The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Children, Families, and Elder Affairs
BILL: CS/SB 478
INTRODUCER: Committee on Children, Families, and Elder Affairs and Senator Brodeur
SUBJECT: Suicide Prevention
DATE: January 11, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Fav/CS
2. AHS
3. AP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 478 directs the Commission on Mental Health and Substance Abuse (the Commission)
adjunct to the Department of Children and Families (the DCF) to conduct a study examining the
following services and programs relating to suicide prevention:
The National Suicide Prevention Lifeline (the NSPL);
Crisis response services;
Strategies to improve linkages between NSPL infrastructure and crisis response services;
Available mental health block grant funds;
Funding sources available through Medicaid; and
Strategies to ensure that managing entities work with community stakeholders in furtherance
of supporting the NSPL and other crisis response services.
The bill requires the Commission to include the findings in a report due September 1, 2023, to
the following individuals:
The Governor;
The President of the Senate; and
The Speaker of the House of Representatives;
The bill may have an indeterminate negative fiscal impact to state government. See Section V.
Fiscal Impact Statement.
REVISED: BILL: CS/SB 478 Page 2
The bill is effective July 1, 2022.
II. Present Situation:
Suicide Prevention
Suicide is a major public health issue and a leading cause of death nationally, with complex
causes such as mental health and substance use disorders, painful losses, exposure to violence,
and social isolation.
1
Suicide rates increased every year from 1999 through 2018.
2
In 2017,
suicide was the second leading cause of death nationwide for persons aged 10–14, 15–19, and
20–24.
3
After stable trends from 2000 to 2007, suicide rates for persons aged 10–24 increased 56
percent from 2007 to 2017,
4
before declining 2 percent from 2018 to 2019.
5
In 2019, 3,427 Floridians died by suicide, representing a 3.5 percent decrease from the number
of deaths in 2018.
6
Over half of suicide deaths in 2019 involved a firearm.
7
According to
preliminary medical examiner’s reports, approximately 2,975 Floridians died from suicide in
2020, a decrease of 13 percent from 2019.
8
Commission on Mental Health and Substance Abuse
In 2021, the Legislature created the Commission, adjunct to the DCF, in response to
recommendations of the 20
th
Statewide Grand Jury.
9
The DCF is required to provide
administrative staff and support services for the Commission.
10
The purposes of the Commission include:
Examining the current methods of providing mental health and substance abuse services in
the state;
Improving the effectiveness of current practices, procedures, programs, and initiatives in
providing such services;
1
Substance Abuse and Mental Health Service Administration, Suicide Prevention, available at
https://www.samhsa.gov/suicide-prevention (last visited January 5, 2022).
2
The Centers for Disease Control and Prevention (The CDC), Suicide in the U.S. Declined During the Pandemic, available at
https://www.cdc.gov/nchs/pressroom/podcasts/2021/20211105/20211105.htm (last visited January 5, 2022).
3
Id.
4
Heron M., Curtin, S., Death Rates Due to Suicide and Homicide Among Persons Aged 10-24: United States, 2007-2017.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health
Statistics, available at https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf (last visited January 5, 2022).
5
The CDC, Changes in Suicide Rates – United States, 2018-2019, available at
https://www.cdc.gov/mmwr/volumes/70/wr/mm7008a1.htm (last visited January 5, 2022).
6
The DCF, 2020 Suicide Prevention Coordinating Council Annual Report, January 1, 2021, p. 7, available at
https://www.myflfamilies.com/service-programs/samh/prevention/suicide-
prevention/docs/2020%20SUICIDE%20PREVENTION%20COORDINATING%20COUNCIL%20annual%20report%20 -
%20FINAL.docx (last visited January 5, 2022).
7
Id.
8
The Tampa Bay Times, A Pandemic Plus: Florida Suicides Plummeted. Experts Worry it Won’t Last, available at
https://www.tampabay.com/news/florida-politics/2021/02/10/a-pandemic-plus-florida-suicides-plummeted-experts-worry-it-
wont-last/ (last visited January 5, 2022).
9
Chapter 2021-170, L.O.F.
10
Section 394.9086(1), F.S. BILL: CS/SB 478 Page 3
Identifying any barriers or deficiencies in the delivery of such services; and
Recommending changes to existing laws, rules, and policies necessary to implement the
Commission’s recommendations.
11
The Commission is comprised of 19 members, including the Secretaries of AHCA and DCF.
12
Membership of the Commission also includes:
Seven members appointed by the Governor, including:
o A psychologist licensed under ch. 490, F.S., practicing within the mental health delivery
system;
o A mental health professional licensed under ch. 491, F.S.;
o A representative of mental health courts;
o An emergency room physician;
o A representative from the field of law enforcement;
o A representative from the criminal justice system; and
o A representative of a child welfare agency involved in the delivery of behavioral health
services.
Five members appointed by the President of the Senate, including:
o A member of the Senate;
o A person living with a mental health disorder;
o A family member of a consumer of publicly funded mental health services;
o A representative of the Louis de la Parte Mental Health Institute within the University of
South Florida; and
o A representative of a county school district.
Five members appointed by the Speaker of the House of Representatives, including:
o A member of the House of Representatives;
o A representative of a treatment facility;
o A representative of a managing entity;
o A representative of a community substance abuse provider; and
o A psychiatrist licensed under chs. 458 or 459, F.S., practicing within the mental health
delivery system.
13
The Governor appoints the Commission chair from among its members, and members serve at
the pleasure of the officer who appointed the member.
14
A vacancy on the Commission is
required to be filled in the same manner as the original appointment.
15
The duties of the Commission include:
Conducting a review and evaluation of the management and functioning of existing publicly
supported mental health and substance abuse systems in the DCF, AHCA, and all other
relevant state departments;
11
Section 394.9086(2), F.S.
12
Section 394.9086(3)(a), F.S.
13
Id.
14
Section 394.9086(3)(b), F.S.
15
Id. BILL: CS/SB 478 Page 4
o At a minimum, such review must include a review of current goals and objectives,
current planning, service strategies, coordination management, purchasing, contracting,
financing, local government funding responsibility, and accountability mechanisms.
Considering the unique needs of people who are dually diagnosed;
Addressing access to, financing of, and scope of responsibility in the delivery of emergency
behavioral health care services;
Addressing the quality and effectiveness of current service delivery systems and professional
staffing and clinical structure of services, roles, and responsibilities of public and private
providers;
Addressing priority population groups for publicly funded services, identifying the
comprehensive delivery systems, needs assessment and planning activities, and local
government responsibilities for funding services;
Reviewing the implementation of ch. 2020-107, Laws of Fla.;
16
Identifying gaps in the provision of mental health and substance abuse services;
Providing recommendations on how managing entities may promote service continuity;
Making recommendations about the mission and objectives of state-supported mental health
and substance abuse services and the planning, management, staffing, financing, contracting,
coordination, and accountability of mechanisms best suited for the recommended mission
and objectives; and
Evaluating and making recommendations regarding the establishment of a permanent,
agency-level entity to manage mental health, behavioral health, substance abuse, and related
services statewide, including the:
o Duties and organizational structure;
o Resource needs and possible sources of funding;
o Impact on access to and the quality of services;
o Impact on individuals with behavioral health needs, and their families, who are currently
receiving services and those who are in need of services; and
o Relation to and integration with service providers, managing entities, communities, state
agencies, and provider systems.
17
The Commission is required to submit an initial report by September 1, 2022, and a final report
by September 1, 2023, to the Governor, President of the Senate, and Speaker of the House of
Representatives on its findings and recommendations on how to best provide and facilitate
mental health and substance abuse services.
18
16
HB 945 (2020) required managing entities to implement the features of a coordinated system of mental health care for
children and expands the use of mobile response teams (MRT) across the state. It required the Florida Mental Health Institute
within the University of South Florida to develop a model protocol for school use of MRTs. The bill also required the AHCA
and DCF to identify children and adolescents who are the highest users of crisis stabilization services and take action to meet
the needs of such children. Lastly, the bill required the AHCA to continually test the Medicaid managed care provider
network databases to ensure behavioral health providers are accepting enrollees and confirm that enrollees have access to
behavioral health systems.
17
Section 394.9086(4)(a), F.S.
18
Section 394.9086(5), F.S. BILL: CS/SB 478 Page 5
National Suicide Prevention Lifeline
The NSPL is a suicide prevention network of over 180 crisis centers that provides 24/7 service to
anyone in a suicidal crisis or emotional distress via a toll-free hotline.
19
The U.S. Substance
Abuse and Mental Health Services Administration (the SAMHSA) and Vibrant Emotional
Health launched the Lifeline on January 1, 2005.
20
The NSPL is independently evaluated by the Columbia University’s Research Foundation for
Mental Hygiene, and receives ongoing consultation and guidance from national suicide
prevention experts, consumer advocates, and other stakeholders through the NSPL’s Steering
Committee; Consumer/Survivor Committee; and Standards, Training and Practices Committee.
21
The NSPL grant is one component of the National Suicide Prevention Initiative, a multi-project
effort to reduce suicide, led by the SAMSHA’s Center for Mental Health Services.
22
Managing Entities (MEs)
The DCF administers a statewide system of safety-net services for substance abuse and mental
health (SAMH) prevention, treatment and recovery for children and adults who are otherwise
unable to obtain these services. SAMH programs include a range of prevention, acute
interventions (e.g. crisis stabilization), residential treatment, transitional housing, outpatient
treatment, and recovery support services. Services are provided based upon state and federally-
established priority populations.
23
In 2001, the Legislature authorized the DCF to implement behavioral health managing entities
(ME) as the management structure for the delivery of local mental health and substance abuse
services.
24
The implementation of the ME system initially began on a pilot basis and, in 2008,
the Legislature authorized DCF to implement MEs statewide.
25
Full implementation of the
statewide ME system occurred in 2013 and all geographic regions are now served by a managing
entity.
26
19
The National Suicide Prevention Lifeline, About, available at https://suicidepreventionlifeline.org/about/ (last visited
January 3, 2022).
20
Id.
21
Id.
22
The SAMSHA, National Suicide Prevention Initiative, available at
https://web.archive.org/web/20080201122133/http://mentalhealth.samhsa.gov/cmhs/nspi/ (last visited January 5, 2022).
23
See s. 394.674(1), F.S., for a complete list of priority populations.
24
Chapter 2001-191, L.O.F.
25
Chapter 2008-243, L.O.F.
26
Florida Tax Watch, Analysis of Florida’s Behavioral Health Managing Entity Models, p. 4, March 2015, available at
https://floridataxwatch.org/Research/Full-Library/ArtMID/34407/ArticleID/15758/Analysis-of-Floridas-Behavioral-Health-
Managing-Entities-Model (last visited January 5, 2022). BILL: CS/SB 478 Page 6
Mobile Response Teams
A mental health crisis can be can be caused by a variety of factors at any hour of the day.
27
Family members and caregivers of an individual experiencing a mental health crisis are often ill-
equipped to handle these situations and need the advice and support of professionals.
28
Law
enforcement or emergency medical technicians (EMTs) are frequently called to respond to
mental health crises and they may lack the training and experience to effectively handle the
situation.
29
Mobile crisis response teams (MRTs) can be beneficial in such instances.
MRTs provide readily available crisis care in a community-based setting and increase
opportunities to stabilize individuals in the least restrictive setting, thereby avoiding the need for
jail or hospital emergency department utilization.
30
Early intervention services are critical to
reducing involuntary examinations in minors and there are areas across the state where options
short of involuntary examination under the Baker Act are limited or nonexistent.
31
MRTs are
available to individuals under age 25 years of age, regardless of their ability to pay, and must be
ready to respond to any mental health emergency.
32
Telehealth can be used to provide direct
services to individuals via video-conferencing systems, mobile phones, and remote monitoring.
33
It can also be used to provide initial triage to determine if an in-person visit is needed to respond
to the crisis, assessments, and follow-up consultation.
34
The DCF established a framework to guide procurement of MRTs. This framework suggests that
the procurement:
Be conducted with the collaboration of local Sheriff’s Offices and public schools in the
procurement planning, development, evaluation, and selection process;
Be designed to ensure reasonable access to services among all counties in the ME’s service
region, taking into consideration the geographic location of existing mobile crisis teams;
Require services be available 24 hours per day, seven days per week with on-site response
time to the location of referred crises within 60 minutes of the request for services;
Require the Network Service Provider to establish formalized written agreements to establish
response protocols with local law enforcement agencies and local school districts or
superintendents;
Require access to a board-certified or board-eligible Psychiatrist or Psychiatric Nurse
Practitioner; and
27
The DCF, Mobile Response Teams Framework, (August 29, 2018), p. 4, available at
https://www.myflfamilies.com/service-programs/samh/publications/docs/Mobile%20Response%20Framework.pdf (last
visited January 5, 2022)(hereinafter cited as “MRT Framework”).
28
Id.
29
Id.
30
MRT Framework, p. 2
31
MRT Framework, p. 4.
32
Id.
33
MRT Framework, p. 7.
34
Id. BILL: CS/SB 478 Page 7
Provide for an array of crisis response services that are responsive to the individual and the
family needs, including screening, standardized assessments, early identification, or linkage
to community services as necessary to address the immediate crisis event.
35
Florida Medicaid
Medicaid provides medical coverage to low-income individuals and families.
36
The state and
federal government share the cost of the Medicaid program, and Medicaid services for Floridians
are administered by the Agency for Health Care Administration (the AHCA).
37
Medicaid
eligibility in Florida is determined either by the DCF or the Social Security Administration for
SSI recipients.
38
Florida has a Section 1115 waiver to use a comprehensive managed care delivery model for
primary and acute care services, the Statewide Medicaid Managed Care (SMMC) program.
39
Within the SMMC, the Managed Medical Assistance (MMA) program provides acute health care
services through managed care plans contracted with the AHCA in the 11 regions across the
state.
40
Coverage includes preventive care, acute care, therapeutics, pharmacy, transportation
services, and behavioral health services.
41
Current law requires each managed care plan to have an accurate and complete online database
of the providers in their networks, including information about their credentials, licensure, hours
of operation, and location.
42
Federal Assistance Related to COVID-19
CARES Act Funding
On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was
signed into law “to provide emergency assistance and health care response for individuals,
families, and businesses affected by the 2020 coronavirus pandemic.”
43
The CARES Act
included multiple resources for services and supports intended to benefit individuals with issues
related to mental health or substance use disorder, including:
$425 million for the SAMHSA, including:
o $250 million to Certified Community Behavioral Health Clinics (CCBHCs);
o $50 million for suicide prevention programs;
o $100 million for emergency-response spending that can target support where it is most
needed, such as outreach to those experiencing homelessness; and
35
MDT Framework, p. 2-3.
36
The DCF, Office of Economic Self-Sufficiency, Medicaid, available at https://www.myflfamilies.com/service-
programs/access/medicaid/ (last visited January 5, 2022).
37
Id.
38
Id.
39
Section 409.964, F.S.
40
See Agency for Health Care Administration, A Snapshot of the Florida Statewide Medicaid Managed Care Program,
https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/mma/SMMC_Snapshot.pdf (last visited January 5, 2022).
41
Id.
42
Section 409.967(2)(c)1., F.S.
43
Pub. L. No. 116-136 (2020). BILL: CS/SB 478 Page 8
o $15 million for tribal communities.
44
American Rescue Plan Act Funding
On March 11, 2021, the American Rescue Plan Act (the Rescue Act) was signed into law.
45
Under the Rescue Act, the SAMSHA distributed an additional $3 billion in funding for mental
health and substance abuse services, comprising the largest ever aggregate amount of funding for
mental health and substance use block grant programs.
46,
47
Specifically, the Community Mental
Health Services Block Grant (MHBG) Program and Substance Abuse Prevention and Treatment
Block Grant Program (SABG) dispersed $1.5 billion each to states and territories.
48
III. Effect of Proposed Changes:
The bill requires the Commission to study the following services and programs relating to
suicide prevention:
An overview of the National Suicide Prevention Lifeline (the NSPL);
An analysis of the current capacity of crisis response services, including services provided by
mobile response teams and centralized receiving facilities. The bill specifically requires the
analysis to include:
o The geographic area and total population served by each mobile response team;
o The average response time to each call made to the mobile response team;
o The number of calls each mobile response team could not respond to due to staffing
issues, travel distance, or other factors; and
o The veteran status and age groups of individuals receiving services from mobile response
teams.
Strategies to improve linkages between NSPL infrastructure and crisis response services;
Available mental health block grant funds which can be used to support the state’s NSPL
infrastructure, including potential funding available through opioid settlements, the CARES
Act, the American Rescue Plan Act, or other federal legislation;
Funding sources available through Medicaid, including potential funding available via
approval of a section 1115 waiver; and
44
The National Alliance on Mental Illness (NAMI), Information on the CARES Act for People with Mental Illness, available
at https://www.nami.org/About-NAMI/NAMI-News/2020/Information-on-the-CARES-Act-for-People-with-Mental-Illness
(last visited January 5, 2022).
45
Pub. L. No. 117-2 (2021).
46
A block grant is a noncompetitive, formula grant mandated by the U.S. Congress where eligible entities must submit an
annual application to demonstrate statutory and regulatory compliance in order to receive the formula-based funding by
Congress. The SAMHSA's block grants provide funding for substance abuse and mental health services, including the
Substance Abuse Prevention and Treatment Block Grant (Funds may be used to plan, implement, and evaluate activities that
prevent and treat substance abuse and promote public health) and the Community Mental Health Services Block Grant
(Funds may be used to provide comprehensive, community-based mental health services to adults with serious mental
illnesses and to children with serious emotional disturbances and to monitor progress in implementing a comprehensive,
community-based mental health system). See The SAMSHA, Substance Abuse and Mental Health Block Grants, available at
https://www.samhsa.gov/grants/block-grants (last visited January 5, 2022).
47
The U.S. Department of Health and Human Services, HHS Announces $3 Billion in American Rescue Plan Funding for
SAMHSA Block Grants to Address Addiction, Mental Health Crisis, available at
https://www.hhs.gov/about/news/2021/05/18/hhs-announces-3-billion-in-american-rescue-plan-funding-for-samhsa-block-
grants.html (last visited January 5, 2022).
48
Id. BILL: CS/SB 478 Page 9
Strategies to ensure that managing entities work with community stakeholders in furtherance
of supporting the NSPL and other crisis response services.
The bill requires that information on the overview of the state’s current suicide prevention
infrastructure be included in the Commission’s final report due to the Speaker, Senate President,
and Governor on September 1, 2023.
The bill is effective July 1, 2022.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
The bill does not appear to require cities and counties to expend funds or limit their
authority to raise revenue or receive state-shared revenues as specified by Article VII,
Section 18 of the Florida Constitution.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None identified.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
There may be an indeterminate negative fiscal impact to the DCF as the Commission is
adjunct to the DCF and will be conducting the study. The DCF may incur costs from
providing services and administrative support. BILL: CS/SB 478 Page 10
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
None.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Children, Families, and Elder Affairs on January 11, 2022:
The committee substitute:
Directs the Commission on Mental Health and Substance Abuse, rather than the Statewide
Office of Suicide Prevention within the DCF, to conduct the review assessing the adequacy
of the current infrastructure of Florida’s National Suicide Prevention Lifeline (NSPL) system
and other components of the state’s behavioral health crisis system; and
Requires that the overview of the state’s current suicide prevention infrastructure be included
in the Commission’s final report due to the Speaker, Senate President, and Governor on
September 1, 2023.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.