2022 -- S 2467

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LC004666

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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: Senators Cano, Seveney, Lawson, DiPalma, Quezada, Acosta, Kallman,
Burke, Valverde, and Zurier

     Date Introduced: March 01, 2022

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

DEVELOPMENTAL DISABILITIES AND HOSPITALS" is hereby amended by adding thereto

the following chapter:

CHAPTER 30

CORE STATE BEHAVIORAL HEALTH CRISIS SERVICES SYSTEMS

     40.1-30-1. Definitions.

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

the context clearly indicates otherwise:

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

Mental Health Crisis Hotline.

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

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

regional 9-8-8 contacts.

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

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

of behavioral healthcare, developmental disabilities and hospitals.

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

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

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

Health Organizations as licensed and certified by relevant state agencies.

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

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

established in this chapter.

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

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

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

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

disabilities and hospitals established pursuant to this title.

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

developmental disabilities and hospitals.

     (9) "EMS" means emergency medical services.

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

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

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

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

law, regulation, and technological innovation.

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

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

services for individuals who are experiencing a behavioral health crisis.

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

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

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

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

staff and volunteers in the management of calls.

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

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

where applicable.

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

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

to advance the behavioral health of the nation.

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

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.

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

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

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

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

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

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

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

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

guidelines for operational and clinical standards.

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

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

administrator.

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

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

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

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

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

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

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

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

to crisis response.

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

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

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

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

and substance use disorder treatment providers including hospital emergency departments and

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

linguistically and culturally competent care.

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

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

and policies established by the NSPL.

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

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

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

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

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

Administration.

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

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

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

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

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

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

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

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

     (b) The mobile crisis teams shall be:

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

professionals and including peers; and/or

     (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

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

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

without law enforcement, and shall:

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

experience utilizing crisis services;

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

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

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

requirements for continuous evaluation and quality improvement.

     40.1-30-4. Funding.

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

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

criteria:

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

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

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

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

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

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

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

made to the provider of service.

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

crisis system.

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

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

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

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

crisis care.

     (b) The fund shall consist of:

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

     (2) Appropriations made by the general assembly;

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

     (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.

     (c) Money in the fund:

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

of the fund in subsequent state fiscal years;

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

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

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

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

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

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

December 31 thereafter.

     40.1-30-6. Statewide fee.

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

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

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

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

pursuant to national guidelines for crisis services.

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

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

enhancements of such services.

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

be reasonably attributed to:

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

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

and technological infrastructure enhancements necessary to achieve operational and clinical

standards and best practices set forth by NSPL;

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

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

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

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

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

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

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

     (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

continuous operation, volume increases and maintenance.

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

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

representatives, and the Federal Communications Commission.

     40.1-30-7. Implementation.

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

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

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

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

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

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

Suicide Prevention Lifeline.

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

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

department and shall serve at the pleasure of the director.

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

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

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

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

public or private source.

     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

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

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

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

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

telephone and/or IP-enabled voice services.

     This act would take effect upon passage.

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