HOUSE DOCKET, NO. 2692        FILED ON: 2/18/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 2081

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Marjorie C. Decker

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act to better coordinate suicide prevention services, behavioral health crisis care and emergency services through 988 implementation.

_______________

PETITION OF:

HOUSE DOCKET, NO. 2692        FILED ON: 2/18/2021

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 2081

The Commonwealth of Massachusetts

_______________

In the One Hundred and Ninety-Second General Court
(2021-2022)

_______________

An Act to better coordinate suicide prevention services, behavioral health crisis care and emergency services through 988 implementation.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 6A of the General Laws is amended by adding the following section after Section 16BB:

Section 16CC: 988 suicide prevention and behavioral health crisis hotline, mobile behavioral health crisis responders

(a) As used in this section, the following words shall have the following meanings:—

''Community services'', services that are available to the general population.

“988 crisis hotline center”, a center designated by the commissioner of the department of public health to respond to statewide or regional 988 calls.

“Community behavioral health centers”, organizations that are designated by the executive office of health and human services, licensed clinics as determined by the department of public health, and/or hold a contract with the department of mental health to provide community-based mental health services.

“Community crisis stabilization programs”, programs providing short-term (under 24 hours) crisis stabilization services with capacity for diagnosis, initial management, observation, crisis stabilization, and follow-up referral services to all persons in a home-like environment. These can include Emergency Service Providers and restoration centers.

“Mobile behavioral health crisis responders”, teams of behavioral health professionals, which may include peers, which provide professional onsite community-based intervention such as evaluation, de-escalation, stabilization, diversion, and triage to acute intervention or community-based settings for individuals who are experiencing a behavioral health crisis. Mobile Behavioral Health Crisis Responders may include: (1) Emergency Service Provider/Mobile Crisis Intervention teams; (2) local or regional behavioral health teams including licensed behavioral health professionals and peers that may include crisis co-responders; and (3) licensed behavioral health professionals and peers embedded in Emergency Medical Services (EMS).

“Peers”, individuals employed on the basis of their personal lived experience of mental illness and/or addiction and recovery who meet peer certification requirements where applicable. Peers may include Family Partners that meet Community Health Worker certification standards. 

(b) Prior to July 16, 2022, the Secretary of the Executive Office of Health and Human Services, hereafter the “Secretary”, shall designate a crisis hotline center or centers to provide crisis intervention services and crisis care coordination to individuals accessing the 988 suicide prevention and behavioral health crisis hotline twenty-four hours a day, seven days a week:

(1) The designated hotline center(s) must meet Secretary’s Ambulatory Behavioral Health System standards and the National Suicide Prevention Lifeline requirements and best practices guidelines for operational and clinical standards.

(2) The designated hotline center(s) must provide data, report, and participate in evaluations and related quality improvement activities as required by the Secretary. 

(3) The designated hotline center(s) shall utilize technology including chat and text that is interoperable between and across crisis and emergency response systems other non-behavioral health crisis services, and others, as necessary.

(4) The Secretary, in consultation with the Executive Office of Public Safety and Security, shall promulgate regulations to allow appropriate information sharing and communication among crisis and emergency response systems for the purpose of real-time crisis care coordination. Such regulations shall include:

(i)a preference for resolving behavioral health crises over the phone where possible;

(ii)if physical intervention is needed, a preference for dispatching Emergency Service Provider/Mobile Crisis Intervention where appropriate;

(iii)if safety is a concern, to provide for dispatching law enforcement to support mobile behavioral health crisis responders;

(iv)    coordination of services during and post-crisis.

(5)  The designated hotline center(s) shall have the authority to deploy crisis and outgoing services, including mobile behavioral health crisis responders, and coordinate access to crisis triage, evaluation, and counseling, and to community crisis stabilization programs or other local resources as appropriate.

(6) The designated hotline center(s) shall maintain standing partnership agreements with community behavioral health centers and other behavioral health programs and facilities.

(7) The designated hotline center(s) shall coordinate access to crisis evaluation, counselling, receiving and stabilization services for individuals accessing the 988 suicide prevention and behavioral health crisis hotline through appropriate information sharing regarding availability of services.

(8)  The designated hotline center(s) shall have the capability to serve high risk and specialized populations including LGBTQ individuals, those with co-occurring substance use and mental health conditions, those with autism spectrum disorders or intellectual and developmental disabilities, Native American, and special populations and capacity for providing linguistically and culturally competent care.

(9) The designated hotline center(s) shall provide follow-up services to individuals accessing the 988 suicide prevention and behavioral health crisis hotline.

(10) The Secretary shall issue a report not more than 1 year following enactment of this Act. Reports shall be issued annually thereafter. Said report shall include the 988 suicide prevention and behavioral health crisis hotline’s usage and the services provided, performance and quality metrics, including law enforcement diversions and hospital diversions, and caller demographics. Said report shall be filed with the clerks of the senate and the house of representatives, and the joint committee on mental health, substance use and recovery.

(c) Mobile behavioral health crisis responders shall collaborate with local law enforcement agencies and include police as co-responders in behavioral health teams only as needed to respond in high-risk situations that cannot be managed without the assistance of law enforcement personnel.

Mobile behavioral health crisis responders and community crisis stabilization programs shall: (i) be designed in partnership with community members, including people with lived experience utilizing crisis services; (ii) be staffed by personnel that reflect the demographics of the community served; and (iii) collect customer service data from individuals served by demographic requirements, including race and ethnicity and performance and quality metrics.

SECTION 2. Chapter 10 of the General Laws is amended by adding the following section after Section 35LLL:

Section 35MMM: Behavioral Health Crisis and Suicide Prevention Trust Fund, 988 fee, 988 Commission

(a) There shall be a Behavioral Health Crisis and Suicide Prevention Trust Fund, hereinafter the “Fund”, established and managed by the Secretary of the Executive Office of Health and Human Services, hereinafter the “Secretary”, for the purposes of creating and maintaining a statewide 988 suicide prevention and mental health crisis system.

(1)  The Fund shall consist of:

(i)  The statewide 988 fee assessed on users under section (b) below;

(ii)  Appropriations made by the General Court;

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

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

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

(2)  Money in the Fund:

(i)  Shall not revert at the end of any state fiscal year but remain available for the purposes of the fund in subsequent state fiscal years;

(ii)  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 section (b) below; and

(iii) Is continuously appropriated for the purposes of the fund.

(3) The Secretary shall file an annual report on Fund deposits and expenditures with the clerks of the senate and the house of representatives, and the joint committee on mental health, substance use and recovery.

(b) The Secretary shall establish a monthly statewide 988 fee on each resident that is a subscriber of commercial mobile and/or IP-enabled voice services at a rate that provides for the robust creation, operation, and maintenance of a statewide 988 suicide prevention and behavioral health crisis system and the continuum of services provided pursuant to national guidelines for crisis services.

(1) The revenue generated by a 988 fee should be sequestered in trust as specified in section (a) above to be obligated or expended only in support of 9–8–8 services, or enhancements of such services.

(2) The revenue generated by a 988 fee must only be used to offset costs that are or will be reasonably attributed to: ensuring the efficient and effective routing of calls made to the 988 suicide prevention and behavioral health crisis hotline to the designated hotline center(s) and community behavioral health centers including staffing and technological infrastructure enhancements necessary to achieve operational and clinical standards and best practices set forth by the Secretary’s Ambulatory Behavioral Health System standards and the National Suicide Prevention Lifeline; recruitment of personnel that reflect the demographics of the community served; specialized training of staff to assess and serve people experiencing mental health, substance use, and suicidal crises, including specialized training to serve at-risk communities, including culturally and linguistically competent services for LGBTQ+, racially, ethnically, and linguistically diverse communities; the provision of acute behavioral health, crisis outreach and stabilization services that are in response to the 9–8–8 national suicide prevention and behavioral health crisis hotline; provision of data, reporting, participation in evaluations and related quality improvement activities as required by the Secretary; administration, oversight and evaluation of the fund; coordination with 911, Emergency Service Providers, crisis co-responders, and other system partners, including service providers; and development of service enhancements or targeted responses to improve outcomes and address gaps and needs.

(3) The 988 fee may be adjusted as needed to provide for continuous operation, volume increases and maintenance.

(4) The Secretary shall file an annual report on Fund deposits and expenditures with the clerks of the senate and the house of representatives, and the joint committee on mental health, substance use and recovery.

(5) The Secretary shall promulgate regulations for the spending the revenue generated by the 988 fee, and for the administration of programs established as a result of fee revenue by July 1, 2022, under advisement of the 988 Commission established in Section (c) below.

(c) There shall be a 988 Commission to accomplish the planning required for implementation and ongoing oversight of this Act in coordination with designated hotline center(s), 911 centers, the department of mental health, and the department of public health. The 988 Commission shall be appointed by the governor and shall include the Secretary or designee, the secretary of the executive office of public safety and security or designee; the executive director of the Massachusetts Behavioral Health Partnership or designee; a one representative from an Emergency Service Provider nominated by the Association for Behavioral Healthcare; a representative from Association for Behavioral Healthcare; a representative from a suicide prevention hotline in Massachusetts nominated by Samaritans; a representative from the  Riverside Community Care MassSupport program; a representative from the United Way’s Call2Talk program; a representative from the Massachusetts Coalition for Suicide Prevention; a representative from the Children’s Mental Health Campaign; a representative from the INTERFACE Referral Service at William James College; a representative from the National Alliance on Mental Illness (NAMI) of Massachusetts; a representative from the Parent Professional Advocacy League; three representatives who identify as having a behavioral health condition as recommended to the governor by the secretary; a representative from the Massachusetts Association for Mental Health; a representative from the Boston Chapter of the NAACP; a representative from the ACLU of Massachusetts; a 911 dispatcher designated by the Massachusetts Association of Police Chiefs; an EMT or first responder nominated by the Massachusetts Ambulance Association; a representative from the Mental Health Legal Advisors Committee; and a representative designated by the National Association of Social Workers Massachusetts Chapter.

The 988 Commission shall review national guidelines and best practices and make recommendations for implementation of 988 in Massachusetts by December 31, 2021, for implementation by July 2022.  Recommendations may include any legislative or regulatory changes that might be needed, a recommended levy amount on commercial mobile service, prepaid wireless voice service, and IP enabled services end users not less than the Electronic 911 wireless surcharge established in M.G.L. Section 18H of Chapter 6A, as well as a plan to spend levied funds in the Fund.