Article
6.3. Miles Hall Lifeline and Suicide Prevention Act
53123.1.
This article shall be known, and may be cited, as the “Miles Hall Lifeline and Suicide Prevention Act.”53123.1.5.
For purposes of this article, the following definitions shall apply:(a) “988” means the three-digit telephone number designated by the Federal Communications Commission for the purpose of connecting individuals experiencing a behavioral health crisis with counselors trained in suicide prevention and
behavioral health crisis and with the capacity to connect callers to behavioral health crisis services through the National Suicide Prevention Lifeline network.
(b) “988 center” means a
center operating on a county or regional basis in California and participating in the National Suicide Prevention Lifeline network to respond to statewide or regional 988 calls.
(c) “Agency” means the California Health and Human Services Agency.
(d) “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 988 centers, mobile crisis teams, and crisis receiving and stabilization services.
(e) “National Suicide Prevention Lifeline” or “988 Suicide and Crisis Lifeline” means the national network of local crisis hotline centers that provide free and confidential support to people in suicidal crisis or
other behavioral health crisis
24 hours per day, seven days per week via a toll-free telephone hotline number that receives calls made through the 988 system. The toll-free telephone number is maintained by the Assistant Secretary for Mental Health and Substance Use under Section 520E-3 of the Public Health Service Act, Section 290bb-36c of Title 42 of the United States Code.
(f) “Office” means the Office of Emergency Services.
(g) “Substance Abuse and Mental Health Services Administration” means that agency of the United States Department
of Health and Human Services.
53123.2.
(a) No later than July 16, 2022, the Office of Emergency Services shall verify that technology that allows for transfers between 988 centers, as well as between 988 centers and 911 public safety answering points, is available to 988 centers and 911 public safety answering points throughout California.(b) No later than 90 days after the passage of this act, the office shall do both of the following:
(1) Appoint a 988 system director to implement and oversee the policy and regulatory framework for the technology infrastructure, coordination, and transfer of calls between 988, 911, and behavioral health crisis services.
(2) (A) Establish and convene the State
988 Technical Advisory Board for purposes of advising the office on the following:
(i) Recommendations on the feasibility and plan for sustainable interoperability between 988, 911, and behavioral health crisis services, including the identification of any legal or regulatory barriers to the transfer of 911 calls.
(ii) The development of technical and operational standards for the
988 system that allow for
coordination with California’s 911 system.
(iii) The creation of standards and protocols for when 988 centers will transfer
988 calls into the “911” public safety answering points or points (PSAP), and vice versa.
(B) The board shall meet no less than quarterly until December 31, 2028. Following that date, the board may be disbanded at the discretion of the office.
(C) The board shall consist of a representative from the California Health and Human Services Agency and expert representatives, including, but not limited to, those from 988 centers, 911, and behavioral health crisis service providers.
(c) No later than July 1, 2024, the
office shall
verify interoperability between and across 911 and 988. This shall include verifying interoperability of telephone calls, texts, chats, and other similar capabilities consistent with the implementation of Next Generation 911.
(d) The office shall consult
with the National Suicide Prevention Lifeline and the Substance Abuse and Mental Health Services Administration on any technology requirements for 988 centers.
53123.3.
(a) (1) No later than December 31, 2023, the California Health and Human Services Agency shall
create a set of recommendations to support a five-year implementation plan for a comprehensive 988 system.(2) The California Health and Human Services Agency shall convene a state 988 advisory group for purposes of advising the California Health and Human Services Agency on the set of recommendations to support the five-year implementation plan. The recommendations shall specify what can be accomplished pursuant to existing administrative authority and what will require additional regulations or legislation for implementation.
(3) The advisory group shall include, but is not limited to, the State Department of Health Care Services, the Office of Emergency Services, the State Department of Public Health, representatives of counties, representatives of
employees working for county behavioral health agencies and agencies who subcontract with county behavioral health agencies who provide these services, health plans, emergency medical services, law enforcement, consumers, families, peers, and other local and statewide public agencies.
(4) The advisory group shall meet at least once per quarter until December 31, 2023.
(5) The advisory group may be disbanded at the discretion of the California Health and Human Services Agency, but shall not be disbanded before January 1, 2024.
(b) The California Health and Human Services Agency and the advisory group shall make recommendations on all of the following:
(1) Federal
Substance Abuse and Mental Health Services Administration requirements and national best practices guidelines for operational and clinical standards, including training requirements and policies for transferring callers to an appropriate specialized center, or subnetworks, within or external to, the National Suicide Prevention Lifeline network.
(2) Maintenance of an active agreement with the administrator of the National Suicide Prevention Lifeline for participation within the network.
(3) Compliance
with state technology requirements or guidelines for the operation of 988.
(4) A state governance structure to support the implementation and administration of behavioral health crisis services accessed through 988.
(5) 988 infrastructure, staffing, and training standards that will support statewide access to crisis counselors through telephone call,
text, and chat, 24 hours per day, seven days per week.
(6) Access to crisis receiving and stabilization services and triage and response to warm handoffs from 911 and 988 call centers.
(7) Resources and policy changes to address statewide and regional needs in order to meet population needs for behavioral health crisis services.
(8) Statewide and regional public communications strategies informed by the National Suicide Prevention Lifeline and the Substance Abuse and Mental Health Services Administration to support public awareness and consistent messaging regarding 988 and behavioral health crisis
services.
(9) Recommendations to achieve statewide provision of mobile crisis team services that meet all of the following criteria:
(A) Are offered 24 hours per day, seven days per week.
(B) Can respond to individuals in crisis in a timely manner.
(C) Are able to respond to clearly articulated suicidal or behavioral health contacts made or routed to 988 as an alternative law enforcement, except in as needed high-risk situations that
cannot be managed without law enforcement.
(10) Quantifiable goals for the provision of statewide and regional behavioral health crisis services, which consider factors such as reported rates of suicide attempts and deaths.
(11) A process for establishing outcome measures, benchmarks, and improvement targets for 988 centers and the behavioral health crisis services system.
(12) Findings from a comprehensive assessment of the behavioral health crisis services system that takes into account infrastructure projects that are planned and funded. These findings shall include an inventory of the infrastructure, capacity, and needs for all of the following:
(A) Statewide and regional 988 centers.
(B) Mobile crisis team services, including mobile crisis access and dispatch call centers.
(C) Other existing behavioral health crisis services and warm lines.
(D) Crisis receiving and stabilization services.
(13) Procedures for determining the annual operating budget for the purposes of establishing the rate of the 988 surcharge and how revenue will be dispersed to fund the 988 system consistent with Section
53123.4 and Section 251a of Title 47 of the United States Code.
(14) Strategies to support the behavioral health crisis
service system is adequately funded, including mechanisms for reimbursement of behavioral health crisis response pursuant to Sections 1374.72 and 1374.721 of the Health and Safety Code, including, but not limited to:
(A) To the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized, seeking
to maximize all available federal funding sources for the purposes of behavioral health crisis services and administrative activities related to 988 implementation, including federal Medicaid reimbursement for services; federal Medicaid reimbursement for administrative expenses, including the development and maintenance of information technology; and federal
grants.
(B) Coordinating with the Department of Insurance and Department of Managed Health Care to verify reimbursement to 988 centers for medically necessary
behavioral health
crisis services by health care service plans and disability insurers, pursuant to Section 1374.72 of the Health and Safety Code and Section 10144.5 of the Insurance Code and consistent with the requirements of the federal Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. Sec. 1185a).
(c) Commencing December 31, 2024, and until December 31, 2029, the California Health and Human Services Agency shall report annually, on or before December 31 and in compliance with Section 9795, to the Legislature on the status of 988 implementation in California, including any actions taken in that calendar year, planned
actions for the future calendar year, barriers to implementation, need for additional funding, and any legislative action required to support implementation.
53123.4.
(a) The 988 State Suicide and Behavioral Health Crisis Services Fund is hereby established in the State Treasury.(b) (1) The fund shall consist of the revenue generated by the 988 surcharge assessed on users under Section 41020 of the Revenue and Taxation Code, which revenue shall be used solely for the operations of the 988 center and mobile crisis teams, as defined in the American Rescue Plan Act of 2021 (Section 1947(b)(2) of Public Law 117-2). The fund shall also consist of any other appropriations made to it by the Legislature.
(2) The revenue generated by the 988 surcharge shall be prioritized to fund the following:
(A) First, the 988 centers, including the efficient and effective routing of telephone calls, personnel, and the provision of acute mental health services through telephone call, text, and chat to the 988 number.
(B) Second, the operation of mobile crisis teams accessed via telephone calls, texts, or chats made to or routed through 988, as specified under Section 4(a)(2)(B) of Public Law 116-172.
(3) Money in the fund shall not be subject to transfer to any other fund or to transfer, assignment, or reassignment for any other use or purpose outside of those specified in this article.
(4) 988 surcharge revenue in the fund shall be
available, upon appropriation by the Legislature, for the purposes specified in this article.
(5) The revenue generated by the 988 surcharge shall be used to supplement and not supplant federal, state, and local funding for 988 centers and mobile crisis services.
(6) The revenue generated by the 988 surcharge may only be used to fund service and operation expenses that are not reimbursable through Medicaid federal financial participation, Medicare, health care service plans, or disability insurers.
(c) The Office of Emergency
Services, in consultation with the State Department of Health Care Services, may adopt regulations regarding how funds received shall be disseminated to support the operations of the 988 system and related behavioral health crisis services.
(d) The office shall require an entity seeking funds available through the 988
Suicide and Behavioral Health Crisis Services Fund to annually file an expenditure and outcomes report in a form and manner as determined by the office and the State Department of Health Care Services. The expenditure and outcomes report shall include, but is not limited to, the following:
(1) The total
budget.
(2) Number and job classification of personnel.
(3) The number of individuals served.
(4) The outcomes for individuals served, if known.
(5) The health coverage status of individuals served, if known.
(6) The amount billed to and reimbursed by Medi-Cal or other public and private health care service plans or insurers.
(7) Measures of system performance, including capacity, wait time, and the ability to meet demand for services.
(e) The State Treasurer shall report annually to the office on fund deposits and expenditures.
53123.5.
The office and the State Department of Health Care Services may implement, interpret, or make specific this article, in whole or in part, by means of all-county letters, plan letters, provider bulletins, information notices, regulations, or other similar instructions, without complying with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2.