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 1340
INTRODUCER: Children, Families, and Elder Affairs and Senator Harrell
SUBJECT: Coordinated Systems of Care for Children
DATE: January 29, 2024
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rao Tuszynski CF Fav/CS
2. AED
3. FP
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1340 requires managing entities to provide care coordinators for each school district and
implement a coordinated system of care for children that have complex behavioral health needs.
The bill requires the school districts to address the recommendations of the care coordinator and
report annually to the Department of Education on the performance outcomes of the child’s
treatment.
The bill has an indeterminate, but likely insignificant, negative fiscal impact on school districts.
See Section V. Fiscal Impact Statement.
The bill is effective July 1, 2024.
II. Present Situation:
Florida Department of Children and Families
The Department of Children and Families (DCF) administers a statewide system of safety-net
services for substance abuse and mental health prevention, treatment, and recovery for children
and adults who are otherwise unable to obtain these services. These services are provided based
REVISED: BILL: CS/SB 1340 Page 2
upon state and federally established priority populations.
1
The DCF provides treatment for
Mental Health and SUD through a community-based provider system.
2
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.
3
The implementation of the ME system initially began on a pilot basis, and, in 2008, the
Legislature authorized the DCF to implement MEs statewide.
4
Full implementation of the
statewide managing entity system occurred in 2013 and all geographic regions are now served by
a ME.
5
Contracted MEs
The MEs are required to comply with various statutory duties, including, in part, to
6
:
Maintain a governing board;
Promote and support care coordination;
Develop a comprehensive list of qualified providers;
Monitor network providers’ performances;
Manage and allocate funds for services in accordance with federal and state laws, rules,
regulations, and grant requirements; and
Operate in a transparent manner, providing access to information, notice of meetings, and
opportunities for public participation in ME decision making.
The DCF contracts with seven MEs as shown in the map below and summarized as follows:
7
1
See chs. 394 and 397, F.S.
2
The DCF, Managing Entities, available at: https://www.myflfamilies.com/services/samh/providers/managing-entities (last
visited 1/24/24).
3
Chapter 2001-191, Laws of Florida; codified in s. 394.9082, F.S.
4
Chapter 2008-243, Laws of Florida
5
The DCF, Managing Entities, available at: https://www.myflfamilies.com/services/samh/providers/managing-entities (last
visited 1/24/24).
6
Section 394.9082(5), F.S.
7
The DCF, Managing Entities, available at: https://www.myflfamilies.com/services/samh/providers/managing-entities (last
visited 1/24/24). BILL: CS/SB 1340 Page 3
The MEs in turn contract with local service providers for the delivery of mental health and
substance abuse services.
8
Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated
system of care. A coordinated system of care means a full array of behavioral and related
services in a region or community offered by all service providers, participating either under
contract with a managing entity or by another method of community partnership or mutual
agreement.
9
A community or region provides a coordinated system of care for those suffering
from mental illness or substance abuse disorder through a “no-wrong-door” model,
10
to the
extent allowed by available resources.
11
There are several essential elements which make up a coordinated system of care, including:
8
Managing entities create and manage provider networks by contracting with service providers for the delivery of substance
abuse and mental health services.
9
Section 394.4573(1)(c), F.S.
10
Section 394.4573(1)(d), F.S.; This means a model for the delivery of acute care services to persons who have mental health
or substance use disorders, or both, which optimizes access to care, regardless of the entry point to the behavioral health care
system.
11
Section 394.4573(2)(b)2., F.S. BILL: CS/SB 1340 Page 4
Community interventions;
Case management;
Care coordination;
Outpatient services;
Residential services;
Transportation to receiving facilities;
Crisis services;
Hospital inpatient care;
Aftercare and post-discharge services;
Medication-assisted treatment and medication management;
Recovery support.
12
Case Management and Care Coordination
Under Ch. 394, Florida’s Mental Health Act, “case management” is defined as those direct
services provided to a client in order to assess his or her needs, plan or arrange services,
coordinate service providers, link the service system to a client, monitor service delivery, and
evaluate patient outcomes to ensure the client is receiving the appropriate services.
13
Florida’s Mental Health Act also defines “care coordination” as the implementation of deliberate
and planned organizational relationships and service procedures that improve the effectiveness
and efficiency of the behavioral health system by engaging in purposeful interactions with
individuals who are not yet effectively connected with services to ensure service linkage. The
purpose of care coordination is to enhance the delivery of treatment services and recovery
supports and to improve outcomes among priority populations.
14
Current law does not define
“care coordinator,” only “care coordination.”
Florida’s Children’s Substance Abuse Services
Part IX of Chapter 397, F.S., Children’s Substance Abuse Services, details a system with the
intent of achieving the following for children who are in need of substance abuse services:
Identification of the presenting problems and conditions of substance abuse through the use
of valid assessment.
Improvement in the child's ability to function in the family with minimum supports.
Improvement in the child's ability to function in school with minimum supports.
Improvement in the child's ability to function in the community with minimum supports.
Improvement in the child's ability to live drug-free.
Reduction of behaviors and conditions that may be linked to substance abuse, such as
unintended pregnancy, delinquency, sexually transmitted diseases, and smoking, and other
negative behaviors.
12
Section 394.4573(2), F.S.
13
Section 394.4573(1)(b), F.S.
14
Section 294.4573(1)(a), F.S. BILL: CS/SB 1340 Page 5
Increased return of children in state custody, drug-free, to their homes, or the placement of
such children, drug-free, in an appropriate setting.
15
Current law requires the DCF to determine if a child receiving substance abuse services is
complex enough to require a case manager.
16
A child‘s case manager is responsible for
periodically reviewing the utilization of services to determine if the child’s SUD treatment is in
compliance with the case plan.
17
A case manager’s activities are to be aimed at:
Implementing a treatment plan;
Advocacy;
Linking services providers to a child and family;
Monitoring services delivery; and
Collecting information to determine the effect of services and treatment.
18
Mental Health Services for Students
The Department of Education, through the Office of Safe Schools, promotes support, policies,
and practices that focus on prevention and early intervention to improve student mental health
and school safety.
19
Florida law requires instructional personnel to teach comprehensive health
education that addresses concepts of mental and emotional health, as well as substance use and
abuse.
20
Mental Health Assistance Program
In 2018, the Marjory Stoneman Douglas High School Public Safety Act created the Mental
Health Assistance Allocation within the Florida Education Finance Program.
21
The allocation is
intended to provide funding to assist school districts in establishing or expanding school-based
mental health care, train educators and other school staff in detecting and responding to mental
health issues, and connect children, youth, and families who may experience behavioral health
issues with appropriate services.
22
For the 2023-2024 school year $160,000,000 was appropriated for the allocation.
23
Each school
district receives a minimum of $100,000, and the remaining balance is allocated based on each
district’s proportionate share of the state’s total unweighted full-time equivalent student
enrollment.
24
15
Section 397.92, F.S.
16
Section 397.96(2), F.S.
17
Section 397.96(4), F.S.
18
Section 397.96(3), F.S.
19
Section 1001.212, F.S.
20
Section 1003.42(2)(n), F.S.
21
Chapter 2018-3, Laws of Fla.; codified as s. 1006.041, F.S.
22
Id.
23
Specific Appropriations 5 and 80, s. 2, ch. 2023-239, Laws of Fla.
24
Section 1011.62(13), F.S.; See also Florida Department of Education, Florida Education Finance Program 2023-24 Second
Calculation, p. 28, available at https://www.fldoe.org/core/fileparse.php/7507/urlt/2324FEFP2ndCalc.pdf (last visited
January 27, 2024). BILL: CS/SB 1340 Page 6
To receive allocation funds, a school district must develop and submit a detailed plan outlining
its local plan and expenditures to the district school board for approval.
25
The plan must focus on
a multitier system of supports to deliver evidence-based mental health care assessments,
diagnoses, interventions, treatment, and recovery services to students with one or more mental
health or co-occurring substance abuse diagnoses and to students at high risk of such diagnoses.
The provision of these services must be coordinated with a student’s primary mental health care
provider and with other mental health providers involved in the student’s care.
26
These plans
must include components such as:
27
Direct employment of school-based mental health service providers to expand and enhance
school-based student services and reduce the ratio of students to staff to align with nationally
recommended ratio models.
Contracts or interagency agreements with one or more local community behavioral health
providers or providers of Community Action Team services to provide behavioral health staff
presence and services at district schools.
Policies and procedures which ensure:
o Students who are referred to a school-based or community-based mental health service
provider for mental health screening are assessed within 15 days of referral;
o School-based mental health services are initiated within 15 days after identification and
assessment and community-based mental health services are initiated within 30 days after
school or district referral;
o Parents and of a student receiving services are provided information about other
behavioral services available through the student’s school or local community-based
behavioral health service providers; and
o Individuals living in a household with a student receiving services are provided
information about behavioral health services available through other delivery systems or
payors for which the individuals may qualify, if such services appear to be needed or
enhancement in such individual’s behavioral health would contribute to the improve
wellbeing of the student.
Strategies or programs to reduce the likelihood of at-risk students developing social,
emotional, or behavioral health problems; depression; anxiety disorders; suicidal tendencies;
or substance use disorders.
Strategies to improve the early identification of social, emotional, or behavioral problems or
substance use disorders; to improve the provision of early intervention services; and to assist
students in dealing with trauma and violence.
Procedures to assist a mental health services provider or a behavioral health provider, or a
school resource officer or school safety officer who has completed mental health crisis
intervention training with attempting to verbally de-escalate a student’s crisis situation before
initiating an involuntary examination.
Policies requiring that school or law enforcement personnel, prior to initiating an involuntary
examination, make a reasonable attempt to contact a mental health professional authorized to
initiate an involuntary examination, unless the student in crisis poses an imminent danger to
him- or herself or others.
25
Section 1006.041(1), F.S.
26
Section 1006.041(2), F.S.
27
Id. BILL: CS/SB 1340 Page 7
School districts are also required to report program outcomes and expenditures for the previous
fiscal year by September 30 each year.
28
The report must, at a minimum, provide the number of
each of the following:
29
Students who receive screenings or assessments.
Students who are referred to either school-based or community-based providers for services.
Students who receive either school-based or community-based interventions, or assistance.
School-based and community-based mental health providers, including licensure type, that
were paid out of the mental health assistance allocation.
Contract-based or interagency agreement-based collaborative efforts or partnerships with
community mental health programs, agencies, or providers.
III. Effect of Proposed Changes:
Section 1 of the bill creates s. 1006.05, F.S., to initiate a coordinated system of care for students
that are diagnosed with one or more mental health or any co-occurring substance use disorders,
and students at high risk of such diagnoses.
The bill defines “care coordinator” as a person who is responsible for participating in the
development and implementation of a services plan, linking service providers to a child or
adolescent and his or her family, monitoring the delivery of services, providing advocacy,
collecting information to determine the effect of services and treatment, and performing care
coordination as defined in s. 394.4573(1), F.S.
30
The bill requires managing entities to provide a care coordinator for each school district. The
care coordinator’s purpose is to implement a coordinated system of care for complex cases
involving children receiving substance abuse services. The bill requires the care coordinator to
ensure students receive necessary services and that appropriate funds such as Medicaid,
governmental or private health care, or insurance are used before accessing school-based mental
health treatment and support system funding to purchase community-based services.
The bill requires school districts that provides mental health assessments, diagnoses,
interventions, treatments, and recovery services to students diagnosed or at high risk of
diagnoses of mental health or co-occurring substance use disorders to:
Adhere to the guiding principles of mental health treatment and support system as provided
under s. 394.491.
Contract with managing entities to provide care coordination for students with complex
behavioral health needs who experience adverse outcomes due to unmet needs or an inability
to engage.
28
Section 1006.041(4), F.S.
29
Id.
30
Section 394.4573(1), F.S. defines ”care coordination” as the implementation of deliberate and planned organizational
relationships and service procedures that improve the effectiveness and efficiency of the behavioral health system by
engaging in purposeful interactions with individuals who are not yet effectively connected with services to ensure service
linkage. Examples of care coordination activities include development of referral agreements, shared protocols, and
information exchange procedures. The purpose of care coordination is to enhance the delivery of treatment services and
recovery supports and to improve outcomes among priority populations BILL: CS/SB 1340 Page 8
Address recommendations from the care coordinator upon a student’s return to the school
setting after experiencing an involuntary admission to an acute psychiatric care facility.
Meet the general performance outcomes for the child and adolescent mental health treatment
and support system.
Report annually to the Department of Education on the general performance outcomes for the
child and adolescent mental health treatment and support system, and how the funding for the
support system is allocated.
Section 2 of the bill provides an effective date of July 1, 2024.
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.
B. Private Sector Impact:
None.
C. Government Sector Impact:
There is an indeterminate negative fiscal impact on school districts, as the bill requires a
contract with MEs to provide care coordinators for students with complex behavioral
health needs. It is unknown how much of the current appropriation for mental health
support in schools may be re-allocated for this purpose. BILL: CS/SB 1340 Page 9
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill creates s. 1006.05 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Children, Families, and Elder Affairs on January 30, 2024:
The CS removes changes to ch. 397, F.S. that pertain to case management for complex
cases involving children who need substance abuse services within the Marchman Act, to
create a coordinated system of care for students in ch. 1006, F.S., and defines “care
coordinator” for use in s. 1006.05, 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.