988 Implementation Act

Eric Rafla-Yuan, MDCongressional FellowOffice of U.S. Representative Tony Cárdenas

Why is the 988 Implementation Act important?

• The lack of an effective and widely available mental health crisis system leads to tragic results for people in crisis.

• Starting in July 2022, 9-8-8 will serve as national calling code for mental health crises.

• The aim of the 988-response system is to connect individuals in crisis to mental health crisis care

• Congress must act to ensure that people who call 988 can get the help they need

988 Implementation Act

• Lead by Representatives Cárdenas, Katko, Napolitano, Blunt Rochester, Fitzpatrick

• Aims to support the implementation of 988 & crisis continuum of care nationwide

• Planned for introduction in late Jan 2022

• Paired with introduction of bipartisan Congressional Crisis Services Taskforce

988 Implementation Act – Guiding Principles

“Someone to call, someone to come, and somewhere to go”

• Comprehensive policy outline for implementation of 988 and continuum of crisis care as envisioned in SAMHSA 2020 guidelines

• Proactively avoid IMD exclusion from interfering with crisis services• Research & evidence collection to refine best practices• Workforce development• Guidance and funding for local crisis services implementation—while retaining

flexibility for states/counties/cities/communities to develop solutions that work for them

Behavioral Health Crisis Services Expansion Act (H.R. 5611 & S. 1902)

- Led by Cortez Masto, Cornyn & Blunt Rochester, Cárdenas, Fitzpatrick, Herrera Beutler

National Standards for Behavioral Health Crisis Services• To guide the implementation of this continuum of crisis services by states, regions,

counties and communities across the nation, the bill directs HHS to define the core regional and community-based components of the behavioral health crisis continuum of care to include:

• 24/7 crisis hotlines and call centers and warm lines• mobile crisis services• behavioral health urgent care• short term crisis residential and crisis stabilization services

Behavioral Health Crisis Services Expansion Act (H.R. 5611 & S. 1902)

Expanding Coverage of Behavioral Health Services• This bill provides coverage of behavioral health crisis services for all patients

no matter where they get their health insurance, and reimbursement to the providers thereof for enrollees in Medicare, Medicaid, ACA health plans, employer-sponsored coverage, VA and TRICARE, and the Federal Employee Health Benefits Program

SAMHSA

• Behavioral Health Crisis Coordinating Office: Authorize $10 million for a Behavioral Health Crisis Coordinating Office under the direct control of the Assistant Secretary of Mental Health and Substance Use to support technical assistance, data analysis and evaluation functions to develop a crisis care system.

• National Suicide Prevention Lifeline: Increase the authorization ceiling for the existing line-item to $240 million, within this allocation, provide resources for specialized services for LGBTQ individuals, people of color and other underserved populations.

• Regional/Local Lifeline Call Center Program: Authorize a free-standing line-item for $441 million that would provide federal funding (for the first time) for technology, training, and operations for the 250+ regional/local lifeline call centers.

• Mental Health Block Grant Crisis Care Set-aside: Permanently authorize the $2.235 billion in MHBG funding appropriated through the combined Consolidated Appropriations Act and the American Rescue Plan allocations. Include and authorize the 10% set aside for crisis services. Amend the existing set-aside to establish a minimum crisis care funding floor for every state.

SAMHSA

• Mental Health Crisis Response Partnership Pilot Program: Authorize $100 million for a new pilot program for communities to create, or enhance existing, mobile crisis response teams composed of licensed counselors, clinical social workers, physicians, EMTs, crisis workers, and/or peers to respond to people in crisis and provide immediate stabilization and referral to community-based mental health services and supports; peer and provider navigation teams that address high risk individuals; and in home crisis stabilization teams that may provide care for a more extended period.

Health Resources Services Administration (HRSA)

• HRSA Capital Development Grants: Broaden these capital projects to include crisis receiving and stabilization programs as well as call centers. Recipients of these grants would be required to demonstrate working relationships with local CBHOs, CMHCs, CCBHCs and other local mental health and substance use care providers including inpatient and residential treatment settings. Entities may be eligible for these grants regardless of whether they are nonprofit, for-profit, or not-for-profit.

• Expand behavioral health workforce training programs (HRSA Behavioral Health Workforce Education and Training (BHWET) Program; SAMHSA Minority Fellowship Program (MFP), and HRSA Graduate Psychology Education (GPE) Program); National Health Service Corp to include crisis call centers, mobile crisis teams, crisis receiving and stabilization programs as eligible sites.

Social Security Act Amendments: Medicaid

• State Crisis Care Option: Amend Sec. 9813 of the ARP…the mobile crisis state option…to add: a) unambiguous Medicaid financing for regional/local lifeline call center operations b) crisis receiving and stabilization programs/beds in home and facilities and c) seek options to extend/expand mobile crisis FMAP incentives

• IMD Amendments: Shrink the IMD payment prohibition to exclude psychiatric acute care crisis beds run by Community Behavioral Health Organizations (as defined by Section 1913 (c) of the PHSA and Section 223 of the PAMA) and community residential programs. Require CMS to issue guidance that crisis stabilization units are excluded from the IMD prohibition and specifying length of stays and size of facility permitted.

• Excellence in Mental Health and Addiction Treatment Expansion Act (S. 2069/H.R. 4323). Expand the existing 10 state Medicaid demonstration to permit any state to participate and authorize 9-8-8/CCBHC partnerships where CCBHCs would help dispatch mobile crisis teams and administer crisis stabilization programs/beds in states and counties where they operate.

Talk.CrisisNow.com/LearningCommunity988 and Core Crisis Continuum