Health and Human Services Roundup

March 5, 2024

Behavioral Health

Several bills under consideration this session resulted from a 2023 JLARC study of the state psychiatric hospital system, several recommendations of which were also endorsed by the Behavioral Health Commission:

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. The bills were amended to apply only to discharges from Central State Hospital, Southern Virginia Mental Health Institute, or Southwestern Virginia Mental Health Institute. SB 179 has passed both chambers; HB 314 is on the Senate floor.
HB 888 (Watts)/SB 176 (Favola) provide that for the purpose of civil commitments and temporary detention orders (TDOs), 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. HB 888 has passed both chambers; SB 176 awaits final action by the Senate to approve amendments made in the House.
HB 313 (Hope)/SB 178 (Favola) direct the Office of the State Inspector General to develop a plan to fulfill its statutory obligation to fully investigate all complaints it receives alleging abuse, neglect, or inadequate care at a state psychiatric hospital.
Two companion bills (HB 808 (Rasoul)/SB 653 (Durant)) that sought to address concerns about patients being dropped off at state hospitals that are unable to meet their medical needs failed to advance this session over concerns about their effects on law enforcement. The bills would have authorized a state hospital to delay admission of an individual who is under a TDO 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. HB 808 reached the House floor but was not passed before the crossover deadline; SB 653 was stricken at the request of the patron.

Several bills that are advancing address other aspects of the behavioral health system:

HB 515 (Hope) directs the Department of Behavioral Health and Developmental Services (DBHDS) to implement a pilot program at one state hospital to allow the hospital director to discharge certain patients over the objection of the CSB if the patient has not been discharged within 15 days of a determination that the individual is ready for discharge, provided certain requirements have been met. The discharge plan would be developed by the state hospital and implemented by the CSB serving the area where the individual resided prior to admission or where the individual (or his/her representative) chose to reside post-discharge. Expenses for a trial or home visit would be covered by a person’s relative, conservator, caregiver, or appropriate local department of social services. Language in the House budget provides for DBHDS to cover an individual’s expenses if the individual is placed in an assisted living facility, nursing home, group home, or similar placements as part of the pilot program and there is no other public or private assistance available. HB 515 has passed both chambers.
HB 823 (Cherry)/SB 497 (Carroll Foy) provide that when a magistrate is issuing a temporary detention order, an alternative transportation provider shall be deemed to be available if the provider is available to take custody of the individual subject to the TDO within six hours of the TDO’s issuance. Under current law, if no alternative transportation provider is willing, available, and able to provide transportation in a safe manner, the magistrate must designate the primary law enforcement agency and jurisdiction designated to provide transportation; the bills add language requiring the same designation if the law enforcement agency elects to provide transportation. Both bills have passed the legislature and are headed to the Governor’s desk.
HB 1242 (Willett)/SB 546 (Bagby) are intended to allow family members or legal guardians to be present with an individual being evaluated for a temporary detention order. The bills require the evaluator or the physician or health care provider providing services to an individual who is being evaluated to allow the individual’s family member or legal guardian to be present, unless the individual objects or the evaluator or the treating physician determines that the family member or legal guardian’s presence would create a risk to the patient or health care provider or interfere with patient care.
HB 1336 (Sickles)/SB 568 (Deeds) are intended to assist with regulatory issues encountered in the development of facilities licensed by DBHDS that provide crisis stabilization services. The bills allow these facilities to maintain a stock of certain controlled substances necessary for treatment, and allow facilities to use remote drug dispensing systems, based on regulations to be adopted by the Board of Pharmacy. A remote dispensing system is a machine that performs certain packaging, labeling, and dispensing functions and allows pharmacist communication with a patient or a person licensed to administer drugs when a pharmacist is not on-site. DBHDS is currently funding two projects using remote dispensing systems approved as a pilot by the Board of Pharmacy; the legislation would allow the pilot to become permanent, as well as the expansion of operations to other sites. These bills have passed the General Assembly.
SB 34 (Locke), in its current form, authorizes certain employees of hospitals with a psychiatric emergency department located in Senate District 23 to perform evaluations to determine whether a person meets the criteria for temporary detention. Under current law, these evaluations are conducted by an employee or designee of the CSB. The bill has a July 1, 2026, sunset date. The bill is on the House floor.
SB 574 (Deeds) directs the Behavioral Health Commission to study how to align current civil admissions laws and processes (to include processes related to licensing, regulations, training, and reimbursement) with new behavioral health and crisis response services and resources. A report is due by July 1, 2025.
HB 292 (Ballard)/SB 725 (Pillion) rename drug treatment courts as recovery courts.

Health

Under current law, churches, fraternal or school organizations, certain tax-exempt organizations, and volunteer fire and EMS agencies are exempt from restaurant regulations when these organizations offer food for sale to the public as part of occasional fundraisers held by the organization. HB 57 (Wright) extends this exemption to fundraising events in which the organization participates; the bill is awaiting action by the Governor.
HB 150 (Helmer) provides that the Department of Social Services may not require individuals applying for or renewing Supplemental Nutrition Assistance Program (SNAP) benefits to appear in person except as provided in federal law or regulation. The bill also codifies the Virginia Department of Health’s authority to implement the Special Supplemental Nutrition Program for Women, Infants, and Children (the WIC Program), which currently exists in regulation, and requires all localities to participate (according to the Virginia Department of Health, all local health departments currently offer the program). This bill is on the Senate floor.
HB 354 (Hope) directs the Board of Health to promulgate regulations governing swimming pools, including requirements for water treatment and disinfection, daily posting of water quality data, safety equipment and features, maintenance and safety of equipment and premises, operational requirements, facility staffing, incident response, and other provisions necessary to protect public health and safety. The regulations would not apply to the design, construction, or maintenance of pool structures and equipment governed by the Uniform Statewide Building Code. The bill provides that localities would not be prohibited from adopting more stringent regulations. HB 354 has passed the General Assembly.
HB 570 (Delaney)/SB 274 (Deeds) establish the Prescription Drug Affordability Board and empower the Board to conduct affordability reviews of certain high-cost drugs and impose upper payment limits on up to 12 drugs annually between January 1, 2025 (when the bills take effect), and January 1, 2028. SB 274 has passed both chambers; HB 570 is on the Senate floor.

Social Services

HB 27 (Callsen)/SB 39 (Favola) create the Parental Child Safety Placement Program. The bills require local boards of social services to first consider placement with a kinship foster parent in placing a child who has been removed from the home, and require an exception report if a local board does not place a child with an approved kinship foster parent. Under the Parental Child Safety Placement Program, a local department may facilitate a temporary out-of-home placement of a child with a caregiver that is arranged by the parent, guardian, or legal custodian in accordance with a written agreement that ensures the child’s safety and is approved by the local department. Such a placement may be facilitated if a family assessment or investigation has been initiated in response to a valid complaint of abuse or neglect, the child cannot remain safely in the home, and the parent, guardian, or legal custodian agrees to the arrangement. The bills set out the provisions that must be included in the parental child safety placement agreement, require the local department to assess the proposed caregiver’s qualifications to care for the child, and set out a process for the safe return of the child to the home at the conclusion of the parental child safety placement agreement (if the child can be safely returned home), or for removal of the child (if the child cannot safely return). HB 27 is on the Senate floor; SB 39 has passed both chambers.
HB 855 (Hernandez), as passed by the House, directs the State Board of Social Services to promulgate regulations to allow applications for the Home Energy Assistance Program to be submitted year-round, provided adequate funding is available. The Senate Finance and Appropriations Committee amended the bill on Monday to direct that the regulations allow applications to be submitted over an application period that provides adequate time for individuals to apply and is extended beyond the current application period, provided adequate funding is available. The bill is now on the Senate floor.
HB 992 (Tran) requires each local department of social services to enter into a written agreement with the local workforce development board to provide for the coordinated provision of workforce development services to participants in the Virginia Initiative for Education and Work (VIEW) and Supplemental Nutrition Assistance Program Employment and Training (SNAP E&T) programs. This bill is a recommendation of a 2023 JLARC study of self-sufficiency programs and is on the Senate floor.
SB 70 (McPike) was a policy option in the 2023 JLARC study of self-sufficiency programs and would have required all local departments of social services to offer a voluntary SNAP E&T program, from such funds as were appropriated for that purpose. Currently, only 37 of the 120 local departments offer the program. This bill was tabled in the House Appropriations Committee over concerns about its fiscal impact.