Bill Text: FL S1340 | 2015 | Regular Session | Comm Sub
Bill Title: Mental Health and Substance Abuse
Spectrum: Bipartisan Bill
Status: (Failed) 2015-05-01 - Died in Appropriations Subcommittee on Health and Human Services [S1340 Detail]
Download: Florida-2015-S1340-Comm_Sub.html
Florida Senate - 2015 CS for SB 1340 By the Committee on Children, Families, and Elder Affairs; and Senator Latvala 586-02542-15 20151340c1 1 A bill to be entitled 2 An act relating to mental health and substance abuse; 3 amending s. 394.455, F.S.; defining the term 4 “interested person”; amending s. 394.4598, F.S.; 5 authorizing a family member of a patient or an 6 interested party to petition a court for the 7 appointment of a guardian advocate; requiring a court 8 to give preference to certain specified surrogates if 9 such surrogate has already been designated by the 10 patient; creating s. 397.803, F.S.; establishing the 11 Substance Abuse Assistance Pilot Program within the 12 Department of Children and Families; requiring the 13 department to determine a target number of 14 participants within available funds; providing the 15 purpose of the pilot program; requiring the program to 16 develop safe and cost efficient treatment alternatives 17 and provide comprehensive case management services for 18 eligible substance abuse impaired adults; authorizing 19 participation in the program as an alternative to 20 criminal imprisonment; requiring that each pilot 21 program submit specified data to the department on a 22 monthly basis; providing eligibility criteria; 23 requiring that maximum enrollment be determined by the 24 department based on available funding; requiring the 25 department to contract with specified entities to 26 serve as program managers; specifying the functions of 27 the program manager; requiring the department to 28 establish certain criteria and qualifications for the 29 project manager; requiring that a pilot program site 30 have only one network in a given region; providing 31 requirements for provider networks; specifying 32 services that must be provided by a provider network; 33 specifying that the primary payor for services 34 provided through the program is the participant’s 35 private pay or Medicaid insurance coverage; allowing 36 eligible participants to share in the cost of provided 37 services based on ability to pay; requiring the 38 department to provide an annual report to the Governor 39 and Legislature evaluating the impact of the program; 40 requiring such report to include specified 41 information; transferring and renumbering s. 765.401, 42 F.S.; transferring and renumbering s. 765.404, F.S.; 43 providing a directive to the Division of Law Revision 44 and Information; creating s. 765.4015, F.S.; providing 45 a short title; creating s. 765.402, F.S.; providing 46 legislative findings; creating s. 765.403, F.S.; 47 defining terms; creating s. 765.405, F.S.; authorizing 48 an adult with capacity to execute a mental health or 49 substance abuse treatment advance directive; providing 50 a presumption of validity if certain requirements are 51 met; providing for execution of the mental health or 52 substance abuse treatment advance directive; creating 53 s. 765.406, F.S.; establishing requirements for a 54 valid mental health or substance abuse treatment 55 advance directive; providing that a mental health or 56 substance abuse treatment directive is valid upon 57 execution even if a part of the mental health or 58 substance abuse treatment directive takes effect at a 59 later date; allowing a mental health or substance 60 abuse treatment advance directive to be revoked, in 61 whole or in part, or to expire under its own terms; 62 specifying that a mental health or substance abuse 63 treatment advance directive does not or may not serve 64 specified purposes; creating s. 765.407, F.S.; 65 providing circumstances under which a mental health or 66 substance abuse treatment advance directive may be 67 revoked; providing circumstances under which a 68 principal may waive specific directive provisions 69 without revoking the directive; creating s. 765.410, 70 F.S.; prohibiting criminal prosecution of a health 71 care facility, provider, or surrogate who acts 72 pursuant to a mental health or substance abuse 73 treatment decision; creating s. 765.411, F.S.; 74 providing for recognition of a mental health and 75 substance abuse treatment advance directive executed 76 in another state if it complies with the laws of this 77 state; amending ss. 394.495, 394.496, 394.9085 78 395.0197, 395.1051, 409.972, 456.0575, 744.704, 79 765.101, and 765.104, F.S.; conforming cross 80 references; reenacting ss. 394.459(3)(b), 394.4598(6) 81 and (7), 394.4655(6)(d) and (7)(f), 394.467(6)(d), 82 394.46715, and 765.202(5), F.S., to incorporate the 83 amendment made to s. 394.4598, F.S., in references 84 thereto; providing an effective date. 85 86 Be It Enacted by the Legislature of the State of Florida: 87 88 Section 1. Present subsections (16) through (32) and (34) 89 through (38) of section 394.455, Florida Statutes, are 90 redesignated as subsections (17) through (33) and (35) through 91 (39), respectively, a new subsection (16) is added to that 92 section, and present subsection (33) of that section is amended, 93 to read: 94 394.455 Definitions.—As used in this part, unless the 95 context clearly requires otherwise, the term: 96 (16) “Interested person” means, for the purposes of this 97 chapter, any person who may reasonably be expected to be 98 affected by the outcome of the particular proceeding involved, 99 including anyone interested in the welfare of an incapacitated 100 person. 101 (34)(33)“Service provider” means any public or private 102 receiving facility, an entity under contract with the Department 103 of Children and Families to provide mental health services, a 104 clinical psychologist, a clinical social worker, a marriage and 105 family therapist, a mental health counselor, a physician, a 106 psychiatric nurse as defined in subsection (24)(23), or a 107 community mental health center or clinic as defined in this 108 part. 109 Section 2. Subsections (1) and (5) of section 394.4598, 110 Florida Statutes, are amended to read: 111 394.4598 Guardian advocate.— 112 (1) The administrator, a family member of the patient, or 113 an interested party, may petition the court for the appointment 114 of a guardian advocate based upon the opinion of a psychiatrist 115 that the patient is incompetent to consent to treatment. If the 116 court finds that a patient is incompetent to consent to 117 treatment and has not been adjudicated incapacitated and a 118 guardian with the authority to consent to mental health 119 treatment appointed, it shall appoint a guardian advocate. The 120 patient has the right to have an attorney represent him or her 121 at the hearing. If the person is indigent, the court shall 122 appoint the office of the public defender to represent him or 123 her at the hearing. The patient has the right to testify, cross 124 examine witnesses, and present witnesses. The proceeding shall 125 be recorded either electronically or stenographically, and 126 testimony shall be provided under oath. One of the professionals 127 authorized to give an opinion in support of a petition for 128 involuntary placement, as described in s. 394.4655 or s. 129 394.467, must testify. A guardian advocate must meet the 130 qualifications of a guardian contained in part IV of chapter 131 744, except that a professional referred to in this part, an 132 employee of the facility providing direct services to the 133 patient under this part, a departmental employee, a facility 134 administrator, or member of the Florida local advocacy council 135 shall not be appointed. A person who is appointed as a guardian 136 advocate must agree to the appointment. 137 (5) In selecting a guardian advocate, the court shall give 138 preference to a health care, mental health care, or substance 139 abuse treatment surrogate, if one has already been designated by 140 the patient. If the patient has not previously selected a health 141 care, mental health care, or substance abuse treatment 142 surrogate, except for good cause documented in the court record, 143 the selection shall be made from the following list in the order 144 of listing: 145 (a) The patient’s spouse. 146 (b) An adult child of the patient. 147 (c) A parent of the patient. 148 (d) The adult next of kin of the patient. 149 (e) An adult friend of the patient. 150 (f) An adult trained and willing to serve as guardian 151 advocate for the patient. 152 Section 3. Section 397.803, Florida Statutes, is created to 153 read: 154 397.803 Substance Abuse Assistance Pilot Program.— 155 (1) PILOT PROGRAM.— 156 (a) There is created within the Department of Children and 157 Families the Substance Abuse Assistance Pilot Program in such 158 regions of the state as may be designated in the general 159 appropriations act. 160 (b) Within available funding, the department shall 161 determine a target number of participants in each pilot program 162 region. 163 (c) The pilot program is created to determine whether the 164 provision of comprehensive care through a coordinated system of 165 case management that offers a range of recovery support services 166 during and after treatment for acute episodes leads to increased 167 employment, stability in housing, and decreased involvement in 168 the criminal justice system on the part of participants. 169 (d) The pilot program shall provide a comprehensive 170 continuum of high-quality and accessible substance abuse 171 intervention, residential and outpatient treatment, 172 comprehensive case management, and recovery support services for 173 substance abuse impaired adults. 174 (e) The pilot program in each selected region shall develop 175 safe and cost efficient treatment alternatives and provide 176 comprehensive case management and continuum of care services for 177 eligible substance abuse impaired adults. 178 (f) Participation in the pilot program may be designated as 179 an alternative to criminal imprisonment for substance abuse 180 impaired adults, as appropriate. 181 (g) Each pilot program region shall submit data to the 182 department on a monthly basis that, at a minimum, reports 183 characteristics of the participants, use of services, and such 184 data as necessary to measure changes in participants’ status 185 with regard to housing, employment, and criminal activity. 186 (2) ELIGIBILITY AND ENROLLMENT.—Maximum enrollment shall be 187 determined by the department, based on funding. To be eligible 188 for participation in the pilot program a person must: 189 (a) Be 18 years of age or older with a history of chronic 190 substance abuse or addiction. 191 (b) Execute a mental health or substance abuse treatment 192 directive as defined in s. 765.403. 193 (c) Include in the mental health or substance abuse 194 treatment directive a self-binding arrangement provision that 195 must: 196 1. Be in writing. 197 2. Be dated and signed by the principal or the principal’s 198 designated representative if the principal is unable to sign. 199 3. State whether the principal wishes to be able to revoke 200 the directive at any time or whether the directive remains 201 irrevocable when the principal is unable to consent to treatment 202 or is incapacitated. Failure to clarify whether the directive is 203 revocable does not render it unenforceable. If the directive 204 fails to state whether it is revocable, the principal may revoke 205 it at any time. 206 4. Contain a clear affirmation that the principal is aware 207 of the nature of the document signed and that the directive was 208 signed freely and voluntarily. 209 5. Be witnessed by at least two adults who, for the 210 purposes of this section, may not be: 211 a. A member of the principal’s treatment team; 212 b. Related to the principal by blood, adoption, or 213 marriage; 214 c. Be in a romantic or dating relationship with the 215 principal; 216 d. The surrogate named by the principal in the signed 217 directive; or 218 e. The owner, operator, or employee of, or a relative of 219 the owner, operator, or an employee of, a treatment facility in 220 which the principal is a patient. 221 6. Be witnessed by persons who attest that: 222 a. They were present when the principal signed the 223 directive; 224 b. The principal appeared to have capacity and not be under 225 undue influence or duress when he or she signed the directive; 226 and 227 c. The principal presented identification or the witness 228 personally knows the principal. 229 7. If the directive includes a provision that it is 230 irrevocable, it must contain a written, signed attestation from 231 a mental health professional that the principal had capacity at 232 the time the directive was executed. If the principal is free to 233 revoke the directive at any time, such attestation is not 234 required. 235 8. Be valid upon execution. 236 9. Contain a designated activation standard other than the 237 principal’s inability to provide consent to treatment or 238 incapacity by describing circumstances or events under which the 239 directive becomes active. 240 10. Affirmatively state that despite activation, a 241 directive does not prevail over contemporaneous preferences 242 expressed by a principal who has capacity or the ability to 243 consent to treatment and has not included a self-binding 244 arrangement provision in the directive. 245 11. Appoint a surrogate to make all health care and 246 substance abuse treatment decisions for the principal, including 247 decisions to consent on behalf of the principal to inpatient 248 mental health or substance abuse treatment. 249 12. Contain a provision that decisions made by a surrogate 250 for a principal’s mental health care or substance abuse 251 treatment are effective without judicial approval. 252 (d) Share responsibility for the costs of pilot program 253 services according to his or her ability to pay, based on a 254 sliding scale. 255 (3) SYSTEM OF CARE; CASE MANAGEMENT; PAYMENT METHOD.— 256 (a) The department shall contract with the Medicaid managed 257 care organization or behavioral health managing entity operating 258 in the applicable geographic region to serve as program manager. 259 (b) The program manager is responsible for the following 260 functions: 261 1. Network management including recruitment and retention 262 of an adequate number of qualified service providers to ensure 263 accessibility and quality of care; 264 2. Coordination of care, including the development and 265 implementation of organizational structures and operational 266 policies necessary to ensure that the network provides 267 continuity of care and avoids unnecessary duplication of 268 services; 269 3. Comprehensive case management, which may be provided by 270 the program manager or by a contracted service provider, 271 including direct interaction with participants and other 272 activities necessary to assess, plan, implement, and monitor the 273 needed services; and 274 4. Administrative functions for the network including, but 275 not limited to, data management, financial management, and 276 contract compliance. 277 (c) The department shall establish criteria for ensuring 278 that an adequate number of providers are included in the network 279 and for provider qualifications, which shall be specified in the 280 contract with the program manager. The pilot program shall be 281 limited to one network in the region for the duration of the 282 pilot program. The provider network shall: 283 1. Offer a comprehensive range of services for substance 284 abuse impaired or drug addicted adults. 285 2. Enter into agreements with law enforcement agencies and 286 the criminal justice system to divert nonviolent offenders with 287 histories of serious substance abuse or chronic addiction into 288 intensive treatment, comprehensive case management, and 289 rehabilitation services. 290 3. Enter into an agreement with the appropriate 291 neighborhood housing services program to provide housing 292 assistance to eligible participants. 293 4. Enter into an agreement with the entity under contract 294 with the Statewide Public Guardianship Office in the pilot 295 program region to provide guardians to act in the capacity of 296 surrogates for eligible participants who do not have family 297 members or other adults available to perform such duties. 298 5. Enter into an agreement with the applicable nonprofit 299 local legal services organization serving the pilot program 300 region to provide legal assistance to eligible participants. 301 (4) SERVICES.—The network must be capable of providing, at 302 a minimum, the following services to substance abuse impaired or 303 drug addicted adults: 304 1. Comprehensive case management and continuum of care 305 coordination; 306 2. Outpatient treatment services; 307 3. Crisis care, including mobile response, and 308 detoxification in short-term residential facilities; 309 4. Inpatient treatment services; 310 5. Step-down residential treatment services; 311 6. Housing needs assessment and assistance; 312 7. Employment assistance programs; 313 8. Transportation needs assessment and assistance; and 314 9. Legal services. 315 (5) PAYMENT FOR SERVICES.— 316 (a) The general revenue funds appropriated by the 317 legislature for the purposes of this section shall be applied to 318 payment for services only after an eligible participant’s 319 private pay or Medicaid insurance coverage has been exhausted. 320 (b) An eligible participant may share in the cost of 321 provided services based on his or her ability to pay. 322 (6) ACCOUNTABILITY; ANNUAL REPORTS.— 323 (a) By October 1 of each year, the department shall provide 324 a written report to the Governor, the President of the Senate, 325 and the Speaker of the House of Representatives which describes 326 the operation and effectiveness of the pilot program. The report 327 must include, but is not limited to, an evaluation of the impact 328 of the following components of the program: 329 1. Comprehensive case management; 330 2. Care coordination and followup care; 331 3. Housing initiatives; and 332 4. Employment assistance. 333 (b) The report must include a recommendation regarding the 334 continuation, expansion, or termination of the pilot program. 335 Section 4. Section 765.401, Florida Statutes, is 336 transferred and renumbered as section 765.311, Florida Statutes. 337 Section 5. Section 765.404, Florida Statutes, is 338 transferred and renumbered as section 765.312, Florida Statutes. 339 Section 6. The Division of Law Revision and Information is 340 directed to rename part IV of chapter 765, Florida Statutes, as 341 “Mental Health and Substance Abuse Advance Directives.” 342 Section 7. Section 765.4015, Florida Statutes, is created 343 to read: 344 765.4015 Short title.—Sections 765.402-765.411 may be cited 345 as the “Jennifer Act.” 346 Section 8. Section 765.402, Florida Statutes, is created to 347 read: 348 765.402 Legislative findings.— 349 (1) The Legislature recognizes that an individual with 350 capacity has the ability to control decisions relating to his or 351 her own mental health care or substance abuse treatment. The 352 Legislature finds that: 353 (a) Substance abuse and some mental illnesses cause 354 individuals to fluctuate between capacity and incapacity; 355 (b) During periods when an individual’s capacity is 356 unclear, the individual may be unable to provide informed 357 consent necessary to access needed treatment; 358 (c) Early treatment may prevent an individual from becoming 359 so ill that involuntary treatment is necessary; and 360 (d) Individuals with substance abuse impairment or mental 361 illness need an established procedure to express their 362 instructions and preferences for treatment and provide advance 363 consent to or refusal of treatment. This procedure should be 364 less expensive and less restrictive than guardianship. 365 (2) The Legislature further recognizes that: 366 (a) A mental health or substance abuse treatment advance 367 directive must provide the individual with a full range of 368 choices. 369 (b) For a mental health or substance abuse directive to be 370 an effective tool, individuals must be able to choose how they 371 want their directives to be applied, including the right of 372 revocation, during periods when they are incompetent to consent 373 to treatment. 374 (c) There must be a clear process so that treatment 375 providers can abide by an individual’s treatment choices. 376 Section 9. Section 765.403, Florida Statutes, is created to 377 read: 378 765.403 Definitions.—As used in this section, the term: 379 (1) “Adult” means any individual who has attained the age 380 of majority or is an emancipated minor. 381 (2) “Capacity” means that an adult has not been found to be 382 incapacitated pursuant to s. 394.463. 383 (3) “Health care facility” means a hospital, nursing home, 384 hospice, home health agency, or health maintenance organization 385 licensed in this state, or any facility subject to part I of 386 chapter 394. 387 (4) “Incapacity” or “incompetent” means an adult who is: 388 (a) Unable to understand the nature, character, and 389 anticipated results of proposed treatment or alternatives or the 390 recognized serious possible risks, complications, and 391 anticipated benefits of treatments and alternatives, including 392 nontreatment; 393 (b) Physically or mentally unable to communicate a willful 394 and knowing decision about mental health care or substance abuse 395 treatment; 396 (c) Unable to communicate his or her understanding or 397 treatment decisions; or 398 (d) Determined incompetent pursuant to s. 394.463. 399 (5) “Informed consent” means consent voluntarily given by a 400 person after a sufficient explanation and disclosure of the 401 subject matter involved to enable that person to have a general 402 understanding of the treatment or procedure and the medically 403 acceptable alternatives, including the substantial risks and 404 hazards inherent in the proposed treatment or procedures or 405 nontreatment, and to make knowing mental health care or 406 substance abuse treatment decisions without coercion or undue 407 influence. 408 (6) “Mental health or substance abuse treatment advance 409 directive” means a written document in which the principal makes 410 a declaration of instructions or preferences or appoints a 411 surrogate to make decisions on behalf of the principal regarding 412 the principal’s mental health or substance abuse treatment, or 413 both. 414 (7) “Mental health professional” means a psychiatrist, 415 psychologist, psychiatric nurse, or social worker, and such 416 other mental health professionals licensed pursuant to chapter 417 458, chapter 464, chapter 490, or chapter 491. 418 (8) “Principal” means a competent adult who executes a 419 mental health or substance abuse treatment advance directive and 420 on whose behalf mental health care or substance abuse treatment 421 decisions are to be made. 422 (9) “Surrogate” means any competent adult expressly 423 designated by a principal to make mental health care or 424 substance abuse treatment decisions on behalf of the principal 425 as set forth in the principal’s mental health or substance abuse 426 treatment advance directive or self-binding arrangement as those 427 terms are defined in this section. 428 Section 10. Section 765.405, Florida Statutes, is created 429 to read: 430 765.405 Mental health or substance abuse treatment advance 431 directive; execution; allowable provisions.— 432 (1) An adult with capacity may execute a mental health or 433 substance abuse treatment advance directive. 434 (2) A directive executed in accordance with this section is 435 presumed to be valid. The inability to honor one or more 436 provisions of a directive does not affect the validity of the 437 remaining provisions. 438 (3) A directive may include any provision relating to 439 mental health or substance abuse treatment or the care of the 440 principal. Without limitation, a directive may include: 441 (a) The principal’s preferences and instructions for mental 442 health or substance abuse treatment. 443 (b) Consent to specific types of mental health or substance 444 abuse treatment. 445 (c) Refusal to consent to specific types of mental health 446 or substance abuse treatment. 447 (d) Consent to admission to and retention in a facility for 448 mental health or substance abuse treatment for up to 14 days. 449 Such consent must be an affirmative statement contained within 450 the directive and must clearly indicate whether such consent is 451 revocable by the principal during a mental health or substance 452 abuse crisis. 453 (e) Descriptions of situations that may cause the principal 454 to experience a mental health or substance abuse crisis. 455 (f) Suggested alternative responses that may supplement or 456 be in lieu of direct mental health or substance abuse treatment, 457 such as treatment approaches from other providers. 458 (g) The principal’s nomination of a guardian, limited 459 guardian, or guardian advocate as provided chapter 744. 460 (4) A directive may be combined with or be independent of a 461 nomination of a guardian, other durable power of attorney, or 462 other advance directive. 463 Section 11. Section 765.406, Florida Statutes, is created 464 to read: 465 765.406 Execution of a mental health or substance abuse 466 advance directive; effective date; expiration.— 467 (1) A directive must: 468 (a) Be in writing. 469 (b) Contain language that clearly indicates that the 470 principal intends to create a directive. 471 (c) Contain language that clearly indicates whether the 472 principal intends for the surrogate to have the authority to 473 provide consent on the principal’s behalf to voluntary admission 474 to inpatient mental health or substance abuse treatment and 475 whether the principal’s consent is revocable. 476 (d) Be dated and signed by the principal or, if the 477 principal is unable to sign, at the principal’s direction in the 478 principal’s presence. 479 (e) Be witnessed by two adults, each of whom must declare 480 that he or she personally knows the principal and was present 481 when the principal dated and signed the directive, and that the 482 principal did not appear to be incapacitated or acting under 483 fraud, undue influence, or duress. The person designated as the 484 surrogate may not act as a witness to the execution of the 485 document designating the mental health or substance abuse care 486 treatment surrogate. At least one person who acts as a witness 487 must be neither the principal’s spouse nor his or her blood 488 relative. 489 (2) A directive is valid upon execution, but all or part of 490 the directive may take effect at a later date as designated by 491 the principal in the directive. 492 (3) A directive may: 493 (a) Be revoked, in whole or in part, pursuant to s. 494 765.407; or 495 (b) Expire under its own terms. 496 (4) A directive does not or may not: 497 (a) Create an entitlement to mental health, substance 498 abuse, or medical treatment or supersede a determination of 499 medical necessity. 500 (b) Obligate any health care provider, professional person, 501 or health care facility to pay the costs associated with the 502 treatment requested. 503 (c) Obligate a health care provider, professional person, 504 or health care facility to be responsible for the nontreatment 505 or personal care of the principal or the principal’s personal 506 affairs outside the scope of services the facility normally 507 provides. 508 (d) Replace or supersede any will or testamentary document 509 or supersede the provision of intestate succession. 510 (e) Be revoked by an incapacitated principal unless that 511 principal selected the option to permit revocation while 512 incapacitated at the time his or her directive was executed. 513 (f) Be used as the authority for inpatient admission for 514 more than 14 days. 515 Section 12. Section 765.407, Florida Statutes, is created 516 to read: 517 765.407 Revocation; waiver.— 518 (1)(a) A principal with capacity may, by written statement 519 of the principal or at the principal’s direction in the 520 principal’s presence, revoke a directive in whole or in part. 521 (b) A person incompetent to consent to treatment may revoke 522 a directive only if he or she elected at the time of executing 523 the directive to be able to revoke when incapacitated. 524 (2) The principal shall provide a copy of his or her 525 written statement of revocation to his or her agent, if any, and 526 to each health care provider, professional person, or health 527 care facility that received a copy of the directive from the 528 principal. 529 (3) The written statement of revocation is effective as to 530 a health care provider, professional person, or health care 531 facility upon receipt. The professional person, health care 532 provider, or health care facility, or persons acting under their 533 direction, shall make the statement of revocation part of the 534 principal’s medical record. 535 (4) A directive also may: 536 (a) Be revoked, in whole or in part, expressly or to the 537 extent of any inconsistency, by a subsequent directive; or 538 (b) Be superseded or revoked by a court order, including 539 any order entered in a criminal matter. The individual’s family, 540 the health care facility, the attending physician, or any other 541 interested person who may be directly affected by the 542 surrogate’s decision concerning any health care may seek 543 expedited judicial intervention pursuant to rule 5.900 of the 544 Florida Probate Rules, if that person believes: 545 1. The surrogate’s decision is not in accord with the 546 individual’s known desires; 547 2. The advance directive is ambiguous, or the individual 548 has changed his or her mind after execution of the advance 549 directive; 550 3. The surrogate was improperly designated or appointed, or 551 the designation of the surrogate is no longer effective or has 552 been revoked; 553 4. The surrogate has failed to discharge duties, or 554 incapacity or illness renders the surrogate incapable of 555 discharging duties; 556 5. The surrogate has abused powers; or 557 6. The individual has sufficient capacity to make his or 558 her own health care decisions. 559 (5) A directive that would have otherwise expired but is 560 effective because the principal is incapacitated remains 561 effective until the principal is no longer incapacitated unless 562 the principal elected to be able to revoke while incapacitated 563 and has revoked the directive. 564 (6) When a principal with capacity consents to treatment 565 that differs from, or refuses treatment consented to in, his or 566 her directive, the consent or refusal constitutes a waiver of a 567 particular provision and does not constitute a revocation of the 568 provision or the directive unless that principal also revokes 569 the provision or directive. 570 Section 13. Section 765.410, Florida Statutes, is created 571 to read: 572 765.410 Immunity from liability; weight of proof; 573 presumption.— 574 (1) A health care facility, provider, or other person who 575 acts under the direction of a health care facility or provider 576 is not subject to criminal prosecution or civil liability, and 577 may not be deemed to have engaged in unprofessional conduct, as 578 a result of carrying out a mental health care or substance abuse 579 treatment decision made in accordance with this section. The 580 surrogate who makes a mental health care or substance abuse 581 treatment decision on a principal’s behalf, pursuant to this 582 section, is not subject to criminal prosecution or civil 583 liability for such action. 584 (2) This section applies unless it is shown by a 585 preponderance of the evidence that the person authorizing or 586 effectuating a mental health or substance abuse treatment 587 decision did not, in good faith, comply with this section. 588 Section 14. Section 765.411, Florida Statutes, is created 589 to read: 590 765.411 Recognition of mental health and substance abuse 591 treatment advance directive executed in another state.—A mental 592 health or substance abuse treatment advance directive executed 593 in another state in compliance with the law of that state is 594 validly executed for the purposes of this chapter. 595 Section 15. Subsection (3) of section 394.495, Florida 596 Statutes, is amended to read: 597 394.495 Child and adolescent mental health system of care; 598 programs and services.— 599 (3) Assessments must be performed by: 600 (a) A professional as defined in s. 394.455(2), (4), (22) 601(21), (24)(23), or (25)(24); 602 (b) A professional licensed under chapter 491; or 603 (c) A person who is under the direct supervision of a 604 professional as defined in s. 394.455(2), (4), (22)(21), (24) 605(23), or (25)(24)or a professional licensed under chapter 491. 606 607 The department shall adopt by rule statewide standards for 608 mental health assessments, which must be based on current 609 relevant professional and accreditation standards. 610 Section 16. Subsection (6) of section 394.496, Florida 611 Statutes, is amended to read: 612 394.496 Service planning.— 613 (6) A professional as defined in s. 394.455(2), (4), (22) 614(21), (24)(23), or (25)(24)or a professional licensed under 615 chapter 491 must be included among those persons developing the 616 services plan. 617 Section 17. Subsection (6) of section 394.9085, Florida 618 Statutes, is amended to read: 619 394.9085 Behavioral provider liability.— 620 (6) For purposes of this section, the terms “detoxification 621 services,” “addictions receiving facility,” and “receiving 622 facility” have the same meanings as those provided in ss. 623 397.311(18)(a)4., 397.311(18)(a)1., and 394.455(27)(26), 624 respectively. 625 Section 18. Paragraph (d) of subsection (1) of section 626 395.0197, Florida Statutes, is amended to read: 627 395.0197 Internal risk management program.— 628 (1) Every licensed facility shall, as a part of its 629 administrative functions, establish an internal risk management 630 program that includes all of the following components: 631 (d) A system for informing a patient or an individual 632 identified pursuant to s. 765.311(1)s.765.401(1)that the 633 patient was the subject of an adverse incident, as defined in 634 subsection (5). Such notice shall be given by an appropriately 635 trained person designated by the licensed facility as soon as 636 practicable to allow the patient an opportunity to minimize 637 damage or injury. 638 Section 19. Section 395.1051, Florida Statutes, is amended 639 to read: 640 395.1051 Duty to notify patients.—An appropriately trained 641 person designated by each licensed facility shall inform each 642 patient, or an individual identified pursuant to s. 765.311(1) 643s. 765.401(1), in person about adverse incidents that result in 644 serious harm to the patient. Notification of outcomes of care 645 that result in harm to the patient under this section shall not 646 constitute an acknowledgment or admission of liability, nor can 647 it be introduced as evidence. 648 Section 20. Paragraph (b) of subsection (1) of section 649 409.972, Florida Statutes, is amended to read: 650 409.972 Mandatory and voluntary enrollment.— 651 (1) The following Medicaid-eligible persons are exempt from 652 mandatory managed care enrollment required by s. 409.965, and 653 may voluntarily choose to participate in the managed medical 654 assistance program: 655 (b) Medicaid recipients residing in residential commitment 656 facilities operated through the Department of Juvenile Justice 657 or mental health treatment facilities as defined by s. 658 394.455(33)s. 394.455(32).659 Section 21. Section 456.0575, Florida Statutes, is amended 660 to read: 661 456.0575 Duty to notify patients.—Every licensed health 662 care practitioner shall inform each patient, or an individual 663 identified pursuant to s. 765.311(1)s.765.401(1), in person 664 about adverse incidents that result in serious harm to the 665 patient. Notification of outcomes of care that result in harm to 666 the patient under this section shall not constitute an 667 acknowledgment of admission of liability, nor can such 668 notifications be introduced as evidence. 669 Section 22. Subsection (7) of section 744.704, Florida 670 Statutes, is amended to read: 671 744.704 Powers and duties.— 672 (7) A public guardian shall not commit a ward to a mental 673 health treatment facility, as defined in s. 394.455(33)s.674394.455(32), without an involuntary placement proceeding as 675 provided by law. 676 Section 23. Subsection (15) of section 765.101, Florida 677 Statutes, is amended to read: 678 765.101 Definitions.—As used in this chapter: 679 (15) “Proxy” means a competent adult who has not been 680 expressly designated to make health care decisions for a 681 particular incapacitated individual, but who, nevertheless, is 682 authorized pursuant to s. 765.311s.765.401to make health care 683 decisions for such individual. 684 Section 24. Subsection (4) of section 765.104, Florida 685 Statutes, is amended to read: 686 765.104 Amendment or revocation.— 687 (4) Any patient for whom a medical proxy has been 688 recognized under s. 765.311s.765.401and for whom any previous 689 legal disability that precluded the patient’s ability to consent 690 is removed may amend or revoke the recognition of the medical 691 proxy and any uncompleted decision made by that proxy. The 692 amendment or revocation takes effect when it is communicated to 693 the proxy, the health care provider, or the health care facility 694 in writing or, if communicated orally, in the presence of a 695 third person. 696 Section 25. Paragraph (b) of subsection (3) of s. 394.459, 697 subsections (6) and (7) of s. 394.4598, paragraph (d) of 698 subsection (6) and paragraph (f) of subsection (7) of s. 699 394.4655, paragraph (d) of subsection (6) of s. 394.467, s. 700 394.46715, and subsection (5) of s. 765.202, Florida Statutes, 701 are reenacted for the purpose of incorporating the amendments 702 made to s. 394.4598, Florida Statutes. 703 Section 26. This act shall take effect July 1, 2015.