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POLICY AND FUNDING
IMPACTS
TO BEHAVIORAL HEALTH
DURING THE
2016 LEGISLATIVE SESSION
Jill Gran
Florida Behavioral Health Association
Florida Alcohol & Drug Abuse Association
Key Decision Makers
Senate
Andy Gardiner
President
(R-Orlando)
Term-limited
Arthenia Joyner
Joe Negron
(D-Saint Petersburg)
Terms out: 2018
Minority Leader
Arthenia Joyner
Term-limited
Rene Garcia
Eleanor Sobel
Terms out: 2018
Term-limited
(R-Hialeah)
Chair, Health Care
Appropriations
(D-Hollywood)
Chair, Children, Families &
Elder Affairs
(R- Palm City)
Chair, Criminal Justice
Appropriations
Key Decision Makers
House
Steve Crisafulli
Speaker
(R-Merritt Island)
Term-limited
Matt Hudson
Speaker Pro-Temp
Chair, Health Care
Appropriations
(R-Naples)
Richard Corcoran
Chair, Appropriations
(R-Zephyrhills)
Terms Out 2018
Term-limited
Gayle Harrell
(R-Stuart)
Chair, Children
Families & Seniors
Subcommittee
Terms out: 2018
Kathleen Peters
(R-St. Petersburg)
V-Chair, Children
Families & Seniors
Subcommittee
Terms out: 2020
Charles McBurney
(R-Jacksonville)
Chair, Judiciary
Term-limited
State Agencies &
Stakeholders
Florida Association of
MANAGING ENTITIES
FADAA’s 2016 LEGISLATIVE SESSION STATISTICS
1814
159
Bills Filed
Bills Tracked
Actively Engaged
9
64
IMPACTS
110
Priority Bills
IMPACT 1: SB 12
Comprehensive legislative package addressing the
delivery of mental health and substance abuse
services in Florida.
• Coordinated system of care, “No Wrong Door” policy
• Baker Act & Marchman Act
• County transportation plans
• Reinvestment grants
• Revenue maximization
• Managing entities
• Substance abuse advance directives
• Scope of practice
IMPACT 1: SB 12
Key Authors of SB 12
Rene Garcia
Gayle Harrell
Kathleen Peters
Chair, Health Care
Appropriations
Chair, Children
Families & Seniors
Subcommittee
V-Chair, Children
Families & Seniors
Subcommittee
(R-Hialeah)
(R-Stuart)
(R-St. Petersburg)
IMPACT 1: SB 12
Major Theme: Identifies Coordinated System of Care for individuals with
mental illness or substance use disorders and defines a “No Wrong Door”
model for accessing care.
Crisis (Acute Care)
Services
“No Wrong Door”
IMPACT 1: SB 12
Coordinated System of Care:
Essential Elements
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Community interventions (i.e. prevention, primary care ,diversion)
Receiving systems (Central, Coordinated, or Tiered)
Transportation
Crisis services
Case management (must be credentialed!)
Local care coordination
Outpatient services
Residential services
Hospital inpatient care
Aftercare
MAT/Medication management
Recovery support
Care plans
Goal
IMPACT 1: SB 12
Major Theme: Baker Act and Marchman Act
Baker Act:
• Authorizes county criminal courts to issue ex-parte and involuntary OP services
• “No Wrong Door” requiring appropriate facility to access individuals brought by LEO, EMT, etc
• Expands who may treat involuntary, but limits court order duration to 90 days
• Prohibits courts from ordering individual with TBI or dementia (without co-occurring SAMH) into state facility
Marchman Act:
• Revises criteria for involuntary assessment, stabilization and treatment
• Prohibits Clerk from requiring filing fees in Marchman Act
• Expands scope of practice on who may execute certificate for emergency admission
• Extends length of initial Order & Order for renewal from 60 to 90 days
• Provides guardian advocate for patients who are incompetent to consent to treatment for SUD
IMPACT 1: SB 12
Major Theme: The DCF & Managing Entity Roles
• The Department must support coordinated system, coordinate stakeholders
(MEs, payors, primary/behavioral health providers, other systems), promote
integration, coordinating discharge from facilities, and review performance of
MEs
• Managing Entity duties
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(in addition to contract management, data, metrics)
Community needs assessment (every 3 years)
Determine optimal array of services
Assist counties in developing designated receiving system and transportation plan
Collaborate & Develop strategies to divert from justice systems/child welfare
Promote care coordination and work to promote better outcomes
Develop comprehensive network
Seek various funding resources
Work with local homeless shelters, housing coalitions, etc.
• Attain national accreditation by June 30, 2019
IMPACT 1: SB 12
Other Themes:
• TRANSPORTATION PLANS - Collaborative approach: Due July 1, 2017
– May be single county or conglomerate of counties
– Must ensure individuals who meet criteria are transported
– Requires law enforcement to establish transportation policy
– Appropriate facility within receiving system must provide basic screening and triage for Marchman Act
• CRIMINAL JUSTICE, MENTAL HEALTH, & SUBSTANCE ABUSE
REINVESTMENT GRANTS
(Investment in diversion strategies and in treatment efforts SAMH disorders will result
in a reduced demand on state resources)
– Expands participants of committee
– Authorizes non-profit applicants
– Authorizes 3-year implementation award
IMPACT 1: SB 12
Other Themes:
REVENUE MAXIMIZATION: DEVELOP A PLAN!
Coordination between DCF and AHCA to apply for increased revenue funds for behavioral
health services
SINGLE CONSOLIDATED LICENSE – REDUCING BURDENS!
Coordination between DCF and AHCA to create a single, consolidated license for substance
abuse and mental health
IMPACT 1: SB 12
Other Themes:
• SUBSTANCE ABUSE ADVANCE DIRECTIVES
– Feasible? Due Jan. 1, 2017
• Scope of Practice
– Rural counties 2nd opinion by licensed physician or psych nurse
– Professional Certificate vs. Physician Certificate
• GUARDIAN ADVOCATES
– Limits who can serve as Guardian Advocate
– Requires 4 hours of training
• HOUSING
– Stable housing is critical
– Managing Entities to coordinate housing
• MEDICAID MANAGED CARE PLANS
– Requires MMA’s and Managing Entities to WORK TOGETHER to enhance integration and coordination
IMPACT 1: SB 12
IMPACT 1: SB 12
LIMITED NEW FUNDING FOR DIRECT SERVICES
• Opportunity to explore increased federal funding via Revenue
Maximization
• $10 million - Funding for housing benefit (MMA Specialty plan
($4 million - GR)
• $9 million - Increase in Reinvestment Grant (from $3 million)
• Funding for transition vouchers
• $20 million - Increased funding for Central Receiving System
grants (from $10 million)
• $5 million to DCF for FHFC to provide services to homeless
persons (Challenge Grant)
**Note: State agencies and the EOG are currently in the process of
reconciling their budgets. Final allocated amounts will be available on
October 15, 2016.
IMPACT 1: SB 12
• BEHAVIORAL HEALTH NEEDS ASSESSMENT by DCF to
Governor/Legislature: Dec 1 annually
• LOCAL RECEIVING SYSTEM PLAN by MEs and community
stakeholders to DCF: July 1, 2017 + every 3 years thereafter
• LOCAL TRANSPORTATION PLAN by counties, LEOs, providers to
MEs: July 1, 2017
• REVENUE MAXIMIZATION by DCF (+MEs + AHCA) to Legislature:
Dec. 31, 2016
• COMMUNITY NEEDS ASSESSMENT by MEs (+ public input) to DCF:
Sept 1, 2017
• GUARDIAN ADVOCATE TRAINING by DCF, approved by Courts (no
timeframe given)
• SA ADVANCE DIRECTIVES by DCF to Governor/Legislature: Jan. 1,
2017
IMPACT 2: MENTAL HEALTH
HB 439
Mental Health
Courts
Rep. Charles McBurney
(R-Jacksonville)
HB 769
Mental Health
Treatment
Rep. Kathleen Peters
(R-St. Petersburg)
• Codifies mental health diversionary courts into law,
just like drug courts
• Creates Forensic Hospital Diversion Pilot program in
Duval, Broward, and Dade Counties
• Expands Veterans Courts
• Authorizes county court judges to order an individual
into Involuntary Outpatient Treatment.
• Authorizes continued use of psychotropic medication
at state hospital
• Requires competency hearing within 30-days of notice
of commitment
• Requires defendant to be transported for status
hearings
• Allows judge to dismiss after 3 years
IMPACT 3: SCOPE OF PRACTICE
HB 977
Behavioral Health
Workforce
Rep. Kathleen Peters
(R-St. Petersburg)
• Tweaks background screening process for SA
• Authorizes PAs and ARNPs to prescribe
controlled substances
• Authorizes psychiatric nurses to prescribe
psychotropic medications to children and
adults for treatment of mental health
disorders
IMPACT 3: SCOPE OF PRACTICE
HB 375
Physicians
Assistants
Rep. Greg Steube
(R-Sarasota)
Authorizes physician
assistants to perform
services under a
physician's protocol
HB 423
Access to Health
Care Services
Rep. Cary Pigman
(R-Sebring)
Expands prescribing
powers of physician
assistants and advanced
registered nurse
practitioners
SB 1062
Nurse Licensure
Compact
Sen. Kelli Stargel
(R-Lakeland)
Authorizes Florida to
enter into the Nurse
Licensure Compact
IMPACT 4: DRUG PREVENTION
SB 964
PDMP
Sen. Denise Grimsley
(R-Sebring)
Allows the designee of a pharmacy,
prescriber, or dispenser (or
impaired practitioner consultant) to
access information in the
Prescription Drug Monitoring
Program (PDMP)
HB 1347
Illicit Drugs
Rep. Clay Ingram
(R-Pensacola)
Adds new “bath salts” to scheduled
list. Unlike previous years, this bill
creates avenues to be proactive in
banning the substances
IMPACT 5: HARM REDUCTION
SB 242
Infectious Disease
Elimination
Sen. Oscar Braynon
(D- Miami Gardens)
Creates needle exchange pilot with
the Univ. of Miami. Provides
educational materials and drug
treatment referral, along with HIV
and viral hepatitis screening
HB 1241
Ordering of
Medication
Rep. Jose Plasencia
(R-Orlando)
Authorizes a physicians “non-patient
specific standing order” to
pharmacists for naloxone
IMPACT 6: HEALTH INSURANCE
SB 422
Health Insurance
Coverage
Sen. Lizbeth
Benacquisto
(R-Ft. Myers)
Prohibits the requirement of prior
authorization for an abuse-deterrent opioid,
unless the policy imposes the same prior
authorization requirement for an opioid
without an abuse-deterrence labeling
claim.
IMPACT 7: SUPPORTIVE
HOUSING
• Provides greater flexibility and increases
accountably for programs receiving public
HB 1235
funds to address homelessness
Housing
• Equalizes the tenant groups (which include
Assistance
persons with special needs) for the State
Rep. Mike Miller
Apartment Incentive Loan Program (SAIL) funds
(R-Orlando)
to at least 10%;
• Defines rapid rehousing;
• Requires engagement with managing entities
• Redefines “rent subsidy” under the SHIP
program
IMPACT 8: HEALTH CARE FUNDING
OTHER RELEVANT FUNDING:
COMMUNITY ACTION TEAMS EXPANSION - $3.75 million
MENTAL HEALTH TRANSITIONAL BEDS - $4.73 million
AUDIO/VISUAL IN STATE MENTAL HOSPITALS - $1.64
FAMILY INTENSIVE TREATMENT TEAMS EXPANSION - $2.8 million
FORENSIC TRANSITIONAL BED EXPANSION - $3.5 million
INCREASE IN FORENSIC FLEX BEDS - $1.2 million
FORENSIC HOSPITAL MULTI-DISCIPLINARY TEAM PILOT - $3.26
million
• TEMPORARY HOUSING ASSISTANCE - $10.26 million
• FACT TEAM (St. Johns/Putnam Counties) - $1.5 million
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Sen. Rene Garcia
(R-Hialeah)
Chair, Health Care
Appropriations
Rep. Matt Hudson
(R-Naples)
Chair, Health Care
Appropriations
**Note: State agencies and the EOG are currently in the process of
reconciling their budgets. Final allocated amounts will be available on
October 15, 2016.
IMPACT 9: CRIMINAL JUSTICE
FUNDING
• COMMUNITY TREATMENT BEDS (replace non-recurring
with recurring)- $934,979
• Long-acting NALTREXONE (Vivitrol ®)to treat alcohol or
opioid-addicted offenders - $5 million
• Several projects across the state aimed at postadjudicatory drug courts
• Several veterans court programs across state
Sen. Joe Negron
(R-Palm City)
Chair, Criminal Justice
Appropriations
Rep. Larry Metz
• Restoring mental health court in Leon County
(R-Groveland)
Chair, Criminal Justice
Appropriations
**Note: State agencies and the EOG are currently in the process of reconciling
their budgets. Final allocated amounts will be available on October 15, 2016.
WHAT DOES ALL OF THIS
MEAN FOR YOU?
Get Involved! Be “In The Know”!
Thank You!
Questions?