key West Office LowerKeya-CitynfKeyVVestand
surrounding area upto7 mile bridge
Marathon (Main Campus-CRF\ MiUU|eKeys- [NarathonanUsurrounUingoreo
Key Largo Office UpperKeys- |s|amnnreUa. Tavernier, Key
Largo, and surrounding area
C. Receiving 11:::::ac1 III Ity Calpacil�-ty and Coordillinatilloin
Monroe County currently has 2 designated receiving facilities. One (1) iao public facility funded
by Thriving Mind South Florida and one (1) is privately funded. Pursuant to Section 394.455' Florida
Stotutem, o public facility is one that has contracted with Thriving Mind to provide mental health
oen/ioem to all persons regardless uf ability tu pay and is receiving state funds for such purpose.
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Public Receiving Facility: Guidance Care Center, Inc.
Private Receiving Facilities: Lower Keys Medical Center (DePoo Hospital)
When a receiving facility does not have available capacity, the facility coordinates with other DRS
providers to identify an appropriate placement for the individual.
Funded e t Public Receiving Facilities
Thriving Mind South Florida funds crisis service capacity at Guidance Care Center. Bed allocations
may change based on funding availability and identified need throughout the fiscal year. Current
funded bed allocations are as follows:
Guidance Care Center, Inc. Adult CSU 7.67
Guidance Care Center, Inc. Inpatient Detoxification 8.00
(DETOX)
Sectioni i i iProviders
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The Monroe County DRS includes Guidance Care Center, Inc. as the primary provider across all
service categories, serving as Monroe County's safety-net crisis provider. Thriving Mind South
Florida contracts with GCC to ensure access to crisis services for individuals regardless of ability to
pay. GCC is responsible for accepting and evaluating uninsured or underinsured individuals
transported under the Baker Act or Marchman Act when capacity allows.
III°Iul llliiic III° eceiiiviiin III°°°aciii III iiitiiies
Public receiving facilities contract with Thriving Mind South Florida using funding received through
the Managing Entity (ME) contract with the Department, to provide behavioral health crisis services
to all individuals regardless of their ability to pay. They serve as the primary safety-net crisis
providers within the Monroe County behavioral health system.
Guidance Care Center, Inc. CSU, ARF, Detox, Screening and Adults
(CRF) Assessment
Ilf III°1iiriiivate IIl eceiiiviiiin IIP::::'aciii III iiitiiies
Private receiving facilities designated by the Department may receive individuals transported under
the Baker Act within Monroe County. Private facilities provide crisis stabilization, psychiatric
evaluation, and stabilization services. They may accept individuals based on clinical need and
payer source and may transfer indigent individuals to Guidance Care Center when ongoing publicly
funded services are required.
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i in, III EN MITMEPENEEMEEPE. MEMO
Lower Keys Medical Center Psychiatric inpatient, evaluation Adults
(DePoo Hospital) and stabilization
1200 Kennedy Drive
Key West, FL 33040
C~ �ed e ira III Illy lll:::::'uinded 111:::::a6l�III 11-ty .......... Veteirains Seirvil�ces
Veterans in Monroe County may be transported directly tothe yNiorni-\6A Healthcare System when
u|inioo||y appropriate and gvoi|ab|a, consistent with the Transportation Plan. It is not designated by
the Department but serves as an important resource for veterans in the DRS.
Miami-VA Healthcare Psychiatric evaluation, inpatient services, Veterans
System 1201 NW 16th crisis stabilization
Street, Miami, FL33125
111'.). Addiction lReceliviling 11:::::'ac11l11I11l-t11es aind IlDetox!!fill catill o in Seirvil�ces
The following facility provides detoxification and addiction receiving services for individuals
experiencing substance use criaes, including individuals transported under the Marchrnon Act.
These facilities provide short-term stabilization and detoxification aan/iuea and coordinate referrals
to ongoing substance use treatment programs.
Guidance Cane Center. Inc. Addiction Receiving Facility (ARF). Inpatient Adults
3000 41et Street Ocean, Detoxification Gnn/ioea
Marathon 305-434-7660
Section
NNN �� Acute m� Ambulatory �~ �� ~ ��0
=������� ~~~�°�� °������ ��= =��� =������� Flows
A~ Acute Caire .......... lFlulblIllic IlRecelliviling 11:::::'ac1 III Ity
Individuals may enter the Centralized Receiving System through multiple occaaa points including
transfers from other facilities (hospitals, jails, phsono, or courts), self/family referrals, |ovv
enforcement transport under the Baker Act or Man:hrnon /\ot. Mobile F(aapunaa Team tronaport,
and referrals from community providers or emergency departments. When law enforcement initiates
o Baker Act or W1orohmon Act, the individual must be transported to the nearest or most appropriate
designated receiving faui|ity, consistent with the Monroe County Transportation Plan (Attachment
B).
K0onroeG'oumtyDeaignmtediReoeivingSystemP|an2O26-2O29
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Intake and Screening: Upon arrival at a public receiving facility, the individual undergoes
behavioral health screening and clinical assessment, and financial eligibility screening (indigent vs.
insured/private pay).
If the Individual Meets Acute Care Criteria:
• The receiving facility accepts, stabilizes, and treats the individual.
• Following stabilization, the facility develops a discharge plan including a recommended level of care.
• If the individual is indigent, the facility screens for Thriving Mind Care Coordination services.
• If eligible, a referral is made to Thriving Mind's Care Coordination Department.
• If not eligible, a referral is made to an appropriate Thriving Mind network provider based on the
recommended level of care.
NOTE: Baker Act: Receiving facilities may temporarily exceed licensed capacity by up to 10
percent. § 394.463, Fla. Stat. Marchman Act: ARFs may not exceed licensed capacity by
more than 10 percent and may not exceed capacity for more than 3 consecutive working
days or more than 7 days in any one month. § 397.401(6), Fla. Stat. If the facility lacks
capacity, it must coordinate transfer to another receiving facility with available capacity.
If the Individual Does Not Meet Acute Care Criteria:
• The facility determines the most appropriate level of care based on clinical assessment.
• If the recommended level is managed by Thriving Mind (e.g., Short-Term Residential Treatment,
Residential Treatment), the facility contacts Thriving Mind's System of Care Department to coordinate
placement.
• If not managed by Thriving Mind, the facility refers the individual directly to an appropriate Thriving Mind
provider.
• Referrals are based on individual clinical needs and geographic preference when possible. When no
preference or special needs are identified, referrals are made on a rotating basis. All referrals are
documented and available for review by Thriving Mind and oversight agencies.
Inter-Facility Coordination: Receiving facilities must coordinate with one another to ensure
individuals are placed in the most appropriate setting based on clinical need, available services,
and system capacity. When a receiving facility cannot meet an individual's clinical needs, it
coordinates transfer to a facility that can provide appropriate services. Transfers must comply with
Florida Statutes governing the Baker Act and Marchman Act, EMTALA, and applicable hospital
transfer protocols. The sending facility is responsible for coordinating the transfer and ensuring
appropriate documentation accompanies the individual.
I113 Acute Care .......... 111FIrlivate 11IReceliviling IP::::'ac1IIliii-t,
When an individual is taken into custody by law enforcement under the Baker Act, the individual is
transported to the appropriate or nearest designated receiving facility in accordance with the
Transportation Plan (Attachment B).
• If the facility is a private receiving facility, the individual undergoes clinical screening and assessment to
determine whether acute care criteria are met.
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• If criteria are met, the individual remains at the private facility for stabilization and treatment. The facility
develops a discharge plan with a recommended level of care.
• If the individual meets criteria and is determined to be indigent, the facility may coordinate transfer to
Guidance Care Center(the CRF)for continued acute care services or refer to an appropriate lower level
of care.
• Transfers are coordinated in accordance with applicable laws, regulations, and DRS procedures.
C rn u Illa-teary Care Services
Individuals may also enter the behavioral health system through ambulatory or outpatient service
pathways. Monroe County's centralized receiving system accommodates self-referrals through
Guidance Care Center, which operates satellite offices throughout the Florida Keys. Based on the
individual's identified needs, GCC makes referrals accordingly, including for acute care services
when necessary.
When an individual presents for services at the CRF or a Thriving Mind network provider, the
individual undergoes screening for behavioral health needs and financial eligibility. Providers must
complete screening and Level of Care placement tools, and enter all information into the Thriving
Mind data system. Thriving Mind monitors this process to ensure appropriate screening and correct
level-of-care placement.
Screening at a CRS Facility:
• If ambulatory care criteria are met, the facility determines the recommended level of care.
• If managed by Thriving Mind (e.g., Short-Term Residential, Residential Treatment), the facility contacts
Thriving Mind to coordinate placement.
• If not managed by Thriving Mind, the individual may receive services directly at the facility or be referred to
another Thriving Mind provider on a rotating basis.
• If ambulatory criteria are not met, the facility proceeds with the acute care process flow.
Screening at a Thriving Mind Provider:
• If ambulatory criteria are met, the provider determines the recommended level of care and contacts
Thriving Mind for placement if managed by Thriving Mind.
• If not managed by Thriving Mind and the provider has capacity, the provider proceeds with internal
admission procedures.
• If the provider lacks capacity, the individual is referred to another Thriving Mind network provider.
• If ambulatory criteria are not met, the provider proceeds with the acute care process flow.
Process flow diagrams for the Centralized Receiving System are provided in Attachment A.
SectioniReceiving System Agreements
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The Monroe County DRS operates through informal and formal agreements and collaborative
partnerships between Thriving Mind South Florida, Guidance Care Center, Inc., Monroe County law
enforcement agencies, and other community stakeholders. These agreements support coordination
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across the behavioral health crisis system and ensure that individuals experiencing behavioral
health emergencies receive timely evaluation, stabilization, and referral to appropriate services.
IIG ata Sharing and Illnfcirmatiiicin 1"o.c1hinoIllogy
Thriving Mind South Florida operates an Acute Care Data System enabling partner facilities to
share real-time bed availability data, displayed on the Thriving Mind website. The information on
the Thriving Mind website updates nightly. Thriving Mind has engaged Carisk to develop a fully
integrated Acute Care and Financial Reporting application to improve clinical outcomes through
secure clinical information sharing. Full platform details are available at..........................L1.1rii i'ii2gmiind„oirq.
IB Network Seirvice lFlirovider Contracts, Ilf u!msiiiiness Associate Agreements, and
IData Shairiling Agreements
Through primary contracts and executed Business Associate Agreements (BAAs) Network Service
Providers (NSP) operate under a shared set of clinical and safety standards. While the BAA set the
rules for protecting data, the primary contracts define the specific administrative, operational,
privacy, and programmatic (clinical) service expectations for the network. These agreements allow
for the secure exchange of information when necessary for treatment, health care operations, and
system coordination.
To further this coordination, Thriving Mind is establishing data sharing agreements with the
Managed Medical Assistance (MMA) plans in our region. These partnerships allows both systems
to better coordinate care for individuals who frequently use crisis services or have complex needs.
To facilitate this, the NSPs use a standardized Thriving Mind consent form that puts the person in
control of their information. This form allows the person to choose exactly how their health
information is shared across the network. Individuals have the option to allow sharing with all
network service providers, select specific ones, or decline sharing altogether. This framework
ensures that the no wrong door model remains seamless while fully respecting the person's choice.
III°1ir11i ac, and CoinfildeinflaIIIII-ty Requirements
All participating agencies within the DRS must comply with applicable federal and state laws
governing the protection of personal health information, including:
Applicable laws:
• Health Insurance Portability and Accountability Act (HIPAA)
• Health Information Technology for Economic and Clinical Health (HITECH) Act
• 42 C.F.R. Part 2 — Confidentiality of Substance Use Disorder Patient Records
• Section 501.171, Florida Statutes
• Section 394.4615, Florida Statutes
• Section 397.501, Florida Statutes
• Applicable Florida privacy laws
• Contracted provider's executed Business Associate Agreements (BAAs)
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• Other confidentiality (data sharing) agreements to support secure information sharing and
care coordination while maintaining compliance with privacy requirements.
Ilf;) System Monitoring and Qualflity Ill im pr im nt
• Thriving Mind South Florida, in coordination with the Department, monitors DRS
performance to ensure compliance with state requirements and improve system
effectiveness. (§ 394.9082, Fla. Stat.)
• Monitoring activities include: review of Network Provider performance and service
capacity; monitoring of referral and placement practices; evaluation of crisis service
utilization; coordination meetings with providers and system partners.
• System partners participate in regular meetings to review performance, identify
challenges, and implement improvements to the crisis response system.
III.......... Continuous System IDevellIolpime umt
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................-
The DRS is designed to evolve as community needs change.
• Thriving Mind works with community partners to expand crisis service capacity, improve
coordination between providers, and strengthen diversion from emergency departments and
jails.
• Integration of new crisis response services including the 988 Suicide and Crisis Lifeline
and Mobile Response Teams is an ongoing priority aligned with Florida's crisis continuum
requirements.
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Attachment A: Process Flow Diagrams
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This attachment contains the Acute Care and Ambulatory Care process flow diagrams for the Monroe County
Designated Receiving System 2026-2029. These diagrams are incorporated herein and referenced
throughout this Plan.
Acute Care — Centralized Receiving System Process Flow
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This flow applies to all individuals entering the Monroe County Designated Receiving System for
acute behavioral health crisis services. Monroe County operates a Centralized Receiving System
with Guidance Care Center, Inc. (GCC) as the sole designated public receiving facility and
Centralized Receiving Facility (CRF). Statutory authority: §§ 394.4573, 394.462, 394.463,
397.401(6), Fla. Stat.
Stelp, 1: III:..:..-"in-tiry 111::"Iollints
............................................................................................................................................................................................... ................................................................................................................................................................................................
Law enforcement Mobile Response Team Other entry
Baker Act/March man Act .......... (MRT) ..........> 7yansfer, self referral, 1.71),
trans,port MIR I traw.,,port/crisis referral community referral
.................................................................................................................................................................................................. ................................................................................................................................................................................................ ................................................................................................................................................................................................
All entry p6lints coinveirgeto GCC (GIRI:::�) I I
Step 2: 11::'uIb11I11c Ill ecelivilling III:::acI1111111-ty: Guidance are Center (C11R111:::::) .......... 111intalke and
Screening
Guidance Care Center, Inc. (CRF) - intake
Behavioral health screening and c-firnical assessment - Financial efigibifit.y screening(indigent vs.
insured1private pay)
3000 41st Street Ocean, Marathon, FL - 305-434-7660 - Open 2417
1
Stelp, 3: Acute Care Cirliteirlia IIC etenimilinatilloin
Does the individual meet acute care criteria?
Clinical assessment by receiving facility
I Yes ---). accepted (left column) No --), see Step '7 (right column)
step 4: Acute Care .......... Stalbi III Izatiloin and 1"ireatinneint
I YES® Meets acute care criteria NO- Does not meet acute care
Accept., stabilize, treat 1"acility develops criteria
dh�charge plan +recommend(�.,�d level ref care Deternpkw recommended level of carp Clinical
assessment to identify appropriate services
--------- ---------------------------------------------
I Indigent? (Step 5) 1 See S
t
e
p7 --�-
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II�'lrairaur�c. a�uauall II u�r,.�u�ua�.ai�;nl 11 �^u;eu°�uua�,.l e telfp ; Illrmdiii ent II eteirrmmiiinatiiion and Care Coordiiiinatiiion
-------------------------------------------------------
Yes® Indigent No— Private pay
Screen for llrriving Adind Care Coordination anion Discharge plan.......private p a'.yl own resources
I 1 ibilily assessment by receiving facility acilrly coordinates discharge without..Rd
referral
...................................................................................................................................................................................................................................................................................................
j If eligible 'for care coord® I
Stepp :: Caere Coordiiinatiiion Ill efeiriralll Outcome
------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------
Yes— Eligible 'for care coordination No—Not eligible 'for care coordination
Refer to �I hriving Mind Care Coordiraoi�ion � Refer to �Fhrriving Mind network provider Based
l.:)epl., Connection to ongoing corgi.,coordination
on recommended level of carp
services
Stepp "7:: Illrmdliivilduallls Il of IMeetiliing Acute Caire Grllltelrllla
Is the recommended level of care managed by Thriving Mind?
e„g,,, Short—I-arm Residential f reualment, Resid('mtial ..i...re lment
Yes I System of Care Dept. No I Direct referral
_____________________________________________________ _____________________________________________________
Yes Managed by Thriving Mind No Not managed by Thriving Mind
Contact ..l..hrivira,q Mind System of Care J.)ePl„ � Refer directly to ..l..hriviri Mind provider
oonfinate placement in managed level of Rotating basis r clinical creedgeographic,
care preference
Capacity Limitation Rules
Baker Act: Receiving facilities may temporarily exceed licensed capacity by up to 10
percent. § 394.463, Fla. Stat.
arcman Act ( ): An ARF may not exceed its licensed capacity by more than 10
percent, and may not exceed capacity for more than 3 consecutive working days or more
than 7 days in any one month. § 397.401(6), Fla. Stat.
If no capacity: GCC will coordinate transfer to another receiving facility with available
capacity within the DRS. Law enforcement should be notified promptly of any transfer.
Referral Documentation Requirements
• All referrals made through the Centralized Receiving System must be documented and
are available for review by Thriving Mind and relevant oversight agencies.
• When no geographic preference or special clinical needs are noted, referrals are made on
a rotating basis among qualified providers.
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Legend:
Required
clinical action placement criteria documentation documentation
Facility Decision point Referral Does not meet Entry/
[I outcome note
Acute Care — Private Facility Pathway and Documentation
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This section covers the private receiving facility pathway and documentation requirements
applicable to all transporting entities. Statutory authority. §§ 394.462, 394.463, 394.462(1)(k),
394.462(2)(a), Fla. Stat
111FIrlivate Ill eceliviling III:::acI111111-ty III:."athway
Individual transported to private receiving facility
Clinical screening and assessment in accordance with the AJonroe County Transportatrion Plan
(Attachment B)
I
Meets acute care criteria?
Clinical assessment
_____________________________________________________
Yes® Indigent Yes— Private pay
Remain at Cf:?I.::::r for stabili7ation and treatment Stabilize and treat at receiving facility Develop
Or transfer to appropriate lower level of care discharge tarp with rocornmended fevel of
care
.................................................................................................................................................................................................................................................................................................
Transfer compliance: Transfers must comply with EMTALA and the Baker Act. Transfers
are conducted through non-law enforcement means. The sending facility is responsible for
transfer costs unless both facilities agree to an alternative arrangement. §§ 394.462(2)(a),
394.463, 394.462(1)(k), Fla. Stat.
Law enforcement responsibility: Once a law enforcement officer has delivered an
individual to a hospital or receiving facility, the officer is not required to provide further
transportation.
Criminal charges/warrants: Persons with open or pending criminal charges or warrants
shall be released to the custody of the appropriate law enforcement agency. §
394.463(2)(g), Fla. Stat.
11IRequilred 11:::::ornns and IIl curneintation
MEN
Baker Act: EMS Patient Care Report - MRT Crisis Assessment Report
. Report of LE Officer Initiating (PCR)or ePCR . Professional Certificate for
Involuntary Examination — part of , Documentation of medical Involuntary Examination (when
clinical record assessment and vital signs MRT clinician is authorized
professional)
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• CF-MH 3100 Transportation to • CF-MH 3100 Transportation to • Documentation of de-escalation
Receiving Facility Form (includes Receiving Facility Form efforts and clinical observations
all emergency contact info • Description of circumstances • Coordination notes regarding
accessible to officer) leading to transport transportation arrangements
Marchman Act: • Notation that transport was • Copy of certificate/assessment
• Form MH 4002—Report of LE conducted in coordination with must accompany individual or be
Officer Initiating Protective Baker Act or Marchman Act transmitted electronically prior to
Custody+written report, part of examination arrival
clinical record • EMS report accompanies • All documentation becomes
• CF-MH 3100 Transportation to individual to receiving facility or part of the clinical record at the
Receiving Facility Form made available electronically receiving facility
• Form MH 4057—Certificate of
Professional for Emergency
Assessment(deliver to GCC
ARF)
Statutory,-§§ 119.0712(2)(d),
394.463(2)(a)2, eta, stel.
Electronic Baker Act (e- akerAct): Monroe County supports the use of electronic Baker
Act documentation. Electronic forms must comply with HIPAA, HITECH, and Florida health
information laws. Electronic records must maintain secure PHI transmission and be
accessible to receiving facilities at intake. A copy must become part of the clinical record. §§
394.463, Fla. Stat.; 45 C.F.R. §§ 164.308, 164.314.
Legend:
Facility/ Decision point Referral/ Does not meet Entry/ Required
clinical action placement criteria documentation documentation/
outcome note
Ambulatory Care — Centralized Receiving
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This flow applies to individuals presenting for ambulatory or outpatient behavioral health services at
Guidance Care Center (CRF) or a Thriving Mind network provider. Monroe County's centralized
receiving system accommodates self-referrals through GCC's satellite offices throughout the Florida
Keys. Statutory authority: §§ 394.4573, 394.9082, Fla. Stat.
t l 1: Ilf;;;'intiry. 1112ollints
Individual presents for ambulatory/ outpatient behavioral health services:
.................................................................................................................................................................................................................................................................................................. ..................................................................................................................................................................................................................................................................................................
Guidance Care Ceinter( IRI ) or satellite
office � I"'lhiriiviiing I l iiind network provider
l ain campt..is(Marattion) or Key West orFCey Provider not within the CRS
Largo
............................................................................. .... ...................... .......................................................................................................................................................................................................................................
IG;totlh Ipathways coinveirge at scirceinmlirmg I I
Stella :: Screening and II[;;°',llliiigiiilbiiillliIty Assessiment
Screening and eligibility assessment
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II�'ic,ir�ur�r. a,uau�ll II u�r,.�uy u�a.�lm;ri 11 r^u;m�u°� .i uu��,
Behavioral health needs • Financial eligibility
Complete Thriving Mind screening tools + Level of Care placement tools
All screening information entered into Thriving Mind data system
I
Step :: imbulllatoi , Care Ciriiiteuriiia IIC eteirirmmiiinatiiion
_________________________________________________________________________________________________________________________
(Boes 'the individual meet ambulatory care criteria?
1.... vel of care, assessment
Yes ---A Step 4 (left column) No --, escalate to acute care ( telp '7)
Stepp :: Recommended ended III,,,,,,evelll of Cara IIC eteirimniiiinatiiioin
I Y Meets ambulatory criteria NO— Does not meet ambulatory
criteria
17eat'earraaarac recommended level of care Clinical
Does t ambulatory core criteria
assessment determines�appropraate;~ 1...Ot:;
17.:ae,�r�rat rrae:c.t
Proceed to Step T escalate to acute care
1 ______________________________________________________
(Yes branch continues)
Stele :: 1"Ihiriiiviiiurmg I iiiind M auna ed III,,,,,,evelll of Care
Is the recommended level of care managed by Thriving Mind?
e.g, Short—1-oars Residential ntiaal .7...re aline nt, Residential ntial ..1...rea:atme nt 1...ev l 11
Yes I Contact Thriving Mind No I Assess provider capacity ( telp )
..................................................................................................................................................................................................................................................................................................
Yes— Managed by Thriving Mind INo Not imainaged Iby"'III'"Ihiriiviing IMind
Contact thriving Mirad....(..,00rdinate placement Assess provider/fracitity capacity Does current
o.,q.,, S..F1.R,..1..y Residential l-roatme;rrt facility or provider have capacity?
Stepp ::: Flirovildeir Capacity and 11111111aceiment
Does the provider/facility have capaci'ty7
Yes I internal admission No I rotating referral
_____________________________________________________ _____________________________________________________
Yes—Has capacity No— Lacks capacity
Rezfi-r to another 1lrrlving Mind provider
1 roceF9eF9a�with internal admissionservices1a'c�t«atirr basis ° clinical rre:erel •geographice delivered at current facility pre=m, ence;�.s1`.sr.s
Stepp '7:: IIf;;;"scalllatiiion to Acute Care
Does not meet ambulatory care criteria —). Proceed to acute care process flow
CCU;or„1„giving Mired provider follows acute,, care,,process flwr(see Section f of this Attachment)
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Thriving Mind Monitoring
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................-----
- Thriving Mind monitors the screening process to ensure appropriate screening is
conducted and individuals are placed in the correct level of care.
. Monitoring activities include annual and ad-hoc program monitoring reviews to ensure
compliance with rotation and referral requirements.
Legend:
Facility Decision point Referral Does not meet Entry Required
clinical action placement criteria documentation documentation
I I E outcome �]note
Ambulatory Care — Requirements and Data System
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
IlRefeirralll Ill ractices
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
- Referrals are based on the individual's clinical needs and geographic preference when
possible. Given Monroe County's island geography, proximity across the Florida Keys is
considered in all referral decisions.
- When no preference or special needs are identified, referrals are made on a rotating basis
among qualified Thriving Mind providers.
- All referrals made through the Centralized Receiving System are documented and
available for review by Thriving Mind and relevant oversight agencies.
• Thriving Mind monitors compliance with the rotation process during annual and ad-hoc
program monitoring reviews.
IData Systenn Requirements
.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................----
- All screening information and Level of Care placement decisions must be entered into the
Thriving Mind data system at every entry point, including all GCC satellite offices.
- Both CRS facilities and Thriving Mind network providers must complete Thriving Mind
screening tools and Level of Care placement tools.
. Daily bed availability data is accessible through Thriving Mind's Acute Care Data System
at www.thrivingmind.org. The Thriving Mind website updates nightly.
. Network providers share data through individual contracts and Business Associate
Agreements (BAAs) with Thriving Mind South Florida.
11:::1r11vacy and Confidentlialflity IllRequilreirnents
Applicable laws:
• Health Insurance Portability and Accountability Act (HIPAA)
• Health Information Technology for Economic and Clinical Health (HITECH)Act
Vlonloo G'ouiilty Il tosugnaWd IltecedMuig Systein 20,26-20,29
Vionme,coun� � �misignotedF?,,ec,6Mn08yaten� 20126- 029
• 42 C.F.R. Part 2 —Confidentiality of Substance Use Disorder Patient Records
• Section 501.171, Florida Statutes
• Section 394.4615, Florida Statutes
• Section 397.501, Florida Statutes
• Applicable Florida privacy laws
• Participating providers execute Business Associate Agreements (BAAs) to support secure
information sharing and care coordination while maintaining compliance with privacy
. Business Associate Agreements are attached to the DRS Plan as Attachment C.
Systern Monitoring and Qualflity 111improverneint
- Thriving Mind South Florida, in coordination with DCF, monitors DRS performance to
ensure compliance with state requirements and improve system effectiveness. 1394.9082,
- Monitoring activities include: review of provider performance and service capacity;
monitoring of referral and placement practices; evaluation of crisis service utilization;
coordination meetings with providers and system partners.
- System partners participate in regular meetings to review performance, identify
challenges, and implement improvements to the crisis response system.
Continuous Systern 111'.)evell1olpinneint
- Thriving Mind works with community partners to expand crisis service capacity, improve
coordination between providers, and strengthen diversion from emergency departments and
* Integration of new crisis response services— including the 988 Suicide and Crisis lifeline
and Mobile Response Teams— is an ongoing priority aligned with Florida's crisis continuum
Statutory Refemgnces —AttachmnentA
§3g4.4573. Fla. Stat. Designated Receiving Systems—No4Nmng'Donr model requirement
§394.4O2. Fla. Stmt. Transportation—governs transport of individuals for involuntary examination
§394.4d3, Fla. Stmt. Involuntary Examination (Baker Act)—criteria, procedures, 72-hour period
§384.455, Fla. 0bst. Definitions—including public facility and designated receiving facility
§394.875, Fla. Stat. Crisis Stabilization Units (C8Ua)—operation and designation
§394.9D82. Fla. Stot. KJanogingEntitioa—m|eandrooponoibi|itioaofthoManagingEntity
§387.311, Fla. Sbmt. AddiutionR000ivingFaoi|itioo—ARFandJARF|ioonoinganddooignadon
§397.4D1(8). Fla. Stot. ARF Capacity—upto1O%over licensed capacity;53 consecutive working days or
!�7duye/month
§397.G75. Fla. Qtoi Involuntary Admission (Marchman Act)—criteria for involuntary admissions
K0onroeG'oumtyDeaignmted �eoeivingSystemP|an2O26-2O29
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§394.463(2)(g), Fla.Stat. Criminal charges/warrants—return to law enforcement custody
45 C.F.R. §§ 164.308, HIPAA Security and Privacy Rules—PHI sharing requirements
164.314
42 C.F.R. Part 2 Confidentiality of Substance Use Disorder Patient Records
EIVITALA Emergency Medical Treatment and Active Labor Act—transfer compliance
lqote�: The list of designated receiving facilities is su4ject to change as new facilities are,desi mated and others are
closed or have their designations removed.An accurate inventory of partic4galing service providers is maintained
on the Thriving Mind South Florida websile at wwmithrivingmind.org—
Vlonlue G'ouinly II)es ginaWd Ilfec6Misill Systein 20,26-20,29
VionmeCounly I ��WaigniatedF?,,ec,6Mng8yatenn 2026- 029
Attachment� �� Transportation
��0 �� County
"�==�°°����~ °�� ° ��������° °=~���� Plan _ °°°������� ,�������
The Florida Department ofChildrenendFam/liea- Circuit /8 (MonroaCounty)
Involuntary Examinations (Baker Act) | Involuntary Admissions /Marchnnan'4o8 | Effective July 1'
2028- June 382029
III~ 11::muirIpose and Authority
This Transportation Plan is developed and implemented by Monroe County in collaboration with the
Managing Entity, Thriving Mind South Florida, in compliance with Section 394.402, Florida Statutes
(Transportation). This Plan establishes procedures for transporting individuals who require:
^ Involuntary Examination under the Baker Act(Chapter 394. Florida Statutes), or
^ Involuntary Admission under the Marchman Act(Chapter 397, Florida Statutes).
This Plan ensures that individuals experiencing behavioral health crises are transported safely and
efficiently to an appropriate receiving facility within the Monroe County DRS and supports the
community's No-Wrong-Door crisis system. This Plan provides guidance to Lovv Enforcement,
Mobile Response Teams, authorized transport providers contracted by the County and
EMS/Ambulance.
Guiding Principles
Transportation decisions under this Plan follow these key principles.
- Safety First: The safety of the individual, responding personnel, and the public is the
highest priority.
- Medical Needs Take Priority: If an individual has an emergency medical condition, they
must be transported to the nearest hospital emergency department before behavioral health
- Transport to the Appropriate Facility: Individuals should be transported to the nearest
appropriate receiving facility capable of meeting clinical needs.
. Efficient Transfer of Custody: Receiving facilities must accept individuals brought by law
enforcement and complete intake quickly so officers can return to duty.
. Use of Least Restrictive Options: Alternatives to involuntary examination shall be
considered when appropriate and safe, including MRT intervention, voluntary treatment
referrals, and voluntary crisis stabilization.
111111~ Ciriteiria -for 111invoIlluntairy ��xaim11inat11oin 1113alkeir Act
Seotion394.403/M' Florida Statutes
A person may be taken to a designated receiving facility for involuntary examination if there is
reason to believe the individual has a mental illness and, because of that mental illness, meets
criteria outlined below. Both Condition Aand Condition B must be satisfied.
ComditiomA- RefumaUorUmabiUitytmComsemttmExamnimatiom (mme of the fmUUmnmimg):
^ The individual has refused voluntary examination after a conscientious explanation of its purpose; OR
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• The individual is unable to determine whether an examination is necessary due to the severity of the
mental illness.
Condition B— Risk of Harm or Neglect (at least one of the following):
1. Risk of Neglect: Without care or treatment, the individual is likely to suffer from neglect or refuse
to care for themselves, resulting in a real and present threat of substantial harm to their well-being;
and it is not apparent that the risk can be avoided through the assistance of willing family, friends,
or other available services.
OR
2. Risk of Harm to Self or Others: There is a substantial likelihood that the individual will cause
serious bodily harm to themselves or others in the near future, as evidenced by recent behavior.
Baker Act— 7 - our Examination Period
Under Section 394.463, Florida Statutes, once an individual is transported under the Baker Act and
accepted for examination, the receiving facility may hold the individual for up to 72 hours for
involuntary examination. The 72-hour period begins upon arrival at and acceptance by the receiving
facility, not at the time of initiation or transport. During this period, the facility must evaluate the
individual and determine the appropriate next step, which may include:
• Release without further action
• Release for voluntary outpatient services
• Voluntary admission for treatment
• Petition for involuntary inpatient or outpatient placement
The receiving facility is responsible for documenting the time of arrival and ensuring that the
examination and any subsequent action comply with the statutory 72-hour timeframe.
Authorized Initiation of Baker Act Involuntary Examination
An involuntary examination may be initiated through the following mechanisms under Chapter 394,
Florida Statutes:
1. Ex Parte Order A circuit or county judge may issue an order directing law enforcement
to take a person into custody and transport them to a receiving facility.
§ 394.463(2)(a)1, Fla. Stat.
2. Professional A physician, clinical psychologist, licensed psychiatric nurse, licensed
Certificate mental health counselor, licensed marriage and family therapist, or
licensed clinical social worker may execute a certificate stating the
individual meets Baker Act criteria. § 394.463(2)(a)2, Fla. Stat.
3. Law Enforcement Law enforcement may take a person into custody when the officer has
Initiation reason to believe the person meets criteria for involuntary examination.
§ 394.463(2)(a)3, Fla. Stat.
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III III III... Criteria -for 111invoIlluintary A i n iii iii n .......... Mardhimain Act
Section 397.675, Florida Statutes
A person meets criteria for involuntary admission for substance use disorder services if there is
good faith reason to believe the individual is substance use impaired or has a co-occurring mental
health disorder, and because of that impairment has lost the power of self-control with respect to
substance use, AND one of the following conditions exists:
A. Impaired Judgment: The person is in need of substance use services and, due to substance
use impairment, their judgment is so impaired that they are incapable of recognizing the need for
treatment or making a rational decision regarding care.
Note: Refusal to receive treatment alone does not constitute evidence of impaired judgment.
OR
B. Risk of Harm or Neglect: Without care or treatment, the individual is likely to suffer neglect or
refuse to care for themselves, resulting in a real and present threat of substantial harm to their well-
being; AND the risk cannot be avoided through willing family, friends, or other services; OR there is
a substantial likelihood the person has inflicted, threatened, or attempted to inflict physical harm on
themselves or another, or is likely to do so without admission.
Transport may occur when:
• A certificate of professional assessment has been completed by an authorized professional;
• A law enforcement protective custody report has been prepared; or
• A court order for involuntary assessment or treatment has been issued.
IIIV III,,,,.aw lf;..:.J -f r im in-t IIl iii g i tiii n -fair „1'r ins po rt tiii n
Section 394.462(1)(a), Florida Statutes
Florida law requires each county to designate a law enforcement agency responsible for
transporting individuals for involuntary examination. Monroe County designates:
• Monroe County Sheriff's Office (MCSO)— responsible for transporting individuals from unincorporated
areas of Monroe County.
• City of Key West Police Department— responsible for transporting individuals within the City of Key West.
• Any successor law enforcement agency shall operate in accordance with this Transportation Plan.
Law enforcement take persons into custody and transport them to the appropriate or nearest
receiving facility when: an ex parte court order has been issued; or a certificate for involuntary
examination has been executed by an authorized professional.
Law Enforcement May Decline Transportation Only When Both Conditions Are Met:
• The county or jurisdiction has contracted with an emergency medical transport service or private transport
company to provide transportation at the county's expense; AND
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• Both the law enforcement agency and the transport provider agree that law enforcement presence is not
necessary for the safety of the individual or others involved.
"'1"ir in p irta-fl un lb, Ibiiillle Cirlislis ll e p rm e "'II or I lentalll IIIie 111 lb OverIllay
Program
When an MRT professional or mental health overlay program member authorized under Section
394.463 (Baker Act) or Section 397.675 (Marchman Act), Florida Statutes, determines
transportation to a receiving facility is necessary, the professional may:
• Request transportation assistance from the law enforcement agency within the jurisdiction; or
• Arrange alternative transportation (e.g., EMS, ambulance, or other approved transport)when clinically
appropriate.
Transportation decisions shall be based on: the safety of the individual and others; the clinical
needs of the individual; and the most appropriate and least restrictive transportation option
available.
III... 1113alkeir Act .......... "'1"ir in p in Ilf equilireime.ints and SpecilaIll 1113opull1latilloins
Transportation may be provided by: Monroe County Sheriff's Office; City of Key West Police
Department; Emergency Medical Services (EMS) or ambulance providers; or authorized transport
providers contracted by the County; when appropriate under Florida law.
NOTE: Emergency medical needs take precedence in all transportation situations. If a law
enforcement officer believes an individual has an emergency medical condition as defined
in Section 395.002(8), Florida Statutes, the individual must be transported to the nearest
hospital emergency department for medical evaluation and treatment. After medical
stabilization, the individual may be transferred to a designated receiving facility if
appropriate. § 394.462(I)(i), Fla. Stat.
Transportation for Non-Emergency Medical Needs: Adults and minors with medical conditions
that are not emergencies shall be taken to the nearest general hospital with a designated Baker Act
Unit. Facilities with substantial medical services are listed in Appendix A.
Special Population Transportation Guidelines:
INININININ
Elderly (Age 60+) May be taken to the nearest designated receiving facility offering
specialized care to older adults. Facilities providing specialty geriatric care
are listed in Appendix A.
Minors (Ages 0— Children (0-12) and adolescents (13-17) shall be taken to the nearest
17) receiving facility licensed to serve children and adolescents. Facilities are
listed in Appendix A.
Incarcerated Individuals in the custody of the Monroe County Detention Center who
Individuals require involuntary examination and are eligible for diversion, or have
reached end of sentence, shall be transported to the receiving facility
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closest to the individual's residence. If homeless or residence is unknown,
transport to the facility closest to the location of arrest.
Veterans Individuals known to be veterans may be transported directly to the VA
Medical Center when appropriate and available.
Role of Emergency Medical Services (EMS) and Ambulance
EMS personnel and ambulance providers play an important role in transporting individuals
experiencing behavioral health crises, particularly when medical monitoring or stabilization is
required. EMS may transport individuals when: the individual has a medical condition requiring
medical supervision; the individual has ingested substances or presents with a possible overdose;
the individual is physically unstable or injured; or law enforcement determines that ambulance
transport is safer or clinically appropriate.
When EMS or ambulance providers are involved in transportation under the Baker Act or
Marchman Act, they should coordinate with law enforcement and the receiving facility to ensure a
safe and efficient transfer of care. EMS should notify the receiving facility as early as possible when
transporting an individual under involuntary examination so the facility can prepare for intake. When
EMS transport is used, law enforcement may accompany the individual if necessary to ensure
safety.
IIIIII Required 11:::::'oirims and IlDociuuummantatiiioin
Law Enforcement Required Forms
• Report of Law Enforcement Officer Initiating Involuntary Examination (Baker Act): A written report detailing
the circumstances establishing the officer's reasonable basis to believe the individual meets criteria for
involuntary examination. Must become part of the patient's clinical record.
• CF-MH 3100 Transportation to Receiving Facility Form: Must include all emergency contact information
accessible to the officer, including information from FDLE or DHSMV electronic databases. Emergency
contact information may be used only to inform listed contacts of the patient's whereabouts. §§
119.0712(2)(d), 394.463(2)(a)2, Fla. Stat.
EMS / mbulance Required Documentation
• EMS Patient Care Report(PCR) or electronic patient care report(ePCR)
• CF-MH 3100 Transportation to Receiving Facility Form
• Documentation of medical assessment and vital signs
• Description of circumstances leading to transport
• Notation that the transport was conducted in coordination with a Baker Act or Marchman Act examination,
when applicable
• The EMS report shall accompany the individual to the receiving facility or be made available electronically
as part of the patient's medical record.
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Mobile Response Team ( ) Required Documentation
• Mobile Response Team Crisis Assessment Report
• Professional Certificate for Involuntary Examination when MRT clinician is an authorized professional
• Documentation of de-escalation efforts and clinical observations
• Coordination notes regarding transportation arrangements
• A copy of the professional certificate or crisis assessment documentation must accompany the individual
to the receiving facility or be transmitted electronically prior to arrival whenever possible.
All documentation related to the involuntary examination or protective custody must become part of
the individual's clinical record at the receiving facility.
Electronic Baker Act Documentation (e- aker Act)
NOTE: Monroe County supports the use of electronic Baker Act documentation when
available. Electronic Baker Act documentation refers to involuntary examination forms
completed, transmitted, and stored through secure electronic systems rather than paper
forms. Electronic documentation may be used by law enforcement agencies, hospitals and
emergency departments, behavioral health providers, Mobile Response Teams, and
authorized clinicians initiating professional certificates.
Electronic Baker Act forms must comply with HIPAA, the HITECH Act, and Florida public
records and health information laws. Electronic systems must maintain secure transmission
of PHI, ensure accurate and complete documentation, and allow receiving facilities to
access documentation at the time of intake. A copy of the electronic Baker Act report must
still become part of the individual's clinical record at the receiving facility.
IIIIIIIII IMairchimain Act .......... ...I it insp in Ile ,Uiiirelments
Law enforcement is responsible for transporting individuals who meet Marchman Act criteria to the
appropriate or nearest facility within the DRS.
NOTE: Emergency medical needs take precedence. If a law enforcement officer believes a
person has an emergency medical condition as defined in Section 395.002(8), Florida
Statutes, the person shall be transported to the nearest hospital emergency room
regardless of whether the facility is an ARF or detoxification facility. § 394.462(I)(i), Fla. Stat.
• Adults: Law enforcement shall contact Guidance Care Center(ARF)to inquire about bed availability. ARF
locations are listed in Appendix B.
• Minors: Monroe County does not currently have a Juvenile Addiction Receiving Facility (JARF). Law
enforcement shall contact the nearest receiving facility who will receive and use the Monroe County
transportation plan to transfer youth to JARF in an adjacent service area to inquire about bed availability.
• Court-Ordered Treatment: Law enforcement shall transport individuals subject to a court order for
Involuntary Services of Substance Abuse Impairment to the appropriate residential treatment provider
indicated on the court order.
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The appropriate DRS facility must provide law enforcement with a basic screening or triage
sufficient to refer the person to appropriate services. § 394.462(1), Fla. Stat. This process including
a responsible handoff of the individual and required paperwork should not exceed five (5) to ten
(10) minutes to facilitate the expeditious release of the transporting unit.
IIIXMardhimain Act .......... lRequilred Ilf°°' urimmm
• Form MH 4002—Report of Law Enforcement Officer Initiating Protective Custody, plus a written report
detailing circumstances establishing good faith reason to believe the individual met Marchman Act
criteria. The written report shall be included in the individual's clinical record.
• Form MH 4057—Certificate of Professional for Emergency Assessment for Substance Abuse Services.
When law enforcement transports an individual for whom this form has been initiated, law enforcement
shall deliver the completed form to the ARF.
• CF-MH 3100 Transportation to Receiving Facility Form
Receiving IIP::::' 1 III Ity Acceptanceand I rainsfe.im
Sections 394.462(2)(a), 394.463, and 394.462(1)(k), Florida Statutes
Facilities within the DRS must accept all individuals transported for involuntary examination when
brought by: law enforcement officers; emergency medical transport services; or private transport
companies authorized by the county. This applies to individuals transported under Section 394.463
(Baker Act) and Section 394.462(1)(k), Florida Statutes.
Transfers to Another Facility: If a person is transported to a facility later determined to be
inappropriate (due to patient choice, lack of necessary clinical services, or insurance/payer status),
the individual may be transferred to another facility. Transfers must comply with EMTALA and the
Baker Act and should occur through non-law enforcement means (e.g., medical transport). The
sending facility is responsible for transfer costs unless both facilities agree to an alternative
arrangement.
• Law enforcement is not required to provide further transportation after delivering an individual to a hospital
or receiving facility. § 394.462(2)(a), Fla. Stat.
• If a person has open or pending criminal charges or warrants, the individual shall be released back to the
custody of the appropriate law enforcement agency. § 394.463(2)(g), Fla. Stat.
III... Ceintiralflized 11IReceliviling II°°° iiilll iiity II III°°)
Guidance Care Center, Inc., 3000 41st Street Ocean, Marathon, Florida 33050, serves as Monroe
County's CRF within the centralized receiving system. The CRF operates 24 hours per day, 7
days per week, and is capable of assessment, evaluation, triage, treatment, and stabilization. The
CRF must accept all individuals brought by law enforcement pursuant to this Plan.
IIIIII III°3I11 un 11IRevilew and Coordination
This Transportation Plan shall be monitored by the Florida Department of Children and Families
Circuit 16 Office of Substance Abuse and Mental Health, and the participating agencies: Monroe
County, Thriving Mind South Florida, the Monroe County Sheriff's Office, and the City of Key West
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Police Department, through coordination and regular meetings. Any inquiries, complaints, or
requests for assistance shall be transmitted from the Department staff to Thriving Mind without
waiting for scheduled meetings.
IIIIIIIII Ilf;;;;;-ffe tiiive ID ate and "'1'eirirr
This Transportation Plan is effective July 1, 2026, and, unless terminated or cancelled earlier, will
expire June 30, 2029. It may be renewed in writing for one (1) additional successive three (3) year
term, subject to preapproval by Monroe County. This Plan may not be amended or modified except
in writing, signed and duly executed by all parties. Future statutory amendments on relevant topics
are incorporated without revision during each three-year term; statutory updates shall be made at
the time of renewal.
This Transportation Plan was drafted in compliance with Section 394.462, Florida Statutes,
Transportation.
AGREED TO AND ACKNOWLEDGED BY THE PARTIES ON THE DATES LISTED BELOW:
[Signature pages follow]
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For Monroe County
Michelle Lincoln I Mayor, Monroe County Board of County Commissioners I Date:
Approved as to form and legal sufficiency I Monroe County Attorney I Date:
-Rest of Page Intentionally Left Blank-
Mono ue ("oliAlAy Il es gnaWd RecedMiig Systein Ikiii 20,26-20,29
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Thriving Mind South Florida
Laura M. Naredo I President and Chief Executive Officer I Date:
-Rest of Page Intentionally Left Blank-
Muni m! G'ouinay Des ginaWd lRecedMuig Systein 20,26-20,29
Moilloe,counly Ws�gnated ��?,,ec,6Mng Systeinin 20126 2029
Florida Department of Children and Families— Circuit 16
Lourdes Dorado-Rubio I SAMH Regional Director I Date:
-Rest of Page Intentionally Left Blank-
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Appendix A: Designated Receiving Facilities — Monroe County
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
As of July 1, 2026. Subject to change as new facilities are designated and others are closed or
have designations removed.
The following is a list of Monroe County facilities designated by the Florida Department of Children
and Families to receive and hold persons with mental illness for involuntary examination and short-
term treatment.
111:3alkeir Act Ilf ecelivilling III:::acI11111111tilles
Guidance Care Center, Inc.** (CRF— CSU, 3000 41 st Street Ocean 305-434-7660
ARF, Inpatient Detox) Marathon, Florida 33050
Lower Keys Medical Center(DePoo 1200 Kennedy Drive Key 305-294-5531
Hospital) Werst, Florida 33040
Public Facility -conli will the Departirnent to proviide ii health services to all persons regardless of
ability to pay, receiviing state funds, § 394.455, IFlla. Stat,
Baker Act Receiving Facility NOT Designated by the Department:
Al
Miami—VA Healthcare System (Federally 1201 NW 16th Street, Miami, Veterans only
Funded) FL 33125
11:::::'ac1 Ill 11111 es wilth Sliginlificallint: Il edlicalll Calpalb1111111-ty
A designated receiving facility capable of providing significant medical examination and treatment is
identified, and the individual is transported to that facility based on availability.
GCC Sate11111111te Office Ill,,,,,,ocations
Key West Office Lower Keys— City of Key West and
surrounding area up to the 7 mile bridge
Marathon (Main Campus—CRF) Middle Keys— Marathon and surrounding area
Key Largo Upper Keys— Islamorada, Tavernier, Key
Largo, and surrounding area
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Appendix 13: Addiction Receiving Facilities and Inpatient
��u��w��'~��*~��~ Facilities
��~."=°"�°°.°�=�K��� ° �����°���es
Aouf July t2020 to change ao new facilities are designatedand others are closed or
have designationsren7ovad
The following is o complete list of Monroe County Addiction Receiving Facilities (ARFn) designated
by the Department to receive and hold persons under Morohmon Act for involuntary admission
and short-term treatment.
NOTE: ARF Capacity Rule: An ARF may not exceed its licensed capacity by more than 10
percent and may not exceed its licensed capacity for more than 3 consecutive working days
or for more than 7 days in any one month. § 397.401(6), Fla. Stat.
11:::::'o ir Ad u III ts
Guidance Care Center, Inc. (ARF & 3O0O41ot Street Ocean Marathon, 305-434-7000
|npatientOotnx) Florida 33050
11:::::'oiir JuveinlillIes
Monroe County does not currently have a designated Juvenile Addiction Receiving Facility
(JARF). Law enforcement shall bring youth to the nearest addiction receiving facility to
receive. The receiving facility will use the Monroe County Transportation Plan to transfer to
the nearest JARF in an adjacent service area for bed availability. For updated information,
contact Thriving Mind South Florida or visit www.thrivingmind.org.
Statutory IlRefeire.inces ��Attachment 113
§3g4.4573. Fla. Stat. Designated Receiving Systems- No-Wrong-Door model requirement
§394.462. Fla. Stmt. Tnanoportetion-governstnanapnrtnfindiviUum|s for involuntary
examination
§394.4h5. Fla. StaL Involuntary Examination (BokerAot)-criteria, procedures, 72-hour
period
§394.455. Fla. Stot. Oofinitinno- including public facility and designated receiving facility
§3y4.875. Fla. 8tat. Crisis Stabilization Units (C8Ua)-operation and designation
g 384.9082. Fla. Stat. Managing Entities- role and responsibilities of the Managing Entity
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§397.311, Fla. Stat. Addiction Receiving Facilities—ARF and JARF licensing and
designation
397.401(6), Fla. Stat. ARF Capacity— up to 10% over licensed capacity; <_3 consecutive
working days or<_7 days/month
§397.675, Fla. Stat. Involuntary Admission (Marchman Act)—criteria for involuntary
admissions
394.463(2)(g), Fla.Stat. Criminal charges/warrants— return to law enforcement custody
45 C.F.R. §§ 164.308, HIPAA Security and Privacy Rules— PHI sharing requirements
164.314
42 C.F.R. part 2 Confidentiality of Substance Use Disorder Patient Records
EMTALA Emergency Medical Treatment and Active Labor Act—transfer
compliance
`Jote I he!r^,t of deaf,gnate::1 teceirnin g fkfl n e n:,,ubiect to change s new fkfl1n° es ate de nrd:gated arul others ate
closed o� have their designations removed er accurate inventory orpatticifmbngservice providers is, maintained
on the 7hrmny Mind South Florida Web1 Me ad WW thdvingo,Ord.or�1�.,
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D9
COUNTY of M�NR�E BOARD OF COUNTY COMMISSIONERS
lJ 1r I M 1r �� D "1 Mayor Craig Cates,District 1
The Florida Keys
e Mayor Pro Tern Holly Merrill Raschein,District 5
J � Michelle Lincoln,District 2
James K.Scholl,District 3
David Rice,District 4
Board of County Commissioners Meeting
July 19, 2023
Agenda Item Number: D9
2023-1191
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: STAFF CONTACT: Tina Boan
AGENDA ITEM WORDING: Approval of the Monroe County Designated Receiving System Plan
for 2023-2026 as presented by South Florida Behavioral Health Network, d.b.a. Thriving Mind South
Florida, the designated Managing Entity for Monroe County and Miami/Dade County, for a centralized
receiving system for Monroe County as required by Senate Bill 12 (Chapter 2016-241).
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 were to plan a designated receiving system. The
initial plan was completed and implemented on July 1, 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.
The Monroe County Designated Receiving System Plan(Plan) is brought before the Board for approval
and acceptance as prepared and presented by SFBHN/Thriving Minds South Florida, the designated
managing entity for Monroe County. The Plan was previously approved by the BOCC at its 1/20/21
meeting, but the Plan and agenda item incorrectly stated that the Plan covered the period of 1/1/21
through 12/31/20 and did not have a signature block for the Mayor to execute the Plan document. The
corrected version of the Plan was ratified by the BOOC at its 3/17/21 meeting.
PREVIOUS RELEVANT BOCC ACTION:
March 17, 2021, agenda item C.11, the BOCC approved of the Monroe County Designated Receiving
System Plan for 2021-2023. (Note: March 17 agenda item was a correction of the plan's cover sheet
to read 2021-2023)
930
September 21, 2022, Item F.2, the BOCC adopted annual operating budget for FY2023; Monroe County
annually provides required matching funds for substance abuse and mental health services.
May 17, 2017, Agenda Item No. C.21, the BOCC approved the Designated Receiving System plan
2017-2020, as designated by the Managing Entity for Monroe County, South Florida Behavioral Health
Network, for a centralized receiving system for Monroe County as required by Senate Bill 12 (Chapter
2016-241)
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval
DOCUMENTATION:
2023-2026 MC DRS Fla .pdf
2017-05-17 Agenda Item C.21 Attach ent.pdf
FINANCIAL IMPACT:
931
Monroe County
Designated Receiving System Plan
In accordance with
Florida Statute 394, Florida Mental Health Act
Florida Statute 397, Hal S. Marchman Alcohol and
Other Drug Services Act
2023-2026
Monroe County DRS Plan Updated May 2023 Page 1 of 27
932
Contents
I. Background/Purpose:.............................................................................................................. 3
IL Monroe County's Designated Receiving System (DRS).................................................... 4
III. Inventory of Participating Service Providers....................................................................... 6
IV. Designated Receiving System (DRS) Agreements.............................................................. 8
Attachment A—Process Flow for Centralized Receiving System Monroe.................................... 9
Attachment B —Transportation Plan Monroe............................................................................... 11
Attachment C —Agreements Template......................................................................................... 19
Attachment D—Sign In Sheet Monroe County Public Meeting .................................................. 27
Monroe County DRS Plan Updated May 2023 Page 2 of 27
933
I. Background/Purpose:
In accordance with the changes promulgated by Senate Bill 12 to Florida Statute 394 (Florida
Mental Health Act, commonly referred to as the"Baker Act"), and Florida Statute 397 (commonly
referred to as the Marchman Act), Monroe County in collaboration with South Florida Behavioral
Health Network, Inc. dba Thriving Mind South Florida (Thriving Mind), the Managing Entity,
have completed this Designated Receiving System (DRS) Plan. Implementation of this plan
assures the coordinated provision of emergency services for people in need of help for behavioral
health disorders and supports a comprehensive behavioral system of care.
This DRS Plan describes how the community shall ensure the provision of the "No Wrong Door
Model" defined in FS 394.4573. This description includes the organization of the DRS and how it
responds to individual needs and integrates services among various providers.
The designated receiving system may be organized in any manner which functions as a no-wrong-
door model. Such models include, but are not limited to:
A central receiving system is identified as a 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.
A coordinated receiving system as a 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.
A tiered receiving system consists of multiple entry points, some of which offer only
specialized or limited services. Each service provider shall be classified according to its
capabilities as either a designated receiving facility or another type of service provider,
such as a triage center, a licensed detoxification facility, or an access center. All
participating service providers shall, within existing resources, be linked by methods to
share data, formal referral agreements, and cooperative arrangements for care coordination
and case management.
OR
The DRS may be organized in any manner that functions as a No-Wrong-Door Model that
responds to individual needs and integrates the services of various providers.
Monroe County DRS Plan Updated May 2023 Page 3 of 27
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The County and the Managing Entity shall review and update, as necessary, the designated
receiving system at least once every 3 years. An accurate inventory of the participating service
providers shall be maintained and made available at all times to all first responders in the service
area.
IL Monroe County's Designated Receiving System (DRS)
Monroe County's Designated Receiving System is best described as a centralized receiving
system.
In Monroe County, there are 2 designated receiving facilities which are both publicly funded
(Guidance Care Center, Inc. and Lower Keys Medical Center). Thriving Mind currently funds
a total of 17.79 beds at these public receiving facilities — 9.79 are CSU beds and 8 are DETOX
beds. The following are the number of funded beds at each facility, by type:
• Guidance Care Center, Inc. —7.50 Adult CSU beds
8 DETOX beds
• Lower Keys Medical Center—2.29 Adult CSU beds
*Note: Contract bed totals are subject to change due to rate enhancements.
The County's approach to develop the designated receiving system for Monroe County is one that
attempts to maintain the current process for Baker Acts for law enforcement, so that they are
transporting Baker Acts to the nearest receiving facility (as is the case currently). This is consistent
with the requirement in Senate Bill 12 to ensure that there is a"no wrong door"approach for acute
care services. Thriving Mind held a public meeting in Monroe County for input and will continue
to receive feedback from the stakeholders on the continued implementation of the Designated
Receiving System through its community needs process. The sign in sheet for the public meeting
can be found in Attachment D.
Thriving Mind has identified the Guidance/Care Center as the provider that will be designated as
the centralized receiving facility for the centralized receiving system, described above.
Individual is taken by Law Enforcement to the appropriate receiving facility, which is the
centralized receiving system:
The individual can be referred to the centralized receiving system through multiple entry points:
as a transfer from other facilities (such as jails/prisons, courts or hospitals), as a self-referral, as a
individual that is picked up by law enforcement for a Baker Act/Marchman Act, etc. If the
individual is referred to the centralized receiving system because he/she is picked up by law
enforcement as a result of a Baker Act, then he/she is taken to the appropriate receiving facility
(public/private). If the appropriate receiving facility is a public receiving facility, then the
individual will be screened for both behavioral health and financial eligibility (indigent vs.private
pay). If that individual meets acute care criteria and there is capacity at that public receiving
facility, then he/she will be accepted, stabilized and treated. Once the person is stabilized, if the
individual is determined to be indigent, then the designated receiving facility will create a
discharge plan, which includes a recommended level of care. The individual will also be screened
Monroe County DRS Plan Updated May 2023 Page 4 of 27
935
for care coordination through Thriving Mind. If that individual meets criteria for care coordination,
then a referral will be made to Thriving Mind's Care Coordination Department. If the person does
not meet criteria for care coordination, then a referral will be made to a Thriving Mind provider
that has the recommended level of care within their treatment continuum.
If it is determined that the individual meets acute care criteria, but the public receiving facility
doesn't have capacity, then the public receiving facility will coordinate a transfer to another
receiving facility that has capacity. It is important to note that if the individual is a Baker Act,then
the law allows for the receiving facility to keep that individual as long as they do not go over 10%
of their licensed bed capacity. However, if the individual is a Marchman Act,which does not allow
for that flexibility and the Addiction Receiving Facility (ARF) is at licensed capacity, then the
facility must provide a basic screening or triage sufficient to refer the person to the appropriate
services and coordinate the transfer of that individual to another facility or hospital that has
capacity.
If it is determined (through the screening process) that the individual does not meet criteria for
acute care,then the public receiving facility will determine the recommended level of care for that
individual. If the recommended level of care is one that is actively managed by Thriving Mind
(Short-term Residential Treatment (SRT), Residential treatment), then Thriving Mind's Adult
System of Care Department will be contacted in order to coordinate that referral. If the
recommended level of care for that indigent individual is not actively managed by Thriving Mind,
then the receiving facility will contact the Thriving Mind provider directly. Referrals will be made
to best match the individuals with their needs and geographic preference. If no preference or
specific needs are noted,then referrals are made on a rotating basis. All referrals that come through
the centralized receiving system will be well documented and available for review at Thriving
Mind.
Individual is taken by Law Enforcement to the appropriate receiving facility, which is a
private receiving facility:
If the individual is referred to the centralized receiving system because he/she is picked up by law
enforcement as a result of a Baker Act, then he/she is taken to the appropriate receiving facility
(public/private). If the facility is a private receiving facility, then he/she will be screened to
determine if he/she meets acute care criteria. If he/she meets criteria, then the individual will
remain at the private receiving facility and will be stabilized and treated. A discharge plan will be
made by the private receiving facility, which includes a recommended level of care. If it is
determined that the individual is an indigent individual and meets acute care criteria, then a
individual may be transferred to the centralized receiving system for continued acute care services
and/or referral to lower level of care services.
Individual is self-referred for any publicly funded service:
If the individual is seeking publicly funded services, the individual can access care through the
centralized receiving facility. The centralized receiving facility has satellite offices throughout
Monroe County which allows for screening and level of care assessment. Based on the individuals
Monroe County DRS Plan Updated May 2023 Page 5 of 27
936
identified needs, the facility will make referrals accordingly including for acute care services if
necessary.
A Process Flow of the Centralized Receiving System is found in Attachment A. The
Transportation plan that outlines how individuals needing acute care are transported can be found
in Attachment B.
III. Inventory of Participating Service Providers
Voluntary Assessment and Evaluation Facilities
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU,Detox, Screening & Yes Yes
Center, Inc. Assessment
Lower Keys CSU Only No Yes
Medical Center
Involuntary Assessment and Evaluation Facilities
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU,Detox, Screening & Yes Yes
Center, Inc. Assessment
Lower Keys CSU Only No Yes
Medical Center
Triage Centers for Mental Health
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients?
Monroe County DRS Plan Updated May 2023 Page 6 of 27
937
Disorders/Co-
Occurring?
Guidance Care CSU,Detox, Screening & Yes Yes
Center, Inc. Assessment
Lower Keys CSU Only No Yes
Medical Center
Triage Centers for Substance Use Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU,Detox, Screening & Yes Yes
Center, Inc. Assessment
Involuntary Treatment for Mental Health Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU,Detox, Screening & Yes Yes
Center, Inc. Assessment
Lower Keys CSU Only No Yes
Medical Center
Involuntary Treatment for Substance Use Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Monroe County DRS Plan Updated May 2023 Page 7 of 27
938
Guidance Care CSU,Detox, Screening & Yes Yes
Center, Inc. Assessment
IV. Designated Receiving System (DRS)Agreements
Through Thriving Mind's Acute Care Data System, partners can share data and be aware of
available beds in the coordinated receiving system. The system provides real-time bed availability
that is fed into the Thriving Mind web-site.
Thriving Mind has been working with Knight Software to expand the current service data system
to fully integrate Acute Care and Financial Reporting into one, cohesive application. The Knight
Integrated Solution (KIS) has been developed with the goal to improve the clinical and
psychosocial outcomes of stakeholders within the mental healthcare system by providing a system
for securely sharing clinical and psychosocial information across authorized healthcare providers
to facilitate coordination of care and improve outcomes.
A full description of the data functions can be found in Thriving Mind's Information Technology
(IT) Plan and is available at�ww'thriV.j � ��jjnd:c�r� .
Network providers have individual contracts and executed Business Associate Agreements
(BAAs) through their main contract with Thriving Mind which allows for data sharing and
coordination of care.
BAA Template can be found in Attachment C.
Monroe County DRS Plan Updated May 2023 Page 8 of 27
939
Attachment A—Process Flow for Centralized Receiving System Monroe
-Page Left Intentionally Blank-
Monroe County DRS Plan Updated May 2023 Page 9 of 27
940
Monroe County DRS Plan Updated May 2023 Page 10 of 27
941
Wl]usn°oe Crauoarry PNl",i 5812 requires"no wrong
PlIU7o:,M:.ss lloyv f'ftlbl PpntraMmSmf door"for acute ca ra services.
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...._._..._...._. __.._._._.._. FacilityCRF Facility Facility
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Monroe County: !r° Yesp
"a Adult Mental Health: 1,680
Adept Substance Abuse: 42$
L /
p*,�, 'Chlldran's Mental Health: 225
" Children'a Substance Abuse: 151
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real-time data CRF:
(CSU/ available that l]s recelvin,g served in Monroe County:
DETOX able to indicate facility that 'Cry I,I„
"".......""•""•" capacity at the has capacity
Adults: I,347
p V. DFIOx $ 333,,64
publicacute Chl]ldren:3'14 Crisis Support- 5 104,2'7'7
care facllities. "•••••'"•'"'"«••'" "°"""""""" °"""°"°""""""°"'""°"°°"..........M"""°""" �A cstruwtt S 259267
Cnsis Stay 'total Ava,llable: $1,841,090
1 8.�S.day,)
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'floes thy«
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,{r c
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recommended 0
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anNarvcemeMs
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'wm :s a b It y,cr
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v*y Th g for lavel of care will be ••• Cdr rail euv rage `»:L 1 605
tted at the CRF Howewe„onrea co p e Start/End C)p nt €E ne e:(ZO`Y� c'j35 r;q5
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ich
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ewer Ievel of
an/ra/zoti
Monroe County DRS Plan Updated May 2023 Page 11 of 27
942
Attachment B — Transportation Plan Monroe
Transportation Plan for Baker Act and Marchman Act Involuntary Examinations
Department of Children and Families
Circuit 16 (Monroe County)
This transportation plan shall describe methods of transport to a facility within the
designated receiving system for individuals subject to involuntary examination under the
Baker Act s. 394.463 or involuntary admission under the Marchman Act s. 397.6772, s.
397.679, s. 397.6798, or s. 397.6811.
When any law enforcement officer has custody of a person based on either noncriminal
or minor criminal behavior that meets the statutory guidelines for involuntary examination
pursuant to s. 394.463, the law enforcement officer shall transport the person to the
appropriate facility within the designated receiving system pursuant to a transportation
plan or an exception or to the nearest receiving facility if neither apply. 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
or to the nearest facility if neither apply.
The Florida Mental Health Act, usually referred to as "The Baker Act," states that a person
may be taken to a receiving facility for involuntary examination if there is reason to believe
that the person has a mental illness and because of his or her mental illness:
The person has refused voluntary examination after conscientious explanation and
disclosure of the purpose of the examination; or the person is unable to determine for
himself or herself whether examination is necessary; and without care or treatment, the
person is likely to suffer from neglect or refuse to care for himself or herself; such neglect
or refusal poses a real and present threat of substantial harm to his or her well-being; and
it is not apparent that such harm may be avoided through the help of willing family
members or friends or the provision of other services; or there is a substantial likelihood
that without care or treatment the person will cause serious bodily harm to himself or
herself or others in the near future, as evidenced by recent behavior.
The Marchman Act is the Florida Substance Abuse Impairment Act which requires that a
person who 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:
Has lost the power of self-control with respect to substance abuse; and 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 is incapable of appreciating his or her need
for such services and of making a rational decision in that regard, although mere refusal
Monroe County DRS Plan Updated May 2023 Page 12 of 27
943
to receive such services does not constitute evidence of lack of judgment with respect to
his or her need for such services; or without care or treatment, 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 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.
The law requires that each county shall designate a single law enforcement agency within
the county, or portions thereof, to take a person into custody upon the entry of an ex parte
order or the execution of a certificate for involuntary examination by an authorized
professional and to transport that person to the appropriate facility within the designated
receiving system pursuant to this transportation plan.
The law enforcement agency may decline to transport the person to a receiving facility
only if:
a. The jurisdiction designated by the county has contracted on an annual basis
with an emergency medical transport service or private transport company
for transportation of persons to receiving facilities pursuant to this section
at the sole cost of the county; and
b. The law enforcement agency and the emergency medical transport service
or private transport company agree that the continued presence of law
enforcement personnel is not necessary for the safety of the person or
others.
The Monroe County Sherriff's Department and City of Key West Police Department
provide transportation of individuals under the Baker Act and/or Marchman Act throughout
Monroe County.
Monroe County Transportation Plan guidelines for Baker Act:
If a law enforcement officer believes that a person has an emergency medical condition
as defined in s. 395.002, the person should be first transported to a hospital for
emergency medical treatment, regardless of whether the hospital is a designated
receiving facility or part of the centralized receiving system.
Law enforcement should transport individuals under the Baker Act to the appropriate
receiving facility.
A list of Monroe County designated receiving facilities that can provide medical
examination and treatment of persons for whom an involuntary examination has been
initiated under the Baker Act can be found in Appendix A.
Monroe County Transportation Plan guidelines for Marchman Act:
If a law enforcement officer believes that a person has an emergency medical condition
as defined in s. 395.002, the person should be first transported to a hospital for
Monroe County DRS Plan Updated May 2023 Page 13 of 27
944
emergency medical treatment, regardless of whether the hospital is a designated
receiving facility or part of the centralized receiving system.
Law enforcement should transport individuals (Adults and Minors) under the Marchman
Act to the nearest Addiction Receiving Facility (ARF).
A list of Monroe County designated ARFs that can provide medical examination and
treatment of persons for whom an involuntary examination has been initiated under the
Marchman Act can be found in Appendix A.
(Signature page follows)
Monroe County DRS Plan Updated May 2023 Page 14 of 27
945
Monroe County Board of Commissioners
Craig Cates, Mayor Date
-Rest of Page Intentionally Left Blank-
Monroe County DRS Plan Updated May 2023 Page 15 of 27
946
South Florida Behavioral Health Network d/b/a Thriving Mind South Florida
John W. Newcomer, President & CEO Date
-Rest of Page Intentionally Left Blank-
Monroe County DRS Plan Updated May 2023 Page 16 of 27
947
Department of Children and Families
Lourdes Dorado-Rubio, Interim Regional Director, Date
Substance Abuse & Mental Health
-Rest of Page Intentionally Left Blank-
Monroe County DRS Plan Updated May 2023 Page 17 of 27
948
Appendix A
Designated Receiving Facilities
The following is a list of Monroe County facilities designated by the Florida Department of
Children and Families to receive and hold persons with mental illness for involuntary examination
and short-term treatment. This list is subject to change from time to time as new facilities are
designated and others are closed or have their designations removed.
Public Receiving Facilities
Guidance Care Center
3000 41 Street Ocean, Marathon
305-434-7660
Lower Fl. Keys Health System (DePoo Hospital)
1200 Kennedy Drive
Key West, Florida 33040
(305) 294-5531
Addiction Receiving Facilities
The following is a list of Monroe County Addiction Receiving Facilities (ARFs)designated by the
Florida Department of Children and Families to receive and hold persons under a Marchman Act
for involuntary examination and short-term treatment. This list is subject to change from time
to time as new facilities are designated and others are closed or have their designations
removed.
Guidance Care Center (ARF & Inpatient Detox)
3000 41 Street Ocean, Marathon
305-434-7660
Monroe County DRS Plan Updated May 2023 Page 18 of 27
949
Attachment C—Agreements Template
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement("Agreement") is entered into by and between South
Florida Behavioral Health Network, Inc., ("SFBHN') and «Legal Company Name »
(individually each a "Parry" or "Associate" and collectively the "Parties" or the "Associates").
The Effective Date of this Agreement shall be July 1, 2016 ("Agreement Effective Date").
RECITALS
A. SFBHN and ((Legal Company Name », are each deemed to be Covered Entities under
the Health Insurance Portability and Accountability Act ("HIPAA") and may, from time to
time, each act as a Business Associate on behalf of the other to provide services in
accordance with one or more agreements (the "Underlying Agreements").
A. SFBHN is deemed to be a Business Associate under the Prime Contract with the Florida
Department of Children and Families and obligated to comply with HIPAA, the HITECH
Act, and any regulations promulgated thereunder, with respect to the PHI it creates,
maintains, receives, or transmits on behalf of((Legal Company Name ».
B. ((Legal Company Name » acknowledges that all provisions, terms and conditions, or
amendments, addendum, changes or revisions applicable to the
((Legal Company Name » made subsequent to the initial execution of the Prime
Contract, (Contract entered into between the Florida Department of Children and
Families) and SFBHN, not in conflict with this Business Associate Agreement shall be
binding upon the ((Legal Company Name », and the ((Legal Company Name »,
agrees to comply with same. The Prime Contract is incorporated by reference in this
Business Associate Agreement.
C. The Associates both acknowledge that they are each obligated to comply with the Privacy
Rule, the Security Rule, the Breach Notification Rule, the Health Information Technology
for Economic and Clinical Health ("HITECH") Act, s. 501.171, F.S., and other laws and
regulations pertaining to the access, use, disclosure, and management of Protected
Health Information ("PHI") without limitation, PHI in an electronic format (EPHI).
D. In the event that either Party (or both Parties) is a Program, as defined by the federal
regulations governing the Confidentiality of Alcohol and Drug Abuse Patient Records, at
42 CFR Part 2 (the "Substance Abuse Regulations"), the Underlying Agreements may also
require each of the Parties to create, receive, transmit, or maintain patient information
on behalf of the other that is subject to the Substance Abuse Regulations. As such, the
Associates further acknowledge that they are each obligated to comply with those
regulations, with respect to a Program's patient information.
E. The Associates intend to protect the privacy and provide for the security of patient
information, including PHI, pursuant to this Agreement, and all in compliance with
Applicable Law.
Monroe County DRS Plan Updated May 2023 Page 19 of 27
950
F. The Parties acknowledge that this Agreement supplements and amends each of the
Underlying Agreements only with respect to the creation, use, or disclosure of patient
information, including PHI. Except as so supplemented or amended, the terms of the
Underlying Agreements shall govern the matters addressed in this Agreement and in
each of the Underlying Agreements.
NOW,THEREFORE, in consideration of the mutual promises below, the Parties agree as follows:
Section 1. Definitions. Capitalized terms used in this Agreement and not otherwise defined
herein shall have the meanings set forth in the HIPAA Rules, which definitions are incorporated
in this Agreement by reference. Capitalized terms used in this Agreement are defined as follows:
a. "Applicable Law" means HIPAA, the HITECH Act, and all regulations issued thereunder, as
well as the Substance Abuse Regulations and any other applicable federal and state law.
b. "Breach" shall have the meaning given to such term under the Breach Notification Rule,
including, but not limited to, 45 CFR § 164.402.
c. "Breach Notification Rule" shall mean the Breach Notification Standards at 45 CFR Parts
160 and 164.
d. "Business Associate" shall have the same meaning as given to such term in 45 CFR §
160.103.
e. "Covered Entity" shall have the same meaning as given to such term in 45 CFR § 160.103.
f. "Electronic Protected Health Information"or"ePHI" shall have the meaning given to such
term under the HIPAA Rules, including, but not limited to, 45 CFR § 160.103, as applied
to the information that each Associate creates, maintains, receives from, or transmits on
behalf of the other Associate.
g. "Enforcement Rule" shall mean the Compliance and Enforcement Standards at 45 CFR
Part 160.
h. "HIPAA" meansthe Health Insurance Portabilityand Accountability Act of 1996("HIPAA"),
Public Law No. 104-191, and any regulations promulgated thereunder.
i. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, Enforcement, and
Transaction Rules at 45 CFR Parts 160, 162, and 164.
j. "HITECH Act" means the Health Information Technology for Economic and Clinical Health
("HITECH") Act, Public Law No. 111-005, and any regulations promulgated thereunder.
k. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health
Information at 45 CFR Parts 160 and 162 and Part 164, Subparts A and E, 42 U.S.C. 1320d-
5 and 1320d-6.
I. "Program" shall have the same meaning as given to such term in 42 CFR § 2.11.
m. "Protected Health Information" or"PHI" shall have the same meaning given to such term
under the HIPAA Rules, including, but not limited to, 45 CFR § 160.103, as applied to the
information created or received by each Associate from, or on behalf of, the other
Monroe County DRS Plan Updated May 2023 Page 20 of 27
951
Associate.
n. "Required by Law"shall have the same meaning as given to such term in 45 CFR§ 164.103.
o. "Secretary" shall mean the Secretary of the Department of Health and Human Services or
his or her designee.
P. "Security Rule" shall mean the Security Standards at 45 CFR Parts 160 and 162 and Parts
164, Subparts A and C.
q. "Subcontractor" shall have the same meaning as given to such term in 45 CFR § 160.103.
r. "Substance Abuse Regulations" shall mean the Confidentiality of Alcohol and Drug Abuse
Patient Records regulations, at 42 CFR Part 2.
s. Transaction"shall have the same meaning given to such term under the Transaction Rule,
including, but not limited to, 45 CFR § 160.103.
t. "Transaction Rule" shall mean the Standards for Electronic Transactions at 45 CFR Parts
160 and 162.
u. "Unsecured PHI" shall have the same meaning given to such term, as "unsecured
protected health information," under the Breach Notification Rule, including but not
limited to, 45 CFR § 164.402, as applied to the information created or received by each
Associate from, or on behalf of, the other Associate.
Section 2. Permitted Uses and Disclosures of PHI.
a. Uses and Disclosures of PHI. Except as otherwise limited in this Agreement, Associates
may each use or disclose PHI received from or created on behalf of the other Associate only to
perform such functions, activities, or services for, or on behalf of, each other pursuant to the
Underlying Agreements.
b. Permitted Uses of PHI by Associates. Except as otherwise limited in this Agreement,
Associates may each use the PHI received from or created on behalf of the other Associate (i) for
their respective proper management and administration, (ii) to carry out their respective legal
responsibilities; and (iii) for Data Aggregation purposes for the Health Care Operations of the
other Associate. Associates may use PHI to create de-identified health information, in
accordance with the HIPAA Rules at 45 CFR § 164.514, and may use such de-identified health
information.
C. Permitted Disclosures of PHI by Associates. Except as otherwise limited in this Agreement,
Associates may each disclose PHI (i)for their proper management and administration; (ii)to carry
out their respective legal responsibilities; (iii) as Required by Law; and (iv) for Data Aggregation
purposes for the Health Care Operations of the other Associate. If an Associate intends to
disclose PHI to a third party, prior to making any such disclosure, such Associate shall first obtain,
(i) reasonable written assurances from such third party that PHI will be held confidential in a
manner that is consistent with the terms of this Agreement and will only be used or disclosed as
Required by Law or for the purposes for which it was disclosed to such third party, and (ii) a
written agreement from such third party to notify Associate of any breaches of confidentiality of
Monroe County DRS Plan Updated May 2023 Page 21 of 27
952
the PHI, to the extent it has obtained knowledge of such breach, without unreasonable delay,
and in any event within sufficient time to meet any breach notification requirements under the
HIPAA Rules.
Section 3. Obligations and Activities of Associates(as Business Associates). Associates shall each
comply with all obligations and requirements for Business Associates under Applicable Law with
respect to PHI, and shall have the following obligations:
a. Appropriate Safeguards. Associates shall each implement administrative, physical, and
technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and
availability of PHI, in accordance with 45 CFR § 164.308, physical safeguards as set forth at 45
CFR § 164.310, and technical safeguards as set forth at 45 CFR § 164.312; including, policies and
procedures regarding the protection of PHI and/or ePHI set forth at 45 CFR § 164.316 and the
provisions of training on such policies and procedures to applicable employees, subcontractors,
independent contractors, and volunteers, that reasonably and appropriately protect the
confidentiality, integrity, and availability of the PHI and/or ePHI that the Provider creates,
receives, maintains or transmits.
Associates shall take immediate steps to limit or avoid recurrence of any security breach and take
any other action pertaining to such unauthorized access or disclosure required by applicable
federal and state laws and regulations regardless of any actions taken by SFBHN or The Florida
Department of Children and Families.
b. Reporting of Improper Use or Disclosure.
(i) Each Associate shall report to the other Associate, in writing, any use or
disclosure of PHI not provided for by this Agreement, including any Breach of Unsecured PHI or
any Security Incident of which it becomes aware as required at 45 CFR 164.410, and any security
incident of which it becomes aware.
(ii) ((Legal Company Name » shall provide notification to SFBHN Security
Officer, Privacy Officer and Contract Manager as soon as possible, but no later than four (4)
business days following the determination of any breach or potential breach of personal and
confidential data.
(iii) ((Legal Company Name »shall provide notification to SFBHN Privacy Officer
and Contract Manager within twenty-four (24) hours of notification by the US Department of
Health and Human Services of any investigations, compliance reviews or inquiries by the US
Department of Health and Human Services concerning violations of HIPAA (Privacy, Security
Breach).
C. Data Breach Notification. No later than four (4) business days following any breach
affecting 500 or more individual, either Associate shall provide to the other, in writing the
elements as required by s. 501.171, F.S. to permit SFBHN to comply with the HIPAA Breach
notification requirements set forth in the Prime Contract, 45 C.F.R. §§ 164.400, et seq., and in
s. 501.171, F.S. Associates, as applicable, at its own cost, shall notice affected parties no later
than thirty (30) days following the determination of any breach or potential breach of personal
or confidential data as provided in § 817.5681, Fla. Stat. Following a HIPAA Breach (Privacy,
Security Breach), each Associate will have a continuing duty to inform the other Associate of new
and material information learned regarding the HIPAA Breach.
Monroe County DRS Plan Updated May 2023 Page 22 of 27
953
d. Mitigation Procedures. Each Associate agrees to mitigate, to the extent practicable, any
harmful effect that is known to it of a use or disclosure of PHI by such Associate in violation of
the requirements of this Agreement, or the HIPAA Rules.
e. Subcontractors and Agents. Each Associate shall ensure that any agent, including a
Subcontractor, to whom it provides PHI, agrees (in writing) to the same restrictions and
conditions that apply through this Agreement to such Associate with respect to such PHI.
Associates shall implement and maintain sanctions against agents and Subcontractors that
violate such restrictions and conditions, and shall attempt to mitigate the effects of any such
violation. Each Associate and their Subcontractors and Agents are directly liable under the civil
and criminal enforcement provisions set forth at Section 13404 of the HITECH Act and section 45
CFR § 164.500 and 164.502(E) of the Privacy Rule (42 U.S.C. 1320d-5 and 1320d-6), as amended,
for failure to comply with the safeguards, policies and procedures requirements and any
guidance issued by the Secretary of Health and Human Services with respect to such
requirements
f. Access to PHI. Each Associate agrees to provide access to PHI in a Designated Record Set
to the other Associate or, as directed by the other Associate, to an Individual, at the written
request of the other Associate within a reasonable time and manner,sufficient to allow the other
Associate to meet the requirements of 45 CFR § 164.524. Each Associate agrees to disclose PHI
in electronic format to the other Associate or, as directed by the other Associate,to an Individual
or an I ndividual's designee, as may be necessary to satisfy the other Associate's obligations under
45 CFR §§ 164.524(c)(2)(ii) and (3)(ii) regarding an individual's request for an electronic copy of
PHI.
g. Amendment of PHI. Each Associate shall make any amendment(s) to PHI in a Designated
Record Set that the other Associate directs or agrees to, pursuant to 45 CFR § 164.526, in a time
and manner reasonably designated by the other Associate.
h. Documentation of Disclosures. Each Associate agrees to document such disclosures of PHI
and information related to such disclosures as would be required for the other Associate to
respond to a request by an Individual for an accounting of disclosures of PHI in accordance with
45 CFR § 164.528.
i. Accounting of Disclosures. Each Associate agrees to provide to the other Associate, within
thirty(30) business days, information collected in accordance with Section 3(f)of this Agreement,
sufficient to permit the other Associate to respond to a request by an Individual, or on behalf of
an Individual, for an accounting of disclosures of PHI in accordance with 45 CFR § 164.528.
j. Minimum Necessary. Each Associate shall request, use, and disclose only the minimum
amount of PHI necessary to accomplish the purpose of the request, use, or disclosure to the
extent that the minimum necessary standard is applicable to the disclosure under 45 CFR §
164.502(b).
k. Governmental Access to Records. Each Associate agrees to make its internal practices,
books, and records relating to the use and disclosure of PHI received from the other Associate,
or created on behalf of the other Associate, available to the Secretary for purposes of
determining either or both Associates' compliance with the HIPAA Rules.
Monroe County DRS Plan Updated May 2023 Page 23 of 27
954
I. Standard Transactions. If an Associate conducts, in whole or in part, any Transactions
electronically on behalf of the other Associate, such Associate shall comply with the applicable
requirements of 45 CFR Part 162 and shall require that any agents or Subcontractors that
perform, in whole or in part, such Transactions on its behalf, agree in writing to comply with such
requirements. Such Associate will not enter into any trading partner agreement in connection
with conducting Standard Transactions on behalf of the other Associate: (i) that changes the
definition, data condition, or use of a data element or segment in a Standard Transaction; (ii)
adds any data element or segment to the maximum defined data set; (iii) uses any code or data
element that is marked as "not used" in the Standard Transaction's implementation specification
or is not in the Standard Transaction's implementation specification; or(iv) changes the meaning
or intent of the Standard Transaction's implementation specification.
m. Qualified Service Organization Agreement. In the event that either Associate (or both
Associates) is a Program, as defined by the Substance Abuse Regulations, each Associate agrees
to provide the services, as described in the Underlying Agreements, and further(i) acknowledges
that in receiving, storing, processing, or otherwise dealing with any information from a Program
about the patients in the Program, it is fully bound by the provisions of the Substance Abuse
Regulations; and (ii) agrees to resist in judicial proceedings any effort to obtain access to
information pertaining to such patients otherwise than as expressly provided for in the Substance
Abuse Regulations.
Section 4. Obligations of Associates (as Covered Entities).
a. Notice of Privacy Practices. Each Associate shall notify the other Associate of any
limitation(s) in its notice of privacy practices, under 45 CFR § 164.520 and under s. 501.171, F.S.
, to the extent that such limitation(s) may affect the other Associate's use or disclosure of PHI.
b. Notification of Changes Regarding Individual Permission. Each Associate shall notify the
other Associate of any changes in, or revocation of, permission by an Individual to use or disclose
PHI, to the extent that such changes may affect the other Associate's use or disclosure of PHI.
C. Notification of Restrictions to Use or Disclosure of PHI. Each Associate shall notify the
other Associate of any restriction(s) imposed on the use or disclosure of PHI that such Associate
has agreed to or is obligated to support in accordance with 45 CFR § 164.522, to the extent that
such restriction may affect the other Associate's use or disclosure of PHI. The other Associate
agrees to abide by such restriction to the extent applicable and provided that it is made aware of
the restriction in a reasonable and timely manner.
d. Permissible Requests by Associates. Neither Associate shall request the other Associate
to use or disclose PHI in any manner that would not be permissible under Applicable Law if done
by such Associate, except as permitted under this Agreement.
e. Marketing, Fundraising and Research. Each Associate shall follow guidance in the HIPAA
Rule regarding marketing, fundraising and research located at Sections 45 CFR § 164.501, 45 CFR
§ 164.508 and 45 CFR § 164.514.
Section 5. Term and Termination.
a. Term. The term of this Agreement shall commence as of the Agreement Effective
Date and shall terminate when all of the PHI provided by each Associate to the other Associate
is destroyed or returned, or, if it is infeasible to return or destroy the PHI, protections are
Monroe County DRS Plan Updated May 2023 Page 24 of 27
955
extended to such information, in accordance with Section 5(c), or when one party gives the other
fifteen (15) calendar days notification of termination in writing to the other party or such time
as mutually agreed upon by both parties.
b. Termination for Cause. A breach by either Associate of any provision set forth in Sections
2, 3 or 4 of this Agreement may, in the sole discretion of the other Associate, be deemed to
constitute a material breach of this Agreement if such breach is not cured,or a plan is not enacted
to enable a cure, within thirty (30) business days of receiving written notice from the non-
breaching Associate. Upon occurrence of such material breach,the non-breaching Associate may
immediately terminate this Agreement, notwithstanding any provision in this Agreement to the
contra ry.
C. Effect of Termination.
(i) Except as provided in paragraph (ii) of this Section 5(c), upon termination
of this Agreement for any reason, each Associate shall return or destroy all PHI received from the
other Associate, or created or received by each Associate on behalf of the other Associate, and
shall retain no copies of the PHI. Each Associate agrees to impose the same obligations to return
or destroy PHI, in writing, on each of its Subcontractors or agents to the extent they are or may
be expected to come into possession of such PHI.
(ii) In the event that an Associate determines that returning or destroying the
said PHI is infeasible, such Associate shall provide notification of the conditions that make return
or destruction infeasible to the other Associate and shall extend the protections of this
Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that
make the return or destruction infeasible, for so long as such Associate maintains such PHI.
Section 6. Indemnification. Each Associate (the "Indemnifying Associate") will indemnify,
defend, and hold harmless the other Associate (the "Indemnified Associate") from any and all
claims, losses, liabilities, damages, judgments, fees, expenses, awards, civil monetary penalties,
and costs (including reasonable attorneys' and court fees and expenses) arising out of or related
to any Breach or alleged Breach of Unsecured PHI created, received, maintained, transmitted,
or otherwise used by the Indemnifying Associate and arising from the Indemnifying Associate's
breach, or failure to perform pursuant to this Agreement (collectively, a "Claim"). This
indemnification does not cover any claims, losses, liabilities, damages, judgments, fees,
expenses, awards, civil monetary penalties, and costs resulting from the negligence or willful
misconduct of the Indemnified Associate, or any of Indemnified Associate's employees,
contractors, or agents (except Indemnifying Associate). This indemnification is contingent upon
(i) Indemnified Associate giving prompt written notice to Indemnifying Associate of any Claim
for which indemnification is sought, and (ii) Indemnified Associate giving Indemnifying Associate
sole control of the defense, including selection of counsel, and related settlement negotiations
regarding the Claim, except that Indemnifying Associate will not enter into a final settlement
involving discharge of any claims against Indemnified Associate without Indemnified Associate's
prior consent. Indemnified Associate may participate in the defense of any Claim at Indemnified
Associate's own cost. Indemnified Associate agrees that it will assist and cooperate in the
defense and related settlement of the Claim, at its expense, as the Indemnifying Associate may
reasonably request.
Section 7. Regulatory References. A reference in this Agreement to a section in the HIPAA Rules,
Monroe County DRS Plan Updated May 2023 Page 25 of 27
956
the Substance Abuse Regulations, or any other Applicable Law means the section as in effect or
as amended, and for which compliance is required by either or both Associates.
Section 8. Amendment. The Parties agree to take such action to amend this Agreement from
time to time as is necessary for both to comply with Applicable Law. Such amendment shall be
in writing and signed by both the Parties.
Section 9. Survival. The respective rights and obligations of the Parties under Section 5(c) and
Section 6 of this Agreement shall survive the termination of the Agreement.
Section 10. No Third Party Beneficiaries. Nothing express or implied in this Agreement is
intended to confer, nor shall anything herein confer, upon any person other than the Parties and
their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.
Section 11. Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a
meaning that permits the Parties to comply with Applicable Law.
Section 12. Waiver. No delay or omission by either Party to exercise any right or remedy under
this Agreement will be construed to be either acquiescence or the waiver of the ability to exercise
any right or remedy in the future.
Section 13. Severability. In the event any part or parts of this Agreement are held to be
unenforceable, the remainder of this Agreement shall continue in effect.
Section 14. Governing Law. This Agreement shall be governed by the laws of Florida
IN WITNESS WHEREOF, the Parties hereto have duly executed this Agreement as of the
Agreement Effective Date.
Monroe County Board of Commissioners SOUTH FLORIDA BEHAVIORAL HEALTH
NETWORK, INC.
SIGNED SIGNED
BY: BY:
NAME: Craig Cates NAME: John W. Newcomer
TITLE: Mayor TITLE: President and CEO
Date: Date:
Federal Tax ID4 (or SSN): 59-6000747
Monroe County DRS Plan Updated May 2023 Page 26 of 27
957
Attachment D— Sign In Sheet Monroe County Public Meeting
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Monroe County DRS Plan Updated May 2023 Page 27 of 27
958
Monroe County
Designated Receiving System Plan
In accordance with
Florida Statute 394, Florida Mental Health Act
Florida Statute 397, Hal S. Marchman Alcohol and
Other Drug Services Act
2017-2020
Monroe County DRS Plan Page 1 of 24
959
Contents
I. Background/Purpose: ............................................................................................................. 3
II. Monroe County's Designated Receiving System (DRS).................................................... 4
III. Inventory of Participating Service Providers....................................................................... 6
IV. Designated Receiving System (DRS) Agreements.............................................................. 8
Attachment A—Process Flow for Centralized Receiving System Monroe.................................... 9
Attachment B — Transportation Plan Monroe............................................................................... 10
Attachment C—Agreements......................................................................................................... 15
Attachment D— Sign In Sheet Monroe County Public Meeting .................................................. 24
Monroe County DRS Plan Page 2 of 24
960
I. Background/Purpose:
In accordance with the changes promulgated by Senate Bill 12 to Florida Statute 394 (Florida
Mental Health Act, commonly referred to as the "Baker Act"), and Florida Statute 397
(commonly referred to as the Marchman Act), Monroe County in collaboration with South
Florida Behavioral Health Network (the Managing Entity) have completed this Designated
Receiving System (DRS) Plan. Implementation of this plan assures the coordinated provision of
emergency services for people in need of help for behavioral health disorders and supports a
comprehensive behavioral system of care.
This DRS Plan describes how the community shall ensure the provision of the "No Wrong Door
Model" defined in FS 394.4573. This description includes the organization of the DRS and how
it responds to individual needs and integrates services among various providers.
The designated receiving system may be organized in any manner which functions as a no-
wrong-door model. Such models include, but are not limited to:
A central receiving system is identified as a 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.
A coordinated receiving system as a 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.
A tiered receiving system consists of multiple entry points, some of which offer only
specialized or limited services. Each service provider shall be classified according to its
capabilities as either a designated receiving facility or another type of service provider,
such as a triage center, a licensed detoxification facility, or an access center. All
participating service providers shall, within existing resources, be linked by methods to
share data, formal referral agreements, and cooperative arrangements for care
coordination and case management.
OR
The DRS may be organized in any manner that functions as a No-Wrong-Door Model that
responds to individual needs and integrates the services of various providers.
Monroe County DRS Plan Page 3 of 24
961
The County and the Managing Entity shall review and update, as necessary, the designated
receiving system at least once every 3 years. An accurate inventory of the participating service
providers shall be maintained and made available at all times to all first responders in the service
area.
II. Monroe County's Designated Receiving System (DRS)
Monroe County's Designated Receiving System is best described as a centralized receiving
system.
In Monroe County, there are 2 designated receiving facilities which are both publicly funded
(Guidance Care Center, Inc. and Lower Keys Medical Center).
SFBHN currently funds a total of 12.80 beds at these public receiving facilities — 10.92 are CSU
beds and 1.88 are DETOX beds. The following are the number of funded beds at each facility, by
type:
• Guidance Center Center, Inc. — 9.10 Adult CSU beds
1.88 DETOX beds
• Lower Keys Medical Center— 1.82 Adult CSU beds
*Note: Contract bed totals are subject to change due to rate enhancements.
The County's approach to develop the designated receiving system for Monroe County is one
that attempts to maintain the current process for Baker Acts for law enforcement, so that they are
transporting Baker Acts to the nearest most appropriate receiving facility (as is the case
currently). This is consistent with the requirement in Senate Bill 12 to ensure that there is a "no
wrong door" approach for acute care services. SFBHN held a public meeting in Monroe County
for input and will continue to receive feedback from the stakeholders on the continued
implementation of the Designated Receiving System through its community needs process. The
sign in sheet for the public meeting can be found in Attachment D.
SFBHN has identified the Guidance/Care Center as the provider that will be designated as the
central receiving facility for the centralized receiving system, described above.
Consumer is taken by Law Enforcement to the nearest receiving facility, which is the
centralized receiving system:
The consumer can be referred to the centralized receiving system through multiple entry points:
as a transfer from other facilities (such as jails/prisons, courts or hospitals), as a self-referral, as a
consumer that is picked up by law enforcement for a Baker Act/Marchman Act, etc. If the
consumer is referred to the centralized receiving system because he/she is picked up by law
enforcement as a result of a Baker Act, then he/she is taken to the nearest receiving facility
(public/private). If the nearest receiving facility is a public receiving facility, then the consumer
will be screened for both behavioral health and financial eligibility (indigent vs. private pay). If
that consumer meets acute care criteria and there is capacity at that public receiving facility, then
he/she will be accepted, stabilized and treated. Once the person is stabilized, if the consumer is
Monroe County DRS Plan Page 4 of 24
962
determined to be indigent, then the designated receiving facility will create a discharge plan,
which includes a recommended level of care. The consumer will also be screened for care
coordination through SFBHN. If that consumer meets criteria for care coordination, then a
referral will be made to SFBHN's Care Coordination Department. If the person does not meet
criteria for care coordination, then a referral will be made to an SFBHN provider that has the
recommended level of care within their treatment continuum.
If it is determined that the consumer meets acute care criteria, but the public receiving facility
doesn't have capacity, then the public receiving facility will coordinate a transfer to another
receiving facility that has capacity. It is important to note that if the consumer is a Baker Act,
then the law allows for the receiving facility to keep that consumer as long as they do not go over
10% of their licensed bed capacity. However, if the consumer is a Marchman Act, which does
not allow for that flexibility should the receiving facility be at licensed capacity, then the
receiving facility must coordinate the transfer of that consumer to another public receiving
facility and/or hospital that has capacity.
If it is determined (through the screening process) that the consumer does not meet criteria for
acute care, then the public receiving facility will determine the recommended level of care for
that consumer. If the recommended level of care is one that is actively managed by SFBHN
(Short-term Residential Treatment (SRT), Residential treatment), then SFBHN's Adult System
of Care Department will be contacted in order to coordinate that referral. If the recommended
level of care for that indigent consumer is not actively managed by SFBHN, then the receiving
facility will contact the SFBHN provider directly. Referrals will be made to best match the
consumers with their needs and geographic preference. If no preference or specific needs are
noted, then referrals are made on a rotating basis. All referrals that come through the centralized
receiving system will be well documented and will available for review to SFBHN.
Consumer is taken by Law Enforcement to the nearest receiving facility, which is a private
receiving facility:
If the consumer is referred to the centralized receiving system because he/she is picked up by law
enforcement as a result of a Baker Act, then he/she is taken to the nearest receiving facility
(public/private). If the nearest receiving facility is a private receiving facility, then he/she will be
screened to determine if he/she meets acute care criteria. If he/she meets criteria, then the
consumer will remain at the private receiving facility and will be stabilized and treated. A
discharge plan will be made by the private receiving facility, which includes a recommended
level of care. If it is determined that the consumer is an indigent consumer and meets acute care
criteria, then a consumer may be transferred to the centralized receiving system for continued
acute care services and/or referral to lower level of care services.
Consumer is self-referred for any publically funded service:
Monroe County DRS Plan Page 5 of 24
963
If the consumer is seeking publically funded services, the consumer can access care through the
centralized receiving facility. The centralized receiving facility has satellite offices throughout
Monroe County which allows for screening and level of care assessment. Based on the
consumers identified needs, the facility will make referrals accordingly including for acute care
services if necessary.
A Process Flow of the Centralized Receiving System is found in Attachment A. The
Transportation plan that outlines how consumers needing acute care are transported can be found
in Attachment B.
HI. Inventory of Participating Service Providers
Voluntary Assessment and Evaluation Facilities
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. & Assessment
Lower Keys CSU Only No Yes
Medical Center
Involuntary Assessment and Evaluation Facilities
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. & Assessment
Lower Keys CSU Only No Yes
Medical Center
Triage Centers for Mental Health
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
Monroe County DRS Plan Page 6 of 24
964
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care Yes - pending Yes - pending Yes
Center, Inc.
Lower Keys CSU Only No Yes
Medical Center
Triage Centers for Substance Use Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. & Assessment
Involuntary Treatment for Mental Health Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. & Assessment
Lower Keys CSU Only No Yes
Medical Center
Involuntary Treatment for Substance Use Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Monroe County DRS Plan Page 7 of 24
965
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. & Assessment
IV. Designated Receiving System (DRS)Agreements
Through SFBHN's Acute Care Data System partners can share data and be aware of available
beds in the Centralized Receiving System.
SFBHN has been working with Knight Software (KIS) to expand the current service data system
to fully integrate Utilization Management, Acute Care reporting and Financial Reporting into
one, cohesive application.
The KIS Integrated Solution has been developed with the goal to improve the clinical and
psychosocial outcomes of stakeholders within the mental healthcare system by providing a
system for securely sharing clinical and psychosocial information across authorized healthcare
providers to facilitate coordination of care and improve outcomes.
The first phase of the new KIS Utilization Management system was implemented effective
March 1, 2016. The system is currently capturing adult screening and assessment data. The
second phase of referral and bed management is currently in development.
The KIS Integrated Solution will allow providers within the network to enroll consumers, record
clinical and other psychosocial history, coordinate their care through management of referrals
and shared access to the clinical information, and document the outcomes of care.
A full description of the data functions can be found in SFBHN's Information Technology (IT)
Plan and is available at r r ...sl h.L. M.
Network providers have individual contracts and executed Business Associate Agreements
(BAAs)through their main contract with SFBHN which allows for data sharing and coordination
of care. Providers collaborate with SFBHN and each other to ensure consumers are linked to
services.
Agreements can be found in Attachment C.
Monroe County DRS Plan Page 8 of 24
966
Attachment A—Process Flow for Centralized Receiving System Monroe
-Page Left Intentionally Blank-
Monroe County DRS Plan Page 9 of 24
967
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K. ber�of new admissions in FN 15.16 in
Monroe Countyi
Adult Mental Health. 1,680
�s,em�• Adult Substance Abuse: 428
Children's Mental HeaBtiv 225
Chi ldren's Substance Abuse: 151
r
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uN or Acute Care7fp4 ,,,,," ,,,,,�,e facility for
rp, Mid Ic
nnn�'ummlfnfnfnfnfnewm..w
a v. if level of care
het is th°d^"" managed by Past discharge,consumer
w recommended w"mj,'YnSF BH h4(SRT, could be referred to CRT or
d el of car "),
Residential), private provider for lower level
act
of care services
Yes
f°
If level of a II t�'
care is not tonsumer hcv'6%, /f�
"the CRr""w y managed by insurance/other `"fM---Y^ Yes 'n
Yes praaulder have
�� contact
w,rl source of tTM"0
a""DOES � allo
r 7 dli�_y' illy contact t� IrnBrdtu4
pacity7 w�. ®,� provider M �M
F'sF,� rT directly m .
mu i
Reer to
/ No private
Provider
,o, W � �,........ "„�.. 1� ;
dfor CRF
Consumer Beginning in i Consumer1. "'�'m'm'
accepted la.rnuary 20 , .transferred Number of new SFBHW
W Ca rent SFBHNl ruau m renx,evadable to bred
than will de loancther t,RF
into CRF consumers in FY 1546
reaV-rime data
(CSU/ available that Vs '.. receiving served in Monroe County:
OETIOX) able to Indicate faciI tytha't (;AI ,5'1,294,9413
capacity at the 'has capacity Adults: 1,347 DE UX $ 8"l,64
publicacute Childrem 314 (Irsils Supp.a 104,277
care faa"lilies. """"•""•""•""•""•""•"" `"""°'"°'"'""'"'°"'�"""""�"""° As cn r i'r9: " 2511,267
Crisis Stay Total Available: $1,841.,05)O
(3-5 daps) 11 WWW Legend;......_.. (SU fundind 11.0,9.2 AfJ411-I'.
m 6aes th 4", UE1GNX funded brats:l RB P4Sfk what s the ^°u Me
mended nriter'ua for Care d^W—f:�; yes Total funded beds: 1,2.90a
fevai ofsa reP " Coordination"I r �
1,11111 um(CC)7 wwv Subprocess *Rote.This is subject to change due to rate
4, ,. enhancements
...... ............ °wow"
'' Referral made'to SFBHtt's " "oeosion veil add t d d�r d i IIF
No CC Dept.for linkage to w,°.palvry uu. cr r 4- u�td vulu r xm cr din
provider for CC services " a b e ysar
" Potentual a i 1 t (,I Fti . 11 I r rC :210(M,
Concernf F e fIFIL `7.1),f7C7A
Addit V fa.
——————— i) 6 Plonr cr, l SrrL 4792,00
The screening for level of,-wI11 ba """`v"""v v r d 5 P Yt, ?9)"wlpp
"""""'". Crn all ou,..-Fr rl:fl!'w17ri
completed t m CRF H a start/End r}pe at g I.xp. y2rr%y S 1'4 605
nsumer Is pd consumer goes to an 5FRHN provider they Ik.
to a w ll rece ve a fulN seessment,.wh h Id ,� Tr rat f n( q i y 1,1 J,i3°A
r level of car adluatthe recommended level of care ��
(discharged
p1 Ye No //) Tote Cost War LUCRF $ 194z,915
naluilzov °� ... f .nr T
Monroe County DRS Plan Page 10 of 24
968
Attachment B— Transportation Plan Monroe
Transportation Plan for Baker Act and Marchman Act Involuntary Examinations
Department of Children and Families
Circuit 16 (Monroe County)
This transportation plan shall describe methods of transport to a facility within the designated
receiving system for individuals subject to involuntary examination under the Baker Act s.
394.463 or involuntary admission under the Marchman Act s. 397.6772, s. 397.679, s. 397.6798,
or s. 397.6811.
When any law enforcement officer has custody of a person based on either noncriminal or minor
criminal behavior that meets the statutory guidelines for involuntary examination pursuant to s.
394.463, the law enforcement officer shall transport the person to the appropriate facility within
the designated receiving system pursuant to a transportation plan or an exception or to the
nearest receiving facility if neither apply. 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 or to the nearest facility if neither apply.
The Florida Mental Health Act, usually referred to as "The Baker Act," states that a person may
be taken to a receiving facility for involuntary examination if there is reason to believe that the
person has a mental illness and because of his or her mental illness:
The person has refused voluntary examination after conscientious explanation and disclosure of
the purpose of the examination; or the person is unable to determine for himself or herself
whether examination is necessary; and without care or treatment, the person is likely to suffer
from neglect or refuse to care for himself or herself, such neglect or refusal poses a real and
present threat of substantial harm to his or her well-being; and it is not apparent that such harm
may be avoided through the help of willing family members or friends or the provision of other
services; or there is a substantial likelihood that without care or treatment the person will cause
serious bodily harm to himself or herself or others in the near future, as evidenced by recent
behavior.
The Marchman Act is the Florida Substance Abuse Impairment Act which requires that a person
who 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:
Has lost the power of self-control with respect to substance abuse; and 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 is incapable of appreciating his or her need for such services and of
making a rational decision in that regard, although mere refusal to receive such services does not
constitute evidence of lack of judgment with respect to his or her need for such services; or
Monroe County DRS Plan Page 11 of 24
969
without care or treatment, 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 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.
The law requires that each county shall designate a single law enforcement agency within the
county, or portions thereof, to take a person into custody upon the entry of an ex parte order or
the execution of a certificate for involuntary examination by an authorized professional and to
transport that person to the appropriate facility within the designated receiving system pursuant
to this transportation plan.
The law enforcement agency may decline to transport the person to a receiving facility only if:
a. The jurisdiction designated by the county has contracted on an annual basis with
an emergency medical transport service or private transport company for
transportation of persons to receiving facilities pursuant to this section at the sole
cost of the county; and
b. The law enforcement agency and the emergency medical transport service or
private transport company agree that the continued presence of law enforcement
personnel is not necessary for the safety of the person or others.
The Monroe County Sherriff s Department and City of Key West Police Department provide
transportation of consumers under the Baker Act and/or Marchman Act throughout Monroe
County.
Monroe County Transportation Plan guidelines for Baker Act:
If a law enforcement officer believes that a person has an emergency medical condition as
defined in s. 395.002, the person should be first transported to a hospital for emergency medical
treatment, regardless of whether the hospital is a designated receiving facility or part of the
centralized receiving system.
Law enforcement should transport consumers meeting the requirements for an involuntary
examination under the Baker Act to the nearest receiving facility, unless the consumer is an
inmate, at which time, law enforcement should transport the consumer directly to the Central
Receiving Facility (Guidance Care Center, Inc.).
A list of Monroe County designated receiving facilities that can provide medical examination
and treatment of persons for whom an involuntary examination has been initiated under the
Baker Act can be found in Appendix A.
Monroe County Transportation Plan guidelines for Marchman Act:
If a law enforcement officer believes that a person has an emergency medical condition as
defined in s. 395.002, the person should be first transported to a hospital for emergency medical
treatment, regardless of whether the hospital is a designated receiving facility or part of the
centralized receiving system.
Monroe County DRS Plan Page 12 of 24
970
Law enforcement should transport consumers (Adults and Minors) under the Marchman Act to
the nearest Addiction Receiving Facility.
A list of Monroe County designated receiving facilities that can provide medical examination
and treatment of persons for whom an involuntary examination has been initiated under the
Marchman Act can be found in Appendix A.
Monroe County DRS Plan Page 13 of 24
971
Appendix A
Designated Receiving Facilities
The following is a list of Monroe County psychiatric facilities designated by the Florida
Department of Children and Families to receive and hold persons with mental illness for
involuntary examination and short-term treatment. This list is subject to change from time to
time as new facilities are designated and others are closed or have their designations
removed.
Public Receiving Facilities
Guidance Care Center
3000 41 Street Ocean, Marathon
305-434-7660
Lower Fl. Keys Health System (DePoo Hospital)
1200 Kennedy Drive
Key West, Florida 33040
(305) 294-5531
Addiction Receiving Facilities
The following is a list of Monroe County Addiction Receiving Facilities (ARFs) designated by
the Florida Department of Children and Families to receive and hold persons under a Marchman
Act for involuntary examination and short-term treatment. This list is subject to change from
time to time as new facilities are designated and others are closed or have their
designations removed.
Guidance Care Center (ARF & Inpatient Detox)
3000 41 Street Ocean, Marathon
305-434-7660
Monroe County DRS Plan Page 14 of 24
972
Attachment C—Agreements
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement("Agreement") is entered into by and between South
Florida Behavioral Health Network, Inc., ("SFBHN') and «Legal Company Name »
(individually each a "Party" or "Associate" and collectively the "Parties" or the "Associates").
The Effective Date of this Agreement shall be July 1, 2016 ("Agreement Effective Date").
RECITALS
A. SFBHN and «LegalCompanyName », are each deemed to be Covered Entities under
the Health Insurance Portability and Accountability Act ("HIPAA") and may, from time
to time, each act as a Business Associate on behalf of the other to provide services in
accordance with one or more agreements (the "Underlying Agreements").
A. SFBHN is deemed to be a Business Associate under the Prime Contract with the Florida
Department of Children and Families and obligated to comply with HIPAA, the HITECH
Act, and any regulations promulgated thereunder, with respect to the PHI it creates,
maintains, receives, or transmits on behalf of((Legal Company Name ».
B. ((Legal Company Name » acknowledges that all provisions, terms and conditions, or
amendments, addendum, changes or revisions applicable to the
((Legal Company Name » made subsequent to the initial execution of the Prime
Contract, (Contract entered into between the Florida Department of Children and
Families) and SFBHN, not in conflict with this Business Associate Agreement shall be
binding upon the ((Legal Company Name_)), and the ((Legal Company Name »,
agrees to comply with same. The Prime Contract is incorporated by reference in this
Business Associate Agreement.
C. The Associates both acknowledge that they are each obligated to comply with the
Privacy Rule, the Security Rule, the Breach Notification Rule, the Health Information
Technology for Economic and Clinical Health ("HITECH") Act, s. 501.171, F.S., and other
laws and regulations pertaining to the access, use, disclosure, and management of
Protected Health Information ("PHI") without limitation, PHI in an electronic format
(EPHI).
D. In the event that either Party (or both Parties) is a Program, as defined by the federal
regulations governing the Confidentiality of Alcohol and Drug Abuse Patient Records, at
42 CFR Part 2 (the "Substance Abuse Regulations"), the Underlying Agreements may
also require each of the Parties to create, receive, transmit, or maintain patient
information on behalf of the other that is subject to the Substance Abuse Regulations.
As such, the Associates further acknowledge that they are each obligated to comply
with those regulations, with respect to a Program's patient information.
E. The Associates intend to protect the privacy and provide for the security of patient
information, including PHI, pursuant to this Agreement, and all in compliance with
Applicable Law.
Monroe County DRS Plan Page 15 of 24
973
F. The Parties acknowledge that this Agreement supplements and amends each of the
Underlying Agreements only with respect to the creation, use, or disclosure of patient
information, including PHI. Except as so supplemented or amended, the terms of the
Underlying Agreements shall govern the matters addressed in this Agreement and in
each of the Underlying Agreements.
NOW, THEREFORE, in consideration of the mutual promises below, the Parties agree as
follows:
Section 1. Definitions. Capitalized terms used in this Agreement and not otherwise defined
herein shall have the meanings set forth in the HIPAA Rules, which definitions are incorporated
in this Agreement by reference. Capitalized terms used in this Agreement are defined as
follows:
a. "Applicable Law" means HIPAA, the HITECH Act, and all regulations issued thereunder,
as well as the Substance Abuse Regulations and any other applicable federal and state
law.
b. "Breach" shall have the meaning given to such term under the Breach Notification Rule,
including, but not limited to, 45 CFR § 164.402.
c. "Breach Notification Rule" shall mean the Breach Notification Standards at 45 CFR Parts
160 and 164.
d. "Business Associate" shall have the same meaning as given to such term in 45 CFR §
160.103.
e. "Covered Entity" shall have the same meaning as given to such term in 45 CFR §
160.103.
f. "Electronic Protected Health Information" or "ePHI" shall have the meaning given to
such term under the HIPAA Rules, including, but not limited to, 45 CFR § 160.103, as
applied to the information that each Associate creates, maintains, receives from, or
transmits on behalf of the other Associate.
g. "Enforcement Rule" shall mean the Compliance and Enforcement Standards at 45 CFR
Part 160.
h. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996
("HIPAA"), Public Law No. 104-191, and any regulations promulgated thereunder.
i. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, Enforcement, and
Transaction Rules at 45 CFR Parts 160, 162, and 164.
j. "HITECH Act" means the Health Information Technology for Economic and Clinical
Health ("HITECH") Act, Public Law No. 111-005, and any regulations promulgated
thereunder.
k. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health
Information at 45 CFR Parts 160 and 162 and Part 164, Subparts A and E, 42 U.S.C.
1320d-5 and 1320d-6.
Monroe County DRS Plan Page 16 of 24
974
I. "Program" shall have the same meaning as given to such term in 42 CFR § 2.11.
m. "Protected Health Information" or "PHI" shall have the same meaning given to such
term under the HIPAA Rules, including, but not limited to, 45 CFR § 160.103, as applied
to the information created or received by each Associate from, or on behalf of, the
other Associate.
n. "Required by Law" shall have the same meaning as given to such term in 45 CFR §
164.103.
o. "Secretary" shall mean the Secretary of the Department of Health and Human Services
or his or her designee.
p. "Security Rule" shall mean the Security Standards at 45 CFR Parts 160 and 162 and Parts
164, Subparts A and C.
q. "Subcontractor" shall have the same meaning as given to such term in 45 CFR § 160.103.
r. "Substance Abuse Regulations" shall mean the Confidentiality of Alcohol and Drug
Abuse Patient Records regulations, at 42 CFR Part 2.
s. Transaction" shall have the same meaning given to such term under the Transaction
Rule, including, but not limited to, 45 CFR § 160.103.
t. "Transaction Rule" shall mean the Standards for Electronic Transactions at 45 CFR Parts
160 and 162.
u. "Unsecured PHI" shall have the same meaning given to such term, as "unsecured
protected health information," under the Breach Notification Rule, including but not
limited to, 45 CFR § 164.402, as applied to the information created or received by each
Associate from, or on behalf of, the other Associate.
Section 2. Permitted Uses and Disclosures of PHI.
a. Uses and Disclosures of PHI. Except as otherwise limited in this Agreement, Associates
may each use or disclose PHI received from or created on behalf of the other Associate only to
perform such functions, activities, or services for, or on behalf of, each other pursuant to the
Underlying Agreements.
b. Permitted Uses of PHI by Associates. Except as otherwise limited in this Agreement,
Associates may each use the PHI received from or created on behalf of the other Associate (i)
for their respective proper management and administration, (ii) to carry out their respective
legal responsibilities; and (iii) for Data Aggregation purposes for the Health Care Operations of
the other Associate. Associates may use PHI to create de-identified health information, in
accordance with the HIPAA Rules at 45 CFR § 164.514, and may use such de-identified health
information.
C. Permitted Disclosures of PHI by Associates. Except as otherwise limited in this
Agreement, Associates may each disclose PHI (i) for their proper management and
administration; (ii) to carry out their respective legal responsibilities; (iii) as Required by Law;
and (iv) for Data Aggregation purposes for the Health Care Operations of the other Associate. If
Monroe County DRS Plan Page 17 of 24
975
an Associate intends to disclose PHI to a third party, prior to making any such disclosure, such
Associate shall first obtain, (i) reasonable written assurances from such third party that PHI will
be held confidential in a manner that is consistent with the terms of this Agreement and will
only be used or disclosed as Required by Law or for the purposes for which it was disclosed to
such third party, and (ii) a written agreement from such third party to notify Associate of any
breaches of confidentiality of the PHI, to the extent it has obtained knowledge of such breach,
without unreasonable delay, and in any event within sufficient time to meet any breach
notification requirements under the HIPAA Rules.
Section 3. Obligations and Activities of Associates (as Business Associates). Associates shall
each comply with all obligations and requirements for Business Associates under Applicable
Law with respect to PHI, and shall have the following obligations:
a. Appropriate Safeguards. Associates shall each implement administrative, physical, and
technical safeguards that reasonably and appropriately protect the confidentiality, integrity,
and availability of PHI, in accordance with 45 CFR § 164.308, physical safeguards as set forth at
45 CFR § 164.310, and technical safeguards as set forth at 45 CFR § 164.312; including, policies
and procedures regarding the protection of PHI and/or ePHI set forth at 45 CFR § 164.316 and
the provisions of training on such policies and procedures to applicable employees,
subcontractors, independent contractors, and volunteers, that reasonably and appropriately
protect the confidentiality, integrity, and availability of the PHI and/or ePHI that the Provider
creates, receives, maintains or transmits.
Associates shall take immediate steps to limit or avoid recurrence of any security breach and
take any other action pertaining to such unauthorized access or disclosure required by
applicable federal and state laws and regulations regardless of any actions taken by SFBHN or
The Florida Department of Children and Families.
b. Reporting of Improper Use or Disclosure.
(i) Each Associate shall report to the other Associate, in writing, any use or
disclosure of PHI not provided for by this Agreement, including any Breach of Unsecured PHI or
any Security Incident of which it becomes aware as required at 45 CFR 164.410, and any
security incident of which it becomes aware.
(ii) ((Legal Company Name » shall provide notification to SFBHN Security
Officer, Privacy Officer and Contract Manager as soon as possible, but no later than four (4)
business days following the determination of any breach or potential breach of personal and
confidential data.
(iii) «LegalCompanyName » shall provide notification to SFBHN Privacy
Officer and Contract Manager within twenty-four (24) hours of notification by the US
Department of Health and Human Services of any investigations, compliance reviews or
inquiries by the US Department of Health and Human Services concerning violations of HIPAA
(Privacy, Security Breach).
C. Data Breach Notification. No later than four (4) business days following any breach
affecting 500 or more individuals , either Associate shall provide to the other, in writing the
elements as required by s. 501.171, F.S. to permit SFBHN to comply with the HIPAA Breach
notification requirements set forth in the Prime Contract, 45 C.F.R. §§ 164.400, et seq.,
Monroe County DRS Plan Page 18 of 24
976
and in s. 501.171, F.S. Associates, as applicable, at its own cost, shall notice affected parties no
later than thirty (30) days following the determination of any breach or potential breach of
personal or confidential data as provided in § 817.5681, Fla. Stat. Following a HIPAA Breach
(Privacy, Security Breach), each Associate will have a continuing duty to inform the other
Associate of new and material information learned regarding the HIPAA Breach.
d. Mitigation Procedures. Each Associate agrees to mitigate, to the extent practicable, any
harmful effect that is known to it of a use or disclosure of PHI by such Associate in violation of
the requirements of this Agreement, or the HIPAA Rules.
e. Subcontractors and Agents. Each Associate shall ensure that any agent, including a
Subcontractor, to whom it provides PHI, agrees (in writing) to the same restrictions and
conditions that apply through this Agreement to such Associate with respect to such PHI.
Associates shall implement and maintain sanctions against agents and Subcontractors that
violate such restrictions and conditions, and shall attempt to mitigate the effects of any such
violation. Each Associate and their Subcontractors and Agents are directly liable under the civil
and criminal enforcement provisions set forth at Section 13404 of the HITECH Act and section
45 CFR § 164.500 and 164.502(E) of the Privacy Rule (42 U.S.C. 1320d-5 and 1320d-6), as
amended, for failure to comply with the safeguards, policies and procedures requirements and
any guidance issued by the Secretary of Health and Human Services with respect to such
requirements
f. Access to PHI. Each Associate agrees to provide access to PHI in a Designated Record Set
to the other Associate or, as directed by the other Associate, to an Individual, at the written
request of the other Associate within a reasonable time and manner, sufficient to allow the
other Associate to meet the requirements of 45 CFR § 164.524. Each Associate agrees to
disclose PHI in electronic format to the other Associate or, as directed by the other Associate,
to an Individual or an Individual's designee, as may be necessary to satisfy the other Associate's
obligations under 45 CFR §§ 164.524(c)(2)(ii) and (3)(ii) regarding an individual's request for an
electronic copy of PHI.
g. Amendment of PHI. Each Associate shall make any amendment(s) to PHI in a Designated
Record Set that the other Associate directs or agrees to, pursuant to 45 CFR § 164.526, in a
time and manner reasonably designated by the other Associate.
h. Documentation of Disclosures. Each Associate agrees to document such disclosures of
PHI and information related to such disclosures as would be required for the other Associate to
respond to a request by an Individual for an accounting of disclosures of PHI in accordance with
45 CFR § 164.528.
i. Accounting of Disclosures. Each Associate agrees to provide to the other Associate, within
thirty (30) business days, information collected in accordance with Section 3(f) of this
Agreement, sufficient to permit the other Associate to respond to a request by an Individual, or
on behalf of an Individual, for an accounting of disclosures of PHI in accordance with 45 CFR §
164.528.
j. Minimum Necessary. Each Associate shall request, use, and disclose only the minimum
amount of PHI necessary to accomplish the purpose of the request, use, or disclosure to the
extent that the minimum necessary standard is applicable to the disclosure under 45 CFR §
164.502(b).
Monroe County DRS Plan Page 19 of 24
977
k. Governmental Access to Records. Each Associate agrees to make its internal practices,
books, and records relating to the use and disclosure of PHI received from the other Associate,
or created on behalf of the other Associate, available to the Secretary for purposes of
determining either or both Associates' compliance with the HIPAA Rules.
I. Standard Transactions. If an Associate conducts, in whole or in part, any Transactions
electronically on behalf of the other Associate, such Associate shall comply with the applicable
requirements of 45 CFR Part 162 and shall require that any agents or Subcontractors that
perform, in whole or in part, such Transactions on its behalf, agree in writing to comply with
such requirements. Such Associate will not enter into any trading partner agreement in
connection with conducting Standard Transactions on behalf of the other Associate: (i) that
changes the definition, data condition, or use of a data element or segment in a Standard
Transaction; (ii) adds any data element or segment to the maximum defined data set; (iii) uses
any code or data element that is marked as "not used" in the Standard Transaction's
implementation specification or is not in the Standard Transaction's implementation
specification; or (iv) changes the meaning or intent of the Standard Transaction's
implementation specification.
m. Qualified Service Organization Agreement. In the event that either Associate (or both
Associates) is a Program, as defined by the Substance Abuse Regulations, each Associate
agrees to provide the services, as described in the Underlying Agreements, and further (i)
acknowledges that in receiving, storing, processing, or otherwise dealing with any information
from a Program about the patients in the Program, it is fully bound by the provisions of the
Substance Abuse Regulations; and (ii) agrees to resist in judicial proceedings any effort to
obtain access to information pertaining to such patients otherwise than as expressly provided
for in the Substance Abuse Regulations.
Section 4. Obligations of Associates (as Covered Entities).
a. Notice of Privacy Practices. Each Associate shall notify the other Associate of any
limitation(s) in its notice of privacy practices, under 45 CFR § 164.520 and under s. 501.171, F.S.
, to the extent that such limitation(s) may affect the other Associate's use or disclosure of PHI.
b. Notification of Changes Regarding Individual Permission. Each Associate shall notify the
other Associate of any changes in, or revocation of, permission by an Individual to use or
disclose PHI, to the extent that such changes may affect the other Associate's use or disclosure
of PHI.
C. Notification of Restrictions to Use or Disclosure of PHI. Each Associate shall notify the
other Associate of any restriction(s) imposed on the use or disclosure of PHI that such Associate
has agreed to or is obligated to support in accordance with 45 CFR § 164.522, to the extent that
such restriction may affect the other Associate's use or disclosure of PHI. The other Associate
agrees to abide by such restriction to the extent applicable and provided that it is made aware
of the restriction in a reasonable and timely manner.
d. Permissible Requests bV Associates. Neither Associate shall request the other Associate
to use or disclose PHI in any manner that would not be permissible under Applicable Law if
done by such Associate, except as permitted under this Agreement.
e. Marketing, Fundraising and Research. Each Associate shall follow guidance in the HIPAA
Monroe County DRS Plan Page 20 of 24
978
Rule regarding marketing, fundraising and research located at Sections 45 CFR § 164.501, 45
CFR § 164.508 and 45 CFR § 164.514.
Section 5. Term and Termination.
a. Term. The term of this Agreement shall commence as of the Agreement Effective
Date and shall terminate when all of the PHI provided by each Associate to the other Associate
is destroyed or returned, or, if it is infeasible to return or destroy the PHI, protections are
extended to such information, in accordance with Section 5(c), or when one party gives the
other fifteen (15) calendar days notification of termination in writing to the other party or such
time as mutually agreed upon by both parties.
b. Termination for Cause. A breach by either Associate of any provision set forth in
Sections 2, 3 or 4 of this Agreement may, in the sole discretion of the other Associate, be
deemed to constitute a material breach of this Agreement if such breach is not cured, or a plan
is not enacted to enable a cure, within thirty (30) business days of receiving written notice from
the non-breaching Associate. Upon occurrence of such material breach, the non-breaching
Associate may immediately terminate this Agreement, notwithstanding any provision in this
Agreement to the contrary.
C. Effect of Termination.
(i) Except as provided in paragraph (ii) of this Section 5(c), upon termination
of this Agreement for any reason, each Associate shall return or destroy all PHI received from
the other Associate, or created or received by each Associate on behalf of the other Associate,
and shall retain no copies of the PHI. Each Associate agrees to impose the same obligations to
return or destroy PHI, in writing, on each of its Subcontractors or agents to the extent they are
or may be expected to come into possession of such PHI.
(ii) In the event that an Associate determines that returning or destroying
the said PHI is infeasible, such Associate shall provide notification of the conditions that make
return or destruction infeasible to the other Associate and shall extend the protections of this
Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes
that make the return or destruction infeasible, for so long as such Associate maintains such PHI.
Section 6. Indemnification. Each Associate (the "Indemnifying Associate") will indemnify,
defend, and hold harmless the other Associate (the "Indemnified Associate") from any and all
claims, losses, liabilities, damages,judgments, fees, expenses, awards, civil monetary penalties,
and costs (including reasonable attorneys' and court fees and expenses) arising out of or
related to any Breach or alleged Breach of Unsecured PHI created, received, maintained,
transmitted, or otherwise used by the Indemnifying Associate and arising from the
Indemnifying Associate's breach, or failure to perform pursuant to this Agreement (collectively,
a "Claim"). This indemnification does not cover any claims, losses, liabilities, damages,
judgments, fees, expenses, awards, civil monetary penalties, and costs resulting from the
negligence or willful misconduct of the Indemnified Associate, or any of Indemnified
Associate's employees, contractors, or agents (except Indemnifying Associate). This
indemnification is contingent upon (i) Indemnified Associate giving prompt written notice to
Indemnifying Associate of any Claim for which indemnification is sought, and (ii) Indemnified
Associate giving Indemnifying Associate sole control of the defense, including selection of
Monroe County DRS Plan Page 21 of 24
979
counsel, and related settlement negotiations regarding the Claim, except that Indemnifying
Associate will not enter into a final settlement involving discharge of any claims against
Indemnified Associate without Indemnified Associate's prior consent. Indemnified Associate
may participate in the defense of any Claim at Indemnified Associate's own cost. Indemnified
Associate agrees that it will assist and cooperate in the defense and related settlement of the
Claim, at its expense, as the Indemnifying Associate may reasonably request.
Section 7. Regulatory References. A reference in this Agreement to a section in the HIPAA
Rules, the Substance Abuse Regulations, or any other Applicable Law means the section as in
effect or as amended, and for which compliance is required by either or both Associates.
Section 8. Amendment. The Parties agree to take such action to amend this Agreement from
time to time as is necessary for both to comply with Applicable Law. Such amendment shall be
in writing and signed by both the Parties.
Section 9. Survival. The respective rights and obligations of the Parties under Section 5(c) and
Section 6 of this Agreement shall survive the termination of the Agreement.
Section 10. No Third Party Beneficiaries. Nothing express or implied in this Agreement is
intended to confer, nor shall anything herein confer, upon any person other than the Parties
and their respective successors or assigns, any rights, remedies, obligations or liabilities
whatsoever.
Section 11. Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a
meaning that permits the Parties to comply with Applicable Law.
Section 12. Waiver. No delay or omission by either Party to exercise any right or remedy under
this Agreement will be construed to be either acquiescence or the waiver of the ability to
exercise any right or remedy in the future.
Section 13. Severability. In the event any part or parts of this Agreement are held to be
unenforceable, the remainder of this Agreement shall continue in effect.
Section 14. Governing Law.This Agreement shall be governed by the laws of Florida
IN WITNESS WHEREOF, the Parties hereto have duly executed this Agreement as of the
Agreement Effective Date.
«Legal_Company_Name_» SOUTH FLORIDA BEHAVIORAL HEALTH
NETWORK, INC.
SIGNED SIGNED
BY: BY:
NAME: «ContractSigner» NAME: John W. Dow
Monroe County DRS Plan Page 22 of 24
980
TITLE: ((Signer Title>> TITLE: President and CEO
Date: Date:
Federal Tax ID# (or SSN): «Fed M>
Monroe County DRS Plan Page 23 of 24
981
Attachment D— Sign In Sheet Monroe County Public Meeting
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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)
1. 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
983
Statutes & Constitution :View Statutes : Online Sunshine Page l of 3
Select Year: 201 fi v o
The 2016 Florida Statutes
Title XXIX Cha ter 394 View Entire Chapter
PUBLIC HEALTH MENTAL HEALTH
394.4573 Coordinated system of care; annual assessment; essential elements; measures of
performance; system improvement grants; reports.-On or before December 1 of each year, the
department shall submit to the Governor, the President of the Senate, and the Speaker of the House of
Representatives an assessment of the behavioral health services in this state. The assessment shall
consider, at a minimum, the extent to which designated receiving systems function as no-wrong-door
models, the availability of treatment and recovery services that use recovery-oriented and peer-involved
approaches, the availability of less-restrictive services, and the use of evidence-informed practices. The
department's assessment shall consider, at a minimum, the needs assessments conducted by the
managing entities pursuant to s. 394.9082(5). Beginning in 2017, the department shall compile and
include in the report all plans submitted by managing entities pursuant to S. 394.9082(8) and the
department's evaluation of each plan.
(1) As used in this section:
(a) "Care coordination" means the implementation of deliberate and planned organizational
relationships and service procedures that improve the effectiveness and efficiency of the behavioral
health system by engaging in purposeful interactions with individuals who are not yet effectively
connected with services to ensure service linkage. Examples of care coordination activities include
development of referral agreements, shared protocols, and information exchange procedures. The
purpose of care coordination is to enhance the delivery of treatment services and recovery supports and
to improve outcomes among priority populations.
(b) "Case management" means those direct services provided to a client in order to assess his or her
needs, plan or arrange services, coordinate service providers, link the service system to a client,
monitor service delivery, and evaluate patient outcomes to ensure the client is receiving the
appropriate services.
(c) "Coordinated system of care" means the full array of behavioral and related services in a region
or community offered by all service providers, whether participating under contract with the managing
entity or by another method of community partnership or mutual agreement.
(d) "No-wrong-door model" means a model for the delivery of acute care services to persons who
have mental health or substance use disorders, or both, which optimizes access to care, regardless of
the entry point to the behavioral health care system.
(2) The essential elements of a coordinated system of care include:
(a) Community interventions, such as prevention, primary care for behavioral health needs,
therapeutic and supportive services, crisis response services, and diversion programs.
(b) A designated receiving system that consists of one or more facilities serving a defined geographic
area and responsible for assessment and evaluation, both voluntary and involuntary, and treatment or
triage of patients who have a mental health or substance use disorder, or co-occurring disorders.
htt /'www.le state.fl.us/STATUTES/index.cfm?A mode=Dis la „Statute&Search St... 3/28/2017 984
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Statutes & Constitution :View Statutes : Online Sunsbine Page 2 of 3
1. A county or several counties shalt plan the designated receiving system using a process that
includes the managing entity and is open to participation by individuals with behavioral health needs
and their families, service providers, law enforcement agencies, and other parties. The county or
counties, in collaboration with the managing entity, shall document the designated receiving system
through written memoranda of agreement or other binding arrangements. The county or counties and
the managing entity shalt complete the plan and implement the designated receiving system by July 1,
2017, and the county or counties and the managing entity shalt review and update, as necessary, the
designated receiving system at least once every 3 years.
2. To the extent permitted by available resources, the designated receiving system shall function as
a no-wrong-door model. The designated receiving system may be organized in any manner which
functions as a no-wrong-door model that responds to individual needs and integrates services among
various providers. Such models include, but are not limited to:
a. A central receiving system that consists of a designated central receiving facility that serves as a
single entry point for persons with mental health or substance use disorders, or co-occurring disorders.
The central receiving facility shall be capable of assessment, evaluation, and triage or treatment or
stabilization of persons with mentat health or substance use disorders, or co-occurring disorders.
b. A coordinated receiving system that consists of multiple entry points that are linked by shared
data systems, formal referral agreements, and cooperative arrangements for care coordination and case
management. Each entry point shall be a designated receiving facility and shall, within existing
resources, provide or arrange for necessary services following an initial assessment and evaluation.
c. A tiered receiving system that consists of multiple entry points, some of which offer only
specialized or limited services. Each service provider shalt be classified according to its capabilities as
either a designated receiving facility or another type of service provider, such as a triage center, a
licensed detoxification facility, or an access center. All participating service providers shad, within
existing resources, be linked by methods to share data, format 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 shalt be maintained and
made available at all times to all first responders in the service area.
(c) Transportation in accordance with a plan developed under s. 394.462.
(d) Crisis services, including 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 July 1, 2017, and, thereafter,
within 6 months after hire.
(f) Care coordination that involves coordination with other local systems and entities, public and
private, which are involved with the individual, such as primary care, child welfare, behavioral health
care, and criminal and juvenile justice organizations.
(g) Outpatient services.
(h) Residential services.
(i) Hospital inpatient care.
(j) Aftercare and other postdischarge services.
http://www.leg.state.fl.us/STATUTES/index.cfm?App,_mode:=Display,,Statute&Search,"-St... 3/28/2017 985
Statutes & Constitution :View Statutes : Online Sunshine Page 3 of 3
(k) Medication-assisted treatment and medication management.
(1) Recovery support, including, but not limited to, support for competitive employment,
educational attainment, independent living skills development, family support and education, wellness
management and self-care, and assistance in obtaining housing that meets the individual's needs. Such
housing may include mental health residential treatment facilities, Limited mental health assisted living
facilities, adult family care homes, and supportive housing. Housing provided using state funds must
provide a safe and decent environment free from abuse and neglect.
(m) Care plans shall assign specific responsibility for initial and ongoing evaluation of the supervision
and support needs of the individual and the identification of housing that meets such needs. For
purposes of this paragraph, the term "supervision" means oversight of and assistance with compliance
with the clinical aspects of an individual's care plan.
(3) SYSTEM IMPROVEMENT GRANTS.—Subject to a specific appropriation by the Legislature, the
department may award system improvement grants to managing entities based on a detailed plan to
enhance services in accordance with the no-wrong-door model as defined in subsection (1) and to
address specific needs identified in the assessment prepared by the department pursuant to this section.
Such a grant must be awarded through a performance-based contract that Links payments to the
documented and measurable achievement of system improvements.
History. --ss, 3, 4, 5, ch. 80-384; s. 5,ch. 84-285;s. 1, ch.89-211; s. 5, ch. 96-169;s. 100, ch. 2010-102;s. 5,ch. 2016-
241.
Copyright 0 1995-2017 The Florida Legislature - —Privacy Statement - Contact Us
http://www.leg.state.fl.us/STATUTES/index.cfm?App,,_jnode:-Display,_,Statute&Search"-St... 3/28/2017 986
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
that Medicaid reimbursements are less than the costs of providing services, the agency and the
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
delivered to eligible individuals.
To more closely align the Baker Act(mental illness) and Marchman Act(substance abuse), the
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.
1 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 consumer support
services related to behavioral health.
This surmnary is provided for infonnation only and does not represent the opinion of any Senator,Senate Officer,or Senate Office.
CS/SB 12 Page: 1
987
Committee on Children, Families,
2016 Summary of Legislation Passed 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 surmnary is provided for infonnation only and does not represent the opinion of any Senator,Senate Officer,or Senate Office.
CS/SB 12 Page: 2
988
Monroe County
Designated Receiving System Plan
In accordance with
Florida Statute 394, Florida Mental Health Act
Florida Statute 397, Hal S. Marchman Alcohol and
Other Drug Services Act
2017-2020
Monroe County DRS Plan Page 1 of 24
Contents
I. Background/Purpose: ............................................................................................................. 3
IL Monroe County's Designated Receiving System(DRS).................................................... 4
III. Inventory of Participating Service Providers....................................................................... 6
IV. Designated Receiving System(DRS) Agreements.............................................................. 8
Attachment A—Process Flow for Centralized Receiving System Monroe.................................... 9
Attachment B —Transportation Plan Monroe............................................................................... 10
Attachment C—Agreements......................................................................................................... 15
Attachment D— Sign In Sheet Monroe County Public Meeting .................................................. 24
Monroe County DRS Plan Page 2 of 24
I. Background/Purpose:
In accordance with the changes promulgated by Senate Bill 12 to Florida Statute 394 (Florida
Mental Health Act, commonly referred to as the `Baker Act"), and Florida Statute 397
(commonly referred to as the Marchman Act), Monroe County in collaboration with South
Florida Behavioral Health Network (the Managing Entity) have completed this Designated
Receiving System (DRS) Plan. Implementation of this plan assures the coordinated provision of
emergency services for people in need of help for behavioral health disorders and supports a
comprehensive behavioral system of care.
This DRS Plan describes how the community shall ensure the provision of the "No Wrong Door
Model" defined in FS 394.4573. This description includes the organization of the DRS and how
it responds to individual needs and integrates services among various providers.
The designated receiving system may be organized in any manner which functions as a no-
wrong-door model. Such models include, but are not limited to:
A central receiving system is identified as a 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.
A coordinated receiving system as a 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.
A tiered receiving system consists of multiple entry points, some of which offer only
specialized or limited services. Each service provider shall be classified according to its
capabilities as either a designated receiving facility or another type of service provider,
such as a triage center, a licensed detoxification facility, or an access center. All
participating service providers shall, within existing resources, be linked by methods to
share data, formal referral agreements, and cooperative arrangements for care
coordination and case management.
OR
The DRS may be organized in any manner that functions as a No-Wrong-Door Model that
responds to individual needs and integrates the services of various providers.
Monroe County DRS Plan Page 3 of 24
The County and the Managing Entity shall review and update, as necessary, the designated
receiving system at least once every 3 years. An accurate inventory of the participating service
providers shall be maintained and made available at all times to all first responders in the service
area.
II. Monroe County's Designated Receiving System (DRS)
Monroe County's Designated Receiving System is best described as a centralized receiving
system.
In Monroe County, there are 2 designated receiving facilities which are both publicly funded
(Guidance Care Center,Inc. and Lower Keys Medical Center).
SFBHN currently funds a total of 12.80 beds at these public receiving facilities — 10.92 are CSU
beds and 1.88 are DETOX beds. The following are the number of funded beds at each facility, by
type:
• Guidance Center Center, Inc. — 9.10 Adult CSU beds
1.88 DETOX beds
• Lower Keys Medical Center— 1.82 Adult CSU beds
*Note: Contract bed totals are subject to change due to rate enhancements.
The County's approach to develop the designated receiving system for Monroe County is one
that attempts to maintain the current process for Baker Acts for law enforcement, so that they are
transporting Baker Acts to the nearest most appropriate receiving facility (as is the case
currently). This is consistent with the requirement in Senate Bill 12 to ensure that there is a "no
wrong door" approach for acute care services. SFBHN held a public meeting in Monroe County
for input and will continue to receive feedback from the stakeholders on the continued
implementation of the Designated Receiving System through its community needs process. The
sign in sheet for the public meeting can be found in Attachment D.
SFBHN has identified the Guidance/Care Center as the provider that will be designated as the
central receiving facility for the centralized receiving system, described above.
Consumer is taken by Law Enforcement to the nearest receiving facility, which is the
centralized receiving system:
The consumer can be referred to the centralized receiving system through multiple entry points:
as a transfer from other facilities (such as jails/prisons, courts or hospitals), as a self-referral, as a
consumer that is picked up by law enforcement for a Baker Act/Marchman Act, etc. If the
consumer is referred to the centralized receiving system because he/she is picked up by law
enforcement as a result of a Baker Act, then he/she is taken to the nearest receiving facility
(public/private). If the nearest receiving facility is a public receiving facility, then the consumer
will be screened for both behavioral health and financial eligibility (indigent vs. private pay). If
that consumer meets acute care criteria and there is capacity at that public receiving facility, then
he/she will be accepted, stabilized and treated. Once the person is stabilized, if the consumer is
Monroe County DRS Plan Page 4 of 24
determined to be indigent, then the designated receiving facility will create a discharge plan,
which includes a recommended level of care. The consumer will also be screened for care
coordination through SFBHN. If that consumer meets criteria for care coordination, then a
referral will be made to SFBHN's Care Coordination Department. If the person does not meet
criteria for care coordination, then a referral will be made to an SFBHN provider that has the
recommended level of care within their treatment continuum.
If it is determined that the consumer meets acute care criteria, but the public receiving facility
doesn't have capacity, then the public receiving facility will coordinate a transfer to another
receiving facility that has capacity. It is important to note that if the consumer is a Baker Act,
then the law allows for the receiving facility to keep that consumer as long as they do not go over
10% of their licensed bed capacity. However, if the consumer is a Marchman Act, which does
not allow for that flexibility should the receiving facility be at licensed capacity, then the
receiving facility must coordinate the transfer of that consumer to another public receiving
facility and/or hospital that has capacity.
If it is determined (through the screening process) that the consumer does not meet criteria for
acute care, then the public receiving facility will determine the recommended level of care for
that consumer. If the recommended level of care is one that is actively managed by SFBHN
(Short-term Residential Treatment (SRT), Residential treatment), then SFBHN's Adult System
of Care Department will be contacted in order to coordinate that referral. If the recommended
level of care for that indigent consumer is not actively managed by SFBHN, then the receiving
facility will contact the SFBHN provider directly. Referrals will be made to best match the
consumers with their needs and geographic preference. If no preference or specific needs are
noted, then referrals are made on a rotating basis. All referrals that come through the centralized
receiving system will be well documented and will available for review to SFBHN.
Consumer is taken by Law Enforcement to the nearest receiving facility, which is a private
receiving facility:
If the consumer is referred to the centralized receiving system because he/she is picked up by law
enforcement as a result of a Baker Act, then he/she is taken to the nearest receiving facility
(public/private). If the nearest receiving facility is a private receiving facility, then he/she will be
screened to determine if he/she meets acute care criteria. If he/she meets criteria, then the
consumer will remain at the private receiving facility and will be stabilized and treated. A
discharge plan will be made by the private receiving facility, which includes a recommended
level of care. If it is determined that the consumer is an indigent consumer and meets acute care
criteria, then a consumer may be transferred to the centralized receiving system for continued
acute care services and/or referral to lower level of care services.
Consumer is self-referred for any publically funded service:
Monroe County DRS Plan Page 5 of 24
If the consumer is seeking publically funded services, the consumer can access care through the
centralized receiving facility. The centralized receiving facility has satellite offices throughout
Monroe County which allows for screening and level of care assessment. Based on the
consumers identified needs, the facility will make referrals accordingly including for acute care
services if necessary.
A Process Flow of the Centralized Receiving System is found in Attachment A. The
Transportation plan that outlines how consumers needing acute care are transported can be found
in Attachment B.
III. Inventory of Participating Service Providers
Voluntary Assessment and Evaluation Facilities
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. &Assessment
Lower Keys CSU Only No Yes
Medical Center
MEM=
Involuntary Assessment and Evaluation Facilities
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. & Assessment
Lower Keys CSU Only No Yes
Medical Center
MEN=
Triage Centers for Mental Health
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
Monroe County DRS Plan Page 6 of 24
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care Yes - pending Yes -pending Yes
Center, Inc.
Lower Keys CSU Only No Yes
Medical Center
Triage Centers for Substance Use Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes - pending Yes
Center, Inc. &Assessment
MEN=
Involuntary Treatment for Mental Health Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Guidance Care CSU, Detox, Screening Yes - pending Yes
Center, Inc. &Assessment
Lower Keys CSU Only No Yes
Medical Center
Involuntary Treatment for Substance Use Disorders
Facility Capabilities/Limitations Does the facility Substance Use
have agreements to Disorders/Mental
accept DRS Health
Patients? Disorders/Co-
Occurring?
Monroe County DRS Plan Page 7 of 24
Guidance Care CSU, Detox, Screening Yes -pending Yes
Center, Inc. &Assessment
mmmnm MEMM,
IV. Designated Receiving System (DRS) Agreements
Through SFBHN's Acute Care Data System partners can share data and be aware of available
beds in the Centralized Receiving System.
SFBHN has been working with Knight Software (KIS) to expand the current service data system
to fully integrate Utilization Management, Acute Care reporting and Financial Reporting into
one, cohesive application.
The KIS Integrated Solution has been developed with the goal to improve the clinical and
psychosocial outcomes of stakeholders within the mental healthcare system by providing a
system for securely sharing clinical and psychosocial information across authorized healthcare
providers to facilitate coordination of care and improve outcomes.
The first phase of the new KIS Utilization Management system was implemented effective
March 1, 2016. The system is currently capturing adult screening and assessment data. The
second phase of referral and bed management is currently in development.
The KIS Integrated Solution will allow providers within the network to enroll consumers, record
clinical and other psychosocial history, coordinate their care through management of referrals
and shared access to the clinical information, and document the outcomes of care.
A full description of the data functions can be found in SFBHN's Information Technology (IT)
Plan and is available at s.lb.hn org.
Network providers have individual contracts and executed Business Associate Agreements
(BAAs) through their main contract with SFBHN which allows for data sharing and coordination
of care. Providers collaborate with SFBHN and each other to ensure consumers are linked to
services.
Agreements can be found in Attachment C.
Monroe County DRS Plan Page 8 of 24
Attachment A—Process Flow for Centralized Receiving System Monroe
-Page Left Intentionally Blank-
Monroe County DRS Plan Page 9 of 24
Monroe County DR8Plan Page 10of24
Attachment B—Transportation Plan Monroe
Transportation Plan for Baker Act and Marchman Act Involuntary Examinations
Department of Children and Families
Circuit 16 (Monroe County)
This transportation plan shall describe methods of transport to a facility within the designated
receiving system for individuals subject to involuntary examination under the Baker Act s.
394.463 or involuntary admission under the Marchman Act s. 397.6772, s. 397.679, s. 397.6798,
or s. 397.6811.
When any law enforcement officer has custody of a person based on either noncriminal or minor
criminal behavior that meets the statutory guidelines for involuntary examination pursuant to s.
394.463, the law enforcement officer shall transport the person to the appropriate facility within
the designated receiving system pursuant to a transportation plan or an exception or to the
nearest receiving facility if neither apply. 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 or to the nearest facility if neither apply.
The Florida Mental Health Act, usually referred to as "The Baker Act," states that a person may
be taken to a receiving facility for involuntary examination if there is reason to believe that the
person has a mental illness and because of his or her mental illness:
The person has refused voluntary examination after conscientious explanation and disclosure of
the purpose of the examination; or the person is unable to determine for himself or herself
whether examination is necessary; and without care or treatment, the person is likely to suffer
from neglect or refuse to care for himself or herself, such neglect or refusal poses a real and
present threat of substantial harm to his or her well-being; and it is not apparent that such harm
may be avoided through the help of willing family members or friends or the provision of other
services; or there is a substantial likelihood that without care or treatment the person will cause
serious bodily harm to himself or herself or others in the near future, as evidenced by recent
behavior.
The Marchman Act is the Florida Substance Abuse Impairment Act which requires that a person
who 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:
Has lost the power of self-control with respect to substance abuse; and 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 is incapable of appreciating his or her need for such services and of
making a rational decision in that regard, although mere refusal to receive such services does not
constitute evidence of lack of judgment with respect to his or her need for such services; or
Monroe County DRS Plan Page 11 of 24
without care or treatment, 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 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.
The law requires that each county shall designate a single law enforcement agency within the
county, or portions thereof, to take a person into custody upon the entry of an ex parte order or
the execution of a certificate for involuntary examination by an authorized professional and to
transport that person to the appropriate facility within the designated receiving system pursuant
to this transportation plan.
The law enforcement agency may decline to transport the person to a receiving facility only i£
a. The jurisdiction designated by the county has contracted on an annual basis with
an emergency medical transport service or private transport company for
transportation of persons to receiving facilities pursuant to this section at the sole
cost of the county; and
b. The law enforcement agency and the emergency medical transport service or
private transport company agree that the continued presence of law enforcement
personnel is not necessary for the safety of the person or others.
The Monroe County Sherriff's Department and City of Key West Police Department provide
transportation of consumers under the Baker Act and/or Marchman Act throughout Monroe
County.
Monroe County Transportation Plan guidelines for Baker Act:
If a law enforcement officer believes that a person has an emergency medical condition as
defined in s. 395.002, the person should be first transported to a hospital for emergency medical
treatment, regardless of whether the hospital is a designated receiving facility or part of the
centralized receiving system.
Law enforcement should transport consumers meeting the requirements for an involuntary
examination under the Baker Act to the nearest receiving facility, unless the consumer is an
inmate, at which time, law enforcement should transport the consumer directly to the Central
Receiving Facility (Guidance Care Center, Inc.).
A list of Monroe County designated receiving facilities that can provide medical examination
and treatment of persons for whom an involuntary examination has been initiated under the
Baker Act can be found in Appendix A.
Monroe County Transportation Plan guidelines for Marchman Act:
If a law enforcement officer believes that a person has an emergency medical condition as
defined in s. 395.002, the person should be first transported to a hospital for emergency medical
treatment, regardless of whether the hospital is a designated receiving facility or part of the
centralized receiving system.
Monroe County DRS Plan Page 12 of 24
Law enforcement should transport consumers (Adults and Minors) under the Marchman Act to
the nearest Addiction Receiving Facility.
A list of Monroe County designated receiving facilities that can provide medical examination
and treatment of persons for whom an involuntary examination has been initiated under the
Marchman Act can be found in Appendix A.
Monroe County DRS Plan Page 13 of 24
Appendix A
Designated Receiving Facilities
The following is a list of Monroe County psychiatric facilities designated by the Florida
Department of Children and Families to receive and hold persons with mental illness for
involuntary examination and short-term treatment. This list is subject to change from time to
time as new facilities are designated and others are closed or have their designations
removed.
Public Receiving Facilities
Guidance Care Center
3000 41 Street Ocean, Marathon
305-434-7660
Lower Fl. Keys Health System (DePoo Hospital)
1200 Kennedy Drive
Key West, Florida 33040
(305) 294-5531
Addiction Receiving Facilities
The following is a list of Monroe County Addiction Receiving Facilities (ARFs) designated by
the Florida Department of Children and Families to receive and hold persons under a Marchman
Act for involuntary examination and short-term treatment. This list is subject to change from
time to time as new facilities are designated and others are closed or have their
designations removed.
Guidance Care Center (ARF & Inpatient Detox)
3000 41 Street Ocean, Marathon
305-434-7660
Monroe County DRS Plan Page 14 of 24
Attachment C —Agreements
BUSINESS ASSOCIATE AGREEMENT
This Business Associate Agreement ("Agreement") is entered into by and between South
Florida Behavioral Health Network, Inc., ("SFBHN') and «Legal Company Name »
(individually each a "Party" or "Associate" and collectively the "Parties" or the "Associates").
The Effective Date of this Agreement shall be July 1, 2016 ("Agreement Effective Date").
RECITALS
A. SFBHN and ((Legal Company Name », are each deemed to be Covered Entities under
the Health Insurance Portability and Accountability Act ("HIPAA") and may, from time
to time, each act as a Business Associate on behalf of the other to provide services in
accordance with one or more agreements (the "Underlying Agreements").
A. SFBHN is deemed to be a Business Associate under the Prime Contract with the Florida
Department of Children and Families and obligated to comply with HIPAA, the HITECH
Act, and any regulations promulgated thereunder, with respect to the PHI it creates,
maintains, receives, or transmits on behalf of«Legal Company Name ».
B. ((Legal Company Name » acknowledges that all provisions, terms and conditions, or
amendments, addendum, changes or revisions applicable to the
((Legal Company Name » made subsequent to the initial execution of the Prime
Contract, (Contract entered into between the Florida Department of Children and
Families) and SFBHN, not in conflict with this Business Associate Agreement shall be
binding upon the ((Legal Company Name », and the «Legal Company Name »,
agrees to comply with same. The Prime Contract is incorporated by reference in this
Business Associate Agreement.
C. The Associates both acknowledge that they are each obligated to comply with the
Privacy Rule, the Security Rule, the Breach Notification Rule, the Health Information
Technology for Economic and Clinical Health ("HITECH") Act, s. 501.171, F.S., and other
laws and regulations pertaining to the access, use, disclosure, and management of
Protected Health Information ("PHI") without limitation, PHI in an electronic format
(EPHI).
D. In the event that either Party (or both Parties) is a Program, as defined by the federal
regulations governing the Confidentiality of Alcohol and Drug Abuse Patient Records, at
42 CFR Part 2 (the "Substance Abuse Regulations"), the Underlying Agreements may
also require each of the Parties to create, receive, transmit, or maintain patient
information on behalf of the other that is subject to the Substance Abuse Regulations.
As such, the Associates further acknowledge that they are each obligated to comply
with those regulations, with respect to a Program's patient information.
E. The Associates intend to protect the privacy and provide for the security of patient
information, including PHI, pursuant to this Agreement, and all in compliance with
Applicable Law.
Monroe County DRS Plan Page 15 of 24
F. The Parties acknowledge that this Agreement supplements and amends each of the
Underlying Agreements only with respect to the creation, use, or disclosure of patient
information, including PHI. Except as so supplemented or amended, the terms of the
Underlying Agreements shall govern the matters addressed in this Agreement and in
each of the Underlying Agreements.
NOW, THEREFORE, in consideration of the mutual promises below, the Parties agree as
follows:
Section 1. Definitions. Capitalized terms used in this Agreement and not otherwise defined
herein shall have the meanings set forth in the HIPAA Rules, which definitions are incorporated
in this Agreement by reference. Capitalized terms used in this Agreement are defined as
follows:
a. "Applicable Law" means HIPAA, the HITECH Act, and all regulations issued thereunder,
as well as the Substance Abuse Regulations and any other applicable federal and state
law.
b. "Breach" shall have the meaning given to such term under the Breach Notification Rule,
including, but not limited to, 45 CFR § 164.402.
c. "Breach Notification Rule" shall mean the Breach Notification Standards at 45 CFR Parts
160 and 164.
d. "Business Associate" shall have the same meaning as given to such term in 45 CFR §
160.103.
e. "Covered Entity" shall have the same meaning as given to such term in 45 CFR §
160.103.
f. "Electronic Protected Health Information" or "ePHI" shall have the meaning given to
such term under the HIPAA Rules, including, but not limited to, 45 CFR § 160.103, as
applied to the information that each Associate creates, maintains, receives from, or
transmits on behalf of the other Associate.
g. "Enforcement Rule" shall mean the Compliance and Enforcement Standards at 45 CFR
Part 160.
h. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996
("HIPAA"), Public Law No. 104-191, and any regulations promulgated thereunder.
i. "HIPAA Rules" shall mean the Privacy, Security, Breach Notification, Enforcement, and
Transaction Rules at 45 CFR Parts 160, 162, and 164.
j. "HITECH Act" means the Health Information Technology for Economic and Clinical
Health ("HITECH") Act, Public Law No. 111-005, and any regulations promulgated
thereunder.
k. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health
Information at 45 CFR Parts 160 and 162 and Part 164, Subparts A and E, 42 U.S.C.
1320d-5 and 1320d-6.
Monroe County DRS Plan Page 16 of 24
I. "Program" shall have the same meaning as given to such term in 42 CFR § 2.11.
m. "Protected Health Information" or "PHI" shall have the same meaning given to such
term under the HIPAA Rules, including, but not limited to, 45 CFR § 160.103, as applied
to the information created or received by each Associate from, or on behalf of, the
other Associate.
n. "Required by Law" shall have the same meaning as given to such term in 45 CFR §
164.103.
o. "Secretary" shall mean the Secretary of the Department of Health and Human Services
or his or her designee.
P. "Security Rule" shall mean the Security Standards at 45 CFR Parts 160 and 162 and Parts
164, Subparts A and C.
q. "Subcontractor" shall have the same meaning as given to such term in 45 CFR § 160.103.
r. "Substance Abuse Regulations" shall mean the Confidentiality of Alcohol and Drug
Abuse Patient Records regulations, at 42 CFR Part 2.
s. Transaction" shall have the same meaning given to such term under the Transaction
Rule, including, but not limited to, 45 CFR § 160.103.
t. "Transaction Rule" shall mean the Standards for Electronic Transactions at 45 CFR Parts
160 and 162.
u. "Unsecured PHI" shall have the same meaning given to such term, as "unsecured
protected health information," under the Breach Notification Rule, including but not
limited to, 45 CFR § 164.402, as applied to the information created or received by each
Associate from, or on behalf of, the other Associate.
Section 2. Permitted Uses and Disclosures of PHI.
a. Uses and Disclosures of PHI. Except as otherwise limited in this Agreement, Associates
may each use or disclose PHI received from or created on behalf of the other Associate only to
perform such functions, activities, or services for, or on behalf of, each other pursuant to the
Underlying Agreements.
b. Permitted Uses of PHI by Associates. Except as otherwise limited in this Agreement,
Associates may each use the PHI received from or created on behalf of the other Associate (i)
for their respective proper management and administration, (ii) to carry out their respective
legal responsibilities; and (iii) for Data Aggregation purposes for the Health Care Operations of
the other Associate. Associates may use PHI to create de-identified health information, in
accordance with the HIPAA Rules at 45 CFR § 164.514, and may use such de-identified health
information.
C. Permitted Disclosures of PHI by Associates. Except as otherwise limited in this
Agreement, Associates may each disclose PHI (i) for their proper management and
administration; (ii) to carry out their respective legal responsibilities; (iii) as Required by Law;
and (iv) for Data Aggregation purposes for the Health Care Operations of the other Associate. If
Monroe County DRS Plan Page 17 of 24
an Associate intends to disclose PHI to a third party, prior to making any such disclosure, such
Associate shall first obtain, (i) reasonable written assurances from such third party that PHI will
be held confidential in a manner that is consistent with the terms of this Agreement and will
only be used or disclosed as Required by Law or for the purposes for which it was disclosed to
such third party, and (ii) a written agreement from such third party to notify Associate of any
breaches of confidentiality of the PHI, to the extent it has obtained knowledge of such breach,
without unreasonable delay, and in any event within sufficient time to meet any breach
notification requirements under the HIPAA Rules.
Section 3. Obligations and Activities of Associates (as Business Associates). Associates shall
each comply with all obligations and requirements for Business Associates under Applicable
Law with respect to PHI, and shall have the following obligations:
a. Appropriate Safeguards. Associates shall each implement administrative, physical, and
technical safeguards that reasonably and appropriately protect the confidentiality, integrity,
and availability of PHI, in accordance with 45 CFR § 164.308, physical safeguards as set forth at
45 CFR § 164.310, and technical safeguards as set forth at 45 CFR § 164.312; including, policies
and procedures regarding the protection of PHI and/or ePHI set forth at 45 CFR § 164.316 and
the provisions of training on such policies and procedures to applicable employees,
subcontractors, independent contractors, and volunteers, that reasonably and appropriately
protect the confidentiality, integrity, and availability of the PHI and/or ePHI that the Provider
creates, receives, maintains or transmits.
Associates shall take immediate steps to limit or avoid recurrence of any security breach and
take any other action pertaining to such unauthorized access or disclosure required by
applicable federal and state laws and regulations regardless of any actions taken by SFBHN or
The Florida Department of Children and Families.
b. Reporting of Improper Use or Disclosure.
(i) Each Associate shall report to the other Associate, in writing, any use or
disclosure of PHI not provided for by this Agreement, including any Breach of Unsecured PHI or
any Security Incident of which it becomes aware as required at 45 CFR 164.410, and any
security incident of which it becomes aware.
(ii) «Legal Company Name-)) shall provide notification to SFBHN Security
Officer, Privacy Officer and Contract Manager as soon as possible, but no later than four (4)
business days following the determination of any breach or potential breach of personal and
confidential data.
(iii) ((Legal Company Name » shall provide notification to SFBHN Privacy
Officer and Contract Manager within twenty-four (24) hours of notification by the US
Department of Health and Human Services of any investigations, compliance reviews or
inquiries by the US Department of Health and Human Services concerning violations of HIPAA
(Privacy, Security Breach).
C. Data Breach Notification. No later than four (4) business days following any breach
affecting 500 or more individuals , either Associate shall provide to the other, in writing the
elements as required by s. 501.171, F.S. to permit SFBHN to comply with the HIPAA Breach
notification requirements set forth in the Prime Contract, 45 C.F.R. §§ 164.400, et seq.,
Monroe County DRS Plan Page 18 of 24
and in s. 501.171, F.S. Associates, as applicable, at its own cost, shall notice affected parties no
later than thirty (30) days following the determination of any breach or potential breach of
personal or confidential data as provided in § 817.5681, Fla. Stat. Following a HIPAA Breach
(Privacy, Security Breach), each Associate will have a continuing duty to inform the other
Associate of new and material information learned regarding the HIPAA Breach.
d. Mitigation Procedures. Each Associate agrees to mitigate, to the extent practicable, any
harmful effect that is known to it of a use or disclosure of PHI by such Associate in violation of
the requirements of this Agreement, or the HIPAA Rules.
e. Subcontractors and Agents. Each Associate shall ensure that any agent, including a
Subcontractor, to whom it provides PHI, agrees (in writing) to the same restrictions and
conditions that apply through this Agreement to such Associate with respect to such PHI.
Associates shall implement and maintain sanctions against agents and Subcontractors that
violate such restrictions and conditions, and shall attempt to mitigate the effects of any such
violation. Each Associate and their Subcontractors and Agents are directly liable under the civil
and criminal enforcement provisions set forth at Section 13404 of the HITECH Act and section
45 CFR § 164.500 and 164.502(E) of the Privacy Rule (42 U.S.C. 1320d-5 and 1320d-6), as
amended, for failure to comply with the safeguards, policies and procedures requirements and
any guidance issued by the Secretary of Health and Human Services with respect to such
requirements
f. Access to PHI. Each Associate agrees to provide access to PHI in a Designated Record Set
to the other Associate or, as directed by the other Associate, to an Individual, at the written
request of the other Associate within a reasonable time and manner, sufficient to allow the
other Associate to meet the requirements of 45 CFR § 164.524. Each Associate agrees to
disclose PHI in electronic format to the other Associate or, as directed by the other Associate,
to an Individual or an Individual's designee, as may be necessary to satisfy the other Associate's
obligations under 45 CFR §§ 164.524(c)(2)(ii) and (3)(ii) regarding an individual's request for an
electronic copy of PHI.
g. Amendment of PHI. Each Associate shall make any amendment(s) to PHI in a Designated
Record Set that the other Associate directs or agrees to, pursuant to 45 CFR § 164.526, in a
time and manner reasonably designated by the other Associate.
h. Documentation of Disclosures. Each Associate agrees to document such disclosures of
PHI and information related to such disclosures as would be required for the other Associate to
respond to a request by an Individual for an accounting of disclosures of PHI in accordance with
45 CFR § 164.528.
i. Accounting of Disclosures. Each Associate agrees to provide to the other Associate, within
thirty (30) business days, information collected in accordance with Section 3(f) of this
Agreement, sufficient to permit the other Associate to respond to a request by an Individual, or
on behalf of an Individual, for an accounting of disclosures of PHI in accordance with 45 CFR §
164.528.
j. Minimum Necessary. Each Associate shall request, use, and disclose only the minimum
amount of PHI necessary to accomplish the purpose of the request, use, or disclosure to the
extent that the minimum necessary standard is applicable to the disclosure under 45 CFR §
164.502(b).
Monroe County DRS Plan Page 19 of 24
k. Governmental Access to Records. Each Associate agrees to make its internal practices,
books, and records relating to the use and disclosure of PHI received from the other Associate,
or created on behalf of the other Associate, available to the Secretary for purposes of
determining either or both Associates' compliance with the HIPAA Rules.
I. Standard Transactions. If an Associate conducts, in whole or in part, any Transactions
electronically on behalf of the other Associate, such Associate shall comply with the applicable
requirements of 45 CFR Part 162 and shall require that any agents or Subcontractors that
perform, in whole or in part, such Transactions on its behalf, agree in writing to comply with
such requirements. Such Associate will not enter into any trading partner agreement in
connection with conducting Standard Transactions on behalf of the other Associate: (i) that
changes the definition, data condition, or use of a data element or segment in a Standard
Transaction; (ii) adds any data element or segment to the maximum defined data set; (iii) uses
any code or data element that is marked as "not used" in the Standard Transaction's
implementation specification or is not in the Standard Transaction's implementation
specification; or (iv) changes the meaning or intent of the Standard Transaction's
implementation specification.
m. Qualified Service Organization Agreement. In the event that either Associate (or both
Associates) is a Program, as defined by the Substance Abuse Regulations, each Associate
agrees to provide the services, as described in the Underlying Agreements, and further (i)
acknowledges that in receiving, storing, processing, or otherwise dealing with any information
from a Program about the patients in the Program, it is fully bound by the provisions of the
Substance Abuse Regulations; and (ii) agrees to resist in judicial proceedings any effort to
obtain access to information pertaining to such patients otherwise than as expressly provided
for in the Substance Abuse Regulations.
Section 4. Obligations of Associates (as Covered Entities).
a. Notice of Privacy Practices. Each Associate shall notify the other Associate of any
limitation(s) in its notice of privacy practices, under 45 CFR § 164.520 and under s. 501.171, F.S.
, to the extent that such limitation(s) may affect the other Associate's use or disclosure of PHI.
b. Notification of Changes Regarding Individual Permission. Each Associate shall notify the
other Associate of any changes in, or revocation of, permission by an Individual to use or
disclose PHI, to the extent that such changes may affect the other Associate's use or disclosure
of PHI.
C. Notification of Restrictions to Use or Disclosure of PHI. Each Associate shall notify the
other Associate of any restriction(s) imposed on the use or disclosure of PHI that such Associate
has agreed to or is obligated to support in accordance with 45 CFR § 164.522, to the extent that
such restriction may affect the other Associate's use or disclosure of PHI. The other Associate
agrees to abide by such restriction to the extent applicable and provided that it is made aware
of the restriction in a reasonable and timely manner.
d. Permissible Requests by Associates. Neither Associate shall request the other Associate
to use or disclose PHI in any manner that would not be permissible under Applicable Law if
done by such Associate, except as permitted under this Agreement.
e. Marketing, Fundraising and Research. Each Associate shall follow guidance in the HIPAA
Monroe County DRS Plan Page 20 of 24
Rule regarding marketing, fundraising and research located at Sections 45 CFR § 164.501, 45
CFR § 164.508 and 45 CFR § 164.514.
Section 5. Term and Termination.
a. Term. The term of this Agreement shall commence as of the Agreement Effective
Date and shall terminate when all of the PHI provided by each Associate to the other Associate
is destroyed or returned, or, if it is infeasible to return or destroy the PHI, protections are
extended to such information, in accordance with Section 5(c), or when one party gives the
other fifteen (15) calendar days notification of termination in writing to the other party or such
time as mutually agreed upon by both parties.
b. Termination for Cause. A breach by either Associate of any provision set forth in
Sections 2, 3 or 4 of this Agreement may, in the sole discretion of the other Associate, be
deemed to constitute a material breach of this Agreement if such breach is not cured, or a plan
is not enacted to enable a cure, within thirty (30) business days of receiving written notice from
the non-breaching Associate. Upon occurrence of such material breach, the non-breaching
Associate may immediately terminate this Agreement, notwithstanding any provision in this
Agreement to the contrary.
C. Effect of Termination.
(i) Except as provided in paragraph (ii) of this Section 5(c), upon termination
of this Agreement for any reason, each Associate shall return or destroy all PHI received from
the other Associate, or created or received by each Associate on behalf of the other Associate,
and shall retain no copies of the PHI. Each Associate agrees to impose the same obligations to
return or destroy PHI, in writing, on each of its Subcontractors or agents to the extent they are
or may be expected to come into possession of such PHI.
(ii) In the event that an Associate determines that returning or destroying
the said PHI is infeasible, such Associate shall provide notification of the conditions that make
return or destruction infeasible to the other Associate and shall extend the protections of this
Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes
that make the return or destruction infeasible, for so long as such Associate maintains such PHI.
Section 6. Indemnification. Each Associate (the "Indemnifying Associate") will indemnify,
defend, and hold harmless the other Associate (the "Indemnified Associate") from any and all
claims, losses, liabilities, damages,judgments, fees, expenses, awards, civil monetary penalties,
and costs (including reasonable attorneys' and court fees and expenses) arising out of or
related to any Breach or alleged Breach of Unsecured PHI created, received, maintained,
transmitted, or otherwise used by the Indemnifying Associate and arising from the
Indemnifying Associate's breach, or failure to perform pursuant to this Agreement (collectively,
a "Claim"). This indemnification does not cover any claims, losses, liabilities, damages,
judgments, fees, expenses, awards, civil monetary penalties, and costs resulting from the
negligence or willful misconduct of the Indemnified Associate, or any of Indemnified
Associate's employees, contractors, or agents (except Indemnifying Associate). This
indemnification is contingent upon (i) Indemnified Associate giving prompt written notice to
Indemnifying Associate of any Claim for which indemnification is sought, and (ii) Indemnified
Associate giving Indemnifying Associate sole control of the defense, including selection of
Monroe County DRS Plan Page 21 of 24
counsel, and related settlement negotiations regarding the Claim, except that Indemnifying
Associate will not enter into a final settlement involving discharge of any claims against
Indemnified Associate without Indemnified Associate's prior consent. Indemnified Associate
may participate in the defense of any Claim at Indemnified Associate's own cost. Indemnified
Associate agrees that it will assist and cooperate in the defense and related settlement of the
Claim, at its expense, as the Indemnifying Associate may reasonably request.
Section 7. Regulatory References. A reference in this Agreement to a section in the HIPAA
Rules, the Substance Abuse Regulations, or any other Applicable Law means the section as in
effect or as amended, and for which compliance is required by either or both Associates.
Section 8. Amendment. The Parties agree to take such action to amend this Agreement from
time to time as is necessary for both to comply with Applicable Law. Such amendment shall be
in writing and signed by both the Parties.
Section 9. Survival. The respective rights and obligations of the Parties under Section 5(c) and
Section 6 of this Agreement shall survive the termination of the Agreement.
Section 10. No Third Party Beneficiaries. Nothing express or implied in this Agreement is
intended to confer, nor shall anything herein confer, upon any person other than the Parties
and their respective successors or assigns, any rights, remedies, obligations or liabilities
whatsoever.
Section 11. Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a
meaning that permits the Parties to comply with Applicable Law.
Section 12. Waiver. No delay or omission by either Party to exercise any right or remedy under
this Agreement will be construed to be either acquiescence or the waiver of the ability to
exercise any right or remedy in the future.
Section 13. Severability. In the event any part or parts of this Agreement are held to be
unenforceable, the remainder of this Agreement shall continue in effect.
Section 14. Governing Law. This Agreement shall be governed by the laws of Florida
IN WITNESS WHEREOF, the Parties hereto have duly executed this Agreement as of the
Agreement Effective Date.
«Legal_Company_Name_» SOUTH FLORIDA BEHAVIORAL HEALTH
NETWORK, INC.
SIGNED SIGNED
BY: BY:
NAME: ((Contract Signer)) NAME: John W. Dow
Monroe County DRS Plan Page 22 of 24
TITLE: ((Signer Title)) TITLE: President and CEO
Date: Date:
Federal Tax ID# (or SSN): «Fed ID»
Monroe County DRS Plan Page 23 of 24
Attachment D — Sign In Sheet Monroe County Public Meeting
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Monroe County DRS Plan Page 24 of 24
South Florida
Behavioral
Health Network, Inc.
Monroe County SB 12 Planning Meeting
Thursday, March 2, 2017
Morning Session—(9:00am)
AGENDA
(SFBHN Staff: John, Steve, Laura, Betty, Carol, Joanna)
I 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
1 0:00am—Florida Keys Outreach Coalition (FKOC)
11:30 am—Guidance Care Center (GCC) CSU Marathon
Statutes & Constitution :View Statutes : Online Sunshine Pagel of3
Select Year:
The 2016 Florida Statutes
Title XXIX C�hater 3L4 View Entire Chapter
PUBLIC HEALTH MENTAL HEALTH
394.4573 Coordinated system of care; annual assessment; essential elements; measures of
performance; system improvement grants; reports.--On or before December 1 of each year, the
department shalt submit to the Governor, the President of the Senate, and the Speaker of the House of
Representatives an assessment of the behavioral health services in this state. The assessment shall
consider, at a minimum, the extent to which designated receiving systems function as no-wrong-door
models, the availability of treatment and recovery services that use recovery-oriented and peer-involved
approaches, the availability of less-restrictive services, and the use of evidence-informed practices. The
department's assessment shall consider, at a minimum, the needs assessments conducted by the
managing entities pursuant to s. 394.9082(5). Beginning in 2017, the department shall compile and
include in the report all plans submitted by managing entities pursuant to S. 394.9082(8) and the
department's evaluation of each plan.
(1) As used in this section:
(a) "Care coordination" means the implementation of deliberate and planned organizational
relationships and service procedures that improve the effectiveness and efficiency of the behavioral
health system by engaging in purposeful interactions with individuals who are not yet effectively
connected with services to ensure service linkage. Examples of care coordination activities include
development of referral agreements, shared protocols, and information exchange procedures. The
purpose of care coordination is to enhance the delivery of treatment services and recovery supports and
to improve outcomes among priority populations.
(b) "Case management" means those direct services provided to a client in order to assess his or her
needs, plan or arrange services, coordinate service providers, link the service system to a client,
monitor service delivery, and evaluate patient outcomes to ensure the client is receiving the
appropriate services.
(c) "Coordinated system of care" means the full array of behavioral and related services in a region
or community offered by all service providers, whether participating under contract with the managing
entity or by another method of community partnership or mutual agreement.
(d) "No-wrong-door model" means a model for the delivery of acute care services to persons who
have mental health or substance use disorders, or both, which optimizes access to care, regardless of
the entry point to the behavioral health care system.
(2) The essential elements of a coordinated system of care include:
(a) Community interventions, such as prevention, primary care for behavioral health needs,
therapeutic and supportive services, crisis response services, and diversion programs.
(b) A designated receiving system that consists of one or more facilities serving a defined geographic
area and responsible for assessment and evaluation, both voluntary and involuntary, and treatment or
triage of patients who have a mental health or substance use disorder, or co-occurring disorders.
http:,//%vww.leg.state.fl.us/STATUTES/index.cfm?App_mode=Display_Statute&Search—St... 3/28/2017
Statutes & Constitution :View Statutes : Online Sunshine Page 2 of 3
1. A county or several counties shalt plan the designated receiving system using a process that
includes the managing entity and is open to participation by individuals with behavioral health needs
and their families, service providers, law enforcement agencies, and other parties. The county or
counties, in collaboration with the managing entity, shalt document the designated receiving system
through written memoranda of agreement or other binding arrangements. The county or counties and
the managing entity shalt complete the plan and implement the designated receiving system by July 1,
2017, and the county or counties and the managing entity shalt review and update, as necessary, the
designated receiving system at least once every 3 years.
2. To the extent permitted by available resources, the designated receiving system shalt function as
a no-wrong-door model. The designated receiving system may be organized in any manner which
functions as a no-wrong-door model that responds to individual needs and integrates services among
various providers. Such models include, but are not limited to:
a. A central receiving system that consists of a designated central receiving facility that serves as a
single entry point for persons with mental health or substance use disorders, or co-occurring disorders.
The central receiving facility shalt 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, format referral agreements, and cooperative arrangements for care coordination and case
management. Each entry point shalt be a designated receiving facility and shalt, within existing
resources, provide or arrange for necessary services following an Initial assessment and evaluation.
c. A tiered receiving system that consists of multiple entry points, some of which offer only
specialized or limited services. Each service provider shalt be classified according to its capabilities as
either a designated receiving facility or another type of service provider, such as a triage center, a
licensed detoxification facility, or an access center. All participating service providers shalt, within
existing resources, be linked by methods to share data, format 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 shalt be maintained and
made available at all times to all first responders in the service area.
(c) Transportation in accordance with a plan developed under s. 394.462.
(d) Crisis services, including 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 shalt hold a valid certification from a
department-approved credentialing entity as defined in s. 397.311(9) by July 1, 2017, and, thereafter,
within 6 months after hire.
(f) Care coordination that involves coordination with other local systems and entities, public and
private, which are involved with the individual, such as primary care, child welfare, behavioral health
care, and criminal and juvenile justice organizations.
(g) Outpatient services.
(h) Residential services.
(i) Hospital inpatient care.
(j) Aftercare and other postdischarge services.
http://www.leg.state.fl.us/STATUTES/index.cfm?App,,,mode:=Display_,Statute&Search,,,/`St... 3/28/2017
Statutes& Constitution :View Statutes : Online Sunshine Page 3 of 3
(k) Medication-assisted treatment and medication management.
(t) Recovery support, including, but not limited to, support for competitive employment,
educational attainment, independent Living skills development, family support and education, wellness
management and self-care, and assistance in obtaining housing that meets the individual's needs. Such
housing may include mental health residential treatment facilities, Limited mental health assisted living
facilities, adult family care homes, and supportive housing. Housing provided using state funds must
provide a safe and decent environment free from abuse and neglect.
(m) Care plans shall assign specific responsibility for initial and ongoing evaluation of the supervision
and support needs of the individual and the identification of housing that meets such needs. For
purposes of this paragraph, the term "supervision" means oversight of and assistance with compliance
with the clinical aspects of an individual's care plan.
(3) SYSTEM IMPROVEMENT GRANTS.—Subject to a specific appropriation by the Legislature, the
department may award system improvement grants to managing entities based on a detailed plan to
enhance services in accordance with the no-wrong-door model as defined in subsection (1) and to
address specific needs identified in the assessment prepared by the department pursuant to this section.
Such a grant must be awarded through a performance based contract that Links payments to the
documented and measurable achievement of system improvements.
History. ss. 3, 4, 5, ch. 80.384; s. 5,ch. 84-285;s. 1, ch. 89.211; s, 5, ch. 96-169;s. 100, ch.2010.102;s. 5,ch. 2016-
241.
Copyright 0 1995-2017 The Florida Legislature -I y_Privac Statement - Contact Us
http://www.leg.state.fl.us/STATUTES/index.cfm?App_mode:-Display,,,Statute&Search—St... 3/28/2017
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
that Medicaid reimbursements are less than the costs of providing services, the agency and the
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
delivered to eligible individuals.
To more closely align the Baker Act(mental illness) and Marchman Act (substance abuse), the
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.
1 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 consumer 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
Committee on Children,Families,
2016 Summary of Legislation Passed 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
Liz Yongue
From: Lamarche-Tamara <lamarche-tamara@monroecounty-fl.gov>
Sent: Friday, June 5, 2026 2:35 PM
To: Liz Yongue
Cc: Shillinger-Bob; Limbert-Christine; Rice-David
Subject: Notice of Voting Conflicts for Reg. BOCC June 10, 2026
Attachments: NVC RICE REG BOCC JUN 10 2026.pdf
Please find attached a notice of voting conflicts for Comm. Rice on the Regular BOCC agenda for June
10, 2026.
He will abstain from the vote on Item numbers C8 and Q1. Please see attached memo for more
information.
Tamara Lamarche, Executive Assistant
Commissioner David P. Rice, BOCC District
9400 Overseas Highway, Ste. 210
Florida Keys Marathon International Airport
Marathon, FL 33050
305.289.6000
T
Board of County Commissioners
Monroe County, Florida
"The Florida Keys"
PLEASE NOTE: FLORIDA HAS A VERY BROAD RECORDS LAW. MOST WRITTEN COMMUNICATIONS TO OR FROM THE COUNTY
REGARDING COUNTY BUSINESS ARE PUBLIC RECORDS AVAILABLE TO THE PUBLIC AND MEDIA UPON REQUEST. YOUR
EMAIL COMMUNICATION MAY BE SUBJECT TO PUBLIC DISCLOSURE.
Please consider the enviroiim,eni w ien
0" 11111
ieciding w!�'^°liether to print tli'is errrail.
1
County of Monroe ��` "����
3,
The Florida Keys °F '� 11f)AI�C�t�6"COt.1C "1""rr° �`f.�M&' M:�SI�+I�) 1E 11S
Mayor Michelle Coldiron. District 2
Mayor Pro Tem David Rice,District 4
Craig Cates, District 1
Holly Raschein.District 5
James Scholl,District 3
DAVID P. RICE,COMMISSIONER
9400 Overseas Highway, Suite 210
Marathon Airport Terminal Building
Marathon, FL 33050
O 305.289.6000
E boccdis4@monroecounty-fl.gov
Interoffice Memorandum
Date: June 05, 2026
To: Kevin Madok, Clerk of the Court
FR: Commissioner David Rice, District 4 �
RE: NOTICE OF VOTING CONFLICT
Per Florida Statute 112.3143, I hereby disclose by written memorandum that I will
abstain from the vote on certain issues brought before the Monroe County Board of
Commissioners with entities with which I am involved.
I will abstain from the vote on issues concerning the following entities:
Guidance Care Center,Inc., a private, not-for-profit entity, which receives some of its
operational funding from the County, as I currently sit on the Board of Directors of the
Guidance Care Center.
At the June 10,2026,BOCC meeting,I will abstain from the vote on item(s):
Item#C8
Approval of the Monroe County Designated Receiving System Plan for 2026-2029 as presented by South
Florida Behavioral Health Network, d.b.a. Thriving Mind South Florida,the designated Managing Entity for
Monroe County and Miami/Dade County. The plan designates Guidance Care Center as the primary
provider and sole public receiving facility for Monroe County as required by Senate Bill 12 (Chapter 2016-
241).
Item#Q1
Approval of a Standard Coordination/Operator Contract between the Guidance/Care Center, Inc., as
the designated Community Transportation Coordinator, and Monroe County for the contract period
of 07/01/2026 to 06/30/2027. This is a non-monetary partnership/collaboration contract required by
the State of Florida Commission for the Transportation Disadvantaged.
ATT. State Form 8B Memorandum of Voting Conflict for County,Municipal, and Other Local Elected
Officers
Copy of agenda item listing from the Revised Agenda for each of the referenced iten:(s) is included for
documentation.
..............w .._.. .......____ .........
�.www
FORM 813 MEMORANDUM OF VOTING CONFLICT FOR
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
LAST NAME—FIRST NAME—MIDDLE NAME NAME OF BOA
................— ........._. RD,COUNCIL COMMISSION,AUTHORITY,OR COMMITTEE
RICE DAVID P MONROE COUNTY BOARD OF COMMISSIONERS
..._..��_..�......................... ....__............ _m �....
MAILING ADDRESS THE BOARD,COUNCIL,COMMISSION,AUTHORITY OR COMMITTEE ON
9400 OVERSEAS HIGHWAY, SUITE 210 WHICH I SERVE IS A UNIT OF:
w._ ...........................................
..
COUNTY
.., ........_ ....❑..CITY. d .._COUNTY ❑OTHER LOCAL AGENCY
MARATHON MONROE
CITY NAMEO... . ... .�POLITICAL SUBDIVISION:
_....� ....._..............,. _....,
F
June 10, 2026 MY POSITION IS: d ELECTIVE ❑ APPOINTIVE
WHO MUST FILE FORM 813
This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council,
commission, authority, or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of
interest under Section 112.3143, Florida Statutes.
Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending
on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before
completing and filing the form,
INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which
would inure to his or her special private gain or loss. Each elected or appointed local officer also MUSTABSTAIN from knowingly voting on
a measure which would inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained
(including the parent, subsidiary, or sibling organization of a principal by which he or she is retained);to the special private gain or loss of a
relative; or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies(CRAB) under
Sec. 163.356 or 163.357, F S., and officers of independent special tax districts elected on a one-acre, one-vote basis are not prohibited
from voting in that capacity.
For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law,
mother-in-law, son-in-law, and daughter-in-law. A"business associate" means any person or entity engaged in or carrying on a business
enterprise with the officer as a partner, joint venturer, coowner of property, or corporate shareholder(where the shares of the corporation
are not listed on any national or regional stock exchange).
ELECTED OFFICERS:
In addition to abstaining from voting in the situations described above, you must disclose the conflict:
PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are
abstaining from voting; and
WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the
minutes of the meeting, who should incorporate the form in the minutes.
* * * * * * * * * * * * * * * *
APPOINTED OFFICERS:
Although you must abstain from voting in the situations described above, you are not prohibited by Section 112.3143 from otherwise
participating in these matters, However, you must disclose the nature of the conflict before making any attempt to influence the decision,
whether orally or in writing and whether made by you or at your direction,
IF YOU INTEND TO MAKE ANY ATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
TAKEN:
• You must complete and file this form (before making any attempt to influence the decision)with the person responsible for recording the
minutes of the meeting, who will incorporate the form in the minutes. (Continued on page 2)
. ...... . .....
CE FORM 813-EFF.11/2013 PAGE 1
Adopted by reference in Rule 34-7 010(1)(f),FA.C,
APPOINTED OFFICERS (continued)
• A copy of the form must be provided immediately to the other members of the agency.
• The form must be read publicly at the next meeting after the form is filed.
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose orally the nature of your conflict in the measure before participating,
• You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the
meeting,who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the
agency, and the form must be read publicly at the next meeting after the form is filed.
DISCLOSURE OFLOCAL OFFICER'S INTEREST
9 DAVID P. RICE hereby disclose that on June 10 20 26
(a)A measure came or will come before my agency which (check one or more)
inured to my special private gain or loss;
inured to the special gain or loss of my business associate, ,
inured to the special gain or loss of my relative,,
inured to the special gain or loss of by
whom I am retained; or
inured to the special gain or loss of Guidance/Care Center, Inc. (Board of Directors) which
is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me.
(b)The measure before my agency and the nature of my conflicting interest in the measure is as follows:
June 10, 2026 Regular Board of County Commissioners Agenda:
Item C8: Approval of the Monroe County Designated Receiving System Plan for 2026-2029 as presented by
South Florida Behavioral Health Network, d.b.a. Thriving Mind South Florida, the designed Managing Entity for
Monroe County and Miami-Dade County. The plan designated Guidance Care Center as the primary provider
and sole public receiving facility for Monroe County as required by Senate Bill 12 (Chapter 2016-241).
Item Q1: Approval of a Standard Coordination/Operator Contract between the Guidance/Care Center, Inc., as the
designated Community Transportation Coordinator, and Monroe County for the contract period of 07/01/2026 to
06/30/2027. This is a non-monetary partnership/collaboration contract required by the State of Florida
Commission for the Transportation Disadvantaged.
If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer,
who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way
as to provide the public with notice of the conflict.
June 5, 2026
Date Filed Signature
NOTICE: UNDER PROVISIONS mOF ITFLORIDA STATUTES mmm§112 317, A FAILURE TO MAKE ANY REQUIRED DISCLOSURE
CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT,
REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A
CIVIL PENALTY NOT TO EXCEED $10,000.
CE FORM 813 EFF.11/2013 � ........ �.� __.......... .. .....�. PAGE 2
Adopted by reference in Rule 34-7.010(1)(f),F.A.C.
COUNTY of MONROE 1:tWR1)01r C.01 N-IN C OMNIIS41ONER
Mayor Michelle Lincoln, District 2
The Florida Keys y Mayor Pro Tem David Rice, District 4
Craig Cates,District 1
James K.Scholl,District 3
.� Holly Merrill Raschein,District 5
. _... ... ..... ... ........... ...._�_ �Regular Meeting �._ ...
June 10, 2026
Agenda Item Number: C8
26-32139
____ _.................. ....... ............ �...
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: NA STAFF CONTACT: Andrew Roltsch
._ _..................... m...m __...................... ..mm ...............
AGENDA ITEM WORDING:
Approval of the Monroe County Designated Receiving System Plan for 2026-2029 as presented by South
Florida Behavioral Health Network,d.b.a. Thriving Mind South Florida,the designated Managing Entity for
Monroe County and Miami/Dade County. The plan designates Guidance Care Center as the primary provider
and sole public receiving facility for Monroe County as required by Senate Bill 12(Chapter 2016-241).
................................................ . w....._............. .._ ........... ------
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 were to plan a designated receiving system. The
initial plan was completed and implemented on July 1, 2017. On March 2, 2017, South Florida
Behavioral Health Network(SFBHN) held a Monroe County SB 12 Planning meeting with
community members and providers. As a result of the meeting an action plan for a Centralized
Receiving System for Monroe County was developed. The Monroe County Designated Receiving
System Plan (Plan) for 2026 to 2029 is brought before the Board for approval and acceptance as
prepared and presented by SFBHN/Thriving Minds South Florida,the designated managing entity for
Monroe County. The Plan was previously approved by the BOCC at its 7/19/23 meeting.
PREVIOUS RELEVANT BOCC ACTION:
July 19, 2023, agenda item D.9, the BOCC approved of the Monroe County Designated Receiving
System Plan for 2023-2026. March 17, 2021, agenda item C.11, the BOCC approved of the Monroe
County Designated Receiving System Plan for 2021-2023. (Note: March 17 agenda item was a
correction of the plan's cover sheet to read 2021-2023). May 17, 2017, Agenda Item No. C.21, the
BOCC approved the Designated Receiving System plan 2017-2020, as designated by the Managing
Entity for Monroe County, South Florida Behavioral Health Network, for a centralized receiving
system for Monroe County as required by Senate Bill 12 (Chapter 2016-241)
..---
_-_------------------
INSURANCE REQUIRED:
No
,.,.,.,..�.,. e„ee,, ------- .......... .... ��
CONTRACT/AGREEMENT CHANGES:
N/A
���W��............�._ �.. ......�.._._ ..., �_�..��... _...
STAFF RECOMMENDATION:�
Approval
................ ..... .............
DOCUMENTATION:
........ ....._. w ....._.............. v ----- .
FINANCIAL IMPACT:
Effective Date: 07/01/2026
Expiration Date: 06/30/2029
Total Dollar Value of Contract:
Total Cost to County:
Current Year Portion:
Budgeted:
Source of Funds:
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: If yes,amount:
Grant:
County Match:
" BOARD of COUNTY Co:N[MISSIoNERS
COUNTY Of MONROE
Mayor Michelle Lincoln,District 2
The Florida Keys Mayor Piro Tem David Rice,District 4
Craig Cates,District 1
James K.Scholl,District 3
`- � Holly Merrill Raschein,District 5
....... ...... _W... ...............
Regular
Meeting
June 10, 2026
Agenda Item Number: Q1
26-32156
...... ...... .._._....................... _....._____..... _....................... ......
BULK ..._............_
ITEM: Yes DEPARTMENT: Community Services
TIME APPROXIMATE: N/A STAFF CONTACT: Cathy Crane
AGENDA I —ING:.................. —m....�.- ..._.
TEM WORD
Approval of a Standard Coordination/Operator Contract between the Guidance/Care Center, Inc., as
the designated Community Transportation Coordinator, and Monroe County for the contract period of
07/01/2026 to 06/30/2027. This is a non-monetary partnership/collaboration contract required by the
State of Florida Commission for the Transportation Disadvantaged.
ITEM BACKGROUND.
This contract is required by the State of Florida Commission for the Transportation Disadvantaged to
ensure a partnership between the Community Transportation Coordinator, Guidance/Care Center, Inc.,
and Monroe County as it relates to Monroe County Transit offerings. The contract allows Monroe
County, as an agency/operator, to coordinate, collaborate, and offer transportation services to Monroe
County's transportation disadvantaged in accordance with Chapter 427, Fla. Stat., Rule Chapter 41-2,
F.A.C., and the most current Community Transportation Coordinator policies. Additionally, this
agreement will enable the County to receive transportation disadvantaged funds through the Florida
Department of Transportation.
PREVIOUS RELEVANT BOCC ACTI
Item #03 BOCC approved previous Community Tranportation Coordinator Agreement with
Guidance/Care
e Center, Inc. on 07/16/2025 retroactively effective as of July 1, 2025„
w .................... .�....... .. ... ..........
....
INSURANCE REQUIRED:
Not from the Coordinator; County has insurance requirements imposed upon it pursuant to the CTC
Agreement.
CONTRACT/A ..._......._._...---
_ .�. ----
-----------
www _ ... .._.�...W____
GREEMENT CHANGES:
N/A.
STAFF .... ......................w _.___....._...... ._.... ........................ ....... .........
RECOMMENDATION.
Approval.
DOCUMENTATION:
Monroe County CTC 26-27 Revised_Lgl Appd5.21.26
CTC WCGCC Reso No. 2023-01
CTC Agreement 7/i/25-6/30/26
WCGCC Resolution 2023-01
Attestation 05-11-2026
INANCIAL IMPACT:
N/A
Effective Date: 07/01/2026
Expiration Date: 06/30/2027
Total Dollar Value of Contract: $0.00
Total Cost to County: $0.00
Current Year Portion: N/A
Budgeted: N/A
Source of Funds: N/A
CPI: N/A
Indirect Costs: $0.00
Estimated Ongoing Costs Not Included in above dollar amounts: $0.00
Revenue Producing: No If yes,amount:
Grant: No
County Match: No
Brynn Morey
From: Gomez-Krystal <Gomez-Krystal@MonroeCounty-FL.Gov>
Sent: Monday,June 8, 2026 1:27 PM
To: MGT; Agenda Distribution Group; County-Attorney; County Commissioners and Aides
Cc: Gomez-Krystal
Subject: Item C8 BOCC 06/10/2026 REVISED BACKUP
Attachments: AIS 32139 Item C8.pdf, Monroe DRS 2026-2029 Final for County 6.8.2026.pdf
Good afternoon,
Please be advised that the backup for the C8 agenda item has been revised.
"Approval of the Monroe County Designated Receiving System Plan for 2026-2029 as presented by South
Florida Behavioral Health Network, d.b.a. Thriving Mind South Florida, the designated Managing Entity for
Monroe County and Miami/Dade County. The plan designates Guidance Care Center as the primary provider
and sole public receiving facility for Monroe County as required by Senate Bill 12 (Chapter 2016-241). "
7Thav�l, IgD�C,
1,CrtJ.stal e�amez
Executive Administrative Coordinator
Monroe County Administrator's Office
1100 Simonton Street, Suite 2-205
Key West, FL 33040
Office: 305-292-4441
Cell: 305-850-8694
Notary Public
PLEASE NOTE: FLORIDA HAS A VERY BROAD RECORDS LAW. MOST WRITTEN COMMUNICATIONS TO OR FROM THE COUNTY REGARDING COUNTY BUSINESS
ARE PUBLIC RECORDS AVAILABLE TO THE PUBLIC AND MEDIA UPON REQUEST. YOUR EMAIL COMMUNICATION MAY BE SUBJECT TO PUBLIC DISCLOSURE.
1
COUNTY Nr11�,Y �� ����� m� � ^ BOARD OF COUNTY COMMISSIONERS
Mayor Michelle Lincoln,District 2
The Florida Keys Mayor Pro Tem David Rice,District 4
Craig Cates,District 1
James K.Scholl,District 3
Holly Merrill Raschein,District 5
Regular Meeting
June 10, 2026
Agenda Item Number: C8
26-32139
BULK ITEM: Yes DEPARTMENT: Budget and Finance
TIME APPROXIMATE: NA STAFF CONTACT: Andrew Roltsch
AGENDA ITEM WORDING:
Approval of the Monroe County Designated Receiving System Plan for 2026-2029 as presented by South
Florida Behavioral Health Network, d.b.a. Thriving Mind South Florida, the designated Managing Entity for
Monroe County and Miami/Dade County. The plan designates Guidance Care Center as the primary provider
and sole public receiving facility for Monroe County as required by Senate Bill 12 (Chapter 2016-241).
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 were to plan a designated receiving system. The
initial plan was completed and implemented on July 1, 2017. On March 2, 2017, South Florida
Behavioral Health Network(SFBHN) held a Monroe County SB 12 Planning meeting with
community members and providers. As a result of the meeting an action plan for a Centralized
Receiving System for Monroe County was developed. The Monroe County Designated Receiving
System Plan (Plan) for 2026 to 2029 is brought before the Board for approval and acceptance as
prepared and presented by SFBHN/Thriving Minds South Florida, the designated managing entity for
Monroe County. The Plan was previously approved by the BOCC at its 7/19/23 meeting.
PREVIOUS RELEVANT BOCC ACTION:
July 19, 2023, agenda item D.9, the BOCC approved of the Monroe County Designated Receiving
System Plan for 2023-2026. March 17, 2021, agenda item C.11, the BOCC approved of the Monroe
County Designated Receiving System Plan for 2021-2023. (Note: March 17 agenda item was a
correction of the plan's cover sheet to read 2021-2023). May 17, 2017, Agenda Item No. C.21, the
BOCC approved the Designated Receiving System plan 2017-2020, as designated by the Managing
Entity for Monroe County, South Florida Behavioral Health Network, for a centralized receiving
system for Monroe County as required by Senate Bill 12 (Chapter 2016-241)
INSURANCE REQUIRED:
No
CONTRACT/AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION:
Approval
DOCUMENTATION:
FINANCIAL IMPACT:
Effective Date: 07/01/2026
Expiration Date: 06/30/2029
Total Dollar Value of Contract:
Total Cost to County:
Current Year Portion:
Budgeted:
Source of Funds:
CPI:
Indirect Costs:
Estimated Ongoing Costs Not Included in above dollar amounts:
Revenue Producing: If yes, amount:
Grant:
County Match:
MONROE COUNTY
IIICii iii g inated II ,,,, iii iii iiir , ,,,, ii i III III in
2026-2029
Developed Pursuant to;
Florida Mental Health (Baker) Act
Chapter 394, Florida Statutes
and
Substance Abuse Services (Marchman) Act
Chapter 397, Florida Statutes
Table of Contents
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Tableof Contents ............................................................................................................................2
Section I: Background and Purpose.................................................................................................4
StatutoryAuthority........................................................................................................................4
No-Wrong-Door Model and Entry Points ...................................................................................... 4
DRSGoals................................................................................................................................... 5
Florida Crisis Services Continuum................................................................................................ 5
Integration with 988 Suicide and Crisis Lifeline............................................................................. 6
Mobile Response Teams (MRTs)................................................................................................. 6
Collaboration with Law Enforcement and Crisis Intervention Teams (CIT).................................... 6
Care Coordination and Referrals.................................................................................................. 6
PlanPeriod and Review............................................................................................................... 7
Definitions........................................................................................................................................ 8
Section II: Monroe County Designated Receiving System.............................................................. 11
A. Coordinated Receiving System Structure............................................................................... 11
Centralized Receiving Facility (CRF) ...................................................................................... 11
B. Geographic Regions .............................................................................................................. 11
C. Receiving Facility Capacity and Coordination ........................................................................ 11
Funded Beds at Public Receiving Facilities............................................................................. 12
Section III: Inventory of Participating Service Providers ................................................................. 12
A. Public Receiving Facilities...................................................................................................... 12
B. Privately Operated Baker Act Receiving Facilities.................................................................. 12
C. Federally Funded Facility —Veterans Services ...................................................................... 13
D. Addiction Receiving Facilities and Detoxification Services..................................................... 13
Section III-B: Acute and Ambulatory Care Service Flows............................................................... 13
A. Acute Care— Public Receiving Facility................................................................................... 13
B. Acute Care— Private Receiving Facility.................................................................................. 14
C. Ambulatory Care Services ..................................................................................................... 15
Section IV: Designated Receiving System Agreements ................................................................. 15
A. Data Sharing and Information Technology............................................................................. 16
B. Network Service Provider Contracts, Business Associate Agreements, and Data Sharing
Agreements................................................................................................................................ 16
C. Privacy and Confidentiality Requirements.............................................................................. 16
D. System Monitoring and Quality Improvement......................................................................... 17
E. Continuous System Development.......................................................................................... 17
Attachment B: Transportation Plan — Monroe County .................................................................... 26
I. Purpose and Authority.............................................................................................................26
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GuidingPrinciples................................................................................................................... 26
II. Criteria for Involuntary Examination— Baker Act..................................................................... 26
Baker Act—72-Hour Examination Period................................................................................ 27
Authorized Initiation of Baker Act Involuntary Examination ..................................................... 27
III. Criteria for Involuntary Admission —Marchman Act ............................................................... 28
IV. Law Enforcement Designation for Transportation.................................................................. 28
V. Transportation by Mobile Crisis Response Team or Mental Health Overlay Program............. 29
VI. Baker Act—Transport Requirements and Special Populations ............................................. 29
Role of Emergency Medical Services (EMS) and Ambulance ................................................. 30
VII. Required Forms and Documentation.................................................................................... 30
Law Enforcement Required Forms.......................................................................................... 30
EMS /Ambulance Required Documentation........................................................................... 30
Mobile Response Team (MRT) Required Documentation....................................................... 31
Electronic Baker Act Documentation (e-Baker Act)................................................................. 31
VI 11. Marchman Act—Transport Requirements........................................................................... 31
IX. Marchman Act— Required Forms.......................................................................................... 32
X. Receiving Facility Acceptance and Transfers......................................................................... 32
XI. Centralized Receiving Facility (CRF)..................................................................................... 32
XI I. Plan Review and Coordination............................................................................................. 32
XI II. Effective Date and Term...................................................................................................... 33
Appendix A: Designated Receiving Facilities — Monroe County ..................................................... 37
Baker Act Receiving Facilities .................................................................................................... 37
Facilities with Significant Medical Capability............................................................................... 37
GCC Satellite Office Locations ................................................................................................... 37
Appendix B: Addiction Receiving Facilities and Inpatient Detoxification Facilities .......................... 38
ForAdults................................................................................................................................... 38
ForJuveniles.............................................................................................................................. 38
Statutory References —Attachment B......................................................................................... 38
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Section 1: Background and Purpose
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The Monroe County Designated Receiving System (DRS) Plan describes how the community
coordinates services for individuals experiencing a behavioral health crisis, including mental health
crises and substance use emergencies. The goal of the DRS is to ensure that individuals receive
timely assessment, stabilization, and access to appropriate treatment and support services.
This Plan is developed in partnership with Monroe County, Thriving Mind South Florida (the
Managing Entity for behavioral health services in Monroe County and Miami-Dade County), the
Florida Department of Children and Families (Department), local law enforcement agencies, and
other community stakeholders.
Statutory ul;ho riiity
Florida law requires each community to establish a coordinated crisis response system under the
following statutes:
394.4573, Fla. tat.: Designated Receiving Systems®requires development of a DRS operating under
a No-Wrong-Door model.
§394.463, la. tat.: Involuntary Examination (Baker Act)®establishes criteria, procedures, and the 72-
hour examination period.
§394.462, la. tat.: Transportation®governs transport of individuals for involuntary examination.
§394.875, Fla. tat.: Crisis Stabilization Units®governs CSU operation and designation.
§394.9082, la. tat.: Managing Entities®governs the role and responsibilities of the Managing Entity.
§394.455, Fla. tat.: Definitions®including public facility and designated receiving facility.
§397.311, Fla. tat.: Addiction Receiving Facilities®governs ARE and JARS licensing and designation.
§ 97. 1( ), Fla. tat.: ARF Capacity®allows ARFs to exceed licensed capacity by up to 10% for no
more than 3 consecutive working days or 7 days in any one month.
§397.675, Fla. tat.: Involuntary Admission (Marchman Act) ®establishes criteria for involuntary
admissions.
§395.002, la. tat.: Emergency medical condition definition®governs medical priority in transport.
5 C.F.R. §§ 16 . , 16 . 1 : HIPAA Security and Privacy Rules®govern PHI sharing among DRS
participants.
C.F.R.42 art : Confidentiality of Substance Use Disorder Patient Records.
Na Wrong 11)oo r Modell and lf.:..:n iiry III°.1 iiiint
Under Section 394.4573, Florida Statutes, Monroe County's DRS operates under the No-Wrong-
Door model, ensuring that individuals can enter the behavioral health system through multiple
access points and be connected to appropriate care regardless of their entry point. Examples of
entry points include:
• Law enforcement under the Baker Act or Marchman Act
• Calls to the 988 Suicide and Crisis Lifeline
• Mobile Response Team crisis interventions
• Emergency departments and hospitals
• Crisis stabilization units and detoxification facilities
` ini oIT� County I D sry gin N(J N rn Rain 2026 202
• Community behavioral health providers and walk-in crisis services
• Referrals from courts,jails, schools, or community partners
• Self-referrals or family referrals through GCC or any satellite office
Regardless of where an individual first seeks help, the system ensures that every person receives:
screening and assessment; crisis stabilization when necessary; referral to the appropriate level of
care; and connection to ongoing behavioral health services.
11'.11f S Goalls
The DRS is designed to:
• Ensure timely access to crisis services
• Improve coordination between law enforcement, hospitals, and behavioral health providers
• Reduce unnecessary incarceration and emergency room utilization
• Ensure individuals receive care regardless of their ability to pay
• Improve outcomes through coordinated treatment and follow-up services
Thriving Mind South Florida, as the Managing Entity for Behavioral Health Services, is responsible
for coordinating the public crisis system, working with community partners to ensure services are
available and accessible, contracting with providers to deliver a continuum of behavioral health
services, and monitoring system performance to ensure compliance with state requirements.
11:::::'11olr11da GirlislisServices ntilrmtmam
Florida recognizes a broader behavioral health crisis services continuum designed to provide
multiple levels of crisis intervention and stabilization. Monroe County's DRS operates within this
statewide crisis continuum. Key components include:
988 Suicide &Crisis Statewide and national crisis call, text, and chat system providing
Lifeline immediate behavioral health support and connecting individuals to local
crisis resources. 988 counselors may provide crisis counseling,
referrals, dispatch MRTs, or contact emergency services when
necessary.
Mobile Response Community-based behavioral health professionals who respond in-
Teams ( Ts) person to crisis situations to conduct assessments, de-escalate crises,
connect individuals to services, and transport individuals when
authorized. §§ 394.463, 397.675, Fla. Stat.
Crisis Stabilization Short-term residential crisis programs providing psychiatric stabilization,
Units ( SUs) evaluation, and treatment for individuals experiencing acute mental
health crises. § 394.875, Fla. Stat.
Addiction Receiving Facilities providing short-term evaluation and stabilization for individuals
Facilities ( s) experiencing substance use crises under the Marchman Act. § 397.311,
Fla. Stat.
Detoxification services Medically supervised services assisting individuals experiencing
substance withdrawal to stabilize prior to ongoing treatment.
` wnnuw-e County De§gn t(1(J I�(ry«>ryiiMing Systern Rain 2026 202
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Hospital Emergency Hospital-based emergency services providing immediate medical and
Departments psychiatric evaluation for individuals in oheie.
Community Behavioral Outpatient and community-based providers delivering ongoing
Health Providers behavioral health treatment and support services.
Care Coordination Services assisting individuals in navigating the system and connecting
Services to appropriate levels of ongoing care. § 394.9082. Fla. 8tat.
Integration wilth 988 Suicide and Girlislis 11~11-felliline
Monroe County participates in the national 988 Suicide and Crisis Lifeline, which provides 24-hour
crisis support via phone, text, and chat. 988 counselors may provide crisis counseling, referrals to
services, dispatch Mobile Response Teams, or contact emergency services when necessary.
Integration of 988 into the crisis system improves access to behavioral health services and helps
reduce unnecessary law enforcement involvement or emergency department utilization.
Molbille lRespoinse I eams (11VU11:1 I s)
Mobile Response Teams (PNRTe) are behavioral health professionals who respond to individuals
experiencing behavioral health crises in community settings. PNRT een/ioee may be requested
through the 988 crisis |ine, behavioral health providere, self and family referra|e, schools or
community organizations, law enforoement, or hospitals and emergency departments.
Mobile Response Teams provide: crisis assessment and intervention; de-escalation of behavioral
health emergencies; referrals to appropriate treatment services; and connection to community
resources. PNRTe help divert individuals from unnecessary hospitalization or criminal justice
involvement when safe and appropriate. When PNRT staff are authorized professionals under
Florida |ew, they may initiate involuntary examinations and coordinate transportation through law
enforcement, EPNG or authorized transport providers contracted by the County when necessary.
Collaboilration wilth 11~aw ��ffolrceinnein't and Girlislis Intervention I eams (01 1�
Law enforcement agencies are critical partners in the Monroe County crisis response system. Law
enforcement participates in the ORG through implementation of the county Transportation Plan;
coordination with receiving facilities; participation in crisis response partnerships; and collaboration
with behavioral health providers and Mobile Response Teams.
The Monroe County Crisis Intervention Team (C|T) program is a community-based initiative that
strengthens collaboration between |avv enforcement agencies and behavioral health providers. The
C|T program is designed to: improve safety for individuals in orieie, responding offioere, and the
community; reduce unnecessary arrests and incarceration of individuals with mental illness or
substance use disorders; facilitate connection to behavioral health services; and strengthen
collaboration between law enforoement, behavioral health providere, and community partners.
Calre Coordilination and lRefeiniralls
Once an individual has been stabilized at a receiving faoi|ity, providers develop a discharge plan
that identifies the most appropriate next level of care. Individuals may be referred to: outpatient
Monroe County DesignotedfReceiving8ystem Rain 2O26-2O2B
mental health treatment; substance use treatment services; residential treatment programs;
community behavioral health providers; or care coordination services. Thriving Mind South Florida
provides oversight and coordination of referrals to ensure individuals are connected to appropriate
services within the behavioral health system.
II°-1Illin III°-' iiriiiod and lReview
This Plan covers the period July 1, 2026, through June 30, 2029. Pursuant to Section 394.4573,
Florida Statutes, Monroe County and the Managing Entity shall review and update this Plan at least
once every three (3) years to ensure it reflects changes in state law, system capacity, community
needs, and best practices. An accurate inventory of participating service providers shall be
maintained and made available at all times to all first responders through the Thriving Mind South
Florida website.
Definitions
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The following terms, as used in this Plan, are defined pursuant to Chapters 394 and 397, Florida
Statutes, and applicable federal regulations, unless context otherwise requires.
988 Suicide and Crisis A statewide and national crisis call, text, and chat system providing
Lifeline immediate behavioral health support and connecting individuals to
local crisis resources. Established under the National Suicide
Hotline Designation Act of 2020.
Addiction Receiving A facility licensed and designated by the Department to receive and
Facility ( ) hold persons with substance use disorders for involuntary admission
or protective custody under the Marchman Act. An ARF may not
exceed its licensed capacity by more than 10 percent and may not
exceed its licensed capacity for more than 3 consecutive working
days or for more than 7 days in 1 month. § 397.401(6); § 397.311,
Fla. Stat.
Baker Act The Florida Mental Health (Baker)Act, Chapter 394, Florida
Statutes, governing the examination, treatment, and rights of
persons with mental illness, including voluntary and involuntary
examination procedures.
Business Associate A written contract governing the permitted uses and disclosures of
Agreement ( ) Protected Health Information (PHI) between covered entities,
required under HIPAA. 45 C.F.R. §§ 164.308, 164.314.
Care Coordination A service that assists individuals in navigating the behavioral health
system, arranging linkages to appropriate levels of care, treatment
services, and community supports. § 394.9082, Fla. Stat.
Centralized Receiving A single-entry-point facility within the DRS capable of assessment,
Facility ( ) evaluation, triage, treatment, and stabilization of persons with
mental health or substance use disorders. Monroe County's CRF is
Guidance Care Center, Inc., 3000 41 st Street Ocean, Marathon, FL,
operating 24/7. § 394.4573, Fla. Stat.
Centralized ReceivingA designated receiving system consisting of one designated central
Systemreceiving facility that serves as the single point of entry for persons
with mental health or substance use disorders, or co-occurring
disorders. Monroe County's DRS operates as a Centralized
Receiving System. § 394.4573, Fla. Stat.
Certificate for A written document executed by an authorized professional initiating
Involuntary a Baker Act involuntary examination. Authorized professionals
Examination include: physicians, licensed clinical psychologists, licensed
psychiatric nurses, licensed mental health counselors, licensed
marriage and family therapists, and licensed clinical social workers.
§ 394.463(2)(a)2, Fla. Stat.
Circuit 16 The Florida Department of Children and Families administrative
circuit encompassing Monroe County, served by the DCF Southern
Region Office of Substance Abuse and Mental Health.
Co-Occurring it r The simultaneous presence of both a mental health disorder and a
substance use disorder in an individual (also referred to as a dual
diagnosis).
Crisis Intervention A community-based initiative that strengthens collaboration between
e ( I ) law enforcement and behavioral health providers to improve
response to individuals in crisis, reduce unnecessary arrests, and
facilitate diversion to appropriate behavioral health services.
Crisis Stabilization nit A short-term residential facility or unit providing immediate
( ) stabilization, assessment, treatment, and discharge planning for
individuals experiencing acute mental health crises. § 394.875, Fla.
Stat.
Department The Florida Department of Children and Families, responsible for
administering behavioral health services, designating receiving
facilities, and funding public mental health and substance use
programs.
Designated eceivin A facility approved by the Department to receive and assess
Facility individuals involuntarily transported under the Baker Act or
Marchman Act. § 394.455(17), Fla. Stat.
Designated eceivin A community-based system of care required by § 394.4573, Fla.
System ( ) Stat., that functions as a No-Wrong-Door model for persons with
mental illness or substance use disorders, ensuring coordinated
access to assessment, stabilization, and treatment. Monroe
County's DRS operates as a Centralized Receiving System.
Detoxification ( ) Medically supervised management of acute withdrawal symptoms
for individuals with substance use disorders, providing physiological
stabilization prior to entry into ongoing treatment.
Electronic Baker Act (e- Baker Act examination forms completed, transmitted, and stored
Baker c ) through secure electronic systems in lieu of paper forms, consistent
with HIPAA, HITECH, and Florida health information laws.
Emergency a icl A federal law requiring hospitals with emergency departments to
Treatment cive provide medical screening examinations and stabilizing treatment to
Labor Act ( L ) any individual regardless of ability to pay, and governing patient
transfer requirements.
Ex arts Order A court order issued by a circuit or county judge directing law
enforcement to take a person into custody for involuntary Baker Act
examination, issued without prior notice to the individual. §
394.463(2)(a)1, Fla. Stat.
Guidance Care Center, The sole public designated receiving facility in Monroe County,
Inc. ( ) serving as the Centralized Receiving Facility and providing CSU,
ARF, Inpatient Detox, and Screening services. Address: 3000 41st
Street Ocean, Marathon, FL 33050. Phone: 305-434-7660. GCC
also operates satellite offices throughout the Florida Keys.
Indigent An individual determined unable to pay for behavioral health
services pursuant to applicable state and federal eligibility criteria.
Involuntary Admission An admission under the Marchman Act when a person meets
substance abuse impairment criteria and is unable to make a
rational decision regarding the need for treatment. § 397.675, Fla.
Stat.
Involuntary A Baker Act examination of a person who has refused or is unable
Examination to consent to voluntary examination and who poses a risk of harm or
is unable to care for themselves. § 394.463(1), Fla. Stat.
Managingi An organization under contract with the Department to manage the
provision of behavioral health services within a specific geographic
area. In Monroe County (and Miami-Dade County), the Managing
Entity is Thriving Mind South Florida. § 394.9082, Fla. Stat.
Marchman ActThe Substance Abuse Services (Marchman)Act, Chapter 397,
Florida Statutes, governing assessment and treatment of persons
with substance use disorders, including voluntary and involuntary
admissions.
Mobile Response Team A community-based team of behavioral health professionals who
( ) respond in-person to crisis situations to conduct assessments, de-
escalate crises, initiate involuntary examinations where criteria are
met, and transport individuals to appropriate receiving facilities. §§
394.463, 397.675, Fla. Stat.
No-Wrong-Door l A service delivery framework required by § 394.4573, Fla. Stat.,
ensuring that individuals can access appropriate behavioral health
services regardless of their initial point of entry into the system.
Protected el Individually identifiable health information created, received,
Information (PHI) maintained, or transmitted by a covered entity, as defined under
HIPAA. 45 C.F.R. § 160.103.
Public Receiving A designated receiving facility that has contracted with the
Facility Department to provide mental health services to all persons
regardless of ability to pay and which receives state funds for such
purpose. § 394.455, Fla. Stat.
7 - our Examination The maximum period a designated receiving facility may hold an
Period individual for involuntary examination under the Baker Act,
beginning upon arrival at and acceptance by the facility. § 394.463,
Fla. Stat.
Thriving i out The Managing Entity under contract with the Department to manage
Floridabehavioral health services in Monroe County and Miami-Dade
County. § 394.9082, Fla. Stat.
Section 11: Monroe County Designated Receiving System
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
„ Coordinated lReceiving S stern Structure
Monroe County's Designated Receiving System is organized as a Centralized Receiving System,
consistent with Section 394.4573, Florida Statutes. The system designates Guidance Care Center,
Inc. as the single-entry-point Centralized Receiving Facility (CRF), linking crisis services across the
Florida Keys through formal referral agreements, shared data systems, and cooperative care
coordination. This approach maintains the current law enforcement transport process, ensuring that
individuals under the Baker Act or Marchman Act are transported to the nearest appropriate
receiving facility, consistent with the No-Wrong-Door mandate.
Centralized Receiving Facility (CRF)
Guidance Care Center, Inc. (GCC)
3000 41 st Street Ocean, Marathon, Florida 33050
Phone: 305-434-7660
Hours: Open 24 hours per day, 7 days per week
Services: CSU (adults) - Inpatient Detoxification - ARF - Screening and Assessment
Satellite offices throughout Monroe County (Key West and Key Largo) to support screening
and level-of-care assessment across the Florida Keys.
The CRF must accept all individuals brought by law enforcement pursuant to this Plan.
lf; „ Geogralphic IlRe iii n
Due to the geographic characteristics of Monroe County as a chain of islands (the Florida Keys),
crisis services are organized to provide accessible care across the full extent of the county.
Guidance Care Center operates satellite offices in key locations to ensure that screening and level-
of-care assessment are available to residents throughout the Keys.
s
Key West Office Lower Keys— City of Key West and
surrounding area up to 7 mile bridge
Marathon (Main Campus— CRF) Middle Keys — Marathon and surrounding area
Key Largo Office Upper Keys— Islamorada, Tavernier, Key
Largo, and surrounding area
G„ Ilf eceiiiviiin II°°°aciiillliiify Gall aciiity and Coordination
Monroe County currently has 2 designated receiving facilities. One (1) is a public facility funded
by Thriving Mind South Florida and one (1) is privately funded. Pursuant to Section 394.455, Florida
Statutes, a public facility is one that has contracted with Thriving Mind to provide mental health
services to all persons regardless of ability to pay and is receiving state funds for such purpose.
Public Receiving Facility: Guidance Care Center, Inc.
Private Receiving Facilities: Lower Keys Medical Center (DePoo Hospital)
When a receiving facility does not have available capacity, the facility coordinates with other DRS
providers to identify an appropriate placement for the individual.
Funded Beds at Public Receiving Facilities
Thriving Mind South Florida funds crisis service capacity at Guidance Care Center. Bed allocations
may change based on funding availability and identified need throughout the fiscal year. Current
funded bed allocations are as follows:
Guidance Care Center, Inc. Adult CSU 7.67
Guidance Care Center, Inc. Inpatient Detoxification 8.00
(DETOX)
Section III: Inventory of Participating Service Providers
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The Monroe County DRS includes Guidance Care Center, Inc. as the primary provider across all
service categories, serving as Monroe County's safety-net crisis provider. Thriving Mind South
Florida contracts with GCC to ensure access to crisis services for individuals regardless of ability to
pay. GCC is responsible for accepting and evaluating uninsured or underinsured individuals
transported under the Baker Act or Marchman Act when capacity allows.
„ III°-lullllliii Ilfeeiiiviiiiir II°°°aiiillliiitiiies
Public receiving facilities contract with Thriving Mind South Florida using funding received through
the Managing Entity (ME) contract with the Department, to provide behavioral health crisis services
to all individuals regardless of their ability to pay. They serve as the primary safety-net crisis
providers within the Monroe County behavioral health system.
Guidance Care Center, Inc. CSU, ARF, Detox, Screening and Adults
(CRF) Assessment
lf; „ III::.'riiivate Ilf e eiiiviiiiir II°°°a iiillliiitiiies
Private receiving facilities designated by the Department may receive individuals transported under
the Baker Act within Monroe County. Private facilities provide crisis stabilization, psychiatric
evaluation, and stabilization services. They may accept individuals based on clinical need and
payer source and may transfer indigent individuals to Guidance Care Center when ongoing publicly
funded services are required.
IIII I INEM-i
NOR===
illllmii,111�1111III. Iliiai ii
Lower Keys Medical Center Psychiatric inpatient, evaluation Adults
(DePoo Hospital) and stabilization
1200 Kennedy Drive
Key West, FL 33040
C„ III°°°e eiirllllll III° un II°°° ciiillliiity eterans Seiirviiice
Veterans in Monroe County may be transported directly to the Miami—VA Healthcare System when
clinically appropriate and available, consistent with the Transportation Plan. It is not designated by
the Department but serves as an important resource for veterans in the DRS.
Miami—VA Healthcare Psychiatric evaluation, inpatient services, Veterans
System 1201 NW 16th crisis stabilization
Street, Miami, FL 33125
lf; Addiction Ilf eceiiiviiiin II°°° ciiillliiitiiie n I'Det iii-tiiic tiii in Seiirviiice
The following facility provides detoxification and addiction receiving services for individuals
experiencing substance use crises, including individuals transported under the Marchman Act.
These facilities provide short-term stabilization and detoxification services and coordinate referrals
to ongoing substance use treatment programs.
Guidance Care Center, Inc. Addiction Receiving Facility (ARF), Inpatient Adults
3000 41 st Street Ocean, Detoxification Services
Marathon 305-434-7660
Section 111-13: Acute and Ambulatory Care Service Flows
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Acute Care II°.'ulbllliiic Ilfeceiiiviiiin II°°° ciiillliiity
Individuals may enter the Centralized Receiving System through multiple access points including
transfers from other facilities (hospitals,jails, prisons, or courts), self/family referrals, law
enforcement transport under the Baker Act or Marchman Act, Mobile Response Team transport,
and referrals from community providers or emergency departments. When law enforcement initiates
a Baker Act or Marchman Act, the individual must be transported to the nearest or most appropriate
designated receiving facility, consistent with the Monroe County Transportation Plan (Attachment
B).
Intake and Screening: Upon arrival at a public receiving facility, the individual undergoes
behavioral health screening and clinical assessment, and financial eligibility screening (indigent vs.
insured/private pay).
If the Individual Meets Acute Care Criteria:
• The receiving facility accepts, stabilizes, and treats the individual.
• Following stabilization, the facility develops a discharge plan including a recommended level of care.
• If the individual is indigent, the facility screens for Thriving Mind Care Coordination services.
• If eligible, a referral is made to Thriving Mind's Care Coordination Department.
• If not eligible, a referral is made to an appropriate Thriving Mind network provider based on the
recommended level of care.
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Baker Act: Receiving facilities may temporarily exceed licensed capacity by up to 10
percent. § 394.463, Fla. Stat. Marchman Act: ARFs may not exceed licensed capacity by
more than 10 percent and may not exceed capacity for more than 3 consecutive working
days or more than 7 days in any one month. § 397.401(6), Fla. Stat. If the facility lacks
capacity, it must coordinate transfer to another receiving facility with available capacity.
If the Individual Does Not Meet Acute Care Criteria:
• The facility determines the most appropriate level of care based on clinical assessment.
• If the recommended level is managed by Thriving Mind (e.g., Short-Term Residential Treatment,
Residential Treatment), the facility contacts Thriving Mind's System of Care Department to coordinate
placement.
• If not managed by Thriving Mind, the facility refers the individual directly to an appropriate Thriving Mind
provider.
• Referrals are based on individual clinical needs and geographic preference when possible. When no
preference or special needs are identified, referrals are made on a rotating basis. All referrals are
documented and available for review by Thriving Mind and oversight agencies.
Inter-Facility Coordination: Receiving facilities must coordinate with one another to ensure
individuals are placed in the most appropriate setting based on clinical need, available services,
and system capacity. When a receiving facility cannot meet an individual's clinical needs, it
coordinates transfer to a facility that can provide appropriate services. Transfers must comply with
Florida Statutes governing the Baker Act and Marchman Act, EMTALA, and applicable hospital
transfer protocols. The sending facility is responsible for coordinating the transfer and ensuring
appropriate documentation accompanies the individual.
lf; „ cute Care 11::.'rivate lReceiving II°°°a iiillliiify
When an individual is taken into custody by law enforcement under the Baker Act, the individual is
transported to the appropriate or nearest designated receiving facility in accordance with the
Transportation Plan (Attachment B).
• If the facility is a private receiving facility, the individual undergoes clinical screening and assessment to
determine whether acute care criteria are met.
• If criteria are met, the individual remains at the private facility for stabilization and treatment. The facility
develops a discharge plan with a recommended level of care.
• If the individual meets criteria and is determined to be indigent, the facility may coordinate transfer to
Guidance Care Center (the CRF) for continued acute care services or refer to an appropriate lower level
of care.
• Transfers are coordinated in accordance with applicable laws, regulations, and DRS procedures.
C Airn1bullatolry Calre Services
Individuals may also enter the behavioral health system through ambulatory or outpatient service
pathways. Monroe County's centralized receiving system accommodates self-referrals through
Guidance Care Center, which operates satellite offices throughout the Florida Keys. Based on the
individual's identified needs, GCC makes referrals accordingly, including for acute care services
when necessary.
When an individual presents for services at the CRF or a Thriving Mind network provider, the
individual undergoes screening for behavioral health needs and financial eligibility. Providers must
complete screening and Level of Care placement tools, and enter all information into the Thriving
Mind data system. Thriving Mind monitors this process to ensure appropriate screening and correct
level-of-care placement.
Screening at a CRS Facility:
• If ambulatory care criteria are met, the facility determines the recommended level of care.
• If managed by Thriving Mind (e.g., Short-Term Residential, Residential Treatment), the facility contacts
Thriving Mind to coordinate placement.
• If not managed by Thriving Mind, the individual may receive services directly at the facility or be referred to
another Thriving Mind provider on a rotating basis.
• If ambulatory criteria are not met, the facility proceeds with the acute care process flow.
Screening at a Thriving Mind Provider:
• If ambulatory criteria are met, the provider determines the recommended level of care and contacts
Thriving Mind for placement if managed by Thriving Mind.
• If not managed by Thriving Mind and the provider has capacity, the provider proceeds with internal
admission procedures.
• If the provider lacks capacity, the individual is referred to another Thriving Mind network provider.
• If ambulatory criteria are not met, the provider proceeds with the acute care process flow.
Process flow diagrams for the Centralized Receiving System are provided in Attachment A.
Section IV: Designated Receiving System Agreements
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The Monroe County DRS operates through informal and formal agreements and collaborative
partnerships between Thriving Mind South Florida, Guidance Care Center, Inc., Monroe County law
enforcement agencies, and other community stakeholders. These agreements support coordination
across the behavioral health crisis system and ensure that individuals experiencing behavioral
health emergencies receive timely evaluation, stabilization, and referral to appropriate services.
113a,ta Shairing andll iirm o rirn tiii n I edhinology
1
Thriving Mind South Florida operates an Acute Care Data System enabling partner facilities to
share real-time bed availability data, displayed on the Thriving Mind website. The information on
the Thriving Mind website updates nightly. Thriving Mind has engaged Carisk to develop a fully
integrated Acute Care and Financial Reporting application to improve clinical outcomes through
secure clinical information sharing. Full platform details are available at yv,,,,,,,,,,, ,,,thiriiiv,i.n�,q,iM.Ii„ncl......org,.
lf; Network Service III::.'r viii eiir Contracts, Ilf; usiiiness Associate Agreements, and
I'Data Shairing Agreements
Through primary contracts and executed Business Associate Agreements (BAAs) Network Service
Providers (NSP) operate under a shared set of clinical and safety standards. While the BAA set the
rules for protecting data, the primary contracts define the specific administrative, operational,
privacy, and programmatic (clinical) service expectations for the network. These agreements allow
for the secure exchange of information when necessary for treatment, health care operations, and
system coordination.
To further this coordination, Thriving Mind is establishing data sharing agreements with the
Managed Medical Assistance (MMA) plans in our region. These partnerships allows both systems
to better coordinate care for individuals who frequently use crisis services or have complex needs.
To facilitate this, the NSPs use a standardized Thriving Mind consent form that puts the person in
control of their information. This form allows the person to choose exactly how their health
information is shared across the network. Individuals have the option to allow sharing with all
network service providers, select specific ones, or decline sharing altogether. This framework
ensures that the no wrong door model remains seamless while fully respecting the person's choice.
C„ III::.'riiiv cy and Confidentiality Ilf equiiiiirerneints
All participating agencies within the DRS must comply with applicable federal and state laws
governing the protection of personal health information, including:
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Applicable laws:
• Health Insurance Portability and Accountability Act (HIPAA)
• Health Information Technology for Economic and Clinical Health (HITECH) Act
• 42 C.F.R. Part 2 —Confidentiality of Substance Use Disorder Patient Records
• Section 501.171, Florida Statutes
• Section 394.4615, Florida Statutes
• Section 397.501, Florida Statutes
• Applicable Florida privacy laws
• Contracted provider's executed Business Associate Agreements (BAAs)
Other confidentiality (data sharing) agreements to support secure information sharing and
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
•
care coordination while maintaining compliance with privacy requirements.
113 Sy f irn Moinitoring andu 111 iii fy Ill im pir v rn in't
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
• Thriving Mind South Florida, in coordination with the Department, monitors DRS
performance to ensure compliance with state requirements and improve system
effectiveness. (§ 394.9082, Fla. Stat.)
• Monitoring activities include: review of Network Provider performance and service
capacity; monitoring of referral and placement practices; evaluation of crisis service
utilization; coordination meetings with providers and system partners.
• System partners participate in regular meetings to review performance, identify
challenges, and implement improvements to the crisis response system.
Continuous System II'D v 111 11 irn in't
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The DRS is designed to evolve as community needs change.
• Thriving Mind works with community partners to expand crisis service capacity, improve
coordination between providers, and strengthen diversion from emergency departments and
jails.
• Integration of new crisis response services including the 988 Suicide and Crisis Lifeline
and Mobile Response Teams is an ongoing priority aligned with Florida's crisis continuum
requirements.
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Attachment A: Process Flow Diagrams
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This attachment contains the Acute Care and Ambulatory Care process flow diagrams for the Monroe County
Designated Receiving System 2026-2029. These diagrams are incorporated herein and referenced
throughout this Plan.
Acute Care — Centralized Receiving System Process Flow
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This flow applies to all individuals entering the Monroe County Designated Receiving System for
acute behavioral health crisis services. Monroe County operates a Centralized Receiving System
with Guidance Care Center, Inc. (GCC) as the sole designated public receiving facility and
Centralized Receiving Facility (CRF). Statutory authority: §§ 394.4573, 394.462, 394.463,
397.401(6), Fla. Stat.
Stella 1 „ Ilf.:..:ntlT III°.Ioiiiints
Law enforcement Mobile Response Team Other entry
Baker Act/Marchrrman Act .........., ( ) , Transfer, self referral, ECG,
transport MRT transport/crisis referral community referral
Al1]ll ermtury Ipoliirmts coinveurge to GCC (ClIRI:::) I I
Stele „ III°.'ull llliiic IlReceliviling II°°°a iiillliiity„ Guidance Calre Centaur (CIII° III°°°) Intake an
Screening
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
(""Wiidaince Care Ceinter, Iliac„ (CIRIF) iiiintallke
Behavioral health screening and clinical assessment . Financial eligibility screening (indigent ors.
insured1private pay)
3000 41st Street Ocean, Marathon, FL . 305 434 7660 . Open 2417
Stele „ Acute Calre Giriiit iiriiia I113 t iirirniiiinatiiioin
Does the iindividual meet acute care criteria'
Clinical assessment by receiving facility
1, "yes > accepted (Illeft colllutnunu) No > see Stelp '7 (right colllurnn)
Stele 4„ Acute Calre Stall iiillliii atiiioin and I"'iir atirn nt
................................................................................................................................................................................................................................................................................................ ------------------------------------------------------
I YIDS— IMeets acute care criteria NO,_ IDoes not meet acute care
Accept, stabilize, treat Facility develops ciriiteiriia
discharge,clan i�recommended level of care Determine recommended level of care Clinical
assessment to identify appropriate services
........ ......... .............. .................. ........ ........ ...............................................................................................................................................................................................................................................
1, Illunudliigeunut (Step 5) 1 See Stelp '7 >
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Sf ll 5'„ Indigent I113eteirrnilinatiloin and Care Coor iiinafiiioin
................................................................................................................................................................................................................................................................................................. -----------------------------------------------------
es — Indigermt No,_ (Private (pay
Screen for 7 hriving Mind Care Coordination n Discharge Galan—private pay/own resources
li�qibility assessment by receiving facility Facility coordinates discharge without TM
referral
... ....................................................................................................................................................................................................................................................................................... .................................................................................................................................................................................................................................................................................................
1, If elllliiglbllle four care coord, 1,
Sf ll '„ Care Coor ilinatiiion III: efeiniralll Outcome
_____________________________________________________ _____________________________________________________
Yes ,_ Eligible -for care coordination No,_ Not eligible -for care coordination
Deter to Thriving Mind Care C oordinatioll � Refer to Thriving Mind network provider Brier/
Crept. Connection to ongoing care coordination on recommended level of care
services
Stelp 'T„ Illin iiiviii uallls Not Meetiling Acute Care Girliiteirliia
Is the recommended level of care managed by Thriving IMind?
e.g., Short-Term Residential Treatment, Residential Treatment
"yes 1, Systeuimrm of Care I11)elp't, No I Ilf.11irect referralll
_____________________________________________________ _____________________________________________________
Yes,_ (Managed Iby Thriving (bind No ,_Not managed Iby Thriving (bind
Contact Thriving Mind System of Care Crept. � Deter directly to Thriving Mind provider
Coordinate placement in managed level of Rotating basis . clinical need . geographic
care preference
Capacity Limitation l
Baker Act. Receiving facilities may temporarily exceed licensed capacity by up to 10
percent. § 394.463, Fla. Stat.
arch c ( ). An ARF may not exceed its licensed capacity by more than 10
percent, and may not exceed capacity for more than 3 consecutive working days or more
than 7 days in any one month. § 397.401(6), Fla. Stat.
If no capacity. GCC will coordinate transfer to another receiving facility with available
capacity within the DRS. Law enforcement should be notified promptly of any transfer.
Referral Documentation Requirements
• All referrals made through the Centralized Receiving System must be documented and
are available for review by Thriving Mind and relevant oversight agencies.
• When no geographic preference or special clinical needs are noted, referrals are made on
a rotating basis among qualified providers.
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Legend:
Facility Decision point Referral Does not meet Entry Required
clinical action placement criteria documentation documentation
I I outcome 1.1 �note
Acute Care — Private Facility Pathway and Documentation
......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This section covers the private receiving facility pathway and documentation requirements
applicable to all transporting entities. Statutory authority: §§ 394.462, 394.463, 394.462(1)(k),
394.462(2)(a), Fla. Stat.
11::.1irlivate IIl eceliviling 11:::::'ac111111'ty 11::.'a't1hway
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
lin6vidual transported to private rec6lviing -facility
Clinical screening and assessment in accordance with the Monroe County Transportation Plan
(Attachment B)
I
Meets acute care criteria?
Clinical assessment
................................................................................................................................................................................................................................................................................................ -------------------------------------------------------
Yes lindigent Yes.— Private pay
Remain at CRF for stabilization and treatment Stabilize and treat at receiving facility Develop
r
Or transfer to appropriate lower level o discha
f care ge plan with recommended level of
care
................................................................................................................................................................................................................................................................................................ ................................................................................................................................................................................................................................................................................................
Transfer compliance. Transfers must comply with EMTALA and the Baker Act. Transfers
are conducted through non-law enforcement means. The sending facility is responsible for
transfer costs unless both facilities agree to an alternative arrangement. §§ 394.462(2)(a),
394.463, 394.462(1)(k), Fla. Stat.
Law enforcement responsibility. Once a law enforcement officer has delivered an
individual to a hospital or receiving facility, the officer is not required to provide further
transportation.
Criminal charges/warrants. Persons with open or pending criminal charges or warrants
shall be released to the custody of the appropriate law enforcement agency. §
394.463(2)(g), Fla. Stat.
IlRequillred 11:::::'oinrns and II'Docurnein'tatiloin
Baker Act: - EMS Patient Care Report - MRT Crisis Assessment Report
- Report of LE Officer Initiating (PCR)or ePCR - Professional Certificate for
Involuntary Examination --+part of - Documentation of medical Involuntary Examination (when
clinical record assessment and vital signs MRT clinician is authorized
professional)
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• CF-MH 3100 Transportation to • CF-MH 3100 Transportation to • Documentation of de-escalation
Receiving Facility Form (includes Receiving Facility Form efforts and clinical observations
all emergency contact info • Description of circumstances • Coordination notes regarding
accessible to officer) leading to transport transportation arrangements
arc manAct: • Notation that transport was • Copy of certificate/assessment
• Form MH 4002—Report of LE conducted in coordination with must accompany individual or be
Officer Initiating Protective Baker Act or Marchman Act transmitted electronically prior to
Custody+written report--�part of examination arrival
clinical record • EMS report accompanies • All documentation becomes
•CF-MH 3100 Transportation to individual to receiving facility or part of the clinical record at the
Receiving Facility Form made available electronically receiving facility
• Form MH 4057—Certificate of
Professional for Emergency
Assessment(deliver to GCC
ARF)
94 463(2)(a) , Ra ,"°plat.
Electronic r Act (e-Baker Act). Monroe County supports the use of electronic Baker
Act documentation. Electronic forms must comply with HIPAA, HITECH, and Florida health
information laws. Electronic records must maintain secure PHI transmission and be
accessible to receiving facilities at intake. A copy must become part of the clinical record. §§
394.463, Fla. Stat.; 45 C.F.R. §§ 164.308, 164.314.
Legend:
Facility/ Decision point Referral/ Does not meet Entry/ Required
clinical action placement Ecriteria documentation documentation/
outcome note
Ambulatory Care — Centralized Receiving System Process Flow
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
This flow applies to individuals presenting for ambulatory or outpatient behavioral health services at
Guidance Care Center (CRF) or a Thriving Mind network provider. Monroe County's centralized
receiving system accommodates self-referrals through GCC's satellite offices throughout the Florida
Keys. Statutory authority: §§ 394.4573, 394.9082, Fla. Stat.
Stelp, 1 lf.:..:n t airy III°.Io iii in is
Individual presents for ambulatory/ outpatient behavioral health services:
.................................................................................................................................................................................................................................................................................................. ..................................................................................................................................................................................................................................................................................................
Guidance Care Center(CIRF") or satellite
office l-hriiviing Mind network provider
Main campus(Marathon) orr Key West orr Key � Provider not within the CRS
Largo
........................................................................................................................................................................ �.,.................................................................................... .. ...................................................................................................................................................................................................................................................................
II,,,,otlh pathways cormverge at scrceurmulurmg I
Stele, „ Screening ails lf;;;;',Ill iii iii lb iii 111 iii ty ss ss inn in t
............................................................................................................................................................................................................. ........ �............................. .. � � eint
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Screening and eligibility assess
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........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Behavioral health needs - Financial eligibility
Complete Thriving Mind screening tools + Level of Care placement tools
H screening llnforrnatlon entered into ...I..hdAng Mlnd data system
S't l '„ Aimbulatory Caere Girliteirlia I113 t irrn it irmatil irm
IDoes, the hnd�vWuW meet arnbWatory care crl!terW
Legal of rare assessment
Ye , Steep 4, flleft colllu nnru) No ,e calllate to acute care (Steep 7)
S t 1p „ lRecomimended II,,,,,. v 111 of Caere II'D t it rn it irm a t it irm
................................................................................................................................................................................................................................................................................................. ------------------------------------------------------
I YES Meets ambLdatory crlteda � INO._ Does not meet arnbUllatory
�
Determine recommended level of care Clinical criteria
assessment determines appropriate LOC; Does not meet ambulatory care criteria
Proceed to Step 7:escalate to acute care
............................................... .... .............................
....................................................................... ..
1, (Yes Ibraunucllhii counutuiin ues) 1,
St 1p 5„ 1 hirlIvIling IIVIIIiind I aina II,,,,,. v 111 of Caere
Is the recommended eleven of care managed by Tlhr�vhng Wind?
e.g., Short-Term Residential Treatment, Residential Treatment Legal 11
Yes 1, Corutact"'III'"Ilh iiriiivliirig Ilylliirud No I Assess Iprovliider capaciiity(Steep )
------------- ---------------------------------------
Yes._ M anaged Iby Thriving Il end No — Not managed by "'rhriiviing Mind
Clontact Thriving Mind—e,00rdinate placement Assess provider/facility capacity Does current
e,g., STRT, Residential Treatment facility orr provider have capacity?
St 1p „ III°.'iir viii iir Calpaclity and II°.1Illac iment
.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
IDoes, the provider/ facHl!ty have capacity'
Yes 1, iiiunuteurunualll admrnliisslioru No I rotatliing referralll
_____________________________________________________ _____________________________________________________
Yea._ IHaa capacity o._ Lacks capacity
Proceed with internal admission seru^ices Refer to another Thriving Mind pr viderr
daliu r d at ecarr nt facility Rotating basis . clinical need . geographic
prreferaence
St 1p °T„ Ilf;..:.. calllatII irm to Acute Caere
Does not meet arrmbWatory care crllteda > ll::)roceed to acute care process flow
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
GCC car Thriving Mind provider follows, acru le rare;process flaw(se Section �1 of this; ttacrhment)
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Thriving iMonitoring
• Thriving Mind monitors the screening process to ensure appropriate screening is
conducted and individuals are placed in the correct level of care.
• Monitoring activities include annual and ad-hoc program monitoring reviews to ensure
compliance with rotation and referral requirements.
Legend:
Facility/ Decision point Referral/ Does not meet Entry/ Required
clinical action placement Ecriteria documentation documentation/
outcome note
RequirementsAmbulatory Care —
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
if efeinir l III°.1iir cfiiices
• Referrals are based on the individual's clinical needs and geographic preference when
possible. Given Monroe County's island geography, proximity across the Florida Keys is
considered in all referral decisions.
• When no preference or special needs are identified, referrals are made on a rotating basis
among qualified Thriving Mind providers.
• All referrals made through the Centralized Receiving System are documented and
available for review by Thriving Mind and relevant oversight agencies.
• Thriving Mind monitors compliance with the rotation process during annual and ad-hoc
program monitoring reviews.
113ata Sysfern Ilf equiiiiirerneinfs
• All screening information and Level of Care placement decisions must be entered into the
Thriving Mind data system at every entry point, including all GCC satellite offices.
• Both CRS facilities and Thriving Mind network providers must complete Thriving Mind
screening tools and Level of Care placement tools.
• Daily bed availability data is accessible through Thriving Mind's Acute Care Data System
at www.thrivingmind.org. The Thriving Mind website updates nightly.
• Network providers share data through individual contracts and Business Associate
Agreements (BAAs) with Thriving Mind South Florida.
II°.1iiriiiv cy and C inflii enfiii llliiify Ilf equiiiiirerneinfs
Applicable laws:
• Health Insurance Portability and Accountability Act (HIPAA)
• Health Information Technology for Economic and Clinical Health (HITECH) Act
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• 42 C.F.R. Part 2 —Confidentiality of Substance Use Disorder Patient Records
• Section 501.171, Florida Statutes
• Section 394.4615, Florida Statutes
• Section 397.501, Florida Statutes
• Applicable Florida privacy laws
• Participating providers execute Business Associate Agreements (BAAs) to support secure
information sharing and care coordination while maintaining compliance with privacy
requirements.
• Business Associate Agreements are attached to the DRS Plan as Attachment C.
Sy fern Moinitolding andu 111 iiify Ill im pir ernein't
• Thriving Mind South Florida, in coordination with DCF, monitors DRS performance to
ensure compliance with state requirements and improve system effectiveness. (§ 394.9082,
Fla. Stat.)
• Monitoring activities include: review of provider performance and service capacity;
monitoring of referral and placement practices; evaluation of crisis service utilization;
coordination meetings with providers and system partners.
• System partners participate in regular meetings to review performance, identify
challenges, and implement improvements to the crisis response system.
Continuous Systern II'De elll pi nein't
• Thriving Mind works with community partners to expand crisis service capacity, improve
coordination between providers, and strengthen diversion from emergency departments and
jails.
• Integration of new crisis response services — including the 988 Suicide and Crisis Lifeline
and Mobile Response Teams — is an ongoing priority aligned with Florida's crisis continuum
requirements.
ReferencesStatutory —Attachment
§39 . 573, Fla.Stat. Designated Receiving Systems—No-Wrong-Door model requirement
§394.462, Fla.Stat. Transportation—governs transport of individuals for involuntary examination
§39 . 63, Fla.Stat. Involuntary Examination (Baker Act)—criteria, procedures, 72-hour period
§394.455, Fla.Stat. Definitions—including public facility and designated receiving facility
§39 .875, Fla.Stat. Crisis Stabilization Units(CSUs)—operation and designation
§394.902, Fla. Stat. Managing Entities—role and responsibilities of the Managing Entity
§397.311, Fla.Stat. Addiction Receiving Facilities—ARF and JARF licensing and designation
§397.401(6), Fla. Stat. ARF Capacity—up to 10%over licensed capacity; <_3 consecutive working days or
<_7 days/month
§397.675, Fla.Stat. Involuntary Admission (Marchman Act)—criteria for involuntary admissions
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§394.463(2)(g), Fla. Stat. Criminal charges/warrants—return to law enforcement custody
5 C.F.R.§§16 .308, HIPAA Security and Privacy Rules—PHI sharing requirements
16 .31
42 G.F.R. Part 2 Confidentiality of Substance Use Disorder Patient Records
EMITALA Emergency Medical Treatment and Active Labor Act—transfer compliance
Note: The list of designated receiving facilities is st...abaect to change as new facilities aie designated and others aie
closed or have their designations removed. .An acci.ji'ate inventor)/of padicipatin sei'vice piovidei's is maintained
on the Thriving Mind Sot.ath Floiida vnrebsite at vnmm/.thi1vin mind.or .
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Attachment 13: Transportation Plan — Monroe County
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
The Florida Department of Children and Families— Circuit 16 (Monroe County)
Involuntary Examinations (Baker Act) ( Involuntary Admissions (Marchman Act) ( Effective July 1,
2026—June 30, 2029
II„ I113uiirpose and Authority
This Transportation Plan is developed and implemented by Monroe County in collaboration with the
Managing Entity, Thriving Mind South Florida, in compliance with Section 394.462, Florida Statutes
(Transportation). This Plan establishes procedures for transporting individuals who require:
• Involuntary Examination under the Baker Act (Chapter 394, Florida Statutes), or
• Involuntary Admission under the Marchman Act (Chapter 397, Florida Statutes).
This Plan ensures that individuals experiencing behavioral health crises are transported safely and
efficiently to an appropriate receiving facility within the Monroe County DRS and supports the
community's No-Wrong-Door crisis system. This Plan provides guidance to Law Enforcement,
Mobile Response Teams, authorized transport providers contracted by the County and
EMS/Ambulance.
Guiding rici l
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
lr lnspoirta-111 In decislloins ullrh ellr" IIIs Rlain f6llow these key pirlllllrh 111 p es:
• Safety First: The safety of the individual, responding personnel, and the public is the
highest priority.
• Medical Needs Take Priority: If an individual has an emergency medical condition, they
must be transported to the nearest hospital emergency department before behavioral health
placement.
• Transport to the Appropriate Facility: Individuals should be transported to the nearest
appropriate receiving facility capable of meeting clinical needs.
• Efficient Transfer of Custody: Receiving facilities must accept individuals brought by law
enforcement and complete intake quickly so officers can return to duty.
• Use of Least Restrictive Options: Alternatives to involuntary examination shall be
considered when appropriate and safe, including MRT intervention, voluntary treatment
referrals, and voluntary crisis stabilization.
II III„ Girliteria for Involuntary Ilf.:..: nn iii in f iii in """"' Ilf; alkeir Act
Section 394.463(1), Florida Statutes
A person may be taken to a designated receiving facility for involuntary examination if there is
reason to believe the individual has a mental illness and, because of that mental illness, meets
criteria outlined below. Both Condition A and Condition B must be satisfied.
Condition A — Refusal or Inability to Consent to Examination (one of the following):
• The individual has refused voluntary examination after a conscientious explanation of its purpose; OR
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• The individual is unable to determine whether an examination is necessary due to the severity of the
mental illness.
Condition B —Risk of Harm or Neglect (at least one of the following):
1. Risk of Neglect: Without care or treatment, the individual is likely to suffer from neglect or refuse
to care for themselves, resulting in a real and present threat of substantial harm to their well-being;
and it is not apparent that the risk can be avoided through the assistance of willing family, friends,
or other available services.
OR
2. Risk of Harm to Self or Others: There is a substantial likelihood that the individual will cause
serious bodily harm to themselves or others in the near future, as evidenced by recent behavior.
Baker Act— 72-Hour Examination Period
Under Section 394.463, Florida Statutes, once an individual is transported under the Baker Act and
accepted for examination, the receiving facility may hold the individual for up to 72 hours for
involuntary examination. The 72-hour period begins upon arrival at and acceptance by the receiving
facility, not at the time of initiation or transport. During this period, the facility must evaluate the
individual and determine the appropriate next step, which may include:
• Release without further action
• Release for voluntary outpatient services
• Voluntary admission for treatment
• Petition for involuntary inpatient or outpatient placement
The receiving facility is responsible for documenting the time of arrival and ensuring that the
examination and any subsequent action comply with the statutory 72-hour timeframe.
Authorized Initiation r Act Involuntary ii
An involuntary examination may be initiated through the following mechanisms under Chapter 394,
Florida Statutes:
1. Ex Parte order A circuit or county judge may issue an order directing law enforcement
to take a person into custody and transport them to a receiving facility.
§ 394.463(2)(a)1, Fla. Stat.
. Professional A physician, clinical psychologist, licensed psychiatric nurse, licensed
Certificate mental health counselor, licensed marriage and family therapist, or
licensed clinical social worker may execute a certificate stating the
individual meets Baker Act criteria. § 394.463(2)(a)2, Fla. Stat.
3. Law Enforcement Law enforcement may take a person into custody when the officer has
Initiation reason to believe the person meets criteria for involuntary examination.
§ 394.463(2)(a)3, Fla. Stat.
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IIIIIIII„ Giriteria for Involuntary irniii iii in Mairchimain Act
Section 397.675, Florida Statutes
A person meets criteria for involuntary admission for substance use disorder services if there is
good faith reason to believe the individual is substance use impaired or has a co-occurring mental
health disorder, and because of that impairment has lost the power of self-control with respect to
substance use, AND one of the following conditions exists:
A. Impaired Judgment: The person is in need of substance use services and, due to substance
use impairment, their judgment is so impaired that they are incapable of recognizing the need for
treatment or making a rational decision regarding care.
Note: Refusal to receive treatment alone does not constitute evidence of impaired judgment.
OR
B. Risk of Harm or Neglect: Without care or treatment, the individual is likely to suffer neglect or
refuse to care for themselves, resulting in a real and present threat of substantial harm to their well-
being; AND the risk cannot be avoided through willing family, friends, or other services; OR there is
a substantial likelihood the person has inflicted, threatened, or attempted to inflict physical harm on
themselves or another, or is likely to do so without admission.
Transport may occur when:
• A certificate of professional assessment has been completed by an authorized professional;
• A law enforcement protective custody report has been prepared; or
• A court order for involuntary assessment or treatment has been issued.
II I aw lf.:..:.n-f iir irn inn 113esigination for "'I"'iir insporf fiii n
Section 394.462(1)(a), Florida Statutes
Florida law requires each county to designate a law enforcement agency responsible for
transporting individuals for involuntary examination. Monroe County designates:
• Monroe County Sheriff's Office (MCSO)— responsible for transporting individuals from unincorporated
areas of Monroe County.
• City of Key West Police Department— responsible for transporting individuals within the City of Key West.
• Any successor law enforcement agency shall operate in accordance with this Transportation Plan.
Law enforcement take persons into custody and transport them to the appropriate or nearest
receiving facility when: an ex parte court order has been issued; or a certificate for involuntary
examination has been executed by an authorized professional.
Law Enforcement May Decline Transportation Only When Both Conditions Are Met:
• The county or jurisdiction has contracted with an emergency medical transport service or private transport
company to provide transportation at the county's expense; AND
• Both the law enforcement agency and the transport provider agree that law enforcement presence is not
necessary for the safety of the individual or others involved.
"'I"'iir inspoirf fiii in lby Molblille GirlislisIlf poin "'I"'eann or Mental 11 leall'th Ovelday
II°.1lr lira
When an MRT professional or mental health overlay program member authorized under Section
394.463 (Baker Act) or Section 397.675 (Marchman Act), Florida Statutes, determines
transportation to a receiving facility is necessary, the professional may:
• Request transportation assistance from the law enforcement agency within the jurisdiction; or
• Arrange alternative transportation (e.g., EMS, ambulance, or other approved transport)when clinically
appropriate.
Transportation decisions shall be based on: the safety of the individual and others; the clinical
needs of the individual; and the most appropriate and least restrictive transportation option
available.
II„ Ilf; lk iir Act ...I iir ins po irf IlRequillrenneints andSpecial III°-1 pu 111 f it in
Transportation may be provided by: Monroe County Sheriff's Office; City of Key West Police
Department; Emergency Medical Services (EMS) or ambulance providers; or authorized transport
providers contracted by the County; when appropriate under Florida law.
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Emergency medical needs take precedence in all transportation situations. If a law
enforcement officer believes an individual has an emergency medical condition as defined
in Section 395.002(8), Florida Statutes, the individual must be transported to the nearest
hospital emergency department for medical evaluation and treatment. After medical
stabilization, the individual may be transferred to a designated receiving facility if
appropriate. § 394.462(I)(i), Fla. Stat.
Transportation for Non-Emergency Medical Needs: Adults and minors with medical conditions
that are not emergencies shall be taken to the nearest general hospital with a designated Baker Act
Unit. Facilities with substantial medical services are listed in Appendix A.
Special Population Transportation Guidelines:
Elderly (Age 60+) May be taken to the nearest designated receiving facility offering
specialized care to older adults. Facilities providing specialty geriatric care
are listed in Appendix A.
Minors (Ages 0— Children (0-12) and adolescents (13-17) shall be taken to the nearest
17) receiving facility licensed to serve children and adolescents. Facilities are
listed in Appendix A.
Incarcerated Individuals in the custody of the Monroe County Detention Center who
Individuals require involuntary examination and are eligible for diversion, or have
reached end of sentence, shall be transported to the receiving facility
closest to the individual's residence. If homeless or residence is unknown,
transport to the facility closest to the location of arrest.
Veterans Individuals known to be veterans may be transported directly to the VA
Medical Center when appropriate and available.
Role of EmergencyMedical Services (EMS) and Ambulance
EMS personnel and ambulance providers play an important role in transporting individuals
experiencing behavioral health crises, particularly when medical monitoring or stabilization is
required. EMS may transport individuals when: the individual has a medical condition requiring
medical supervision; the individual has ingested substances or presents with a possible overdose;
the individual is physically unstable or injured; or law enforcement determines that ambulance
transport is safer or clinically appropriate.
When EMS or ambulance providers are involved in transportation under the Baker Act or
Marchman Act, they should coordinate with law enforcement to ensure a safe and efficient transfer
of care when needed. EMS goes to the nearest emergency room and the ER contacts Baker
Act/Marchman Act transportation. Emergency Room staff should notify the receiving facility as early
as possible so the facility can prepare for intake. When EMS transport is used, law enforcement
may accompany the individual if necessary to ensure safety.
III III„ Ilf eq a iii iire II°°° inms and I'D a imentatiii in
Law Enforcement a uireForms
• Report of Law Enforcement Officer Initiating Involuntary Examination (Baker Act): A written report detailing
the circumstances establishing the officer's reasonable basis to believe the individual meets criteria for
involuntary examination. Must become part of the patient's clinical record.
• CF-MH 3100 Transportation to Receiving Facility Form: Must include all emergency contact information
accessible to the officer, including information from FDLE or DHSMV electronic databases. Emergency
contact information may be used only to inform listed contacts of the patient's whereabouts. §§
119.0712(2)(d), 394.463(2)(a)2, Fla. Stat.
EMS /Ambulance Required Documentation
• EMS Patient Care Report (PCR)or electronic patient care report (ePCR)
• CF-MH 3100 Transportation to Receiving Facility Form
• Documentation of medical assessment and vital signs
• Description of circumstances leading to transport
• Notation that the transport was conducted in coordination with a Baker Act or Marchman Act examination,
when applicable
• The EMS report shall accompany the individual to the receiving facility or be made available electronically
as part of the patient's medical record.
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Mobile Tea ( ) Required Documentation
• Mobile Response Team Crisis Assessment Report
• Professional Certificate for Involuntary Examination when MRT clinician is an authorized professional
• Documentation of de-escalation efforts and clinical observations
• Coordination notes regarding transportation arrangements
• A copy of the professional certificate or crisis assessment documentation must accompany the individual
to the receiving facility or be transmitted electronically prior to arrival whenever possible.
All documentation related to the involuntary examination or protective custody must become part of
the individual's clinical record at the receiving facility.
Electronic Baker Act Documentation (e-Baker c )
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Monroe County supports the use of electronic Baker Act documentation when
available. Electronic Baker Act documentation refers to involuntary examination forms
completed, transmitted, and stored through secure electronic systems rather than paper
forms. Electronic documentation may be used by law enforcement agencies, hospitals and
emergency departments, behavioral health providers, Mobile Response Teams, and
authorized clinicians initiating professional certificates.
Electronic Baker Act forms must comply with HIPAA, the HITECH Act, and Florida public
records and health information laws. Electronic systems must maintain secure transmission
of PHI, ensure accurate and complete documentation, and allow receiving facilities to
access documentation at the time of intake. A copy of the electronic Baker Act report must
still become part of the individual's clinical record at the receiving facility.
IIIIIIIII„ II aiirclhi ain Act ...I irainsport IIl e ,uillrernents
Law enforcement is responsible for transporting individuals who meet Marchman Act criteria to the
appropriate or nearest facility within the DRS.
Emergency medical needs take precedence. If a law enforcement officer believes a
person has an emergency medical condition as defined in Section 395.002(8), Florida
Statutes, the person shall be transported to the nearest hospital emergency room
regardless of whether the facility is an ARF or detoxification facility. § 394.462(I)(i), Fla. Stat.
• Adults: Law enforcement shall contact Guidance Care Center(ARF) to inquire about bed availability. ARF
locations are listed in Appendix B.
• Minors: Monroe County does not currently have a Juvenile Addiction Receiving Facility (JARF). Law
enforcement shall contact the nearest receiving facility who will receive and use the Monroe County
transportation plan to transfer youth to JARF in an adjacent service area to inquire about bed availability.
• Court-Ordered Treatment: Law enforcement shall transport individuals subject to a court order for
Involuntary Services of Substance Abuse Impairment to the appropriate residential treatment provider
indicated on the court order.
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The appropriate DRS facility must provide law enforcement with a basic screening or triage
sufficient to refer the person to appropriate services. § 394.462(I), Fla. Stat. This process including
a responsible handoff of the individual and required paperwork should not exceed five (5) to ten
(10) minutes to facilitate the expeditious release of the transporting unit.
II Mairchimain Act lRequired if°°' inrn
• Form MH 4002 —Report of Law Enforcement Officer Initiating Protective Custody, plus a written report
detailing circumstances establishing good faith reason to believe the individual met Marchman Act
criteria. The written report shall be included in the individual's clinical record.
• Form MH 4057—Certificate of Professional for Emergency Assessment for Substance Abuse Services.
When law enforcement transports an individual for whom this form has been initiated, law enforcement
shall deliver the completed form to the ARF.
• CF-MH 3100 Transportation to Receiving Facility Form
„ lReceiving 11:::::'ac111111,ty Acceptancen Iiir ins-f iir
Sections 394.462(2)(a), 394.463, and 394.462(1)(k), Florida Statutes
Facilities within the DRS must accept all individuals transported for involuntary examination when
brought by: law enforcement officers; emergency medical transport services; or private transport
companies authorized by the county. This applies to individuals transported under Section 394.463
(Baker Act) and Section 394.462(1)(k), Florida Statutes.
Transfers to Another Facility: If a person is transported to a facility later determined to be
inappropriate (due to patient choice, lack of necessary clinical services, or insurance/payer status),
the individual may be transferred to another facility. Transfers must comply with EMTALA and the
Baker Act and should occur through non-law enforcement means (e.g., medical transport). The
sending facility is responsible for transfer costs unless both facilities agree to an alternative
arrangement.
• Law enforcement is not required to provide further transportation after delivering an individual to a hospital
or receiving facility. § 394.462(2)(a), Fla. Stat.
• If a person has open or pending criminal charges or warrants, the individual shall be released back to the
custody of the appropriate law enforcement agency. § 394.463(2)(g), Fla. Stat.
III„ Centralized lReceiving II°°° iii 111 iii fy (C III° III°°°)
Guidance Care Center, Inc., 3000 41st Street Ocean, Marathon, Florida 33050, serves as Monroe
County's CRF within the centralized receiving system. The CRF operates 24 hours per day, 7
days per week, and is capable of assessment, evaluation, triage, treatment, and stabilization. The
CRF must accept all individuals brought by law enforcement pursuant to this Plan.
IIIIII„ III°.1Ill in lReview andCoordination
This Transportation Plan shall be monitored by the Florida Department of Children and Families
Circuit 16 Office of Substance Abuse and Mental Health, and the participating agencies: Monroe
County, Thriving Mind South Florida, the Monroe County Sheriff's Office, and the City of Key West
` oini oIT :ry County [N:ry§gn tee fRery>:ryi iin3 Systern Rain 2026 202
Police Department, through coordination and regular meetings. Any inquiries, complaints, or
requests for assistance shall be transmitted from the Department staff to Thriving Mind without
waiting for scheduled meetings.
IIIIIIIII 11:..:..:..-ffect11ve 113at n I eirim
This Transportation Plan is effective July 1, 2026, and, unless terminated or cancelled earlier, will
expire June 30, 2029. It may be renewed in writing for one (1) additional successive three (3) year
term, subject to preapproval by Monroe County. This Plan may not be amended or modified except
in writing, signed and duly executed by all parties. Future statutory amendments on relevant topics
are incorporated without revision during each three-year term; statutory updates shall be made at
the time of renewal.
This Transportation Plan was drafted in compliance with Section 394.462, Florida Statutes,
Transportation.
AGREED TO AND ACKNOWLEDGED BY THE PARTIES ON THE DATES LISTED BELOW:
[Signature pages follow]
For Monroe County
Michelle Lincoln I Mayor, Monroe County Board of County Commissioners I Date:
Approved as to form and legal sufficiency I Monroe County Attorney I Date:
-Rest of Page Intentionally Left Blank-
Monioe County I [ha �gnoN�dFRecekjng8ysN�mP|on2O26-2O2B
Thriving Mind South Florida
Laura PN. Naredo | President and Chief Executive Officer | Date:
-Rest mf Page Intentionally Left 8lank+
MonroeCountyDesignotedFReceiving8ystemP|on2O26-2O2B
Monioe County I [ha �gnoN�dFRecekjng8ysN�mP|on2O26-2O2B
Florida Department of Children and Families—Circuit 16
Lourdes Dorado-Rubio | GAPNH Regional Director | Date:
-Rest mf Page Intentionally Left 8lank+
MonroeCountyDesignotedfReceiving8ystemP|on2O26-2O2B
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Appendix A: Designated Receiving Facilities — Monroe County
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
As of July 1, 2026. Subject to change as new facilities are designated and others are closed or
have designations removed.
The following is a list of Monroe County facilities designated by the Florida Department of Children
and Families to receive and hold persons with mental illness for involuntary examination and short-
term treatment.
lf; alkeir Act lReceiving 11:::::'ac111111't11es
Guidance Care Center, Inc.** (CRF—CSU, 3000 41 st Street Ocean 305-434-7660
ARF, Inpatient Detox) Marathon, Florida 33050
Lower Keys Medical Center(DePoo 1200 Kennedy Drive Key 305-294-5531
Hospital) Werst, Florida 33040
Public Facility--contracted with the Department to provide mental health services to all persons regardless of
ability to pay, receiving state funds. § 394.455, Fla. Stat..
Baker Act Receiving Facility NOT Designated by the Department:
Miami—VA Healthcare System (Federally 1201 NW 16th Street, Miami, Veterans only
Funded) FL 33125
11:::::'ac111111't11es wilth Significant II iii 111 Capability
A designated receiving facility capable of providing significant medical examination and treatment is
identified, and the individual is transported to that facility based on availability.
GCC Satellite ffiii Ill,,,,,.ocations
s
Key West Office Lower Keys— City of Key West and
surrounding area up to the 7 mile bridge
Marathon (Main Campus— CRF) Middle Keys — Marathon and surrounding area
Key Largo Upper Keys— Islamorada, Tavernier, Key
Largo, and surrounding area
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Appendix 13: Addiction Receiving Facilities and Inpatient
Detoxification Facilities
.......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
As of July 1, 2026. Subject to change as new facilities are designated and others are closed or
have designations removed.
The following is a complete list of Monroe County Addiction Receiving Facilities (ARFs) designated
by the Department to receive and hold persons under a Marchman Act for involuntary admission
and short-term treatment.
ARF Capacity Rule: An ARF may not exceed its licensed capacity by more than 10
percent and may not exceed its licensed capacity for more than 3 consecutive working days
or for more than 7 days in any one month. § 397.401(6), Fla. Stat.
II°°° iir Adults
Guidance Care Center, Inc. (ARF & 3000 41 st Street Ocean Marathon, 305-434-7660
Inpatient Detox) Florida 33050
II°°° iir Juveniles
........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Monroe County does not currently have a designated Juvenile Addiction Receiving Facility
(JARF). Law enforcement shall bring youth to the nearest addiction receiving facility to
receive. The receiving facility will use the Monroe County Transportation Plan to transfer to
the nearest JARF in an adjacent service area for bed availability. For updated information,
contact Thriving Mind South Florida or visit www.thrivingmind.org.
Statutory Ilf efelrein e ttachirnen't Ilf;
§39 . 573, Fla.Stat. Designated Receiving Systems— No-Wrong-Door model requirement
§394.462, Fla.Stat. Transportation —governs transport of individuals for involuntary
examination
§39 . 63, Fla.Stat. Involuntary Examination (Baker Act)— criteria, procedures, 72-hour
period
§394.455, Fla.Stat. Definitions— including public facility and designated receiving facility
§39 .875, Fla.Stat. Crisis Stabilization Units (CSUs)—operation and designation
§394.902, Fla. Stat. Managing Entities— role and responsibilities of the Managing Entity
§397.311, Fla.Stat. Addiction Receiving Facilities—ARF and JARF licensing and
designation
§397.401(6), Fla. Stat. ARF Capacity— up to 10% over licensed capacity; :53 consecutive
working days or<_7 days/month
§397.675, Fla.Stat. Involuntary Admission (Marchman Act)—criteria for involuntary
admissions
§394.463(2)(g), Fla. Stat. Criminal charges/warrants— return to law enforcement custody
5 C.F.R.§§16 .308, HIPAA Security and Privacy Rules—PHI sharing requirements
16 .31
42 C.F.R. Part 2 Confidentiality of Substance Use Disorder Patient Records
EMTALA Emergency Medical Treatment and Active Labor Act—transfer
compliance
Note The live of clesignaled?,eceiving fa cilffies is suuhjed ftu change as new fa cilufivs ate clvsi, naled and cffiets ate
closed csu have 1hviu.clvsignalions uemoved An accutale invvuulcuuy of patficipaling se?viucv poviclets is anainlained
on the 7htiving Mind ouulh C:: vicla websile al www ffitiviuu, anuind cvg
FORM 813 MEMORANDUM ICUI' mmmmOmF VOTING CONFL
ICT FOR,
COUNTY, MUNICIPAL, AND OTHER LOCAL PUBLIC OFFICERS
LAST NAME—FIRST NAME—MIDDLE NAME NAME OF BOARD,COUNCIL,COMMISSION,AUTHORITY OR COMMITTEE
Merrill RaSChein Holly Monroe County BOCC
MAILING ADDRESS THE BOARD,COUNCIL,COMMISSION,AUTHORITY OR COMMITTEE ON
102050 O/S Hwy WHICH I SERVE IS A UNIT OF:
............•- •-•--- - -..................................... ❑CITY P'COUNTY ❑OTHER LOCALAGENCY
CITY COUNTY _.__-...,.. ...............�
Key Largo Monroe NAME OF POLITICAL SUBDIVISION:
.... .........
DATE ON WHICH VOTE OCCURRED __--. ...
06/1 0/2026 MY POSITION IS: d ELECTIVE ❑ APPOINTIVE
WHO MUST FILE FORM 813
This form is for use by any person serving at the county, city, or other local level of government on an appointed or elected board, council,
commission, authority, or committee. It applies to members of advisory and non-advisory bodies who are presented with a voting conflict of
interest under Section 112,3143, Florida Statutes.
Your responsibilities under the law when faced with voting on a measure in which you have a conflict of interest will vary greatly depending
on whether you hold an elective or appointive position. For this reason, please pay close attention to the instructions on this form before
completing and filing the form,
INSTRUCTIONS FOR COMPLIANCE WITH SECTION 112.3143, FLORIDA STATUTES
A person holding elective or appointive county, municipal, or other local public office MUST ABSTAIN from voting on a measure which
would inure to his or her special private gain or loss. Each elected or appointed local officer also MUST ABSTAIN from knowingly voting on
a measure which would inure to the special gain or loss of a principal (other than a government agency) by whom he or she is retained
(including the parent, subsidiary, or sibling organization of a principal by which he or she is retained);to the special private gain or loss of a
relative; or to the special private gain or loss of a business associate. Commissioners of community redevelopment agencies(CRAB)under
Sec. 163,356 or 163„357, F.S., and officers of independent special tax districts elected on a one-acre, one-vote basis are not prohibited
from voting in that capacity.
For purposes of this law, a "relative" includes only the officer's father, mother, son, daughter, husband, wife, brother, sister, father-in-law,
mother-in-law, son-in-law, and daughter-in-law. A"business associate" means any person or entity engaged in or carrying on a business
enterprise with the officer as a partner,joint venturer, coowner of property, or corporate shareholder(where the shares of the corporation
are not listed on any national or regional stock exchange).
ELECTED OFFICERS:
In addition to abstaining from voting in the situations described above, you must disclose the conflict:
PRIOR TO THE VOTE BEING TAKEN by publicly stating to the assembly the nature of your interest in the measure on which you are
abstaining from voting; and
WITHIN 15 DAYS AFTER THE VOTE OCCURS by completing and filing this form with the person responsible for recording the
minutes of the meeting, who should incorporate the form in the minutes.
APPOINTED OFFICERS:
Although you must abstain from voting in the situations described above, you are not prohibited by Section 112,3143 from otherwise
participating in these matters. However, you must disclose the nature of the conflict before making any attempt to influence the decision,
whether orally or in writing and whether made by you or at your direction.
IF YOU INTEND TO MAKE ANYATTEMPT TO INFLUENCE THE DECISION PRIOR TO THE MEETING AT WHICH THE VOTE WILL BE
TAKEN:
• You must complete and file this form (before making any attempt to influence the decision)with the person responsible for recording the
minutes of the meeting,who will incorporate the form in the minutes. (Continued on page 2)
.......................................... ..._...._. ....
CE FORM 8B-EFF 11/2013 PAGE 1
Adopted by reference in Rule 34-7 010(1)(f),F.A,C.
APPOINTED OFFICERS (continued)
• A copy of the form must be provided immediately to the other members of the agency.
• The form must be read publicly at the next meeting after the form is filed.
IF YOU MAKE NO ATTEMPT TO INFLUENCE THE DECISION EXCEPT BY DISCUSSION AT THE MEETING:
• You must disclose orally the nature of your conflict in the measure before participating.
• You must complete the form and file it within 15 days after the vote occurs with the person responsible for recording the minutes of the
meeting,who must incorporate the form in the minutes.A copy of the form must be provided immediately to the other members of the
agency, and the form must be read publicly at the next meeting after the form is filed.
............................................................... ........
DISCLOSURE OF LOCAL OFFICER'S INTEREST
I Holly Merrill Raschein , hereby disclose that on June 10 20 26
(a)A measure came or will come before my agency which (check one or more)
inured to my special private gain or loss;
inured to the special gain or loss of my business associate,
inured to the special gain or loss of my relative,
inured to the special gain or loss of Thriving Mind Item C8 Comm. Merrill Raschein is a BOD „ by
whom I am retained; or
inured to the special gain or loss of which
is the parent subsidiary, or sibling organization or subsidiary of a principal which has retained me.
(b)The measure before my agency and the nature of my conflicting interest in the measure is as follows:
If disclosure of specific information would violate confidentiality or privilege pursuant to law or rules governing attorneys, a public officer,
who is also an attorney, may comply with the disclosure requirements of this section by disclosing the nature of the interest in such a way
as to provide the public with notice of the conflict.
06/10/2026 �
Date Filed Signature
NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES §112.317,mmmA FAILURE TO MAKE ANY REQUIRED DISCLOSURE
CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT,
REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A
CIVIL PENALTY NOT TO EXCEED $10,000.
CE FORM 8B-EFF.11/2013 PAGE 2
Adopted by reference in Rule 34-7,010(1)(f),F.A.C.