STORAGE NAME: h1091a.HHS
DATE: 4/14/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: CS/HB 1091
TITLE: Substance Abuse and Mental Health Care
SPONSOR(S): Gonzalez Pittman
COMPANION BILL: CS/SB 1240 (Calatayud)
LINKED BILLS: None
RELATED BILLS: CS/SB 1240 (Calatayud)
Committee References
Human Services
16 Y, 0 N, As CS
Health & Human Services
SUMMARY
Effect of the Bill:
CS/HB 1091 makes substantive changes regarding mental health and substance use services. The bill recognizes
Florida’s 988 Suicide and Crisis Lifeline (988 Lifeline) as a component of the coordinated system of care and
requires DCF to authorize and provide oversight of the 988 Lifeline call centers.
The bill establishes clear roles for the courts and administrative law judges regarding continued involuntary
services proceedings. The bill expands the training requirements for court-appointed forensic evaluators, requiring
annual training and coverage of specified topics.
The bill requires clinical psychologists to have at least three years of clinical experience to authorize the transfer of
a patient from voluntary to involuntary status.
Further, the bill authorizes DCF to issue licenses to medication-assisted treatment providers without conducting an
annual needs assessment.
Fiscal or Economic Impact:
None
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Mental Health
Florida’s 988 Suicide and Crisis Lifeline and the Coordinated System of Care
The federal government established the 988 Suicide and Crisis Lifeline in 2022 with the intention of turning over
its oversight and funding responsibilities to the states in 2026.
1
The Department of Children and Families (DCF) is the entity responsible for mental health and suicide prevention
in Florida and for managing the state’s 988 Suicide and Crisis Lifeline call centers. Florida’s 988 Suicide and Crisis
Lifeline connects callers with highly trained crisis counselors who provide early intervention services to
individuals that are experiencing a suicidal crisis, mental health and/or substance abuse crisis, or emotional
1 The National Suicide Hotline Designation Act of 2020, designated 988 as the universal telephone number for the nation’s suicide
prevention and mental health crisis hotline to simplify calling and to redirect mental health crises from nation’s 911 emergency system. The
988 dialing code became available in 2022. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
2
distress.
2 Although, DCF administers the state’s 988 Suicide and Crisis Lifeline call centers under a federal grant,
current law does not grant DCF oversight of these centers.
Crisis Services
Crisis services provided by a crisis call center, such as Florida’s 988 Suicide and Crisis Lifeline, are key components
of a crisis response system because the call centers help ensure that an individual who is experiencing an acute
mental health or emotional crisis has someone to talk to while in crisis. Current law does not recognize Florida’s
988 Suicide and Crisis Lifeline as a crisis service or as a component of the coordinated system of care.
The bill recognizes the 988 Suicide and Crisis Lifeline as a crisis service and a component of the coordinated
system of care. The bill designates DCF to provide oversight of the 988 Suicide and Crisis Lifeline call centers and
prohibits a call center from conducting crisis services unless authorized by DCF. The bill requires a 988 Suicide and
Crisis Lifeline call center to meet national accreditation standards and be authorized by DCF to receive 988 calls,
texts, or other forms of communication in the state. (Sections 1, 6, and 7)
The bill also authorizes DCF to adopt rules establishing the following:
Standards for authorizing 988 Suicide and Crisis Lifeline call centers, including but not limited to, service
delivery, quality of care and performance outcomes; quality assurance standards; and
The adequacy and consistency of 988 call center’s personnel certifications and minimum training
standards. (Section 7)
Further, the bill directs DCF to require authorized 988 Suicide and Crisis Lifeline call centers to implement a
cohesive plan to achieve statewide interoperability with the 911 system . The bill also authorizes DCF to adopt
rules relating to 988/911 interoperability. (Section 7)
Involuntary Services
Involuntary Outpatient Services
Pursuant to s. 394.4655, F.S., a court may order a person to involuntary outpatient services if the person meets the
criteria for such services under s. 394.467, F.S.
3 Section 394.467, F.S., establishes the criteria, processes and
procedures for ordering a person to involuntary services, which includes both involuntary outpatient services and
involuntary inpatient placement.
The bill conforms a cross-reference in s. 394.4655, F.S., to clarify that the criteria for ordering a person to
involuntary outpatient services, and the requirements and processes for placement, including, but not limited to
recommendations for involuntary outpatient services, petitions, appointment of counsel, and hearings on
involuntary outpatient services are provided in s. 394.467, F.S. (Section 4)
Continued Involuntary Services
Petitions for continued involuntary services are either filed and heard in the appropriate county or circuit court or
handled administratively by the Division of Administrative Hearings (DOAH). Hearings for petitions filed with the
courts are presided over by a judge and hearings for petitions filed with DOAH are presided over by an
administrative law judge. Current law addresses the roles and responsibilities of the courts when handling
continued involuntary services proceedings, but is in some places unclear on the role of the administrative law
judge.
2 DCF, 988 Florida Lifeline, available at
https://www.myflfamilies.com/988#:~:text=Managed%20by%20the%20Florida%20Department,to%20a%20highly%20trained%20crisis,
(last visited March 14, 2025).
3 S. 394.4655, F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
The bill clarifies the roles and responsibilities of the courts and the administrative law judges regarding hearings
for continued involuntary services. The bill requires immediate scheduling of hearings and directs the clerk of
DOAH, as applicable, to provide copies of the petition for continued involuntary services and the patient’s
individualized plan of continued services to DCF and other specified individuals. The bill also authorizes the
administrative law judge to waive a patient’s attendance at a hearing, if certain criteria are met, and to issue orders
for continued involuntary services if it is determined that the patient meets the criteria for such services. (Section
5)
Voluntary Admissions and Transfer to Involuntary Status
Current law requires a clinical psychologist to have three years of postdoctoral experience in the practice of clinical
psychology to authorize the transfer of a patient from voluntary to involuntary status. The three years of
postdoctoral experience includes two years of postdoctoral experience acquired prior to licensure and one year of
clinical experience acquired after licensure. The bill requires a clinical psychologist to have at least three years
clinical experience, post licensure, to authorize the transfer of a patient from voluntary to involuntary status.
(Section 3)
State Forensic System
Forensic Evaluators
DCF Forensic Evaluator Training Development Requirements
DCF is responsible for developing and contracting with accredited institutions to provide training for mental health
professionals on the application of protocols and procedures for performing forensic evaluations and providing
reports to the courts. Current law does not require the training to include information on statutory updates or
updates to rules related to competency restoration, nor does it require the training to include information
regarding industry best practices or alternative treatment and placement options.
The bill requires the training to include, but not be limited to, information on the statutes and rules related to
competency restoration, evidence-based practices, least restrictive treatment alternatives and placement options.
Implementing these requirements ensures that the most up-to-date information is provided to forensic evaluators
during training, which will help the evaluators stay informed about the latest laws, regulations, best practices and
treatment and placement options. These training requirements will also help to improve forensic evaluator
performance and compliance with statutory and regulatory requirements, and promote uniform reporting to the
courts. (Section 10)
Forensic Evaluator Training Requirements
Current law requires forensic evaluators (experts) to complete forensic evaluator training. Forensic evaluators
who complete training, and meet certain other requirements, are placed on a list of available experts, from which
criminal courts may appoint experts to determine the competency of defendants in certain criminal cases. This list
is maintained and updated by DCF and provided to the courts annually. Current law does not require forensic
evaluators to complete continual training and education to remain on the list of experts that DCF provides to the
court or require experts remain up to date on the latest protocols, procedures and statutory changes regarding
forensic evaluations.
The bill requires forensic evaluators to complete initial and annual forensic evaluator training provided by DCF. If
the evaluator performs juvenile evaluations, the evaluator must annually complete juvenile forensic competency
evaluation training. The bill also requires existing evaluators as of July 1, 2024, to complete DCF-provided
continuing education training by July 1, 2026, to remain active on the list that DCF provides to the court. (Section
11)
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
4
Mental Competence Evaluation
A criminal defendant is considered incompetent to proceed if the defendant does not have sufficient present ability
to consult with his or her lawyer with a reasonable degree of rational understanding or the defendant has no
rational, as well as factual, understanding of the proceedings.
4 If an expert finds that a defendant is incompetent to
proceed, the expert must report to the court the recommended treatment for the defendant to attain competence
to proceed and specify the availability of acceptable treatment, and whether treatment is available in the
community.
5
Current law does not establish criteria for determining the availability of acceptable treatments within the
community for the defendant. The bill requires the expert to, at a minimum, use current information or resources
on less restrictive treatment alternatives, as described in s. 916.12(4)(c), F.S., and those obtained from training and
continuing education provided by DCF to determine which acceptable treatments are available within the
community. The treatment alternatives described in s. 916.12(4)(c), F.S., include at a minimum, mental health
services, treatment services, rehabilitative services, support services, and case management services, which may
be provided by or within multidisciplinary community treatment teams, such as Florida Assertive Community
Treatment, conditional release programs, outpatient services or intensive outpatient treatment programs, and
supportive employment and supportive housing opportunities in treating and supporting the recovery of the
patient. (Section 12)
Substance Use Disorder
Medication-Assisted Treatment
DCF is required to conduct an annual needs assessment to determine the need for additional medication-assisted
treatment (MAT) services throughout the state. The required federal data used in the methodology for
determining such need is often outdated. Due to the lag in data, the annual needs assessments do not reflect the
true need for MAT providers in Florida and has resulted in a lack of new applicants and MAT licenses issued by the
department. Current law does not permit DCF to issue MAT licenses outside of the annual needs determination
process, which creates a barrier to access to care and treatment for those with opioid use disorders.
The bill removes the requirement for DCF to conduct an annual needs assessments before issuing a license to a
MAT provider. (Section 8)
The bill makes technical changes and updates cross-references. (Sections 2, 9, 13, and 14)
The bill provides an effective date July 1, 2025. (Section 15)
RULEMAKING:
The bill authorizes the Department of Children and Families to adopt rules establishing the process and minimum
standards for authorization of 988 Suicide and Crisis Lifeline call centers. The bill also authorizes DCF to adopt
rules relating to the implementation of a statewide plan for 988 Suicide and Crisis Lifeline call centers to achieve
interoperability with the 911 system.
Lawmaking is a legislative power; however, the Legislature may delegate a portion of such power to executive
branch agencies to create rules that have the force of law. To exercise this delegated power, an agency must
have a grant of rulemaking authority and a law to implement.
4 s. 916.12(1), F.S.
5 Id. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
5
RELEVANT INFORMATION
SUBJECT OVERVIEW:
Mental Health System
Mental illness affects millions of people in the United States each year. It is estimated that more than one in five
adults live with a mental illness.
6 In 2023, approximately 22.8 percent of adults experienced mental illness.
7
Mental Health Safety Net Services
The Department of Children and Families (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.
Behavioral Health Managing Entities
In 2001, the Legislature authorized DCF to implement behavioral health managing entities (ME) as the
management structure for the delivery of local mental health and substance abuse services.
8 The implementation
of the ME system initially began on a pilot basis and, in 2008, the Legislature authorized DCF to implement MEs
statewide.
9 MEs were fully implemented statewide in 2013, serving all geographic regions.
DCF currently contracts with seven MEs for behavioral health services throughout the state. These entities do not
provide direct services; rather, they allow the department’s funding to be tailored to the specific behavioral health
needs in the various regions of the state.
10
Coordinated System of Care
Managing entities are required to promote the development and implementation of a coordinated system of care.
11
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.
12 A community or region provides a coordinated system of care
for those with a mental illness or substance use disorder through a no-wrong-door model, to the extent allowed by
available resources. If funding is provided by the Legislature, DCF may award system improvement grants to
managing entities.
13 MEs must submit detailed plans to enhance crisis services based on the no-wrong-door model
or to meet specific needs identified in DCF’s assessment of behavioral health services in this state.
14 DCF must use
performance-based contracts to award grants.
15
There are several essential elements which make up a coordinated system of care, including:
16
6 National Institute of Mental Health (NIH), Mental Illness, https://www.nimh.nih.gov/health/statistics/mental-illness (last visited March 6,
2025).
7 Substance Abuse and Mental Health Services Administration (SAMHSA), Key Substance Use and Mental Health Indicators in the United
States: Results from the 2023 National Survey on Drug Use and Health
https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-
national.pdf, (last visited March 6, 2025).
8 Ch. 2001-191, Laws of Fla.
9 Ch. 2008-243, Laws of Fla.
10 DCF, Managing Entities, available at https://www.myflfamilies.com/services/samh/provIders/managing-entities, (last visited February
23, 2025).
11 S. 394.9082(5)(d), F.S.
12 S. 394.4573(1)(c), F.S.
13 S. 394.4573(3), F.S. The Legislature has not funded system improvement grants.
14 Id.
15 Id.
16 S. 394.4573(2), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
6
Community interventions;
Case management;
Care coordination;
Outpatient services;
Residential services;
Hospital inpatient care;
Aftercare and post-discharge services;
Medication assisted treatment and medication management; and
Recovery support.
A coordinated system of care must include, but is not limited to, the following array of services:
17
Prevention services;
Home-based services;
School-based services;
Family therapy;
Family support;
Respite services;
Outpatient treatment;
Crisis stabilization;
Therapeutic foster care;
Residential treatment;
Inpatient hospitalization;
Case management;
Services for victims of sex offenses;
Transitional services; and
Trauma-informed services for children who have suffered sexual exploitation.
Crisis Response System
A crisis response system, which is a network of crisis services, processes and structures put in place to help those
who are in crisis, is an essential element of a coordinated system of care. Crisis services are short-term evaluation,
stabilization, and brief intervention services provided to a person experiencing an acute mental or emotional crisis
or an acute substance abuse crisis to prevent further deterioration of the person’s mental health.
18 Crisis services
are provided in settings such as a crisis stabilization unit, an inpatient unit, a short-term residential treatment
program, a detoxification facility or an addictions receiving facility, at the site of the crisis by a mobile response
team, or at a hospital on an outpatient basis.
19
The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) identifies three components to an
ideal crisis response system: someone to talk to, someone to respond, and somewhere to go. Florida has various
crisis support services that address the different components. The 988 Suicide and Crisis Lifeline helps to ensure
that an individual has someone to talk to. Mobile response teams respond to the crisis, and the centralized
receiving facilities, crisis stabilization units, and hospitals provide some place to go.
As the single state authority for mental health and substance abuse, DCF administers the Statewide Office for
Suicide Prevention and facilitates the development of strategies for preventing suicide. The agency also oversees
and sets policy for mobile response team services, centralized receiving facilities, and crisis stabilization units, as
well as other crisis services. Although, the 988 Suicide and Crisis Lifeline is an important component of the crisis
response system, current law, does not recognize the 988 Suicide and Crisis Lifeline as a component of crisis
services in Florida.
17 S. 394.495(4), F.S.
18 S. 394.67, F.S.
19 Id. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
7
National 988 Suicide and Crisis Lifeline
The National Suicide Hotline Designation Act of 2020, designated 988 as the universal telephone number for the
nation’s suicide prevention and mental health crisis hotline.
20 This designation was made to simplify calling and to
redirect mental health crises currently coming into the nation’s 911 emergency system. The 988 dialing code
became available nationally in July 2022.
21
The 988 Suicide and Crisis Lifeline (988 Lifeline or Lifeline) connects callers who are in suicidal crisis or emotional
distress to free and confidential emotional support.
22 The 988 Lifeline is composed of a national network of over
200 local, independent, and state-funded crisis centers. Vibrant Emotional Health (Vibrant) is the administrator of
the service, which is funded by SAMHSA.
23
Florida’s 988 Suicide and Crisis Lifeline System
All 988 Lifelines nationwide must be fully accredited by Vibrant to take 988 calls, texts, or chats. In Florida, there
are 12 active 988 Lifeline or local crisis call centers that are a part of the 988 network.
24 Ten of the state’s 988
Lifeline centers are affiliated with 2-1-1 United Way, while the other centers are housed in comprehensive non-
profit or county mental health centers.
25
Although, most of Florida’s 988 call centers are also a part of the 211 network, 988 and 211 provide very different
services. Florida’s 211 network is the state’s single point of coordination for information and referral for health
and human services.
26 The 211 network provides information and referral services that connect callers to a
referral specialist who provides the caller with information on various services and programs.
27 Florida’s 988
Lifeline call centers provide free behavioral health support service, available 24/7, that connects callers
experiencing suicidal thoughts, substance use disorder, mental health crises, or any kind of emotional distress to a
highly trained crisis counselor in their immediate area.
28
988/911 Interoperability
The implementation of the 988 Lifeline, brought awareness to the need for standardized interoperability practices
between Public Service Answering Points (PSAP)
29/Emergency Communications Centers (ECC) and the 988
Lifeline centers.
30 In January 2025, the National Emergency Number Association (NENA) released NENA Standards
for 911/988 Interactions.
31 NENA is a non-profit professional organization that solely focuses on 911 operations,
technology, education, and policy issues. The purpose of NENA is to ensure that 911 is able to meet the needs of
20 National Suicide Hotline Designation Act of 2020 (Pub. L. No. 116-172).
21 SAMHSA, 988 America’s Suicide Prevention and Mental Health Crisis Lifeline, at https://www.samhsa.gov/sites/default/ files/988-
factsheet.pdf (last visited February 24, 2023).
22 988 Suicide & Crisis Lifeline at https://988lifeline.org/about/ (last visited February 24, 2025). Also see DCF Office of SAMH, Suicide
Prevention Coordinating Council 2023 Annual Report, available at https://www.myflfamilies.com/sites/default/files/2024-
01/2023%20Suicide%20Prevention%20Coordinating%20Council%20Annual%20Report.pdf, (last visited February 24, 2025).
23 988 Suicide & Crisis Lifeline at https://988lifeline.org/about/ (last visited February 24, 2025).
24 DCF, Agency Bill Analysis HB 1901 (2025), p. 2, on file with the House Health Services Subcommittee. Also, see DCF Office of SAMH, Suicide
Prevention Coordinating Council 2021 Annual Report, available at https://www.myflfamilies.com/sites/default/files/2022-
12/2021%20Suicide%20Prevention%20Coordinating %20Council%20Annual%20Report%20-%20Final.pdf (last visited February 24,
2025).
25 Id.
26 S. 408.918, F.S.
27 DCF, Agency Bill Analysis HB 1901 (2025), p. 2, on file with the House Health Services Subcommittee.
28 DCF, 988 Florida Lifeline, available at
https://www.myflfamilies.com/988#:~:text=Managed%20by%20the%20Florida%20Department,to%20a%20highly%20trained%20crisis,
(last visited March 14, 2025).
29 A PSAP is a call center where 911 calls are handled. Every 988 Lifeline call center in Florida has a least one formal agreement with a PSAP
in their 988 catchment area.
29 DCF, Agency Bill Analysis HB 1901 (2025), p. 2, on file with the House Health Services Subcommittee.
30 DOH, Suicide Prevention Coordinating Council Annual Report 2023, pg. 17, available at https://www.myflfamilies.com/sites/default/files/
2024-01/2023%20Suicide%20Prevention%20Coordinating%20Council%20Annual%20Report.pdf, (last visited March 8, 2025).
31 NENA The 9-1-1 Association, (January 31, 2025). NENA Standard for 911/988 Interactions Now Available! [Press Release], available at
https://www.nena.org/news/692596/NENA-Standard-for-911988-Interactions-Now-Available.htm, (last visited March 14, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
8
those requesting emergency services, which includes establishing standards to make the 911 system work,
providing training and best practices for 911 professionals, and educating the public and policymakers about 911
and its proper use.
32
The NENA Standards for 911/988 Interactions
33 provide recommendations and best practices to help callers who
are experiencing mental health crises.
34 They also provide standards and best practices for interoperability
between 911/988 and outline operational and technical considerations for PSAPs and ECCs to establish an
effective working relationship with the 988 community.
The Baker Act
The Florida Mental Health Act, commonly referred to as the Baker Act, was enacted in 1971 to revise the state’s
mental health commitment laws.
35 The Baker Act includes legal procedures for mental health examination and
treatment, including voluntary and involuntary examinations. It additionally protects the rights of all individuals
examined or treated for mental illness in Florida.
36 The Baker Act also governs voluntary and involuntary
admissions for mental health care, among other aspects of the state’s mental health program.
Involuntary Examination
Individuals in an acute mental health crisis may require emergency treatment to stabilize their condition.
Emergency mental health examination and stabilization services may be provided on a voluntary or involuntary
basis.
37 Certain courts or authorized individuals may initiate an involuntary examination if there is reason to
believe that the person of concern has a mental illness and, because of that mental illness:
Has refused voluntary examination;
Is likely to refuse to care for him or herself to the extent that such refusal threatens to cause substantial
harm to that person’s well-being, and
Such harm is unavoidable through the help of willing, able, and responsible family members or friends, or
will cause serious bodily harm to him or herself or others in the near future based on recent behavior.
38
An involuntary examination may be initiated by:
A circuit or county court entering an ex parte order stating that a person appears to meet the criteria for
involuntary examination, based on sworn testimony;
39
A law enforcement officer taking a person who appears to meet the criteria for involuntary examination
into custody and delivering the person or having him or her delivered to a receiving facility for
examination;
40 or
A physician, clinical psychologist, psychiatric nurse, an autonomous advanced practice registered nurse,
mental health counselor, marriage and family therapist, or clinical social worker executing a certificate
stating that he or she has examined a person within the preceding 48 hours and finds that the person
32 NENA The 9-1-1 Association, Who We Are, available at https://www.nena.org/page/who-we-are, (last visited March 14, 2025).
33 The NENA 911 Standards were developed over the course of four years through the collaboration and input of 108 contributors, including
DCF’s 988 Coordinator. DCF, Agency Bill Analysis HB 1901 (2025), p. 2, on file with the House Health Services Subcommittee.
34 NENA Standards for 9-1-1/988 Interactions, NENA-STA-045.1-2025, available at
https://cdn.ymaws.com/www.nena.org/resource/resmgr/standards/NENA-STA-045.1-202Y_911-988_.pdf, (last visited March 14, 2025).
35 The Baker Act is contained in Part I of ch. 394, F.S.
36 S. 394.459, F.S.
37 Ss. 394.4625, F.S., and 394.463, F.S.
38 S. 394.463(1), F.S.
39 S. 394.463(2)(a)1., F.S. The order of the court must be made a part of the patient’s clinical record.
40 S. 394.463(2)(a)2., F.S. The officer must execute a written report detailing the circumstances under which the person was taken into
custody, and the report must be made a part of the patient’s clinical record. If transporting a minor and the parent or legal guardian of the
minor is present, the law enforcement officer must provide the parent or legal guardian of the minor the name, address, and contact
information of the receiving facility to which the minor is being transported. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
9
appears to meet the criteria for involuntary examination, including a statement of the professional’s
observations supporting such conclusion.
41
Involuntary patients must be taken to either a public or a private facility that has been designated by DCF as a
Baker Act receiving facility. Under the Baker Act, a receiving facility has up to 72 hours to examine the patient.
42
During that 72 hours, an involuntary patient must be examined by a physician or a clinical psychologist, or by a
psychiatric nurse performing within the framework of an established protocol with a psychiatrist at the facility, to
determine if the criteria for involuntary services are met.
43 The 72-hour examination period begins when the
patient arrives at the receiving facility. However, if the patient is a minor, a receiving facility must initiate the
examination within 12 hours of arrival.
44
Within the 72-hour examination period, one of the following must happen:
45
The patient must be released, unless he or she is charged with a crime, in which case law enforcement will
assume custody;
The patient must be released for voluntary outpatient treatment;
The patient, unless charged with a crime, must give express and informed consent to be placed and
admitted as a voluntary patient; or
A petition for involuntary services must be filed in a circuit or county court for involuntary outpatient or
inpatient treatment.
Involuntary Services
Involuntary services are court-ordered inpatient and outpatient services for mental health treatment.
46 A court
47
may order a person to involuntary outpatient services, involuntary inpatient placement, or a combination of both
types of involuntary services, based on the individual needs of the person, upon a finding of the court that by clear
and convincing evidence, the person meets the criteria for the services ordered.
48
A person ordered to involuntary services must meet the following criteria:
49
The person has a mental illness, and, because of that mental illness:
o Is unlikely to participate in, and/or has refused, voluntary services for treatment, even after
explanation of why the services are necessary, or is unable to determine for himself or herself
whether services are necessary; and
Is unlikely to survive safely in the community without supervision, based on clinical
determination;
50 or
Is incapable of surviving alone or with the help of willing, able, and responsible family or
friends, including available alternative services, and, without treatment, is likely to suffer
from neglect or refuse to care for himself or herself, and such neglect or refusal poses a real
and present threat of substantial harm to his or her well-being or without treatment is
likely to suffer from neglect or refuse to care for himself or herself;
51 and
o All available less restrictive treatment alternatives that would offer an opportunity for
improvement of the person’s condition have been deemed to be inappropriate or unavailable.
41 S. 394.463(2)(a)3., F.S. The report and certificate shall be made a part of the patient’s clinical record.
42 S. 394.463(2)(g), F.S.
43 S. 394.463(2)(f), F.S.
44 S. 394.463(2)(g), F.S.
45 Id.
46 S. 394.455(23), F. S.
47 S. 394.467(1)(a), F.S. defines the term “court” as a circuit court, or for commitments only to involuntary outpatient services, a county
court.
48 S. 394. 467(2) and (8)(a), F.S.
49 S. 394.467(2)(a), F.S. and S. 394.467(2)(b), F.S.
50 S. 394.467(2)(a), F.S.
51 S. 394.467(2)(b), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
10
In addition to criteria above, a person ordered to involuntary outpatient services must also meet the following
criteria:
52
Have a history of lack of compliance with treatment for mental illness;
Is in need of involuntary outpatient services in order to prevent a relapse or deterioration that would be
likely to result in serious bodily harm to himself or herself or others, or a substantial harm to his or her
well-being;
53 and
Is likely to benefit from involuntary outpatient services.
Petition for Involuntary Services
A petition for involuntary services may be filed by either a facility administrator or a service provider who is
treating the person. The petitioner must state the type of involuntary services (outpatient services, inpatient
placement, or a combination of both) being recommended, the length of time recommended for each type of
involuntary service, and the reasons for the recommendation.
54 The petition must be based on the opinions of two
professionals who have personally examined the individual.
55 For recommendations to involuntary inpatient
placement, the patient must have been examined within the preceding 72 hours.
56 For recommendations to
involuntary outpatient services, the patient must have been examined within the preceding 30 days.
57
A petition that includes a recommendation for a period of involuntary outpatient services must meet additional
requirements. For such a petition, the petitioner must:
Identity the service provider that has agreed to provide services for the person, unless the person is
otherwise participating in outpatient psychiatric treatment and is not in need of public financing; and
58
Prepare a written proposed services plan for the patient.
59 If a services plan is not available, the
petitioner may not file the petition.
Regardless of the type of involuntary services being recommended, the administrator or service provider must file
the petition in the appropriate court:
A petition for involuntary inpatient placement, or inpatient placement followed by outpatient services
must be filed in the court in the county where the patient is located.
A petition for only involuntary outpatient services must be filed in the county where the patient is
located, unless the patient is being held in a state treatment facility, in which case the petition must be
filed in the county where the patient will reside.
Once the petition for involuntary services is filed, the court must hold a hearing within five business days, unless a
continuance is granted.
60 If at the hearing the court concludes that the person meets the criteria for involuntary
services, the court may order the person to involuntary inpatient placement, involuntary outpatient services, or a
combination of involuntary services, for a period of up to six months.
61
Continued Involuntary Services
52 S. 394.467(2)(a), F.S.
53 This factor is evaluated based on the person’s treatment history and current behavior.
54 S. 394.467(4)(a), F.S.
55 S. 394.467(3), F.S.
56 S. 394.467(3)(b), F.S.
57 Id.
58 S. 394.467(4)(d)2, F.S.
59 S. 394.467(4)(d)3, F.S. A services plan is an individualized plan detailing the recommended behavioral health services and supports based
on a thorough assessment of the needs of the patient to safeguard and enhance the patient’s health and well-being in the community. S.
394.467(1)(d), F.S. The proposed services plan must be prepared by the petitioner in consultation with the patient, or the patient’s guardian
advocate.
60 S. 394.467(6), F.S.
61 S. 394.467(8)(a), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
11
If a patient continues to meet the criteria for involuntary services, a petition for continued involuntary services
must be filed to extend treatment for the patient. The petition must be filed before the expiration of the initial
order committing the patient to involuntary services.
62
Petitions for Continued Involuntary Services
Petitions for continued involuntary outpatient services, and petitions for continued involuntary inpatient
placement for patients being treated at a receiving facility, must be filed by the service provider or the
administrator of the receiving facility, respectively, in the court that issued the initial order.
63 Petitions for
continued involuntary inpatient placement for patients being treated at a state mental health treatment facility,
must be filed with the Division of Administrative Hearings (DOAH), as proceedings regarding these petitions are
handled administratively pursuant to s. 120.57(1), F.S.
64
Hearings on Petitions for Continued Involuntary Services
Current law directs the court to immediately schedule a hearing, to be held within 15 days, after a petition for
involuntary services is filed.
65 Current law defines “court” as a circuit or county court. This definition excludes
DOAH, even though DOAH historically received petitions, scheduled and conducted hearings, and issued orders
regarding petitions for continued involuntary services for patients who were being treated at a state mental health
treatment facility.
66
Hearings on petitions for continued involuntary outpatient services must be heard in the court that issued the
initial order.
67 Hearings on petitions for continued involuntary inpatient placement for patients being treated at a
receiving facility, and for patients ordered to involuntary outpatient services following involuntary inpatient
placement, must be heard in the county or facility, as appropriate, where the patient is located.
68 If it is determined
at the hearing that the patient continues to meet the criteria for involuntary services, the court may issue an order
for continued involuntary outpatient services, involuntary inpatient placement, or a combination of involuntary
services for up to six months.
69
Hearings on petitions for continued involuntary inpatient placement for patients being treated at a state mental
health treatment facility are administrative and are conducted by DOAH. If it is determined at the hearing that the
patient continues to meet the criteria for involuntary services, current law states that the “court” may issue an
order for continued involuntary services, as opposed to the administrative law judge presiding over the hearing.
70
A patient is required to attend the hearing unless the patient’s attendance at the hearing is waived. If the patient
waives his or her attendance, the judge must determine that the patient knowingly, intelligently, and voluntarily
waived his or her right to be present, before waiving the patient’s presence at the hearing.
71 If at the hearing, the
judge finds that the patient’s attendance is not in the patient’s best interest, the judge may also waive the patient’s
attendance.
72 Current law does not define “judge” or distinguish whether judge refers to a circuit or county judge
or an administrative law judge.
Voluntary Admissions and Transfer to Involuntary Status
62 S. 394.467(11), F.S.
63 S. 394.467(11(b), F.S.
64 S. 394.467(11)(b)3., F.S., and s. 394.467(11), F.S.
65 S. 394.467(11(b)4., F.S.
66 S. 394.467(11)(b)3., F.S.
67 S. 394.467(11)(e), F.S.
68 S. 394.467(11)(f), F.S.
69 s. 394.467(11)(j), F.S.
70 The court may issue an order for continued involuntary outpatient services, involuntary inpatient placement or a combination of
involuntary services for up to six months. See s. 394.467(11)(j), F.S.
71 S. 394.467(11)(i), F.S.
72 Id. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
12
An individual may be admitted to a Baker Act receiving facility on voluntary status for observation, diagnosis or
treatment.
73 A receiving facility may admit any adult who applies for admission by giving their expressed and
informed consent, or any minor for whom application for admission is made by his or her parent or legal
guardian.
74 If an adult is found to show evidence of mental illness, to be competent to provide express and
informed consent, and to be suitable for treatment, he or she may be admitted to the facility. A minor may be
admitted if the parent or legal guardian provides express and informed consent and the facility performs a clinical
review to verify the voluntariness of the minor’s assent.
75
Discharge of Voluntary Patient
A facility must discharge a voluntary patient if the patient has sufficiently improved and retention at the facility is
no longer needed, the patient is discharged to the care of a community facility, the patient revokes consent to
admission, or the patient, or an authorized person on behalf of the patient, requests discharge.
76 If the patient, or
authorized person on the patient’s behalf, makes an oral request for discharge the request must be immediately
entered in the patient’s clinical record. If the request for discharge is made by an authorized person on behalf of
the patient, the discharge may be conditioned upon the express and informed consent of the patient.
The patient must be discharged within 24 hours of the request unless the request is rescinded or the patient is
transferred to involuntary status.
77 The 24-hour time period may be extended by the facility if necessary for
adequate discharge planning, but may not exceed 3 days exclusive of weekends and holidays. A patient who has
been voluntarily admitted to a facility and who refuses to consent to or revokes consent to treatment must also be
discharged within 24 hours after such refusal or revocation, unless transferred to involuntary status.
Transfer to Involuntary Status
When a voluntary patient, or an authorized person on the patient’s behalf, makes a request for discharge, unless
the request is freely and voluntarily rescinded, the request must be communicated to a physician, a clinical
psychologist with at least three years of postdoctoral experience in the practice of clinical psychology, or a
psychiatrist within 12 hours of the request.
78 If it is determined that the patient meets the criteria for involuntary
placement, the administrator of the facility must petition the court, within two court working days after the
request for discharge, to transfer the patient to involuntary status.
79 If a petition is not filed within two court
working days, the patient must be discharged.
80
Psychologists
A clinical psychologist is an individual who is licensed to practice psychology in Florida.
81 A psychologist may be
licensed by examination or by endorsement.
82 To be licensed by examination an applicant must:
Hold a doctoral degree from a program accredited by the American Psychological Association;
83
Have at least two years or 4,000 hours of supervised experience in the field of psychology;
Pass the Examination for Professional Practice in Psychology; and
Pass an examination on Florida laws and rules.
84
73 S. 394.4625(1), F.S.
74 Id.
75 Id.
76 S. 394.4625(2), F.S.
77 Id.
78 S. 394.4625(5), F.S.
79 Id.
80 Id.
81 S. 394.455(5), F.S.
82 Ss. 490.005, F.S., and 490.006, F.S.
83 Alternatively, the applicant may have received the equivalent of a doctoral-level education from a program at a school or university
located outside of the United States, which is officially recognized by the government of the country in which it is located as a program or
institution to train students to practice professional psychology. The burden is on the applicant to establish that this requirement has been
met. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
13
Applicants seeking licensure are titled a psychology resident or a postdoctoral fellow.
85 This title follows the
applicant until licensure is acquired. A psychology resident or postdoctoral fellow is an individual who has met
Florida’s educational requirements for licensure and intends to meet the postdoctoral supervised experience
requirement.
86 Each applicant for licensure must complete a total of two years or 4,000 hours of supervised
experience. One year or 2,000 hours of the supervised experience may be satisfied through a doctoral level
psychology internship. The second year or the remaining 2,000 hours must be completed as postdoctoral
supervised experience, which is supervised experience acquired prior to licensure.
Current law only requires a clinical psychologist to have three years of postdoctoral experience in the practice of
clinical psychology to authorize the transfer of a patient from voluntary to involuntary status. The three years of
postdoctoral experience includes two years of postdoctoral experience acquired prior to licensure and one year of
clinical experience acquired after licensure.
State Forensic System
Criminal Defendants and Competency to Stand Trial
The Due Process Clause of the 14th Amendment to the United States Constitution prohibits states from trying and
convicting criminal defendants who are incompetent to stand trial.
87 The states must have procedures in place that
adequately protect the defendant’s right to a fair trial, which includes his or her participation in all material stages
of the process.
88 Defendants must be able to appreciate the range and nature of the charges and penalties that may
be imposed, understand the adversarial nature of the legal process, and disclose to counsel facts pertinent to the
proceedings. Defendants also must manifest appropriate courtroom behavior and be able to testify relevantly.
89
Involuntary Commitment of Defendant Adjudicated Incompetent
Chapter 916, F.S., governs the state forensic system, which is a network of state facilities and community services
for persons who have mental health issues, an intellectual disability, or autism, and who are involved with the
criminal justice system. Offenders who are charged with a felony and adjudicated incompetent to proceed due to
mental illness
90 and offenders who are adjudicated not guilty by reason of insanity may be involuntarily committed
to state civil
91 and forensic
92 treatment facilities by the circuit court,
93 or in lieu of such commitment, may be
released on conditional release
94 by the circuit court if the person is not serving a prison sentence.
95 The
committing court retains jurisdiction over the defendant while the defendant is under involuntary commitment or
conditional release.
96
84 S. 490.005, F.S., and R. 64B19-11.001, F.A.C.
85 R. 64B19-11.005, F.A.C.
86 R. 64B19-11.005(1)(b), F.A.C.
87 Pate v. Robinson, 383 U.S. 375, 86 S.Ct. 836, 15 L.Ed. 815 (1966); Bishop v. U.S., 350 U.S.961, 76 S.Ct. 440, 100 L.Ed. 835 (1956); Jones v.
State, 740 So.2d 520 (Fla. 1999).
88 Id. See also Rule 3.210(a)(1), Fla.R.Crim.P.
89 Id. See also ss. 916.12, F.S., 916.3012, F.S., and s. 985.19, F.S.
90 “Incompetent to proceed” means “the defendant does not have sufficient present ability to consult with her or his lawyer with a
reasonable degree of rational understanding” or “the defendant has no rational, as well as factual, understanding of the proceedings against
her or him.” s. 916.12(1), F.S.
91 A “civil facility” is a mental health facility established within DCF or by contract with DCF to serve individuals committed pursuant to
chapter 394, F.S., and defendants pursuant to chapter 916, F.S., who do not require the security provided in a forensic facility; or an
intermediate care facility for the developmentally disabled, a foster care facility, a group home facility, or a supported living setting
designated by the Agency for Persons with Disabilities (APD) to serve defendants who do not require the security provided in a forensic
facility. S. 916.106(4), F.S. DCF oversees two state-operated forensic facilities, Florida State Hospital and North Florida Evaluation and
Treatment Center, and two privately-operated, maximum security forensic treatment facilities, South Florida Evaluation and Treatment
Center and Treasure Coast Treatment Center.
92 S. 916.106(10), F.S.
93 S. 916.13, 916.15, and s. 916.302, F.S.
94 Conditional release is release into the community accompanied by outpatient care and treatment. S. 916.17, F.S.
95 S. 916.17(1), F.S.
96 S. 916.16(1), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
14
A civil facility is, in part, a mental health facility established within DCF or by contract with DCF to serve
individuals committed pursuant to ch. 394, F.S., and defendants pursuant to ch. 916, F.S., who do not require the
security provided in a forensic facility.
97
A forensic facility is a separate and secure facility established within DCF or the Agency for Persons with
Disabilities (APD) to service forensic clients committed pursuant to ch. 916, F.S.
98 A separate and secure facility
means a security-grade building for the purpose of separately housing individuals with mental illness from persons
who have intellectual disabilities or autism and separately housing persons who have been involuntarily
committed from non-forensic residents.
99
If a defendant is suspected of being mentally incompetent, the court, counsel for the defendant, or the state may file
a motion for examination to have the defendant’s cognitive state assessed.
100 If the motion is well-founded, the
court will appoint experts to evaluate the defendant’s cognitive state. The defendant’s competency is then
determined by the judge in a subsequent hearing.
101 If the defendant is found to be mentally competent, the
criminal proceeding resumes.
102 If the defendant is found to be mentally incompetent to proceed, the proceeding
may not resume unless competency is restored.
103
Mental Competence Evaluation
A defendant is considered incompetent to proceed if the defendant does not have sufficient present ability to
consult with his or her lawyer with a reasonable degree of rational understanding or the defendant has no rational,
as well as factual, understanding of the proceedings.
104
Under current law, the court may appoint no more than three experts (forensic evaluators) to determine the
mental condition of a defendant in a criminal case, including competency to proceed, insanity, involuntary
placement, and treatment. The experts may evaluate the defendant in jail or in another appropriate local facility or
in a facility of the Department of Corrections.
105 A defendant must be evaluated by at least two experts before the
court commits the defendant or takes other action, except if one expert finds that the defendant is incompetent to
proceed and the parties stipulate to that finding.
106 The court may commit the defendant or take other action
without further evaluation or hearing, or the court may appoint no more than two additional experts to evaluate
the defendant. Notwithstanding any stipulation by the state and the defendant, the court may require a hearing
with testimony from the expert or experts before ordering the commitment of a defendant.
107
In considering the issue of competence to proceed, an examining expert must first consider and specifically include
in the expert’s report the defendant’s capacity to:
108
Appreciate the charges or allegations against the defendant;
Appreciate the range and nature of possible penalties, if applicable, that may be imposed in the proceedings
against the defendant;
Understand the adversarial nature of the legal process;
Disclose to counsel facts pertinent to the proceedings at issue;
Manifest appropriate courtroom behavior; and
97 S. 916.106(4), F.S.
98 S. 916.106(10), F.S. A separate and secure facility means a security-grade building for the purpose of separately housing persons who have
mental illness from persons who have intellectual disabilities or autism and separately housing persons who have been involuntarily
committed pursuant to chapter 916, F.S., from non-forensic residents.
99 Id.
100 Rule 3.210, Fla.R.Crim.P.
101 Id.
102 Rule 3.212, Fla.R.Crim.P.
103 Id.
104 s. 916.12(1), F.S.
105 S. 916.115, F.S.
106 S. 916.12(2), F.S.
107 Id.
108 S. 916.12(3), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
15
Testify relevantly.
In addition, an examining expert must consider and include in the expert’s report any other factor deemed relevant
by the expert. If an expert finds that the defendant is incompetent to proceed, the expert must report on any
recommended treatment for the defendant to attain competence to proceed. In considering the issues relating to
treatment, the examining expert must report on the following:
109
The mental illness causing the incompetence;
The completion of a clinical assessment by approved mental health experts trained by the department to
ensure safety of the patient and the community;
The treatment or treatments appropriate for the mental illness of the defendant and an explanation of each
of the possible treatment alternatives, including, at a minimum, mental health services, treatment services,
rehabilitative services, support services, and case management, which may be provided by or within
multidisciplinary community treatment teams, such as Florida Assertive Community Treatment,
conditional release programs, outpatient services or intensive outpatient treatment programs, and
supportive employment and supportive housing opportunities in treating and supporting the recovery of
the patient;
The availability of acceptable treatment and, if treatment is available in the community, the expert must so
state in the report; and
The likelihood of the defendant’s attaining competence under the treatment recommended, an assessment
of the probable duration of the treatment required to restore competence, and the probability that the
defendant will attain competence to proceed in the foreseeable future.
The examining expert’s report to the court must also include full and detailed explanations regarding why the
alternative treatment options referenced in the evaluation are insufficient to meet the needs of the defendant.
Forensic Evaluator Training
To be appointed by the court, an expert must be a psychiatrist, licensed psychologist, or physician and have
completed DCF-approved forensic evaluator training.
110 DCF is required to maintain and annually provide the
courts with a list of available experts who have completed the required training.
111 Courts may appoint experts
who are on the DCF provided list.
DCF is required to develop and contract with accredited institutions to provide:
112
A plan for training mental health professionals to perform forensic evaluations and to standardize the
criteria and procedures to be used in the evaluations;
Clinical protocols and procedures based upon the criteria of Rules 3.210 and 3.216, Florida Rules of
Criminal Procedure;
Training for mental health professionals in the application of the protocols and procedures in performing
forensic evaluations and providing reports to the courts; and
To compile and maintain the necessary information for evaluating the success of the training program,
including the number of persons trained, the cost of operating the program, and the effect on the quality of
forensic evaluations as measured by appropriateness of admissions to state forensic facilities and to
community-based care programs.
113
Substance Use Disorder
109 S. 916.12(4), F.S.
110 S. 916.115(1)(a), F.S.
111 S. 916.115(1)(b), F.S.
112 S. 916.111(1), F.S.
113 s. 916.111(2), F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
16
A substance use disorder (SUD) is a complex medical condition in which there is an uncontrolled continued use of a
substance or substances despite the harmful consequences and long-lasting changes to the brain.
114 A SUD is
considered both a complex brain disorder and a mental illness. Approximately, 48.5 million people in the U.S. aged
12 and older had a substance use disorder (SUD) in 2023.
115 The most common substance use disorders in the U.S.
are from the use of alcohol, tobacco, cannabis, stimulants, hallucinogens, and opioids.
116
Safety Net System
The Department of Children and Families (DCF) administers a statewide system of safety-net services for
substance abuse and mental health (SAMH) prevention, treatment, and recovery. DCF provides substance abuse
treatment through a community-based provider system that offers detoxification, treatment and recovery support
for adolescents and adults affected by substance misuse, abuse or dependence:
117
Detoxification Services: Detoxification services use medical and clinical procedures to assist individuals
and adults as they withdraw from the physiological and psychological effects of substance abuse.
118
Treatment Services: Treatment services
119 include a wide array of assessment, counseling, case
management, and support services that are designed to help individuals who have lost their abilities to
control their substance use on their own and require formal, structured intervention and support. Some of
these services may also be offered to the family members of the individual in treatment.
120
Recovery Support: Recovery support services, including transitional housing, life skills training, parenting
skills, and peer-based individual and group counseling, are offered during and following treatment to
further assist individuals in their development of the knowledge and skills necessary to maintain their
recovery.
121
The Marchman Act
In the early 1970s, the federal government furnished grants for states “to develop continuums of care for
individuals and families affected by substance abuse.”
122 The grants provided separate funding streams and
requirements for alcoholism and drug abuse.
123 In response, the Florida Legislature enacted ch. 396, F.S., (alcohol)
and ch. 397, F.S. (drug abuse).
124 In 1993, legislation combined chapters 396 and 397, F.S., into a single law, entitled
the Hal S. Marchman Alcohol and Other Drug Services Act (Marchman Act).
125 The Marchman Act supports
substance abuse prevention and remediation through a system of prevention, detoxification, and treatment
services to assist individuals at risk for or affected by substance abuse.
114 American Psychiatric Association, What is a Substance Use Disorder?, available at https://www.psychiatry.org/patients-
families/addiction-substance-use-disorders/what-is-a-substance-use-disorder, and Substance Use Disorder Defined by NIDA and SAMHSA,
What is Drug Addiction, available at https://wyoleg.gov/InterimCommittee/2020/10-20201105Handoutfor6JtMHSACraig11.4.20.pdf, (last
visited March 5, 2025).
115 SAMHSA, Key Substance Use and Mental Health Indicators in the United States: Results from the 2023 National Survey on Drug Use and
Health, available https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-
nsduh-annual-national.pdf, (last visited on February 23, 2025).
116 The Rural Health Information Hub, Defining Substance Abuse and Substance Use Disorders, available at
https://www.ruralhealthinfo.org/toolkits/substance-abuse/1/definition (last visited February 23, 2025).
117 Department of Children and Families, Treatment for Substance Abuse https://www.myflfamilies.com/services/samh/treatment, (last
visited February 23, 2025).
118 Id.
119 Id. Research indicates that persons who successfully complete substance abuse treatment have better post-treatment outcomes related to
future abstinence, reduced use, less involvement in the criminal justice system, reduced involvement in the child protection system,
employment, increased earnings, and better health.
120 Department of Children and Families, Treatment for Substance Abuse https://www.myflfamilies.com/services/samh/treatment, (last
visited February 23, 2025).
121 Id.
122 Darran Duchene & Patrick Lane, Fundamentals of the Marchman Act, Risk RX, Vol. 6 No. 2 (Apr. – Jun. 2006) State University System of
Florida Self-Insurance Program, available at http://flbog.sip.ufl.edu/risk-rx-article/fundamentals-of-the-marchman-act/ (last visited
October 5, 2024).
123 Id.
124 Id.
125 Ch. 93-39, Laws of Fla., codified in Chapter 397, F.S. Reverend Hal S. Marchman was an advocate for persons who suffer from alcoholism
and drug abuse. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
17
An individual may receive services under the Marchman Act through either voluntary
126 or involuntary
admission.
127 The Marchman Act establishes a variety of methods under which substance abuse assessment,
stabilization, and treatment can be obtained on an involuntary basis. The Marchman Act encourages individuals to
seek services on a voluntary basis within the existing financial and space capacities of a service
provider.
128 However, denial of addiction is a prevalent symptom of a SUD, creating a barrier to timely intervention
and effective treatment.
129 As a result, a third party must typically provide a person the intervention needed to
receive SUD treatment.
130
Opioid Use Disorder
An opioid use disorder is a chronic mental health condition characterized by the compulsive misuse of opioid
drugs.
131 Opioids are a class of medications derived from the opium poppy plant or mimic its naturally occurring
substances.
132 Opioids function by binding to specific receptors in the brain that are associated with pain sensation,
resulting in pain relief.
133 The opioid family includes several drugs, such as oxycodone, fentanyl, morphine, codeine,
and heroin.
134 These drugs are effective at reducing pain; however, they can be highly addictive even when
prescribed by a doctor. Overtime, individuals who use opioids can develop a tolerance to the drug, a physical
dependence on it, and ultimately, succumb to an opioid use disorder. This condition can have grave consequences,
including a heightened risk of overdose and even death. Effective treatment of opioid use disorders includes the
use of medication, counseling and behavioral therapy.
135
Medication-Assisted Treatment
Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral
therapies, to provide a whole-person approach to treat substance use disorders.
136 MAT helps treat opioid use
disorders by helping to normalize brain chemistry, blocking the euphoric effects of opioids, and relieving physical
cravings. There are three medications approved by the Federal Drug Administration to treat opioid use disorder:
methadone, buprenorphine, and naltrexone.
137
DCF is responsible for regulatory oversight and licensure of methadone MAT clinics in accordance with state and
federal regulations. Under Florida law, DCF may not license any new MAT programs for opioid addiction unless it
126 See s. 397.601, F.S.
127 See ss. 397.675, F.S. – 397.6977, F.S.
128 See s. 397.601(1) and (2), F.S. An individual who wishes to enter treatment may apply to a service provider for voluntary admission.
Within the financial and space capabilities of the service provider, the individual must be admitted to treatment when sufficient evidence
exists that he or she is impaired by substance abuse and his or her medical and behavioral conditions are not beyond the safe management
capabilities of the service provider.
129 SAMHSA, Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and
Health, available at https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf, (last visited on March 6,
2025).
130 Id.
131 Cleveland Clinic, Opioid Use Disorder, available at https://my.clevelandclinic.org/health/diseases/24257-opioid-use-disorder-oud, and
Yale Medicine, Opioid Use Disorder, available at https://www.yalemedicine.org/conditions/opioid-use-disorder, (last visited February 23,
2025).
132 John Hopkins Medicine, Opioids, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids (last visited February
23, 2025).
133 Id.
134 Id.
135 Yale Medicine, Opioid Use Disorder, available at https://www.yalemedicine.org/conditions/opioid-use-disorder, (last visited February
23, 2025).
136 DCF, Treatment for Substance Abuse, available at https://www.myflfamilies.com/services/samh/treatment, (last visited March 5, 2025).
137 Illinois Department of Public Health, Medication-Assisted Treatment FAQ, available at https://dph.illinois.gov/topics-
services/opioids/treatment/mat-faq.html#:~:text=What%20Is%20Medication%2DAssisted%20Treatment,to%20treat%20
substance%20use%20disorders., (last visited March 5, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
18
conducts a needs assessment to determine whether additional providers are needed.
138 DCF must annually
perform the assessments using methodology based on federal data from the National Survey on Drug Use and
Health.
139
Once the assessment is complete, DCF must publish the results for the assessment in the Florida Administrative
Register.
140 The publication must direct interested providers where to submit a letter of intent to apply for
licensure to provide MAT services for opioid use disorders.
141 The letter of intent must identify the fiscal year of
the needs assessment to which the interested provider is responding to and the number of awards the provider is
applying for per county identified in the assessment.
142 If the number of letters of intent received is equal to or less
than the determined need, interested parties are awarded the opportunity to proceed to apply for licensure.
143
Applications may not be rolled over for consideration in response to a needs assessment published in a different
year and may only be submitted for a current fiscal year needs assessment.
144
DCF’s first cycle of needs assessment was published for fiscal year (FY) 2018-2019.
145 However, several of the
federal data points that must be used in the methodology for determining need are not updated annually. Due to
the lag in federal data updates, the needs assessments published since the 2018-2019 FY have been duplicative.
Although, there is dire need of MAT providers throughout the state, the annual needs assessment does not
reflective this need and has resulted in a lack of new applicants.
146 Current law does not permit DCF to issue MAT
licenses outside of the annual needs determination process. This extends an already lengthy licensure process and
creates a barrier to access to care and treatment for those with opioid use disorders.
BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Human Services Subcommittee 16 Y, 0 N, As CS 3/18/2025 Mitz Curry
THE CHANGES ADOPTED BY THE
COMMITTEE:
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Health & Human Services
Committee
4/14/2025 Calamas Curry
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THIS BILL ANALYSIS HAS BEEN UPDATED TO INCORPORATE ALL OF THE CHANGES DESCRIBED ABOVE.
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138 s. 397.427, F.S.
139 The methodology used for the needs assessment is detailed in DCF’s report on, Methodology of Determination of Need Methadone
Medication-Assisted Treatment, CF-MH 4038, May 2019 [65D-30.0141, F.A.C.], available at https://www.myflfamilies.com/
sites/default/files/2024-07/Attachment%202%20-%20Data%20Methodology.pdf, (last visited February 24, 2025).
140 Rule 65D-30.0141, F.A.C. and s. 397.427, F.S.
141 Id.
142 Id.
143 Id.
144 Id.
145 DCF, Treatment for Substance Abuse, available at https://www.myflfamilies.com/services/samh/treatment, (last visited March 6, 2025).
146 Id.