Article
6.1. Miles Hall Lifeline and Suicide Prevention Act
53123.
This article is known and may be cited as the “Miles Hall Lifeline 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 teams, and crisis receiving and stabilization services and other behavioral health crisis services through the National Suicide Prevention Lifeline Network.(b) “988 Center” means a county or county contractor operated center, operating on a county or regional basis and participating in the National Suicide Prevention Lifeline Network to respond to statewide or regional 988 calls.
(c) “988 Local Planning Council” means the
regional or county advisory body of designated stakeholders as defined in section 53123.6 working on a county or regional basis to plan, coordinate, and oversee the dispatch or deployment of county behavioral health crisis services and crisis receiving and stabilization services accessible through 988.
(d) “Agency” shall mean the California Health and Human Services Agency.
(e) “Behavioral 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. These include, but are not limited to, crisis intervention, including counseling provided by 988 centers, mobile crisis teams, and crisis receiving and stabilization services.
(f) “Mobile crisis team” means a jurisdiction-based
behavioral health team, as defined in the American Rescue Plan Act of 2021 (Section 1947(b)(2) of Public Law 117-2). Mobile crisis teams provide onsite interventions including de-escalation, stabilization, and referrals to behavioral health and other social services to individuals who are experiencing a behavioral health crisis. mobile crisis teams may include:
(1) Teams that include both medical professionals and a team of behavioral health professionals that are embedded in emergency medical services.
(2) Specialized teams that can provide coordinated care for individuals experiencing chronic homelessness.
(g) “Coresponder teams” means a jurisdiction-based behavioral health team in which a trained mental health professional and law enforcement officer jointly respond to a suicidal or mental health crisis.
Coresponder mobile crisis teams shall include at least one mental health professional and officers shall dress in plain clothes and travel in unmarked vehicles.
(h) “Crisis receiving and stabilization services” means facilities with capacity for diagnosis, initial management, observation, crisis stabilization, and followup referral services. They include crisis stabilization units, sobering centers, crisis residential treatment, peer respite services, and services related to involuntary commitments under the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code).
(i) “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 United States Code (42 U.S.C. Sec. 290bb-36c).
(j) “Office” shall mean the Office of Emergency Services.
(k) “Substance Abuse and Mental Health Services Administration” means that agency of the United States Department of Health and Human Services.
(l) “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) By January 1, 2027, 988 centers shall provide a person experiencing a behavioral health crisis access to a trained counselor to address their immediate needs 24 hours a day, seven days a week via call, text, and chat. Beginning July 16, 2022, these services shall be provided by call.(b) By January 1, 2027, 988 centers shall coordinate with the relevant program or programs, as determined by the 988 Local Planning Council, for the deployment of mental health crisis services, including mobile crisis teams, and coordinate access to crisis receiving and stabilization services, as follows:
(1) Mobile crisis teams shall respond to any individual in need of immediate suicidal
or behavioral health crisis intervention in a timely manner in all jurisdictions 24 hours a day, seven days a week.
(2) (A) Any call made to 911 pertaining to a clearly articulated suicidal or behavioral health crisis shall be transferred to a 988 center unless both of the following conditions are met in which case 988 and 911 operators shall coordinate the simultaneous deployment of law enforcement, medical, or fire with mobile crisis teams:
(i) Based on the information provided and known facts available at the time of a call, a 911 operator has reason to believe there is a medical emergency, someone is in immediate danger, other than the suicidal person, the person is threatening others’ personal safety, or there are reported conditions where law enforcement is mandated to investigate a potential crime, or crimes, by federal or state statute.
(ii) The situation cannot be reasonably managed without law enforcement, medical, or fire assistance.
(B) Law enforcement, medical, or fire may only be deployed independently if the simultaneous deployment of a mobile crisis team would delay a timely response that a reasonable person would believe will lead to personal injury or death.
(i) In the event that a law enforcement response is authorized under subparagraph (A), any available coresponder team shall respond or law enforcement shall be deployed simultaneously with a mobile crisis team. If a coresponder team or a mobile crisis team deployed with law enforcement is present, mental health professionals shall have primary jurisdiction over the situation.
(ii) Only in the event that no coresponder team
is available and the simultaneous deployment of a mobile crisis team would delay a timely response that a reasonable person would believe will lead to personal injury or death may uniformed law enforcement officers respond independently.
(iii) If law enforcement other than a coresponder team responds independently to a suicidal or behavioral health crisis and it is determined that none of the conditions in subparagraph (A) are met, law enforcement shall request the response of a mobile crisis team.
(c) The 988 centers shall 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.
53123.3.
The Office of Emergency Services, the California Health and Human Services Agency, the 988 Local Planning Council, and all other entities responsible for implementing the 988 system shall ensure the system is designed and implemented to ensure equitable access to services regardless of an individual’s race, ethnicity, gender, socioeconomic status, sexual orientation, gender identity or expression, disability status, or geographic location. This shall include meeting 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) Black, Hispanic, Latino, Asian,
Pacific Islander, Native American, Native Hawaiian, Alaska Native, and other underserved communities, and the diverse communities and backgrounds within these categories.
(c) Individuals experiencing homelessness, housing instability, or who are at risk of experiencing homelessness in the future.
(d) Children and youth.
(e) Older adults.
(f) Individuals with disabilities.
(g) Lesbian, gay, bisexual, transgender, nonbinary, queer, and questioning individuals.
(h) Immigrants and refugees.
(i) Individuals who are limited-English proficient.
(j) Low-income persons.
(k) Religious communities.
(l) Individuals who are incarcerated or those who have been incarcerated.
(m) Veterans.
53123.4.
(a) The Office of Emergency Services shall implement, oversee, and enforce the provisions of this act related to emergency communications system components and operations of the 988 system. Duties shall include all of the following:(1) Adopting regulations for the purposes of implementing this act, which shall be regularly reviewed and updated.
(2) Developing technology that does both of the following:
(A) Is interoperable between and across crisis and emergency response systems used throughout the state, including 911, emergency services, behavioral health crisis services, and other nonbehavioral health
crisis services. This shall include ensuring 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) Tracks 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.
(3) Establishing training guidelines, in collaboration with the California Health and Human Services Agency, for employees involved in the implementation of 988 including 988 center staff, 911 operators, emergency medical services, law enforcement, and firefighters. Training guidelines shall be written consistent with Section 53123.3.
(b) The
office, in partnership with the agency, shall hold quarterly stakeholder convenings until December 31, 2026, to provide input and guidance during, and following, the adoption of regulations. Beginning January 1, 2027, the office shall hold biannual stakeholder convenings. The convenings shall include, but not be limited to, representatives from all of the following:
(1) Organizations representing behavioral health consumers and peers who are receiving or have received mental health services and their relatives.
(2) Behavioral health and disability rights advocates.
(3) Local governments, including county behavioral health departments and California Indian tribes as defined in subdivision (c) of Section 8012 of the Health and Safety Code.
(4) Mental
health and suicide hotline centers.
(5) First responders, including law enforcement, emergency medical services, fire, and 911 operators.
(c) 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.
(d) No later than January 1, 2022, the office shall do all of the following:
(1) Appoint a 988 crisis hotline system director to implement and oversee the administration coordinating emergency mental health crisis response with emergency crisis lines.
(2) (A) Determine the anticipated operating budget for the fiscal years 2021–2022 and 2022–2023 pursuant to Section 41030 of the Revenue and Taxation Code. This budget shall be used to establish the 988 surcharge rate under Section 41020 of the Revenue and Taxation Code to be assessed on access lines and prepaid lines beginning January 1, 2022.
(B) If the office determines that the anticipated operating budget will exceed anticipated 988 surcharge revenue generated within fiscal years 2021–22 and 2022–23, the office may seek an emergency appropriation outside of the Budget Act of 2022. The Director of Finance shall recommend an appropriation to provide additional resources to the Office of Emergency Services for the purposes of implementing the 988 system. The Director of Finance shall not approve any augmentation unless the approval is made in writing to the Chairperson of the Joint Legislative Budget Committee and the chairpersons of
the committees in each house of the Legislature that considers appropriations not later than 30 days prior to the effective date of the approval, or not sooner than whatever lesser time the chairperson of the joint committee, or their designee, may determine. Additional funding shall be available for encumbrance or expenditure until June 30, 2022.
(3) (A) Designate a 988 center or centers to provide crisis intervention services and crisis care coordination to individuals accessing 988. Each designated 988 center shall do both of the following:
(i) 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.
(ii) Maintain an active agreement with the administrator of the National Suicide Prevention Lifeline for participation within the network.
(B) Ensure that designated 988 centers utilize technology that allows for transfers between 988 centers as well as between 988 centers and 911 public safety answering points beginning July 16, 2022.
(4) Appoint and convene the State 988 Technical Advisory Board, which is, by this reference hereby established, for the purposes of expediting the implementation of 988 prior to July 16, 2022.
(A) The board shall advise the office on all of the following:
(i) Developing policies, practices, and procedures for 988 system
communications.
(ii) Technical and operational standards for the California 988 system.
(iii) Initial budget, funding, and reimbursement decisions.
(B) The board shall be comprised of all of the following:
(i) Two representatives from National Suicide Prevention Lifeline call centers.
(ii) Two County Behavioral Health Directors.
(iii) One regional representative from a 911 Public Safety Answering Point from the Northern, Southern, Central, and Los Angeles regions.
(iv) One 911 County Coordinator representative with significant experience as a County Coordinator
to ensure that the details of receiving and transferring calls is represented.
(v) One representative from the California Highway Patrol Communications Support Section.
(vi) Two representatives from secondary fire and emergency medical services Public Safety Answering Points.
(vii) One police chief.
(viii) One sheriff.
(ix) One fire chief.
(x) One chief emergency medical services officer.
(xi) Two representatives on the recommendation of the California Health and Human Services Agency.
(C) Board
members shall not receive compensation for their service on the board, but may be reimbursed for travel and per diem for time spent in attending meetings of the board.
(D) The board shall begin meeting no later than January 30, 2022, and shall meet monthly through December 31, 2022, at which point the advisory board may be disbanded by the office.
(E) The board shall meet in public sessions in accordance with the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2). The board shall, at its first meeting, adopt bylaws and operating procedures consistent with this article and establish committees as necessary.
(e) No later than October 31, 2023, the office, in partnership with the California Health and Human Services Agency, shall develop and release
a plan to fully implement this act by January 1, 2027. This plan shall be informed by the local landscape analyses provided by the 988 Local Planning Council pursuant to Section 53123.5. The plan shall include guidelines to allow 988 centers to coordinate with counties for the deployment of existing mobile crisis teams beginning January 1, 2024.
53123.5.
(a) The California Health and Human Services Agency shall provide direction and oversight of the implementation and administration of mental health crisis services accessible through 988. The duties of the agency shall include all of the following:(1) Establishing standards for behavioral health crisis services accessible through 988.
(2) Seeking to maximize all available federal funding sources for the purposes of 988 implementation, including federal Medicaid reimbursement for services; federal Medicaid reimbursement for administrative expenses, including the development and maintenance of information technology to support the 988 system and crisis services; and federal
grants, including the funding of mental health crisis services.
(3) Coordinating with the Department of Insurance to ensure efficient and timely reimbursement to counties for medically necessary crisis intervention, mobile crisis, crisis stabilization, and crisis residential 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. 1189(a)). The Department of Managed Health Care and the Department of Insurance shall issue guidance and may adopt emergency regulations relating to efficient and timely reimbursement to counties. The departments may readopt any emergency regulation authorized by this subdivision that is the same as or substantially equivalent to an emergency regulation previously adopted under this subdivision.
(4) Overseeing the local and regional planning and coordination of the 988 system by the 988 Local Planning Council, including approving the 988 Local Services Plans, pursuant to Section 53123.6. In consultation with the Office of Emergency Services, the agency shall approve or deny a 988 Local Services Plan within 30 business days of receiving a completed proposal.
(5) Maintaining and evaluating data on the usage of, services provided for, and outcomes from the 988 system.
(b) No later than January 1, 2022, the agency shall appoint a 988 crisis services director to provide direction and oversight of the implementation and administration of mental health crisis services. The director shall have experience in suicide prevention and behavioral health crisis services, including coordination of county and state mental
health administrative services organizations for the provision of mental health and substance use disorder services.
(c) No later than January 1, 2022, the agency shall issue an administrative claiming policy and procedure letter for the local drawdown of federal reimbursement for services provided by and operations of the 988 system, including any federal reimbursement opportunities included in the American Rescue Plan Act of 2021 (Public Law 117-2).
(d) Beginning January 1, 2024, and annually thereafter, the agency shall prepare a report and deliver it to the Legislature, the Substance Abuse and Mental Health Services Administration, and the Federal Communications Commission, in compliance with Section 9795 and including information on all of the following:
(1) Data gathered pursuant to paragraph (4) of subdivision
(a).
(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 Mental Health and Crisis Services Special Fund as reported by the State Treasurer per subdivision (e) of the Section 53123.7.
(4) The state of county behavioral health crisis services, how funds from the 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 (4) of subdivision (e) of Section 53123.7.
53123.6.
No later than July 1, 2022, each county board of supervisors shall appoint a 988 Local Planning Council to implement the guidelines, standards, and regulations established by the Office of Emergency Services and the Health and Human Services Agency for the coordination of county behavioral health crisis services with 988 centers, emergency medical services, law enforcement, cities, and when appropriate, other specialty behavioral health warm lines and hotlines.(a) The council shall include, but not be limited to, the following:
(1) Organizations representing mental health consumers and peers who are receiving or have received mental health services and relatives of mental health consumers.
(2) The 988 center or centers.
(3) The County Behavioral Health Director or directors.
(4) Mental health and substance use disorder service providers, including public service employees.
(5) First responders, including law enforcement, emergency medical services, fire, and 911 operators.
(6) California Indian tribes, as defined in subdivision (c) of Section 8012 of the Health and Safety Code.
(b) No later than January 1, 2023, the council shall prepare and submit to the office and the agency a landscape analysis of existing local behavioral health crisis services, including mobile crisis teams and coresponse teams, and the state
of coordination and integration of services with National Suicide Prevention Lifeline Call Centers, which may or may not be designated 988 centers.
(c) By January 1, 2026, the council shall prepare and submit the 988 Local Services Plan outlining how the county or region will implement the plan developed by the office and the agency.
(1) Beginning January 1, 2024, counties seeking to coordinate with 988 centers for the deployment of mobile crisis teams, at the discretion of the council, shall submit a supplemental 988 Local Services Plan outlining a proposal for mobile crisis team deployment to the agency and the office.
(2) In the event that the council cannot reach consensus on the 988 Local Services Plan, the local or regional planning shall be completed by the agency.
53123.7.
(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 in the fund shall be available, upon appropriation by the Legislature, for the purposes specified in this article.
(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) The 988 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.
(3) The revenue generated by the 988 surcharge shall be used to supplement and not supplant federal, state, and local funding for mobile crisis services and crisis receiving and stabilization services as calculated in fiscal year 2019–2020.
(4) The revenue generated by the 988 surcharge may only be used to fund service and operation expenses that are not reimbursable through federal Medicaid match, Medicare, health care service plans, or disability insurers.
(f) The Office of Emergency Services may adopt regulations regarding the process for counties to receive funds.
(g) 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:
(1) The total budget, by fund source.
(2) Number and job classification of personnel allocated to each modality.
(3) The number of individuals served.
(4) The outcomes for individuals served.
(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.
(h) The State Treasurer shall report annually to the office on fund deposits and expenditures.