The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: CS/CS/SB 1262
INTRODUCER: Appropriations Committee (Recommended by Appropriations Subcommittee on Health
and Human Services); Children, Families, and Elder Affairs Committee; and Senators
Burgess and Rouson
SUBJECT: Mental Health and Substance Abuse
DATE: February 25, 2022 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Fav/CS
2. Sneed Money AHS Recommend: Fav/CS
3. Sneed Sadberry AP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 1262 makes several changes to procedures surrounding voluntary and involuntary
examinations of individuals under the Baker and Marchman Acts. The bill prohibits restrictions
on visitors, phone calls, and written correspondence for Baker Act patients unless certain
qualified medical professionals document specific conditions are met. The bill requires law
enforcement officers to search certain electronic databases for emergency contact information of
Baker and Marchman Act patients being transported to a receiving facility.
Under the bill, patients subject to an involuntary Baker Act examination who do not meet the
criteria for a petition for involuntary services must be released at the end of 72 hours, regardless
of whether the examination period ends on a weekend or holiday, as long as certain discharge
criteria are met. The bill also permits psychiatric APRNs practicing under the protocols of a
psychiatrist in a nationally accredited community mental health center to conduct discharge
examinations for patients held under an involuntary Baker Act.
The bill makes it a first degree misdemeanor for a person to knowingly and willfully:
Furnish false information for the purpose of obtaining emergency or other involuntary
admission for any person;
Cause, or conspire with another to cause, any emergency or other involuntary mental health
procedure for the person under false pretenses; or,
BILL: CS/CS/SB 1262 Page 2
Cause, or conspire with another to cause, without lawful justification, any person to be
denied their rights under the Baker Act statutes.
The bill requires receiving facilities to offer voluntary Baker and Marchman Act patients the
option to authorize the release of clinical information to certain individuals known to the patient
within 24 hours of admission.
The bill clarifies that telehealth may be used when discharging patients under an involuntary
Baker Act examination, and directs facilities receiving transportation reports detailing the
circumstances of a Baker Act to share such reports with the Department of Children and Families
(DCF) for use in analyzing annual Baker Act data.
The bill also makes several changes to the Commission on Mental Health and Substance Abuse
(Commission), including:
Authorizing the Commission to conduct meetings in person at locations throughout the state
or via teleconference or other electronic means;
Authorizing members to receive per diem and reimbursement and travel expenses;
Authorizing the Commission to access information and records necessary to carry out its
duties, including exempt and confidential information, provided that the Commission does
not disclose such exempt or confidential information; and
Modifying the due date for the Commission’s interim report from September 1, 2022 to
January 1, 2023.
The bill is expected to have a negative fiscal impact on state government. See Section V. Fiscal
Impact Statement.
The bill takes effect July 1, 2022.
II. Present Situation:
Refer to Section III (Effect of Proposed Changes) for discussion of the relevant portions of
current law.
III. Effect of Proposed Changes:
The Baker Act
In 1971, the Legislature adopted the Florida Mental Health Act, known as the Baker Act.1 The
Baker Act deals with Florida’s mental health commitment laws, and includes legal procedures
for mental health examination and treatment, including voluntary and involuntary examinations.2
The Baker Act also protects the rights of all individuals examined or treated for mental illness in
Florida.3
1
Ch. 71-131, LO.F.; The Baker Act is contained in ch. 394, F.S.
2
Sections 394.451-394.47891, F.S.
3
Section 394.459, F.S.
BILL: CS/CS/SB 1262 Page 3
Involuntary Examination
Individuals suffering from an acute mental health crisis may require emergency treatment to
stabilize their condition. Emergency mental health examination and stabilization services may be
provided on a voluntary or involuntary basis.4 An involuntary examination is required if there is
reason to believe that the person has a mental illness and because of his or her mental illness:
The person has refused voluntary examination after conscientious explanation and disclosure
of the purpose of the examination or is unable to determine for himself or herself whether
examination is necessary; and
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 family members or friends or the provision of other services; or
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.5
The involuntary examination may be initiated by:
A court entering an ex parte order stating that a person appears to meet the criteria for
involuntary examination, based on sworn testimony;6
A law enforcement officer taking a person who appears to meet the criteria for involuntary
examination into custody and delivering the person or having him or her delivered to a
receiving facility for examination;7 or
A physician, clinical psychologist, psychiatric nurse, mental health counselor, marriage and
family therapist, or clinical social worker executing a certificate stating that he or she has
examined a person within the preceding 48 hours and finds that the person appears to meet
the criteria for involuntary examination, including a statement of the professional’s
observations supporting such conclusion.8
A law enforcement officer who delivers an individual to a receiving facility must execute a
written report detailing the circumstances under which the person was taken into custody, and
the report must be made a part of the patient’s clinical record.9 Any facility accepting the patient
based on this certificate must send a copy of the certificate to the DCF within 5 working days.10
The same reporting requirements apply in instances where a law enforcement officer delivers a
person to a receiving facility pursuant to a certificate executed by a health care professional. 11
Involuntary patients must be taken to either a public or a private facility that has been designated
by the DCF as a Baker Act receiving facility. The purpose of receiving facilities is to receive and
hold, or refer, as appropriate, involuntary patients under emergency conditions for psychiatric
4
Sections 394.4625 and 394.463, F.S.
5
Section 394.463(1), F.S.
6
Section 394.463(2)(a)1., F.S. In addition, the order of the court must be made a part of the patient’s clinical record.
7
Section 394.463(2)(a)2., F.S.
8
Section 394.463(2)(a)3., F.S.
9
Section 394.463(2)(a)2., F.S.
10
Id.
11
Section 394.463(2)(a)3., F.S.
BILL: CS/CS/SB 1262 Page 4
evaluation and to provide short-term treatment or transportation to the appropriate service
provider.12
The patient must be examined by the receiving facility within 72 hours of the initiation of the
involuntary examination. The examination may be performed by:
A physician;13
A clinical psychologist;14 or
A psychiatric nurse15 performing within the framework of an established protocol with a
psychiatrist at a facility.16
Under current law, a receiving facility may not release an involuntary examination patient
without the documented approval of a psychiatrist, or a clinical psychologist.17 However, if the
receiving facility is owned or operated by a hospital or health system, 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 who has completed the involuntary examination.18 A psychiatric
nurse may not approve a patient’s release if the involuntary examination was initiated by a
psychiatrist unless the release is approved by the initiating psychiatrist.19
Because of the current setting restrictions on where a psychiatric nurse may approve Baker Act
releases, there are 28 nationally accredited community mental health providers in Florida that
operate receiving facilities licensed under chapter 394, F.S., but cannot allow their psychiatric
nurses to discharge a Baker Act patient under the protocol of their psychiatrists.20
By the end of the 72 hour period, or if the period ends on a weekend or holiday, no later than the
next working day, one of the following actions must be taken to address the individual needs of
the patient:
The patient must be released, unless he or she is charged with a crime, in which case the
patient is to be returned to the custody of a law enforcement officer;
The patient must be released for voluntary outpatient treatment;
12
Section 394.455(40), F.S.
13
“Physician” means a medical practitioner licensed under ch. 458, F.S., or ch. 459, F.S., who has experience in the diagnosis
and treatment of mental illness or a physician employed by a facility operated by the United States Department of Veterans
Affairs or the United States Department of Defense. Section 394.455(33), F.S.
14
“Clinical psychologist” means a psychologist as defined in s. 490.003(7), F.S., with 3 years of postdoctoral experience in
the practice of clinical psychology, inclusive of the experience required for licensure, or a psychologist employed by a
facility operated by the United States Department of Veterans Affairs that qualifies as a receiving or treatment facility.
Section 394.455(5), F.S.
15
“Psychiatric nurse” means an advanced practice registered nurse licensed under s. 464.012, F.S., who has a master’s or
doctoral degree in psychiatric nursing, holds a national advanced practice certification as a psychiatric mental health
advanced practice nurse, and has 2 years of post-master’s clinical experience under the supervision of a physician. Section
394.455(36), F.S.
16
Section 394.463(2)(f), F.S.
17
Id.
18
Id.
19
Id.
20
Florida Behavioral Health Association, Psychiatric APRNs in a Community Behavioral Healthcare Setting (on file with the
Senate Committee on Appropriations).
BILL: CS/CS/SB 1262 Page 5
The patient, unless he or she is charged with a crime, must be asked to give express and
informed consent to placement as a voluntary patient and, if such consent is given, the patient
must be admitted as a voluntary patient; or
A petition for involuntary services must be filed in the circuit court if inpatient treatment is
deemed necessary or with the criminal county court, as applicable. When inpatient treatment
is deemed necessary, the least restrictive treatment consistent with the optimum improvement
of the patient’s condition must be made available. A petition for involuntary inpatient
placement must be filed by the facility administrator.21
Receiving facilities must also ensure that a patient’s discharge plan considers all of the following
prior to the patient’s release:
The patient’s transportation resources;
The patient’s access to stable living arrangements;
How assistance in securing needed living arrangements or shelter will be provided to patients
at risk of readmission within the 3 weeks immediately following discharge due to
homelessness or transient status. The discharging facility must document that, before
discharging the patient, it has requested a commitment from a shelter provider that assistance
will be rendered;
The availability of assistance in obtaining a timely aftercare appointment for needed services,
including continuation of prescribed psychotropic medications. Aftercare appointments for
psychotropic medication and case management must be requested to occur not later than 7
days after the expected date of discharge; if the discharge is delayed, the discharging facility
must document notification of the delay to the aftercare provider. The discharging facility
shall coordinate with the aftercare service provider and document the aftercare planning;
The availability of, and access to, prescribed psychotropic medications in the community. To
ensure a patient’s safety and provision of continuity of essential psychotropic medications,
such prescribed psychotropic medications, prescriptions, multiple partial prescriptions for
psychotropic medications, or a combination thereof, must be provided to the patient upon
discharge to cover the intervening days until the first scheduled psychotropic medication
aftercare appointment, up to a maximum of 21 calendar days;
The provision of education and written information about the patient’s illness and
psychotropic medications, including other prescribed and over-the-counter medications; the
common side-effects of any medications prescribed; and any common adverse clinically
significant drug-to-drug interactions between that medication and other commonly available
prescribed and over-the-counter medications;
The provision of contact and program information about, and referral to, any community-
based peer support services in the community;
The provision of contact and program information about, and referral to, any needed
community resources;
Referral to substance abuse treatment programs, trauma or abuse recovery-focused programs,
or other self-help groups, if indicated by assessments; and
The provision of information about advance directives, including how to prepare and use
them.22
21
Section 394.463(2)(g), F.S.
22
Rule 65E-5.1303, F.A.C.
BILL: CS/CS/SB 1262 Page 6
Involuntary Inpatient Placement
A person may be placed in involuntary inpatient placement for treatment upon a finding of the
court by clear and convincing evidence that:
He or she is mentally ill and because of his or her mental illness:
o He or she has refused voluntary placement for treatment after sufficient and conscientious
explanation and disclosure of the purpose of placement or is unable to determine for
himself or herself whether placement is necessary; and
o He or she is manifestly incapable of surviving alone or with the help of willing and
responsible family or friends, including available alternative services; and
o Without treatment, is likely to suffer from neglect or refuse to care for himself or herself;
and
o Such neglect or refusal poses a real and present threat of substantial harm to his or her
well-being; or
o There is a substantial likelihood that in the near future he or she will inflict serious bodily
harm on himself or herself or another person, as evidenced by recent behavior causing,
attempting, or threatening such harm; and
All available less re