HOUSE OF REPRESENTATIVES STAFF FINAL BILL ANALYSIS
BILL #: CS/SB 330 Behavioral Health Teaching Hospitals
SPONSOR(S): Appropriations Committee on Health and Human Services, Boyd and others
TIED BILLS: IDEN./SIM. BILLS: CS/HB 1617
FINAL HOUSE FLOOR ACTION: 114 Y’s 0 N’s GOVERNOR’S ACTION: Approved
SUMMARY ANALYSIS
CS/HB 1617 passed the House on March 6, 2024, as CS/SB 330 as amended. The Senate concurred in the
House amendment to the Senate bill and subsequently passed the bill as amended on March 6, 2024.
Current challenges to the recruitment and retainer of behavioral health providers include financial limitations
(e.g., resources, reimbursement rates, student debt), educational limitations (e.g., lack of training to serve
diverse populations, barriers to enter workforce), and workplace limitations (e.g., shortages in rural areas, high
workloads that lead to burnout). To increase the overall supply of behavioral health professionals, some states
incentivize workforce development partnerships between hospitals and universities.
CS/HB 1617 creates a behavioral health teaching hospital program within the Agency for Health Care
Administration (AHCA). It requires AHCA to designate four named hospitals as behavioral health teaching
hospitals within 30 days after the act becomes law. It establishes standards for behavioral health teaching
hospitals for those four, and for future behavioral health teaching hospitals, which AHCA may designate
starting July 1, 2025. The bill requires AHCA to award each behavioral health teaching hospital funds for up to
10 new residency slots and for workforce development programs. The bill establishes a competitive grant
program for behavioral health teaching hospitals based on the quality of the hospitals’ integrated workforce
development plans and of their implementation of those plans.
The bill establishes the Florida Center for Behavioral Health Workforce (Center) within the Louis de la Parte
Florida Institute for Mental Health at the University of South Florida. The bill authorizes the Center to perform
original research, policy analysis, and to develop and share best practices that advance the behavioral health
professions.
The bill requires the Department of Children and Families (DCF) to conduct a comprehensive, systematic study
of the behavioral health supply-and-demand relationship in Florida by January 31, 2025.
The bill appropriates $300 million in nonrecurring funds for the grant program, for use in $100 million
increments over the next three fiscal years, $6 million in recurring funds for residencies through the Slots for
Doctors Program for the first four designated hospitals, $2 million in recurring funds for workforce development
programs through the Training, Education and Clinicals in Health Funding Program for the first four designated
hospitals, and $5 million to operate the Center. The bill has no fiscal impact to local government.
The bill was approved by the Governor on March 21, 2024, ch. 2024-12, L.O.F., and will become effective on
July 1, 2024; except for provisions related to the DCF study which are effective upon the act becoming law,
and amendments to s. 409.909, F.S., related to the Slots for Doctors Program which are effective July 1, 2025.
This document does not reflect the intent or official position of the bill sponsor or House of Representatives.
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I. SUBSTANTIVE INFORMATION
A. EFFECT OF CHANGES:
Background
Mental Health Safety Net Services
In February 2023, over 32.3% of adults in the Florida self-reported symptoms of anxiety and or
depression. Mental illnesses can be acute or chronic and are diagnosable conditions that affect an
individual’s emotional, psychological, and social well-being, and often their behavior. These conditions
include depression, anxiety, schizophrenia, and mood or personality disorders, among others. 1
Magnifying the mental health crisis undercurrent, Florida’s drug overdose deaths per 100,000 people
increased from 15.4 in 2011 to 37.5 in 2021. Similarly, suicide is often linked to underlying mental
health conditions. Florida’s age-adjusted suicide rate in 2021 was 14.0 per 100,000 people. 2
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of
Health and Human Services’ agency that leads public health efforts to advance the behavioral health of
the nation.3 Congress established SAMHSA in 1992 to make substance use and mental disorder
information, services, and research more accessible. To this end, state mental health agencies compile
and report annual data as part of their application package for SAMHSA’s Community Mental Health
Block Grant.
The Department of Children and Families (DCF) Office of Substance Abuse and Mental Health is the
state mental health agency in Florida. DCF administers a statewide system of safety-net services for
substance abuse and mental health (SAMH) prevention, treatment and recovery for children and adults
who are otherwise unable to obtain these services. SAMH programs include a range of prevention,
acute interventions (e.g. crisis stabilization), residential treatment, transitional housing, outpatient
treatment, and recovery support services.
The table below itemizes the federal block grants for mental health-related funding that Florida received
the last three years: 4
Federal SAMHSA Block Grant Funding: FFY 2021-2022 - 2022-2023 (in $ millions)
Substance Abuse Prevention Community Mental Health
and Treatment Block Grant Services Block Grant
Award Year (Oct 1 – Sept 30) FFY 2021-2022 FFY 2022-2023
Recurring 2021 $111,389,890 $47,760,577
Recurring 2022 $112,320,687 $55,973,788
Recurring 2023 $116,814,207 $65,481,738
1 Mental Health in Florida, KFF (Mar. 2023) https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/florida
(last visited Dec. 16, 2023).
2 Id.
3
Substance Abuse and Mental Health Services Administration, Ab out Us, https://www.samhsa.gov/about-us (last visited Dec. 16,
2023).
4 Comprehensive, Multi-Year Review of the Revenues, Expenditures, and Financial Positions of the Managing Entities Including A
System of Care Analysis, Office of Substance Abuse and Mental Health, Florida Department of Children and Families, p. 13 (Nov. 1,
2023) https://www.myflfamilies.com/services/samh/publications (last visited Dec. 16, 2023).
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The DCF table below records the number of unduplicated individuals served in community mental
health settings, state psychiatric hospitals, and residential treatment settings: 5
Number of Unduplicated Individuals Served in the Community
FY 2021-22 FY 2022-23
Service Setting Total Percentage Total Percentage
Community Mental Health 196,328 94.2% 242,849 93.6%
State Hospitals 4,436 2.1% 5,153 2.0%
Residential Treatment 7,640 3.7% 11,365 4.4%
Total 208,404 100% 259,367 100%
For federal FY 2022, Florida’s total mental health expenditures were $914,342,441. This total amounts
to $41.98 per capita. Florida’s safety net system served 147,804 clients in community settings, with
4,523 of those served in state hospitals. The 147,804 total clients represent a utilization rate of 6.8 per
1,000 people. 6
Behavioral Health Managing Entities
DCF provides SAMH services based upon state and federally-established priority populations,
administered by regional managing entities under contract with the Department of Health. Managing
entities are local, not-for-profit organizations with community boards that hold service providers
accountable for quality service delivery and leverage local resources to meet each county’s behavioral
health needs. Managing entities adapt and tailor funding from the state and federal governments in
response to evolving community trends on prevention, intervention, crisis support, opioid, medication-
assisted treatment, residential treatment, and outpatient services for adults, children, and families. 7
Managing entities provide SAMH services to over 320,000 Floridians, including:8
Substance-abusing mothers and women who are pregnant.
Families in the foster care system.
People who inject drugs.
Substance abusers who are infected with HIV.
Individuals with a serious mental illness.
Youth in the juvenile justice System.
Veterans.
Incarcerated individuals.
Chronically homeless individuals.
As the map below illustrates, DCF currently contracts with seven behavioral health managing entities
for the delivery of local SAMH services throughout Florida. 9
5 Id. at p. 14.
6 2022 Uniform Reporting System (URS) Tab le for Florida, Substance Abuse and Mental Health Services Administration, p. 3 (Nov. 21,
2023), https://www.samhsa.gov/data/sites/default/files/reports/rpt42746/Florida.pdf (last visited Mar. 15, 2024).
7
The Florida Association of Managing Entities, Who We Are, https://flmanagingentities.com/who-we-are/ (last visited Feb. 11, 2024).
8 The Florida Association of Managing Entities, Who We Help, https://flmanagingentities.com/who-we-help/ (last visited Feb. 11, 2024).
9 Florida Association of Managing Entities, Map, https://flmanagingentities.com/map/ (last Feb. 11, 2024); Florida Department of
Children and Families, Managing Entities, https://www.myflfamilies.com/services/samh/providers/managing-entities (last visited Feb.
11, 2024).
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Managing entities must submit detailed plans to enhance crisis services based on the no-wrong-door
model10 or to meet specific needs identified in DCF’s assessment of behavioral health services in this
state.11 DCF must use performance-based contracts to award grants.12
Managing entities are required to conduct a community behavioral health care needs assessment once
every three years in the geographic area served by the managing entity, which identifies needs by sub-
region.13 The assessments must be submitted to DCF for inclusion in the state and district substance
abuse and mental health plan.14
10 The no-wrong-door model means a model for the delivery of acute care services to persons who have mental health or substance
use disorders, or both, which optimizes access to care, regardless of the entry point to the behavioral health care system. s.
394.4573(1)(d), F.S.
11 S. 394.4573(3), F.S.
12 Id.
13 S. 394.9082(5)(b), F.S.
14 S. 394.75(3), F.S.
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Involuntary Commitment: The Baker Act
The Florida Mental Health Act, commonly referred to as the Baker Act 15, focuses on crisis services for
individuals with mental illness, much like an emergency department serves individuals experiencing a
medical emergency.16 Under the Baker Act, DCF designates hospitals and crisis stabilization units as
receiving facilities to provide emergency mental health treatment. 17 The purpose of a crisis stabilization
unit is to stabilize and redirect a patient to the most appropriate and least restrictive community setting
available. Similar to a hospital’s emergency department, a crisis stabilization unit provides services
regardless of a person’s ability to pay.18
Emergency mental health examination and stabilization services may be provided on a voluntary or
involuntary basis.19 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, has refused voluntary examination, is
likely to refuse to care for him or herself to the extent that such refusal threatens to cause substantial
harm to that person’s well-being, and such harm is unavoidable through help of willing family members
or friends, or will cause serious bodily harm to him or herself or others in the near future based on
recent behavior.20
In FY 2021-22, hospitals and crisis stabilization units in Florida conducted 170,048 involuntary
examinations for 115,239 individuals. As the table below indicates, the number of involuntary
examinations for FY 2021-22 is significantly less than the prior four years.21
Baker Act Involuntary Examinations for the Past Five Fiscal Years
Year-to-Year Percent Change
Fiscal Year Involuntary Exams
Involuntary Exams Population
2021-2022 170,048 -12.65% 1.45%
2020-2021 194,680 -3.91% 1.75%
2019-2020 202,598 -3.98% 1.74%
2018-2019 210,992 2.53% 1.80%
2017-2018 205,781 2.92% 1.62%
While researchers cannot extrapolate from the data the reasons why the number of involuntary
examinations decreased, they emphasize that this decrease in involuntary examinations should not be
read to indicate reduced need for mental health crisis services. Rather, researchers recommend an
additional study to determine the impact of the following possible factors: 22
An increase in the use of DCF-funded services such as Care Coordination and Mobile
Response Teams;
15 The Baker Act is contained in Part I of ch. 394, F.S.
16 The Florida Department of Children and Families, The Baker Act, https://www.myflfamilies.com/crisis-services/baker-act (last visited
Feb. 11, 2024).
17 Florida Department of Children and Families, Baker Act Resources for Individuals & Families, https://www.myflfamilies.com/crisis-
services/baker-act/baker-act-resources-individuals-families (last visited Feb. 11, 2024).
18 S. 394.875(1)(a), F.S.
19 Ss. 394.4625 and 394.463, F.S.
20
S. 394.463(1), F.S.
21 Annette Christy, Kevin Jenkins, Sara Rhode, Sarah Bogovic, Lillian Deaton, and Charles Dion, Baker Act Reporting Center Fiscal
Year 2021-2022 Report. University of South Florida, Department of Mental Health Law and Policy, Baker Act Reporting Center, p. 4
(2023) https://www.usf.edu/cbcs/baker-act/documents/ba_usf_annual_report_2021_2022.pdf (last visited Feb. 12, 2024).
22 Id. at 5.
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Collaboration between DCF and the Administration for Health Care Administration (AHCA) to
identify and address high utilizers of crisis services;
Changes to law enforcement and designated receiving facility transportation processing
procedures;
An increase in the percentage of involuntary examinations by Crisis Intervention Team (CIT)
trained law enforcement officers; and
Workforce shortage for health professionals of all types.
Commission on Mental Health and Substance Abuse
In 2021, the legislature created the Commission on Mental Health and Substance Abuse (Commission)
within DCF.23 The Commission consists of 19 members, which include the Secretaries of DCF and the
Agency of Health Care Administration (AHCA). The remaining members are appointed by the
Governor, the President of the Senate, and the Speaker of the House of Representatives. 24
The duties of the Commission include: 25
1. Conducting a review and evaluation of the management and functioning of existing publicly
supported mental health and substance abuse systems in DCF, AHCA, and all other relevant
state departments;
2. Considering the unique needs of people who are dually diagnosed;
3. Addressing access to, financing of, and scope of responsibility in the delivery of emergency
behavioral health care services;
4. Addressing the quality and effectiveness of current service delivery systems and professional
staffing and clinical structure of services, roles, and responsibilities of public and private
providers;
5. Addressing priority population groups for publicly funded services, identifying the
comprehensive delivery systems, needs assessment and planning activities,