A BILL TO BE ENTITLED
AN ACT to appropriate funds for start‑up crisis services, to hire a consultant to assist area authorities and county programs develop and implement a plan to create a continuum of crisis services, to pay for crisis services for nonmedicaid eligible indigent individuals, to ensure access to core psychiatric services, and to extend the sunset for the first commitment pilot program as recommended by the joint legislative oversight committee on mental health, developmental disabilities, and substance abuse services.
The General Assembly of North Carolina enacts:
SECTION 1.(a)  There is appropriated from the General Fund to the Department of Health and Human Services the sum of ten million five hundred thousand dollars ($10,500,000) for the 2006‑2007 fiscal year. The funds shall be allocated on a per capita basis and shall be used by area authorities and county programs for operational start‑up, capital, or subsidies related to the development and implementation of a plan for a continuum of regional crisis facilities and local crisis services ("crisis plan"). Funds not expended during the 2006‑2007 fiscal year shall not revert. As used in this section, the term "crisis" includes services for individuals with mental illnesses, developmental disabilities, and substance abuse addictions.
SECTION 1.(b)  There is appropriated from the General Fund to the Department of Health and Human Services (Department) the sum of four hundred twenty‑five thousand dollars ($425,000) for the 2006‑2007 fiscal year to be used by the Department to hire a consultant to provide technical assistance to Local Management Entities (LMEs) to develop and implement the crisis plans required under Section 1(a) of this act. As used in this act, the term "consultant" may refer to an individual or a business entity such as a corporation, a partnership, or a limited liability company. The roles and responsibilities of the Department, the consultant, and the LMEs are more fully explained in Section 1(c) of this act. Funds not expended during the 2006‑2007 fiscal year shall not revert.
SECTION 1.(c)  The Department shall hire a consultant to assist LMEs to carry out the requirements of Section 1 of this act.  In addition to any other factors the Department determines are relevant when selecting the consultant, the Department shall take into consideration whether an applicant has prior experience evaluating crisis services at a local, regional, and statewide level, prior experience assisting State and local public agencies develop and implement crisis services, and the ability to implement its responsibilities within the time frames established under this act.
The consultant shall do all of the following:
(1)	Develop a model for a continuum of crisis services for an urban area and for a rural area. The model shall outline how an LME, or a group of LMEs, can develop over a period of time the following components:  24‑hour crisis telephone lines, walk‑in crisis services, mobile crisis outreach, crisis respite/residential services, crisis stabilization units, 23‑hour beds, regional crisis facilities, inpatient crisis and transportation. Options for voluntary admissions to a secured facility shall include at least one service appropriate to address the mental health, developmental disability, and substance abuse needs of adults, and the mental health, developmental disability, and substance abuse needs of children. Options for involuntary commitment to a secured facility shall include at least one option in addition to admission to a State facility. These models shall be the first deliverable under the consultant's contract.
(2)	Review the findings and recommendations regarding crisis services developed by the Department as part of the long‑range plan required under Section 10.24 of S.L. 2005‑276. The consultant shall use this information and any other information it determines to: identify local and regional gaps in crisis services; identify options for providing those services; assist LMEs with developing and implementing a plan to provide a continuum of crisis services; and maintain transparency and accountability for the use of funds appropriated under this section.
(3)	Designate appropriate groupings of LMEs for the development of regional crisis facilities. As used in this act, the term "regional crisis facility" means a facility‑based crisis unit that serves an area that may be larger than the catchment area of a single LME. The consultant shall consult with LMEs in determining the grouping of LMEs for regional crisis facilities. The consultant shall also take into consideration geographical factors, prior LME groupings and partnerships, and existing community facilities. Each LME shall participate in the regional grouping established by the consultant in order to be eligible to receive funding under this section.
The consultant shall work with each regional group to determine whether a facility‑based crisis center is needed in that region and whether one would be financially sustainable on a long-term basis. If the regional group and the consultant determine that a regional crisis facility is needed and sustainable, the regional group shall attempt to secure those services through a community hospital or other community facility first.
(4)	Assist LMEs to develop a plan to implement a continuum of local crisis services. The plan shall be consistent with the models developed by the consultant under subdivision (1) of this subsection and shall address any gaps in crisis services identified by the study required under Section 10.24 of S.L. 2005‑276. The plan for a continuum of local crisis services may be combined with a plan for the implementation of a regional crisis facility.
The Department may allocate up to three percent (3%) of the funds appropriated under Section 1(a) of this section to LMEs to assist them with the cost of developing their crisis services plans. Each LME shall submit its crisis services plan to the consultant and to the Department for review no later than March 1, 2007. The plan shall take into consideration all other sources of funds in addition to the funds appropriated under this act. The consultant and the Department shall review the plans to determine whether they meet all the requirements of this section. If the plan meets all the requirements of this section, the LME shall receive funding to implement the plan.  
LMEs shall report monthly to the consultant and to the Department regarding the use of the funds, whether there has been a reduction in the use of State psychiatric hospitals for acute admissions, and any remaining gaps in local and regional crisis services. The consultant and the Department shall report quarterly to the Senate Appropriations Committee on Health and Human Services, the House of Representatives Appropriations Subcommittee on Health and Human Services, the Fiscal Research Division, and the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services regarding each LME's proposed and actual use of the funds appropriated under this section.  The reporting requirement under this paragraph shall expire July 1, 2008.
SECTION 2.  There is appropriated from the General Fund to the Department of Health and Human Services the sum of nine million dollars ($9,000,000) for the 2006‑2007 fiscal year.  These funds shall be allocated to area authorities and county programs on a per capita basis.  Area authorities and county programs may bill this fund to pay for mental health, developmental disabilities, or substance abuse crisis services provided to non‑Medicaid eligible adults and children who are indigent and have no other third‑party payment source.  Nothing in this section shall prohibit an area authority or county program from using other funds to provide crisis services, nor shall it limit an area authority or county program's obligation under G.S. 122C‑2(2) to provide emergency services.  The Department shall report quarterly to the Fiscal Research Division on the expenditure of the funds appropriated under this section.
SECTION 3.  There is appropriated from the General Fund to the Department of Health and Human Services the sum of nine million dollars ($9,000,000) for the 2006‑2007 fiscal year.  These funds shall be allocated to area authorities and county programs on a per capita basis.  Area authorities and county programs may use these funds to maintain public access to community psychiatric services.  The funds may be used on a unit cost reimbursement or nonunit cost reimbursement basis.  The Department shall report quarterly to the Fiscal Research Division on the expenditure of the funds appropriated under this section.
SECTION 4.  S.L. 2003‑178 reads as rewritten:
"SECTION 1. The Secretary of Health and Human Services may, upon request of a phase‑one local management entity, waive temporarily the requirements of G.S. 122C‑261 through G.S. 122C‑263 and G.S. 122C‑281 through G.S. 122C‑283 pertaining to initial (first‑level) examinations by a physician or eligible psychologist of individuals meeting the criteria of G.S. 122C‑261(a) or G.S. 122C‑281(a), as applicable, as follows:
(1)	The Secretary has received a request from a phase‑one local management entity to substitute for a physician or eligible psychologist, a licensed clinical social worker, a masters level psychiatric nurse, or a masters level certified clinical addictions specialist to conduct the initial (first‑level) examinations of individuals meeting the criteria of G.S. 122C‑261(a) or G.S. 122C‑281(a). The waiver shall be implemented on a pilot‑program basis. The request from the local management entity shall be submitted as part of the entity's local business plan and shall specifically describe:
a.	How the purpose of the statutory requirement would be better served by waiving the requirement and substituting the proposed change under the waiver.
b.	How the waiver will enable the local management entity to improve the delivery or management of mental health, developmental disabilities, and substance abuse services.
c.	How the services to be provided by the licensed clinical social worker, the masters level psychiatric nurse, or the masters level certified clinical addictions specialist under the waiver are within each of these professional's scope of practice.
d.	How the health, safety, and welfare of individuals will continue to be at least as well protected under the waiver as under the statutory requirement.
(2)	The Secretary shall review the request and may approve it upon finding that:
a.	The request meets the requirements of this section.
b.	The request furthers the purposes of State policy under G.S. 122C‑2 and mental health, developmental disabilities, and substance abuse services reform.
c.	The request improves the delivery of mental health, developmental disabilities, and substance abuse services in the counties affected by the waiver and also protects the health, safety, and welfare of individuals receiving these services.
d.	The duties and responsibilities performed by the licensed clinical social worker, the masters level psychiatric nurse, or the masters level certified clinical addictions specialist are within the individual's scope of practice.
(3)	The Secretary shall evaluate the effectiveness, quality, and efficiency of mental health, developmental disabilities, and substance abuse services and protection of health, safety, and welfare under the waiver. The Secretary shall send a report on the evaluation to the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substances Abuse Services on or before July 1, 2006.
(4)	The waiver granted by the Secretary under this section shall be in effect until October 1, 2007.
(5)	The Secretary may grant a waiver under this section to up to five local management entities that have been designated as phase‑one entities as of July 1, 2003.
(6)	In no event shall the substitution of a licensed clinical social worker, masters level psychiatric nurse, or masters level certified clinical addictions specialist under a waiver granted under this section be construed as authorization to expand the scope of practice of the licensed clinical social worker, the masters level psychiatric nurse, or the masters level certified clinical addictions specialist.
(7)	The Department shall assure that staff performing the duties are trained and privileged to perform the functions identified in the waiver. The Department shall involve stakeholders including, but not limited to, the North Carolina Psychiatric Association, The North Carolina Nurses Association, National Association of Social Workers, The North Carolina Substance Abuse Professional Certification Board, North Carolina Psychological Association, The North Carolina Society for Clinical Social Work, and the North Carolina Medical Society in developing required staff competencies.
(8)	The local management entity shall assure that a physician is available at all times to provide backup support to include telephone consultation and face‑to‑face evaluation, if necessary.
SECTION 2.  This act becomes effective July 1, 2003, and expires October 1, 2007."
SECTION 5.  This act becomes effective July 1, 2006.