Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0779 Compare Versions

Only one version of the bill is available at this time.

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5	5	2023 -- S 0779
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7	7	LC002039
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9	9	S TATE OF RHODE IS LAND
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABI LITIES AND
16	16	HOSPITALS -- CORE STATE BEHAVIORA L HEALTH CRISIS SERVICES SYSTEMS
17	17	Introduced By: Senators Cano, Valverde, DiMario, Murray, Acosta, Quezada, Zurier,
18	18	Euer, Lawson, and Britto
19	19	Date Introduced: March 23, 2023
20	20	Referred To: Senate Finance
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23	23	It is enacted by the General Assembly as follows:
24	24	SECTION 1. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE, 1
25	25	DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto 2
26	26	the following chapter: 3
27	27	CHAPTER 30 4
28	28	CORE STATE BEHAVIORAL HEALTH CRISIS SERVICES SYSTEMS 5
29	29	40.1-30-1. Definitions. 6
30	30	As used in this chapter, the following words and terms have the following meanings, unless 7
31	31	the context clearly indicates otherwise: 8
32	32	(1) "9-8-8 Administrator" means the administrator of the 9-8-8 Suicide Prevention and 9
33	33	Mental Health Crisis Hotline. 10
34	34	(2) "9-8-8 Crisis Hotline Center" or "hotline center" means a state-identified center 11
35	35	participating in the National Suicide Prevention Lifeline Network to respond to statewide or 12
36	36	regional 9-8-8 contacts. 13
37	37	(3) "9-8-8 Suicide Prevention and Mental Health Crisis Hotline" means the National 14
38	38	Suicide Prevention Lifeline ("NSPL") or its successor maintained by the director of the department 15
39	39	of behavioral healthcare, developmental disabilities and hospitals. 16
40	40	(4) "Community mental health centers," and "Certified community behavioral health 17
41	41	centers" means facilities as defined under Sec. 1913(c) of the Public Health Services Act and/or 18
42	42
43	43
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45	45	Section 223(d) of the Protecting Access to Medicare Act of 2014, and Community Behavioral 1
46	46	Health Organizations as licensed and certified by relevant state agencies. 2
47	47	(5) "Core state behavioral health crisis services systems" refers to the hotlines, the response 3
48	48	teams, the revolving funds, and all other aspects of health crisis service systems which are 4
49	49	established in this chapter. 5
50	50	(6) "Crisis receiving and stabilization services" are facilities providing short-term (under 6
51	51	twenty-four (24) hours) care with capacity for diagnosis, initial management, observation, crisis 7
52	52	stabilization and follow up referral services to all persons in a home-like environment. 8
53	53	(7) "Department" means the department of behavioral healthcare, developmental 9
54	54	disabilities and hospitals established pursuant to this title. 10
55	55	(8) "Director" means the director of the department of behavioral healthcare, 11
56	56	developmental disabilities and hospitals. 12
57	57	(9) "EMS" means emergency medical services. 13
58	58	(10) "Federal Communications Commission" means the federal agency that regulates 14
59	59	interstate and international communications by radio, television, wire, satellite, and cable in all fifty 15
60	60	(50) states, the District of Columbia and U.S. territories. An independent U.S. government agency 16
61	61	overseen by Congress, the Commission is the United States' primary authority for communications 17
62	62	law, regulation, and technological innovation. 18
63	63	(11) "Mobile crisis teams" include behavioral health professionals and peers that provide 19
64	64	professional onsite community-based intervention such as de-escalation, stabilization, and other 20
65	65	services for individuals who are experiencing a behavioral health crisis. 21
66	66	(12) "National Suicide Prevention Lifeline" ("NSPL") means the national network of local 22
67	67	crisis centers providing free and confidential emotional support to people in suicidal crisis or 23
68	68	emotional distress twenty-four (24) hours a day, seven (7) days a week. Membership as an NSPL 24
69	69	center requires nationally-recognized certification which includes evidence-based training for all 25
70	70	staff and volunteers in the management of calls. 26
71	71	(13) "Peers" means individuals employed on the basis of their personal lived experience of 27
72	72	mental illness and/or addiction and recovery who meet the state's peer certification requirements 28
73	73	where applicable. 29
74	74	(14) "Substance Abuse and Mental Health Services Administration" ("SAMHSA") is the 30
75	75	agency within the U.S. Department of Health and Human Services that leads public health efforts 31
76	76	to advance the behavioral health of the nation. 32
77	77	(15) "Veterans crisis line" ("VCL") means the veterans crisis line maintained by the 33
78	78	Secretary of Veterans Affairs under section 1720F(h) of title 38, United States Code. 34
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82	82	40.1-30-2. Crisis services systems established. 1
83	83	(a) The director is hereby authorized to designate a crisis hotline center or centers to 2
84	84	provide crisis intervention services and crisis care coordination to individuals accessing the 9-8-8 3
85	85	suicide prevention and behavioral health crisis hotline from any jurisdiction within Rhode Island 4
86	86	twenty-four (24) hours a day, seven (7) days a week. 5
87	87	(b) The designated hotline center(s) shall have an active agreement with the administrator 6
88	88	of the National Suicide Prevention Lifeline ("NSPL") maintained by the substance abuse and 7
89	89	mental health service administration, or any successor entity, for participation within the network. 8
90	90	(c) The designated hotline center(s) shall meet NSPL requirements and best practices 9
91	91	guidelines for operational and clinical standards. 10
92	92	(d) The designated hotline center(s) shall provide data, report, and participate in 11
93	93	evaluations and related quality improvement activities as required by the 9-8-8 system 12
94	94	administrator. 13
95	95	(e) To ensure cohesive, coordinated crisis care, the designated hotline center(s) must utilize 14
96	96	technology including chat and text that is interoperable between and across crisis and emergency 15
97	97	response systems used throughout the state (911, EMS, other non-behavioral health crisis services, 16
98	98	and others as necessary) and with the administrator of the NSPL. 17
99	99	(1) State agencies and departments shall cooperate as requested to assist the director in 18
100	100	promulgating rules and regulations to allow appropriate information sharing and communication 19
101	101	between and across crisis and emergency response systems for the purpose of real-time crisis care 20
102	102	coordination including, but not limited to, deployment of crisis and outgoing services and linked, 21
103	103	flexible services specific to crisis response. 22
104	104	(f) The designated hotline center(s) shall have the authority to deploy crisis and outgoing 23
105	105	services, including mobile crisis teams, and coordinate access to crisis receiving and stabilization 24
106	106	services or other local resources as appropriate and according to guidelines and best practices 25
107	107	established by the NSPL. The designated center(s) shall also actively collaborate with mental health 26
108	108	and substance use disorder treatment providers including hospital emergency departments and 27
109	109	inpatient psychiatric settings, local community mental health centers, including certified 28
110	110	community behavioral health clinics and community behavioral health centers, crisis receiving and 29
111	111	stabilization centers, and mobile crisis teams throughout the state to coordinate linkages for persons 30
112	112	contacting 9-8-8 with ongoing care needs and establishing formal agreements where appropriate. 31
113	113	(g) The designated hotline center(s) shall coordinate access to crisis receiving and 32
114	114	stabilization services for individuals accessing the 9-8-8 suicide prevention and behavioral health 33
115	115	crisis hotline through appropriate information sharing regarding availability of services. 34
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119	119	(h) The department, in consultation with the governor’s council on behavioral health 1
120	120	established pursuant to chapter 29 of title 40.1, the department of public safety established pursuant 2
121	121	to chapter 7.3 of title 42, and with any entity within the department which is designated by the 3
122	122	director as having primary oversight of suicide prevention and crisis service activities and essential 4
123	123	coordination with designated 9-8-8 hotline center(s), shall work in concert with the NSPL and VCL 5
124	124	networks for the purposes of ensuring consistency of public messaging about 9-8-8 services. 6
125	125	(i) The designated hotline center(s) shall meet the requirements set forth by NSPL for 7
126	126	serving high risk and specialized populations as identified by the Substance Abuse and Mental 8
127	127	Health Services Administration, including training requirements and policies for transferring 9
128	128	specialized population callers to an appropriate specialized center or subnetworks within or external 10
129	129	to the NSPL network. These populations shall include, but not be limited to, LGBTQ+ youth, 11
130	130	minorities, rural individuals, and other high-risk populations as well as those with co-occurring 12
131	131	substance use, and for providing linguistically and culturally competent care. 13
132	132	(j) The designated hotline center(s) shall provide follow-up services to individua ls 14
133	133	accessing the 9-8-8 suicide prevention and behavioral health crisis hotline consistent with guidance 15
134	134	and policies established by the NSPL. 16
135	135	(k) Commencing on December 31, 2023, and annually on or before December 31 17
136	136	thereafter, a written annual report compiled by the department relating to the 9-8-8 suicide 18
137	137	prevention and behavioral health crisis hotline’s usage and the services provided shall be provided 19
138	138	to the governor, the speaker of the house of representatives and the president of the senate. This 20
139	139	report shall also be filed at the same time with the Substance Abuse and Mental Health Services 21
140	140	Administration. 22
141	141	(l) The director may, but is not required to, operate the 9-8-8 suicide prevention hotline in 23
142	142	conjunction with the state’s E-911 emergency telephone system established pursuant to chapter 21 24
143	143	of title 39, but only if the director of the department of behavioral healthcare, developmental 25
144	144	disabilities and hospitals and the director of the department of public safety concur that such 26
145	145	operation is both feasible and in the best interests of the people of the state. 27
146	146	40.1-30-3. Response to calls -- Mobile crisis teams. 28
147	147	(a) There are hereby established, and the state shall provide, onsite response services to 29
148	148	crisis calls utilizing state and/or locally funded mobile crisis teams: 30
149	149	(b) The mobile crisis teams shall be: 31
150	150	(1) Jurisdiction-based behavioral health teams including licensed behavioral health 32
151	151	professionals and including peers; and/or 33
152	152	(2) Behavioral health teams embedded in EMS and including peers. 34
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156	156	(c) Mobile crisis teams shall collaborate with local law enforcement agencies and include 1
157	157	police as potential co-responders in behavioral health teams; however, the inclusion of police with 2
158	158	licensed behavioral health professionals and peers, shall only be required as needed to respond in 3
159	159	high-risk situations that cannot be managed without law enforcement, and shall: 4
160	160	(1) Be designed in partnership with community members, including people with lived 5
161	161	experience utilizing crisis services; 6
162	162	(2) Be staffed by personnel that reflect the demographics of the community served; and 7
163	163	(3) Collect customer service data from individuals served by demographic requirements, 8
164	164	including race and ethnicity, set forth by SAMHSA and consistent with the state block grant 9
165	165	requirements for continuous evaluation and quality improvement. 10
166	166	40.1-30-4. Funding. 11
167	167	(a) The state shall establish a revolving fund within the general treasurer's office to fund 12
168	168	treatment for crisis receiving and stabilization services as related to a call which meets the following 13
169	169	criteria: 14
170	170	(1) Crisis receiving and stabilization services as related to the call shall be funded by the 15
171	171	state if the individual meets the state's definition of uninsured or if the crisis stabilization service is 16
172	172	not a covered service by the individual's health coverage; or 17
173	173	(2) For Medicaid recipients, the state executive office of health and human services shall 18
174	174	work with the entity responsible for the development of crisis receiving and stabilization services 19
175	175	to explore options for appropriate coding of and payment for crisis management services. 20
176	176	(c) The director shall promulgate rules and regulations to determine how payment will be 21
177	177	made to the provider of service. 22
178	178	40.1-30-5. Revolving fund for maintaining 9-8-8 suicide prevention and mental health 23
179	179	crisis system. 24
180	180	(a) The state shall establish a revolving statewide 9-8-8 trust fund within the office of the 25
181	181	general treasurer for the purposes of creating and maintaining a statewide 9-8-8 suicide prevention 26
182	182	and mental health crisis system pursuant to the National Suicide Hotline Designation Act of 2020, 27
183	183	the Federal Communication Commission’s rules adopted July 16, 2020, and national guidelines for 28
184	184	crisis care. 29
185	185	(b) The fund shall consist of: 30
186	186	(1) The statewide 9-8-8 fee assessed on users; 31
187	187	(2) Appropriations made by the general assembly; 32
188	188	(3) Grants and gifts intended for deposit in the fund; 33
189	189	(4) Interest, premiums, gains, or other earnings on the fund; and 34
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193	193	(5) Money from any other source that is deposited in or transferred to the fund. 1
194	194	(c) Money in the fund: 2
195	195	(1) Shall not revert at the end of any state fiscal year but remains available for the purposes 3
196	196	of the fund in subsequent state fiscal years; 4
197	197	(2) Is not subject to transfer to any other fund or to transfer, assignment, or reassignment 5
198	198	for any other use or purpose outside of those specified in this chapter; and 6
199	199	(3) Shall be periodically appropriated for the purposes of the fund. 7
200	200	(d) A written annual report of fund deposits and expenditures shall be provided to the 8
201	201	governor, the president of the senate, and the speaker of the house of representatives and the Federal 9
202	202	Communications Commission, on or before December 31, 2024, and annually on or before 10
203	203	December 31 thereafter. 11
204	204	40.1-30-6. Statewide fee. 12
205	205	(a) The general assembly shall establish a monthly statewide 9-8-8 fee on each resident 13
206	206	that is a subscriber of commercial landline telephone, mobile telephone and/or IP-enabled voice 14
207	207	services at a rate that provides for the robust creation, operation, and maintenance of a statewide 9-15
208	208	8-8 suicide prevention and behavioral health crisis system and the continuum of services provided 16
209	209	pursuant to national guidelines for crisis services. 17
210	210	(b) The revenue generated by a 9-8-8 fee shall be sequestered in the revolving trust fund 18
211	211	established in § 40.1-30-5 to be obligated or expended only in support of 9–8–8 services, or 19
212	212	enhancements of such services. 20
213	213	(c) The revenue generated by a 9-8-8 fee shall only be used to offset costs that are or will 21
214	214	be reasonably attributed to: 22
215	215	(1) Primarily ensuring the efficient and effective routing of calls made to the 9-8-8 suicide 23
216	216	prevention and behavioral health crisis hotline to the designated hotline center(s) including staffing 24
217	217	and technological infrastructure enhancements necessary to achieve operational and clinical 25
218	218	standards and best practices set forth by NSPL; 26
219	219	(2) Personnel, including recruitment of personnel that reflect the demographics of the 27
220	220	community served; specialized training of staff to serve at-risk communities, including culturally 28
221	221	and linguistically competent services for LGBTQ+, racially, ethnically, and linguistically diverse 29
222	222	communities; and the provision of acute behavioral health, crisis outreach and stabilization services 30
223	223	by directly responding to the 9–8–8 national suicide prevention and behavioral health crisis hotline; 31
224	224	(3) Provision of data, reporting, participation in evaluations and related quality 32
225	225	improvement activities as required by the 9-8-8 administrator; and 33
226	226	(4) Administration, oversight and evaluation of the fund. 34
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230	230	(d) The 9-8-8 fee may be adjusted by the general assembly as needed to provide for 1
231	231	continuous operation, volume increases and maintenance. 2
232	232	(e) A written annual report compiled by the department on the revenue generated by the 9-3
233	233	8-8 fee shall be provided to the governor, the president of the senate, the speaker of the house of 4
234	234	representatives, and the Federal Communications Commission. 5
235	235	40.1-30-7. Implementation. 6
236	236	(a) The director shall provide general oversight to the core state behavioral health crisis 7
237	237	services systems established by this chapter. During the course of this oversight, the director may 8
238	238	assign and designate tasks to existing agencies, boards or committees within the department to 9
239	239	accomplish the planning required for implementation or ongoing oversight of this chapter in 10
240	240	coordination with designated hotline center(s), 9-1-1 centers, the state mental health authority, state 11
241	241	substance abuse agency, law enforcement, hospital emergency departments and the National 12
242	242	Suicide Prevention Lifeline. 13
243	243	(b) The director shall designate the 9-8-8 administrator after consultation with the 14
244	244	governor’s council on behavioral health. The 9-8-8 administrator shall be an employee of the 15
245	245	department and shall serve at the pleasure of the director. 16
246	246	(c) The revolving trust fund established in this chapter shall be maintained by the general 17
247	247	treasurer. The general treasurer shall draw upon the fund based upon orders from the director. The 18
248	248	fund may also be funded by appropriations from the general assembly as well as interest earnings, 19
249	249	money received from the federal government, gifts, bequests, donations, or otherwise from any 20
250	250	public or private source. 21
251	251	SECTION 2. This act shall take effect upon passage. 22
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258	258	EXPLANATION
259	259	BY THE LEGISLATIVE COUNCIL
260	260	OF
261	261	A N A C T
262	262	RELATING TO BEHAVIORAL HEALTHCARE, DEVEL OPMENTAL DISABILITIES AND
263	263	HOSPITALS -- CORE STATE BEHAVIORA L HEALTH CRISIS SERVICES SYSTEMS
264	264	***
265	265	This act would establish a core state behavioral health crisis services system, to be 1
266	266	administered by the director of behavioral healthcare, developmental disabilities and hospitals. The 2
267	267	systems would include establishing and administering a 9-8-8 suicide prevention hotline, 3
268	268	establishing mobile crisis response teams, and establishing a revolving trust fund to pay for the 4
269	269	costs of the system generated by a fee on subscribers of commercial land line telephone, mobile 5
270	270	telephone and/or IP-enabled voice services. 6
271	271	This act would take effect upon passage. 7
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