Regular Session 2023-2024 House Bill 0849 P.N. 1296

PRIOR PRINTER'S NO. 825

PRINTER'S NO. 1296

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

849

Session of

2023

INTRODUCED BY SCHLOSSBERG, BENHAM, BIZZARRO, BRADFORD, CIRESI,

DALEY, T. DAVIS, FRANKEL, FREEMAN, HANBIDGE, HARKINS, HILL-

EVANS, HOHENSTEIN, HOWARD, ISAACSON, KINKEAD, KINSEY,

KRUEGER, MADDEN, MALAGARI, McNEILL, D. MILLER, O'MARA, OTTEN,

PASHINSKI, PISCIOTTANO, SAMUELSON, SANCHEZ, SCOTT,

SHUSTERMAN, STURLA, TOMLINSON, D. WILLIAMS, ABNEY AND

CERRATO, APRIL 10, 2023

AS REPORTED FROM COMMITTEE ON HUMAN SERVICES, HOUSE OF

REPRESENTATIVES, AS AMENDED, MAY 23, 2023

AN ACT

Amending the act of April 9, 1929 (P.L.343, No.176), entitled

"An act relating to the finances of the State government;

providing for cancer control, prevention and research, for

ambulatory surgical center data collection, for the Joint

Underwriting Association, for entertainment business

financial management firms, for private dam financial

assurance and for reinstatement of item vetoes; providing for

the settlement, assessment, collection, and lien of taxes,

bonus, and all other accounts due the Commonwealth, the

collection and recovery of fees and other money or property

due or belonging to the Commonwealth, or any agency thereof,

including escheated property and the proceeds of its sale,

the custody and disbursement or other disposition of funds

and securities belonging to or in the possession of the

Commonwealth, and the settlement of claims against the

Commonwealth, the resettlement of accounts and appeals to the

courts, refunds of moneys erroneously paid to the

Commonwealth, auditing the accounts of the Commonwealth and

all agencies thereof, of all public officers collecting

moneys payable to the Commonwealth, or any agency thereof,

and all receipts of appropriations from the Commonwealth,

authorizing the Commonwealth to issue tax anticipation notes

to defray current expenses, implementing the provisions of

section 7(a) of Article VIII of the Constitution of

Pennsylvania authorizing and restricting the incurring of

certain debt and imposing penalties; affecting every

department, board, commission, and officer of the State

government, every political subdivision of the State, and

certain officers of such subdivisions, every person,

association, and corporation required to pay, assess, or

collect taxes, or to make returns or reports under the laws

imposing taxes for State purposes, or to pay license fees or

other moneys to the Commonwealth, or any agency thereof,

every State depository and every debtor or creditor of the

Commonwealth," in emergency COVID-19 response, providing for

adult mental health program funding; IN 2022-2023 BUDGET

IMPLEMENTATION, REPEALING PROVISIONS RELATING TO DEPARTMENT

OF HUMAN SERVICES; and making appropriations.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The act of April 9, 1929 (P.L.343, No.176), known

as The Fiscal Code, is amended by adding a section to read:

Section 164-C. Adult mental health program funding.

(a) Findings and purpose.--The General Assembly finds and

declares as follows:

(1) The Behavioral Health Commission for Adult Mental

Health established under section 163-C was charged with

making recommendations for the allocation of funding in the

following 10 priority areas:

(i) Delivery of services by telemedicine.

(ii) Behavioral health rates, network adequacy and

mental health payment parity.

(iii) Workforce development and retention.

(iv) Expansion of certified peer support specialist

services and peer-run services.

(v) The development and provision of crisis

services.

(vi) The integration of behavioral health and

substance use disorder treatment.

(vii) Cultural competencies when providing

behavioral health care.

(viii) The impact of social determinants of health

on behavioral health.

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(ix) The intersection of behavioral health and the

criminal justice system.

(x) Establishing an integrated care model that can

deliver timely psychiatric care in a primary care

setting.

(2) The Behavioral Health Commission for Adult Mental

Health determined that intersectionality between the 10

priority areas indicates that investment in one sector will

have impacts in others and recommended that funding awards

should prioritize culturally responsive initiatives that

promote equity in historically under-resourced communities.

(3) The Behavioral Health Commission for Adult Mental

Health recommended categorizing the 10 priority areas in

three overarching categories:

(i) Increasing workforce development programs and

incentives.

( ii) Expanding criminal justice and public safety

programs.

(iii) Expanding mental health services and supports.

(4) In accordance with section 1730-F.1(24), the THE

purpose of this section is to allocate funds based on the

recommendations of the Behavioral Health Commission for Adult

Mental Health to address adult behavioral health needs in the

areas of workforce development programs and incentives,

criminal justice and expanding mental health services and

supports.

(b) Use of money.--From money appropriated for COVID-Relief

- ARPA - Adult Mental Health Programs, the sum of $100,000,000

shall be used for the purposes specified in subsections (c),

(d), (e) and (f).

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( c) Workforce.--The sum of $34,000,000 is to be used for the

purpose of retaining existing behavioral health staff and

providers, incentive programs and opportunities for staff to

develop skills as follows:

(1) The sum of $15,000,000 to the Department of Labor

and Industry to establish a program to award competitive

grants, in consultation with the Department of Human

Services , AND the Department of Health and the Department of

Education , to partnerships of eligible applicants for

training, recruiting and retention strategies for

professionals in behavioral health settings. The following

apply:

(i) Eligible applicants include:

(A) Employers of behavioral health

professionals.

(B) County mental health administrations.

(D) Institutions of higher education, including

community colleges.

(E) School districts.

(F) Area career and technical schools.

(G) Local education providers.

(H) Training providers.

(I) Community-based organizations.

(J) Community health workers, as defined in 42

U.S.C. § 280g-11(k)(1) (relating to grants to promote

positive health behaviors and outcomes).

(E) TRAINING PROVIDERS.

(F) COMMUNITY-BASED ORGANIZATIONS.

(G) EMPLOYERS OF COMMUNITY HEALTH WORKERS, AS

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DEFINED IN 42 U.S.C. § 280G-11(K)(1) (RELATING TO

GRANTS TO PROMOTE POSITIVE HEALTH BEHAVIORS AND

OUTCOMES).

(ii) Grant money may be used to:

(A) Develop, expand or enhance training

programs, including apprenticeships or other earn and

learn models, scholarships, tuition assistance and

paid field placements, including internships,

residencies and fellowships.

(B) Assist with costs relating to supervision,

certifications, tests and other fees.

strategies, including one-time payments and other

recruitment and retention initiatives.

(iii) The Department of Labor and Industry shall

develop grant guidelines, a grant application and a

process to review applications.

(iv) Priority shall be given to grant applications

that support underserved populations and communities and

demonstrate high need for partnerships in behavioral

health settings.

(V) THE DEPARTMENT OF LABOR AND INDUSTRY MAY TAKE A

REASONABLE ADMINISTRATIVE FEE OF NO MORE THAN 5% FOR

DIRECT COSTS ASSOCIATED WITH THE IMPLEMENTATION,

ADMINISTRATION AND SERVICING OF THIS PARAGRAPH. THE FEE

SHALL BE TAKEN FROM THE FUNDING RECEIVED UNDER THIS

PARAGRAPH.

(2) The sum of $12,000,000 to the Pennsylvania Higher

Education Assistance Agency to expand the School-based Mental

Health Internship Grant Program established under section

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1318-B of the act of March 10, 1949 (P.L.30, No.14), known as

the Public School Code of 1949, to include internships,

fellowships, residencies and other paid workforce

opportunities with behavioral health preparation programs and

behavioral health settings as follows:

(i) The Pennsylvania Higher Education Assistance

Agency shall administer the expanded program and, in its

sole discretion, award grants to individuals who submit a

completed application and satisfy eligible criteria.

(ii) The Pennsylvania Higher Education Assistance

Agency shall establish eligible criteria in order for an

individual or program setting to receive a grant under

the expanded program.

(iii) An eligible individual under this paragraph

shall, at a minimum:

(A) Be a Commonwealth resident as defined by the

Pennsylvania Higher Education Assistance Agency.

(B) Be enrolled in an eligible program.

Higher Education Assistance Agency to work in this

Commonwealth for a minimum of three years following

completion of the eligible individual's respective

program.

(iv) Eligible program settings shall be determined

by the Pennsylvania Higher Education Assistance Agency,

in consultation with the Department of Human Services,

and shall include:

(A) Residential and outpatient behavioral health

providers.

(B) Psychiatric hospitals and psychiatric

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practices.

(D) Service providers that contract with county

mental health administrations to deliver behavioral

health services.

(E) Community-based organizations providing

behavioral health services.

(F) Federally Qualified Health Centers.

(G) County jails and State correctional

institutions.

(v) Grant money may be used:

(A) For tuition assistance.

(B) To support paid internships, residency and

fellowship placements.

(D) For equipment, training and technical

assistance to support the eligible individual or

program setting, including to expand service delivery

using telemedicine.

(vi) Priority shall be given to behavioral health

preparation programs and behavioral health settings in

designated medically underserved or health care shortage

areas.

( vii) The Pennsylvania Higher Education Assistance

Agency shall consult with the Department of Human

Services in the implementation of the expanded program

instead of the advisory committee established under

section 1318-B(b)(5) of the Public School Code of 1949.

(viii) The Pennsylvania Higher Education Assistance

Agency may take a reasonable administrative fee of no

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more than 5% for direct costs associated with the

implementation, administration and servicing of this

paragraph. The fee shall be taken from the funding

received under this paragraph.

(3) The sum of $7,000,000 to the Department of Health to

establish or expand a loan repayment program for eligible

applicants serving in COUNTY JAILS, STATE CORRECTIONAL

INSTITUTIONS OR designated medically underserved or health

care shortage areas. The following apply:

(i) The program shall be designed to increase the

number of mental health care practitioners in designated

areas, including activities such as:

(A) Reviewing and updating on a regular basis

the practice sites eligible for the program.

(B) Promoting the recruitment and retention of

mental health care practitioners in COUNTY JAILS,

STATE CORRECTIONAL INSTITUTIONS OR designated

medically underserved or health care shortage areas.

Federal funding to achieve the purposes of this

paragraph.

(ii) An eligible applicant includes an individual

who works in an eligible behavioral health services

setting as defined by the Department of Health and:

(A) h as a medical degree from an accredited

medical school or osteopathic medical college, has

completed an approved residency or fellowship program

in psychiatry, is licensed to practice medicine in

this Commonwealth and is board certified or board

eligible in psychiatry;

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(B) holds a nursing degree from an accredited

nursing program, has completed a training program for

nurse practitioners and holds a license in nursing

and psychiatry or a related mental health field in

this Commonwealth;

physician assistants and holds a license as a

physician assistant in psychiatry or a related mental

health field in this Commonwealth; or

(D) is licensed to practice in this Commonwealth

as a psychologist, licensed clinical social worker,

licensed professional counselor or licensed marriage

and family therapist.

(iii) Eligible behavioral health services settings

as defined by the Department of Health must accept

reimbursement from Medicaid.

( iv) (III) Repayment assistance may not be made for

a loan that is in default at the time of the application

or for a loan being repaid through any other loan

repayment assistance program. Repayment shall be made

directly to the recipient who shall then repay the

financial lending institution.

(v) (IV) A recipient of loan repayment assistance

under this paragraph shall enter into an agreement with

the Department of Health, which shall be considered a

legally binding agreement with the Commonwealth and shall

include the terms of the Department of Health's Primary

Care Loan Repayment Program.

(vi) (V) Loan repayment assistance may be provided

as follows:

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(A) An individual under subparagraph (ii)(A) and

a psychologist under subparagraph (ii)(D) shall be

eligible to receive up to $80,000 in loan repayment

assistance.

(B) An individual, except for a psychologist,

under subparagraph (ii)(B), (C) or (D) shall be

eligible to receive up to $48,000 in loan repayment

assistance.

(VI) THE DEPARTMENT OF HEALTH MAY TAKE A REASONABLE

ADMINISTRATIVE FEE OF NO MORE THAN 5% FOR DIRECT COSTS

ASSOCIATED WITH THE IMPLEMENTATION, ADMINISTRATION AND

SERVICING OF THIS PARAGRAPH. THE FEE SHALL BE TAKEN FROM

THE FUNDING RECEIVED UNDER THIS PARAGRAPH.

(d) Expanding criminal justice and public safety programs.--

The sum of $25,500,000 is to be used for the purpose of

expanding criminal justice and public safety programs as

follows:

(1) T he sum of $13,500,000 to the Pennsylvania

Commission on Crime and Delinquency to establish a program or

programs to award competitive grants to eligible applicants.

The following apply:

(i) Eligible applicants include:

(A) Counties.

(B) Nonprofit and community-based organizations.

(D) Mental health and substance use disorder

providers.

(E) Housing authorities.

(ii) Grant money may be used to:

(A) Provide comprehensive evidence-based mental

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health and substance use disorder treatment and

support services for incarcerated persons or services

for reentrants.

(B) Establish or support existing specialty

courts and services.

first responder crisis intervention training.

(iii) The Pennsylvania Commission on Crime and

Delinquency , in consultation with the Department of Human

Services, shall develop grant guidelines, a grant

application and a process to review applications.

(2) The sum of $7,000,000 to the Pennsylvania Commission

on Crime and Delinquency for prearrest diversion.

( 3) The sum of $5,000,000 to the Department of Human

Services for a one-time CRIMINAL JUSTICE AND PUBLIC SAFETY

payment to each county mental health administration as

follows:

(i) Divide:

(A) the population of a county mental health

administration catchment area under the 2020 Federal

decennial census; by

(B) the total State population.

(ii) Multiply:

(A) t he quotient under subparagraph (i); by

(B) $5,000,000.

(iii) A county mental health administration shall

not receive less than $20,000.

( iv) A county may use money received under this

paragraph:

(A) For comprehensive evidence-based mental

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health and substance use disorder services and

supports for incarcerated persons, services for

reentry, including partnerships with community-based

organizations providing reentry services or supports,

case management and service coordination for

individuals incarcerated in county jails.

(B) To create or expand partnerships with county

jails or local law enforcement.

(v) Each county mental health administration shall

submit a quarterly report accounting for all money

received under this paragraph. The accounting shall:

(A) Be in a form prescribed by the Department of

Human Services.

(B) Include , BUT SHALL NOT BE LIMITED TO, a

listing of all expenditures, the status of all

unspent money and the impact of money spent.

(e) Strengthening and expanding mental health services and

supports.--The sum of $40,000,000 is to be used to ensure the

stability and expansion of mental health services and supports

as follows:

(1) The sum of $ 15,000,000 to the Department of Human

Services to award competitive grants to county-provider

partnerships that support suicide prevention and the crisis

continuum of care through investments in mobile crisis teams,

medical mobile crisis teams, crisis walk-in centers and

crisis stabilization units. The following apply:

(i) The Department of Human Services shall develop a

grant application and a process to review applications.

The process shall give priority to applications that

demonstrate innovative and collaborative partnerships

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between counties or partnerships of counties and other

system partners and providers, including area agencies on

aging, children and youth services, substance use

treatment providers, autism and intellectual and

developmental disabilities service providers, existing

providers of crisis services, including family and peer

advocates, victim services, first responders or criminal

and juvenile justice system leadership.

(ii) (Reserved).

(2) The sum of $10,000,000 to the Department of Human

Services for a third-party contractor to award grants to

support primary care practitioners and primary care practices

in establishing or expanding the use of the collaborative

care model. A third-party contractor selected may take an

administrative fee of no more than 5% for direct costs

associated with the implementation, administration and

servicing of the grants under this paragraph. The following

apply:

(i) Grants under this paragraph shall be awarded to

primary care practitioners and primary care practices to

establish and expand the use of the collaborative care

model and to entities to provide technical assistance to

primary care practitioners and primary care practices on

providing behavioral health integration services through

the collaborative care model or primary care behavioral

health model.

(ii) Primary care practitioners and primary care

practices may collaborate with a larger health system for

the purposes of applying for and implementing grants

under this paragraph.

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(iii) A primary care practitioner or primary care

practice that receives a grant under this paragraph may

use money received under this paragraph for such purposes

as establishing and delivering behavioral health

integration services through the collaborative care model

or primary care behavioral health model and utilizing

telemedicine to deliver behavioral health integration

services.

(iv) For the purposes of this paragraph, the term

"collaborative care model" means the evidence-based,

integrated behavioral health service delivery method

described in 81 Fed. Reg. 220, 80230 (November 15, 2016).

(3) The sum of $8,000,000 shall be used by the

Department of Human Services for a one-time MENTAL HEALTH

SERVICES AND SUPPORT payment to each county mental health

administration as follows:

(i) Divide:

(A) the population of a county mental health

administration catchment area under the 2020 Federal

decennial census; by

( B) the total State population.

(ii) Multiply:

(A) the quotient under subparagraph (i); by

(B) $8,000,000.

(iii) A county mental health administration shall

not receive less than $30,000.

(iv) A county may use money received under this

paragraph to expand behavioral health services and

supports with particular attention to , AT A MINIMUM, ONE

OF THE FOLLOWING :

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(A) The utilization of telemedicine to expand

the delivery of supports and services.

(B) Suicide prevention and crisis intervention.

on behavioral health, including supportive housing.

(v) Each county mental health administration shall

submit a quarterly report accounting for all money

received under this paragraph. The accounting shall:

(A) Be in a form prescribed by the Department of

Human Services.

(B) Include , BUT SHALL NOT BE LIMITED TO, a

listing of all expenditures, the status of all

unspent money and the impact of money spent.

(4) The sum of $6,000,000 to the Department of Drug and

Alcohol Programs to award grants to eligible applicants to

develop and implement peer-led mental health and substance

use disorder services or develop recruitment and retention

programs, including training, for the mental health and

substance abuse peer workforce. The following apply:

(i) Eligible applicants include:

(A) Peer-run organizations.

(B) Crisis intervention service providers.

peer-run organizations.

(D) County mental health administrations.

(ii) The Department of Drug and Alcohol Programs

shall develop grant guidelines, a grant application and a

process to review applications.

(5) The sum of $1,000,000 to the Office of Mental Health

and Substance Abuse Services in the Department of Human

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Services to award competitive grants to qualified providers

to invest in technology and training for behavioral health

telehealth providers. The following apply:

(i) To be eligible for funding UNDER THIS PARAGRAPH ,

an entity must be a provider with a service location in

this Commonwealth and serving clients or patients in this

Commonwealth, of which no less than 51% are Pennsylvania

medical assistance enrolled beneficiaries. The Department

of Human Services may not restrict eligible applicants to

entities with no more than 50 employees across the

provider's entire organization. BASED ON THE NUMBER OF

EMPLOYEES ACROSS THE ENTIRE ORGANIZATION.

(ii) Funding shall be used to implement one or more

of the following activities:

(A) Purchasing equipment for providers,

including computers, monitors, tablets, webcams,

microphones, mobile medical devices for providers,

telemedicine carts and telemedicine kiosks.

(B) Purchasing equipment for service recipients

CLIENTS , including computers, monitors, tablets,

webcams, microphones and other similar equipment.

software or platforms, including telemedicine

software and online patient portals, including setup

fees and telehealth system maintenance.

(D) Support for increased broadband speed.

(E) Purchasing Wi-Fi hotspots.

(F) Purchasing provider training on telehealth

best practices, beyond what is offered by the Office

of Mental Health and Substance Abuse Services in the

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Department of Human Services.

(G) Telehealth technical assistance.

(iii) The Department of Human Services shall develop

grant guidelines, a grant application and a process to

review applications.

(f) Study.--

(1) The sum of $500,000 is to be used by the Department

of Human Services, in coordination with the Department of

Labor and Industry, the Department of Drug and Alcohol

Programs, the Department of Health, the Pennsylvania Higher

Education Assistance Agency, the Department of Education and

the Pennsylvania Commission on Crime and Delinquency, to

study the impact of initiatives supported by the funding

distributed under this section.

(2) No later than June 30, 2026, JUNE 30, 2027, the

Department of Human Services shall issue a report containing

the results of the study under paragraph (1) to the Governor

and the General Assembly.

(3) RECIPIENTS OF THE FUNDING ALLOCATIONS UNDER THIS

SECTION SHALL PROVIDE INFORMATION TO THE DEPARTMENT OF HUMAN

SERVICES AS THE DEPARTMENT DETERMINES NECESSARY TO ADEQUATELY

CONDUCT THE STUDY.

(g) Obligations.--The following apply to a department or

agency under this section:

(1) A payment received under this section shall be

obligated by July 1, 2024, and spent by December 31, 2026.

(2) Entities receiving money under this section shall

comply with any applicable Federal or State law or guidance.

(h) Recoupment.--A department or agency under this section

may recover:

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(1) All or a portion of money disbursed under this

section from any individual or entity that fails to comply

with this section or with Federal or State law or guidance.

(2) Unobligated money after July 1, 2024, which may be

subject to recoupment and reallocation. Money subject to

recoupment shall be reallocated in a manner to ensure that

the money is spent by the Federal deadline for the use of the

money.

SECTION 2. SECTION 1730-F.1(24) OF THE ACT IS REPEALED:

SECTION 1730-F.1. DEPARTMENT OF HUMAN SERVICES.

THE FOLLOWING APPLY TO APPROPRIATIONS FOR THE DEPARTMENT OF

HUMAN SERVICES:

* * *

[(24) OF THE FUNDING APPROPRIATED FOR COVID RELIEF -

ARPA - ADULT MENTAL HEALTH PROGRAMS, NO FUNDING SHALL BE

EXPENDED UNTIL ENABLING LEGISLATION IS ENACTED BY THE GENERAL

ASSEMBLY.]

Section 2 3. This act shall take effect immediately.

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