PRINTER'S NO. 825
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 AND D. WILLIAMS, APRIL 10, 2023
REFERRED TO COMMITTEE ON HUMAN SERVICES, APRIL 10, 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
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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; 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.
(ix) The intersection of behavioral health and the
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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 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).
( c) Workforce.--The sum of $34,000,000 is to be used for the
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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, 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.
(C) Local workforce development boards.
(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).
(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
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paid field placements, including internships,
residencies and fellowships.
(B) Assist with costs relating to supervision,
certifications, tests and other fees.
(C) Develop recruitment and retention
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.
(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
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.
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(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.
(C) Enter into a contract with the Pennsylvania
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
practices.
(C) County mental health administrations.
(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
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fellowship placements.
(C) For supervision fees and training expenses.
(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
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 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.
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(B) Promoting the recruitment and retention of
mental health care practitioners in designated
medically underserved or health care shortage areas.
(C) To the extent possible, maximizing the
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;
(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;
(C) has graduated from an accredited program for
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
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reimbursement from Medicaid.
( iv) 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) 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) Loan repayment assistance may be provided as
follows:
(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.
(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.
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The following apply:
(i) Eligible applicants include:
(A) Counties.
(B) Nonprofit and community-based organizations.
(C) County reentry coalitions.
(D) Mental health and substance use disorder
providers.
(E) Housing authorities.
(ii) Grant money may be used to:
(A) Provide comprehensive evidence-based mental
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.
(C) Create or expand co-responder models or
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 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
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(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
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 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
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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
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
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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.
(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 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:
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(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:
(A) The utilization of telemedicine to expand
the delivery of supports and services.
(B) Suicide prevention and crisis intervention.
(C) The impact of social determinants of health
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 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.
(C) Treatment providers in partnership with
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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
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, 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.
(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,
including computers, monitors, tablets, webcams,
microphones and other similar equipment.
(C) Purchasing or maintaining HIPAA-compliant
software or platforms, including telemedicine
software and online patient portals, including setup
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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
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, 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.
(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.
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(h) Recoupment.--A department or agency under this section
may recover:
(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. This act shall take effect immediately.
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