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 130
INTRODUCER: Appropriations Committee (Recommended by Appropriations Subcommittee on Health
and Human Services); Children, Families, and Elder Affairs Committee; and Senator
Rouson and others
SUBJECT: Mental Health and Substance Use Disorders
DATE: April 18, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Fav/CS
2. Sneed Kidd 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 130 promotes the use of peer specialists to assist an individual’s recovery from
substance use disorder (SUD) or mental illness. Peer specialists are persons who have recovered
from a substance use disorder or mental illness who support a person with a current substance
use disorder or mental illness.
Specifically, the bill:
 Adds the use of peer specialists as an essential element of a coordinated system of care;
 Provides legislative findings and intent related to the use of peer specialists in the provision
of behavioral health care;
 Requires the Department of Children and Families (the DCF) to develop a training program
for peer specialists, giving preference to trainers who are certified peer specialists;
 Requires the DCF to certify peer specialists, directly or through the use of a third-party
credentialing entity;
 Revises background screening requirements and codifies existing training and certification
requirements for peer specialists;
 Adds offenses for which individuals seeking certification as a peer specialist may seek an
exemption from eligibility disqualification;
BILL: CS/CS/SB 130 Page 2
 Allows peer specialists to work with adults with mental health disorders, in addition to SUDs
and co-occurring disorders, while a request for an exemption from a background check
disqualification is pending.
 Expands the statutory limit for the number of days during which a service provider can work
while a request for exemption from a background check disqualification is pending to 180
days from the current 90 days.
 Allows for recovery support services to be reimbursed as a recovery service through the
DCF, a behavioral health managing entity, or the Medicaid program.
 Provides that individuals certified as peer specialists by July 1, 2021, will be deemed to have
met the requirements for certification under the bill.
The bill is expected to have an insignificant negative fiscal impact on state government.
The bill is effective July 1, 2021.
II. Present Situation:
Substance Abuse
Substance abuse is the harmful or hazardous use of psychoactive substances, including alcohol
and illicit drugs. Substance use disorder (SUD) is determined based on specified criteria included
in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).1 According
to the DSM-5, a diagnosis of SUD is based on evidence of impaired control, social impairment,
risky use, and pharmacological criteria.2 SUD occurs when an individual chronically uses
alcohol or drugs, resulting in significant impairment, such as health problems, disability, and
failure to meet major responsibilities at work, school, or home.3 Repeated drug use leads to
changes in the brain’s structure and function that can make a person more susceptible to
developing a substance abuse disorder.4 Imaging studies of brains belonging to persons with
SUD reveal physical changes in areas of the brain critical to judgment, decision making, learning
and memory, and behavior control.5
In 2018, approximately 20.3 million people aged 12 or older had a SUD related to corresponding
use of alcohol or illicit drugs within the previous year, including 14.8 million people diagnosed
with alcohol use disorder and 8.1 million people diagnosed with drug use disorder.6 The most
1
The World Health Organization, Mental Health and Substance Abuse, available at
https://www.who.int/westernpacific/about/how-we-work/programmes/mental-health-and-substance-abuse; the National
Institute on Drug Abuse (NIDA), The Science of Drug Use and Addiction: The Basics, available at
https://www.drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics (last visited February 21, 2021).
2
The National Association of Addiction Treatment Providers, Substance Use Disorder, available at
https://www.naatp.org/resources/clinical/substance-use-disorder (last visited February 21, 2021).
3
The Substance Abuse and Mental Health Services Administration (The SAMHSA), Substance Use Disorders,
http://www.samhsa.gov/disorders/substance-use (last visited February 21, 2021).
4
The NIDA, Drugs, Brains, and Behavior: The Science of Addiction, available at
https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-abuse-addiction (last visited February
21, 2021).
5
Id.
6
The SAMHSA, Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National
Survey on Drug Use and Health, p. 2, available at https://www.samhsa.gov/data/sites/default/files/cbhsq-
reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf (last visited February 23, 2021).
BILL: CS/CS/SB 130 Page 3
common substance abuse disorders in the United States are from the use of alcohol, tobacco,
cannabis, opioids, hallucinogens, and stimulants.7
Substance Abuse Treatment in Florida
In the early 1970s, the federal government enacted laws creating formula grants for states to
develop continuums of care for individuals and families affected by substance abuse.8 The laws
resulted in separate funding streams and requirements for alcoholism and drug abuse. In response
to the laws, the Florida Legislature enacted chs. 396 and 397, F.S., relating to alcohol and drug
abuse, respectively.9 Each of these laws governed different aspects of addiction, and thus had
different rules adopted by the state to fully implement the respective pieces of legislation.10
However, because persons with substance abuse issues often do not restrict their misuse to one
substance or another, having two separate laws dealing with the prevention and treatment of
addiction was cumbersome and did not adequately address Florida’s substance abuse problem.11
In 1993, legislation was adopted to combine ch. 396 and 397, F.S., into a single law, the Hal S.
Marchman Alcohol and Other Drug Services Act (Marchman Act).12
The Marchman Act encourages individuals to seek services on a voluntary basis within the
existing financial and space capacities of a service provider.13 However, denial of addiction is a
prevalent symptom of SUD, creating a barrier to timely intervention and effective treatment.14
As a result, treatment typically must stem from a third party providing the intervention needed
for SUD treatment.15
The Department of Children and Families (DCF) administers a statewide system of safety-net
services for substance abuse and mental health (SAMH) prevention, treatment and recovery for
children and adults who are otherwise unable to obtain these services. Services are provided
based upon state and federally-established priority populations.16 The DCF provides treatment
for SUD through a community-based provider system offering detoxification,17 treatment
7
The Rural Health Information Hub, Defining Substance Abuse and Substance Use Disorders, available at
https://www.ruralhealthinfo.org/toolkits/substance-abuse/1/definition (last visited February 23, 2021).
8
The DCF, Baker Act and Marchman Act Project Team Report for Fiscal Year 2016-2017, p. 4-5. (on file with the Senate
Children, Families, and Elder Affairs Committee).
9
Id.
10
Id.
11
Id.
12
Chapter 93-39, s. 2, Laws of Fla., codifying current ch. 397, F.S.
13
See s. 397.601(1) and (2), F.S. An individual who wishes to enter treatment may apply to a service provider for voluntary
admission. Within the financial and space capabilities of the service provider, the individual must be admitted to treatment
when sufficient evidence exists that he or she is impaired by substance abuse and his or her medical and behavioral
conditions are not beyond the safe management capabilities of the service provider.
14
Darran Duchene and Patrick Lane, Fundamentals of the Marchman Act, Risk RX, Vol. 6 No. 2 (Apr. – Jun. 2006) State
University System of Florida Self-Insurance Programs, available at http://flbog.sip.ufl.edu/risk-rx-article/fundamentals-of-
the-marchman-act/ (last visited February 23, 2021).
15
Id.
16
See chs. 394 and 397, F.S.
17
Detoxification services use medical and clinical procedures to assist individuals and adults as they withdraw from the
physiological and psychological effects of substance abuse.
BILL: CS/CS/SB 130 Page 4
services18 and recovery support19 for individuals affected by substance misuse, abuse or
dependence.20
Peer Specialists
Research has shown that social support provided by peers is beneficial to those in recovery from
a SUD or mental illness.21 Section 397.311, F.S., defines a peer specialist as “a person who has
been in recovery from a SUD or mental illness for at least 2 years who uses his or her personal
experience to provide services in behavioral health settings to support others in their recovery, or
a person who has at least 2 years of experience as a family member or caregiver of an individual
who has a SUD or mental illness. The term does not include a qualified professional or a person
otherwise certified under ch. 394 or ch. 397.”22
There are four primary types of social support provided by peers:
 Emotional: where a peer demonstrates empathy, caring or concern to bolster a person’s self-
esteem. (i.e., peer mentoring or peer-led support groups).
 Informational: where a peer shares knowledge and information to provide life or vocational
skills training. (i.e., parenting classes, job readiness training, or wellness seminars).
 Instrumental: where a peer provides concrete assistance to help others accomplish tasks. (i.e.,
child care, transportation, and help accessing health and human services).
 Affiliational: where a peer facilitates contacts with other people to promote learning of social
skills, create a sense of community, and acquire a sense of belonging. (i.e., recovery centers,
sports league participation, and alcohol or drug free socialization opportunities).23
In Florida, DCF and Medicaid both allow reimbursement for peer support services, but only if
provided by certified peer specialists.24
An individual seeking to become a certified peer specialist either must have been in recovery
from a SUD or mental illness for at least two years, or must have at least two years of experience
as a family member or caregiver of an individual suffering from a substance use disorder or
mental illness.25 The DCF must approve one or more third-party credentialing entities for the
18
Treatment services include a wide array of assessment, counseling, case management, and support that are designed to help
individuals who have lost their abilities to control their substance use on their own and require formal, structured intervention
and support.
19
Recovery support services, including transitional housing, life skills training, parenting skills, and peer-based individual
and group counseling, are offered during and following treatment to further assist individuals in their development of the
knowledge and skills necessary to maintain their recovery.
20
The DCF, Treatment for Substance Abuse, available at https://www.myflfamilies.com/service-programs/samh/substance-
abuse.shtml (last visited February 21, 2021).
21
Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment, What Are Peer
Recovery Support Services?, available at https://store.samhsa.gov/system/files/sma09-4454.pdf (last visited February 23,
2021).
22
Section 397.311(30), F.S.
23
The DCF, Florida Peer Services Handbook at p. 4-5, 2016, available at https://www.myflfamilies.com/service-
programs/samh/publications/docs/peer-services/DCF-Peer-Guidance.pdf (last visited February 23, 2021).
24
The DCF, Agency Analysis for 2019 HB 369, p. 2 February 8, 2019 (on file with the Senate Children, Families, and Elder
Affairs Committee staff). Florida’s Medicaid program currently covers peer recovery services; the DCF allows the state’s
behavioral health managing entities to reimburse for peer recovery services.
25
Section 397.417(1), F.S.
BILL: CS/CS/SB 130 Page 5
purposes of certifying peer specialists, approving training programs for individuals seeking
certification as peer specialists, approving continuing education programs, and establishing the
minimum requirements and standards that applicants must achieve to maintain certification.26 To
obtain approval, the third-party credentialing entity must demonstrate compliance with nationally
recognized standards for developing and administering professional certification programs to
certify peer specialists.27 All individuals providing DCF-funded recovery support services as a
peer specialist must be certified, however an individual who is not currently certified may work
as a peer specialist for a maximum of one year if they are working toward certification and are
supervised by a qualified professional or by a certified peer specialist with at least three years of
full-time experience as a peer specialist at a licensed behavioral health organization.28
The Florida Certification Board (FCB) is currently the only credentialing entity approved by the
DCF for certifying peer specialists in the state.29 The FCB credentials Certified Recovery Peer
Specialist (CRPS), which assist in providing client directed care by helping individuals develop
skills, and relationships that will allow them to achieve and maintain recovery from SUDs and
mental illness.30 CRPS applicants must attest to having been in recovery for a minimum of two
years.31 The CRPS must also have demonstrated competency through training and experience in
the performance domains of: Recovery Support, Advocacy, Mentoring and Professional
Responsibilities.32 As of June 2020, 630 individuals maintain active CRPS certifications
statewide.33
Individuals seeking certification must adhere to the CRPS credentialing standards and
requirements, complete a background screening, and have completed all court-ordered sanctions
related to any prior crimes committed for at least three years.34 Prospective CRPS must also
successfully complete training and a competency exam demonstrating proficiency in certain
educational areas.35
Background Screening
Substance Use Disorder and Criminal History
Certain individuals receiving substance abuse treatment may have a criminal or violent history:
about 54 percent of state prisoners and 61 percent of sentenced jail inmates incarcerated for
violent offenses met the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition,
(DSM-IV) criteria for drug dependence or abuse.36 Additionally, individuals who use illicit drugs
26
Section 397.417(2), F.S.
27
Id.
28
Section 397.417(3), F.S.
29
The DCF, Agency Analysis for SB 130, p. 2, December 10, 2020 (on file with the Senate Children, Families, and Elder
Affairs Committee staff) (hereinafter cited as, “The DCF Analysis”).
30
Id.
31
Id.
32
Id.
33
Id.
34
Id.
35
Id.
36
Jennifer Bronson, et al., Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009, U.S.
Department of Justice, Office of Justice Programs, Bureau of Justice Statistics at p. 1, June 2017, available at
https://www.bjs.gov/content/pub/pdf/dudaspji0709.pdf (last visited February 23, 2021).
BILL: CS/CS/SB 130 Page 6
are more likely to commit crimes, and it is common for many offenses, including violent crimes,
to be committed by individuals who had used drugs or alcohol prior to committing the crime, or
who were using at the time of the offense