Revision: Jan. 9, 2023, 9:54 a.m.
2023 SESSION
23-0996.0
07/04
SENATE BILL [bill number]
SPONSORS: [sponsors]
COMMITTEE: [committee]
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ANALYSIS
This bill:
I. Defines behavioral health crisis services within the mental health treatment laws.
II. Establishes criteria for, and makes an appropriation for, crisis stabilization facilities.
III. Creates a commission on behavioral health crisis services.
IV. Mandates insurance coverage of emergency mental health services for persons 21 years of age and younger within this state.
V. Makes an appropriation for the complete development of a behavioral health crisis services system to the department of health and human services.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-0996.0
07/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Declaration of Purpose. The general court hereby finds that:
I. In October 2020, the President signed the National Suicide Hotline Designation Act (Public Law No: 116-172), making the 988 line the universal telephone number for the national suicide prevention and mental health crisis hotline system. The National Suicide Hotline Designation Act also expanded the scope of the Lifeline to include mental health crises. The best practice guideline for creating a comprehensive system of care for behavioral health crisis services, as established by SAMSA, includes three pillars: regional crisis call centers, mobile crisis teams, and crisis receiving and stabilization programs. Implementation of 988 and associated call centers provide critical real-time coordination of crisis services and community support for those in a behavioral health crisis. Mobile crisis teams offer community-based interventions, including triage, assessment, and de-escalation, to individuals in need wherever they are, and are more effective and more cost-effective than hospitalization. Crisis receiving and stabilization services offer communities a no-wrong-door access to mental health and substance use care and can replace hospitalization in a high proportion of cases that may otherwise require it. These types of crisis stabilization services have been shown to reduce the need for hospitalization, and therefore reduce costs associated with behavioral health crises. The 988 line was nationally implemented on July 16, 2022, as required by the National Suicide Hotline Designation Act of 2020, including in New Hampshire. New Hampshire seeks to continue to develop and maintain access to a system of care that is interconnected, effective, and just.
II. The general court finds that New Hampshire recognizes the imperative to fully support mental health treatment for our children through the development of a comprehensive system of care. The New Hampshire 10-year mental health plan and the passage in 2019 of SB 14 have laid the foundation for this level of support. With COVID-19, improving access to mental health care has developed into a crisis, with children in psychiatric distress boarding in our emergency rooms in record numbers for days or weeks. The general court recognizes that appropriate rapid assessment, intervention, and in-home and community-based treatment may well avoid the need for presentation to the emergency room in the first place or preclude the need for transfer from an emergency room to an inpatient psychiatric facility. This evidence-based, best practice intervention has also been demonstrated in national studies to be ultimately cost saving and achieve better outcomes for children and families. For this small number of New Hampshire children in mental health crisis, these services are currently covered by Medicaid but not by the commercial carriers. This act continues the state’s commitment to addressing the mental health needs of children by requiring commercial carriers to cover the initial assessment and intervention without prior authorization, recognizing that these steps are critical to preventing and addressing psychiatric distress in children. This act also delays any prior authorization requirements on longer term treatment such as residential or intensive home-based treatment for 72 hours to allow for immediate home and community-based intervention.
III. Therefore, it is in the best interest of all New Hampshire citizens to create a comprehensive, sustainable behavioral health crisis stabilization system by:
(a) Adopting and developing the 3 pillars of the national guideline for behavioral health crisis service model in a sustainable manner, which includes:
(1) A regional, clinically staffed crisis call center that provides crisis intervention capabilities via telephone, online chat, and text message, available at all times;
(2) Mobile crisis teams available to reach any person in the service area in his or her home, workplace, or any other community-based location of the individual in crisis in a timely manner; and
(3) Crisis stabilization facilities that provide short-term observation and crisis stabilization services to all referrals in a home-like, non-hospital environment.
(b) Creating a commission to develop and maintain the 3 pillars of the national guideline for behavioral health crisis services model in New Hampshire.
(c) Ensuring that behavioral health crisis services for persons 21 years of age and younger are available and covered by all insurance carriers.
2 New Paragraph; New Hampshire Mental Health System; Definitions. Amend RSA 135-C:2 by inserting after paragraph II-b the following new paragraph:
II-c. "Behavioral health crisis services" means the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs of those with a mental health or substance use disorder crisis that are wellness, resiliency, and recovery oriented. These include, but are not limited to, crisis intervention, including counseling provided by centers participating in the National Suicide Prevention Lifeline network, mobile crisis teams, and crisis receiving and stabilization services.
3 New Subdivision; Behavioral Health Crisis Services. Amend RSA 135-C by inserting after section 67 the following new subdivision:
Behavioral Health Crisis Services
135-C:68 Crisis Stabilization Facilities.
I. Crisis receiving and stabilization facilities shall:
(a) Accept all referrals;
(b) Not require medical clearance prior to admission but rather assessment and support for medical stability while in the program;
(c) Design their services to address mental health and substance use crisis issues;
(d) Employ the capacity to assess physical health needs and deliver care for most minor physical health challenges with an identified pathway in order to transfer the individual to more medically staffed services if needed;
(e) Be staffed at all times (24/7/365) with a multidisciplinary team capable of meeting the needs of individuals experiencing all levels of crisis in the community, including:
(1) Psychiatrists or psychiatric nurse practitioners (telehealth may be used);
(2) Nurses;
(3) Licensed and/or credentialed clinicians capable of completing assessments in the region; and
(4) Peers with lived experience similar to the experience of the population served.
(f) Offer walk-in and first responder drop-off options;
(g) Screen for suicide risk and complete comprehensive suicide risk assessments and planning when clinically indicated; and
(h) Screen for violence risk and complete more comprehensive violence risk assessments and planning when clinically indicated.
II. Any person who enters a crisis receiving and stabilization facility for treatment shall be treated and referred to community-based care as soon as the person has been stabilized and it is clinically appropriate, but in any event, no longer than 14 days after arrival at the facility. If community-based care is not clinically appropriate after 14 days at the crisis receiving and stabilization facility, the facility shall refer the person receiving treatment to an appropriate facility to receive further treatment.
135-C:69 Commission on Behavioral Health Crisis Services Established.
I. There is established a commission on behavioral health crisis services.
(a) The commission’s duties shall include, but not be limited to:
(1) Identifying and recommending means to create sustainable financing for delivery of behavioral health crisis services.
(2) Conducting a review and evaluation of the accessibility of behavioral health crisis services for all Granite Staters, and identifying and recommending solutions to any barriers to accessibility of behavioral health crisis services.
(3) Identifying and recommending solutions for any gaps in New Hampshire’s ability to deliver behavioral health crisis services.
(4) Identifying and recommending strategies to increase the behavioral health crisis workforce, including but not limited to, the use of Bachelor’s level clinicians on mobile crisis teams.
(5) Evaluating and recommending improvements for linking behavioral health crisis service providers to one another to better facilitate warm-handoffs of clients between behavioral health crisis service providers at the different levels of care.
(6) Reviewing the relation to, integration with, and impact on providers, managing entities, communities, state agencies, and systems which provide mental health and substance abuse services in this state.
(7) Recommending best use of any funds granted to the department of health and human services for the purpose of improving the behavioral health crisis system.
(8) Reviewing any other matter the commission deems relevant to its objective.
(b) The members of the commission shall be as follows:
(1) Five members of the house of representatives, appointed by the speaker of the house of representatives.
(2) Five members of the senate, appointed by the president of the senate.
(3) The commissioner of the department of health and human services, or designee.
(4) The commissioner of the department of safety, or designee.
(5) The director of the division of state police, or designee.
(6) One representative from the New Hampshire Council for Suicide Prevention, appointed by the council chairperson.
(7) One representative from the National Alliance on Mental Illness of New Hampshire, appointed by that organization.
(8) One representative of the New Hampshire Disability Rights Center, appointed by the center.
(9) One representative of the Bi-State Primary Care Association, appointed by the association.
(10) One representative of the Endowment for Health, appointed by the endowment.
(11) One representative of the New Hampshire Community Behavioral Health Association, appointed by the association.
(12) One representative of the New Hampshire Hospital Association, appointed by the association.
(13) One representative of New Futures, appointed by the organization.
(14) One representative of the care management entities of New Hampshire.
(15) Two public members, at least one of whom shall have lived-experience with behavioral health crisis services.
(c) All appointing authorities shall coordinate their appointments so that diversity of gender, race, sexual and gender orientation, and geographical areas is reflective of the makeup of this state.
(d) Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission.
(e) The commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named senate member. The first meeting of the commission shall be held within 45 days of the effective date of this section. Ten members of the commission shall constitute a quorum.
(f) The commission shall report its findings and any recommendations for proposed legislation to the speaker of the house of representatives, the president of the senate, the house clerk, the senate clerk, the governor, and the state library on or before November 1, 2023.
4 New Section; Coverage for Emergency Services; Emergency Mental Health Services for Persons 21 Years of Age and Younger. Amend RSA 417-F by inserting after section 4 the following new section:
417-F:5 Emergency Mental Health Services for Persons 21 Years of Age and Younger.
I. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for expenses arising from the use of emergency services by a person 21 years of age or under suffering a mental health crisis. For purposes of this section, "emergency services" shall include:
(a) Behavioral health or mental health crisis assessments, including both in person and tele health services.
(b) Behavioral health crisis intervention, including mobile or stationary crisis services.
(c) Behavioral health crisis stabilization services.
(d) Behavioral health intensive in home services.
(e) Behavioral health residential treatment services.
II. No prior authorization shall be required for subparagraphs I(a), I(b), or I(c).
III. A prior authorization of up to 72 hours may be required for subparagraphs I(d) and I(e).
5 Appropriation; Creation of Regional Crisis Receiving and Stabilization Facilities. The sum of $1 for the fiscal year ending June 30, 2025 is hereby appropriated to the department of health and human services to establish 10 regional crisis receiving and stabilization facilities, in regions corresponding with the community mental health centers, that provide short-term observation and crisis stabilization services to all referrals in a home-like, non-hospital environment. Of this amount, the governor shall determine if any remaining discretionary funds appropriated in the American Rescue Plan Act of 2021, Public Law 117-2 or any other federal funds can be used for this purpose and any remainder shall be general funds. The governor is authorized to draw a warrant for the general fund share of said sum out of any money in the treasury not otherwise appropriated.
6 Appropriation; Behavioral Health Crisis Services System. The sum of $1 for the fiscal year ending June 30, 2025 is hereby appropriated to the department of health and human services to establish and complete development of any underdeveloped elements to a successful behavioral health crisis services system. Of this amount, the governor shall determine if any remaining discretionary funds appropriated in the American Rescue Plan Act of 2021, Public Law 117-2 or any other federal funds can be used for this purpose and any remainder shall be general funds. The governor is authorized to draw a warrant for the general fund share of said sum out of any money in the treasury not otherwise appropriated.
7 Effective Date. This act shall take effect upon its passage.