Bills and Budget Amendments Under Consideration to Implement Behavioral Health Commission Recommendations

Members of the Behavioral Health Commission adopted a series of recommendations in December, with proposals emerging from the Commission’s review of the implementation of the STEP-VA initiative, its study of school-based mental health services, and its review of proposals to create an expedited court diversion process, as well as a 2022 JLARC study of the Community Services Board (CSB) system and a 2023 JLARC study of state psychiatric hospitals.  Key recommendations have been introduced as a set of bills and a large number of budget amendments, as outlined below.

HB 314 (Hope)/SB 179 (Favola), as introduced, would have required state hospitals (rather than CSBs) to conduct discharge planning for individuals who are discharged within 30 days of admission; CSBs would continue to be responsible for discharge planning for individuals with longer stays.  As passed by the House and Senate, respectively, these provisions are limited to discharges from Central State Hospital, Southern Virginia Mental Health Institute, or Southwestern Virginia Mental Health Institute.

SB 590 (Deeds) clarifies what core services are to be provided by the CSBs as part of STEP-VA and specifies that the services are to be available to adults with a serious mental illness, children with (or at risk of) serious emotional disturbance, and individuals with substance use disorder, and are to be provided in a timely manner and within a reasonable distance of the individual’s residence, subject to the availability of funds.  This bill has passed the Senate; a companion bill, HB 885 (Watts), was tabled in House Appropriations.

HB 888 (Watts)/SB 176 (Favola) provides that for the purpose of civil commitments and temporary detention orders, behaviors or symptoms that manifest from a neurocognitive disorder or a neurodevelopmental disability are not sufficient, in themselves, to justify a finding of mental illness.  The bills stem from a JLARC finding that state hospitals are inappropriate placements for individuals with these conditions.  To address concerns about the limited availability of placement options other than state hospitals, the bills direct the convening of a workgroup and include reenactment clauses.  These bills have passed their originating chambers and await hearings post-crossover.

HB 808 (Rasoul)/SB 653 (Durant) would have authorized a state hospital to delay admission of an individual who is under a temporary detention order until the state facility has determined that the individual does not have potentially life-threatening medical needs requiring immediate evaluation and treatment that the state facility is incapable of providing, effective July 1, 2025.  The bills were recommendations of the JLARC study on state hospitals and sought to address concerns about patients being dropped off at state hospitals.  HB 808 reached the House floor but was not passed before the Tuesday crossover deadline; SB 653 was stricken at the request of the patron.

Budget amendments related to CSB operations

• Item 297 #2h (Rasoul) and Item 295 #23s (Deeds) direct the Department of Behavioral Health and Developmental Services (DBHDS) to work with the Department of Medical Assistance Services (DMAS) to review CSB billing for Medicaid-eligible services.

• Item 288 #5h (Rasoul)/Item 292 #10s (Deeds) direct DMAS to work with Medicaid managed care organizations to standardize policies, procedures, and requirements that CSBs must follow to receive Medicaid reimbursement.

• Item 295 #5h (Hope)/Item 295 #9s (Favola) direct 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 295 #4h (Hope)/Item 295 #18s (Deeds) direct DBHDS to amend CSB performance contracts to require that (i) any funding appropriated by the General Assembly to CSBs for staff compensation only be used for staff compensation and (ii) CSBs report annually to DBHDS on any staff compensation actions taken during the prior fiscal year.

• Item 295 #3h (Hope)/Item 295 #10s (Favola) direct DBHDS to identify all current DBHDS requirements related to documentation and reporting of CSB behavioral health services and eliminate any requirements that are not essential or are duplicative or conflicting.

• Item 288 #35h (Hope)/Item 292 #1s (Favola) direct DMAS to ensure that comprehensive information about all available managed care organization preferred provider programs is provided to all CSBs, including information about which behavioral health services are included in the preferred provider programs and the requirements CSBs must meet to participate in the programs.

• Item 267 #2h (Watts)/Item 267 #2s (Deeds) direct the Secretary of Health and Human Resources to report on plans to implement the Certified Community Behavioral Health Clinic (CCBHC) model in the Commonwealth.

• Item 292 #6h (Watts)/Item 292 #11s (Deeds) direct DMAS to examine how Virginia can most effectively and efficiently transition to a prospective payment system as required to fully adopt the CCBHC model.

• Item 295 #14h (Watts)/Item 295 #14s (Favola) direct DBHDS to report annually on CSB performance in improving functioning levels of consumers.

• Item 295 #12h (Watts)/Item 295 #12s (Favola) direct DBHDS to revise all performance measures in CSB performance contracts to ensure that: (i) performance measures are designed to measure outcomes for each service; (ii) performance measures include a relevant benchmark for each measure, and (iii) DBHDS has given clear direction on how it will monitor performance and enforce compliance with performance requirements.

• Item 295 #11h (Watts)/Item 295 #17s (Favola) direct DBHDS to provide CSB-level performance information to each CSB governing board; the Behavioral Health Commission, and the State Board of Behavioral Health and Developmental Services.

Budget amendments related to STEP-VA

• Item 295 #2h (Hope)/Item 295 #13s (Favola) direct DBHDS to finalize performance measures and benchmarks for every STEP-VA service component that has been initiated statewide.

• Item 295 #1h (Hope)/Item 295 #11s (Favola) direct DBHDS to report to the Behavioral Health Commission by December 1, 2024, on the changes to STEP-VA performance measures and benchmarks that are anticipated to be included in CSB performance contracts that will take effect July 1, 2025.

• Item 295 #6h (Hope)/Item 295 #19s (Deeds) direct DBHDS to conduct a needs assessment to determine the unmet need for each of the nine service components of STEP-VA and develop an estimate of the cost of satisfying the unmet need for each of the nine STEP-VA service components statewide.

Budget amendments related to school-based mental health

• Item 295 #10h (Watts) directs DBHDS to develop performance measures for participating school mental health sites and for the pilot overall; Item 295 #3s (Deeds) includes this language and also provides $7.5 million per year for school mental health pilots.

• Item 288 #6h (Rasoul)/Item 292 #12s (Deeds) direct DMAS and the Department of Education to revise their interagency agreement to reduce the percentage of administrative reimbursement pass-through funds retained by DMAS and appropriate an equivalent amount of funding to the Department of Education to provide school divisions with additional technical assistance with Medicaid billing.

• Item 125 #2h (Rasoul) provides $20 million in FY 2025 in temporary funding for school-based mental health services following the expiration of federal ESSER funds. Item 124 #50s (Deeds) would provide $30 million in FY 2025 for this purpose.  Item 117 #1h (Rasoul) and Item 118 #3s (Deeds) direct VDOE to work collaboratively with DBHDS and DMAS on a plan for creating a new program to deliver flexible mental health funds to divisions.

• Item 118 #6h (Rasoul) and Item 124 #57s (Favola) provide $1.5 million per year for the Virginia Tiered System of Supports.

Budget amendments related to Expedited Diversion to Court-Ordered Treatment

• Item 31 #2h (Watts) and Item 31 #14s (Deeds) direct the Office of the Executive Secretary, in collaboration with DBHDS, to examine existing jail diversion programs for individuals with a serious mental illness and the feasibility of implementing an expedited diversion to court-ordered treatment (EDCOT) process to divert individuals with a serious mental illness to court-supervised mental health treatment.

Budget amendments related to state psychiatric hospitals and the crisis system

• Item 267 #1h (Hope)/Item 267 #1s (Deeds) direct the Secretary of Health and Human Resources to provide to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees and to the Behavioral Health Commission a plan detailing how funds appropriated during the 2023 Session of the General Assembly will be expended to expand and modernize the comprehensive crisis services system.

• Item 296 #4h (Rasoul)/Item 296 #6s (Favola) provide $5 million each year for DBHDS to establish a program for state-licensed psychiatric hospitals to provide funding for hospitals that agree to increase the percentage of involuntary inpatient admissions they accept and demonstrate the need for funding to safely admit such patients.

• Item 296 #5h (Rasoul)/Item 296 #1s (Favola) expand eligibility for the discharge assistance provided by DBHDS to individuals facing substantial barriers to discharge from private hospitals.

• Item 302 #2s (Deeds) earmarks $6.2 million of the amounts provided for salary increases for direct care staff and food and environmental services staff for salary increases for psychologists, social workers, housekeeping, and food services staff at state psychiatric hospitals that will bring these positions’ salaries within 10 percent of the median salary paid to these positions by other health care employers in the region. Item 302 #1s (Deeds) directs DBHDS to report annually to the Behavioral Health Commission on average turnover and vacancy rates and salary competitiveness, by hospital and position type, for the state’s psychiatric hospitals.

• Item 302 #2h (Watts)/Item 296 #12s (Favola) provide $407,500 per year for scheduling software for state hospitals.

• Item 302 #1h (Watts) provides $40 million the first year and $80 million the second year to increase nursing staff at state psychiatric hospitals.

• Item 302 #3h (Watts)/Item 295 #7s (Deeds) provides $250,000 in FY 2025 for DBHDS to contract for an assessment of state hospitals’ staffing levels and the development of a methodology to allow DBHDS to conduct future biennial assessments on its own.

• Item 301 #1h (Hope) and Item 295 #2s (Deeds) direct DBHDS to identify and develop alternative placements for children who would otherwise be admitted to the Commonwealth Center for Children and Adolescents.

• Item 295 #13h (Watts) directs DBHDS to contract for a secure online portal for CSBs to upload and share patient documents with inpatient psychiatric facilities; Item 295 #1s (Favola) provides $650,000 in FY 2025 for this purpose.

• Item 296 #8h (Hope)/Item 296 #11s (Favola) direct DBHDS to contract with one or more institutions of higher education for training and technical assistance for preadmission screening clinicians.

• Item 296 #20h (Rasoul) provides $33 million the first year and $2.6 million the second year to ensure existing crisis centers are fully staffed. Item 297 #4s (Deeds) provides $2.5 million each year help community services boards hire additional staff for crisis stabilization units whose bed capacity is not fully utilized.

• Item 295 #16s (Favola) directs DBHDS to provide detailed information to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees before funding is provided for a new Crisis Stabilization Unit on: (i) the unmet needs the new unit will address, (ii) the capacity of CSBs or private providers to staff the proposed unit, (iii) the unit’s ability to serve individuals under a temporary detention order, (iv) expected initial and ongoing costs of the proposed unit, and (v) the planned timeframe for when the unit would become operational.

VACo Contact:  Katie Boyle