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F I S C A L I M P A C T R E P O R T

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ORIGINAL DATE

LAST UPDATED

01/28/08

HB 225

SHORT TITLE HSD Behavioral Health Quick Response Team

SB

ANALYST Weber

APPROPRIATION (dollars in thousands)

Appropriation

Recurring

or Non-Rec

Fund

Affected

FY08

FY09

$1,000.0

Recurring

General

(Parenthesis ( ) Indicate Expenditure Decreases)

REVENUE (dollars in thousands)

Estimated Revenue

Recurring

or Non-Rec

Fund

Affected

FY08

FY09

FY10

Potential revenue but

depends on final

program design

Recurring

Federal

Medicaid

(Parenthesis ( ) Indicate Revenue Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Human Services Department (HSD)

Public Education Department (PED)

SUMMARY

Synopsis of Bill

House Bill 225 appropriates $1 million from the general fund to the Human Services Department

to recruit, train and certify peer support specialists and health care workers for quick response

teams statewide and match the teams throughout the state with behavioral health professionals

and paramedics on contract with the department. Qualifications and certification of quick

response team members may be detailed in rule by the department.

The HSD must extend information on quick response team availability and services to "warm

House Bill 225 – Page

2

lines", suicide hot lines and 911 operators so that responders may elect to use a quick response

team rather than a law enforcement officer in an initial contact with a person experiencing an

urgent need for behavioral health support.

FISCAL IMPLICATIONS

The appropriation of $1 million contained in this bill is a recurring expense to the general fund.

Any unexpended or unencumbered balance remaining at the end of FY09 shall revert to the

general fund.

HSD adds that fiscal implications for the agency will include program management and

administrative costs. Also, an independently licensed clinician who is credentialed as such

through the single state entity may bill for professional services provided to Medicaid-eligible

recipients served under this program. State General Fund dollars used to fund these specific

services would be eligible for a federal match.

Any behavioral health services provided to Medicaid-eligible individuals would be eligible for

federal match if all the following criteria are met:

.

The service must be a benefit under the NM Medicaid State Plan

.

The provider must be credentialed as a Medicaid provider of that service as part of the

single state entity contracted provider network

.

The provider is providing services in accordance with their license

While some services of certified peer specialists as defined in Medicaid regulations on

Comprehensive Community Support Services (CCSS) may be related to the services described in

HB225, the only specifically crisis related aspect of CCSS is “Assessment, support and

intervention in crisis situations including the development and use of crisis plans which

recognize the early signs of crisis/relapse, use of natural supports, use of alternatives to

emergency departments and inpatient services."

Based on these criteria some of the general fund may be eligible for federal Medicaid match.

SIGNIFICANT ISSUES

HSD provides the following comment:

The proposed Quick Response Team to introduce one element of a crisis system that would

effectively respond to identified needs throughout New Mexico. The development of a

behavioral health crisis system is a strategic priority of the Behavioral Health Collaborative and

its member agencies as well as an identified priority of a number of Local Collaboratives,

including Local Collaborative 2.

While the proposal is a variation on models of mobile crisis and pre- and post-crisis peer support

services, some areas need substantial clarification:

1.

Cost of Service: The NM Medicaid State Plan does not offer as a benefit mobile crisis

behavioral health services but could cover ancillary services if allowed by the State Plan.

Medicaid could pay for certified peer specialists in supervised situations under

House Bill 225 – Page

3

Comprehensive Community Support Services, but only under the Medicaid criteria

outlined above.

2.

Definitions: “Urgent need" in Section 2 is defined by using the term “critical need" and

needs substantial clarification in order to be implemented effectively. Section 3B(5)

uses the term “mental and behavioral health disorders" but does not define the distinction,

if any;

3.

Service Users: HB225 needs clarification regarding whether persons with substance use

related crises are anticipated as service users, a large proportion of New Mexico’s

citizens with behavioral health needs have co-occurring mental illness and substance use

disorders.

4.

Training: Section 3 the HSD to match staff “throughout the state with behavioral health

professionals and paramedics on contract with the department. Paramedics are licensed

and regulated through the Department of Health, but are not generally under contract with

either DOH or HSD;

5.

Staffing: Section 2A defines “peer support specialist" This definition differs from New

Mexico’s existing “Certified Peer Specialists" and the definition of those professionals

under Medicaid regulations. In particular, the definition in the bill requires experience of

“urgent behavioral health needs". While the intention is for people who truly are ‘peers’

for the proposed services and have recovered to provide such services, the definition both

limits the available as well as being in conflict with existing Medicaid reimbursable

service providers.

A critical concern with HB225 at this time is that creation of an individual component does not

create a system that is designed to address the concerns that the services seek to address. And

there is a danger that other states have experienced, particularly with a new and creative service,

that the absence of other essential components of a crisis system can jeopardize the success of

any single program.

MW/mt