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 Health Policy
BILL: SB 914
INTRODUCER: Senator Garcia
SUBJECT: Suicide Prevention
DATE: March 17, 2023
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Favorable
2. Brown Brown HP Favorable
3. RC
I. Summary:
SB 914 modifies statutory provisions governing confidentiality for peer support communications
between a first responder and a first responder peer. The bill allows certain first responder
organizations to designate first responder peers and clarifies that first responder peers include
active, volunteer, and retired first responders. The bill also permits diagnosis of post-traumatic
stress disorder in first responders via telehealth for the purposes of obtaining worker’s
compensation benefits.
The bill 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 extends the statutory repeal date of the Commission from September 1, 2023, to
September 1, 2026.The bill also requires the Commission to submit interim reports, beginning
January 1, 2023, annually thereafter through January 1, 2025, and a final report due September 1,
2026, to the Governor; the President of the Senate; and the Speaker of the House of
Representatives. The bill requires the Commission to include the findings of the suicide
prevention study in the final report due September 1, 2026.
REVISED: BILL: SB 914 Page 2
The bill is unlikely to have a significant negative impact on state government and may have an
indeterminate impact on certain affiliated first responder organizations as defined in the bill. See
Section V. Fiscal Impact Statement.
The bill is effective July 1, 2023.
II. Present Situation:
Suicide Prevention
Suicide is a major public health issue and a leading cause of death nationally.
1
In 2020, 45,979
suicide deaths were reported across the U.S., while an estimated 12.2 million American adults
seriously thought about suicide, 3.2 million planned a suicide attempt, and 1.2 million attempted
suicide.
2
Suicide rates increased every year from 2000 through 2018.
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 two percent from 2018 to 2019.
5
Provisional data indicate that both the number
and the rate of suicides nationally increased four percent from 2020 to 2021, after two
consecutive years of decline in 2019 and 2020.
6
In 2020, 3,113 Floridians died by suicide, representing a 10-percent decrease from the number of
deaths in 2019.
7
According to provisional data, approximately 3,325 Floridians died from suicide
in 2021, an increase of approximately seven percent from 2020.
8
1
The Centers for Disease Control and Prevention (The CDC), Facts About Suicide, available at
https://www.cdc.gov/suicide/facts/index.html (last visited March 17, 2023).
2
Id.
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 March 17, 2023).
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 March 17, 2023).
6
The CDC, Suicide Increases in 2021 After Two Years in Decline, available at
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220930.htm (last visited March 17, 2023).
7
The DCF, 2022 Suicide Prevention Coordinating Council Annual Report, January 1, 2023, p. 11 (on file with the Senate
Committee on Children, Families, and Elder Affairs).
8
The Florida Department of Health, FLHealthCharts – Death Count Query System, available at
https://www.flhealthcharts.gov/FLQUERY_New/Death/Count (last visited March 17, 2023). BILL: SB 914 Page 3
First Responders
Under ss. 111.09 and 112.1815, F.S., a first responder is a law enforcement officer,
9
firefighter,
10
or an emergency medical technician or paramedic
11
employed by state or local government.
12
Additionally, volunteer law enforcement officers, firefighters, and emergency medical
technicians and paramedics engaged by the state or a local government are considered first
responders of the state or local government.
13
First responders are often exposed to incidents of death and destruction that can result in post-
traumatic stress disorder (PTSD), depression, and suicide. A study by the Ruderman Family
Foundation revealed that 35 percent of police officers have suffered from PTSD and 46.8 percent
of firefighters have experienced suicidal thoughts.
14
Firefighters and police officers are both
more likely to die by suicide than in the line of duty.
15
Further, according to a 2015 article
published in the Journal of Emergency Medical Services, a survey of 4,000 first responders
found that 6.6 percent had attempted suicide, which is more than 10 times the rate in the general
population.
16
Volunteer Firefighters
A volunteer firefighter is an individual who holds a current and valid Volunteer Firefighter
Certificate of Completion issued by the Division of State Fire Marshal under s. 633.408, F.S.
17
Approximately 12 million Florida citizens depend on volunteer firefighters to protect their
community.
18
To keep these residents safe, it is important for individuals to volunteer for local
9
Section 943.10(1), F.S. defines the term “law enforcement officer” to mean “any person who is elected, appointed, or
employed full time by any municipality or the state or any political subdivision thereof; who is vested with authority to bear
arms and make arrests; and whose primary responsibility is the prevention and detection of crime or the enforcement of the
penal, criminal, traffic, or highway laws of the state. The term includes all certified supervisory and command personnel
whose duties include, in whole or in part, the supervision, training, guidance, and management responsibilities of full-time
law enforcement officers, part-time law enforcement officers, or auxiliary law enforcement officers but does not include
support personnel employed by the employing agency.”
10
Section 633.102(9), F.S. defines the term “firefighter” to mean “an individual who holds a current and valid Firefighter
Certificate of Compliance or Special Certificate of Compliance issued by the Division of State Fire Marshal within the
Department of Financial Services.”
11
Section 401.23(12), F.S. defines the term “emergency medical technician” to mean “a person who is certified by the
Department of Health to perform basic life support.” Section 401.23(18), F.S., defines the term “paramedic” to mean “a
person who is certified by the Department of Health to perform basic and advanced life support.”
12
Section 125.01045, F.S.
13
Id.
14
Miriam Heyman, Jeff Dill & Robert Douglas, The Ruderman White Paper on Mental Health and Suicide of First
Responders, at p. 12, available at
https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/First%20Responder%20White%20Paper_Final%20(2)
.pdf (last visited March 17, 2023).
15
Id. at p. 7.
16
Fire Rescue News, Increasing Suicide Rates Among First Responders Spark Concerns, available at
https://www.firerescue1.com/fire-ems/articles/222673018-Increasing-suicide-rates-among-first-responders-spark-concern/
(last visited March 17, 2023).
17
See s. 633.408, F.S.
18
The Florida Department of Financial Services, Division of State Fire Marshal, Florida Volunteer Firefighter Information,
available at
https://www.myfloridacfo.com/division/sfm/volff#:~:text=More%20than%20200%20departments%20throughout%20Florida
%20utilize%20volunteers%20to%20sustain%20operations (last visited March 17, 2023). BILL: SB 914 Page 4
departments.
19
More than 200 departments throughout Florida utilize volunteers to sustain
operations.
20
First Responders Suicide Deterrence Task Force
In 2020, the Legislature created the First Responders Suicide Deterrence Task Force within the
Statewide Office of Suicide Prevention, which is housed within the DCF and coordinates
education and training curricula on suicide prevention efforts for veterans and service
members.
2122
The most recent report of the task force, published on July 1, 2022, included the findings of a
survey conducted by the 2
nd
Alarm Project,
23
a nonprofit organization established to offer
comprehensive, evidence-based resiliency initiatives in first responder communities.
24
According to the survey, upwards of 24 percent of first responders reported provisional diagnosis
of PTSD, 52.3 percent reported depression; 39.1 percent reported anxiety; 38.3 percent reported
harmful levels of drinking; and 15.1 percent are at higher risk for suicide.
25
The findings
indicated generally higher rates of these issues among respondents who are single certified
emergency medical services (EMS) professionals and among dual certified/combined Fire/EMS
personnel who serve as advanced life support/transport providers.
26
Peer Support
Research has shown that social support provided by peers is beneficial to those in recovery from
substance abuse or mental illness. There are four primary types of social support provided by
peers:
Emotional: where a peer demonstrates empathy, caring, or concern to bolster a person’s self-
esteem (e.g., peer mentoring or peer-led support groups).
Informational: where a peer shares knowledge and information to provide life or vocational
skills training (e.g., parenting classes, job readiness training, or wellness seminars).
Instrumental: where a peer provides concrete assistance to help others accomplish tasks (e.g.,
child care, transportation, and help accessing health and human services).
Affiliation-based: where a peer facilitates contacts with other people to promote learning of
social skills, create a sense of community, and acquire a sense of belonging (e.g., recovery
centers, sports league participation, and alcohol- or drug-free socialization opportunities).
27
19
Id.
20
Id.
21
Section 14.2019, F.S.
22
Chapter 2020-39, L.O.F.
23
The 2
nd
Alarm Project, Our Services, available at https://2ndalarmproject.org/ (last visited March 17, 2023).
24
The DCF, First Responder Suicide Deterrence Task Force 2022 Annual Report, available at
https://myflfamilies.com/sites/default/files/2022-
11/FINAL%202022%20First%20Responder%20Suicide%20Deterrence%20Task%20Force%20Report.pdf (last visited
March 17, 2023).
25
Id. at p. 8.
26
Id.
27
The Substance Abuse and Mental Health Services Administration (The SAMSHA), Center for Substance Abuse Treatment,
What Are Peer Recovery Support Services?, p. 2, available at https://store.samhsa.gov/system/files/sma09-4454.pdf; See also
the DCF, Florida Peer Services Handbook at p. 4-5, 2016, available at
https://www.myflfamilies.com/sites/default/files/2022-11/Peer%20Guidance_2016.pdf (all sites last visited March 17, 2023). BILL: SB 914 Page 5
First Responder Peer Support
A survey by the Journal of Emergency Medical Services revealed that first responders were less
likely to contemplate suicide when they felt supported and encouraged at work.
28
One study
showed that while some firefighters reported positive experiences with professional mental
health help, others felt more distressed after such intervention.
29
Alternatively, these firefighters
reported benefits from peer support, such as bonding with their fire crew after negative incidents,
which can reduce the stigma, scheduling difficulties, lack of access, lack of trust, and fear or
repercussions that may prevent first responders from seeking mental health care.
30
In 2020, the Legislature recognized the need for mental health counseling for first responders by
adopting confidentiality provisions intended to encourage peer support programs for law
enforcement officers, firefighters, emergency medical technicians, paramedics, and 911 public
safety telecommunicators.
31
A
“first responder peer” is defined as a person who:
Is not a health care practitioner as that term is defined in s. 456.001, F.S.;
32
Has experience working as or with a first responder regarding any physical or emotional
conditions or issues associated with the first responder’s employment; and
Has been designated by the first responder’s employing agency to provide peer support and
has received training for this purpose.
33
First responder peers are prohibited from divulging information from, or testifying about, a peer
support communication in a civil, criminal, administrative, or disciplinary proceeding, unless:
The first responder peer is a defendant in a civil, criminal, administrative, or disciplinary
proceeding arising from a complaint filed by the first responder who was a party to the peer
support communication, in which case such information may be divulged but is limited to the
scope of the proceeding;
The first responder who was a party to the peer support communication agrees, in writing, to
allow the first responder peer to testify about or divulge information related to the peer
support communications;
Based on the peer support communications, the first responder peer suspects that the first
responder who was a party to the peer support communications has committed a criminal act
or intends to commit a criminal act. There is no liability on the part of, and no cause of action
of any nature may arise against, the first responder peer for disclosing relevant information;
or
28
Journal of Emergency Medical Services, Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide,
available at https://www.jems.com/2015/09/28/survey-reveals-alarming-rates-of-ems-provider-stress-and-thoughts-of-
suicide/ (last visited March 17 2023).
29
The SAMSHA, First Responders: Behavioral Health Concerns, Emergency Response, and Trauma, (May 2019) at p. 10
and 12, available at https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-
may2018.pdf (last visited March 17, 2023).
30
Id.
31
Chapter 2020-104, L.O.F.
32
Section 456.001, F.S., defines “health care practitioner” to mean “any person licensed under chapter 457; chapter 458;
chapter 459; chapter 460; chapter 461; chapter 462; chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; part I,
part II, part III, part V, part X, part XIII, or part XIV of chapter 468; chapter 478; chapter 480; part I, part II, or part III of
chapter 483; chapter 484; chapter 486; chapter 490; or chapter 491.”
33
Section 111.09(1)(b), F.S. BILL: SB 914 Page 6
There are articulable facts or circumstances that would lead a reasonable, prudent person to
fear for the safety of the first responder who was a party to the peer support communication,
another person, or society, and the first responder peer communicates the information only to
a potential victim and law enforcement or other appropriate authorities. There is no liability
on the part of, and no cause of action of any nature may arise against, the first responder peer
for disclosing relevant information.
34
Currently, the infrastructure for peer support teams is varied across Florida depending on the
agency or department.
35
Many larger agencies contain high-functioning, sustainable peer support
models, and will often share these peer support teams with smaller departments throughout the
state.
36
The Orlando Fire Department houses the oldest peer support model in the state and
operates within a best practice model.
37
Training for peer support teams is often provided by
reputable behavioral health organizations (e.g. the 2nd Alarm Project) or within an agency’s
behavioral health unit (e.g., Ft. Lauderdale Police Department; Tallahassee Fire Mental Health
Wellness Program).
38
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.
39
The DCF is required to provide
administrative staff and support services for the Commission.
40
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;
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.
41
The Commission is composed of 19 members, including the secretaries of the AHCA and the
DCF.
42
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;
34
Section 111.09(2), F.S.
35
The DCF, First Responder Suicide Deterrence Task Force 2021 Annual Report, p. 6, available at
https://www.myflfamilies.com/sites/default/files/2022-11/First%20Responder%20Task%20Force%202021%20Report%20-
%20Final%20-%208-4-21.pdf (last visited March 17, 2023),
36
Id.
37
Id.
38
Id.
39
Chapter 2021-170, L.O.F.
40
Section 394.9086(1), F.S.
41
Section 394.9086(2), F.S.
42
Section 394.9086(3)(a), F.S. BILL: SB 914 Page 7
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.
43
The Governor appoints the Commission chair from among its members, and members serve at
the pleasure of the officer who appointed the member.
44
A vacancy on the Commission is
required to be filled in the same manner as the original appointment.
45
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, the AHCA, and all other
relevant state departments;
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;
43
Id.
44
Section 394.9086(3)(b), F.S.
45
Id. BILL: SB 914 Page 8
Reviewing the implementation of ch. 2020-107, L.O.F.;
46
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.
47
The Commission is required to submit an initial report by January 1, 2023, 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.
48
The Commission issued its initial report,
containing ten preliminary recommendations, on January 1, 2023.
49
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.
50
The U.S. Substance
Abuse and Mental Health Services Administration (the SAMHSA) and Vibrant Emotional
Health launched the Lifeline on January 1, 2005.
51
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
46
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.
47
Section 394.9086(4)(a), F.S.
48
Section 394.9086(5), F.S.
49
The DCF, Commission on Mental Health and Substance Abuse, Legislative Report, January 1, 2023, pp. 11-25 (on file
with the Senate Committee on Children, Families, and Elder Affairs).
50
The National Suicide Prevention Lifeline, About, available at https://suicidepreventionlifeline.org/about/ (last visited
March 17, 2023).
51
Id. BILL: SB 914 Page 9
Committee; Consumer/Survivor Committee; and Standards, Training, and Practices
Committee.
52
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.
53
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.
54
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.
55
The implementation of the ME system initially began on a pilot basis and, in 2008,
the Legislature authorized DCF to implement MEs statewide.
56
Full implementation of the
statewide ME system occurred in 2013 and all geographic regions are now served by a managing
entity.
57
Mobile Response Teams
A mental health crisis can be can be caused by a variety of factors at any hour of the day.
58
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.
59
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.
60
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.
61
Early intervention services are critical to
reducing involuntary examinations in minors and there are areas across the state where options
52
Id.
53
The SAMSHA, National Suicide Prevention Initiative, available at
https://web.archive.org/web/20080201122133/http://mentalhealth.samhsa.gov/cmhs/nspi/ (last visited March 17, 2023).
54
See s. 394.674(1), F.S., for a complete list of priority populations.
55
Chapter 2001-191, L.O.F.
56
Chapter 2008-243, L.O.F.
57
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 March 17, 2023).
58
The DCF, Mobile Response Teams Framework, (August 29, 2018), p. 4, available at https://www.lsfnet.org/wp-
content/uploads/2018/10/Solicitation-2018-007-Mobile-Response-Team-APPEN-B-Mobile-Response-Framework.pdf (last
visited March 17, 2023) (hereinafter cited as “MRT Framework”).
59
Id.
60
Id.
61
MRT Framework, p. 2 BILL: SB 914 Page 10
short of involuntary examination under the Baker Act are limited or nonexistent.
62
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.
63
Telehealth can be used to provide direct
services to individuals via video-conferencing systems, mobile phones, and remote monitoring.
64
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.
65
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
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.
66
Florida Medicaid
Medicaid provides medical coverage to low-income individuals and families.
67
The state and
federal government share the cost of the Medicaid program, and Medicaid services for Floridians
are administered by the AHCA.
68
Medicaid eligibility in Florida is determined either by the DCF
or the Social Security Administration for SSI recipients.
69
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.
70
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
62
MRT Framework, p. 4.
63
Id.
64
MRT Framework, p. 7.
65
Id.
66
MDT Framework, p. 2-3.
67
The DCF, Office of Economic Self-Sufficiency, Medicaid, available at https://www.myflfamilies.com/Medicaid (last
visited March 17, 2023).
68
Id.
69
Id.
70
Section 409.964, F.S. BILL: SB 914 Page 11
state.
71
Coverage includes preventive care, acute care, therapeutics, pharmacy, transportation
services, and behavioral health services.
72
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.
73
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.”
74
The CARES Act
included multiple resources for services and supports intended to benefit individuals with issues
related to mental health or substance use disorder. The CARES Act specifically provided $425
million for the SAMHSA, including:
$250 million to Certified Community Behavioral Health Clinics (CCBHCs);
$50 million for suicide prevention programs;
$100 million for emergency-response spending that can target support where it is most
needed, such as outreach to those experiencing homelessness; and
$15 million for tribal communities.
75
American Rescue Plan Act Funding
On March 11, 2021, the American Rescue Plan Act (the Rescue Act) was signed into law.
76
Under the Rescue Act, the SAMSHA distributed an additional $3 billion in funding for mental
health and substance abuse services, representing the largest-ever aggregate amount of funding
for mental health and substance use block grant programs.
77, 78
Specifically, the Community
71
See The 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 March 17, 2023).
72
Id.
73
Section 409.967(2)(c)1., F.S.
74
Pub. L. No. 116-136 (2020).
75
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 March 17, 2023).
76
Pub. L. No. 117-2 (2021).
77
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 March 17, 2023).
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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.samhsa.gov/newsroom/press-
announcements/202105181200#:~:text=The%20Substance%20Abuse%20and%20Mental,substance%20use%20block%20gra
nt%20programs (last visited March 17, 2023). BILL: SB 914 Page 12
Mental Health Services Block Grant (MHBG) Program and Substance Abuse Prevention and
Treatment Block Grant Program (SABG) allocated $1.5 billion each to states and territories.
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III. Effect of Proposed Changes:
First Responder Peer Support
SB 914 amends s. 111.09, F.S., permitting affiliated first responder organizations, in addition to
a first responder employing agency, to designate first responder peers for the purpose of
providing peer support. The bill amends s. 111.09, F.S., defining “affiliated first responder
organization” to mean an organization including, but not limited to:
Regularly organized volunteer firefighting departments or associations;
Regularly organized ambulance services; and
Combination fire departments, as that term is defined in s. 633.135(1), F.S.
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The bill also clarifies that a person is eligible to serve as a first responder peer if he or she has
experience working as or with a first responder, including as:
An active first responder;
A volunteer first responder; or
A retired first responders.
The bill amends s. 112.1815, F.S., to allow diagnosis of PTSD in first responders via telehealth
for the purposes of obtaining worker’s compensation benefits.
The bill amends s. 394.9086, F.S., requiring the Commission to study the following services and
programs relating to suicide prevention:
An overview of the the NSPL;
An analysis of the current capacity of crisis response services, including services provided by
mobile response teams and centralized receiving facilities, including specifically an analysis
of:
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 Rescue Act, or other federal legislation;
Funding sources available through Medicaid, including potential funding available via
approval of a Section 1115 waiver; and
79
Id.
80
Section 633.135, F.S., defines “combination fire department” to mean “a fire department composed of a combination of
career and volunteer firefighters.” BILL: SB 914 Page 13
Strategies to ensure that managing entities work with community stakeholders in furtherance
of supporting the NSPL and other crisis response services.
The bill also amends s. 394.9086, F.S., requiring the Commission to submit interim reports,
beginning January 1, 2023, annually thereafter through January 1, 2025, and a final report due
September 1, 2026, to:
The Governor;
The President of the Senate; and
The Speaker of the House of Representatives.
This will require the Commission to submit a total of two additional interim reports and moves
the due date of the final report from September 1, 2023, to September 1, 2026. The bill also
extends the statutory repeal date of the Commission from September 1, 2023, to September 1,
2026.
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, 2026.
The bill is effective July 1, 2023.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
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. BILL: SB 914 Page 14
B. Private Sector Impact:
None.
C. Government Sector Impact:
The DCF states that expenditures for the bill can be absorbed within existing resources.
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The bill may have a positive impact on affiliated first responder organizations who wish
to designate first responder peers; however, because the decision to engage in this process
is voluntary, the fiscal impact on these organizations is indeterminate.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 111.09, 112.1815,
and 394.9086.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.
81
The Department of Children and Families, Agency Analysis of SB 478 (2022 Session) at p. 5 (on file with the Senate
Committee on Children, Families, and Elder Affairs).