HB 915 — Outpatient Health Services

PageSection 1of1. 21 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 Section 1.

Subsections (32) through (39) and (40) through (50) of section 394.455, Florida Statutes, are renumbered as subsections (33) through (40) and (42) through (52), respectively, subsection (23) is amended, and new subsections (32) and (41) are added to that section, to read:

394.455 Definitions.—As used in this part, the term:

(23) "Involuntary examination" means an examination performed under s.

394.463, s.

397.6772, s.

397.679, s.

397.6798, or s.

397.6957 s.

397.6811 to determine whether a person qualifies for involuntary services.

(32) "Neglect or refuse to care for himself or herself" means a refusal to accept treatment and includes, but is not limited to, evidence that a person:

(a) Is, for a reason other than indigence, unable to satisfy basic needs for nourishment, clothing, medical care, shelter, or safety, thereby creating a substantial probability of imminent death, serious physical debilitation, or disease;

or (b) Is substantially unable to make an informed treatment choice, after an explanation of the advantages and disadvantages of, and alternatives to, treatment, and needs care or treatment to prevent deterioration.

However, the following do not constitute a refusal to accept treatment:

1.

A willingness to take medication appropriate for the person's condition, but a reasonable disagreement about type or Page 2of 21 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 dosage;

2.

A good faith effort to follow a reasonable treatment plan;

3.

An inability to obtain access to appropriate treatment because of inadequate health care coverage or an insurer's refusal or delay in providing coverage for treatment;

or 4.

An inability to obtain access to needed services because the provider has no available treatment beds or qualified professionals, the provider only accepts patients under court order, or the provider gives persons under court order priority over voluntary patients in obtaining treatment and services.

(41) "Real and present threat of substantial harm" includes, but is not limited to, evidence of a substantial probability that the untreated person will:

(a) Lack, refuse, or not receive services for health and safety which are actually available in the community;

or (b) Suffer severe mental, emotional, or physical harm that will result in the loss of his or her ability to function in the community or in the loss of cognitive or volitional control over his or her thoughts or actions.

Section 2.

Section 394.4655, Florida Statutes, is amended to read:

(Substantial rewording of section.

See s.

394.4655, F.S., for present text.) Page 3of 21 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 394.4655 Involuntary outpatient services.— (1)(a) A court may order a respondent into outpatient treatment for up to 6 months if, during the initial hearing under s.

394.467 or a subsequent hearing before a respondent's anticipated discharge from inpatient placement, at the request of the facility, and providing at least 1 week notice to the court and the parties of its belief that the respondent would benefit from involuntary outpatient services, it is established that the respondent meets the involuntary placement criteria and all of the following:

1.

The respondent has been incarcerated, has been involuntarily admitted to a receiving facility or treatment facility as defined in s.

394.455, or has received mental health services in a forensic or correctional facility at least twice during the previous 36 months.

2.

The outpatient treatment is provided and available in the county in which the respondent resides or will reside if he or she is being placed from a state treatment facility.

3.

The respondent's treating physician certifies, within a reasonable degree of medical probability, that the respondent:

a.

May be appropriately treated on an outpatient basis.

b.

Is able to follow and benefit from the prescribed treatment plan.

(b) For the duration of his or her treatment, the respondent must be monitored by a social worker or case manager Page 4of 21 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 of the outpatient treatment provider, or a willing, able, and responsible individual appointed by the court who must inform the court, state attorney, and respondent's counsel of any failure by the respondent to comply with his or her outpatient program.

(2) The court shall, if required, retain jurisdiction over the case and parties for the entry of further orders after a hearing.

Such jurisdiction includes, but is not limited to, ordering inpatient treatment to stabilize a respondent who decompensates while under court-ordered treatment and meets the commitment criteria of s.

394.467(1), and extending, modifying, or ending outpatient services.

For a court to extend, modify, or end outpatient services, the appropriate motion must be filed with the court before the operating order expires, and the court shall schedule a hearing as soon as practicable to determine whether the respondent still meets the commitment criteria and assess the appropriateness of any treatment modification.

(3) A criminal county court exercising its original jurisdiction in a misdemeanor case under s.

34.01 may order into involuntary outpatient services a respondent who meets the commitment criteria.

The court may not use incarceration as a sanction for noncompliance with the outpatient treatment plan, but it may order an evaluation for possible inpatient placement if there is significant, or multiple instances of, noncompliance.

Page 5of 21 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 Section 3.

Paragraph (a) of subsection (1) of section 394.467, Florida Statutes, is amended to read:

394.467 Involuntary inpatient placement.— (1) CRITERIA.—A person may be ordered for involuntary inpatient placement for treatment upon a finding of the court by clear and convincing evidence that:

(a) He or she has a mental illness and because of his or her mental illness:

1.a.

He or she has refused voluntary inpatient placement for treatment after sufficient and conscientious explanation and disclosure of the purpose of inpatient placement for treatment;

or b.

He or she is unable to determine for himself or herself whether inpatient placement is necessary;

and 2.a.

He or she is incapable of surviving alone or with the help of willing 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 b.

There is substantial likelihood that in the near future, and without services, he or she will inflict serious bodily harm to on self or others, as evidenced by recent acts, omissions, or behavior causing, attempting, or threatening such harm, including, but not limited to, significant property Page 6of 21 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 damage;

and Section 4.

a.Page 3of 54 CODING:

InvoluntaryWords inpatientstrickenare treatmentdeletions; pursuant to s.

394.467words hasunderlined beenare filedadditions. with the circuit court in the county in which the individual is hospitalized and the address of such court;

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 a.

Involuntary services inpatient treatment pursuant to s.

394.467 has been filed with the circuit court and the address of such court in the county in which the individual is hospitalized and the address of such court;

394.4655394.467 has been filed with the criminal county court, as provided under s.

394.4655 has been filed with the criminal county court, as defined in s.

Notice that the individual, the individual's guardian, guardian advocate, health care surrogate or proxy, or Pagerepresentative, 7ofor 21the CODING:administrator may apply for a change of venue for the convenience of the parties or witnesses or because of the condition of the individual.

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 representative, or the administrator may apply for a change of venue for the convenience of the parties or witnesses or because of the condition of the individual.

Section 5.2.

394.4615Page Clinical4of records;54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 394.4615 Clinical records;

(b) When the administrator of the facility or secretary of the department deems release to a qualified researcher as defined in administrative rule, an aftercare treatment provider, or an employee or agent of the department is necessary for Pagetreatment 8ofof 21the CODING:patient, maintenance of adequate records, compilation of treatment data, aftercare planning, or evaluation of programs.

For the purpose of determining whether a person meets the criteria for involuntary services outpatient placement or for preparing the proposed treatment plan pursuant to s.

394.4655 or s.

394.467, the clinical record may be released to the state Page 5of 54 CODING:

hb0915-00hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915CS/HB915 2024 treatmentattorney, ofthe public defender or the patient,patient's maintenanceprivate oflegal adequatecounsel, records,the compilationcourt, ofand treatmentto data,the aftercareappropriate planning,mental orhealth evaluationprofessionals, ofincluding programs.the service provider under s.

For394.4655 the purpose of determining whether a person meets the criteria for involuntary outpatient placement or for preparing the proposed treatment plan pursuant to s.

394.4655,394.467 the clinical record may be released to the state attorney, the public defender or the patient's private legal counsel, the court, and to the appropriate mental health professionals, including the service provider identified in s.

Section 6.3.

ParagraphSubsection (g)(1) and paragraphs (a), (e), (f), (g), and (h) of subsection (2) of section 394.463, Florida Statutes, isare amended to read:

394.463 Involuntary examination.— (2)(1) INVOLUNTARYCRITERIA.—A EXAMINATION.—person (g)may Thebe examinationtaken periodto musta bereceiving facility for upinvoluntary examination if there is reason to 72believe hours.that the person has a mental illness and because of his or her mental illness:

(a)1.

The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination;

or 2.

The person is unable to determine for himself or herself whether examination is necessary;

and (b)1.

Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself;

such neglect or refusal poses a real and present threat of substantial harm to his or her well-being;

and it is not apparent that such harm may be avoided through the help of willing, able, and responsible family members or friends or the provision of other services;

or Page 6of 54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 2.

There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior.

(2) INVOLUNTARY EXAMINATION.— (a) An involuntary examination may be initiated by any one of the following means:

1.

A circuit or county court may enter an ex parte order stating that a person appears to meet the criteria for involuntary examination and specifying the findings on which that conclusion is based.

The ex parte order for involuntary examination must be based on written or oral sworn testimony that includes specific facts that support the findings.

If other less restrictive means are not available, such as voluntary appearance for outpatient evaluation, a law enforcement officer, or other designated agent of the court, shall take the person into custody and deliver him or her to an appropriate, or the nearest, facility within the designated receiving system pursuant to s.

394.462 for involuntary examination.

The order of the court shall be made a part of the patient's clinical record.

A fee may not be charged for the filing of an order under this subsection.

A facility accepting the patient based on this order must send a copy of the order to the department within 5 working days.

The order may be submitted electronically through existing data systems, if available.

The order shall be valid only until Page 7of 54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 the person is delivered to the facility or for the period specified in the order itself, whichever comes first.

If a time limit is not specified in the order, the order is valid for 7 days after the date that the order was signed.

2.

A law enforcement officer may shall take a person who appears to meet the criteria for involuntary examination into custody and deliver the person or have him or her delivered to an appropriate, or the nearest, facility within the designated receiving system pursuant to s.

394.462 for examination.

A law enforcement officer transporting a person pursuant to this section subparagraph shall restrain the person in the least restrictive manner available and appropriate under the circumstances.

The officer shall execute a written report detailing the circumstances under which the person was taken into custody, which must be made a part of the patient's clinical record.

The report must include all emergency contact information for the person that is readily accessible to the law enforcement officer, including information available through electronic databases maintained by the Department of Law Enforcement or by the Department of Highway Safety and Motor Vehicles.

Such emergency contact information may be used by a receiving facility only for the purpose of informing listed emergency contacts of a patient's whereabouts pursuant to s.

119.0712(2)(d).

Any facility accepting the patient based on this report must send a copy of the report to the department within 5 Page 8of 54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 working days.

3.

A physician, a physician assistant, a clinical psychologist, a psychiatric nurse, an advanced practice registered nurse registered under s.

464.0123, a mental health counselor, a marriage and family therapist, or a clinical social worker may execute a certificate stating that he or she has examined a person within the preceding 48 hours and finds that the person appears to meet the criteria for involuntary examination and stating the observations upon which that conclusion is based.

If other less restrictive means, such as voluntary appearance for outpatient evaluation, are not available, a law enforcement officer shall take into custody the person named in the certificate and deliver him or her to the appropriate, or nearest, facility within the designated receiving system pursuant to s.

394.462 for involuntary examination.

The law enforcement officer shall execute a written report detailing the circumstances under which the person was taken into custody and include all emergency contact information required under subparagraph 2.

The report must include all emergency contact information for the person that is readily accessible to the law enforcement officer, including information available through electronic databases maintained by the Department of Law Enforcement or by the Department of Highway Safety and Motor Vehicles.

Such emergency contact information may be used by a receiving facility only for the purpose of Page 9of 54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 informing listed emergency contacts of a patient's whereabouts pursuant to s.

119.0712(2)(d).

The report and certificate shall be made a part of the patient's clinical record.

Any facility accepting the patient based on this certificate must send a copy of the certificate to the department within 5 working days.

The document may be submitted electronically through existing data systems, if applicable.

When sending the order, report, or certificate to the department, a facility shall, at a minimum, provide information about which action was taken regarding the patient under paragraph (g), which information shall also be made a part of the patient's clinical record.

(e) The department shall receive and maintain the copies of ex parte orders, involuntary outpatient services orders issued pursuant to ss.

394.4655 and 394.467 s.

394.4655, involuntary inpatient placement orders issued pursuant to s.

394.467, professional certificates, law enforcement officers' reports, and reports relating to the transportation of patients.

These documents shall be considered part of the clinical record, governed by the provisions of s.

394.4615.

These documents shall be used to prepare annual reports analyzing the data obtained from these documents, without including the personal identifying information of the patient.

The department identifying patients, and shall post the reports on its website and provide copies of Page 10 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 such reports to the department, the President of the Senate, the Speaker of the House of Representatives, and the minority leaders of the Senate and the House of Representatives by November 30 of each year.

(f) A patient shall 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 a facility without unnecessary delay to determine if the criteria for involuntary services are met.

Emergency treatment may be provided upon the order of a physician if the physician determines that such treatment is necessary for the safety of the patient or others.

The patient may not be released by the receiving facility or its contractor without the documented approval of a psychiatrist or a clinical psychologist or, if the receiving facility is owned or operated by a hospital, health system, or nationally accredited community mental health center, the release may also be approved by a psychiatric nurse performing within the framework of an established protocol with a psychiatrist, or an attending emergency department physician with experience in the diagnosis and treatment of mental illness after completion of an involuntary examination pursuant to this subsection.

A psychiatric nurse may not approve the release of a patient if the involuntary examination was initiated by a psychiatrist unless the release is approved by the initiating psychiatrist.

Page 11 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 The release may be approved through telehealth.

(g) The examination period must be for up to 72 hours and begins when a patient arrives at the receiving facility.

The patient shall be released, subject to subparagraph Page1., 9offor 21voluntary CODING:outpatient treatment;

Words strickenare deletions;

words underlined are additions.

hb0915-00 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915 2024 1., for voluntary outpatient treatment;

The When a petition is to be filed for involuntary outpatient placement, it shall be filed by one of the petitioners specified in s.

394.467, and the court shall dismiss an untimely filed Page 12 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 petition s.

If a patient's 72-hour examination period ends on a weekend or holiday, including the hours before the ordinary business hours on the morning of the next working day, and the receiving facility:

Intends to file a petition for involuntary services, such patient may be held at the a receiving facility through the next working day thereafter and the such petition for involuntary services must be filed no later than such date.

If the receiving facility fails to file the a petition by for involuntary services at the ordinary close of business on the next working day, the patient shall be released from the receiving facility following approval pursuant to paragraph (f).

Pageb. 10 of21 CODING:

Does not intend to file a petition for involuntary services, the a receiving facility may postpone release of a patient until the next working day thereafter only if a qualified professional documents that adequate discharge planning and procedures in accordance with s.

394.468, and approval pursuant to paragraph (f), are not possible until the next working day.

(h) A person for whom an involuntary examination has been initiated who is being evaluated or treated at a hospital for an emergency medical condition specified in s.

395.002 must be examined by a facility within the examination period specified Page 13 of54 CODING:

hb0915-00hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S HB915CS/HB915 2024 b.in paragraph (g).

DoesThe notexamination intendperiod tobegins filewhen athe petitionpatient forarrives involuntaryat services,the ahospital receivingand facilityceases maywhen postpone release of a patient until the nextattending workingphysician day thereafter only if a qualified professional documents that adequatethe dischargepatient planninghas andan proceduresemergency inmedical accordancecondition. with s.

394.468,If andthe approvalpatient pursuantis examined at a hospital providing emergency medical services by a professional qualified to paragraphperform (f),an areinvoluntary examination and is found as a result of that examination not possibleto untilmeet the nextcriteria workingfor day.involuntary outpatient services pursuant to s.

Section394.467 7.s.

Paragraph394.4655(2) (c)or ofinvoluntary subsectioninpatient (6)placement ofpursuant section 394.467, Florida Statutes, is amended to read:s.

394.467394.467(1), Involuntary inpatient placement.— (6) HEARING ON INVOLUNTARY INPATIENT PLACEMENT.— (c) If at any time before the conclusionpatient ofmay thebe hearingoffered onvoluntary involuntaryoutpatient inpatientor placement it appears to the court that the person does not meet the criteria for involuntary inpatient placementservices underor thisplacement, section,if butappropriate, insteador meetsreleased thedirectly criteriafrom for involuntary outpatient services, the courthospital mayproviding orderemergency themedical personservices. evaluated for involuntary outpatient services pursuant to s.

The finding by the professional that the patient has been examined and does not meet the criteria for involuntary inpatient services or involuntary outpatient placement must be entered into the patient's clinical record.

This paragraph is not intended to prevent a hospital providing emergency medical services from appropriately transferring a patient to another hospital before stabilization if the requirements of s.

395.1041(3)(c) have been met.

Section 4.

Section 394.4655, Florida Statutes, is amended to read:

394.4655 Involuntary outpatient services.— (1) DEFINITIONS.—As used in this section, the term:

(a) "Court" means a circuit court or a criminal county Page 14 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 court.

(b) "Criminal county court" means a county court exercising its original jurisdiction in a misdemeanor case under s.

34.01.

(c) "Involuntary outpatient placement" means involuntary outpatient services as defined in s.

394.467.

(2) A criminal county court may order an individual to involuntary outpatient placement under s.

394.467.

CRITERIA FOR INVOLUNTARY OUTPATIENT SERVICES.—A person may be ordered to involuntary outpatient services upon a finding of the court, by clear and convincing evidence, that the person meets all of the following criteria:

(a) The person is 18 years of age or older.

(b) The person has a mental illness.

(c) The person is unlikely to survive safely in the community without supervision, based on a clinical determination.

(d) The person has a history of lack of compliance with treatment for mental illness.

(e) The person has:

1.

At least twice within the immediately preceding 36 months been involuntarily admitted to a receiving or treatment facility as defined in s.

394.455, or has received mental health services in a forensic or correctional facility.

The 36-month period does not include any period during which the person was Page 15 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 admitted or incarcerated;

or 2.

Engaged in one or more acts of serious violent behavior toward self or others, or attempts at serious bodily harm to himself or herself or others, within the preceding 36 months.

(f) The person is, as a result of his or her mental illness, unlikely to voluntarily participate in the recommended treatment plan and has refused voluntary services for treatment after sufficient and conscientious explanation and disclosure of why the services are necessary or is unable to determine for himself or herself whether services are necessary.

(g) In view of the person's treatment history and current behavior, the person 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 as set forth in s.

394.463(1).

(h) It is likely that the person will benefit from involuntary outpatient services.

(i) All available, less restrictive alternatives that would offer an opportunity for improvement of his or her condition have been judged to be inappropriate or unavailable.

(3) INVOLUNTARY OUTPATIENT SERVICES.— (a)1.

A patient who is being recommended for involuntary outpatient services by the administrator of the facility where the patient has been examined may be retained by the facility Page 16 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 after adherence to the notice procedures provided in s.

394.4599.

The recommendation must be supported by the opinion of a psychiatrist and the second opinion of a clinical psychologist or another psychiatrist, both of whom have personally examined the patient within the preceding 72 hours, that the criteria for involuntary outpatient services are met.

However, if the administrator certifies that a psychiatrist or clinical psychologist is not available to provide the second opinion, the second opinion may be provided by a licensed physician who has postgraduate training and experience in diagnosis and treatment of mental illness, a physician assistant who has at least 3 years' experience and is supervised by such licensed physician or a psychiatrist, a clinical social worker, or by a psychiatric nurse.

Any second opinion authorized in this subparagraph may be conducted through a face-to-face examination, in person or by electronic means.

Such recommendation must be entered on an involuntary outpatient services certificate that authorizes the facility to retain the patient pending completion of a hearing.

The certificate must be made a part of the patient's clinical record.

2.

If the patient has been stabilized and no longer meets the criteria for involuntary examination pursuant to s.

394.463(1), the patient must be released from the facility while awaiting the hearing for involuntary outpatient services.

Before filing a petition for involuntary outpatient services, the Page 17 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 administrator of the facility or a designated department representative must identify the service provider that will have primary responsibility for service provision under an order for involuntary outpatient services, unless the person is otherwise participating in outpatient psychiatric treatment and is not in need of public financing for that treatment, in which case the individual, if eligible, may be ordered to involuntary treatment pursuant to the existing psychiatric treatment relationship.

3.

The service provider shall prepare a written proposed treatment plan in consultation with the patient or the patient's guardian advocate, if appointed, for the court's consideration for inclusion in the involuntary outpatient services order that addresses the nature and extent of the mental illness and any co-occurring substance use disorder that necessitate involuntary outpatient services.

The treatment plan must specify the likely level of care, including the use of medication, and anticipated discharge criteria for terminating involuntary outpatient services.

Service providers may select and supervise other individuals to implement specific aspects of the treatment plan.

The services in the plan must be deemed clinically appropriate by a physician, clinical psychologist, psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker who consults with, or is employed or contracted by, the service provider.

The service provider must certify to the court in the proposed plan whether sufficient services for Page 18 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 improvement and stabilization are currently available and whether the service provider agrees to provide those services.

If the service provider certifies that the services in the proposed treatment plan are not available, the petitioner may not file the petition.

The service provider must notify the managing entity if the requested services are not available.

The managing entity must document such efforts to obtain the requested services.

(b) If a patient in involuntary inpatient placement meets the criteria for involuntary outpatient services, the administrator of the facility may, before the expiration of the period during which the facility is authorized to retain the patient, recommend involuntary outpatient services.

The recommendation must be supported by the opinion of a psychiatrist and the second opinion of a clinical psychologist or another psychiatrist, both of whom have personally examined the patient within the preceding 72 hours, that the criteria for involuntary outpatient services are met.

However, if the administrator certifies that a psychiatrist or clinical psychologist is not available to provide the second opinion, the second opinion may be provided by a licensed physician who has postgraduate training and experience in diagnosis and treatment of mental illness, a physician assistant who has at least 3 years' experience and is supervised by such licensed physician or a psychiatrist, a clinical social worker, or by a psychiatric Page 19 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 nurse.

Any second opinion authorized in this subparagraph may be conducted through a face-to-face examination, in person or by electronic means.

Such recommendation must be entered on an involuntary outpatient services certificate, and the certificate must be made a part of the patient's clinical record.

(c)1.

The administrator of the treatment facility shall provide a copy of the involuntary outpatient services certificate and a copy of the state mental health discharge form to the managing entity in the county where the patient will be residing.

For persons who are leaving a state mental health treatment facility, the petition for involuntary outpatient services must be filed in the county where the patient will be residing.

2.

The service provider that will have primary responsibility for service provision shall be identified by the designated department representative before the order for involuntary outpatient services and must, before filing a petition for involuntary outpatient services, certify to the court whether the services recommended in the patient's discharge plan are available and whether the service provider agrees to provide those services.

The service provider must develop with the patient, or the patient's guardian advocate, if appointed, a treatment or service plan that addresses the needs identified in the discharge plan.

The plan must be deemed to be clinically appropriate by a physician, clinical psychologist, Page 20 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 psychiatric nurse, mental health counselor, marriage and family therapist, or clinical social worker, as defined in this chapter, who consults with, or is employed or contracted by, the service provider.

3.

If the service provider certifies that the services in the proposed treatment or service plan are not available, the petitioner may not file the petition.

The service provider must notify the managing entity if the requested services are not available.

The managing entity must document such efforts to obtain the requested services.

(4) PETITION FOR INVOLUNTARY OUTPATIENT SERVICES.— (a) A petition for involuntary outpatient services may be filed by:

1.

The administrator of a receiving facility;

or 2.

The administrator of a treatment facility.

(b) Each required criterion for involuntary outpatient services must be alleged and substantiated in the petition for involuntary outpatient services.

A copy of the certificate recommending involuntary outpatient services completed by a qualified professional specified in subsection (3) must be attached to the petition.

A copy of the proposed treatment plan must be attached to the petition.

Before the petition is filed, the service provider shall certify that the services in the proposed plan are available.

If the necessary services are not available, the petition may not be filed.

The service provider Page 21 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 must notify the managing entity if the requested services are not available.

The managing entity must document such efforts to obtain the requested services.

(c) The petition for involuntary outpatient services must be filed in the county where the patient is located, unless the patient is being placed from a state treatment facility, in which case the petition must be filed in the county where the patient will reside.

When the petition has been filed, the clerk of the court shall provide copies of the petition and the proposed treatment plan to the department, the managing entity, the patient, the patient's guardian or representative, the state attorney, and the public defender or the patient's private counsel.

A fee may not be charged for filing a petition under this subsection.

(5) APPOINTMENT OF COUNSEL.—Within 1 court working day after the filing of a petition for involuntary outpatient services, the court shall appoint the public defender to represent the person who is the subject of the petition, unless the person is otherwise represented by counsel.

The clerk of the court shall immediately notify the public defender of the appointment.

The public defender shall represent the person until the petition is dismissed, the court order expires, or the patient is discharged from involuntary outpatient services.

An attorney who represents the patient must be provided access to the patient, witnesses, and records relevant to the presentation Page 22 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 of the patient's case and shall represent the interests of the patient, regardless of the source of payment to the attorney.

(6) CONTINUANCE OF HEARING.—The patient is entitled, with the concurrence of the patient's counsel, to at least one continuance of the hearing.

The continuance shall be for a period of up to 4 weeks.

(7) HEARING ON INVOLUNTARY OUTPATIENT SERVICES.— (a)1.

The court shall hold the hearing on involuntary outpatient services within 5 working days after the filing of the petition, unless a continuance is granted.

The hearing must be held in the county where the petition is filed, must be as convenient to the patient as is consistent with orderly procedure, and must be conducted in physical settings not likely to be injurious to the patient's condition.

If the court finds that the patient's attendance at the hearing is not consistent with the best interests of the patient and if the patient's counsel does not object, the court may waive the presence of the patient from all or any portion of the hearing.

The state attorney for the circuit in which the patient is located shall represent the state, rather than the petitioner, as the real party in interest in the proceeding.

2.

The court may appoint a magistrate to preside at the hearing.

One of the professionals who executed the involuntary outpatient services certificate shall be a witness.

The patient and the patient's guardian or representative shall be informed Page 23 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 by the court of the right to an independent expert examination.

If the patient cannot afford such an examination, the court shall ensure that one is provided, as otherwise provided by law.

The independent expert's report is confidential and not discoverable, unless the expert is to be called as a witness for the patient at the hearing.

The court shall allow testimony from individuals, including family members, deemed by the court to be relevant under state law, regarding the person's prior history and how that prior history relates to the person's current condition.

The testimony in the hearing must be given under oath, and the proceedings must be recorded.

The patient may refuse to testify at the hearing.

(b)1.

If the court concludes that the patient meets the criteria for involuntary outpatient services pursuant to subsection (2), the court shall issue an order for involuntary outpatient services.

The court order shall be for a period of up to 90 days.

The order must specify the nature and extent of the patient's mental illness.

The order of the court and the treatment plan must be made part of the patient's clinical record.

The service provider shall discharge a patient from involuntary outpatient services when the order expires or any time the patient no longer meets the criteria for involuntary placement.

Upon discharge, the service provider shall send a certificate of discharge to the court.

2.

The court may not order the department or the service Page 24 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 provider to provide services if the program or service is not available in the patient's local community, if there is no space available in the program or service for the patient, or if funding is not available for the program or service.

The service provider must notify the managing entity if the requested services are not available.

The managing entity must document such efforts to obtain the requested services.

A copy of the order must be sent to the managing entity by the service provider within 1 working day after it is received from the court.

The order may be submitted electronically through existing data systems.

After the order for involuntary services is issued, the service provider and the patient may modify the treatment plan.

For any material modification of the treatment plan to which the patient or, if one is appointed, the patient's guardian advocate agrees, the service provider shall send notice of the modification to the court.

Any material modifications of the treatment plan which are contested by the patient or the patient's guardian advocate, if applicable, must be approved or disapproved by the court consistent with subsection (3).

3.

If, in the clinical judgment of a physician, the patient has failed or has refused to comply with the treatment ordered by the court, and, in the clinical judgment of the physician, efforts were made to solicit compliance and the patient may meet the criteria for involuntary examination, a person may be brought to a receiving facility pursuant to s.

Page 25 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 394.463.

If, after examination, the patient does not meet the criteria for involuntary inpatient placement pursuant to s.

394.467, the patient must be discharged from the facility.

The involuntary outpatient services order shall remain in effect unless the service provider determines that the patient no longer meets the criteria for involuntary outpatient services or until the order expires.

The service provider must determine whether modifications should be made to the existing treatment plan and must attempt to continue to engage the patient in treatment.

For any material modification of the treatment plan to which the patient or the patient's guardian advocate, if applicable, agrees, the service provider shall send notice of the modification to the court.

Any material modifications of the treatment plan which are contested by the patient or the patient's guardian advocate, if applicable, must be approved or disapproved by the court consistent with subsection (3).

(c) If, at any time before the conclusion of the initial hearing on involuntary outpatient services, it appears to the court that the person does not meet the criteria for involuntary outpatient services under this section but, instead, meets the criteria for involuntary inpatient placement, the court may order the person admitted for involuntary inpatient examination under s.

394.463.

If the person instead meets the criteria for involuntary assessment, protective custody, or involuntary admission pursuant to s.

397.675, the court may order the person Page 26 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 to be admitted for involuntary assessment for a period of 5 days pursuant to s.

397.6811.

Thereafter, all proceedings are governed by chapter 397.

(d) At the hearing on involuntary outpatient services, the court shall consider testimony and evidence regarding the patient's competence to consent to services.

If the court finds that the patient is incompetent to consent to treatment, it shall appoint a guardian advocate as provided in s.

394.4598.

The guardian advocate shall be appointed or discharged in accordance with s.

394.4598.

(e) The administrator of the receiving facility or the designated department representative shall provide a copy of the court order and adequate documentation of a patient's mental illness to the service provider for involuntary outpatient services.

Such documentation must include any advance directives made by the patient, a psychiatric evaluation of the patient, and any evaluations of the patient performed by a psychologist or a clinical social worker.

(8) PROCEDURE FOR CONTINUED INVOLUNTARY OUTPATIENT SERVICES.— (a)1.

If the person continues to meet the criteria for involuntary outpatient services, the service provider shall, at least 10 days before the expiration of the period during which the treatment is ordered for the person, file in the court that issued the order for involuntary outpatient services a petition Page 27 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 for continued involuntary outpatient services.

The court shall immediately schedule a hearing on the petition to be held within 15 days after the petition is filed.

2.

The existing involuntary outpatient services order remains in effect until disposition on the petition for continued involuntary outpatient services.

3.

A certificate shall be attached to the petition which includes a statement from the person's physician or clinical psychologist justifying the request, a brief description of the patient's treatment during the time he or she was receiving involuntary services, and an individualized plan of continued treatment.

4.

The service provider shall develop the individualized plan of continued treatment in consultation with the patient or the patient's guardian advocate, if applicable.

When the petition has been filed, the clerk of the court shall provide copies of the certificate and the individualized plan of continued services to the department, the patient, the patient's guardian advocate, the state attorney, and the patient's private counsel or the public defender.

(b) Within 1 court working day after the filing of a petition for continued involuntary outpatient services, the court shall appoint the public defender to represent the person who is the subject of the petition, unless the person is otherwise represented by counsel.

The clerk of the court shall Page 28 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 immediately notify the public defender of such appointment.

The public defender shall represent the person until the petition is dismissed or the court order expires or the patient is discharged from involuntary outpatient services.

Any attorney representing the patient shall have access to the patient, witnesses, and records relevant to the presentation of the patient's case and shall represent the interests of the patient, regardless of the source of payment to the attorney.

(c) Hearings on petitions for continued involuntary outpatient services must be before the court that issued the order for involuntary outpatient services.

The court may appoint a magistrate to preside at the hearing.

The procedures for obtaining an order pursuant to this paragraph must meet the requirements of subsection (7), except that the time period included in paragraph (2)(e) is not applicable in determining the appropriateness of additional periods of involuntary outpatient placement.

(d) Notice of the hearing must be provided as set forth in s.

394.4599.

The patient and the patient's attorney may agree to a period of continued outpatient services without a court hearing.

(e) The same procedure must be repeated before the expiration of each additional period the patient is placed in treatment.

(f) If the patient has previously been found incompetent Page 29 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 to consent to treatment, the court shall consider testimony and evidence regarding the patient's competence.

Section 394.4598 governs the discharge of the guardian advocate if the patient's competency to consent to treatment has been restored.

Section 5.

Section 394.467, Florida Statutes, is amended to read:

394.467 Involuntary services inpatient placement.— (1) DEFINITIONS.—As used in this section, the term:

(a) "Court" means a circuit court.

(b) "Involuntary inpatient placement" means services provided on an inpatient basis to a person 18 years of age or older who does not voluntarily consent to services under this chapter or a minor who does not voluntarily assent to services under this chapter.

(c) "Involuntary outpatient services" means services provided on an outpatient basis to a person who does not voluntarily consent to services under this chapter.

(2)(1) CRITERIA FOR INVOLUNTARY SERVICES.—A person may be ordered by a court to be provided for involuntary services inpatient placement for treatment upon a finding of the court, by clear and convincing evidence, that the person meets the following criteria:

(a) The person He or she has a mental illness and because of his or her mental illness:

1.a.

Is unlikely to voluntarily participate in the Page 30 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 recommended treatment plan and has refused voluntary services or He or she has refused voluntary inpatient placement for treatment after sufficient and conscientious explanation and disclosure of the purpose of inpatient placement for treatment;

or b.

He or she Is unable to determine for himself or herself whether services or inpatient placement is necessary;

and 2.a.

Is unlikely to survive safely in the community without supervision, based on clinical determination;

b.2.a.

He or she 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 c.b.

Without treatment, there is a substantial likelihood that in the near future the person he or she will inflict serious bodily harm on self or others, as evidenced by recent behavior causing, attempting to cause, or threatening to cause such harm.;

and (b) In view of the person's treatment history and current behavior, the person is in need of involuntary outpatient services to prevent a relapse or deterioration of his or her mental health that would be likely to result in serious bodily Page 31 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 harm to self or others, or a substantial harm to his or her well-being as set forth in s.

394.463(1).

(c) The person has a history of lack of compliance with treatment for mental illness.

(d) It is likely that the person will benefit from involuntary services.

(e)(b) All available less restrictive treatment alternatives that would offer an opportunity for improvement of the person's his or her condition have been deemed judged to be inappropriate or unavailable.

(3)(2) RECOMMENDATION FOR INVOLUNTARY SERVICES AND ADMISSION TO A TREATMENT FACILITY.—A patient may be recommended for involuntary inpatient placement, involuntary outpatient services, or a combination of both.

(a) A patient may be retained by a facility for involuntary services or involuntarily placed in a treatment facility upon the recommendation of the administrator of the facility where the patient has been examined and after adherence to the notice and hearing procedures provided in s.

394.4599.

However, if a patient who is being recommended for only involuntary outpatient services has been stabilized and no longer meets the criteria for involuntary examination pursuant to s.

394.463(1), the patient must be released from the facility while awaiting the hearing for involuntary outpatient services.

(b) The recommendation must be supported by the opinion of Page 32 of54 CODING:

Words strickenare deletions;

words underlined are additions.

hb0915-01-c1 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/HB915 2024 a psychiatrist and the second opinion of a clinical psychologist or another psychiatrist, both of whom have personally examined the patient within the preceding 72 hours, that the criteria for involuntary services inpatient placement are met.

(c) If However, if the administrator certifies that a psychiatrist or clinical psychologist is not available to provide a the second opinion, the administrator must certify that a clinical psychologist is not available and the second opinion may be provided by a licensed physician who has postgraduate training and experience in diagnosis and treatment of mental illness or by a psychiatric nurse.

If the patient is being recommended for involuntary outpatient services only, the second opinion may be provided by a physician assistant who has at least 3 years' experience and is supervised by a licensed physician or psychiatrist or a clinical social worker.

(d) Any opinion authorized in this subsection may be conducted through a face-to-face or in-person examination, in person, or by electronic means.

Recommendations for involuntary services must Such recommendation shall be entered on an a petition for involuntary services inpatient placement certificate, which shall be made a part of the patient's clinical record.