,,ii #aag? ,,congress #a/ ,session ,s4 #aijb ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #bg1 #bjba,ms4 ,cortez ,ma/o 7= h]self & ,mr4 ,cornyn7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,heal?1 ,education1 ,labor1 & ,p5sions ,a ,,bill ,to emp[] communities to e/abli% a cont9uum ( c>e = individuals exp]i5c+ m5tal or behavioral heal? crisis1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,behavioral ,heal? ,crisis ,s]vices ,expansion ,act4 #b4 ,crisis response cont9uum ( c>e 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices 79 ?is section ref]r$ to z ! ,secret>y7 %all e/abli% /&>ds = a cont9uum ( c>e = use by heal? c>e provid]s & communities 9 respond+ to individuals exp]i5c+ a m5tal or behavioral heal? crisis1 includ+ ^? individuals ) co-occurr+ sub/ance use disord]s 7ref]r$ to 9 ?is section z ! crisis response cont9uum74 7b7 ,requirem5ts 7#a7 ,scope ( /&>ds ,su* /&>ds %all def9e-- 7,a7 m9imum requirem5ts ( core crisis s]vices1 z det]m9$ by ! ,secret>y1 to include requirem5ts t ea* entity t furni%es su* s]vices %\ld-- 7i7 n require prior au?orization f an insurance provid] nor ref]ral f a heal? c>e provid] prior to ! deliv]y ( s]vices2 7ii7 s]ve all individuals reg>dless ( age or ability to pay2 7iii7 op]ate #bd h\rs a day1 #g days a week1 & provide c>e to all individuals2 & 7iv7 provide c>e & support ?r\gh res\rces describ$ 9 p>agraph 7#b77;,a7 until ! individual has be5 /abiliz$ or transf] ! individual to ! next level ( crisis c>e2 & 7,b7 psy*iatric /abilization1 includ+ ! po9t at :i* a case may be clos$ =-- 7i7 individuals scre5$ ov] ! phone2 & 7ii7 individuals /abiliz$ on ! sc5e by mobile teams4 7#b7 ,id5tification ( ess5tial functions ,! ,secret>y %all id5tify ! ess5tial functions ( ea* s]vice 9 ! crisis response cont9uum1 :i* %all include at lea/ ! foll[+3 7,a7 ,id5tification ( res\rces = ref]ral & enrollm5t 9 cont9u+ behavioral heal? & o!r human s]vices = ! individual 9 crisis :]e necess>y4 7,b7 ,del9eation ( access & entry po9ts to s]vices )9 ! crisis response cont9uum4 7,c7 ,developm5t ( & adh]5ce to protocols & agreem5ts = ! transf] & receipt ( individuals to & f o!r segm5ts ( ! crisis response cont9uum segm5ts z ne$$1 & f outside ref]rals includ+ heal? c>e provid]s1 law en=cem5t1 ,,ems1 fire1 education in/itutions1 & community-bas$ organizations4 7,d7 ,description ( ! qualifications ( crisis s]vices /aff1 includ+ roles = physicians1 lic5s$ cl9icians1 case manag]s1 & pe]s 79 accordance ) ,/ate lic5s+ requirem5ts74 7,e7 ,requirem5ts = ! conv5tion ( collaborative meet+s ( crisis response s]vice provid]s1 fir/ respond]s1 & community p>tn]s op]at+ 9 a common region = ! discussion ( case managem5t1 be/ practices1 & g5]al p]=mance improvem5t4 7#c7 ,s]vice capacity & quality /&>ds ,su* /&>ds %all include def9itions (-- 7,a7 adequate volume ( s]vices to meet population ne$2 7,b7 appropriate timely response2 & 7,c7 capacity to meet ! ne$s ( diff]5t pati5t populations1 includ+ all age gr\ps1 cultural & l+ui/ic m9orities1 & individuals ) co-occurr+ m5tal heal? & sub/ance use disord] crisis1 individuals ) cognitive disabilities exp]i5c+ behavioral heal? crises1 & individuals ) *ronic m$ical conditions & physical disabilities exp]i5c+ behavioral heal? crises4 7#d7 ,ov]sight & accr$itation ,! ,secret>y %all designate entities *>g$ ) ! ov]sight & accr$itation ( entities )9 ! crisis response cont9uum4 7#e7 ,implem5tation timeframe ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is ,act1 ! ,secret>y %all e/abli% ! /&>ds "u ?is section4 7#f7 ,data collection & evaluations 7,a7 ,9 g5]al ,! ,secret>y1 directly or ?r\gh grants1 contracts1 or int]ag5cy agreem5ts1 %all collect data & conduct evaluations ) respect to ! provision ( s]vices & programs (f]$ on ! crisis response cont9uum = purposes ( assess+ ! ext5t to :i* ! provision ( su* s]vices & programs meet c]ta9 objectives & outcomes measures z det]m9$ by ! ,secret>y4 ,su* objectives %all include-- 7i7 a r$uction 9 inappropriate arre/s ( individuals :o are 9 m5tal heal? crisis2 7ii7 a r$uction 9 inappropriate em]g5cy room admissions & readmissions2 & 7iii7 evid5ce ( adequate access to crisis c>e c5t]s & crisis b$ s]vices4 7,b7 ,rulemak+ ,! ,secret>y %all c>ry out ?is subsection ?r\gh notice & comm5t rulemak+1 foll[+ a reque/ = in=mation f /akehold]s4 7,c7 ,au?orization ( appropriations ,to c>ry out ?is subsection1 !re is au?oriz$ to be appropriat$ su* sums z are necess>y to rema9 available until exp5d$4 7c7 ,compon5ts ( crisis response cont9uum ,! crisis response cont9uum consi/s ( at lea/ ! foll[+ compon5ts3 7#a7 ,crisis call c5t]s ,regional cl9ically manag$ crisis call c5t]s t provide telephonic crisis int]v5tion capabilities4 ,su* c5t]s %\ld meet ,national ,suicide ,prev5tion ,lifel9e op]ational guidel9es reg>d+ suicide risk assessm5t & engagem5t & (f] air traffic control-quality coord9ation ( crisis c>e 9 real-"t4 7#b7 ,mobile crisis response team ,teams ( provid]s t are available to rea* any individual 9 ! s]vice area 9 _! home1 workplace1 or any o!r community-bas$ location ( ! individual 9 crisis 9 a timely mann]4 7#c7 ,crisis receiv+ & /abilization facilities ,subacute inpati5t facilities & o!r facilities specifi$ by ! ,secret>y t provide %ort-t]m obs]vation & crisis /abilization s]vices to all ref]rals1 includ+ ! foll[+ s]vices3 7,a7 #bc-;h\r crisis /abilization s]vices ,a direct c>e s]vice t provides individuals 9 sev]e di/ress ) up to #bc consecutive h\rs ( sup]vis$ c>e to assi/ ) deescalat+ ! sev]ity ( _! crisis or ne$ = urg5t c>e 9 a sub-acute inpati5t sett+4 7,b7 ,%ort-t]m crisis resid5tial s]vices ,a direct c>e s]vice t assi/s ) deescalat+ ! sev]ity ( an individual's level ( di/ress or ne$ = urg5t c>e associat$ ) a sub/ance use or m5tal heal? disord] 9 a resid5tial sett+4 7#d7 ,behavioral heal? urg5t c>e facilities ,ambulatory s]vices available #ab-bd h\rs p] day1 #g days a week1 :]e individuals exp]i5c+ crisis c walk 9 )\t an appo9tm5t to receive crisis assessm5t1 crisis int]v5tion1 m$ication1 & connection to cont9uity ( c>e4 7#e7 ,additional facilities & provid]s ,! ,secret>y %all specify additional facilities & heal? c>e provid]s z "p ( ! crisis response cont9uum1 z ! ,secret>y det]m9es appropriate4 7d7 ,relation%ip to ,/ate law 7#a7 ,9 g5]al ,subject to p>agraph 7#b71 ! /&>ds e/abli%$ "u ?is section are m9imum /&>ds & no?+ 9 ?is section may be con/ru$ to preclude a ,/ate f e/abli%+ additional /&>ds1 s long z su* /&>ds are n inconsi/5t ) ! requirem5ts ( ?is section or o!r applicable law4 7#b7 ,waiv] or modification ,! ,secret>y %all e/abli% a process "u :i* a ,/ate may reque/ a waiv] or modification ( a /&>d e/abli%$ "u ?is section4 #c4 ,cov]age ( crisis response s]vices 7a7 ,cov]age "u ! ,m$ic>e program 7#a7 ,9 g5]al ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$-- 7,a7 9 subp>agraph 7,,gg71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,,hh71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,,ii7 crisis response s]vices z def9$ 9 subsection 7lll72 4 7#b7 ,crisis response s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7lll7 ,crisis response s]vices def9$ 7#a7 ,9 g5]al ,! t]m crisis response s]vices means m5tal or behavioral heal? s]vices t are furni%$ by a mobile crisis response team1 a crisis receiv+ & /abilization facility1 behavioral heal? urg5t c>e facility1 or o!r appropriate provid]1 z det]m9$ by ! ,secret>y1 to an individual exp]i5c+ a m5tal or behavioral heal? crisis4 ,su* t]m includes s]vices id5tifi$ by ! ,secret>y z "p ( ! crisis response cont9uum ( c>e "u section #b ( ! ,behavioral ,heal? ,crisis ,s]vices ,expansion ,act4 7#b7 ,def9itions ,9 ?is subsection1 ! t]ms mobile crisis response team1 crisis receiv+ & /abilization facility1 & behavioral heal? urg5t c>e facility h ! mean+ giv5 ^? t]ms = purposes ( su* section4 4 7#c7 ,paym5t ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is am5d$-- 7,a7 by /rik+ & 7,,dd7 & ins]t+ 7,,dd72 & 7,b7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 & 7,,ee7 ) respect to crisis response s]vices describ$ 9 section #ahfa7s77#b77;,,ii71 ! am\nts paid %all be #hj p]c5t ( ! less] ( ! actual *>ge = ! s]vice or ! fee s*$ule am\nt provid$ "u section #ahdh4 7#d7 ,ambulance transport ( individuals 9 crisis 7,a7 ,9 g5]al ,section #ahcd7l7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7l77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ah7 ,transportation ( individuals 9 crisis ,) respect to ambulance s]vices furni%$ on or aft] ! date t is #c ye>s aft] ! date ( ! enactm5t ( ! ,behavioral ,heal? ,crisis ,s]vices ,expansion ,act1 ! regulations describ$ 9 section #ahfa7s77#g7 %all provide cov]age "u su* section = ambulance s]vices to transport an individual exp]i5c+ a m5tal or behavioral heal? crisis to an appropriate facility1 su* z a community m5tal heal? c5t] 7z def9$ 9 section #ahfa7;ff77#c77;,b77 or o!r facility or provid] id5tifi$ by ! ,secret>y z "p ( ! crisis response cont9uum ( c>e "u section #b ( ! ,behavioral ,heal? ,crisis ,s]vices ,expansion ,act1 z appropriate1 = crisis response s]vices describ$ 9 section #ahfa7s77#b77;,,ii74 4 7,b7 ,con=m+ am5dm5t ,section #ahfa7s77#g7 ( su* ,act 7#db ,u4,s4,c4 #aciex7s77#g77 is am5d$ by /rik+ section #ahcd7l77#ad7 & ins]t+ p>agraphs 7#ad7 & 7#ah7 ( section #ahcd7l74 7#e7 ,effective date ,! am5dm5ts made by ?is subsection %all apply to s]vices furni%$ on or aft] ! date t is #c ye>s aft] ! date ( ! enactm5t ( ?is ,act4 7b7 ,m&atory cov]age ( crisis response s]vices "u ! ,m$icaid program 7#a7 ,9 g5]al ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$-- 7,a7 9 section #aijb7;a77#aj77;,a71 9 ! matt] prec$+ clause 7i71 by /rik+ & 7#cj7 & ins]t+ 7#cj71 & 7#ca72 & 7,b7 9 section #aije-- 7i7 9 subsection 7a7-- 7,i7 9 p>agraph 7#cj71 by /rik+ 2 & & ins]t+ a semicolon2 7,,ii7 by r$esignat+ p>agraph 7#ca7 z p>agraph 7#cb72 & 7,,iii7 by ins]t+ ! foll[+ p>agraph aft] p>agraph 7#cj73 7#ca7 subject to subsection 7jj71 crisis response s]vices 7z def9$ 9 section #ahfa7lll772 & 2 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7jj7 ,exception to requirem5t ,to provide cov]age = crisis response s]vices ,! requirem5t to provide s]vices describ$ 9 p>agraph 7#ca7 ( subsection 7a7 %all n apply ) respect to a ,/ate = a fiscal ye>1 if be=e ! beg9n+ ( su* ye> ! ,/ate c]tifies to ! satisfaction ( ! ,secret>y t implem5t+ su* requirem5t /atewide = all individuals eligible to enroll 9 ! ,/ate plan 7or waiv] ( ! ,/ate plan7 w\ld n be feasible by reason ( a %ortage ( qualifi$ provid]s ( crisis response s]vices1 or facilities provid+ su* treatm5t1 t w contract ) ! ,/ate or a manag$ c>e entity ) :i* ! ,/ate has a contract "u section #aijc7m7 or "u section #aije7t77#c74 4 7#b7 ,presumptive eligibility det]m9ation by crisis response s]vice provid]s ,section #aijb7;a77#dg77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#dg77;,b77 is am5d$ by ins]t+ or provid] ( crisis response s]vices 7z def9$ 9 section #ahfa7lll77 aft] any hospital4 7#c7 ,effective date 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 ! am5dm5ts made by ?is section %all take effect on ! date t is #c ye>s aft] ! date ( ! enactm5t ( ?is ,act4 7,b7 ,delay p]mitt$ if /ate legislation requir$ ,9 ! case ( a ,/ate plan "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5ts impos$ by ! am5dm5ts made by ?is section1 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( ! failure ( ! plan to meet su* additional requirem5ts be=e ! #a/ day ( ! #a/ cal5d> qu>t] beg9n+ aft] ! close ( ! #a/ regul> session ( ! ,/ate legislature t beg9s aft] ! date ( enactm5t ( ?is ,act4 ,= purposes ( ! previ\s s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( su* session %all be deem$ to be a sep>ate regul> session ( ! ,/ate legislature4 7c7 ,ess5tial heal? b5efits ,section #acjb7;b77#a77;,e7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;b77#a77;,e77 is am5d$ by ins]t+ & crisis response s]vices 7z def9$ 9 section #ahfa7lll7 ( ! ,social ,security ,act7 be=e ! p]iod4 7d7 ,gr\p heal? plans ,section #bgjg ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#f7 is am5d$ by add+ at ! end ! foll[+3 7e7 ,crisis response s]vices ,a gr\p heal? plan or a heal? insurance issu] t (f]s heal? insurance cov]age 9 ! l>ge gr\p m>ket %all ensure t su* cov]age includes crisis response s]vices 7z def9$ 9 section #ahfa7lll7 ( ! ,social ,security ,act74 4 7e7 ,,tric>e cov]age 7#a7 ,9 g5]al ,! ,secret>y ( ,def5se %all provide cov]age "u ! ,,tric>e program = crisis response s]vices1 z def9$ 9 section #ahfa7lll7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 7z am5d$ by section #c74 7#b7 ,,tric>e program def9$ ,9 ?is section1 ! t]m ,,tric>e program has ! mean+ giv5 ! t]m 9 section #ajgb ( title #aj1 ,unit$ ,/ates ,code4 7f7 ,reimbursem5t = crisis response s]vices = vet]ans ,section #agbe7;f77#a7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$1 9 ! matt] prec$+ subp>agraph 7,a71 by ins]t+ 1 includ+ crisis response s]vices 7z def9$ 9 subsection 7lll7 ( section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex771 aft] s]vices4 7g7 ,cov]age "u ,,fehb 7#a7 ,9 g5]al ,section #hijb ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 7p7 ,ea* contract = a plan "u ?is *apt] %all require ! c>ri] to provide cov]age = crisis response s]vices1 z t t]m is def9$ 9 subsection 7lll7 ( section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex74 4 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 %all apply beg9n+ ) respect to ! ?ird contract ye> = *apt] #hi ( title #e1 ,unit$ ,/ates ,code1 t beg9s on or aft] ! date t is #c ye>s aft] ! date ( enactm5t ( ?is ,act4 #d4 ,build+ ! crisis cont9uum infra/ructure 7a7 ,additional am\nts = ,m5tal ,heal? ,block grant ,section #aibj ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjx-#i7 is am5d$ by add+ at ! end ! foll[+3 7d7 ,support = crisis response s]vices infra/ructure 7#a7 ,9 g5]al ,9 addition to am\nts made available "u subsection 7a71 !re are au?oriz$ to be appropriat$ su* sums z are necess>y = ea* ( fiscal ye>s #bjbb1 #bjbc1 & #bjbd1 = purposes ( support+ ! infra/ructure ne$$ to provide crisis response s]vices 7z def9$ 9 section #ahfa7lll7 ( ! ,social ,security ,act7 9 ! ,/ates1 :i* may include tra9+ & cont9u+ education1 & adm9i/rative exp5ses ) respect to ! provision ( su* s]vices4 7#b7 ,allotm5ts ,ea* fiscal ye> = :i* am\nts are appropriat$ "u p>agraph 7#a71 ! ,secret>y %all allot to ea* ,/ate t receives a grant "u section #aiaa = ! fiscal ye> an am\nt t be>s ! same relation%ip to ! total am\nt appropriat$ "u p>agraph 7#a7 = ! fiscal ye> t ! am\nt receiv$ by ! ,/ate "u section #aiaa7;a7 = ! fiscal ye> be>s to ! total am\nt appropriat$ "u subsection 7a7 = ! fiscal ye>4 4 7b7 ,te*nical assi/ance ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y7 %all provide to ,/ates te*nical assi/ance reg>d+ ! provision ( crisis response s]vices1 z def9$ 9 section #ahfa7lll7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 7z am5d$ by section #c71 includ+ guidance on h[ ,/ates may bl5d ,m$icaid funds available to ,/ates "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 & funds available to ,/ates "u ! community m5tal heal? s]vices block grant program "u subp>t ,i ( "p ,b ( title ,,xix ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjjx et seq47 & ! sub/ance abuse prev5tion & treatm5t block grant program "u subp>t ,,ii ( "p ,b ( title ,,xix ( su* ,act 7#db ,u4,s4,c4 #cjjx-#ba et seq47 to provide su* s]vices4 7c7 ,cle>+h\se ( be/ practices ,! ,secret>y %all develop & ma9ta9 a publicly available cle>+h\se ( be/ practices = ! successful op]ation ( ea* segm5t ( ! sy/em = provid+ crisis response s]vices 7z def9$ 9 section #ahfa7lll7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 7z am5d$ by section #c77 & ! integration ( su* be/ practices into ! provision ( su* s]vices4 ,! cle>+h\se %all be updat$ annually4 #e4 ,incid5t report+ 7a7 ,e/abli%m5t ( protocol panel ,! ,secret>y ( ,heal? & ,human ,s]vices 7ref]r$ to 9 ?is section z ! ,secret>y71 9 consultation ) ! ,attorney ,g5]al1 %all conv5e a panel = ! purposes ( mak+ recomm5dations = tra9+ & protocol = #iaa dispat*]s to respond appropriately to individuals exp]i5c+ a psy*iatric crisis bas$ on ! *>act]i/ics ( ! incid5t & ! ne$s ( ! call]4 7b7 ,paneli/s ,! ,secret>y %all appo9t individuals to s]ve /agg]$ #aj-ye> t]ms on ! panel e/abli%$ "u subsection 7a74 ,su* individuals %all include-- 7#a7 firefight]s2 7#b7 em]g5cy m$ical s]vices p]sonnel2 7#c7 law en=cem5t (fic]s2 7#d7 #iaa dispat*]s2 7#e7 repres5tatives f ea* segm5t ( ! crisis response cont9uum1 z describ$ 9 section #b1 includ+ #ihh dispat*]s2 7#f7 individuals :o h receiv$ s]vices "u su* crisis response cont9uum1 includ+ individuals "u ! age ( #ah & memb]s ( und]s]v$ communities2 & 7#g7 o!r individuals1 z ! ,secret>y det]m9es appropriate4 7c7 ,recomm5dations 7#a7 ,topics ,9 issu+ recomm5dations "u ?is section1 ! panel %all consid]-- 7,a7 connect+ #iaa call]s to crisis c>e s]vices in/ead ( respond+ ) law en=cem5t (fic]s2 7,b7 integrat+ ! #ihh sy/em into ! #iaa sy/em1 or transf]r+ calls f ! #iaa sy/em to ! #ihh sy/em z appropriate2 & 7,c7 a process = id5tify+ #iaa call]s :o are 9 m5tal heal? di/ress & evaluat+ ! level ( ne$ ( su* call]s1 z def9$ by /&>diz$ assessm5t tools su* z ! ,level ( ,c>e ,utilization ,sy/em 7,,locus7 & ! ,*ild & ,adolesc5t ,level ( ,c>e ,utilization ,sy/em 7,,calocus74 7#b7 ,updates ,! panel %all update recomm5dations issu$ "u ?is section n less frequ5tly ?an e #e ye>s4