2022 -- H 7389

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LC003640

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- CORE STATE BEHAVIORAL HEALTH CRISIS SERVICES SYSTEMS

     

     Introduced By: Representatives Shallcross Smith, Casimiro, Kislak, J Lombardi,
Morales, McGaw, Henries, Alzate, Fenton-Fung, and Ruggiero

     Date Introduced: February 09, 2022

     Referred To: House Finance

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 40.1 of the General Laws entitled "BEHAVIORAL HEALTHCARE,

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DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto

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the following chapter:

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CHAPTER 30

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CORE STATE BEHAVIORAL HEALTH CRISIS SERVICES SYSTEMS

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     40.1-30-1. Definitions.

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     As used in this chapter, the following words and terms have the following meanings, unless

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the context clearly indicates otherwise:

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     (1) "9-8-8 Administrator" means the administrator of the 9-8-8 Suicide Prevention and

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Mental Health Crisis Hotline.

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     (2) "9-8-8 Crisis Hotline Center" or "hotline center" means a state-identified center

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participating in the National Suicide Prevention Lifeline Network to respond to statewide or

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regional 9-8-8 contacts.

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     (3) "9-8-8 Suicide Prevention and Mental Health Crisis Hotline" means the National

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Suicide Prevention Lifeline ("NSPL") or its successor maintained by the director of the department

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of behavioral healthcare, developmental disabilities and hospitals.

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     (4) "Community mental health centers," and "Certified community behavioral health

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centers" means facilities as defined under Sec. 1913(c) of the Public Health Services Act and/or

 

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Section 223(d) of the Protecting Access to Medicare Act of 2014, and Community Behavioral

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Health Organizations as licensed and certified by relevant state agencies.

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     (5) "Core state behavioral health crisis services systems" refers to the hotlines, the response

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teams, the revolving funds, and all other aspects of health crisis service systems which are

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established in this chapter.

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     (6) "Crisis receiving and stabilization services" are facilities providing short-term (under

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twenty-four (24) hours) care with capacity for diagnosis, initial management, observation, crisis

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stabilization and follow up referral services to all persons in a home-like environment.

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     (7) "Department" means the department of behavioral healthcare, developmental

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disabilities and hospitals established pursuant to this title.

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     (8) "Director" means the director of the department of behavioral healthcare,

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developmental disabilities and hospitals.

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     (9) "EMS" means emergency medical services.

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     (10) "Federal Communications Commission" means the federal agency that regulates

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interstate and international communications by radio, television, wire, satellite, and cable in all fifty

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(50) states, the District of Columbia and U.S. territories. An independent U.S. government agency

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overseen by Congress, the Commission is the United States' primary authority for communications

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law, regulation, and technological innovation.

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     (11) "Mobile crisis teams" include behavioral health professionals and peers that provide

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professional onsite community-based intervention such as de-escalation, stabilization, and other

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services for individuals who are experiencing a behavioral health crisis.

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     (12) "National Suicide Prevention Lifeline" ("NSPL") means the national network of local

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crisis centers providing free and confidential emotional support to people in suicidal crisis or

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emotional distress twenty-four (24) hours a day, seven ( 7 ) days a week. Membership as an NSPL

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center requires nationally-recognized certification which includes evidence-based training for all

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staff and volunteers in the management of calls.

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     (13) "Peers" means individuals employed on the basis of their personal lived experience of

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mental illness and/or addiction and recovery who meet the state's peer certification requirements

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where applicable.

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     (14) "Substance Abuse and Mental Health Services Administration" ("SAMHSA") is the

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agency within the U.S. Department of Health and Human Services that leads public health efforts

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to advance the behavioral health of the nation.

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     (15) "Veterans crisis line" ("VCL") means the veterans crisis line maintained by the

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Secretary of Veterans Affairs under section 1720F(h) of title 38, United States Code.

 

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     40.1-30-2. Crisis services systems established.

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     (a) The director is hereby authorized to designate a crisis hotline center or centers to

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provide crisis intervention services and crisis care coordination to individuals accessing the 9-8-8

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suicide prevention and behavioral health crisis hotline from any jurisdiction within Rhode Island

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twenty-four (24) hours a day, seven (7) days a week.

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     (b) The designated hotline center(s) must have an active agreement with the administrator

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of the National Suicide Prevention Lifeline ("NSPL") maintained by the substance abuse and

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mental health service administration, or any successor entity, for participation within the network.

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     (c) The designated hotline center(s) must meet NSPL requirements and best practices

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guidelines for operational and clinical standards.

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     (d) The designated hotline center(s) must provide data, report, and participate in

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evaluations and related quality improvement activities as required by the 9-8-8 system

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administrator.

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     (e) To ensure cohesive, coordinated crisis care, the designated hotline center(s) must utilize

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technology including chat and text that is interoperable between and across crisis and emergency

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response systems used throughout the state (911, EMS, other non-behavioral health crisis services,

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and others as necessary) and with the administrator of the NSPL.

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     (1) The state shall use its authority to assist the director in promulgating rules and

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regulations to allow appropriate information sharing and communication between and across crisis

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and emergency response systems for the purpose of real-time crisis care coordination including,

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but not limited to, deployment of crisis and outgoing services and linked, flexible services specific

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to crisis response.

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     (f) The designated hotline center(s) shall have the authority to deploy crisis and outgoing

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services, including mobile crisis teams, and coordinate access to crisis receiving and stabilization

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services or other local resources as appropriate and according to guidelines and best practices

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established by the NSPL. The designated center(s) shall also actively collaborate with mental health

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and substance use disorder treatment providers including hospital emergency departments and

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inpatient psychiatric settings, local community mental health centers, including certified

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community behavioral health clinics and community behavioral health centers, crisis receiving and

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stabilization centers, and mobile crisis teams throughout the state to coordinate linkages for persons

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contacting 9-8-8 with ongoing care needs and establishing formal agreements where appropriate.

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     (g) The designated hotline center(s) shall coordinate access to crisis receiving and

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stabilization services for individuals accessing the 9-8-8 suicide prevention and behavioral health

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crisis hotline through appropriate information sharing regarding availability of services.

 

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     (h) The department, in consultation with the governor’s council on behavioral health

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established pursuant to chapter 29 of 40.1, the department of public safety established pursuant to

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chapter 7.3 of title 42, and with any entity within the department which is designated by the director

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as having primary oversight of suicide prevention and crisis service activities and essential

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coordination with designated 9-8-8 hotline center(s), shall work in concert with the NSPL and VCL

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networks for the purposes of ensuring consistency of public messaging about 9-8-8 services.

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     (i) The designated hotline center(s) shall meet the requirements set forth by NSPL for

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serving high risk and specialized populations as identified by the Substance Abuse and Mental

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Health Services Administration, including training requirements and policies for transferring such

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callers to an appropriate specialized center or subnetworks within or external to the NSPL network.

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These populations shall include, but not be limited to, LGBTQ+ youth, minorities, rural individuals,

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and other high-risk populations as well as those with co-occurring substance use, and for providing

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linguistically and culturally competent care.

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     (j) The designated hotline center(s) must provide follow-up services to individuals

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accessing the 9-8-8 suicide prevention and behavioral health crisis hotline consistent with guidance

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and policies established by the NSPL.

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     (k) Commencing on December 31, 2022, and annually on or before December 31

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thereafter, a written annual report compiled by the department relating to the 9-8-8 suicide

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prevention and behavioral health crisis hotline’s usage and the services provided shall be provided

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to the governor, the speaker of the house of representatives and the president of the senate. This

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report shall also be filed at the same time with the Substance Abuse and Mental Health Services

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Administration.

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     (l) The director may, but is not required to, operate the 9-8-8 suicide prevention hotline in

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conjunction with the state’s E-911 emergency telephone system established pursuant to chapter 21

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of title 39, but only if the director of the department of behavioral healthcare, developmental

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disabilities and hospitals and the director of the department of public safety concur that such

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operation is both feasible and in the best interests of the people of the state.

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     40.1-30-3. Response to calls -- Mobile crisis teams.

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     (a) There are hereby established, and the state shall provide, onsite response services to

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crisis calls utilizing state and/or locally funded mobile crisis teams:

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     (b) The mobile crisis teams shall be:

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     (1) Jurisdiction-based behavioral health teams including licensed behavioral health

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professionals and including peers; and/or

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     (2) Behavioral health teams embedded in EMS and including peers.

 

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     (c) Mobile crisis teams shall collaborate with local law enforcement agencies and include

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police as co-responders in behavioral health teams, including police, licensed behavioral health

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professionals and peers, only as needed to respond in high-risk situations that cannot be managed

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without law enforcement, and shall:

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     (1) Be designed in partnership with community members, including people with lived

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experience utilizing crisis services;

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     (2) Be staffed by personnel that reflect the demographics of the community served; and

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     (3) Collect customer service data from individuals served by demographic requirements,

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including race and ethnicity, set forth by SAMHSA and consistent with the state block grant

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requirements for continuous evaluation and quality improvement.

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     40.1-30-4. Funding.

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     (a) The state shall establish a revolving fund within the general treasurer's office to fund

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treatment for crisis receiving and stabilization services as related to a call which meets the following

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criteria:

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     (1) Crisis receiving and stabilization services as related to the call shall be funded by the

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state if the individual meets the state's definition of uninsured or if the crisis stabilization service is

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not a covered service by the individual's health coverage; or

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     (2) For Medicaid recipients, the state executive office of health and human services shall

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work with the entity responsible for the development of crisis receiving and stabilization services

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to explore options for appropriate coding of and payment for crisis management services.

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     (c) The director shall promulgate rules and regulations to determine how payment will be

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made to the provider of service.

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     40.1-30-5. Revolving fund for maintaining 9-8-8 suicide prevention and mental health

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crisis system.

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     (a) The state shall establish a revolving statewide 9-8-8 trust fund within the office of the

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general treasurer for the purposes of creating and maintaining a statewide 9-8-8 suicide prevention

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and mental health crisis system pursuant to the National Suicide Hotline Designation Act of 2020,

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the Federal Communication Commission’s rules adopted July 16, 2020, and national guidelines for

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crisis care.

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     (b) The fund shall consist of:

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     (1) The statewide 9-8-8 fee assessed on users;

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     (2) Appropriations made by the general assembly;

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     (3) Grants and gifts intended for deposit in the fund;

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     (4) Interest, premiums, gains, or other earnings on the fund; and

 

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     (5) Money from any other source that is deposited in or transferred to the fund.

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     (c) Money in the fund:

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     (1) Shall not revert at the end of any state fiscal year but remains available for the purposes

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of the fund in subsequent state fiscal years;

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     (2) Is not subject to transfer to any other fund or to transfer, assignment, or reassignment

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for any other use or purpose outside of those specified in this chapter; and

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     (3) Shall be periodically appropriated for the purposes of the fund.

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     (d) A written annual report of fund deposits and expenditures shall be provided to the

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governor, the president of the senate, and the speaker of the house of representatives and the Federal

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Communications Commission, on or before December 31, 2023, and annually on or before

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December 31 thereafter.

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     40.1-30-6. Statewide fee.

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     (a) The general assembly shall establish a monthly statewide 9-8-8 fee on each resident

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that is a subscriber of commercial landline telephone, mobile telephone and/or IP-enabled voice

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services at a rate that provides for the robust creation, operation, and maintenance of a statewide 9-

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8-8 suicide prevention and behavioral health crisis system and the continuum of services provided

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pursuant to national guidelines for crisis services.

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     (b) The revenue generated by a 9-8-8 fee shall be sequestered in the revolving trust fund

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established in §40.1-30-5 to be obligated or expended only in support of 9–8–8 services, or

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enhancements of such services.

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     (c) The revenue generated by a 9-8-8 fee shall only be used to offset costs that are or will

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be reasonably attributed to:

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     (1) Primarily ensuring the efficient and effective routing of calls made to the 9-8-8 suicide

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prevention and behavioral health crisis hotline to the designated hotline center(s) including staffing

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and technological infrastructure enhancements necessary to achieve operational and clinical

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standards and best practices set forth by NSPL;

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     (2) Personnel, including recruitment of personnel that reflect the demographics of the

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community served; specialized training of staff to serve at-risk communities, including culturally

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and linguistically competent services for LGBTQ+, racially, ethnically, and linguistically diverse

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communities; and the provision of acute behavioral health, crisis outreach and stabilization services

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by directly responding to the 9–8–8 national suicide prevention and behavioral health crisis hotline;

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     (3) Provision of data, reporting, participation in evaluations and related quality

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improvement activities as required by the 9-8-8 administrator; and

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     (4) Administration, oversight and evaluation of the fund.

 

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     (d) The 9-8-8 fee may be adjusted by the general assembly as needed to provide for

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continuous operation, volume increases and maintenance.

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     (e) A written annual report compiled by the department on the revenue generated by the 9-

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8-8 fee shall be provided to the governor, the president of the senate, the speaker of the house of

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representatives, and the Federal Communications Commission.

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     40.1-30-7. Implementation.

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     (a) The director shall provide general oversight to the core state behavioral health crisis

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services systems established by this chapter. During the course of this oversight, the director may

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assign and designate tasks to existing agencies, boards or committees within the department to

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accomplish the planning required for implementation or ongoing oversight of this chapter in

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coordination with designated hotline center(s), 9-1-1 centers, the state mental health authority, state

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substance abuse agency, law enforcement, hospital emergency departments and the National

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Suicide Prevention Lifeline.

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     (b) The director shall designate the 9-8-8 administrator after consultation with the

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governor’s council on behavioral health. The 9-8-8 administrator shall be an employee of the

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department and shall serve at the pleasure of the director.

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     (c) The revolving trust fund established in this chapter shall be maintained by the general

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treasurer. The general treasurer shall draw upon the fund based upon orders from the director. The

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fund may also be funded by appropriations from the general assembly as well as interest earnings,

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money received from the federal government, gifts, bequests, donations, or otherwise from any

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public or private source.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BEHAVIORAL HEALTHCARE, DEVELOPMENTAL DISABILITIES AND

HOSPITALS -- CORE STATE BEHAVIORAL HEALTH CRISIS SERVICES SYSTEMS

***

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     This act would establish a core state behavioral health crisis services system, to be

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administered by the director of behavioral healthcare, developmental disabilities and hospitals. The

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systems would include establishing and administering a 9-8-8 suicide prevention hotline,

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establishing mobile crisis response teams, and establishing a revolving trust fund to pay for the

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costs of the system generated by a fee on subscribers of commercial land line telephone, mobile

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telephone and/or IP-enabled voice services.

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     This act would take effect upon passage.

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