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Updated November, 2003
394.451 Short title.--This
part shall be known as "The Florida Mental Health Act" or "The
Baker Act."
394.453 Legislative intent.--It is the intent of the
Legislature to authorize and direct the Department of Children and Family
Services to evaluate, research, plan, and recommend to the Governor and the
Legislature programs designed to reduce the occurrence, severity, duration, and
disabling aspects of mental, emotional, and behavioral disorders. It is the
intent of the Legislature that treatment programs for such disorders shall
include, but not be limited to, comprehensive health, social, educational, and
rehabilitative services to persons requiring intensive short-term and continued
treatment in order to encourage them to assume responsibility for their
treatment and recovery. It is intended that such persons be provided with
emergency service and temporary detention for evaluation when required; that
they be admitted to treatment facilities on a voluntary basis when extended or
continuing care is needed and unavailable in the community; that involuntary
placement be provided only when expert evaluation determines that it is
necessary; that any involuntary treatment or examination be accomplished in a
setting which is clinically appropriate and most likely to facilitate the
person's return to the community as soon as possible; and that individual
dignity and human rights be guaranteed to all persons who are admitted to
mental health facilities or who are being held under s. 394.463. It is the
further intent of the Legislature that the least restrictive means of
intervention be employed based on the individual needs of each person, within
the scope of available services.
394.455 Definitions.--As used
in this part, unless the context clearly requires otherwise, the term:
(1)
"Administrator" means the chief administrative officer of a
receiving or treatment facility or his or her designee.
(2) "Clinical
psychologist" means a psychologist as defined in s. 490.003(7) with 3
years of postdoctoral experience in the practice of clinical psychology,
inclusive of the experience required for licensure, or a psychologist employed
by a facility operated by the United States Department of Veterans Affairs that
qualifies as a receiving or treatment facility under this part.
(3) "Clinical
record" means all parts of the record required to be maintained and
includes all medical records, progress notes, charts, and admission and
discharge data, and all other information recorded by a facility which pertains
to the patient's hospitalization and treatment.
(4) "Clinical
social worker" means a person licensed as a clinical social worker under
chapter 491.
(5) "Community
facility" means any community service provider contracting with the
department to furnish substance abuse or mental health services under part IV
of this chapter.
(6) "Community
mental health center or clinic" means a publicly funded, not-for-profit
center which contracts with the department for the provision of inpatient,
outpatient, day treatment, or emergency services.
(7)
"Court," unless otherwise specified, means the circuit court.
(8)
"Department" means the Department of Children and Family
Services.
(9) "Express and
informed consent" means consent voluntarily given in writing, by a
competent person, after sufficient explanation and disclosure of the subject
matter involved to enable the person to make a knowing and willful decision
without any element of force, fraud, deceit, duress, or other form of
constraint or coercion.
(10) "Facility" means any hospital,
community facility, public or private facility, or receiving or treatment
facility providing for the evaluation, diagnosis, care, treatment, training, or
hospitalization of persons who appear to have a mental illness or have been
diagnosed as having a mental illness. "Facility" does not include any
program or entity licensed pursuant to chapter 400.
(11)
"Guardian" means the natural guardian of a minor, or a person
appointed by a court to act on behalf of a ward's person if the ward is a minor
or has been adjudicated incapacitated.
(12) "Guardian
advocate" means a person appointed by a court to make decisions regarding
mental health treatment on behalf of a patient who has been found incompetent
to consent to treatment pursuant to this part. The guardian advocate may be
granted specific additional powers by written order of the court, as provided
in this part.
(13)
"Hospital" means a facility licensed under chapter 395.
(14)
"Incapacitated" means that a person has been adjudicated
incapacitated pursuant to part V of chapter 744 and a guardian of the person
has been appointed.
(15)
"Incompetent to consent to treatment" means that a person's
judgment is so affected by his or her mental illness that the person lacks the
capacity to make a well-reasoned, willful, and knowing decision concerning his
or her medical or mental health treatment.
(16) "Law
enforcement officer" means a law enforcement officer as defined in s.
943.10.
(17) "Mental
health overlay program" means a mobile service which provides an
independent examination for voluntary admissions and a range of supplemental
onsite services to persons with a mental illness in a residential setting such
as a nursing home, assisted living facility, adult family-care home, or
nonresidential setting such as an adult day care center. Independent
examinations provided pursuant to this part through a mental health overlay
program must only be provided under contract with the department for this
service or be attached to a public receiving facility that is also a community
mental health center.
(18) "Mental
illness" means an impairment of the mental or emotional processes that
exercise conscious control of one's actions or of the ability to perceive or
understand reality, which impairment substantially interferes with a person's
ability to meet the ordinary demands of living, regardless of etiology. For the
purposes of this part, the term does not include retardation or developmental
disability as defined in chapter 393, intoxication, or conditions manifested
only by antisocial behavior or substance abuse impairment.
(19) "Mobile
crisis response service" means a nonresidential crisis service attached to
a public receiving facility and available 24 hours a day, 7 days a week,
through which immediate intensive assessments and interventions, including
screening for admission into a receiving facility, take place for the purpose
of identifying appropriate treatment services.
(20)
"Patient" means any person who is held or accepted for mental
health treatment.
(21)
"Physician" means a medical practitioner licensed under
chapter 458 or chapter 459 who has experience in the diagnosis and treatment of
mental and nervous disorders or a physician employed by a facility operated by
the United States Department of Veterans Affairs which qualifies as a receiving
or treatment facility under this part.
(22) "Private
facility" means any hospital or facility operated by a for-profit or
not-for-profit corporation or association that provides mental health services
and is not a public facility.
(23)
"Psychiatric nurse" means a registered nurse licensed under
part I of chapter 464 who has a master's degree or a doctorate in psychiatric
nursing and 2 years of post-master's clinical experience under the supervision
of a physician.
(24)
"Psychiatrist" means a medical practitioner licensed under
chapter 458 or chapter 459 who has primarily diagnosed and treated mental and
nervous disorders for a period of not less than 3 years, inclusive of
psychiatric residency.
(25) "Public
facility" means any facility that has contracted with the department to
provide mental health services to all persons, regardless of their ability to
pay, and is receiving state funds for such purpose.
(26) "Receiving
facility" means any public or private facility designated by the
department to receive and hold involuntary patients under emergency conditions
or for psychiatric evaluation and to provide short-term treatment. The term
does not include a county jail.
(27)
"Representative" means a person selected to receive notice of
proceedings during the time a patient is held in or admitted to a receiving or
treatment facility.
(28)
"Secretary" means the Secretary of Children and Family
Services.
(29) "Transfer
evaluation" means the process, as approved by the appropriate district
office of the department, whereby a person who is being considered for
placement in a state treatment facility is first evaluated for appropriateness
of admission to the facility by a community-based public receiving facility or
by a community mental health center or clinic if the public receiving facility
is not a community mental health center or clinic.
(30) "Treatment
facility" means any state-owned, state-operated, or state-supported
hospital, center, or clinic designated by the department for extended treatment
and hospitalization, beyond that provided for by a receiving facility, of
persons who have a mental illness, including facilities of the United States
Government, and any private facility designated by the department when
rendering such services to a person pursuant to the provisions of this part.
Patients treated in facilities of the United States Government shall be solely
those whose care is the responsibility of the United States Department of
Veterans Affairs.
394.457 Operation and administration.--
(1)
ADMINISTRATION.--The Department of Children and Family Services is
designated the "Mental Health Authority" of
(2) RESPONSIBILITIES
OF THE DEPARTMENT.--The department is responsible for:
(a)
The planning, evaluation, and implementation of a complete and
comprehensive statewide program of mental health, including community services,
receiving and treatment facilities, child services, research, and training as
authorized and approved by the Legislature, based on the annual program budget
of the department. The department is also responsible for the coordination of
efforts with other departments and divisions of the state government, county
and municipal governments, and private agencies concerned with and providing mental
health services. It is responsible for establishing standards, providing
technical assistance, and exercising supervision of mental health programs of,
and the treatment of patients at, community facilities, other facilities for
persons who have a mental illness, and any agency or facility providing
services to patients pursuant to this part.
(b)
The publication and distribution of an information handbook to
facilitate understanding of this part, the policies and procedures involved in
the implementation of this part, and the responsibilities of the various
providers of services under this part. It shall stimulate research by public
and private agencies, institutions of higher learning, and hospitals in the
interest of the elimination and amelioration of mental illness.
(3) POWER TO
CONTRACT.--The department may contract to provide, and be provided with,
services and facilities in order to carry out its responsibilities under this
part with the following agencies: public and private hospitals; receiving and
treatment facilities; clinics; laboratories; departments, divisions, and other
units of state government; the state colleges and universities; the community
colleges; private colleges and universities; counties, municipalities, and any
other governmental unit, including facilities of the United States Government;
and any other public or private entity which provides or needs facilities or
services. Baker Act funds for community inpatient, crisis stabilization,
short-term residential treatment, and screening services must be allocated to
each county pursuant to the department's funding allocation methodology.
Notwithstanding the provisions of s. 287.057(5)(f),
contracts for community-based Baker Act services for inpatient, crisis
stabilization, short-term residential treatment, and screening provided under
this part, other than those with other units of government, to be provided for
the department must be awarded using competitive sealed bids when the county
commission of the county receiving the services makes a request to the
department's district office by January 15 of the contracting year. The
district shall not enter into a competitively bid contract under this provision
if such action will result in increases of state or local expenditures for
Baker Act services within the district. Contracts for these Baker Act services
using competitive sealed bids will be effective for 3 years. Services
contracted for by the department may be reimbursed by the state at a rate up to
100 percent. The department shall adopt rules establishing minimum standards
for such contracted services and facilities and shall make periodic audits and
inspections to assure that the contracted services are provided and meet the
standards of the department.
(4) APPLICATION FOR
AND ACCEPTANCE OF GIFTS AND GRANTS.--The department may apply for and accept
any funds, grants, gifts, or services made available to it by any agency or
department of the Federal Government or any other public or private agency or
individual in aid of mental health programs. All such moneys shall be deposited
in the State Treasury and shall be disbursed as provided by law.
(5) RULES.--
(a)
The department shall adopt rules establishing forms and procedures
relating to the rights and privileges of patients seeking mental health
treatment from facilities under this part.
(b)
The department shall adopt rules necessary for the implementation and
administration of the provisions of this part, and a program subject to the
provisions of this part shall not be permitted to operate unless rules designed
to ensure the protection of the health, safety, and welfare of the patients
treated through such program have been adopted.
(c)
The department shall adopt rules establishing minimum standards for
services provided by a mental health overlay program or a mobile crisis
response service.
(6) PERSONNEL.--
(a)
The department shall, by rule, establish minimum standards of education
and experience for professional and technical personnel employed in mental health
programs, including members of a mobile crisis response service.
(b)
The department shall design and distribute appropriate materials for the
orientation and training of persons actively engaged in implementing the
provisions of this part relating to the involuntary examination and placement
of persons who are believed to have a mental illness.
(7) PAYMENT FOR CARE
OF PATIENTS.--Fees and fee collections for patients in state-owned,
state-operated, or state-supported treatment facilities shall be according to
s. 402.33.
394.4572 Screening of mental health personnel.--
(1)(a) The department
and the Agency for Health Care Administration shall require employment
screening for mental health personnel using the standards for level 2 screening
set forth in chapter 435. "Mental health personnel" includes all
program directors, professional clinicians, staff members, and volunteers
working in public or private mental health programs and facilities who have
direct contact with unmarried patients under the age of 18 years.
(b) Students in the health care professions who
are interning in a mental health facility licensed under chapter 395, where the
primary purpose of the facility is not the treatment of minors, are exempt from the fingerprinting
and screening requirements, provided they are under direct supervision in the
actual physical presence of a licensed health care professional.
(c)
Mental health personnel working in a facility licensed under chapter 395
who have less than 15 hours per week of direct contact with patients or who are
health care professionals licensed by the Agency for Health Care Administration
or a board thereunder are exempt from the
fingerprinting and screening requirements, except for persons working in mental
health facilities where the primary purpose of the facility is the treatment of
minors.
(d)
A volunteer who assists on an intermittent basis for less than 40 hours
per month is exempt from the fingerprinting and screening requirements,
provided the volunteer is under direct and constant supervision by persons who
meet the screening requirements of paragraph (a).
(2) The department or
the Agency for Health Care Administration may grant exemptions from
disqualification as provided in s. 435.06.
(3) Prospective
mental health personnel who have previously been fingerprinted or screened
pursuant to this chapter, chapter 393, chapter 397, chapter 402, or chapter
409, or teachers who have been fingerprinted pursuant to chapter 1012, who have
not been unemployed for more than 90 days thereafter, and who under the penalty
of perjury attest to the completion of such fingerprinting or screening and to
compliance with the provisions of this section and the standards for level 1
screening contained in chapter 435, shall not be required to be refingerprinted or rescreened in
order to comply with any screening requirements of this part.
394.4573 Continuity of care management system; measures of performance; reports.--
(1) For the purposes
of this section:
(a)
"Case management" means those activities aimed at assessing
client needs, planning services, linking the service system to a client,
coordinating the various system components, monitoring service delivery, and
evaluating the effect of service delivery.
(b)
"Case manager" means an individual who works with clients, and
their families and significant others, to provide case management.
(c)
"Client manager" means an employee of the department who is
assigned to specific provider agencies and geographic areas to ensure that the
full range of needed services is available to clients.
(d)
"Continuity of care management system" means a system that
assures, within available resources, that clients have access to the full array
of services within the mental health services delivery system.
(2) The department is
directed to implement a continuity of care management system for the provision
of mental health care, through the provision of client and case management,
including clients referred from state treatment facilities to community mental
health facilities. Such system shall include a network of client managers and
case managers throughout the state designed to:
(a)
Reduce the possibility of a client's admission or readmission to a state
treatment facility.
(b)
Provide for the creation or designation of an agency in each county to
provide single intake services for each person seeking mental health services.
Such agency shall provide information and referral services necessary to ensure
that clients receive the most appropriate and least restrictive form of care,
based on the individual needs of the person seeking treatment. Such agency
shall have a single telephone number, operating 24 hours per day, 7 days per
week, where practicable, at a central location, where each client will have a
central record.
(c)
Advocate on behalf of the client to ensure that all appropriate services
are afforded to the client in a timely and dignified manner.
(d)
Require that any public receiving facility initiating a patient transfer
to a licensed hospital for acute care mental health services not accessible
through the public receiving facility shall notify the hospital of such
transfer and send all records relating to the emergency psychiatric or medical
condition.
(3) The department is
directed to develop and include in contracts with service providers measures of
performance with regard to goals and objectives as specified in the state plan.
Such measures shall use, to the extent practical, existing data collection methods
and reports and shall not require, as a result of this subsection, additional
reports on the part of service providers. The department shall plan monitoring
visits of community mental health facilities with other state, federal, and
local governmental and private agencies charged with monitoring such
facilities.
(4) The department is
directed to submit a report to the Legislature, prior to April 1 of each year,
outlining departmental progress towards the implementation of the minimum
staffing patterns' standards in state mental health treatment facilities. The
report shall contain, by treatment facility, information regarding goals and
objectives and departmental performance toward meeting each such goal and
objective.
394.4574 Department responsibilities for a mental health resident who resides in an
assisted living facility that holds a limited mental health license.--
(1) The term
"mental health resident," for purposes of this section, means an
individual who receives social security disability income due to a mental
disorder as determined by the Social Security Administration or receives
supplemental security income due to a mental disorder as determined by the
Social Security Administration and receives optional state supplementation.
(2) The department
must ensure that:
(a)
A mental health resident has been assessed by a psychiatrist, clinical
psychologist, clinical social worker, or psychiatric nurse, or an individual
who is supervised by one of these professionals, and determined to be
appropriate to reside in an assisted living facility. The documentation must be
provided to the administrator of the facility within 30 days after the mental
health resident has been admitted to the facility. An evaluation completed upon
discharge from a state mental hospital meets the requirements of this
subsection related to appropriateness for placement as a mental health resident
if it was completed within 90 days prior to admission to the facility.
(b)
A cooperative agreement, as required in s. 400.4075, is developed
between the mental health care services provider that serves a mental health
resident and the administrator of the assisted living facility with a limited
mental health license in which the mental health resident is living. Any entity
that provides Medicaid prepaid health plan services shall ensure the
appropriate coordination of health care services with an assisted living
facility in cases where a Medicaid recipient is both a member of the entity's
prepaid health plan and a resident of the assisted living facility. If the
entity is at risk for Medicaid targeted case management and behavioral health
services, the entity shall inform the assisted living facility of the
procedures to follow should an emergent condition arise.
(c)
The community living support plan, as defined in s. 400.402, has been
prepared by a mental health resident and a mental health case manager of that
resident in consultation with the administrator of the facility or the
administrator's designee. The plan must be provided to the administrator of the
assisted living facility with a limited mental health license in which the
mental health resident lives. The support plan and the agreement may be in one
document.
(d)
The assisted living facility with a limited mental health license is
provided with documentation that the individual meets the definition of a
mental health resident.
(e)
The mental health services provider assigns a case manager to each
mental health resident who lives in an assisted living facility with a limited
mental health license. The case manager is responsible for coordinating the
development of and implementation of the community living support plan defined
in s. 400.402. The plan must be updated at least annually.
(3) The Secretary of
Children and Family Services, in consultation with the Agency for Health Care
Administration, shall annually require each district administrator to develop,
with community input, detailed plans that demonstrate how the district will
ensure the provision of state-funded mental health and substance abuse
treatment services to residents of assisted living facilities that hold a
limited mental health license. These plans must be consistent with the
substance abuse and mental health district plan developed pursuant to s. 394.75
and must address case management services; access to consumer-operated drop-in
centers; access to services during evenings, weekends, and holidays;
supervision of the clinical needs of the residents; and access to emergency
psychiatric care.
394.458 Introduction or removal of certain articles unlawful; penalty.--
(1)(a) Except as
authorized by law or as specifically authorized by the person in charge of each
hospital providing mental health services under this part, it is unlawful to
introduce into or upon the grounds of such hospital, or to take or attempt to
take or send therefrom, any of the following
articles, which are hereby declared to be contraband for the purposes of this
section:
1.
Any intoxicating beverage or beverage which causes or may cause an
intoxicating effect;
2.
Any controlled substance as defined in chapter 893; or
3.
Any firearms or deadly weapon.
(b)
It is unlawful to transmit to, or attempt to transmit to, or cause or
attempt to cause to be transmitted to, or received by, any patient of any
hospital providing mental health services under this part any article or thing
declared by this section to be contraband, at any place which is outside of the
grounds of such hospital, except as authorized by law or as specifically
authorized by the person in charge of such hospital.
(2) A person who
violates any provision of this section commits a felony of the third degree,
punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
394.459 Rights of patients.--
(1) RIGHT TO
INDIVIDUAL DIGNITY.--It is the policy of this state that the individual dignity
of the patient shall be respected at all times and upon all occasions,
including any occasion when the patient is taken into custody, held, or transported.
Procedures, facilities, vehicles, and restraining devices utilized for
criminals or those accused of crime shall not be used in connection with
persons who have a mental illness, except for the protection of the patient or
others. Persons who have a mental illness but who are not charged with a
criminal offense shall not be detained or incarcerated in the jails of this
state. A person who is receiving treatment for mental illness in a facility
shall not be deprived of any constitutional rights. However, if such a person
is adjudicated incapacitated, his or her rights may be limited to the same
extent the rights of any incapacitated person are limited by law.
(2) RIGHT TO
TREATMENT.--
(a)
A person shall not be denied treatment for mental illness and services
shall not be delayed at a receiving or treatment facility because of inability
to pay. However, every reasonable effort to collect appropriate reimbursement
for the cost of providing mental health services to persons able to pay for
services, including insurance or third-party payments, shall be made by
facilities providing services pursuant to this part.
(b)
It is further the policy of the state that the least restrictive
appropriate available treatment be utilized based on the individual needs and
best interests of the patient and consistent with optimum improvement of the
patient's condition.
(c)
Each person who remains at a receiving or treatment facility for more
than 12 hours shall be given a physical examination by a health practitioner
authorized by law to give such examinations, within 24 hours after arrival at
such facility.
(d)
Every patient in a facility shall be afforded the opportunity to
participate in activities designed to enhance self-image and the beneficial
effects of other treatments, as determined by the facility.
(e)
Not more than 5 days after admission to a facility, each patient shall
have and receive an individualized treatment plan in writing which the patient
has had an opportunity to assist in preparing and to review prior to its
implementation. The plan shall include a space for the patient's comments.
(3) RIGHT TO EXPRESS
AND INFORMED PATIENT CONSENT.--
(a)
Each patient entering a facility shall be asked to give express and
informed consent for admission and treatment. If the patient has been
adjudicated incapacitated or found to be incompetent to consent to treatment,
express and informed consent to treatment shall be sought instead from the
patient's guardian or guardian advocate. If the patient is a minor, express and
informed consent for admission and treatment shall also be requested from the
patient's guardian. Express and informed consent for admission and treatment of
a patient under 18 years of age shall be required from
the patient's guardian, unless the minor is seeking outpatient crisis
intervention services under s. 394.4784. Express and informed consent for
admission and treatment given by a patient who is under 18 years of age shall
not be a condition of admission when the patient's guardian gives express and
informed consent for the patient's admission pursuant to s. 394.463 or s.
394.467. Prior to giving consent, the following information shall be disclosed
to the patient, or to the patient's guardian if the patient is 18 years of age or
older and has been adjudicated incapacitated, or to the patient's guardian
advocate if the patient has been found to be incompetent to consent to
treatment, or to both the patient and the guardian if the patient is a minor:
the reason for admission, the proposed treatment, the purpose of the treatment
to be provided, the common side effects thereof, alternative treatment
modalities, the approximate length of care, and that any consent given by a
patient may be revoked orally or in writing prior to or during the treatment
period by the patient, the guardian advocate, or the guardian.
(b)
In the case of medical procedures requiring the use of a general
anesthetic or electroconvulsive treatment, and prior
to performing the procedure, express and informed consent shall be obtained
from the patient if the patient is legally competent, from the guardian of a
minor patient, from the guardian of a patient who has been adjudicated
incapacitated, or from the guardian advocate of the patient if the guardian
advocate has been given express court authority to consent to medical
procedures or electroconvulsive treatment as provided
under s. 394.4598.
(c)
When the department is the legal guardian of a patient, or is the
custodian of a patient whose physician is unwilling to perform a medical
procedure, including an electroconvulsive treatment,
based solely on the patient's consent and whose guardian or guardian advocate
is unknown or unlocatable, the court shall hold a
hearing to determine the medical necessity of the medical procedure. The
patient shall be physically present, unless the patient's medical condition
precludes such presence, represented by counsel, and provided the right and
opportunity to be confronted with, and to cross-examine, all witnesses alleging
the medical necessity of such procedure. In such proceedings, the burden of
proof by clear and convincing evidence shall be on the party alleging the
medical necessity of the procedure.
(d)
The administrator of a receiving or treatment facility may, upon the
recommendation of the patient's attending physician, authorize emergency
medical treatment, including a surgical procedure, if such treatment is deemed
lifesaving, or if the situation threatens serious bodily harm to the patient,
and permission of the patient or the patient's guardian or guardian advocate
cannot be obtained.
(4) QUALITY OF
TREATMENT.--
(a)
Each patient in a facility shall receive services suited to his or her
needs, which shall be administered skillfully, safely, and humanely with full
respect for the patient's dignity and personal integrity. Each patient shall
receive such medical, vocational, social, educational, and rehabilitative
services as his or her condition requires to bring
about an early return to the community. In order to achieve this goal, the
department is directed to coordinate its mental health programs with all other
programs of the department and other state agencies.
(b)
Receiving and treatment facilities shall develop and maintain, in a form
accessible to and readily understandable by patients, the following:
1.
Criteria, procedures, and required staff training for any use of close
or elevated levels of supervision, of restraint, seclusion, or isolation, or of
emergency treatment orders, and for the use of bodily control and physical
management techniques.
2.
Procedures for documenting, monitoring, and requiring clinical review of
all uses of the procedures described in subparagraph 1. and for documenting and
requiring review of any incidents resulting in injury to patients.
3.
A system for the review of complaints by patients or their families or
guardians.
(c)
A facility may not use seclusion or restraint for punishment, to
compensate for inadequate staffing, or for the convenience of staff. Facilities
shall ensure that all staff are made aware of these restrictions on the use of
seclusion and restraint and shall make and maintain records which demonstrate
that this information has been conveyed to individual staff members.
(5) COMMUNICATION, ABUSE
REPORTING, AND VISITS.--
(a)
Each person receiving services in a facility providing mental health
services under this part has the right to communicate freely and privately with
persons outside the facility unless it is determined that such communication is
likely to be harmful to the person or others. Each facility shall make
available as soon as reasonably possible to persons receiving services a
telephone that allows for free local calls and access to a long-distance
service. A facility is not required to pay the costs of a patient's
long-distance calls. The telephone shall be readily accessible to the patient
and shall be placed so that the patient may use it to communicate privately and
confidentially. The facility may establish reasonable rules for the use of this
telephone, provided that the rules do not interfere with a patient's access to
a telephone to report abuse pursuant to paragraph (e).
(b)
Each patient admitted to a facility under the provisions of this part
shall be allowed to receive, send, and mail sealed, unopened correspondence;
and no patient's incoming or outgoing correspondence shall be opened, delayed,
held, or censored by the facility unless there is reason to believe that it
contains items or substances which may be harmful to the patient or others, in
which case the administrator may direct reasonable examination of such mail and
may regulate the disposition of such items or substances.
(c)
Each facility must permit immediate access to any patient, subject to
the patient's right to deny or withdraw consent at any time, by the patient's
family members, guardian, guardian advocate, representative,
(d)
Each facility shall establish reasonable rules governing visitors,
visiting hours, and the use of telephones by patients in the least restrictive
possible manner. Patients shall have the right to contact and to receive
communication from their attorneys at any reasonable time.
(e)
Each patient receiving mental health treatment in any facility shall
have ready access to a telephone in order to report an alleged abuse. The
facility staff shall orally and in writing inform each patient of the procedure
for reporting abuse and shall make every reasonable effort to present the
information in a language the patient understands. A written copy of that
procedure, including the telephone number of the central abuse hotline and
reporting forms, shall be posted in plain view.
(f)
The department shall adopt rules providing a procedure for reporting
abuse. Facility staff shall be required, as a condition of employment, to
become familiar with the requirements and procedures for the reporting of
abuse.
(6) CARE AND CUSTODY
OF PERSONAL EFFECTS OF PATIENTS.--A patient's right to the possession of his or
her clothing and personal effects shall be respected. The facility may take
temporary custody of such effects when required for medical and safety reasons.
A patient's clothing and personal effects shall be inventoried upon their
removal into temporary custody. Copies of this inventory shall be given to the
patient and to the patient's guardian, guardian advocate, or representative and
shall be recorded in the patient's clinical record. This inventory may be
amended upon the request of the patient or the patient's guardian, guardian
advocate, or representative. The inventory and any amendments to it must be
witnessed by two members of the facility staff and by the patient, if able. All
of a patient's clothing and personal effects held by the facility shall be returned
to the patient immediately upon the discharge or transfer of the patient from
the facility, unless such return would be detrimental to the patient. If
personal effects are not returned to the patient, the reason must be documented
in the clinical record along with the disposition of the clothing and personal
effects, which may be given instead to the patient's guardian, guardian
advocate, or representative. As soon as practicable after an emergency transfer
of a patient, the patient's clothing and personal effects shall be transferred
to the patient's new location, together with a copy of the inventory and any
amendments, unless an alternate plan is approved by the patient, if able, and
by the patient's guardian, guardian advocate, or representative.
(7) VOTING IN PUBLIC
ELECTIONS.--A patient in a facility who is eligible to vote according to the
laws of the state has the right to vote in the primary and general elections.
The department shall establish rules to enable patients to obtain voter registration
forms, applications for absentee ballots, and absentee ballots.
(8) HABEAS CORPUS.--
(a)
At any time, and without notice, a person held in a receiving or
treatment facility, or a relative, friend, guardian, guardian advocate,
representative, or attorney, or the department, on behalf of such person, may
petition for a writ of habeas corpus to question the cause and legality of such
detention and request that the court order a return to the writ in accordance
with chapter 79. Each patient held in a facility shall receive a written notice
of the right to petition for a writ of habeas corpus.
(b)
At any time, and without notice, a person who is a patient in a
receiving or treatment facility, or a relative, friend, guardian, guardian
advocate, representative, or attorney, or the department, on behalf of such
person, may file a petition in the circuit court in the county where the
patient is being held alleging that the patient is being unjustly denied a
right or privilege granted herein or that a procedure authorized herein is
being abused. Upon the filing of such a petition, the court shall have the
authority to conduct a judicial inquiry and to issue any order needed to
correct an abuse of the provisions of this part.
(c)
The administrator of any receiving or treatment facility receiving a
petition under this subsection shall file the petition with the clerk of the
court on the next court working day.
(d)
No fee shall be charged for the filing of a petition under this
subsection.
(9) VIOLATIONS.--The
department shall report to the Agency for Health Care Administration any
violation of the rights or privileges of patients, or of any procedures
provided under this part, by any facility or professional licensed or regulated
by the agency. The agency is authorized to impose any sanction authorized for
violation of this part, based solely on the investigation and findings of the
department.
(10) LIABILITY FOR
VIOLATIONS.--Any person who violates or abuses any rights or privileges of
patients provided by this part is liable for damages as determined by law. Any
person who acts in good faith in compliance with the provisions of this part is
immune from civil or criminal liability for his or her actions in connection
with the admission, diagnosis, treatment, or discharge of a patient to or from
a facility. However, this section does not relieve any person from liability if
such person commits negligence.
(11) RIGHT TO
PARTICIPATE IN TREATMENT AND DISCHARGE PLANNING.--The patient shall have the opportunity
to participate in treatment and discharge planning and shall be notified in
writing of his or her right, upon discharge from the facility, to seek
treatment from the professional or agency of the patient's choice.
(12) POSTING OF
NOTICE OF RIGHTS OF PATIENTS.--Each facility shall post a notice listing and
describing, in the language and terminology that the persons to whom the notice
is addressed can understand, the rights provided in this section. This notice
shall include a statement that provisions of the federal Americans with
Disabilities Act apply and the name and telephone number of a person to contact
for further information. This notice shall be posted in a place readily
accessible to patients and in a format easily seen by patients. This notice
shall include the telephone numbers of the
394.4595 Florida statewide and local advocacy
councils; access to patients and records.--Any facility designated by the department as a
receiving or treatment facility must allow access to any patient and the
clinical and legal records of any patient admitted pursuant to the provisions
of this act by members of the Florida statewide and local advocacy councils.
394.4597 Persons to be notified; patient's representative.--
(1) VOLUNTARY
PATIENTS.--At the time a patient is voluntarily admitted to a receiving or
treatment facility, the identity and contact information of a person to be
notified in case of an emergency shall be entered in the patient's clinical
record.
(2) INVOLUNTARY
PATIENTS.--
(a)
At the time a patient is admitted to a facility for involuntary
examination or placement, or when a petition for involuntary placement is
filed, the names, addresses, and telephone numbers of the patient's guardian or
guardian advocate, or representative if the patient has no guardian, and the
patient's attorney shall be entered in the patient's clinical record.
(b)
If the patient has no guardian, the patient shall be asked to designate
a representative. If the patient is unable or unwilling to designate a
representative, the facility shall select a representative.
(c)
The patient shall be consulted with regard to the selection of a
representative by the receiving or treatment facility and shall have authority
to request that any such representative be replaced.
(d)
When the receiving or treatment facility selects a representative, first
preference shall be given to a health care surrogate, if one has been previously
selected by the patient. If the patient has not previously selected a health
care surrogate, the selection, except for good cause documented in the
patient's clinical record, shall be made from the following list in the order
of listing:
1.
The patient's spouse.
2.
An adult child of the patient.
3.
A parent of the patient.
4.
The adult next of kin of the patient.
5.
An adult friend of the patient.
6.
The appropriate
(e)
A licensed professional providing services to the patient under this
part, an employee of a facility providing direct services to the patient under
this part, a department employee, a person providing other substantial services
to the patient in a professional or business capacity, or a creditor of the
patient shall not be appointed as the patient's representative.
394.4598 Guardian advocate.--
(1) The administrator
may petition the court for the appointment of a guardian advocate based upon
the opinion of a psychiatrist that the patient is incompetent to consent to
treatment. If the court finds that a patient is incompetent to consent to
treatment and has not been adjudicated incapacitated and a guardian with the
authority to consent to mental health treatment appointed, it shall appoint a
guardian advocate. The patient has the right to have an attorney represent him
or her at the hearing. If the person is indigent, the court shall appoint the
office of the public defender to represent him or her at the hearing. The
patient has the right to testify, cross-examine witnesses, and present
witnesses. The proceeding shall be recorded either electronically or stenographically, and testimony shall be provided under
oath. One of the professionals authorized to give an opinion in support of a
petition for involuntary placement, as described in s. 394.467(2), must
testify. A guardian advocate must meet the qualifications of a guardian
contained in part IV of chapter 744, except that a professional referred to in
this part, an employee of the facility providing direct services to the patient
under this part, a departmental employee, a facility administrator, or member
of the Florida local advocacy council shall not be appointed. A person who is
appointed as a guardian advocate must agree to the appointment.
(2) A facility
requesting appointment of a guardian advocate must, prior to the appointment,
provide the prospective guardian advocate with information about the duties and
responsibilities of guardian advocates, including the information about the
ethics of medical decisionmaking. Before asking a
guardian advocate to give consent to treatment for a patient, the facility
shall provide to the guardian advocate sufficient information so that the
guardian advocate can decide whether to give express and informed consent to
the treatment, including information that the treatment is essential to the
care of the patient, and that the treatment does not present an unreasonable
risk of serious, hazardous, or irreversible side effects. Before giving consent
to treatment, the guardian advocate must meet and talk with the patient and the
patient's physician in person, if at all possible, and by telephone, if not.
The decision of the guardian advocate may be reviewed by the court, upon
petition of the patient's attorney, the patient's family, or the facility
administrator.
(3) Prior to a
guardian advocate exercising his or her authority, the guardian advocate shall
attend a training course approved by the court. This training course, of not
less than 4 hours, must include, at minimum, information about the patient
rights, psychotropic medications, diagnosis of mental illness, the ethics of
medical decisionmaking, and duties of guardian
advocates. This training course shall take the place of the training required
for guardians appointed pursuant to chapter 744.
(4) The information
to be supplied to prospective guardian advocates prior to their appointment and
the training course for guardian advocates must be developed and completed
through a course developed by the department and approved by the chief judge of
the circuit court and taught by a court-approved organization. Court-approved
organizations may include, but are not limited to, community or junior
colleges, guardianship organizations, and the local bar association or The
Florida Bar. The court may, in its discretion, waive some or all of the
training requirements for guardian advocates or impose additional requirements.
The court shall make its decision on a case-by-case basis and, in making its
decision, shall consider the experience and education of the guardian advocate,
the duties assigned to the guardian advocate, and the needs of the patient.
(5) In selecting a
guardian advocate, the court shall give preference to a health care surrogate,
if one has already been designated by the patient. If the patient has not
previously selected a health care surrogate, except for good cause documented
in the court record, the selection shall be made from the following list in the
order of listing:
(a)
The patient's spouse.
(b)
An adult child of the patient.
(c)
A parent of the patient.
(d)
The adult next of kin of the patient.
(e)
An adult friend of the patient.
(f)
An adult trained and willing to serve as guardian advocate for the
patient.
(6) If a guardian
with the authority to consent to medical treatment has not already been
appointed or if the patient has not already designated a health care surrogate,
the court may authorize the guardian advocate to consent to medical treatment,
as well as mental health treatment. Unless otherwise limited by the court, a
guardian advocate with authority to consent to medical treatment shall have the
same authority to make health care decisions and be subject to the same
restrictions as a proxy appointed under part IV of chapter 765. Unless the
guardian advocate has sought and received express court approval in proceeding
separate from the proceeding to determine the competence of the patient to
consent to medical treatment, the guardian advocate may not consent to:
(a)
Abortion.
(b)
Sterilization.
(c)
Electroconvulsive treatment.
(d)
Psychosurgery.
(e)
Experimental treatments that have not been approved by a federally
approved institutional review board in accordance with 45 C.F.R. part 46 or 21
C.F.R. part 56.
The court must base its decision on evidence that the
treatment or procedure is essential to the care of the patient and that the
treatment does not present an unreasonable risk of serious, hazardous, or
irreversible side effects. The court shall follow the procedures set forth in
subsection (1) of this section.
(7) The guardian
advocate shall be discharged when the patient is discharged from a receiving or
treatment facility to the community or when the patient is transferred from
involuntary to voluntary status. The court or a hearing officer shall consider
the competence of the patient pursuant to subsection (1) and may consider an
involuntarily placed patient's competence to consent to treatment at any
hearing. Upon sufficient evidence, the court may restore, or the hearing
officer may recommend that the court restore, the patient's competence. A copy
of the order restoring competence or the certificate of discharge containing
the restoration of competence shall be provided to the patient and the guardian
advocate.
394.4599 Notice.--
(1) VOLUNTARY
PATIENTS.--Notice of a voluntary patient's admission shall only be given at the
request of the patient, except that in an emergency, notice shall be given as
determined by the facility.
(2) INVOLUNTARY
PATIENTS.--
(a)
Whenever notice is required to be given under this part, such notice
shall be given to the patient and the patient's guardian, guardian advocate,
attorney, and representative.
1.
When notice is required to be given to a patient, it shall be given both
orally and in writing, in the language and terminology that the patient can
understand, and, if needed, the facility shall provide an interpreter for the
patient.
2.
Notice to a patient's guardian, guardian advocate, attorney, and
representative shall be given by
(b)
A receiving facility shall give prompt notice of the whereabouts of a
patient who is being involuntarily held for examination, by telephone or in
person within 24 hours after the patient's arrival at the facility, unless the
patient requests that no notification be made. Contact attempts shall be
documented in the patient's clinical record and shall begin as soon as
reasonably possible after the patient's arrival. Notice that a patient is being
admitted as an involuntary patient shall be given to the
(c)
The written notice of the filing of the petition for involuntary
placement must contain the following:
1.
Notice that the petition has been filed with the circuit court in the
county in which the patient is hospitalized and the address of such court.
2.
Notice that the office of the public defender has been appointed to
represent the patient in the proceeding, if the patient is not otherwise
represented by counsel.
3.
The date, time, and place of the hearing and the name of each examining
expert and every other person expected to testify in support of continued
detention.
4.
Notice that the patient, the patient's guardian or representative, or
the administrator may apply for a change of venue for the convenience of the
parties or witnesses or because of the condition of the patient.
5.
Notice that the patient is entitled to an independent expert examination
and, if the patient cannot afford such an examination, that the court will
provide for one.
(d)
A treatment facility shall provide notice of a patient's involuntary
admission on the next regular working day after the patient's arrival at the
facility.
(e)
When a patient is to be transferred from one facility to another, notice
shall be given by the facility where the patient is located prior to the
transfer.
394.460 Rights of professionals.-- No professional referred to in this part shall be required to accept
patients for treatment of mental, emotional, or behavioral disorders. Such
participation shall be voluntary.
394.461 Designation of receiving and treatment
facilities.--The
department is authorized to designate and monitor receiving facilities and
treatment facilities and may suspend or withdraw such designation for failure
to comply with this part and rules adopted under this part. Unless designated
by the department, facilities are not permitted to hold or treat involuntary
patients under this part.
(1) RECEIVING
FACILITY.--The department may designate any community facility as a receiving
facility. Any other facility within the state, including a private facility or
a federal facility, may be so designated by the department, provided that such
designation is agreed to by the governing body or authority of the facility.
(2) TREATMENT
FACILITY.--The department may designate any state-owned, state-operated, or
state-supported facility as a state treatment facility. A civil patient shall
not be admitted to a state treatment facility without previously undergoing a
transfer evaluation. Before a court hearing for involuntary placement in a
state treatment facility, the court shall receive and consider the information
documented in the transfer evaluation. Any other facility, including a private
facility or a federal facility, may be designated as a treatment facility by
the department, provided that such designation is agreed to by the appropriate
governing body or authority of the facility.
(3) PRIVATE
FACILITIES.--Private facilities designated as receiving and treatment
facilities by the department may provide examination and treatment of
involuntary patients, as well as voluntary patients, and are subject to all the
provisions of this part.
(4) RULES.--The
department shall adopt rules relating to:
(a)
Procedures and criteria for receiving and evaluating facility
applications for designation, which may include onsite facility inspection and
evaluation of an applicant's licensing status and performance history, as well
as consideration of local service needs.
(b)
Minimum standards consistent with this part that a facility must meet
and maintain in order to be designated as a receiving or treatment facility and
procedures for monitoring continued adherence to such standards.
(c)
Procedures for receiving complaints against a designated facility and
for initiating inspections and investigations of facilities alleged to have
violated the provisions of this part or rules adopted under this part.
(d)
Procedures and criteria for the suspension or withdrawal of designation.
394.4615 Clinical records; confidentiality.--
(1) A clinical record
shall be maintained for each patient. The record shall include data pertaining
to admission and such other information as may be required under rules of the
department. A clinical record is confidential and exempt from the provisions of
s. 119.07(1). Unless waived by express and informed consent, by the patient or
the patient's guardian or guardian advocate or, if the patient is deceased, by
the patient's personal representative or the family member who stands next in
line of intestate succession, the confidential status
of the clinical record shall not be lost by either authorized or unauthorized
disclosure to any person, organization, or agency.
(2) The clinical
record shall be released when:
(a)
The patient or the patient's guardian authorizes the release. The
guardian or guardian advocate shall be provided access to the appropriate
clinical records of the patient. The patient or the patient's guardian or
guardian advocate may authorize the release of information and clinical records
to appropriate persons to ensure the continuity of the patient's health care or
mental health care.
(b)
The patient is represented by counsel and the records are needed by the
patient's counsel for adequate representation.
(c)
The court orders such release. In determining whether there is good
cause for disclosure, the court shall weigh the need for the information to be
disclosed against the possible harm of disclosure to the person to whom such
information pertains.
(d)
The patient is committed to, or is to be returned to, the Department of
Corrections from the Department of Children and Family Services, and the
Department of Corrections requests such records. These records shall be
furnished without charge to the Department of Corrections.
(3) Information from
the clinical record may be released when:
(a)
A patient has declared an intention to harm other persons. When such
declaration has been made, the administrator may authorize the release of
sufficient information to provide adequate warning to the person threatened
with harm by the patient.
(b)
The administrator of the facility or secretary of the department deems
release to a qualified researcher as defined in administrative rule, an
aftercare treatment provider, or an employee or agent of the department is
necessary for treatment of the patient, maintenance of adequate records,
compilation of treatment data, aftercare planning, or evaluation of programs.
(4) Information from
clinical records may be used for statistical and research purposes if the
information is abstracted in such a way as to protect the identity of
individuals.
(5) Information from
clinical records may be used by the Agency for Health Care Administration, the
department, and the
(6) Clinical records
relating to a Medicaid recipient shall be furnished to the Medicaid Fraud
Control Unit in the Department of Legal Affairs, upon request.
(7) Any person,
agency, or entity receiving information pursuant to this section shall maintain
such information as confidential and exempt from the provisions of s.
119.07(1).
(8) Any facility or private
mental health practitioner who acts in good faith in releasing information
pursuant to this section is not subject to civil or criminal liability for such
release.
(9) Nothing in this
section is intended to prohibit the parent or next of kin of a person who is
held in or treated under a mental health facility or program from requesting
and receiving information limited to a summary of that person's treatment plan
and current physical and mental condition. Release of such information shall be
in accordance with the code of ethics of the profession involved.
(10) Patients shall
have reasonable access to their clinical records, unless such access is
determined by the patient's physician to be harmful to the patient. If the
patient's right to inspect his or her clinical record is restricted by the
facility, written notice of such restriction shall be given to the patient and
the patient's guardian, guardian advocate, attorney, and representative. In
addition, the restriction shall be recorded in the clinical record, together
with the reasons for it. The restriction of a patient's right to inspect his or
her clinical record shall expire after 7 days but may be renewed, after review,
for subsequent 7-day periods.
(11) Any person who
fraudulently alters, defaces, or falsifies the clinical record of any person
receiving mental health services in a facility subject to this part, or causes
or procures any of these offenses to be committed, commits a misdemeanor of the
second degree, punishable as provided in s. 775.082 or s. 775.083.
394.462 Transportation.--
(1) TRANSPORTATION TO
A RECEIVING FACILITY.--
(a)
Each county shall designate a single law enforcement agency within the
county, or portions thereof, to take a person into custody upon the entry of an
ex parte order or the execution of a certificate for involuntary examination by
an authorized professional and to transport that person to the nearest
receiving facility for examination. The designated law enforcement agency may
decline to transport the person to a receiving facility only if:
1.
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
2.
The law enforcement agency and the emergency medical transport service
or private transport company agree that the continued presence of law
enforcement personnel is not necessary for the safety of the person or others.
3.
The jurisdiction designated by the county may seek reimbursement for
transportation expenses. The party responsible for payment for such
transportation is the person receiving the transportation. The county shall
seek reimbursement from the following sources in the following order:
a. From an insurance company, health care corporation, or
other source, if the person receiving the transportation is covered by an
insurance policy or subscribes to a health care corporation or other source for
payment of such expenses.
b. From the person receiving the transportation.
c. From a financial settlement for medical care, treatment,
hospitalization, or transportation payable or accruing to the injured party.
(b)
Any company that transports a patient pursuant to this subsection is
considered an independent contractor and is solely liable for the safe and
dignified transportation of the patient. Such company must be insured and
provide no less than $100,000 in liability insurance with respect to the
transportation of patients.
(c)
Any company that contracts with a governing board of a county to
transport patients shall comply with the applicable rules of the department to
ensure the safety and dignity of the patients.
(d)
When a law enforcement officer takes custody of a person pursuant to
this part, the officer may request assistance from emergency medical personnel
if such assistance is needed for the safety of the officer or the person in
custody.
(e)
When a member of a mental health overlay program or a mobile crisis
response service is a professional authorized to initiate an involuntary
examination pursuant to s. 394.463 and that professional evaluates a person and
determines that transportation to a receiving facility is needed, the service,
at its discretion, may transport the person to the facility or may call on the
law enforcement agency or other transportation arrangement best suited to the
needs of the patient.
(f)
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 under this part, the law
enforcement officer shall transport the person to the nearest receiving
facility for examination.
(g)
When any law enforcement officer has arrested a person for a felony and
it appears that the person meets the statutory guidelines for involuntary
examination or placement under this part, such person shall first be processed
in the same manner as any other criminal suspect. The law enforcement agency
shall thereafter immediately notify the nearest public receiving facility,
which shall be responsible for promptly arranging for the examination and
treatment of the person. A receiving facility is not required to admit a person
charged with a crime for whom the facility determines
and documents that it is unable to provide adequate security, but shall provide
mental health examination and treatment to the person where he or she is held.
(h)
If the appropriate law enforcement officer believes that a person has an
emergency medical condition as defined in s. 395.002, the person may be first
transported to a hospital for emergency medical treatment, regardless of
whether the hospital is a designated receiving facility.
(i) The costs of transportation, evaluation,
hospitalization, and treatment incurred under this subsection by persons who
have been arrested for violations of any state law or county or municipal
ordinance may be recovered as provided in s. 901.35.
(j)
The nearest receiving facility must accept persons brought by law
enforcement officers for involuntary examination.
(k)
When a jurisdiction has entered into a contract with an emergency
medical transport service or a private transport company for transportation of
persons to receiving facilities, such service or company shall be given
preference for transportation of persons from nursing homes, assisted living
facilities, adult day care centers, or adult family-care homes, unless the
behavior of the person being transported is such that transportation by a law
enforcement officer is necessary.
(l)
Nothing in this section shall be construed to limit emergency
examination and treatment of incapacitated persons provided in accordance with
the provisions of s. 401.445.
(2) TRANSPORTATION TO
A TREATMENT FACILITY.--
(a)
If neither the patient nor any person legally obligated or responsible
for the patient is able to pay for the expense of transporting a voluntary or
involuntary patient to a treatment facility, the governing board of the county
in which the patient is hospitalized shall arrange for such required
transportation and shall ensure the safe and dignified transportation of the
patient. The governing board of each county is authorized to contract with
private transport companies for the transportation of such patients to and from
a treatment facility.
(b)
Any company that transports a patient pursuant to this subsection is
considered an independent contractor and is solely liable for the safe and
dignified transportation of the patient. Such company must be insured and
provide no less than $100,000 in liability insurance with respect to the
transportation of patients.
(c)
Any company that contracts with the governing board of a county to
transport patients shall comply with the applicable rules of the department to
ensure the safety and dignity of the patients.
(d)
County or municipal law enforcement and correctional personnel and
equipment shall not be used to transport patients adjudicated incapacitated or
found by the court to meet the criteria for involuntary placement pursuant to
s. 394.467, except in small rural counties where there are no cost-efficient
alternatives.
(3) EXCEPTIONS.--An
exception to the requirements of this section may be granted by the secretary
of the department for the purposes of improving service coordination or better
meeting the special needs of individuals. A proposal for an exception must be
submitted by the district administrator after being approved by the governing
boards of any affected counties, prior to submission to the secretary.
(a)
A proposal for an exception must identify the specific provision from
which an exception is requested; describe how the proposal will be implemented
by participating law enforcement agencies and transportation authorities; and
provide a plan for the coordination of services such as case management.
(b)
The exception may be granted only for:
1.
An arrangement centralizing and improving the provision of services
within a district, which may include an exception to the requirement for
transportation to the nearest receiving facility;
2.
An arrangement by which a facility may provide, in addition to required
psychiatric services, an environment and services which are uniquely tailored
to the needs of an identified group of persons with special needs, such as
persons with hearing impairments or visual impairments, or elderly persons with
physical frailties; or
3.
A specialized transportation system that provides an efficient and
humane method of transporting patients to receiving facilities, among receiving
facilities, and to treatment facilities.
(c)
Any exception approved pursuant to this subsection shall be reviewed and
approved every 5 years by the secretary.
394.4625 Voluntary admissions.--
(1) AUTHORITY TO
RECEIVE PATIENTS.--
(a)
A facility may receive for observation, diagnosis, or treatment any
person 18 years of age or older making application by express and informed consent
for admission or any person age 17 or under for whom such application is made
by his or her guardian. If found to show evidence of mental illness, to be
competent to provide express and informed consent, and to be suitable for
treatment, such person 18 years of age or older may be admitted to the
facility. A person age 17 or under may be admitted only after a hearing to
verify the voluntariness of the consent.
(b)
A mental health overlay program or a mobile crisis response service or a
licensed professional who is authorized to initiate an involuntary examination
pursuant to s. 394.463 and is employed by a community mental health center or
clinic must, pursuant to district procedure approved by the respective district
administrator, conduct an initial assessment of the ability of the following
persons to give express and informed consent to treatment before such persons
may be admitted voluntarily:
1.
A person 60 years of age or older for whom transfer is being sought from
a nursing home, assisted living facility, adult day care center, or adult
family-care home, when such person has been diagnosed as suffering from
dementia.
2.
A person 60 years of age or older for whom transfer is being sought from
a nursing home pursuant to s. 400.0255(12).
3.
A person for whom all decisions concerning medical treatment are
currently being lawfully made by the health care surrogate or proxy designated
under chapter 765.
(c)
When an initial assessment of the ability of a person to give express
and informed consent to treatment is required under this section, and a mobile
crisis response service does not respond to the request for an assessment
within 2 hours after the request is made or informs the requesting facility
that it will not be able to respond within 2 hours after the request is made,
the requesting facility may arrange for assessment by any licensed professional
authorized to initiate an involuntary examination pursuant to s. 394.463 who is
not employed by or under contract with, and does not have a financial interest
in, either the facility initiating the transfer or the receiving facility to
which the transfer may be made.
(d)
A facility may not admit as a voluntary patient a person who has been
adjudicated incapacitated, unless the condition of incapacity has been
judicially removed. If a facility admits as a voluntary patient a person who is
later determined to have been adjudicated incapacitated, and the condition of
incapacity had not been removed by the time of the admission, the facility must
either discharge the patient or transfer the patient to involuntary status.
(e)
The health care surrogate or proxy of a voluntary patient may not
consent to the provision of mental health treatment for the patient. A
voluntary patient who is unwilling or unable to provide express and informed
consent to mental health treatment must either be discharged or transferred to
involuntary status.
(f)
Within 24 hours after admission of a voluntary patient, the admitting
physician shall document in the patient's clinical record that the patient is
able to give express and informed consent for admission. If the patient is not
able to give express and informed consent for admission, the facility shall
either discharge the patient or transfer the patient to involuntary status
pursuant to subsection (5).
(2) DISCHARGE OF
VOLUNTARY PATIENTS.--
(a)
A facility shall discharge a voluntary patient:
1.
Who has sufficiently improved so that retention in the facility is no
longer desirable. A patient may also be discharged to
the care of a community facility.
2.
Who revokes consent to admission or requests discharge.
A voluntary patient or a relative, friend, or attorney of the patient may
request discharge either orally or in writing at any time following admission
to the facility. The patient must be discharged within 24 hours of the request,
unless the request is rescinded or the patient is transferred to involuntary
status pursuant to this section. The 24-hour time period may be extended by a
treatment facility when necessary for adequate discharge planning, but shall
not exceed 3 days exclusive of weekends and holidays. If the patient, or
another on the patient's behalf, makes an oral request for discharge to a staff
member, such request shall be immediately entered in the patient's clinical
record. If the request for discharge is made by a person other than the
patient, the discharge may be conditioned upon the express and informed consent
of the patient.
(b)
A voluntary patient who has been admitted to a facility and who refuses
to consent to or revokes consent to treatment shall be discharged within 24
hours after such refusal or revocation, unless transferred to involuntary
status pursuant to this section or unless the refusal or revocation is freely
and voluntarily rescinded by the patient.
(3) NOTICE OF RIGHT
TO DISCHARGE.--At the time of admission and at least every 6 months thereafter,
a voluntary patient shall be notified in writing of his or her right to apply
for a discharge.
(4) TRANSFER TO
VOLUNTARY STATUS.--An involuntary patient who applies to be transferred to
voluntary status shall be transferred to voluntary status immediately, unless
the patient has been charged with a crime, or has been involuntarily placed for
treatment by a court pursuant to s. 394.467 and continues to meet the criteria
for involuntary placement. When transfer to voluntary status occurs, notice
shall be given as provided in s. 394.4599.
(5) TRANSFER TO
INVOLUNTARY STATUS.--When a voluntary patient, or an authorized person on the
patient's behalf, makes a request for discharge, the request for discharge,
unless freely and voluntarily rescinded, must be communicated to a physician,
clinical psychologist, or psychiatrist as quickly as possible, but not later than
12 hours after the request is made. If the patient meets the criteria for
involuntary placement, the administrator of the facility must file with the
court a petition for involuntary placement, within 2 court working days after
the request for discharge is made. If the petition is not filed within 2 court
working days, the patient shall be discharged. Pending the filing of the
petition, the patient may be held and emergency treatment rendered in the least
restrictive manner, upon the written order of a physician, if it is determined
that such treatment is necessary for the safety of the patient or others.
394.463 Involuntary examination.--
(1) CRITERIA.--A
person may be taken to a receiving facility for involuntary examination if
there is reason to believe that he or she is mentally ill and because of his or
her mental illness:
(a)1. The person has refused voluntary examination
after conscientious explanation and disclosure of the purpose of the
examination; or
2.
The person is unable to determine for himself or herself whether
examination is necessary; and
(b)1. Without care or treatment, the person is
likely to suffer from neglect or refuse to care for himself or herself; such
neglect or refusal poses a real and present threat of substantial harm to his
or her well-being; and it is not apparent that such harm may be avoided through
the help of willing family members or friends or the provision of other
services; or
2.
There is a substantial likelihood that without care or treatment the
person will cause serious bodily harm to himself or herself or others in the
near future, as evidenced by recent behavior.
(2) INVOLUNTARY
EXAMINATION.--
(a)
An involuntary examination may be initiated by any one of the following
means:
1.
A court may enter an ex parte order stating that a person appears to
meet the criteria for involuntary examination, giving the findings on which
that conclusion is based. The ex parte order for involuntary examination must
be based on sworn testimony, written or oral. If other less restrictive means
are not available, such as voluntary appearance for outpatient evaluation, a
law enforcement officer, or other designated agent of the court, shall take the
person into custody and deliver him or her to the nearest receiving facility
for involuntary examination. The order of the court shall be made a part of the
patient's clinical record. No fee shall be charged for the filing of an order
under this subsection. Any receiving facility accepting the patient based on
this order must send a copy of the order to the Agency for Health Care
Administration on the next working day. The order shall be valid only until
executed or, if not executed, for the period specified in the order itself. If
no time limit is specified in the order, the order shall be valid for 7 days
after the date that the order was signed.
2.
A law enforcement officer shall take a person who appears to meet the
criteria for involuntary examination into custody and deliver the person or
have him or her delivered to the nearest receiving
facility for examination. The officer shall execute a written report detailing
the circumstances under which the person was taken into custody, and the report
shall be made a part of the patient's clinical record. Any receiving facility
accepting the patient based on this report must send a copy of the report to
the Agency for Health Care Administration on the next working day.
3.
A physician, clinical psychologist, psychiatric nurse, or clinical
social worker may execute a certificate stating that he or she has examined a
person within the preceding 48 hours and finds that the person appears to meet
the criteria for involuntary examination and stating the observations upon
which that conclusion is based. If other less restrictive means are not
available, such as voluntary appearance for outpatient evaluation, a law
enforcement officer shall take the person named in the certificate into custody
and deliver him or her to the nearest receiving facility for involuntary
examination. The law enforcement officer shall execute a written report
detailing the circumstances under which the person was taken into custody. The
report and certificate shall be made a part of the patient's clinical record.
Any receiving facility accepting the patient based on this certificate must
send a copy of the certificate to the Agency for Health Care Administration on
the next working day.
(b)
A person shall not be removed from any program or residential placement
licensed under chapter 400 and transported to a receiving facility for
involuntary examination unless an ex parte order, a professional certificate,
or a law enforcement officer's report is first prepared. If the condition of
the person is such that preparation of a law enforcement officer's report is
not practicable before removal, the report shall be completed as soon as
possible after removal, but in any case before the person is transported to a
receiving facility. A receiving facility admitting a person for involuntary
examination who is not accompanied by the required ex parte order, professional
certificate, or law enforcement officer's report shall notify the Agency for
Health Care Administration of such admission by certified mail no later than
the next working day. The provisions of this paragraph do not apply when
transportation is provided by the patient's family or guardian.
(c)
A law enforcement officer acting in accordance with an ex parte order
issued pursuant to this subsection may serve and execute such order on any day
of the week, at any time of the day or night.
(d)
A law enforcement officer acting in accordance with an ex parte order
issued pursuant to this subsection may use such reasonable physical force as is
necessary to gain entry to the premises, and any dwellings, buildings, or other
structures located on the premises, and to take custody of the person who is
the subject of the ex parte order.
(e)
The Agency for Health Care Administration shall receive and maintain the
copies of ex parte orders, professional certificates, and law enforcement
officers' reports. These documents shall be considered part of the clinical
record, governed by the provisions of s. 394.4615. The agency shall prepare
annual reports analyzing the data obtained from these documents, without information
identifying patients, and shall provide copies of reports to the department,
the President of the Senate, the Speaker of the House of Representatives, and
the minority leaders of the Senate and the House of Representatives.
(f)
A patient shall be examined by a physician or clinical psychologist at a
receiving facility without unnecessary delay and may, upon the order of a
physician, be given emergency treatment if it is determined that such treatment
is necessary for the safety of the patient or others. The patient may not be
released by the receiving facility or its contractor without the documented
approval of a psychiatrist, a clinical psychologist, or, if the receiving
facility is a hospital, the release may also be approved by an attending
emergency department physician with experience in the diagnosis and treatment
of mental and nervous disorders and after completion of an involuntary
examination pursuant to this subsection. However, a patient may not be held in
a receiving facility for involuntary examination longer than 72 hours.
(g)
A person for whom an involuntary examination has been initiated who is
being evaluated or treated at a hospital for an emergency medical condition
specified in s. 395.002 must be examined by a receiving facility within 72
hours. The 72-hour period begins when the patient arrives at the hospital and
ceases when the attending physician documents that the patient has an emergency
medical condition. If the patient is examined at a hospital providing emergency
medical services by a professional qualified to perform an involuntary
examination and is found as a result of that examination not to meet the
criteria for involuntary placement, the patient may be offered voluntary
placement, if appropriate, or released directly from the hospital providing
emergency medical services. The finding by the professional that the patient
has been examined and does not meet the criteria for involuntary placement must
be entered into the patient's clinical record. Nothing in this paragraph is
intended to prevent a hospital providing emergency medical services from
appropriately transferring a patient to another hospital prior to
stabilization, provided the requirements of s. 395.1041(3)(c) have been met.
(h)
One of the following must occur within 12 hours after the patient's
attending physician documents that the patient's medical condition has
stabilized or that an emergency medical condition does not exist:
1.
The patient must be examined by a designated receiving facility and
released; or
2.
The patient must be transferred to a designated receiving facility in
which appropriate medical treatment is available. However, the receiving
facility must be notified of the transfer within 2 hours after the patient's
condition has been stabilized or after determination that an emergency medical
condition does not exist.
(i) Within the 72-hour examination period or, if
the 72 hours ends on a weekend or holiday, no later than the next working day
thereafter, one of the following actions must be taken, based on the individual
needs of the patient:
1.
The patient shall be released, unless he or she is charged with a crime,
in which case the patient shall be returned to the custody of a law enforcement
officer;
2.
The patient shall be released, subject to the provisions of subparagraph
1., for outpatient treatment;
3.
The patient, unless he or she is charged with a crime, shall be asked to
give express and informed consent to placement as a voluntary patient, and, if
such consent is given, the patient shall be admitted as a voluntary patient; or
4.
A petition for involuntary placement shall be filed in the appropriate
court by the facility administrator when treatment is deemed necessary; in
which case, the least restrictive treatment consistent with the optimum
improvement of the patient's condition shall be made available.
(3) NOTICE OF
RELEASE.--Notice of the release shall be given to the patient's guardian or
representative, to any person who executed a certificate admitting the patient
to the receiving facility, and to any court which ordered the patient's
evaluation.
394.467 Involuntary placement.--
(1) CRITERIA.--A
person may be involuntarily placed for treatment upon a finding of the court by
clear and convincing evidence that:
(a)
He or she is mentally ill and because of his or her mental illness:
1.a.
He or she has refused voluntary placement for treatment after sufficient
and conscientious explanation and disclosure of the purpose of placement for
treatment; or
b. He or she is unable to determine for himself or herself
whether placement is necessary; and
2.a.
He or she is manifestly incapable of surviving alone or with the help of
willing and responsible family or friends, including available alternative
services, and, without treatment, is likely to suffer from neglect or refuse to
care for himself or herself, and such neglect or refusal poses a real and
present threat of substantial harm to his or her well-being; or
b.
There is substantial likelihood that in the near future he or she will
inflict serious bodily harm on himself or herself or another person, as
evidenced by recent behavior causing, attempting, or threatening such harm; and
(b)
All available less restrictive treatment alternatives which would offer
an opportunity for improvement of his or her condition have been judged to be
inappropriate.
(2) ADMISSION TO A
TREATMENT FACILITY.--A patient may be retained by a receiving facility or
involuntarily placed in a treatment facility upon the recommendation of the
administrator of a receiving facility where the patient has been examined and
after adherence to the notice and hearing procedures provided in s. 394.4599.
The recommendation must be supported by the opinion of a psychiatrist and the
second opinion of a clinical psychologist or another psychiatrist, both of whom
have personally examined the patient within the preceding 72 hours,
that the criteria for involuntary placement are met. However, in
counties of less than 50,000 population, if the
administrator certifies that no psychiatrist or clinical psychologist is
available to provide the second opinion, such second opinion may be provided by
a licensed physician with postgraduate training and experience in diagnosis and
treatment of mental and nervous disorders or by a psychiatric nurse. Such
recommendation shall be entered on an involuntary placement certificate, which
certificate shall authorize the receiving facility to retain the patient
pending transfer to a treatment facility or completion of a hearing.
(3) PETITION FOR
INVOLUNTARY PLACEMENT.--The administrator of the facility shall file a petition
for involuntary placement in the court in the county where the patient is
located. Upon filing, the clerk of the court shall provide copies to the
department, the patient, the patient's guardian or representative, and the
state attorney and public defender of the judicial circuit in which the patient
is located. No fee shall be charged for the filing of a petition under this subsection.
(4) APPOINTMENT OF
COUNSEL.--Within 1 court working day after the filing of a petition for
involuntary placement, the court shall appoint the public defender to represent
the person who is the subject of the petition, unless the person is otherwise
represented by counsel. The clerk of the court shall immediately notify the
public defender of such appointment. Any attorney representing the patient
shall have access to the patient, witnesses, and records relevant to the
presentation of the patient's case and shall represent the interests of the
patient, regardless of the source of payment to the attorney.
(5) CONTINUANCE OF
HEARING.--The patient is entitled, with the concurrence of the patient's
counsel, to at least one continuance of the hearing. The continuance shall be
for a period of up to 4 weeks.
(6) HEARING ON
INVOLUNTARY PLACEMENT.--
(a)1. The court shall hold the hearing on
involuntary placement within 5 days, unless a continuance is granted. The
hearing shall be held in the county where the patient is located and shall be
as convenient to the patient as may be consistent with orderly procedure and
shall be conducted in physical settings not likely to be injurious to the
patient's condition. If the court finds that the patient's attendance at the
hearing is not consistent with the best interests of the patient, and the
patient's counsel does not object, the court may waive the presence of the
patient from all or any portion of the hearing. The state attorney for the
circuit in which the patient is located shall represent the state, rather than
the petitioning facility administrator, as the real party in interest in the
proceeding.
2.
The court may appoint a master to preside at the hearing. One of the
professionals who executed the involuntary placement certificate shall be a
witness. The patient and the patient's guardian or representative shall be
informed by the court of the right to an independent expert examination. If the
patient cannot afford such an examination, the court shall provide for one. The
independent expert's report shall be confidential and not discoverable, unless
the expert is to be called as a witness for the patient at the hearing. The
testimony in the hearing must be given under oath, and the proceedings must be
recorded. The patient may refuse to testify at the hearing.
(b)
If the court concludes that the patient meets the criteria for
involuntary placement, it shall order that the patient be transferred to a
treatment facility or, if the patient is at a treatment facility, that the
patient be retained there or be treated at any other appropriate receiving or
treatment facility, or that the patient receive services from a receiving or
treatment facility, on an involuntary basis, for a period of up to 6 months.
The order shall specify the nature and extent of the patient's mental illness.
The facility shall discharge a patient any time the patient no longer meets the
criteria for involuntary placement, unless the patient has transferred to
voluntary status.
(c)
If at any time prior to the conclusion of the hearing on involuntary
placement it appears to the court that the person does not meet the criteria
for involuntary placement under this chapter, but instead meets the criteria
for involuntary assessment, protective custody, or involuntary admission
pursuant to s. 397.675, then the court may order the person to be admitted for
involuntary assessment for a period of 5 days pursuant to s. 397.6811.
Thereafter, all proceedings shall be governed by chapter 397.
(d)
At the hearing on involuntary placement, the court shall consider
testimony and evidence regarding the patient's competence to consent to
treatment. If the court finds that the patient is incompetent to consent to
treatment, it shall appoint a guardian advocate as provided in s. 394.4598.
(e)
The administrator of the receiving facility shall provide a copy of the
court order and adequate documentation of a patient's mental illness to the
administrator of a treatment facility whenever a patient is ordered for
involuntary placement, whether by civil or criminal court. Such documentation
shall include any advance directives made by the patient, a psychiatric
evaluation of the patient, and any evaluations of the patient performed by a
clinical psychologist or a clinical social worker. The administrator of a
treatment facility may refuse admission to any patient directed to its
facilities on an involuntary basis, whether by civil or criminal court order,
who is not accompanied at the same time by adequate orders and documentation.
(7) PROCEDURE FOR
CONTINUED INVOLUNTARY PLACEMENT.--
(a)
Hearings on petitions for continued involuntary placement shall be
administrative hearings and shall be conducted in accordance with the
provisions of s. 120.57(1), except that any order entered by the hearing
officer shall be final and subject to judicial review in accordance with s.
120.68. Orders concerning patients committed after successfully pleading not
guilty by reason of insanity shall be governed by the provisions of s. 916.15.
(b)
If the patient continues to meet the criteria for involuntary placement,
the administrator shall, prior to the expiration of the period during which the
treatment facility is authorized to retain the patient, file a petition requesting
authorization for continued involuntary placement. The request shall be
accompanied by a statement from the patient's physician or clinical
psychologist justifying the request, a brief description of the patient's
treatment during the time he or she was involuntarily placed, and an
individualized plan of continued treatment. Notice of the hearing shall be
provided as set forth in s. 394.4599. If at the hearing the hearing officer
finds that attendance at the hearing is not consistent with the best interests
of the patient, the hearing officer may waive the presence of the patient from
all or any portion of the hearing, unless the patient, through counsel, objects
to the waiver of presence. The testimony in the hearing must be under oath, and
the proceedings must be recorded.
(c)
Unless the patient is otherwise represented or is ineligible, he or she
shall be represented at the hearing on the petition for continued involuntary
placement by the public defender of the circuit in which the facility is located.
(d)
If at a hearing it is shown that the patient continues to meet the
criteria for involuntary placement, the administrative
law judge shall sign the order for continued involuntary placement for a period
not to exceed 6 months. The same procedure shall be repeated prior to the
expiration of each additional period the patient is retained.
(e)
If continued involuntary placement is necessary for a patient admitted
while serving a criminal sentence, but whose sentence is about to expire, or
for a patient involuntarily placed while a minor but who is about to reach the
age of 18, the administrator shall petition the administrative law judge for an
order authorizing continued involuntary placement.
(f)
If the patient has been previously found incompetent to consent to
treatment, the hearing officer shall consider testimony and evidence regarding
the patient's competence. If the hearing officer finds evidence that the
patient is now competent to consent to treatment, the hearing officer may issue
a recommended order to the court that found the patient incompetent to consent
to treatment that the patient's competence be restored and that any guardian
advocate previously appointed be discharged.
(8) RETURN OF
PATIENTS.--When a patient at a treatment facility leaves the facility without
authorization, the administrator may authorize a search for the patient and the
return of the patient to the facility. The administrator may request the
assistance of a law enforcement agency in the search for and return of the
patient.
1Note.--Redesignated as paragraph
(7)(b) and amended by s. 18, ch.
96-169. This version is published as the last expression of legislative will
(see Journal of the House of Representatives 1996, pp. 2168 and 2374).
Paragraph (4)(a) was also amended by s. 124, ch. 96-410, and that version of paragraph (4)(a), redesignated as paragraph (7)(b), reads:
(7) PROCEDURE FOR
CONTINUED INVOLUNTARY PLACEMENT.--
* * *
* *
(b) If continued
placement of an involuntary patient is necessary, the administrator shall,
prior to the expiration of the period during which the treatment facility is
authorized to retain the patient, request an order authorizing continued
involuntary placement. This request shall be accompanied by a statement from
the patient's physician or clinical psychologist justifying the request and a
brief summary of the patient's treatment during the time he or she was
involuntarily placed. In addition, the administrator shall submit an
individualized plan for the patient for whom he or she is requesting continued
involuntary placement. Notification of this request for retention shall be
mailed to the patient and his or her guardian or representative along with a
completed petition, requiring only a signature, for a hearing regarding the
continued hospitalization and a waiver-of-hearing form. The waiver-of-hearing
form shall require express and informed consent and shall state that the
patient is entitled to a hearing under the law; that he or she is entitled to
be represented by an attorney at the hearing and, if he or she cannot afford an
attorney, that one will be appointed; and that, if it is shown at the hearing
that the patient does not meet the criteria for involuntary placement, he or
she is entitled to be released. In a proceeding involving a person 18 years of
age or older, the hearing may be waived by express and informed consent in
writing by the patient after the advice of counsel. If the patient or his or
her guardian or representative does not sign the petition, or if the patient
does not sign a waiver within 15 days, the administrative law judge shall
notice a hearing with regard to the patient involved in accordance with ss. 120.569 and 120.57(1). In a proceeding involving a
person under the age of 18, the hearing shall not be waived; however, if, at
the hearing, the administrative law judge finds that attendance at the hearing
is not consistent with the best interests of the patient, he or she may waive
the presence of the patient from all or any portion of the hearing.
Note.--Redesignated as paragraph
(7)(f) and amended by s. 18, ch.
96-169. This version is published as the last expression of legislative will
(see Journal of the House of Representatives 1996, pp. 2168 and 2374).
Paragraph (4)(h) was also amended by s. 124, ch.
96-410, and that version of paragraph (4)(h), redesignated
as paragraph (7)(f), reads:
(f) At any hearing
hereunder for a patient who has been previously adjudicated incompetent to
consent to treatment, the administrative law judge shall consider testimony and
evidence regarding the patient's competence. If the administrative law judge
finds evidence that the patient is competent to consent to treatment, he or she
may issue to the court in which the patient was adjudicated incompetent to
consent to treatment a recommended order that the patient's competence be
restored and that any guardian advocate previously appointed be discharged.
394.4672 Procedure for placement of veteran with federal agency.--
(1) Whenever it is
determined by the court that a person meets the criteria for involuntary
placement and it appears that such person is eligible for care or treatment by
the United States Department of Veterans Affairs or other agency of the United
States Government, the court, upon receipt of a certificate from the United
States Department of Veterans Affairs or such other agency showing that
facilities are available and that the person is eligible for care or treatment
therein, may place that person with the United States Department of Veterans
Affairs or other federal agency. The person whose placement is sought shall be
personally served with notice of the pending placement proceeding in the manner
as provided in this part, and nothing in this section shall affect his or her
right to appear and be heard in the proceeding. Upon placement, the person
shall be subject to the rules and regulations of the United States Department
of Veterans Affairs or other federal agency.
(2) The judgment or
order of placement by a court of competent jurisdiction of another state or of
the District of Columbia, placing a person with the United States Department of
Veterans Affairs or other federal agency for care or treatment, shall have the
same force and effect in this state as in the jurisdiction of the court
entering the judgment or making the order; and the courts of the placing state
or of the District of Columbia shall be deemed to have retained jurisdiction of
the person so placed. Consent is hereby given to the application of the law of
the placing state or district with respect to the authority of the chief
officer of any facility of the United States Department of Veterans Affairs or
other federal agency operated in this state to retain custody or to transfer,
parole, or discharge the person.
(3) Upon receipt of a
certificate of the United States Department of Veterans Affairs or such other
federal agency that facilities are available for the care or treatment of
mentally ill persons and that the person is eligible for care or treatment, the
administrator of the receiving or treatment facility may cause the transfer of
that person to the United States Department of Veterans Affairs or other
federal agency. Upon effecting such transfer, the
committing court shall be notified by the transferring agency. No person shall
be transferred to the United States Department of Veterans Affairs or other
federal agency if he or she is confined pursuant to the conviction of any
felony or misdemeanor or if he or she has been acquitted of the charge solely on
the ground of insanity, unless prior to transfer the court placing such person
enters an order for the transfer after appropriate motion and hearing and
without objection by the United States Department of Veterans Affairs.
(4) Any person
transferred as provided in this section shall be deemed to be placed with the
United States Department of Veterans Affairs or other federal agency pursuant
to the original placement.
394.4674 Plan and report.--
(1) The department is
directed to develop a comprehensive plan for the deinstitutionalization
of patients in a treatment facility who are over age 55 and do not meet the
criteria for involuntary placement pursuant to s. 394.467. The plan shall
include, but need not be limited to, the projected numbers of patients, the
timetables for deinstitutionalization, and the
specific actions to be taken to accomplish the deinstitutionalization.
(2) The department
shall prepare and submit a semiannual report to the
Legislature, until the conditions specified in subsection (1) are met,
which shall include, but not be limited to:
(a)
The status of compliance with the deinstitutionalization
plan;
(b)
The specific efforts to stimulate alternative living and support
resources outside the hospitals and all documentation of the success of these
efforts;
(c)
The specific efforts to facilitate the development and retention of
daily living skills identified by the department as being necessary for living
outside an institution and any evidence of the success of these efforts;
(d)
The specific plans for new efforts to accomplish the deinstitutionalization
of patients in this age group; and
(e)
Any evidence of involvement between the Mental Health Program Office and
other program offices within the department and between the department and
other state and private agencies and individuals to accomplish the deinstitutionalization of patients in this age group.
394.468 Admission and discharge procedures.-- Admission and discharge procedures and treatment policies
of the department are governed solely by this part. Such procedures and
policies shall not be subject to control by court procedure rules. The matters
within the purview of this part are deemed to be substantive, not procedural.
394.4685 Transfer of patients among facilities.--
(1) TRANSFER BETWEEN
PUBLIC FACILITIES.--
(a) A patient who has been admitted to a public
receiving facility, or the family member, guardian, or guardian advocate of
such patient,
may request the transfer of the patient to another public receiving facility. A
patient who has been admitted to a public treatment
facility, or the family member, guardian, or guardian advocate of such patient,
may request the transfer of the patient to another public treatment facility.
Depending on the medical treatment or mental health treatment needs of the
patient and the availability of appropriate facility resources, the patient may
be transferred at the discretion of the department. If the department approves
the transfer of an involuntary patient, notice according to the provisions of
s. 394.4599 shall be given prior to the transfer by the transferring facility.
The department shall respond to the request for transfer within 2 working days
after receipt of the request by the facility administrator.
(b)
When required by the medical treatment or mental health treatment needs
of the patient or the efficient utilization of a public receiving or public
treatment facility, a patient may be transferred from one receiving facility to
another, or one treatment facility to another, at the department's discretion,
or, with the express and informed consent of the patient or the patient's
guardian or guardian advocate, to a facility in another state. Notice according
to the provisions of s. 394.4599 shall be given prior to the transfer by the
transferring facility. If prior notice is not possible, notice of the transfer
shall be provided as soon as practicable after the transfer.
(2) TRANSFER FROM
PUBLIC TO PRIVATE FACILITIES.--A patient who has been admitted to a public
receiving or public treatment facility and has requested, either personally or
through his or her guardian or guardian advocate, and is able to pay for
treatment in a private facility shall be transferred at the patient's expense
to a private facility upon acceptance of the patient by the private facility.
(3) TRANSFER FROM
PRIVATE TO PUBLIC FACILITIES.--
(a)
A patient or the patient's guardian or guardian advocate may request the
transfer of the patient from a private to a public facility, and the patient
may be so transferred upon acceptance of the patient by the public facility.
(b)
A private facility may request the transfer of a patient from the
facility to a public facility, and the patient may be so transferred upon
acceptance of the patient by the public facility. The cost of such transfer
shall be the responsibility of the transferring facility.
(c)
A public facility must respond to a request for the transfer of a
patient within 2 working days after receipt of the request.
(4) TRANSFER BETWEEN
PRIVATE FACILITIES.--A patient in a private facility or the patient's guardian
or guardian advocate may request the transfer of the patient to another private
facility at any time, and the patient shall be transferred upon acceptance of
the patient by the facility to which transfer is sought.
394.469 Discharge of involuntary patients.--
(1) POWER TO
DISCHARGE.--At any time a patient is found to no longer meet the criteria for
involuntary placement, the administrator shall:
(a)
Discharge the patient, unless the patient is under a criminal charge, in
which case the patient shall be transferred to the custody of the appropriate
law enforcement officer;
(b)
Transfer the patient to voluntary status on his or her own authority or
at the patient's request, unless the patient is under criminal charge or
adjudicated incapacitated; or
(c)
Place an improved patient, except a patient under a criminal charge, on
convalescent status in the care of a community facility.
(2) NOTICE.--Notice
of discharge or transfer of a patient shall be given as provided in s.
394.4599.
394.473 Attorney's fee; expert witness fee.--
(1) In case of indigency of any person for whom an attorney is appointed
pursuant to the provisions of this part, the attorney shall be entitled to a
reasonable fee to be determined by the court and paid from the general fund of
the county from which the patient was involuntarily detained. In case of indigency of any such person, the court may appoint a
public defender. The public defender shall receive no additional compensation
other than that usually paid his or her office.
(2) In case of indigency of any person for whom expert testimony is
required in a court hearing pursuant to the provisions of this act, the expert,
except one who is classified as a full-time employee of the state or who is
receiving remuneration from the state for his or her time in attendance at the
hearing, shall be entitled to a reasonable fee to be determined by the court
and paid from the general fund of the county from which the patient was
involuntarily detained.
Note.--Section 107, ch.
2003-402, amended s. 394.473, effective
394.473 Attorney's fee; expert witness fee.--
(1) In case of the
indigence of any person for whom an attorney is appointed pursuant to the
provisions of this part, the attorney shall be entitled to a reasonable fee to
be determined by the court and paid from the general fund of the county from
which the patient was involuntarily detained. In case of the indigence of any
such person, the court may appoint a public defender. The public defender shall
receive no additional compensation other than that usually paid his or her
office.
(2) In case of the
indigence of any person for whom expert testimony is required in a court
hearing pursuant to the provisions of this act, the expert, except one who is
classified as a full-time employee of the state or who is receiving
remuneration from the state for his or her time in attendance at the hearing,
shall be entitled to a reasonable fee to be determined by the court and paid
from the general fund of the county from which the patient was involuntarily
detained.
394.475 Acceptance, examination, and involuntary placement of
(1) Upon the request
of the state mental health authority of another state, the department is
authorized to accept as a patient, for a period of not more than 15 days, a
person who is and has been a bona fide resident of this state for a period of
not less than 1 year.
(2) Any person
received pursuant to subsection (1) shall be examined by the staff of the state
facility where such patient has been accepted, which examination shall be
completed during the 15-day period.
(3) If upon
examination such a person requires continued involuntary placement, a petition
for a hearing regarding involuntary placement shall be filed with the court of
the county wherein the treatment facility receiving the patient is located or
the county where the patient is a resident.
(4) During the pendency of the examination period and the pendency of the involuntary placement proceedings, such
person may continue to be held in the treatment facility unless the court
having jurisdiction enters an order to the contrary.
394.4781 Residential care for psychotic and emotionally disturbed children.--
(1) DEFINITIONS.--As
used in this section:
(a)
"Psychotic or severely emotionally disturbed child" means a
child so diagnosed by a psychiatrist or clinical psychologist who has specialty
training and experience with children. Such a severely emotionally disturbed
child or psychotic child shall be considered by this diagnosis to benefit by
and require residential care as contemplated by this section.
(b)
"Department" means the Department of Children and Family
Services.
(2) FUNDING OF
PROGRAM.--The department shall provide for the purposes of this section such
amount as shall be set forth in the annual appropriations act as payment for
part of the costs of residential care for psychotic or severely emotionally
disturbed children.
(3) ADMINISTRATION OF
THE PROGRAM.--
(a)
The department shall provide the necessary application forms and office
personnel to administer the purchase-of-service program.
(b)
The department shall review such applications monthly and, in accordance
with available funds, the severity of the problems of the child, the
availability of the needed residential care, and the financial means of the
family involved, approve or disapprove each application. If an application is
approved, the department shall contract for or purchase the services of an
appropriate residential facility in such amounts as are determined by the
annual appropriations act.
(c)
The department is authorized to promulgate such rules as are necessary
for the full and complete implementation of the provisions of this section.
(d)
The department shall purchase services only from those facilities which
are in compliance with standards promulgated by the department.
(4) RULE
ADOPTION.--The department may adopt rules to carry out this section, including
rules concerning review and approval of applications for placement,
cost-sharing, and client eligibility for placement, and rules to ensure that
facilities from which the department purchases or contracts for services under
this section provide:
(a)
Minimum standards for client care and treatment practices, including
ensuring that sufficient numbers and types of qualified personnel are on duty
and available at all times to provide necessary and adequate client safety,
care, and security.
(b)
Minimum standards for client intake and admission, eligibility criteria,
discharge planning, assessment, treatment planning, continuity of care,
treatment modalities, service array, medical services, physical health
services, client rights, maintenance of client records, and management of the
treatment environment, including standards for the use of seclusion,
restraints, and time-out.
(c)
Minimum standards for facility operation and administration, fiscal
accountability, personnel policies and procedures, and staff education,
qualifications, experience, and training.
(d)
Minimum standards for adequate infection control, housekeeping sanitation,
disaster planning, firesafety, construction
standards, and emergency services.
(e)
Minimum standards for the establishment, organization, and operation of
the licensed facility in accordance with program standards of the department.
(f)
Licensing requirements.
394.4784 Minors; access to outpatient crisis
intervention services and treatment.-- For the purposes of this section, the disability of
nonage is removed for any minor age 13 years or older to access services under
the following circumstances:
(1) OUTPATIENT
DIAGNOSTIC AND EVALUATION SERVICES.--When any minor age 13 years or older
experiences an emotional crisis to such degree that he or she perceives the
need for professional assistance, he or she shall have the right to request, consent
to, and receive mental health diagnostic and evaluative services provided by a
licensed mental health professional, as defined by Florida Statutes, or in a
mental health facility licensed by the state. The purpose of such services
shall be to determine the severity of the problem and the potential for harm to
the person or others if further professional services are not provided.
Outpatient diagnostic and evaluative services shall not include medication and
other somatic methods, aversive stimuli, or substantial deprivation. Such
services shall not exceed two visits during any 1-week period in response to a
crisis situation before parental consent is required for further services, and
may include parental participation when determined to be appropriate by the
mental health professional or facility.
(2) OUTPATIENT CRISIS
INTERVENTION, THERAPY AND COUNSELING SERVICES.--When any minor age 13 years or
older experiences an emotional crisis to such degree that he or she perceives
the need for professional assistance, he or she shall have the right to
request, consent to, and receive outpatient crisis intervention services
including individual psychotherapy, group therapy, counseling, or other forms
of verbal therapy provided by a licensed mental health professional, as defined
by Florida Statutes, or in a mental health facility licensed by the state. Such
services shall not include medication and other somatic treatments, aversive
stimuli, or substantial deprivation. Such services shall not exceed two visits
during any 1-week period in response to a crisis situation before parental
consent is required for further services, and may include parental
participation when determined to be appropriate by the mental health
professional or facility.
(3) LIABILITY FOR
PAYMENT.--The parent, parents, or legal guardian of a minor shall not be liable
for payment for any such outpatient diagnostic and evaluation services or
outpatient therapy and counseling services, as provided in this section, unless
such parent, parents, or legal guardian participates in the outpatient
diagnostic and evaluation services or outpatient therapy and counseling
services and then only for the services rendered with such participation.
(4) PROVISION OF
SERVICES.--No licensed mental health professional shall be obligated to provide
services to minors accorded the right to receive services under this section.
Provision of such services shall be on a voluntary basis.
394.4785 Children and adolescents; admission and placement in mental facilities.--
(1) A child or
adolescent as defined in s. 394.492 may not be admitted to a state-owned or
state-operated mental health treatment facility. A child may be admitted
pursuant to s. 394.4625 or s. 394.467 to a crisis stabilization unit or a
residential treatment center licensed under this chapter or a hospital licensed
under chapter 395. The treatment center, unit, or hospital must provide the
least restrictive available treatment that is appropriate to the individual
needs of the child or adolescent and must adhere to the guiding principles,
system of care, and service planning provisions contained in part III of this
chapter.
(2) A person under
the age of 14 who is admitted to any hospital licensed pursuant to chapter 395
may not be admitted to a bed in a room or ward with an adult patient in a
mental health unit or share common areas with an adult patient in a mental
health unit. However, a person 14 years of age or older may be admitted to a
bed in a room or ward in the mental health unit with an adult if the admitting
physician documents in the case record that such placement is medically
indicated or for reasons of safety. Such placement shall be reviewed by the
attending physician or a designee or on-call physician each day and documented in
the case record.
394.4786 Intent.--
(1) The Legislature
intends that all hospitals, excluding hospitals owned and operated by the
department or the Department of Corrections, be assessed on a continuing basis
an amount equal to 1.5 percent of the hospital's annual net operating revenues
and that the assessments be deposited into the Public Medical Assistance Trust
Fund.
(2) Further, the
Legislature intends that a specialty psychiatric hospital that provides health
care to specified indigent patients be eligible for reimbursement up to the
amount that hospital contributed to the Public Medical Assistance Trust Fund in
the previous fiscal year.
394.47865
(1) The Department of
Children and Family Services shall, through a request for proposals, privatize
(a)
Notwithstanding s. 287.057(14), the department may enter into agreements,
not to exceed 20 years, with a private provider, a coalition of providers, or
another agency to finance, design, and construct a treatment facility having up
to 350 beds and to operate all aspects of daily operations within the facility.
The department may subcontract any or all components of this procurement to a
statutorily established state governmental entity that has successfully
contracted with private companies for designing, financing, acquiring, leasing,
constructing, and operating major privatized state facilities.
(b)
The selected contractor is authorized to sponsor the issuance of
tax-exempt bonds, certificates of participation, or other securities to finance
the project, and the state is authorized to enter into a lease-purchase agreement
for the treatment facility.
(2) The contractor
shall operate
(a)
South Florida State Hospital shall remain a participant in the mental
health disproportionate share program so long as the residents receive eligible
services.
(b)
The department and the contractor shall ensure that the treatment
facility is operated as a part of a total continuum of care for persons who are
mentally ill. The contractor shall have as its primary goal for the treatment
facility to effectively treat and assist residents to return to the community
as quickly as possible.
(3)(a)
(b)
Any savings that result from the privatization of
394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
394.4789.-- As used
in this section and ss. 394.4786, 394.4788, and
394.4789:
(1) "Acute
mental health services" means mental health services provided through
inpatient hospitalization.
(2)
"Agency" means the Agency for Health Care Administration.
(3) "Charity
care" means that portion of hospital charges for care provided to a
patient whose family income for the 12 months preceding the determination is
equal to or below 150 percent of the current federal nonfarm
poverty guideline or the amount of hospital charges due from the patient which
exceeds 25 percent of the annual family income and for which there is no compensation.
Charity care shall not include administrative or courtesy discounts,
contractual allowances to third party payors, or
failure of a hospital to collect full charges due to partial payment by
governmental programs.
(4)
"Indigent" means an individual whose financial status would
qualify him or her for charity care.
(5) "Operating
expense" means all common and accepted costs appropriate in developing and
maintaining the operating of the patient care facility and its activities.
(6) "PMATF"
means the Public Medical Assistance Trust Fund.
(7) "Specialty
psychiatric hospital" means a hospital licensed by the agency pursuant to
s. 395.002(29) as a specialty psychiatric hospital.
394.4788 Use of certain PMATF funds for the purchase of acute care mental health
services.--
(1) A hospital may be
eligible to be reimbursed an amount no greater than the hospital's previous
year contribution to the PMATF for acute mental health services provided to
indigent mentally ill persons who have been determined by the agency or its
agent to require such treatment and who:
(a)
Do not meet Medicaid eligibility criteria, unless the agency makes a
referral for a Medicaid eligible patient pursuant to s. 394.4789;
(b)
Meet the criteria for mental illness under this part; and
(c)
Meet the definition of charity care.
(2) The agency shall
annually calculate a per diem reimbursement rate for each specialty psychiatric
hospital to be paid to the specialty psychiatric hospitals for the provision of
acute mental health services provided to indigent mentally ill patients who
meet the criteria in subsection (1). After the first rate period, providers
shall be notified of new reimbursement rates for each new state fiscal year by
June 1. The new reimbursement rates shall commence July 1.
(3) Reimbursement
rates shall be calculated using the most recent audited actual costs received
by the agency. Cost data received each April 15 shall be used in the
calculation of the rates. Historic costs shall be inflated from the midpoint of
a hospital's fiscal year to the midpoint of the state fiscal year. The
inflation adjustment shall be made utilizing the latest available projections
as of March 31 for the Data Resources Incorporated National and Regional
Hospital Input Price Indices as calculated by the Medicaid program office.
(4) Reimbursement
shall be based on compensating a specialty psychiatric hospital at a per diem
rate equal to its operating costs per inpatient day.
(5) A hospital shall
not be entitled to receive more in any one fiscal year than that hospital
contributed to the PMATF during the previous fiscal year.
(6) Hospitals that
agree to participate in the program set forth in this section and ss. 394.4786, 394.4787, and 394.4789 shall agree that payment
from the PMATF is payment in full for all patients for which reimbursement is
received under this section and ss. 394.4786,
394.4787, and 394.4789, until the funds for this program are no longer
available.
(7) The agency shall
develop a payment system to reimburse specialty psychiatric hospitals quarterly
as set forth in this part.
394.4789 Establishment of referral process and eligibility determination.--
(1) The department
shall adopt by rule a referral process which shall provide each participating
specialty psychiatric hospital with a system for accepting into the hospital's
care indigent mentally ill persons referred by the department. It is the intent
of the Legislature that a hospital which seeks payment under s. 394.4788 shall
accept referrals from the department. However, a hospital shall have the right
to refuse the admission of a patient due to lack of functional bed space or
lack of services appropriate to a patient's specific treatment and no hospital
shall be required to accept referrals if the costs for treating the referred
patient are no longer reimbursable because the hospital has reached the level
of contribution made to the PMATF in the previous fiscal year. Furthermore, a
hospital that does not seek compensation for indigent mentally ill patients
under the provisions of this act shall not be obliged to accept department
referrals, notwithstanding any agreements it may have entered into with the
department. The right of refusal in this subsection shall not affect a
hospital's requirement to provide emergency care pursuant to s. 395.1041 or
other statutory requirements related to the provision of emergency care.
(2) The department
shall adopt by rule a patient eligibility form and shall be responsible for
eligibility determination. However, the department may contract with
participating psychiatric hospitals for eligibility determination. The
eligibility form shall provide the mechanism for determining a patient's
eligibility according to the requirements of s. 394.4788(1).
(a)
A specialty psychiatric hospital shall be eligible for reimbursement
only when an eligibility form has been completed for each indigent mentally ill
person for whom reimbursement is sought.
(b)
As part of eligibility determination, every effort shall be made by the
hospital to determine if any third party insurance coverage is available.
394.65 Short title.--This part may be cited as
"The Community Substance Abuse and Mental Health Services Act."
394.66 Legislative intent with respect to
substance abuse and mental health services.--It is the intent of the Legislature to:
(1) Recognize
that mental illness and substance abuse impairment are diseases that are
responsive to medical and psychological interventions and management that
integrate treatment, rehabilitative, and support services to achieve quality
and cost-efficient outcomes for clients and for community-based treatment
systems.
(2) Promote
and improve the mental health of the citizens of the state by making substance
abuse and mental health treatment and support services available to those
persons who are most in need and least able to pay, through a community-based
system of care.
(3) Involve
local citizens in the planning of substance abuse and mental health services in
their communities.
(4) Ensure
that the department and the Agency for Health Care Administration work
cooperatively in planning and designing comprehensive community-based substance
abuse and mental health programs that focus on the individual needs of clients.
(5) Ensure
that all activities of the Department of Children and Family Services and the
Agency for Health Care Administration, and their respective contract providers,
involved in the delivery of substance abuse and mental health treatment and
prevention services are coordinated and integrated with other local systems and
groups, public and private, such as juvenile justice, criminal justice, child
protection, and public health organizations; school districts; and local groups
or organizations that focus on services to older adults.
(6) Provide
access to crisis services to all residents of the state with priority of
attention being given to individuals exhibiting symptoms of acute mental
illness or substance abuse.
(7) Ensure
that services provided to persons with co-occurring mental illness and
substance abuse problems be integrated across treatment systems.
(8) Ensure
continuity of care, consistent with minimum standards, for persons who are
released from a state treatment facility into the community.
(9) Provide
accountability for service provision through statewide standards for treatment
and support services, and statewide standards for management, monitoring, and
reporting of information.
(10) Include
substance abuse and mental health services as a component of the integrated
service delivery system of the Department of Children and Family Services.
(11) Ensure
that the districts of the department are the focal point of all substance abuse
and mental health planning activities, including budget submissions, grant
applications, contracts, and other arrangements that can be effected at the
district level.
(12) Organize
and finance community substance abuse and mental health services in local
communities throughout the state through locally administered service delivery
programs that are based on client outcomes, are programmatically effective, and
are financially efficient, and that maximize the involvement of local citizens.
(13) Promote
best practices and the highest quality of care in contracted alcohol, drug
abuse, and mental health services through achievement of national
accreditation.
(14) Ensure
that the state agencies licensing and monitoring contracted providers perform
in the most cost-efficient and effective manner with limited duplication and
disruption to organizations providing services.
394.67 Definitions.--As used in this part, the term:
(1) "Agency"
means the Agency for Health Care Administration.
(2) "Applicant"
means an individual applicant, or any officer, director, agent, managing
employee, or affiliated person, or any partner or shareholder having an
ownership interest equal to a 5-percent or greater interest in the corporation,
partnership, or other business entity.
(3) "Client"
means any individual receiving services in any substance abuse or mental health
facility, program, or service, which facility, program, or service is operated,
funded, or regulated by the agency and the department or regulated by the
agency.
(4) "Crisis
services" means short-term evaluation, stabilization, and brief
intervention services provided to a person who is experiencing an acute mental
or emotional crisis, as defined in subsection (18), or an acute substance abuse
crisis, as defined in subsection (19), to prevent further deterioration of the
person's mental health. Crisis services are provided in settings such as a
crisis stabilization unit, an inpatient unit, a short-term residential
treatment program, a detoxification facility, or an addictions receiving
facility; at the site of the crisis by a mobile crisis response team; or at a
hospital on an outpatient basis.
(5) "Crisis
stabilization unit" means a program that provides an alternative to
inpatient hospitalization and that provides brief, intensive services 24 hours
a day, 7 days a week, for mentally ill individuals who are in an acutely
disturbed state.
(6) "Department"
means the Department of Children and Family Services.
(7) "Director"
means any member of the official board of directors reported in the
organization's annual corporate report to the Florida Department of State, or,
if no such report is made, any member of the operating board of directors. The
term excludes members of separate, restricted boards that serve only in an
advisory capacity to the operating board.
(8) "District
administrator" means the person appointed by the Secretary of Children and
Family Services for the purpose of administering a department service district
as set forth in s. 20.19.
(9) "District
plan" or "plan" means the combined district substance abuse and
mental health plan approved by the district administrator and governing bodies
in accordance with this part.
(10) "Federal
funds" means funds from federal sources for substance abuse or mental
health facilities and programs, exclusive of federal funds that are deemed
eligible by the Federal Government, and are eligible through state regulation,
for matching purposes.
(11) "Governing
body" means the chief legislative body of a county, a board of county commissioners,
or boards of county commissioners in counties acting jointly, or their
counterparts in a charter government.
(12) "Health
and human services board" or "board" means the board within a
district or subdistrict of the department which is
established in accordance with s. 20.19 and designated in this part for the
purpose of assessing the substance abuse and mental health needs of the
community and developing a plan to address those needs.
(13) "Licensed
facility" means a facility licensed in accordance with this chapter.
(14) "Local
matching funds" means funds received from governing bodies of local
government, including city commissions, county commissions, district school
boards, special tax districts, private hospital funds, private gifts, both
individual and corporate, and bequests and funds received from community drives
or any other sources.
(15) "Managing
employee" means the administrator or other similarly titled individual who
is responsible for the daily operation of the facility.
(16) "Mental
health services" means those therapeutic interventions and activities that
help to eliminate, reduce, or manage symptoms or distress for persons who have
severe emotional distress or a mental illness and to effectively manage the
disability that often accompanies a mental illness so that the person can
recover from the mental illness, become appropriately self-sufficient for his
or her age, and live in a stable family or in the community. The term also
includes those preventive interventions and activities that reduce the risk for
or delay the onset of mental disorders. The term includes the following types
of services:
(a) Treatment services, such as psychiatric
medications and supportive psychotherapies, which are intended to reduce or
ameliorate the symptoms of severe distress or mental illness.
(b) Rehabilitative services, which are intended
to reduce or eliminate the disability that is associated with mental illness.
Rehabilitative services may include assessment of personal goals and strengths,
readiness preparation, specific skill training, and assistance in designing
environments that enable individuals to maximize their functioning and
community participation.
(c) Support services, which include services that
assist individuals in living successfully in environments of their choice. Such
services may include income supports, social supports, housing supports,
vocational supports, or accommodations related to the symptoms or disabilities
associated with mental illness.
(d) Case management
services, which are intended to assist individuals in obtaining the formal and
informal resources that they need to successfully cope with the consequences of their
illness. Resources may include treatment or rehabilitative or supportive
interventions by both formal and informal providers. Case management may
include an assessment of client needs; intervention planning with the client,
his or her family, and service providers; linking the client to needed
services; monitoring service delivery; evaluating the effect of services and
supports; and advocating on behalf of the client.
Mental health services may be delivered in a variety of settings, such as
inpatient, residential, partial hospital, day treatment, outpatient, club
house, or a drop-in or self-help center, as well as in other community
settings, such as the client's residence or workplace. The types and intensity
of services provided shall be based on the client's clinical status and goals,
community resources, and preferences. Services such as assertive community
treatment involve all four types of services which are delivered by a
multidisciplinary treatment team that is responsible for identified individuals
who have a serious mental illness.
(17) "Patient
fees" means compensation received by a community substance abuse or mental
health facility for services rendered to a specific client from any source of
funds, including city, county, state, federal, and private sources.
(18) "Person
who is experiencing an acute mental or emotional crisis" means a child,
adolescent, or adult who is experiencing a psychotic episode or a high level of
mental or emotional distress which may be precipitated by a traumatic event or
a perceived life problem for which the individual's typical coping strategies
are inadequate. The term includes an individual who meets the criteria for
involuntary examination specified in s. 394.463(1).
(19) "Person
who is experiencing an acute substance abuse crisis" means a child,
adolescent, or adult who is experiencing a medical or emotional crisis because
of the use of alcoholic beverages or any psychoactive or mood-altering
substance. The term includes an individual who meets the criteria for
involuntary admission specified in s. 397.675.
(20) "Premises"
means those buildings, beds, and facilities located at the main address of the
licensee and all other buildings, beds, and facilities for the provision of
acute or residential care which are located in such reasonable proximity to the
main address of the licensee as to appear to the public to be under the
dominion and control of the licensee.
(21) "Program
office" means the Mental Health Program Office of the Department of
Children and Family Services.
(22) "Residential
treatment center for children and adolescents" means a 24-hour residential
program, including a therapeutic group home, which provides mental health
services to emotionally disturbed children or adolescents as defined in s.
394.492(5) or (6) and which is a private for-profit or not-for-profit corporation
under contract with the department which offers a variety of treatment
modalities in a more restrictive setting.
(23) "Residential
treatment facility" means a facility providing residential care and
treatment to individuals exhibiting symptoms of mental illness who are in need
of a 24-hour-per-day, 7-day-a-week structured living environment, respite care,
or long-term community placement.
(24) "Sliding
fee scale" means a schedule of fees for identified services delivered by a
service provider which are based on a uniform schedule of discounts deducted
from the service provider's usual and customary charges. These charges must be
consistent with the prevailing market rates in the community for comparable
services.
(25) "Substance
abuse services" means services designed to prevent or remediate
the consequences of substance abuse, improve an individual's quality of life
and self-sufficiency, and support long-term recovery. The term includes the
following service categories:
(a) Prevention services, which include
information dissemination; education regarding the consequences of substance
abuse; alternative drug-free activities; problem identification; referral of
persons to appropriate prevention programs; community-based programs that
involve members of local communities in prevention activities; and
environmental strategies to review, change, and enforce laws that control the
availability of controlled and illegal substances.
(b) Assessment services, which include the
evaluation of individuals and families in order to identify their strengths and
determine their required level of care, motivation, and need for treatment and
ancillary services.
(c) Intervention services, which include early
identification, short-term counseling and referral, and outreach.
(d) Rehabilitation services, which include
residential, outpatient, day or night, case management, in-home, psychiatric,
and medical treatment, and methadone or medication management.
(e) Ancillary services, which include self-help
and other support groups and activities; aftercare provided in a structured,
therapeutic environment; supported housing; supported employment; vocational
services; and educational services.
394.674 Clinical eligibility for publicly
funded substance abuse and mental health services; fee collection requirements.--
(1) To
be eligible to receive substance abuse and mental health services funded by the
department, a person must be a member of one of the department's target groups
approved by the Legislature, pursuant to 1s. 216.0166.
(2) Crisis
services, as defined in s. 394.67, must, within the limitations of available
state and local matching resources, be available to each person who is eligible
for services under subsection (1), regardless of the person's ability to pay
for such services. A person who is experiencing a mental health crisis and who
does not meet the criteria for involuntary examination under s. 394.463(1), or
a person who is experiencing a substance abuse crisis and who does not meet the
involuntary admission criteria in s. 397.675, must contribute to the cost of
his or her care and treatment pursuant to the sliding fee scale developed under
subsection (4), unless charging a fee is contraindicated because of the crisis
situation.
(3) Mental
health services, substance abuse services, and crisis services, as defined in
s. 394.67, must, within the limitations of available state and local matching
resources, be available to each person who is eligible for services under
subsection (1). Such person must contribute to the cost of his or her care and
treatment pursuant to the sliding fee scale developed under subsection (4).
(4) The
department shall adopt rules to implement the clinical eligibility and fee
collection requirements for publicly funded substance abuse and mental health
services. The rules must require that each provider under contract with the
department develop a sliding fee scale for persons who have a net family income
at or above 150 percent of the Federal Poverty Income Guidelines, unless
otherwise required by state or federal law. The sliding fee scale must use the
uniform schedule of discounts by which a provider under contract with the
department discounts its established client charges for services supported with
state, federal, or local funds, using, at a minimum, factors such as family
income, financial assets, and family size as declared by the person or the
person's guardian. The rules must include uniform criteria to be used by all
service providers in developing the schedule of discounts for the sliding fee
scale. The rules must address the most expensive types of treatment, such as
residential and inpatient treatment, in order to make it possible for a client
to responsibly contribute to his or her mental health or substance abuse care
without jeopardizing the family's financial stability. A person who is not
eligible for Medicaid and whose net family income is less than 150 percent of
the Federal Poverty Income Guidelines must pay a portion of his or her
treatment costs which is comparable to the copayment
amount required by the Medicaid program for Medicaid clients pursuant to s.
409.9081. The rules must require that persons who receive financial assistance
from the Federal Government because of a disability and are in long-term
residential treatment settings contribute to their board and care costs and
treatment costs and must be consistent with the provisions in s. 409.212.
(5) A
person who meets the eligibility criteria in subsection (1) shall be served in
accordance with the appropriate district substance abuse and mental health
services plan specified in s. 394.75 and within available resources.
1Note.--Repealed by s. 61, ch. 2000-371.
394.675 Substance abuse and mental health
service system.--
(1) A
community-based system of comprehensive substance abuse and mental health
services shall be established and shall include:
(a) Crisis services.
(b) Substance abuse services.
(c) Mental health services.
(2) Notwithstanding
the provisions of this part, funds that are provided through state and federal
sources for specific services or for specific populations shall be used for
those purposes.
394.676 Indigent psychiatric medication
program.--
(1) Within
legislative appropriations, the department may establish the indigent
psychiatric medication program to purchase psychiatric medications for persons
as defined in s. 394.492(5) or (6) or pursuant to s. 394.674(1), who do not
reside in a state mental health treatment facility or an inpatient unit.
(2) The
department must adopt rules to administer the indigent psychiatric medication
program. The rules must prescribe the clinical and financial eligibility of
clients who may receive services under the indigent psychiatric medication
program, the requirements that community-based mental health providers must
meet to participate in the program, and the sanctions to be applied for failure
to meet those requirements.
(3) To
the extent possible within existing appropriations, the department must ensure
that non-Medicaid-eligible indigent individuals discharged from mental health
treatment facilities continue to receive the medications which effectively
stabilized their mental illness in the treatment facility, or newer
medications, without substitution by a service provider unless such
substitution is clinically indicated as determined by the licensed physician
responsible for such individual's psychiatric care.
394.73 Joint alcohol, drug abuse, and
mental health service programs in two or more counties.--
(1) Subject
to rules established by the department, any county within a service district
shall have the same power to contract for alcohol, drug abuse, and mental
health services as the department has under existing statutes.
(2) In
order to carry out the intent of this part and to provide alcohol, drug abuse,
and mental health services in accordance with the district plan, the counties
within a service district may enter into agreements with each other for the
establishment of joint service programs. The agreements may provide for the
joint provision or operation of services and facilities or for the provision or
operation of services and facilities by one participating county under contract
with other participating counties.
(3) When
a service district comprises two or more counties or portions thereof, it is
the obligation of the planning council to submit to the governing bodies, prior
to the budget submission date of each governing body, an estimate of the
proportionate share of costs of alcohol, drug abuse, and mental health services
proposed to be borne by each such governing body.
(4) Any
county desiring to withdraw from a joint program may submit to the district
administrator a resolution requesting withdrawal therefrom
together with a plan for the equitable adjustment and division of the assets,
property, debts, and obligations, if any, of the joint program.
394.74 Contracts for provision of local
substance abuse and mental health programs.--
(1) The
department, when funds are available for such purposes, is authorized to
contract for the establishment and operation of local substance abuse and
mental health programs with any hospital, clinic, laboratory, institution, or
other appropriate service provider.
(2)(a) Contracts
for service shall be consistent with the approved district plan.
1(b) Notwithstanding s.
394.76(3)(a) and (c), the department may use unit cost methods of payment in
contracts for purchasing mental health and substance abuse services. The unit
cost contracting system must account for those patient fees that are paid on
behalf of a specific client and those that are earned and used by the provider
for those services funded in whole or in part by the department. The department
may also use a fee-for-service arrangement, case rates, or a capitation
arrangement in order to account for those services. The department is
authorized to implement through administrative rule fee-for-service, prepaid
case rate, and prepaid capitation contract methodologies to purchase mental
health and substance abuse services. Fee-for-service, prepaid case rate, or
prepaid capitation mechanisms shall not be implemented statewide without the
elimination of the unit cost method of payment. Notwithstanding the provisions
of s. 394.76(3), the department may adopt administrative rules that account for
local match in a manner that is consistent with fee-for-service, prepaid case
rate, and prepaid capitated payment methodologies.
Such provisions may not result in a change of the ratio of state to local
matching resources or in the sources of local matching funds and may not
increase the amount of required local matching funds. It is the intent of the
Legislature that the provisions to account for local match be consistent with
the financial principles adopted for the payment of state funds.
(c) The department may reimburse actual
expenditures for startup contracts and fixed capital outlay contracts in
accordance with contract specifications.
(3) Contracts
shall include, but are not limited to:
(a) A provision that, within the limits of
available resources, substance abuse and mental health crisis services, as
defined in s. 394.67(4), shall be available to any individual residing or
employed within the service area, regardless of ability to pay for such
services, current or past health condition, or any other factor;
(b) A provision that such services be available
with priority of attention being given to individuals who exhibit symptoms of chronic
or acute substance abuse or mental illness and who are unable to pay the cost
of receiving such services;
(c) A provision that every reasonable effort to
collect appropriate reimbursement for the cost of providing substance abuse and
mental health services to persons able to pay for services, including
first-party payments and third-party payments, shall be made by facilities
providing services pursuant to this act;
(d) A program description and line-item operating
budget by program service component for substance abuse and mental health
services, provided the entire proposed operating budget for the service
provider will be displayed;
(e) A provision that client demographic, service,
and outcome information required for the department's Mental Health and
Substance Abuse Data System be submitted to the department by a date specified
in the contract. The department may not pay the provider unless the required
information has been submitted by the specified date; and
(f) A requirement that the contractor must
conform to department rules and the priorities established thereunder.
(4) The
department shall develop standard contract forms for use between the district
administrator and community substance abuse and mental health service
providers.
(5) This
part does not prevent any municipality or county, or combination of
municipalities and counties, from owning, financing, and operating a substance
abuse or mental health program by entering into an arrangement with the
district to provide, and be reimbursed for, services provided as part of the
district plan.
(6) The
department may use a fee-for-service arrangement, case rates, or capitation in
order to account for mental health and substance abuse services.
1Note.--Sections 6 and 10, ch. 2003-279, provide that "[e]xcept
as otherwise provided, this act shall be implemented within available
resources."
1394.741 Accreditation requirements for providers of
behavioral health care services.--
(1) As
used in this section, the term "behavioral health care services"
means mental health and substance abuse treatment services.
(2) Notwithstanding
any provision of law to the contrary, accreditation shall be accepted by the
agency and department in lieu of the agency's and department's facility
licensure onsite review requirements and shall be accepted as a substitute for
the department's administrative and program monitoring requirements, except as
required by subsections (3) and (4), for:
(a) Any organization from which the department
purchases behavioral health care services that is accredited by the Joint
Commission on Accreditation of Healthcare Organizations or the Council on
Accreditation for Children and Family Services, or has those services that are
being purchased by the department accredited by CARF--the Rehabilitation
Accreditation Commission.
(b) Any mental health facility licensed by the
agency or any substance abuse component licensed by the department that is
accredited by the Joint Commission on Accreditation of Healthcare
Organizations, CARF--the Rehabilitation Accreditation Commission, or the
Council on Accreditation of Children and Family Services.
(c) Any network of providers from which the
department or the agency purchases behavioral health care services accredited
by the Joint Commission on Accreditation of Healthcare Organizations, CARF--the
Rehabilitation Accreditation Commission, the Council on Accreditation of
Children and Family Services, or the National Committee for Quality Assurance.
A provider organization, which is part of an accredited network, is afforded
the same rights under this part.
(3) For
organizations accredited as set forth in subsection (2), before the department
or the agency conducts additional monitoring for mental health services, the
department and the agency must adopt rules that establish:
(a) Additional standards for monitoring and
licensing accredited programs and facilities that the department and the agency
have determined are not specifically and distinctly covered by the
accreditation standards and processes. These standards and the associated
monitoring must not duplicate the standards and processes already covered by
the accrediting bodies.
(b) An onsite monitoring process between 24
months and 36 months after accreditation for nonresidential facilities to
assure that accredited organizations exempt from licensing and monitoring
activities under this part continue to comply with critical standards.
(c) An onsite monitoring process between 12
months and 24 months after accreditation for residential facilities to assure
that accredited organizations exempt from licensing and monitoring activities
under this part continue to comply with critical standards.
(4) For
substance abuse services, the department shall conduct full licensure
inspections every 3 years and shall develop in rule criteria which would
justify more frequent inspections.
(5) The
department and the agency shall be given access to all accreditation reports,
corrective action plans, and performance data submitted to the accrediting
organizations. When major deficiencies, as defined by the accrediting
organization, are identified through the accreditation process, the department
and the agency may perform followup monitoring to
assure that such deficiencies are corrected and that the corrections are
sustained over time. Proof of compliance with fire and health safety standards
will be submitted as required by rule.
(6) The
department or agency, by accepting the survey or inspection of an accrediting
organization, does not forfeit its rights to monitor for the purpose of ensuring
that services for which the department has paid were provided. The department
may investigate complaints or suspected problems and 2monitor the
provider's compliance with negotiated terms and conditions, including
provisions relating to consent decrees, which are unique to a specific contract
and are not statements of general applicability. The department may monitor
compliance with federal and state statutes, federal regulations, or state
administrative rules, if such monitoring does not duplicate the review of
accreditation standards or independent audits pursuant to subsections (3) and
(8).
(7) For
purposes of licensure and monitoring of facilities under contract with the
department, the department shall rely only upon properly adopted and applicable
federal and state statutes and rules.
(8) The
department shall file a State Projects Compliance Supplement pursuant to s.
215.97 for behavioral health care services. In monitoring the financial
operations of its contractors, the department shall rely upon certified public
accountant audits, if required. The department shall perform a desk review of
its contractor's most recent independent audit and may conduct onsite
monitoring only of problems identified by these audits, or by other sources of
information documenting problems with the contractor's financial management.
Certified public accountants employed by the department may conduct an onsite
test of the validity of a contractor's independent audit every third year.
(9) The
department and the agency shall report to the Legislature by
(10) The
accreditation requirements of this section apply to contracted organizations
that are already accredited immediately upon becoming law.
1Note.--Sections 6 and 10, ch. 2003-279, provide that "[e]xcept
as otherwise provided, this act shall be implemented within available
resources."
2Note.--The word "to" preceding
the word "monitor" was deleted by the editors to improve clarity.
394.745 Annual report; compliance of
providers under contract with department.--By November 1 of each year, the Department of
Children and Family Services shall submit a report to the President of the
Senate and the Speaker of the House of Representatives which describes the
compliance of providers that provide substance abuse treatment programs and
mental health services under contract with the Department of Children and
Family Services. The report must describe the status of compliance with the
annual performance outcome standards established by the Legislature and must
address the providers that meet or exceed performance standards, the providers
that did not achieve performance standards for which corrective action measures
were developed, and the providers whose contracts were terminated due to
failure to meet the requirements of the corrective plan.
394.75 State and district substance abuse
and mental health plans.--
(1)(a) Every
3 years, beginning in 2001, the department, in consultation with the Medicaid
program in the Agency for Health Care Administration, shall prepare a state
master plan for the delivery and financing of a system of publicly funded,
community-based substance abuse and mental health services throughout the
state.
(b) The initial plan must include an assessment
of the clinical practice guidelines and standards for community-based mental
health and substance abuse services delivered by persons or agencies under
contract with the Department of Children and Family Services. The assessment
must include an inventory of current clinical guidelines and standards used by
persons and agencies under contract with the department, and by nationally
recognized accreditation organizations, to address the quality of care and must
specify additional clinical practice standards and guidelines for new or
existing services and programs.
(c) The plan must propose changes in department
policy or statutory revisions to strengthen the quality of mental health and
substance abuse treatment and support services.
(d) The plan must identify strategies for meeting
the treatment and support needs of children, adolescents, adults, and older
adults who have, or are at risk of having, mental, emotional, or substance
abuse problems as defined in this chapter or chapter 397.
(e) The plan must include input from persons who
represent local communities; local government entities that contribute funds to
the local substance abuse and mental health treatment systems; consumers of
publicly funded substance abuse and mental health services, and their families;
and stakeholders interested in mental health and substance abuse services. The
plan must describe the means by which this local input occurred. The plan shall
be updated annually.
(f) The plan must include statewide policies and
planning parameters that will be used by the 1health and human services
boards in preparing the district substance abuse and mental health plans.
(g) The district plans shall be one component of
the state master plan.
(2) The
state master plan shall also include:
(a) A proposal for the development of a data system
that will evaluate the effectiveness of programs and services provided to
clients of the substance abuse and mental health service system.
(b) A proposal to resolve the funding
discrepancies between districts.
(c) A methodology for the allocation of resources
available from federal, state, and local sources and a description of the
current level of funding available from each source.
(d) A description of the statewide priorities for
clients and services, and each district's priorities for clients and services.
(e) Recommendations for methods of enhancing
local participation in the planning, organization, and financing of substance
abuse and mental health services.
(f) A description of the current methods of
contracting for services, an assessment of the efficiency of these methods in
providing accountability for contracted funds, and recommendations for
improvements to the system of contracting.
(g) Recommendations for improving access to
services by clients and their families.
(h) Guidelines and formats for the development of
district plans.
(i) Recommendations for
future directions for the substance abuse and mental health service delivery
system.
A
schedule, format, and procedure for development and review of the state master
plan shall be adopted by the department by June of each year. The plan and
annual updates must be submitted to the President of the Senate and the Speaker
of the House of Representatives by January 1 of each year, beginning
(3) The
district 1health and human services board shall prepare an
integrated district substance abuse and mental health plan. The plan shall be
prepared and updated on a schedule established by the 2Alcohol, Drug
Abuse, and Mental Health Program Office. The plan shall reflect the needs and
program priorities established by the department and the needs of the district
established under ss. 394.674 and 394.675. The plan
must list in order of priority the mental health and the substance abuse
treatment needs of the district and must rank each program separately. The plan
shall include:
(a) A record of the total amount of money
available in the district for mental health and substance abuse services.
(b) A description of each service that will be
purchased with state funds.
(c) A record of the amount of money allocated for
each service identified in the plan as being purchased with state funds.
(d) A record of the total funds allocated to each
provider.
(e) A record of the total funds allocated to each
provider by type of service to be purchased with state funds.
(f) Input from community-based persons,
organizations, and agencies interested in substance abuse and mental health
treatment services; local government entities that contribute funds to the
public substance abuse and mental health treatment systems; and consumers of
publicly funded substance abuse and mental health services, and their family
members. The plan must describe the means by which this local input occurred.
The plan shall be submitted by the district 1board to the district
administrator and to the governing bodies for review, comment, and approval.
(4) The
district plan shall:
(a) Describe the publicly funded, community-based
substance abuse and mental health system of care, and identify statutorily
defined populations, their service needs, and the resources available and
required to meet their needs.
(b) Provide the means for meeting the needs of
the district's eligible clients, specified in ss.
394.674 and 394.675, for substance abuse and mental health services.
(c) Provide a process for coordinating the
delivery of services within a community-based system of care to eligible
clients. Such process must involve service providers, clients, and other
stakeholders. The process must also provide a means by which providers will
coordinate and cooperate to strengthen linkages, achieve maximum integration of
services, foster efficiencies in service delivery and administration, and
designate responsibility for outcomes for eligible clients.
(d) Provide a projection of district program and
fiscal needs for the next fiscal year, provide for the orderly and economical
development of needed services, and indicate priorities and resources for each
population served, performance outcomes, and anticipated expenditures and
revenues.
(e) Include a summary budget request for the
total district substance abuse and mental health program, which must include
the funding priorities established by the district planning process.
(f) Provide a basis for the district legislative
budget request.
(g) Include a policy and procedure for allocation
of funds.
(h) Include a procedure for securing local
matching funds. Such a procedure shall be developed in consultation with
governing bodies and service providers.
(i) Provide for the
integration of substance abuse and mental health services with the other
departmental programs and with the criminal justice, juvenile justice, child
protection, school, and health care systems within the district.
(j) Provide a plan for the coordination of
services in such manner as to ensure effectiveness and avoid duplication,
fragmentation of services, and unnecessary expenditures.
(k) Provide for continuity of client care between
state treatment facilities and community programs to assure that discharge
planning results in the rapid application for all benefits for which a client
is eligible, including Medicaid coverage for persons leaving state treatment
facilities and returning to community-based programs.
(l) Provide for the most appropriate and
economical use of all existing public and private agencies and personnel.
(m) Provide for the fullest possible and most
appropriate participation by existing programs; state hospitals and other
hospitals; city, county, and state health and family service agencies; drug
abuse and alcoholism programs; probation departments; physicians;
psychologists; social workers; marriage and family therapists; mental health
counselors; clinical social workers; public health nurses; school systems; and
all other public and private agencies and personnel that are required to, or
may agree to, participate in the plan.
(n) Include an inventory of all public and
private substance abuse and mental health resources within the district,
including consumer advocacy groups and self-help groups known to the
department.
(5) The
district plan shall address how substance abuse and mental health services will
be provided and how a system of care for target populations will be provided
given the resources available in the service district. The plan must include
provisions for maximizing client access to the most recently developed
psychiatric medications approved by the United States Food and Drug
Administration, for developing independent housing units through participation
in the Section 811 program operated by the United States Department of Housing
and Urban Development, for developing supported employment services through the
Division of Vocational Rehabilitation of the Department of Education, for
providing treatment services to persons with co-occurring mental illness and
substance abuse problems which are integrated across treatment systems, and for
providing services to adults who have a serious mental illness, as defined in
s. 394.67, and who reside in assisted living facilities.
(6) The
district plan shall provide the means by which the needs of the population
groups specified pursuant to s. 394.674 will be addressed in the district.
(7) In
developing the district plan, optimum use shall be made of any federal, state,
and local funds that may be available for substance abuse and mental health
service planning. However, the department must provide these services within
legislative appropriations.
(8) The
district 1health and human services board shall establish a
subcommittee to prepare the portion of the district plan relating to children
and adolescents. The subcommittee shall include representative membership of
any committee organized or established by the district to review placement of
children and adolescents in residential treatment programs. The 1board
shall establish a subcommittee to prepare the portion of the district plan
which relates to adult mental health and substance abuse. The subcommittee must
include representatives from the community who have an interest in mental
health and substance abuse treatment for adults.
(9) All
departments of state government and all local public agencies shall cooperate
with officials to assist them in service planning. Each district administrator
shall, upon request and the availability of staff, provide consultative
services to the local agency directors and governing bodies.
(10) The
district administrator shall ensure that the district plan:
(a) Conforms to the priorities in the state plan,
the requirements of this part, and the standards adopted under this part;
(b) Ensures that the most effective and
economical use will be made of available public and private substance abuse and
mental health resources in the service district; and
(c) Has adequate provisions made for review and
evaluation of the services provided in the service district.
(11) The
district administrator shall require such modifications in the district plan as
he or she deems necessary to bring the plan into conformance with the provisions
of this part. If the district 1board and the district administrator
cannot agree on the plan, including the projected budget, the issues under
dispute shall be submitted directly to the secretary of the department for
immediate resolution.
(12) Each
governing body that provides local funds has the authority to require necessary
modification to only that portion of the district plan which affects substance
abuse and mental health programs and services within the jurisdiction of that
governing body.
(13) The
district administrator shall report annually to the district 1board
the status of funding for priorities established in the district plan. Each
report must include:
(a) A description of the district plan priorities
that were included in the district legislative budget request.
(b) A description of the district plan priorities
that were included in the departmental budget request.
(c) A description of the programs and services
included in the district plan priorities that were appropriated funds by the
Legislature in the legislative session that preceded the report.
1Note.--Health and Human Services Boards
were abolished by s. 2, ch. 2000-139, which
substantially reworded s. 20.19.
2Note.--Section 2, ch.
2000-139, amended s. 20.19, relating to the structure of the Department of
Children and Family Services; separate program offices are established for
mental health and for substance abuse.
394.76 Financing of district programs and
services.--If the local
match funding level is not provided in the General Appropriations Act or the
substantive bill implementing the General Appropriations Act, such funding
level shall be provided as follows:
(1) The
district administrator shall ensure that, to the extent possible within
available resources, a continuum of integrated and comprehensive services will
be available within the district.
(2) If
in any fiscal year the approved state appropriation is insufficient to finance
the programs and services specified by this part, the department shall have the
authority to determine the amount of state funds available to each service
district for such purposes in accordance with the priorities in both the state
and district plans. The district administrator shall consult with the planning
council to ensure that the summary operating budget conforms to the approved
plan.
(3) The
state share of financial participation shall be determined by the following
formula:
(a) The state share of approved program costs
shall be a percentage of the net balance determined by deducting from the total
operating cost of services and programs, as specified in s. 394.675(1), those
expenditures which are ineligible for state participation as provided in
subsection (7) and those ineligible expenditures established by rule of the
department pursuant to s. 394.78.
(b) Residential and case management services
which are funded as part of a deinstitutionalization
project shall not require local matching funds and shall not be used as local
matching funds. The state and federal financial participation portions of
Medicaid earnings pursuant to Title XIX of the Social Security Act, except for
the amount of general revenue equal to the amount appropriated in 1985-1986
plus all other general revenue that is shifted from any other alcohol, drug
abuse, and mental health appropriation category after fiscal year 1986-1987 or
substance abuse and mental health appropriation category after fiscal year
2000-2001, shall not require local matching funds and shall not be used as
local matching funds. Local matching funds are not required for general revenue
transferred by the department into substance abuse and mental health
appropriations categories during a fiscal year to match federal funds earned
from Medicaid services provided for mental health clients in excess of the
amounts initially appropriated. Funds for children's services which were
provided through the Children, Youth, and Families Services budget which did
not require local match prior to being transferred to the Substance Abuse and
Mental Health Services budget shall be exempt from local matching requirements.
All other contracted community alcohol and mental health services and programs,
except as identified in s. 394.457(3), shall require local participation on a
75-to-25 state-to-local ratio.
(c) The expenditure of 100 percent of all
third-party payments and fees shall be considered as eligible for state
financial participation if such expenditures are in accordance with subsection
(7) and the approved district plan.
(d) Fees generated by residential and case
management services which are funded as part of a deinstitutionalization
program and do not require local matching funds shall be used to support
program costs approved in the district plan.
(e) Any earnings pursuant to Title XIX of the
Social Security Act in excess of the amount appropriated shall be used to
support program costs approved in the district plan.
(4) Notwithstanding
the provisions of subsection (3), the department is authorized to develop and
demonstrate alternative financing systems for substance abuse and mental health
services. Proposals for demonstration projects conducted pursuant to this
subsection shall be reviewed by the substantive and appropriations committees of
the Senate and the House of Representatives prior to implementation of the
projects.
(5) The
department is authorized to make investigations and to require audits of
expenditures. The department may authorize the use of private certified public
accountants for such audits. Audits shall follow department guidelines.
(6) Claims
for state payment shall be made in such form and in such manner as the
department determines.
(7) The
expenditures which are subject to state payment include expenditures that are
approved in the district plan for: salaries of personnel; approved facilities
and services provided through contract; operation, maintenance, and service
cost; depreciation of facilities; and such other expenditures as may be
approved by the district administrator. Such expenditures do not include
expenditures for compensation to members of a community agency board, except
the actual and necessary expenses incurred in the performance of official
duties, or expenditures for a purpose for which state payment is claimed under
any other provision of law.
(8) Expenditures
for capital improvements relating to construction of, addition to, purchase of,
or renovation of a community substance abuse or mental health facility may be
made by the state, provided such expenditures or
capital improvements are part and parcel of an approved district plan. Nothing
shall prohibit the use of such expenditures for the construction of, addition
to, renovation of, or purchase of facilities owned by a county, city, or other governmental
agency of the state or a nonprofit entity. Such expenditures are subject to the
provisions of subsection (6).
(9)(a) State
funds for community alcohol and mental health services shall be matched by
local matching funds as provided in paragraph (3)(b).
The governing bodies within a district or subdistrict
shall be required to participate in the funding of alcohol and mental health
services under the jurisdiction of such governing bodies. The amount of the
participation shall be at least that amount which, when added to other
available local matching funds, is necessary to match state funds.
(b) The provisions of paragraph (a) to the
contrary notwithstanding, no additional matching funds may be required solely
due to the addition in the General Appropriations Act of Substance Abuse and
Mental Health Block Grant Funds for local community mental health centers and
alcohol project grants.
(10) A
local governing body is authorized to appropriate moneys, in lump sum or
otherwise, from its public funds for the purpose of carrying out the provisions
of this part. In addition to the payment of claims upon submission of proper
vouchers, such moneys may also, at the option of the governing body, be
disbursed in the form of a lump-sum or advance payment for services for
expenditure, in turn, by the recipient of the disbursement without prior audit
by the auditor of the governing body. Such funds shall be expended only for
substance abuse or mental health purposes as provided in the approved district
plan. Each governing body appropriating and disbursing moneys pursuant to this
subsection shall require the expenditure of such moneys by the recipient of the
disbursement to be audited annually either in conjunction with an audit of
other expenditures or by a separate audit. Such annual audits shall be
furnished to the governing bodies of each participating county and municipality
for their examination.
(11) No
additional local matching funds shall be required solely due to the addition in
the General Appropriations Act of substance abuse and mental health block grant
funds for local community mental health centers, drug abuse programs, and
alcohol project grants.
394.80 Authorization to appropriate
funds.--The several
cities and counties of this state are authorized to appropriate funds to
support all or any portion of the cost of services and construction not met
through support by the state or federal governments.
History.--s.
16, ch. 70-109.
394.82 Funding of expanded services.--
(1) Pursuant
to the General Appropriations Acts for the 2001-2002 and 2002-2003 fiscal
years, funds appropriated to the Department of Children and Family Services for
the purpose of expanding community mental health services must be used to
implement programs that emphasize crisis services as defined in s. 394.67(4)
and treatment services, rehabilitative services, support services, and case
management services, as defined in s. 394.67(16). Following the 2002-2003
fiscal year, the Department of Children and Family
Services must continue to expand the provision of these community mental health
services.
(2) In
order to estimate the cost of the expansion of community mental health
services, the Department of Children and Family Services in collaboration with
the Agency for Health Care Administration shall develop, and update annually,
estimates of the need for mental health services, including forecasts of Baker
Act expenditures, based on periodic actuarial analysis, caseload estimates of
adults with serious mental illness and children with serious emotional
disturbance, the associated costs per person served, and recommendations for
maximizing the use of federal funds to meet these needs. The estimates must be
submitted to the Executive Office of the Governor, the President of the Senate,
and the Speaker of the House of Representatives on August 1 of each year.
(3) Each
fiscal year, any funding increases for crisis services or community mental
health services that are included in the General Appropriations Act shall be
appropriated in a lump-sum category as defined in s. 216.011(1)(aa). In accordance with s. 216.181(6)(a), the Executive
Office of the Governor shall require the Department of Children and Family
Services to submit a spending plan for the use of funds appropriated for this
purpose. The spending plan must include a schedule for phasing in the new
community mental health services in each service district of the department and
must describe how the new services will be integrated and coordinated with all
current community-based health and human services.
(4) On
(5) By
January 1, 2004, the crisis services defined in s. 394.67(4) shall be
implemented, as appropriate, in the state's public community mental health
system to serve children and adults who are experiencing an acute mental or
emotional crisis, as defined in s. 394.67(18). By January 1, 2006, the mental
health services defined in s. 394.67(16) shall be implemented, as appropriate,
in the state's public community mental health system to serve adults and older
adults who have a severe and persistent mental illness and to serve children
who have a serious emotional disturbance or mental illness, as defined in s. 394.492(6).
(6) The
provisions of subsections (1) and (5) shall be implemented to the extent of
available appropriations contained in the annual General Appropriations Act for
such purposes.
History.--s.
1, ch. 2002-290.
394.875 Crisis stabilization units,
residential treatment facilities, and residential treatment centers for
children and adolescents; authorized services; license required; penalties.--
(1)(a) The
purpose of a crisis stabilization unit is to stabilize and redirect a client to
the most appropriate and least restrictive community setting available,
consistent with the client's needs. Crisis stabilization units may screen,
assess, and admit for stabilization persons who present themselves to the unit
and persons who are brought to the unit under s. 394.463. Clients may be
provided 24-hour observation, medication prescribed by a physician or
psychiatrist, and other appropriate services. Crisis stabilization units shall
provide services regardless of the client's ability to pay and shall be limited
in size to a maximum of 30 beds.
(b) The purpose of a residential treatment
facility is to be a part of a comprehensive treatment program for mentally ill
individuals in a community-based residential setting.
(c) The purpose of a residential treatment center
for children and adolescents is to provide mental health assessment and
treatment services pursuant to ss. 394.491, 394.495,
and 394.496 to children and adolescents who meet the target population criteria
specified in s. 394.493(1)(a), (b), or (c).
(2) It
is unlawful for any entity to hold itself out as a crisis stabilization unit, a
residential treatment facility, or a residential treatment center for children
and adolescents, or to act as a crisis stabilization unit, a residential treatment
facility, or a residential treatment center for children and adolescents,
unless it is licensed by the agency pursuant to this chapter.
(3) Any
person who violates subsection (2) is guilty of a misdemeanor of the first
degree, punishable as provided in s. 775.082 or s. 775.083.
(4) The
agency may maintain an action in circuit court to enjoin the unlawful operation
of a crisis stabilization unit, a residential treatment facility, or a
residential treatment center for children and adolescents if the agency first
gives the violator 14 days' notice of its intention to maintain such action and
if the violator fails to apply for licensure within such 14-day period.
(5) Subsection
(2) does not apply to:
(a) Homes for special services licensed under
chapter 400; or
(b) Nursing homes licensed under chapter 400.
(c) Comprehensive transitional education programs
licensed under s. 393.067.
(6) The
department, in consultation with the agency, may establish multiple license
classifications for residential treatment facilities.
(7) The
agency may not issue a license to a crisis stabilization unit unless the unit
receives state mental health funds and is affiliated with a designated public
receiving facility.
(8) The
agency may issue a license for a crisis stabilization unit or short-term
residential treatment facility, certifying the number of authorized beds for
such facility as indicated by existing need and available appropriations. The
agency may disapprove an application for such a license if it determines that a
facility should not be licensed pursuant to the provisions of this chapter. Any
facility operating beds in excess of those authorized by the agency shall, upon
demand of the agency, reduce the number of beds to the authorized number,
forfeit its license, or provide evidence of a license issued pursuant to
chapter 395 for the excess beds.
(9) A
children's crisis stabilization unit which does not exceed 20 licensed beds and
which provides separate facilities or a distinct part of a facility, separate
staffing, and treatment exclusively for minors may be located on the same
premises as a crisis stabilization unit serving adults. The department, in
consultation with the agency, shall adopt rules governing facility
construction, staffing and licensure requirements, and the operation of such
units for minors.
(10) The
department, in consultation with the agency, must adopt rules governing a
residential treatment center for children and adolescents which
specify licensure standards for: admission; length of stay; program and
staffing; discharge and discharge planning; treatment planning; seclusion,
restraints, and time-out; rights of patients under s. 394.459; use of
psychotropic medications; and standards for the operation of such centers.
(11) Notwithstanding
the provisions of subsection (8), crisis stabilization units may not exceed
their licensed capacity by more than 10 percent, nor may they exceed their
licensed capacity for more than 3 consecutive working days or for more than 7
days in 1 month.
(12) Notwithstanding
the other provisions of this section, any facility licensed under former
chapter 396 and chapter 397 for detoxification, residential level I care, and
outpatient treatment may elect to license concurrently all of the beds at such
facility both for that purpose and as a long-term residential treatment
facility pursuant to this section, if all of the following conditions are met:
(a) The licensure application is received by the
department prior to
(b) On
(c) The facility restricted its practice to the
treatment of law enforcement personnel for a period of at least 12 months
beginning after
(d) The number of beds to be licensed under this
chapter is equal to or less than the number of beds licensed under former
chapter 396 and chapter 397 as of
(e) The licensee agrees in writing to a condition
placed upon the license that the facility will limit its treatment exclusively
to law enforcement personnel and their immediate families who are seeking
admission on a voluntary basis and who are exhibiting symptoms of posttraumatic
stress disorder or other mental health problems, including drug or alcohol
abuse, which are directly related to law enforcement work and which are
amenable to verbal treatment therapies; the licensee agrees to coordinate the provision
of appropriate postresidential care for discharged
individuals; and the licensee further agrees in writing that a failure to meet
any condition specified in this paragraph shall constitute grounds for a
revocation of the facility's license as a residential treatment facility.
(f) The licensee agrees that the facility will
meet all licensure requirements for a residential treatment facility, including
minimum standards for compliance with lifesafety
requirements, except those licensure requirements which are in express conflict
with the conditions and other provisions specified in this subsection.
(g) The licensee agrees that the conditions
stated in this subsection must be agreed to in writing by any person acquiring
the facility by any means.
Any facility licensed under this subsection is not required to provide any
services to any persons except those included in the specified conditions of
licensure, and is exempt from any requirements related to the 60-day or greater
average length of stay imposed on community-based residential treatment
facilities otherwise licensed under this chapter.
(13) Each
applicant for licensure must comply with the following requirements:
(a) Upon
receipt of a completed, signed, and dated application, the agency shall require
background screening, in accordance with the level 2 standards for screening
set forth in chapter 435, of the managing employee and financial officer, or
other similarly titled individual who is responsible for the financial
operation of the facility, including billings for client care and services. The
applicant must comply with the procedures for level 2 background screening as
set forth in chapter 435, as well as the requirements of s. 435.03(3).
(b) The agency may require background screening
of any other individual who is an applicant if the agency has probable cause to
believe that he or she has been convicted of a crime or has committed any other
offense prohibited under the level 2 standards for screening set forth in
chapter 435.
(c) Proof of compliance with the level 2
background screening requirements of chapter 435 which has been submitted
within the previous 5 years in compliance with any other health care licensure
requirements of this state is acceptable in fulfillment of the requirements of
paragraph (a).
(d) A provisional license may be granted to an
applicant when each individual required by this section to undergo background
screening has met the standards for the Department of Law Enforcement
background check, but the agency has not yet received background screening
results from the Federal Bureau of Investigation, or a request for a
disqualification exemption has been submitted to the agency as set forth in
chapter 435, but a response has not yet been issued. A standard license may be
granted to the applicant upon the agency's receipt of a report of the results
of the Federal Bureau of Investigation background screening for each individual
required by this section to undergo background screening which confirms that
all standards have been met, or upon the granting of a disqualification
exemption by the agency as set forth in chapter 435. Any other person who is
required to undergo level 2 background screening may serve in his or her
capacity pending the agency's receipt of the report from the Federal Bureau of
Investigation. However, the person may not continue to serve if the report
indicates any violation of background screening standards and a
disqualification exemption has not been requested of and granted by the agency
as set forth in chapter 435.
(e) Each applicant must submit to the agency,
with its application, a description and explanation of any exclusions,
permanent suspensions, or terminations of the applicant from the Medicare or
Medicaid programs. Proof of compliance with the requirements for disclosure of
ownership and control interests under the Medicaid or Medicare programs shall
be accepted in lieu of this submission.
(f) Each applicant must submit to the agency a
description and explanation of any conviction of an offense prohibited under
the level 2 standards of chapter 435 by a member of the board of directors of
the applicant, its officers, or any individual owning 5 percent or more of the
applicant. This requirement does not apply to a director of a not-for-profit
corporation or organization if the director serves solely in a voluntary
capacity for the corporation or organization, does not regularly take part in
the day-to-day operational decisions of the corporation or organization,
receives no remuneration for his or her services on the corporation or
organization's board of directors, and has no financial interest and has no
family members with a financial interest in the corporation or organization,
provided that the director and the not-for-profit corporation or organization
include in the application a statement affirming that the director's
relationship to the corporation satisfies the requirements of this paragraph.
(g) A license may not be granted to an applicant
if the applicant or managing employee has been found guilty of, regardless of
adjudication, or has entered a plea of nolo contendere or guilty to, any offense prohibited under the
level 2 standards for screening set forth in chapter 435, unless an exemption
from disqualification has been granted by the agency as set forth in chapter
435.
(h) The agency may deny or revoke licensure if
the applicant:
1. Has falsely represented a material fact in the
application required by paragraph (e) or paragraph (f), or has omitted any
material fact from the application required by paragraph (e) or paragraph (f);
or
2. Has had prior action taken against the
applicant under the Medicaid or Medicare program as set forth in paragraph (e).
(i) An application for
license renewal must contain the information required under paragraphs (e) and
(f).
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