Bill Text: NJ A3076 | 2022-2023 | Regular Session | Introduced
Bill Title: "Behavioral Health Crisis Mobile Response Act."
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2022-02-28 - Introduced, Referred to Assembly Human Services Committee [A3076 Detail]
Download: New_Jersey-2022-A3076-Introduced.html
Sponsored by:
Assemblyman RAJ MUKHERJI
District 33 (Hudson)
SYNOPSIS
"Behavioral Health Crisis Mobile Response Act."
CURRENT VERSION OF TEXT
As introduced.
An Act concerning behavioral crisis mobile response and supplementing Titles 26 and 30 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. This act shall be known, and may be cited, as the "Behavioral Health Crisis Mobile Response Act."
2. As used in this act:
"9-8-8 Crisis Hotline Center" or "hotline center" means a State identified and funded center participating in the National Suicide Prevention Lifeline Network to respond to Statewide or regional 9- 8-8 calls.
"9-8-8 Suicide Prevention and Mental Health Crisis Hotline" means the National Suicide Prevention Lifeline (NSPL) or its successor maintained by the Assistant Secretary for Mental Health and Substance Use under section 520E-3 of the federal Public Health Service Act.
"Adult in crisis" means an adult with disabilities who is experiencing a behavioral health crisis.
"Behavioral health crisis" means an emergency or crisis situation in which an adult with a disability experiences mental, emotional, or behavioral health challenges that endanger the health, safety, or wellbeing of the disabled adult, or of other persons interacting with the disabled adult, and which cannot be controlled, or otherwise properly addressed or stabilized by the adult, or by the adult's family members, attendant caregivers, or direct care staff members, without professional assistance.
"Crisis bed" means an available bed in a temporary stabilization unit that is used, when needed, for the temporary placement, not exceeding seven days, and stabilization of an adult in crisis.
"Crisis response" means face-to-face emergency response, which is provided by a mobile crisis response team under this act, with the assistance of a temporary stabilization unit, where needed, and which is available 24 hours a day, 365 days a year, to de-escalate and stabilize any behavioral health crisis being experienced by an adult with disabilities.
"Crisis response services" means services that are provided during the initial crisis response period, either by a mobile crisis response team, or by a temporary stabilization unit, to stabilize the adult in crisis.
"Department" means the Department of Human Services.
"Direct care staff member" means a person 18 years of age or older who is employed by a group home, and who may come into direct contact with group home residents.
"Disability" means an intellectual or developmental disability, or a mental illness.
"Group home" means the same as that term is defined by section 1 of P.L.2017, c.238 (C.30:6D-9.1).
"Home" means a private residence or a community-based residential facility, such as a group home or halfway house, where an adult in crisis is a resident.
"Individualized crisis stabilization plan (ICSP)" means an individualized service plan, developed by a mobile crisis response team for an adult in crisis, which identifies target behaviors to be addressed in, desired outcomes to be attained by, and necessary mental or behavioral health services to be provided to, the adult in crisis, both during the initial crisis response period and, if indicated, during a subsequent stabilization management period lasting up to eight weeks thereafter, as necessary to ensure the stabilization of the adult in crisis and minimize or eliminate the dangers stemming from the crisis.
"Initial 72-hour mobile response period" means the initial period of time, lasting 72 hours, over a four-day span of time, during which a mobile crisis response team is required to provide mobile crisis response services to an adult in crisis, while at the adult's home or at another place where the adult is located, as provided by section 5 of this act.
"Initial 72-hour mobile response period" does not include any time during which the adult in crisis is housed in a temporary stabilization unit.
"Initial crisis response period" means the initial 72-hour mobile response period, and any additional period of time, lasting up to seven days, during which the adult in crisis is housed in a temporary stabilization unit.
"Initial crisis response period" shall include the period of time during which an adult in crisis is being transported by a mobile crisis response unit from the person's home, or other place where the person is located, to a temporary stabilization unit.
"Mental health care professional" means a psychiatrist, professional counselor, practicing psychologist, psychoanalyst, clinical social worker, or psychiatric nurse practitioner licensed pursuant to Title 45 of the Revised Statutes.
"Mobile crisis response agency" means an entity that is approved and authorized, pursuant to subsection a. of section 4 of this act, to provide mobile crisis response services and stabilization 36 management services to adults in crisis.
"Mobile crisis response services" means services, as described in subsection b. of section 5 of this act, which are provided by a mobile crisis response team during the initial 72-hour mobile response period.
"Mobile crisis response team" means a mobile team of mental health care professionals who are qualified to assess and stabilize a behavioral health crisis situation, and address the immediate needs of an adult with disabilities who is in crisis.
"National Suicide Prevention Lifeline" or "NSPL" means a national network of local crisis centers that provide free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.
"Peers" means individuals employed on the basis of their personal experience of mental illness, addiction, or both, and recovery therefrom, and who meet the State's peer certification requirements. "Veterans Crisis Line" or "VCL" means the Veterans Crisis Line maintained by the Secretary of Veterans Affairs pursuant to section 1720F(h) of Title 38 of the United States Code.
"Stabilization," "initial stabilization," or "stabilize" means the initial stabilization of an adult in crisis, which is effectuated by a mobile crisis response team or staff at a temporary stabilization unit during the initial crisis response period, and prior to any stabilization management period, and which effectively calms and stabilizes the behavior of the adult in crisis, and removes the immediate potential for danger arising out of the crisis situation.
"Stabilization management period" means a period of time, lasting no more than eight weeks, and commencing at the end of the initial 72-hour mobile response period, or at the time that the adult is discharged from a temporary stabilization unit, whichever is later, during which the mobile crisis response team provides ongoing stabilization management services to the adult with disabilities in the adult's home.
"Stabilization management services" means the ongoing provision, monitoring, and coordination of, and referral to, services and supports identified in the ICSP, in accordance with section 6 of this act, for up to eight weeks immediately following the completion of the initial crisis response period, as necessary for the mobile crisis response team to ensure the long-term stabilization of the crisis situation.
"Temporary stabilization unit" means a facility, or a part of a facility, which is licensed pursuant to section 9 of this act, and which is authorized to provide a safe, non-clinical, and non-punitive inpatient space to be used to stabilize an adult in crisis, for a period of no more than seven days, in cases where the responding mobile crisis response team has determined that the adult is in need of a crisis bed.
3. a. The Commissioner of Human Services, in consultation with the Commissioner of Health, and the Directors of the Division of Mental Health and Addiction Services, and the Division of Developmental Disabilities in the Department of Human Services, shall establish a Statewide mobile crisis response system, in accordance with the provisions of this section, which shall be designed to provide immediate crisis response services, and ongoing stabilization management services, upon request, to adults with disabilities who are experiencing a behavioral health crisis, and their families and attendant caregivers or other staff.
b. The mobile crisis response system established pursuant to this section shall:
(1) be designed to prevent the hospitalization of adults in crisis, and to provide for the stabilization of adults in crisis in the least restrictive environment;
(2) be implemented on a Statewide basis, with at least one mobile crisis response agency available to provide crisis response services and stabilization management services, and at least one temporary stabilization unit available to provide temporary crisis beds, in each of the Northern, Central, and Southern regions of the State; and
(3) be designed to allow the mobile crisis response system to access to the 9-8-8 suicide prevention and behavioral health crisis hotline designated pursuant to section 11 of this act in order to refer an eligible adult for crisis response services and stabilization management services in accordance with section 5 of this act.
c. An adult with a disability shall be eligible to receive crisis response services and stabilization management services, as provided in this act, if:
(1) the adult is covered under the Medicaid or NJ FamilyCare programs, or the adult is ineligible for coverage under the Medicaid or NJ FamilyCare programs, but is receiving services for a disability from the Division of Developmental Disabilities, or from the Division of Mental Health and Addiction Services, in the department;
(2) in the case of crisis response services, the services are deemed to be necessary, either by the department, or by the mobile crisis response team that is authorized to assess the need for those services; and
(3) in the case of stabilization management services, the services are deemed to be necessary by both the mobile crisis response team and the department, and are approved by the department pursuant to subsection b. of section 6 of this act.
4. a. Any person, group, or entity wishing to provide mobile crisis response services or stabilization management services, pursuant to this act, shall:
(1) submit an application to the Department of Human Services, and be approved and contracted by the department as a mobile response agency; and
(2) submit an application to, and be approved by, the New Jersey Medicaid and NJ FamilyCare fee-for-service program as a mobile response agency.
b. Each mobile crisis response agency approved pursuant to this section shall employ one or more mobile crisis response teams to:
(1) provide mobile crisis response services in the home of a person in crisis, or at another community location where a person in crisis is located, as described in section 5 of this act;
(2) when deemed to be appropriate, transport the adult in crisis to a temporary stabilization unit established and licensed pursuant to section 9 of this act; and
(3) provide ongoing stabilization management services to the adult in crisis, in the adult's home, when authorized to do so pursuant to section 6 of this act.
c. Mobile crisis response services and stabilization management services, which are provided by a mobile crisis response team under this act, shall be delivered directly by, or under the supervision of, a licensed psychiatrist who, at a minimum, has three and a half years of applicable clinical and supervisory experience, and has the authority to directly provide, or to supervise the provision of, these services within the scope of the psychiatrist's authorized practice, as defined by law. Any other staff member on a mobile crisis response team shall have, at a minimum, a master's degree in behavioral health or a related human services field, such as social work, counseling, or psychology; or shall have a bachelor's degree in a behavioral health or a related human services field, and a minimum of one year of related field work experience.
d. Any person seeking to deliver crisis response services or stabilization management services, pursuant to this act, as a member of a mobile crisis response team, or as a staff member at a temporary stabilization unit, shall be deemed to be a "community agency employee," as defined by section 1 of P.L.1999, c.358 (C.30:6D-63), and shall be required to comply with the criminal history record background check requirements established by P.L.1999, c.358 (C.30:6D-63 et seq.) as a condition of the person's employment with the mobile crisis response agency or temporary stabilization unit.
5. a. Mobile crisis response services under this act shall be provided by a mobile crisis response team to an eligible adult in crisis for a period of up to 72 hours per episode, over the course of up to a four-day period, immediately following the initial referral or dispatch, and shall be designed to stabilize the presenting behaviors and crisis situation, with the goal of preventing a disruption of the current living arrangement, and avoiding inappropriate psychiatric hospitalization or residential placement, of the adult in crisis. Each referral to, or dispatch of, a mobile crisis response team shall be registered with the department within 24 hours after the team receives notice thereof.
b. Mobile crisis response services provided by a mobile crisis response team shall include, but need not be limited to:
(1) mobile outreach and face-to-face contact with the adult in crisis, which face-to-face contact shall occur within 24 hours following the initial referral or dispatch, except in situations requiring an immediate response, in which case, face-to-face contact shall occur within one hour after the initial referral or dispatch, unless a delay is requested by the family of the adult in crisis, in order to meet the family's needs;
(2) the immediate assessment and evaluation of the presenting crisis, which shall include an assessment of the safety of, or danger to, the adult in crisis, other residents of the home, and members of the community, as well as an assessment of caregiver culpability and clinical and environmental factors that contributed to the crisis;
(3) the immediate use of clinical and therapeutic interventions to stabilize the presenting crisis;
(4) the development of an individualized crisis stabilization plan, as provided by subsection d. of this section; and
(5) the provision of relevant information, crisis training, and program and service referrals to the family members or caregivers of the adult in crisis.
c. (1) If, at any time during the initial 72-hour mobile response period, the mobile crisis response team determines that the presenting crisis can only be stabilized through the temporary placement of the adult in a temporary stabilization unit, the crisis response team shall transport the adult in crisis to a temporary stabilization unit, and the adult shall be admitted to the unit, for a period not exceeding seven days, as necessary to facilitate the initial stabilization of the crisis.
(2) Whenever an adult is placed in a crisis bed in a temporary stabilization unit pursuant to this subsection, the need for such placement shall be reviewed and documented by the mobile crisis response team on a daily basis during such placement, and the adult shall be immediately discharged from such placement upon a determination by the team that continued placement is no longer necessary.
d. The individualized crisis stabilization plan developed under paragraph (4) of subsection b. of this section shall be prepared after the mobile crisis response team has made initial face-to-face contact with the adult in crisis and the family members or caregivers thereof, and shall be registered with the department within 24 hours after such contact. At a minimum, the ICSP shall:
(1) identify the mental health diagnoses of the adult in crisis;
(2) identify the environmental, situational, mental, physical, and other factors that contributed to the presenting crisis;
(3) identify appropriate clinical and therapeutic interventions to be used in addressing and stabilizing the presenting crisis;
(4) include a plan to ensure the stabilization of the adult in crisis in the least restrictive environment, which plan shall: (a) provide for the adult in crisis to remain in the home, if the initial stabilization of the crisis can be effectuated in the home within the initial 72-hour mobile response period; (b) provide for the adult in crisis to be transported, and temporarily admitted to, a temporary stabilization unit, at any time during the initial 72-hour mobile response period, and for a period of not more than seven days, if the team determines, at any time, that initial stabilization of the crisis cannot be achieved while at the home; (c) provide for the immediate discharge of the adult from a temporary stabilization unit to their home following a determination by the team, under paragraph (2) of subsection c. of this section, that such placement is no longer necessary; and (d) provide for the at-home provision of ongoing stabilization management services, as deemed by the mobile crisis response team to be appropriate, and as approved by the department pursuant to subsection b. of section 6 of this act, for a period of up to eight weeks following initial stabilization;
(5) a description of services that will be provided to the adult in crisis, and the adult's family and attendant caregivers and staff, during the stabilization management period, in cases where the ongoing provision of stabilization management services is deemed by the team to be appropriate and is approved by the department pursuant to subsection b. of section 6 of this act; and
(6) a transition plan that links the adult in crisis to clinical and therapeutic mental and behavioral health services, formal and informal community supports, and appropriate system partners that can be used as resources following the completion of the stabilization management period.
6. a. If a crisis is not sufficiently stabilized during the initial 72-hour mobile response period, or during a related stay at a temporary stabilization unit, the mobile crisis response team shall provide the adult in crisis with ongoing stabilization management services, in the home, for a period of up to eight weeks following the completion of the initial crisis response period, as provided in this section.
b. Stabilization management services shall not be provided under this section, unless the mobile crisis response team obtains prior approval from the department authorizing the provision of such services to the adult in crisis. The department may authorize the mobile crisis response team to provide stabilization management services for a period of up to eight weeks, as deemed by the department to be appropriate.
c. During the stabilization management period, a designated representative of the mobile crisis response team shall, on at least a weekly basis, review the ICSP, in order to ensure that the services included therein are effectively addressing the presenting crisis and any factors that contributed to the crisis. Any necessary amendments to the ICSP shall be registered with the department within 24 hours after each review is concluded pursuant to this subsection.
d. The following stabilization management services may be provided during the stabilization management period:
(1) necessary mental or behavioral health intervention services to maintain the stabilization of the crisis and minimize or eliminate the factors that contributed to the crisis, including, but not limited to, psychiatric or psychological services, medication management services, community-based mental health rehabilitation services, such as behavioral assistance services and intensive in-community services, and any other formal or informal community-based mental health or behavioral health rehabilitation services; and
(2) continued advocacy, networking, and support by the mobile crisis response team, as may be necessary to provide linkages and referrals to appropriate community-based services, and to assist the adult in crisis, and the family members or caregivers thereof, in accessing other benefits or assistance programs for which they may be eligible.
7. a. (1) Reimbursement for services provided during the initial crisis response period shall be paid on a fee-for-service basis, and shall cover the costs of all the services provided during this time period, including the costs of services provided by the mobile crisis response team during the initial 72-hour mobile response period, and the costs of services provided by a temporary stabilization unit during any temporary placement therein. Reimbursement for services provided by a temporary stabilization unit shall be paid directly to the temporary stabilization unit, and reimbursement for other services provided during the initial 72-hour mobile response period shall be paid to the mobile crisis response team that provided the services.
(2) Reimbursement for stabilization management services, which are provided for a period of up to eight weeks following the initial crisis response period, shall be paid on a fee-for-service basis, but shall cover only the mobile crisis response team's monitoring and management of the ICSP. Each unit of service shall be for 15 minutes of continuous services provided directly to, or on behalf of, the adult in crisis, including collateral contacts and activities that are necessary to develop, implement, coordinate, monitor, and support the ICSP. A provider may bill for a maximum of 64 units (16 hours) over the eight-week maximum stabilization management period, as authorized by the department. Each provider shall bill only for the amount of time actually provided for stabilization management on each date of service.
(3) Reimbursement for services rendered by an individual Medicaid or NJ FamilyCare provider, in accordance with an ICSP developed under this act, shall be paid in accordance with the provider-specific rules relative to the respective type of provider, including, but not limited to, provider qualification, prior authorization, and service delivery requirements.
b. (1) If an adult in crisis is not provided with ongoing stabilization management services in response to a crisis episode, and the mobile crisis response team, within three days after the termination of the initial crisis response period, receives another referral or dispatch request for another crisis episode involving the same adult, the mobile crisis response team shall provide mobile crisis response services to the adult in crisis without additional reimbursement.
(2) If an adult in crisis is provided with stabilization management services, and the mobile crisis response team, following the completion of the stabilization management period, receives a subsequent referral or dispatch request for another crisis episode involving the same adult, the mobile crisis response team shall initiate a new course of treatment, beginning with an initial 72-hour mobile crisis response period, and shall be reimbursed accordingly.
8. a. Each mobile crisis response agency shall maintain an individual service record for each adult served thereby.
b. Each individual service record shall contain, at a minimum, the following information:
(1) the name and address of the adult in crisis who has received services from the mobile crisis response agency;
(2) the mental health diagnosis of the adult in crisis;
(3) the ISCP developed by the mobile crisis response team for each separate crisis episode involving the same adult, and all approved amendments to each such ISCP;
(4) weekly quantifiable progress notes toward the defined goals stipulated in each ISCP;
(5) documentation of any and all crisis or emergency situations that have occurred during the provision of stabilization management services to the adult, including a summary of the corrective action that was taken to resolve each such situation;
(6) the total number of care hours, across episodes, that the adult in crisis has received from the mobile crisis response agency; and
(7) for each distinct crisis episode: (a) the date on which the initial 72-hour mobile response period was commenced, and the date and time on which initial face-to-face contact actually occurred; (b) the exact dates and times when, and locations where, mobile crisis response services and stabilization management services, if any, were provided to the adult in crisis; (c) the stated reason for the team's involvement; (d) the total amount of face-to-face contact engaged in, and the type of services provided, during the initial 72-hour mobile response period; (e) whether the adult in crisis was temporarily placed in a crisis stabilization unit, and the length of the person's stay in such unit; (f) whether the adult in crisis was approved for ongoing stabilization management services following the initial crisis response period; and (g) the types of stabilization management services, if any, that were provided to the adult in crisis, and the manner in which such services were consistent with, and supportive of, the goals specified in the ICSP.
9. a. Within 180 days after the effective date of this act, the Commissioner of Health shall provide for the establishment and licensure of a sufficient number of temporary stabilization units throughout the State to handle the behavioral health crisis needs of adults with disabilities, as provided by this act. At a minimum, at least one temporary stabilization unit shall be licensed to operate in each of the northern, central and southern regions of the State. No person shall operate a temporary stabilization unit, unless the person has applied for, and has obtained, a license pursuant to this section.
b. A temporary stabilization unit approved and licensed pursuant to this section shall:
(1) provide a calming, non-clinical, and non-punitive environment for the stabilization of adults in crisis;
(2) be staffed by properly credentialed mental health professionals who are capable of, and have expertise in, calming and stabilizing crisis situations in adults with disabilities;
(3) have a sufficient number of crisis beds to meet the behavioral health crisis needs of citizens in the region in which the unit is situated; and
(4) be situated separately and apart from any other clinical or mental health care unit or facility. If the temporary stabilization unit is a part of a separately licensed health care facility or hospital, the temporary stabilization unit shall be unconnected to, and shall be located separately from, any emergency department or other department or unit of medicine, and shall utilize an entrance that is separate from the entrance that is used by patients of, and visitors to, such other departments or units.
c. On at least a biennial basis, the Commissioner of Health shall perform an on-site inspection of each temporary stabilization unit licensed pursuant to this section, in order to ensure that each such unit is complying with the provisions of this section and all other applicable laws or regulations.
d. If the commissioner finds, based on a facility inspection or other information, that a temporary stabilization unit is violating the provisions of this section or any other applicable laws or regulations, the commissioner shall undertake appropriate disciplinary action, including, but not limited to, ordering the temporary stabilization unit to undertake corrective action, imposing an appropriate administrative penalty, or suspending or revoking the unit's license.
10. a. The Commissioner of Human Services shall require all direct care staff members providing services at a group home for individuals with intellectual or developmental disabilities to successfully complete a course of training on:
(1) the de-escalation and stabilization of crisis episodes in adults with disabilities;
(2) behavioral analysis and management; and
(3) behavioral health crisis recognition and identification.
b. The training provided under this section shall also inform direct care staff members of the provisions of this act and the procedures that may be used under this act to obtain assistance from a mobile crisis response team whenever a group home resident is experiencing a behavioral health crisis.
11. The Commissioner of Human Services shall, on or before July 16, 2022, designate a crisis hotline center or centers to receive crisis calls by individuals accessing the 9-8-8 suicide prevention and behavioral health crisis hotline from anywhere within the State 24 hours a day, seven days a week.
a. A designated hotline center shall have an active agreement with the administrator of the National Suicide Prevention Lifeline for participation within the network.
b. A designated hotline center shall meet NSPL requirements and best practices guidelines for operational and clinical standards.
c. To ensure cohesive and coordinated crisis care, a designated hotline center shall utilize technology that is interoperable between and across crisis and emergency response systems used throughout the State and with the Administrator of the National Suicide Prevention Lifeline.
d. A designated hotline center shall have the authority to deploy crisis and outgoing services, including mobile crisis teams, and coordinate access to crisis receiving and stabilization services as appropriate and according to guidelines and best practices established by the NSPL.
e. A designated hotline center shall be utilized by the mobile crisis response system to refer an eligible adult for mobile crisis response services and stabilization management services pursuant to section 5 of this act.
f. A designated hotline center shall coordinate access to crisis response services and stabilization management services for individuals accessing the 9-8-8 suicide prevention and behavioral health crisis hotline through appropriate information sharing regarding availability of services.
g. The Commissioner of Human Services shall have primary oversight of suicide prevention and crisis service activities and essential coordination with a designated 9-8-8 hotline center, and shall work in concert with NSPL and VCL networks for the purposes of ensuring consistency of public messaging about 9-8-8 services.
h. A designated hotline center 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 outside the NSPL network and for providing linguistically and culturally competent care.
i. A designated hotline center shall 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.
j. An annual report of the 9-8-8 suicide prevention and behavioral health crisis hotline's usage and services provided shall be transmitted to the Legislature and the Substance Abuse and Mental Health Services Administration.
12. The Commissioner of Human Services shall provide onsite response services for crisis calls utilizing State or local mobile crisis teams.
a. A mobile crisis team shall include a behavioral health team, licensed behavioral health professionals, and peers, or a behavioral health team and peers embedded within an emergency medical services entity.
b. A mobile crisis team shall collaborate on data and crisis response protocols with local law enforcement agencies and include police as co-responders in behavioral health teams, and licensed behavioral health professionals and peers, only as needed to respond to high-risk situations that are unmanageable without law enforcement.
c. A mobile crisis team shall be designed in partnership with community members, including people with experience utilizing crisis services.
13. Crisis receiving and stabilization services as related to crisis calls shall be funded by the Commissioner of Human Services with available funds if the individual that is the subject of the crisis call lacks health insurance or if the crisis stabilization service is not a covered service under the individual's health coverage, as determined by the commissioner.
14. The Commissioner of Human Services shall establish and maintain a 9-8-8 trust fund 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 and the Federal Communication Commission's rules adopted July 16, 2020, and national guidelines for crisis care.
a. The fund shall consist of:
(1) monies from a Statewide 9-8-8 fee assessed on users pursuant to section 8 of this act;
(2) appropriations, if any;
(3) grants and gifts intended for deposit in the fund;
(4) interest, premiums, gains, or other earnings on the fund; and
(5) any other monies that are deposited in or transferred to the fund.
b. Monies in the fund:
(1) do not revert at the end of any fiscal year and remain available for the purposes of the fund in subsequent fiscal years;
(2) are 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 15 of this act; and
(3) are continuously dedicated for the purposes of the fund.
c. An annual report of fund deposits and expenditures shall be to the transmitted to the Legislature and the Federal Communications Commission.
15. The Commissioner of Human Services, consistent with the National Suicide Hotline Designation Act of 2020, shall establish a monthly Statewide 9-8-8 fee on each resident that is a subscriber of commercial mobile services or IP-enabled voice services at a fixed rate that provides for the 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 federal guidelines for crisis services. The 9-8-8 fee shall not be applied to mobile service users who receive benefits under the federal Lifeline program as defined in 47 CFR 54.401.
a. Revenue generated by the 9-8-8 fee shall be expended only in support of 9-8-8 services or enhancements of such services.
b. The revenue generated by a 9-8-8 fee shall only be used to offset costs that are reasonably attributed to:
(1) ensuring efficient and effective routing of calls made to the 9-8-8 suicide prevention and behavioral health crisis hotline to a designated hotline center, including staffing and technological infrastructure enhancements necessary to achieve operational and clinical standards and best practices set forth by NSPL;
(2) personnel; 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; and
(3) administration, oversight, and evaluation of the fund.
16. The Commissioner of Human Services shall implement the provisions of this act in a manner that is consistent with timeframes required by the National Suicide Hotline Designation Act of 2020 and the Federal Communication Commission's rules adopted on July 16, 2020.
17. a. The Commissioners of Health and Human Services shall each adopt rules and regulations, in accordance with each agency's respective jurisdiction, and pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as may be necessary to implement the provisions of this act.
b. Departments within the executive branch shall promulgate rules and regulations in accordance with the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), as are necessary 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.
18. This act shall take effect on the first day of the sixth month next following the date of enactment, except that the Commissioner of Human Services and the Commissioner of Health may each take anticipatory administrative action, in advance of the effective date, as may be necessary to implement the provisions of this act.
STATEMENT
This bill, to be known as the "Behavioral Health Crisis Mobile Response Act," requires the Commissioner of Human Services (the commissioner), in consultation with the Commissioner of Health, and the Directors of the Division of Mental Health and Addiction Services, and the Division of Developmental Disabilities in the Department of Human Services (DHS), to establish a Statewide mobile crisis response system to provide immediate crisis response services, and ongoing stabilization management services, upon request, to adults with disabilities (i.e., with intellectual or developmental disabilities, or mental illness) who are experiencing a behavioral health crisis, and their families and attendant caregivers or other staff.
The mobile crisis response system would be designed to prevent the hospitalization of adults in crisis to provide for the stabilization of adults in crisis in the least restrictive environment, and to allow the mobile crisis response system to access to the 9-8-8 suicide prevention and behavioral health crisis hotline in order to refer an eligible adult for crisis response services and stabilization management services in accordance with the provisions of the bill.
The system would be implemented on a Statewide basis, with at least one mobile crisis response agency available to provide crisis response services and stabilization management services, and at least one temporary stabilization unit available to provide temporary crisis beds, in each of the northern, central, and southern regions of the State.
Any person, group, or entity wishing to provide initial crisis response services or stabilization management services, pursuant to this bill's provisions, would need to be approved by the New Jersey Medicaid and FamilyCare programs, and by the DHS, as a mobile response agency. Each mobile crisis response agency approved under the bill would be required to employ one or more mobile crisis response teams, composed of mental health professionals, to:
1) provide mobile crisis response services in the home of a person in crisis, or at another community location where a person in crisis is located; 2) when deemed to be appropriate, transport the adult in crisis to a temporary stabilization unit established and licensed pursuant to the bill; and 3) provide ongoing stabilization management services to the adult in crisis, in the adult's home, when authorized to do so by the DHS.
Mobile crisis response services and stabilization management services, which are provided by a mobile crisis response team under this bill's provisions, are to be delivered directly by, or under the supervision of, a licensed and experienced psychiatrist.
Mobile crisis response services are to be provided to an eligible adult in crisis for a period of up to 72 hours per crisis episode, over the course of up to a four-day period, immediately following the initial referral or dispatch, and are to be designed to stabilize the presenting behaviors and crisis situation, with the goal of preventing a disruption of the current living arrangement, and avoiding inappropriate psychiatric hospitalization or residential placement, of the adult in crisis. Each referral to, or dispatch of, a mobile crisis response team will be registered with the DHS within 24 hours after the team receives notice thereof.
Mobile crisis response services provided by a mobile crisis response team are to include, but need not be limited to: 1) mobile outreach and face-to-face contact with the adult in crisis, which face-to-face contact is to occur within 24 hours following the initial referral or dispatch, except in situations requiring an immediate response, in which case, face-to-face contact is to occur within one hour after the initial referral or dispatch, unless a delay is requested by the family of the adult in crisis, in order to meet the family's needs; 2) the immediate assessment and evaluation of the presenting crisis, including an assessment of the safety of, or danger to, the adult in crisis, other residents of the home, and members of the community, as well as an assessment of caregiver culpability and clinical and environmental factors that contributed to the crisis; 3) the immediate use of clinical and therapeutic interventions to stabilize the presenting crisis; 4) the development of an individualized crisis stabilization plan (ICSP), as provided by the bill, which plan is to include, among other things, an indication of appropriate clinical and therapeutic interventions to be used in addressing and stabilizing the presenting crisis; and a plan to ensure the stabilization and treatment of the adult in crisis in the least restrictive environment; and 5) the provision of relevant information, crisis training, and program and service referrals to the family members or caregivers of the adult in crisis.
If, at any time during the initial 72-hour mobile response period, the mobile crisis response team determines that the presenting crisis can only be stabilized through the temporary placement of the adult in a temporary stabilization unit, the crisis response team will be required to transport the adult in crisis to a temporary stabilization unit, and the adult will be admitted to the unit, for a period not exceeding seven days, as necessary to facilitate the initial stabilization of the crisis. A temporary stabilization unit is to be approved and licensed by the Department of Health, and is to: 1) provide a calming, non-clinical, and non-punitive environment for the stabilization of adults in crisis; 2) be staffed by properly credentialed mental health professionals who are capable of, and have expertise in, calming and stabilizing crisis situations in adults with disabilities; 3) have a sufficient number of crisis beds to meet the behavioral health crisis needs of citizens in the region in which the unit is situated; and 4) be situated separately and apart from any other clinical or mental health care unit or facility. If the temporary stabilization unit is a part of a separately licensed health care facility or hospital, the temporary stabilization unit is to be unconnected to, and located separately from, any emergency department or other department or unit of medicine, and is to utilize an entrance that is separate from the entrance that is used by patients of, and visitors to, such other departments or units.
Whenever an adult is placed in a crisis bed in a temporary stabilization unit, the need for such placement is to be reviewed and documented by the mobile crisis response team on a daily basis during such placement, and the adult is to be immediately discharged from such placement upon a determination by the team that continued placement is no longer necessary.
If a crisis is not sufficiently stabilized during the initial 72-hour mobile response period, or during a related stay at a temporary stabilization unit, the mobile crisis response team will be required to provide the adult in crisis with ongoing stabilization management services, in the adult's home, following the completion of the initial crisis response period. Stabilization management services may not be provided, unless the DHS grants prior approval authorizing the provision of such services to the adult in crisis. The DHS may authorize the mobile crisis response team to provide stabilization management services for a period of up to eight weeks, as deemed by the department to be appropriate.
Stabilization management services may include: 1) necessary mental or behavioral health intervention services to maintain the stabilization of the crisis and minimize or eliminate the factors that contributed to the crisis, including, but not limited to, psychiatric or psychological services, medication management services, community-based mental health rehabilitation services, such as behavioral assistance services and intensive in-community services, and any other formal or informal community-based mental health or behavioral health rehabilitation services; and 2) continued advocacy, networking, and support by the mobile crisis response team, as may be necessary to provide linkages and referrals to appropriate community-based services, and to assist the adult in crisis, and the family members or caregivers thereof, in accessing other benefits or assistance programs for which they may be eligible.
During the stabilization management period, the mobile crisis response team will be required to review the ICSP on a weekly basis, in order to ensure that the services included therein are effectively addressing the presenting crisis and any factors that contributed to the crisis. Any necessary amendments to the ICSP are to be registered with the division within 24 hours after each review is concluded.
Each mobile crisis response agency will be required, under the bill, to maintain an individual service record for each adult who is served thereby.
Each mobile crisis response agency and temporary stabilization unit will be eligible for reimbursement, as described in the bill, for the services provided thereby under the bill's provisions.
Any person seeking to deliver crisis response services or stabilization management services as a member of a mobile crisis response team, or as a staff member at a temporary stabilization unit, will be required to comply with the criminal history record background check requirements established by P.L.1999, c.358 (C.30:6D-63 et seq.), which are applicable to "community agency employees," as a condition of the person's employment.
The bill also requires all direct care staff members providing services at group homes for individuals with intellectual or developmental disabilities to successfully complete a course of training on: 1) the de-escalation and stabilization of crisis episodes in adults with disabilities; 2) behavioral analysis and management; and 3) behavioral health crisis recognition and identification. The training would also be required to inform direct care staff members of the mobile crisis response system established under the bill, and the procedures that may be used to obtain assistance from a mobile crisis response team whenever a group home resident is experiencing a behavioral health crisis.
The bill also requires the commissioner to, on or before July 16, 2022, 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 anywhere within the State 24 hours a day, seven days a week. A designated hotline center is to have an active agreement with the administrator of the National Suicide Prevention Lifeline (NSPL) for participation within the network. To ensure cohesive and coordinated crisis care, a designated hotline center is to utilize technology that is interoperable between and across crisis and emergency response systems used throughout the State and with the Administrator of the National Suicide Prevention Lifeline.
The bill provides that a designated hotline center is to have the authority to deploy crisis and outgoing services, including mobile crisis teams, and coordinate access to crisis receiving and stabilization services as appropriate and according to guidelines and best practices established by the NSPL. A designated hotline center is to 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. A designated hotline center is to be utilized by the mobile crisis response system to refer an eligible adult for mobile crisis response services and stabilization management services pursuant to the bill.
The commissioner is to have primary oversight of suicide prevention and crisis service activities and essential coordination with a designated 9-8-8 hotline center. A designated hotline center is to 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 outside the NSPL network and for providing linguistically and culturally competent care. A designated hotline center is to 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.
Under the bill, the commissioner is to provide onsite response services for crisis calls utilizing State or local mobile crisis teams. A mobile crisis team is to include a behavioral health team, licensed behavioral health professionals, and peers, or a behavioral health team and peers embedded within an emergency medical services entity. A mobile crisis team is to collaborate on data and crisis response protocols with local law enforcement agencies and include police as co-responders in behavioral health teams, and licensed behavioral health professionals and peers, only as needed to respond to high-risk situations that are unmanageable without law enforcement. A mobile crisis team is to be designed in partnership with community members, including people with experience utilizing crisis services.
The commissioner is to establish and maintain a 9-8-8 trust fund 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 and the Federal Communication Commission's rules adopted July 16, 2020, and national guidelines for crisis care. The fund is to consist of: monies from a Statewide 9-8-8 fee assessed on users pursuant to the bill's provisions; appropriations, if any; grants and gifts intended for deposit in the fund; interest, premiums, gains, or other earnings on the fund; and any other monies that are deposited in or transferred to the fund.
Under the bill, monies in the fund: do not revert at the end of any fiscal year and remain available for the purposes of the fund in subsequent fiscal years; are 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 the bill; and are continuously dedicated for the purposes of the fund.
The bill provides that the commissioner, consistent with the National Suicide Hotline Designation Act of 2020, is to establish a monthly Statewide 9-8-8 fee on each resident that is a subscriber of commercial mobile services or IP-enabled voice services at a fixed rate that provides for the 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 federal guidelines for crisis services.
Under the bill, the 9-8-8 fee is not to be applied to mobile service users who receive benefits under the federal Lifeline program as defined in 47 CFR 54.401.
