AB201A - Revises provisions relating to planning for the provision of behavioral health care. (BDR 39-325)

EXEMPT (Reprinted with amendments adopted on June 4, 2023) SECOND REPRINT A.B. 201 - *AB201_R2* ASSEMBLY BILL NO. 201–COMMITTEE ON HEALTH AND HUMAN SERVICES (ON BEHALF OF THE JOINT INTERIM STANDING COMMITTEE ON HEALTH AND HUMAN SERVICES) FEBRUARY 20, 2023 ____________ Referred to Committee on Health and Human Services SUMMARY—Revises provisions relating to planning for the provision of behavioral health care. (BDR 39-325) FISCAL NOTE: Effect on Local Government: May have Fiscal Impact. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to behavioral health; requiring the Department of Health and Human Services to provide certain oversight and make certain recommendations concerning the children’s behavioral health system of care; adding certain members to the subcommittee on the mental health of children of the Commission on Behavioral Health; prescribing certain duties of a regional behavioral health policy board; requiring a mental health consortium to submit certain documents to the Administrator of the Division of Child and Family Services of the Department; clarifying the authority of the State Board of Health to require the licensing of certain facilities; requiring the Legislative Committee on Senior Citizens, Veterans and Adults With Special Needs to conduct a study of the feasibility of formulating and operating a comprehensive state plan to provide behavioral health services; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires: (1) the Division of Public and Behavioral Health of the 1 Department of Health and Human Services to perform certain duties relating to the 2 provision of behavioral health services in this State; and (2) the Division of Child 3 and Family Services of the Department to administer provisions governing mental 4 health services for children. (NRS 433.331-433.374, chapter 433B of NRS) 5 – 2 – - *AB201_R2* Section 2 of this bill requires the Department to: (1) track the spending of federal 6 and state money on the children’s behavioral health system of care, which consists 7 of certain behavioral health services for children and their families; (2) quantify and 8 track the costs avoided through such expenditures; and (3) perform certain duties to 9 provide oversight for and make recommendations concerning the reinvestment of 10 the money saved through such avoided costs in the children’s behavioral health 11 system of care. 12 Existing law establishes a regional behavioral health policy board for each of 13 the five behavioral health regions of this State. (NRS 433.428, 433.429) Existing 14 law requires each regional behavioral health policy board to: (1) advise the 15 Department, the Division of Public and Behavioral Health and the Commission on 16 Behavioral Health regarding certain matters relating to behavioral health in the 17 region; and (2) submit an annual report to the Commission concerning the 18 behavioral health needs of the region and certain duties of the policy board. (NRS 19 433.4295) Section 8 of this bill additionally requires each regional behavioral 20 health policy board to advise the Division of Child and Family Services regarding 21 behavioral health for children in the region over which the policy board has 22 jurisdiction. Section 8 also requires a regional behavioral health policy board to 23 additionally submit the annual report to the Division of Public and Behavioral 24 Health and the Division of Child and Family Services. 25 Existing law establishes a mental health consortium for each county whose 26 population is 100,000 or more (currently Clark and Washoe Counties) and another 27 behavioral health consortium for the jurisdiction consisting of all other counties in 28 this State. (NRS 433B.333) 29 Existing law requires each mental health consortium to: (1) prepare and submit 30 to the Director of the Department a long-term strategic plan for the provision of 31 mental health services to children with emotional disturbance in the jurisdiction of 32 the consortium; and (2) annually submit to the Director of the Department and the 33 Commission certain reports relating to the long-term strategic plan. (NRS 34 433B.335) Section 11 of this bill requires each mental health consortium to submit 35 the long-term strategic plan and the annual reports to the Administrator of the 36 Division of Child and Family Services. 37 Existing law requires the Commission to appoint a subcommittee on the mental 38 health of children to review each long-term strategic plan submitted by a mental 39 health consortium that represents a particular region. (NRS 433.317) Section 6 of 40 this bill requires that subcommittee to include two members recommended by and 41 upon agreement of the mental health consortia. 42 Existing law: (1) requires a medical facility or facility for the dependent to 43 obtain a license from the Division of Public and Behavioral Health; and (2) 44 authorizes the State Board of Health to adopt regulations requiring the licensing of 45 other types of facilities that provide any type of medical care or treatment. (NRS 46 449.030, 449.0303) Section 12.8 of this bill clarifies that the authority of the State 47 Board to require such licensing includes the authority to require the licensing of 48 facilities that provide behavioral health care or treatment. 49 Existing law requires the Division of Public and Behavioral Health to formulate 50 and operate a comprehensive state plan for programs for alcohol or other substance 51 use disorders. (NRS 458.025) Section 13.5 of this bill requires the Legislative 52 Committee on Senior Citizens, Veterans and Adults With Special Needs to study, 53 during the 2023-2024 interim, the feasibility of formulating and operating a similar 54 comprehensive state plan for the provision of behavioral health services in this 55 State. 56 – 3 – - *AB201_R2* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 433 of NRS is hereby amended by adding 1 thereto the provisions set forth as sections 2 and 3 of this act. 2 Sec. 2. 1. The Department shall: 3 (a) Track the spending of federal and state money on the 4 children’s behavioral health system of care; 5 (b) Quantify and track the costs avoided through the 6 expenditures described in paragraph (a) over time; 7 (c) Solicit, compile and analyze information and hold public 8 hearings concerning: 9 (1) The use of federal and state money spent on the 10 children’s behavioral health system of care; and 11 (2) Ways to reinvest the money saved through the avoided 12 costs quantified pursuant to paragraph (b) in the children’s 13 behavioral health system of care in a manner that addresses the 14 behavioral health needs of children in this State and reduces the 15 involvement of such children in the child welfare and juvenile 16 justice systems; 17 (d) On or before June 30 of every even-numbered year, present 18 at a meeting of the Joint Interim Standing Committee on Health 19 and Human Services concerning: 20 (1) The costs that are projected to be avoided through the 21 expenditure of federal and state money on the children’s 22 behavioral health system of care during the immediately following 23 2 years; and 24 (2) Recommendations for the reinvestment of such avoided 25 costs in accordance with subparagraph (2) of paragraph (c); and 26 (e) On or before December 31 of every even-numbered year, 27 submit a report of the information described in paragraph (d) to 28 the Governor and the Director of the Legislative Counsel Bureau 29 for transmittal to the Senate Standing Committee on Finance and 30 the Assembly Standing Committee on Ways and Means at the 31 beginning of the next regular session of the Legislature. 32 2. For the purposes of this section, the children’s behavioral 33 health system of care consists of: 34 (a) Respite care for families and caregivers; 35 (b) Community-based and in-home behavioral health services 36 for children; 37 (c) Services for children in a behavioral health crisis, 38 including, without limitation, mobile crisis services and services 39 for in-home stabilization; 40 – 4 – - *AB201_R2* (d) Services to promote the coordination of behavioral health 1 care between families and providers, including, without limitation, 2 high fidelity wraparound; 3 (e) Family-to-family peer support services; 4 (f) Specialty services for children with an emotional 5 disturbance and dual diagnoses; 6 (g) Behavioral health services identified in the state plan for 7 foster care and adoption assistance established pursuant to 42 8 U.S.C. § 671; and 9 (h) Any other services prescribed by regulation of the Division 10 of Child and Family Services of the Department. 11 3. As used in this section: 12 (a) “Child with an emotional disturbance” has the meaning 13 ascribed to it in NRS 433B.045. 14 (b) “High fidelity wraparound” means an evidence-based, 15 structured and team-oriented process for developing and 16 implementing a plan to meet all of the behavioral health needs of 17 a child with complex behavioral health issues in collaboration 18 with the family of the child. 19 Sec. 3. (Deleted by amendment.) 20 Sec. 4. (Deleted by amendment.) 21 Sec. 5. (Deleted by amendment.) 22 Sec. 6. NRS 433.317 is hereby amended to read as follows: 23 433.317 1. The Commission shall appoint a subcommittee on 24 the mental health of children to review the findings and 25 recommendations of each mental health consortium submitted 26 pursuant to NRS 433B.335 and to create a statewide plan for the 27 provision of mental health services to children. The members of the 28 subcommittee must include, without limitation, two members 29 recommended by and upon agreement of the mental health 30 consortia established pursuant to NRS 433B.333. 31 2. The members of the subcommittee appointed pursuant to 32 this section serve at the pleasure of the Commission. The members 33 serve without compensation, except that each member is entitled, 34 while engaged in the business of the subcommittee, to the per diem 35 allowance and travel expenses provided for state officers and 36 employees generally if funding is available for this purpose. 37 Sec. 7. (Deleted by amendment.) 38 Sec. 8. NRS 433.4295 is hereby amended to read as follows: 39 433.4295 1. Each policy board shall: 40 (a) Advise the Department, the Division , the Division of Child 41 and Family Services and the Commission , as appropriate, 42 regarding: 43 (1) The behavioral health needs of adults and children in the 44 behavioral health region; 45 – 5 – - *AB201_R2* (2) Any progress, problems or proposed plans relating to the 1 provision of behavioral health services and methods to improve the 2 provision of behavioral health services in the behavioral health 3 region; 4 (3) Identified gaps in the behavioral health services which 5 are available in the behavioral health region and any 6 recommendations or service enhancements to address those gaps; 7 (4) Any federal, state or local law or regulation that relates to 8 behavioral health which it determines is redundant, conflicts with 9 other laws or is obsolete and any recommendation to address any 10 such redundant, conflicting or obsolete law or regulation; and 11 (5) Priorities for allocating money to support and develop 12 behavioral health services in the behavioral health region. 13 (b) Promote improvements in the delivery of behavioral health 14 services in the behavioral health region. 15 (c) Coordinate and exchange information with the other policy 16 boards to provide unified and coordinated recommendations to the 17 Department, the Division , the Division of Child and Family 18 Services and the Commission regarding behavioral health services 19 in the behavioral health region. 20 (d) Review the collection and reporting standards of behavioral 21 health data to determine standards for such data collection and 22 reporting processes. 23 (e) To the extent feasible, establish an organized, sustainable 24 and accurate electronic repository of data and information 25 concerning behavioral health and behavioral health services in the 26 behavioral health region that is accessible to members of the public 27 on an Internet website maintained by the policy board. A policy 28 board may collaborate with an existing community-based 29 organization to establish the repository. 30 (f) To the extent feasible, track and compile data concerning 31 persons placed on a mental health crisis hold pursuant to NRS 32 433A.160, persons admitted to mental health facilities and hospitals 33 under an emergency admission pursuant to NRS 433A.162, persons 34 admitted to mental health facilities under an involuntary court- 35 ordered admission pursuant to NRS 433A.200 to 433A.330, 36 inclusive, and persons ordered to receive assisted outpatient 37 treatment pursuant to NRS 433A.335 to 433A.345, inclusive, in the 38 behavioral health region, including, without limitation: 39 (1) The outcomes of treatment provided to such persons; and 40 (2) Measures taken upon and after the release of such 41 persons to address behavioral health issues and prevent future 42 mental health crisis holds and admissions. 43 (g) If a data dashboard is established pursuant to NRS 439.245, 44 use the data dashboard to review access by different groups and 45 – 6 – - *AB201_R2* populations in this State to behavioral health services provided 1 through telehealth, as defined in NRS 629.515, and evaluate policies 2 to make such access more equitable. 3 (h) Identify and coordinate with other entities in the behavioral 4 health region and this State that address issues relating to behavioral 5 health to increase awareness of such issues and avoid duplication of 6 efforts. 7 (i) In coordination with existing entities in this State that address 8 issues relating to behavioral health services, submit an annual report 9 to the Commission , the Division and the Division of Child and 10 Family Services which includes, without limitation: 11 (1) The specific behavioral health needs of the behavioral 12 health region; 13 (2) A description of the methods used by the poli [Text truncated for display. 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