October 5, 2023 - Introduced by Representatives Moses, Summerfield, Callahan, C. Anderson, Brooks, Dittrich, Donovan, Edming, Green, Gundrum, Jacobson, Kitchens, Krug, Maxey, Murphy, Mursau, Novak, O’Connor, Petryk, Rozar, Shankland, Spiros, Tranel, Zimmerman and Sapik, cosponsored by Senators Marklein, James, Ballweg, Cabral-Guevara, Felzkowski, Spreitzer, Testin, Tomczyk and Quinn. Referred to Committee on Mental Health and Substance Abuse Prevention.

This bill requires the Department of Health Services to establish a certification process for crisis urgent care and observation facilities and a grant program to award grants to develop and support these facilities. Under the bill, a crisis urgent care and observation facility is a treatment facility that admits an individual to prevent, de-escalate, or treat the individual’s mental health or substance use disorder and includes the necessary structure and staff to support the individual’s needs relating to the mental health or substance use disorder. The bill provides that no person may operate a crisis urgent care and observation facility without a certification from DHS. Under the bill, a certified crisis urgent care and observation facility is not regulated as a hospital, except to the extent the facility is otherwise required due to the facility’s licensure or certification for other services or purposes. The bill provides that the provisions of the bill may not be construed to prohibit, limit, or otherwise interfere with services provided by a county or a hospital or other facility that are provided consistent with the facility’s existing licensure or certification, whether the facility is publicly or privately funded.

The bill provides that DHS may certify crisis urgent care and observation facilities that demonstrate the ability to do certain things, including 1) accept referrals for crisis services for adults, and, if applicable, for youth, including involuntary patients under emergency detention, walk-ins, and individuals brought by law enforcement, emergency medical responders or emergency medical services practitioners, or county crisis personnel; 2) abstain from having a requirement for medical clearance before admission assessment; 3) provide assessments for physical health, substance use disorder, and mental health; 4) provide screening for suicide and violence risk; 5) provide medication management and therapeutic counseling; 6) provide coordination of services for basic needs; 7) provide for the safety and security of both the staff and the patients; 8) have adequate staffing 24 hours a day, 7 days a week, including through use of telehealth, with a multidisciplinary team, including, as needed, psychiatrists or psychiatric nurse practitioners, nurses, licensed clinicians capable of completing assessments, peers with lived experience, and other appropriate staff; 9) allow for voluntary and involuntary treatment of individuals in crisis as a means to avoid unnecessary placement of those individuals in hospital inpatient beds and allow for an effective conversion to voluntary stabilization when warranted in the same setting; and 10) contribute, from one or more nonstate, federal, or third-party sources, an amount, as determined by DHS, in addition to any grant awarded by DHS under the bill. The bill requires that DHS must provide the Joint Committee on Finance with certain information and obtain approval of that committee before granting certification to a crisis urgent care and observation facility. The bill also requires DHS to provide an annual report to the Joint Committee on Finance regarding the facilities.

Under the bill, a certified crisis urgent care and observation facility must accept adult individuals for emergency detention, and may accept youths for emergency detention. The bill provides that a certified crisis urgent care and observation facility may accept individuals for services including voluntary stabilization; observation and treatment, including for assessments for mental health or substance use disorder; screening for suicide and violence risk; and medication management and therapeutic counseling.

The bill provides that a certified crisis urgent care and observation facility must coordinate to the fullest extent possible with any facility established or operated with funding received from settlement proceeds from the opiate litigation, which under current law refers to the litigation in In re: National Prescription Opiate Litigation, Case No.: MDL 2804 or any proceeding filed in a circuit court in this state containing allegations and seeking relief that is substantially similar to allegations contained and relief sought in that matter. The bill also requires that DHS promulgate rules establishing policies that encourage awareness of and communication and coordination between certified crisis urgent care and observation facilities and other facilities that provide similar services.

The bill requires DHS, in accordance with existing requirements to obtain approval from the Joint Committee on Finance, to request any necessary federal approval by seeking either a waiver, specifically, what is known as a 1115 waiver, or a Medical Assistance state plan amendment to add services provided by a crisis urgent care and observation facility as a type of crisis intervention service reimbursable under the Medical Assistance program. If DHS determines a state plan amendment is appropriate, DHS must follow the procedures for review by the Joint Committee on Finance, regardless of whether the amendment is expected to have a fiscal effect of $7,500,000 or more. Under the bill, if federal approval is either unnecessary or is necessary and is granted, DHS may provide reimbursement for these services.

AB467,,111149.45 (41) (b) If a county elects to become certified as a provider of crisis intervention services under par. (a) 2., the county may provide crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

AB467,,151549.45 (41) (d) The department shall, in accordance with all procedures set forth under s. 20.940, request a waiver under 42 USC 1315 or submit a Medical Assistance state plan amendment to the federal department of health and human services to obtain any necessary federal approval required to provide reimbursement to crisis urgent care and observation facilities certified under s. 51.036 for crisis intervention services under this subsection. If the department determines submission of a state plan amendment is appropriate, the department shall, notwithstanding whether the expected fiscal effect of the amendment is $7,500,000 or more, submit the amendment to the joint committee on finance for review in accordance with the procedures under s. 49.45 (2t). If federal approval is granted or no federal approval is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15. If federal approval is necessary but is not granted, the department may not provide reimbursement for crisis intervention services provided by crisis urgent care and observation facilities.

AB467,,1818(a) “Crisis” means a situation caused by an individual’s apparent mental or substance use disorder that results in a high level of stress or anxiety for the individual, persons providing care for the individual, or the public and that is not resolved by the available coping methods of the individual or by the efforts of those providing ordinary care or support for the individual.