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Updates: SJ 47 Joint Subcommittee Actions and Recommendations to the 2017 General Assembly Session.

A. SJ 47 Joint Subcommittee Actions and Recommendations to the 2017 General Assembly Session

As noted in the last issue of DMHL, at the October 26, 2016 meeting of the SJ 47 Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century the Subcommittee's Work Groups and members appeared to move closer to adopting a shared vision of a future statewide system of mental health services, while acknowledging the significant obstacles to realizing that vision. Each Work Group chairperson set out recommendations for budget and statutory actions in the 2017 General Assembly session to support a variety of mental health reform measures. They also described ongoing work and goals for the balance of 2017.

At its next meeting, on December 6, the Joint Subcommittee formally considered and approved those Work Group recommendations. Specific bills, resolutions and budget proposals to implement those recommendations have since been drafted and submitted to the General Assembly. Significantly, the members reached a consensus that the implementation of meaningful reform will be a multi-year process, and that it was vital that the Joint Subcommittee continue its operations beyond its current termination date of December 2017 in order to monitor reform efforts and ensure that they are fully implemented.

Below is a summary of the Joint Subcommittee's actions on December 6. (Another summary by Division of Legislative Services staff is available here on the DLS website.) Also included is identification of, and a link to, the bills, resolutions and budget proposals developed as a result of the Joint Subcommittee's actions. Those matters are now pending before the General Assembly.

Work Group #1: System Structure and Financing

1. Adopting and funding a new model for public mental health system services

a. Adopting the STEP-VA model: The Work Group recommended endorsing the goal of the Department of Behavioral Health and Developmental Services for the Commonwealth's public mental health system to provide equal access for individuals throughout the state to ten key services: emergency services; same day access to mental health screening services; outpatient primary care screening and monitoring services; crisis services; outpatient mental health and substance abuse services; psychiatric rehabilitation services; peer support and family support services; mental health services for members of the armed forces and veterans; care coordination services; and case management services, including targeted mental health case management services. (This model, now known as the STEP-VA (System Transformation, Excellence and Performance in Virginia) program, is discussed in more detail in the July 2016 issue of DMHL, with DBHDS Commissioner Barber's explanatory power point available here.)

b. Implementing the STEP-VA model over a period of years, beginning with 2017: Because full implementation of the STEP-VA model involves a major financial investment, and therefore cannot be fully financed in one budget cycle, the Work Group supported full funding by the 2017 General Assembly of two of the ten core services-same day access to mental health screening and timely access to assessment, diagnostic, and treatment services (estimated cost: $1.5 million in FY 2017, $12.3 million in FY 2018, and $17.3 million annually thereafter) and outpatient primary care screening and monitoring services (estimated cost: $3.72 million in FY 2019 and $7.44 million annually thereafter). Along with (and subject to) this funding being provided, the mandated "core" services to be provided by local CSBs under Virginia Code Section 37.2-500 would be expanded to include these services. (Currently, the core services are limited to emergency services, and, "subject to the availability of funds appropriated for them," case management services.)

These two "core" services were recommended for implementation first because they enable individuals to access mental health care in a timely way when they are seeking care. Currently in many jurisdictions people seeking help are given initial appointments that are weeks away, and their untreated conditions may lead to mental health crises or to other life disruptions while they wait to be seen. The goal of same-day access is to help people avoid these crises and disruptions in their lives.

The subsequent expansion of the "core" services to include all ten services identified in the STEP VA program would occur in a later budget cycle, with the dedication of the additional funds needed to implement those services.

Discussion among the Joint Subcommittee members noted some key continuing concerns, including: how to ensure that the nature of these new services is sufficiently defined so that all CSBs are providing the intended "baseline" of services and quality of care; and how to square the "standard services" ideal with the remaining reality that some local CSBs receive far more financial support from their local governments than others and will therefore always be able to provide a richer array of services.

Legislation to implement this: HB 1549 and SB 1005 (identical bills) would expand the set of "core" services set out in Virginia Code Section 37.2-500 that CSBs (and BHAs) are required to provide, with the inclusion and implementation of the first two STEP-VA core services being effective July 1, 2018, and the implementation of the rest of the core services being effective July 1, 2021. The funding for the first implementation is included in the Governor's budget submission to the 2017 General Assembly.

2. Providing DBHDS with access to involuntary commitment records for purposes of research

The Work Group recommended amending Va. Code [section] 37.2-818 to allow transmission of records related to involuntary admission proceedings to the Department of Behavioral Health and Developmental Services (DBHDS) to enable it to maintain statistical archives and conduct research on the consequences and characteristics of such proceedings. The Work Group found that lack of access to this information limited needed research into the effectiveness of the involuntary commitment process.

Legislation to implement this: HB 1551 and SB 1006 (identical bills) would amend Virginia Code Section 37.1-818 by enabling DBHDS to receive such records upon request, with a provision requiring DBHDS to maintain the confidentiality of those records.

3. Directing DBHDS and DMAS to study the use of the Involuntary Mental Health Commitment Fund to also pay for certain voluntary hospitalizations (as part of a larger strategy for reducing the numbers of patients at DBHDS facilities)

The Work Group's report noted a recent agreement between DBHDS and CSBs statewide to implement a number of practices to stabilize and reduce the census in state psychiatric hospitals. While finding this a positive development, the Work Group also saw the need for other actions to address this significant and growing hospital census problem. The Work Group recommended the following:

1. Implementation of the census reduction initiatives adopted by DBHDS and the Community Service Boards;

2. Development of budget requests by DBHDS for FY 2018 to stabilize and maintain state hospital utilization at no more than 90 percent of capacity;

3. Continued study by the Work Group of the statutory, policy, financing, and administrative elements of the current mental health system that are not aligned with the Work Group's strategic and operational objectives; and

4. Study by DBHDS and the Department of Medical Assistance Services (DMAS) of the potential use of the Involuntary Mental Commitment Fund for both involuntary and voluntary temporary detention. (This recommendation was prompted by the Work Group's finding that, in a number of involuntary commitment cases, the individuals in mental health crisis and in need of hospitalization had been willing to consent to hospitalization in a local psychiatric facility but could not be admitted because the person had no (or inadequate) insurance to pay for care. Involuntary commitment became necessary in order for the person to be eligible for funding from the Fund to pay for the needed hospital care.)

Legislation implementing this: HB 1550 and SB 1007 (identical bills), if enacted, would require DBHDS and DMAS to study "the potential use" of the Involuntary Mental Commitment Fund to "fund mental health treatment" in Virginia, including (1) the "potential use" of the funds for voluntary as well as involuntary treatment in a mental health care facility; (2) the "potential benefits" of enabling DBHDS instead of DMAS to administer the funds; and (3) "any other strategies" for improving use of the funds.

4. Expanding telemental health services

The Work Group recommended that the Joint Commission on Health Care (JCHC) be asked to review the telemental health work group's report on telemental health services and develop recommendations for increasing the use of telemental health services. (The significant value of such services, recognized by the Joint Subcommittee, is set out in a presentation from the UVA telemental health program available here.)

Legislation to implement this: HJ 568 and SJ 257 (identical resolutions) would direct the JCHC to "study options for increasing the use of telemental health services in the Commonwealth," and specifically to "study the issues and recommendations set forth in the report of the Telemental Health Work Group of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century."

Work Group #2: Criminal Justice Diversion

1. Require the use of a standardized instrument by jails to screen individuals for mental illness during intake process

The Work Group found that there is not a standard practice among the local or regional jails in Virginia in regard to screening incoming inmates for mental illness and providing services for those found to need them. The Work Group recommended that all jails use the same intake screening instrument (to be identified by DBHDS based on proven effectiveness in identifying persons with mental illness) and to require follow-up services when mental illness is identified.

Legislation to implement this: HB 1783 would modify Virginia Code Section 9.1-102 to require the Department of Criminal Justice Services (DCJS) to work with DBHDS and the State Board of Corrections to identify a "scientifically validated instrument" to screen correctional inmates to identify those needing mental health services and "develop and deliver" a training program for correctional facility staff to administer that instrument. The bill would add Virginia Code Section 53.1-126.1 to require the use of this instrument to screen all prisoners at intake, and to require that anyone identified by the instrument as needing mental health services be seen by a "qualified mental health professional" (also defined in the bill) within 72 hours of screening.

2. Require discharge planning for persons with mental illness leaving jail

The Work Group recommended that DBHDS be directed to develop a plan for providing discharge planning services to persons with mental illness being released from any jail in the Commonwealth. The plan would include cost estimates for implementation, and an estimate of cost savings from preventing re-arrest and/or the provision of emergency services for these individuals following discharge.

Legislation to implement this: HB 1784 and SB 941 (identical bills) would direct the Commissioner of DBHDS, in consultation with relevant stakeholders, to develop and submit such a plan to the Joint Subcommittee (and to the House and Senate Committees for Courts of Justice) by November 1, 2017.

3. Provide authority to the Board of Corrections to investigate in-custody deaths in jails.

In the wake of the 2015 death of Mr. Jamycheal Mitchell in the Hampton Roads Regional Jail, and numerous concerns raised over the adequacy of the investigation into that death conducted by the State Office of the Inspector General, the Work Group recommended that the Board of Corrections be given explicit authority to conduct any investigations into the "in-custody" deaths that occur in local and regional jails.

Legislation to implement this: SB 942 would add Virginia Code Section 53.1-69.1, which would authorize the Board of Corrections to investigate any in-custody jail deaths, determine whether the death involved violation of existing regulations and standards, and take enforcement action and recommend any changes needed to existing regulations and standards. A report setting out all findings, actions and recommendations in response to a death must be completed and submitted to the Governor, the General Assembly, and the DOC.

Work Group #3: Mental Health Crisis and Emergency Services

1. Alternative transportation services for persons in mental health crisis

Finding that programs in Virginia (including a DBHDS-funded pilot project) and in other states have confirmed the safety and efficacy of using transport services other than law enforcement for most transportation of individuals in mental health crisis, the work group recommended that DBHDS be required to develop (in collaboration with other relevant stakeholders) a model for using alternative transportation providers, including the criteria for the certification of such providers and the costs and benefits associated with the implementation of the model. The goal of such a model is to reduce the sense of stigma and coercion experienced by individuals when being transported in a law enforcement vehicle, and to enable law enforcement officers to return to their normal public safety duties.

Legislation to implement this: SB 1221 requires DBHDS and DCJS to develop the model, and to include in that process stakeholders identified in the bill (as well as any others that the agencies wish to add), with the model to be submitted to the SJ 47 Joint Subcommittee and the House and Senate Courts of Justice Committees by October 1, 2017.

2. Facilitating the use of telemental health services (particularly for prescribing controlled substances via telemental health)

Following a report from Sen. Dunnavant and the stakeholder group she formed to determine what actions were needed to enable physicians to prescribe controlled substances via telemental health to the extent allowed under federal law (a number of key conditions have been set by the Drug Enforcement Administration [DEA] for such telemental health prescribing of controlled substances), the Work Group recommended that Virginia's statute governing telemedicine be amended to authorize the prescription of controlled substances via telemedicine to the extent allowable under federal law.

Legislation to implement this: HB 1767 and SB 1009 (identical bills) amend Virginia Code Section 54.1-3303 by stating that a medical practitioner is authorized to prescribe Schedule II-VI medications via telemedicine if the practitioner is in compliance with federal requirements for doing so. The bill also amends Virginia Code Section 54.1-3423 to make clear the authority of the Board of Pharmacy to "register" an entity as a site where controlled substances can be prescribed via telemedicine, with the Board applying certain specified criteria (which meet DEA requirements) in determining whether an entity should be so registered. This clarification will allow Community Services Boards to serve as originating sites for prescribing via telemedicine. (The DEA recognizes such registrations as making the site an authorized site under federal law.)

Work Group #4: Housing

1. Provide additional funding for permanent supportive housing targeted to "frequent users " of high-cost systems.

As described in more detail in an accompanying article in this issue, studies in Virginia and other states have shown conclusively that the stability brought to the lives of persons with serious mental illness through permanent supportive housing significantly reduces their use of costly emergency services. They have fewer emergency room visits, fewer psychiatric hospitalizations, and fewer incidents of arrest and incarceration in local jails. The Work Group recommended that the 2017 budget include an appropriation of $10 million in new funding for permanent supportive housing targeted to address frequent users of high-cost systems, and thereby reduce demand on these overburdened correctional, medical and psychiatric facilities.

Legislation to implement this: A budget amendment has been submitted to add $10,260,000 in additional funding in FY 2018 to expand permanent supportive housing (PSH) for individuals with serious mental illness. In addition to the program funding, $260,000 in general funds are to be provided for three positions to oversee the program. This is identified as Item 315 #2s, and can be found here on the General Assembly website. (A House version of this budget amendment has been submitted as Item 108 #2H, and can be found here.)

2. Develop strategies for housing individuals with serious mental illness

The work group recommended that the Department of Housing and Community Development be required, in consultation with other agencies and stakeholders, to develop and implement strategies for housing individuals with serious mental illness.

Legislation to implement this: A budget amendment has been submitted (without any identified funding) directing the Department of Housing and Community Development (DHCD) to "develop and implement strategies for housing individuals with serious mental illness," and to include a number of identified state agencies and public and private stakeholder groups (including NAMI Virginia, the Virginia Housing Alliance, and the Virginia Sheriffs Association) in the process. An annual report on progress and strategies is to be provided to the Chairmen of the House Appropriations and Senate Finance Committees. This is identified as Item 108 #1s on the Senate side (and can be found here), and as Item 108 #2h on the House side (and can be found here).

3. Financing permanent supportive housing services through Medicaid

Studies and reports cited by the Work Group note that a key to the success of permanent supportive housing is the provision of supportive services to the individuals living in that housing. Many states have recognized a number of these services as mental health treatment services that qualify for Medicaid reimbursement. As a result, the Work Group recommended that DMAS be required, in consultation with other agencies and stakeholders, to research and recommend strategies for financing permanent supportive housing services through Medicaid reimbursement.

Legislation to implement this: A budget amendment has been submitted directing the Department of Medical Assistance Services (DMAS) to "research and recommend strategies for the financing of supportive housing services through Medicaid reimbursement." DMAS is directed to include a number of identified state agencies and public and private stakeholder groups (including NAMI Virginia, the Virginia Housing Alliance, and the Virginia Sheriffs Association) in this process. A report to the Chairmen of the House Appropriations and Senate Finance Committees and the Chairman of the Joint Subcommittee to Study Mental Health Services in the Twenty-First Century is due by September 30, 2017." This is identified as Item 306 #34s on the Senate side (and can be found here), and as Item 306 #34h on the House side (and can be found here).

Extending the Joint Subcommittee

At the Joint Subcommittee's December 6 meeting, Senator Deeds presented a proposal that, after the expiration of the Joint Subcommittee's charge at the end of 2017, the Joint Commission on Health Care be required to oversee the continuing public mental health system reform effort, including making recommendations on issues related to the organization, delivery, financing, management, and oversight of publicly funded behavioral health care services in the Commonwealth. In the ensuing discussion, the Joint Subcommittee members expressed their conviction, based on their work to this point, that the success of a meaningful system-wide reform effort required that the legislators continue to be involved with the process as they are currently constituted and monitor its implementation. The Joint Subcommittee members unanimously approved submitting to the General Assembly a resolution extending the Joint Subcommittee's charge for another two years.

Legislation to implement this: HJ 637 would continue the SJ 47 Joint Subcommittee through December 1, 2019.

B. Other Mental Health Related Bills in the 2017 General Assembly

HB 1480 (Helsel, Boysko, Kory and Peace)--Mental health awareness training for emergency services professionals. Amends Virginia Code Sections 9.1-102, 27-23.11 and 32.1-111.4 to require biennial training for law-enforcement officers, firefighters, and emergency medical services personnel on mental health awareness, with the focus being on recognizing and responding to mental health issues arising among emergency services professionals due to the stresses of their work environments. Section 37.2-312.3 is added to require DBHDS to establish and administer the training program and to also provide certification of similar programs developed by others for use by emergency services professionals. (Senate version: SB 1064 (Deeds))

HB 1508 (Hope)--DBHDS critical incident reports: expanding reporting requirement to include incidents in licensed programs. Currently, the DBHDS commissioner is required by Virginia Code Section 37.2-304(7) to provide to the Director of the Commonwealth's designated protection and advocacy system a written report on critical incidents or deaths of individuals in DBHDS facilities. The amendment would expand the reporting requirement to include any such incidents occurring in either facilities or programs operated or licensed by the Department. Reports are due within 15 working days of the critical incident or death. (Senate version: SB 894 (Favola))

HB 1522 (Leftwich) Death penalty in capital case; proof that defendant had a severe mental illness at the time of the offense precludes death penalty. Adds Virginia Code Section 19.2-264.3:1.4 to provide that a defendant in a capital case who shows by a preponderance of the evidence that he had a severe mental illness (as defined in the bill) at the time of the offense is not subject to the death penalty. The bill establishes procedures for making and processing such a claim, and includes the appointment of expert evaluators.

HB 1548 (Farrell) Advance directives; authorizing certain professionals to activate an advance directive in regard to consenting to admission to a mental health facility. Amends Virginia Code Section 54.1-2983.2 by providing that, where a person has executed an advance directive authorizing an agent to consent to the person's admission to a mental health facility, the determination that the person is incapable of making an informed decision regarding such admission (thereby activating the advance directive and the agent's authority to make that decision) may be made by the attending physician or a psychiatrist, licensed clinical psychologist, licensed psychiatric nurse practitioner, or designee of the local community services board following an in-person. Admission to the facility must still meet the requirements of Section 37.2-805.1. (Senate version: SB 1511 (Deeds))

HB 1567 (Orrock) Advance directives; requiring that persons applying for medical assistance services and social services be informed about advance directives. Amends Sections 32.1-325 and 63.2-501 by requiring that all entities that receive applications and determine eligibility for medical assistance must provide applicants with information about advance directives, including information about the purpose and benefits of advance directives and how the applicant can make one.

HB 1642 (Hope) Naloxone; authorizing possession and administration of Naloxone by trained staff of Department of Forensic Science and Office of the Chief Medical Examiner. Amends Virginia Code Section 54.1-3408(X) by adding to the list of persons who can possess and administer Naloxone "or other opioid antagonist" to a person to reverse a life-threatening overdose (provided that they have completed training and follow protocols developed by the Board of Pharmacy) to include staff of the Department of Forensic Science and the Office of the Chief Medical Examiner. Currently the list is limited to law enforcement officers and firefighters. (Senate version: SB 1031 (Marsden))

HB 1747 (O'Bannon) Advance directives; authorizing persons trained as facilitators to assist individuals in completing advance directives, and allowing "ministerial" assistance. Amends Virginia Code Section 54.1-2982, and adds 54.1-2988.1, to provide that persons who have completed certain training as "facilitators" (either in programs identified in the bill or as approved by the Department of Health) may assist people in completing their advance directive without being engaged in the unauthorized practice of law ("UPL"). The bill also defines "ministerial" assistance that any person can provide to another person in completing an advance directive without violating UPL standards. (Senate version: SB 1242 (Dunnavant))

HB 1750 (O'Bannon) Naloxone; authorizing Commissioner of Health to issue a standing order for the dispensing of Naloxone for overdose reversal. Amends Virginia Code Section 54.1-3408(X) by authorizing the Commissioner of Health to issue a standing order authorizing the dispensing of Naloxone or other opioid antagonist for overdose reversal, in the absence of an oral or written order for a specific patient issued by a prescriber.

HB 1758 (Sullivan) Firearms; temporary removal through court warrant and order from persons upon application and evidence by police or prosecutor that person poses substantial risk of harm to self or others. Adds Virginia Code Section 19.2-60.2 to create a procedure in which a local prosecutor or law-enforcement officer may apply to a circuit court judge for a warrant to remove firearms from a person who poses a substantial risk of injury to himself or others. A hearing must be held within 14 days of execution of the warrant, to determine whether the firearms should be returned or retained by law enforcement. The Court may order retention for up to 180 days, and may also approve transfer of firearms by the person to a third party. A person subject to a warrant or order cannot have a concealed gun permit, purchase a firearm or be employed by a firearms dealer; knowing sale of firearms to such a person would be a class 6 felony. (Senate version: SB 1443 (Barker))

HB 1777 (Stolle) Board of Health regulations on admission of persons to psychiatric facilities; procedures regarding denial of admission. Amends Virginia Code Section 32.1-127 by requiring the Board of Health to develop regulations requiring that each hospital that provides psychiatric services establish a protocol that (i) requires, prior to refusing the admission of a medically stable patient referred to its psychiatric unit, direct verbal communication between the on-call physician in the psychiatric unit and the referring physician and (ii) prohibits on-call physicians or other hospital staff from refusing a request for such direct verbal communication with a referring physician.

HB 1845 (Cox) Local and regional correctional facilities; addiction recovery program to be developed by DCJS. Adds to the powers and duties of DCJS by amending Virginia Code Section 9.1-102 to provide that DCJS, in consultation with DBHDS, will develop a comprehensive "model addiction recovery program" that "may" be administered by local and regional jail officials.

HB 1885 (Hugo) Prescribing controlled substances containing opioids; limits set. Adds Virginia Code Section 54.1-3408.05 to limit prescriptions for opioid containing drugs to a 7-day supply unless the prescriber finds more is needed to (1) stabilize a patient's "acute medical condition," or (2) manage pain from cancer, use in palliative/hospice care, or manage non-cancer-related chronic pain.

HB 1894 (Herring) Law enforcement training; DCJS to train on community "engaged" policing. Amends Virginia Code Section 9.1-102 to provide that DCJS training of local law enforcement include community "engaged" policing, and that DCJS encourage such policing philosophy and practices throughout the state, with an emphasis on transparency, reflecting community values, working effectively with underserved populations and those with special needs, and including strategic hiring and comprehensive officer training. (Senate version: SB 1047 (Lucas))

HB 1898 (Bell) Prescribing controlled substances containing opioids in emergency department setting; limits. Adds Virginia Code Section 54.1-3408.05 to place a 3-day limit on prescriptions for drugs containing opioids for patients treated in emergency department settings, and directs pharmacists to make sure this limit is honored when filling such prescriptions. (Senate version: SB1232 (Dunnavant))

HB 1910 (Yost) Physician assistant as "mental health provider"; duty to take protective action when client threatens harm to a third party. Amends Virginia Code Section 54.1-2400.1 by adding "physician assistant" to the list of professionals who are defined as a "mental health provider" having a duty to take specified precautions to protect third parties when a client threatens harm to such parties. (Senate version: SB 1062 (Deeds))

HB 1918 (Robinson) Establishing an acute psychiatric patient registry. Adds Virginia Code Section 37.2-308.2 to require DBHDS to develop and administer a web-based acute psychiatric patient registry containing de-identified information about individuals who meet the criteria for a temporary detention order (TDO) in order to facilitate the timely identification of a facility for temporary detention and treatment of the individual. Local CSBs are required to update registry information and private providers are required to check the registry and notify the involved CSB or state facility if such provider is able to provide temporary detention and treatment for certain patients. (Senate version: SB 1222 (Barker))

HB 1930 (Carr) Drug overdose; expanding protection for reporting. Amends Virginia Code Section 18.2-251.03 by expanding the affirmative defenses to criminal charges for an individual's unlawful purchase, possession or consumption of alcohol or controlled substances to include situations where another person in good faith seeks or obtains emergency medical attention for the individual because the individual is experiencing an overdose.

HB 1944 (Peace) Regulations from DMAS and DBHDS; giving providers prior notice of and access to proposed regulations and opportunity to comment; analysis of economic impact of proposed regulations to be included in the process. Adds Virginia Code Sections 32.1-321.4 and 37.2-203.1 to require DMAS and DBHDS to give affected providers certain notice of and opportunity to review and comment on proposed regulations, to have the Department of Planning and Budget conduct an economic impact analysis, and allow providers a period of time to come into compliance with finalized regulations. The bill also amends Virginia Code Section 2.2-4007.04 by allowing providers to submit comments to the Department of Planning and Budget regarding the economic impact of proposed DMAS and DBHDS regulations.

HB 1948 (Peace) Drug possession convictions; "recovery community organization" included as treatment option in court sentencing disposition. Amends various sections of Title 18.2 by providing that, if the Court determines that any part of sentencing or deferred sentencing is to include completion of a substance abuse treatment program, the treatment options from which the Court may choose shall include a "recovery community organization," defined as "a nonprofit organization composed of and governed by representatives of local communities of addiction recovery that offers peer recovery support services for persons with substance abuse and is accredited by the Council on Accreditation of Peer Recovery Support Services."

HB 1975 (Yost) Temporary detention pending involuntary commitment hearing; setting a minimum time period of detention. Amends Virginia Code Sections 19.2-169.6 and 19.2-182.9 by providing that, when an inmate in a jail or an acquittee on conditional release is psychiatrically hospitalized under a temporary detention order (TDO), the involuntary commitment hearing for that person shall be heard "no sooner than" 23 hours after the execution of the TDO," and also amends Sections 37.2-809 and 37.2-814 by providing that individuals hospitalized under a TDO shall be held for a duration pending the involuntary commitment hearing that is sufficient not only for "completion of the examination required by [section] 37.2-815" and "preparation of the preadmission screening report required by [section] 37.2-816" (as currently required by law) but also for the " provision of mental health treatment for up to 24 hours after admission to the facility of temporary detention, as determined by the treating physician at such facility to be reasonably necessary." (The maximum TDO period remains 72 hours, with specified exceptions.)

HB 1996 (Hope) Defendants ordered restored to competency in hospital setting; 10 day limit for transfer to hospital for competency restoration. Amends Virginia Code Section 19.2-169.9 to require that, when a defendant is found by a Court to be incompetent to stand trial for a crime and is ordered to receive treatment in a hospital to restore competency, the defendant must be transferred to the hospital as soon as practicable, but no later than 10 days from the issuance of the order.

HB 1997 (Hope) Misdemeanor arrest without a warrant; officer's option to take person to crisis stabilization unit instead of magistrate if person appears mentally ill. Amends Virginia Code Section 19.2-82 by providing that an officer who arrests a person without a warrant for a misdemeanor and believes that the person has a mental illness may, in lieu of bringing such person before a magistrate, transport the person to a crisis stabilization unit or similar facility, and issue a summons instead. (The chief judge of the Circuit Court must have approved the facility for this purpose.)

HB 2042 (Murphy) Suicide prevention; continuing education requirements for health care providers. Amends various sections of Title 54.1 to require the Board of Health Care Professions to establish regulations requiring continuing education for health care providers on suicide assessment, treatment, and management.

HB 2059 (Watts) Drug Treatment Court; expanding offenders who are eligible to participate in Drug Treatment Court. Amends Virginia Code Section 18.2-254.1 (The Drug Treatment Court Act) to eliminate the current restriction that makes persons convicted of certain violent felonies within the preceding 10 years ineligible to participate in a drug treatment court. (However, persons convicted of felony "acts of violence" (i.e, offenses that result in life imprisonment upon conviction of a third offense) within the preceding 10 years remain ineligible to participate in a drug treatment court.) (Senate version: SB 1227(Barker))

HB 2095 (Price) Creation of categories "peer recovery specialist" and "qualified mental health professional" as professional positions registered by the Board of Counseling. Amends various sections of Title 37.2 and 54.1 by creating the professional categories of "peer recovery specialist" and "qualified mental health professional," the qualifications, education, and experience for which will be set by the Board of Behavioral Health and Developmental Services, for registration by the Board of Counseling. (Senate version: SB 1020 (Barker))

HB 2109 (Kory) Service dogs for persons with disabilities; expansion of approved activities for service dogs. Amends Virginia Code Section 51.5-40.1 by deleting current language stating that the provision of "emotional support, well-being, comfort, or companionship" is not part of the definition of "service dog," and inserting language stating that "providing therapeutic contact to help with depression, anxiety, or certain phobias, or to improve physical or cognitive functioning; and providing emotional support, well-being, comfort, or companionship" are activities that are included in the definition of "service dog."

HB 2161 (Pillion) Education of health care professionals on prescribing opioids; task force. Directs the Secretary of Health and Human Resources to convene a workgroup with a variety of stakeholders, including DBHDS, the State Council of Higher Education and representatives from each medical, dental, pharmacy and nursing school, to develop standards and curricula for training health care providers in the safe and appropriate use of opioids to treat pain while minimizing the risk of addiction and substance abuse. Requires a report on progress to the Governor and the General Assembly by December 1, 2017. (Senate version: SB1179 (Chafin))

HB 2163 (Pillion) Prescription of buprenorphine without naloxone; limitation. Adds Virginia Code Section 54.1-3408.4 to provide that prescriptions for buprenorphine mono or products containing buprenorphine without naloxone shall be issued only for a patient who is pregnant. (Senate version: SB 1178 (Chafin))

HB 2165 (Pillion) Opiate prescriptions; requiring that prescriptions be solely electronic by 2020. Amends sections of Title 54.1 of the Virginia Code Section to require that a prescription for any controlled substance containing an opiate must be issued as an electronic prescription and prohibits a pharmacist from dispensing a controlled substance that contains an opiate unless the prescription is issued as an electronic prescription, beginning July 1, 2020. The bill defines "electronic" and requires the Secretary of Health and Human Resources to convene a work group to review actions necessary for the implementation of the bill and report on the work group's progress to the Chairmen of the House Committee on Health, Welfare and Institutions and the Senate Committee on Education and Health by November 1, 2017, with a final report due by November 1, 2018. (Senate version: SB 1230 (Dunnavant))

HB 2183 (Yost) Medicaid; providing for suspension instead of termination of Medicaid eligibility for persons who are incarcerated more than 30 days. Amends Virginia Code Section 32.1-325 by directing the State Board of Health to include in its state Medicaid Plan a provision for a person's Medicaid eligibility to be suspended, instead of terminated, in the event of incarceration for over 30 days, and to ensure that the person's time incarcerated is not included in determining the date by which the person must recertify eligibility for medical insurance.

HB 2184 (Yost) Psychiatric hospitalization of inmates; ensuring required evaluations are performed. Amends Virginia Code Section 19.2-169.6 to require that the person having custody of an inmate ensure that the inmate receives any evaluation or assessment that is required to be considered in a hearing related to inpatient psychiatric hospital admission.

HB 2258 (Filler-Corn) Suicide awareness and prevention; directive for comprehensive statewide initiative. Directs the Secretaries of Health and Human Resources and Public Safety to convene a task force to develop a comprehensive campaign to raise public awareness of suicide and increase suicide prevention education in multiple venues across the state. A website with resources would be developed, and a report to the Governor and the General Assembly would be made by December 1, 2017.

HJ 597 (Marshall) Heroin use in the Commonwealth; JCHC to study. Directs the JCHC (Joint Commission on Health Care) to study heroin use in the Commonwealth, including rates of use, pathways that lead individuals to use, possible education and prevention strategies, and heroin overdose prevention initiatives, including the use of naloxone to prevent heroin overdoses. Requires annual reports for the two year project to the General Assembly.

HJ 616 (O'Bannon) Health care quality in jails; JCHC to study. Citing the decentralized, highly variable and inconsistent quality of care among the state's correctional facilities, the bill directs the JCHC (Joint Commission on Health Care) to (i) review the requirements for delivery of health care services in jails and prisons; (ii) review the oversight of health care service delivery in jails and prisons, including the process for the development and implementation of performance measures and oversight and enforcement of contracts for the delivery of health care services in jails and prisons; (iii) evaluate the current quality of health care services delivered in jails and prisons; and (iv) develop recommendations for improving the quality of health care services delivered in jails and prisons in the Commonwealth.

HJ 695 Sentencing of drug offenders; JLARC to study effectiveness of approaches. Noting the high and continuing rate of drug abuse and drug overdose-related deaths, the frequent association of drug abuse with a mental health condition, and the development of evidence-based alternatives to prosecution, conviction and incarceration for addressing such use, the bill directs JLARC (the Joint Legislative Audit and Review Commission) to study and report on the efficiency and effectiveness of Virginia courts' sentencing of Schedule I and II drug offenders. Requires reports at the end of 2017 and 2018.

SB 797 (McDougle) Competency to stand trial; court discretion to order additional evaluation. Amends Virginia Code Section 19.2-169.1 by providing that, after the initial competency evaluation report on a defendant is received but before the court makes a determination of the defendant's competency to stand trial, the court, on its own motion or that of either party, may order an additional evaluation and report of the defendant's competency.

SB 811(Favola) DCJS training of law enforcement; inclusion of de-escalation training. Amends Virginia Code Section 9.1-102 by adding to the powers and duties of DCJS to include the establishment of compulsory training for law enforcement personnel that ensures training in "de-escalation techniques."

SB 848 (Wexton) Naloxone; authorizing more individuals to administer naloxone for purposes of opioid overdose reversal. Amends Virginia Code Sections 8.01-225 and 54.1-3408 to allow a person who is authorized by DBHDS "to train individuals on the administration of naloxone for use in opioid overdose reversal and who is acting on behalf of an organization that provides substance abuse treatment services to individuals at risk of experiencing opioid overdose or training in the administration of naloxone for overdose reversal and that has obtained a controlled substances registration from the Board of Pharmacy pursuant to [section] 54.1-3423 to dispense naloxone to a person who has completed a training program on the administration of naloxone for opioid overdose reversal, provided that such dispensing is (i) pursuant to a standing order issued by a prescriber,(ii) in accordance with protocols developed by the Board of Pharmacy in consultation with the Board of Medicine and the Department of Health, and (iii) without charge or compensation". Individuals receiving naloxone as provided for by the bill may possess the drug and administer it to a person who is believed to be experiencing or about to experience a life-threatening opioid overdose. A person who dispenses naloxone as provided for by the bill is immune from civil liability for ordinary negligence for acts or omissions from the rendering of naloxone treatment if the person acts in good faith.

SB 895 (Marsden) Petition for psychiatric hospitalization of inmate of local correctional facility; removing the current requirement that the inmate cannot currently be found to be incompetent to stand trial. Amends Virginia Code Section 19.2-169.6 by removing existing language stating that, for psychiatric hospitalization of a local correctional inmate to be sought under Section 19.2-169.6, the inmate must be a person who is "not subject to the provisions of Section 19.2-169.2", which address the disposition for a defendant who has been found by a court to be incompetent to stand trial.

SB 933 (Favola) DCJS training standards for jail officers; inclusion of mental health first aid. Amends Virginia Code Section 9.1-102 by expanding the powers and duties of DCJS to include "annual training in mental health first aid" as part of the compulsory training standards for local deputy sheriffs and jail officers.

SB 975 (Lucas) CSBs and regional jails; responsibility for psychiatric hospital preadmission screening for jail inmates from CSB's jurisdiction. Amends Virginia Code Section 37.2-505 by providing that CSBs must provide psychiatric hospital pre-admission screening services for regional jail inmates who were "convicted in the county or city served by" the CSB, unless the CSBs in the region served by the jail agree to a different arrangement.

SB 1078 (Edwards) DBHDS; Catawba State Hospital expansion. Directs DBHDS to develop a comprehensive plan to expand Catawba Hospital to include a step-down facility of 40 or more beds for individuals who no longer require acute care. Plan completion and a report to the General Assembly would be due by November 1, 2017.

SB 1180 (Chafin) Prescribing of opioids and buprenorphine; Boards of Dentistry and Medicine to adopt regulations. Adds Virginia Code Sections 54.1-2708.4 and 54.1-2928.2 to require the Boards of Dentistry and Medicine to adopt regulations for the prescribing of opioids and products containing buprenorphine. The bill contains an emergency clause.

SB 1233 (Chafin) Temporary detention orders (TDOs) for psychiatric hospitalization; authorizing certain hospital emergency department providers to perform evaluation for issuance of TDOs in lieu of CSB designee if designee is not available. Amends Virginia Code Sections 37.2-804.2 and 37.2-808 through 37.2-810 by enabling emergency physicians and psychiatrists and other named medical professionals to become "certified evaluators" through training provided by the Department of Behavioral Health and Developmental Services. These "certified evaluators" would be authorized to perform the evaluations of individuals that are required for a Temporary Detention Order (TDO), placing such individuals in a mental health treatment facility, in those cases where the local Community Services Board (CSB) designee who normally performs these evaluations "is not available to perform the evaluation within two hours of receipt of notification that an evaluation is required." The local CSB retains full responsibility for finding an available mental health facility for placement of individuals found by a "certified evaluator" to meet the criteria for a TDO, and to communicate with local and state mental health facilities regarding placement of those individuals.
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Title Annotation:Virginia
Publication:Developments in Mental Health Law
Date:Dec 22, 2016
Previous Article:Case law developments.
Next Article:The case for permanent supportive housing for persons with serious mental illness: Improved lives, reduced costs, and compliance with federal law.

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