As reported earlier in the session, several bills are under consideration to address aspects of the temporary detention process in an effort to relieve pressure on the state hospital system, as well as on law enforcement agencies. In addition, both the House and Senate budget proposals recommend additional investments in crisis services over and above the funding included in the introduced budget.
HB 1792 (Ransone) and SB 1302 (Deeds) seek to streamline the process of seeking a “medical temporary detention order [TDO]” by allowing a licensed physician who has attempted to obtain informed consent of an adult for treatment of a mental or physical condition that appears to be a result of intoxication to seek an order from the magistrate or the court authorizing temporary detention of the person in a hospital emergency department or other appropriate facility for testing, observation, or treatment upon a finding that (i) probable cause exists to believe the person’s intoxication has rendered the person incapable of making or communicating an informed decision regarding treatment and (ii) the medical standard of care calls for observation, testing, or treatment within the next 24 hours to prevent injury, disability, death, or other harm to the person or another person resulting from such intoxication. Several working groups in the past have discussed options to treat individuals in these circumstances that would provide alternatives to inpatient hospitalization at state hospitals. HB 1792 has passed both chambers and SB 1302 is on the House floor.
HB 1976 (Bell) and SB 1299 (Deeds) are headed to a conference committee to resolve differences between the two bills. As HB 1976 passed the House, it would authorize the director of a facility where a person who is subject to a TDO (but has not been transported to the facility of temporary detention) is housed to request a psychiatrist or clinical psychologist, in consultation with the treating physician and the CSB, to perform a new assessment of the person. If the new assessment concludes that the person no longer meets commitment criteria, the CSB would then conduct an evaluation. Alternatively, the facility director could request the CSB or its designee, in consultation with the treating physician, to conduct an evaluation. Under either approach, if the CSB determined that the person no longer met commitment criteria, it could authorize the release of the person. SB 1299, as it passed the Senate, would allow the facility director to release the person if the CSB, in consultation with the treating physician, conducted an evaluation, determined that the person no longer met commitment criteria, authorized the release, and provided a discharge plan.
SB 872 (Newman) seeks to expand use of alternative transportation for individuals subject to emergency custody or temporary detention orders by requiring the magistrate to authorize alternative transportation under certain circumstances. The bill also allows an employee or contractor providing alternative transportation under contract with the Department of Behavioral Health and Developmental Services (DBHDS) who has completed training in the proper use of restraint may use restraint if necessary to ensure the safety of the individual being transported or the safety of others, or to prevent escape when less restrictive techniques have been determined to be ineffective. This bill is on the House floor.
SB 1512 (Mason), which would have temporarily allowed certain individuals employed or contracted by hospitals with psychiatric emergency departments who met certain criteria to conduct evaluations for temporary detention orders, was tabled in a subcommittee of House Courts.
In addition, several bills and a series of budget amendments have been introduced that propose to implement recommendations from JLARC’s study of the CSB system, which was released in December 2022.
HB 2185 (Rasoul)/SB 1169 (Hanger), which have both passed both chambers, strengthen requirements for oversight of CSBs through performance contracts with DBHDS. The bills require performance contracts to include provisions that enable DBHDS to enforce the contract in the event a CSB fails to substantially comply with contract requirements, including provisions for notification of the CSB executive director and chair, provisions for a remediation process to allow the CSB to come into substantial compliance, provisions for termination of all or part of a performance contract in the event of failure to come into substantial compliance, and provisions for an appeal of an enforcement action. These provisions take effect July 1, 2025.
SB 1465 (Hanger) refines Code sections dealing with the purpose of CSBs to clearly state their overall role (functioning as the single point of entry into publicly funded mental health, developmental, and substance abuse services in order to provide comprehensive mental health, developmental, and substance abuse services within a continuum of care) and also includes language specifying the purpose of behavioral health services provided by CSBs. The bill also requires performance contracts to set forth specific goals and objectives related to service delivery. This bill has passed both chambers.
Budget amendments that incorporate additional JLARC recommendations are listed below:
- House: Directs DBHDS to identify current documentation and reporting requirements for CSBs and eliminate requirements of direct care staff that are not essential, duplicative, or conflicting. (Item 311 #2h) Similar language is included in the Senate budget. (Item 311 #18s)
- House: Directs DBHDS to report annually on CSB performance in improving consumer functioning. (Item 311 #3h)
- Senate: Directs DBHDS to complete a comprehensive review of the performance contracts with community services boards and revise all performance measures, with a report due to the Behavioral Health Commission by December 1, 2023, and changes to be implemented before the finalization of the FY 2025 performance contract. (Item 311 #13s)
- Senate: Directs DBHDS to report CSB performance information, including any substantial underperformance or non-compliance and associated enforcement actions, annually to each CSB governing board, the Behavioral Health Commission, and the State Board of Behavioral Health and Developmental Services. (Item 311 #14s)
- Senate: Directs DBHDS and DMAS to assess the extent to which community services boards (CSBs) are billing for Medicaid-eligible services they provide; provide technical assistance and training on appropriate Medicaid billing and claiming practices to relevant CSB staff; and evaluate the feasibility of a central billing entity that would handle all Medicaid claims for the entire system. (Item 311 #17s)
- Senate: Directs DBHDS to report annually to the State Board of Behavioral Health and Developmental Services and the Behavioral Health Commission on average salaries, turnover, and vacancy rates by position type across community services boards. (Item 311 #20s)
- Senate: Directs DBHDS to contract with one or more higher education institutions to establish training and technical assistance centers to provide training and technical assistance to preadmission screening clinicians. (Item 312 #4s).
- Senate: Directs DBHDS to amend CSB performance contracts to require that any funding appropriated by the General Assembly to CSBs for staff compensation shall be used only for staff compensation and to require that CSBs report annually to DBHDS on any staff compensation actions taken during the prior fiscal year. (Item 312 #5s)
VACo Contact: Katie Boyle