Bill Text: FL S0476 | 2015 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Mental Health
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2015-04-23 - Laid on Table, companion bill(s) passed, see CS/CS/HB 335 (Ch. 2015-111) [S0476 Detail]
Download: Florida-2015-S0476-Introduced.html
Bill Title: Mental Health
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2015-04-23 - Laid on Table, companion bill(s) passed, see CS/CS/HB 335 (Ch. 2015-111) [S0476 Detail]
Download: Florida-2015-S0476-Introduced.html
Florida Senate - 2015 SB 476 By Senator Grimsley 21-00420B-15 2015476__ 1 A bill to be entitled 2 An act relating to the Florida Mental Health Act; 3 amending s. 394.455, F.S.; redefining terms; requiring 4 that a psychiatric-mental health advanced registered 5 nurse practitioner hold a specified national 6 certification; conforming terminology to changes made 7 by the act; amending s. 394.463, F.S.; authorizing a 8 psychiatric-mental health advanced registered nurse 9 practitioner to approve the involuntary examination or 10 release of a patient from a receiving facility; 11 amending ss. 394.4574, 394.4655, and 394.467, F.S.; 12 conforming terminology to changes made by the act; 13 reenacting ss. 394.495(3) and 394.496(6), F.S., 14 relating to child and adolescent mental health 15 programs and services, to incorporate the amendment 16 made to s. 394.455, F.S., in references thereto; 17 reenacting ss. 39.407(4)(b), 394.455(34), 18 394.462(1)(e), 394.4625(1)(b) and (1)(c), 395.1041(6), 19 and 984.19(3), F.S., relating to medical, psychiatric, 20 and psychological examination and treatment of a 21 child, involuntary examination, transportation to a 22 receiving facility, voluntary admissions, the rights 23 of a person being treated, and certain criteria and 24 procedures used in evaluating a child, respectively, 25 to incorporate amendments made to s. 394.463, F.S., in 26 references thereto; reenacting s. 394.4598(1), F.S., 27 relating to guardian advocates, to incorporate 28 amendments made to ss. 394.4655 and 394.467, F.S., in 29 references thereto; providing an effective date. 30 31 Be It Enacted by the Legislature of the State of Florida: 32 33 Section 1. Subsections (23) and (33) of section 394.455, 34 Florida Statutes, are amended to read: 35 394.455 Definitions.—As used in this part, unless the 36 context clearly requires otherwise, the term: 37 (23) “Psychiatric-mental health advanced registered 38Psychiatricnurse practitioner” means a registered nurse 39 certifiedlicensedunder s. 464.012part I of chapter 464who 40 has a master’s degree or a doctorate in psychiatric nursing and 41 holds a national advanced practice certification as a 42 psychiatric-mental health nurse practitioner2 years of post43master’s clinical experience under the supervision of a44physician. 45 (33) “Service provider” means any public or private 46 receiving facility, an entity under contract with the Department 47 of Children and Families to provide mental health services, a 48 clinical psychologist, a clinical social worker, a marriage and 49 family therapist, a mental health counselor, a physician, a 50 psychiatric-mental health advanced registeredpsychiatricnurse 51 practitioneras defined in subsection (23), or a community 52 mental health center or clinic as defined in this part. 53 Section 2. Paragraphs (a) and (f) of subsection (2) of 54 section 394.463, Florida Statutes, are amended to read: 55 394.463 Involuntary examination.— 56 (2) INVOLUNTARY EXAMINATION.— 57 (a) An involuntary examination may be initiated by any one 58 of the following means: 59 1. A court may enter an ex parte order stating that a 60 person appears to meet the criteria for involuntary examination, 61 giving the findings on which that conclusion is based. The ex 62 parte order for involuntary examination must be based on sworn 63 testimony, written or oral. If other less restrictive means are 64 not available, such as voluntary appearance for outpatient 65 evaluation, a law enforcement officer, or other designated agent 66 of the court, shall take the person into custody and deliver him 67 or her to the nearest receiving facility for involuntary 68 examination. The order of the court shall be made a part of the 69 patient’s clinical record. ANofee may notshallbe charged for 70 the filing of an order under this subsection. Any receiving 71 facility accepting the patient based on this order must send a 72 copy of the order to the Agency for Health Care Administration 73 on the next working day. The order shall be valid only until 74 executed or, if not executed, for the period specified in the 75 order itself. If no time limit is specified in the order, the 76 order shall be valid for 7 days after the date that the order 77 was signed. 78 2. A law enforcement officer shall take a person who 79 appears to meet the criteria for involuntary examination into 80 custody and deliver the person or have him or her delivered to 81 the nearest receiving facility for examination. The officer 82 shall execute a written report detailing the circumstances under 83 which the person was taken into custody, and the report shall be 84 made a part of the patient’s clinical record. Any receiving 85 facility accepting the patient based on this report must send a 86 copy of the report to the Agency for Health Care Administration 87 on the next working day. 88 3. A physician, clinical psychologist, psychiatric-mental 89 health advanced registeredpsychiatricnurse practitioner, 90 mental health counselor, marriage and family therapist, or 91 clinical social worker may execute a certificate stating that he 92 or she has examined a person within the preceding 48 hours and 93 finds that the person appears to meet the criteria for 94 involuntary examination and stating the observations upon which 95 that conclusion is based. If other less restrictive means are 96 not available, such as voluntary appearance for outpatient 97 evaluation, a law enforcement officer shall take the person 98 named in the certificate into custody and deliver him or her to 99 the nearest receiving facility for involuntary examination. The 100 law enforcement officer shall execute a written report detailing 101 the circumstances under which the person was taken into custody. 102 The report and certificate shall be made a part of the patient’s 103 clinical record. Any receiving facility accepting the patient 104 based on this certificate must send a copy of the certificate to 105 the Agency for Health Care Administration on the next working 106 day. 107 (f) A patient shall be examined by a physician or clinical 108 psychologist at a receiving facility without unnecessary delay 109 and may, upon the order of a physician, be given emergency 110 treatment if it is determined that such treatment is necessary 111 for the safety of the patient or others. The patient may not be 112 released by the receiving facility or its contractor without the 113 documented approval of a psychiatrist, a clinical psychologist, 114 or a psychiatric-mental health advanced registered nurse 115 practitioner or, if the receiving facility is a hospital, the 116 release may also be approved by an attending emergency 117 department physician with experience in the diagnosis and 118 treatment of mental and nervous disorders and after completion 119 of an involuntary examination pursuant to this subsection. 120 However, a patient may not be held in a receiving facility for 121 involuntary examination longer than 72 hours. 122 Section 3. Paragraph (a) of subsection (2) of section 123 394.4574, Florida Statutes, is amended to read: 124 394.4574 Department responsibilities for a mental health 125 resident who resides in an assisted living facility that holds a 126 limited mental health license.— 127 (2) The department must ensure that: 128 (a) A mental health resident has been assessed by a 129 psychiatrist, clinical psychologist, clinical social worker, or 130 psychiatric-mental health advanced registeredpsychiatricnurse 131 practitioner, or an individual who is supervised by one of these 132 professionals, and determined to be appropriate to reside in an 133 assisted living facility. The documentation must be provided to 134 the administrator of the facility within 30 days after the 135 mental health resident has been admitted to the facility. An 136 evaluation completed upon discharge from a state mental hospital 137 meets the requirements of this subsection related to 138 appropriateness for placement as a mental health resident if it 139 was completed within 90 days beforeprior toadmission to the 140 facility. 141 Section 4. Subsection (2) of section 394.4655, Florida 142 Statutes, is amended to read: 143 394.4655 Involuntary outpatient placement.— 144 (2) INVOLUNTARY OUTPATIENT PLACEMENT.— 145 (a)1. A patient who is being recommended for involuntary 146 outpatient placement by the administrator of the receiving 147 facility where the patient has been examined may be retained by 148 the facility after adherence to the notice procedures provided 149 in s. 394.4599. The recommendation must be supported by the 150 opinion of a psychiatrist and the second opinion of a clinical 151 psychologist or another psychiatrist, both of whom have 152 personally examined the patient within the preceding 72 hours, 153 that the criteria for involuntary outpatient placement are met. 154 However, in a county having a population of fewer than 50,000, 155 if the administrator certifies that a psychiatrist or clinical 156 psychologist is not available to provide the second opinion, the 157 second opinion may be provided by a licensed physician who has 158 postgraduate training and experience in diagnosis and treatment 159 of mental and nervous disorders or by a psychiatric-mental 160 health advanced registeredpsychiatricnurse practitioner. Any 161 second opinion authorized in this subparagraph may be conducted 162 through a face-to-face examination, in person or by electronic 163 means. Such recommendation must be entered on an involuntary 164 outpatient placement certificate that authorizes the receiving 165 facility to retain the patient pending completion of a hearing. 166 The certificate shall be made a part of the patient’s clinical 167 record. 168 2. If the patient has been stabilized and no longer meets 169 the criteria for involuntary examination pursuant to s. 170 394.463(1), the patient must be released from the receiving 171 facility while awaiting the hearing for involuntary outpatient 172 placement. Before filing a petition for involuntary outpatient 173 treatment, the administrator of a receiving facility or a 174 designated department representative must identify the service 175 provider that will have primary responsibility for service 176 provision under an order for involuntary outpatient placement, 177 unless the person is otherwise participating in outpatient 178 psychiatric treatment and is not in need of public financing for 179 that treatment, in which case the individual, if eligible, may 180 be ordered to involuntary treatment pursuant to the existing 181 psychiatric treatment relationship. 182 3. The service provider shall prepare a written proposed 183 treatment plan in consultation with the patient or the patient’s 184 guardian advocate, if appointed, for the court’s consideration 185 for inclusion in the involuntary outpatient placement order. The 186 service provider shall also provide a copy of the proposed 187 treatment plan to the patient and the administrator of the 188 receiving facility. The treatment plan must specify the nature 189 and extent of the patient’s mental illness, address the 190 reduction of symptoms that necessitate involuntary outpatient 191 placement, and include measurable goals and objectives for the 192 services and treatment that are provided to treat the person’s 193 mental illness and assist the person in living and functioning 194 in the community or to prevent a relapse or deterioration. 195 Service providers may select and supervise other individuals to 196 implement specific aspects of the treatment plan. The services 197 in the treatment plan must be deemed clinically appropriate by a 198 physician, clinical psychologist, psychiatric-mental health 199 advanced registeredpsychiatricnurse practitioner, mental 200 health counselor, marriage and family therapist, or clinical 201 social worker who consults with, or is employed or contracted 202 by, the service provider. The service provider must certify to 203 the court in the proposed treatment plan whether sufficient 204 services for improvement and stabilization are currently 205 available and whether the service provider agrees to provide 206 those services. If the service provider certifies that the 207 services in the proposed treatment plan are not available, the 208 petitioner may not file the petition. 209 (b) If a patient in involuntary inpatient placement meets 210 the criteria for involuntary outpatient placement, the 211 administrator of the treatment facility may, before the 212 expiration of the period during which the treatment facility is 213 authorized to retain the patient, recommend involuntary 214 outpatient placement. The recommendation must be supported by 215 the opinion of a psychiatrist and the second opinion of a 216 clinical psychologist or another psychiatrist, both of whom have 217 personally examined the patient within the preceding 72 hours, 218 that the criteria for involuntary outpatient placement are met. 219 However, in a county having a population of fewer than 50,000, 220 if the administrator certifies that a psychiatrist or clinical 221 psychologist is not available to provide the second opinion, the 222 second opinion may be provided by a licensed physician who has 223 postgraduate training and experience in diagnosis and treatment 224 of mental and nervous disorders or by a psychiatric-mental 225 health advanced registeredpsychiatricnurse practitioner. Any 226 second opinion authorized in this subparagraph may be conducted 227 through a face-to-face examination, in person or by electronic 228 means. Such recommendation must be entered on an involuntary 229 outpatient placement certificate, and the certificate must be 230 made a part of the patient’s clinical record. 231 (c)1. The administrator of the treatment facility shall 232 provide a copy of the involuntary outpatient placement 233 certificate and a copy of the state mental health discharge form 234 to a department representative in the county where the patient 235 will be residing. For persons who are leaving a state mental 236 health treatment facility, the petition for involuntary 237 outpatient placement must be filed in the county where the 238 patient will be residing. 239 2. The service provider that will have primary 240 responsibility for service provision shall be identified by the 241 designated department representative beforeprior tothe order 242 for involuntary outpatient placement and must, beforeprior to243 filing a petition for involuntary outpatient placement, certify 244 to the court whether the services recommended in the patient’s 245 discharge plan are available in the local community and whether 246 the service provider agrees to provide those services. The 247 service provider must develop with the patient, or the patient’s 248 guardian advocate, if appointed, a treatment or service plan 249 that addresses the needs identified in the discharge plan. The 250 plan must be deemed to be clinically appropriate by a physician, 251 clinical psychologist, psychiatric-mental health advanced 252 registeredpsychiatricnurse practitioner, mental health 253 counselor, marriage and family therapist, or clinical social 254 worker, as defined in this chapter, who consults with, or is 255 employed or contracted by, the service provider. 256 3. If the service provider certifies that the services in 257 the proposed treatment or service plan are not available, the 258 petitioner may not file the petition. 259 Section 5. Subsection (2) of section 394.467, Florida 260 Statutes, is amended to read: 261 394.467 Involuntary inpatient placement.— 262 (2) ADMISSION TO A TREATMENT FACILITY.—A patient may be 263 retained by a receiving facility or involuntarily placed in a 264 treatment facility upon the recommendation of the administrator 265 of the receiving facility where the patient has been examined 266 and after adherence to the notice and hearing procedures 267 provided in s. 394.4599. The recommendation must be supported by 268 the opinion of a psychiatrist and the second opinion of a 269 clinical psychologist or another psychiatrist, both of whom have 270 personally examined the patient within the preceding 72 hours, 271 that the criteria for involuntary inpatient placement are met. 272 However, in a county that has a population of fewer than 50,000, 273 if the administrator certifies that a psychiatrist or clinical 274 psychologist is not available to provide the second opinion, the 275 second opinion may be provided by a licensed physician who has 276 postgraduate training and experience in diagnosis and treatment 277 of mental and nervous disorders or by a psychiatric-mental 278 health advanced registeredpsychiatricnurse practitioner. Any 279 second opinion authorized in this subsection may be conducted 280 through a face-to-face examination, in person or by electronic 281 means. Such recommendation shall be entered on an involuntary 282 inpatient placement certificate that authorizes the receiving 283 facility to retain the patient pending transfer to a treatment 284 facility or completion of a hearing. 285 Section 6. For the purpose of incorporating the amendment 286 made by this act to section 394.455, Florida Statutes, in a 287 reference thereto, subsection (3) of section 394.495, Florida 288 Statutes, is reenacted to read: 289 394.495 Child and adolescent mental health system of care; 290 programs and services.— 291 (3) Assessments must be performed by: 292 (a) A professional as defined in s. 394.455(2), (4), (21), 293 (23), or (24); 294 (b) A professional licensed under chapter 491; or 295 (c) A person who is under the direct supervision of a 296 professional as defined in s. 394.455(2), (4), (21), (23), or 297 (24) or a professional licensed under chapter 491. 298 299 The department shall adopt by rule statewide standards for 300 mental health assessments, which must be based on current 301 relevant professional and accreditation standards. 302 Section 7. For the purpose of incorporating the amendment 303 made by this act to section 394.455, Florida Statutes, in a 304 reference thereto, subsection (6) of section 394.496, Florida 305 Statutes, is reenacted to read: 306 394.496 Service planning.— 307 (6) A professional as defined in s. 394.455(2), (4), (21), 308 (23), or (24) or a professional licensed under chapter 491 must 309 be included among those persons developing the services plan. 310 Section 8. For the purpose of incorporating the amendment 311 made by this act to section 394.463, Florida Statutes, in a 312 reference thereto, paragraph (b) of subsection (4) of section 313 39.407, Florida Statutes, is reenacted to read: 314 39.407 Medical, psychiatric, and psychological examination 315 and treatment of child; physical, mental, or substance abuse 316 examination of person with or requesting child custody.— 317 (4) 318 (b) The judge may also order such child to be evaluated by 319 a psychiatrist or a psychologist or, if a developmental 320 disability is suspected or alleged, by the developmental 321 disability diagnostic and evaluation team of the department. If 322 it is necessary to place a child in a residential facility for 323 such evaluation, the criteria and procedure established in s. 324 394.463(2) or chapter 393 shall be used, whichever is 325 applicable. 326 Section 9. For the purpose of incorporating the amendment 327 made by this act to section 394.463, Florida Statutes, in a 328 reference thereto, subsection (34) of section 394.455, Florida 329 Statutes, is reenacted to read: 330 394.455 Definitions.—As used in this part, unless the 331 context clearly requires otherwise, the term: 332 (34) “Involuntary examination” means an examination 333 performed under s. 394.463 to determine if an individual 334 qualifies for involuntary inpatient treatment under s. 335 394.467(1) or involuntary outpatient treatment under s. 336 394.4655(1). 337 Section 10. For the purpose of incorporating the amendment 338 made by this act to section 394.463, Florida Statutes, in a 339 reference thereto, paragraph (e) of subsection (1) of section 340 394.462, Florida Statutes, is reenacted to read: 341 394.462 Transportation.— 342 (1) TRANSPORTATION TO A RECEIVING FACILITY.— 343 (e) When a member of a mental health overlay program or a 344 mobile crisis response service is a professional authorized to 345 initiate an involuntary examination pursuant to s. 394.463 and 346 that professional evaluates a person and determines that 347 transportation to a receiving facility is needed, the service, 348 at its discretion, may transport the person to the facility or 349 may call on the law enforcement agency or other transportation 350 arrangement best suited to the needs of the patient. 351 Section 11. For the purpose of incorporating the amendment 352 made by this act to section 394.463, Florida Statutes, in a 353 reference thereto, paragraphs (b) and (c) of subsection (1) of 354 section 394.4625, Florida Statutes, are reenacted to read: 355 394.4625 Voluntary admissions.— 356 (1) AUTHORITY TO RECEIVE PATIENTS.— 357 (b) A mental health overlay program or a mobile crisis 358 response service or a licensed professional who is authorized to 359 initiate an involuntary examination pursuant to s. 394.463 and 360 is employed by a community mental health center or clinic must, 361 pursuant to district procedure approved by the respective 362 district administrator, conduct an initial assessment of the 363 ability of the following persons to give express and informed 364 consent to treatment before such persons may be admitted 365 voluntarily: 366 1. A person 60 years of age or older for whom transfer is 367 being sought from a nursing home, assisted living facility, 368 adult day care center, or adult family-care home, when such 369 person has been diagnosed as suffering from dementia. 370 2. A person 60 years of age or older for whom transfer is 371 being sought from a nursing home pursuant to s. 400.0255(12). 372 3. A person for whom all decisions concerning medical 373 treatment are currently being lawfully made by the health care 374 surrogate or proxy designated under chapter 765. 375 (c) When an initial assessment of the ability of a person 376 to give express and informed consent to treatment is required 377 under this section, and a mobile crisis response service does 378 not respond to the request for an assessment within 2 hours 379 after the request is made or informs the requesting facility 380 that it will not be able to respond within 2 hours after the 381 request is made, the requesting facility may arrange for 382 assessment by any licensed professional authorized to initiate 383 an involuntary examination pursuant to s. 394.463 who is not 384 employed by or under contract with, and does not have a 385 financial interest in, either the facility initiating the 386 transfer or the receiving facility to which the transfer may be 387 made. 388 Section 12. For the purpose of incorporating the amendment 389 made by this act to section 394.463, Florida Statutes, in a 390 reference thereto, subsection (6) of section 395.1041, Florida 391 Statutes, is reenacted to read: 392 395.1041 Access to emergency services and care.— 393 (6) RIGHTS OF PERSONS BEING TREATED.—A hospital providing 394 emergency services and care to a person who is being 395 involuntarily examined under the provisions of s. 394.463 shall 396 adhere to the rights of patients specified in part I of chapter 397 394 and the involuntary examination procedures provided in s. 398 394.463, regardless of whether the hospital, or any part 399 thereof, is designated as a receiving or treatment facility 400 under part I of chapter 394 and regardless of whether the person 401 is admitted to the hospital. 402 Section 13. For the purpose of incorporating the amendment 403 made by this act to section 394.463, Florida Statutes, in a 404 reference thereto, subsection (3) of section 984.19, Florida 405 Statutes, is reenacted to read: 406 984.19 Medical screening and treatment of child; 407 examination of parent, guardian, or person requesting custody.— 408 (3) A judge may order that a child alleged to be or 409 adjudicated a child in need of services be examined by a 410 licensed health care professional. The judge may also order such 411 child to be evaluated by a psychiatrist or a psychologist, by a 412 district school board educational needs assessment team, or, if 413 a developmental disability is suspected or alleged, by the 414 developmental disability diagnostic and evaluation team of the 415 Department of Children and Families. The judge may order a 416 family assessment if that assessment was not completed at an 417 earlier time. If it is necessary to place a child in a 418 residential facility for such evaluation, then the criteria and 419 procedure established in s. 394.463(2) or chapter 393 shall be 420 used, whichever is applicable. The educational needs assessment 421 provided by the district school board educational needs 422 assessment team shall include, but not be limited to, reports of 423 intelligence and achievement tests, screening for learning 424 disabilities and other handicaps, and screening for the need for 425 alternative education pursuant to s. 1003.53. 426 Section 14. For the purpose of incorporating the amendments 427 made by this act to sections 394.4655 and 394.467, Florida 428 Statutes, in a reference thereto, subsection (1) of section 429 394.4598, Florida Statutes, is reenacted to read: 430 394.4598 Guardian advocate.— 431 (1) The administrator may petition the court for the 432 appointment of a guardian advocate based upon the opinion of a 433 psychiatrist that the patient is incompetent to consent to 434 treatment. If the court finds that a patient is incompetent to 435 consent to treatment and has not been adjudicated incapacitated 436 and a guardian with the authority to consent to mental health 437 treatment appointed, it shall appoint a guardian advocate. The 438 patient has the right to have an attorney represent him or her 439 at the hearing. If the person is indigent, the court shall 440 appoint the office of the public defender to represent him or 441 her at the hearing. The patient has the right to testify, cross 442 examine witnesses, and present witnesses. The proceeding shall 443 be recorded either electronically or stenographically, and 444 testimony shall be provided under oath. One of the professionals 445 authorized to give an opinion in support of a petition for 446 involuntary placement, as described in s. 394.4655 or s. 447 394.467, must testify. A guardian advocate must meet the 448 qualifications of a guardian contained in part IV of chapter 449 744, except that a professional referred to in this part, an 450 employee of the facility providing direct services to the 451 patient under this part, a departmental employee, a facility 452 administrator, or member of the Florida local advocacy council 453 shall not be appointed. A person who is appointed as a guardian 454 advocate must agree to the appointment. 455 Section 15. This act shall take effect July 1, 2015.