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 Fiscal Policy
BILL: CS/SB 210
INTRODUCER: Children, Families, and Elder Affairs Committee and Senator Harrell
SUBJECT: Substance Abuse Services
DATE: March 22, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Delia Cox CF Fav/CS
2. Sneed Money AHS Favorable
3. Delia Yeatman FP Favorable
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 210 modifies requirements for licensed substance abuse service providers offering
treatment to individuals living in recovery residences. The bill prohibits the following substances
from being used on the premises of a provider licensed by the Department of Children and
Families (the DCF):
 Alcohol;
 Marijuana, including marijuana certified by a qualified physician for medical use;
 Illegal drugs; and
 Prescription drugs when used by persons other than for whom the medication is prescribed.
The bill also prohibits referrals from licensed service providers to recovery residences which
allow the use of such substances on the premises, and it requires service providers to provide
proof of a prohibition on the use of such substances in applications for licensure with the DCF.
Additionally, the bill provides that referrals to a recovery residence include placement into the
licensed housing component of a service provider’s day or night treatment program, regardless of
whether the housing component is affiliated with the service provider. This will ensure that all
patients referred to a recovery residence are also referred into licensed community housing as
part of treatment.
The bill makes it a second degree misdemeanor for any person discharged from a recovery
residence to willfully refuse to depart after being warned by an owner or authorized employee of
the residence.
BILL: CS/SB 210 Page 2
The bill requires the DCF to establish a mechanism for the imposition and collection of fines
arising from failed inspections of recovery residences and improper referrals made by licensed
service providers.
The bill may have a negative fiscal impact to private substance abuse service providers and state
government. See Section V. Fiscal Impact Statement.
The bill is effective July 1, 2023.
II. Present Situation:
Substance abuse is the harmful or hazardous use of psychoactive substances, including alcohol
and illicit drugs.1 According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5), a diagnosis of substance use disorder (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 2021, approximately 46.3 million people aged 12 or older had a SUD related to corresponding
use of alcohol or illicit drugs within the previous year.6 The most common substance abuse
disorders in the United States are from the use of alcohol, tobacco, cannabis, opioids,
hallucinogens, and stimulants.7 Provisional data from the CDC’s National Center for Health
Statistics indicate there were an estimated 107,622 drug overdose deaths in the United States
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; (last visited
February 8, 2023); 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 8,
2023).
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 8, 2023).
3
The Substance Abuse and Mental Health Services Administration (The SAMHSA), Substance Use Disorders,
http://www.samhsa.gov/disorders/substance-use (last visited February 8, 2023).
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
8, 2023).
5
Id.
6
The SAMHSA, Highlights for the 2021 National Survey on Drug Use and Health, p. 2, available at
https://www.samhsa.gov/data/sites/default/files/2022-12/2021NSDUHFFRHighlights092722.pdf (last visited February 8,
2023).
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 8, 2023).
BILL: CS/SB 210 Page 3
during 2021 (the last year for which there is complete data), an increase of nearly 15% from the
93,655 deaths estimated in 2020.8
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.9 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.10 Each of these laws governed different aspects of addiction, and thus had
different rules promulgated by the state to fully implement the respective pieces of legislation.11
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.12
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).13
The Marchman Act encourages individuals to seek services on a voluntary basis within the
existing financial and space capacities of a service provider.14 However, denial of addiction is a
prevalent symptom of SUD, creating a barrier to timely intervention and effective treatment.15
As a result, treatment typically must stem from a third party providing the intervention needed
for SUD treatment.16
The 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.17 The DCF provides treatment for SUD through a community-based
provider system offering detoxification, treatment, and recovery support for individuals affected
by substance misuse, abuse, or dependence.18
8
The Center for Disease Control and Prevention, National Center for Health Statistics, U.S. Overdose Deaths In 2021
Increased Half as Much as in 2020 – But Are Still Up 15%, available at
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm (last visited February 8, 2023).
9
The DCF, Baker Act and Marchman Act Project Team Report for Fiscal Year 2016-2017, p. 4-5. (on file with the Senate
Committee on Children, Families, and Elder Affairs).
10
Id.
11
Id.
12
Id.
13
Chapter 93-39, s. 2, L.O.F., which codified current ch. 397, F.S.
14
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.
15
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 8, 2023) (hereinafter cited as “Fundamentals of the Marchman Act”).
16
Id.
17
See chs. 394 and 397, F.S.
18
The DCF, Treatment for Substance Abuse, available at https://www.myflfamilies.com/service-programs/samh/substance-
abuse.shtml (last visited February 8, 2023).
BILL: CS/SB 210 Page 4
 Detoxification Services: Detoxification services use medical and clinical procedures to
assist individuals and adults as they withdraw from the physiological and psychological
effects of substance abuse.19
 Treatment Services: Treatment services20 include a wide array of assessment, counseling,
case management, and support that are designed to help individuals who have lost their
ability to control their substance use on their own and require formal, structured intervention
and support.21
 Recovery Support: 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.22
Licensure of Substance Abuse Service Providers
The DCF regulates substance use disorder treatment by licensing individual treatment
components under ch. 397, F.S., and Rule 65D-30, F.A.C. Licensed service components include
a continuum of substance abuse prevention,23 intervention,24 and clinical treatment services.25
Clinical treatment is a professionally directed, deliberate, and planned regimen of services and
interventions that are designed to reduce or eliminate the misuse of drugs and alcohol and
promote a healthy, drug-free lifestyle.26 “Clinical treatment services” include, but are not limited
to, the following licensable service components:
 Addictions receiving facility.
 Day or night treatment.
 Day or night treatment with community housing.
 Detoxification.
 Intensive inpatient treatment.
 Intensive outpatient treatment.
 Medication-assisted treatment for opiate addiction.
19
Id.
20
Id. Research indicates that persons who successfully complete substance abuse treatment have better post-treatment
outcomes related to future abstinence, reduced use, less involvement in the criminal justice system, reduced involvement in
the child-protective system, employment, increased earnings, and better health.
21
Id.
22
Id.
23
Section 397.311(26)(c), F.S. “Prevention” is defined as “a process involving strategies that are aimed at the individual,
family, community, or substance and that preclude, forestall, or impede the development of substance use problems and
promote responsible lifestyles”. Substance abuse prevention is achieved through the use of ongoing strategies such as
increasing public awareness and education, community-based processes and evidence-based practices. These prevention
programs are focused primarily on youth, and, in recent years, have shifted to the local level, giving individual communities
the opportunity to identify their own unique prevention needs and develop action plans in response. This community focus
allows prevention strategies to have a greater impact on behavioral change by shifting social, cultural and community
environments. See also, The DCF, Substance Abuse: Prevention, available at https://www.myflfamilies.com/service-
programs/samh/prevention/index.shtml (last visited February 8, 2023).
24
Section 397.311(26)(b), F.S. “Intervention” is defined as “structured services directed toward individuals or groups at risk
of substance abuse and focused on reducing or impeding those factors associated with the onset or the early stages of
substance abuse and related problems.”
25
Section 397.311(26), F.S.
26
Section 397.311(26)(a), F.S.
BILL: CS/SB 210 Page 5
 Outpatient treatment.
 Residential treatment.27
Florida does not license recovery residences. Instead, in 2015 the Legislature enacted ss. 397.487
through 397.4872, F.S., which establish voluntary certification programs for recovery residences
and recovery residence administrators, implemented by private credentialing entities. 28
Day or Night Treatment with Community Housing
The DCF licenses “Day or Night Treatment” facilities both with and without community housing
components. Day or night treatment programs provide substance use treatment as a service in a
nonresidential environment, with a structured schedule of treatment and rehabilitative services. 29
Day or night treatment programs with community housing are intended for individuals who can
benefit from living independently in peer community housing while participating in treatment
services for a minimum of 5 hours a day or 25 hours per week.30
Day or night treatment with community housing is appropriate for individuals who do not require
structured, 24-hours-a-day, 7-days-a-week residential treatment.31 The housing must be provided
and managed by the licensed service provider, including room and board and any ancillary
services such as supervision, transportation, and meals. Activities for day or night treatment with
community housing programs emphasize rehabilitation and treatment services using
multidisciplinary teams to provide integration of therapeutic and family services.32 This
component allows individuals to live in a supportive, community housing location while
participating in treatment. Treatment must not take place in the housing where the individuals
live, and the housing must be utilized solely for the purpose of assisting individuals in making a
transition to independent living.33 Individuals who are considered appropriate for this level of
care:
 Would not have active suicidal or homicidal ideation or present a danger to self or others;
 Are able to demonstrate motivation to work toward independence;
 Are able to demonstrate a willingness to live in supportive community housing;
 Are able to demonstrate commitment to comply with rules established by the provider;
 Are not in need of detoxification or residential treatment; and
 Typically need ancillary services such as transportation, assistance with shopping, or
assistance with medical referrals and may need to attend and participate in certain social and
recovery oriented activities in addition to other required clinical services.34
Services provided by such programs may include:
 Individual counseling;
 Group counseling;
27
Id.
28
Chapter 2015-100, L.O.F.
29
Section 397.311(26)(a)2., F.S.
30
Section 397.311(26)(a)3., F.S.
31
Rule 65D-30.0081(1), F.A.C.
32
Id.
33
Id.
34
Id.
BILL: CS/SB 210 Page 6
 Counseling with families or support system;
 Substance-related and recovery-focused education, such as strategies for avoiding substance
use or relapse, information regarding health problems related to substance use, motivational
enhancement, and strategies for achieving a substance-free lifestyle;
 Life skills training such as anger management, communication skills, employability skills,
problem solving, relapse prevention, recovery management, decision-making, relationship
skills, symptom management, and food purchase and preparation;
 Expressive therapies, such as recreation therapy, art therapy, music therapy, or dance
(movement) therapy to provide the individual with alternative means of self-expression and
problem resolution;
 Training or provision of information regarding