Bill Text: FL S0920 | 2020 | Regular Session | Introduced
Bill Title: First-episode Psychosis Programs
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Failed) 2020-03-14 - Died in Appropriations Subcommittee on Health and Human Services [S0920 Detail]
Download: Florida-2020-S0920-Introduced.html
Florida Senate - 2020 SB 920 By Senator Rouson 19-01316-20 2020920__ 1 A bill to be entitled 2 An act relating to first-episode psychosis programs; 3 amending ss. 394.455 and 394.67, F.S.; defining the 4 term “first-episode psychosis program”; amending s. 5 394.658, F.S.; revising the application criteria for 6 the Criminal Justice, Mental Health, and Substance 7 Abuse Reinvestment Grant Program to include support 8 for first-episode psychosis programs; amending s. 9 394.4573, F.S.; requiring the Department of Children 10 and Families to include specified information 11 regarding first-episode psychosis programs in its 12 annual assessment of behavioral health services; 13 defining the term “first-episode psychosis program”; 14 providing that first-episode psychosis programs are an 15 essential element of a coordinated system of care; 16 amending ss. 394.495, 394.496, 394.674, 394.9085, 17 409.972, 464.012, and 744.2007, F.S.; conforming 18 cross-references; providing an effective date. 19 20 Be It Enacted by the Legislature of the State of Florida: 21 22 Section 1. Present subsections (17) through (48) of section 23 394.455, Florida Statutes, are redesignated as subsections (18) 24 through (49), respectively, and a new subsection (17) is added 25 to that section, to read: 26 394.455 Definitions.—As used in this part, the term: 27 (17) “First-episode psychosis program” means an evidence 28 based program for individuals from 15 through 30 years of age 29 who are experiencing the early indications of serious mental 30 illness, especially symptoms of a first psychotic episode, and 31 which includes, but is not limited to, intensive case 32 management, individual or group therapy, supported employment, 33 family education and supports, and the provision of appropriate 34 psychotropic medication as needed. 35 Section 2. Present subsections (10) through (24) of section 36 394.67, Florida Statutes, are redesignated as subsections (11) 37 through (25), respectively, a new subsection (10) is added to 38 that section, and subsection (3) of that section is amended, to 39 read: 40 394.67 Definitions.—As used in this part, the term: 41 (3) “Crisis services” means short-term evaluation, 42 stabilization, and brief intervention services provided to a 43 person who is experiencing an acute mental or emotional crisis, 44 as defined in subsection (18)(17), or an acute substance abuse 45 crisis, as defined in subsection (19)(18), to prevent further 46 deterioration of the person’s mental health. Crisis services are 47 provided in settings such as a crisis stabilization unit, an 48 inpatient unit, a short-term residential treatment program, a 49 detoxification facility, or an addictions receiving facility; at 50 the site of the crisis by a mobile crisis response team; or at a 51 hospital on an outpatient basis. 52 (10) “First-episode psychosis program” means an evidence 53 based program for individuals from 15 through 30 years of age 54 who are experiencing the early indications of serious mental 55 illness, especially symptoms of a first psychotic episode, and 56 which includes, but is not limited to, intensive case 57 management, individual or group therapy, supported employment, 58 family education and supports, and the provision of appropriate 59 psychotropic medication as needed. 60 Section 3. Paragraph (b) of subsection (1) of section 61 394.658, Florida Statutes, is amended to read: 62 394.658 Criminal Justice, Mental Health, and Substance 63 Abuse Reinvestment Grant Program requirements.— 64 (1) The Criminal Justice, Mental Health, and Substance 65 Abuse Statewide Grant Review Committee, in collaboration with 66 the Department of Children and Families, the Department of 67 Corrections, the Department of Juvenile Justice, the Department 68 of Elderly Affairs, and the Office of the State Courts 69 Administrator, shall establish criteria to be used to review 70 submitted applications and to select the county that will be 71 awarded a 1-year planning grant or a 3-year implementation or 72 expansion grant. A planning, implementation, or expansion grant 73 may not be awarded unless the application of the county meets 74 the established criteria. 75 (b) The application criteria for a 3-year implementation or 76 expansion grant shall require information from a county that 77 demonstrates its completion of a well-established collaboration 78 plan that includes public-private partnership models and the 79 application of evidence-based practices. The implementation or 80 expansion grants may support programs and diversion initiatives 81 that include, but need not be limited to: 82 1. Mental health courts; 83 2. Diversion programs; 84 3. Alternative prosecution and sentencing programs; 85 4. Crisis intervention teams; 86 5. Treatment accountability services; 87 6. Specialized training for criminal justice, juvenile 88 justice, and treatment services professionals; 89 7. Service delivery of collateral services such as housing, 90 transitional housing, and supported employment;and91 8. Reentry services to create or expand mental health and 92 substance abuse services and supports for affected persons; and 93 9. First-episode psychosis programs. 94 Section 4. Section 394.4573, Florida Statutes, is amended 95 to read: 96 394.4573 Coordinated system of care; annual assessment; 97 essential elements; measures of performance; system improvement 98 grants; reports.—On or before December 1 of each year, the 99 department shall submit to the Governor, the President of the 100 Senate, and the Speaker of the House of Representatives an 101 assessment of the behavioral health services in this state. The 102 assessment shall consider, at a minimum, the extent to which 103 designated receiving systems function as no-wrong-door models, 104 the availability of treatment and recovery services that use 105 recovery-oriented and peer-involved approaches, the availability 106 of less-restrictive services, and the use of evidence-informed 107 practices. The assessment shall also consider the availability 108 of and access to first-episode psychosis programs and identify 109 any gaps in the availability of and access to such programs in 110 the state. The department’s assessment shall consider, at a 111 minimum, the needs assessments conducted by the managing 112 entities pursuant to s. 394.9082(5). Beginning in 2017, the 113 department shall compile and include in the report all plans 114 submitted by managing entities pursuant to s. 394.9082(8) and 115 the department’s evaluation of each plan. 116 (1) As used in this section: 117 (a) “Care coordination” means the implementation of 118 deliberate and planned organizational relationships and service 119 procedures that improve the effectiveness and efficiency of the 120 behavioral health system by engaging in purposeful interactions 121 with individuals who are not yet effectively connected with 122 services to ensure service linkage. Examples of care 123 coordination activities include development of referral 124 agreements, shared protocols, and information exchange 125 procedures. The purpose of care coordination is to enhance the 126 delivery of treatment services and recovery supports and to 127 improve outcomes among priority populations. 128 (b) “Case management” means those direct services provided 129 to a client in order to assess his or her needs, plan or arrange 130 services, coordinate service providers, link the service system 131 to a client, monitor service delivery, and evaluate patient 132 outcomes to ensure the client is receiving the appropriate 133 services. 134 (c) “Coordinated system of care” means the full array of 135 behavioral and related services in a region or community offered 136 by all service providers, whether participating under contract 137 with the managing entity or by another method of community 138 partnership or mutual agreement. 139 (d) “First-episode psychosis program” means an evidence 140 based program for individuals from 15 through 30 years of age 141 who are experiencing the early indications of serious mental 142 illness, especially symptoms of a first psychotic episode, and 143 which includes, but is not limited to, intensive case 144 management, individual or group therapy, supported employment, 145 family education and supports, and the provision of appropriate 146 psychotropic medication as needed. 147 (e)(d)“No-wrong-door model” means a model for the delivery 148 of acute care services to persons who have mental health or 149 substance use disorders, or both, which optimizes access to 150 care, regardless of the entry point to the behavioral health 151 care system. 152 (2) The essential elements of a coordinated system of care 153 include: 154 (a) Community interventions, such as prevention, primary 155 care for behavioral health needs, therapeutic and supportive 156 services, crisis response services, and diversion programs. 157 (b) A designated receiving system that consists of one or 158 more facilities serving a defined geographic area and 159 responsible for assessment and evaluation, both voluntary and 160 involuntary, and treatment or triage of patients who have a 161 mental health or substance use disorder, or co-occurring 162 disorders. 163 1. A county or several counties shall plan the designated 164 receiving system using a process that includes the managing 165 entity and is open to participation by individuals with 166 behavioral health needs and their families, service providers, 167 law enforcement agencies, and other parties. The county or 168 counties, in collaboration with the managing entity, shall 169 document the designated receiving system through written 170 memoranda of agreement or other binding arrangements. The county 171 or counties and the managing entity shall complete the plan and 172 implement the designated receiving system by July 1, 2017, and 173 the county or counties and the managing entity shall review and 174 update, as necessary, the designated receiving system at least 175 once every 3 years. 176 2. To the extent permitted by available resources, the 177 designated receiving system shall function as a no-wrong-door 178 model. The designated receiving system may be organized in any 179 manner which functions as a no-wrong-door model that responds to 180 individual needs and integrates services among various 181 providers. Such models include, but are not limited to: 182 a. A central receiving system that consists of a designated 183 central receiving facility that serves as a single entry point 184 for persons with mental health or substance use disorders, or 185 co-occurring disorders. The central receiving facility shall be 186 capable of assessment, evaluation, and triage or treatment or 187 stabilization of persons with mental health or substance use 188 disorders, or co-occurring disorders. 189 b. A coordinated receiving system that consists of multiple 190 entry points that are linked by shared data systems, formal 191 referral agreements, and cooperative arrangements for care 192 coordination and case management. Each entry point shall be a 193 designated receiving facility and shall, within existing 194 resources, provide or arrange for necessary services following 195 an initial assessment and evaluation. 196 c. A tiered receiving system that consists of multiple 197 entry points, some of which offer only specialized or limited 198 services. Each service provider shall be classified according to 199 its capabilities as either a designated receiving facility or 200 another type of service provider, such as a triage center, a 201 licensed detoxification facility, or an access center. All 202 participating service providers shall, within existing 203 resources, be linked by methods to share data, formal referral 204 agreements, and cooperative arrangements for care coordination 205 and case management. 206 207 An accurate inventory of the participating service providers 208 which specifies the capabilities and limitations of each 209 provider and its ability to accept patients under the designated 210 receiving system agreements and the transportation plan 211 developed pursuant to this section shall be maintained and made 212 available at all times to all first responders in the service 213 area. 214 (c) Transportation in accordance with a plan developed 215 under s. 394.462. 216 (d) Crisis services, including mobile response teams, 217 crisis stabilization units, addiction receiving facilities, and 218 detoxification facilities. 219 (e) Case management. Each case manager or person directly 220 supervising a case manager who provides Medicaid-funded targeted 221 case management services shall hold a valid certification from a 222 department-approved credentialing entity as defined in s. 223 397.311(10) by July 1, 2017, and, thereafter, within 6 months 224 after hire. 225 (f) Care coordination that involves coordination with other 226 local systems and entities, public and private, which are 227 involved with the individual, such as primary care, child 228 welfare, behavioral health care, and criminal and juvenile 229 justice organizations. 230 (g) Outpatient services. 231 (h) Residential services. 232 (i) Hospital inpatient care. 233 (j) Aftercare and other postdischarge services. 234 (k) Medication-assisted treatment and medication 235 management. 236 (l) Recovery support, including, but not limited to, 237 support for competitive employment, educational attainment, 238 independent living skills development, family support and 239 education, wellness management and self-care, and assistance in 240 obtaining housing that meets the individual’s needs. Such 241 housing may include mental health residential treatment 242 facilities, limited mental health assisted living facilities, 243 adult family care homes, and supportive housing. Housing 244 provided using state funds must provide a safe and decent 245 environment free from abuse and neglect. 246 (m) Care plans shall assign specific responsibility for 247 initial and ongoing evaluation of the supervision and support 248 needs of the individual and the identification of housing that 249 meets such needs. For purposes of this paragraph, the term 250 “supervision” means oversight of and assistance with compliance 251 with the clinical aspects of an individual’s care plan. 252 (n) First-episode psychosis programs. 253 (3) SYSTEM IMPROVEMENT GRANTS.—Subject to a specific 254 appropriation by the Legislature, the department may award 255 system improvement grants to managing entities based on a 256 detailed plan to enhance services in accordance with the no 257 wrong-door model as defined in subsection (1) and to address 258 specific needs identified in the assessment prepared by the 259 department pursuant to this section. Such a grant must be 260 awarded through a performance-based contract that links payments 261 to the documented and measurable achievement of system 262 improvements. 263 Section 5. Subsection (3) of section 394.495, Florida 264 Statutes, is amended to read: 265 394.495 Child and adolescent mental health system of care; 266 programs and services.— 267 (3) Assessments must be performed by: 268 (a) A professional as defined in s. 394.455(5), (7), (33), 269(32), (35), or(36), or (37); 270 (b) A professional licensed under chapter 491; or 271 (c) A person who is under the direct supervision of a 272 qualified professional as defined in s. 394.455(5), (7), (33), 273(32), (35), or(36), or (37) or a professional licensed under 274 chapter 491. 275 Section 6. Subsection (5) of section 394.496, Florida 276 Statutes, is amended to read: 277 394.496 Service planning.— 278 (5) A professional as defined in s. 394.455(5), (7), (33), 279(32), (35), or(36), or (37) or a professional licensed under 280 chapter 491 must be included among those persons developing the 281 services plan. 282 Section 7. Paragraph (a) of subsection (1) of section 283 394.674, Florida Statutes, is amended to read: 284 394.674 Eligibility for publicly funded substance abuse and 285 mental health services; fee collection requirements.— 286 (1) To be eligible to receive substance abuse and mental 287 health services funded by the department, an individual must be 288 a member of at least one of the department’s priority 289 populations approved by the Legislature. The priority 290 populations include: 291 (a) For adult mental health services: 292 1. Adults who have severe and persistent mental illness, as 293 designated by the department using criteria that include 294 severity of diagnosis, duration of the mental illness, ability 295 to independently perform activities of daily living, and receipt 296 of disability income for a psychiatric condition. Included 297 within this group are: 298 a. Older adults in crisis. 299 b. Older adults who are at risk of being placed in a more 300 restrictive environment because of their mental illness. 301 c. Persons deemed incompetent to proceed or not guilty by 302 reason of insanity under chapter 916. 303 d. Other persons involved in the criminal justice system. 304 e. Persons diagnosed as having co-occurring mental illness 305 and substance abuse disorders. 306 2. Persons who are experiencing an acute mental or 307 emotional crisis as defined in s. 394.67(18)s. 394.67(17). 308 Section 8. Subsection (6) of section 394.9085, Florida 309 Statutes, is amended to read: 310 394.9085 Behavioral provider liability.— 311 (6) For purposes of this section, the terms “detoxification 312 services,” “addictions receiving facility,” and “receiving 313 facility” have the same meanings as those provided in ss. 314 397.311(26)(a)4., 397.311(26)(a)1., and 394.455(40)394.455(39), 315 respectively. 316 Section 9. Paragraph (b) of subsection (1) of section 317 409.972, Florida Statutes, is amended to read: 318 409.972 Mandatory and voluntary enrollment.— 319 (1) The following Medicaid-eligible persons are exempt from 320 mandatory managed care enrollment required by s. 409.965, and 321 may voluntarily choose to participate in the managed medical 322 assistance program: 323 (b) Medicaid recipients residing in residential commitment 324 facilities operated through the Department of Juvenile Justice 325 or a treatment facility as defined in s. 394.455(48)s.326394.455(47). 327 Section 10. Paragraph (e) of subsection (4) of section 328 464.012, Florida Statutes, is amended to read: 329 464.012 Licensure of advanced practice registered nurses; 330 fees; controlled substance prescribing.— 331 (4) In addition to the general functions specified in 332 subsection (3), an advanced practice registered nurse may 333 perform the following acts within his or her specialty: 334 (e) A psychiatric nurse, who meets the requirements in s. 335 394.455(36)s. 394.455(35), within the framework of an 336 established protocol with a psychiatrist, may prescribe 337 psychotropic controlled substances for the treatment of mental 338 disorders. 339 Section 11. Subsection (7) of section 744.2007, Florida 340 Statutes, is amended to read: 341 744.2007 Powers and duties.— 342 (7) A public guardian may not commit a ward to a treatment 343 facility, as defined in s. 394.455(48)s. 394.455(47), without 344 an involuntary placement proceeding as provided by law. 345 Section 12. This act shall take effect July 1, 2020.