Article
6.1. Miles Hall Lifeline and Suicide Prevention Act
53123.
This article is known and may be cited as the “Miles Hall Lifeline Act”. and Suicide Prevention Act.”53123.1.
(a) “988” means the three-digit phone number designated by the Federal Communications Commission for the purpose of connecting individuals experiencing a mental health crisis with suicide prevention and mental health crisis counselors, mobile crisis support teams, and crisis receiving and stabilization services and other mental health crisis services through the National Suicide Prevention Lifeline Network.(b) “988 Crisis Hotline Center” means a county or contractor operated center participating in the National Suicide Prevention Lifeline Network to respond to statewide or regional 988 calls.
(c) “Mental health crisis services” means the continuum of services to address crisis intervention, crisis stabilization, and crisis residential treatment needs that are wellness, resiliency, and recovery oriented. Mental health crisis services include, but are not limited to:
(1) Crisis intervention, including counseling provided by 988 crisis hotline centers.
(2) Jurisdiction-based mental health teams, known as mobile crisis support teams, that include licensed mental health professionals and peer support specialists, as defined in subdivision (g) of Section 14045.12 of the Welfare and Institution Code, and may include medical and health professionals. Mobile crisis support teams provide onsite interventions including deescalation, stabilization, and
referrals to mental health and other social services to individuals who are experiencing a mental health crisis.
(A) “Mental health professional” means any of the following:
(i) A licensed clinical social worker, pursuant to Chapter 14 (commencing with Section 4991) of Division 2 of the Business and Professions Code.
(ii) A licensed professional clinical counselor, pursuant to Chapter 16 (commencing with Section 4999.10) of Division 2 of the Business and Professions Code.
(iii) A licensed marriage and family therapist, pursuant to Chapter 13 (commencing with Section 4980) of Division 2 of the Business and Professions Code.
(iv) A licensed psychologist, pursuant to Chapter 6.6 (commencing with Section 2900) of Division 2 of the Business and Professions Code.
(v) A licensed physician under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code who is either a board certified psychiatrist or has completed a residency in psychiatry.
(B) (i) Mobile crisis support teams may include mental health teams embedded in Emergency Medical Services.
(ii) Mobile crisis support teams may include specialized teams that can provide coordinated care for individuals experiencing chronic homelessness.
(3) Crisis receiving and stabilization services
that are facilities with capacity for diagnosis, initial management, observation, crisis stabilization, and follow up followup referral services and include, but are not limited to:
(i) Short-term residential facilities that provide care under 24 hours.
(ii) Crisis residential treatment.
(iii) Peer respite services.
(iv) Services related to involuntary commitments under the Lanterman-Petris-Short Act, Part
Act (Part 1 (commencing with Section 5000) of Division 5 of
the Welfare and Institution Code. Institutions Code).
(d) “National Suicide Prevention Lifeline” means the national network of local crisis hotline centers that provide free and confidential emergency support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week via a toll-free hotline number, which receives calls made through the 988 system. The toll-free 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 Unites States Code (42 U.S.C. 290bb–36c).
Sec. 290bb-36c).
(e) “Office” means the Office of Emergency Services.
(f) “Substance Abuse and Mental Health Services Administration” means that agency of the United States Department of Health and Human Services.
(g) “Veterans Crisis Line” means the hotline which provides crisis intervention to veterans and that is maintained by the Secretary of Veterans Affairs under Section 1720F(h) of Title 38 of the United States Code (38 U.S.C. Sec. 1720F(h)).
53123.2.
(a) The office shall implement, oversee, and enforce the provisions of this article.(b) (1) The office shall appoint a 988 crisis hotline system director to provide direction and oversight of the implementation and administration of the 988 crisis hotline and the mental health crisis services that work in conjunction with the crisis hotline centers.
(2) The director shall have experience in all of the following:
(A) Emergency crisis response and emergency crisis lines.
(B) Suicide
prevention and mental health crisis services.
(C) Implementation of mental health crisis services, including coordination of county and state mental health administrative service organizations for the provision of mental health and substance use disorder services.
(c) The office shall do all of the following:
(1) Designate a 988 crisis hotline center or centers to provide crisis intervention services and crisis care coordination to individuals accessing the 988. The office shall designate at least one 988 crisis hotline center prior to July 16, 2022.
(2) Ensure coordination between the 988 crisis hotline centers, 911, mental health crisis services, and, when
appropriate, other speciality mental health warm lines and hotlines.
(3) Establish training guidelines for employees involved in the implementation of 988 including 988 crisis hotline center staff, 911 operators, emergency medical services, law enforcement, and firefighters. Training guidelines shall be written consistent with Section 53123.5.
(4) Establish standards for mental health crisis services accessible through the 988 system.
(5) Seek to maximize all available federal funding sources, including federal medicaid reimbursement, for the purposes of 988 implementation, including the funding of mental health crisis services, in consultation with the State Department of Health Care Services.
(d) (1) To meet its obligations under subdivision (c), the office shall adopt regulations by January 1, 2023, which shall be regularly reviewed and updated.
(2) The office shall hold quarterly stakeholder convenings to provide input and guidance during, and following, the adoption of regulations. The convenings shall include representatives from all of the following:
(A) Mental health consumers who are receiving or have received mental health services.
(B) Parents, spouses, siblings, or adult children of mental health consumers.
(C) Disability rights advocates.
(D) County behavioral health departments.
(E) California Indian tribes, as defined in subdivision (c) of Section 8012 of the Health and Safety Code.
(F) Mental health and suicide hotline centers.
(G) Hospitals.
(H) Law enforcement.
(I) Emergency responders.
(J) Suicide prevention lines.
(K) State Department of Health Care Services.
(L) Department of
Insurance.
(M) Department of Managed Health Care.
(N) State Department of Social Services.
(O) Mental Health Services Oversight and Accountability Commission.
(P) Office of Suicide Prevention, if established.
(3) Beginning on January 1, 2023, and no later than January 1, 2024, 988 crisis hotline centers, counties, and other relevant entities shall become fully compliant with the regulations adopted under this section, unless otherwise provided by the office.
(4) The office may adopt emergency regulations implementing this act by July 16,
2022. The office may readopt any emergency regulation authorized by this section that is the same as or substantially equivalent to an emergency regulation previously adopted under this section.
(e) The office shall maintain and evaluate data on the usage of, services provided for, and outcomes from the 988 system.
(f) The office shall work with the National Suicide Prevention Lifeline, Veterans Crisis Line, and the Substance Abuse and Mental Health Services Administration for the purposes of implementing 988 and ensuring consistency of public messaging about 988 services. The office shall also seek to maximize efficiency and access to crisis hotlines beyond those previously provided.
(g) Beginning January 1, 2025, and
annually thereafter, the office shall prepare a report and deliver it to the Legislature, the Substance Abuse and Mental Health Services Administration, and the Federal Communications Commission, including information on the all of the following:
(1) Data gathered pursuant to subdivision (e).
(2) Revenue generated by the 988 surcharge as reported by the California Department of Tax and Fee Administration pursuant to Section 41135 of the Revenue and Taxation Code.
(3) Deposits made to and expenditures from the 988 Mental Health and Crisis Services
Special Fund as reported by the State Treasurer per subdivision (e) of the Section 53123.6.
(4) State of county mental health crisis services, how funds from the 988 Mental Health and Crisis Services Special Fund are being used to support these services, and how additional funds would be used to improve, create, or expand access to mental health crisis services pursuant to paragraph (1) of subdivision (d) of Section 53123.6.
(h) The report to be submitted to the Legislature pursuant to subdivision (f) shall be submitted in compliance with Section 9795.
53123.3.
(a) 988 crisis hotline centers shall be designated by the office as provided in paragraph (1) of subdivision (b) of Section 53123.2 to operate within California.(b) Each 988 crisis hotline center shall do all of the following:
(1) Maintain an active agreement with the administrator of the National Suicide Prevention Lifeline for participation within the network.
(2) Meet federal Substance Abuse and Mental Health Services Administration requirements and national best practice 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.
(3) Utilize technology that is interoperable between and across crisis and emergency response systems used throughout the state including to 911, emergency services, and other nonmental health crisis services. Technology shall include the capability for all the following:
(A) Interoperability of phone calls, texts, chats, and other similar capabilities consistent with the county’s implementation of Next Generation 911 pursuant to Section 53121.
(B) Assigning and tracking local response to mental health crisis calls, including the capacity to rapidly deploy mobile crisis support teams through global
positioning technology.
(C) Tracking and providing
real-time bed and service availability to crisis responders and individuals in crisis for all mental health bed types, such as crisis stabilization, psychiatric inpatient, substance use disorder inpatient treatment, withdrawal management, and peer crisis respite, including voluntary and involuntary beds.
(4) Maintain information sharing agreements with entities that operate 911 call centers for the purpose of real-time care coordination including deployment of mobile crisis support teams and other mental health crisis services.
(5) Deploy mental health crisis services, including mobile crisis support teams, and coordinate access to crisis receiving and stabilization services.
(A) Any call made to 911 pertaining to a mental health crisis shall be transferred to a 988 crisis hotline center. If a law enforcement, medical, or fire response is also needed, 988 and 911 operators shall coordinate the simultaneous deployment of those services with mobile crisis support teams.
(B) Law enforcement shall not be contacted or deployed in partnership with a mobile crisis support team unless there is an explicit threat to public safety and the situation cannot be reasonably managed without law enforcement assistance.
(6) Provide follow-up services to individuals accessing 988 consistent with guidance and policies established by the National Suicide Prevention Lifeline and within the timeframes established by
all plan letters pursuant to Section 1374.73 of the Health and Safety Code.
(7) Employ or contract to provide a sufficient number of qualified bilingual persons or interpreters to ensure provision of information and services in the language of the
non-English-speaking person.
(8) Provide data, and reports, and participate in evaluations and related quality improvement activities as required by the office.
(c) To the extent the National Suicide Prevention Lifeline admits new crisis centers to the network, counties and independent crisis hotline centers shall seek to certify, license, and accredit any existing county operated, county contracted, or independently operated mental health access or suicide prevention lines by July 16, 2022.
(d) Crisis hotline centers shall, beginning January 1, 2023, and no later than January 1, 2024, unless otherwise provided by the office, become fully compliant with any regulations issued by the office under
subparagraphs (1) and (3) of subdivision (d) of Section 53123.2.
(e) All crisis hotline centers shall provide care consistent with Section 53123.6.
53123.4.
(a) Counties shall seek to offer a full continuum of use funds made available through the 988 State Mental Health and Crisis Services Special Fund to expand access to mental health crisis services, to the extent resources are available. This continuum shall include services funded by Section 5848.5 of the Welfare and Institutions Code and additional grants, including grants awarded by the Mental Health Services Oversight and Accountability Commission, for the purpose of establishing a mental health crisis response system.
as defined in Section 53123.1, and consistent with Section 53123.5.(1) Counties shall seek to maximize existing funding sources to maintain mental health crisis services.
(2) Counties may form a joint powers authority, pursuant to Chapter 5 (commencing with Section 6500) of Division 7 of Title 1, for the purposes of expanding access to mental health crisis services and reducing associated costs.
(b) Counties shall work with their crisis care providers to bill the appropriate health care service plan or disability insurer for all medically necessary treatment of a mental health or substance use
disorder provided to privately-insured privately insured individuals through the 988 system. “Medically necessary treatment of a mental health or substance use disorder” shall have the same meaning as Section 10144.5 of the Insurance Code. Health care service plans and disability insurers shall reimburse for such medically necessary treatment within 30 calendar days. Counties shall report to the Department of Managed Health Care and Care, the Department of Insurance
Insurance, and the State Department of Health Care Services any health care services plans or disability insurers that fail to reimburse services provided through the 988 system for possible enforcement actions.
(c) County operated mental health crisis services, including mobile crisis support teams and crisis receiving and stabilization services, shall be made available to 988 callers and counties shall coordinate with 988 crisis hotline centers on the deployment of, and access to, these services.
(1) Counties shall consult with California Indian tribes, as defined in subdivision (c) of Section 8012 of the Health and Safety Code, to ensure mental health crisis services support the unique needs of, and are accessible to, the tribes. This may include
regional coordination with tribal governments and capacity building efforts.
(d) County operated mental health crisis services shall provide care consistent with Section 53123.5.
53123.5.
(a) All elements of the 988 system shall be designed to meet the unique needs of California’s diverse communities.(b) In compliance with Section 1810.410 of Title 9 of the California Code of Regulations and in accordance with the National Culturally and Linguistically Appropriate Services Standards established by the United States Department of Health and Human Services, crisis hotline centers and mental health crisis services shall do all of the following:
(1) Ensure equitable access to services regardless of an individual’s race, ethnicity, gender, socioeconomic status, sexual orientation, gender
identity or expression, or geographic location.
(2) Meet the unique needs of specific populations, including all of the following:
(A) Populations at greater risk of suicide as identified by the Substance Abuse and Mental Health Services Administration.
(B) Individuals experiencing homelessness, housing instability, or who are at risk of experiencing homelessness in the future.
(C) Children and youth.
(D) Older adults.
(E) Individuals with disabilities.
(F) Black, African American,
Hispanic, Latino, Asian, Pacific Islander, Native American, Native Hawaiian, Alaska Native, and other underserved communities, and the diverse communities and backgrounds within these categories.
(G) Lesbian, gay, bisexual, transgender, nonbinary, queer, and questioning individuals.
(H) Immigrants and refugees.
(I) Non-English speakers.
(J) Low-income persons.
(K) Religious communities.
(c) The Office of Health Equity within the State Department of Public Health shall provide technical assistance to the office, counties, contracted
crisis hotline centers, and other contracted entities seeking to obtain funds for initiatives in multicultural health, including identification of funding sources and assistance with writing grants in compliance with paragraph (9) of subdivision (a) of Section 152 of the Health and Safety Code.
53123.6.
(a) The 988 State Mental Health and Crisis Services Special Fund is hereby established in the State Treasury.(b) The fund shall consist of all of the following:
(1) Revenue generated by the 988 surcharge assessed on users under Section 41020 of the Revenue and Taxation Code.
(2) Appropriations made by the Legislature.
(3) Grants and gifts intended for deposit in the fund.
(4) Interest, premiums, gains, or other earnings on the
fund.
(5) Money from any other source that is deposited in or transferred to the fund.
(c) Notwithstanding Section 11754 of the Health and Safety Code, federal funds payable directly to the state by the Substance Abuse and Mental Health Services Administration to implement 988 may be made directly to the fund.
(d) Money in the fund is subject to all of the following:
(1) Money shall not revert at the end of any fiscal year and shall remain available for the purposes of the fund in subsequent state fiscal years.
(2) Money 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.
(3) Money shall be continuously appropriated for the purposes of the fund. in the fund shall be available, upon appropriation by the Legislature, for the purposes specified in this article.
(e)(1)Counties shall use any funds remitted to them to fund their 988 crisis hotline centers. Any surplus may be used to fund mental health crisis services including, but not limited to, mobile crisis support teams and crisis receiving and stabilization services.
(e) (1) All revenue generated by the 988 surcharge assessed on users under Section 41020 of the Revenue and Taxation Code shall only be expended on purposes authorized by the National Suicide Hotline Designation Act of Section 251a(a)(2) of Title 47 of the United States Code (47 U.S.C. 251a(a)(2)).
(2) The revenue generated by the 988 surcharge shall be prioritized to fund the following, in order of priority:
(A) 988 crisis hotline centers, including the efficient and effective routing of calls, personnel, and the provision of acute mental health services through call, text, and chat to the 988 number.
(B) The operation of mobile crisis support teams.
(C) All other
eligible expenses under the federal act.
(2)
(3) The office may adopt regulations regarding the process for counties to receive funds.
(3)Beginning on December 31, 2022 and annually thereafter, counties shall report to the office on the state of their mental health crisis services, how they are funding these services, and how any additional remittance from the 988 State Mental Health and Crisis Services Special Fund will be used to improve, create, and expand access to mental
health crisis services.
(4) The office shall require an entity seeking funds available through the 988 State Mental Health and Crisis Services Special Fund to annually file an expenditure and outcomes report with information including, but not limited to, the following, as applicable to each modality, including call center, mobile crisis services, and crisis receiving and stabilization services:
(A) The total budget, by fund source.
(B) Number and job classification of personnel allocated to each modality.
(C) The number of individuals
served.
(D) The outcomes for individuals served.
(E) The health coverage status of individuals served, if known.
(F) The amount billed to and reimbursed by Medi-Cal or other public and private health care service plans or insurers.
(G) Measures of system performance, including capacity, wait time, and the ability to meet demand for services.
(f) The State Treasurer shall report annually to the office on fund deposits and expenditures.