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 non‑medicaid 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 used by area authorities and county programs to establish a continuum of regional crisis facilities and local crisis services for persons with mental illness, developmental disabilities, and substance abuse addictions.
There is appropriated from the General Fund to the General Assembly, Legislative Services Commission, the sum of four hundred twenty-five thousand dollars ($425,000) for the 2006-2007 fiscal year to be used by the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services to hire one or more consultants to provide technical assistance to Local Management Entities (LMEs) to develop and implement crisis services plans under this section. The consultant shall assist area authorities and county programs and crisis regions to identify local and regional gaps in crisis services, identify options for providing services, implement new services, and maintain transparency and accountability for the use of funds.
The area authorities and county programs will organize themselves into no more than 21 crisis regions based upon the existing Geriatric Specialty team configurations or other approved regions. The funds shall be allocated to each area authority or county programs on a per capita basis. The funds may be used for operational start‑up, capital, or subsidies related to developing a continuum of crisis services. No more than three percent (3%) may be spent for administrative costs. The area authorities and county program within a crisis region shall work together to identify gaps in their ability to provide a continuum of crisis services for all consumers and use the funds appropriated to them to develop and implement a plan to address those needs. At a minimum, the plan must address the development over time of 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, facility‑based crisis, in‑patient crisis and transportation. Options for voluntary admissions to a secured facility must 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 must include at least one option in addition to admission to a State facility.
If all area authorities and county programs in a crisis region determine that a facility‑based crisis center is needed and sustainable on a long term basis, the crisis region shall attempt to secure those services through a community hospital or other community facility first. If all the area authorities and county programs in the crisis region determine the region's crisis needs are being met, the area authorities and county programs may use the funds to meet local crisis service needs. 
Each area authority and county program and each crisis region will be required to utilize the technical assistance of a consultant under contract with the General Assembly to develop and implement its crisis services plan. The consultant shall assist area authorities and county programs and crisis regions to identify local and regional gaps in crisis services, identify options for providing services, implement new services, and maintain transparency and accountability for the use of funds. The crisis region or area authorities and county programs shall submit their crisis services plan to the consultant and to the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (Division) for review and public comment. The crisis regions and area authorities and county programs shall consider the comments prior to submitting a final plan for implementation. Upon submission of a final plan to DHHS, each crisis region, area authority, and county program will receive implementation funds. Funds not expended during the 2006‑2007 fiscal year shall not revert.
Area authorities and county programs and crisis regions must report monthly to the consultant and to the Division regarding the use of the funds, whether there has been a reduction in the use of State psychiatric hospitals for acute admissions, and remaining gaps in local and regional crisis services. The consultant shall report regularly to the General Assembly, the Fiscal Research Division, and the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services regarding each crisis region's and area authorities' and county programs' proposed and actual use of the funds. 
SECTION 1.(b)  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.
SECTION 1.(c)  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 non‑unit cost reimbursement basis.
SECTION 2.  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 3.  This act becomes effective July 1, 2006.  The Fiscal Research Division shall track the allocation and utilization of the funds appropriated under this act.