2018 Legislative Session Report

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Table of Contents Introduction...... 3 Legislative Session Statistics ...... 3 2018 Priority Issues ...... 3 Florida’s Opioid Crisis ...... 3 Background Screening ...... 4 Parity ...... 5 Public Safety ...... 6 Budget Overview ...... 7 Health Care ...... 7 Agency for Health Care Administration (AHCA) ...... 7 Department of Children and Families (DCF) ...... 9 Department of Veterans Affairs (DVA) ...... 10 Justice and the Courts ...... 10 Department of Corrections (DOC) ...... 10 Department of Juvenile Justice (DJJ) ...... 10 State Courts System (SCS) ...... 11 Housing ...... 11 Appendix 1: Priority Legislation that passed ...... 12 Controlled Substances (Opioid Package) ...... 12 Criminal Justice (Civil Citation) ...... 13 Perinatal Mental Health ...... 14 Public Records/Addiction Treatment Facility Personnel ...... 15 Workers Compensation for First Responders (PTSD) ...... 15 Appendix 2: Priority Legislation that failed ...... 16 Substance Abuse Services (“Sober Homes”/Background Screening) ...... 16 Peer Specialists (& Background Screening) ...... 17 Alcohol & Substance Abuse Prevention (Office of Drug Control) ...... 17 Insurance Coverage Parity for Mental Health & Substance Use Disorders (Parity) ...... 17 Appendix 3: Overview of Filed Legislation Tracked by FBHA ...... 18 Appendix 4: FY2018-19 Funding (Includes Opioid and Mental Health Funding Legislation) ...... 23 Appendix 5: Key Provisions of “Marjory Stoneman Douglas High School Public Safety Act” ...... 29

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INTRODUCTION The 2018 Legislative Session can be summed up in a short phrase: this year was the “Session of Circumstance”. Legislative committee weeks leading up to the first half of session placed heavy emphasis on hurricane recovery efforts and the opioid crisis. There were five committee meetings dedicated to understanding the impact heroin and opioids have had on Florida’s communities and strategies to address the epidemic. Lawmakers heard from parents, physicians, law enforcement, health plans, individuals in recovery, and the substance abuse treatment community. In the end, the Legislature passed a sweeping opioid package with additional $53.65 million R/NR to fund treatment, emergency services, and enhancements to the Prescription Drug Monitoring Program (PDMP).

The House and Senate passed their respective budgets in early February, setting the stage for budget conference. One week later, nineteen-year old Nikolas Cruz opened fire at Marjory Stoneman Douglas High School in Parkland, Florida killing seventeen students and teachers and injuring dozens more. This tragedy drastically changed the course of the Legislature. Within days, Governor Rick Scott and House and Senate leaders released recommendations for addressing mental health and public safety in schools, including gun control. Students, parents, and advocates for action lined the streets of Tallahassee surrounding the Capitol demanding change.

Negotiating the components of the public safety and opioid legislative packages with funding elements and reconciling the General Appropriations Act caused a two-day extension of session that left many legislative priorities, such as background screening and the expansion of the needle exchange program on the table this year.

Legislative Session Statistics The 2018 Legislative Session commenced January 9, 2018 after five committee weeks and adjourned sine die on Sunday, March 11, at 4:16 pm.

Fewer bills passed under the leadership of Senate President Joe Negron (R-Palm City) and House Speaker Richard Corcoran (R-Land O’Lakes) than leadership chambers in recent decades. This year, 3,189 bills were filed, including 1,314 appropriations project bills ($2.275 billion). Only 200 bills passed, compared to 249 passed in the previous year (2017).

The budget (HB 5001 – General Appropriations Act) totaled $88,727,534,353. The Governor vetoed $64 million in appropriations. Additionally, legislation passed with attached funding totaled $616,553,730, including public/school safety funding ($400 million) and opioid funding ($53.65 million).

2018 Priority Issues

Florida’s Opioid Crisis After the January 2017 “Ten a Day Die This Way” campaign initiated by the Florida Behavioral Health Association, the Legislature (2017) passed several laws that incorporated five of the recommendations promoted by the FBHA. In April Governor Rick Scott declared a Public Health Emergency after conducting a statewide listening tour in four cities heavily impacted by the opioid

Page | 3 crisis. The declaration authorized immediate release of the federal State Targeted Response Grant (STR) funds ($27.35 million), which went immediately into providing services to individuals with opioid use disorders.

This year Governor Scott also released recommendations for a comprehensive opioid legislative package. Filed by Senator Lizbeth Benacquisto (R-Ft. Myers) and Rep. (R-Bradenton) the legislation enhances penalties for trafficking opioids; reschedules buprenorphine to a Schedule II controlled substance to align with federal laws, and includes a controversial 3-day, and in some instances 7-day limit on prescription opioids.

Both bills funded an expansion of substance use disorder treatment services but had slight differences in how the spending would be allocated. The Senate bill also contained a provision prohibiting prior authorization for medication assisted treatment for opioid use disorders. The final negotiated bill removed the prior authorization language and funded the following: • $27,035,532 NR Federal Grants Trust Fund to Department of Children and Families (DCF) for the State Targeted Response to the Opioid Crisis grant (authorization to spend federal funding); • $14,626,911 R to DCF for enhancement of community-based substance abuse services to address the opioid crisis for outreach, addiction treatment, and recovery support services; • $5,000,000 R to the Department of Health (DOH) for naloxone to be made available to first responders; • $6,000,000 R to the Office of State Court Administrator (OSCA) for MAT for patients involved in the criminal justice system; • $873,089 R, $117,700 NR to the DOH for improvements to the Prescription Drug Monitoring Program (PDMP).

A complete breakdown of the legislation can be found in the Appendix 1.

Aside from the Governor’s opioid package, two other bills each were filed that created a high-level office to coordinate drug control policy. One measure (SB 1068.HB 865) reinstated the former Office of Drug Control Policy and one measure (HB 1025/SB 1468) created expanded roles and duties or an Office of Drug Control. The bills did not gain traction in the Legislature, despite being a key recommendation of the Drug Policy Advisory Council.

Background Screening Changes in background screening and the exemption process has been a priority issue for the Association. Until now, the Legislature was unwilling to consider reforming the law. In fact, new disqualifying offenses have been added and the pool of employees who are subject to Level 2 screening has been expanded.

This year, the FBHA provided documented instances of complications within the process to the House Children, Families, and Seniors Subcommittee Chair (R- Port St. Lucie). The Association also worked extensively with House and Senate committee staff on this issue. The barriers ranged from length of time to receive a clearance or exemption, to difficulties in obtaining records needed to submit a complete exemption packet. Additionally, the FBHA presented information from a provider perspective, exacerbating an already strained workforce. To provide

Page | 4 relief to both providers and prospective employees, the FBHA presented several solutions from addressing the exemption process to reducing the list of disqualifying offenses. To create partnerships, the FBHA worked to include background screening changes in the recommendations by the “Sober Homes Task Force”.

The Senate Children, Families, and Elder Affairs Chairman Rene Garcia (R-Hialeah) filed legislation that provided a framework for the peer support workforce in substance abuse and mental health. The bill (SB 450) proposed changes to background screening within the substance abuse and mental health statutes and removed twelve disqualifying offenses for the peer workforce.

Meanwhile, HB 1069, which incorporated many of the recommendations of the 2017 “Sober Homes Task Force” report also included changes to background screening. Sponsored by Rep. Bill Hagar (R-Boca Raton), HB 1069 applied to the entire mental health and substance abuse workforce and removed ten offenses from the list of disqualifying offenses and required that the Agency for Healthcare Administration and the Department of Children & Families make their exemption determination within sixty days. Meanwhile, prospective employees would have been authorized to work under supervision throughout the background screening process.

While both bills removed certain disqualifying offenses, both added the disqualifying offenses listed in Chapter 408, to align with the mental health chapter. Those offenses relate to crimes such as Medicaid fraud and patient brokering. Also, both bills authorized the Agency or the Department to grant an exemption for individuals to work solely in mental health and substance abuse. This was aimed to expedite the process and provide greater flexibility when making exemption determinations.

SB 450 passed the Senate, but the companion bill was never heard in committee. HB 1069 passed the House. When considered by the Senate, amendments were added to strengthen the background screening process, including much of the language contained within SB 450. Unfortunately, HB 1069 was on a message list that was not considered by the House in the waning moments of the session, thus the bill died.

Parity Full implementation of substance abuse and mental health parity has been an on-going priority of the FBHA. This year, the Association worked with The Kennedy Forum to develop draft parity legislation for Florida.

Filed by Senator (D-St. Petersburg) and Representative Sean Shaw (D-Tampa), the legislation would have codified the federal Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008 into state law by repealing maximum benefits for various levels of treatment. The legislation would also require the Office of Insurance Regulation and the Agency for Health Care Administration to examine health plans to determine health plan compliance with the law and report to the Legislature progress on implementing parity. The Senate bill (SB 1422) was heard in the Banking & Insurance Committee, where it was approved unanimously. The House bill did not move, thus ending the effort this year.

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Public Safety After the shooting in Parkland, legislators and staff worked around the clock to develop a legislative package that addressed mental health, gun control, and school safety. The Governor convened three policy groups to recommend policy changes with many of these changes included in the Governor’s recommendations to the legislature. The Governor’s proposal for action became the foundation of the Senate and House version of proposed legislation and funding. The legislature held special committee meetings to hear from the students and parents from Parkland and thousands joined the students and parents for a rally at the capitol demanding action.

The Senate took the lead on legislation, SB 7026. Many components of the proposed bill were contentious and did not have the support of the entire legislature. The Senate debated the bill in a marathon floor session, barely passing on a 20-18 vote. This legislation was met with similar resistance in the House which ultimately passed on a 67-50 vote.

Gun control was the most contentious issue. SB 7026 raises the age of purchasing a firearm to 21 years (with some exceptions) and bans the sale or possession of bump stocks. Supporters of the National Rifle Association (NRA) opposed these provisions. Others opposed the provisions because the proposed bill did not ban the sale and possession of all semi-automatic weapons. The bill additionally authorizes law enforcement to temporarily seize weapons from individuals who are experiencing a mental health crisis. A judge may sign a “Risk Protection Order” to seize an individual’s weapons for up to twelve months.

Another contentious issue was the establishment of school “guardians”, which was previously referred to as the sheriff’s “marshal program”. One earlier version of the bill allowed teachers to become school marshals, thus carry weapons. SB 7026 requires the local sheriff to develop a guardian program and authorizes schools to adopt a program that includes crisis intervention training and 132 hours of weapons training. School guardians must also pass a mental health exam and undergo drug testing. Primary teachers may not become guardians unless they are former military, law enforcement or active reserves.

Agreement was reached in the legislation that additional mental health treatment should be available for students. Senate Appropriations Subcommittee on Prek-12 Education Chair (R-Naples) promoted mental health in schools throughout session and prior to the shooting. She had included “mental health assistance allocation” in several pieces of legislation that funded $40 million to assist school districts to establish or expand comprehensive school-based mental health care. Similar provisions were adopted in SB 7026 that require schools to adopt plans that deliver evidence-based mental health services and treatment to students; the legislation includes the following elements: • Provision for mental health assessment, diagnosis, intervention, treatment, and recovery services to students with one or more mental health or co-occurring substance abuse diagnoses and students at high risk of such diagnoses. • Coordination of such services with a student’s primary care provider and with other mental health providers involved in the student’s care.

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• Direct employment of such service providers, or a contract-based collaborative effort or partnership with one or more local community mental health programs, agencies, or providers.

Continuing education and in-service training on youth mental health awareness and assistance will be required using a trainer certification model facilitated by a Department-selected national authority.

Additionally, bill provides for the development of “threat assessment teams” to identify youth who may be at risk or in need of crisis services for either mental health or substance abuse. The assessment team would include selected experts in counseling, instruction, school administration, and law enforcement.

The bill allocates nearly $400 million to implement these efforts including $69,237,286 R to fund the mental health assistance allocation; $500,000 R/$6,200,000 NR to implement the youth mental health awareness and assistance training; $9,800,000 R to competitively procure additional community action treatment teams (CATs) to serve the areas of greatest need; $18,300,000 R to competitively procure proposals for additional mobile crisis teams to ensure reasonable access among all counties.

A summary of SB 7026 can be found in Appendix 5.

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Budget Overview Passing a balanced budget is the only Constitutionally required act of the Legislature. During session, House and Senate appropriations subcommittee chairs release their proposals for each silo of government. Those proposals are embedded into a larger budget which is then voted on by their respective chambers. Like any other legislation, the House and Senate budget must match before sending to the Governor. If either side refuses to concur with the other proposal, then conference committees are appointed to reconcile the differences.

Prior to the budget conference, the Senate President and Speak of the House agree to budget allocations, which provide direction for the conference committees. Funding issues not agreed to by the conference subcommittees are “bumped” to the full appropriations conference committee. Any unresolved issues are then “bumped” for decision by the President and Speaker.

The budget requires a mandatory 72-hour “cooling off” period so legislators can review the spending plan. This means that the “Conference Report” and associated conforming bills and implementing bill must be printed and distributed Tuesday (day 57) to conclude on-time Friday (day 60).

The House and Senate budgets as initially passed were close dollar-wise ($100 million difference) but far apart in spending philosophy, particularly as it related to the Medicaid funding formula to hospitals. This year, the House led the budget negotiations and the final spending plan for FY2018- 19 totaled $88.7 billion, $3.8 billion more than the current FY2017-18 (+4.4%). The increase is driven by a few specific issues, which include: price and workload increases in Medicaid; hurricane relief effort; increased spending for PreK-12 and higher education; and various other environmental programs. Additionally, special funding for the opioid crisis ($53,653,232) and public safety ($399,999,910) are wholly contained and have been approved by the Governor. They are not part of the General Appropriations Act (HB 5001).

Appendix 4 is a summary of HB 5001, the General Appropriations Act for FY 2018-19.

Health Care The Health Care budget is funded at $37.1 billion ($9.9 billion General Revenue and $27.3 billion Trust Funds), a 3.30% increase in total spending and a 4.90% increase in general revenue funds from FY2017– 18.

Agency for Health Care Administration (AHCA) The AHCA budget is funded at $29.2 billion ($6.89 billion GR; $22.3 billion TF). Funding for Medicaid was increased due to caseload and price level adjustment as was funding for rural hospitals. Additionally, the Legislature funded Medicaid rate increases for pediatric care and Intermediate Care Facilities for Developmentally Disabled.

One change in the Medicaid process this year is the limit of retroactive eligibility from 90-days to 30-days. Estimated to save $98.4 million, this would limit Medicaid eligibility to the first day of the month in which a person applies for Medicaid. This change is designed to encourage medical providers to enroll their patients in Medicaid in a timely manner to receive coordinated care services in the most appropriate setting.

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Low Income Pool (LIP) The Legislature appropriated $1.508 billion NR TF for Low Income Pool, which is supplemental funding for safety net providers for the costs of uncompensated care for low income individuals who are uninsured. This year, the Legislature included proviso directing AHCA to seek federal approval to develop LIP funding for behavioral healthcare (substance abuse and mental health) naming central receiving systems. The Proviso states: The Agency for Health Care Administration shall seek federal approval to amend the Special Terms and Conditions for the Low-Income Pool to include a payment group for uncompensated behavioral health care services. The behavioral health care services are for individuals in the substance abuse and mental health safety net system (Central Receiving Systems) administered by the Department of Children and Families. Subject to federal approval of the terms and conditions, the Agency shall submit a budget amendment requesting authority for the release of funds pursuant to chapter 216, Florida Statutes.

The current LIP program process: local government entities put money into the pool through Intergovernmental Transfers (IGTs). Contributing entities may include counties, municipalities, and local health care taxing districts. The AHCA draws matching funds from the federal government based on the Federal Medical Assistance Percentage (FMAP) and distributes the combined local and federal funds to qualified providers based on a legislatively approved distribution model.

LIP funding provides support for the costs of uncompensated charity care for individuals with incomes up to 200% of the federal poverty level. It does not include uncompensated care for individuals with insurance, bad debt, or Medicaid or Children’s Health Insurance Program (CHIP) “shortfall.”

To qualify for LIP, an entity must contract with at least 50% of the standard Medicaid health plans and at least one specialty plan for each target area in their region. They must also participate in the Event Notification System and be enrolled Medicaid providers with a minimum of 1% Medicaid utilization.

Department of Children & Families (DCF) The DCF budget totals $3.192 billion ($1.7 billion GR; $1.4 billion TF); with $704 million for community substance abuse and mental health. Of note, the Legislature fully funded Central Receiving Facilities $19,878,768 R, a top priority of the FBHA. The Reinvestment Grant ($9 million R) and the Challenge Grant ($44.1 million R) were funded at existing levels as well as funding for pregnant women, mothers, and their affected families ($10 million R).

The Legislature funded with recurring dollars three new Family Intensive Treatment (FIT) teams totaling $12.9 million R and invested $20.5 million R/NR in Community Action Teams (CAT). This year, rather than naming new CATs, the Legislature directed DCF to competitively procure two new CATs in the area of greatest need. (Note: In addition, the Public Safety bill – SB 7026 – adds $9.8 million for approximately 13 new CATs and $18.3 million for mobile crisis teams).

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Long acting injectable naltrexone (Vivitrol) was funded at the existing level ($1.5 m R; $1.021 m NR). Additionally, there will be funding through the opioid package (HB 21) which reauthorizes the State Targeted Response grant ($27.035 m NR) and increases base funding for opioid treatment ($14.626 m R), both of which may be used for medication assisted treatment.

Department of Veterans Affairs (DVA) The VA budget included proviso, which was the substance of SB 440 by Sen. Rene Garcia (R- Hialeah) to seek federal approval to shift VA nursing home placement into community-based care, including behavioral health services. The proviso states: The Florida Department of Veterans’ Affairs is directed to seek federal authorization and funding for a program to reduce nursing home placements by providing home and community-based services to the veterans population. The program may include medical, behavioral health, or long-term care services, as negotiated. The Department of Veterans’ Affairs shall provide a report on the status of negotiations by February 1, 2019, to the Executive Office of the Governor, the President of the Senate, and the Speaker of the House of Representatives. Implementation of the program is subject to Legislative approval and contingent on federal funding.

Justice and the Courts

Department of Corrections (DOC): The total spend for the DOC was $2.5 billion, which was a $73.6 million increase ($37.7 million R; $40.0 million NR). Lawsuits filed against the Department of Corrections caused an increase in overall spending including: $46.8 million GR to improve the treatment of inmates with mental health disorders; $14.6 million GR for Hepatitis C virus treatment costs; and $6.4 million to address ADA compliance issues.

However, downward estimates from the Criminal Justice Estimating Conference reduced the operational budget by -$15.5 million R. The Legislature continued funding for the Wakulla CI mental health unit ($10 million R) as well as long acting injectable naltrexone ($500,000).

The total for community substance abuse and mental health was $26 million, with $21.3 million R/TF set aside for contracted community residential substance abuse beds. This is less than funded in FY2017-18. Rather than reducing the DOC budget by $15.5 in one category, the reduction was spread across the entire budget.

Department of Juvenile Justice (DJJ): The total DJJ budget is $590.2 million ($409.4 million GR; $180.8 million TF). Key items funded this year include a 10% pay raise ($6.1 million R/TF) for juvenile detention officers and juvenile probation officers and $2 million R retention bonus for contracted direct care staff. In response to Miami Herald’s Fight Club investigation, the Legislature funded $1.0 million to install security cameras at detention/ residential facilities. Other items of note include: $6.1 million R for increased residential beds; $800k NR to develop an At-Risk–Assessment instrument; and $3.7 million NR for Prevention and Intervention Program.

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State Courts System (SCS) The Legislature fully funded long acting injectable naltrexone at the FY 2017-18 existing levels ($5 m R; $2.5 m NR). Initially, the House eliminated all funding for Vivitrol. The Senate only included the recurring funding. This ended up being a bump issue and the end result was full funding of the program. Additionally, HB 21 sets aside $6 million to the state courts for medication assisted treatment.

Housing Funding available for housing is through the Sadowski Trust Fund. Total available for funding this year was $300 million, however as in years past, the Legislature swept many of those funds to be spent in other areas of the budget. The Senate invested $108 million to SHIP (State Housing Incentive Program) and $114 million for other affordable housing, including $10 million set aside for developmental disabilities and $40 million for SAIL (State Apartment Incentive Loan) in hurricane-impacted areas. The House approach is to invest nearly all of the Sadowski funds to housing in hurricane-impacted areas: $74 million rental recovery in hurricane impacted areas; $48.9 million SHIP in hurricane-impacted areas. In the end, the Legislature funded $79.18 million for affordable housing programs ($15 million specifically for SAIL and an additional $15 million for SAIL in hurricane impacted areas) and $44.45 in SHIP.

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Appendix 1: Priority Legislation that Passed - Key Provisions

HB 21: Governor's Opioid Package Relating to Controlled Substances HB 21 Rep. Jim Boyd (R-Manatee)/SB 458 Sen. Lizbeth Benacquisto (R-Ft. Myers)

CS/CS/HB 21 amends various sections of law to increase the regulation, training, and reporting required when controlled substances are prescribed and dispensed. The bill: 1. Requires all prescribing practitioners who are authorized to prescribe controlled substances to complete a two-hour training course prior to biennial licensure renewal on the safe and effective prescribing of controlled substances, unless such practitioner is already required to take such a course by his or her practice act. 2. Defines “acute pain” as the normal, predicted, physiological, and time-limited response to an adverse chemical, thermal, or mechanical stimulus associated with surgery, trauma, or acute illness. The term specifically does not include pain related to: • Cancer; • A terminal condition; • Palliative care to provide relief of symptoms related to an incurable, progressive illness or injury; or • A serious traumatic injury with an Injury Severity Score of 9 or greater. 3. Provides restrictions on certain prescriptions written to treat acute pain by: • Requiring applicable health care regulatory boards to create guidelines for prescribing controlled substances for the treatment of acute pain. • Limiting a prescription for an opioid listed in Schedule II to no more than 3 days if prescribed to treat acute pain as defined, and 6 days if determined to be medically necessary by the prescribing practitioner and with proper documentation. • Requiring a prescriber to co-prescribe an opioid antagonist when prescribing controlled substances for serious traumatic injury. 4. Requires clinics that are exempt from the requirement to register as a pain management clinic to obtain and maintain a certificate of exemption from the Department of Health (DOH). These provisions take effect January 1, 2019. 5. Requires pharmacists and dispensing practitioners to verify a patient’s identity prior to dispensing controlled substances. 6. Conforms an exemption allowing health care practitioners to dispense controlled substances in connection with a surgical procedure to the limits on prescribing established for Schedule II opioid medications. 7. Creates an exemption to allow a physician to dispense Schedule II and III controlled substances approved by the United States Food and Drug Administration (FDA) for the medication-assisted treatment (MAT) of his or her own patients. 8. Explicitly authorizes electronic prescriptions for controlled substances. 9. Adds and reschedules substances to the various schedules of controlled substances. 10. Substantially rewords the Prescription Drug Monitoring Program (PDMP) with changes including, but not limited to: • Including Schedule V controlled substances in the list of drugs that must be reported to the Prescription Drug Monitoring Program (PDMP); • Requiring prescribing practitioners to consult the PDMP before prescribing controlled substances with certain exceptions;

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• Allowing the DOH to coordinate and share Florida’s PDMP data with other states’ PDMPs and to enter into contracts to establish secure connections between the PDMP and prescribing or dispensing health care practitioner’s electronic health records; and • Allowing prescribers and dispensers with Veterans’ Affairs, the military, and the Indian Health Services, and Florida medical examiners access to data in the PDMP. • Increases the penalty from a 3rd degree felony to a 2nd degree felony for a patient or health care practitioner who knowingly obtains or provides a controlled substance that is not medically necessary. • Creates a new 3rd degree felony for unlawfully possessing/using tableting or encapsulation machines. 11. Allocates for FY2018-19: • $27,035,532 NR Federal Grants Trust Fund to Department of Children and Families (DCF) for the State Targeted Response to the Opioid Crisis grant. • $14,626,911 R to DCF for community-based services to address the opioid crisis for outreach, addiction treatment, and recovery support services to include: Stated goals of this funding: o Expand capacity to increase access to and reduce waitlists for treatment; o Increase efforts to effectively engage and retain in treatment youth, pregnant women, high-risk populations, and high utilizers of acute care services; and o Further develop a recovery-based model of care. Funding for specific services may include: o Case management; o Residential services; o Outpatient services o Aftercare services; and o Medication-assisted treatment (methadone, buprenorphine, and naltrexone extended release injectable). • $5,000,000 R to the Department of Health (DOH) for naloxone (for first responders). • $6,000,000 R to the Office of State Court Administrator (OSCA) for MAT of substance abuse disorders related to the criminal justice system. o High likelihood of becoming involved in the criminal justice system; or o Individuals who are in court-ordered, community-based drug treatment. o MAT (methadone, buprenorphine, and naltrexone extended release injectable). • $873,089 R, $117,700 NR to the DOH for improvements to the PDMP.

Effective date: July 1, 2018. Vote: Senate 37-0; House 99-0

SB 1392: Adult and Civil Citation - passed SB 1392(1394) Sen. (R-St. Petersburg)/HB 1197(1199) Rep. Larry Ahern (R- Seminole) The bill creates a model of uniform criminal justice data collection. Specifically, the bill: • Defines terms used in the bill as they relate to data collection; • Requires the clerks of court, state attorneys, public defenders, county detention facility administrators, and the Department of Corrections to collect specified data on a biweekly basis and report it to the Florida Department of Law Enforcement (FDLE) monthly;

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• Requires the FDLE to publish the data collected on the FDLE’s website and make it searchable and accessible to the public; • Provides that any clerk of the court or county detention facility that does not comply with the required data collection is ineligible to receive funding from the General Appropriations Act, any state grant program administered by the FDLE, or any other state agency for five years after the date of noncompliance; • Requires additional pretrial release information to be reported in the annual report; • Digitizes the Criminal Punishment Code sentencing scoresheet; and • Authorizes a pilot project in the Sixth Judicial Circuit for the purpose of improving criminal justice data transparency. Additionally, the bill provides for the establishment of civil citation or similar prearrest diversion programs for adults and juveniles.

The bill permits local communities and public or private educational institutions to adopt a model prearrest diversion program for adults and provides guidelines for the establishment of such programs and requires a civil citation or similar prearrest diversion program for juveniles to be established in each judicial circuit in the state and outlines criteria that each civil citation or similar prearrest diversion program must specify in developing such program.

Additionally, FDLE is required to adopt rules to provide for the expunction of a nonjudicial record of the arrest of a minor who has successfully completed a diversion program. Each diversion program must to submit data that identifies each minor participating in the diversion program to the Department of Juvenile Justice (DJJ), who must publish on department website.

Effective date: July 1, 2018. Vote: Senate 36-1; House 116-0

HB 937: Perinatal Mental Health - passed HB 937 Rep. Jeanette Nunez (R-Miami)/SB 138 Sen. (D-Plantation)

The bill creates the Florida Families First Act, which requires the Department of Health (department), by January 1, 2019, to provide perinatal mental health information through its toll- free hot line, the Family Health Line. The bill requires the hotline to provide basic information on postpartum depression, and may: • Recommend that a caller be further evaluated by a qualified health care provider; and • Refer a caller to an appropriate health care provider in the caller's local area.

The birth center’s postpartum evaluation and follow-up care are expanded, to include: • A mental health screening; • Information on postpartum depression; and • The telephone number of the Family Health Line.

The bill appropriates $104,320 recurring General Revenue funds and $21,600 nonrecurring General Revenue funds to the department to implement the provisions in the bill.

Effective date: July 1, 2018. Vote: Senate 36-0; House 113-0

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SB 1364: Public Records/Addiction Treatment Facility Personnel - passed HB 1055 Rep. Bobby DuBose (D-Ft. Lauderdale)/SB 1364 Sen. Kevin Rader (D-Boca Raton)

The bill exempts from public record requirements personal identifying information of current or former directors, managers, supervisors, nurses, and clinical employees (& their spouses and children) who work in treatment facilities licensed under Chapter 397. It exempts: • Home addresses; • Telephone numbers; • Dates of birth; • Photographs; and • Names /locations of schools/day care facilities attended by the children of those persons

Provides that some clients of addiction treatment facilities may become disgruntled with the assistance provided or the recommendations or decisions of such personnel and may seek revenge against these personnel or family members. Accordingly, the harm that may result from the release of such identifying and location information outweighs the public benefit that may be derived from the disclosure of such information.

The bill also provides for repeal of the exemption on October 2, 2023, unless reviewed and saved from repeal through reenactment by the Legislature.

Effective date: July 1, 2018. Vote: Senate 36-0; House 105-9 SB 376: Workers’ Compensation Benefits for First Responders - passed SB 376 Sen. Lauren Book (D-Plantation)/HB 227 Rep. Matt Willhite (D-Royal Palm Beach)

The bill revises the standards for determining compensability of employment-related post- traumatic stress disorder (PTSD) under workers’ compensation insurance for first responders, which includes volunteers or employees engaged as law enforcement officers, firefighters, emergency medical technicians, and paramedics. The bill creates an exception to current law to authorize the compensation of indemnity benefits for PTSD, if the first responder: • Has PTSD that resulted from the course and scope of employment; and • Is examined and diagnosed with PTSD by an authorized treating psychiatrist of the employer or carrier due to the first responder experiencing one of the following qualifying events relating to minors or others.

The PTSD must be demonstrated by clear and convincing evidence. Medical and indemnity benefits for a first responder’s PTSD are due regardless of whether the first responder incurred a physical injury and must file the notice of injury with their employer or carrier within 90 days of the qualifying event, described above, or manifestation of the PTSD.

Effective Date: October 1, 2018 Vote: Senate 33-0; House 114-0

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Appendix 2: Priority Legislation that Failed - Key Provisions

“Sober Home” Bill – died in House messages SB 1418 Sen. Darryl Rouson (D-St. Petersburg) HB 1069 Rep. Bill Hagar (R-Boca Raton)

Section 1: Amends 394.4572 relating to Background Screening (mental health personnel) Authorizes AHCA and DCF to grant an exemption to work solely in mental health, substance abuse, or co-occurring treatment programs or facilities Section 2: Adds definition of “Peer Specialist” as a person who has been in recovery for at least 2 years who uses his or her personal experience to deliver services in behavioral health settings to support others in their recovery, or a person who has experience as a family member or a caregiver of a person with a SAMH disorder. Section 3: Amends 397.4073 relating to Background Screening (substance abuse) • Adds disqualifying offenses in Chapter 408.809 to substance abuse. It is already included in the mental health chapter • Requires peer specialists who have direct contact with individuals receiving services to a Level 2 background screening • Requires department to grant or deny exemption within 60 days and provide technical assistance to personnel requesting exemption including: o Provide a step by step process, timeframes, and guidance on addressing problems; o Notify personnel of likely deficiencies in the application within 10 days of submission; o Advise on alternative methods to obtain information if court records are no longer available; and o Maintain communication with personnel for those who have had an incomplete exemption after than 30 days. • Authorizes applicant with work under supervision until the agency makes a final determination on applicant’s exemption request • Removes six offenses to the list of disqualifying offenses ONLY for those who work under Chapter 397: o Prostitution o Burglary (3rd degree felony) o Grand theft of the third degree (3rd degree felony) o Forgery (3rd degree felony) o Uttering forged instruments (3rd degree felony) o Related attempt crimes • Authorizes department to grant exemptions solely in substance abuse or mental health or co-occurring disorders Section 4: Creates 397.417 relating to Peer Specialists • States qualification (restating definition) • Requires department to develop and implement training program and select credentialing entities • Requires individuals receiving department-funded recovery support services as a peer specialist to be certified. Allows 1 year to get certified if they are supervised by

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qualified professional or supervised peer with 3-yrs fulltime experience and supervisory training • Requires department to provide special considerations on exemptions from disqualification because of their lived experiences including: o The need to support the workforce; o That peer specialists may have criminal histories; o That peer specialists provide effective support services; and o That research has shown that peer support facilitates recovery and reduces health care costs. Section 5: Amends 397.487 relating to voluntary certification of recovery residences • Clarifies legislative intent to add that a person suffering from addiction has a higher success rate by living in a recovery residence “while receiving treatment” or after completing treatment • Adds disqualifying offenses outlined in Chapter 408.809 for owners, directors, and CFOs, but allows for the same flexibility in exemption for disqualification in offenses listed above Section 6: Amends 397.4873 relating to referrals to or from recovery residences; • Clarifies that the prohibition does not apply to a referral when a resident living in an uncertified recovery residence has experienced a relapse and the recovery residence administrator believes that the resident may benefit from clinical treatment • Allows a 6-month extension to the recovery residence certification requirement from July 1, 2018 to January 1, 2019 if applications and associated fees are submitted by July 1, 2018 • Clarifies that a recovery residence and owners/staff may not receive a direct or indirect pecuniary benefit by a licensed treatment provider in exchange for a referral Section 7: Conforming language relating to exemptions from disqualification. Section 8-10: Corrects cross-references Section 11: Provides an effective date of July 1, 2018

Peer Specialists – died in House Messages SB 450 Sen. Rene Garcia (R-Hialeah) HB 1327 Rep. Kathleen Peters (R-Clearwater)

Sections 1, 4 Defined “peer specialist,” as a person who has been in recovery from a substance use disorder or mental illness for the past 2 years, or a family member of such a person, and who is certified. Section 2. Conforming language related to background screening. Section 3. Adds peer specialists to the list of recovery support services as an essential element of a coordinated system of behavioral health care. Section 5. Repeals language in background screening and moves to another section. Section 6. Establishes framework for behavioral health peer specialists. This section provides: • Legislative findings that: there is a shortage of behavioral health care employees; the state is experiencing an opioid epidemic; and peers are often an effective support for persons with substance use disorders or mental illness because the peer shares common life experiences. • Defines intent. • Sets qualifications for peer specialists and responsibilities of the department (to be certified and meet the background screening requirements, as well as complete a training program approved by the department).

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• Requires department to develop training program for peer specialists—with preference given to trainers who are certified peer specialists—and certify peer specialists directly or may designate a private, nonprofit certification organization to certify peer specialists, implement the training program, and administer the competency exam. • Requires peer specialists that are providing services be supervised by a licensed behavioral health care professional or a certified peer specialist with supervisory training. • Authorizes reimbursement through the department, behavioral health managing entity, or the Medicaid program. • Specifies revised background screening requirements that differ from current law because persons who have recovered from a substance use disorder or mental illness may be more likely to have committed certain offenses. • Disqualifying offenses are aligned with Chapter 394 • Eliminates the following disqualifying offenses from current law for peer specialists: o Misdemeanor assault, or battery o Prostitution o Lower level burglary offenses o Lower level theft and robbery offenses o Lower level drug abuse offenses o Mail or wire fraud o Insurance fraud o Credit card fraud o Identification fraud; and o Forgery (ss. 831.01, 831.02, 831.07 and 831.09, F.S.). • Includes grandfather clause to allow all peer specialists certified as of the effective date of the act to be recognized as having met the requirements of this bill. Sections 7-14. Conforms cross references Section 15. Effective date: July 1, 2018.

Office of Drug Control –this was never heard in committee SB 1468 Sen. Darryl Rouson (D-St. Petersburg) HB 1025 Rep. Nicholas Duran (D-Miami) These bills updated the former office of Drug Control, reestablishing the office and requiring further coordination and dialogue between federal state and local governments and community-based providers. The bills also required AHCA to seek 1115 waiver to better serve the substance abuse population currently eligible for services under Medicaid. – note: a variation of the 1115 waiver language was included in the AHCA budget.

Insurance Parity –this was heard in 2 committees in the senate; but never heard in a house committee SB 1422 Sen. Darryl Rouson (D-St. Petersburg) HB 955 Rep. Sean Shaw (D-Tampa) These bills updated statutes by repealing maximum coverage benefits to fall in line with parity and require health plans to report to OIR and Medicaid MMAs to report to AHCA how they comply with federal parity laws and required state agencies to report to the Legislature how they regulate, monitor and ensure plans comply with the law.

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Appendix 3: Overview of Filed Legislation Tracked by FBHA Note: Unless indicated, the filed legislation did not pass Mental Health Baker Act SB 112 Sen. (D-North Miami Beach) HB 573 Rep. Kim Daniels (D-Jacksonville) Would have authorized physician assistants and advanced registered nurse practitioners to execute a certificate under certain conditions stating that they have examined a person and find the person appears to meet the criteria for involuntary examination.

SB 202 Sen. Greg Steube (R-Sarasota) Revised criteria for involuntary examination by adding an individual who has been resuscitated by a law enforcement officer by an overdose-reversal agent and authorized a LEO to detain an individual for up to 72 hours.

SB 270 Sen. Greg Steube (R-Sarasota) HB 947 Rep. Bobby Payne (R-Palatka) Authorized a parent to transfer a minor under age 14 to a receiving facility. Adds a new section for under age 14 and authorizes individuals other than parents to initiate involuntary examination under certain circumstances; requires examination to begin within 8 hours of minor arriving to facility and required immediate release of minor to the parent at their request unless there is suspected abuse.

SB 708 Sen. Jeff Brandes (R-St. Petersburg) HB 973 Rep. Kim Daniels (D-Jacksonville) These bills sought to clarify the scope of practice, authorizing a physician assistant to sign, certify, stamp, verify, or endorse a document that which is required of a physician; authorizing an advanced registered nurse practitioner to sign, certify, stamp, verify, or endorse same if within the framework of an established protocol and under supervision. An exemption was made for the release of a Baker Act, in which case the professional must be a psychiatric nurse.

Other Mental Health Legislation SB 960 Sen. (R-Ocala) HB 721 Rep. David Silvers (D-West Palm Beach) The bills required county jails to continue to administer psychiatric medications as prescribed at mental health treatment facilities upon a facility client’s return to jail, unless the jail physician documents compelling reason otherwise. It also required the Department of Children and Families (DCF) to request an individual’s medical information from county jails when an individual is committed to a DCF forensic facility within certain timeframes, repealed certification process for community substance abuse prevention coalitions. These changes were a part of DCF’s 2018 legislative package.

SB 1440 Sen. Bobby Powell (D-Palm Beach) HB 781 Rep. Bobby Dubose (D-Ft. Lauderdale) These bills would have required a specific plan in place for 40 hours of law enforcement training on mental health every four years.

SB 1434 Sen. Kathleen Passidomo (R-Naples) This bill would have provided a structure for mental health in schools and outlines mental health assistance allocations ($40 million). Note: some of this was included in SB 7026

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Substance Use Disorders Opioids/Drug Overdoses SB 434 Sen. Kathleen Passidomo (R-Naples) HB 407 Rep. Bob Rommel (R-Naples) Would have authorized a neonatal abstinence syndrome pilot program in SW Florida to treat infants in a community-based setting and authorized the Department of Health to contract with a university to establish baseline data on outcomes of infants with NAS.

SB 800 Sen. Oscar Braynon (D-Miami Gardens) HB 579 Rep. “Shev” Jones (D-West Park) These bills expanded the needle exchange pilot program to Palm Beach and Broward Counties.

HB 1159 David Santiago (R-Deltona) Limited controlled substance prescribing to 3-days and banned the use of pill pressers, rewrote trafficking laws by repealing the various compounds of individual opioids and instead created one broad category (100 – 2,000 pills) with minimum mandatory levels.

SB 1372 Sen. (D-Miami) HB 605 Rep. Joe Geller (D-Dania Beach) Required warning labels to be applied to specified opioids dispensed by pharmacists or practitioners. Establishes prescription lock box and authorized DOH to develop and distribute education materials on dangers of opioids.

Prevention SB 562 Sen. (R-Melbourne) HB 627 Rep. Thad Altman (R-Melbourne) Authorized municipalities and counties to further restrict smoking within the boundaries of public parks.

Substance Abuse/Other SB 1068 Sen. Kevin Rader (D-Boca Raton) HB 865 Rep. Joe Abruzzo (D-Boca Raton) These bills would have reestablished the Office of Drug Control. This was the same language previously contained in statutes before its repeal in 2011.

SB 970 Sen. Jeff Brandes (R-St. Petersburg) HB 1261 Rep. David Silvers (D-West Palm Beach) These bills would have expanded current Good Samaritan laws by including alcohol as substances individuals may call for emergency help without fear of prosecution.

Third Party Payers Health Care Payments SB 154 Sen. (D-Orlando) HB 499 Rep. Amy Mercado (D-Orlando) This bill removed “optional” coverage for substance abuse and mental health, thereby creating a mandate for coverage.

SB 162 Sen. Greg Steube (R-Sarasota) HB 217 Rep. Bill Hagar (R-Boca Raton) These bills sough to prohibit a health insurer to retroactively deny a claim if the health insurer verified the eligibility of an insured at the time of treatment and provided an authorization number.

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SB 98 Sen. Greg Steube (R-Sarasota) HB 199 Rep. Shawn Harrison (R-Tampa) Prohibited a prior authorization form from requiring more information than necessary to determine medical necessity; required health plans to notify a health care provider an authorization decision within 72 hours of for nonurgent care situations and 24-hrs for urgent care situations.

SB 280 Sen. (R-Jacksonville) HB 793 Rep. Ralph Massullo, Jr. (R-Beverly Hills) These bills sought to implement many of the recommendations of the Telehealth Advisory Council.

Justice Diversion SB 1222 Sen. Jeff Brandes (R-St. Petersburg) HB 1409 Rep. Joe Geller (D-Dania Beach) These bills required the Department of Corrections to administer a reentry program for certain inmates with substance abuse, mental health, or co-occurring disorders and specified that establishing the program consists of an in-prison treatment program and a community-based aftercare treatment program.

SB 644 Sen. Randolph Bracy (D-Ocoee) HB 489 Rep. Sharon Pritchett (D-Miramar) The bills mandated use of juvenile civil citation in every county for juveniles who commit certain first-time misdemeanor offenses. Law enforcement officers would have been required to document reason for not offering a civil citation.

Reentry SB 522 Sen. Aaron Bean (R-Jacksonville) HB 281 Rep. Patricia Williams (D-Ft. Lauderdale) Requires DCF to include parents who are incarcerated in development of case plans for their children; specifies respective responsibilities of department, correctional facilities, & incarcerated parents; provides conditions for amending case plan. - passed

SB 344 Sen. Randolph Bracy (D-Ocoee) Required the Department of Corrections and certain local governmental agencies to adopt policies and rules that supervised individuals be in accordance with evidence-based practices.

SB 418 Sen. Randolph Bracy (D-Ocoee) Created the "Criminal Diversion Racial and Ethnic Impact Data Collection Act”; Required each law enforcement agency to report to the Department of Law Enforcement on arrest data including state attorneys and court clerks.

SB 484 Sen. Rob Bradley (R-Jacksonville) Authorized the courts to sentence certain offenders to county jails for up to 24-months.

Veterans SB 326 Sen. (R-Tampa) HB 179 Rep. (R-Zephyrhills) These bills expanded 2-1-1 Network for veterans statewide and placed the care coordination program under managing entities. Page | 21

SB 440 Sen. Rene Garcia (R-Hialeah) HB 403 Rep. Bryan Avila (R-Hialeah) Creates program within AHCA through managed care to negotiate with federal agencies in order to seek federal funding to veterans care. - similar language was included in the budget

Miscellaneous SB 874 Sen. Kathleen Passidomo (R-Naples) HB 191 Rep. Sean Shaw (D-Tampa) These bills sought to prohibit transfer of funds intended to be used for housing.

SB 102 Sen. Randolph Bracy (D-Ocoee) HB 433 Rep. Patrick Henry (D-Daytona Beach) Prohibited an employer from inquiring into an applicant’s criminal history on an initial employment application unless otherwise required by law.

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Appendix 4: FY 2018-19 Funding Note: Most of the funding is included in HB 5001 – The General Appropriations Act Some of the funding listed below is contained within HB 21 (Controlled Substances) and SB 7026 (Marjory Stoneman Douglas High School Public Safety Act) They are indicated on the spreadsheet

Category Proviso Agency Statewide and Local Funding Line R/NR Amount Amount TOTAL BUDGET FY2018-2019 $88,727,534,353

SB 7026 - Mental Health Assistance Allocation - DOE may be used to contract for services or increase $69,237,286 R/TF staff SB 7026 - Youth Mental Health First Aid DOE $6,700,000 R/NR ($500k R; $6.2 NR) DOE State Grants/K-12 Program - FEFP 6, 92 Safe schools allocation $64,456,019 R/TF

AHCA Community Mental Health Services 194 $212,246,638 AHCA Low Income Pool 201 $1,508,385,773 The Agency for Health Care Administration shall seek federal approval to amend the Special Terms and Conditions for the Low-Income Pool to include a payment group for uncompensated behavioral health care services. The behavioral health care services are for individuals in the substance abuse and mental health

safety net system (Central Receiving Systems) administered by the Department of Children and Families. Subject to federal approval of the terms and conditions, the Agency shall submit a budget amendment requesting authority for the release of funds pursuant to chapter 216, Florida Statutes. AHCA Special Categories - Statewide Inpatient Psychiatric 210 $1,413,120 Special Categories - State Mental Health Hospital AHCA 219 $6,726,825 Program

Special Categories - Grants and Aids/Contracted DCF 333 $33,749,004 Services (State Hospitals) Cost of living increase at state contracted hospitals ($4,101,789) from Lines 333 & 334 above. Breakdown is shown below: South Florida State Hospital $981,921 R Florida Civil Commitment Center $222,158 R Treasure Coast Forensic Treatment Center $2,136,288 R So. Florida Evaluation and Treatment Center $761,422 R Category Proviso Agency Statewide and Local Funding Line R/NR Amount Amount

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DCF Challenge Grants 345 $4,107,206 R Special Categories: Grants and Aids/Homeless DCF 347 $3,590,800 R Housing National Veteran Homeless Support Housing $150,000 NR Assistance Transition House Homeless Veterans - Bradford $300,000 NR Citrus Health Network $140,800 NR HB 21 - Federal Spending Authority: State Targeted DCF $27,035,532 NR Response Grant DCF HB 21 - Base Increase/Opioid Treatment $14,626,911 R Public Safety, Mental Health, and Substance Abuse DCF Local Matching Grant Program (Reinvestment 365 $9,000,000 R Grant) DCF SB 7026 - Mobile Crisis Teams $18,300,000 R SB 7026 - Community Action Teams (Approximately DCF $9,800,000 R 13 new teams) DCF Community Action Teams 366 $20,250,000 R/NR Competitively procure two CATS: DCF to determine $1,500,000 R area of greatest need SalusCare - Lee $750,000 R Manatee Glens - Sarasota, Desoto $750,000 R Circles of Care - Brevard $750,000 R Life Management Center - Bay $750,000 R David Lawrence Center - Collier $750,000 R Child Guidance Center - Duval $750,000 R Institute for Child and Family Health - Dade $750,000 R Mental Health Care - Hillsborough $750,000 R Personal Enrichment MH Services - Pinellas $750,000 R Peace River - Polk, Highlands, Hardee $750,000 R COPE Center - Walton $750,000 R Lifestream BH - Sumter, Lake $750,000 R Family Preservations Services - Treasure Coast Lakeside BH - Orange $750,000 R Citrus Health - Dade $750,000 R Manatee Glens - Manatee $750,000 R Lakeview Center - Escambia $750,000 R Sinfonia - Alachua $750,000 R Baycare BH - Pasco $750,000 R Category Proviso Agency Statewide and Local Funding Line R/NR Amount Amount Meridian BH - Alachua, Columbia, Dixie, Hamilton, $750,000 R Lafayette, Suwanee

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The Centers- Marion $750,000 R Sinfonia - Palm Beach $750,000 R Bridgeway Center - Okaloosa $750,000 R Clay BH - Putnam, Clay $750,000 R Charlotte Behavioral Healthcare $750,000 NR Apalachee - Big Bend Area $750,000 NR DCF Community Mental Health Services 367 $276,886,108 Citrus Health Network $455,000 R Apalachee Center - 4 additional short term forensic $1,401,600 R transitional beds Henderson Behavioral Health - Forensic treatment $1,401,600 R Mental Health Care - Forensic treatment services $700,800 R Apalachee Center - Civil Treatment Services $1,593,853 R Lifestream Behavioral Center - Transition beds $1,622,235 R New Horizons of the Treasure Coast-Civil Treatment $1,393,482 R Apalachee Center - Forensic Services $500,000 NR Supported employment services for individuals with $700,000 NR mental health disorders DCF Baker Act Services 368 $72,738,856 DCF Community Substance Abuse Services 369 $221,364,287 Pregnant women, mothers, and their affected $10,000,000 R families Family Intensive Treatment team (Note: the House places Centerstone FIT in separate proviso at $12,900,000 R/TF $840,000R) St. John's Detox $1,300,000 R Here's Help $200,000 R DACCO $100,000 R DCF Central Receiving Facilities 370 $19,878,768 R DCF Special Categories - Contracted Services 371 $8,047,605 Naltrexone Extended Release Injectable Medication $2,521,726 R/NR ($1.5 m R; $1,021,726 NR) DCF Special Categories - Contracted Services 372 $22,180,340 David Lawrence Center $100,000 NR Orange Park Medical Center $1,775,332 NR Lifestream CSU $1,123,634 NR Circles of Care - Geopsychiatric Care Center $900,000 NR Trilogy Integrated Services $500,000 NR St. Vincents - Saving Lives Project $624,105 NR New Hope C.O.R.P.S. Residential SAMH Pilot $250,000 NR Baycare - Veterans Intervention Program $485,000 NR Centerstone - Psychiatric Residency $500,000 NR DACCO - Zero Exposure Newborn Program $200,000 NR

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Category Proviso Agency Statewide and Local Funding Line R/NR Amount Amount Miami-Dade Homeless Trust $250,000 NR John Hopkins All Children's Hospital - Management $250,000 NR of Perinatal and Postpartum Depression Ft. Myers Salvation Army $165,000 NR Circles of Care - Harbor Pines & Cedar Village $500,000 NR The Renaissance - Assisted Living for MH $600,000 NR Jerome Golden Level I & II Residential Co-Occurring $200,000 NR SFBHN Involuntary OP $300,000 NR Specialized Treatment Education and Prevention $150,000 NR (STEPS) - Women's Residential Park Place Behavioral Health $150,000 NR Veterans Alternative Retreat $250,000 NR Phoenix Affiliates - Family Stabilization for Opioid $1,200,000 NR Here's Help - Opioid Treatment & Training $100,000 NR Florida Association of Recovery Residences $300,000 NR Memorial Regional Hospital - Broward County - $500,000 NR Medication Assisted Treatment SalusCare Wrap-around services/opioid $606,000 NR FL Alliance for Healthy Communities - Opioid $250,000 NR Addiction Training ChildNet $360,000 NR Stewart-Marchman (FACT: Putnam, St. Johns) $1,500,000 TF Personal Enrichment through MH Program - CSU $500,000 TF Clay BH Community Crisis Prevention Team $800,000 TF Westcare Gulfcoast Veterans Integrated BH $200,000 TF DCF Managing Entities 379 $21,765,157 Lakeland Hospital Freestanding Behavioral Health 380B $1,000,000 NR Hospital Agape Village - construction of community health 380C $500,000 NR and residential treatment DCF Grants and Aids - Fixed Capital Outlay NR Henderson CSU 380A $500,000 NR DCF TOTAL COMMUNITY SAMH $704,068,628 General Revenue $499,894,541 Trust Funds $204,174,087

DOH HB 21 - Naloxone Kits for First Responders/LEO $5,000,000 R DOH HB 21 - PDMP Upgrade ($873,089 R; $117,700 NR) $990,789 R/NR

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Category Proviso Agency Statewide and Local Funding Line R/NR Amount Amount DVA Veterans Homes (Proviso) The (department) is directed to seek federal authorization and funding for a program to reduce nursing home placements by providing home and community-based services to the veterans population. The program may include medical, behavioral health, or

long-term care services, as negotiated. The (department) shall provide a report on the status of negotiations by February 1, 2019, to the Executive Office of the Governor, the President of the Senate, and the Speaker of the House of Representatives.

DOC Special Categories: Private Prison Operations 614 $126,299,375 R/TF Continuum of Care Program at Bay, Moore Haven, $6,962,578 NR South Bay and Blackwater River DOC Community SA Prevention, Evaluation & Tx $26,094,623 Authorizing proviso to implement court liaison yes DOC Community Residential SA - Contracted Services 744 $4,493,762 GR Residential SA Tx Alachua Bradford Clay Counties $1,000,000 R Naltrexone Extended Release Injectable Medication $500,000 R DOC Community Residential SA - Contracted Services 745 $21,300,861 DACCO $600,000 R

DJJ Juvenile Redirections Program 1120 $4,098,831 Parenting with Love and Limits $750,000 NR DJJ Residential Corrections Program 2% pay raise to residential direct care staff 1155 $2,000,000 NR

Florida Housing Finance Corporation - Affordable TED 2225 $79,180,000 Housing

At least 60 % through (State Apartment Incentive Loan (SAIL) Program). Each SAIL development that receives an award from these funds and will be targeted to families, elderly persons, and persons who are homeless, must include not less than 5% and no more than 10% of the development’s units designed and constructed for, and targeted to, persons with special needs

SAIL $15,000,000 SAIL (Hurricane Impacted) $15,000,000 TED SHIP 2226 $44,450,000 Training & Technical Assistance/Affordable Housing $500,000

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Category Proviso Agency Statewide and Local Funding Line R/NR Amount Amount OSCA Special Categories - Problem Solving Courts 3165A $9,900,000 R Provided for treatment services, drug testing, case management, and ancillary services for participants in problem-solving courts, including, but not limited to, $7,500,000 R adult drug courts, juvenile drug courts, family dependency drug courts, early childhood courts, mental health courts, and veterans courts Pretrial or post-adjudicatory veterans’ treatment

intervention programs: Alachua $150,000 R Clay $150,000 R Duval $200,000 R Escambia $150,000 R Leon $125,000 R Okaloosa $150,000 R Orange $200,000 R Pasco $150,000 R Pinellas $150,000 R HB 21 - Medicated Assisted Treatment OSCA $6,000,000 R (Methadone, Buprenorphine, Naltrexone) OSCA Contracted Services - Special Categories 3169 $8,172,017 R/NR Naltrexone Extended Release Injectable Medication $7,500,000 R/NR ($5 million, R; $2.5 million NR)

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Appendix 5: Key Provisions of CS for SB 7026 “Marjory Stoneman Douglas High School Public Safety Act”

Statute Relating to Sec. CS for SB 7026 1 "Marjory Stoneman Douglas High School Public Safety Act" Provides legislative findings to protect schools, address gun safety, and 2 handle individuals experiencing mental health crisis. 16.555 Crime Stoppers 3 Authorizes Grants to fund student crime watch programs through TF Office of Safe 20.15 4 Establishes title "Office of Safe Schools" within DOE Schools Authorizes sheriff to establish a "Coach Aaron Feis" Guardian Program; authorizes weapon possession for selected school employees; participants may not act in any law enforcement capacity except to prevent active Powers duties and 30.15 5 assailant. Excludes teachers, unless they are member of reserves, current obligations servicemember, former law enforcement. Must complete 132 hrs. of firearm training, pass psychological exam, drug testing, ongoing training, and diversity training. Powers duties and Instructs FDLE to change name of school marshal program to "Coach Aaron 30.15 6 obligations Feis Guardian Program" Addresses DROP/Retirement program for state employees who are hired 121.091 Benefits payable 7 as a school resource officer Authorizes law enforcement officer (LEO) to use reasonable force to gain Involuntary entry into premises; authorizes LEO to seize firearm/ammunition if possess examination for credible threat; requires LEO to release firearm/ammunition no longer 394.463 mental 8 than 24-hrs if person is able to document they no longer subject to health/weapons voluntary exam (unless risk protect order is filed, in which case it is 7 days); possession individual may retrieve thereafter. Codified functions of a Community Action Team (through ME) to provide (a) Community-based behavioral health and support for ages 11-13 and 18-21 with serious behavioral health conditions who are at-risk of out-of- home placement (i.e. repeated failures at less intensive levels of care; 2 or more behavioral health hospitalizations; DJJ involvement; history of multiple episodes with LEO; record of poor academic 394.495 Child MH SOC 9 performance/suspensions. Note: children <11 eligible if two or more above are met. (b) Must use integrated approach; address therapeutic needs of child, assist parents in obtaining supports, and make referrals for specialized treatment. (c) Focus on engagement; (d) coordinate with key entities; (e) names existing teams and authorizes new teams subject to appropriation Creates statutes prohibiting individual who has been "adjudicated Firearm mentally defective or who has been committed to a mental institution 790.064 possession/ 10 (defined in 790.065(2))" to own or possess firearm unless a "firearm ownership disability" is obtained. Individual must petition court for disability. Sale/delivery of Changes the age limit for firearms to 21 y/o (exceptions for military, LEO, 790.065 11 firearms & correctional officers)

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Imposes a 3-day waiting period for all firearms. Provides exceptions for Purchase/ delivery 790.0655 12 those who have completed a hunter safety course and is certified; or of firearms military, LEO, or correctional officers 790.222 Bump-fire stocks 13 Creates new section prohibiting bump-fire stocks Creates a "Risk Protection Order Act"; stating that a law enforcement officer can petition court to enter such order; clarifies the intent is to temporarily restrict a person's access to firearms if they pose a significant danger of harming themselves or others; creates statutes setting framework for Risk Protection Order; establishes petition process; prohibits fees or posting bond; setting hearing within 14 days; orders may 14, Risk Protection be up to 12 months from possessing or purchasing firearm/ammunition; 790.401 15, Order sets temporary ex parte risk protection order; authorizes individual to 16 submit one written request to vacate order and prove by clear and convincing evidence that s/he does not pose a threat (hearing within 30 days; requires LEO to develop policies for storage; outlines reporting process by clerk to databases and LEO; adds penalties for individuals who file petition falsely; requires OSCA to develop brochures and standards petitions Written threats to Clarifies that electronic posts or threats to kill in writing or other record is 836.1 17 kill a 2nd degree felony Offense Severity 921.0022 18 Codifies Section 17 into the severity ranking chart Ranking Chart Creates "School Safety Awareness Program" requiring DOE to School Safety competitively procure mobile app to report suspicious activity. Authorizes 943.082 Awareness 19 anonymous reporting, though all reporting will be confidential. All Program information received will be reported to LEO/school official Creates "Marjory Stoneman Douglas High School Public Safety Commission" comprised of 15 voting members. Governor, President and Speaker each appoint 5; DCF, DJJ, DOE, AHCA are nonvoting members. Public Safety 943.687 20 Requires FDLE to staff commission. Investigate system failures, develop Commission timeline, review existing policies, and make recommendation for improving law enforcement. Provides power to subpoena and investigate. Report due Jan 1, 2019 and annually thereafter, sunsetting July 1, 2023. Creates "Office of Safe Schools" within DOE. Requires development of risk assessment tool; provides coordinated approach; develop School Safety Office of Safe 1001.212 21 Specialist Training Program; make recommendations and provide analytic Schools resources; award grants to schools; and develop and disseminate educational materials 1001.32 22 Conforming sections Rewrites existing statutes to provide multiagency network for students with emotional and behavioral disabilities to work with education, mental Educational health, child welfare, DJJ to provide children and their families access to services for 1006.04 23 services and supports. The idea is to expand children's mental health emotionally services, transition services and integrated education and treatment disturbed students programs. The network will also improve coordination of services and increase parent/youth involvement.

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Adds referral to mental health services identified by the school district throughout section; adds student crime watch program; and requires active shooter drills (including the development of best practices for safety and security). Section also creates "threat assessment teams" that include District school 1006.07 24 persons with expertise in counseling, instruction, administration and LEO duties and establishes process of reporting to superintendent. Authorizes teams to obtain criminal history; authorizes state agencies to share information relating to student mental health; and authorizes school personnel to engage in crisis supports for substance abuse and mental health. District school Adds name and address of any student whom the court refers for mental 1006.08 superintendent 25 health services to the list of notifications that court shall inform schools duties (within 48 hours) Renames "safe-school" officers, requiring each public school to contract with LEO for one or more officers at each school by implementing one or more of the following: Establish school resource officer programs; School resource 1006.12 26 Commission one or more school safety officers for the protection and officers safety of school personnel, property, and students within the school district; At the school district’s discretion, participate in the school marshal program if such program is established. Provides new language into other statutes for consistency; requires threat Zero tolerance 1006.13 27 assessment team to consult with law enforcement when student exhibits a policy pattern of behavior or commits more than one misdemeanor. Florida Safe Creates "Florida Safe Schools Assessment Tool" and requires department 1006.1493 Schools 28 to contract with security consulting firm; requires consulting firm to Assessment Tool submit report by December 1, 2018 and annually thereafter Creates Mental Health Assistance Allocation: Provides funds to be distributed annually with $100,000 minimum to each district and remaining funds through district proportionate share. Funds may not supplant other funding and may not be used to increase salaries/benefits. Schools are encouraged to maximize third party payers. Requires schools Mental Health districts to develop a plan focused on delivering evidence-based mental 1011.62 Assistance 29 health treatment including assessment, diagnosis, intervention, treatment Allocation/Funding and recovery to students with SAMH. Requires districts to coordinate with student's primary care and MH providers. Requires districts to submit plan by Aug 1 annually and a report by Sept 30, 2019 and annually stating number of students receiving screening/assessments; referred to services; received services; direct employment service providers; and contracted community mental health providers, agencies, or providers Requires DOE to establish a program beginning 2018-2019 year; requires department to select national authority on youth mental health awareness Continuing and assistance training program using trainer certification model to all K- education and in- 12 schools. Requires training to include: overview SAMH regarding stigma; 1012.584 service training for 30 information on potential risk factors; information on who personnel can youth mental contact for students in need of services such as community mental health health awareness services, health care providers, and other services described in 1006.04 (Educational multiagency services for students with severe emotional

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disturbance.) and 1011.62(17) (computation of prior year district required local effort) States that the cost per student station shall not account for the cost for 1013.64 Construction costs 31 securing entries or other school hardening. 32- Conforming sections 35 Allocation 36 Mental Health Assistance Allocation: $69,237,286 R (Section 29) Allocation 37 Youth Mental Health First Aid: $500,000 R, $6,200,000 NR (Section 30) Allocation 38 Marjory Stoneman Douglas HS Memorial: $1 million NR Allocation 39 Replacing Building 12 at MSDHS: $25,262,714 Screening and training costs and one-time ($500) marshal/guardian Allocation 40 stipend: $500,000 R; $67 million NR (Section 5) Allocation 41 3 FTE at DOE for Office of State Schools: $344,393 R (Section 4) Allocation 42 Safe School Allocation: $97,500,000 R Allocation 43 Active shooter training component (competitively procured): $100,000 R Allocation 44 DOE FCO for school hardening (grant program): $98,962,286 NR Mobile App (competitively procured) FDLE: $300,000 NR, $100,000 R Allocation 45 (Section 19) Allocation 46 Public Safety Commission 5 FTE: $600,000 R, $50,000 NR (Section 20) Allocation 47 New CATs through DCF: $9,800,000 R Allocation 48 Mobile crisis teams through DCF: $18,300,000 R Provides death benefits to teachers who lost lives at MSTDHS: $18,321 R, Allocation 49 $225,000 NR Allocation 50 DOE data analytics (competitively procure): $3 million R DOE security and risk assessment consultant (competitively procure): $1 Allocation 51 million NR Effective date 52 Upon becoming law

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