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 1120
INTRODUCER: Committee on Children, Families, and Elder Affairs and Senator Rodriguez
SUBJECT: Child Welfare
DATE: January 26, 2022
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Berger Cox CF Fav/CS
2. AHS
3. AP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantive Changes
I. Summary:
CS/SB 1120 authorizes the Department of Children and Families (DCF) to place children who
meet the definition of a “child or adolescent who has an emotional disturbance” or a “child or
adolescent who has a serious emotional disturbance or mental illness” in therapeutic group
homes for mental health treatment without prior court approval under certain circumstances.
The DCF has established a process for credentialing an existing licensed therapeutic group home
as a qualified residential treatment program (QRTP) in accordance with rule and in compliance
with federal requirements for QRTPs. The bill ensures that the process the DCF has established
for credentialing an existing licensed therapeutic group home as a qualified residential treatment
program (QRTP) will result in placements that only occur in accordance with rule and in
compliance with federal requirements for QRTPs.
The bill makes a number of changes to definitions that apply to s. 39.407, F.S., relating, in part,
to medical, psychiatric, and psychological examination and treatment of child, to:
Add the term “therapeutic group home” and define such term to mean a 24-hour residential
program providing community-based mental health treatment and mental health support
services to children who meet the criteria in s. 394.492(5) or (6), F.S., in a nonsecure,
homelike setting.
Amend the definition of a “residential treatment center” or “residential treatment program” to
include a therapeutic group home as defined above.
REVISED: BILL: CS/SB 1120 Page 2
Clarify the definition of “suitable for residential treatment” or “suitability” to apply when the
criteria is met for a child to be placed if the child is expected to benefit from emotional, or
behavioral health treatment, in addition to mental health treatment.
The bill maintains current requirements for qualified evaluators that will be conducting
suitability assessments for placement in a residential treatment center or hospital. However, the
bill amends the qualifications of qualified evaluators for placement in a TGH, including those
credentialed as a QRTP, to require an evaluator to:
Be a psychiatrist licensed under ch. 458, F.S., or ch. 459, F.S.; a psychiatrist licensed under
ch. 459, F.S.; or a mental health counselor licensed under ch. 491, F.S.;
Have at least two experience in the diagnosis and treatment of serious emotional or
behavioral disturbance in children and adolescents; and
Not have any actual or perceived conflict of interest with any residential treatment center or
program.
The bill also statutorily updates the qualified evaluators’ process to reflect current practices
providing that the DCF, rather than the Agency for Health Care Administration (ACHA), must
appoint qualified evaluators to conduct suitability assessments and modifies the time frame for
providing a copy of the suitability assessment to a child’s guardian ad litem and the court.
Lastly, the bill authorizes the DCF to adopt rules to administer the provisions of the bill.
The bill will likely have an insignificant fiscal impact on state and local government. See Section
V. Fiscal Impact Statement.
This act shall take effect upon becoming a law.
II. Present Situation:
Family First Prevention Services Act
The federal Family First Prevention Services Act (FFPSA), included in the 2018 Bipartisan
Budget Act,
1
focuses on evidence-based services to prevent children from entering foster care;
limits reimbursement for congregate (group home) care; and makes changes affecting adoption
subsidies, reunification, and extended foster care supports. The FFPSA reformed the federal
child welfare funding streams. Unlike the previous Title IV-E provisions which primarily funded
out-of-home care for families with very low incomes, the FFPSA gives states the ability to earn
federal Title IV-E matching funds in support of certain prevention services provided on a time-
limited basis that avoid an out-of-home placement for children without regard to family income.
In providing for children and their families meeting eligibility requirements, the FFPSA provides
for the reimbursement of specific federally approved, evidence-based services that address
mental health, substance abuse, family counseling, and parent skills training. The FFPSA also
limits federal funding for group homes placements.
2
1
H.R. 1862 of 2018. Pub.L. 115-123
2
The DCF, The Florida Center for Child Welfare FFPSA Updates, available at Florida's Center for Child Welfare | FFPSA
Updates (usf.edu); see also the National Conference of State Legislatures (NCSL), Family First Prevention Services Act, BILL: CS/SB 1120 Page 3
The Title IV- E Prevention Services Clearinghouse was established by the U.S. Department of
Health and Human Services Administration for Children and Families (ACF) to conduct an
objective and transparent review of research on programs and services intended to provide
enhanced support to children and families and prevent foster care placements. The Prevention
Services Clearinghouse, developed in accordance with the FFPSA and codified in Title IV-E of
the Social Security Act, rates programs and services as well-supported, supported, promising, or
does not currently meet criteria.
3
Congress made the FFPSA effective October 1, 2018, but gave states the opportunity to delay
implementation of select provisions of the law.
4
Florida received approval to delay the
implementation of the FFPSA until October 1, 2021.
5
Mental Health Residential Treatment Programs
Residential Treatment Centers for Children and Adolescents (RTC) are 24 hour residential
programs, including therapeutic group homes, licensed by the ACHA.
6
These centers were
designed to provide mental health treatment and services to children under the age of 18 who
have been diagnosed as having mental, emotional, or behavioral disorders.
7
All providers
rendering Florida Medicaid therapeutic group care services to recipients must be in compliance
with the provisions of the Florida Medicaid Therapeutic Group Care Services Coverage Policy,
July 2017.
8
Section 394.4781, F.S., authorizes the DCF to pay a portion of the costs associated with
residential care for children who have been diagnosed with severe emotional disturbance, who
are recommended to need a residential level of mental health treatment by a Florida licensed
psychologist or psychiatrist, and who are not eligible for public or private insurance.
9
Due to
limited funds, the DCF must review applications monthly to approve or deny applications for
treatment according to criteria:
10
The severity level of the child’s mental health;
The financial means of the child’s family;
The availability of the needed residential care; and
available at https://www.ncsl.org/research/human-services/family-first-prevention-services-act-ffpsa.aspx (all sites last
visited January 18, 2022).
3
See the U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation, Title IV-E
Prevention Services Clearinghouse, 2018 – 2023, available at https://www.acf.hhs.gov/opre/project/title-iv-e-prevention-
services-clearinghouse-2018-2023 (last visited January 18, 2022).
4
The NCSL, Family First Prevention Services Act, available at https://www.ncsl.org/research/human-services/family-first-
prevention-services-act-ffpsa.aspx (last visited January 18, 2022).
5
The DCF, Agency Analysis for SB 900 (2021), p. 4, (on file with Senate Committee on Children, Families, and Elder
Affairs).
6
See the ACHA, Residential Treatment Centers for Children and Adolescents, available at
https://ahca.myflorida.com/mchq/health_facility_regulation/hospital_outpatient/rtc.shtml (last visited January 20, 2022)
7
Id.
8
Rule 59G-4.295, F.A.C.
9
Section 394.4781, F.S.
10
See the DCF, Children's Mental Health Residential Treatment, available at https://www.myflfamilies.com/service-
programs/samh/childrens-mental-health/residential-treatment.shtml (last visited January 18, 2022). BILL: CS/SB 1120 Page 4
The funds available to the DCF.
11
Mental health treatment is aimed to assist children to live successfully in their community and
with their families. Placement into a residential mental health treatment center is made only after
careful consideration and assessments. Before a placement, all other avenues of less restrictive
treatment are weighed and must be deemed non appropriate.
12
Only if the needed services cannot
be provided in a less restrictive environment, a residential mental health treatment program is
then considered for the child.
13
Qualified Residential Treatment Programs
Qualified Residential Treatment Programs (QRTP) are a new placement setting created by the
FFPSA which were implemented in Florida in May 2021.
14
Placement of a child in a QRTP is
for the specific purpose of addressing the child’s emotional and behavioral health needs through
observation, diagnosis, and treatment in a treatment setting.
15
Florida currently has five licensed QRTPs with a total capacity of 50 beds. A QRTP must obtain
a residential treatment center license through the AHCA and a credential from the DCF, which
aligns the QRTP with all federal requirements.
16
Each facility that aims to be a QRTP must meet
the licensing requirements set forth in s. 394.875, F.S., and the credentialing standards set forth
in Rule 65C-46.021, F.A.C., in addition to, in part:
Completing an application for credential as a QRTP;
Providing a copy of their active Florida license issued by the ACHA;
Completing a background screening as specified in rule;
Working in conjunction with a qualified evaluator to conduct all assessments;
Completing training in trauma-informed care, including to submit to the regional licensing
authority a staff roster outlining the dates of completion for the trauma-informed care
training;
Employing registered or licensed nursing staff and other licensed clinical staff that, in part,
are onsite in accordance with the QRTP trauma-informed treatment model and who are
available 24 hours a day, 7 days a week to respond;
Becoming accredited by one of the approved organizations;
Providing high level supportive services for youth;
Developing treatment plans, discharge, and aftercare plans; and
Informing the DCF regional licensing authority within one business day of any disciplinary
actions executed by the AHCA.
17
11
Id.
12
Id.
13
Id.
14
The DCF, Agency Analysis for SB 1120, January 21, 2022, p. 2-3 (on file with Senate Committee on Children, Families,
and Elder Affairs) (hereinafter cited “The DCF SB 1120 Analysis”). Florida has defined QRTPs through rulemaking
authority under Rule 65C-28.021, F.A.C.
15
Id.
16
Id.
17
Rule 65C-46.021, F.A.C. BILL: CS/SB 1120 Page 5
The DCF states that reimbursement for the service delivery is available for children placed in the
QRTP through the bundled specialized therapeutic group home fee as a result of the state agency
collaborative approach to license and credential a QRTP.
18
The FFPSA requires an assessment using an evidence-based tool within 30 days of placement.
The DCF states it has identified the Child and Adolescent Needs and Strengths (CANS) –
Trauma version as the evidence-based tool which has been incorporated into the suitability
assessment.
19
Although Florida law does not contemplate QRTP assessments, any child in need
of placement in a QRTP is required to submit to a suitability assessment to align with s. 39.407,
F.S.
Specific Children In Need of Placement in a RTC or QRTP
RTCs and QRTPS serve children and adolescents with emotional disturbance or serious
emotional disturbance or mental illness. Section 394.492(5), F.S., defines a “child or adolescent
who has an emotional disturbance” to mean a person under 18 years of age who is diagnosed
with a mental, emotional, or behavioral disorder of sufficient duration to meet one of the
diagnostic categories specified in the most recent edition of the Diagnostic and Statistical
Manual of the American Psychiatric Association, but who does not exhibit behaviors that
substantially interfere with or limit his or her role or ability to function in the family, school, or
community.
20
Additionally, s. 394.492(6), F.S., defines a “child or adolescent who has a serious emotional
disturbance or mental illness” to mean a person under 18 years of age who:
Is diagnosed as having a mental, emotional, or behavioral disorder that meets one of the
diagnostic categories specified in the most recent edition of the Diagnostic and Statistical
Manual of Mental Disorders of the American Psychiatric Association; and
Exhibits behaviors that substantially interfere with or limit his or her role or ability to
function in the family, school, or community, which behaviors are not considered to be a
temporary response to a stressful situation.
Both of these terms do not include a child or adolescent who meets the criteria for involuntary
placement under s. 394.467(1), F.S., also known as the Baker Act.
21
Licensure of Mental Health Residential Treatment Facilities
Under Rule 65E-4.016 of the Florida Administrative Code (FAC), to be licensed as a mental
health residential treatment facility an applicant must provide a long term, homelike residential
environment that provides care, support, assistance and limited supervision in daily living to
adults diagnosed with a serious and persistent major mental illness who do not have another
primary residence.
22
Any facility licensed as a residential treatment facility must sustain a 60 day
18
The DCF SB 1120 Analysis, p. 3.
19
Id.
20
The definition further provides that that the emotional disturbance must not be considered to be a temporary response to a
stressful situation.
21
The Baker Act is contained in ch. 394, F.S.
22
Rule 65E-4.016, F.A.C. BILL: CS/SB 1120 Page 6
average or greater length of stay of residents, except as specifically provided for in s.
394.875(11), F.S.
23
Qualified Evaluators and Suitability Assessments for Placement
Section 39.407(6), F.S., requires the DCF to conduct an examination and suitability assessment if
it is believed that a child needs residential treatment.
24
The DCF must conduct a suitability
assessment prior to placing children in a Psychiatric Residential Treatment Facility (PRTF/SIPP)
and Specialized Therapeutic Group Homes (STGH).
25
The suitability assessment must be conducted by a qualified evaluator who meets the following
requirements:
Is a psychiatrist or a psychologist licensed in Florida who has at least 3 years of experience in
the diagnosis and treatment of serious emotional disturbances in children and adolescents;
Has at least 2 years’ experience working with children or adolescents involved in the child
welfare system of care;
Has no actual or perceived conflict of interest with an in-patient or STGH facility; and
Has completed training pertaining to the population of children in the child welfare system.
26
The Qualified Evaluator Network (QEN) was established by Magellan in July, 2001 to provide
assessment services for children in the care and custody of the DCF. The DCF contracts with the
QEN who is responsible for recruiting qualified evaluators to conduct suitability assessments.
Each assessment must provide an independent, professional assessment of suitability for
residential treatment for mental health.
27
QENs are intended to prevent premature or
inappropriate referrals to residential psychiatric placements and utilizing the QEN results in a
return to community-based services as soon as clinically possible.
28
Once a qualified evaluators receives a referral, the contract requires that a recommendation be
rendered within 11 business days from receipt of the referral.
29
The DCF states that at this time
there are only 18 qualified evaluators statewide who are completing assessments on an average
of six business days. Through the implementation of teleconference, the QEN was able to reduce
the time it takes to complete an assessment with final submission by the QEN to the Community-
Based Care lead agency.
30
Initially, the suitability assessment was conducted by a qualified evaluator appointed through a
contract with Magellan procured by the AHCA. During this time, the DCF was the primary
23
Id.
24
Section 39.407(6), F.S.
25
See the DCF, Suitability for Residential Placement Guidelines, available at https://www.myflfamilies.com/service-
programs/community-based-care/docs/SuitabilityAssessmentGuidance.pdf (last visited January 20, 2022).
26
Section 39.407(6), F.S.
27
See Magellan Healthcare, Qualified Evaluator Network, available at
https://www.magellancompletecareoffl.com/documents/2019/09/florida-qen-
overview.pdf/#:~:text=All%20Qualified%20Evaluators%20are%20required,in%2Dpatient%20or%20STGH%20facility (last
visited January 21, 2022).
28
Id.
29
The DCF SB 1120 Analysis, p. 2-3.
30
Id., p. 3. BILL: CS/SB 1120 Page 7
executor the contract, but the AHCA held the rule making authority, set the fee schedule for the
evaluators, and maintained the list of providers. However, in 2016, the contract under Magellan
was transferred entirely to the DCF to determine the qualified evaluator requirements.
31
This
contract transfer allotted for a more cohesive execution of services. The DCF currently continues
to contract with this third-party vendor for the management of the QEN.
32
Under s. 39.407(6)(d), F.S., the timeframe to provide the assessments to the guardian ad litem
and the court is “immediately” upon placement.
33
Rulemaking Authority
The DCF does not currently have broad rulemaking authority, as the rulemaking authority for
suitability assessments is currently split between the DCF and AHCA, specifically requiring the:
DCF to adopt rules for implementing timeframes for the completion of suitability
assessments by qualified evaluators and a procedure that includes timeframes for completing
the 60-day independent review by the qualified evaluators of the child’s progress toward
achieving the goals and objectives of the treatment plan.
ACHA to adopt rules for the registration of qualified evaluators, the procedure for selecting
the evaluators to conduct the reviews required under s. 39.407, F.S., and a reasonable, cost-
efficient fee schedule for qualified evaluators.
34
Florida Medicaid Program
The Medicaid program is a joint federal-state program that finances health coverage for
individuals, including eligible low-income adults, children, pregnant women, elderly adults, and
persons with disabilities.
35
The Centers for Medicare & Medicaid Services (CMS) within the
U.S. Department of Health and Human Services (HHS) is responsible for administering the
federal Medicaid program. Florida Medicaid is the health care safety net for low-income
Floridians. Florida’s program is administered by the AHCA and financed through state and
federal funds.
36
A Medicaid state plan is an agreement between a state and the federal government describing
how the state administers its Medicaid programs. The state plan establishes groups of individuals
covered under the Medicaid program, services that are provided, payment methodologies, and
other administrative and organizational requirements.
In order to participate in Medicaid, federal law requires states to cover certain population groups
(mandatory eligibility groups) and gives states the flexibility to cover other population groups
31
See Magellan Complete Care, Am I Eligible, available at https://www.magellancompletecareoffl.com/enrollment-and-
renewal/are-you-eligible/; see also Magellan Complete Care; Qualified Evaluator
Network (QEN), p. 7, available at PowerPoint Presentation (magellanofflorida.com) (all sites last visited January 20, 2022).
32
See Magellan of Florida, QEN Training Manual, available at
https://www.magellanofflorida.com/documents/2019/09/2019-florida-qen-training-manual.pdf/ (last visited January 20,
2022).
33
Section 39.407(6)(d), F.S.
34
Section 39.407(6)(i), F.S.
35
Medicaid.gov, Medicaid, available at https://www.medicaid.gov/medicaid/index.html (last visited January 23, 2022).
36
Section 20.42, F.S. BILL: CS/SB 1120 Page 8
(optional eligibility groups).
States set individual eligibility criteria within federal minimum
standards. The AHCA may seek an amendment to the state plan as necessary to comply with
federal or state laws or to implement program changes. States send state plan amendments to the
federal CMS for review and approval.
37
Florida Medicaid enrollees generally receive benefits through one of two service-delivery
systems: fee-for-service (FFS) or managed care. Under FFS, health care providers are paid by the
state Medicaid program for each service provided to a Medicaid enrollee. Under managed care,
the AHCA contracts with private managed care plans for the coordination and payment of
services for Medicaid enrollees. The state pays the managed care plans a capitation payment, or
fixed monthly payment, per recipient enrolled in the managed care plan.
In Florida, the majority of Medicaid recipients receive their services through a managed care
plan contracted with the AHCA under the Statewide Medicaid Managed Care (SMMC) program.
The SMMC program has two components, the Managed Medical Assistance (MMA) program
and the Long-term Care program. Florida’s SMMC offers a health care package covering both
acute and long-term care. The SMMC benefits are authorized by federal authority and are
specifically required in ss. 409.973 and 409.98, F.S.
The AHCA contracts with managed care plans on a regional basis to provide services to eligible
recipients. The MMA program, which covers most medical and acute care services for managed
care plan enrollees, was fully implemented in August 2014 and was re-procured for a period
beginning December 2018 and ending in 2023.
III. Effect of the Bill
The bill amends s. 39.407, F.S, authorizing the DCF to place a child or adolescent who meet the
definition of a “child or adolescent who has an emotional disturbance” or a “child or adolescent
who has a serious emotional disturbance or mental illness” in therapeutic group homes for
mental health treatment without prior court approval under certain circumstances.
The bill makes a number of changes to definitions that apply to s. 39.407, F.S., relating, in part,
to medical, psychiatric, and psychological examination and treatment of child, to:
Add the term “therapeutic group home”, which is not currently defined in ch. 39, F.S., and
define such term to mean a 24-hour residential program providing community-based mental
health treatment and mental health support services to children who meet the criteria in s.
394.492(5) or (6), F.S., in a nonsecure, homelike setting;
Amend the definition of a “residential treatment center” or “residential treatment program” to
include a therapeutic group home as defined above; and
Expanding the definition of “suitable for residential treatment” or “suitability” to include if
the child is expected to benefit from emotional, or behavioral health treatment, in addition to
mental health treatment.
37
Medicaid.gov, Medicaid State Plan Amendments, available at https://www.medicaid.gov/medicaid/medicaid-state-plan-
amendments/index.html (last visited January 23, 2022). BILL: CS/SB 1120 Page 9
Through the above definitions and the application of such terms throughout s. 39.407, F.S., the
bill ensures that the process the DCF has established for credentialing an existing licensed
therapeutic group home as a QRTP will result in placements that only occur in accordance with
rule and in compliance with federal requirements for QRTPs.
The bill also statutorily updates the qualified evaluators’ process to reflect current practices
providing that the DCF, rather than the ACHA, must appoint qualified evaluators to conduct
suitability assessments.
The bill maintains current requirements for qualified evaluators that will be conducting
suitability assessments for placement in a residential treatment center or hospital. However, the
bill amends the qualifications of qualified evaluators for placement in a TGH, including those
credentialed as a QRTP, to require an evaluator to:
Be a psychiatrist licensed under ch. 458, F.S., or ch. 459, F.S.; a psychiatrist licensed under
ch. 459, F.S.; or a mental health counselor licensed under ch. 491, F.S.;
Have at least two years of experience in the diagnosis and treatment of serious emotional or
behavioral disturbance in children and adolescents; and
Not have any actual or perceived conflict of interest with any residential treatment center or
program.
These changes to the qualifications will expand the pool of qualified evaluators for conducting
suitability assessments for STGH and QRTP placements to more than the 18 currently used for
PRTF/SIPP suitability assessments.
38
The bill also amends s. 39.407, F.S., requiring the DCF to provide the guardian ad litem and the
court with a copy of the assessment by the qualified evaluator within five days after the DCF’s
receipt of the assessment, rather than immediately upon placement as required in current law.
The bill authorizes the DCF to adopt rules to administer the provisions of s. 39.407, F.S., rather
than just the time frames for completion of suitability as is provided for in current law.
This act shall take effect upon becoming a law.
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.
38
The DCF states that the third-party vendor contracted for the management of the QEN estimates that this change in
requirements will increase the pool of potentially qualified evaluators to approximately 2,000. The DCF SB 1120 Analysis, p.
4. BILL: CS/SB 1120 Page 10
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:
The bill will likely have an indeterminate impact on the DCF due to the additional
licensing and evaluator requirements. The bill also maximizes Medicaid claiming as well
as capacity of federally Title IV-E funded QRTP placements.
39
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends section 39.407 of the Florida Statutes.
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 25, 2022.
The committee substitute:
39
The DCF SB 1120 Analysis, p. 6. BILL: CS/SB 1120 Page 11
Modifies the definition of the term “therapeutic group home” (TGHs) to remove the
cross-reference to s. 419.001, F.S., and to remove the limitation of 16 beds for the
TGHs; and
Expands persons who can be qualified evaluators to include psychiatrists licensed
under ch. 459, F.S., in addition to those licensed under ch. 458, F.S.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.